Impacto clínico de tocilizumab en pacientes con presentación severa de COVID-19: cohorte retrospectiva / Clinical impact of Tocilizumab in treatment of severe Covid-19 patients: Retrospective cohort study

Introducción: Tocilizumab (TCZ) es un bloqueador del re-ceptor de la interleuquina 6, propuesto como tratamiento de pacientes con COVID-19 grave o crítico. El objetivo es evaluar el impacto clínico de la administración de TCZ en pacientes hospitalizados con COVID-19 grave y describir los eventos adversos e infecciosos más frecuentes.Materiales y métodos: Estudio analítico, observacional de casos y controles emparejado por edad, sexo y co-morbilidades de pacientes adultos con COVID-19 grave, hospitalizados entre diciembre de 2020 y marzo de 2021. Criterios de inclusión: requerimiento de aporte de O2 ma-yor o igual 5 l/min para lograr saturación >93% y uno de los siguientes: ACV, IAM, IMC >30, ERC, edad >60 años, dímero D >1000 ng/ml o proteína C reactiva cuantitativa >75 mg/l. Desenlaces evaluados: muerte por todas las causas, traslado a unidad de cuidados críticos (UCC) y requerimiento de asistencia ventilatoria mecánica (AVM).Resultados: Se incluyeron 320 pacientes, 210 expuestos a corticoterapia (controles) y 110 recibieron además TCZ (casos). La tasa de letalidad fue 44% en el grupo contro-les vs.29% en el grupo casos (p= 0.0081); el traslado a UCC fue del 81% vs.48% (p= 0.0081) respectivamente y el requerimiento de AVM en el grupo casos fue del 56% vs.24% (p= 0.0001) respectivamente. Conclusiones: Los pacientes tratados con TCZ presenta-ron una proporción de uso de UCC, de AVM y de mortali-dad menor en comparación con pacientes con similares características que no lo recibieron. Estos resultados coinciden con la evidencia disponible a la fecha

Introduction: Tocilizumab (TCZ) is an interleukin-6 recep-tor blocker proposed to treat severe or critical COVID-19 patients. This study aims to evaluate the clinical effects of TCZ administration in hospitalized patients with severe COVID-19. Additionally, the study investigates the most common adverse and infectious events associated with the use of TCZ.Materials and Methods: Analytical, observational case-control study matched by age, sex, and comorbidi-ties of adult patients with severe COVID-19, hospitalized between December 2020 and March 2021. Inclusion criteria: requirement for oxygen provision greater than or equal to 5 l/min to achieve saturation >93% and one of the following: stroke, myocardial infarction, BMI >30, chronic kidney disease, age >60 years, D-dimer >1000 ng/ml, or quantitative C-reactive protein >75 mg/l. Outcomes evaluated: all-cause mortality, transfer to critical care unit (CCU), and mechanical ventilatory assistance (MVA) re-quirement.Results: The study included 320 patients, out of which 110 patients received TCZ in addition to corticosteroids (cas-es), while 210 patients were only exposed to corticoste-roids (controls). The mortality rate was 29% in the cases group, compared to 44% in the control group (p=0.0081). Similarly, 48% of the cases were transferred to CCU, while 81% of the control group were transferred (p=0.0081). The requirement for mechanical ventilation (MVA) was 24% in the cases group and 56% in the control group (p=0.0001).Conclusion: Patients treated with TCZ had a lower propor-tion of CCU use, MVA, and mortality compared to similar patients who did not receive it. These results are consis-tent with the current evidence

Chloroplast and ITS phylogenies to understand the evolutionary history of southern South American Azorella, Laretia and Mulinum (Azorelloideae, Apiaceae).

Azorella, Laretia and Mulinum are taxonomically complex, and good candidates to study evolutionary radiations in the Andes and the importance of hybridizations. Previous phylogenetic studies of subfamily Azorelloideae agree that Azorella and Mulinum as currently conceived are not monophyletic, and hence a revision of their circumscription is necessary. However, these phylogenies were based only on chloroplast DNA sequence data. Here, phylogenetic relationships within Azorelloideae were inferred using sequence data from five chloroplast DNA (rps16 intron, trnQ-rps16, rps16-trnKUUU 5' -exon, trnGGCC-trnSGCU and rpL32-trnLUAG), and from nuclear rDNA ITS regions to assess the monophyly of Azorella and Mulinum and discuss generic re-circumscriptions, determine hybridization and radiation events, identify and characterize important lineages, and propose hypotheses on evolution of key morphological characters. In total, 121 accessions of Azorelloideae were analyzed. Phylogenetic analyses of the different genomes were conducted separately and combined, with and without indels, using maximum parsimony, maximum likelihood, and Bayesian methods. To analyze the incongruence between plastid and nuclear-derived trees a consensus network from strongly supported nodes from cpDNA and ITS trees was constructed. Internode certainty values were calculated to evaluate the reliability of the relationships estimated from the individual cpDNA and ITS data sets and to examine the degree of conflict within the total evidence data set. Azorella and Mulinum were confirmed as not monophyletic. Except three Azorella species, the remaining azorellas, all species of Mulinum, and Laretia form a monophyletic group, designated here as Andean-Patagonian. The three species of Azorella that are not part of the Andean-Patagonian lineage are grouped together with Huanaca and Schizeilema in another lineage, designated here as Austral. Within the Andean-Patagonian clade, three major lineages can be recognized: Diversifolia, Trifurcata, and Spinosum. Each of these lineages have different leaf morpho-anatomies, Diversifolia species being more mesomorphic compared to species of Trifurcata, and species of Spinosum being the most xeromorphic. Hybridizations have been important in the evolution of the group, especially within Diversifolia, with at least six reticulation events resulting in putative homoploid and allopolyploid hybrid species. Evidence from branch lengths and low sequence divergences suggest a rapid radiation in the Spinosum group, probably associated with the acquisition of wings in the fruits.

[Plasmodium falciparum malaria acquired in Sub-Saharan Africa]. / Paludismo por Plasmodium falciparum adquirido en Africa subsahariana.

The purpose of this paper is to present the cases of malaria caused by Plasmodium falciparum in travelers coming from tropical Africa, who were treated at the Hospital Alemán (Buenos Aires). African malaria was defined as an infection acquired in any country within Africa, diagnosed and treated in Argentina. Diagnostic tools included clinical features and optic microscopy with Giemsa stained peripheral blood films. We reviewed the medical records of 11 adult patients -five tourists and six sailors- with no history of malaria, immunosuppressive condition or associated morbidity, admitted from 1993 to 2007. The age ranged from 21 to 48 years old, nine of them were males and two females. The patients were retrospectively classified into severe malaria -six of them- or mild malaria -five of them- according to severity criteria established by the World Health Organization, within the first three days of the beginnings of the symptoms. All patients presented fever; severe complications included encephalitis, renal failure, bleeding, haemoglobinuria, hypoglycemia, and pulmonary edema. Three patients required admission at the intensive care unit; no patient died. Only three off them had received properly chemoprophylaxis before traveling; all received treatment with at least one of the following drugs: mefloquine, quinidine, clyndamicine and cotrimoxazol.

Paludismo por Plasmodium falciparum adquirido en África subsahariana / Plasmodium falciparum malaria acquired in Subsaharian Africa

El objetivo de este trabajo es presentar los casos de paludismo por Plasmodium falciparum ocurridos en viajeros provenientes del África tropical, atendidos en el Hospital Alemán. Se definió paludismo de origen africano como la infección adquirida en un país del África subsahariana, diagnosticado y tratado en la Argentina. El diagnóstico se realizó por la clínica y la microscopía óptica en frotis de sangre periférica coloreados con Giemsa. Se revieron las historias clínicas de 11 pacientes adultos -cinco turistas y seis marineros mercantes- no oriundos de área endémica, sin condición inmunosupresora, ni morbilidad asociada, internados entre 1993 y 2007. El rango de edad fue de 21 a 48 años; nueve hombres y dos mujeres. Los pacientes fueron clasificados retrospectivamente en malaria grave (seis) o no grave (cinco) según cumplieran con uno o más de los criterios de gravedad de la Organización Mundial de la Salud. Todos presentaron fiebre como signo más significativo. Como complicaciones graves se observaron casos de insuficiencia renal, epistaxis, hemoglobinuria, hipoglucemia, edema pulmonar, acidosis y coma. Tres pacientes requirieron internación en la unidad de terapia intensiva. Todos sobrevivieron y solamente tres habían recibido la quimioprofilaxis correcta antes de viajar. El tratamiento se realizó con una o más de las siguientes drogas: mefloquina, quinidina, clindamicina y cotrimoxazol.

The purpose of this paper is to present the cases of malaria caused by Plasmodium falciparum in travelers coming from tropical Africa, who were treated at the Hospital Alemán (Buenos Aires). African malaria was defined as an infection acquired in any country within Africa, diagnosed and treated in Argentina. Diagnostic tools included clinical features and optic microscopy with Giemsa stained peripheral blood films. We reviewed the medical records of 11 adult patients -five tourists and six sailors- with no history of malaria, immunosuppressive condition or associated morbidity, admitted from 1993 to 2007. The age ranged from 21 to 48 years old, nine of them were males and two females. The patients were retrospectively classified into severe malaria -six of them- or mild malaria -five of them- according to severity criteria established by the World Health Organization, within the first three days of the beginnings of the symptoms. All patients presented fever; severe complications included encephalitis, renal failure, bleeding, haemoglobinuria, hypoglycemia, and pulmonary edema. Three patients required admission at the intensive care unit; no patient died. Only three off them had received properly chemoprophylaxis before traveling; all received treatment with at least one of the following drugs: mefloquine, quinidine, clyndamicine and cotrimoxazol.

Floristic relationships among vegetation types of new zealand and the southern andes: similarities and biogeographic implications.

BACKGROUND AND AIMS: Similarities between the floras of geographically comparable regions of New Zealand (NZ) and the southern Andes (SA) have interested biologists for over 150 years. The present work selects vegetation types that are physiognomically similar between the two regions, compares their floristic composition, assesses the environmental factors that characterize these matching vegetation types, and determines whether phylogenetic groups of ancestral versus modern origin are represented in different proportions in their floras, in the context of their biogeographic history. METHODS: Floristic relationships based on 369 genera of ten vegetation types present in both regions were investigated with correspondence analysis (CA) and ascending hierarchical clustering (AHC). The resulting ordination and classification were related to the environmental characteristics of the different vegetation types. The proportions of different phylogenetic groups between the regions (NZ, SA) were also compared, and between forest and non-forest communities. KEY RESULTS: Floristic similarities between NZ and SA tend to increase from forest to non-forest vegetation, and are highest in coastal vegetation and bog. The floras of NZ and SA also differ in their phylogenetic origin, NZ being characterized by an 'excess' of genera of basal origin, especially in forests. CONCLUSIONS: The relatively low similarities between forests of SA and NZ are related to the former being largely of in situ South American and Gondwanan origin, whereas the latter have been mostly reconstituted though transoceanic dispersal of propagules since the Oligocene. The greater similarities among non-forest plant communities of the two regions result from varied dispersal routes, including relatively recent transoceanic dispersal for coastal vegetation, possible dispersal via a still-vegetated Antarctica especially for bog plants, and independent immigration from Northern Hemisphere sources for many genera of alpine vegetation and grassland.

Uncoupled geographical variation between leaves and flowers in a South-Andean Proteaceae.

BACKGROUND AND AIMS: Geographical variation in foliar and floral traits and their degree of coupling can provide relevant information on the relative importance of abiotic, biotic and even neutral factors acting at geographical scales as generators of evolutionary novelty. Geographical variation was studied in leaves and flowers of Embothrium coccineum, a species that grows along abrupt environmental gradients and exhibits contrasting pollinator assemblages in the southern Andes. METHODS: Five foliar and eight floral morphological characters were considered from 32 populations, and their patterns of variation and covariation were analysed within and among populations, together with their relationship with environmental variables, using both univariate and multivariate methods. The relationships between foliar and floral morphological variation and geographical distance between populations were compared with Mantel permutation tests. KEY RESULTS: Leaf and flower traits were clearly uncoupled within populations and weakly associated among populations. Whereas geographical variation in foliar traits was mostly related to differences in precipitation associated with geographical longitude, variation in floral traits was not. CONCLUSIONS: These patterns suggest that leaves and flowers responded to different evolutionary forces, environmental (i.e. rainfall) in the case of leaves, and biotic (i.e. pollinators) or genetic drift in the case of flowers. This study supports the view that character divergence at a geographical scale can be moulded by different factors acting in an independent fashion.

[Acute cholecystitis and biliary tract infections due to Candida]. / Colecistitis aguda e infección de la vía biliar por Candida.

Candida biliary tract infection is a rare disease. Most of the reported cases have been diagnosed in patients with surgery or invasive procedures of the biliary tract, critical illness, immunosuppression or antibiotic treatment. This report deals with an 85 years old female patient with Candida albicans cholecystitis without previous risk factors and with a literature review on the subject. Only four patients without risk factors have been so far reported.

Importancia de los conocimientos ecológicos para la interpretación de eventos médicos / Importance of the environmental knowledge for the interpretation of medical events

Es posible entender al hospital como un ecosistema. Ecología es el estudio científico de la interacción que determina la distribución y abundancia de los organismos en su locus. Medicamentos, particularmente los antibióticos, tienen una fuerte influencia en él. La flora normal, de los pacientes hospitalizados, sufre transformaciones. La principal fuente de micoorganismos emergente en el paciente internado es la micorbiota humana. La razón es una necesidad imperiosa de cambio y adaptación a las condiciones cambiantes del medio ambiente. Las caractrísticas de virulencia y epidemicidad de los diferentes microorganismos que componen los nichos harán que dominene el escenario hospitalario. Son aquellas que frente a la debilidad del paciente toman un comportamiento oportunista

Importancia de los conocimientos ecológicos para la interpretación de eventos médicos / Importance of the environmental knowledge for the interpretation of medical events

Es posible entender al hospital como un ecosistema. Ecología es el estudio científico de la interacción que determina la distribución y abundancia de los organismos en su locus. Medicamentos, particularmente los antibióticos, tienen una fuerte influencia en él. La flora normal, de los pacientes hospitalizados, sufre transformaciones. La principal fuente de micoorganismos emergente en el paciente internado es la micorbiota humana. La razón es una necesidad imperiosa de cambio y adaptación a las condiciones cambiantes del medio ambiente. Las caractrísticas de virulencia y epidemicidad de los diferentes microorganismos que componen los nichos harán que dominene el escenario hospitalario. Son aquellas que frente a la debilidad del paciente toman un comportamiento oportunista