Echocardiographic evaluation and clinical management of ductal shunting in hemodynamically unstable preterm neonates without congenital heart disease in the pediatric intensive care unit.

Although significant steps have been taken to monitor complex hemodynamics in neonatal and pediatric intensive care units, cardiovascular function in neonates is still evaluated by measuring blood pressure, heart rate, diuresis, central venous pressure (if a central venous catheter was placed), capillary refill time and oxygen saturation measurement in the upper and lower extremities. The use of other non-invasive or invasive technologies (for example, continuous impedance cardiography, transesophageal Doppler and continuous pulse contour methods) is, in fact, quite problematic in neonates in whom relevant hemodynamic changes are common during the transition to postnatal life. For these reasons, use of transthoracic echocardiography, performed by skilled pediatric intensivists, is increasing in several dedicated centers to guide treatment choices in hemodynamically unstable neonates.

Isolation of Cryptococcus neoformans and Cryptococcus gattii from trunk hollows of living trees in Buenos Aires City, Argentina.

The aim of this work was to describe the distribution of the members of the Cryptococcus species complex (Cryptococcus neoformans and C. gattii) in hollows of trees from seven parks in Buenos Aires City, to determine the serotypes and genotypes of these environmental isolates and to compare them with the ones reported in the 2001 survey. Four hundred and eighty nine samples were collected by swabbing all trees which had hollows or fissures in the seven parks studied. Each tree was sampled once during the study period and one or more isolates were recovered from each swab. Eight isolates of C. neoformans and 18 isolates of C. gattii were recovered from 15 out of 489 tree samples. C. neoformans was isolated from Tipuana tipu, Eucalyptus spp., and Phoenix sp. All isolates were serotype A and belonged to genotype VNI. C. gattii was isolated from Tipuana tipu, Cedrus deodara, Eucalyptus spp., Acacia visca, Cupresus sempervirens and Ulmus campestrus. All isolates were serotype B and genotype VGI, like both C. gattii strains isolated in 2001. On two occasions, both species were isolated from the same tree sample. These results reinforce and extend our previous findings especially about the presence of C. gattii serotype B, genotype VGI, in Argentina.

Treatment of severe diabetic acidosis with tris-hydroxymethyl aminomethane in a thirteen-year-old child.

Diabetic ketoacidosis is a severe complication of type I diabetes. A 13-year-old female (40 kg) patient was admitted to our Intensive Care Unit with severe metabolic acidosis (pH: 6.8), hyperglycemia (835 mg/dL) and coma. Her hemodynamic conditions were unstable and, even though a large amount of plasma expanders, crystalloids, and inotropic support were supplied, the patient went into cardiac arrest in the first hour of treatment. After resuscitation, a better hemodynamic balance was achieved and metabolic acidosis was treated with fluid replacement therapy, continuous insulin infusion, and Tris-hydroxymethyl aminomethane (THAM) as a buffering agent. This therapy rapidly improved her metabolic conditions. The patient was discharged 5 days after Intensive Care Unit admission in good condition and without neurological sequelae.

S100B is not a reliable prognostic index in paediatric TBI.

BACKGROUND: As far as paediatric traumatic brain injury is concerned, it is difficult to quantify the extent of the primary insult, to monitor secondary changes and to predict neurological outcomes by means of the currently used diagnostic tools: physical examination, Glasgow Coma Scale (GCS) score and computed tomography. For this reason, several papers focused on the use of biochemical markers (S100B, neuron-specific enolase) to detect and define the severity of brain damage and predict outcome after traumatic head injury or cardiac arrest. OBJECTIVE: The aim of this paper is measuring the range of S100B serum concentrations in children affected by traumatic brain injury and describing the possible roles of this protein in the reaction to trauma. METHODS: Fifteen children aged 1-15 years were included in the study. Traumatic brain injury severity was defined by paediatric GCS score as mild (9 patients), moderate (2 patients) or severe (4 patients). Blood samples for S100B serum measurement were taken at emergency department admission and after 48 h. RESULTS: The serum S100B concentration was higher in the group of severe trauma patients, who scored the lowest on the GCS at admission, and among them, the highest values were reported by the children with concomitant peripheral lesions. CONCLUSIONS: The role of S100B in paediatric traumatic brain injury has not been clarified yet, and the interpretation of its increase when the head trauma is associated with other injuries needs the understanding of the physiopathological mechanisms that rule its release in the systemic circulation. The levels of S100B in serum after a brain injury could be related to the mechanical discharge from a destroyed blood-brain barrier, or they could be due to the active expression by the brain, as a part of its involvement in the systemic inflammatory reaction. Early increase of this protein is not a reliable prognostic index of neurological outcome after pediatric traumatic brain injury, since even very elevated values are compatible with a complete neurological recovery.

Evaluación no invasiva del status volémico. Confrontación entre indicadores radiográficos y volumétricos / Not invasive evaluation of the status volémico. Confrontation between warning radiográficos and volumetric

La finalidad de nuestro estudio ha sido la de evaluar la existencia de posibles correlaciones entre los principales indicadores volumétricos de carga previa y de función cardiaca, obtenida mediante el sistema PiCCO® (Pulsion Medical Systems, Munich, Alemania), con todos los datos derivados del análisis sistemático de la radiografía de tórax en proyección antero posterior, así como el pedúnculo vascular (VPW) y el índice cardiotorácico (RCT). Materiales y Métodos: Hemos incluido 15 pacientes y analizado conjuntamente 79 radiografías de pacientes electivos. Todos fueron sometidos a monitorización hemodinámica mediante PiCCO y al estudio de los parámetros radiográficos obtenidos (VPW, RCT). El análisis: cálculo de la media y desviación estándar; un análisis de la correlación para las siguientes parejas de parámetros: volumen de sangre intratorácica (ITBVI)-RCT, ITBVI-VPW, agua extravascular (EVLWI )-RCT, EVLWI-VPW . Resultados. Las parejas de los valores estudiados han evidenciado una correlación linear con R igual a 0.54 entre EVLWI-RCT. Discusión. Aunque es un estudio preliminar, los hallazgos más significativos se ven en las variaciones de RCT, que presentan una correspondencia con el edema intersticial antes de que aparezca un incremento crítico de la rata de líquido alveolar. En nuestra experiencia no hemos evidenciado una fuerte correlación entre VPW y los normales indicadores volumétricos de precarga. De acuerdo con los datos en literatura y también en la experiencia pediátrica, estos instrumentos presentan límites que aún no consienten sustituir completamente a la correcta cuantificación de la rata de agua extravascular, en respuesta al incremento volémico. Palabras Claves: Monitorización Hemodinámica, Monitor de PiCCO, Volemia, pedúnculo vascular, índice cardiotorácico, Volumen de sangre intratorácica, Volumen de agua extravascular intrapulmonar, Índice de función cardiaca...

[Immunodiagnosis of endemic mycoses and bronchopulmonary aspergillosis: a multicenter study in Argentina]. / Inmunodiagnóstico de micosis endémicas y aspergilosis broncopulmonar: estudio multicéntrico en la República Argentina.

In order to contribute to the knowledge of the relative frequency of chronic fungal diseases and assess the performance of diagnostic laboratories in Argentina, a multicenter study was performed with the participation of 25 medical centers located in 12 different provinces and Buenos Aires City. Between 04-01-2000 and 03-30-2001, 965 serum specimens from patients clinically suspected of having histoplasmosis (HP), paracoccidioidomycosis (PCM), coccidioidomycosis (CM) or aspergilosis were analyzed. Agar immunodiffusion tests (IDD) were done locally. All positive and 35% of negative sera were retested in the reference center. Results of laboratories of origin showed 98.8% concordance with those of reference center. Antibodies against any of the etiological agents were detected in 120 specimens from 98 patients. Endemic mycoses (HP, PCM and CM) were diagnosed in 70 patients (71.4%) and aspergilosis in 28 (28.6%). The frequencies of the different mycoses in decreasing order were PCM 47 patients (47.9%), aspergilosis 28 patients (28.6%), HP 13 patients (13.3%) and CM 10 patients (10.2%). The study was carried out on a voluntary basis and some areas of the country were not represented. However, the frequencies were in range with the expected rates in the population under study.

Inmunodiagnóstico de micosis endémicas y aspergilosis broncopulmonar: Estudio multicéntrico en la República Argentina / Immunodiagnosis of endemic mycoses and bronchopulmonary aspergilosis: A multicenter study in Argentina

Se realizó entre 01-04-2000 y 30-03-2001, un estudio de corte transversal, para conocer la frecuencia relativa de las enfermedades por hongos dimorfos y Aspergillus spp. en la República Argentina y evaluar la certeza en el diagnóstico de los laboratorios de diferentes áreas geográficas. Participaron 25 centros de salud provenientes de 12 provincias y de la Ciudad Autónoma de Buenos Aires. Fueron analizados en el laboratorio de origen 965 sueros de pacientes con sospecha clínica de histoplasmosis (HP), paracoccidioidomicosis (PCM), coccidioidomicosis (CM) y aspergilosis. Todos los sueros positivos y el 35% de los negativos fueron reevaluados en el laboratorio de referencia por inmunodifusión doble en agar. La concordancia entre los resultados obtenidos en los centros de origen y el de referencia fue de 98,8%. Se detectaron anticuerpos específicos en 120 sueros correspondientes a 98 pacientes. El 71,4% (70 casos) de los diagnósticos correspondió a micosis endémicas (HP, PCM y CM) y el resto a aspergilosis. PCM fue diagnosticada en 47,9% (47 casos), aspergilosis en 28,6% (28 casos), HP en13,3% (13 casos) y CM en 10,2% (10 casos). La participación en este estudio fue voluntaria y no todos los centros del país estaban representados, sin embargo, las frecuencias de enfermedades fúngicas fueron las esperadas y coincidentes con estudios previos realizados a nivel nacional.

In order to contribute to the knowledge of the relative frequency of chronic fungal diseases and assess the performance of diagnostic laboratories in Argentina, a multicenter study was performed with the participation of 25 medical centers located in 12 different provinces and Buenos Aires City. Between 04-01-2000 and 03-30-2001, 965 serum specimens from patients clinically suspected of having histoplasmosis (HP), paracoccidioidomycosis (PCM), coccidioidomycosis (CM) or aspergilosis were analyzed. Agar immunodiffusion tests (IDD) were done locally. All positive and 35% of negative sera were retested in the reference center. Results of laboratories of origin showed 98.8% concordance with those of reference center. Antibodies against any of the etiological agents were detected in 120 specimens from 98 patients. Endemic mycoses (HP, PCM and CM) were diagnosed in 70 patients (71.4%) and aspergilosis in 28 (28.6%). The frequencies of the different mycoses in decreasing order were PCM 47 patients (47.9%), aspergilosis 28 patients (28.6%), HP 13 patients (13.3%) and CM 10 patients (10.2%). The study was carried out on a voluntary basis and some areas of the country were not represented. However, the frequencies were in range with the expected rates in the population under study.

Low dose remifentanyl infusion for analgesia and sedation in ventilated newborns.

AIM: The aim of this study was to evaluate the analgesic effects of remifentanyl on mechanically ventilated newborns. METHODS: Eighteen newborns, mechanically ventilated, were submitted to continuous infusion of R. A pain scale was used to evaluate comfort during mechanical ventilation. Data were collected at T0, T1, Tn, T ext, T post-ext; statistical analysis was performed by Student's t test and Pearson coefficient. RESULTS: Mean R infusion time was 66.94+/-22.24 h, with mean dose of R 0.146+/-0.038 gamma/kg/min. Mean time to reach comfort was 20+/-13.11 h with a mean infusion of R equal to 0.173+/-0.146 gamma/kg/min; R was 0.18+/-0.039 gamma/kg/min on pressure controlled ventilation and R was 0.09+/- 0.045 gamma/kg/min on assisted ventilation. Statistically significant was considered the decrease in HR as well as the increase of SpO2 at T0 vs 30 min after infusion. CONCLUSION: No adverse effects were observed during and after infusion.

Inmunodiagnóstico de micosis endémicas y aspergilosis broncopulmonar: estudio multicéntrico en la República Argentina. / [Immunodiagnosis of endemic mycoses and bronchopulmonary aspergillosis: a multicenter study in Argentina]

In order to contribute to the knowledge of the relative frequency of chronic fungal diseases and assess the performance of diagnostic laboratories in Argentina, a multicenter study was performed with the participation of 25 medical centers located in 12 different provinces and Buenos Aires City. Between 04-01-2000 and 03-30-2001, 965 serum specimens from patients clinically suspected of having histoplasmosis (HP), paracoccidioidomycosis (PCM), coccidioidomycosis (CM) or aspergilosis were analyzed. Agar immunodiffusion tests (IDD) were done locally. All positive and 35

of negative sera were retested in the reference center. Results of laboratories of origin showed 98.8

concordance with those of reference center. Antibodies against any of the etiological agents were detected in 120 specimens from 98 patients. Endemic mycoses (HP, PCM and CM) were diagnosed in 70 patients (71.4

) and aspergilosis in 28 (28.6

). The frequencies of the different mycoses in decreasing order were PCM 47 patients (47.9

), aspergilosis 28 patients (28.6

), HP 13 patients (13.3

) and CM 10 patients (10.2

). The study was carried out on a voluntary basis and some areas of the country were not represented. However, the frequencies were in range with the expected rates in the population under study.

[Malassezia species isolated from skin diseases in a care center in the city of Buenos Aires, Argentina]. / Especies de Malassezia aisladas de patologías de piel en un centro asistencial de la ciudad de Buenos Aires, Argentina.

The epidemiology of Malassezia genus is poorly understood; geographical and population factors might have influence on the species distribution. The aim of this work was to determine the frequency of Malassezia species involved in skin diseases in a diagnostic center at Buenos Aires City. From 02/01/1999 to 10/31/2001, 456 skin specimens from 447 patients diagnosed as pityriasis versicolor, seborrheic dermatitis, foliculitis and atopic dermatitis, were analyzed by microscopic examination and culture. Malassezia spp was evidenced in 255 skin samples (55.9%) by microscopic analysis but it could be recovered from only 99 (38.8%) specimens. Malassezia species were isolated from 10 (3.9%) scarring lesions that were negative by microscopy. Among 109 isolates, M. sympodialis (58.7%) was the most frequent, followed by M. globosa and M. furfur (18.3% and 9.2%). Unique isolates (0.9%) of M. obtusa, M. slooffiae and M. restricta were recovered. Eleven isolates (10.1%) could not be identified because they had lost viability in the culture. This is the first study on Malassezia species associated to skin diseases in Argentina; further screening including other geographic regions of the country is necessary in order to confirm these results.

[1st environmental isolation of Cryptococcus neoformans var. gattii in Argentina]. / Primer aislamiento ambiental de Cryptococcus neoformans var. gattii en Argentina.

Two strains of C. neoformans var. gattii serotype B were isolated from a park in Buenos Aires city, Argentina. Samples were collected in spring, rubbing with swabs on the inner hollow of Eucalyptus spp. and other trees, which were not identified at the collection moment. Samples were swabbed directly onto cafeic acid with antibiotic agar, then incubated at 28 degrees C and observed daily for a week. Isolates were recovered from cafeic acid medium showing characteristic colonies of the species that allowed differentiation from other microorganisms of the sample. Identification was performed using carbohydrate fermentation, assimilation of nitrogen and carbon sources, and urease and phenoloxidase detection. Strain variety was determined with canavanine-glicine-bromotimol blue agar medium (CGB). Genotypic characterization using AP-PCR with (GACA)4 aleatory primer showed that both band profiles could be differentiated by only one band. These two strains were isolated from tree species different from Eucalyptus spp. These isolates from natural sources demonstrate that C. neoformans var. gattii efosts in Buenos Aires city environment and that it is not necessarily associated with Eucalyptus spp. The presence of C. neoformansvar. gattii in the environment, detected for the first time in Argentina, may explain its sporadic association with human infections in the local population.

Primer aislamiento ambiental de Cryptococcus neoformans var. gattii en Argentina / Firs environmental detection of Cryptococcus neoformans var. gattii in Argentina

Dos cepas de C.neoformans var. gattii serotipo B, fueron aisladas en el Parque de los Patricios de la ciudad de Buenos Aires, Argentina. Las muestras se recogieron en primavera, mediante el hisopado de la superficie interior de huecos y grietas de Eucalyptus spp. y otros árboles que, lamentablemente, no fueron identificados en el momento de la recolección. Los hisopos se inocularon en placas de agar ácido cafeico suplementado con antibióticos que se incubaron a 28§C durante una semana con observación diaria. Los aislamientos produjeron colonias características de la especie, lo que permitió detectarlos y separarlos de otros microorganismos presentes en la muestra. La identificación se realizó mediante estudios de fermentación de carbohidratos, asimilación de fuentes de carbono y nitrógeno y detección de ureasa y fenoloxidasa. La variedad se determinó utilizando el medio agarizado de canavanina-glicina-azul de bromotimol (CGB). La caracterización genotípica por reacción en cadena de la polimerasa con primer aleatorio (AP-PCR con el primer (GACA)4)mostró que el patrón de bandas de ambos aislamientos se diferenciaba en una única banda. En ambos casos el material provino de especies arbóreas diferentes de Eucalyptus spp. Estos dos aislamientos de fuentes naturales demuestran que C.neoformans var. gattii está presente en el medio ambiente de la ciudad de Buenos Aires, no necesariamente asociado a Eucalyptus spp. Este hallazgo podría explicar su asociación esporádica a infecciones humanas en la población local.

Primer aislamiento ambiental de Cryptococcus neoformans var. gattii en Argentina / Firs environmental detection of Cryptococcus neoformans var. gattii in Argentina

Dos cepas de C.neoformans var. gattii serotipo B, fueron aisladas en el Parque de los Patricios de la ciudad de Buenos Aires, Argentina. Las muestras se recogieron en primavera, mediante el hisopado de la superficie interior de huecos y grietas de Eucalyptus spp. y otros árboles que, lamentablemente, no fueron identificados en el momento de la recolección. Los hisopos se inocularon en placas de agar ácido cafeico suplementado con antibióticos que se incubaron a 28ºC durante una semana con observación diaria. Los aislamientos produjeron colonias características de la especie, lo que permitió detectarlos y separarlos de otros microorganismos presentes en la muestra. La identificación se realizó mediante estudios de f

Especies de Malassezia aisladas de patologías de piel en un centro asistencial de la ciudad de Buenos Aires, Argentina / [Malassezia species isolated from skin diseases in a care center in the city of Buenos Aires, Argentina]

The epidemiology of Malassezia genus is poorly understood; geographical and population factors might have influence on the species distribution. The aim of this work was to determine the frequency of Malassezia species involved in skin diseases in a diagnostic center at Buenos Aires City. From 02/01/1999 to 10/31/2001, 456 skin specimens from 447 patients diagnosed as pityriasis versicolor, seborrheic dermatitis, foliculitis and atopic dermatitis, were analyzed by microscopic examination and culture. Malassezia spp was evidenced in 255 skin samples (55.9

) by microscopic analysis but it could be recovered from only 99 (38.8

) scarring lesions that were negative by microscopy. Among 109 isolates, M. sympodialis (58.7

) was the most frequent, followed by M. globosa and M. furfur (18.3

) of M. obtusa, M. slooffiae and M. restricta were recovered. Eleven isolates (10.1

) could not be identified because they had lost viability in the culture. This is the first study on Malassezia species associated to skin diseases in Argentina; further screening including other geographic regions of the country is necessary in order to confirm these results.

Primer aislamiento ambiental de Cryptococcus neoformans var. gattii en Argentina. / [1st environmental isolation of Cryptococcus neoformans var. gattii in Argentina]

Two strains of C. neoformans var. gattii serotype B were isolated from a park in Buenos Aires city, Argentina. Samples were collected in spring, rubbing with swabs on the inner hollow of Eucalyptus spp. and other trees, which were not identified at the collection moment. Samples were swabbed directly onto cafeic acid with antibiotic agar, then incubated at 28 degrees C and observed daily for a week. Isolates were recovered from cafeic acid medium showing characteristic colonies of the species that allowed differentiation from other microorganisms of the sample. Identification was performed using carbohydrate fermentation, assimilation of nitrogen and carbon sources, and urease and phenoloxidase detection. Strain variety was determined with canavanine-glicine-bromotimol blue agar medium (CGB). Genotypic characterization using AP-PCR with (GACA)4 aleatory primer showed that both band profiles could be differentiated by only one band. These two strains were isolated from tree species different from Eucalyptus spp. These isolates from natural sources demonstrate that C. neoformans var. gattii efosts in Buenos Aires city environment and that it is not necessarily associated with Eucalyptus spp. The presence of C. neoformansvar. gattii in the environment, detected for the first time in Argentina, may explain its sporadic association with human infections in the local population.

Especies de Malassezia aisladas de patologías de piel en un centro asistencial de la ciudad de Buenos Aires, Argentina. / [Malassezia species isolated from skin diseases in a care center in the city of Buenos Aires, Argentina]

The epidemiology of Malassezia genus is poorly understood; geographical and population factors might have influence on the species distribution. The aim of this work was to determine the frequency of Malassezia species involved in skin diseases in a diagnostic center at Buenos Aires City. From 02/01/1999 to 10/31/2001, 456 skin specimens from 447 patients diagnosed as pityriasis versicolor, seborrheic dermatitis, foliculitis and atopic dermatitis, were analyzed by microscopic examination and culture. Malassezia spp was evidenced in 255 skin samples (55.9

) by microscopic analysis but it could be recovered from only 99 (38.8

) specimens. Malassezia species were isolated from 10 (3.9

) scarring lesions that were negative by microscopy. Among 109 isolates, M. sympodialis (58.7

) was the most frequent, followed by M. globosa and M. furfur (18.3

and 9.2

). Unique isolates (0.9

) of M. obtusa, M. slooffiae and M. restricta were recovered. Eleven isolates (10.1

) could not be identified because they had lost viability in the culture. This is the first study on Malassezia species associated to skin diseases in Argentina; further screening including other geographic regions of the country is necessary in order to confirm these results.

[Electrophoretic karyotypes and genomic DNA restriction fragment analysis: their usefulness as tools in the epidemiological study of Candid parapsilosis]. / Cariotipos electroforéticos y análisis de los fragmentos de restricción de ADN genómico: su utilidad como herramientas en estudios epidemiológicos de Candida parapsilosis.

During the past decades, several studies have reported an increase in the incidence of nosocomial candidosis. In a prospective study, performed at the Departamento de Micología, INEI, ANLIS Dr. C. G. Malbrán and the Servicio de Neonatología and Microbiología, Hospital de Niños Sor María Ludovica, from October 1995 to December 1996, 167 patients with candidosis were detected. Candida species isolated were C. albicans (53.1%), C. parapsilosis (26.5%) and C. tropicalis (14.8%). The aim of this work was to characterize the clinical C. parapsilosis isolates from pediatric patients hospitalized in two neonatal intensive care units from the same hospital and to evaluate the usefulness of electrophoretic karyotype (EK) and restriction endonuclease analysis of genomic DNA (REAG) using a low frequency digestion enzyme. EK of all isolates disclosed 12 banding patterns and REAG with endonuclease Sfi I showed only 5 groups. However, isolates from the control group could not be separated from the clinical isolates. The isolates within each dendogram group for EK or REAG were apparently unrelated. Our results show that EK yields better results than REAG, but that it falls short of the desired discrimination, which suggests that these techniques do not seem to be useful for studying nosocomial C. parapsilosis outbreaks.

[Distribution of Cryptococcus neoformans serotypes associated with human infections in Argentina]. / Distribución de los serotipos de Cryptococcus neoformans asociados a infecciones humanas en Argentina.

C. neoformans (Cn) causes severe meningitis in immunocompromised patients, particularly those with AIDS. Little is known about Cn serotypes associated with human infections in Argentina due to the lack of antisera availability. The aim of this study was to produce these antisera, to serotype the Argentinean clinical isolates of Cn received at our laboratory from 1984 to 2001 and to evaluate the agreement of these results with the variety differentiation obtained with Canavanine-Glycine-Bromothymol Blue agar (CGB) medium. We studied 123 isolates recovered from first episodes of cryptococcosis from HIV-infected patients (85), non HIV-infected patients (6) and from other non specified patients (32). Of the isolates, 89% (110/123) were serotype A, 4% (5/123) corresponded to serotype D, 3% (3/129) were serotype AD, 3 isolates were untypable and 2 corresponded to serotype B. All the serotyped isolates agreed with the variety determined by CGB medium. These results indicate that, in our country, most cryptococcal infections in patients with AIDS are associated with serotype A (77/85), which agrees with international studies. In patients with other immunosuppressions, this serotype may be also predominant, although a low number of isolates were tested (4/6). Recovery of Cn serotype B in these clinical isolates suggests that studying the variety and their serotypes might be important to detect a probable epidemiological alteration.