Peridomestic natural breeding sites of Nyssomyia whitmani (Antunes and Coutinho) in an endemic area of tegumentary leishmaniasis in northeastern Argentina

The scarce information about breeding sites of phlebotomines limits our understanding of the epidemiology of tegumentary leishmaniasis. Identifying the breeding sites and seasons of immature stages of these vectors is essential to propose prevention and control strategies different from those targeting the adult stage. Here we identified the rural breeding environments of immature stages of Ny. whitmani, vector species of Leishmania braziliensis in the north of Misiones province, Argentina; then we determined and compared the environmental and structural characteristics of those sites. We also identified the season of greatest emergence and its relationship with adult abundance. During a first collection period, between 28 and 48 emergence traps were set continuously for 16 months in six environments of the farm peridomicile and domicile: below house, chicken shed, experimental chicken shed, forest edge, pigsty and under fruit tree. Traps were checked and rotated every 40 nights. A total of 146 newly emerged individuals were collected (93.8% of them were Ny. whitmani), totaling an effort of 23,040 emergence trap-nights. The most productive environments were chicken shed and below house, and the greatest emergence was recorded in spring and summer. During a second collection period, emergence traps and light traps for adult cap-ture were placed in the chicken shed and below house environments of eight farms. Emergence traps were active continuously during spring, summer, and early autumn. Environmental and structural characteristics of each environment were recorded. A total of 84 newly emerged phlebotomines (92.9% Ny. whitmani; 72,144 emergence trap-nights) and 13,993 adult phlebotomines (147 light trap-nights) were recorded in the chicken shed and below house environments. A positive correlation was also observed between trap success of newly emerged phlebotomines and of adults after 120 days. A high spatial variability was observed in the emergence of Ny. whitmani, with the number of newly emerged individuals being highest in soils of chicken sheds with the highest number of chickens and closest to forest edge. Moreover, below house was found to be as important as chicken sheds as breeding sites of Ny. whitmani. Management of the number of chickens in sheds, soil mois-ture and pH, and the decision of where to localize the chicken sheds in relation to the houses and the forest edge, might contribute to reduce the risk of human vector exposure and transmission of Leishmania.Fil: Manteca Acosta, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Cavia, Regino. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Utgés, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán". Instituto Nacional de Medicina Tropical; ArgentinaFil: Santini, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; Argentin

Peridomestic natural breeding sites of Nyssomyia whitmani (Antunes and Coutinho) in an endemic area of tegumentary leishmaniasis in northeastern Argentina

The scarce information about breeding sites of phlebotomines limits our understanding of the epidemiology of tegumentary leishmaniasis. Identifying the breeding sites and seasons of immature stages of these vectors is essential to propose prevention and control strategies different from those targeting the adult stage. Here we identified the rural breeding environments of immature stages of Ny. whitmani, vector species of Leishmania braziliensis in the north of Misiones province, Argentina; then we determined and compared the environmental and structural characteristics of those sites. We also identified the season of greatest emergence and its relationship with adult abundance. During a first collection period, between 28 and 48 emergence traps were set continuously for 16 months in six environments of the farm peridomicile and domicile: below house, chicken shed, experimental chicken shed, forest edge, pigsty and under fruit tree. Traps were checked and rotated every 40 nights. A total of 146 newly emerged individuals were collected (93.8% of them were Ny. whitmani), totaling an effort of 23,040 emergence trap-nights. The most productive environments were chicken shed and below house, and the greatest emergence was recorded in spring and summer. During a second collection period, emergence traps and light traps for adult cap-ture were placed in the chicken shed and below house environments of eight farms. Emergence traps were active continuously during spring, summer, and early autumn. Environmental and structural characteristics of each environment were recorded. A total of 84 newly emerged phlebotomines (92.9% Ny. whitmani; 72,144 emergence trap-nights) and 13,993 adult phlebotomines (147 light trap-nights) were recorded in the chicken shed and below house environments. A positive correlation was also observed between trap success of newly emerged phlebotomines and of adults after 120 days. A high spatial variability was observed in the emergence of Ny. whitmani, with the number of newly emerged individuals being highest in soils of chicken sheds with the highest number of chickens and closest to forest edge. Moreover, below house was found to be as important as chicken sheds as breeding sites of Ny. whitmani. Management of the number of chickens in sheds, soil mois-ture and pH, and the decision of where to localize the chicken sheds in relation to the houses and the forest edge, might contribute to reduce the risk of human vector exposure and transmission of Leishmania.Fil: Manteca Acosta, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Cavia, Regino. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Utgés, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán". Instituto Nacional de Medicina Tropical; ArgentinaFil: Santini, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; Argentin

Manifestaciones clínicas y laboratoriales en el Lupus Eritematoso Sistémico-LES

El Lupus eritematoso sistémico (LES) es una enfermedad autoinmune compleja que se caracteriza por su capacidad de afectar a diversos órganos, lo que determina las diferentes manifestaciones clínicas objetivadas durante la evolución de la enfermedad. De forma asociada se ha descrito que estas manifestaciones presentan una variación geográfica o étnica, siendo por lo general menos grave en pacientes con ascendencia europea que en aquellos que presentan ascendencia africana, asiática o hispana. Alteraciones, tanto del sistema inmune adaptativo (células T y B) como del innato (Toll like receptorx-TLR), contribuyen al desarrollo del LES. Las células B tienen su papel en la producción de los autoanticuerpos (i.e. anticuerpos anti-ADN y anticuerpos anti-nucleosoma) y de determiandas citocinas. Las pruebas de laboratorio son de gran valor cuando se evalúa a un paciente con sospecha de enfermedad autoinmune. Los resultados pueden confirmar el diagnóstico, estimar la severidad de la enfermedad, evaluar el pronóstico y son de suma utilidad para el seguimiento de la actividad del LES

Lutzomyia longipalpis presence and abundance distribution at different microspatial scales in an urban scenario

The principal objective of this study was to assess a modeling approach to Lu. longipalpis distribution in an urban scenario, discriminating micro-scale landscape variables at microhabitat and macrohabitat scales and the presence from the abundance of the vector. For this objective, we studied vectors and domestic reservoirs and evaluated different environmental variables simultaneously, so we constructed a set of 13 models to account for microhabitats, macro-habitats and mixed-habitats. We captured a total of 853 sandflies, of which 98.35% were Lu. longipalpis.We sampled a total of 197 dogs; 177 of which were associated with households where insects were sampled. Positive rK39 dogs represented 16.75% of the total, of which 47% were asymptomatic. Distance to the border of the city and high to medium density vegetation cover ended to be the explanatory variables, all positive, for the presence of sandflies in the city. All variables in the abundance model ended to be explanatory, trees around the trap, distance to the stream and its quadratic, being the last one the only one with negative coefficient indicating that the maximum abundance was associated with medium values of distance to the stream. The spatial distribution of dogs infected with L. infantum showed a heterogeneous pattern throughout the city; however, we could not confirm an association of the distribution with the variables assessed. In relation to Lu. longipalpis distribution, the strategy to discriminate the micro-spatial scales at which the environmental variables were recorded allowed us to associate presence with macrohabitat variables and abundance with microhabitat and macrohabitat variables. Based on the variables associated with Lu. longipalpis, the model will be validated in other cities and environmental surveillance, and control interventions will be proposed and evaluated in the microscale level and integrated with socio-cultural approaches and programmatic and village (mesoscale) strategies.Fil: Santini, Maria Soledad. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Red de Investigación de la Leishmaniasis en Argentina; ArgentinaFil: Utgés, María Eugenia. Red de Investigación de la Leishmaniasis en Argentina; Argentina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; ArgentinaFil: Berrozpe, Pablo Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Red de Investigación de la Leishmaniasis en Argentina; Argentina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; ArgentinaFil: Manteca Acosta, Mariana. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Red de Investigación de la Leishmaniasis en Argentina; ArgentinaFil: Casas, Natalia. Red de Investigación de la Leishmaniasis en Argentina; Argentina. Ministerio de Salud. Programa Nacional de Control de Enfermedades Zoonóticas.; ArgentinaFil: Heuer, Paola. Fundación Héctor A. Barceló. Laboratorio de Control de Vectores Entomológicos de Importancia Sanitaria; ArgentinaFil: Salomón, Oscar Daniel. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Red de Investigación de la Leishmaniasis en Argentina; Argentin

H&E and OCT4/CD34 for the assessment of lympho-vascular invasion in seminoma and embryonal carcinoma

Background: Lymphovascular invasion (LVI) is a relevant prognostic factor in germ cell tumors of the testis (GCTT), and it is included in the pT stage. However, its detection on hematoxylin and eosin (H&E) slides is very challenging, and previous studies reported fair to moderate inter-observer agreement among dedicated uropathologists. In the present study, we tested H&E and a recently developed in-house double staining for OCT4/CD34 to detect LVI in GCTT. Methods: Nine authors [5 non-uropathologists and 4 uropathologists] independently evaluated 34 consecutive and retrospectively enrolled cases of GCTT. We assessed the inter-observer agreement (Fleiss's Kappa) with both H&E and OCT4/CD34. Besides, we compared the consensus diagnosis on both H&E and OCT4/CD34-stained sections with the original diagnosis to evaluate the pT re-staging (McNemar test) and identify the sources of disagreement. Results: The inter-observer agreement among uropathologists plus non-uropathologists was fair with both H&E (KF=0.398; p < 0.001) and OCT4/CD34 (KF=0.312; p < 0.001). OCT4/CD34 (KF=0.290; p < 0.001) slightly reduces the inter-observer agreement compared to H&E (KF=0.321; p < 0.001) for non-uropathologists; in contrast, OCT4/CD34 (KF=0.293; p < 0.001) significantly reduces the inter-observer agreement compared to H&E (KF=0.529; p < 0.001) for uropathologists, changing it from moderate to fair. Consensus diagnosis with H&E modified the LVI status of the original diagnosis in 8/34 (23.5 %) cases (p: 0.070), with pT re-staging in 2/34 (5.9 %) cases (p: 0.500). Consensus diagnosis with OCT4/CD34 modified the LVI status of the original diagnosis in 8/34 (23.5 %) cases (p: 0.289), with pT re-staging in 3/34 (8.8 %) cases (p: 0.250). The consensus diagnosis with OCT4/CD34 modified the consensus diagnosis with H&E in 8/34 (23.5 %) cases (p: 0.727), and these findings resulted in pT-restaging in 3/34 (8.8 %) cases (p: 0.500). The sources of disagreement among uropathologists were: H&E [artefactual clefts misinterpreted as LVI in 4/6 (66.7 %) cases and true foci of LVI misinterpreted as clusters of histiocytes within the vessels in 2/6 (33.3 %) cases], OCT4/CD34 [artefactual clefts misinterpreted as LVI in 2/8 (25 %) cases, true LVI misinterpreted as artefactual clefts in 2/8 (25 %) cases or floaters in 4/8 (50 %) cases]. Conclusions: OCT4/CD34 does not improve the inter-observer agreement for the assessment of LVI in OCT4(+) GCTT. Consensus diagnosis with H&E modifies the LVI status in a significant number of cases, resulting in changes of the pT stage in a relatively small subgroup. Consensus diagnosis with OCT4/CD34 provides little additional benefit since it cannot exclude mimickers of LVI such as floaters and artefactual clefts. These results argue against the adoption of this diagnostic tool for the routine assessment of OCT4(+) GCTT

Clinical features and genetic biomarkers associated with different phenotypes of systemic lupus erythematosus in Paraguayan patients

Corresponding author: Isabel Acosta-Colman, Department of Rheumatology, Faculty of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay; email: [email protected] lupus erythematosus (SLE) is a complex autoimmune disease characterized by a heterogeneous clinical picture that makes the diagnosis and follow-up of these patients difficult. This study aimed to identify correlations between clinical, immunological, and genetic biomarkers and clinical manifestations in SLE. A retrospective study of data from medical records and immunological and genetic studies of SLE patients in Paraguay was carried out. A descriptive analysis was performed based on the type of variable. Human leukocyte antigen (HLA) allele frequencies (DPA1, DPB1, DQA1, DQB1, and DRB1) were calculated, and univariate logistic regression analyses were performed between each of the explanatory variables and the presence or absence of each phenotype. Odds ratios, 95% confidence intervals, and p values were recorded. Associations with p<0.05 were considered statistically significant. 104 SLE patients were included: 86% were female, with a mean age of 32.80±10.36 years. An association was identified between anti-double stranded DNA (antidsDNA) and the presence of the renal phenotype and between anti-dsDNA and the absence of the joint and hematological phenotypes. Immunoglobulin M isotype rheumatoid factor was associated with the absence of a renal phenotype. HLA-DQB1*02:02 and HLA-DRB1*07:01 were associated with the cutaneous phenotype. An association was identified between age at disease onset over 30 years and the presence of the joint phenotype. No other associations were identified. Potential clinical, immunological, and genetic biomarkers of phenotypes have been identified in SLE Paraguayan patients.Consejo Nacional de Ciencia y TecnologíaPrograma Paraguayo para el Desarrollo de la Ciencia y Tecnología. Proyectos de investigación y desarroll

Relación entre el déficit de Vitamina D y el diagnóstico de depresión y/o ansiedad en pacientes con Lupus eritematoso sistémico en el Departamento de Reumatología del Hospital de Clínicas

Introduction: It has previously been postulated that low serum concentrations of 25-hydroxyvitamin D [25 (OH) D] are associated with a higher prevalence of depression. People with vitamin D deficiency are more likely to experience mood disorders such as depression and anxiety. Vitamin D plays a role in the release of neurotransmitters such as serotonin and dopamine, which makes patients with systemic lupus erythematosus, which are discouraged from sun exposure, an interesting target to study. Objective: To determine the association between vitamin D deficiency or insufficiency and anxiety / depression in patients with SLE of the Rheumatology Department of Hospital de Clínicas Methodology: Cross-sectional observational study based on a questionnaire recording the HADS (Hospitality and Depression Scale) scale and vitamin D measurements performed on patients admitted to the LUPUS PY cohort, after informed consent. The measurement of vitamin D was performed by chemiluminescence. Mean and standard deviation were used for the descriptive analysis of the quantitative variables, and frequencies and percentages were used to describe the qualitative variables. The x 2 test was used for the association analysis. A p value of less than 0.05 was considered statistically significant. Results: In relation to the characteristics of the cohort, a total of 74 patients were included, of which 90.5% were female, with an average age of 33 ± 10.2 years. The value of the mean vitamin D concentration was 31.8 ± 10.2 ng / ml. We found that 2.70% of patients with vitamin D deficiency had depression and 12.16% presented anxiety. No association was found between vitamin D deficiency and the presence of depression or anxiety in these patients. Conclusion: In this study, no association was found between the value of this vitamin D and the studied mood disturbances.Introducción: Se ha postulado que bajas concentraciones de 25-hidroxivitamina D sérica [25 (OH) D] se asocian con una mayor prevalencia de depresión. Las personas con niveles deficientes de vitamina D son más propensas a experimentar trastornos del estado de ánimo como la depresión y la ansiedad. La vitamina D juega un papel en la liberación de neurotransmisores como la serotonina y la dopamina por lo que es interesante el estudio de ésta en pacientes con Lupus Eritematoso Sistémico, a quienes se les desaconseja la exposición solar. Objetivo: Determinar la asociación entre el déficit y/o insuficiencia de vitamina D y la ansiedad/depresión en pacientes con LES del Departamento de Reumatología del Hospital de Clínicas. Metodología: Estudio observacional de corte transverso basado en un cuestionario según la escala HADS (Hospital anxiety and Depression Scale) y los dosajes de vitamina D realizados en pacientes que ingresaron a la cohorte LUPUS PY del Departamento de Reumatología del Hospital de Clínicas, previo consentimiento informado. El dosaje de vitamina D se realizó por quimioluminiscencia. Para el análisis descriptivo de las variables cuantitativas se utilizó las medias y desviación estándar, para las cualitativas las frecuencias y porcentajes. Para el análisis de asociación entre el déficit y la insufiencia de vitamina D y la presencia de depresión y ansiedad, se utilizó el test x 2. El valor de la p considerado estadísticamente significativo fue de menor a 0,05. Resultados: En relación a las características de la cohorte estudiada, se incluyó un total de 74 pacientes, donde se pudo observar que el 90,5% fueron de sexo femenino, con una media de la edad de 33 ± 10,2 años. El valor de la media de la concentración de vitamina D fue de 31,8 ± 10,2 ng / ml. Se constató que el 2,70% de los pacientes con deficiencia de vitamina D tuvo depresión y el 12,16% presentó ansiedad. En el análisis de asociación no se constató asociación entre el déficit de vitamina D y la presencia de depresión o ansiedad de estos pacientes. Conclusión: En este estudio no se constató una asociación entre el estado de esta vitamina D y las alteraciones del estado de ánimo estudiada

Espectro Clínico y Biomarcadores Genéticos de susceptibilidad en el síndrome de Vogt-Koyanagi- Harada en pacientes Paraguayos

Introducción: La enfermedad de Vogt-Koyanagi-Harada (VKH) es de etiología autoinmune y severa, se manifiesta con panuveítis bilateral y puede afectar sistema neuroauditivo y piel. La influencia de los factores genéticos en la expresión de VKH, ha quedado en evidencia en múltiples estudios. Posee mal pronóstico visual si se realiza el diagnóstico y el tratamiento en forma tardía, contar con biomarcadores genéticos susceptibilidad podrían ser de gran ayuda. El objetivo de este estudio es describir el espectro clínico y determinar biomarcadores genéticos de susceptibilidad en la enfermedad de VKH. Metodología: Estudio de casos y controles, de susceptibilidad genética para VKH. Se procedió al registro clínico de los pacientes y genotipado HLA DRB1 a casos y controles. Resultados: se incluyeron 21 pacientes con VKH para el registro clínico, de éstos se enrolaron 16 para el genotipado HLA-DRB1, los controles sanos incluidos fueron 32. Sexo fe- menino 81%, edad promedio 35 años, las formas clínicas fueron VKH Probable 10(47,6%) y VKH incompleto 10(47,6%), VKH Completo 1 caso (4,7%) Genotipado: los alelos del grupo HLA DRB1*02 estaban presentes 5 de los 16 pacientes (31%) (p 0,004) y ausente en los controles, no se encontró relación con alelos específicos. El alelo más frecuente fue HLA DRB1*01:02 presente en 4 (25) % de casos y ausente en los controles. Conclusión: La mayoría de los pacientes fueron adultos jóvenes, predominancia del sexo femenino, las formas clínicas VKH Probables e Incompleta fueron más comunes. Se ha encontrado en esta cohorte paraguaya asociación genética de la enfermedad de VKH con alelos del grupo DRB1*02, no se halló relación estadísticamente significativa con ningún alelo específico, probablemente esto se debió a que la muestra fue pequeña. El alelo más frecuente HLA DRB1*01:02 podría ser un candidato a biomarcador genético en esta población

Biomarcadores Genéticos y no Genéticos de susceptibilidad a padecer una enfermedad inmunomediada

El Proyecto tiene el objetivo de identificar Biomarcadores GENETICOS (i.e. HLA) y NO GENETICOS (i.e. clínicos, epidemiológicos e inmunológicos) de susceptibilidad de pacientes con enfermedades inmunomediadas pacientes paraguayos.CONACYT – Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Características clínicas de implantes más utilizados en pacientes que acuden a la cátedra de Implantología Oral de la Facultad de Odontología de la Universidad Autónoma de Asunción (UAA)

Los implantes dentales son sustitutos radiculares colocados en los huesos maxilares con la finalidad de reponer uno o más dientes faltantes y devolver la funcionalidad y estética perdidas por su ausencia. Estudio observacional descriptivo retrospectivo, donde se analizó 139 fichas de pacientes que acudieron a la cátedra de Implantología de la Universidad Autónoma de Asunción desde el año 2012 al 2018, de las cuales 98 cumplieron con los criterios de inclusión. Se utilizaron para estos análisis la planilla Excel y el programa Epiinfo v7.1 (CDC, Atlanta, USA). Del total de 98 fichas analizadas, 59 (60,2%) correspondieron a pacientes de sexo femenino y 39 (39,8%) de sexo masculino. La edad promedio de los pacientes fue de 44,2 años (DE+/-12,6). En cuanto a las enfermedades sistémicas presentaron diabetes e hipertensión arterial en un 6,1% respectivamente y enfermedades cardiacas en un 2,1%. Solo 10/98 reportaron que fumaban. En cuanto a los implantes, hemos observado que se realizaron en total 217. Se colocaron 141 (64,97 %) implantes cilíndricos y 76 (35,03%) cónicos. Se observaron las zonas implantadas, en el maxilar superior se colocaron 129 implantes (59,44%) mientras que en el inferior 88 (40,56%). Los implantes más utilizados fueron los de longitud y diámetro medio. En cuanto a la regeneración ósea, el procedimiento más frecuente fue el de levantamiento de seno maxilar. Es importante realizar en el futuro trabajos de evaluación del éxito o fracaso de los implantes realizados para tomar medidas correctivas y mejorar el servicio al paciente