New Applications of Cardiopulmonary Exercise Testing and Training in Paediatric Heart Disease

Congenital heart defects (CHD) have an incidence of 4-8/1000 live births and encompass a broad spectrum of disorders. Due to advances in cardiac surgery and cardiology care, most children born with CHD are now surviving into adulthood and there are currently more adults affected than children. Exercise capacity is reduced across the spectrum of patients with CHD, both in natural history and after surgical and interventional treatment. The aim of this project was to better understand exercise limitations and safety/usefulness of training in young patients with heart disease across a broad spectrum of disorders and in particular we focused on left-to-right shunts, systemic right ventricular physiology, univentricular physiology with Fontan palliation and dilated cardiomyopathy. Future perspective include exploring new ways of engaging teenagers with univentricular palliation in systemic and respiratory muscle training. Furthermore, the collaboration with biomedical engineers will allow us to gain in depth understanding of univentricular physiology. Similarities exisit in the physiological changes observed during exercise and pregnancy and the final goal is to implement the model with these variables to achieve better clinical outcome in this growing population of young adults with complex lesions and limited exercise and child-bearing potential. Exercise testing and training are becoming more and more relevant to guide therapy and management but also to assess the ability in daily activities that play an important role in many aspects of life that have not been addressed specifically until now. The increasing data available enable physicians to give adequate counseling regarding vocational or professional choices, suitable leisure activities and family planning according to the levels of activity considered safe and sustainable in the specific physiology. Further studies will warrant deeper understanding of issues that are specific to univentricular physiology and will help us to target interventions to improve quantity and quality of life

Disopyramide is a safe and effective treatment for children with obstructive hypertrophic cardiomyopathy

BACKGROUND: Left ventricular outflow tract obstruction (LVOTO) is present in 1/3 of children with Hypertrophic Cardiomyopathy (HCM). Disopyramide improves symptoms associated with LVOTO and delays surgical intervention in adults, but it is not licensed in children. AIM: To describe a single-centre thirty-year experience of using disopyramide to treat LVOTO-related symptoms in a paediatric HCM cohort. METHODS: Clinical data were collected for all patients meeting diagnostic criteria for HCM (<18 years) at the time of initiation, 6 months after, and last follow-up or end of disopyramide treatment. It included demographics, clinical history, 12‑lead electrocardiography, and echocardiography. Comparisons between baseline and 6 month follow up, and end of follow up respectively were performed. RESULTS: Fifty-one patients with HCM were started on disopyramide at a mean age 10.2±5.3 years. At 6 months, of those previously symptomatic, 33(86.8%) reported an improvement of symptoms and 12(31.6%) were asymptomatic. PR interval, corrected QT interval and maximal LVOT gradient had not significantly changed, but fewer participants were noted to have systolic anterior motion of the mitral valve 31 (72.1%) vs. 26 (57.80%). Patients were followed up for a median of 1.9 years (IQR 0.83-4.5). Nine patients (17.6%) reported side effects, and eleven patients (33.3%) with initial improvement in symptoms reported a return or worsening of symptoms requiring a change in medication (n = 4, 12.1%) or left ventricular septal myomectomy (n = 7, 21.2%) during follow up. CONCLUSION: Disopyramide is a safe and effective treatment for LVOTO-related symptoms in childhood obstructive HCM. Any delay in the need for invasive intervention, particularly during childhood, is of clear clinical benefit

Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy

Childhood hypertrophic cardiomyopathy; Outcomes; PhenotypeMiocardiopatía hipertrófica infantil; Resultados; FenotipoMiocardiopatia hipertròfica infantil; Resultats; FenotipBackground Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. Objectives The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. Methods Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. Results At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. Conclusions Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.This work was supported by the British Heart Foundation (grant FS/16/72/32270) to Drs Norrish and Kaski. This work is (partly) funded by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Dr Norrish is supported by Great Ormond Street Hospital Children’s Charity. Drs Field and Kaski are supported by Max’s Foundation and Great Ormond Street Hospital Children’s Charity. Dr Kaski is supported by a Medical Research Council–National Institute for Health Research Clinical Academic Research Partnership award. This work was financially supported by the Foundation for Paediatric Research of Finland (Dr Ojala). Dr Fernandez has received speaker fees from Sanofi-Genzyme. Dr Kubus is supported by MH CZ – DRO, Motol University Hospital (00064203). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose

Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy

Child; Death; Hypertrophic cardiomyopathyNiño; Muerte; Miocardiopatía hipertróficaNen; Mort; Miocardiopatia hipertròficaBackground: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM

Arrhythmia and impaired myocardial function in heritable thoracic aortic disease: An international retrospective cohort study

Arrhythmia; Heritable thoracic aortic diseaseArritmia; Enfermedad hereditaria de la aorta torácicaArrítmia; Malaltia hereditària de l'aorta toràcicaBackground Heritable thoracic aortic diseases (HTAD), typically entailing aortic complications, can be caused by pathogenic variants or likely pathogenic variants (PV/LPVs) in several genes, including fibrillin1 (FBN1), Actin Alpha2 (ACTA2) and genes encoding components of the transforming growth factor (TGF)-β signaling pathway. In addition to aortic complications, non-aortic cardiac disease such as impaired myocardial function and/or arrhythmia have been increasingly reported, mainly in Marfan syndrome with underlying FBN1 PV/LPVs and are acknowledged as additional causes of morbidity and mortality. The prevalence of these manifestations in the various HTAD entities is largely unknown. Methods This international multicentre retrospective study collected data on patients with HTAD presenting non-aortic cardiac disease. A total of 9 centers from 7 different countries participated. Patients 12 years or older carrying a PV/LPV in one of the following genes: FBN1, TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD3 and ACTA2 were screened. Non-aortic cardiac disease included impaired myocardial function and/or arrhythmia. Impaired myocardial function was defined as (a)symptomatic reduced ejection fraction (EF<50%). Arrhythmias included atrial fibrillation (AF), atrial flutter (AFL), ventricular tachycardia (VT), ventricular fibrillation (VF) and (aborted) sudden cardiac death (presumed arrhythmogenic) (SCD). Results Medical records of 3219 patients with HTAD were screened (2761, 385 and 73 carrying a PV/LPV in FBN1, in a TGF-β signaling gene and in ACTA2 respectively). Non-aortic cardiac disease was reported 142 times in 101 patients (3.1%) (age 37 [range 12–77] years, 39% female): 88 patients carrying an FBN1 PV/LPV and 13 carrying a PV/LPV in one of the TGF-β signaling genes. Neither impaired myocardial function nor arrhythmia was reported in screened patients carrying a PV/LPV in ACTA2. Among the 142 reported non-aortic cardiac diseases, 68 (48%) were impaired myocardial function, 47 (33%) were AF/AFL and 27 (19%) were VT/VF/SCD. Among the patients with non-aortic cardiac disease, prior cardiac surgery was noted in 80% and severe valvular disease (valvular surgery or severe valvular regurgitation) in 58%, while 18% of the patients developed non-aortic cardiac disease in the absence of any of the latter. Conclusions In patients with HTAD, arrhythmia and impaired myocardial function was reported in patients with PV/LPVs in FBN1 and in the TGF-β signaling genes and not in patients harboring PV/LPVs in ACTA2. Though infrequent, non-aortic cardiac disease should be acknowledged as potentially severe, also occurring in young patients with no underlying significant valvular or aortic disease

Cardiac Manifestations of Myotonic Dystrophy in a Pediatric Cohort

Myotonic dystrophy type 1 (DM1) is the most prevalent inherited neuromuscular dystrophy in adults. It is a multisystem disease with cardiac manifestations. Whilst these are well-defined in adults, there are scarce published data in the pediatric population. This study aimed to investigate the yield and progression of cardiac disease in pediatric DM1 patients, focusing on congenital DM1 (cDM1). Methods: A retrospective observational study of all pediatric DM1 patients referred to our center (December 2000-November 2020) was conducted. Patients were classified into DM1 forms according to age of symptom onset and disease severity. Patients underwent clinical and cardiac evaluation with 12-lead ECG, transthoracic echocardiography and 24-h ECG Holter monitoring. Results: 67 DM1 pediatric patients were included: 56 (83.6%) cDM1 and 11 (16.4%) non-cDM1. Median follow-up time of cDM1 patients was 8.0 [3.25-11.0] years. 49 (87.5%) cDM1 patients had baseline 12-lead ECG and 44 (78.6%) had a follow-up 12-lead-ECG, with a median follow-up time from diagnosis to baseline ECG of 2.8 [1.0-8.5] years and to follow-up ECG of 10.9 [5.7-14.2] years. Overall, 43 (87.8%) presented ECG abnormalities, most commonly in the form of asymptomatic conduction disease (n = 23, 46.9%), of which 21 (42.9%) had first degree atrioventricular block (1st AVB). There was an increase of prevalence from baseline to follow-up ECG in low QRS voltage (16.7%), poor R wave progression (13.9%), abnormal repolarisation (11.9%) and 1st AVB (7.6%). one patient (1.8%) underwent pacemaker implantation for syncope in the context of progressive conduction disease. No patients developed left ventricular systolic dysfunction. 4 (7.1%) cDM1 patients died during follow up, including three who died suddenly with no clear cause of death. Conclusions: This study is the first to analyse the prevalence and progression of ECG abnormalities in cDM1 pediatric patients. The high prevalence of abnormal findings, progressive changes and number of potentially associated events (1 pacemaker implantation and 3 unexplained sudden deaths) stresses the importance of systematic and continued cardiac evaluation of these patients

Interface Investigations on Titanium Nitride Bilayer Systems

Nanocomposite coatings composed of two phases with atomically sharp phase boundaries, show interesting mechanical properties. These properties are often originating from their high interface to volume ratio. Composites of nanocrystalline titanium nitride (TiN) grains surrounded by a one to two monolayer thick interlayer of silicon nitride (Si3N4) show an enhanced nanohardness. The central theme of this thesis is concernedwith the interfacial properties of two-dimensional bilayer systems, which are used as model systems to describe the interfaces occurring in nanocomposite coatings. The systems under investigation are TiN interfaces in contact with silicon (Si), silicon nitride (Si3N4) and aluminum nitride (AlN). The primary tool used to analyze the interfaces of bilayer systems is X-ray Photoelectron Spectroscopy (XPS) with emphasis put on the shake-up feature of the Ti 2p photoelectron line. Shake-ups in TiN are observed as an additional peak on the lower binding energy side of the energy lines of the Ti 2p orbitals. Shake-ups are strongly influenced by valence electrons and electron density distributions. This makes them a powerful tool to probe the chemical and electronic structure of TiN interfaces. The aim of this study is to utilize the shake-up energy and its intensity to gain insight into interfacial structures and correlate their changes to interfacial polarization and macroscopic mechanical properties. Single crystalline (sc-) and oxygen-free TiN as well as oxygen-free bilayer systems were deposited by unbalanced magnetron sputtering and analyzed by Angle Resolved (AR-)XPS. Bilayer samples were deposited and their quality was controlled using X-ray diffraction (crystallinity), Rutherford back scattering (elemental composition), and atomic force microscopy (roughness). All XPS samples were fabricated, transfered and analyzed whilst maintaining ultra high vacuum. A precise and self-consistent XPS data processing method was developed to evaluate Ti 2p spectra. This method accounts for the correct photoelectron line shape, background subtraction and photoelectron peak area intensity. Binding energy, shake-up energy and intensity ratios of shake-ups taken frompristine TiN surfaces are precisely determined, and the influence of oxygen on the information content in peak positions and intensities was investigated. The shake-up energy and intensity of bulk sc-TiN and its origin of the shake-up are discussed. An analytical description for the XPS signal ratio of bilayer systems is derived to separate the interfacial signals from the bulk information. The results obtained by this analytical description are strongly influenced by the interface thickness that has been found to be proportional to the overlayer thickness. The revealed interface properties show a correlation between the shake-up intensity and the interface morphology, oxygen content, overlayer material and overlayer thickness. AR-XPS and X-ray Photoelectron Diffraction (XPD) results were used to interpret the crystalline structure of the different TiN/AlN and TiN/Si3N4 bilayer systems. AlN shows XPD patterns indicating a crystalline growth of AlN on sc-TiN. The electrically insulating AlN overlayer creates a charge accumulation at the TiN interface, which results in an enhanced shake-up intensity. XPD patterns of Si3N4 systems revealed a crystalline growth of Si3N4 in the first 0.6nm. The intensity of the diffraction patterns reduces with increasing Si3N4 overlayer thickness due to a change in the growth behavior from crystalline to amorphous structures. Si3N4 films show, in comparison to AlN, reduced interface charging and hence a lower shakeup intensity. The crystalline growth of Si3N4 in the initial stages is hindered in systems where a bias voltage is applied to the substrate during the deposition process. In contrast to the unbiased systems, which have crystalline interfacial structures, the biased systems no longer show XPD patterns due to a loss of crystallinity. Additionally the shake-up intensity of biased systems is thickness-independent, which is in contrast to unbiased systems. The difference in the shake-up intensity of biased and unbiased Si3N4 is explained by a different band gap of the Si3N4 structure in the first two monolayers. This thesis shows that the increase in the shake-up intensity is correlated to intrinsic and extrinsic interface charging. The obtained results, in combination with theoretical structure models from literature, show that in one to two monolayer thick interlayers a build-up of interface polarization is unlikely. The observed nanohardness enhancement in TiN/Si3N4 systems is explained with already known hardness effects

REBISALUD: la red de bibliotecas virtuales de salud

Rebisalud; Cooperació bibliotecària; Biblioteques virtuals de ciències de la salutRebisalud; Cooperación bibliotecaria; Bibliotecas virtuales de ciencias de la saludRebisalud; Library cooperation; Virtual libraries of health sciencesLa Red de Bibliotecas Virtuales de Salud - REBISALUD, como red que integra a 9 bibliotecas virtuales de salud de ámbito autonómico (Andalucía, Aragón, Islas Baleares, Canarias, Cataluña, Comunidad Valenciana, Región de Murcia, Comunidad Foral de Navarra y País Vasco), surge con la misión de potenciar la cooperación entre ellas, mediante la coordinación y elaboración de distintas estrategias y proyectos de colaboración conjuntos, encaminados a optimizar la difusión y el intercambio de la información en el ámbito de la salud

Dynamics of soluble immune mediators in COVID-19 patients from an Argentinean cohort with moderate and severe symptoms

The cytokine storm, a form of systemic inflammatory response syndrome, is one of the most dreadful complications that can occur during COVID-19. The severity of infection is associated at different levels of these immune mediators and many molecules are considered marker of COVID mortality. Because of its central role in the pathogenesis of SARS-CoV-2 infection, the cytokine storm have become a therapeutic target in the treatment of COVID-19 patients.In this work, we aimed at studying the concentration of different pro- and anti-inflammatory cytokines in a cohort of COVID-19 patients from Córdoba (Argentine). The immunological reaction triggered by infection with SARS-CoV-2 mobilizes numerous cytokines, mainly of proinflammatory character. Changes in their levels are associated with the presence of the disease and with a more severe prognosis. Although our data have similarities with those in international reports, the complete profiling of different parameters (cytokine/chemokines, risk factors, epidemiological and clinical characteristics) in the local cases add value by identifying particularities that may be relevant for the management and prognosis during SARS-CoV2 infection in Argentine.Fil: Almada, Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Angiolin, Sofia C.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Dho, Nicolás. Universidad Nacional de Córdoba; ArgentinaFil: Dutto, Jeremias. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Gazzon, Yamila. Universidad Nacional de Córdoba; ArgentinaFil: Manzone, Clarisa. Universidad Nacional de Córdoba; ArgentinaFil: Marin, Constanza. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Ponce, Nicolás Eric. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Iribarren, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Cerban, Fabio Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Morón, Gabriel. Universidad Nacional de Córdoba; ArgentinaFil: Amezcua Vesely, Carolina. Universidad Nacional de Córdoba; ArgentinaFil: Ana, Yamile. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Cervi, Laura Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Chiapello, Laura Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Fozzatt, Laura. Universidad Nacional de Córdoba; ArgentinaFil: Icely, Paula Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Maccioni, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Mena, Cristian Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Montes, Carolina Lucia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Motrán, Cristina. Universidad Nacional de Córdoba; ArgentinaFil: Rodríguez Galán, Cecilia. Universidad Nacional de Córdoba; ArgentinaFil: Stempin, Cinthia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Viano, María Estefanía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Bertone, M.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Abiega, Claudio Daniel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Escudero, Daiana Sabrina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Privado Universitario de Córdoba; ArgentinaFil: Kahn, Adrian Mario. Hospital Privado Universitario de Córdoba; ArgentinaFil: Caeiro, Juan Pablo. Hospital Privado Universitario de Córdoba; ArgentinaFil: Arroyo, Daniela Soledad. Hospital Privado Universitario de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Maletto, Belkys Angélica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Acosta Rodriguez, Eva Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Gruppi, Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Sotomayor, Claudia Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaLXVI reunión anual de la sociedad argentina de investigación clínica (saic), LXIX reunión anual de la sociedad argentina de inmunología (sai), LIII reunión anual de la asociación argentina de farmacología experimental (aafe), XI reunión anual de la asociación argentina de nanomedicinas (nanomed-ar)Buenos AiresArgentinaSociedad Argentina de Inmunologí