Rickettsial infection in northwestern Argentina

Las rickettsias son entidades clínicas emergentes y reemergentes del tipo zoonótico, de la familia Rickettsiaceae. Son un género de bacterias intracelulares obligadas transmitidas por diferentes vectores artrópodos hematófagos como garrapatas, pulgas, piojos y ácaros. Estos vectores condicionan el establecimiento y la epidemiología de la enfermedad en diferentes regiones del mundo. En la actualidad se reconocen aproximadamente 25 especies del género Rickettsia (1). La más virulenta de estas enfermedades febriles se conoce como la “Fiebre Manchada de las Montañas Rocosas” (FMMR) causada por la bacteria Rickettsia rickettsii (R. rickettsii) (2). Con tasas de letalidad documentadas de entre el 23 y 85% en la era preantibiótica y del 5% con un tratamiento adecuado (3). Los estudios realizados por Howard Ricketts en 1906 en curíes y cobayos demostraron que la FMMR era transmitida a través de sangre infectada por una bacteria y que el vector eran las garrapatas (4). Se decidió llevar a cabo esta revisión con la intención de realizar una descripción general sobre el tema, y brindar información básica y actualizada sobre todo de R. rickettsii, que es el agente causal descripto en nuestra región como causante de enfermedad rápidamente letal cuando no media un tratamiento oportuno y adecuado.Rickettsial diseases are a genus of obligate intracellular bacteria transmitted by hematophagous arthropods such as ticks, fleas, lice and mites. These emerging and reemerging clinical entities of the zoonotic type are caused by strict intracellular bacteria of the family Rickettsiaceae, determined by the presence of specific vectors that condition the establishment and epidemiology in different regions of the world. At present, approximately 25 species of the Rickettsia genus are recognized (1). The most virulent of these febrile diseases is known as the Rocky Mountain Spotted Fever (RMSF) caused by the Rickettsia rickettsii (2). This disease belongs to the group of spotted fevers, with documented lethality rates between 23 and 85% in the preantibiotic era, and 5% with an adequate antibiotic treatment (3). In 1906, studies conducted by Howard Ricketts in curies and guinea pigs showed that RMSF was detected through infected blood and that the vector was ticks (4). We have selected the topic of this review to provide updated knowledge on Rickettsia rickettsii infectious disease, the principal bacteria described in our region, responsible for fatal disease without appropriate treatment.Fil: Sanchez, Alejandra P.. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Herrera Verduguez, Mauricio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Caucota, Claudia. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Borgatta, Marianela. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Fiebre Manchada por Rickettsia Rickettsii

Las Rickettsias son entidades clínicas emergentes y reemergentes del tipo zoonótico, de la famillia Rickettsiaceae, son un género de bacterias intracelulares obligadas transmitidas por diferentes vectores artrópodos hematófagos como garrapatas, pulgas, piojos y ácaros. Estos vectores condicionan el establecimiento y la epidemiología de la enfermedad en diferentes regiones del mundo. En la actualidad se reconocen aproximadamente 25 especies del género Rickettsia. 1. La más virulenta de estas enfermedades febriles se conoce como la "Fiebre Manchada de las Montañas Rocosas" (FMMR) causada por la bacteria Rickettsia rickettsii (R. rickettsii) 2. Con tasas de letalidad documentadas entre 23 y 85% en la era preantibiótica y del 5% con un tratamiento adecuado 3. Los estudios realizados por Howard Ricketts en 1906, en curíes y cobayos, demostraron que la FMMR era transmitida a través de sangre infectada por una bacteria y que el vector eran las garrapatas 4. Se decidió realizar esta revisión con la intención de realizar una descripción general sobre el tema, y brindar información básica y actualizada sobre todo de R. rickettsii que es el agente causal descripto en nuestra región como causante de enfermedad rápidamente letal cuando no media un tratamiento oportuno y adecuado.Fil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Herrera, Mauricio. No especifíca;Fil: Sánchez, Alejandra P.. No especifíca

Fatal spotted fever in Salta province

Describimos el caso de un varón de 17 años oriundo de la ciudad de Salta quien, 10 días después de visitar una zona rural de la provincia homónima, ingresó a nuestro hospital por convulsiones febriles. Durante la internación presentó exantema seguido de disfunción orgánica múltiple, la que evolucionó rápidamente hacia shock séptico irreversible y muerte a las 48 horas de su admisión. El diagnóstico serológico –altos títulos de IgM e IgG anti-Rickettsia spp. por inmunofluorescencia indirecta– arribó post mortem. Las rickettsiosis del grupo de las fiebres manchadas son transmitidas por garrapatas, tienen distribución global y en varios países continúan siendo subdiagnosticadas debido a una baja sospecha clínica. En las provincias del noroeste argentino se agrega la carencia de un laboratorio regional capacitado para efectuar el diagnóstico etiológico. Esta limitación es crítica porque en esa región del país ya ha sido documentada la presencia de las formas graves de la enfermedad, usualmente debidas a R. rickettsii. Dado que las fiebres manchadas se presentan como sindromes febriles inespecíficos y los componentes del ciclo enzoótico están presentes en vastas áreas geográficas, incluso en algunas aún no consideradas endémicas para rickettsiosis, su diagnóstico nunca debe ser subestimado. Con el tratamiento antibiótico adecuado instaurado en tiempo oportuno, el pronóstico de este grupo de enfermedades potencialmente mortales mejora en forma drástica.We describe the case of a 17-year-old male patient living in Salta city who, 10 days after visiting a rural area in Salta province, was hospitalized for febrile seizures. Shortly after admission, he developed an exanthema followed by a multiple organ dysfunction that evolved to irreversible septic shock followed by death 48 hours after admission. Serological diagnosis –high IgM and IgG anti-Rickettsia spp. antibody titres as detected by indirect immunofluorescence– arrived post mortem. Spotted fever group rickettsioses are tick-borne diseases distributed worldwide and continue being under diagnosed in several countries mainly due to a low clinical suspicion. In the north-western provinces of Argentina there is also the limitation of not counting with a regional laboratory to perform the etiological diagnosis. This is crucial because the severe forms of the disease, which are commonly caused by R. rickettsii, have been already documented in the region. Given that spotted fevers have broadly unspecific febrile presentations and the components of the enzootic cycle are present even in geographic areas not yet considered to be endemic for tick borne diseases, their diagnosis should not be underestimated. If the adequate antibiotic treatment is administered timely, the prognosis of this group of life-threatening diseases improves drastically.Fil: Sánchez, Alejandra P.. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Herrera Verduguez, Mauricio. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Asis, Enzo. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Barrojo, Gustavo. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Ortega, Marisa. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; ArgentinaFil: Leon de la Fuente, Ricardo Alfonso. Gobierno de la Provincia de Salta. Ministerio de Salud Publica. Hospital Papa Francisco.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Antimicrobial resistant Escherichia coli in the reproductive tract microbiota of cows and sows

Escherichia coli is a natural colonizer of the urogenital mucosa of healthy females; however it is one of the pathogens associated to reproductive failures in cows and sows. A better knowledge about the characteristics of native E. coli will allow us to differentiate them from pathogenic strains. Ninety autochthonous isolates from the reproductive tract of sows and cows were characterized to determine the phylogenetic profile, antibiotic resistance and virulence factors; also, comparisons between different breeding systems were performed. Vaginal colonization of E. coli was statistically higher in cows (57.5%) than sows (23.8%), and most isolates belonged to the phylogenetic group A: 79.69 and 80.77%, respectively; moreover phylo-groups B1 (12.5 and 11.54%) and D (7.81 and 7.69%) were significantly lower; however, none was classified as B2. Positive associations between virulence factors and group D were found. Isolates with antimicrobial susceptibility were associated with group A and the MDR (Multiple Drug Resistance) was related to the porcine source. These results contribute to the knowledge of extra-intestinal E. coli populations; which could affect the reproductive performance of females.Fil: Torres Luque, Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; ArgentinaFil: Gonzalez Moreno, Candelaria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina. Universidad Nacional de Tucumán. Facultad de Agronomía y Zootecnia; ArgentinaFil: Pasteris, Sergio Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; ArgentinaFil: Orden, José A.. Universidad Complutense de Madrid; EspañaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Complutense de Madrid; EspañaFil: Otero, María Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentin

Suggested Cut-Off Values for Vitamin D as a Risk Marker for Total and Cardiac Death in Patients with Suspected Acute Coronary Syndrome

Background: Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut-off levels are still under debate.Objectives: To assess two cut-off levels, 40 and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D in chest pain patients with suspected acute coronary syndrome.Methods: We investigated 1853 patients from coastal-Norway and inland NorthernArgentina. A similar database was used for pooling of data. Two-year follow-up data including all-cause mortality, cardiac death, and sudden cardiac death in the total patient population were analyzed, applying univariate and multivariable analysis.Results: Two hundred fifty-five patients with known vitamin D concentrations died. In the multivariable analysis, there was a decrease in total mortality above a cut-off level of 40 nmol/L and a decrease in cardiac death above a cut-off level of 70 nmol/L [HRs of 0.66 (95% CI, 0.50?0.88), p = 0.004 and 0.46 (95% CI, 0.22?0.94), p = 0.034, respectively].Conclusion: Vitamin D cut-off levels of 40 and 70 nmol/L were related to total mortality and cardiac death, respectively.Fil: Naesgaard, Patrycja A.. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Stavanger University Hospital; Noruega. University Of Bergen; Noruega. Universidad Católica de Salta; ArgentinaFil: Nilsen, Stein Tore. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Pönitz, Volker. Stavanger University Hospital; NoruegaFil: Brügger Andersen, Trygve. Stavanger University Hospital; NoruegaFil: Grundt, Heidi. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Staines, Harry. Sigma Statistical Services; Reino UnidoFil: Nilsen, Dennis W. T.. Stavanger University Hospital; Noruega. University Of Bergen; Norueg

Borderline Values of Troponin-T and High Sensitivity C-Reactive Protein Did Not Predict 2-Year Mortality in TnT Positive Chest-Pain Patients, Whereas Brain Natriuretic Peptide Did

Background: Troponin-T (TnT), high-sensitive C-reactive protein (hsCRP), and Brain Natriuretic Peptide (BNP) have been shown to be independent prognostic indicators of total and cardiac death during short- and long-term follow-up. Methods: We investigated prospectively the prognostic value of admission samples of TnT, hsCRP, and BNP in 871 chest-pain patients from South-Western Norway and 982 patients from Northern Argentina, based on a similar protocol and database setup. Follow-up was 2 years for the pooled population. The prognostic value of the selected biomarkers was investigated in quartiles of 239 patients with TnT values greater than 0.01 and up to and including 0.1 ng/mL, with continuous TnT as a potential confounder. Results: After 24 months, 69 patients had died, of whom 38 died from cardiac causes. In the selected range of TnT, this biomarker was not significantly different between patients who died and survived (mean 0.0452 and 0.0457, p = 0.887). The BNP levels were significantly higher among patients dying than in long-term survivors [340 (142–656) versus 157 (58–367) pg/mL (median, 25 and 75% percentiles), p < 0.001]. In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR) for BNP in the highest quartile (Q4) as compared to the lowest (Q1) was significantly related to total mortality [HR 2.84 (95% confidence interval (CI), 1.13–7.17)], p = 0.027, in addition to age (p ≤ 0.001) and hypercholesterolemia (p = 0.043). For cardiac death, the HR for BNP was 5.18 (95% CI, 1.06–25.3), p = 0.042. Several other variables (age, congestive heart failure, ST elevation myocardial infarction, and study country) were also significantly related to cardiac death. In a multivariable Cox regression model, hsCRP rendered no significant prognostic information for all-cause mortality (p = 0.089) or for cardiac mortality (p = 0.524). Conclusion: In patients with borderline TnT values (greater than 0.01 and up to and including 0.1 ng/mL), this biomarker as well as hsCRP did not render prognostic information, whereas BNP was found to be a strong prognostic indicator of 2-year total and cardiac mortality.Fil: Nilsen, Dennis W. T.. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Mjelva, Øistein Rønneberg. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Leon de la Fuente, Ricardo Alfonso. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Católica de Salta; ArgentinaFil: Naesgaard, Patrycja. Stavanger University Hospital; Noruega. University Of Bergen; NoruegaFil: Pönitz, Volker. Stavanger University Hospital; NoruegaFil: Brügger Andersen, Trygve. Stavanger University Hospital; NoruegaFil: Grundt, Heidi. University Of Bergen; Noruega. Stavanger University Hospital; NoruegaFil: Staines, Harry. Sigma Statistical Service; NoruegaFil: Nilsen, Stein Tore. University Of Bergen; Norueg

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. This was an observational retrospective study. A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures

Clínica Integrada - ME210 - 202101

Curso de especialidad, de la carrera de medicina, de carácter teórico- práctico del ciclo 7, en el que los estudiantes integran conocimientos previos con la anamnesis, el examen físico y establecen el diagnostico por síndromes o problemas y el plan de trabajo. El curso de Clínica integrada busca desarrollar las competencias generales de comunicación escrita y comunicación oral(nivel 2) y las competencias específicas de práctica clínica-diagnóstico (nivel 2) y profesionalismo-sentido ético y legal y responsabilidad profesional(nivel 2). La integración de conocimientos en la historia clínica, permitirá al estudiante, plantear un adecuado diagnóstico, plan de trabajo para la atención de su futuro paciente

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale &amp; Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting &amp; Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (&lt;60, 60-69, and &gt;_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 &amp; PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages &lt;60, 60-69, and &gt;_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791