Rol del rinovirus en niños hospitalizados con infección respiratoria aguda

Acute respiratory infections (ARIs), among which the most frequent pathologies\ninclude pneumonia, bronchiolitis and influenza-like illness, affect the whole, but\nespecially people under 5 and over 65. It is among the leading causes of mortality\nworldwide. In Argentina, ARIs are the leading cause for consultation and\nhospitalization in all ages, and in Santa Fe they accounted for nearly 20% of admissions\nat the local pediatric referral hospital in 2010. The most common IRA-causing viral\npathogens are respiratory syncytial virus (RSV), influenza, parainfluenza, adenovirus,\nmetapneumovirus, coronavirus and rhinovirus.\nHuman rhinovirus (HRV) belongs to the family Picornaviridae. They are nonenveloped\nspherical viruses and their genome is a single positive-sense RNA linear\nmolecule which is coated by a capsid of icosahedral symmetry. First isolated in 1956,\nover 100 different serotypes are currently known which are grouped into three\nspecies, HRVA, HRVB and HRVC. They are heat stable and can spread through\ncontaminated respiratory secretions through direct contact between people. They may\nbe found in people of all ages and are spread worldwide. Although their frequency of\ncirculation is usually higher in autumn and spring, they can be detected in every month\nof the year. While historically considered upper airways pathogens, they have recently\nbeen shown to cause infections in the lower respiratory tract as well, causing\nhospitalizations of children with pneumonia, bronchiolitis and chronic pulmonary\nobstruction. They are also associated with patients with recurrent episodes of\nwheezing, asthma exacerbations, bronchitis, sinusitis and acute otitis media.\nVirological diagnosis is needed to determine the etiology of ARIs, since the clinical\nsymptoms caused by each of these viruses are often similar. In addition, the\nunnecessary use of antibiotics can be thus restricted. Viral isolation in tissue culture\nfollowed by an acid liability test represents the standard method in the laboratory for\nconfirmation of HRV infection, but the time required is longer than two weeks, which\nis of limited value for therapeutic decision. Techniques based on the detection of\nnucleic acids through chain reaction (PCR) have led to advance in ARI identification.\nThe fact that no HRV-related studies have been conducted in Santa Fe so far led to\nthe completion of this work, which aims to select and optimize a PCR technique\nenabling the detection of the virus in ARI hospitalized pediatric patients during THE\nmarch 2010-february 2011 period, and then study their frequency, seasonality and\nepidemiology, as well as clinical and epidemiological aspects of infected patients.\nIn order to develop the study, a highly sensitive and specific nested RT-PCR was\nselected which was tested by Steininger et al. (2001) for most known HRV serotypes,\namplifying a highly preserved fragment of the viral genome. Technique was optimized\nwith positive virus controls, varying critical test parameters, and specificity was\nthereby confirmed by testing positive controls of other respiratory viruses.\nA total of 2020 nasopharyngeal aspirates (NPA) were obtained during the study\nperiod from patients who underwent antigen detection RSV, adenovirus, parainfluenza\nand influenza A and B by immunofluorescence (IF). Detection of influenza A and B was\nalso carried out through real time RT-PCR. For a representative proportion of NPAs\nwho were negative by IF (452 samples) HRV was determined through RT-PCR,\ndetecting the virus genome in 172. This resulted in a 38.1% positivity and a second place (8.5%) in the rate of respiratory virus flow. It was found in all months of the year,\npredominantly during March 2010 and from August to February 2011.\n60% of hospitalized children with HRV attributable to ARI were under 6 months,\nwith a median age of 4 months. Age proved not to be a risk factor for developing\nsevere disease. The proportion of infected children was similar for both genders.\nClinical and epidemiological aspects of 145 patients were analyzed. 31% had a\nmedical history, including prematurity (55.6 %) and recurrent wheezing (51.1%) as\nprevailing conditions. The most common discharge diagnoses were pneumonia\n(35.2%), bronchiolitis (32.4%) and bronchitis (12.4%). The aerial radiological findings\nobserved include (75.2%) trapping interstitial infiltrate (67.9 %) and alveolar infiltrates\n(35.8%). 72.7% of patients had leukocytosis. Antibiotics were used in 66.4 % of\ntreatments and 85.5% of the children required oxygen supply during hospitalization.\nThe median duration of hospital stay was 6 days and 15.9 % of patients required\nadmission to intensive care unit (ICU). No significant differences were observed\nbetween the age of ICU patients and that of patients who did not have severe clinical\nsymptoms. Similarly, having a clinical history did not prove a risk factor for developing\nsevere disease.\nThis study showed that HRVs are associated with ARI-induced children\nhospitalizations. The implementation of an RT-PCR endpoint technique could quickly\ndetect, with sensitivity and specificity, a virus that is the second in importance with\ngreatest circulation (after VSR), and will be capable of routinely reducing ARI cases of\nunknown origin, thus establishing the role these viruses play in our environment and\nfacilitating the choice of appropriate therapeutic approaches.Fil: Rudi, Juan Manuel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaLas infecciones respiratorias agudas (IRA), cuyas patologías más frecuentes son la\nneumonía, la bronquiolitis y la enfermedad tipo influenza, afectan a toda la población,\npero principalmente a los menores de 5 años y mayores de 65 años, encontrándose\nentre las primeras causas de mortalidad a nivel mundial. En Argentina, son la principal\ncausa de consulta e internación en todas las edades, y en Santa Fe, representaron casi\nel 20% de las internaciones registradas en el hospital pediátrico de referencia de la\nciudad durante el año 2010. Los patógenos virales más frecuentes causantes de IRA\nson el virus sincicial respiratorio (VSR), influenza, parainfluenza, adenovirus,\nmetapneumovirus, coronavirus y rinovirus.\nLos rinovirus humanos (HRV) pertenecen a la familia Picornaviridae. Son virus\nesféricos no envueltos y su genoma es una única molécula lineal de ARN de sentido\npositivo, que se encuentra recubierta por una cápside de simetría icosaédrica. Aislados\npor primera vez en 1956, en la actualidad se conocen más de 100 serotipos diferentes\nque se encuentran agrupados en tres especies, HRVA, HRVB y HRVC. Son\ntermoestables y se diseminan a través de las secreciones respiratorias contaminadas\nmediante el contacto directo entre personas. Es posible hallarlos en personas de todas\nlas edades, su diseminación es a nivel mundial y, aunque la frecuencia de circulación\nsuele ser mayor en los meses de otoño y primavera, pueden detectarse en todos los\nmeses del año. Si bien históricamente los HRV fueron considerados patógenos de las\nvías aéreas superiores, en la actualidad se ha demostrado que también ocasionan\ninfecciones en el tracto respiratorio inferior, causando hospitalizaciones de niños con\nneumonía, bronquiolitis y obstrucciones pulmonares crónicas. También se encuentran\nasociados a pacientes que presentan episodios de sibilancias recurrentes,\nexacerbaciones de asma, bronquitis, sinusitis y otitis media aguda.\nEl diagnóstico virológico es necesario para determinar la etiología de las IRAs, ya\nque los cuadros clínicos producidos por los distintos virus suelen ser similares. Además,\npermite restringir el uso innecesario de antibióticos. El aislamiento viral en cultivo de\ntejido seguido por el test de labilidad ácida representa el método estándar en el\nlaboratorio para la confirmación de una infección por HRV, pero el tiempo requerido\nes superior a dos semanas, lo que es de valor limitado para una decisión terapéutica.\nLas técnicas basadas en la detección de ácidos nucleicos por reacción en cadena de la\npolimerasa (PCR) han permitido incrementar la identificación de este virus.\nEl hecho de que en Santa Fe no se hayan efectuado hasta el momento estudios\nrelacionados a los HRV motivó la realización de este trabajo, que se propuso\nseleccionar y optimizar una técnica de PCR que permitiera la detección del virus en\npacientes pediátricos hospitalizados con IRA durante el período marzo 2010-febrero\n2011, para luego estudiar su frecuencia, estacionalidad y epidemiología, como así\ntambién aspectos clínicos-epidemiológicos de los pacientes infectados.\nPara el desarrollo del estudio, se seleccionó una RT-PCR anidada, altamente\nsensible y específica, que fue testeada por Steininger et al. (2001) para la mayoría de\nlos serotipos de HRV conocidos y que amplifica un fragmento altamente conservado\ndel genoma viral. Se optimizó la técnica con controles de positivos del virus, variando\nparámetros críticos del ensayo, y se corroboró la especificidad de la misma al ensayar\ncontroles positivos de otros virus respiratorios.\nSe obtuvieron un total de 2020 aspirados nasofaríngeos (ANF) de pacientes\ndurante el período estudiado, a los cuales se les realizó la detección de antígenos VSR,\nadenovirus, parainfluenza e influenza A y B por inmunofluorescencia (IF). La detección\nde influenza A y B se realizó además por RT-PCR real time. A un porcentaje\nrepresentativo de ANF que resultaron negativos por IF (452 muestras) se les realizó la\ndeterminación de HRV mediante RT-PCR, detectando el genoma del virus en 172, lo\nque representó una positividad del 38,1% y un segundo lugar (8,5%) en la frecuencia\nde circulación de virus respiratorios. Se encontró en todos los meses del año,\npredominando durante marzo de 2010 y desde agosto hasta febrero de 2011.\nEl 60% de los niños hospitalizados con IRA atribuibles a HRV fueron menores de 6\nmeses, siendo la mediana de la edad de 4 meses. Se comprobó que la edad no fue un\nfactor de riesgo para desarrollar enfermedad grave. La proporción de infectados fue\nsimilar para ambos géneros.\nSe analizaron aspectos clínicos y epidemiológicos de 145 pacientes. El 31%\npresentó antecedentes clínicos, entre los que se destacaron la prematurez (55,6%) y\nlas sibilancias recurrentes (51,1%). Los diagnósticos de egreso más frecuentes fueron la\nneumonía (35,2%), la bronquiolitis (32,4%) y la bronquitis (12,4%). Como hallazgos\nradiológicos se observó atrapamiento aéreo (75,2%), infiltrado instersticial (67,9%) e\ninfiltrado alveolar (35,8%). El 72,7% de los pacientes presentó leucocitosis. Se\nutilizaron antibióticos en el 66,4% de los tratamientos y el 85,5% de los niños requirió\nsuministro de oxígeno durante la internación. La mediana de la duración de la estadía\nhospitalaria fue de 6 días y el 15,9% de los pacientes requirió internación en unidad de\nterapia intensiva (UTI). No se observaron diferencias significativas entre las edades de\nlos pacientes internados en UTI y las de aquellos que no presentaron un cuadro clínico\nde gravedad, como así tampoco el presentar un antecedente clínico fue un factor de\nriesgo para desarrollar enfermedad severa.\nEl presente estudio evidenció que los HRV están asociados a hospitalizaciones de\nniños por IRA. La implementación de una técnica de RT-PCR de punto final logró\ndetectar con rapidez, sensibilidad y especificidad un virus que se ubicó en el segundo\nlugar de circulación (luego del VSR), y permitirá, en forma rutinaria, disminuir los casos\nde IRA de origen desconocido, estableciendo el papel que desempeñan estos virus en\nnuestro medio y facilitando la elección de conductas terapéuticas apropiadas

DESARROLLO DE DISPOSITIVOS DIDÁCTICOS COMO ESTRATEGIA PARA LA ENSEÑANZA DE LAS CIENCIAS NATURALES EN EL NIVEL INICIAL

O ensino das Ciências da Natureza no Nível Inicial é, em certas ocasiões, esse assunto é pouco divulgado nas salas de aula. O objetivo principal deste trabalho foi projetar e desenvolver dispositivos didáticos que contribuam, de forma interdisciplinar, para o ensino de conteúdos estruturantes das Ciências Naturais na primeira infância, utilizando a abordagem STEAM e a Design-Based Research para a avaliação de materiais. Um dispositivo para estudar o processo de germinação, as partes de uma planta e os tropismos; um tabuleiro de xadrez usado para ensinar táxis; e um extrato de curcumina que muda de cor quando reage com soluções com diferentes características químicas, são alguns exemplos dos materiais desenhados e distribuídos em creches da cidade de Santa Fé, Argentina. O corpo docente que fez uso desses dispositivos os valorizou positivamente e destacou o potencial da proposta.La enseñanza de las Ciencias Naturales en el Nivel Inicial es un tema complejo y en ciertas ocasiones esta temática es poco promovida en las aulas. El objetivo principal de este trabajo fue diseñar y desarrollar dispositivos didácticos que contribuyan, de manera interdisciplinaria, a la enseñanza de contenidos estructurantes de Ciencias Naturales en las primeras infancias, recurriendo al enfoque STEAM y a la Investigación Basada en el Diseño para la evaluación de los materiales. Un dispositivo para estudiar el proceso de germinación, las partes de una planta y los tropismos; un tablero de damas utilizado para la enseñanza de taxismos; y un extracto de curcuminas que cambia de color cuando reacciona con soluciones de características químicas diferentes, son algunos ejemplos de los materiales diseñados, y que fueron distribuidos en jardines de infantes de la ciudad de Santa Fe, Argentina. El personal docente que ha hecho uso de estos dispositivos valoró positivamente los mismos y destacó la potencialidad de la propuesta.The teaching of Natural Sciences at the Initial Level is a complex issue and on certain occasions this subject is little promoted in the classrooms. The main objective of this work was to design and develop didactic devices that contribute, in an interdisciplinary way, to the teaching of structuring contents of Natural Sciences in early childhood, using the STEAM approach and Design-Based Research for the evaluation of materials. A device to study the germination process, the parts of a plant and the tropisms; a checkerboard used for teaching taxis; and a curcumin extract that changes color when it reacts with solutions with different chemical characteristics, are some examples of the materials designed, and which were distributed in kindergartens in the city of Santa Fe, Argentina. The teaching staff who have made use of these devices valued them positively and highlighted the potential of the proposal

DESENVOLVIMENTO DE MATERIAIS DIDÁTICOS COM ABORDAGEM STEAM PARA O ENSINO DE CIÊNCIAS EXPERIMENTAIS NA ESCOLA PRIMÁRIA

Science, Technology, Engineering, Art and Mathematics are integrated in the same field through the STEAM approach. Its objective is to nurture creative human resources for science and technology, and allow students, through the use of these resources, to acquire the necessary skills to face today's world. To this end, the role played by science and technology education in promoting skills related to innovation, continuous learning and critical thinking from an early age is essential. The main purpose of this research is to contribute to the teaching of structuring contents of Natural Sciences for the Primary Level, proposed in the Priority Learning Hubs of Argentina. For this, a series of didactic devices with a STEAM perspective were designed and developed, using a research methodology based on design. The implementation of these devices as part of a didactic sequence is expected to be useful for students and teachers in the teaching and learning of Experimental Sciences. The evaluation of the results of this work is currently under development and will allow it to be validated in the future or to make modifications based on the observations made.La Ciencia, la Tecnología, la Ingeniería, el Arte y las Matemáticas se encuentran integradas en un mismo ámbito a través del enfoque Science, Technology, Egineering, Arts e Mathematics (STEAM). Su objetivo es nutrir de recursos humanos creativos a la ciencia y a la tecnología, y permitir a las y los estudiantes, a través del uso de estos recursos, adquirir las habilidades necesarias para enfrentar al mundo actual. Para ello, es fundamental el papel que desempeña la educación científica y tecnológica en la promoción de capacidades relacionadas con la innovación, el aprendizaje continuo y el pensamiento crítico desde edades tempranas. El propósito principal de esta investigación es contribuir a la enseñanza de contenidos estructurantes de Ciencias Naturales para el Nivel Primario, propuestos en los Núcleos de Aprendizaje Prioritarios de Argentina. Para ello, se diseñaron y desarrollaron una serie de dispositivos didácticos con perspectiva STEAM, utilizando una metodología de investigación basada en el diseño. Se espera que la implementación de estos dispositivos como parte de una secuencia didáctica, sean de utilidad para estudiantes y docentes en la enseñanza y en el aprendizaje de las Ciencias Experimentales. La evaluación de los resultados de este trabajo se encuentra actualmente en desarrollo y permitirá a futuro validar el mismo o realizar modificaciones en función de las observaciones realizadas.Ciência, Tecnologia, Engenharia, Arte e Matemática estão integrados no mesmo campo através da abordagem STEAM. Seu objetivo é nutrir recursos humanos criativos para a ciência e tecnologia, e permitir que os alunos, através do uso desses recursos, adquiram as habilidades necessárias para enfrentar o mundo de hoje. Para tal, é fundamental o papel desempenhado pela educação científica e tecnológica na promoção de competências relacionadas com a inovação, a aprendizagem contínua e o pensamento crítico desde cedo. O objetivo principal desta pesquisa é contribuir para o ensino de conteúdos estruturantes de Ciências Naturais para o Nível Primário, propostos no Centros de Aprendizagem Prioritários na Argentina. Para isso, uma série de dispositivos didáticos com uma perspectiva STEAM foram projetados e desenvolvidos, utilizando uma metodologia de pesquisa baseada em design. Espera-se que a implementação destes dispositivos como parte de uma sequência didática seja útil para alunos e professores no ensino e aprendizagem das Ciências Experimentais. A avaliação dos resultados deste trabalho está atualmente em desenvolvimento e permitirá validá-lo no futuro ou fazer modificações com base nas observações feitas

Corrigendum: Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects

[This corrects the article DOI: 10.3389/fneur.2018.00395.]

Percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage in malignant distal bile duct obstruction using a self-expanding metal stent: Study protocol for a prospective European multicenter trial (PUMa trial)

Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) was associated with better clinical success and a lower rate of adverse events (AEs) than fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD) in recent single center studies with mainly retrospective design and small case numbers (< 50). The aim of this prospective European multicenter study is to compare both drainage procedures using ultrasound-guidance and primary metal stent implantation in patients with malignant distal bile duct obstruction (PUMa Trial). Methods The study is designed as a non-randomized, controlled, parallel group, non-inferiority trial. Each of the 16 study centers performs the procedure with the best local expertise (PTBD or EUS-BD). In PTBD, bile duct access is performed by ultrasound guidance. EUS-BD is performed as an endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade stenting (EUS-AGS). Insertion of a metal stent is intended in both procedures in the first session. Primary end point is technical success. Secondary end points are clinical success, duration pf procedure, AEs graded by severity, length of hospital stay, re-intervention rate and survival within 6 months. The target case number is 212 patients (12 calculated dropouts included). Discussion This study might help to clarify whether PTBD is non-inferior to EUS-BD concerning technical success, and whether one of both interventions is superior in terms of efficacy and safety in one or more secondary endpoints. Randomization is not provided as both procedures are rarely used after failed endoscopic biliary drainage and study centers usually prefer one of both procedures that they can perform best

Shifting the limits in wheat research and breeding using a fully annotated reference genome

Introduction: Wheat (Triticum aestivum L.) is the most widely cultivated crop on Earth, contributing about a fifth of the total calories consumed by humans. Consequently, wheat yields and production affect the global economy, and failed harvests can lead to social unrest. Breeders continuously strive to develop improved varieties by fine-tuning genetically complex yield and end-use quality parameters while maintaining stable yields and adapting the crop to regionally specific biotic and abiotic stresses. Rationale: Breeding efforts are limited by insufficient knowledge and understanding of wheat biology and the molecular basis of central agronomic traits. To meet the demands of human population growth, there is an urgent need for wheat research and breeding to accelerate genetic gain as well as to increase and protect wheat yield and quality traits. In other plant and animal species, access to a fully annotated and ordered genome sequence, including regulatory sequences and genome-diversity information, has promoted the development of systematic and more time-efficient approaches for the selection and understanding of important traits. Wheat has lagged behind, primarily owing to the challenges of assembling a genome that is more than five times as large as the human genome, polyploid, and complex, containing more than 85% repetitive DNA. To provide a foundation for improvement through molecular breeding, in 2005, the International Wheat Genome Sequencing Consortium set out to deliver a high-quality annotated reference genome sequence of bread wheat. Results: An annotated reference sequence representing the hexaploid bread wheat genome in the form of 21 chromosome-like sequence assemblies has now been delivered, giving access to 107,891 high-confidence genes, including their genomic context of regulatory sequences. This assembly enabled the discovery of tissue- and developmental stage–related gene coexpression networks using a transcriptome atlas representing all stages of wheat development. The dynamics of change in complex gene families involved in environmental adaptation and end-use quality were revealed at subgenome resolution and contextualized to known agronomic single-gene or quantitative trait loci. Aspects of the future value of the annotated assembly for molecular breeding and research were exemplarily illustrated by resolving the genetic basis of a quantitative trait locus conferring resistance to abiotic stress and insect damage as well as by serving as the basis for genome editing of the flowering-time trait. Conclusion: This annotated reference sequence of wheat is a resource that can now drive disruptive innovation in wheat improvement, as this community resource establishes the foundation for accelerating wheat research and application through improved understanding of wheat biology and genomics-assisted breeding. Importantly, the bioinformatics capacity developed for model-organism genomes will facilitate a better understanding of the wheat genome as a result of the high-quality chromosome-based genome assembly. By necessity, breeders work with the genome at the whole chromosome level, as each new cross involves the modification of genome-wide gene networks that control the expression of complex traits such as yield. With the annotated and ordered reference genome sequence in place, researchers and breeders can now easily access sequence-level information to precisely define the necessary changes in the genomes for breeding programs. This will be realized through the implementation of new DNA marker platforms and targeted breeding technologies, including genome editing

Activity-Structure Study on the Peptide Fraction of AG2: a Potent In Vitro Transfection Agent

Gemini-based amphiphiles are candidates for biomedical applications. In fact, most of thegemini compounds described in the literature have been prepared to be used as new syntheticvectors in gene transfection. Our group carried out an activity-structure study starting from thestructure of the gemini [AG2-C18/]2, which is an effective in vitro transfection reagent. Wesynthesized a series of novel amphiphilic amino acid derivatives of low molecular weight,named AGn-Cm(N), in which the same apolar region (m) of oleic or palmitic acid wasmaintained and the peptide region was modified by amino acid insertions, deletions, andsubstitutions. We also determined the transfection efficiency, critical micelle concentration,particle size, and ζ-potential for these derivatives. Amphiphiles AG10-C16and AG 10-C18weremore active at a lower N/P ratio than AG2-C18. These amphiphiles showed no activity whenlysine was replaced by ornithine, and the activity of all derivatives increased when there weremore ornithine residues and a W/O = 1 ratio in the peptide region. It can be said that for AG10-C16, these two structural requirements on the amino acid portion predominated over the type ofaliphatic chain used.Fil: Grippo, Lucía Daniela. Laboratorio de Química Aplicada; ArgentinaFil: Rudi, Juan Manuel. Laboratorio de Química Aplicada; ArgentinaFil: de Zan, María Mercedes. Laboratorio de Control de Medicamentos; ArgentinaFil: Giorello, Antonella. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Desarrollo Tecnológico para la Industria Química. Universidad Nacional del Litoral. Instituto de Desarrollo Tecnológico para la Industria Química; ArgentinaFil: Antuña, Sebastián. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas. Laboratorio de Cultivos Celulares; ArgentinaFil: Prieto, Claudio. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas. Laboratorio de Cultivos Celulares; ArgentinaFil: Veaute, Carolina Melania Isabel. Laboratorio de Inmunología Básica; ArgentinaFil: Müller, Diana María. Laboratorio de Química Aplicada; Argentin

Impact of influenza in the post-pandemic phase: Clinical features in hospitalized patients with influenza A (H1N1) pdm09 and H3N2 viruses, during 2013 in Santa Fe, Argentina

It is important to characterize the clinical and epidemiological pattern of the influenza A (H1N1) pdm09 virus and compare it with influenza A (H3N2) virus, as surveyed in just a few studies, in order to contribute to the implementation and strengthening of influenza control and prevention strategies. The aims in this study were to describe influenza clinical and epidemiological characteristics in hospitalized patients, caused by influenza A (H1N1)pdm09 and influenza A (H3N2) viruses during 2013, in Santa Fe, Argentina. A retrospective study was conducted over 2013 among hospitalized patients with laboratory-confirmed influenza diagnosis. In contrast to patients with influenza A (H3N2) (20.5%), a higher proportion of hospitalizations associated with influenza H1N1pdm were reported among adults aged 35-65 years (42.8%). Of all patients, 73.6% had an underlying medical condition. Hospitalized patients with H1N1pdm were subject to 2.6 (95%CI, 1.0-6.8) times higher risk of severity, than those hospitalized with influenza A (H3N2). This results demonstrate the impact in the post-pandemic era of H1N1pdm virus, with increased risk of severe disease, in relation to H3N2 virus, both viruses co-circulating during 2013

Impact of influenza in the post-pandemic phase: Clinical features in hospitalized patients with influenza A (H1N1) pdm09 and H3N2 viruses, during 2013 in Santa Fe, Argentina

It is important to characterize the clinical and epidemiological pattern of the influenza A (H1N1) pdm09 virus and compare it with influenza A (H3N2) virus, as surveyed in just a few studies, in order to contribute to the implementation and strengthening of influenza control and prevention strategies. The aims in this study were to describe influenza clinical and epidemiological characteristics in hospitalized patients, caused by influenza A (H1N1)pdm09 and influenza A (H3N2) viruses during 2013, in Santa Fe, Argentina. A retrospective study was conducted over 2013 among hospitalized patients with laboratory-confirmed influenza diagnosis. In contrast to patients with influenza A (H3N2) (20.5%), a higher proportion of hospitalizations associated with influenza H1N1pdm were reported among adults aged 35-65 years (42.8%). Of all patients, 73.6% had an underlying medical condition. Hospitalized patients with H1N1pdm were subject to 2.6 (95%CI, 1.0-6.8) times higher risk of severity, than those hospitalized with influenza A (H3N2). This results demonstrate the impact in the post-pandemic era of H1N1pdm virus, with increased risk of severe disease, in relation to H3N2 virus, both viruses co-circulating during 2013

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks