The province of Formosa, Argentina, is endemic for leprosy. In the present paper, we assessed the trend (T, 2002-2016 time series) and the forecast for 2022 of new case detection rate (NCDR) and ...determined the spatial distribution of new cases detected (NCD) of leprosy.
This is a descriptive observational study of 713 NCD of leprosy from provincial medical records between January 2002 and December 2016. The whole dataset from the provincial medical record was used to independently estimate the NCDR trends of the general population, age groups, sexes and Departments. This same database was used to estimate the NCDR forecast of the general population for 2022, applying a dynamic linear model with a local linear trend, using the MCMC algorithm. The NCDR was higher in men (p<0.05), increased with age (0.20, 8.17, 21.04, and 29.49 for the 0-14, 15-44, 45-64 and over 65-year-old age groups, respectively; p<0.05) and showed a downward trend (negative values) of estimated slopes for the whole province and each Department. Bermejo Department showed the highest (T:-1.02, 95%CI: -1.42, -0.66) and Patiño the lowest decreasing trend (T:-0.45, 95%CI: -0.74, -0.11). The NCDR trend for both sexes was similar (T:-0.55, 95%CI: -0.64, -0.46), and age groups showed a decreasing trend (S15-44:-103, S45-64:-81, S>65:-61, p<0.05), except for the 0-14 age group (S:-3, p>0.05), which showed no trend. Forecasts predicted that leprosy will not be eliminated by 2022 (3.64, 95%CI: 1.22, 10.25).
Our results highlight the status of leprosy in Formosa and provide information to the provincial public health authorities on high-risk populations, stressing the importance of timely detection of new cases for further elimination of the disease in the province.
Leprosy is a chronic, neglected tropical infectious disease, currently endemic in Formosa, a province in northwestern Argentina. To analyze the performance, distribution, and effectiveness of the ...health system in leprosy diagnosis in Formosa, we estimated the trend of the number of new cases of leprosy diagnosed between 2002 and 2019 and estimated a forecast for 2022 at the primary health care centers (PHCCs) of at the first level of care (1stLC), at district hospitals (DHs) of the second level of care (2ndLC), high-complexity hospitals at the third level of care (3rdLC), and in rural and urban areas. The general trend was calculated based on the new cases detection rate (NCDR) using the autoregressive-moving average model (ARMA). The 1stLC, 2ndLC, and 3rdLC and the rural/urban variables were assessed using a proportional Bayesian trend ARMA (TrARMA) model. A predictive model was used for estimated forecasts. Markov-Monte Carlo chains were applied with A Metropolis-Hastings's algorithm. The highest median proportion (Mp) of new cases of leprosy was diagnosed at the 2ndLC (Mp, 0.67; 97.5% credibility interval CI 0.56-0.77), at the 3rdLC (Mp, 0.11; 97.5% CI 0.08-0.15), and in urban areas (urban median proportion (uMp), 0.86; 97.5% CI 0.83- 0.88), whereas the lowest proportion of new cases was diagnosed at the 1stLC (Mp, 0.082; 97.5% CI 0.061-0.108) and in rural areas (rural median proportion (rMp), 0.13; 97.5% CI 0.11-0.16). Our model predicts for 2022 that a median number of new cases of leprosy of 19.70 will be diagnosed in urban areas (97.5% CI 15.94-23.80), and will continue to be diagnosed at the 2ndLC (median number of cases, 15.33; 97.5% CI 12.40-10.52) and 3rdLC (median number of cases, 2.43; 97.5% CI 1.97-2.94).
Dengue is a major and rapidly increasing public health problem. In Argentina, the southern extreme of its distribution in the Americas, epidemic transmission takes place during the warm season. Since ...its re-emergence in 1998 two major outbreaks have occurred, the biggest during 2016. To identify the environmental factors that trigger epidemic events, we analyzed the occurrence and magnitude of dengue outbreaks in time and space at different scales in association with climatic, geographic and demographic variables and number of cases in endemic neighboring countries.
Information on dengue cases was obtained from dengue notifications reported in the National Health Surveillance System. The resulting database was analyzed by Generalized Linear Mixed Models (GLMM) under three methodological approaches to: identify in which years the most important outbreaks occurred in association with environmental variables and propose a risk estimation for future epidemics (temporal approach); characterize which variables explain the occurrence of local outbreaks through time (spatio-temporal approach); and select the environmental drivers of the geographical distribution of dengue positive districts during 2016 (spatial approach).
Within the temporal approach, the number of dengue cases country-wide between 2009 and 2016 was positively associated with the number of dengue cases in bordering endemic countries and negatively with the days necessary for transmission (DNT) during the previous autumn in the central region of the country. Annual epidemic intensity in the period between 1999-2016 was associated with DNT during previous autumn and winter. Regarding the spatio-temporal approach, dengue cases within a district were also associated with mild conditions in the previous autumn along with the number of dengue cases in neighboring countries. As for the spatial approach, the best model for the occurrence of two or more dengue cases per district included autumn minimum temperature and human population as fixed factors, and the province as a grouping variable. Explanatory power of all models was high, in the range 57-95%.
Given the epidemic nature of dengue in Argentina, virus pressure from endemic neighboring countries along with climatic conditions are crucial to explain disease dynamics. In the three methodological approaches, temperature conditions during autumn were best associated with dengue patterns. We propose that mild autumns represent an advantage for mosquito vector populations and that, in temperate regions, this advantage manifests as a larger egg bank from which the adult population will re-emerge in spring. This may constitute a valuable anticipating tool for high transmission risk events.
Numerous protocols have been published for extracting DNA from phlebotomines. Nevertheless, their small size is generally an issue in terms of yield, efficiency, and purity, for large-scale ...individual sand fly DNA extractions when using traditional methods. Even though this can be circumvented with commercial kits, these are generally cost-prohibitive for developing countries. We encountered these limitations when analyzing field-collected
spp. by polymerase chain reaction (PCR) and, for this reason, we evaluated various modifications on a previously published protocol, the most significant of which was a different lysis buffer that contained Ca
(buffer TESCa). This ion protects proteinase K against autolysis, increases its thermal stability, and could have a regulatory function for its substrate-binding site. Individual sand fly DNA extraction success was confirmed by amplification reactions using internal control primers that amplify a fragment of the
gene. To the best of our knowledge, this is the first time a lysis buffer containing Ca
has been reported for the extraction of DNA from sand flies.
Chromosome translocations are a hallmark of B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Additional genomic aberrations are also crucial in both BCP-ALL leukemogenesis and treatment ...management. Herein, we report the phenotypic and molecular cytogenetic characterization of an extremely rare case of BCP-ALL harboring two concomitant leukemia-associated chromosome translocations: t(1;19)(q23;q13.3) and t(9;17)(p13;q11.2). Of note, we described a new rearrangement between exon 6 of PAX5 and a 17q11.2 region, where intron 3 of SPECC1 is located. This rearrangement seems to disrupt PAX5 similarly to a PAX5 deletion. Furthermore, a distinct karyotype between diagnosis and relapse samples was observed, disclosing a complex clonal evolution during leukemia progression.
A 16-year-old boy was admitted febrile with abdominal and joint pain. At clinical investigation, he presented with anemia, splenomegaly, low white blood cell count and 92% lymphoblast. He was diagnosed with pre-B ALL and treated according to high risk GBTLI-ALL2009. Twelve months after complete remission, he developed a relapse in consequence of a high central nervous system and bone marrow infiltration, and unfortunately died.
To our knowledge, this is the first report of a rearrangement between PAX5 and SPECC1. The presence of TCF3-PBX1 and PAX5-rearrangement at diagnosis and relapse indicates that both might have participated in the malignant transformation disease maintenance and dismal outcome.
Actualizamos la distribución de las especies de Phlebotominae (Diptera: Psychodidade) y los casos humanos de leishmaniasis en la provincia de Corrientes, Argentina. Evandromyia correalimai (Martins, ...Coutinho & Lutz, 1970) es un nuevo registro para la provincia, reportado en el área urbana de Santo Tomé. Incluimos el mapa de distribución actualmente conocido de las especies de flebótomos en Corrientes, y las localidades donde fueron registradas, así como un mapa de las especies vectores y los casos humanos de leishmaniasis reportados. PALABRAS CLAVE. América del sur. Ecoepidemiologia. Flebótomos. Leishmaniasis visceral y cutánea. Vector. We updated the distribution of Phlebotominae (Diptera: Psychodidae) species and human cases of leishmaniasis in the Province of Corrientes, Argentina. Evandromyia correalimai (Martins, Coutinho & Lutz, 1970) is a new record for the province, reported in the urban area of Santo Tomé. We include the currently known distribution map of Phlebotominae sandfly species in Corrientes, and the localities where they were recorded, as well as a map of vector species and reported human cases of leishmaniases. KEYWORDS. Eco-epidemiology. Sand flies. South America. Vector. Visceral and cutaneous leishmaniasis.
Background and Aims The biological characterization of childhood acute myeloid leukemia (c-AML) is an important outcome predictor. In Brazil, very little is known about the frequency of AML ...subgroups, although c-AML accounts for about 18% of leukemias. We carried out this study to investigate the contribution of type I and II gene mutations in the probability of overall survival (pOS) of c-AML in Brazil. Methods Seven hundred and three de novo pediatric AML cases (2000–2015) were assessed throughout a multicentric network study. Mutations in hotspot regions of FLT3 , NRAS , KRAS , PTPN11 , and c- KIT genes were analyzed as well as fusion genes ( RUNX1 - RUNX1T1 , MLL / KMT2A -r, CBFβ - MYH11 , and PML - RARα ) associated with AML. Patients were treated out of the clinical trial although following the BFM-AML2004 protocol. Acute promyelocytic leukemia (APL) was treated differently. AML with Down syndrome was excluded. Results There were significant differences in gene mutations among age ranges (≤2 years-old; >2–10 years old and ≥11 years old) and the nonrandom association between type I/II mutations. Lower white blood cell count (≤50 × 109 /L) was associated with RUNX1 - RUNX1T1 , whereas higher WBC with CBFβ-MYH11 ( p <0.05). Cumulative pOS in 5 years was 37.7 ± 2.8% for total AMLs and 59.8 ± 6.2% for APL ( p = 0.03). pOS differences were observed between Brazilian regions. The South-Southeast regions had a better 5-year pOS, whereas the Midwest region presented the poorest pOS (23.7 ± 4.9%). PTPN11 mutations conferred an adverse prognosis as an independent prognostic factor. Conclusions Identification of genetic subgroups contributes to the molecular epidemiology and biology of AML worldwide, reflecting the profile of pediatric AML cases in Brazil.
Visceral leishmaniasis (VL) is a notifiable disease in Argentina. Every new case diagnosed must be reported to the National Health Surveillance System. In the period 2006-2012, a total of 103 cases ...have been notified in four provinces: Entre Rios, Santa Fe, Misiones and Santiago del Estero. Misiones has the largest amount of cases: a total of 80, detected in 15 towns from May 2006 to July 2012. The highest incidence is observed in children (less than 15 years of age). In 2004 the vector Lutzomyia longipalpis was detected for the first time in Formosa Province. Cases of human and canine VL, as well as the presence of the canine vector were reported in 2006 in the province of Misiones, and in 2008-2009 in the province of Corrientes. In Santiago del Estero cases of human and canine VL (2008) were possibly associated with secondary vectors. In 2010 Lu longipalpis was found in Entre Rios, showing its dispersal to the south. Between January and April 2011 a systematic search of the VL vector was carried out in 13 towns, in Entre Ríos, Santa Fe and Santiago del Estero Provinces (275 traps/night). The colonization of the vector Lu longipalpis was proved in Chajarí town (Entre Rios), but not in Santiago del Estero Province, where Migonemyia migonei appears as a putative LV vector.
The first case of visceral leishmaniasis (VL) in Argentina was reported in 2006 in Posadas, Misiones. During the summer 2008-2009 Lutzomyia longipalpis, the VL vector, and canine VL cases were ...already spread along the province of Corrientes. In order to know the distribution of VL risk, systematic captures of the vector were performed between February and March 2010, in 18 areas of the provinces of Entre Ríos and Corrientes, and the city of Puerto Iguazú, Misiones, with a total of 313 traps/night. We confirmed the presence of Lu. longipalpis, for the first time in Chajarí (Entre Ríos), Alvear, La Cruz, Curuzú Cuatiá and Bella Vista (Corrientes), and Puerto Iguazú (Misiones). In Santo Tome and Monte Caseros (Corrientes), where the vector had been previously reported, traps with more samples were obtained with 830 and 126 Lu. Longipalpis trap/site/night respectively. These results show that the vector of urban VL continues spreading in the Argentine territory. Simultaneously, the spread of the parasite and the resulting human VL cases are associated with the dispersion of reservoirs, infected dogs, with or without clinical symptoms or signs, due to human transit.
New generation oxygenators with integrated arterial line filters have been marketed to improve the efficacy of cardiopulmonary bypass (CPB). Differences in designs, materials, coating surfaces, pore ...size of arterial filter, and static prime exist between the oxygenators. Despite abundant preclinical data, literature lacks clinical studies. From September 2010 to March 2011, 80 consecutive patients were randomized to CPB using Terumo Capiox FX25 (40 patients, Group‐T) or Sorin Synthesis (40 patients, Group‐S) oxygenators. Pressure drop and gas exchange efficacy were registered during CPB. High‐sensitivity C‐reactive protein (hs‐CRP), white blood cells (WBCs), fluid balance, activated clotting time, international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, platelets (PLTs), serum albumin, and total proteins were measured perioperatively at different timepoints. Clinical outcome was recorded. Repeated measure analysis of variance and nonparametric statistics assessed between‐groups and during time differences. The two groups showed similar baseline and intraoperative variables. No differences were recorded in pressure drop and gas exchange (group‐P and group*time‐P = N.S. for all) during CPB. Despite similar fluid balance (P = N.S. for static/dynamic priming and ΔVolume administered intraoperatively), Group‐T showed higher hs‐CRP (group‐P = 0.034), aPTT (group‐P = 0.0001), and INR (group‐P = 0.05), with lower serum albumin (group‐P = 0.014), total proteins (group‐P = 0.0001), fibrinogen (group‐P = 0.041), and PLTs (group‐P = 0.021). Group‐T also showed higher postoperative bleeding (group‐P = 0.009) and need for transfusions (P = 0.008 for packed red cells and P = 0.0001 for fresh frozen plasma and total transfused volumes). However, clinical outcome was comparable (P = N.S. for all clinical endpoints). Both oxygenators proved effective and resulted in comparable clinical outcomes. However, Sorin Synthesis seems to reduce inflammation and better preserve the coagulative cascade and serum proteins, resulting in lower transfusions and post‐CPB inflammatory response.
PDF
