Breakthrough infection by hepatitis B virus in a vaccinated blood donor: An emerging threat for transfusion safety in low-endemic countries?

We present the case of a breakthrough infection by hepatitis B virus (HBV), intending to warn about the challenge that HBV represents for transfusion safety. Virological markers for HBV infection were assayed during a blood donor screening by detection of HBsAg, anti-HBc, and viral nucleic acid (HBV DNA) by a nucleic acid test (NAT). Additionally, samples were analyzed for detection of immunoglobulin M anti-HBc, HBeAg, anti-HBe, and anti-HBs. A first-time donor repeatedly tested positive for HBV DNA by NAT and nonreactive for HBV-serological markers of infection. He stated having completed the anti-HBV vaccination schedule; thus, study of anti-Hbs resulted in reactive at protective level (18 mIU/mL). The donor denied clinical symptoms of hepatitis and remained healthy during the follow-up period. 95 days postdonation, NAT was negative, seroconversion of anti-HBc ab was detected, and a significant increase in anti-HBs concentration was measured (>1000 mIU/mL). This is the first case of HBV-breakthrough infection reported in Argentina and to our knowledge, this potential threat to transfusion safety is novel in an HBV low-endemic region with high coverage of HBV vaccination. The occurrence of breakthrough infections challenges the current protocols for the identification of HBV-infected subjects, could be a source of silent HBV transmission.

Between the personal and the political: life experiences during the covid-19 pandemic in Tucumán, Argentina, 2020-2022

This article analyzes feelings, experiences, practices, and actions that underlie the meanings attributed to the covid-19 pandemic. Based on a case study located in the province of Tucumán (Argentina), a mixed-methods investigation was developed, interested in capturing life experiences. Discourse analysis show the resignification of life itself, the valorization of close ties, community social capital, the State and politics. From the personal to the political, the interpretive frames people use to signify life experiences during the covid-19 pandemic exhibit differentiated feelings, experiences, practices, and actions.

The effectiveness of COVID-19 vaccines in Latin America, 2021: a multicenter regional case–control study

Background

As of September 2022, nearly 1.3 billion doses of COVID-19 vaccine products have been administered in Latin America and the Caribbean, where 27% of global COVID-19 deaths have occurred. This study aimed to estimate the effectiveness of COVID-19 vaccines against lab-confirmed COVID-19 related hospitalizations and deaths among adults in Argentina, Brazil, Chile, and Colombia.

Methods

Using a test-negative case control design, we evaluated the effectiveness of a primary vaccination series considering six COVID-19 vaccine products (Sputnik V, mRNA-1273, CoronaVac, ChAdOx1, BNT162b2, Ad26.COV2.S) against lab-confirmed COVID-19 hospitalizations and deaths among 83,708 hospitalized adults from February–December, 2021. Data from hospitalization records, COVID surveillance, and vaccination registries were used. Vaccine effectiveness was estimated using logistic regression ((1-OR) x 100).

Findings

The average age of participants was 56.7 (SD = 17.5), and 45,894 (54.8%) were male. Adjusted VE (aVE) estimates for full vaccination against hospitalization were 82% for mRNA-1273 (95% confidence interval (CI) = −30 to 98%), 76% (71%–81%) for BNT162b2, 65% (61–68%) for ChAdOx1, 57% (10–79%) for Sputnik V, 53% (50–56%) for CoronaVac, and 46% (23–62%) for Ad26.COV2.S. Estimates, particularly for CoronaVac, varied by variant. Decreasing aVE was estimated as age increased, particularly for CoronaVac and ChAdOx1. aVE estimates against death were generally higher, with 100% (CI not estimated) for mRNA-1273, 82% (69–90%) for BNT162b2, 73% (69–77%) for ChAdOx1, 65% (60–67%) for CoronaVac, 38% (−75 to 78%) for Sputnik V, 6% (−58 to 44%) for Ad26.COV2.S.

Interpretation

Primary series vaccination with available COVID-19 vaccine products was effective against COVID-19 hospitalization and mortality. Effectiveness varied by product and declined with increasing age.

Funding

This study was funded by the Pan-American Health Organization (10.13039/100011893PAHO, World Health Organization (WHO)). PAHO convened and led the study implementation.

Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry)

BACKGROUND/OBJECTIVE

This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs).

METHODS

Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out.

RESULTS

A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06).

CONCLUSIONS

SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs.

STUDY REGISTRATION

This study has been registered in ClinicalTrials.gov under the number NCT04568421.

“CARACTERISTICAS CLÍNICAS Y RESULTADOS DEL SOPORTE CON MEMBRANA DE CIRCULACIÓN EXTRACORPÓREA EN PACIENTES CON COVID-19: UN ESTUDIO DE COHORTE NACIONAL”

Introduction

One of the great challenges during the COVID-19 pandemic was the management of ventilatory support. Extracorporeal membrane oxygenation (ECMO) was the main strategy for the management of refractory acute respiratory distress syndrome.

Objective

Retrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed.

Material and methods

Retrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed.

Results

Twenty-six patients were included in the analysis. Mortality during ECMO was 42.3% (n = 11) and overall hospital mortality was 65.3% (n = 17). The patient cohort did not differ in terms of sociodemographic characteristics and predictors of mortality at ICU admission between survivors and non-survivors. Mobile ECMO was performed in 10 patients, while 16 were cannulated in situ at the participating centers. The median time from symptom onset to ECMO was 14.5 days (IQR 10.7–21.5), 11 days (IQR 9.5–15.5) in the survivor group, and 17 days (IQR 12.5–27) in non-survivors. The median IMV time was 28.5 (IQR 13–38.25) days. Driving pressure (12 vs 10 cmH₂O; p < .01), compliance (37.2 vs 21.4 ml/cmH₂O; p < .01), and mechanical power (17.4 vs 11.3 J/min; p = .051) of the respiratory system showed statistically significant differences when comparing survivors and non-survivors, during the 3rd day of ECMO support.

Conclusion

In our cohort, mortality after ECMO and after 30 days of hospital stay, was 42.3%, similar to that stated on the extracorporeal life support organization (ELSO) COVID-19 registry dashboard. Information about patients with COVID-19 who required ECMO during the first wave in Argentina was provided in this analysis.

Brain volume loss and physical and cognitive impairment in naive multiple sclerosis patients treated with fingolimod: prospective cohort study in Buenos Aires, Argentina

BACKGROUND

The percentage of brain volume loss (PBVL) has been classically considered as a biomarker in multiple sclerosis (MS).

OBJECTIVE

The objective of the present study was to analyze if the PBVL during the 1^st year after the onset of the disease predicts physical and cognitive impairment (CI).

METHODS

Prospective study that included naïve patients without cognitive impairment who initiated MS treatment with fingolimod. Patients were followed for 3 years and relapses, expanded disability status scale (EDSS) progression (defined as worsening of 1 point on the EDSS), the annual PBVL (evaluated by structural image evaluation using normalization of atrophy [SIENA]), and the presence of CI were evaluated. Cognitive impairment was defined in patients who scored at least 2 standard deviations (SDs) below controls on at least 2 domains. The PBVL after 1 year of treatment with fingolimod was used as an independent variable, while CI and EDSS progression at the 3^rd year of follow-up as dependent variables.

RESULTS

A total of 71 patients were included, with a mean age of 35.4 ± 3 years old. At the 3^rd year, 14% of the patients were classified as CI and 6.2% had EDSS progression. In the CI group, the PBVL during the 1^st year was - 0.52 (±0.07) versus -0.42 (±0.04) in the no CI group (p < 0.01; odds ratio [OR] = 2.24; 95% confidence interval [CI]: 1.72-2.44). In the group that showed EDSS progression, the PBVL during the 1^st year was - 0.59 (±0.05) versus - 0.42 (±0.03) (p < 0.01; OR = 2.33; 95%CI: 1.60-2.55).

CONCLUSIONS

A higher PBVL during the 1^st year in naïve MS patients was independently associated with a significant risk of CI and EDSS progression.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

Epidemiology and Characterization of Shiga Toxin-Producing Escherichia Coli of Hemolytic Uremic Syndrome in Argentina

Argentina has one of the highest prevalence in Shiga toxin-producing Escherichia coli (STEC) and the high rate of hemolytic uremic syndrome (HUS) in the world. Though preventive steps such as food safety have been implemented as a way to reduce STEC infections, these have proven to be insufficient. STEC's pathogenesis, virulence factors, relationship with the environment, and emerging strains have been studied in the past few years in the country. Many factors that contribute to the morbidity and mortality of STEC infections include the expression of pathologic genes, alternative characteristics (inhibition of phagocytosis, invasion, cytotoxicity, and bacterial attachment), and host factors (age, immune status, treatments, medical history). However, research studies in combination with epidemiological data suggest trends of the prognosis, with the relationship between and genetic combinations of adherence, Shiga toxin (Stx) genes, and virulence genes, which significantly influence disease outcomes. This review explains the characteristics and epidemiology of STEC in Argentina. All these facts show that the application of molecular subtyping techniques in real-time is essential for detecting and controlling outbreaks. Applying molecular subtyping techniques in hemorrhagic diarrhea can avoid severe consequences caused by progression to HUS, and help the epidemiological analysis of the outbreak. 

Molecular characterization and antimicrobial resistance profiles of Salmonella Heidelberg isolates from poultry

In the last 10 years, Salmonella Heidelberg has been extensively isolated from poultry in several countries. In this context, molecular characterization is essential to understand whether the strains have entered the farms from a single or several sources. Thus, the aim of this study was to determine the genetic relationship and antimicrobial susceptibility of S. Heidelberg strains isolated between 2011 and 2012 from broiler farms belonging to three integrated poultry companies located in Argentina. The genetic relatedness of the S. Heidelberg isolates was determined by pulsed-field gel electrophoresis (PFGE), and resistance to 21 antimicrobials was determined by the disc diffusion method. The isolates were assigned to four PFGE patterns. Most of the strains showed 100% similarity and belonged to the same integrated poultry company. This PFGE pattern was also prevalent in S. Heidelberg strains isolated from humans in several provinces of Argentina, which suggests an epidemiological association between human and poultry strains. All the isolates were classified as multidrug-resistant (MDR), and no clear relationship was observed between PFGE and resistance patterns. S. Heidelberg strains may circulate among farms from the same integrated company due to common sources of contamination. To guarantee the safety of the poultry product for the consumers, holistic approaches including surveillance of Salmonella throughout the production chain together with control measures are crucial.

Lung donation and donor lung management: a survey among health care professionals in Argentina

OBJECTIVE

To describe health care providers' knowledge about lung donation and donor lung management.

METHODS

A descriptive, cross-sectional study based on an anonymous survey was conducted between March and September 2018 among health care professionals registered to Sociedad Argentina de Terapia Intensiva.

RESULTS

Of the 736 respondents, the mean age was 40.5 years (standard deviation 8.9), and 61.3% were female. Sixty percent were physicians, 21.5% were nurses, and 17.9% were physiotherapists. Seventy-eight percent considered themselves appropriately informed about organ procurement, and 79.8% stated that they knew potential organ donor critical care management. The lung donor criteria were answered correctly by 71.3% of the respondents. However, after the donor's brain death, 51% made no changes to ventilator parameters, 22.9% were not aware of which parameters to reprogram, and 44.5% selected tidal volume of 6 - 8mL/kg and positive end expiratory pressure of 5cmH2O. For 85% of the health care providers, the type of apnea test chosen was disconnection from the ventilator, and only 18.5% used a lung management protocol. The most frequent interventions used in the case of arterial oxygen partial pressure/fractional inspired oxygen < 300 were positive end expiratory pressure titration, closed-circuit endotracheal suctioning, and recruitment maneuvers.

CONCLUSION

Health care professionals surveyed in Argentina correctly answered most of the questions related to lung donor criteria. However, they lacked detailed knowledge about ventilatory settings, ventilatory strategies, and protocols for lung donors. Educational programs are key to optimizing multiorgan donation and should be focused on protecting the donor lungs to increase the numbers of organs available for transplantation.

GJB2 and GJB6 Genetic Variant Curation in an Argentinean Non-Syndromic Hearing-Impaired Cohort

Genetic variants in GJB2 and GJB6 genes are the most frequent causes of hereditary hearing loss among several deaf populations worldwide. Molecular diagnosis enables proper genetic counseling and medical prognosis to patients. In this study, we present an update of testing results in a cohort of Argentinean non-syndromic hearing-impaired individuals. A total of 48 different sequence variants were detected in genomic DNA from patients referred to our laboratory. They were manually curated and classified based on the American College of Medical Genetics and Genomics/Association for Molecular Pathology ACMG/AMP standards and hearing-loss-gene-specific criteria of the ClinGen Hearing Loss Expert Panel. More than 50% of sequence variants were reclassified from their previous categorization in ClinVar. These results provide an accurately interpreted set of variants to be taken into account by clinicians and the scientific community, and hence, aid the precise genetic counseling to patients.

Genetics and genomic medicine in Argentina

In this letter, we want to add information to the paper "Genetics and genomic medicine in Argentina" that we considered it was lacking. Argentina is a big country with inequalities in the access to public health care, especially in medical genetics and genomics.

Individual deprivation, regional deprivation, and risk for oral clefts in Argentina

OBJECTIVE

The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina.

METHODS

This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P.

RESULTS

A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls.

CONCLUSIONS

Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES-including poor prenatal care, low parental education, lack of information, and lifestyle factors-should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.

X-Chromosome Alu Insertions in Bahía Blanca, Argentina: Assessment of Population Information from Varied Genetic Markers and Usefulness of X-Chromosome Markers to Trace Sex-Biased Parental Contributions

Bahía Blanca is an urban city in a historically and geographically strategic location for the mixture of different populations in Argentina. In the present study, 10 Alu elements from the X chromosome are analyzed to characterize the genetic composition of the city's population, to compare it with other worldwide populations, and to explore the usefulness of X-chromosome markers for human population genetics purposes. In the Bahía Blanca sample, 7 of 10 Alu insertion frequencies are polymorphic. X-chromosome Alu results in Bahía Blanca are compared with eight different populations from Africa, Europe, and America. Genetic distance analysis indicates that the Bahía Blanca sample is closer to the European and North African samples (average distances of 0.106 and 0.113) than to the Native American (0.163) and sub-Saharan African samples (0.247). Genetic relationships shown by multidimensional scaling illustrate the intermediate position of Bahía Blanca compared with groups in other regions (European, Native American, and African). Admixture results of the Bahía Blanca sample for X-chromosome markers indicate similar proportions of Native American (0.472) and European parental contributions (0.479) and a minor sub-Saharan African contribution (0.049). These results are consistent with the past decade's genetic studies of Argentinean populations that reported higher Native American and sub-Saharan African contributions than previous data.

[Impact of physical inactivity on mortality and the economic costs of cardiovascular deaths: evidence from Argentina]

OBJECTIVE

Estimate mortality and economic costs from cardiovascular diseases attributable to physical inactivity in Argentina.

METHODS

Attributable mortality (AM) from physical inactivity was estimated as the product of the population attributable fraction and the number of deaths caused by associated cardiovascular diseases. Value of statistical life (VSL) was calculated using the human capital approach, in which VSL was estimated through lost productivity from premature death. Economic costs were calculated using AM and VSL, stratifying by sex, age group, and physical activity level. A sensitivity analysis was used to evaluate how costs vary in three possible scenarios.

RESULTS

AM from low and moderate physical activity ranged from 33 (18 to 24 years) to 7 857 (>84 years) deaths annually in both sexes. VSL ranged from I$441 005 (international dollars) (18 to 24 years) to I$4,121 (>84 years). Assessment of total costs by sex indicates that economic losses amounted to I$752.5 million for men and I$444.5 million for women.

CONCLUSION

Economic losses ranged from 0.61% of GDP for the minimum scenario, 0.85% for the average scenario, and 1.48% for the maximum scenario. Stronger public policy-making aimed at reduction of sedentary lifestyles in Argentina is recommended.

Psychometric Properties of Brief Screening Tests for Alcohol Use Disorders during Pregnancy in Argentina

Background Considering the physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest a brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identifying women with alcohol use disorders is important because they could need a more specific intervention than simple advice to abstain. Most screening tests have been developed and validated in male populations and focused on the long-term consequences of heavy alcohol use, so they might be inappropriate to assess consumption in pregnant women. Objective To analyze the internal reliability and validity of the alcohol screening instruments Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen - Quantity Frequency (RAPS-QF) and Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) to identify alcohol use disorders in pregnant women. Methods A total of 641 puerperal women were personally interviewed during the 48 hours after delivery. The receiver operating characteristics (ROC) curves and the sensitivity and specificity of each instrument using different cut-off points were analyzed. Results All instruments showed areas under the ROC curves above 0.80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced the low reliability of those instruments and a better performance of the AUDIT in this population.

[Strategy to improve access to etiological treatment of Chagas disease at the first level of care in Argentina]

Objective

Improve distribution of etiological treatment of Chagas disease by identifying barriers to the decentralization of treatment to the first level of care in Argentina.

Methods

A qualitative, exploratory, and descriptive study was conducted using semi-structured interviews of key actors belonging to the National Chagas Program and members of health teams at the first level of care, for the purpose of identifying barriers to diagnosis and treatment of Chagas disease at different levels (administrative, health agents, and community) that could affect a decentralized distribution strategy. Additionally, pilot decentralization was instituted in 10 primary health care centers in an Argentine province.

Results

Semi-structured interviews were conducted with 22 program heads and health professionals. Principal obstacles found were lack of systematic case-finding, poor coordination among levels of care and health system actors, lack of health team training on treatment, patient monitoring, and patient-related barriers. A pilot decentralization program was carried out and strategies were evaluated to optimize large-scale intervention.

Conclusions

The results made it possible to improve implementation of the plan to decentralize treatment through better inter-program coordination, capitalization on existing monitoring and communication tools, and sensitization of health teams. Furthermore, recommendations were developed to improve diagnosis and treatment of Chagas disease.

The HIV care cascade in Buenos Aires, Argentina: results in a tertiary referral hospital

OBJECTIVE

To determine rates of retention, antiretroviral therapy (ART) use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina.

METHODS

HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression.

RESULTS

A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5%) were retained in 2014. Among those retained, 459 (81.5%) were on ART in 2014. Of those 459 on ART, 270 (58.8%) were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio): 0.67; 95% CI (confidence interval): 0.44-0.92 for ≥ 35 vs. < 35 years), but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001) and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023).

CONCLUSIONS

Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.

New host, geographic records, and histopathologic studies of Angiostrongylus spp (Nematoda: Angiostrongylidae) in rodents from Argentina with updated summary of records from rodent hosts and host specificity assessment

To date, 21 species of the genus Angiostrongylus (Nematoda: Angiostrongylidae) have been reported around the world, 15 of which are parasites of rodents. In this study, new host, geographic records, and histopathologic studies of Angiostrongylus spp in sigmodontine rodents from Argentina, with an updated summary of records from rodent hosts and host specificity assessment, are provided. Records of Angiostrongylus costaricensis from Akodon montensis and Angiostrongylus morerai from six new hosts and geographical localities in Argentina are reported. The gross and histopathologic changes in the lungs of the host species due to angiostrongylosis are described. Published records of the genus Angiostrongylus from rodents and patterns of host specificity are presented. Individual Angiostrongylus species parasitise between one-19 different host species. The most frequent values of the specificity index (STD) were between 1-5.97. The elevated number of host species (n = 7) of A. morerai with a STD = 1.86 is a reflection of multiple systematic studies of parasites from sigmodontine rodents in the area of Cuenca del Plata, Argentina, showing that an increase in sampling effort can result in new findings. The combination of low host specificity and a wide geographic distribution of Angiostrongylus spp indicates a troubling epidemiological scenario although, as yet, no human cases have been reported.

Prevalence and spatial distribution of bovine brucellosis in San Luis and La Pampa, Argentina

BACKGROUND

Bovine brucellosis (BB) is a zoonotic disease caused by Brucella abortus. BB is endemic in Argentina, where vaccination with Brucella abortus strain 19 is compulsory for 3-to-8 month-old heifers. The objectives of this study were to quantify the prevalence of BB and to identify factors associated with its occurrence, along with the spatial distribution of the disease, in the provinces of La Pampa and San Luis. A two-stage random sampling design was used to sample 8,965 cows (3,513 in La Pampa and 5,452 in San Luis) from 451 farms (187 in La Pampa and 264 in San Luis).

RESULTS

Cow and herd prevalence were 1.8 % (95 % CI: 1.3-2.2; n = 157) and 19.7 % (95 % CI: 17.0-22.4; n = 89), respectively. Both cow-level and herd-level prevalence in La Pampa (2.4 and 26.0 %, respectively) were significantly higher than in San Luis (1.4 and 15.5 %, respectively). There were not differences between the proportions of reactive cattle compared to that obtained in a survey conducted in 2005. However, herd prevalence in La Pampa was significantly (P < 0.05) higher compared to that study. Disease was found to be spatially clustered in west La Pampa. The lower the bovine density and the calf/cow ratio, the higher odds of belonging to the cluster.

CONCLUSIONS

The increase of farm prevalence in the last five years suggests that the disease is spreading and that control measures should be applied in the region. The cluster of infected farms was located in the west region of La Pampa. There, farms have lower animal densities and smaller cow/calf indices compared to the rest of the province. Although western La Pampa has more infected herds, within-farm prevalence was not higher, which suggests that the control program has been relatively successful in controlling the disease at the farm level, and/or that low animal density inherently results in low disease prevalence. Our results provide baseline information on the epidemiology of BB and its potential pattern of transmission in Argentina, which will ultimately help to improve BB control programs in the country.

Ethical issues in genetics and public health in Latin America with a focus on Argentina

This paper reviews the health situation and developments in medical genetics and bioethics in Latin America, with a focus on Argentina. The region is the most inequitable in the world, with an average Gini Index of 52.5 and 25 % of the population living in poverty. Health expenditures are low and health systems are fragmented and privatised, with curtailed governmental responsibility and regulation. Health-care decision making is mostly in the hands of private insurance corporations and the medical-industrial complex, so that what is (or is not) covered by health plans is arbitrary and determined by the market and not by population health needs. This inequity and the lack of meaningful governmental intervention in the provision of health care, including genetic services, are at the heart of the bioethical dilemmas in Latin America. It is not surprising, therefore, that bioethics in the region has developed an approach grounded in social justice, equity and human rights as guiding principles, in contrast to the individualism espoused by Anglo-Saxon bioethics. The main ethical issues identified in genetics in Latin America are (1) inequity in access to genetic services, particularly in prenatal diagnosis, (2) genetic discrimination and (3) the lack of adherence to internationally accepted requisites of clinical validity and utility for diagnostic and predictive genetic testing. In this context, there is a risk that the impressive advances in genetics/genomics occurring in developed countries may fail to improve the public's health and deepen inequity, with the implementation of expensive genetic technologies of unproven validity.

The burden of diabetes in Argentina

OBJECTIVE

To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs).

METHODS

DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD).

RESULTS

In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age.

CONCLUSIONS

Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.

Medicinal plants in the cultural landscape of a Mapuche-Tehuelche community in arid Argentine Patagonia: an eco-sensorial approach

BACKGROUND

The taste and smell of medicinal plants and their relation to the cultural landscape of a Mapuche-Tehuelche community in the Patagonian steppe was investigated. We assume that the landscapes as a source of therapeutic resources is perceived, classified and named according to different symbolic, ecological and utilitarian criteria which are influenced by chemosensorial appearance of medicinal plants which are valued by inhabitants.

METHODS

Information relating to the cultural landscape experienced by 18 inhabitants, all representing 85% of the families, in terms of medicinal plants, knowledge of species and their organoleptic perception was obtained through participant observation, interviews and free listing. The data were examined using cualitative and quantitative approach, including discourse analysis and non-parametric statistics.

RESULTS

Informants use 121 medicinal species, obtained from both wild and non-wild environments, most of which (66%) present aroma and/or taste. It was found that the plants with highest use consensus used for digestive, respiratory, cardio-vascular, analgesic-anti-inflammatory, obstetric-gynaecological and genito-unrinary complaints, have the highest frequencies of cites reporting flavor; and those with the highest frequencies relating to digestive, analgesic-anti-inflammatory and cultural syndromes present the highest frequencies of aroma. Flavor and/or aroma are interpreted as strong or soft, and the strongest are associated with treatment of supernatural ailments. Also, taste is a distinctive trait for the most of the species collected in all natural units of the landscape, while aroma is more closely associated with species growing at higher altitudes. The local pharmacopeia is also enriched with plants that come from more distant phytogeographical environments, such as the Andean forest and the Patagonian Monte, which are obtained through barter with neighboring populations. Herbal products are also obtained in regional shop. The practices of barter and purchase extend the limits of the landscape as a provider of therapeutic resources, improving the dynamics of its functions and structure, leading to more effective solutions to the various health needs that arise in the community.

CONCLUSIONS

Herbal landscape perceived by the community exhibits notable eco sensorial and spatial heterogeneity. Local inhabitants' sensorial interpretations play a role as heuristic tools in the recreation and redefinition of old and new available resources.

Aedes aegypti from temperate regions of South America are highly competent to transmit dengue virus

BACKGROUND

Aedes aegypti is extensively spread throughout South America where it has been responsible for large dengue epidemics during the last decades. Intriguingly, dengue transmission has not been reported in Uruguay and is essentially prevalent in subtropical northern Argentina which borders Uruguay.

METHODS

We assessed vector competence for dengue virus (DENV) of Ae. aegypti populations collected in subtropical Argentina (Corrientes) as well as temperate Uruguay (Salto) and Argentina (Buenos Aires) in 2012 using experimental oral infections with DENV-2. Mosquitoes were incubated at 28 °C and examined at 14 and 21 days p.i. to access viral dissemination and transmission. Batches of the Buenos Aires mosquitoes were also incubated at 15 °C and 20 °C.

RESULTS

Although mosquitoes from temperate Uruguay and Argentina were competent to transmit DENV, those from subtropical Argentina were more susceptible, displaying the highest virus titters in the head and presenting the highest dissemination of infection and transmission efficiency rates when incubated at 28 °C. Interestingly, infectious viral particles could be detected in saliva of mosquitoes from Buenos Aires exposed to 15 °C and 20 °C.

CONCLUSIONS

There is a potential risk of establishing DENV transmission in Uruguay and for the spread of dengue outbreaks to other parts of subtropical and temperate Argentina, notably during spring and summer periods.

Culicidae (Diptera) selection of humans, chickens and rabbits in three different environments in the province of Chaco, Argentina

Studies were conducted to determine the selection of humans, chickens and rabbits by Culicidae in three different environments in the province of Chaco, Argentina. Mosquitoes were collected fortnightly using cylindrical metal traps containing animal bait (chickens and rabbits). The mosquitoes were collected between June 2001-May 2002. During the same period and with the same frequency, mosquitoes biting the human operators of the traps were collected during the first 15 min of exposure within different time intervals: from 09:00 am-11:00 am, 01:00 pm-03:00 pm, 05:00 pm-07:00 pm and 09:00 pm-10:00 pm. A total of 19,430 mosquitoes of 49 species belonging to 10 genera were collected. Culex species mainly selected chicken bait and Wyeomyia species selected rabbit bait. Ochlerotatus and Psorophora species were more abundant in rabbit-baited traps. Anopheles triannulatus, Coquillettidia nigricans, Ochlerotatus scapularis, Mansonia titillans and Psorophora albigenu showed a strong attraction for human bait. The Anopheles, Coquillettidia, Culex and Mansonia species were more active between 05:00 pm-09:00 pm, while Ochlerotatus, Psorophora, Haemagogus and Wyeomyia were most active from 09:00 am-07:00 pm. This study provides additional information about the biology and ecology of arbovirus vectors in Chaco.

Culicidae (Diptera) selection of humans, chickens and rabbits in three different environments in the province of Chaco, Argentina

Studies were conducted to determine the selection of humans, chickens and rabbits by Culicidae in three different environments in the province of Chaco, Argentina. Mosquitoes were collected fortnightly using cylindrical metal traps containing animal bait (chickens and rabbits). The mosquitoes were collected between June 2001-May 2002. During the same period and with the same frequency, mosquitoes biting the human operators of the traps were collected during the first 15 min of exposure within different time intervals: from 09:00 am-11:00 am, 01:00 pm-03:00 pm, 05:00 pm-07:00 pm and 09:00 pm-10:00 pm. A total of 19,430 mosquitoes of 49 species belonging to 10 genera were collected. Culex species mainly selected chicken bait and Wyeomyia species selected rabbit bait. Ochlerotatus and Psorophora species were more abundant in rabbit-baited traps. Anopheles triannulatus, Coquillettidia nigricans, Ochlerotatus scapularis, Mansonia titillans and Psorophora albigenu showed a strong attraction for human bait. The Anopheles, Coquillettidia, Culex and Mansonia species were more active between 05:00 pm-09:00 pm, while Ochlerotatus, Psorophora, Haemagogus and Wyeomyia were most active from 09:00 am-07:00 pm. This study provides additional information about the biology and ecology of arbovirus vectors in Chaco.

Two new species and new records of biting midges of the genus Culicoides from northwestern Argentina (Diptera: Ceratopogonidae)

The following two new species of Culicoides from the Argentinean Yungas are described, illustrated and placed to subgenus or species group and compared with related congeners: Culicoides calchaqui Spinelli & Veggiani Aybar and Culicoides willinki Spinelli & Veggiani Aybar. Culicoides daedaloides Wirth & Blanton is recorded for the first time for Argentina and Culicoides pseudoheliconiae Felippe-Bauer is firstly mentioned from the northwestern region of the country.

The PAMPA datasets: a metagenomic survey of microbial communities in Argentinean pampean soils

BACKGROUND

Soil is among the most diverse and complex environments in the world. Soil microorganisms play an essential role in biogeochemical cycles and affect plant growth and crop production. However, our knowledge of the relationship between species-assemblies and soil ecosystem processes is still very limited. The aim of this study was to generate a comprehensive metagenomic survey to evaluate the effect of high-input agricultural practices on soil microbial communities.

RESULTS

We collected soil samples from three different areas in the Argentinean Pampean region under three different types of land uses and two soil sources (bulk and rhizospheric). We extracted total DNA from all samples and also synthetized cDNA from rhizospheric samples. Using 454-FLX technology, we generated 112 16S ribosomal DNA and 14 16S ribosomal RNA amplicon libraries totaling 1.3 M reads and 36 shotgun metagenome libraries totaling 17.8 million reads (7.7 GB). Our preliminary results suggested that water availability could be the primary driver that defined microbial assemblages over land use and soil source. However, when water was not a limiting resource (annual precipitation >800 mm) land use was a primary driver.

CONCLUSION

This was the first metagenomic study of soil conducted in Argentina and our datasets are among the few large soil datasets publicly available. The detailed analysis of these data will provide a step forward in our understanding of how soil microbiomes respond to high-input agricultural systems, and they will serve as a useful comparison with other soil metagenomic studies worldwide.

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina

BACKGROUND

The increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET.

METHODS

A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon.

RESULTS

The SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was $7,374 and $20,490, respectively.

CONCLUSIONS

According to the criteria proposed by the Commission on Macroeconomics and Health, the use of the combination SAXA + MET is highly cost-effective in Argentina.

Economic gradients in early child neurodevelopment: a multi-country study

Little is known about the importance of household wealth for child neurodevelopment very early in life including during infancy. Previous studies have focused on specific developmental domains instead of more holistic multi-domain measures of neurodevelopment and on economic effects for the "average" child instead of evaluating the heterogeneity in economic gradients by different levels of developmental ability. Furthermore, not much is known about whether economic gradients in early child neurodevelopment are country-specific or generalizable between populations. We evaluate wealth gradients in child neurodevelopment, an important predictor of future health and human capital, between ages 3 and 24 months in four South American countries. We also assess the heterogeneity in these gradients at different locations of the neurodevelopment distribution using quantile regression. Employing a unique dataset of 2032 children with neurodevelopment measures obtained by physicians in 2005-2006, we find a large positive wealth gradient in neurodevelopment in Brazil. The wealth gradient is larger for children at higher neurodevelopment rankings, suggesting that wealth is associated with child development inequalities in the form of a wider gap between low and high achievers on neurodevelopment in Brazil. This result highlights the need to target poverty in Brazil as a key factor in health and human capital disparities earlier in life rather than later as early developmental deficits will be carried forward and possibly multiplied later in life. More importantly, small or insignificant wealth gradients are generally found in the other countries. These results suggest that wealth gradients in child neurodevelopment are country-specific and vary with population demographic, health, and socioeconomic characteristics. Therefore, findings from previous studies based on specific populations may not be generalizable to other countries. Furthermore, wealth gradients in child neurodevelopment appear to be dynamic rather than fixed and sensitive to population characteristics that modify their intensity.

The use of a Toolkit for health needs assessment on neural tube defects in Argentina

Health needs assessment (HNA) is a commonly used process for those working in public health. The PHG Foundation has developed a Toolkit to provide users with a stepwise approach for undertaking a HNA on birth defects. We report the findings from using the Toolkit to examine needs in relation to policies and programs, services, and interventions for neural tube defects (NTDs) in Argentina. The trend over the last few decades is one of decline in infant mortality from nutritional and infectious causes, thus further increasing the relative importance of birth defects. The observed prevalence of NTDs is consistent with that reported internationally. Since 2002 folic acid fortification (FAF) has been mandatory by law, and different studies have shown at least a 50 % decrease in the birth prevalence of NTDs after FAF. In Argentina, there is inequity between the public and non-public health sectors. The birth prevalence of NTDs seems lower in the non-public sector, possibly as a result of better nutritional status of women, higher access to folic acid supplementation, and earlier prenatal diagnosis followed by termination of pregnancy (ToP) in non-public hospitals. Although illegal, ToP is believed to be widespread, with better access for people of higher socioeconomic status. Through the process of HNA, we identified several unmet needs regarding registration of cases, public and professional education, legislation, and organization of care pathways. In our experience, the Toolkit brought together people working on the same issue, and it engaged and motivated experts and stakeholders to work together to tackle the problem.

Epidemiology of Invasive Fungal Infections in Latin America

The pathogenic role of invasive fungal infections (IFIs) has increased during the past two decades in Latin America and worldwide, and the number of patients at risk has risen dramatically. Working habits and leisure activities have also been a focus of attention by public health officials, as endemic mycoses have provoked a number of outbreaks. An extensive search of medical literature from Latin America suggests that the incidence of IFIs from both endemic and opportunistic fungi has increased. The increase in endemic mycoses is probably related to population changes (migration, tourism, and increased population growth), whereas the increase in opportunistic mycoses may be associated with the greater number of people at risk. In both cases, the early and appropriate use of diagnostic procedures has improved diagnosis and outcome.

Descriptions of immatures of the South American plant hopper, Taosa (C.) longula

Descriptions of the immature stages of Taosa (Cuernavaca) longula Remes Lenicov (Hemiptera: Fulgoroidea: Dictyopharidae) and a key for their identification is provided for specimens collected on the water hyacinth, Eichhornia crassipes (Martius) Solms-Laubach (Commelinales: Pontederiaceae), in northeastern Argentina and Peru. Newly emerged nymphs from eggs collected in the field were reared in rearing chambers, and each stage was fixed to microscopic examination and illustration. Fifth nymphal instars can be easily recognized from congeners by the brown marked pattern coloration, shorter vertex, and the distinguishable median carina along the frons. Information on behavior and developmental time is also included.

First record of Fusarium verticillioides as an entomopathogenic fungus of grasshoppers

Fusarium verticillioides (Saccardo) Nirenberg (Ascomycota: Hypocreales) is the most common fungus reported on infected corn kernels and vegetative tissues, but has not yet been documented as being entomopathogenic for grasshoppers. Grasshoppers and locusts represent a large group of insects that cause economic damage to forage and crops. Tropidacris collaris (Stoll) (Orthoptera: Acridoidea: Romaleidae) is a large and voracious grasshopper that in recent years has become an increasingly recurrent and widespread pest in progressively more greatly extended areas of some of in Argentina's northern provinces, with chemical insecticides being currently the only means of control. During February and March of 2008-09, nymphs and adults of T. collaris were collected with sweep nets in dense woodland vegetation at a site near Tres Estacas in western Chaco Province, Argentina, and kept in screened cages. F. verticillioides was isolated from insects that died within 10 days and was cultured in PGA medium. Pathogenicity tests were conducted and positive results recorded. Using traditional and molecular-biological methods, an isolate of F. verticillioides was obtained from T. collaris, and its pathogenecity in the laboratory was shown against another harmful grasshopper, Ronderosia bergi (Stål) (Acridoidea: Acrididae: Melanoplinae). The mortality caused by F. verticillioides on R. bergi reached 58 ± 6.53% by 10 days after inoculation. This is the first record of natural infection caused by F. verticillioides in grasshoppers.

First record of the genus Zygina from a Neotropical region on Populus spp.: taxonomic and biological characteristics

The typhlocybine, Zygina nivea Mulsant & Rey 1855, was found in urban areas of Argentina colonizing trees of poplar (Populus alba L. and P. nigra L.). This is the first mention of the genus Zygina Fieber from the Neotropical region. In this paper redescription of the male, description of the female, distributional and host plant data, and behavioural observations of this species are given.

strain Argentina"and Rickettsia bellii in Amblyomma ticks (Acari: Ixodidae) from Northern Argentina

Ixodid ticks were collected from vegetation and from humans, wild and domestic mammals in a rural area in the semi-arid Argentine Chaco in late spring 2006 to evaluate their potential role as vectors of Spotted Fever Group (SFG) rickettsiae. A total of 233 adult ticks, identified as Amblyomma parvum, Amblyomma tigrinum and Amblyomma pseudoconcolor, was examined for Rickettsia spp. We identified an SFG rickettsia of unknown pathogenicity, "Candidatus Rickettsia sp. strain Argentina", in A. parvum and A. pseudoconcolor by PCR assays targeting gltA, ompA, ompB and 17-kDa outer membrane antigen rickettsial genes. Rickettsia bellii was detected in a host-seeking male of A. tigrinum. Amblyomma parvum is widespread in the study area and is a potential threat to human health.

DRINKING PATTERNS AND DSM-IV ALCOHOL USE DISORDERS' CRITERIA IN ARGENTINEAN EMERGENCY DEPARTMENT PATIENTS

BACKGROUND: Previous studies have shown cultural variations in normative drinking and furthermore, in the quantity and frequency of drinking related to alcohol use disorders. AIM: The main goal of this study is to characterize alcohol drinking patterns in Argentinean Emergency Department patients, and secondly, to explore the association between those drinking patterns and DSM-IV alcohol use disorders. METHOD: Data were collected from a probability sample of patients admitted to the Emergency Department of a large public hospital in Mar del Plata, Argentina. Data analyzed here pertain to those who reported consuming at least one drink during the last twelve months (n=529). A factor analysis of multiple correspondences and a hierarchic classification were performed. For the factor analysis, usual quantity and frequency of drinking (for the last 12 months) were considered active variables; number of DSM-IV dependence criteria met, positive or negative diagnostic status for abuse, positive or negative diagnostic status for dependence (both for the last 12 months), and socio-demographic characteristics (age, gender and economic level) were considered illustrative variables. RESULTS: The first five factorial axes were retained, accounting for 88% of the total variance. Hierarchic classification resulted in six distinctive classes of drinking patterns. Two patterns were associated with a positive diagnosis of abuse and dependence, respectively. One, drinking between 4 and 6 drinks per occasion mostly on a weekly basis, was associated with a diagnosis of abuse; this pattern was also associated with meeting one or two dependence criteria (dependence orphans). The other, drinking 7 or more drinks per occasion, was associated with a diagnosis of dependence, and also with a diagnostic orphan condition. This class, composed primarily of males, was not characterized by any particular frequency of drinking. The other four drinking patterns were not associated with a positive diagnosis of an alcohol use disorder. Two of them were characterized by drinking low quantities with a low frequency (either monthly or yearly). Participants in both of these classes tended to be female. The other two patterns were characterized by drinking less than 3 drinks per occasion, either daily or weekly: the former associated with being older than 35 years, and the later with no distinctive socio-demographic characteristics. CONCLUSIONS: Results demonstrated six distinct drinking patterns, two of them related to a positive diagnosis of an alcohol use disorder. Our findings support previous research indicating that dependence orphans share some characteristics with abuse and dependence cases. Given the lack of similar studies in the region, these findings, although descriptive, enrich the knowledge of alcohol use disorders in the regional context. Furthermore, they may contribute to the development of local drinking guidelines and prevention strategies.

Burden of acute gastrointestinal illness in Gálvez, Argentina, 2007

This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the 'high' and the 'low' seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI.

Molecular characterization of severe and mild cases of influenza A (H1N1) 2009 strain from Argentina

While worldwide pandemic influenza A(H1N1) pdm case fatality rate (CFR) was 0.4%, Argentina's was 4.5%. A total of 34 strains from mild and severe cases were analyzed. A full genome sequencing was carried out on 26 of these, and a partial sequencing on the remaining eight. We observed no evidence that the high CFR can be attributed to direct virus changes. No evidence of re-assortment, mutations associated with resistance to antiviral drugs, or genetic drift that might contribute to virulence was observed. Although the mutation D225G associated with severity in the latest reports from the Ukraine and Norway is not observed among the Argentine strains, an amino acid change in the area (S206T) surrounding the HA receptor binding domain was observed, the same previously established worldwide.

The South American dung beetle genus Ennearabdus Lansberge (Coleoptera: Scarabaeidae: Scarabaeinae: Eucraniini)

The South American endemic dung beetle genus Ennearabdus Lansberge is revised. Description, diagnosis and illustrations are presented for the only known species of the genus, E. lobocephalus (Harold). A lectotype is designated for Onthophagus lobocephalus Harold, the type species of Ennearabdus. The biology, biogeography, conservation status, and distribution based on the predictive distribution model of E. lobocephalus are also discussed.

nov., the first petrified bamboo culm record from the Ituzaingó Formation (Pliocene), Paraná basin, Argentina

BACKGROUND AND AIMS

The anatomical characterization and morphology of Guadua zuloagae nov. sp. (Poaceae-Bambusoideae) culm was determined. This material was collected at the Toma Vieja fossil locality, Paraná basin, Argentina. This fossil culm is the first record of Bambusoideae in sediments of the Pliocene from the Ituzaingó Formation. The studied specimen was compared with the taxa of the Bambusoideae sub-family, especially with the American woody bamboos and others taxa that have woody culms, including Arundo, Thysalonaena and Gynerium.

METHODS

The material was preserved by siliceous cellular permineralization, and it was prepared for microscopic examination by surface polishing and thin sections. The morphology and anatomy of this new species were described. The estimated height, critical buckling height and safety factor were calculated on the basis of the fossil bamboo diameter using the formula of Niklas. The relationship and comparison with the nearest living relatives (NLRs) are discussed.

KEY RESULTS

Well-preserved petrified culm with internodes and nodes from the Pliocene of Argentina provides the basis for the description of a new fossil bamboo, Guadua zuloagae. The results of the anatomical analysis of the fossil bamboo showed a great affinity with the extant species Guadua angustifolia and constitute the first evidence of petrified bamboo culm.

CONCLUSIONS

The new fossil bamboo culm constitutes the only fossil record, preserved as permineralized by silicification, in the world. This fossil record indicates that the genus Guadua was more widespread in the past than today. Discovery of G. zuloagae allows the presence of a Bambusoideae understorey in the mixed forests described for the Ituzaingó Formation to be inferred. The climatic conditions inferred from fossil bamboo and sedimentary deposits indicate a temperate-warm, humid climate.

Two measurement methods of leaf dry matter content produce similar results in a broad range of species

BACKGROUND AND AIMS

Leaf dry matter content (LDMC) is widely used as an indicator of plant resource use in plant functional trait databases. Two main methods have been proposed to measure LDMC, which basically differ in the rehydration procedure to which leaves are subjected after harvesting. These are the 'complete rehydration' protocol of Garnier et al. (2001, Functional Ecology 15: 688-695) and the 'partial rehydration' protocol of Vendramini et al. (2002, New Phytologist 154: 147-157).

METHODS

To test differences in LDMC due to the use of different methods, LDMC was measured on 51 native and cultivated species representing a wide range of plant families and growth forms from central-western Argentina, following the complete rehydration and partial rehydration protocols.

KEY RESULTS AND CONCLUSIONS

The LDMC values obtained by both methods were strongly and positively correlated, clearly showing that LDMC is highly conserved between the two procedures. These trends were not altered by the exclusion of plants with non-laminar leaves. Although the complete rehydration method is the safest to measure LDMC, the partial rehydration procedure produces similar results and is faster. It therefore appears as an acceptable option for those situations in which the complete rehydration method cannot be applied. Two notes of caution are given for cases in which different datasets are compared or combined: (1) the discrepancy between the two rehydration protocols is greatest in the case of high-LDMC (succulent or tender) leaves; (2) the results suggest that, when comparing many studies across unrelated datasets, differences in the measurement protocol may be less important than differences among seasons, years and the quality of local habitats.

Diagnosis and Molecular Variability of an Argentinean Population of Nacobbus aberrans with Some Observations on Histopathology in Tomato

Diagnosis of an Argentinean population of Nacobbus sp. infecting sweet pepper (lamuyo) was carried out including morphology, scanning electron microscopy, and molecular studies. In light of our morphometric, molecular and host-range results, we consider the studied population to belong to N. aberrans s. l., and by host range tests the population is assigned to the "sugar beet group." ITS-PCR analysis on individual male and immature female specimens of this population yielded amplification products of approximately 922 bp. RFLP profiles and sequencing of the ITS region revealed that, in addition to the host group, the present population can be assigned to the "Argentina 2" group. Disease development and histopathology were investigated with glasshouse observations using tomato, pepper, sugar beet and potato seedlings exposed to nematode infection for 45 days at 28 +/- 2 degrees C. Histopathology of tomato roots confirmed that all immature stages and young females and males are migratory, whereas mature females are obligate sedentary endoparasites. Rather than syncytia, large regions of cortical necrosis and cavities were detected in tomato swellings infected by juveniles. However, syncytia were associated only with adult females. Large root galls, hyperplasia, abnormal proliferation of lateral roots and asymmetry of root structure were common anatomical changes induced by the nematode feeding in tomato roots.

Phytolith assemblages and systematic associations in grassland species of the South-eastern Pampean plains, Argentina

BACKGROUND AND AIMS

Phytolith descriptions of South American plant species are scarce. This knowledge is crucial for the interpretation of the fossil phytolith record of a region. In this study phytolith assemblages and systematic relationships of the main grasses and Asteraceae species of Paspalum quadrifarium grassland are described.

METHODS

Phytoliths from leaves of Poaceae and Asteraceae species were extracted by using a calcination technique. For each species, 350-400 phytoliths were counted and the relative frequency of each morphotype was calculated. Phytolith assemblages were subject to principal components analysis (PCA) and cluster analysis (Morisita index).

KEY RESULTS

PCA and cluster analysis showed family (Poaceae vs. Asteraceae) and subfamily (within Poaceae) differentiation. Exceptions to general trends described for other species were detected. Floristic variants of Paspalum quadrifarium grassland can be separated by their phytolith assemblages.

CONCLUSIONS

The study provides a reference collection of phytolith assemblages of the main Poaceae and Asteraceae species of Paspalum quadrifarium grassland and describes some phytolith morphotypes/systematic relationships useful for the analysis of fossil phytolith assemblages of the Pampean region.

Spatial and temporal variations in arsenic exposure via drinking-water in northern Argentina

This study evaluated the spatial, temporal and inter-individual variations in exposure to arsenic via drinking-water in Northern Argentina, based on measurements of arsenic in water, urine, and hair. Arsenic concentrations in drinking-water varied markedly among locations, from <1 to about 200 microg/L. Over a 10-year period, water from the same source in San Antonio de los Cobres fluctuated within 140 and 220 microg/L, with no trend of decreasing concentration. Arsenic concentrations in women's urine (3-900 microg/L, specific weight 1.018 g/mL) highly correlated with concentrations in water on a group level, but showed marked variations between individuals. Arsenic concentrations in hair (range 20-1,500 microg/kg) rather poorly correlated with urinary arsenic, possibly due to external contamination. Thus, arsenic concentration in urine seems to be a better marker of individual arsenic exposure than concentrations in drinking-water and hair.

In the wake of structural adjustment programs: Exploring the relationship between domestic policies and health outcomes in Argentina and Uruguay

BACKGROUND

The implementation of structural adjustment programs (SAPs) in developing countries has been followed by a marked reduction in their progress on economic growth, health outcomes, and social indicators. Comprehensive and contextualized explorations of the effects of SAPs are needed to assist health and social policy-makers in better determining responses to such programs that continue to dominate global trade, aid and debt cancellation negotiations.

METHODS

A comparative case study of Argentina and Uruguay was developed exploring the effects of SAPs on health. Using a framework developed to analyze the relationship between globalization and health, changes in domestic policies resulting from SAPs and the corresponding economic, social and health outcomes of the countries were explored.

RESULTS

In general, SAPs were implemented with greater severity and speed in Argentina than in Uruguay, with the greatest differences occurring over the 1980s. The more gradual and modest reforms implemented in Uruguay were associated with better economic, social and health outcomes.

CONCLUSIONS

Findings support those of previous studies demonstrating that countries that have maintained more dynamic public social and health programming while applying SAPs have been better able to protect the health of the most vulnerable sectors of society.

Richness of plant-insect associations in Eocene Patagonia: a legacy for South American biodiversity

South America has some of the most diverse floras and insect faunas that are known, but its Cenozoic fossil record of insects and insect herbivory is sparse. We quantified insect feeding on 3,599 leaves from the speciose Laguna del Hunco flora (Chubut, Argentina), which dates to the early Eocene climatic optimum (52 million years ago) and compared the results with three well preserved, rich, and identically analyzed early- and middle-Eocene floras from the following sites in North America: Republic, WA; Green River, UT; and Sourdough, WY. We found significantly more damage diversity at Laguna del Hunco than in the North American floras, whether measured on bulk collections or on individual plant species, for both damage morphotypes and feeding groups. An ancient history of rich, specialized plant-insect associations on diverse plant lineages in warm climates may be a major factor contributing to the current biodiversity of South America.

Phytolith assemblages in grasses native to central Argentina

BACKGROUND AND AIMS

Phytolith reference collections are a prerequisite for accurate interpretation of soil phytolith assemblages aimed at reconstructing past vegetation. In this study a phytolith reference collection has been developed for several grasses native to central Argentina: Poa ligularis, Piptochaetium napostaense, Stipa clarazii, Stipa tenuis, Stipa tenuissima, Stipa eriostachya, Stipa ambigua, Stipa brachychaeta, Pappophorum subbulbosum, Digitaria californica, Bothriochloa edwardsiana and Aristida subulata.

METHODS

For each species, phytoliths present in the leaf blades were classified into 47 morphotypes, and their relative frequency determined by observing 300-400 phytoliths per sample (n = 5). Data were analyzed by complete linkage cluster analysis, using the Morisita Index as measure of association.

KEY RESULTS

The results showed differentiation among phytolith assemblages at species level or at plant functional type level. Cluster analysis separated C3 from C4 species and palatable from non-palatable species.

CONCLUSIONS

This study highlights the possibility of reconstructing past vegetation in central Argentina grasslands through the analysis of soil phytolith assemblages.

Floral nectaries, nectar production dynamics and chemical composition in six ipomoea species (convolvulaceae) in relation to pollinators

BACKGROUND AND AIMS

Floral nectaries and nectar features were compared between six Argentinian Ipomoea species with differences in their pollinator guilds: I. alba, I. rubriflora, I. cairica, I. hieronymi var. hieronymi, I. indica, and I. purpurea.

METHODS

Pollinators were recorded in natural populations. The morpho-anatomical study was carried out through scanning electron and light microscopy. Nectar sugars were identified via gas chromatography. Nectar production and the effect of its removal on total nectar sugar amount were determined by using sets of bagged flowers.

KEY RESULTS

Hymenopterans were visitors of most species, while hummingbirds visited I. rubriflora and sphingids I. alba. All the species had a vascularized discoidal nectary surrounding the ovary base with numerous open stomata with a species-specific distribution. All nectar samples contained amino acids and sugars. Most species had sucrose-dominant nectars. Flowers lasted a few hours. Mean nectar sugar concentration throughout the lifetime of the flower ranged from 34.28 to 39.42 %, except for I. cairica (49.25 %) and I. rubriflora (25.18 %). Ipomoea alba had the highest nectar volume secreted per flower (50.12 microL), while in the other taxa it ranged from 2.42 to 12.00 microL. Nectar secretion began as soon as the flowers opened and lasted for a few hours (in I. purpurea, I. rubriflora) or it was continuous during the lifetime of the flower (in the remaining species). There was an increase of total sugar production after removals in I. cairica, I. indica and I. purpurea, whereas in I. alba and I. rubriflora removals had no effect, and in I. hieronymi there was a decrease in total sugar production.

CONCLUSIONS

The chemical composition, production dynamics and removal effects of nectar could not be related to the pollinator guild of these species. Flower length was correlated with nectary size and total volume of nectar secreted, suggesting that structural constraints may play a major role in the determination of nectar traits of these species.