Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry.

BACKGROUND: Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS: Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS: IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS: A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION: Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.

[Variability between health areas in antibiotic consumption among pediatric outpatients of Principado de Asturias, Spain (2005-2018)]. / Variabilidad entre áreas sanitarias en el consumo extrahospitalario de antibióticos de uso sistémico en la población pediátrica del Principado de Asturias, España (2005-2018).

OBJECTIVE: Antibiotics in Spain are mainly prescribed in the community sector, remarking a high variability between areas. The aim of this study is to describe the variability between health areas in the antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. METHODS: Retrospective and comparative study using data about consumption of antibacterial agents for systemic use (J01C group in ATC, Anatomical Therapeutic Chemical, classification) in the pediatric outpatients of the eight health areas of Principado de Asturias between 2005 and 2018, based on defined daily dose (DDD) per 1000 inhabitants and day (DID). RESULTS: Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4 - 14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). ß-lactam penicillins was the most consumed therapeutic group (10.7 DID). There were statistically significant differences among the areas with the highest and the lowest consumption rates (Avilés, 19 DID; Oviedo, 11.5 DID). A high variability between health areas was observed when analysing data temporally (difference of 11.8 DID in 2011) and therapeutic groups. The consumption of macrolides in Langreo health area and quinolones in Jarrio health area were 2.3 and 4.1 times higher, respectively, comparing to Gijón health area. CONCLUSIONS: There is a wide quantitative and qualitative variability of antibiotic consumption in the pediatric outpatients among the different health areas of Asturias.

A rural-urban latitudinal study of the distributions of Culex quinquefasciatus and Culex pipiens bioforms in their southernmost sympatric fringe.

Mosquitoes grouped in the complex Culex pipiens L. (Diptera: Culicidae) are important vectors of medical and veterinary diseases. In the South American sympatric region, Cx. pipiens and Culex quinquefasciatus Say coexist and potentially hybridize. To identify key drivers of their geographical distribution, mosquito immatures were collected from flower vases of eight urban/rural cemetery pairs within a 5° latitudinal transect along Buenos Aires Province, Argentina. The specimens were identified by molecular methods and their relative proportion modelled as a function of environmental variables. At the beginning of the warm season, northern and southern cemeteries presented exclusively Cx. quinquefasciatus and Cx. pipiens, respectively, with different proportions of both at mid latitudes. By the end of the summer, Cx. quinquefasciatus was present throughout the study area, exclusively in 11 of the 16 cemeteries both rural and urban, whereas Cx. pipiens was predominant only in the southernmost pair. Mean annual temperature, photoperiod variability and time of the season were key drivers of their distributions. All specimens of Cx. pipiens were identified as form molestus and no hybrids were recognized. The reported distribution patterns and the potential absence of Cx. pipiens f. pipiens and hybrids are discussed, along with their implications in disease transmission.

Real-world short-term effectiveness of ustekinumab in 305 patients with Crohn's disease: results from the ENEIDA registry.

BACKGROUND: There are limited data of ustekinumab administered according to the doses recommended in the UNITI studies. AIM: To assess the real-world, short-term effectiveness of ustekinumab in refractory Crohn's disease (CD) METHODS: Multicentre study of CD patients starting ustekinumab after June 2017 at the recommend dose (260, 390 or 520 mg based on weight ~6 mg/kg IV week 0 and 90 mg subcutaneously week 8). Values for Harvey-Bradshaw Index (HBI), C-reactive protein (CRP) and faecal calprotectin (FC) were recorded at baseline and at weeks 8 and 14. Demographic and clinical data, previous treatments, AEs and hospitalisations were documented. Possible predictors of clinical remission were examined. RESULTS: Three hundred and five patients were analysed (≥2 previous anti-TNFα therapies 64% and vedolizumab 29%). At baseline, 217 (72%) had an HBI >4 points. Of these, 101 (47%) and 126 (58%) achieved clinical remission at weeks 8 and 14, respectively. FC levels returned to normal (<250 µg/g) in 46% and 54% of the patients at weeks 8 and 14 respectively. CRP returned to normal (<3 mg/L) in the 35% and 41% of the patients at week 8 and 14 respectively. AEs were recorded in 38, and 40 patients were hospitalised. Intolerance to the most recent anti-TNF agent and fewer previous anti-TNF agents were associated with clinical remission at week 14. Endoscopic severity was associated with poor response. CONCLUSION: This is the first study to show the real-world effectiveness and safety of ustekinumab administered according to the recommended induction regimen in a cohort of highly refractory CD patients.

Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS: Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS: A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS: Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.

Modelling the association between deltamethrin resistance in Triatoma infestans populations of the Argentinian Gran Chaco region with environmental factors.

In Latin America, Triatoma infestans is the main vector of the protozoan Trypanosoma cruzi, causal agent of Chagas disease. This blood-sucking triatomine is widely distributed in the Gran Chaco ecoregion, where chemical control has failed because of the evolution of resistance to pyrethroid insecticides. Recently, we described a deltamethrin high resistant focus in Güemes Department (Chaco province) characterized by susceptible populations, populations with low resistance (without field control failures) and some of the populations with the highest resistance level detected. This toxicological heterogeneity could be a result of non-homogenous insecticide pressure and be influenced by environmental factors. The present study evaluated the association of deltamethrin resistance ratios (RR50s) of T. infestans populations with explanatory variables extracted from the WorldClim dataset and constructed from information of National Chagas Program actions during 2005-2015. Control actions were distributed throughout the analyzed period, representing a homogeneous selective pressure. The average percentage of total positive houses was 33.66%. Models that included temperature and precipitation indicators presented 65% explanation. When village size variables where added, the explanatory power reached 70%. This observational result suggests that the climate may favor directly or indirectly the development/selection for resistance, representing a valuable tool to understand the occurrence of resistance that could increase the Chagas disease in the Gran Chaco.

Past, present and future of Aedes aegypti in its South American southern distribution fringe: What do temperature and population tell us?

Aedes aegypti (Diptera: Culicidae) (Linnaeus) is currently the major threat among arbovirus vectors in the Americas. We examined its past, present, and future distribution patterns in the South American fringe in association with environmental and demographic variables at two spatial scales. We updated the database of the occurrence of Ae. aegypti per locality and modelled by GLMM the past occurrence (until 2000) and its expansion (2001-2017) as a function of air temperature, precipitation, altitude, and population. We also conducted a field survey in 7 pairs of urban/rural cemeteries along the entire temperature range within the expansion region. At both scales, mean annual air temperature and human population were significantly associated with the distribution of Ae. aegypti. Projection of the expansion models for 2030 under two climatic change scenarios showed a vast infestation, mainly driven by the shift of the 16 °C isotherm. We postulate a quantitative compromise between air temperature and human population associated with vector occurrence, along with potential thresholds for their mutual favourability.

Heterogeneous distribution of Culex pipiens, Culex quinquefasciatus and their hybrids along the urbanisation gradient.

The mosquitoes of the Culex pipiens complex, hereafter referred to as the Pipiens Assemblage, are vectors of arbovirus of worldwide concern including West Nile and St. Louis encephalitis. Given their distinct eco-physiology and vectorial capacity, accurate specimen identification and insight in the environmental drivers of their distribution are essential for the understanding of disease transmission patterns. Using a PCR-based identification protocol, we characterized the spatial distribution of Cx. pipiens, Cx. quinquefasciatus and their hybrids developing in used tyres located within the overlapping region in South America as a function of different estimators of the urbanisation gradient. Out of 84 samples collected from tyre piles of 20 sites, we identified 369 larvae which corresponded predominantly to Cx. quinquefasciatus (76.4% of immatures) all along the gradient but more frequent at the urban end. Cx. pipiens (21.4%) was more conspicuous at the low urbanised end but was also present in highly urbanised sites, whereas hybrids were collected in very low numbers (2.2%). The urbanisation estimator best associated with the heterogeneous occurrence of the Pipiens Assemblage members was the proportion of impervious surface 1km around each tyre pile, which explained 41.7% of the variability in the data, followed closely by the distance to the Capital City (38.3%). Cumulative annual precipitation, population number in a 1km radius around each pile and distance to the de la Plata River were significantly associated with the distribution of the Pipiens Assemblage at lower explanation percentages (20-23%). A thorough understanding of the ecological basis and environmental associations of the distribution of Pipiens Assemblage members will enable forecasting population trends in changing environments to develop effective control measures for mosquitoes and the diseases they transmit.

Modeling and experiment of the suspended seismometer concept for attenuating the contribution of tilt motion in horizontal measurements.

Tilt-horizontal coupling in inertial sensors limits the performance of active isolation systems such as those used in gravitational wave detectors. Inertial rotation sensors can be used to subtract the tilt component from the signal produced by horizontal inertial sensors, but such techniques are often limited by the sensor noise of the tilt measurement. A different approach is to mechanically filter the tilt transmitted to the horizontal inertial sensor, as discussed in this article. This technique does not require an auxiliary rotation sensor and can produce a lower noise measurement. The concept investigated uses a mechanical suspension to isolate the inertial sensor from input tilt. Modeling and simulations show that such a configuration can be used to adequately attenuate the tilt transmitted to the instrument, while maintaining translation sensitivity in the frequency band of interest. The analysis is supported by experimental results showing that this approach is a viable solution to overcome the tilt problem in the field of active inertial isolation.

[Primary care follow-up of newborns with sickle cell disease detected in neonatal screening in the Community of Madrid]. / Seguimiento en Atención Primaria de los recién nacidos con enfermedad falciforme detectados en el cribado neonatal de la Comunidad de Madrid.

OBJECTIVES: The main aim of the study was to assess the effects of the recommended preventive program in the population affected with Sickle Cell Disease in Primary Care. The program included, antibiotic prophylaxis, immunizations and health education, following the introduction of universal neonatal screening program for Sickle Cell Disease in the Community of Madrid. PATIENTS AND METHODS: A cross-sectional observational study was performed with retrospective data collected from a cohort of newborns with Sickle Cell Disease diagnosed by neonatal screening test in the Community of Madrid. RESULTS: From the data obtained from a sample of 20 patients, it was found that 95% had been diagnosed by the newborn screening test performed between 5 and 13 days of life. The mean age was 39 months when the study was conducted. During follow-up, from Primary Care Paediatric clinic, it was observed that the compliance for antibiotic prophylaxis was 90%, and the coverage for the official vaccination schedule was 85%. Specific vaccine coverage as a risk population was highly variable (85% for pneumococcal 23V, 50% for influenza, and 15% for hepatitis A). Health education only reached one in every four families. CONCLUSIONS: Acceptable compliance with antibiotic prophylaxis was observed during the follow-up of patients with sickle cell disease in Primary Care, but a low coverage of routine immunization, as well as specific immunizations. Coverage of health education was very low. Improving these parameters would require greater coordination and involvement of Primary Care Professionals so that these patients were followed up appropriately, and could be translated into a reduction of disease complications and an improvement in the quality of life of these patients.

Spatio-temporal dynamics of dengue 2009 outbreak in Córdoba City, Argentina.

During 2009 the biggest dengue epidemic to date occurred in Argentina, affecting almost half the country. We studied the spatio-temporal dynamics of the outbreak in the second most populated city of the country, Córdoba city. Confirmed cases and the results of an Aedes aegypti monitoring during the outbreak were geolocated. The imported cases began in January, and the autochthonous in March. Thirty-three percent of the 130 confirmed cases were imported, and occurred mainly at the center of the city. The autochthonous cases were more frequent in the outskirts, specially in the NE and SE. Aedes aegypti infestation showed no difference between neighborhoods with or without autochthonous cases, neither between neighborhoods with autochthonous vs. imported cases. The neighborhoods with imported cases presented higher population densities. The majority of autochthonous cases occurred at ages between 25 and 44 years old. Cases formed a spatio-temporal cluster of up to 20 days and 12km. According to a mathematical model that estimates the required number of days needed for transmission according to daily temperature, the number of cases begun to fall when more than 15.5 days were needed. This may be a coarse estimation of mean mosquito survival in the area, provided that the study area is close to the global distribution limit of the vector, and that cases prevalence was very low.

Imperviousness as a predictor for infestation levels of container-breeding mosquitoes in a focus of dengue and Saint Louis encephalitis in Argentina.

Dengue and Saint Louis encephalitis virus are among the most important emerging viruses transmitted by mosquitoes at the global scale, and from 2009 onward both diseases have reached temperate Argentina. To test whether the urbanization level can be used as a predictor for the infestation levels of container-breeding mosquito vectors, we searched for Aedes aegypti and Culex pipiens in 8400 water-filled containers from 14 cemeteries of Buenos Aires Province and we used generalized linear models to relate positive containers with the impervious area quantified inside (internal PIA) and outside (external PIA) cemeteries. The best model for Ae. aegypti explained 91% of the variability and included the season, the internal PIA and the external PIA at 1km as a quadratic function, showing a parabolic response peaking in ∼75%. Regarding the infestation levels of Cx. pipiens, the final model explained 75% of the variability and included only the season. In view of these results, the percentage of impervious area efficiently predicted the infestation levels of Ae. aegypti but not of Cx. pipiens. Considering the worldwide relevance of the former in dengue transmission, the simple quantification of imperviousness proposed herein provides a helpful basis for vector surveillance and control in urbanized areas.

Oviposition strategies of temporary pool mosquitoes in relation to weather, tidal regime and land use in a temperate wetland.

Wetlands have traditionally been associated with harbouring mosquitoes, a well-known nuisance and vectors of diseases. Within mosquito life cycle, oviposition is a determinant event by shaping their individual fitness and vectorial capacity. The study was conducted in one of the main temperate wetlands in South America. We used Generalized Linear Models to study the relation between temperature, precipitation, tidal regime, land use, microenvironment, and the occurrence of floodwater (Ochlerotatus and Psorophora spp.) and raft-laying (Culex and Uranotaenia spp.) mosquitoes using temporary pools as larval habitats. Pool occurrence was negatively associated with temperature, and positively related to precipitation and high tides. As regards the land use, it was lowest in domestic areas and plantations, intermediate in secondary forests, and highest in marshes. Each oviposition strategy was best modelled as a function of different environmental factors. The occurrence of floodwater mosquitoes was positively associated with high cumulative precipitation and low tide records. Raft-laying mosquitoes were related to low temperature records, while the effect of flooding varied with the land use. In view of these results, physical (water inputs and movement), chemical, and biological (egg and larval flushing, and predatory interactions) considerations are given to provide insight in the oviposition patterns of mosquitoes occurring in this complex wetland. We finally propose the generation of a tidal flow as a control measure against floodwater mosquitoes, which are the most anthropophilic in the study area.

Environmental predictors of the occurrence of ground water mosquito immatures in the Paraná Lower Delta, Argentina.

Characterizing mosquito larval habitats is essential for understanding the complex interactions between immatures and the biotic and abiotic components of their environment. Using generalized linear mixed models, we studied the environmental predictors of the presence of three ubiquitous mosquito species breeding in ground water habitats in the Paraná Lower Delta, Argentina. During a year-round survey, 34.1% of the 419 ground water habitats inspected were positive for either Culex dolosus s.l. (Lynch Arribálzaga 1891), Aedes crinifer (Theobald 1903), or Culex intrincatus Brèthes 1916. Univariate analysis showed that the former two occurred throughout the year, whereas the latter during the summer and fall. Ae. crinifer and Cx. intrincatus were more frequently collected in secondary forests, whereas Cx. dolosus s.l. was homogeneously distributed among land uses. Best generalized linear mixed models included the sampling period and landscape variables in different combinations for each species. Spatial dependence of the data was evident for Cx. dolosus s.l. and Ae. crinifer. Our results showed that the most widespread species presented different spatio-temporal distribution patterns, related with land use, anthropic intervention, and seasonality, highlighting the complexity of the wetland under study. This methodological approach could aid in the selection of priority areas for vector control and disease risk management.

Spatial distribution pattern of oviposition in the mosquito Aedes aegypti in relation to urbanization in Buenos Aires: southern fringe bionomics of an introduced vector.

The distribution of Aedes aegypti (L) (Diptera: Culicidae) oviposition in Buenos Aires City is spatially heterogeneous. Oviposition activity was monitored for a year with a grid of 279 traps at 850-m intervals that were serviced weekly. Geostatistics were used for the spatial analysis and generalized linear regression to model oviposition as a function of demographic and environmental variables. The proportion of weeks infested and the total number of eggs showed spatial continuity and were higher in areas that had higher densities of houses and were closer to industrial sites; they were lower in areas with higher human populations or higher densities of flats. When all sites were considered, the spatial structure showed a strong trend, but after regression, the residuals presented lower spatial dependence. When only infested sites were considered, the oviposition variables were spatially autocorrelated and the regression residuals showed little or no spatial dependence. The spatial pattern of Ae. aegypti oviposition in a highly urbanized city such as Buenos Aires seems to be related to the urbanization gradient. These urban environments might present different resource availability or continuity between patches of resources.

[Needle-knife sphincterotomy for biliary access: a prospective study]. / Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo.

OBJECTIVE: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. MATERIAL AND METHODS: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. RESULTS: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). CONCLUSIONS: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found.

Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo / Needle-knife sphincterotomy for biliary access: a prospective study

Objetivo: La esfinterotomía de aguja es una técnica empleada para conseguir el acceso a la vía biliar, cuando los métodos de canulación habituales han fallado. El objetivo ha sido analizar los resultados de la realización de la esfinterotomía de aguja en pacientes con inaccesibilidad a la vía biliar (canulación difícil) mediante técnicas estándar en colangiopancreatografía retrógrada endoscópica, y los factores asociados con el éxito y complicaciones. Material y métodos: Estudio prospectivo que incluye a 72 pacientes entre enero de 1998 y diciembre de 2004, sometidos a esfinterotomía de aguja por canulación difícil de la vía biliar por el mismo endoscopista (J.E.). Los resultados se analizaron respecto al éxito en acceder a la vía biliar, su consecución en una o más sesiones, su posible relación con la enfermedad de base y la incidencia y gravedad de las complicaciones. Resultados: Se realizaron 72 esfinterotomías de aguja de un total de 1.062 esfinterotomías (6,7%). En el 77,7% de los pacientes se colocó previamente una prótesis pancreática. El diagnóstico final fue: coledocolitiasis en el 31,9%; cáncer de páncreas en el 16,6%; colangiocarcinoma en el 13,8%; estenosis benigna en el 8,3%; disfunción del esfínter de Oddi en el 6,9%; normal en el 6,9%, y miscelánea en el 13,8%. Se obtuvo éxito en la canulación en el 87,5% (63/72), y se consiguió en la primera sesión en el 73% (46/63). Se logró el acceso biliar en el 72,7% de los casos (16/22) de neoplasia biliopancreática, frente al 94% (47/50) en pacientes con otros diagnósticos (p = 0,03). Once pacientes (15,2%) presentaron 12 complicaciones (16,6%) (6 pancreatitis, 4 colangitis, 1 hemorragia papilar y 1 relleno de la vena porta). El uso de prótesis pancreática se relacionó con un porcentaje mayor de éxito y menor de complicaciones, alcanzando significación estadística en esta última (p = 0,03).Conclusiones: La esfinterotomía de aguja con prótesis pancreática puede ser un procedimiento seguro en pacientes con canulación difícil de la vía biliar. La presencia de neoplasia biliopancreática es un factor de riesgo de no consecución del acceso biliar frente a otros diagnósticos. La incidencia de complicaciones está en consonancia con otros estudios, y no se han hallado pancreatitis graves ni perforaciones

Objective: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. Material and methods: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. Results: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). Conclusions: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found

[Enteral prostheses for palliative treatment of gastroduodenal obstruction: endoscopic procedure]. / Prótesis enterales en el tratamiento paliativo de la obstrucción gastroduodenal: técnica endoscópica.

Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life. Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome.

Prótesis enterales en el tratamiento paliativo de la obstrucción gastroduodenal: técnica endoscópica / Enteral prostheses for palliative treatment of gastroduodenal obstruction: endoscopic procedure

La obstrucción gastroduodenal neoplásica puede causar una significativa morbilidad. La inserción de prótesis enterales como tratamiento paliativo es una aceptable opción para conseguir un adecuado vaciamiento gástrico sin la morbilidad asociada a la cirugía paliativa, con menor mortalidad relacionada con el procedimiento y menor coste, proporcionando una mejor calidad de vida. Es importante unificar y consolidar la técnica endoscópica de colocación de las prótesis enterales evitando variaciones que impidan un adecuado análisis de los resultados de esta técnica (AU)

Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life.Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome (AU)

Spatial and temporal analysis of the distribution of hantavirus pulmonary syndrome in Buenos Aires Province, and its relation to rodent distribution, agricultural and demographic variables.

We studied the spatial and temporal distribution of Hantavirus Pulmonary Syndrome (HPS) cases from 1998 to 2001 in the Buenos Aires Province, Argentina. HPS is a severe viral disease whose natural reservoir are rodents of the subfamily Sigmodontinae (Muridae) and which occurs in many countries of South and North America. We considered two spatial arrangements: cells of 18.5 x 18.5 km(2); and departments, the political subdivisions of the province, as spatial units. We tested the departure from a Poisson distribution of the number of cases per cell and per month with the Variance/Mean index, while the interaction between spatial and temporal clustering was tested by means of the Knox and Mantel tests. We constructed probability maps in which the HPS rates per department were considered Poisson variates according to population, area and the product of population and area. We analysed the relation between rodent distribution, environmental and demographic variables and HPS cases conducting preliminary univariate analysis from which we selected variables to enter in general linearized models. We found that both the spatial and temporal distribution of cases is strongly aggregated. The spatiotemporal interaction appears to be related to a strong seasonality and the existence of particular ecological conditions rather than epidemic transmission of the disease. The main explanatory variables for the distribution of HPS cases among the departments of the Buenos Aires Province were human population, the distribution of the rodent Oxymycterus rufus and evapotranspiration. The last two variables are probably indicators of favourable ecological conditions for the reservoirs, which encompass other variables not taken into account in this study.