Highly HLA Sensitized Kidney Transplant Patients in a Transplant Center.

INTRODUCTION: Approximately 10% to 30% of patients on renal transplant waiting lists are sensitized, which gives them more time on the waiting list. Transplantation in this setting has a greater risk of rejection and decreased graft survival. New strategies of donor allocation through virtual crossmatching and optimization of immunosuppressive therapies in induction and maintenance have allowed the allocation of organs for this population, which in other circumstances would not be chosen for a kidney transplant. OBJECTIVE: To describe the experience of renal transplantation in highly sensitized patients with a panel reactive antibody of >80% in a transplant center, through virtual crossmatching, discarding unacceptable antigens, and without desensitization treatment. METHODS: An observational, descriptive, retrospective case series study was conducted on highly sensitized kidney transplant patients with a panel reactive antibody of ≥80% from 2010 to 2016. RESULTS: A total of 10 highly sensitized transplant patients were identified. Six patients were women, all of whom had a history of pregnancy; all patients had undergone blood transfusions, and 40% had undergone a first transplant. Average time spent on dialysis was 148.5 months, and on the waiting list, 45.8 months. Average follow-up was 42 months (range, 10-84 months). The estimated glomerular filtration rate by the Chronic Kidney Disease Epidemiology Collaboration method at year 1 was 75 mL/min/1.73 m2 body surface. Nine patients at 1 year posttransplantation had graft and patient survivals of 100%, as did 5 patients at >3 years posttransplantation. CONCLUSIONS: Renal transplantation based on virtual crossmatching is a good alternative for highly sensitized patients.

Biomphalaria tenagophila potencial vector of Schistosoma mansoni in the Paraná River basin (Argentina and Paraguay).

Susceptibility and compatibility experiments were carried out with 700 Biomphalaria tenagophila from the Paraná River basin exposed to infection with Schistosoma mansoni. Individual infection was performed with 10 miracidia of SJ2 strain from the Paraiba valley (Brazil) originally infective to B. tenagophila. These snails were laboratory-breed progeny of B. tenagophila collected from six localities of Argentina and one from Paraguay. From Argentina: Rincón de Vences (7%) and Posadas (11%) became infected with S. mansoni and the calculation of Frandsen's index (TCP/100) shows that they were Class II poorly compatible. Those snails from Goya (22%), Maloyas (5%), and Berón de Astrada (3%) were Class III compatible to the S. mansoni. None of the 100 snails exposed from Caá-Catí became infected (Class 0 incompatible). Tested samples from Paraguay (Encarnación) were infected (20%) and compatible (Class III). It was also studied the persistence of the infection in 244 snails of the first generation (F1) of those that were susceptible from three places. It was demonstrated an increment of the susceptibility in the F1 from Maloyas (chi2 = 27.22; p = 0.0001) and Posadas (chi2 = 4.24; p = 0.04). The results point out the possibility that schistosomiasis might be able to spread into the Paraná River basin where B. tenagophila exists.

Biomphalaria tenagophila potencial vector of Schistosoma mansoni in the Paraná River basin (Argentina and Paraguay)

Susceptibility and compatibility experiments were carried out with 700 Biomphalaria tenagophila from the Paraná River basin exposed to infection with Schistosoma mansoni. Individual infection was performed with 10 miracidia of SJ2 strain from the Paraiba valley (Brazil) originally infective to B. tenagophila. These snails were laboratory-breed progeny of B. tenagophila collected from six localities of Argentina and one from Paraguay. From Argentina: Rincón de Vences (7 percent) and Posadas (11 percent) became infected with S. mansoni and the calculation of Frandsen's index (TCP/100) shows that they were Class II poorly compatible. Those snails from Goya (22 percent), Maloyas (5 percent), and Berón de Astrada (3 percent) were Class III compatible to the S. mansoni. None of the 100 snails exposed from Caá-Catí became infected (Class 0 incompatible). Tested samples from Paraguay (Encarnación) were infected (20 percent) and compatible (Class III). It was also studied the persistence of the infection in 244 snails of the first generation (F1) of those that were susceptible from three places. It was demonstrated an increment of the susceptibility in the F1 from Maloyas (chi2 = 27.22; p = 0.0001) and Posadas (chi2 = 4.24; p = 0.04). The results point out the possibility that schistosomiasis might be able to spread into the Paraná River basin where B. tenagophila exists.

Intermediate and definitive hosts of Schistosoma mansoni in Corrientes province, Argentina

Corrientes province is located in the humid subtropical region of Argentina northeast on the left riverbank of Paraná River in the border with the South of Brazil. This is a region without schistosomiasis but planorbid and rodents that would serve as host of the life cycle of Schistosoma mansoni inhabit here. The objective of this work is to know the role of rodent as definitive host of schistosomiasis. Biomphalaria tenagophila (4 to 8 mm Ø) from Maloyas, exposed each to 10 miracidia of SJ2 strain of S. mansoni natives from Brazil were susceptible (5 percent). The degree of compatibility was Class II of Frandsen. Five wild rodents captured in the same ecological niche were exposed transcutaneously to infection with 40 cercariae for animal: two Olygoryzomys flavescens, two Holochilus braziliensis, and one Scapteromys tuncidus. Only one H. braziliensis eliminated eggs in feces. Prepatent period was of 83 days. With these feces, two of six (33.3 percent) B. tenagophila from Maloyas were infected with miracidium. It was demonstrated, in an area free of schistosomiasis, that life cycle S. mansoni is closed with planorbid and rodents that live in the same ecological niche.

Intermediate and definitive hosts of Schistosoma mansoni in Corrientes province, Argentina.

Corrientes province is located in the humid subtropical region of Argentina northeast on the left riverbank of Paraná River in the border with the South of Brazil. This is a region without schistosomiasis but planorbid and rodents that would serve as host of the life cycle of Schistosoma mansoni inhabit here. The objective of this work is to know the role of rodent as definitive host of schistosomiasis. Biomphalaria tenagophila (4 to 8 mm Ø) from Maloyas, exposed each to 10 miracidia of SJ2 strain of S. mansoni natives from Brazil were susceptible (5%). The degree of compatibility was Class II of Frandsen. Five wild rodents captured in the same ecological niche were exposed transcutaneously to infection with 40 cercariae for animal: two Olygoryzomys flavescens, two Holochilus braziliensis, and one Scapteromys tuncidus. Only one H. braziliensis eliminated eggs in feces. Prepatent period was of 83 days. With these feces, two of six (33.3%) B. tenagophila from Maloyas were infected with miracidium. It was demonstrated, in an area free of schistosomiasis, that life cycle S. mansoni is closed with planorbid and rodents that live in the same ecological niche.

Species assignation of Leishmania from human and canine American tegumentary leishmaniasis cases by multilocus enzyme electrophoresis in North Argentina.

Sixteen Leishmania stocks, 15 isolated from patients with cutaneous (CL), mucocutaneous (MCL), or recurrent cutaneous leishmaniasis, plus one from a dog with CL in Salta and Corrientes Provinces, Argentina, were studied by multilocus enzyme electrophoresis. Thirteen of the stocks from humans were grouped in two zymodemes; nine termed as KMS 1, four as KMS 2, and assigned to Leishmania (Viannia) braziliensis. Two additional stocks from CL cases expressed a KMS 4 enzyme profile, corresponding to L. (V.) guyanensis. Although the parasites from the dog were also assigned to L. (V.) braziliensis, its zymodeme, KMS 3, was not expressed in any of the current human isolates. The characterization of Leishmania from a dog was done for the first time in Argentina. The importance of the intraspecific polymorphism in the induction of clinical forms and in the host-reservoir concept is briefly discussed, based on the zymodeme data of isolates from humans and dogs. The presence of L. (V.) guyanensis was confirmed in the country.

[Susceptibility of Biomphalaria tenagophila from the Paraná and Uruguay River basins to Schistosoma mansoni]. / Susceptibilidad de Biomphalaria tenagophila de las cuencas de los ríos Paraná y Uruguay a Schistosoma mansoni.

To study the possibility that schistosomiasis might be able to spread into the basins of the Paraná and Uruguay rivers, 1,711 snails were experimentally exposed to infection with Schistosoma mansoni. These snails were laboratory-bred progeny of Biomphalaria tenagophila collected from 15 populations in the geographic area under consideration. Three strains of S. mansoni were used: BH2, adapted to B. glabrata, and SJ and SJ2 adapted to B. tenagophila. None of the 543 snails exposed to the BH2 strain became infected, nor did any of the 668 exposed to SJ. However, of the 500 exposed the SJ2, 4 of the 163 snails (2%) from Ayolas, a locality in the Paraná basin, were susceptible, as were 8 of 45 (18%) from Fuente, Salto, in the Uruguay basin. These findings are similar to those of studies done in other geographic areas, where some populations of B. tenagophila do not become infected with S. mansoni while others are susceptible. The results of this study signal the possibility of the expansion of schistosomiasis into a broad region of South America in which B. tenagophila is found.

Intestinal parasitism in San Cayetano, Corrientes, Argentina.

An epidemiologic study was conducted in San Cayetano, a village in the province of Corrientes, Argentina, to determine the prevalence of intestinal parasitoses in children. Eighty-eight households were randomly selected. Stool samples were collected from 207 children (72% of the school-age population and 12% of the total village population) over a period of six consecutive days, and were subjected to microscopic examination. Of the samples examined, 170 (83%) contained one or more parasites, of which the most frequently found was Blastocystis hominis (in 43% of the samples). Other parasites and commensals detected included Giardia lamblia (29%), hookworms (27%), Entamoeba coli (27%), Enterobius vermicularis (4%), Strongyloides stercoralis (2%), and Ascaris lumbricoides, Trichuris trichiura, Taenia saginata, Isospora belli, Iodamoeba bütschlii, and Balantidium coli (each 0.5%). The high observed prevalence of intestinal parasitoses indicates active parasite transmission in San Cayetano as a result of poor environmental hygiene-ascribable largely to a lack of public water supply, sewerage, and waste removal services.

Parasitismo intestinal en San Cayetano, Corrientes, Argentina / Intestinal parasitism in San Cayetano, Corrientes, Argentina

En San Cayetano, aldea de la provincia de Corrientes, Argentina, se llevó a cabo una investigación epidemiológica para determinar la prevalencia de parasitosis intestinales en niños. Se eligieron aleatoriamente 88 viviendas y se sometieron a examen microscópico las muestras fecales, recolectadas durante 6 días consecutivos, de 207 niños (72 porciento de la población en edad escolar y 12 porciento de la población total de la aldea). De las muestras examinadas, 170 (83 porciento) tuvieron uno o más parásitos, de los cuales el más frecuente fue Blastocystis hominis (43 porciento). También se hallaron Giardia lamblia (29 porciento), uncinarias (27 porciento), Entamoeba coli (27 porciento), Enterobius vermicularis (3 porciento), Strongyloides stercoralis (2 porciento), Ascaris lumbrocoides, Trichuris trichiura, Taenia saginata, Isospora belli, Balantidium coli y Iodamoeba butschlii (0,5 porciento). La alta prevalencia de parasitosis intestinales indica que en San Cayetano hay una transmisión activa de parásitos como consecuencia de la mala higiene ambiental, particularmente la falta de agua potable, de una red de alcantarillado y de un sistema de recolección domiciliaria de basuras

[Diseases diagnosed at a pneumology unit integrated with its health area. Comparison with historical controls]. / Patología diagnosticada en una unidad neumológica integrada con su área de salud. Comparación con controles históricos.

An understanding of changes in pulmonology disease patterns observed at a general hospital before and after implantation of a population-based model of health care not only provides useful insight into the diseases treated but also aids adjustment of health care service organization. The aim of this study was to compare data collected after 1992 (when the new system was established) with records kept by the same pulmonology group in earlier years (1974-1986). Data after 1992 described patients attended in Health District 11 by the newly organized pneumologists. For the two periods the most common pneumological diagnoses were chronic air flow obstruction and chronic hypersecretory bronchitis. The most common non pneumological diagnoses were systemic arterial hypertension, obesity, diabetes, liver disease and hiatus hernia/gastroesophageal reflux. The prospective study covered a larger population and was closer to primary care, including as it did patients at clinics unattached to hospitals. In the earlier hospital-based experience the most common diagnoses were acute respiratory infection, chronic air flow obstruction and asthma, apart from those patients referred in whom no respiratory disease was found. With the organizational integration of hospital and health district pulmonology service, contact between patients and specialists has increased. Record systems have been established for a well-defined population to permit better forecasting at less cost and facilitate contact with primary care givers and epidemiological studies.

Parasitismo intestinal en San Cayetano, Corrientes, Argentina / Intestinal parasitism in San Cayetano, Corrientes, Argentina

En San Cayetano, aldea de la provincia de Corrientes, Argentina, se llevó a cabo una investigación epidemiológica para determinar la prevalencia de parasitosis intestinales en niños. Se eligieron aleatoriamente 88 viviendas y se sometieron a examen microscópico las muestras fecales, recolectadas durante 6 días consecutivos, de 207 niños (72 porciento de la población en edad escolar y 12 porciento de la población total de la aldea). De las muestras examinadas, 170 (83 porciento) tuvieron uno o más parásitos, de los cuales el más frecuente fue Blastocystis hominis (43 porciento). También se hallaron Giardia lamblia (29 porciento), uncinarias (27 porciento), Entamoeba coli (27 porciento), Enterobius vermicularis (3 porciento), Strongyloides stercoralis (2 porciento), Ascaris lumbrocoides, Trichuris trichiura, Taenia saginata, Isospora belli, Balantidium coli y Iodamoeba butschlii (0,5 porciento). La alta prevalencia de parasitosis intestinales indica que en San Cayetano hay una transmisión activa de parásitos como consecuencia de la mala higiene ambiental, particularmente la falta de agua potable, de una red de alcantarillado y de un sistema de recolección domiciliaria de basuras

Se publica en inglés en el Bulletin PAHO Vol. 30(2), 1996