Cutaneous toxicities in patients with melanoma receiving checkpoint inhibitor therapy: a retrospective review. The experience of a single large specialist institution.

Checkpoint inhibitor (CPI) therapy has significantly improved overall survival for metastatic melanoma, and is now approved for use in the adjuvant setting. Modulating the immune system is recognized to cause cutaneous immune-related adverse events (irAEs). We conducted a retrospective observational cohort study of adult patients with melanoma at our tertiary referral centre, who received CPI therapy from 2006 to March 2018. This is the single largest study of cutaneous irAEs occurring on CPI therapy in patients with melanoma to date and encompasses 12 years. The results showed that cutaneous toxicity occurs in 24% of patients but is generally manageable, with < 5% patients discontinuing treatment.

[Hantavirus pulmonary syndrome in Buenos Aires Province]. / Sindrome pulmonar por hantavirus en la Provincia de Buenos Aires.

In Argentina the first Hantavirus Pulmonary Syndrome (HPS) cases were characterized in 1995. Since then, Argentina is the country with the highest number of notified cases in South America. The disease is distributed in Northern, Southern and Central regions of the country, being Buenos Aires the most affected province from the Central region. In this study, we present seasonal and geographical distribution of HPS cases in Buenos Aires province, the association with diverse viral lineages and the serological characteristics of hantavirus infection in the period from 1997 up to the first semester of the year 2000. An increase in the number of HPS cases was observed up to 1999 and a gradual mortality decrease in the whole period. The cases occurred between spring and autumn, with a maximum peak in summer. The serological response was studied in 58 HPS confirmed cases at different times after the onset of symptoms. The cases were distributed between 27 localities, in two different directions from the city of Buenos Aires: South-southwest and North-northeast. More than 52% of the cases occurred in La Plata and neighboring localities. The viral genomes from 39 cases were all characterised as Andes virus (AND): AND Cent Plata 16%; AND Cent 21% and AND Cent Bs.As. 60%. Andes virus lineages only cocirculated in La Plata city. These results will contribute to establish a risk map leading to the implementation of improved strategies of prevention.

Sindrome pulmonar por hantavirus en la Provincia de Buenos Aires. / [Hantavirus pulmonary syndrome in Buenos Aires Province]

In Argentina the first Hantavirus Pulmonary Syndrome (HPS) cases were characterized in 1995. Since then, Argentina is the country with the highest number of notified cases in South America. The disease is distributed in Northern, Southern and Central regions of the country, being Buenos Aires the most affected province from the Central region. In this study, we present seasonal and geographical distribution of HPS cases in Buenos Aires province, the association with diverse viral lineages and the serological characteristics of hantavirus infection in the period from 1997 up to the first semester of the year 2000. An increase in the number of HPS cases was observed up to 1999 and a gradual mortality decrease in the whole period. The cases occurred between spring and autumn, with a maximum peak in summer. The serological response was studied in 58 HPS confirmed cases at different times after the onset of symptoms. The cases were distributed between 27 localities, in two different directions from the city of Buenos Aires: South-southwest and North-northeast. More than 52

of the cases occurred in La Plata and neighboring localities. The viral genomes from 39 cases were all characterised as Andes virus (AND): AND Cent Plata 16

; AND Cent 21

and AND Cent Bs.As. 60

. Andes virus lineages only cocirculated in La Plata city. These results will contribute to establish a risk map leading to the implementation of improved strategies of prevention.

Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina.

CONTEXT: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. OBJECTIVES: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. MAIN OUTCOME MEASURE: Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak. RESULTS: Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established. CONCLUSIONS: Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.