Description of Pintomyia salomoni sp. n., a new phlebotomine species from northwest Argentina.

A new species of phlebotomine sandfly is described and illustrated using male and female specimens collected in the provinces of Jujuy and Tucumán, Argentina. Both male and female morphological characters allow the inclusion of the new species within the Pintomyia genus, Pifanomyia subgenus, serrana series (Diptera: Psychodidae). The species was denominated as Pintomyia salomoni n. sp., and is closely related to Pintomyia (Pifanomyia) torresi and Pintomyia (Piffanomyia) boliviana.

Intense foreshocks and a slow slip event preceded the 2014 Iquique Mw 8.1 earthquake.

The subduction zone in northern Chile is a well-identified seismic gap that last ruptured in 1877. The moment magnitude (Mw) 8.1 Iquique earthquake of 1 April 2014 broke a highly coupled portion of this gap. To understand the seismicity preceding this event, we studied the location and mechanisms of the foreshocks and computed Global Positioning System (GPS) time series at stations located on shore. Seismicity off the coast of Iquique started to increase in January 2014. After 16 March, several Mw > 6 events occurred near the low-coupled zone. These events migrated northward for ~50 kilometers until the 1 April earthquake occurred. On 16 March, on-shore continuous GPS stations detected a westward motion that we model as a slow slip event situated in the same area where the mainshock occurred.

Phlebotominae of epidemiological importance in cutaneous leishmaniasis in northwestern Argentina: risk maps and ecological niche models.

In Argentina, 58.2% out of the 8126 Cutaneous Leishmaniasis (CL) incident cases accumulated from 1954 to 2006 were reported in the provinces of Salta and Jujuy. The aim of this study was to develop an exploratory risk map and a potential distribution map of the vector, in order to offer recommendations for CL prevention. A total of 12 079 Phlebotominae (Diptera: Psychodidae) belonging to the species Lutzomyia neivai (Pinto), Lu. migonei (França), Lu. cortelezzii (Brèthes), Lu. shannoni (Dyar), Lu. quinquefer (Dyar) and Brumptomyia spp. (França & Parrot) were captured. Potential distribution models were created for two species, Lu. neivai (incriminated vector of Leishmania braziliensis) and Lu. migonei, associated with domestic animals in Argentina and that in turn could be involved as a link between zoonotic transmission cycles and anthropozoonotic. The Maximum Entropy Modeling System (MaxEnt) was used. The Jackknife test was performed, and the 'rainfall of the driest month' was the variable that best generalized the models. Accuracy was evaluated by the area under the curve (AUC) and validated by the Cohen's kappa index. This approximation provides a new analytical resource of high potential for the prevention of the disease, in order to allocate resources properly and to develop the most suitable strategies for action.

Relación entre rendimiento laboral y síndrome premenstrual / Relation between the labor performance and premenstrual syndrome

El Síndrome Premenstrual (SPM) afecta a gran cantidad de mujeres en edad reproductiva y se caracteriza por una repetición cíclica de síntomas físicos y psicológicos que, en algunos casos, pueden llegar a ser lo suficientemente severos como para interferir en los patrones de vida. El objetivo de esta revisión bibliográfica es conocer cómo afecta el SPM el rendimiento laboral de las mujeres. A pesar de las significativas repercusiones personales y económicas, existen pocas investigaciones que estudien la relación entre SPM y rendimiento laboral. Sin embargo, la literatura es concluyente en señalar que la productividad laboral es un importante dominio de la vida de la mujer adversamente afectado por el SPM, manifestado en un aumento de la tasa de ausentismo laboral y reducción de la productividad. Se concluye, según la literatura revisada, que el SPM afecta el rendimiento laboral, lo que sugiere a los profesionales de la salud tomar un rol activo en la derivación y tratamiento oportuno, para de esta forma lograr un aumento en la productividad laboral de las mujeres.

[Community-acquired pneumonia requiring hospitalization in immunocompetent elderly patients: clinical features, prognostic factors and treatment]. / Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuacro clínico, factores pronósticos y tratamiento.

BACKGROUND: Community-acquired pneumonia (CAP) is the leading cause of death from infectious disease among the elderly. This study was carried out to examine the clinical manifestations, etiology, prognostic factors and treatment of CAP in immunocompetent elderly patients requiring hospitalization. RESULTS: A total of 306 elderly (80 +/- 7 years) patients were evaluated: 54% were male, 89% had concurrent diseases (principally cardiovascular and neurological disease, chronic obstructive lung disease and diabetes), and 97% were treated with second-or third-generation cephalosporins. Mean hospital stay was 10 days, and mortality was approximately 10% in hospital and around 13% on follow up at 30 days. As compared to younger CAP patients, multiple comorbidity, altered mental status, hypoxemia, high serum urea nitrogen on hospital admission were more frequent in the elderly. Intermediate care and intensive care unit admissions were also more frequent in the elderly. Hospital length of stay as well as mortality in the hospital and at 30 days were higher in elderly patients. The pathogen was identified as part of routine care in around 25% of cases. The most frequent pathogens were Streptococcus pneumoniae (10.5%), enteric Gram negative bacilli (5.2%), Staphylococcus aureus (4.2%) and Haemophilus influenzae (3.9%). In multivariate analysis the prognostic factors on admission associated with in-hospital mortality were advanced age (> 83 years), absence of cough, low blood pressure and hyperphosphatemia. CONCLUSION: CAP in elderly patients is a prevalent disease with specific clinical and epidemiological characteristics, clinical course and prognosis.

Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuadro clínico, factores pronósticos y tratamiento / Community-acquired pneumonia requiring hospitalization in immunocompetent elderly patients: clinical features, prognostic factors and treatment

FUNDAMENTO Y OBJETIVOS: La neumonía adquirida en la comunidad (NAC) es la principal causa de muerte de origen infeccioso en el anciano. Realizamos este trabajo con el propósito de examinar el cuadro clínico, la etiología, los factores pronósticos y el tratamiento de la NAC en el anciano inmunocompetente que requiere hospitalización. Diseño: estudio clínico prospectivo descriptivo observacional. RESULTADOS: Se evaluó a 306 pacientes (80 ñ 7 años), un 54 por ciento de ellos eran varones, el 89 por ciento presentaba comorbilidad (especialmente cardiovascular, neurológica, enfermedad pulmonar obstructiva crónica, diabetes) y el 97 por ciento fue tratados con cefalosporinas de segunda o tercera generación. La estancia promedio en el hospital fue de 10 días, aproximadamente el 10 por ciento de los pacientes falleció en el hospital y alrededor del 13 por ciento en el seguimiento a los 30 días. En la NAC del anciano, comparada con la del adulto joven, fue más frecuente la presencia de comorbilidad múltiple, estado mental alterado, hipoxemia y nitrógeno ureico sérico elevado en la admisión, así como la necesidad de ingreso en la unidad de cuidado intensivo. Además, la estancia y la mortalidad en el hospital y en el seguimiento a los 30 días fueron más elevadas en la población senescente. En la práctica clínica habitual, la etiología microbiana se estableció en aproximadamente el 25 por ciento de los casos. Los patógenos aislados con mayor frecuencia fueron Streptococcus pneumoniae (10,5 por ciento), bacilos gramnegativos entéricos (5,2 por ciento), Staphylococcus aureus (4,2 por ciento) y Haemophilus influenzae (3,9 por ciento). En el análisis multivariado, los factores medidos en la admisión asociados con mayor riesgo de morir en el hospital fueron la edad avanzada (> 83 años), ausencia de tos, hipotensión arterial e hiperfosfemia. CONCLUSIÓN: La NAC en el anciano es una enfermedad prevalente que presenta características clinicoepidemiológicas, evolución y pronóstico particulares (AU)

Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina.

OBJECTIVE: To survey the etiology and epidemiology of community-acquired pneumonia (CAP) in relation to age, comorbidity, and severity and to investigate prognostic factors. DESIGN: Prospective epidemiologic study, single center. SETTING: University hospital at Buenos Aires, Argentina. PATIENTS: Outpatients and inpatients fulfilling clinical criteria of CAP. INTERVENTIONS: Systematic laboratory evaluation for determining the etiology, and clinical evaluation stratifying patients into mild, moderate, and severe CAP (groups 1 to 3), a clinical rule used for hospitalization. RESULTS: During a 12-month period, 343 patients (mean age, 64.4 years; range, 18 to 102 years) were evaluated. We found 167 microorganisms in 144 cases (yield, 42%). Streptococcus pneumoniae, the most common pathogen, was isolated in 35 cases (24%). Mycoplasma pneumoniae, present in 19 (13%), was second in frequency in group 1; Haemophilus influenzae, present in 17 cases (12%), was second in group 2; and Chlamydia pneumoniae, present in 12 cases (8%), was second in group 3. Etiology could not be determined on the basis of clinical presentation; identifying the etiology had no impact on mortality. Some findings were associated with specific causative organisms and outcome. A significantly lower number of nonsurvivors received adequate therapy (50% vs 77%). CONCLUSIONS: Age, comorbidities, alcohol abuse, and smoking were related with distinct etiologies. PaO(2) to fraction of inspired oxygen ratio < 250, aerobic Gram-negative pathogen, chronic renal failure, Glasgow score < 15, malignant neoplasm, and aspirative pneumonia were associated with mortality by multivariate analysis. Local microbiologic data could be of help in tailoring therapeutic guidelines to the microbiologic reality at different settings. The stratification schema and the clinical rule used for hospitalization were useful.

[Community-acquired pneumonia in the elderly requiring hospitalization. Clinical features and prognosis]. / Neumonía adquirida en la comunidad en ancianos que requieren internación. Cuadro clínico y pronostico.

We evaluated retrospectively 96 patients older than 64 years admitted with the diagnosis of Community Acquired Pneumonia (CAP) in order to describe the clinical features, evaluate severity and assess prognostic factors. During an 18-month period 100 cases of CAP were included. Average age was 82.3 years +/- 8.3 (+/- SD). By the time of admission, cough and fever were found in 35% of cases and 48% had altered mental status. Fourteen per cent needed mechanical ventilation. Etiology was determined in 21% of cases. Most common pathogens were S. pneumoniae (38.1%), S. aureus (19%) and H. infuenzae (14.3%). Overall mortality was 29%. The most commonly present criteria of severity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60% of patients and mortality in that group was 40%. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95% confidence interval [CI] = 1.9-249.5), oliguria (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1.8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly patients requiring hospitalization are atypical, severe presentations are frequent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.

Neumonía adquirida en la comunidad en ancianos que requieren internación. Cuadro clínico y pronostico. / [Community-acquired pneumonia in the elderly requiring hospitalization. Clinical features and prognosis]

We evaluated retrospectively 96 patients older than 64 years admitted with the diagnosis of Community Acquired Pneumonia (CAP) in order to describe the clinical features, evaluate severity and assess prognostic factors. During an 18-month period 100 cases of CAP were included. Average age was 82.3 years +/- 8.3 (+/- SD). By the time of admission, cough and fever were found in 35

of cases and 48

had altered mental status. Fourteen per cent needed mechanical ventilation. Etiology was determined in 21

of cases. Most common pathogens were S. pneumoniae (38.1

), S. aureus (19

) and H. infuenzae (14.3

). Overall mortality was 29

. The most commonly present criteria of severity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60

of patients and mortality in that group was 40

. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95

confidence interval [CI] = 1.9-249.5), oliguria (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1.8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly patients requiring hospitalization are atypical, severe presentations are frequent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.

[Cholestasis associated with ticlopidine]. / Colestasis asociada a ticlopidina.

The case of a 56-years-old male with cholestasis associated with ticlopidine is presented. Cholestasis is an infrequent adverse effect of this drug. The patient was admitted to hospital because of jaundice, choluria, and itching of one month of evolution. The patient had taken ticlopidine twice a day for 3 months up to one week prior to admission for peripheral arteriopathy. Biopsy was performed showing acinar cholestasis and portal inflammatory infiltrate compatible with cholestasis due to hypersensitivity. Ticlopidine was discontinued by the patient himself one week prior to admission. The drug was not readministered and the evolution of the clinical and biochemical parameters of cholestasis decreased. The patient was asymptomatic and laboratory data were normal 4 months later.