Gut Microbiota and Other Factors Associated With Increased Regulatory T Cells in Hiv-exposed Uninfected Infants.

HIV-exposed uninfected infants (HEU) have higher infectious morbidity than HIV-unexposed infants (HUU). HEU have multiple immune defects of unknown origin. We hypothesized that HEU have higher regulatory T cells (Treg) than HUU, which may dampen their immune defenses against pathogens. We compared 25 Treg subsets between HEU and HUU and sought the factors that may affect Treg frequencies. At birth, 3 Treg subsets, including CD4 + FOXP3 + and CD4 + FOXP3 + CD25+, had higher frequencies in 123 HEU than 117 HUU and 3 subsets were higher in HUU. At 28 and 62 weeks of life, 5 Treg subsets were higher in HEU, and none were higher in HUU. The frequencies of the discrepant Treg subsets correlated at birth with differential abundances of bacterial taxas in maternal gut microbiome and at subsequent visits in infant gut microbiomes. In vitro, bacterial taxa most abundant in HEU expanded Treg subsets with higher frequencies in HEU, recapitulating the in vivo observations. Other factors that correlated with increased Treg were low maternal CD4 + T cells in HEU at birth and male sex in HUU at 28 weeks. We conclude that maternal and infant gut dysbiosis are central to the Treg increase in HEU and may be targeted by mitigating interventions.

Surgical experience in cardiac myxomas at a tertiary hospital / Experiencia quirúrgica en mixomas cardiacos en un hospital de tercer nivel

Introduction Cardiac myxomas account for 50% of all benign cardiac tumors. Their clinical presentation varies from embolisms to fever. Our objective was to describe the surgical experience in the resection of cardiac myxomas during an 8-year period.MethodsThis is a retrospective, descriptive study of a series of cases with cardiac myxomas diagnosed from 2014 to 2022 at a tertiary care center. Descriptive statistics were used to define the populational and surgical characteristics. We used Pearson’s correlation to study the relationship between postoperative complications and age, tumor size and affected cardiac chamber.Results31 patients were included, with a predominance of females (1:2 ratio). The prevalence was 0.44%, which was calculated based on the number of cardiac surgeries performed in our unit over the 8-year period. The main clinical manifestation was dyspnea (85%, n = 23), followed by cerebrovascular event (CVE) (18%, n = 5). Atriotomy and resection of the pedicle were performed with preservation of the interatrial septum. Mortality was 3.2%. The postoperative evolution was uneventful in 77%. Tumor recurrence occurred in 2 patients (7%), both debuting with embolic phenomena. No association was observed between postoperative complications or recurrence and tumor size, nor aortic clamping and extracorporeal circulation times with regard to age.ConclusionsFour atrial myxoma resections are performed in our unit per year, with an estimated prevalence of 0.44%. The tumor characteristics described coincide with the previous literature. A relationship between embolisms and recurrences cannot be ruled out. Wide surgical resection of the pedicle and base of tumor implantation may influence tumor recurrence, although further studies are needed. (AU)

Introducción Los mixomas cardíacos representan el 50% de los tumores cardíacos benignos. La presentación clínica varía desde embolismos hasta fiebre. El objetivo fue describir la experiencia quirúrgica en la resección de mixomas cardíacos durante 8 años.MétodosEstudio retrospectivo, descriptivo, de serie de casos de mixomas cardíacos diagnosticados entre 2014 y 2022 en un centro de tercer nivel. Se utilizó estadística descriptiva para definir las características poblacionales y quirúrgicas. Mediante la correlación de Pearson se estudió la relación entre las complicaciones postoperatorias y la edad, el tamaño del tumor y la cavidad cardiaca afectada.ResultadosSe incluyeron 31 pacientes, predominantemente mujeres (1:2). La prevalencia fue 0.44%, calculada en base a las cirugías cardíacas realizadas en nuestra unidad durante 8 años. La principal manifestación fue disnea (85%, n = 23), seguida de EVC (18%, n = 5). Se realizó atriotomía y resección del pedículo con preservación del tabique interauricular. La mortalidad fue del 3.2%. La evolución posquirúrgica fue adecuada en el 77%. La recidiva ocurrió en 2 pacientes (7%), debutando ambos con embolismos. No se observó asociación entre las complicaciones postoperatorias o recurrencia y el tamaño tumoral; ni en pinzamiento aórtico y los tiempos de circulación extracorpórea con respecto a la edad.ConclusionesEn nuestra unidad se realizan cuatro resecciones de mixoma auricular anuales (prevalencia de 0.44%). Las características tumorales descritas coinciden con la literatura previa. No se descarta relación entre embolismos y recurrencias. La resección amplia del pedículo y base del tumor puede influir en la recurrencia tumoral, aunque, se requieren más estudios. (AU)

Surgical experience in cardiac myxomas at a tertiary hospital.

INTRODUCTION: Cardiac myxomas account for 50% of all benign cardiac tumors. Their clinical presentation varies from embolisms to fever. Our objective was to describe the surgical experience in the resection of cardiac myxomas during an 8-year period. METHODS: This is a retrospective, descriptive study of a series of cases with cardiac myxomas diagnosed from 2014 to 2022 at a tertiary care center. Descriptive statistics were used to define the populational and surgical characteristics. We used Pearson's correlation to study the relationship between postoperative complications and age, tumor size and affected cardiac chamber. RESULTS: 31 patients were included, with a predominance of females (1:2 ratio). The prevalence was 0.44%, which was calculated based on the number of cardiac surgeries performed in our unit over the 8-year period. The main clinical manifestation was dyspnea (85%, n = 23), followed by cerebrovascular event (CVE) (18%, n = 5). Atriotomy and resection of the pedicle were performed with preservation of the interatrial septum. Mortality was 3.2%. The postoperative evolution was uneventful in 77%. Tumor recurrence occurred in 2 patients (7%), both debuting with embolic phenomena. No association was observed between postoperative complications or recurrence and tumor size, nor aortic clamping and extracorporeal circulation times with regard to age. CONCLUSIONS: Four atrial myxoma resections are performed in our unit per year, with an estimated prevalence of 0.44%. The tumor characteristics described coincide with the previous literature. A relationship between embolisms and recurrences cannot be ruled out. Wide surgical resection of the pedicle and base of tumor implantation may influence tumor recurrence, although further studies are needed.

Understanding the mechanism of action of cytomegalovirus-induced regulatory T cells.

We previously showed that CMV-induced CD4+CD27-CD28- T cells have regulatory (Treg) function. Here we sought to identify the target/s and the mechanistic underpinning/s of this effect. CMV-induced CD4+CD27-CD28-were sorted from CMV-stimulated PBMC and added to CMV-stimulated autologous PBMC cultures. Transwell experiments showed that the CMV-induced Treg mechanism of action required cell-to-cell contact. CMV-Treg significantly decreased proliferation of autologous CMV-stimulated CD8+ and, to a lesser extent, CD4+ T cells; reduced activation and increased apoptosis of CD4+ and CD8+ T cells; and increased apoptosis and expression of CTLA-4, T cell-inhibitory ligand, on dendritic cells. There was no effect on monocytes. Anti-PD-1, but not anti-CTLA-4, mAb-treatment increased proliferation of CD8+ T cells and decreased apoptosis of CD4+ and CD8+ T cells. Our data indicated that CD8+ T cells were the main target of CMV-specific Treg, which induced apoptosis of their targets using the PD-1 pathway.

Human CardioChimeras: Creation of a Novel "Next-Generation" Cardiac Cell.

Background CardioChimeras produced by fusion of murine c-kit+ cardiac interstitial cells with mesenchymal stem cells promote superior structural and functional recovery in a mouse model of myocardial infarction compared with either precursor cell alone or in combination. Creation of human CardioChimeras (hCCs) represents the next step in translational development of this novel cell type, but new challenges arise when working with c-kit+ cardiac interstitial cells isolated and expanded from human heart tissue samples. The objective of the study was to establish a reliable cell fusion protocol for consistent optimized creation of hCCs and characterize fundamental hCC properties. Methods and Results Cell fusion was induced by incubating human c-kit+ cardiac interstitial cells and mesenchymal stem cells at a 2:1 ratio with inactivated Sendai virus. Hybrid cells were sorted into 96-well microplates for clonal expansion to derive unique cloned hCCs, which were then characterized for various cellular and molecular properties. hCCs exhibited enhanced survival relative to the parent cells and promoted cardiomyocyte survival in response to serum deprivation in vitro. Conclusions The generation of hCC is demonstrated and validated in this study, representing the next step toward implementation of a novel cell product for therapeutic development. Feasibility of creating human hybrid cells prompts consideration of multiple possibilities to create novel chimeric cells derived from cells with desirable traits to promote healing in pathologically damaged myocardium.

Immune Correlates of Herpes Zoster in People Living with HIV on Effective Antiretroviral Therapy.

Herpes zoster (HZ) has high morbidity in people living with HIV (PLHIV). We investigated immunological factors that correlated with the development of HZ in PLHIV with controlled HIV replication on antiretroviral therapy (ART). PLHIV who developed HZ on ART (cases), with undetectable plasma HIV RNA, and CD4 counts ≥200 cells/µL were matched 1:1 to controls by CD4 count, age, gender, race, and duration of ART. Varicella-zoster virus (VZV)-specific T cells and circulating regulatory T cells (Treg) were measured by flow cytometry before and after HZ. Differences between cases and controls were assessed by paired t-tests and longitudinal changes by Wilcoxon signed rank test. HZ cases (N = 31) had higher CD4+FOXP3+CD25+% Treg before HZ compared with 31 controls. After VZV ex vivo restimulation, cases had lower T cell responses, including CD8+perforin+% cytotoxic T lymphocytes (CTLs), CD4+IL10+%, and CD4+TGFß+% compared with controls. Overall, Treg negatively correlated with VZV-specific Th1 responses. Moreover, Treg decreased over time on ART in HZ cases, VZV-CTLs were stable and did not increase even after HZ. Increased circulating Treg and decreased VZV-specific T cell immune responses were associated with the risk of HZ in PLHIV. The kinetics of Treg over time, but not of VZV-CTLs, paralleled the natural history of HZ, whose incidence decreases over time on effective ART.

The Effect of Age on the Immunogenicity of the Live Attenuated Zoster Vaccine Is Predicted by Baseline Regulatory T Cells and Varicella-Zoster Virus-Specific T Cell Immunity.

Older age is associated with increased infectious morbidity and decreased immune responses to vaccines, but the mechanisms that mediate this effect are incompletely understood. The efficacy and immunogenicity of the live attenuated zoster vaccine (ZVL) have a very-well-described negative association with the age of the vaccinee. In a study of 600 ZVL recipients 50 to >80 years of age, we investigated immunological factors that might explain the effect of age on the immunogenicity of ZVL. Using FluoroSpot assays and flow cytometry, we determined that varicella-zoster virus (VZV)-specific peak T helper 1 (VZV-Th1) responses to ZVL were independently predicted by prevaccination VZV-Th1 responses, regulatory T cells (Treg), and PD1-expressing immune checkpoint T cells (Tcheck) but not by the age of the vaccinee. Persistence of VZV-Th1 1 year after vaccination was independently predicted by the factors mentioned above, by peak VZV-Th1 responses to ZVL, and by the age of the vaccinee. We further demonstrated by ex vivo blocking experiments the mechanistic role of PD1 and CTLA4 as modulators of decreased VZV-Th1 responses in the study participants. VZV-specific cytotoxic T cell (VZV-CTL) and T follicular helper responses to ZVL did not correlate with age, but similar to other Th1 responses, VZV-CTL peak and baseline responses were independently correlated. These data expand our understanding of the factors affecting the magnitude and kinetics of T cell responses to ZVL in older adults and show the importance of prevaccination Treg and Tcheck in modulating the immunogenicity of ZVL. This presents new potential interventions to increase vaccine responses in older adults.IMPORTANCE Vaccination is the most effective method to protect older adults against viral infections. However, the immunogenicity of viral vaccines in older adults is notoriously poor. The live attenuated zoster vaccine (ZVL) provides the best example of a gradual decrease of vaccine immunogenicity with every 10-year age increase above 50 years. Here we show that the abundance of regulatory T cells before vaccine administration to older adults has a significant inhibitory effect on immune responses to ZVL and, together with baseline immunity to varicella-zoster virus, explains the effect of age on the immunogenicity of ZVL. Moreover, in vitro blockade of regulatory T cell mechanisms of action with biologic modulators restores immune responses to varicella-zoster virus in vaccinees. Collectively, these observations suggest that immune modulators that block regulatory T cell activity may increase responses to viral attenuated vaccines in older adults.

Persistence of Varicella-Zoster Virus Cell-Mediated Immunity After the Administration of a Second Dose of Live Herpes Zoster Vaccine.

Protection against zoster conferred by zoster vaccine live (ZVL; Zostavax) wanes over time. We compared varicella-zoster virus cell-mediated immunity (VZV-CMI) of adults ≥70 years who received a second dose of ZVL ≥10 years after the initial dose with de novo-immunized age-matched controls. Before and during the first year after vaccination, VZV-CMI was significantly higher in reimmunized compared with de novo vaccinees. At 3 years, VZV-CMI differences between groups decreased and only memory responses remained marginally higher in reimmunized participants. In conclusion, the increase in VZV-CMI generated by reimmunization with ZVL is at least equally persistent compared with de novo immunization.

El futuro de la feminización de la medicina en Argentina / The future impact of the feminization of medicine in Argentina

En los últimos años, la proporción de mujeres que estudian medicina creció de forma constante en numerosos países. En Argentina, la feminización de la profesión médica ya muestra una mayor representación de la mujer en los grupos de edad más joven, y la proyección a 10 años indica que la mujer abarcará el 60-70% de la fuerza laboral médica en todos los estratos de edad. La adaptación a las características laborales de las mujeres requerirá aceptar la flexibilidad del trabajo a tiempo parcial y las interrupciones de la carrera originadas por la maternidad u otros compromisos familiares. Una consecuencia futura de que las mujeres eludan la mayoría de las especialidades quirúrgicas será una escasez relativa de profesionales en estas especialidades. De todas forma, deberá explorarse si este supuesto desinterés por las especialidades quirúrgicas depende del fuerte condicionamiento del modelo masculino en estos espacios. A pesar de ser mayoría, la mujer está menos representada en el ámbito académico, lo que origina a su vez una menor representación en el liderazgo médico. La mujer médica parece ser más humanitaria, empática y honesta que el varón, aportes que podrían ser muy significativos cuando las mujeres alcancen un equitativo liderazgo de opinión con los hombres. Potencialmente, hay importantes diferencias entre el perfil laboral femenino y masculino y, con seguridad, esto influirá en la organización y la economía de los futuros servicios médicos, que serán probablemente más complejos, comparativamente más caros y mejor socializados

In recent years, the proportion of women studying medicine grew steadily in many countries. In Argentina, the feminization of the medical profession shows an overrepresentation of women in the younger group of physicians, and the 10-year projection indicates that women will comprise 60-70% of the medical workforce in all age strata. Adaptation to labor characteristics of women will require flexibility to accept part-time work and career interruptions caused by motherhood or other family obligations. A future consequence of women avoidance of most surgical specialties, is a relative shortage of doctors in these specialties. Anyway, it should be explored whether this supposed lack of interest in surgical specialties depends on the strong conditioning of the male model in these spaces. Despite being majority, woman is less represented in academia, resulting underrepresented in medical leadership in turn. Medical woman seems to be more humanistic, empathetic and honest than male. These contributions could be very significant, as long as women were able to achieve an egalitarian opinion leadership with men. There are potentially significant differences between the female and male occupational profiles, and this will certainly influence the organization and economy of future medical services, which are likely to be more complex, comparatively more expensive and better socialized

Cytomegalovirus infection in HIV-infected and uninfected individuals is characterized by circulating regulatory T cells of unconstrained antigenic specificity.

Cytomegalovirus (CMV) infection is associated with immune-suppression in immune-compromised hosts and old adults. We previously showed that ex vivo CMV restimulation of peripheral blood mononuclear cells (PBMC) of CMV-seropositive volunteers expanded CD4+CD27-CD28- regulatory T cells (Tregs). Here we evaluate the phenotype and function of circulating CD4+CD27-CD28- T cells of CMV-seropositive adults. Compared with CMV-seronegative, CMV-seropositive adults had 10-fold higher CD4+CD27-CD28-% T cells in PBMC. Circulating CD4+CD27-CD28- T cells from both CMV-seropositive and seronegative donors expressed higher levels of TGFß, granzyme B, CD39, CD147 and IL-35, and lower levels of CD127, compared with their parent circulating CD4+ T cells. However, only CMV-seropositive circulating CD4+CD27-CD28- had increased FOXP3 expression. CD4+CD27-CD28- sorted from the PBMC of CMV-seropositive donors expanded ex vivo in the presence of rhIL2 and inhibited ex vivo proliferation of autologous PBMC restimulated with CMV, varicella-zoster virus or C. albicans antigens. CD4+CD27-CD28- sorted from CMV-seronegative PBMC did not expand in the presence of rhIL2 and did not inhibit autologous PBMC proliferation. CD3+CD27-CD28- circulating T cells (≥80% CD8+) from CMV-seropositive HIV-infected donors also inhibited ex vivo proliferation of autologous PBMC restimulated with CMV or HIV. These data indicate that CMV-seropositive individuals have circulating Tregs that inhibit cell-mediated immune responses to CMV and other antigens and may be contribute to an immune-suppressive effect of CMV infection. Moreover, the phenotypic similarity between circulating CD4+CD27-CD28- Tregs with differentiated effector T cells suggests that the two T-cell subsets might evolve in parallel or in sequence from the same progenitor cells in response to CMV stimulation during reactivations.

[Quality of life in patients with psoriasis]. / Calidad de vida en el paciente con psoriasis.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease, in which an autoimmune mechanism participates, triggering an accelerated keratopoiesis. Its etiology is unknown; environmental factors, trauma, and infections are involved. The aim of this paper is to present the correlation between the index of severity of psoriasis and quality of life in patients with psoriasis. METHODS: This was a cross-sectional study in 72 patients with psoriasis, older than 15 years old, who agreed to participate in the study. We applied the Dermatology Life Quality Index and the Psoriasis Severity Index; descriptive statistics, measures of central tendency, dispersion, and correlation measures were used. RESULTS: Patients (n = 72), were 43% male, 57% female, with a mean age 51.22 (15-77) ± 14.05 years. Education: bachelor's degree 23.6%, housework occupation 26.4%, duration of the disease 12.25 (1-50) ± 10.58 years. Psoriasis plaques occurred in 88.9%, the Psoriasis Severity Index was mild in 70.8%. The result of the impact on quality of life was moderate in effect in 33.3%, the difference between the degree of involvement of the disease and the impact on quality of life was p = 0.104, and correlation between the quality of life and degree of psoriasis was p = 0.463. CONCLUSION: Quality of life is independent of the degree of disease in patients with psoriasis.

Community-Acquired Pneumococcal Pneumonia in Virologically Suppressed HIV-Infected Adult Patients: A Matched Case-Control Study.

BACKGROUND: The study aimed to investigate whether the clinical presentations and outcomes (length of stay, ICU admission, and 30-day mortality) of pneumococcal pneumonia in virologically suppressed patients who were HIV-infected on ART with a CD4+ T-cell count > 350 cells/mm3 are comparable to those seen in patients with HIV, using a case-control design. METHODS: A case-control study was carried out in Hospital Clinic, Barcelona, Spain (2001-2016). Control patients were matched by age (±10 years), sex, comorbidities, and pneumonia diagnosis in the same calendar period. Clinical presentation and outcomes of pneumococcal pneumonia in patients who were and were not infected with HIV were compared. RESULTS: Pneumococcal pneumonia was studied in 50 cases (HIV infection) and 100 control patients (non-HIV infection). Compared with the control patients, case patients had higher rates of influenza (14% vs 2%, P = .007) and pneumococcal vaccination (10% vs 1%, P = .016). The group of cases also presented a higher rate of coinfection with hepatitis B virus (6% vs 0%, P = .036). Both groups presented similar ICU admission (18% vs 27%, P = .22), need for mechanical ventilation (12% vs 8%; P = .43), length of stay (7 days vs 7 days, P = .76), and 0% of 30-day mortality. No evidence was found of a more severe presentation or a worse clinical outcome in cases than in control patients. CONCLUSIONS: Pneumococcal pneumonia episodes requiring hospitalization in virologically suppressed patients with HIV with > 350 CD4+ T-cell count/mm3 were neither more severe nor had worse prognosis compared with uninfected patients. These results support the fact that such patients do not need treatment, admission, or care sites different to the general population. TRIAL REGISTRY: ClinicalTrials.gov; No. 2009/5451; URL: www.clinicaltrials.gov.

Anxiety Sensitivity and Smoking Behavior Among Trauma-Exposed Daily Smokers: The Explanatory Role of Smoking-Related Avoidance and Inflexibility.

Anxiety sensitivity (AS), defined as the extent to which individuals believe that anxiety-related sensations have harmful consequences, is associated with smoking processes and poorer clinical outcomes among trauma-exposed smokers. Yet the specific mechanisms underlying this association are unclear. Smoking-specific avoidance and inflexibility is a construct implicated in multiple manifestations of mood regulation that may underlie smoking behavior. The current study examined the explanatory role of smoking-specific avoidance and inflexibility in terms of the relation between AS and indices of smoking behavior among trauma-exposed smokers. The sample consisted of 217 treatment-seeking adult smokers (44% female; M age = 37.8; SD = 13.2; age range: 18-65 years), who were exposed to at least one lifetime Criterion A trauma event (Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR] Criterion A for trauma exposure). Bootstrap analysis (5,000 re-samples) revealed that AS was indirectly related to the (a) number of cigarettes smoked per day, (b) number of years being a daily smoker, (c) number of failed quit attempts, and (d) heaviness of smoking index among trauma-exposed smokers through its relation with smoking-specific avoidance and inflexibility. These findings provide initial evidence suggesting that smoking-specific avoidance and inflexibility may be an important construct in better understanding AS-smoking relations among trauma-exposed smokers. Future work is needed to explore the extent to which smoking-specific avoidance and inflexibility account for relations between AS and other smoking processes (e.g., withdrawal, cessation outcome) in the context of trauma and smoking comorbidity.

Expectations about the Future in a Population of argentine Cardiologists / Expectativas acerca del futuro en una población de cardiólogos argentinos

Background: Studies on the professional status of cardiologists in Argentina demonstrated that worse quality of life was associated with lower incomes and poorer working conditions. Knowledge of cardiologists’ present and future perceptions and expectations is necessary for the individual and proper organization of each professional, as well as for the design of public policies. Objectives: The aim of this study was to describe the present and future perceptions about the professional and economic situation of cardiologists in Argentina and analyze individual and common characteristics associated with negative perceptions. Methods: This was an observational, cross-sectional study, based on an electronically delivered survey on the demographics, work-ing characteristics and present, in 10 years and at retirement perceptions of professional situation, defining “Bad” or “Very bad” answers as a negative perception. Results: A total of 236 cardiologists answered the survey; 26% were women and 57.1% were from CABA and the Buenos Aires subur-ban area. The perceived professional situation was: a) Current: Bad/Very bad 9.7%, Fair 45.1%, Good/Very good 45.1%; b) In 10 years: Bad/Very bad 17.1%, Fair 44.6%, Good/Very good 38.3%; c) At retirement: Bad/Very bad 49.1%, Fair 30.3%, Good/Very good 20.6%. Univariate analysis showed greater negative expectation at retirement in: heart disease (p=0.007), coronary risk factors (p=0.027), anxiety/depression (p=0.016), main breadwinner supporting more than three children/relatives (p=0.034) and having suffered any disease (p=0.03). The presence of four factors (or hidden variables) was established in the principal component analysis, probingly defined as: vulner-ability, over-adaptation, overt disease and insulated autonomy. Conclusions: Although cardiologists consider that the present is promising, the near future and retirement impress like a threaten-ing and negative reality. This could then be the opportunity to assume a deep and critical attitude to change the ways of working in order to promote a safer and better future.

Introducción: Estudios sobre la situación profesional de los cardiólogos en la Argentina mostraron peor calidad de vida relacionada con menores ingresos y peores condiciones laborales. Conocer las percepciones y expectativas actuales y alejadas de los cardiólogos resulta una información necesaria para la organización individual y propia de cada profesional, así como para el diseño de políticas públicas. Objetivos: Describir las percepciones de los cardiólogos en la Argentina sobre su situación profesional y económica actual y futura y analizar las características individuales y comunes asociadas con las percepciones negativas. Material y métodos: Estudio observacional, de corte transversal, por medio de una encuesta realizada por vía electrónica sobre ca­racterísticas demográficas, laborales y percepciones de situación profesional actual, a 10 años y al retiro, definiendo como percepción negativa las respuestas “Mala” o ”Muy mala”. Resultados: Contestaron 236 cardiólogos: 26% mujeres, 57,1% de CABA y conurbano. La situación profesional percibida fue: a) Ac­tual: Mala/Muy mala 9,7%, Regular 45,1%, Buena/Muy buena 45,1%; b) A 10 años: Mala/Muy mala 17,1%, Regular 44,6%, Buena/ Muy buena 38,3%; c) Al retiro: Mala/Muy mala 49,1%, Regular 30,3%, Buena/Muy buena 20,6%. El análisis univariado mostró mayor expectativa negativa al retiro en cardiopatía (p = 0,007), factores de riesgo coronario (p = 0,027), ansiedad/depresión (p = 0,016), principal sostén del hogar con más de tres hijos/familiares a cargo (p = 0,034) y haber pade­cido alguna enfermedad (p = 0,03). En el análisis de componente principal se estableció la presencia de cuatro factores (o variables ocultas), que definimos exploratoriamente como mayor vulnerabilidad, sobreadaptación, enfermedad manifiesta y autonomía con aislamiento. Conclusiones: Aunque los cardiólogos ven el presente favorablemente, el futuro cercano y el retiro impresionan como una realidad amenazadora y negativa. Tal vez sea oportunidad de tener un rol crítico y profundo con actitud de cambio de los modos de trabajar para promover un futuro más seguro y mejor.

Barreras de género en la prevención cardiovascular: actitudes yconocimientos de profesionales de la salud y usuarias / Gender barriers to cardiovascular prevention: attitudes and knowledge of health care professionals and women users

INTRODUCCION: La enfermedad cardiovascular en mujeres constituye un tema de relevancia epidemiológica enArgentina y debe ser abordada desde una perspectiva integral. OBJETIVOS: Indagar acerca de los imaginarios de profesionales y usuarias del sistema sanitario, que podrían operar como barreras para la prevención y el tratamiento de la enfermedad cardiovascular en mujeres. METODOS: Estudio descriptivo que incluyó: entrevistas a médicos/as e informantes clave, dispositivos grupales de cardiólogos/as y encuestas a usuarias de servicios de Cardiología de un centropúblico y uno privado. Se realizó un análisis cualicuantitativo de la información recogida. RESULTADOS: Se observó que los/as profesionales perciben especificidades y rasgos diferenciales de la enfermedad cardiovascular en mujeres, aunque tienen dificultad para conceptualizarlos y traducirlos en cambios en sus prácticas clínicas. Se observó vulnerabilidad de clase y género como determinante de riesgo cardiovascular, con predominio del paradigma de la igualdad de atención en los imaginarios. En las usuarias se identificó que haypercepción del riesgo psicosocial en enfermedad cardiovascular, aunque con brechas entre percepción y prácticas. Se observaron discordancias entre los imaginarios de los/as profesionales y el de las usuarias del sistema de salud. CONCLUSIONES: Los resultadosmuestran que existen sesgos en los imaginarios de género en relacióncon la salud cardiovascular que operan como barreras para adoptarestrategias preventivas eficaces en enfermedad cardiovascular dirigidasa mujeres. La revisión de estos imaginarios puede promover mayoresgrados de equidad de género en la calidad de prevención y en el acceso a la atención.

INTRODUCTION: Cardiovascular disease in women is an issue of epidemiological relevance in Argentina,which should be approached from a holistic perspective. OBJECTIVES: To investigate the imaginary of health system professionals and women users, that could act as a barrier for the prevention and treatment of cardiovascular disease in this group. METHODS: Descriptive study that included: interviews to physiciansand clue actors, group mechanisms for cardiologists, and surveys to users of public and private cardiology services.A qualitative and quantitative analysis was performed. RESULTS: Professionals perceived some specific features ofcardiovascular disease in women, although there were still difficulties for conceptualize and make changes in clinical practices. Class and gender vulnerability was seen as a determinant of cardiovascular risk, under the prevalent paradigm of equality in health care. Female users showed psychosocial risk perception, with differences between beliefs and practices. Some differences were observed between imaginaries of professionals and health system female users. CONCLUSIONS: Some bias between genderrelatedimaginary regarding cardiovascular health are still present, and they can hinder the adoption of effectivepreventive strategies for manage cardiovascular disease in women.By reviewing this, it would be possible to achieve a higher degree of gender equity in terms of prevention quality and health care access.

Regulatory T cells and the risk of CMV end-organ disease in patients with AIDS.

OBJECTIVES: Cytomegalovirus (CMV)-specific T-cell effectors (CMV-Teff) protect against CMV end-organ disease (EOD). In HIV-infected individuals, their numbers and function vary with CD4 cell numbers and HIV load. The role of regulatory T cells (Treg) in CMV-EOD has not been extensively studied. We investigated the contribution of Treg and Teff toward CMV-EOD in HIV-infected individuals independently of CD4 cell numbers and HIV load and controlling for CMV reactivations. DESIGN: We matched 43 CMV-EOD cases to 93 controls without CMV-EOD, but with similar CD4 cell numbers and HIV plasma RNA. CMV reactivation was investigated by blood DNA polymerase chain reaction over 32 weeks preceding the CMV-EOD in cases and preceding the matching point in controls. METHODS: CMV-Teff and Treg were characterized by the expression of interferon-γ (IFN-γ), interleukin 2, tumor necrosis factor α (TNFα), MIP1ß, granzyme B (GrB), CD107a, TNFα, FOXP3, and CD25. RESULTS: Sixty-five percent cases and 20% controls had CMV reactivations. In multivariate analyses that controlled for CMV reactivations, none of the CMV-Teff subsets correlated with protection, but high CMV-GrB enzyme-linked immunosorbent spot responses and CMV-specific CD4FOXP3+%, CD4TNFα+%, and CD8CD107a% were significant predictors of CMV-EOD. CONCLUSIONS: Because both FOXP3 and GrB have been previously associated with Treg activity, we conclude that CMV-Treg may play an important role in the development of CMV-EOD in advanced HIV disease. We were not able to identify a CMV-Teff subset that could be used as a surrogate of protection against CMV-EOD in this highly immunocompromised population.

Epidermolysis Bullosa Oropharyngeal Severity (EBOS) score: a multicenter development and reliability assessment.

BACKGROUND: Epidermolysis bullosa (EB) is a genetic mucocutaneous disorder characterized by blister formation upon mild trauma. All 4 EB types may show oropharyngeal lesions involving either hard or soft tissues. Currently, there are very few data on EB scoring that include the oropharyngeal cavity. OBJECTIVES: We sought to develop an oropharyngeal severity score that was objective, valid, reliable, reproducible, easy to perform, and appropriate for all EB types. METHODS: In this study, oral medicine specialists developed a new score, the EB Oropharyngeal Severity (EBOS) score. This measured oropharyngeal disease activity (erythema, atrophy, blisters, erosion/ulceration) and structural damage (microstomia, ankyloglossia, scarring phenotype beyond microstomia and ankyloglossia, enamel hypoplasia). It was tested on 92 patients with different types/subtypes of EB, and interobserver and intraobserver reliability were assessed. RESULTS: The EBOS mean total score was 12.9 ± 10.9 (range: 0-34). Both interobserver and intraobserver reliability for total score on all patients with EB were considered excellent (intraclass correlation coefficient 0.94; 95% confidence interval 0.90-0.96 and intraclass correlation coefficient 0.90; 95% confidence interval 0.84-0.94, respectively). Even analyzing each single parameter of the disease activity and structural damage, a substantial to excellent correlation was found in the interobserver (except for 4 sites) and intraobserver reliability. A significant correlation was found between EB types/subtypes and the EBOS median score (P < .001), but not between age and the EBOS mean total score in each group. LIMITATIONS: The sample size was small and the number of EB subtypes was limited. CONCLUSIONS: The EBOS score seems to represent an instrument capable of truly quantifying the oropharyngeal severity in different types/subtypes of EB, demonstrating excellent interobserver and intraobserver reliability.

Trabajar mejor para trabajar mejor: ¿Se discute la problemática profesional en el Congreso Argentino de Cardiología? ¿Se ocupa el médico de esta problemática? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem?

Introducción Los grandes cambios producidos en las dos últimas décadas en las reglas laborales en salud, los estilos de trabajo, la organización sanitaria, el uso y la importancia de la tecnología y en la consideración social acerca del profesional médico tienen causas complejas y multifactoriales; las mismas presentan elementos comunes como el empeoramiento de la remuneración que perciben los médicos, la disminución absoluta y relativa de los honorarios profesionales y la percepción del médico respecto de su propia profesión y marcan una realidad que exige reconsiderar el lugar del médico en sus nuevos escenarios de trabajo. Objetivos Definimos como "problemática médica" a toda vivencia o situación problemática que experimenta el médico durante el ejercicio de su actividad. Sobre el tema existen abundantes datos y opiniones en los últimos años referidos a la insalubre situación laboral del médico y a la propia percepción negativa sobre su tarea. El objetivo de presente trabajo fue explorar si la problemática médica era tratada en el Congreso Argentino de Cardiología. Material y métodos Estudio observacional, descriptivo, sobre la existencia de temas libres y mesas sobre problemática médica en los últimos tres Congresos Argentinos de Cardiología y su ubicación temática. Algunas de las palabras clave fueron: realidad laboral, trabajo médico, burn out, bioética, ética, condiciones de trabajo y otras. Resultados Hubo en total 2254 temas libres en los tres años, de los cuales 8 (0,35%) trataron sobre elementos de problemática médica. Los temas libres se ubicaron en las categorías "miscelánea", psicosociales, educación médica o salud pública. Hubo 13 mesas, organizadas por el Comité de Bioética, el Área de Investigación de la Sociedad Argentina de Cardiología, CONAREC y la Fundación Cardiológica Argentina. Conclusiones En el período estudiado hubo una proporción muy escasa de mesas y temas libres dirigidos a la problemática médica, estos últimos sin un marco conceptual preestablecido adecuado. Así, la problemática médica no es considerada un objeto de estudio relevante. Es conveniente la discusión e investigación para la búsqueda de planteos y soluciones a múltiples niveles, o no podrá hacerse un diagnóstico y tratamiento del tema, con las eventuales y enormes implicaciones futuras potenciales.

Background The big changes produced during the last two decades have produced a reality that requires physicians to reconsider the role they play in their new working scenario. These changes include regulations in health care working, work styles, health organization, use and importance of technology and how the physician is socially considered. The causes are complex and multifactorial, yet they share common elements as worse payment to physicians, an absolute and relative reduction in professional fees and physicians' perception about their own profession. Objectives A "medical problem" is defined as any problematic experience or situation felt by a physician during his/her practice. In the last years, there are plenty of information and several opinions about this matter, in reference to the working conditions of physicians and to their negative self-perception about medical practice. The goal of the present study was to explore if the Argentine Congress of Cardiology dealt with the medical problem. Material and Methods Observational and descriptive study about open-topic sessions and roundtable sessions dealing with the medical problem -and under which field the medical problem was considered- during the past/latest three Argentine Congresses of Cardiology. The following key words were used: working reality, medical practice, burnout, bioethics, ethics and working conditions, among others. Results Of 2254 open topics presented in the three years, 8 (0.35%) dealt with the medical problem. The open topics were considered under "miscellany", psychosocial, medical education or public health fields. Thirteen roundtable sessions were identified and organized by the Committee on Bioethics, the Research Area of the Argentine Society of Cardiology, the CONAREC and the Argentine Cardiology Foundation. Conclusions We found very few roundtable sessions and opened-topic sessions -and without an adequate preestablished conceptual framework- focused on the medical problem. Thus, the medical problem is not considered an important topic of study. Discussion and investigation are convenient to search for arguments and solutions at multiple levels, otherwise it will not be possible to make a diagnosis and treatment of the topic, with the eventual and important future implications.

Trabajar mejor para trabajar mejor: ¿Se discute la problemática profesional en el Congreso Argentino de Cardiología? ¿Se ocupa el médico de esta problemática? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem? / Better Work, Working Better: Are Professional-Related Problems Discussed at the Argentine Congress of Cardiology? Are Physicians Concerned with this Problem?

Introducción Los grandes cambios producidos en las dos últimas décadas en las reglas laborales en salud, los estilos de trabajo, la organización sanitaria, el uso y la importancia de la tecnología y en la consideración social acerca del profesional médico tienen causas complejas y multifactoriales; las mismas presentan elementos comunes como el empeoramiento de la remuneración que perciben los médicos, la disminución absoluta y relativa de los honorarios profesionales y la percepción del médico respecto de su propia profesión y marcan una realidad que exige reconsiderar el lugar del médico en sus nuevos escenarios de trabajo. Objetivos Definimos como "problemática médica" a toda vivencia o situación problemática que experimenta el médico durante el ejercicio de su actividad. Sobre el tema existen abundantes datos y opiniones en los últimos años referidos a la insalubre situación laboral del médico y a la propia percepción negativa sobre su tarea. El objetivo de presente trabajo fue explorar si la problemática médica era tratada en el Congreso Argentino de Cardiología. Material y métodos Estudio observacional, descriptivo, sobre la existencia de temas libres y mesas sobre problemática médica en los últimos tres Congresos Argentinos de Cardiología y su ubicación temática. Algunas de las palabras clave fueron: realidad laboral, trabajo médico, burn out, bioética, ética, condiciones de trabajo y otras. Resultados Hubo en total 2254 temas libres en los tres años, de los cuales 8 (0,35%) trataron sobre elementos de problemática médica. Los temas libres se ubicaron en las categorías "miscelánea", psicosociales, educación médica o salud pública. Hubo 13 mesas, organizadas por el Comité de Bioética, el Area de Investigación de la Sociedad Argentina de Cardiología, CONAREC y la Fundación Cardiológica Argentina. Conclusiones En el período estudiado hubo una proporción muy escasa de mesas y temas libres dirigidos a la problemática médica, estos últimos sin un marco conceptual preestablecido adecuado. Así, la problemática médica no es considerada un objeto de estudio relevante. Es conveniente la discusión e investigación para la búsqueda de planteos y soluciones a múltiples niveles, o no podrá hacerse un diagnóstico y tratamiento del tema, con las eventuales y enormes implicaciones futuras potenciales.(AU)

Background The big changes produced during the last two decades have produced a reality that requires physicians to reconsider the role they play in their new working scenario. These changes include regulations in health care working, work styles, health organization, use and importance of technology and how the physician is socially considered. The causes are complex and multifactorial, yet they share common elements as worse payment to physicians, an absolute and relative reduction in professional fees and physicians perception about their own profession. Objectives A "medical problem" is defined as any problematic experience or situation felt by a physician during his/her practice. In the last years, there are plenty of information and several opinions about this matter, in reference to the working conditions of physicians and to their negative self-perception about medical practice. The goal of the present study was to explore if the Argentine Congress of Cardiology dealt with the medical problem. Material and Methods Observational and descriptive study about open-topic sessions and roundtable sessions dealing with the medical problem -and under which field the medical problem was considered- during the past/latest three Argentine Congresses of Cardiology. The following key words were used: working reality, medical practice, burnout, bioethics, ethics and working conditions, among others. Results Of 2254 open topics presented in the three years, 8 (0.35%) dealt with the medical problem. The open topics were considered under "miscellany", psychosocial, medical education or public health fields. Thirteen roundtable sessions were identified and organized by the Committee on Bioethics, the Research Area of the Argentine Society of Cardiology, the CONAREC and the Argentine Cardiology Foundation. Conclusions We found very few roundtable sessions and opened-topic sessions -and without an adequate preestablished conceptual framework- focused on the medical problem. Thus, the medical problem is not considered an important topic of study. Discussion and investigation are convenient to search for arguments and solutions at multiple levels, otherwise it will not be possible to make a diagnosis and treatment of the topic, with the eventual and important future implications.(AU)