Rosa Bologna

Garrahan Hospital

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Andrea Mangano

Garrahan Hospital

Silvina Ruvinsky

Garrahan Hospital

Moira Taicz

Garrahan Hospital

Paula Aulicino

Garrahan Hospital

Luisa Sen

Garrahan Hospital

Débora Mecikovsky

Departamento de Epidemiología

Guadalupe Pérez

Garrahan Hospital

María Teresa Rosanova

Garrahan Hospital

Vanesa Reijtman

Garrahan Hospital

Carlos Rocco

Garrahan Hospital

Cooperative Institutions

Garrahan Hospital

212

University College London

136

Universidad Nacional Autónoma de México

Instituto de Investigación Sanitaria del Hospital Clínico San Carlos

MRC Clinical Trials Unit at UCL

Inserm

Consejo Nacional de Investigaciones Científicas y Técnicas

Medical Research Council

University of Buenos Aires

Université Paris Cité

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Panencefalitis esclerosante subaguda

H. A. Arroyo Rosa Bologna

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Series de Pediatría Garrahan. El adolescente en el consultorio del pediatra

Roberto Mato Valeria Bulgach Paula López Solange Arazi Caillaud Rosa Bologna

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Anidulafungin in children: Experience in a tertiary care children’s hospital in Argentina

Archivos Argentinos de Pediatria (2017)

María Teresa Rosanova Claudia Sarkis Florencia Escarrá Carolina Epelbaum Norma Sberna

The experience using anidulafungin for the treatment of invasive fungal infections in pediatrics is limited.In this article, we describe our experience in 55 children.Anidulafungin was administered intravenously at a loading dose of 3 mg/kg once daily, followed by 1.5 mg/kg every 24 hours over a mean period of 14 days (range: 7-22 days).Patients' median age was 114 months old (interquartile range: 32-168 months old).All patients had underlying diseases.Among patients with bone marrow transplant, the difference in white blood cell count, transaminase levels, and renal function at baseline and at the end of anidulafungin administration was not significant.No adverse events were reported and no patient died from an anidulafungin-related cause.Anidulafungin may be considered an alternative for the prophylaxis or treatment of invasive fungal infections in pediatrics but methodologically robust studies are needed to confirm this.

Anidulafungin

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White blood cell

10.5546/aap.2017.eng.374

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Persistencia de anticuerpos IgG contra SARS-CoV2 en personal de salud - provincia de Buenos Aires.

SciELO (SciELO Preprints) (2020)

Marina Pífano Laura Fischerman Regina Ercole Laura Muñoz Nicolás Kreplak

Objetivo: evaluar la persistencia de los anticuerpos IgG contra SARS-CoV2, en trabajadores de salud del subsector público de la Provincia de Buenos Aires, y correlacionarla con variables demográficas (sexo, edad) y otros indicadores de salud (diagnóstico de COVID-19, comorbilidades y embarazo). Metodología: Estudio descriptivo, observacional, de corte transversal. Al personal de salud con un resultado positivo en una primera muestra (N=388) se les realizó una segunda prueba para evaluar la persistencia de anticuerpos mediante ELISA. Resultados: De las 386 personas evaluadas con resultado concluyente, 296 contaban con un primer resultado positivo entre los 30 y los 90 días anteriores a la segunda prueba, el 90% presentó anticuerpos detectables. En aquellas personas con un resultado positivo hacía más de 90 días (45) se observó una caída significativa en la persistencia del 26,7%. No hubo asociaciones significativas entre las variables demográficas y de salud y el resultado de la segunda prueba. Conclusión: Los anticuerpos se mantienen detectables por al menos 90 días en el 90% de los casos analizados. Resulta fundamental continuar este estudio en el tiempo para contar con un período de tiempo mayor entre pruebas. La información aquí mostrada arroja datos interesantes y prometedores en cuanto a la posible protección de nuevos contagios de COVID-19 en personal con alta exposición de riesgo. Estas evidencias podrían contribuir a la toma de decisiones, tanto a nivel local como regional, para la adecuada planificación de la vacunación, así como también, para el manejo de la pandemia ante una posible segunda ola de casos en América Latina.

10.1590/scielopreprints.1634

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Role of 3 Lipoprotein Lipase Variants in Triglycerides in Children Receiving Highly Active Antiretroviral Therapy

The Pediatric Infectious Disease Journal (2014)

Cecilia Colombero Gabriel Catano Carlos Rocco Débora Mecikovsky Rosa Bologna

Lipoprotein lipase is a key enzyme in lipid metabolism, especially for plasma triglycerides (TGs). Genetic variants have been associated with lipid levels in healthy individuals, cardiovascular disease, obesity and diabetes. Our aim was to evaluate the influence of 3 polymorphisms: Hind III, Pvu II and S447X in plasma TG levels in human immunodeficiency virus-1-infected children under highly active antiretroviral therapy (HAART).Fifty-two children diagnosed with human immunodeficiency virus-1 between 2005 and 2009 were retrospectively selected with at least 1 plasma TG level assessment. TG levels were examined before and after 1 year of HAART. Hypertriglyceridemia was defined as TG > 150 mg/dL. Hind III (H+/H-), Pvu II (P+/P-) and S447X (S/X) were determined by polymerase chain reaction and restricted fragment length polymorphism. The Wilcoxon sum-rank test was used to compare median plasma TG among groups. Also, allelic frequencies were estimated for these variants in an Argentinean population.Allelic frequencies for human immunodeficiency virus-1-infected children were: H-, 0.21; P-, 0.53; and X, 0.05 with no significant differences to controls. After 1 year of HAART, median TG levels were significantly lower in P-/P- (98.5 mg/dL) when compared with P+/P+ (180 mg/dL) (P = 0.039). The presence of the P- allele was associated with an 11-fold lower risk of hypertriglyceridemia. Hind III and S447X were not associated with TG at the selected time points.Our findings suggest a protective effect of lipoprotein lipase polymorphisms against hypertriglyceridemia in children after 1 year of HAART. These results could endorse a prompt nutritional or pharmacological intervention in patients lacking the P- allele.

10.1097/inf.0000000000000474

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Effectiveness of a program to improve antibiotic use in children hospitalized in a children’s tertiary care facility in Argentina

Archivos Argentinos de Pediatria (2014)

Juan P. Garrahan Silvina Ruvinsky Andrea Lo Monaco Guadalupe Pérez Moira Taicz

Introduction.Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health.Objective.To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan.Material and Methods.Prospective, longitudinal, before and after study with no control group.Study period: From November 1 st , 2010 to June 30 th , 2011.Patients receiving parenteral antibiotics were included.Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded.The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared.An univariate analysis and a multiple logistic regression study were performed (STATA 8.0).Results.In the pre-intervention period, 376 patients were included; of them, 35.6% had received inadequate treatment.The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26;p = 0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6;p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7;p < 0.01).In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment.A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01).The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93;p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.22-0.94;p= 0.04). Conclusion.The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.

Tertiary care

Tertiary level

10.5546/aap.2014.eng.124

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Citations (6)

CHAGAS DISEASE IN IMMUNOCOMPROMISED PEDIATRIC PATIENTS

Pediatric Research (1990)

Héctor Freilij Roberto Debbag Rosa Bologna M F Sackman

Etiology

Chagas Disease

Nifurtimox

10.1203/00006450-199011000-00052

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HIV and pregnancy: maternal and neonatal evolution.

PubMed (2011)

Diego Cecchini Analía Urueña Patricia Trinidad Fernando Vesperoni Débora Mecikovsky

Data regarding epidemiological aspects, antiretroviral drug safety, and outcomes of HIV-infected pregnant women and their newborns are limited in Argentina. We underwent a retrospective analysis of registries of HIV-infected pregnant women assisted at Helios Salud, Buenos Aires, Argentina (1997-2006). Variables associated with preterm delivery and neonatal complications were analyzed by univariate and logistic regression analyses. A total of 204 mother-child binomium were included. Maternal age (median): 29 years; 32.5% without prior diagnosis of HIV-infection. Baseline median CD4 T-cell count: 417 cell/ųl; 98% received antiretroviral drugs during pregnancy [2 nucleoside analogs plus either nevirapine (55%) or a protease inhibitor (32%)]. Overall incidence of toxicity was 12.5%: rash (8%), anemia (3.5%) and hepatotoxicity (1%). Rash was associated with exposure to nevirapine. Eighty one percent and 50% reached HIV-viral loads <1000 and <50 copies/ml at the end of pregnancy, respectively. Twenty six percent had obstetric complications and 16% had preterm delivery. Of the newborns, 1.6% had congenital defects and 9% had neonatal complications. Overall neonatal mortality was 1% and perinatal transmission was 0.7%. Protease inhibitor use and obstetric complications were associated to preterm delivery while obstetric complications were associated with neonatal complications. In our population, hepatotoxicity was low despite frequent use of nevirapine. Protease inhibitor use was associated to preterm delivery. A favorable virological response and a low rate of perinatal transmission was observed, what supports the consensus that antiretroviral therapy benefits during pregnancy outweigh risks of maternal and neonatal adverse events.

Nevirapine

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Hearing Impairment in Childhood Bacterial Meningitis Is Little Relieved by Dexamethasone or Glycerol

PEDIATRICS (2009)

Heikki Peltola Irmeli Roine Josefina Fernández Antonio González Mata Inés Zavala

Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels.Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression.Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent.With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.

10.1542/peds.2009-0395

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Pre-treatment drug resistance and HIV-1 subtypes in infants from Argentina with and without exposure to antiretroviral drugs for prevention of mother-to-child transmission

Journal of Antimicrobial Chemotherapy (2018)

Paula Aulicino Inés Zapiola Silvia Kademián María M Valle Silvina Fernández Giuliano

To assess the prevalence and patterns of pre-treatment HIV drug resistance (PDR) and HIV-1 subtype in infants from Argentina with exposure to different antiretroviral drugs (ARVs) for the prevention of mother-to-child transmission (PMTCT).HIV-1 genotyping was performed in 115 infants (median age = 2.3 months) born between 2007 and 2014 to screen for drug resistance mutations (DRMs) before starting first-line ART. HIV-1 subtype was characterized by phylogenetic and recombination analysis.Overall, DRMs were found in 34 of 115 infants (PDR level 30% to any ARV, 3.5% to PIs, 12% to NRTIs and 22% to NNRTIs). Of the 115 infants, 22 (19.1%) were ARV-unexposed. Another 93 were ARV-exposed: 28 (24.3%) to short-course zidovudine monotherapy ARV prophylaxis; 25 (21.7%) to nevirapine-based ARV prophylaxis; 12 (10.4%) to perinatal infant zidovudine prophylaxis + maternal combination ART with NNRTIs; and 28 (24.3%) to perinatal infant zidovudine prophylaxis+maternal combination ART with PIs. Transmitted drug resistance among ARV-unexposed infants was 32% (5% to PIs, 9% to NRTIs and 18% to NNRTIs). ART-exposed infants showed multi-class ARV resistance. Importantly, vertical transmission of a triple-class-resistant virus was confirmed in one case. Patterns of DRMs predicted high-level resistance to NNRTIs in a similar and high proportion (>50%) of infants with at least one DRM independently of ARV exposure. BF recombinants were found in 74%, subtype B in 20%, subtype C in 3% and novel AG and AB recombinants in 3%.PDR in HIV-1-infected children from Argentina is among the highest reported, jeopardizing successful lifelong suppressive ART as well as the efficacy of current PMTCT regimens.

Nevirapine

10.1093/jac/dky486

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Citations (13)