Hospital Aleman

Buenos Aires, Argentina

Hospital Aleman

Buenos Aires, Argentina
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Blois S.M.,Charité - Medical University of Berlin | Dechend R.,Max Delbrück Center for Molecular Medicine | Barrientos G.,Hospital Aleman | Staff A.C.,University of Oslo
Cellular and Molecular Life Sciences | Year: 2015

This review discusses a potential role of galectins and the renin-angiotensin system (RAS) in the pathophysiology of preeclampsia (PE). Preeclampsia affects between 3 and 5 % of all pregnancies and is a heterogeneous disease, which may be caused by multiple factors. The only cure is the delivery of the placenta, which may result in a premature delivery and baby. Probably due to its heterogeneity, PE studies in human have hitherto only led to the identification of a limited number of factors involved in the pathogenesis of the disease. Animal models, particularly in mice and rats, have been used to gain further insight into the molecular pathology behind PE. In this review, we discuss the picture emerging from human and animal studies pointing to galectins and the RAS being associated with the PE syndrome and affecting a broad range of cellular signaling components. Moreover, we review the epidemiological evidence for PE increasing the risk of future cardiovascular disease later in life. © Springer Basel 2014.

Nigro C.A.,Hospital Aleman | Dibur E.,Hospital Aleman | Malnis S.,Hospital Aleman | Grandval S.,NeuroLogica | Nogueira F.,NeuroLogica
Sleep and Breathing | Year: 2013

Objective: The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox™ (ALOX) in patients with suspected obstructive sleep apnea (OSA). Methods: All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed. Results: Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m2). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a-RDI, -3.6 ± 10.1; AHI4-a-RDI, -6.5 ± 10.9, p < 0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k = 0.81). Conclusion: The AHI obtained automatically from the ApneaLink Ox™ using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox™ was better than the automatic scoring to discriminate patients with OSA. © 2012 Springer-Verlag.

Mella J.M.,Hospital Aleman | Perret M.C.,Hospital Aleman | Manzotti M.,Hospital Aleman | Catalano H.N.,Hospital Aleman | Guyatt G.,McMaster University
Archives of Dermatology | Year: 2010

Context: Androgenetic alopecia is the most common form of alopecia in men. Objective: To determine the efficacy and safety of finasteride therapy for patients with androgenetic alopecia. Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Registers, and LILACS were searched for randomized controlled trials reported in any language that evaluated the efficacy and safety of finasteride therapy in comparison to treatment with placebo in adults with androgenetic alopecia. Study Selection and Data Extraction: Two reviewers independently evaluated eligibility and collected the data, including assessment of methodological quality ( Jadad score). Outcome measures included patient self-assessment, hair count, investigator clinical assessment, global photographic assessment, and adverse effects at short term (≤12 months) and long term (≥24 months). Heterogeneity was explored by testing a priori hypotheses. Data Synthesis: Twelve studies fulfilled the eligibility criteria (3927 male patients), 10 of which demonstrated a Jadad score of 3 or more. The proportion of patients reporting an improvement in scalp hair was greater with finasteride therapy than with placebo treatment in the short term (relative risk [RR], 1.81 [95% confidence interval (CI), 1.42-2.32]; I2, 64%) and in the long term (RR, 1.71 [95% CI, 1.15-2.53]; I2, 16%); both results were considered to have moderate-quality evidence. Thenumberneeded to treat for 1 patient to perceive himself as improved was 5.6 (95% CI, 4.6-7.0) in the short term and 3.4 (95% CI, 2.6-5.1) in the long term. Moderate-quality evidence suggested that finasteride therapy increased themeanhair count from baseline in comparison to placebo treatment, expressed as a percentage of the initial count in each individual, at short term (mean difference [MD], 9.42% [95% CI, 7.95%-10.90%]; I2, 50%) and at long term (MD, 24.3% [95% CI, 17.92%-30.60%]; I2, 0%). Also, the proportion of patients reported as improved by investigator assessment was greater in the short term (RR, 1.80 [95% CI, 1.43-2.26]; number needed to treat, 3.7 [95% CI, 3.2-4.3]; I 2, 82%) (moderate-quality evidence). Moderate-quality evidence suggested an increase in erectile dysfunction (RR, 2.22 [95% CI, 1.03-4.78]; I2, 1%; number needed to harm, 82.1 [95% CI, 56-231]) and a possible increase in the risk of any sexual disturbances (RR, 1.39 [95% CI, 0.99-1.95]; I2, 0%). The risk of discontinuing treatment because of sexual adverse effects was similar to that of placebo (RR, 0.88 [95% CI, 0.51-1.49]; I2, 5%) (moderate-quality evidence). Conclusion: Moderate-quality evidence suggests that daily use of oral finasteride increases hair count and improves patient and investigator assessment of hair appearance, while increasing the risk of sexual dysfunction. ©2010 American Medical Association. All rights reserved.

Izcovich A.,Hospital Aleman | Malla C.G.,Hospital Aleman | Manzotti M.,Hospital Aleman | Catalano H.N.,Hospital Aleman | Guyatt G.,McMaster University
Neurology | Year: 2014

Objective: Symptomatic orthostatic hypotension (SOH) and recurrent reflex syncope (RRS) can be disabling. Midodrine has been proposed in the management of patients with these conditions but its impact on patient important outcomes remains uncertain. We performed a systematic review to evaluate the efficacy and safety of midodrine in patients with SOH and RRS. Methods: We searched multiple electronic databases without language restriction from their inception to June 2013. We included randomized controlled trials of patients with SOH or RRS that compared treatment with midodrine against a control and reported data on patient important outcomes. We graded the quality of evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: Eleven trials involving 593 patients were included in this review. Three studies addressed health-related quality of life in patients with RRS, showing improvement with midodrine: risk difference 14% (95% confidence interval [CI] 23.5 to 31.6), very low confidence. Seven studies addressed symptom improvement and provided poolable data showing improvement with midodrine in patients with SOH: risk difference 32.8% (95% CI 13.5-48), low confidence; and RRS: risk difference 63.3% (95% CI 47.6-68.2), very low confidence. Five studies reported syncope recurrence in patients with RRS showing improvement with midodrine: risk difference 37%(95% CI 20.8%-47.4%), moderate confidence. The most frequent side effects in the midodrine arm were pilomotor reactions (33.6%, risk ratio 4.58 [95% CI 2.03-10.37]). Conclusions: Evidence warranting low/moderate confidence suggests that midodrine improves clinical important outcomes in patients with SOH and RRS. © 2014 American Academy of Neurology.

Fernandez-Canigia L.,Hospital Aleman | Dowzicky M.J.,Pfizer
Annals of Clinical Microbiology and Antimicrobials | Year: 2012

Background: The Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) is a global surveillance study of antimicrobial susceptibility. This study reports data from Gram-negative isolates collected from centers in Latin America between 2004 and 2010.Methods: Consecutive bacterial isolates were tested at each center using broth microdilution methodology as described by the Clinical Laboratory Standards Institute (CLSI). Susceptibility was determined using the CLSI interpretive criteria. For tigecycline the US Federal Drug Administration (FDA) criteria were used.Results: A total of 16 232 isolates were analyzed. Susceptibility to imipenem, meropenem, and tigecycline was >95% against both non-extended-spectrum β-lactamase (ESBL) and ESBL producing Escherichia coli. Susceptibility to amikacin was also >95% for non-ESBL E. coli. 24.3% of E. coli were ESBL producers, ranging from 11.2% (58/519) in Colombia to 40.3% (31/77) in Honduras. Greater than 90% of non-ESBL Klebsiella pneumoniae were susceptible to tigecycline, carbapenems and amikacin. 35.3% of K. pneumoniae were ESBL producers, ranging from 17.2% (36/209) in Venezuela to 73.3% (55/75) in Honduras, with only imipenem and tigecycline maintaining >90% susceptibility. Greater than 90% of Klebsiella oxytoca, Enterobacter spp., and Serratia marcescens were susceptible to amikacin, carbapenems and tigecycline. The highest rates of susceptibility against Acinetobacter baumannii were seen for minocycline (89.4%) and imipenem (62.5%), while 95.8% of the A. baumannii isolates displayed an MIC ≤2 μg/mL for tigecycline.Conclusions: In this study carbapenems and tigecycline remain active against Enterobacteriaceae and A. baumannii; however, there is cause for concern with carbapenem non-susceptible isolates reported in all countries included in this study. © 2012 Fernández-Canigia and Dowzicky; licensee BioMed Central Ltd.

Cell phenotype does not only depend on the nucleotide sequence, but is determined by those genes that are expressed and those that are not. One way to regulate this gene expression pattern is by modifying the chromatin structure via diverse epigenetic mechanisms. In the present article we present the most important epigenetic mechanisms: deoxyribonucleic acid methylation, histone post-translational modifications, non-coding ribonucleic acid mediated gene-silencing, ATP-dependent chromatin remodeling, and Polycomb and Trithorax group proteins.

Fernandez-Canigia L.,Hospital Aleman | Cejas D.,University of Buenos Aires | Gutkind G.,University of Buenos Aires | Radice M.,University of Buenos Aires
Anaerobe | Year: 2015

A prospective analysis on β-lactam resistance mechanisms and β-lactamase prevalence was conducted on Prevotella intermedia and Prevotella nigrescens recovered from patients with chronic periodontitis and peritonsillar abscesses. Both phenotypic and genotypic methods were performed to characterize the β-lactamases, their coding genes and their genetic contexts. Overall, β-lactamase production was observed in 64% (16/25) P.intermedia and 23.8% (5/21) P.nigrescens (p<0.01). Besides higher β-lactamase production rates were observed in P.intermedia (8/16) than in P.nigrescens (2/16) recovered from chronic periodontitis, almost all isolates from peritonsillar abscesses were producers (8/9 and 3/3, respectively). cfxA, but not cepA and cblA, was detected in those isolates, which were previously categorized as β-lactamase producers. CfxA producing isolates displayed higher β-lactam MICs than non-producers in both species. The most frequent allele was cfxA2, followed by cfxA3 and a new allelic variant named cfxA6. The analysis of the downstream flanking region in the three cfxA variants revealed the association with mobA of Tn. 4555, suggesting their localization in a mobilizable element. β-lactam resistance and cfxA carriage prevalence seems to be not only related to the bacterial species but also to the infection site. © 2015 Elsevier Ltd.

Introduction: The radiological isolated syndrome (RIS) describes persons who incidentally present lesions in central nervous system white matter (WM) in magnetic resonance imaging (MRI) suggestive of multiple sclerosis (MS) with criteria of Barkhof/Tintoré for dissemination in space but they present no signs or symptoms of the disease. Development: The increasingly frequent use of MRI in clinical practice has made it possible to detect nonspecific lesions in WM. The most common cause of a study requirement is migraine. Even before the term RIS was introduced, along with its criteria for diagnosis, longitudinal studies of MRI in health subjects and autopsies found WM lesions suggestive of MS. One problem we face in determining whether if the patients are asymptomatic or not is cognitive deficit, as this is often found in the RIS. The efforts made to increase the amount of available data helped find predictors of progression that are detailed in this review. Possible scenarios of progression are: dissemination in time for MRI or first clinical outbreak. It is estimated that two thirds of the affected progress through RM and a third part progresses by clinic within the time of five years. Regarding the management, recommendations are to wait, follow or treat. The most promoted attitude is to follow these patients with periodic MRI and clinical evaluation. At present there is insufficient evidence to recommend treatment. However, some authors suggest its use in patients with multiple risk factors of progression. The aim of this review is to describe developments regarding diagnosis, prognosis, possible conversion to MS and make a summary of the steps to follow regarding these patients. Conclusions: Prospective studies are needed to allow us to determine if the RIS is a clinical entity itself or a subclinical or asymptomatic form of MS. These studies should validate existing diagnostic criteria, to determine the prevalence, prognosis, impact on quality of life and the beginning of treatment. © 2014 Sociedad Neurológica Argentina. Published by Elsevier España, S.L.U. All rights reserved.

Ciocca M.,Hospital Aleman | Alvarez F.,University of Montréal
Archivos Argentinos de Pediatria | Year: 2012

Alagille syndrome (AS) is a multisystemic disease autosomal dominant, with variable expression. The major clinical manifestations are: chronic cholestasis, congenital heart disease, posterior embryotoxon in the eye, characteristic facial phenotype, and butterfly vertebrae. AS is caused by mutations in JAGGED1 (more than 90%) and in NOTCH2. Differential diagnosis include: infections, genetic-metabolic diseases, biliary atresia, idiopathic cholestasis. Cholestasis, pruritus and xanthomas have been successfully treated with choleretic agents (ursodeoxycholic acid) and other medications (cholestyramine, rifampin, naltrexone). In certain cases, partial external biliary diversion has also proved successful. Liver transplantation is indicated in children with cirrhosis and liver failure.

During the last two decades, the outcome of various gene therapy protocols lead to medical community disbelief. Nevertheless, successful results obtained in recent years, repositioned gene therapy as a promising option for treatment of several diseases. Facing this renaissance of the international scientific community interest on gene therapy, it seems to be necessary for the generalist physician to understand its strength and limitations. The objective of this article is to comment the way gene therapy addresses nowadays the treatment of such different pathologies as neoplasias, infections and monogenic diseases.

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