Buenos Aires Children Research Articles

Long-term cardiology outcomes in children after early treatment for Chagas disease, an observational study.

Parasite persistence after acute infection with Trypanosoma cruzi is an important factor in the development of Chagas disease (CD) cardiomyopathy. Few studies have investigated the clinical effectiveness of CD treatment through the evaluation of cardiological events by long term follow-up of treated children. Cardiological evaluation in children is challenging since features that would be diagnosed as abnormal in an adult's ECG may be normal, age-related findings in a pediatric ECG trace. The objective was to evaluate cardiac involvement in patients with Chagas disease with a minimum follow-up of 6 years post-treatment. A descriptive study of a cohort of pediatric patients with CD treated with benznidazole (Bz) or nifurtimox (Nf) was conducted. Children (N = 234) with at least 6 years post CD treatment followed at the Parasitology and Chagas Service, Buenos Aires Children's Hospital (Argentina) were enrolled. By convenience sampling, children who attended a clinical visit between August 2015 and November 2019 were also invited to participate for additional cardiovascular studies like 24-hour Holter monitoring and speckle-tracking 2D echocardiogram (STE). Benznidazole was prescribed in 171 patients and nifurtimox in 63 patients. Baseline parasitemia data was available for 168/234 patients. During the follow-up period, alterations in routine ECG were observed in 11/234 (4.7%, 95% CI [2-7.4%]) patients. In only four patients, with complete right bundle branch block (cRBBB) and left anterior fascicular block (LAFB), ECG alterations were considered probably related to CD. During follow-up, 129/130 (99%) treated patients achieved persistent negative parasitemia by qPCR. Also decrease in T.cruzi antibodies titers was observed in all patients and negative seroconversion occurred in 123/234 (52%) patients. A low incidence of cardiological lesions related to CD was observed in patients treated early for pediatric CD. This suggests a protective effect of parasiticidal treatment on the development of cardiological lesions and highlights the importance of early treatment of infected children. ClinicalTrials.gov NCT04090489.

Congenital syphilis in Argentina: Experience in a pediatric hospital.

In spite of being preventable, Congenital syphilis (CS) is still an important, and growing health problem worldwide. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and, if left untreated, develop systemic compromise afterwards with poor prognosis. We analyzed 61 CS diagnosis cases between 1987-2019 presenting at the Buenos Aires Children' Hospital. The distribution of cases showed a bimodal curve, with a peak in 1992-1993 and in 2014-2017. Median age at diagnosis was 2 months (IQ 1-6 months). The main clinical findings were: bone alterations (59%); hepatosplenomegaly (54.1%); anemia (62.8%); skin lesions (42.6%) and renal compromise (33.3%). Cerebrospinal fluid (CSF) was abnormal in 5 patients, normal in 45 and was not available for 11 patients. Remarkably, spinal lumbar puncture did not modify therapeutic decisions in any case. Between mothers, only 46% have been tested for syphilis during pregnancy and 60.5% patients had non-treponemal titers equal to or less than fourfold the maternal titer. Intravenous penicillin G was prescribed for all except one patient, who received ceftriaxone with good therapeutic response. During follow-up, 1.6% infants died, 6.5% had persistent kidney disorders and 1.6% showed bone sequelae damage. RPR titers decreased after treatment, reaching negative seroconversion in 43% subjects at a median of 26.4 months. Low adherence to follow up was observed due to inherent vulnerable and low-income population characteristics in our cohort. Our results highlight a rising tendency in cases referred for CS in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed. CS requires a greater effort from the health system to adequately screen for this disease during pregnancy, and to detect cases earlier, to provide an adequate diagnosis and treatment.

Activity of the antioxidant enzyme paraoxonase in Argentinean children living at high altitude

ABSTRACTBackground: Children living at high altitude in San Antonio de los Cobres (SAC), Argentina, were shown to have lower high-density lipoprotein cholesterol (HDL-C) levels than Buenos Aires (BA) children. HDL antioxidant capacity is mainly attributed to paraoxonase1 (PON1).Objective: To compare PON1 activity in indigenous SAC vs. BA children.Methods: A cross-sectional study compared 158 SAC vs. 97 BA children (6–16 years). Anthropometric data and lipoprotein profile were measured. PON1 was evaluated employing paraoxon (PON) and phenylacetate (ARE) activity.Results: The prevalence of overweight/obesity was lower in SAC than in BA children (18.3 vs. 30.9%). Triglycerides (1.34 vs. 0.90 mmol/l), apo B (0.84 vs.0.72 g/l), apo A-I (1.33 vs. 1.27 g/l), and ARE activity (100 vs. 90 µmol/ml/min) were higher, while HDL-C (1.16 vs. 1.32 mmol/l) and PON activity (170 vs. 203 nmol/ml/min) were lower in SAC than in BA. Separate multiple linear regression analyses showed that SAC children had significantly higher triglyceride (Beta −0.38), apo B (Beta −0.34), and ARE (Beta −0.36) plus lower HDL-C (Beta 0.33) and PON (Beta 0.25) compared with BA; adjusted for age, gender, and BMI.Conclusion: SAC showed an unfavorable lipoprotein profile, lower PON and higher ARE activities compared with BA children, suggesting the presence of altered HDL metabolism and antioxidant capacity.

Healthier Lipid Profiles with Vitamin D Supplementation in a Pilot Study in Argentinean Children of Two Ethnicities.

to explore changes in lipid levels in two groups of children of different ethnicities who were able to access vitamin D supplementation versus those who were not. A prospective one-year study evaluated 87 San Antonio de los Cobres (SAC) Indigenous and 36 Buenos Aires (BA) urban schoolchildren aged 9.7 + 2.1 years between October 2013 and October 2014. SAC children included 70 (80.5%) treated with 100,000 IU/year of vitamin D and 17 (19.5%) untreated; and BA children included 25 (69,5%) treated and 11(30.5%) untreated. BMI, lipids, and 25-hydroxyvitamin D (25(OH)D) concentrations were measured at baseline and after one year. There was a significantly lower prevalence of overweight/obesity in SAC (n = 7; 8%) versus BA (n = 7; 36.4%) children. There was a significant association between changes in (25(OH)D) and changes in HDL-C levels in SAC (r0.44;p < 0.01) and in BA (r0.34;p < 0.05). Multiple linear regression analyses showed that changes in (25(OH)D ) were significantly associated with changes in HDL-C in SAC (Beta = 0.55, p = 0.02; R20.11) and BA children (Beta = 0.42, p = 0.04; R2 0.21) adjusted for age, gender, and BMI. Furthermore, multiple logistic regression analysis showed that children in the treated group had a likelihood six times greater of having HDL-C >40 mg/dL than the untreated group, adjusted for age, gender, and BMI (OR 6.3: CI 2.0 - 19.8; p < 0.01). These results suggest that children who had received vitamin D supplementation had significantly higher vitamin D status and HDL-C, as compared with non-supplemented children in both communities.

Status of Dyslipidemia in Vitamin D Supplemented Argentinean Indigenous Children Versus A Non-supplemented Mixed Population Group.

Epidemiological studies have suggested an inverse association between circulating levels of vitamin D and cardiovascular disease risk biomarkers, including an atherogenic lipid profile. To compare the prevalence and the distribution of lipid levels among vitamin D supplemented Argentinean indigenous San Antonio de los Cobres (SAC) children with a nonsupplemented Buenos Aires (BA) mixed population group. A group of indigenous children from SAC with hypovitaminosis D supplemented with vitamin D; and a nonsupplemented group from a BA mixed population were compared via a cross sectional study. Anthropometric measures, glucose, lipids, vitamin D, and insulin were measured. The mean ages were 10.3 + 2.3 in SAC and 8.7 ± 1.8 years in BA children. There was a lower prevalence of overweight 7.9%(15/192) vs 17.8% (23/129); and of obesity 1.6% (3/192) vs 30.2% (39/129) in SAC vs. BA respectively. Approximately half of the SAC children versus 30% from BA had optimal vitamin D levels (≥30ng/mL). There was a significantly higher prevalence of high triglycerides (TG) (27.6%vs 4.6%) and low HDL-C (21.3% vs 5.4%) in SAC vs BA children, respectively. In separate linear regression models, we found that despite effective vitamin D repletion, SAC children had higher TG and TG/HDL-C values, whereas HDL-C levels were lower than those of BA children adjusted for age, gender, BMI, and insulin levels. Indigenous Argentinean children have a higher risk for dyslipidemia in comparison with BA children, even after vitamin D treatment, suggesting that dyslipidemia could be related to diet or ethnic backgrounds.

Only one health, and so many omics.

The development of new approaches based on wide profiling methods in studying biological and medical systems is bringing large amounts of data on a daily basis.The causes of complex diseases have been directed to the genome examination bringing formidable knowledge. We can study genome, but also proteome, exome, transcriptome, epigenome, metabolome, and newcomers too such as microbiome, connectome and exposome. The title of this editorial is paraphrasing the famous saying of Victor Schlichter from Buenos Aires children hospital in Argentina who said “How unfair! Only one health, and so many diseases”. Today there is indeed a whole lot of omics. We think that we are lucky to have all the omics possible, but we also wanted to stress the importance of future holistic approach in integrating the knowledge omics has rewarded us.

Maternal misperceptions of children's overweight in an indigenous Argentinean community.

To compare the prevalence of misperception between 2 groups of mothers towards their children's weight status from an indigenous population in San Antonio de los Cobres (SAC) and a Buenos Aires (BA) mixed population. Questionnaires regarding mothers' perceptions about their children's shape were performed during 2014. Overall, 152 SAC children (80 males) aged 9.0+2.1 years and 119 BA children (59 males) aged 8.1+1.7 years were evaluated. There was a significant difference in the prevalence of maternal misperception of normal weight vs overweight children in both ethnicities: SAC (38.8% vs 66.7%) and BA (33.3% vs 62.9%). These results suggest that maternal misperception of children's overweight was poor in both communities despite having different socio-economic and ethnic backgrounds.

Association of vitamin D with glucose levels in indigenous and mixed population Argentinean boys

IntroductionThere is little information about low vitamin D concentrations in apparently healthy indigenous children in South America. Objectives(a) To compare the prevalence of hypovitaminosis D in SAC (San Antonio de los Cobres) versus BA (Buenos Aires) boys and (b) to determine the association of serum vitamin D concentration with age, gender, and risk factors for diabetes. MethodsThis cross-sectional study compares 129 boys from SAC with a 98% indigenous population, versus 116 boys from BA with a mixed population. Anthropometric measures and serum levels of glucose, lipids, insulin, and 25-hydroxyvitamin D [25(OH)D] were measured in May 2011 and May 2010 (fall season). Optimal, insufficiency, deficiency, and severe deficiency of vitamin D were defined as [25(OH)D[levels ≥75nmol/L, 50 to <75nmol/L, 25 to <50nmol/L, and <25nmol/L respectively. ResultsThe mean age was 9.7±2.7 in SAC and 11.3±2.51years in BA children. Seventeen (13.2%) SAC and 2 (1.7%) BA children were underweight; 99 (76.7%) SAC and 58 (50.0%) BA children were normal weight; 5 (3.9%) SAC and 15 (12.9%) BA children were overweight; and 8 (6.2%) SAC and 41 (35.3%) BA children were obese (p<0.001). Sixty-six (51.2%) SAC and 1 (0.9%) BA children had vitamin D severe deficiency; 58 (45.0%) SAC and 53 (45.7%) BA children had deficiency; 5 (3.9%) SAC and 61 (52.6%) BA had insufficiency; and 0 (0%) SAC and 1 (0.9%) BA children had optimal vitamin D (p<0.001). Therefore, there was a lower prevalence of overweight/obesity and a higher prevalence of vitamin D deficiency in SAC than in BA children. Separate linear regression models showed an inverse association between glucose levels (beta=−0.22; p=0.01) and HOMA=IR (beta=−0.21; p=0.02) with vitamin D levels adjusted for age, z-BMI and community. ConclusionsThere was a higher prevalence of 25(OH)D deficiency in SAC versus BA boys, suggesting that dark skin, high altitudes, or genetic backgrounds could contribute to this problem. In addition, we found an inverse association between [25(OH)D] and glucose concentration in apparently healthy children. Additional longitudinal studies should be done to confirm these findings.

Dyslipidemia without Obesity in Indigenous Argentinean Children Living at High Altitude

To compare the prevalence of cardiovascular disease risk factors in Indian children from San Antonio de los Cobres (SAC) and children from Buenos Aires (BA), and to examine body mass index (BMI), waist circumference (WC), and WC/height as predictors of dyslipidemia in both groups. Data were collected cross-sectionally from BMI, WC, blood pressure, Tanner scale, glucose, lipids, and insulin. Dyslipidemia was defined by the National Cholesterol Education Program and American Heart Association. The mean ages were 10.6 ± 3.0 and 9.5 ± 2.0 years in SAC vs BA children. Of the 330 SAC children, 15 (4.5%) were overweight and 12 (3.6%) obese, and of the 603 BA, 97 (16.1%) were overweight and 82 (13.6%) obese per Centers for Disease Control. There was a significantly higher prevalence of high triglycerides (28.8% vs 3.5%) and low high-density lipoprotein cholesterol (30.0% vs 5.5%) in SAC vs BA children. The areas under the receiver operating characteristic curve in predicting high triglycerides were BMI = 0.55 (95% CI, 0.48-0.62; P = .15) in SAC and BMI = 0.65 (95% CI, 0.52-0.77; P = .02) in BA children. Similar results from the areas under the receiver operating characteristic curve were obtained when low high-density lipoprotein cholesterol was used, indicating that BMI was not a significant predictor for dyslipidemia in SAC children. When BMI was replaced by WC and WC/height, results were similar. Anthropometric markers were not an acceptable predictor for National Cholesterol Education Program cutoffs for dyslipidemia in SAC children. Longitudinal studies should determine if SAC children are at high risk for cardiovascular diseases because of genetic background.

Lifestyle behaviors and dyslipidemia in Argentinean native versus urban children

ObjectiveTo determine the prevalence and distribution of dyslipidemia among urban children from Buenos Aires (BA) versus Koya Indian from San Antonio de los Cobres (SAC). Design and methodsAnthropometric measures, blood pressure, Tanner stages, glucose, lipids and insulin were measured. Dyslipidemia was defined by the NCEP (the National Cholesterol Education Program standards) and AHA (American Heart Association) criteria. ResultsThe mean ages were 10.6±3.0 of SAC and 9.5±2.0years of BA children. Of the 603 BA children, 97 (16.1%) were overweight (OW) and 82 (13.6%) obese (OB), and of 330 SAC, 15 (4.5%) were OW and 12 (3.6%) OB (p<0.01). Twenty six percent SAC vs 2.5% BA children ate ≥5 servings/day of fruits and vegetables (p<0.001), 30% SAC vs 59% BA children watched TV≥2h/day(p<0.001), and 8.2% SAC vs 13.1% BA children skipped breakfast (p<0.001). In separate linear regression models, we found that SAC children had a 1.8mmol/L (p<0.001) higher hemoglobin level, a 0.56mmol/L higher triglyceride level (p<0.001), a 0.15mmol/L higher total cholesterol level (p=0.001), a 0.19mmol/L higher LDL-C level (p<0.001), and a 0.33mmol/L lower HDL-C level (p<0.001) than BA children adjusted for confounding factors. ConclusionKoya children have a higher risk for dyslipidemia in comparison with BA children, even after controlling for lifestyle behaviors, obesity, age, and sex , suggesting that dyslipidemia could be related to their genetic backgrounds.

Development of Pediatric Cardiology in Latin America

Until the first quarter of the 20th century, most physicians were more than happy to differentiate congenital heart lesions from rheumatic heart disease, which then was rampant. As early as 1932, Dr Rodolfo Kreutzer, from Buenos Aires, Argentina, was already involved in the study of congenital heart defects. He started off assessing children with a stethoscope and with Einthoven electrocardiography equipment. The cardiac unit at the Buenos Aires Children's Hospital was created in 1936. It established the onset of pediatric cardiology in Argentina and fueled its development in South America. Nearly at the same time, Agustin Castellanos from Cuba also became a pioneer in the assessment of congenital heart disease. He described the clinical applications of intravenous angiocardiography in 1937. Meanwhile in Mexico, Dr Ignacio Chavez founded the National Institute of Cardiology in 1944 in Mexico City. It was the first center in the world to be exclusively devoted to cardiology. From this center, Victor Rubio and Hugo Limon performed the first therapeutic cardiac catheterization in 1953. Meanwhile, Professor Euriclydes Zerbini from Sao Paulo, Brazil, built the largest and most important school of cardiac surgeons in South America. In Santiago, Chile, the Calvo Makenna Hospital was the center where Helmut Jaegger operated on the first infant with extracorporeal circulation in Latin America in 1956. The patient was a 1-month-old baby, with complete transposition of the great arteries, who underwent an Albert procedure. Currently, there are many fully equipped centers all over the region, capable of dealing with most lesions and of providing excellent medical, interventional, and surgical treatment. Outcomes have improved substantially over the last 20 years. These achievements have gone beyond our pioneers' dreams. However, many neonates and young infants die prior to surgery because referral centers are overburdened and have long surgical waiting lists. Clearly, we still have to mastermind and establish sustainable public health policies to overcome these challenges.

Ultrastructural Pathology of the Sperm Flagellum: Association Between Flagellar Pathology and Fertility Prognosis in Severely Asthenozoospermic Men

No AccessJournal of UrologyUrological Survey: Abstracts: Male Infertility1 May 1999Ultrastructural Pathology of the Sperm Flagellum: Association Between Flagellar Pathology and Fertility Prognosis in Severely Asthenozoospermic Men H.E. Chemes, S. Brugo Olmedo, C. Carrere, R. Oses, C. Carizza, M. Leisner, and J. Blaquier H.E. ChemesH.E. Chemes More articles by this author , S. Brugo OlmedoS. Brugo Olmedo More articles by this author , C. CarrereC. Carrere More articles by this author , R. OsesR. Oses More articles by this author , C. CarizzaC. Carizza More articles by this author , M. LeisnerM. Leisner More articles by this author , and J. BlaquierJ. Blaquier More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)69031-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Ultrastructural Pathology of the Sperm Flagellum: Association Between Flagellar Pathology and Fertility Prognosis in Severely Asthenozoospermic Men." The Journal of Urology, 161(5), p. 1725 Laboratory of Testicular Physiology and Pathology, Endocrinology Division, Buenos Aires Children's Hospital, Buenos Aires, Argentina© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 161Issue 5May 1999Page: 1725 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information H.E. Chemes More articles by this author S. Brugo Olmedo More articles by this author C. Carrere More articles by this author R. Oses More articles by this author C. Carizza More articles by this author M. Leisner More articles by this author J. Blaquier More articles by this author Expand All Advertisement PDF downloadLoading ...

Dysplasia of the fibrous sheath: an ultrastructural defect of human spermatozoa associated with sperm immotility and primary sterility : Chemes HE; Brugo S; Zanchetti F; et al Laboratory of Testicular Physiology and Pathology, Endocrine Unit, Buenos Aires Children's Hospital, Buenos Aires, Argentina Fertil. Steril.; 48/4 (664–669)/1987/

Dysplasia of the fibrous sheath: an ultrastructural defect of human spermatozoa associated with sperm immotility and primary sterility : Chemes HE; Brugo S; Zanchetti F; et al Laboratory of Testicular Physiology and Pathology, Endocrine Unit, Buenos Aires Children's Hospital, Buenos Aires, Argentina Fertil. Steril.; 48/4 (664–669)/1987/