Macarena Roel

Subjective cognitive difficulties are common in midlife and later life, and flavonoid-rich foods may support everyday cognitive function. Tartary buckwheat ( Fagopyrum tataricum ) sprouts are rich in rutin and other flavonoids, but their cognitive effects have not been tested in humans. In this randomized, double-blind, placebo-controlled trial, US adults with self-reported cognitive difficulties received 18 g per day of Himalayan Tartary buckwheat (HTB) sprout powder or matched placebo for 12 weeks. Of 848 randomized participants, 662 were analyzed. While the rate of change in the primary outcome, PROMIS Cognitive Function, did not differ between arms (contrast = 0.03, 95% CI −0.07 to 0.13; p = .59), PROMIS Cognitive Abilities improved nominally faster with HTB (contrast = 0.12, 95% CI 0.00 to 0.24; p = .046), but not after Bonferroni adjustment. Among participants with final-week data (n = 296), more HTB than placebo participants achieved a meaningful (≥0.5 SD) improvement in Cognitive Abilities (68.7% vs 52.5%; RR = 1.32, 95% CI 1.10 to 1.59; p = .003). Fatigue, sleep-related impairment and depressive symptoms did not differ between arms. In exploratory computerized testing (n = 512), HTB participants had faster reaction times on the Flanker and Stroop tasks, without loss of accuracy. Exploratory epigenetic analyses (n = 34) identified hypothesis-generating signals in epigenetic age and immune-cell composition, none surviving multiple-testing correction. Side-effect rates were similar between arms. HTB sprout powder did not improve the primary outcome, but findings for perceived cognitive abilities and processing speed warrant confirmation in adequately powered trials. Trial registration: NCT07245784 .

Introduction: Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a preferred antiretroviral regimen in international guidelines, but long-term real-world data in Latin American people living with HIV (PLWH) are scarce. This study describes 48-month persistence, virological effectiveness, safety and metabolic changes in the Argentine BICTARG cohort. Material and methods: We conducted an observational, retrospective, open cohort study including treatment-naïve (TN) and treatment-experienced (TE) adults with HIV who initiated B/F/TAF between October 2019 and December 2022 at a large HIV centre. Persistence on B/F/TAF, virological suppression (VS, <50 copies/mL), B/F/TAF-related adverse events (AEs), and metabolic parameters (fasting glucose, cholesterol, and triglycerides) were assessed at 24, 36 and 48 months. Results: Overall, 3,057 PLWH were included: 425 TN (14%) and 2,632 TE (86%). In TN, persistence at 24, 36 and 48 months was 99%, 97% and 95%, and VS rates were 95%, 93% and 90%, respectively, with no AEs reported. In TE, persistence was 98%, 96%, and 88%, and VS rates were 96%, 98%, and 98%; AE rates were ≤0.4%, with no virological failure. Fasting glucose remained unchanged; TN participants showed increases in total, LDL, and HDL cholesterol, whereas in TE participants, lipid levels were stable and triglycerides decreased over time (p<0.001). Conclusions: In this large Argentine cohort, B/F/TAF demonstrated high persistence, sustained VS, low AE rates and an overall favourable metabolic profile over 48 months in both TN and TE PLWH, providing the first long-term real-world evidence from Latin America.

Ntroduction. Sepsis is one of the leading causes of pediatric mortality in Argentina. The aim was to describe the epidemiological characteristics of sepsis and septic shock (ESSPED-2 study) in pediatric intensive care units (PICUs) in Argentina and compare them with previous data from the Epidemiological Study of Severe Pediatric Sepsis (ESSPED). Population and methods. An observational, cross-sectional, prospective study in patients with sepsis hospitalized in PICUs in Argentina from September 15, 2021, to December 15, 2021. Results. A total of 3230 patients were admitted to 55 PICUs. We included 428 patients who had 476 events. The median age was 17 months (4.2-74.2). The prevalence was 14.7%, and the 28-day mortality rate was 16.5%; 36.7% of patients did not receive antibiotics within the first hour. Receiving more than 60 mL/kg of fluids in the first 60 minutes showed a negative trend in mortality. Patients with comorbidities, septic shock, acute respiratory distress syndrome (ARDS), dysfunction of 2 or more organs, and phenotype D had higher mortality. The clinical characteristics and prevalence remained unchanged, whereas the administration of fluids and the use of vasoactive drugs changed, and mortality rates decreased significantly. Conclusions. Sepsis is an event of high prevalence and mortality in Argentina. In the multivariate analysis, the variables lose relevance, except for the presence of dysfunction in 2 or more organs, septic shock, a Pediatric Mortality Index (PMI3) value greater than 15, or being an immunocompromised host.

Background Portal hypertension in children can result from a wide range of liver diseases, both cirrhotic and non-cirrhotic. Non-invasive diagnosis of esophageal varices, a potentially life-threatening complication, is of utmost importance in these patients. Objective To assess the agreement between spleen stiffness by bidimensional shear wave elastography (2D SWE) and endoscopic findings (presence and grading of esophageal varices) in pediatric patients with portal hypertension. Materials and methods Single-center retrospective observational study between February 2021 and August 2024. Data from pediatric patients (< 18 years old) who underwent esophagogastroduodenoscopy within a month of a grayscale ultrasound including spleen elastography were collected. Patients were divided into three groups: varices-free, low-risk varices, and high-risk varices (enlarged tortuous varices with red color sign, or large size varices). The area under the receiver operating characteristic curve (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were estimated. Results We included 163 patients (86 males, 77 females; median age: 9 years (interquartile range (IQR) 6–13 years)). The sample included 80 varices-free (49%), 38 low-risk varices (23%), and 45 high-risk varices (28%) cases. The median spleen elastography was 20 kPa (2.58 m/s), 34 kPa (3.36 m/s), and 40 kPa (3.65 m/s) in the varices-free, low-risk, and high-risk varices groups, respectively. When a cut-off value of 28.5 kPa (3.08 m/s) was used to detect varices of any grade, the sensitivity was 93% (95% confidence interval: 85–97), the specificity was 94% (86–98), PPV 94% (86–98), and NPV 93% (85–97). An AUROC of 0.93 (0.90–0.98) was obtained. When comparing the high versus low-risk varices groups, using a cut-off point of 35.35 kPa (3.43 m/s), we obtained an AUROC of 0.66, with a sensitivity of 71%, specificity of 61%, PPV 68%, and NPV of 64%. Conclusion Spleen stiffness by bidimensional shear wave elastography showed excellent diagnostic performance for detecting esophageal varices in children with portal hypertension and a moderate performance for distinguishing patients with low-risk varices from those with high-risk varices. Graphical Abstract

Introduction: Dolutegravir plus lamivudine (DTG/3TC) dual therapy has demonstrated efficacy in HIV treatment, but access remains challenging in Latin America. Argentina approved a generic co-packaged DTG+3TC presentation to improve accessibility. This study evaluated the effectiveness and safety of co-packed DTG/3TC compared to DTG-based triple therapy in clinical practice. Materials and methods: A retrospective observational cohort study conducted between October 2019 and November 2023 at a reference HIV center in Argentina. Treatment-experienced people living with HIV (PLWH) with viral suppression who switched to either co-packaged DTG/3TC or DTG-based triple therapy were included. Primary outcomes included persistence, virologic suppression rates (VSR), and safety at 6, 12, and 18 months. Results: Of 599 PLWH, 245 (41%) switched to dual therapy and 354 (59%) to triple therapy. Persistence rates for dual therapy at 6, 12, and 18 months were 99%, 100% and 98%; for triple therapy: 99%, 97% and 97%, respectively. VSR for dual therapy were 99%, 98% and 99%; for triple therapy: 99%, 97% and 98% at the same timepoints. Adverse event rates were low in both groups: dual therapy (0.5%, 0%, 0.8% at 6, 12, 18 months) and triple therapy (1.2%, 0.7%, 0.4% at 6, 12, 18 months). Conclusions: Co-packaged DTG/3TC demonstrated high persistence and virologic suppression rates with a favorable safety profile in clinical practice. Its effectiveness and safety were comparable to DTG-based triple therapy, supporting its use as a cost-effective alternative for treatment-experienced PLWH in resource-limited settings.

Background: Worldwide, there has been a worrying increase in the prevalence of syphilis. Blood banks have a major role in monitoring the trend of these events, despite the bias due to the altruistic donation strategy.Objectives: To determine the seroprevalence of syphilis and analyse its association with defined risk factors among blood donors at the regional blood center at Hospital Prof. Dr. J. P. Garrahan, period 2016–2022.Materials and Methods: Donor screening was performed with treponemal and non‐treponemal tests to determine the prevalence of active and past syphilis. Sociodemographic characteristics of donors were analysed and the association with potential risk factors was assessed.Results: A total of 72 874 donations were processed during the study period. The overall prevalence of specific anti‐Treponema pallidum antibodies was 0.69% (95% CI = 0.63–0.75). Active syphilis seroprevalence was 0.30% (95% CI = 0.25–0.33). Not active syphilis seroprevalence was 0.39% (95% CI = 0.35–0.44). Anti‐T. pallidum seroprevalence among first‐time donations was 1.26% (95% CI = 1.14–1.38) while in repeat donations it was 0.16% (95% CI = 0.12–0.21). In univariate analysis, we found an association between syphilis and having a history of any sexually transmitted infection (OR: 5.09, 95% CI = 2.20–11.70, p < 0.01) and being first‐time donors (OR: 3.48, 95% CI = 1.70–7.09, p = 0.0001).Conclusion: Although the overall prevalence of syphilis is 0.69%, among repeat donors prevalence as low as 0.16% was found. This demonstrates the need to maintain and improve screening strategies and promotion of voluntary, altruistic and repeat donation.

Background: Data on the health impact of carbapenem-resistant Enterobacteriaceae bloodstream infections (CRE-BSIs) in pediatric populations from Latin America and the Caribbean (LAC) are limited. This systematic review aims to examine the demographic, clinical, and microbiological aspects and resource utilization of this infection in children from this region. Methods: This systematic review investigates the impact of CRE-BSIs in pediatric populations across LAC. Following the Cochrane methodology and PRISMA/MOOSE guidelines, we conducted an extensive search of different databases, including MEDLINE/PubMed, LILACS (SciELO), CENTRAL, CINAHL, Embase (Ovid), the Cochrane Library, and the World Health Organization (WHO) database, and relevant websites for published articles between January 2012 and September 2024. The review included studies on hospitalized patients under 19 years of age with CRE-BSIs. Results: Fourteen studies involving 189 patients were analyzed. Most cases were reported from Brazil, Argentina, Colombia, and Paraguay. The median age of the patients was 35 months. Key risk factors included immunocompromised status, invasive procedures, carbapenem use, and colonization. The infections were predominantly hospital-acquired, with Klebsiella pneumoniae and Serratia spp. being the most common pathogens. KPC and NDM were the primary resistance mechanisms. Most patients received combination antimicrobial therapy for a median of 17 days. An alarmingly high mortality rate at 34% was found. Conclusions: Our findings highlight that CRE-BSIs pose a significant threat to children with underlying conditions in LAC, leading to substantial morbidity and mortality. Implementing robust antimicrobial stewardship programs and effective infection control measures are crucial to curbing the spread of CRE-BSIs in the region. This review underscores the need for targeted interventions and further research to address this critical public health concern in pediatric populations across LAC.

Background: Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents.Methods: We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0–18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023.Results: A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%–28% of cases were asymptomatic, 68%–88% were mild or moderate, and 3%–10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC.Conclusion: Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.

OBJECTIVE: Endoscope-assisted repair of sagittal craniosynostosis is an effective technique that requires a learning curve. Surgical simulation models can be applied to acquire the necessary skills for this procedure. Several models with a wide range of costs have been described for training in this technique. The aim of this work was to present the results of training with a low-cost simulation model for endoscope-assisted sagittal craniosynostosis repair. METHODS: A simulation model for sagittal craniosynostosis was developed using low-cost materials. The model is easily assembled and allows successive uses. Three neurosurgery residents, 3 fellows, and 2 neurosurgeons performed a 4-session training program in sagittal craniosynostosis repair. The Global Rating Scale (GRS) score, number of errors, and the time required to perform the task were reported by 2 independent evaluators using a checklist. Measurements were compared between the first and last training using the Wilcoxon signed-rank test. All participants completed a questionnaire (5-point Likert scale) regarding the realism of the simulation model. RESULTS: A model was developed to recreate the steps required to perform an endoscope-assisted scaphocephaly repair with the patient in a simulated sphinx position. All participants improved their GRS performance between the first and final training. The median time needed to perform the initial training was 47.5 minutes (interquartile range [IQR] 44.5–48 minutes, interrater difference [IRD] p = 0.77), and for the last training was 40.5 minutes (IQR 35.5–43 minutes, IRD p > 0.99). The median number of errors reported in the initial training was 5.5 (IQR 3–7.75 errors, IRD p = 0.8), and in the last training was 1 (IQR 0.75–2.25 errors, IRD p = 0.35). There was a statistically significant difference regarding the time and number of errors between the initial and final training (p < 0.001). More than 85% of the participants found that the surface anatomy, skull and anterior fontanel, fused sagittal suture, and epidural space of the model were realistic and had appropriate detail required to perform the surgery. All respondents agreed or strongly agreed that the endoscope handling was realistic, and that the steps and skills required to complete the task were representative of those required for the real procedure. CONCLUSIONS: A low-cost sagittal craniosynostosis simulation model was developed, allowing successive uses. The acquisition of skills within the simulation was demonstrated for all participants regarding the GRS score and the number of errors and time needed to perform the task. In addition, the model was found to be realistic in terms of anatomical references and the procedural steps required for this minimally invasive technique.