RESUMO
Meningococcal (Neisseria meningitidis) serogroup B (MenB) strain antigens are diverse and a limited number of strains can be evaluated using the human serum bactericidal antibody (hSBA) assay. The genetic Meningococcal Antigen Typing System (gMATS) was developed to predict the likelihood of coverage for large numbers of isolates by the 4CMenB vaccine, which includes antigens Neisseria adhesin A (NadA), Neisserial Heparin-Binding Antigen (NHBA), factor H-binding protein (fHbp), and Porin A (PorA). In this study, we characterized by whole-genome analyses 284 invasive MenB isolates collected from 2010 to 2014 by the Argentinian National Laboratories Network (52-61 isolates per year). Strain coverage was estimated by gMATS on all isolates and by hSBA assay on 74 randomly selected isolates, representative of the whole panel. The four most common clonal complexes (CCs), accounting for 81.3% of isolates, were CC-865 (75 isolates, 26.4%), CC-32 (59, 20.8%), CC-35 (59, 20.8%), and CC-41/44 (38, 13.4%). Vaccine antigen genotyping showed diversity. The most prevalent variants/peptides were fHbp variant 2, NHBA peptides 24, 21, and 2, and PorA variable region 2 profiles 16-36 and 14. The nadA gene was present in 66 (23.2%) isolates. Estimated strain coverage by hSBA assay showed 78.4% of isolates were killed by pooled adolescent sera, and 51.4% and 64.9% (based on two different thresholds) were killed by pooled infant sera. Estimated coverage by gMATS (61.3%; prediction interval: 55.5%, 66.7%) was consistent with the infant hSBA assay results. Continued genomic surveillance is needed to evaluate the persistence of major MenB CCs in Argentina.
The most common clinical manifestations of invasive meningococcal disease include meningitis and septicemia, which can be deadly, and many survivors suffer long-term serious after-effects. Most cases of invasive meningococcal disease are caused by six meningococcal serogroups (types), including serogroup B. Although vaccines are available against meningococcal serogroup B infection, these vaccines target antigens that are highly diverse. Consequently, the effectiveness of vaccination may vary from country to country because the meningococcal serogroup B strains circulating in particular regions carry different forms of the target vaccine antigens. This means it is important to test serogroup B strains isolated from specific populations to estimate the percentage of strains that a vaccine is likely to be effective against (known as 'vaccine strain coverage'). The genetic Meningococcal Antigen Typing System (gMATS) was developed to predict strain coverage by the four-component meningococcal serogroup B vaccine, 4CMenB, against large numbers of serogroup B strains. In this study, we analyzed 284 invasive meningococcal serogroup B isolates collected between 2010 and 2014 in Argentina. Genetic analyses showed that the vaccine antigens of the isolates were diverse and some genetic characteristics had not been found in isolates from other countries. However, vaccine strain coverage estimated by gMATS was consistent with that reported in other parts of the world and with strain coverage results obtained for a subset via another method, the human serum bactericidal antibody (hSBA) assay. These results highlight the need for continued monitoring of circulating bacterial strains to assess the estimated strain coverage of meningococcal serogroup B vaccines.
Assuntos
Antígenos de Bactérias , Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis Sorogrupo B , Humanos , Argentina/epidemiologia , Vacinas Meningocócicas/imunologia , Vacinas Meningocócicas/administração & dosagem , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/prevenção & controle , Infecções Meningocócicas/epidemiologia , Lactente , Adolescente , Criança , Antígenos de Bactérias/genética , Antígenos de Bactérias/imunologia , Pré-Escolar , Adulto Jovem , Neisseria meningitidis Sorogrupo B/genética , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Neisseria meningitidis Sorogrupo B/imunologia , Adulto , Feminino , Masculino , Sequenciamento Completo do Genoma , Proteínas de Bactérias/genética , Proteínas de Bactérias/imunologia , Genótipo , Adesinas Bacterianas/genética , Adesinas Bacterianas/imunologia , Pessoa de Meia-Idade , Porinas/genética , Porinas/imunologia , Ensaios de Anticorpos Bactericidas Séricos , Idoso , Neisseria meningitidis/genética , Neisseria meningitidis/imunologia , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/classificaçãoRESUMO
Resumen Se considera infección mixta por Mycobacterium tuberculosis (Mtb) a la coexistencia en forma simul tánea y en un mismo paciente de 2 cepas diferentes de Mtb o 2 variantes distintas de la misma cepa. Cuando una de las variantes selecciona mutaciones de resistencia, se denomina heterorresistencia (HTR) monoclonal; en caso de que sean 2 cepas diferentes, una sensible y una resistente (o cepas con diferentes patrones de resistencia), se denomina HTR policlo nal. Se presentan 3 pacientes, HIV/sida, todos con reiterados problemas de adherencia al tratamiento, en los cuales a través de la secuenciación genómica completa de Mtb se diagnosticó HTR monoclonal con coexistencia de 2 variantes de la misma cepa aisladas de muestras de pulmón y ganglios linfáticos, con diferentes perfiles de resistencia en cada uno de los casos. Es importante pensar en la posibilidad de HTR, principalmente en pacientes con múltiples intentos terapéuticos previos y altas poblaciones bacilares, como en el sida avanzado, dado que esta situación compromete potencialmente los resultados del tratamiento al coexistir cepas o variantes de ce pas sensibles y resistentes.
Abstract Mixed infection by Mycobacterium tuberculosis (Mtb) consists in the simultaneous coexistence in the same patient of two different strains of Mtb or 2 different variants of the same strain. When one of the variants selects for resistance mutations, it is called monoclonal heteroresistance (HTR); if there are 2 different strains, one sensitive and one resistant (or with different resis tance patterns), it is called polyclonal HTR. Three cases of HIV/AIDS patients are presented, all with repeated treatment adherence problems, in whom monoclonal HTR was diagnosed through Mtb complete genomic sequentiation with the coexistence of two variants of the same strain isolated from samples from lung and lymph nodes, with different resistance profiles in each case. It is important to consider the possibility of HTR, especially in patients with multiple previous therapeu tic attempts and high bacillary populations, such as in advanced AIDS, since this situation potentially com promises treatment results by coexisting sensitive and resistant variants of a strain (or strains).
RESUMO
Mixed infection by Mycobacterium tuberculosis (Mtb) consists in the simultaneous coexistence in the same patient of two different strains of Mtb or 2 different variants of the same strain. When one of the variants selects for resistance mutations, it is called monoclonal heteroresistance (HTR); if there are 2 different strains, one sensitive and one resistant (or with different resistance patterns), it is called polyclonal HTR. Three cases of HIV/AIDS patients are presented, all with repeated treatment adherence problems, in whom monoclonal HTR was diagnosed through Mtb complete genomic sequentiation with the coexistence of two variants of the same strain isolated from samples from lung and lymph nodes, with different resistance profiles in each case. It is important to consider the possibility of HTR, especially in patients with multiple previous therapeutic attempts and high bacillary populations, such as in advanced AIDS, since this situation potentially compromises treatment results by coexisting sensitive and resistant variants of a strain (or strains).
Se considera infección mixta por Mycobacterium tuberculosis (Mtb) a la coexistencia en forma simultánea y en un mismo paciente de 2 cepas diferentes de Mtb o 2 variantes distintas de la misma cepa. Cuando una de las variantes selecciona mutaciones de resistencia, se denomina heterorresistencia (HTR) monoclonal; en caso de que sean 2 cepas diferentes, una sensible y una resistente (o cepas con diferentes patrones de resistencia), se denomina HTR policlonal. Se presentan 3 pacientes, HIV/sida, todos con reiterados problemas de adherencia al tratamiento, en los cuales a través de la secuenciación genómica completa de Mtb se diagnosticó HTR monoclonal con coexistencia de 2 variantes de la misma cepa aisladas de muestras de pulmón y ganglios linfáticos, con diferentes perfiles de resistencia en cada uno de los casos. Es importante pensar en la posibilidad de HTR, principalmente en pacientes con múltiples intentos terapéuticos previos y altas poblaciones bacilares, como en el sida avanzado, dado que esta situación compromete potencialmente los resultados del tratamiento al coexistir cepas o variantes de cepas sensibles y resistentes.
Assuntos
Síndrome da Imunodeficiência Adquirida , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Humanos , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Mutação , Antituberculosos/uso terapêuticoRESUMO
La elección del momento más adecuado para realizar radioterapia en el tratamiento del cáncer de próstata es controversial ya que puede ser realizada inmediatamente posterior a la prostatectomía o como tratamiento de rescate ante una recaída. En este artículo, se realiza una búsqueda del tema, se seleccionan los ensayos clínicos con mayor evidencia y se analizan los resultados. Si bien existe beneficio en la radioterapia adyuvante, este resultado no se encuentra en todos los pacientes y sí se asocia a mayor toxicidad genitourinaria tardía, por lo tanto, la clave está en la selección del tratamiento según el paciente específico.
The choice of the most appropriate time to perform radiotherapy in the treatment of prostate cancer is controversial since it can be performed immediately after prostatectomy or as rescue treatment in case of relapse. In this article, a search for the topic is carried out, the clinical trials with the greatest evidence are selected and the results are analyzed. Although there is benefit in adjuvant radiotherapy, this result is not found in all patients and it is associated with greater late genitoutinary toxicity, therefore, the key is in the selection of treatment according to the specific patient.
RESUMO
Introducción: Actualmente existen discrepancias en cuanto a la indicación, dosis, técnica y contorneo de la sobreimpresión o aumento de dosis de irradiación sobre el lecho quirúrgico en el trata-miento adyuvante en cáncer de mama. Propósito de la revisión: El objetivo de la revisión es presentar la evidencia disponible en sobre-impresión del lecho quirúrgico en el tratamiento de cáncer de mama. Realizamos una revisión bibliográfica en MEDLINE pubmed, se analizaron 61 estudios publicados entre enero del 2000 a enero del 2022. Recientes hallazgos: La sobreimpresión sobre el lecho quirúrgico en la mama mejora el control local en aquellas pacientes con elementos de alto riesgo. Las diferentes técnicas disponibles son oncológicamente equivalentes. La delimitación del blanco de tratamiento debe guiarse por los clips quirúrgicos. Conclusiones: La indicación de dicho tratamiento deberá ser evaluado por los servicios de oncología radioterápica, definiendo sus protocolos y algoritmos de acción.
Introduction: Currently, there are discrepancies regarding the indication, dose, technique, and con-touring of the super impression or increase in irradiation dose on the surgical bed in adjuvant treatment in breast cancer. Purpose of the review: The objective is to present evidence on superimposing the surgical bed to treat breast cancer. We conducted a bibliographic review in MEDLINE PubMed; 61 studies published between January 2000 and January 2022 were analyzed. Recent findings: Superimpression of the surgical bed in the breast improves local control in patients with high-risk elements. The different techniques available are oncologically equivalent, and the surgical clips should guide the delineation of the treatment target. Conclusions: The indication of this treatment must be evaluated by radiotherapy oncology services, defining their protocols and action algorithms.
Assuntos
Neoplasias da Mama , Radioterapia Adjuvante , Neoplasias Inflamatórias MamáriasRESUMO
Se define carcinoma de cabeza y cuello (CCC) de primario desconocido al cuadro de adenopatía cervical en que, luego de examen físico, estudios de imágenes y panendoscopía con biopsias, no se encuentra el tumor primario pero sí la confirmación de malignidad de la adenomegalia. Son infrecuentes, por lo que estudios prospectivos que arrojen resultados estadísticamente significativos no están disponibles actualmente, y el tratamiento definitivo es aún motivo de controversia. Al ser la radioterapia un tratamiento dirigido es imprescindible definir adecuadamente los volúmenes blanco de tratamiento; es ideal el hallazgo del tumor primario, pero en muchos casos a pesar de un estudio escalonado, exhaustivo y multidisciplinar esto no se logra. Esto motiva el debate de qué regiones tratar, dosis, fraccionamiento y modalidad (exclusiva, adyuvante, en concurrencia). Hasta el momento el tratamiento de ganglios cervicales y mucosa de alto riesgo parece ser la estrategia con mejor control locorregional.
Head and neck carcinoma (HNC) of unknown primary is a clinical condition defined as a cervical adenopathy for which, after physical examination, imaging studies and panendoscopy with biopsies, the primary tumor is not found, but there is confirmed malignancy of the adenomegaly. It is infrequent, so prospective studies that yield statistically significant results are not currently available, and definitive treatment is still controversial. Since radiation therapy is a targeted treatment, it is essential to adequately define treatment target volumes; the discovery of the primary tumor is ideal, but in many cases, despite a phased, exhaustive and multidisciplinary study, this is not achieved. This motivates the debate on which regions to treat, dose, fractionation and modality (exclusive, adjuvant, concurrent). Until now, the treatment of high-risk cervical nodes and mucosa seems to be the strategy with the best locoregional control.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Radioterapia , Neoplasias de Cabeça e Pescoço , Carcinoma de Células Escamosas , LinfadenopatiaRESUMO
Resumen: La mucositis es un efecto adverso frecuente e invalidante en los pacientes oncológicos que reciben tratamiento de Radioterapia y Quimioterapia a altas dosis y muchas veces lleva a la suspensión del tratamiento. Si bien es una entidad que tiene gran relevancia en los pacientes e importante impacto económico en las instituciones de salud, no existen tratamientos claramente establecidos ni eficaces para mejorar esta condición. El objetivo de esta revisión es analizar la evidencia disponible en el tratamiento de la mucositis, y el respaldo científico e impacto que tienen conductas habitualmente tomadas en su tratamiento.
Abstract: Mucositis is a frequent and disabling adverse effect in cancer patients who received radiation therapy and chemotherapy at high doses and often discontinues treatment. Although it is an entity that has great relevance in patients and an important economic impact in health institutions, there are no clearly established or modified treatments to improve this condition. The objective of this review is to analyze the available evidence in the treatment of mucositis, and the scientific support and impact of behaviors commonly taken in its treatment.
Resumo: A mucosite é um efeito adverso frequente e incapacitante em pacientes com câncer que receberam radioterapia e quimioterapia em altas doses e muitas vezes interrompe o tratamento. Embora seja uma entidade que tenha grande relevância nos pacientes e um importante impacto econômico nas instituições de saúde, não existem tratamentos claramente estabelecidos ou modificados para melhorar essa condição. O objetivo desta revisão é analisar as evidências disponíveis no tratamento da mucosite, o suporte científico e o impacto das condutas comumente adotadas no seu tratamento.