Con el objetivo de generar conciencia sobre el Síndrome Urémico Hemolítico (SUH) y la forma de prevenirlo la Ley 26926, estableció el 19 de agosto como Día Nacional de Lucha contra esa enfermedad, recordó el Servicio nacional de Sanidad y Calidad Agroalimentaria (Senasa). Tambien, instituida en honor a la fecha natal del pediatra Carlos Gianantonio, nacido en 1926, quien describió este síndrome en la literatura médica internacional.

Efemérides IFMSA Agosto

Argentina presenta la mayor tasa de incidencia mundial de SUH en niños menores a 5 años de edad, constituyendo un problema crítico para la salud pública. El SUH es la principal causa pediátrica de insuficiencia renal aguda y la segunda de insuficiencia renal crónica, siendo además responsable del 20% de los transplantes de riñón en niños y adolescentes en Argentina

Gianantonio y el SUH

El SUH fue descrito por primera vez en 1955 en Suiza y denominado así por por Gasser. Las primeras observaciones en niños, la mayor parte de los cuales presentaban insuficiencia renal aguda reversible, provinieron de Argentina. La experiencia subsecuente especialmente desde las descripciones  de Gianantonio, se demostró que la incidencia de este tipo de microangiopatía trombótica, era más alta en la Argentina que en cualquier otra parte del mundo, registrándose entre 300 y 350 casos nuevos por año.

El Dr. Carlos Arturo Gianantonio, nació el 19 de Agosto de 1926, egresó como médico en 1954. Durante su servicio como practicante en los hospitales Argerich, de Clínicas, Tigre, Pirovano y, fundamentalmente, en el Hospital de Niños Ricardo Gutiérrez de Buenos Aires. En 1953 recibió el premio “Guillermina de Oliveira Cesar de Wilde” al mejor estudiante de Medicina de los hospitales. Y fue un entusiasta jugador del equipo de fútbol de los practicantes del Hospital de Niños hasta que, recién egresado, viajó con una beca a Estados Unidos para desempeñarse como asistente del Jefe de Residentes en el “St. Christopher´s Hospital for Children”, de la Universidad de Temple, Pensylvania, bajo la dirección de Waldo Nelson.

Volvió a la Argentina donde llevó a cabo investigaciones clínicas que le reportaron un merecido reconocimiento internacional. Fue el primero en describir y reportar en el mundo “el SINDROME UREMICO HEMOLITICO” 

Por su propia experiencia, y como resultado de profundas reflexiones sobre la formación médica en la Argentina, en 1958 creó la Residencia pediátrica en el Hospital de Niños, primera iniciativa de enseñanza de posgrado que luego se extendería a todo el país. La adopción de esa iniciativa formativa, de la cual el doctor Gianantonio estaba “enamorado”, significó desarrollar un sistema de capacitación dinámico, eficiente y moderno, apto para la adecuación continua de objetivos y programas. Esta herramienta impactó en las sucesivas promociones de pediatras argentinos cambiando positiva y gradualmente el ejercicio de la Especialidad.

Hablaba poco pero jamás silenció sus convicciones de demócrata convencido y se comportó siempre como un hombre de coraje civil. Por ello renunció al Hospital de Niños y formó el Departamento de Pediatría del Hospital Italiano donde funcionaba un Comité de Ética que será siempre modelo.

El trato y el tiempo que dedicaba a los niños y sus familias era producto de su amor por la pediatría a la que llegó por “vocación y convicción

El 20 de Julio de 1989 la Academia Nacional de Medicina lo distinguió eligiéndolo Miembro titular. Era el reconocimiento a la trayectoria de quien creara en 1979 el Departamento de Pediatría del Hospital Italiano, asesorara en numerosas oportunidades al Ministerio de Asistencia Social y Salud Pública, y aportara toda su sabiduría y experiencia trabajando entre 1984 y 1987, con las autoridades nacionales y municipales para la organización y apertura del Hospital de Pediatría “Juan P. Garraham”.

Falleció en Buenos Aires el 21 de Octubre de 1995

Prevención

A pesar de los intentos en busca de un tratamiento durante la etapa aguda de la enfermedad ninguno de los estudios prospectivos y controlados realizados hasta la fecha han mostrado algún beneficio clínico. Es lógico que los esfuerzos están dirigidos a evitar la infección intestinal y los efectos de la toxina. Sin embargo, el tratamiento de la infección intestinal con antibióticos puede ser perjudicial e incrementar el riesgo de desarrollar la enfermedad

En este sentido tres diferentes propuestas podrían disminuir la incidencia del SUH;

  1. Disponibilidad de una adecuada información al público acerca de los riesgos del consumo de carne de escasa cocción, de quesos no pasteurizados o leche cruda,
  2. Desarrollo de una vacuna dirigida contra la E.Coli o sus toxinas,
  3. Administración oral de absorbentes que se unen a la toxina (en fase de estudio en Canadá).

Consejos de prevención del SUH

1) Asegurar la correcta cocción de la carne; la bacteria se destruye a los 70 ºC. Esto se consigue cuando la  carne tiene una cocción homogénea.

2) Tener especial cuidado con la cocción de la carne picada, ya que generalmente se cocina bien la parte superficial, permaneciendo la bacteria en el interior. El jugo de la carne picada bien cocida debe ser completamente translúcido.

3) Utilizar distintos utensilios de cocina para cortar la carne cruda y para trozarla antes de ser ingerida.

4) Evitar el contacto de las carnes crudas con otros alimentos.

5) Controlar el uso de leche y derivados lácteos correctamente pasteurizados y conservar la cadena de frío.

6)  No consumir jugos de frutas no pasteurizados

7) Lavar cuidadosamente las frutas y verduras

8)  Asegurar la correcta higiene de las manos (debenlavarse con agua y jabón), antes de preparar los alimentos

9)  Lavarse las manos con agua y jobón luego de ir al baño

10) Utilizar natatorios habilitados para tal fin.

11) Se sugiere que los menores de 5 años no ingieran comida  rápida

12) Respetar la prohibición de bañarse en aguas potencialmente  contaminadas

13) Consumir agua potable. Ante la duda, hervirla.

Fuentes:

Intramed, Síndrome urémico hemolítico: Actualización (http://www.intramed.net/contenidover.asp?contenidoID=25786)

BTI, Dr. Carlos Arturo Gianantonio (https://www.baraderoteinforma.com.ar/carlos-arturo-gianantonio-el-maestro-de-la-pediatria-argentina/)

SÍNDROME URÉMICO HEMOLÍTICO (SUH) EN ARGENTINA, 2010-2013 Extracto del Boletín Integrado de Vigilancia, Agosto 2014 (http://www.msal.gob.ar/images/stories/bes/graficos/0000000799cnt-2014-08_Informe-SUH.pdf)

SENASA, Día Nacional de la Prevención contra el Síndrome Urémico Hemolítico (http://www.senasa.gob.ar/senasa-comunica/noticias/dia-nacional-de-la-prevencion-contra-el-sindrome-uremico-hemolitico)

Telam, la Argentina conmemora el dia nacional de la lucha contra el síndrome urémico hemolitico (http://www.telam.com.ar/notas/201708/198630-la-argentina-conmemora-el-dia-nacional-de-la-lucha-contra-el-sindrome-uremico-hemolitico.html)

Sociedad Argentina de Pediatria, Dia nacional de la lucha contra el Síndrome Urémico Hemolítico (http://www.sap.org.ar/novedades/61/19-de-agosto-dia-nacional-de-la-lucha-contra-el-sindrome-uremico-hemolitico.html)


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