Medicina-buenos Aires最新文献

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder in children and adolescents, and it is frequently associated with a range of comorbidities. However, an analysis of critical factors -such as mortality, legal issues, access to care, and academic or occupational impairment- reveals that the most serious comorbidities of ADHD are primarily psychiatric in nature. These include depression, suicidal behaviors, substance use disorders, legal problems, and personality disorders, particularly borderline and antisocial personalities. These comorbid conditions share core features, including difficulties with self-regulation, impulsivity and repetitive behaviors. They also exhibit overlapping neurological and genetic substrates, as well as common environmental risk factors. A review of the current literature underscores the significant morbidity and adverse outcomes associated with ADHD when these comorbidities are present. Given the complexity and severity of these conditions, it is crucial for clinicians working with children and adolescents, to be vigilant about monitoring their appearance. Early recognition and intervention may help mitigate the risk of developing these associated psychiatric disorders and their long-term consequences. Furthermore, evidence suggests that timely and appropriate treatment of ADHD can play a protective role in preventing the onset of these comorbid conditions.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Its diagnosis and treatment are complex due to its clinical heterogeneity and comorbid pathologies, such as epilepsy and sleep disorders, which affect its evolution and management. Studies such as electroencephalogram (EEG), quantified EEG and event related potentials (ERP) provide key neurophysiological information to better understand this disorder. EEG allows the identification of abnormal patterns such as increased frontal theta activity and increased the theta/beta ratio, which are associated with problems with attention and inhibitory control. Comorbidity between epilepsy and ADHD is high. Patients with ADHD are more likely to present subclinical interictal discharges. EEG allows us to differentiate between ADHD and epilepsy symptoms, such as typical absences, which can be confused with inattention, as well as detect the presence of interictal epileptiform discharges, improving diagnosis and treatment. ERP, such as P300, evaluate cognitive functions such as attention, working memory and inhibitory control, providing information for the diagnosis, developmental monitoring and treatment of ADHD. In parallel, sleep studies using polysomnography reveal a high prevalence of sleep disorders such as respiratory disorders and decreased REM sleep, exacerbating ADHD symptoms. Neurophysiological studies allow a more precise approach to ADHD, integrating objective diagnoses and personalized treatments that improve clinical results and long-term prognosis.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and/or hyperactivity/impulsivity, which is associated with various neuropsychological deficits. These deficits are thought to mediate the relationship between etiological factors and the manifestation of the disorder, making them important targets for treatment. Within this context, and based on promising results, computerized cognitive training (CCT) through adaptive programs and/or video games has garnered considerable interest. Therapeutic programs and video games for ADHD have even been commercialized. However, the most rigorous and reliable evidence currently available suggests that CCT, in its current forms, lacks sufficient empirical support to be considered either a standalone or an alternative treatment to first-choice interventions for ADHD. Its effects on core ADHD symptoms are modest and limited, with minimal transfer or generalization to other contexts or functional skills. The complexity of ADHD suggests that highly specific, singular interventions such as CCT may be neither appropriate nor sufficient as standalone treatments. Further research is needed to evaluate the added effects of CCT when integrated with existing treatments, including its role within more holistic and comprehensive neuropsychological interventions.

Breastfeeding in newborn infants born to people living with HIV continues to be a controversial issue. However, there is numerous evidence that reveals that in the context of sustained virological suppression, the risk of postnatal HIV transmission through breast milk is less than 1%. From the activism of people with HIV, civil society and the medical and scientific community, there is a demand for reopening the issue, with the purpose of defining new guidelines for the feeding of children born to people with HIV. This review analyzes the available scientific evidence and the current knowledge gaps regarding breastfeeding in HIV situations and proposes an institutional approach and shared decision-making modality for HIV-positive pregnant people who wish to breastfeed.

Introduction: The cost of cancer treatments is a concern of the health system. The search for strategies that optimize the costs of these treatments is essential to ensure access to them. Dose banding is a methodology that has been successfully implemented in several countries, demonstrating effectiveness and efficiency. It is based on establishing dose bands rounding cytostatics ±5% and monoclonal antibodies ±10%, optimizing commercial presentations and avoiding waste. In our country there are no experiences with this system. The objective was to evaluate the savings in drug costs using dose banding.

Material and methods: Observational study of the costs of oncology drugs in a sample of patients affiliated with the Institute of Social Work of the Armed Forces (IOSFA) diagnosed with breast, colon and prostate cancer who received treatment during June 2022. The cost of each dose was determined and was simulated according to the dose banding system.

Results: Twenty-eight patients who received 29 doses were analysed.

Diagnoses: colon cancer (n:7; 25.0%), breast cancer (n:18; 64.3%) and prostate cancer (n:3; 10.7%). Mean age 61.7 years (range 34-85 years); 22 patients were female. Drugs tested: bevacizumab, cabazitaxel, cetuximab, docetaxel, trastuzumab, and trastuzumab+emtasine. The total cost was $14 101 596.39 (U$S 112 605.58 -sale value of the U.S. dollar in the Banco Nación Argentina, June 30, 2022), the simulation of the application of dose banding showed a cost of $11 185 371.49 (U$S 89 318.63). The potential savings are 20.7%.

Discussion: Dose standardization may represent a strategy that generates a significant decrease in cancer treatment costs.

Tuberculosis (TB) in Argentina has been on the rise in recent years, with a higher notification rate in the 15 to 49-year-old age group. Although it is estimated that the incidence of TB in pregnant and postpartum individuals is higher than in the general population, there is insufficient data in our country. Congenital transmission is very rare. We report a case of congenital TB transmission diagnosed through epidemiological criteria and molecular methods. We emphasize the importance of implementing TB screening algorithms in pregnancy, tailored to the populations served and the resources available, and we highlight the contribution of genomic sequencing at clinical and epidemiological levels.

Introduction: Influenza represents a global public health challenge. Influenza vaccination is crucial for preventing complications. The World Health Organization recommends a coverage rate of at least 75% for the at-risk population. The aim of this study was to evaluate vaccination coverage among members of the Health Plan of the Hospital Italiano de Buenos Aires.

Materials and methods: Cross-sectional study nested within a dynamic cohort. All members of the Health Plan during the influenza vaccination campaigns of 2022 and 2023 were included. The influenza vaccination rate was calculated and reported as a percentage with its respective 95% confidence interval (CI95%). Demographic variables and comorbidities were analyzed.

Results: The influenza vaccination rate was 12% in 2022 and 10% in 2023. Subjects aged between 6 and 23 months had the highest vaccination rates in both periods, at 43% (CI95% 41-46) in 2022 and 48% (CI95% 45-51) in 2023, followed by the population over 65 years old with a rate of 23% (CI95% 23-24) in 2022 and 18% (CI95% 18-19) in 2023. The most common comorbidities were hypertension and dyslipidemia.

Discussion: Influenza vaccination coverage in our population fell below the recommendations of the World Health Organization, highlighting the presence of barriers to influenza immunization.

In Argentina, dengue is an emerging health problem, with high morbidity during epidemic periods, which generates a significant burden on the population. Despite the efforts that have been made to control it, the disease has managed to spread rapidly due to the favorable conditions for its development. Faced with this situation, there is a need, in a private outpatient care center, for adequate control and clinical management of dengue cases, which is why the objective of carrying out a SWOT analysis (strengths, opportunities, weaknesses and threats) was established to develop a model that improves operational-care results. This SWOT analysis covered two areas: a) institutional and b) laboratory, in which the internal situation of the institution was evaluated to determine the characteristics presented after the last dengue outbreak, and thus develop strategies for future outbreaks. The results include trained personnel, the possibility of early diagnosis and timely control generated from spontaneous demand, which is why we determined that the institution has the capacity to respond to outbreaks, epidemics and pandemics. This analysis presents a strengthening activity between different areas through a comprehensive approach and the identification of new cases, which can respond to the needs of the population with dengue. By this means, valid and reliable information is provided for the approach and strategy of possible new outbreaks.