Medicina-buenos Aires最新文献

Adult xanthogranulomatous orbital disease (AXOD) is an uncommon condition belonging to the group of non-Langerhans cell histiocytoses. We present the case of a male with a recent diagnosis of adult-onset asthma, who presented with progressive bilateral eyelid edema of one year's duration. Imaging studies revealed diffuse thickening of orbital fat and extraocular muscles. Skin biopsy confirmed the diagnosis of AXOD. The patient was treated with intraorbital (triamcinolone) and systemic (meprednisone) corticosteroids, with clinical and radiological improvement. The final diagnosis was AXOD in its form associated with adult-onset asthma. This case highlights the importance of considering AXOD in the differential diagnosis of progressive exophthalmos and the need for a multidisciplinary approach for its diagnosis and management.

Introduction: Entrustable professional activities (EPA) were developed to connect competencies with clinical practice and make them operational. These are tasks that can be entrusted to a trainee once he/she has obtained adequate competence to perform them, without supervision. By definition, residencies are the ideal setting for their implementation. However, one of the main challenges lies in the design and incorporation of EPA into current training programs. Through a collaborative effort between the Medical Education Department at Medicine University and Hospital de Clínicas, a pathway has been initiated for the design and incorporation of EPA. The objective of this study is to describe the process of developing professional profiles and EPA's titles for the 39 residency programs at Hospital de Clínicas.

Materials and methods: A team was formed between the Medical Education Department and Hospital de Clínicas. Using an eight-step procedure, professional profile and EPA for 39 residency programs were written and validated.

Results: Professional profiles for 39 specialties and 655 titles for EPA, were written and published to incorporate them into residency programs, as a standard for their accreditation.

Discussion: This work compiles the experience and communicates the progress towards the implementation of EPA for health residencies, in order to promote competency-based education and to improve the quality of postgraduate training programs.

We present the cases of two patients who underwent surgery for right-sided colon adenocarcinoma stage III and, after receiving adjuvant therapy, developed early peritoneal recurrence. In both cases, the molecular phenotype was MSI-H/dMMR, which led to treatment with immunotherapy, resulting in a complete clinical response. The first patient, a 51-year-old woman, was diagnosed with moderately differentiated adenocarcinoma (pT-3N1bM0). Immunohistochemistry revealed loss of MLH1 and PMS2. Six months after completing adjuvant treatment with CAPOX, she developed peritoneal recurrence. She started combination therapy with ipilimumab and nivolumab, achieving complete metabolic and imaging response as confirmed by PET-CT at 12 months. The second case concerns an 81-year-old woman with adenocarcinoma (pT3N2Mx) and loss of expression of MLH1 and PMS2. She presented with peritoneal relapse five months after completing adjuvant therapy. She started treatment with pembrolizumab, achieving a sustained complete response at 12 months. Currently, 22 months after starting treatment, the patient is in optimal functional status (ECOG 0). She continues with pembrolizumab 800 mg every 42 days as a maintenance regimen. Both cases illustrate the remarkable clinical benefit of immunotherapy in patients with early peritoneal recurrence of MSI-H/dMMR colon cancer, which is usually associated with poor prognosis. These cases highlight the need to consider the molecular profile in therapeutic planning and reinforce the emerging value of immunotherapy as a cornerstone in the management of these cases.

Introduction: Neurological complications, particularly cerebrovascular diseases, have emerged as a significant concern in patients with coronavirus disease (COVID-19). Understanding these characteristics is essential for improving the clinical management and outcomes.

Materials and methods: This observational study analyzed data from patients hospitalized at Hospital da Irmandade da Santa Casa de Misericórdia de São Paulo between 2020 and 2021. We included patients aged ≥18 years with a confirmed SARS-CoV-2 infection and a diagnosis of cerebrovascular disease within 60 days of symptom onset. Clinical, demographic, and outcome data were collected and analyzed.

Results: Among the 1998 patients with confirmed COVID-19, 550 (27.5%) presented with neurological symptoms. Fifty patients were diagnosed with cerebrovascular disease: 27 (54%) had ischemic stroke, 20 (40%) had hemorrhagic stroke, and three (6%) had cerebral venous thrombosis. Patients with neurological symptoms had significantly higher mortality rates and longer hospital stays than those without neurological symptoms.

Conclusion: This study highlights the severity and clinical impact of cerebrovascular events in COVID-19 patients. These findings reinforce the need for early neurological evaluation, and underscore the importance of accessible and cost-effective strategies for surveillance, prevention, and timely intervention in high-risk populations.

Modern nursing has evolved into a profession, and its contribution to healthcare is unquestionable. In Argentina, despite favourable changes, the nursing profession has yet to produce research knowledge that has an impact on health. In this document, the Asociación de Escuelas Universitarias de Enfermería de la República Argentina (AEUERA) provides recommendations for the development and implementation of policies to foster the development of health research by nursing in Argentina. The analysis of relevant evidence, academic discussion, and consensus among the participants of the AEUERA research commission led to the formulation of principles and recommendations. Five outlined principles underpin 20 recommendations. These principles represent the values that support a rigorous research practice, grounded in a robust scientific background and tailored to population needs. For Argentine nurses to investigate priority health problems, AEUERA recommends: 1) to guarantee access to scientific training programs with the same standards as other professions within the Argentine scientific system, 2) to guarantee access to doctoral scholarship programs, 3) to create job positions, protected by regulation, for nurse scientists, 3) to provide funding to conduct studies guided by both local and global health priorities. The implementation of these recommendations requires a sustained education and health policy to promote research training for this professional group. AEUERA urges decision-makers to consider these recommendations in their strategic planning for the sector.

Introduction: Assessing functional status upon hospital admission helps identify patients at higher risk. The Katz Index is a validated tool that measures the ability to perform basic activities of daily living (ADLs). This study aimed to determine whether functional dependence, assessed via the Katz Index, is associated with higher in-hospital mortality in patients admitted to the Internal Medicine Service of the Hospital Naval Pedro Mallo.

Materials and methods: A prospective, observational cohort study was conducted between January 1 and December 31, 2024. Patients aged ≥15 years were included. They were classified as non-dependent (Katz A) or dependent (Katz B-G) upon admission. Demographic variables, diagnoses, length of stay, and outcomes were analyzed. Descriptive and comparative statistics were used, along with multivariate logistic regression.

Results: A total of 1293 patients were evaluated. Functional dependence (Katz B-G) was observed in 38% of patients. Overall mortality was 13%, significantly higher among dependent patients (25%) compared to non-dependent patients (6%) (RR 5.2; 95% CI: 3.6-7.4, p < 0.001). In the multivariate model, functional status, age, length of stay, pneumonia, and cancer were independent predictors of mortality.

Discussion: Functional dependence at admission, as measured by the Katz Index, is a common condition and a significant predictor of in-hospital mortality. Its assessment should be implemented as a routine evaluation tool upon admission.

Postoperative stereotactic radiosurgery or hypofractionated radiotherapy represent the standard local adjuvant treatment modality after surgical resection of single brain metastases. Intraoperative radiotherapy (IORT) offers the advantage of delivering an ablative dose during the same surgical procedure, avoiding delays and allowing early reinitiation of systemic therapies. This work describes our first national experience with IORT, with preliminary results from a case series. The series included three male patients diagnosed with a single supratentorial brain metastasis (two right frontal and one left temporal), with surgical indication due to mass effect or diagnostic need (pathology analysis) and who met criteria for IORT. The primary tumors were colorectal carcinoma in one case and non-small cell lung cancer in two cases. In our experience, we documented no cases of local recurrence at follow-up, nor evidence of radionecrosis or leptomeningeal dissemination, the patients were alive at the close of the analysis and without central nervous system disease progression. IORT resulted feasible and safe, with encouraging preliminary results, which, with future studies, could consolidate it as an alternative to the traditional regimen of surgery plus postoperative radiotherapy.