Medicina-buenos Aires最新文献

Introduction: The 2022-2023 Mpox outbreak in Argentina presented unique challenges due to the lack of vaccination and antiviral therapy. This study analyzed the epidemiological and clinical characteristics of cases in the Buenos Aires Metropolitan Area (MABA), examining temporal trends, HIV status, and concomitant sexually transmitted infections (STIs).

Materials and methods: An ambispective, analitic, and multicenter study was conducted between September 2022 and May 2023 in HIV/STI clinics and hospitals in MABA. Cases were classified as confirmed (positive PCR) or possible (clinical and epidemiological criteria). Patients infected with MPox with and without HIV were compared.

Results: 247 patients were included, 95.5% were confirmed cases. The median age was 36 years; 98% were men; 93.7% were men who have sex with men. Sexual exposure was the main transmission route (91%). The 25.2% presented concomitant STIs. The 74% were people living with HIV (PLWH), with good immuno-virological control. Common clinical manifestations included papular, pustular, and vesicular lesions; 59.4% presented >20 lesions. Rectal involvement occurred in 25.6%. Complications were observed in 9.3%, hospitalization in 6.6%, and mortality was 0.4%. PLWH showed a higher prevalence of perianal lesions and proctitis, without differences in complications and hospitalization.

Discussion: The outbreak in Argentina, mainly affecting men who have sex with men living with HIV, had low mortality. No significant differences were observed in complications and hospitalization between people with and without HIV.

Introduction: The main objective of this study was to evaluate the association between the baseline level of Histoplasma capsulatum urinary antigen (AgU) and the severity of histoplasmosis in the context of HIV, as well as its utility for treatment monitoring. Secondary objectives included determining the appropriate cutoff point for AgU detection for the diagnosis of proven histoplasmosis.

Materials and methods: The study was an analytical, retrospective cohort study in adults diagnosed with HIV, with at least one determination of AgU using ELISA. Sociodemographic, clinical, and laboratory variables were collected. Statistical analysis was performed using R-project® software.

Results: A total of 452 individuals with AgU were included from March 2018 to July 2022, with 42 (9.3%) positive results (25 proven histoplasmosis and 17 probable cases). An statistically significant correlation was found between the baseline concentration of AgU and positive cultures. However, the utility of AgU as a followup tool could not be evaluated. The optimal cutoff point for detecting proven histoplasmosis was an AgU value ≥2.2 ng/mL (specificity: 96.3% and sensitivity: 100%).

Discussion: Further studies are needed to evaluate the utility of AgU as a tool for monitoring antifungal treatment. A value of AgU ≥2.2 ng/mL could potentially correspond to a diagnosis of proven histoplasmosis.

The case involves a 61-year-old female patient with a history of systemic lupus erythematosus, who sought urgent medical attention due to abdominal pain and an abdominal tomography consistent with colonic obstruction. Exploratory laparotomy followed by transverse colectomy was performed. The pathological examination of the specimen revealed a colonic diaphragmatic ring secondary to chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs). This condition primarily affects elderly women exposed to chronic NSAID therapy. It results from mucosal ulceration followed by submucosal inflammation and fibrosis. Management involves, in addition to discontinuation of the medication, surgical resection in acute cases, or diagnostic-therapeutic endoscopy in uncomplicated cases.

Management in primary health care (PHC) focuses on system design, improvement policies, and implementation of evidence-based interventions. This review identifies and describes management strategies used to improve PHC in terms of quality, accessibility, efficiency, and satisfaction of health professionals and patients. A review of the literature published in PubMed, Ovid/Medline, Cochrane Library, ScienceDirect, and Google Scholar was conducted. Research focused on management models, open access, and published in the last 5 years was selected. Validity was determined, results were described, and a thematic discussion of the content was conducted. Eighteen studies were included, most of which were narrative reviews (38.9%) (n = 7). The most frequently studied management strategies corresponded to the quality domain (94.4%) (n = 17), followed by efficiency (61.1%) (n = 11) and accessibility (38.9%) (n = 7). Strategies to improve the satisfaction of healthcare professionals and patients were the least studied, at 16.7% (n = 3) each. Strategies to improve management in PHC should cover several dimensions and adapt to the needs of the environment. It is recommended to emphasize optimizing quality, accessibility, efficiency, ensuring the well-being of professionals and improving the user experience, while fostering the ability to withstand challenges and innovate.

Introduction: Low back pain is one of the main causes of medical consultation worldwide, with heterogeneous management in the request for complementary methods. This study sought to determine the frequency and clinical and imaging characteristics of patients with low back pain in a tertiary hospital, considering the presence or absence of red flags.

Materials and methods: A retrospective analytical study was carried out at the Private University Hospital of Córdoba. Patients over 18 years of age who consulted for the first time for low back pain between January and June 2021 were included, excluding pregnant and those without complete records.

Results: A total of 880 patients were included. Of these, 589 (67%) presented acute low back pain, 112 (13%) subacute and 179 (20%) chronic. Simple low back pain was the most common cause (n=652, 74%), followed by herniated disc (n=179, 20%) and spondylolisthesis (n=33, 4%). Red flags were identified in 190 (22%) patients according to American College of Radiology (ACR) criteria and in 420 (48%) according to the Agency for Health Care Policy and Research (AHCPR). Imaging studies were performed in 314 (75%) patients with AHCPR criteria and 255 (55%) with ACR criteria. Neoplasia/infection and vertebral fracture were diagnosed in 2 (2%) and 5 (9%) patients with red flags, respectively.

Discussion: The first consultation for low back pain represented 1.8% of consultations, with acute low back pain being more frequent. Obesity was the most common comorbidity. About half of the patients had red flags according to AHCPR and 21% according to ACR.

Introduction: Microorganisms isolated from clinical samples in hospitalized patients vary in species and antibiotic sensitivity, depending on whether they are community or healthcare-associated infections. In a hospital in the Buenos Aires Metropolitan Area, bacterial isolates and their antibiotic resistance were related to the length of hospitalization, as a guide to adjust antibiotic therapy.

Materials and methods: Microbiological isolates, antibiogram results, and antibiotic treatment of hospitalized patients were recorded weekly between 1/1/2022 and 12/31/2023. Four groups were assigned according to time since hospitalization: G1 (<3 days), G2 (3-7 days), G3 (7-14 days), and G4 (≥14 days).

Results: In the first week of hospitalization, the main microorganism isolated, from community-acquired infection, was Escherichia coli (132 isolates), with high levels of resistance to quinolones, followed by Klebsiella pneumoniae (82 isolates) and Staphylococcus aureus (64 isolates). Between 11/10/23 and 8/12/23, an outbreak of K. pneumoniae carbapenemase MBL was detected in biliodigestive and urological surgery, and it was controlled. Of the antibiotics used: ciprofloxacin went from second in use in G1 and first in G2, to third and fifth in G4. Indications for amoxicillin/sulbactam decreased from G3. Carbapenems and colistin increased from G3. Piperacillin/tazobactam and vancomycin were widely used in all periods. This simple weekly control allowed us to know the microbiology in the hospital, its antibiotic sensitivity patterns, detect outbreaks, and adjust the rational use of antibiotics, especially empirical, notably in the abuse of ciprofloxacin in urinary or abdominal foci; and compare the isolations and therapeutic behaviors with national and international patterns.

Congenital central alveolar hypoventilation (CCAH), previously called Ondine Syndrome, is a rare disease, with an incidence of 1/200000 births and a prevalence of 1/500000. It is a defect in the central control of ventilation, not explained by muscular, neurological, cardiological, or pulmonary abnormalities. Early diagnosis is important to avoid episodes of hypoxia and hypercapnia, which overshadow the prognosis. The definitive diagnosis is made by determining mutations in the PHOX2B gene on chromosome 4p13. Two members of the same family are presented, mother and daughter with different clinical presentations. CCAH is a diagnostic challenge. Suspected or confirmed cases should be evaluated in reference centers.

Introduction: Malignant rhabdoid tumor (MRT) is a highly aggressive disease, mainly affecting infants and small children.

Material and methods: Between January 2007 and May 2021 a retrospective study was conducted at the Hospital de Pediatría J. P. Garrahan in Buenos Aires, Argentina, including 13 patients diagnosed with ERNC-MRT (extra-renal non-cerebral malignant rhabdoid tumor). Event-free survival (EFS) and overall survival (OS) were assessed using the Kaplan-Meier method and compared using the log-rank test.

Results: Seven patients were less than 1 year old, all of them died. Four of 13 had metastatic disease, all of them in the lungs, 2 had locoregional lymph node involvement. Six achieved complete remission, 4 of them remained alive. Five received maintenance therapy (MT) with cyclophosphamide/vinorelbine, 4 were alive at last follow-up. Only one was studied for germline mutations, the result was negative. With a median follow-up of 126 months (range: 72-161), 3 and 5-year EFS and OS were 30.7% and 38.4%, respectively.

Discussion: Although the sample size is small, survival rates are similar or slightly lower than other series. Age was the main prognostic factor. All but one patient that received MT are alive, suggesting that MT might have a role in ERNC-MRT; however, the prognostic significance is not entirely clear since there are multiple confounding factors.