Medicina-buenos Aires最新文献

Introduction: SARS-CoV-2 can cause mild upper respiratory tract involvement to pulmonary disease of varying severity, as well as cardiovascular complications with increased mortality. The prevalence is similar in men and women, although there are sex differences in disease characteristics and outcome. In this study, we analyze the clinical characteristics, progression, and in-hospital outcome by sex of patients included in the RACCOVID-19 registry.

Materials and methods: We included data from 2750 patients consecutively admitted to 50 centers in 11 provinces of the country, from May 18 to October 31, 2020.

Results: A total of 1541 men (60.2%) and 1018 women (39.8%) were included (p<0.001). The prevalence of cardiovascular risk factors (because of current smoking) was higher in men. During hospitalization, men had a higher incidence of cardiovascular complications (17.9% vs. 12.5%; p=0.0002) and mortality (20.8% vs. 16.8%; p=0.01). Poor performance status on hospital admission was more common in men (53.9% vs. 42.6%, p<0.0001). On multivariate analysis, male sex, the presence of hypertension and diabetes, and a history of other medical conditions were independent predictors of inhospital mortality.

Discussion: In the RACCOVID-19 registry, men had worse performance status and higher incidence of cardiovascular complications with higher in-hospital mortality. Male sex, hypertension, diabetes, and history of other diseases were independent predictors of in-hospital mortality.

Introduction: Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM.

Materials and methods: This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients' medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM.

Results: One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012).

Discussion: Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.

Introduction: Cranioencephalic traumatism (CET) is a serious public health problem worldwide. Advances in treatment have reduced mortality, increasing the demand for rehabilitation. The objective was to describe the demographic characteristics and functional outcomes in adult patients with traumatic brain injury (TBI) treated in a rehabilitation center.

Materials and methods: Retrospective study between 2002 and 2022. Patients received 4 hours of rehabilitation daily. The level of functional independence was assessed with the Functional Independence Measure (FIM) at admission and discharge.

Results: 229 patients were included, the median (25-75 percentiles) time from injury to admission to rehabilitation was 56 (36-98) days; 76% were men. Mean age (standard deviation) 42 (17) years. The most frequent etiologies were car accidents and falls; 46.8% were under 40 years of age and the median length of stay was 82 days (14-132). At discharge, 79.9% of patients over 65 years of age had low to severe disability (GOS-E) and 79.5% returned home. The median (p 25-75) FIM at admission was 30 (20-55) and at discharge was 90 (58-106); a statistically significant difference was observed (p = 0.001). Differences in functional outcomes were found based on age and place of residence.

Discussion: In Argentina, patients admitted to rehabilitation for TBI are predominantly young men, the main cause being car accidents. The implementation of an early and intensive rehabilitation program has shown significant improvements in functional outcomes. At discharge, most patients required home supervision and assistance in daily activities.

Introduction: Hostile learning environments in medicine are present at the undergraduate and postgraduate levels. Currently, international research continues to demonstrate this problem of a structural and universal nature. There are few antecedents in Argentina, the research carried out by Reboiras (2020) was the starting point of the present work. The objective was to characterize the mistreatment perceived by physicians during training in basic medical residency programs in Argentina.

Materials and methods: A quantitative study was carried out using a descriptive-interpretative approach. The sample consisted of 509 residents, and data were collected between April 2022 and May 2023. The dimensions of analysis were educational mistreatment, psychoemotional abuse, discrimination, physical violence and sexual harassment. The study included 22 health care centers in 10 provinces of the 7 geographical regions of Argentina (Province of Buenos Aires, City of Buenos Aires, Pampas region, Cuyo region, Northwest region, Northeast region and Patagonia region).

Results: A total of 95.5% reported having suffered some type of mistreatment during their education. Prevalences of 94.5% for educational mistreatment, 62.5% for psychoemotional mistreatment, 42.1% for discrimination, 13.9% for sexual harassment and 6.8% for physical mistreatment were reported.

Discussion: There is evidence of a high prevalence of situations of mistreatment at the national level. The introjection of violence as a formative standard is confirmed, which enables the reproduction of hostile contexts and leads to difficulties in the development of professional skills such as empathy or compassion, which are key to care and quality of attention.

Introduction: The use of antidementia drugs near the end of life remains controversial. We evaluated the prevalence of and factors associated with antidementia drug use in the last 6 months of life in older adults with dementia.

Materials and methods: Observational retrospective study of adults ≥60 years, affiliated to the Hospital Italiano de Buenos Aires health maintenance organization, who died with a dementia diagnosis, between 2017 and 2021. The main event was the use of antidementia drugs in the 6 months prior to death. We fit a logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (CI) of baseline variables associated with antidementia drug use.

Results: A total of 540/1898 (28%) patients used antidementia drugs in the 6 months preceding death. Lewy body dementia (OR=1.97; 95%CI, 1.22-3.19) and Alzheimer's disease (OR=1.47; 95%CI, 1.12-1.92) were associated with higher odds of antidementia drug use. Heart failure (OR=0.65; 95%CI, 0.48-0.89), older age (OR=0.75; 95%CI, 0.68-0.81), and prior hospitalizations (OR=0.81; 95%CI, 0.70-0.93) were inversely associated with antidementia drug use.

Discussion: One out of three patients with dementia receive antidementia drugs in the 6 months prior to death despite limited evidence in such a scenario.