Medicina-buenos Aires最新文献

Introduction: Delay in initiating appropriate antimicrobial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Currently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential antimicrobial costs.

Methods: This is a retrospective observational study focused on positive blood cultures in hospitalized patients. FA processing was conducted concurrently with routine sample processing. Changes in antibiotic treatments based on FA results were evaluated, and the reduction in antimicrobial therapy duration and associated cost savings were calculated.

Results: Eighty-seven bacteremia episodes were analysed. In 42 (48%) of them antimicrobial therapy was de-escalated to narrower spectrum agents, while in 7 (8%) therapy was escalated to broader spectrum antimicrobials. Additionally, in 8 (9%) antimicrobials were switched without changing spectrum and in 30 (34%) no changes were made based on FA results. Antimicrobial changes were made 2.3 days faster than with routine sample processing resulting in calculated potential savings of US$ 7408.

Conclusion: The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broadspectrum empirical antimicrobial therapy and subsequent economic savings.

Introduction: Since the onset of the COVID-19 pandemic, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been described. Possible risk factors for the development of this condition have been proposed, although evidence in Latin American populations is limited. The objectives were to identify risk factors for the development of CAPA and describe the characteristics of this infection.

Materials and methods: A retrospective case-control study was conducted. The population consisted of adult patients with severe COVID-19, hospitalized in ICU and who had undergone diagnostic tests for invasive pulmonary aspergillosis.

Results: Seventy-five patients were evaluated, 21 in the case group and 54 in the control group. 64% were male, with an average age of 62.7 years. It was found that a history of diabetes (OR 3.3, CI 1.09-9.95, p=0.03), smoking (OR 3.47, CI 1.20-10, p=0.02), coronary artery disease (OR 5, CI 1.24-20.08, p=0.02), and a Charlson score equal to or greater than 5 (OR 1.27, CI 1-1.60, p=0.013) could be associated with the development of CAPA. Most cases were considered as possible CAPA (87.5%). The time between orotracheal intubation to the diagnosis of CAPA was 11.5 days. Fever was the most common symptom (90%), and only 24% of patients had compatible radiographic findings. Mortality in the case group was 61.9%.

Discussion: A history of diabetes, smoking, coronary artery disease, and a Charlson score equal to or greater than 5 may increase the risk of developing CAPA.

Introduction: The American Heart Association (AHA/ACC) sets as a goal for blood pressure (BP) control not to exceed values of 130/80 mmHg, both in individuals with and without a diagnosis of hypertension (HT), standards not evaluated so far in the Argentine population. The objective was to determine the prevalence of high BP (HBP) in individuals with and without a diagnosis of HT taking into account the AHA/ACC criteria and to evaluate its association with sociodemographic and lifestyle factors.

Materials and methods: Cross-sectional populationbased study in 911 persons >18 years of age in Córdoba, Argentina (period 2020-2022). Sociodemographic and lifestyle data, history of HT, diabetes and medication use, anthropometric measurements, BP and dietary intake were collected. HBP was defined for systolic and/or diastolic BP ≥130 / ≥80mmHg, respectively at the time of measurement. The presence of HT was assessed by self-report and/or consumption of antihypertensive medication. The association of HBP with lifestyle was assessed using multiple logistic regression models.

Results: 84.8% and 55.6% of the patients with and without hypertension had HBP, respectively. HBP was positively associated with age and BMI, the latter only in persons without HT (OR:1.10; 95%CI:1.06-1.14), while hours of sleep showed an inverse association (OR:0.63; 95%CI:0.45-0.88).

Discussion: There is a high prevalence of HBP in the city of Córdoba, Argentina. It is of utmost importance and urgency to implement sanitary measures to control BP in order to avoid adverse health consequences.

Introduction: Treatment of ischemic stroke has expanded beyond the 6-hour window, but identification of eligible patients requires advanced imaging, which is often unavailable. This study aimed to validate a prediction model using the NIHSS score (a measure of stroke severity) to estimate hypoperfusion volume and determine eligibility for DEFUSE 3 treatment criteria.

Materials and methods: Data from ischemic stroke patients with less than 24 hours' evolution were analyzed. A previously developed prediction rule based on the NIHSS score was used to estimate the volume of hypoperfused tissue with Tmax>6s, a marker for eligibility for the DEFUSE 3 treatment criteria. This estimated volume was compared with actual perfusion volumes obtained by magnetic resonance imaging or computed tomography with AI segmentation. Sensitivity, specificity and predictive values for determining DEFUSE 3 eligibility were calculated.

Results: Sixty-one patients were included (age: 71.9 ± 14.8 years, female: 60%, NIHSS: 16.5 ± 7.4 points). The prediction rule showed high accuracy in determining DEFUSE 3 eligibility with a sensitivity of 0.96, specificity of 0.93, positive predictive value of 0.98 and negative predictive value of 0.87.

Discussion: Estimating hypoperfusion volume directly from the NIHSS score using a simple prediction rule provides a reliable and readily available method for identifying patients potentially eligible for DEFUSE 3 treatment. Rapid and reliable estimation of hypoperfusion volume could improve access to advanced stroke care in settings with limited imaging resources.

In pediatric intensive care units (PICU), achieving adequate sedation for patients can be a challenging task for healthcare staff. While the use of intravenous sedatives helps improve comfort and treatment tolerance, it is a priority to develop strategies to use in patients who are difficult to sedate. This case study presents the first reported use of inhaled sevoflurane in a patient admitted to a PICU who was unresponsive to conventional intravenous sedatives. Sevoflurane was a safe and effective alternative.

Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biological sex was selected. They were questioned about gynecological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unprotected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

In patients with chronic obstructive pulmonary disease (COPD), single lung transplantation (SLT) is sometimes performed as an alternative to bilateral lung transplantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compliance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distribution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.