Medicina-buenos Aires最新文献

Brugada syndrome is a hereditary channelopathy associated with a high risk of sudden cardiac death in young individuals. We present the case of a 25-yearold man with a syncopal episode, without prodromes or defenses, during physical activity and a bilateral mandible fracture, who had a recovered sudden death during surgical repair.

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.

Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis and limited response to current therapies. The sarcomatoid subtype represents the rarest and most aggressive form of ACC, with very few cases reported in the literature. We present the case of a 62-year-old male with a history of an untreated left adrenal incidentaloma, who was diagnosed four years later with advanced-stage sarcomatoid ACC. Despite surgical and oncologic treatment, the disease progressed rapidly with systemic involvement and limited survival. The histopathological diagnosis is particularly challenging, as this subtype is characterized by the coexistence of epithelial and fusocelular/pleomorphic components with sarcomatoid differentiation, which may hinder its distinction from other primary or metastatic neoplasms. This case underscores the importance of appropriate initial evaluation of adrenal incidentalomas and highlights the highly malignant behavior of this rare variant, emphasizing the need for early diagnosis and timely intervention.

Community-acquired pneumonia (CAP) is responsible for substantial morbidity and mortality worldwide. Epidemiological surveillance indicates that Streptococcus pneumoniae remains the most frequent etiological agent and the leading cause of mortality. However, with the advent of new diagnostic techniques, viral etiology has gained priority. Chest X-ray is considered mandatory to confirm the diagnosis and establish the spread. Microbiological, antigen, molecular, biomarker, and carriage tests have specific indications and a role to play in reconsidering empirical treatments. Severity scales are useful for defining the site of care, and the most validated prognostic models are PSI and CURB-65. When antibacterial treatment is appropriate, aminopenicillins ± beta-lactamase inhibitors are the preferred treatment, with the addition of a macrolide in severe cases. Pseudomonas and methicillin-resistant Staphylococcus aureus should be considered primarily in patients with a history of prior infection/colonization or severe structural lung disease. Shortened courses have gained support in the literature, and once clinical stability is achieved, it is suggested that treatment be continued for 3-5 days for CAP managed in an outpatient/general ward setting, and 5-7 days for CAP requiring intensive care. The role of corticosteroids in reducing mortality has been documented in severe forms. The benefit of neuraminidase inhibitors for influenza is of low certainty and relatively marginal. Treatments that have had an impact on reducing mortality from severe-critical COVID-19 are corticosteroids, IL-6 receptor blockers, and baricitinib.

Proteinuria is an adverse event described in 30% of thyroid cancer patients treated with lenvatinib, a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptors. Management of proteinuria is challenging, involving control of arterial hypertension. We describe the case of a patient with advanced radioiodine refractory thyroid cancer treated with lenvatinib who developed late-onset grade 3 proteinuria, despite adequate blood pressure control. He was treated with dapagliflozin 10 mg/day, which promptly improved proteinuria to grade 1. Treatment with lenvatinib was subsequently restarted, with good control of proteinuria. Dapagliflozin is a sodiumglucose co-transporter type 2 (SGLT2) inhibitor that acts in the proximal convoluted tubule, improving renal function in diabetic and non-diabetic patients. SGLT2 inhibitors may have a role in the management of lenvatinib-induced proteinuria, however further study is needed.

Introduction: This study validates and cross-culturally adapts a Spanish version of the "Provider Expectations for Recovery Scale" (EXPECT-P) and evaluates agreement among patients, families, and physicians regarding recovery expectations after hospitalization.

Materials and methods: Translation of the questionnaire was done by five healthcare professionals. The final version was completed by 42 hospitalized patients aged over 60, their family members, and treating physicians. Patients with dementia, terminal illness, language barriers, or refusal to participate were excluded. Internal consistency was assessed using Cronbach's alpha, and agreement among raters was measured with the intraclass correlation coefficient (ICC).

Results: The median ages of patients, family members, and physicians were 79.5, 56.5, and 35, respectively. Cronbach's alpha values were 0.82, 0.88, and 0.91, respectively. The ICC was 0.71 (95% CI 0.53-0.84, p=0.001). Patients had the highest EXPECT-P scores (median 23.5), followed by family members (median 19.5) and physicians (median 18). Significant differences were observed: 5.5 points between patients and physicians (p<0.001), 4 points between patients and family members (p=0.02), and 1.5 points between physicians and family members (p=0.26).

Discussion: The EXPECT-P Scale showed strong validity and internal consistency. Significant discrepancies in recovery expectations were found between patients, family members, and physicians. These findings highlight the importance of aligning expectations to improve rehabilitation outcomes and reduce potential frustration.