Medicina-buenos Aires最新文献

Introduction: Chronic migraine (CM) is one of the most disabling neurological diseases, with a marked impact on quality of life and the use of health resources. In Argentina, there is no published real-life data on the use of botulinum toxin type A; onabotulinumtoxinA (onabotA), in chronic migraine. The objective was to describe the clinical outcomes of patients with CM treated with onabotA at a specialized headache center in Argentina.

Materials and methods: We conducted a retrospective review of electronic medical records of all patients treated with onabotA between January and December 2021. Data collected included demographics, medication overuse, prior preventive therapies, headache diaries, treatment response, and adverse events.

Results: A total of 394 patients were analyzed (91% women; mean age 46 years). Medication overuse was present in 66% (n=241). Forty percent (n=160) reported end-of-dose deterioration. Adverse events were reported by 4% (n=15), none requiring discontinuation. Among the 162 patients who completed headache diaries, 65% achieved ≥50% reduction in monthly headache days, and 34% reversed medication overuse.

Conclusion: OnabotA was safe, well tolerated, and effective in reducing headache frequency and medication overuse in CM patients. Our findings are consistent with pivotal trials and real-world studies and represent the first published experience in Argentina.

Introduction: Diabetes mellitus increases the risk of invasive pneumococcal disease. Vaccination is recommended but coverage remains low.

Materials and methods: Descriptive cross-sectional study of 308 diabetic adults in Argentina. Associations were analyzed with chi-square and crude odds ratios.

Results: Complete vaccination prevalence was 25.65%. It was associated with age (p=0.0001), diabetology followup (p=0.0091), frequent visits (p=0.0037), and >5 years since diagnosis (p=0.0004). HbA1c 7-9% was borderline (p=0.058) but not significant in OR (p=0.08).

Discussion: Coverage is low. Stronger links to healthcare favor vaccination. Proactive strategies are needed.

Gossypiboma is a rare surgical complication. It has an estimated incidence of 1/1000 to 1/10 000 surgeries. Although most cases occur in abdominal surgeries, they can also be found at the thoracic level. Diagnosis is difficult due to the insidious course of symptoms, and is based on high suspicion, chest images, and a history of previous surgery. Treatment is based on surgical removal of the retained material. We describe a patient with an intrathoracic gossypiboma secondary to performing decortication by open thoracotomy.

Introduction: The low detection of respiratory syncytial virus (RSV) pneumonia in hospitalized adults favors hospital-acquired transmission (HI) and inappropriate use of resources.

Materials and methods: Retrospective observational study of patients hospitalized between May and August 2024 over 18 years of age with a diagnosis of RSV pneumonia by nasopharyngeal swab polymerase chain reaction (PCR) test.

Results: A total of 88 patients were included, classified into four groups: pneumonia without etiological rescue (48/88), bacterial pneumonia (7/88), viral pneumonia (33/88). Positive RSV cases (18/33) made up the cohort of interest. The median age was 74 years (25-75th percentiles: 61-86), with a predominance of females and the presence of comorbidities, mainly cardiovascular (12/18) and chronic respiratory (6/18); 12/18 patients had IH infection. Most frequent symptoms: dyspnea (14/18), fever (13/18) and cough (10/18). In imaging studies, the alveolar pattern predominated (8/18), followed by the mixed pattern (4/18). Most received empirical antibiotic therapy (17/18); only 9 discontinued treatment after the viral etiology was confirmed. Five deaths were recorded, mostly women over 80 years of age with IH pneumonia, all secondary to acute respiratory failure.

Conclusion: RSV pneumonia in hospitalized adults was associated with a high frequency of nosocomial transmission, antibiotic use despite viral diagnosis, and high mortality in people over 80 years of age with comorbidities. These findings underscore the need to strengthen prevention and surveillance strategies, along with the implementation of vaccination measures in vulnerable groups.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has emerged as a distinct entity within central nervous system autoimmune demyelinating disorders, clearly differentiated from multiple sclerosis and aquaporin-4 antibody-associated neuromyelitis optica spectrum disorders. Although international diagnostic criteria have been established and the clinical spectrum has broadened, several controversies remain. Serological diagnosis remains a major challenge: not all laboratories use standardized methods, and the interpretation of low or borderline antibody titers is still debated. Furthermore, the prognostic value of serial antibody testing is unclear. The clinical course is also variable. While some patients follow a monophasic course, up to 50% may relapse, and there are no reliable predictors of recurrence. Whether to initiate long-term immunotherapy after a first event, especially in patients with incomplete recovery, remains controversial. Acute and maintenance treatments lack robust, comparative evidence. There is no consensus on the optimal therapeutic strategy, treatment duration, or which patients may benefit most from prolonged immunosuppression. In conclusion, MOGAD is a rapidly evolving field. Clinical decision-making must currently rely on a combination of limited evidence, expert opinion, and individualized patient evaluation.

Migraine is the most common acute and recurrent headache disorder in the pediatric population. Its management is typically divided into acute and preventive interventions. This article aims to review the current evidence for both therapeutic approaches in migraine, with a focus on emerging treatment options approved for adult use, and currently under investigation in children and adolescents. Both pharmacological and nonpharmacological strategies under study are discussed, including onabotulinumtoxinA, neuromodulation devices, gepants, monoclonal antibodies, and 5-hydroxytryptamine receptor agonists. To date, topiramate and propranolol have shown modest benefits compared to placebo. Although the evidence supporting the use of novel therapies in pediatric migraine is expanding, it remains limited and under development.

Dyskinesias encompass a range of hyperkinetic involuntary movements that may occur in isolation or in combination. In this review, we focus on four key movement types: dystonia, chorea, ballism, and athetosis. We begin by defining each of these phenomenologies. Next, we explore the etiologies of dyskinetic disorders in the pediatric population, which span a broad spectrum and include cerebral palsy, genetic syndromes, acquired brain injuries, and autoimmune conditions. We then provide an overview of dyskinetic disorders, highlighting specific diagnostic pearls. A particular focus is given to status dystonicus, the most severe and life-threatening form of dystonia exacerbation. Though it can occur in any patient with dyskinesia, it is most associated with genetic forms. Finally, we discuss both pharmacologic and surgical treatments -including deep brain stimulation- using a phenomenology-based approach to management.

Autism is a neurodevelopmental disorder characterized by a qualitative alteration in social interaction and communication, associated with restricted interests and stereotyped behaviors. Before 3 years old, it can be inferred by the lack of social and communicative intention, stereotyped behaviors, poor response to being called by name, poor eye contact, absence of language and inadequate sensory responses. It is often associated with other neurodevelopmental disorders (attention deficit hyperactivity disorders, language disorders, intellectual disability, motor clumsiness), neuropsychiatric disorders (depression, suicidal ideation, schizophrenia, bipolarity, catatonia, behavioral disorders), epilepsy and/or sleep disorders. This condition continues throughout their lives, with variations in its evolution. Therapeutic approaches, with scientific evidence, are complex given that they depend on many factors such as age, sex, environment, objectives, associated conditions andunderlying neurogenetic etiology, which can allow the recognition of certain characteristic cognitive and behavioral phenotypes which will facilitate faster intervention. In this work, therapeutic approaches of proven usefulness from childhood to adulthood, prioritizing those that improve communication, socialization, language, inappropriate behaviors and work and social inclusion, were analyzed.

A relationship between epilepsy an autoimmune disorder has been demonstrated by multiple studies. This association is stronger, when looking at specific disorders, such as systemic lupus erythematosus and diabetes mellitus type 1. Seizures could also represent a manifestation of immunological disorders with antibodies direct towards neuronal targets. This article focus on the diseases with more convincing evidence about this association or the disorders most frequently observed in pediatrics.