Medicina-buenos Aires最新文献

Reports of excess mortality during the COVID-19 pandemic in Argentina have been partial and fragmented so far. This study aimed to quantify excess deaths and explore their demographic, temporal, and geographic distribution during the period 2020-2022. Using data from 1 192 963 death records from vital statistics and population projections, expected mortality was estimated using regression models. Excess death was calculated as the difference between observed and expected mortality. An excess of 160 676 deaths (95% CI 146 861 to 174 491) was estimated, representing a rate of 116.9 (95% CI 115.5 to 118.3) additional deaths per 100 000 personyears. Significant heterogeneity was found among the different argentine provinces. The results indicate an uneven impact of the pandemic, with higher excess mortality rates in some regions and more vulnerable age groups. These patterns suggest the need for differentiated strategies of healthcare response and support to the most vulnerable populations in scenarios of new epidemics.

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of cancer-related deaths worldwide. Hepatic resection is the treatment of choice for non-cirrhotic patients, while in cirrhotic individuals, the choice depends on tumor stage and liver function.

Methods: In this retrospective study conducted at Hospital El Cruce between 2015 and 2022, patients with HCC undergoing hepatic resection, both cirrhotic and non-cirrhotic, were evaluated. Morbidity, mortality, recurrence rate, and survival were analyzed.

Results: A total of 262 hepatectomies were performed, with 44 for HCC treatment. Among them, 35 were minor hepatectomies, and 9 were major hepatectomies (noncirrhotic patients). The majority were males (77%) with an average age of 58.5 years. Twenty-nine patients had cirrhosis, with hepatitis C (HCV) being the main cause in 48%, HCV with alcohol as a cofactor (21%), and alcohol alone (17%). Morbidity was 47.7%, with predominance of minor complications. Disease recurrence occurred in 59% of patients, and associated factors included tumor size and elevated AFP levels. Survival was better in cirrhotic patients compared to non-cirrhotic ones.

Discussion: Results tion 5837 Hepatic resection is an effective option for treating HCC in well-selected cirrhotic and non-cirrhotic patients, with encouraging results in terms of survival and disease control. Additionally, close surveillance for early recurrence detection and timely interventions is suggested.

Introduction: Sarcopenia is a global health problem, there are currently several criteria for its diagnosis and the implementation of its own cut-off values for each population is recommended. The objective was to evaluate the handgrip strength (HG) in postmenopausal women from Buenos Aires and establish a cut-off value.

Methods: A total of 704 women ≥50 years of age were evaluated, who answered a questionnaire on osteoporosis risk and HG was taken. Those with arthritis or pain in the hands were excluded, leaving 678 women for analysis. A subpopulation of 148 healthy women was selected to define the minimum normal value of the HG of our population.

Results: The HG was 20.44 ± 5.19 kg, with a significant decrease in values after 70 years. The HG in the group of healthy women was 22.08 ± 5.13 kg. And the cutoff value of 17.5 kg was established in our population (first quintile). 28.6% of the total population presented decreased HG and reached 53.7% in women >80 years. HG <17.5 kg was associated with a 67% increased risk of falls in the total group of women >50 years.

Discussion: The HG is a simple tool that is easy to implement in clinical practice and is considered the first step for the diagnosis of sarcopenia. The cut-off value of HG <17.5 kg could be used for the evaluation of sarcopenia in women >50 years of Buenos Aires.

Metastases to the thyroid gland from nonthyroidal malignant tumors are rare but significant. They are often asymptomatic, indicating advanced-stage primary tumors and poor prognosis. Although infrequently, breast cancer (BC) can metastasize to the thyroid gland. We present the case of a 56-year-old woman with a history of BC who presented with a nodular goiter. Physical examination and imaging revealed a thyroid nodule and cervical lymph nodes with suspicious features. Fine-needle aspiration biopsy (FNAB) confirmed the presence of atypical epithelial cells in the thyroid nodule and lymph nodes. Further evaluation, including positron emission tomography, histological biopsy, and immunohistochemistry, supported the diagnosis of metastatic BC to the thyroid gland. Due to the local extent of the disease, total thyroidectomy was not feasible. The treatment with ribociclib and letrozole was initiated, but unfortunately, the patient had an unfavorable progression with the development of metastasis in the nervous system. Metastatic carcinoma to the thyroid gland is rare but has increased due to improved diagnostic techniques. BC can metastasize to the thyroid. Diagnosis involves imaging, FNAB, and immunohistochemistry. Treatment options include surgery, radiotherapy, and chemotherapy, but the prognosis is generally poor.

Introduction: Hemifacial spasm (HFS) is a rare condition, characterized by unilateral, paroxysmal and involuntary contraction of the muscles innervated by the facial nerve (FN). The most common cause is a vascular conflict in the exit zone of the FN. The objective of this work is to demonstrate the efficacy and safety of neurovascular decompression (NVD).

Materials and methods: Retrospective analytical study, patients operated on for NVD due to HFS (n: 48), from June 2005 to December 2023, using a retrosigmoid approach and clinical-radiological follow-up, whose intraoperative recording was with a 2D or 3D video system. Age, gender, time of evolution, side of the condition, use of botulinum toxin, intraoperative findings, postsurgical results and complications were evaluated.

Results: The average age was 50 years, with 60% women. The right side was affected in 23 cases. The vessel most identified as causing the neurovascular conflict was the anterior inferior cerebellar artery in 48% of the cases. The clinical response was complete (disappearance of HFS) in 41 patients (85%), partial in 5 cases and null in 2 cases. Complications included transient deficits in 11 cases and permanent deficits in 2 cases.

Discussion: Most of our patients with HFS (85%) obtained a total improvement, along with a low rate of permanent morbidity (4%) and no cases of mortality. NVD should be considered as the first line of treatment in patients with primary HFS with evidence of neurovascular conflict on MRI.