Medicina-buenos Aires最新文献

Introduction: Falls in the elderly are a frequent phenomenon during hospitalization and are preventable adverse events. Falls could cause serious injuries in this vulnerable patient population and also lead to poor health outcomes such as increased morbidity, mortality and healthcare costs. The objective of this study is to characterize falls in hospitalized elderly people and analyze the implication of polypharmacy and inappropriate prescription of medications in a University Hospital in Argentina.

Materials and methods: Descriptive, observational, retrospective study.

Results: A sampling 226 patients was taken, the mean age was 74.7 SD: 12.9, range 69-91. The total number of falls was 237 (9 patients suffered more than one fall). Falls are associated with several factors including polypharmacy, cognitive status, advanced age, female sex, and inappropriate prescription of medications.

Discussion: Incidents of falls are frequent, preventable and multi-causal. Some factors such as polypharmacy, cognitive impairment, among others, would be associated with its occurrence; the published literature confirms these concepts.

"Mild autonomous cortisol secretion" is present in up to one-third of patients with adrenal incidentalomas and is characterized by excessive cortisol production without the typical clinical signs of Cushing's syndrome. Due to the lack of typical symptoms, biochemical evaluation is essential for diagnosis, as chronic cortisol secretion has been linked to multiple comorbidities (hypertension, diabetes, metabolic syndrome, dyslipidemia and osteoporosis) as well as increased mortality. While numerous studies address the comorbidities associated with autonomous cortisol secretion and its clinical impact, the indication for surgery remains uncertain and controversial; currently, no guidelines provide precise recommendations for surgical treatment in these patients. However, the few studies reported in the literature suggest an improvement in the cardiometabolic profile after adrenalectomy.

Spinal epidural abscess (SEA) is a classically monomicrobial infection most commonly caused by Staphylococcus aureus (∼65%), followed by Gram-negative bacilli (∼16%), and less frequently by Gram-positive diplococci such as Streptococcus pneumoniae (∼7%), which typically reach the epidural space hematogenously from another focus, mainly respiratory. SEA can originate from hematogenous seeding or direct inoculation, and in approximately one-third of cases, the source of infection cannot be identified. We present a clinical case of SEA associated with pneumococcal bacteremia. A 65-year-old woman with no relevant medical history presented with a 48-hour history of right-sided lower back pain, rendering her unable to sit or stand, with radiation to the thigh and associated fever. A contrast-enhanced magnetic resonance imaging of the spine revealed 5 and 6 mm collections in the posterior epidural space at the L4 and L5 levels. Blood cultures grew multi-sensitive S. pneumoniae, prompting initiation of antibiotic therapy with good clinical response. The traumatology team assessed the patient and obtained a sample from the larger collection, which also yielded the same pathogen. Isolated pneumococcal spinal infection is a rare but extremely serious condition, with a mortality rate exceeding 20%, and can lead to significant neurological consequences if not managed through a multidisciplinary approach involving broad-spectrum antibiotics and, in some cases, surgical intervention.

Introduction: Chronic kidney disease (CKD) represents a growing health burden, with insufficient epidemiological evidence. The objective was to characterize the spatial distribution of CKD mortality in Argentina by sex, age group, and regions.

Materials and methods: Crude mortality rates (CMR), age-standardized mortality rates (ASMR), and age-specific mortality rates for CKD (ICD-10: N18) were calculated per 100 000 inhabitants for Argentina's 511 departments, grouped by geographic regions and stratified by sex; period 2017-2019. Mortality rates (MR) were represented in choropleth maps at the departmental level. Rates were compared by sex, and regional effects were evaluated by fitting a generalized Poisson regression model. Spatial autocorrelation was assessed using Moran's global index. A ratio between departmental ASMR and the national average was calculated, categorizing departments by percentiles (=P25, P25-average, average-P90, =P90), sex, and total population.

Results: A total of 10 850 CKD deaths were registered in Argentina (54% among males), with CMR and ASMR of 8.4 (95% CI: 7.8-9.1) and 9.2 (95% CI: 8.5-10.0) per 100 000 inhabitants, respectively. At the regional level, significantly different patterns were observed, with higher MR in males and a marked increase in mortality after the age of 60. Mortality rates showed spatial autocorrelation, with high mortality burdens in the northwest and southern regions of the country.

Discussion: Spatial clustering patterns in CKD mortality were identified in Argentina. The findings highlight the need for health policies that integrate sex- and region-specific approaches to reduce the burden of this disease with equity-based criteria.

Lesch-Nyhan syndrome is an inborn error of purine metabolism caused by deficiency of the enzyme hypoxanthine-guanine phosphoribosyl transferase, with X-linked inheritance. At present, there are a few cases available in the international literature of twins with this condition. The object of this publication is to report the case of two twins with Lesch-Nyhan syndrome and to describe the clinical and therapeutic management. We present two dizygotic 10-year-old twins, with global developmental delay and nephrolithiasis, who developed dystonia and self-mutilation. The diagnosis was suspected due to the developmental delay associated with dystonia and hyperuricemia in two male patients, as in most of these patients. It was confirmed with the measurement of enzymatic activity, being undetectable. They required multiple therapeutic schemes, including extraction of teeth and restraint measures to avoid major injuries.