Medicina-buenos Aires最新文献

Introduction: The COVID-19 pandemic has had significant impacts on society, particularly on children and adolescents, who have faced serious social, educational, and health consequences due to the loss of their primary caregivers.

Materials and methods: Female fertility rates were analyzed, and estimates of male fertility were made to calculate the number of children under 18 years old by age group. Demographic and mortality information from COVID-19 infection was used to calculate the resulting orphanhood in Argentina during the period 2020-2021, considering the loss of one or both parents or the main caregiver grandparent.

Results: A total of 25161 Argentine children and adolescents lost one of their primary caregivers due to COVID-19 during the pandemic. Of these, 22729 were orphaned by mother or father during the analyzed period. The majority of cases (79.5%) were related to the father's death. Specific age groups with higher incidence of orphanhood were identified. The loss of caregiver grandparents was also significant, affecting 2432 children and adolescents.

Discussion: The findings underscore the need for specific policies and programs to address the comprehensive needs of children and adolescents affected by orphanhood during the pandemic. Potential long-term impacts on the physical, mental, educational, and socioeconomic health of these children and adolescents are highlighted.

Introduction: Transthyretin cardiac amyloidosis (ATTR-CM) usually presents as heart failure with preserved ejection fraction. Its diagnosis has a significant clinical impact, as specific treatment is currently available. The aim of this study is to assess the prevalence of ATTR-CM in patients hospitalized for heart failure with preserved ejection fraction and septal thickness in our region.

Methods: Cross-sectional study. Patients over 18 years old hospitalized for heart failure with preserved ejection fraction (greater than 50%) and septal thickness greater than or equal to 12 mm during the period from 8/2019 to 1/2023 were prospectively included. A pyrophosphate bone scintigraphy (PYP) was planned to assess cardiac involvement. The prevalence of ATTR-CM and its 95% confidence interval were calculated.

Results: A PYP was performed in 59/82 patients. The median age was 85 [IQR 78-88] years old, 54% women. On admission, 61% had atrial fibrillation/flutter rhythm and the median NT-Pro-Bnp was 3536 [IQR 1700-7748] pg/nl. The mean ejection fraction was 57% (± 5). The prevalence of ATTR-CM diagnosed by bone scintigraphy with PYP was 19% (95%CI 9.7-30.1). No differences were found compared with those patients who did not perform a PYP.

Conclusion: In patients admitted for heart failure with preserved ejection fraction and septal thickness, the diagnosis of ATTR-CM was relatively common (1/5). We believe that it should be routinely explored.

Approximately 10% of the population reports being allergic to penicillin, although usually less than 1% really are. In addition, people with proven allergies over the years may no longer be allergic. Unconfirmed penicillin allergy and use of alternative antimicrobials result in more treatment failures; more severe adverse effects. Higher cost; longer hospitalizations; increase in the emergence of multi-resistant germs associated with health care. The risk of cross-allergy between β-lactam groups is usually <2%, depending on the similarity of the side chains, so prescribing antibiotics from another β-lactam group is safe as long as we take into account the structural similarity. Incorporating the reassessment of allergies and improving the prescription of antibiotics in this group of patients reduces the generation and spread of multi-resistant germs, and the associated costs. There are simple methods and specific scores that simplify allergy reassessment. The objective of this review is to expose how, through these methods, the delabeling of patients erroneously labeled as allergic and the safe prescription of β-lactam antibiotics can be achieved.

Introduction: Kidney transplant continues to be the best treatment option for patients with end-stage chronic renal failure. The shortage of organs and long waiting times mean that many patients arrive at the transplant with a significant level of deterioration. The objective was to analyze the relationship between socioeconomic variables and knowledge about pre-emptive kidney transplant in the pre-transplant consultation.

Methods: Cross-sectional study. A group of patients over 18 years' old who began pre-transplant evaluation was analyzed. Socioeconomic variables were evaluated and a brief survey on nephrological follow-up and information on kidney transplant prior to dialysis (preemptive) was carried out.

Results: A total of 164 patients with (mean ± SD) 57 ± 14 years were evaluated. A 56% (n = 92) had a predialysis nephrological follow-up of 33 ± 66 months, with 41% (n = 68) of more than one year. The time on dialysis before the pre-transplant consultation averaged 20 ± 23 months. Seventy-two % (n = 118) did not have information on pre-emptive kidney transplantation. Patients with predialysis nephrological follow-up were more likely to have information about pre-emptive kidney transplantation (OR 2.94; IC 1.30-6.63; p 0.009).

Discussion: Referral to the transplant center is postponed by increasing the time on dialysis. Most patients are not aware of pre-emptive kidney transplantation. These findings point out the need to implement policies to improve patient education, access to information, and timely referral to transplant centers.

Spiny keratoderma is a rare dermatological manifestation that occurs sporadically or hereditarily. These are millimetric hyperkeratotic lesions on the palms and/or soles, usually asymptomatic. Histopathologically, they consist of well-defined columns of parakeratosis on a thinned stratum corneum. Sporadic cases can be associated with chronic diseases or neoplasms. We present a case of palmar spiny keratoderma in a man in the seventh decade of life with cirrhosis due to primary sclerosing cholangitis, and hepatocellular carcinoma. He had remission of the skin lesions two months after performing a liver transplant. This behavior favors the interpretation of spiny keratoderma as a paraneoplastic manifestation of hepatocellular carcinoma. We have not found previous reports of spiny keratoderma from Argentina. We review the literature on this entity.

A case is presented of a 64-year-old male patient who was admitted because of delirium, jaundice, a pattern of cholestasis in the liver profile and a right lung mass in the context of a constitutional syndrome and weight loss in the last eight months. The lung mass was punctured and the culture of the obtained material developed white colonies, identified by mass spectrometry (MALDI-TOF) as Nocardia cyriacigeorgica. Regarding the clinical diagnosis, it was considered as systemic lupus erythematosus (SLE), on the basis of fulfilling 8 criteria according to SLICC 2012 group, and 24 points according to EULAR/ACR 2019. The liver biopsy showed a mixt cellular infiltrate in portal spaces, with absence of interphase hepatitis and presence of peripheral ductular reaction. These findings were interpreted as liver compromise relate to SLE. Delirium was also considered as a neurological manifestation related to SLE on the basis of ruling out other causes. After being treated with antibiotics and documenting a reduction in the size of the lung mass he received cyclophosphamide in intravenous pulses, achieving normalization of his liver profile and his state of consciousness, and a progressively weight recovering. A year after he was in good health. The report of this case is justified because of the rare presenting form of late onset SLE, as well as the concomitant pulmonary nocardiosis in the absence of previous immunosuppressant treatment.