Medicina-buenos Aires最新文献

Opsoclonus-myoclonus-ataxia syndrome is uncommon in adults. Causes are usually autoimmune, infectious, or paraneoplastic. There are cases secondary to some flaviviruses, West Nile virus, or dengue virus (1%); however, to our knowledge, there are no reports of cases in Argentina associated with the Saint Louis virus (SLEV). This virus presents with nonspecific symptoms that precede neurological manifestations. Gadolinium-enhanced brain MRI is usually normal, while cerebrospinal fluid (CSF) may show elevated protein levels and moderate pleocytosis. The diagnosis is established with the presence of IgM and IgG antibodies in serum (with seroconversion) and/or IgM or direct viral detection in CSF. Supportive treatment or immunomodulatory therapy with corticosteroids and/or immunoglobulins is described. We present the case of a 35-year-old man with no medical history who was admitted for opsoclonus, multifocal myoclonus, axial ataxia, and generalized tremor following a 10-day history of nonspecific symptoms. Neuroimaging studies were normal, CSF showed mildly elevated protein levels, multiplex encephalitis PCR was negative, and viral serology tests were negative. Samples of CSF, serum, and plasma from the patient were sent to the National Reference Laboratory for Dengue and other arboviruses, where SLEV-specific neutralizing antibodies were detected in both sera using a neutralization technique. Treatment with pulses of methylprednisolone (3 g) and gamma globulin 2 g/kg was initiated, with slight improvement. Outpatient treatment continued with a slow taper of corticosteroids, and complete resolution of symptoms occurred after 2 months of follow-up.

Hereditary angioedema (HAE) is a rare autosomal dominant disease, characterized by episodes of edema involving the skin, gastrointestinal tract and larynx. HAE has a 15% to 50% historical asphyxia mortality. It is the consequence of C1 inhibitor deficiency. The identification of bradykinin as the principal mediator of the disease has led to the development of new drugs for the treatment of HAE. HAE treatment is agreed in international consensus. A therapeutic guide for the treatment of the disease was published in Medicina (Buenos Aires) in 2012, but new and relevant diagnostic and therapeutic advances have been described subsequently. We here update the pharmacology of new drugs available for the treatment of HAE in Argentina, as well as briefly describe the new forms of the disease.

Introduction: Adverse events in healthcare can have significant emotional and psychological consequences for the professionals involved, known as "second victims." These effects include guilt, anxiety, and depression, which can affect their performance and well-being. This highlights the need for effective interventions to mitigate the effects of these events on professionals.

Materials and methods: A bibliometric analysis was conducted on the second victim experience to evaluate the use and validity of the SVEST (Second Victim Experience and Support Tool) in recent studies. Key publications were reviewed to analyze the application of SVEST and the effectiveness of support strategies implemented in healthcare organizations.

Results: The analysis confirmed that SVEST is a reliable tool for measuring the emotional impact on second victims and for assessing the quality of the support they receive. Studies highlighted the effectiveness of peer support programs and leadership training as key strategies to mitigate the negative consequences of adverse events.

Discussion: The findings underscore the importance of establishing structured support systems within healthcare organizations to create a more supportive and resilient environment. Support and training initiatives significantly contribute to the well-being and performance of affected healthcare professionals, enhancing their ability to cope with the emotional effects of adverse events and strengthening their professional practice.

Autoimmune polyglandular syndrome type 2 (APS-2) is a rare and complex clinical entity, whose etiology and evolution are not fully understood. We present the case of a 78-year-old male, followed and treated for Addison's disease for 45 years, in whom macrocytosis with a hemoglobin level of 11.8 g/dL was detected during a routine evaluation. The immunological vitamin B12 deficiency led to the diagnosis of Biermer's disease, while the thyroid, diabetic and liver immunological evaluations were negative. Treatment was started with periodic injections of vitamin B12 and hormone replacement therapy (glucocorticoids and mineralocorticoids) was adjusted, which produced a favorable clinical response with progressive normalization of macrocytosis and hemoglobin levels. Long-term follow-up confirmed clinical stability and effective control of the autoimmune evolution. APS-2 is defined as the coexistence of autoimmune Addison's disease with autoimmune thyroid diseases (such as Graves' disease or Hashimoto's thyroiditis) and/or type 1 diabetes mellitus, in the absence of hypoparathyroidism. Various genetic and environmental factors appear to contribute to its development, although its exact etiology remains unknown. This clinical case supports the recommendation of active screening for autoimmune disorders in patients with Addison's disease.

Tuberculosis (TB) in Argentina has been on the rise in recent years, with a higher notification rate in the 15 to 49-year-old age group. Although it is estimated that the incidence of TB in pregnant and postpartum individuals is higher than in the general population, there is insufficient data in our country. Congenital transmission is very rare. We report a case of congenital TB transmission diagnosed through epidemiological criteria and molecular methods. We emphasize the importance of implementing TB screening algorithms in pregnancy, tailored to the populations served and the resources available, and we highlight the contribution of genomic sequencing at clinical and epidemiological levels.