Revista de la Facultad de Ciencias Medicas de Cordoba最新文献

Objective: To describe a case of bilateral diaphragmatic paralysis secondary to Parsonage–Turner syndrome, emphasizing its uncommon clinical presentation, the multidisciplinary diagnostic approach, and the therapeutic strategies implemented.

Case report: A 63-year-old male, former smoker with hypertension and type 2 diabetes, presented with sudden and intense pain in both upper limbs followed by proximal paresis. Within 24 hours, he developed hypercapnic respiratory failure requiring invasive mechanical ventilation. Chest computed tomography revealed elevation of both hemidiaphragms, and diaphragmatic ultrasound confirmed bilateral dysfunction. Neurophysiological studies demonstrated a sensory–motor neuropathy without associated structural abnormalities. After excluding other causes, a diagnosis of bilateral diaphragmatic paralysis secondary to Parsonage–Turner syndrome was established. Non-invasive positive pressure ventilation was initiated, leading to clinical improvement and no hospital readmissions. At one-year follow-up, the patient remains clinically stable with good tolerance to nocturnal ventilatory support.

Conclusion: This case highlights the importance of considering Parsonage–Turner syndrome in the differential diagnosis of diaphragmatic dysfunction, particularly in patients with recent viral infections and neuromuscular symptoms. The combined use of functional assessments such as maximal transdiaphragmatic pressure (PdiMax) measurement and diaphragmatic ultrasound enables objective characterization of diaphragmatic function and represents a high-value diagnostic approach to guide ventilatory management and respiratory rehabilitation.

Our objective was to analyze some obstructive respiratory variables during sleep in women considering the perimenopausal age range, between 40 to 58 years old.

Materials and methods: A retrospective cross-sectional study, consisting of analysis of reports of polysomnographies performed in women. The studies were divided by age into three groups: Group G1, G2, and G3. Data from the general series and intergroup differences were analyzed. Respiratory variables evaluated were the obstructive apneas-hypopneas index per hour of sleep (AHI) in total and REM, as well as the minimum and mean oxygen saturation. Continuous variables were expressed as mean and standard deviation (SD). Nominal variables were expressed as percentages with contingency for each analyzed variable. Significant p-value <0.5.

Results: The total number of polysomnography reports analyzed in women in perimenopause was 145. Age in G1 was 40-46, G2=47-52, and G3=53-58. The total AHI was G1=5±6 events/hour, G2=8±13 events/hour, and G3=12±18 events/hour, with p=0.001. The AHI in REM phase was G1=15±6, G2=17±23, and G3=14±6 events/hour. The mean minimum saturation was G1=89±5%, G2=82±15%, and G3=84±8%, p=0.05.

Conclusions: We found a statistically significant difference in the total AHI, and also a trend toward a decrease in the minimum oxygen saturation as women age. This is the first national study considering this period of a woman's life to analyze obstructive events during sleep.

Objective: To systematically assess the effectiveness of Cognitive Behavioral Therapy (CBT) in reducing disability associated with chronic pain, identifying the most effective therapeutic approaches, key components of the interventions, and clinical conditions that exhibit the greatest improvements

Materials and methods: The systematic review followed the PRISMA methodology. Searches were conducted in PubMed, Embase, and ScienceDirect to identify clinical trials evaluating disability associated with chronic pain in patients treated with CBT, published between January 2019 and January 2024, in English or Spanish. Due to data heterogeneity, a meta-analysis was not feasible, and a narrative synthesis was employed to present the results.

Results: Nineteen studies were analyzed, incorporating various CBT modalities (in-person, digital, and combined with other therapies). 84% of the interventions demonstrated significant improvements in disability related to chronic pain. The most effective modalities included in-person CBT, digital CBT, and Acceptance and Commitment Therapy (ACT). The key components identified were psychoeducation, cognitive restructuring, graded activity, relaxation techniques, emotional regulation, an interdisciplinary approach, and the use of technology. Conditions showing the greatest improvements included chronic low back pain, generalized chronic pain, migraine with comorbid depression, and chronic pain in patients with prolonged opioid use.

Conclusion: CBT is effective in reducing disability in patients with chronic pain, with greater benefits observed when combined with other strategies. Its implementation in primary care settings could enhance initial pain management and prevent the chronicity of disability.

Colon cancer according to the World Health Organization is classified histologically as: adenocarcinoma in 95%, mucinous adenocarcinoma 3.9-19%, signet ring cell carcinoma 1-2%, small cell carcinoma less than 1%, medullary carcinoma in less than 1%, undifferentiated carcinoma and neuroendocrine carcinoma 1-2%. Medullary and mucinous carcinoma usually occur in the right colon predominantly in females and are associated with microsatellite instability. The incidence of synchronous colorectal tumors varies between 1.3 and 7.3%, 43% of them are located proximal to the main lesion and one third are advanced tumors. To our knowledge there are no reports of synchrony in the right colon. Objective: To present a case report. Clinical Case: Patient operated for a right colon tumor diagnosed by videocolonoscopy, presenting in the anatomopathological study two tumors, one of mucinous origin and the other a synchronous medullary tumor. Conclusion: This case reveals the importance of correlating endoscopic findings with the anatomopathological study of the surgical specimen, since videocolonoscopy can underdiagnose synchronous tumors, particularly those located in the right colon.

Introduction: The aim of this study is to evaluate the incidence of anaerobic bacteremia over a 26-year period. : Conclusion: The incidence of anaerobic bacteremia was 1.69% in the 26-year period, with most of the patients involved being elderly and with different comorbidities.

Methods: Retrospective observational study of blood cultures processed between January 1996 and December 2021 in the Bacteriology laboratory of the Hospital Nacional de Clínicas, considering two time periods (IP and IIP). Isolated species, demographic variables, origin, type of bacteremia, associated focus, and comorbidities were analyzed.

Results: 53,553 blood cultures were processed, of which 9.5% were positive and of these, 86 (1.69%) corresponded to anaerobic bacteremias with 96 isolated species, 53.1% gram-positive bacteria, and 46.9% gram-negative bacteria. There were older patients in IIP compared to IP (p=0.0004). Outpatient acquisition predominated in IIP and nosocomial acquisition in IP (p= 0.0041). Polymicrobial bacteremias represented 31.4%, with no significant differences. The foci were abdominal (32.6%), skin and soft tissue (18.6%) throughout the period; neoplasia (20.9%), abdominal surgery (16.3%) and diabetes (11.6%) as comorbidities. Bacteroides/Parabacteroides of the fragilis group (29.2%), Clostridium perfringens (13.5%) and Clostridium septicum (10.3%) were isolated. Clostridium species predominated in IP and Bacteroides/Parabacteroides in IIP (p= 0.0027).

Conclusion: The incidence of anaerobic bacteremia was 1.69% in the 26-year period, with most of the patients involved being elderly and with different comorbidities.

Background: Hospital discharge is a vulnerable moment often marked by poor communication and limited patient education. Information and Communication Technologies, like instant messaging, offer scalable tools to improve continuity of care and reduce rehospitalizations.

Objective: To evaluate the effectiveness of an intervention designed to improve medication adherence, survival, and prevent rehospitalization through a post-discharge follow-up program.

Methods: A quasi-experimental study was conducted in adults discharged from general hospitalization or ambulatory surgery. The intervention group received four weekly educational messages via instant messaging; the pre-intervention group received only a follow-up form. Measured outcomes included response rate, medication adherence, appointment attendance, rehospitalization, and quality of life.

Results: 278 patients were included (154 pre-intervention, 124 intervention), with no major differences in age, sex, or residence. Orthopedics was the most common discharging specialty. Follow-up attendance was similar (84.03%). At 30 days, the probability of avoiding rehospitalization was 95.92% in the intervention group (95% CI: 89.49%-98.45%; p = 0.776). However, the intervention group showed a higher rate of non-response (20.97% vs. 5.19%; p < 0.001) and lower contact effectiveness (79.03% vs. 94.81%; p < 0.001). A significant shift toward messaging apps was observed during the intervention period (p < 0.001).

Conclusion: While messaging showed potential, findings underscore the continued importance of phone-based follow-up and the need for hybrid, patient-centered communication strategies. Future interventions should tackle engagement barriers and consider risk-based approaches with extended follow-up to maximize impact.

The Latin American Academy for Child Development and Disability (ALDID) promotes access to evidence-based scientific information. ALDID celebrates 10 years of experience with multiple educational and academic exchange initiatives achieved.

Introduction: Indigenous-descendant adults in Argentina have historically been marginalized in health information systems, hindering the development of policies tailored to their needs. Urbanization and lifestyle changes have impacted their cardiovascular risk profile. This study evaluates the prevalence of myocardial infarction and cardiovascular risk factors in this population.

Methods: This is a cross-sectional observational study based on open data from the Second National Nutrition and Health Survey of Argentina (2018-2019). A total of 7,367 adults were included, of whom 218 (3%) self-identified as indigenous descendants. The prevalence of myocardial infarction, hypertension, diabetes, chronic kidney disease, dyslipidemia, and obesity was analyzed. Comparisons between groups were performed using appropriate statistical tests.

Results: No significant association was found between being an indigenous descendant and the presence of myocardial infarction (1.8% vs. 1.6%; p = 0.7831), chronic kidney disease (6.0% vs. 3.9%; p = 0.1779), or heart disease (9.2% vs. 6.1%; p = 0.0963). However, a higher prevalence of dyslipidemia, obesity, and smoking was observed in this group. Dietary patterns were similar to those of the general population, although a higher percentage of indigenous descendants perceived their diet as healthy.

Conclusion: These findings highlight the need to implement prevention strategies and health education programs tailored to the sociocultural contexts of this population, considering their specific healthcare access barriers and dietary self-perceptions.

Introduction: Chronically critically ill patients may require tracheostomy due to the need for prolonged mechanical ventilation, which could increase the risk of laryngotracheal injuries. The aim of the study was to evaluate whether tracheostomized patients with severe laryngotracheal injuries have a higher rate of decannulation failure.

Materials and method: A retrospective cohort study was conducted at Clínica Basilea. Adult patients requiring a tracheostomy cannula, weaned from invasive mechanical ventilation and who had undergone flexible fiberoptic bronchoscopy were included.

Results: During the study period analyzed 622 patients were admitted to the center. 69.29% (n=431) presented airway pathologies, of which 72.62% (n=313) were mild injuries and 27.38% (n=118) were severe. Patients with severe injuries had a lower decannulation rate of 27.12% (n=32) and a higher recannulation rate of 5.93% (n=7) compared to patients with normal airway and mild injuries. The most frequent pathology was granulomas in 59.34% (n=324), followed by dynamic airway collapse in 34.06% (n=186) and stenosis in 6.59% (n=36).

Conclusion: Adult tracheostomized patients with severe laryngotracheal injuries were decannulated less and had a greater need for recannulation compared to those with normal airway and mild injuries. The incidence of decannulation failure in patients with normal airway was 2.09% and in those with mild and severe injuries was 2.55% and 5.93%, respectively.