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

Introduction: Hidradenitis Suppurativa (HS) is a chronic inflammatory disease that primarily affects intertriginous areas of the skin, causing painful lesions and scarring. The pathophysiology remains partially unknown, and the disease is often diagnosed late, which significantly impacts patients' quality of life.

Objectives: The aim of this study was to determine the prevalence of HS in a hospital population, describe its most relevant clinical and ultrasound characteristics, and evaluate the treatments used and their therapeutic responses.

Methodology: A cross-sectional study was conducted based on the medical records of patients diagnosed with HS at the Hospital Universitario Austral between 2000 and 2024. Data on comorbidities, clinical manifestations, ultrasound findings, disease stage according to the modified Hurley scale, treatments, and therapeutic responses were collected.

Results: A total of 205 patients were analyzed, with an average diagnosis age of 30 years, and 64.9% were women. The most affected areas were the axillae (74.6%), inguinal region (34.1%), and gluteal region (13.7%). The most common comorbidities were obesity (26.3%) and smoking (19.5%). The majority of patients were in Hurley stage I (14%).

Conclusion: HS is a chronic disease that significantly affects the quality of life. Early diagnosis is key to effective treatment. This study provides valuable information about the prevalence, clinical and ultrasound characteristics of the disease, which may improve patient management.

Introduction: Invasive mechanical ventilation (IMV) in pediatric intensive care units (PICUs) is a ubiquitous practice; the weaning process is supported by predictors, none of which guarantees success.

Objetive: To describe the weaning process from IMV and to determine the predictive factors of extubation failure (EF).

Patients and methods: Retrospective study, patients with more than 48 h of IMV, period 11/2019 to 10/2023. The following were excluded: deceased, referred to another institution and tracheostomized patients. Demographic characteristics, ventilatory status prior to extubation (IMV and blood gas parameters), variables related to the spontaneous breathing test and post-extubation support [noninvasive ventilation (NIV)] of successful vs failed extubation groups were compared aimed at determining the existence of predictors.

Results: 510 extubation events were recorded in 445 patients, with an EF rate of 12.7%. Admission for respiratory reasons (92 vs 78%), higher respiratory rate (22 vs 20 per minute) and fraction of inspired O2 (0.32 vs 0.4) programmed on the ventilator, and use of post-extubation NIV (51 vs 24%) were significantly associated with EF. In multivariate analysis, this association persisted for higher expiratory tidal volume prior to extubation and the use of NIV post-extubation. EF resulted in more days in IMV (10 vs 7) and PICU (13 vs 9).

Conclusion: Higher exhaled tidal volume prior to extubation and use of NIV post-extubation were predictive factors of EF, this being associated with longer stay in IMV.

Adolescence and the aging process involve understanding health throughout the life course. In the 21st century, 87.2% of the population uses a mobile health-related application, and the use of these tools has the capacity to promote healthier habits, with an odds ratio of 2.9 (CI 1.3–6.4) for engaging in frequent self-care health practices. Thus, access to health services goes beyond adolescence and extends into adulthood and old age. In old age, access to care has also been widely reported as a critical issue. Health education, when approached from a digital perspective, creates a differential environment for current times. It is essential to integrate digitalization into the health landscape, leading to a necessary reconfiguration of the processes of health and life care. This not only contributes to the timely identification of risks, the traceability of care, individual follow-up, early detection, or epidemiological analysis for decision-making, but—when aligned with the operationalization of the health system—it should also contribute to improving access, timeliness, safety, and the strengthening of quality of care. Furthermore, it promotes individual responsibility in self-care, even at the end of life. In conclusion, the importance of digitalization and primary health care in building health contexts throughout the aging process cannot be overlooked.

Objective: To present a case with tracheal stenosis, secondary to airway abscess, and describe its clinical presentation, diagnostic methods and treatment.

Clinical case: An 85-year-old patient presented with dry cough, inspiratory laryngeal stridor and dyspnea. Physical examination: No particularities. A computed tomography scan of the neck and chest was performed, which reported a decrease in the caliber of the tracheal lumen. It was decided to admit him to the intensive care unit, and fiberoptic bronchoscopy was performed where critical stenosis was observed. Mechanical dilation was performed with candles and in the absence of clinical improvement, a surgical tracheostomy was performed. During the procedure, an abscess was observed in the anterior tracheal wall, which was drained. Culture of the liquid development of Pseudomona Aeruginosa. The patient presented a good clinical evolution. being discharged 72 hours after surgery with targeted antibiotic treatment. Due to resolution of the infection process, it is decannulated 30 days after the surgical procedure. The follow-up after the extraction of the tracheostomy tube showed no particularities.

Conclusion: Airway abscesses as a cause of tracheal stenosis are uncommon; at the time of the article's presentation, there is only one recorded case in the available literature. The diagnosis requires a correct clinical evaluation and the judicious use of complementary studies such as bronchoscopies and computed axial tomography. Management is multidisciplinary, and the treatment modality will be determined by the type of patient and the severity of the stenosis.

Introduction: COVID-19 differentially affected individuals with chronic diseases such as cancer, with greater severity and mortality than the general population.

Objetives: Estimate the incidence of infection, hospitalization and fatality due to COVID-19 in cancer patients diagnosed between January 1, 2018 and December 31, 2020, treated at a Hospital in the city of Mar del Plata and evaluate risk factors for infection.

Methods: retrospective cohort study in cancer patients aged 15 years or older. Demographic variables, comorbidities, tumor characteristics, oncological treatments, infection, hospitalization and death due to COVID-19 were collected. Kaplan-Meier curves and a Cox regression model were fitted, the time until infection was the response variable.

Results: 995 patients were included and 8.9% had COVID-19. 95.6% had solid tumors, 41.4% had severe forms of cancer, 1.7% had more than one malignant tumor and 10.9% had tumors with metastatic forms. Patients under 60 years of age, with hematological cancer and/or severe forms of cancer had significantly higher risk of COVID-19 infection.

Discussion: The greater circulation and exposure in those under 60 years of age could explain the higher risk of infection, while the decrease in the immune status in the case of solid cancers with more severe stages or those of a hematological type could explain the higher risk.

Introduction: Software tools that assist in the pharmacotherapeutic optimization of narrow therapeutic range drugs are widely available. However, empirical (“trial and error”) methods are still common. The aim of this work was to evaluate the characteristics and performance of free-online software that assist in precision dosing of vancomycin.

Materials and method: An exhaustive search was performed in Google, Google Scholar, and Pubmed/Medline, with no time limits. General descriptive and pharmacokinetic characteristics related to vancomycin and, occasionally, to other drugs were evaluated. Different scores were assigned for each attribute of each program, comparing, when appropriate, with reference programs: BestDose, PrecisePK and DoseMeRx.

Results: 8 free online software were found: Clincalc, Globalrph, IDS-ODS, NextDose, TDMx, Vancocalc, VancoPK and Vancovanco. Although all of them are suitable for use, TDMx, NextDose, and IDS-ODS provided the best performance. Some are especially useful for academic settings, while others are suitable for the clinical setting. Each one must be evaluated by the users to decide its applicability. These software can be a valid option for those who are beginning to learn about pharmacotherapeutic optimization processes and for those who do not yet justify an economic investment. However, the performance of commercial programs is usually much more advantageous.

Conclusions: The free online software for precision dosing of vancomycin (especially TDMx, NextDose, and IDS-ODS) can be used, with the limitations of each case, as starting assistant tools, both in the clinical and in the teaching-academic field.

Introduction: Primary empty sella (PES) consists of herniation of the suprasellar subarachnoid space within the sella turcica in patients with no history of sellar pathology. Diagnosis is mostly made incidentally.

Objective: Describe the characteristics of patients with PES.

Methods: Patients with PES from 6 Argentine centers specialized in Neuroendocrinology in Buenos Aires diagnosed between 1997-2021 were included. Diagnosis was based in sellar magnetic resonance, pituitary functional evaluation by baseline hormonal measurement and visual function assessed by neuro-ophthalmological evaluation and campimetry.

Results: Sixty-three patients with a mean age of 52.3 ± 13.2 years and a predominance of female gender (79%, 4:1 ratio) were included. The average BMI was 32.7 ± 8.13 kg/m2 and 68% were overweight or obese. HTA was also found in 59%. Among women, the parity frequency was 78%: 92% had multiple pregnancies. The diagnosis was incidental in 22%. In symptomatic patients (n= 49), the reasons for consultation were headache in 61%, symptoms of endocrine dysfunction in 51% and visual disturbances in 33%: 43% of the patients presented multiple symptoms. MRI showed partial PES in 63% and total PES in 37% of the patients. In the biochemical evaluation, hypopituitarism was observed in 46%.

Conclusions: Although the diagnosis of PES can be made incidentally, in our series most of the patients presented symptoms. Most of them were multiparous women, obese and hypertensive patients. Biochemical evaluation should be carried out to investigate isolated or multiple pituitary deficits in order to indicate the corresponding replacement treatment.

Introduction: Reconstruction after internal hemipelvectomy of the acetabular dome is complex, especially in young patients. At our institution, we have developed a technique that uses a proximal tibial allograft to recreate the acetabulum without compromising the proximal femur.

Materials and methods: Three patients with primary bone sarcoma of the pelvis in Zone 2+1 underwent limb-sparing surgery and reconstruction with proximal tibial allograft.

Results: All patients were minors, with a follow-up of 42 months. Two patients were discharged in the second week and one in the fourth week, achieving satisfactory reconstruction allowing assisted ambulation and full weight bearing in two cases. There were two acute and one chronic infection-related complications. Discussion: Pelvic sarcomas have a worse prognosis than long bone sarcomas and require massive resections. The tibial allograft reconstruction technique improves function and satisfaction without compromising the proximal femur. This technique is feasible in low-income countries and allows for future primary arthroplasty.

Conclusion: We present a successful pelvic reconstruction technique that does not affect growth in young patients, avoiding the use of prostheses and preserving the proximal femur.

The present investigates the needs presented by currente young people who spent their adolescence in the covid pandemic (2029/2020). Reflects on the role of affective reference and its importance in the construction of identity of these young people guiding towards a modality that is effective and salutogenic.

Spontaneous remission of malignant tumors following bacterial or viral infections is a rare event. The SARS-CoV-2 virus has been associated with cases of remission, but published cases in follicular lymphoma are scarce. We present a case of spontaneous remission of follicular lymphoma following severe coronavirus infection.