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

Introduction: Female infertility affects 15% of couples. Endocrine-metabolic disorders play a key role in reproductive health, yet data are lacking in Argentine populations treated in the public health system.

Objectives: To describe and analyze the endocrine-metabolic characteristics of infertile women treated at the Department of Endocrinology and Diabetes, referred from IUMeR.

Methods: Cross-sectional observational study. Women aged 18–44 years referred to the Endocrinology Clinic for infertility were included. Endocrine-metabolic and ultrasonographic features were assessed.

Results: A total of 103 patients were studied. Thyroid disorders were present in 70%, hyperprolactinemia in 29%, and polycystic ovary syndrome in 21%. In addition, 50% of the women presented non-endocrine factors, such as tubal obstruction (42%) and semen abnormalities in their partners (26%).

Conclusion: The high prevalence of thyroid dysfunction, hyperprolactinemia, and overweight highlights the need for an integral, multidisciplinary approach to female infertility in the public health setting. In many cases, initial endocrine treatments proved effective, reducing the need for referral to high-complexity assisted reproductive technologies. These findings emphasize the importance of reinforcing reproductive health education and implementing programs that promote healthy lifestyle habits, with the potential to improve fertility outcomes in this population.

Giant diaphragmatic hernias are frequently diagnosed in the intrauterine stage and are often incompatible with life if not treated. We report a rare case of a giant defect in an adult male associated with agenesis of the pericardium resolved by laparoscopy.

Introduction: Due to potential disruptions in HIV care services caused by COVID-19, this study aimed to evaluate the variability in HIV screening between 2019 and 2022 among adults hospitalized in the general ward of a tertiary care hospital in Santa Fe.

Materials and methods: This ambispective and observational study evaluated the request for HIV serologic screening in patients selected through randomized sampling at a 2:1 ratio from October to December of the years 2019 to 2022. The impact of the COVID-19 pandemic during 2020 was compared to 2019, followed by the impact of an institutional intervention aimed at increasing the rate of HIV screening requests.

Results: A total of 995 subjects were included. HIV screening was requested for 47.4% (n=472) of them, with a positivity rate of 1.7% (n=8). In 2020, HIV screening decreased compared to 2019 (34% vs. 43.9%, p<0.001), and increased to 84.2% in 2022 (p<0.001). In the multivariate analysis, the odds of HIV screening decreased with age (OR 0.986), while hospital admission in 2019 and 2022 (OR 1.48 y 9.76, respectively) increased it.

Discussion: The COVID-19 pandemic exacerbated the already low rate of HIV screening requests, which was also influenced by the age of the subjects. However, through institutional guidelines, this situation was successfully reversed in 2022.

Introduction: After the marketing approval of a medicine, pharmacovigilance monitoring must be carried out at an international level and the necessary measures must be adopted to reduce the risk that its use may present. Restrictive measures are not taken with the same speed in all countries and there are differences in withdrawal patterns.

Objectives: Identify medicines that have been withdrawn from marketing for safety reasons in countries with health reference agencies (SRA), between January 2014 and June 2023. Establish if these medicines were withdrawn from the market in Argentina.

Methodology: Search for information on SRA, National Administration of Food Drugs and Medical Technology (ANMAT) websites and secondary sources. For each medication withdrawn by any SRA, the validity of the marketing certificate and regulatory actions in Argentina were verified.

Results: In countries with SRA health agencies, 31 medications were withdrawn for safety reasons. Of these, in Argentina, 7 were identified with a valid marketing certificate, another 7 were withdrawn from the market mostly by the manufacturing laboratories, 14 were never marketed and no data was obtained for 3.

Conclusion: In Argentina, medications were identified that were withdrawn from other countries and continue to have a valid marketing certificate. The number of regulatory actions related to safety aspects in our country was lower than those of countries with SRA. It is necessary to strengthen the pharmacovigilance system, and for ANMAT to apply measures that reduce the risk associated with the use of the questioned medications.

Introduction: International scientific evidence highlights the growing need for nutritional information among oncology patients and their search behavior. However, in Argentina, the available information is limited.

Objective: To describe the need for nutritional information and search behaviors among Argentine oncology patients in 2023.

Methodology: Non-experimental, descriptive, cross-sectional design. A non-probabilistic sampling was used, and adult cancer patients who voluntarily gave their consent participated. A questionnaire was applied to evaluate the importance, need for nutritional information, search behavior, and perceived information overload. Data collection was conducted in a mixed manner, and statistical analysis was performed using SPSS software. A 95% confidence level was used.

Results: A total of 500 patients participated; 87.2% (n=436) were women, and the most frequent diagnosis was breast cancer. 98% (n=490) emphasized the importance of receiving information about nutrition after diagnosis and during treatment, 91% (n=455) considered it a necessity, and 83.8% (n=419) reported having searched for information on this topic. This behavior was more frequent in patients with higher educational levels (p<0.05). The most consulted source was the internet, followed by doctors and nutritionists. 62% (n=310) agreed with the information overload regarding diet and cancer.

Conclusion: These findings underscore the importance of meeting this information need and training healthcare professionals who care for this patient group.

Objective: Renal cell carcinoma may be associated with highly aggressive behavior and metastatic disease may be present in 30% of patients at the time of diagnosis. The most common sites of metastasis are the lungs, regional lymph nodes, liver, and bones. Metastases at rare sites include gums, larynx, nasal cavity, and thyroid gland. The objective of this article is to report an unusual manifestation of a known disease and present emerging technology useful in patient management.

Clinical case: A 60-year-old male patient with a history of renal cell carcinoma. He initially received onco-specific treatment with nephrectomy and, ten years later, with zoledronate, pazopanib, and nivolumab due to metastatic progression. Four months after starting systemic treatment, drug-induced thyroid dysfunction was diagnosed, manifested by fatigue and abnormal laboratory results (TSH 9,23 uUI/mL). Due to the sensation of a lump in the neck, an ultrasound revealed a thyroid nodule on the right side.Aided by doppler ultrasound, and strain elastography, an ultrasound guided fine-needle aspiration biopsy of the thyroid nodule was performed, which confirmed metastasis of renal cell carcinoma.

Conclusion: The emergence of a thyroid nodule in patients with a history of renal cell carcinoma and thyroid dysfunction could indicate oncological progression, even a long time after the initial diagnosis.

Introduction: SARS-CoV-2 can lead to a more severe infection during pregnancy. However, population-level data on COVID-19 disease and vaccine uptake in this population group are lacking, especially in South America.

Objective: We aimed to describe SARS-CoV-2 infection in pregnant women from a central region of Argentina.

Methodology: From March-2020 to March-2022, 2407 cases of pregnant women from Córdoba province with confirmed SARS-CoV-2 infection reported in the official records were analyzed. The infectivity and mortality rates were calculated; a control group of non-pregnant women infected with SARS-CoV-2 was included. Sixty-six samples were subjected to variants of concern (VOC) detection by real time RT-PCR.

Results: The overall infection rate was 0.25%, and the number of infections mirrored the number of cases for general population. In September-2021 (when mass vaccination in pregnant women occurred) the infection rate decreased (0.35% in March 2020-September 2021 vs. 0.14% in October 2021-March 2022). The global fatality rate was 0.75% (18/2407). During March-2020 to September-2021 the fatality rate was higher than in the control group: 1.01% vs. 0.08% (p<0.05). Since then, no deaths were recorded in pregnant women (fatality rate 0% vs. 0.01% in the control group). The VOCs distribution was: Gamma: 56%, Delta: 20%, Omicron: 12%, Alpha: 3%, 9% of non-VOC lineages.

Conclusions: The fatality rate found was similar to that obtained for the entire country in this group, and higher than the control group. The frequency of VOCs reflected what happened in the general population. The decrease in cases and deaths since September-2021 correlated with the mass vaccination in this group.

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that uses fluoroscopy to diagnose and treat diseases within the biliopancreatic system. The first ERCP was performed by surgeons in 1968 at George Washington University. While ERCP is most commonly performed by gastroenterologists, surgeons with training in advanced gastrointestinal endoscopy have demonstrated similar success rates and outcomes despite differing training pathways. The purpose of this review is to highlight basic tenants of ERCP and describe how ERCP is performed in our practice.

Objective: To describe a case of acute appendicitis with an atypical presentation, complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis.

Case report: A 55-year-old female patient without relevant history presented with 8 days of epigastric and right hypochondrial pain, fever, dark urine, and vasovagal syncope. Laboratory tests showed anemia, thrombocytopenia, liver dysfunction, and signs of sepsis. CT scan revealed an enlarged cecal appendix with wall disruption, portal and superior mesenteric vein thrombosis, and free fluid. Emergency laparoscopy was converted to laparotomy due to hemodynamic instability, revealing hemoperitoneum and retroperitoneal hematoma. Appendectomy, abdominal packing, and delayed closure were performed. The patient completed 19 days of antibiotic therapy, was transferred to the general ward on postoperative day 17, and discharged on day 20 with full recovery.

Conclusion: Acute appendicitis complicated by hemoperitoneum, retroperitoneal hematoma, and pylephlebitis is rare but severe. Early diagnosis and appropriate surgical management are key to improving outcomes.

Introduction: The COVID-19 pandemic caused a dramatic increase in ICU admissions due to severe acute respiratory syndrome. The NUTRIC score (with IL-6) and its variants NUTRICm (without IL-6) and NUTRICpcr (CRP instead of IL-6) were proposed to evaluate nutritional risk (RN) and even prognosis in critically ill patients.

Methods: Scores with inflammatory biomarkers (NUTRIC and NUTRICpcr) and without them (NUTRICm) were evaluated through a prospective and observational study to discriminate mortality and assess NB in patients ventilated for COVID-19.

Results: 418 patients were analyzed. The median (IQR) age and APACHE II were: 54 years (6-61) and 13 points (10-19). 79% died in the ICU. The highest agreement was between NUTRICm and NUTRICpcr (Kappa= 0.88). The AUCROC (95% CI) to discriminate mortality was: NUTRIC 0.661 (0.598-0.724), NUTRICpcr 0.635 (0.572-0.697) and NUTRICm 0.659 (0.596-0.722). The high RN classification showed differences between the scores with and without an inflammatory biomarker, being significant between NUTRIC and NUTRICm (14.6% vs 22.7%, p 0.0033).

Conclusion: In ventilated COVID-19 patients, the three nutritional risk scores studied discriminate mortality in a similar way, but the assessment of high NR differs between them, with a higher prevalence for the NUTRICm, which omits the inflammatory biomarker.