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[Characterization and risk prediction of cardiovascular surgeries with cardiopulmonary bypass: a cross-sectional study] [心肺旁路心血管手术的特征和风险预测:一项横断面研究]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.42432
Maria Teresa Politi, Sarah Di Benedetto, Raúl Ferreyra, Guillermo Bortman, Antonio Piazza, Claudia Capurro

Introduction: Cardiovascular surgery risk prediction models are widely applied in medical practice. However, they have been criticized for their low methodological quality and scarce external validation. An additional limitation added in Latin America is that most of these models have been developed in the United States or Europe, which present marked geographical differences. The objective of this study is to characterize the postoperative clinical events of cardiovascular surgeries with the use of cardiopulmonary bypass pump in a local setting and to evaluate the prediction of postoperative mortality using the EuroSCORE II predictive model.

Methods: Cross-sectional study in an urban university hospital in Buenos Aires. Patients ≥21 years of age were included, with a clinical indication for on-pump cardiovascular surgery. Patients with incomplete clinical data regarding EuroSCORE II variables or in-hospital survival, ≥95 years of age, or undergoing heart transplantation were excluded.

Results: 195 patients were enrolled. Postoperative mortality estimated by EuroSCORE II presented a clear underestimation of risk (3.0% vs 7.7%). Discrimination (AUC = 0.82; 95% CI 0.74-0.92) and goodness of fit of the model were adequate (χ2 = 7.91; p = 0.4418). The most frequent postoperative complications were postoperative heart failure (35.9%), vasoplegic shock (13.3%), and cardiogenic shock (10.26%).

Conclusion: The EuroSCORE II is an appropriate tool to discriminate between different risk categories in patients undergoing on-pump cardiovascular surgery, although it underestimates the risk.

导言心血管手术风险预测模型被广泛应用于医疗实践中。然而,这些模型因其方法质量低和缺乏外部验证而饱受诟病。在拉丁美洲,这些模型还存在另一个局限性,即大多数模型都是在美国或欧洲开发的,而这两个地区存在明显的地域差异。本研究的目的是描述在当地环境下使用心肺旁路泵进行心血管手术的术后临床事件,并评估使用 EuroSCORE II 预测模型预测术后死亡率的情况:方法:在布宜诺斯艾利斯的一家城市大学医院进行横断面研究。研究对象包括年龄≥21 岁的患者,他们都有接受泵上心血管手术的临床指征。排除EuroSCORE II变量或院内存活率临床数据不完整、年龄≥95岁或正在接受心脏移植手术的患者:结果:195 名患者入选。根据 EuroSCORE II 估计的术后死亡率明显低估了风险(3.0% 对 7.7%)。该模型的区分度(AUC = 0.82;95% CI 0.74-0.92)和拟合度(χ2 = 7.91;P = 0.4418)均符合要求。最常见的术后并发症是术后心力衰竭(35.9%)、血管性休克(13.3%)和心源性休克(10.26%):结论:EuroSCORE II 是对接受泵上心血管手术的患者进行不同风险类别区分的合适工具,尽管它低估了风险。
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引用次数: 0
[The Metabolic syndrome and metabolic characteristics in blood donors] [献血者的代谢综合征和代谢特征]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.42446
Pedro Aro, Rodrigo Paredes, Grace Tello, Christian Lezama, Ana Oyola, Lesly Talavera, Max Acosta, Milton Tello

Introduction: Metabolic syndrome (MS) is associated with increased cardiovascular risk. Blood donors are an apparently healthy population in which certain cardiometabolic characteristics are not evaluated in their selection, and there is limited information on their presence.

Aim: To determine the frequency of metabolic syndrome and its metabolic characteristics in blood donors. Materials and methods: Cross-sectional study was carried in a population of 244 blood donors between 18 and 55 years of age who attended the Hemotherapy and Blood Bank Service of the Cayetano Heredia Hospital in Lima, Perú during the month of May 2023. The diagnosis of MS was made according to the Adult Treatment Panel III (ATP III) criteria. A bivariate analysis was performed between MS and metabolic characteristics with sex and a significance level of 5% was considered.

Results: 63.9% of blood donors were male. 43.6% of the population had MS. The most frequent characteristics found were hypertriglyceridemia (54.5%), abdominal obesity (51.2%) and high-density lipoprotein (HDL) low (48.8%). The age range of 40 to 49 years presented the highest frequency of MS (14.3%). Hypertriglyceridemia and high blood pressure were associated with male sex (p=0.003 and p=0.019 respectively), while low HDL was associated with female sex (p<0.001).

Conclusions: Blood donors present an elevated frequency of MS. The detection of MS in apparently healthy populations as part of primary care could allow the formulation of strategies for early detection of cardiovascular risk factors.

简介代谢综合征(MS)与心血管风险增加有关。献血者是表面上健康的人群,但在选择献血者时并未对其某些心脏代谢特征进行评估,有关其存在的信息也很有限。目的:确定献血者中代谢综合征的频率及其代谢特征。材料和方法:横断面研究的对象是 2023 年 5 月期间在秘鲁利马卡耶塔诺-埃雷迪亚医院血液疗法和血库服务处就诊的 244 名年龄在 18 至 55 岁之间的献血者。多发性硬化症的诊断依据的是成人治疗小组 III(ATP III)标准。在 MS 和代谢特征与性别之间进行了二元分析,显著性水平为 5%:结果:63.9%的献血者为男性。43.6%的献血者患有多发性硬化症。最常见的特征是高甘油三酯血症(54.5%)、腹部肥胖(51.2%)和高密度脂蛋白(HDL)低(48.8%)。40 至 49 岁年龄段的多发性硬化症发病率最高(14.3%)。高甘油三酯血症和高血压与男性有关(p=0.003 和 p=0.019),而低高密度脂蛋白与女性有关(p结论:献血者罹患 MS 的频率较高。作为初级保健的一部分,在看似健康的人群中检测出 MS,有助于制定早期检测心血管风险因素的策略。
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引用次数: 0
[Food consumption patterns and risk of gallstone disease (GD): Case and Control Study in Rosario Argentina.] [食物消费模式与胆石症(GD)风险:阿根廷罗萨里奥的病例与对照研究]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.36961
Agustina Bertola Compagnucci, Herman A Perroud, Stella M Batallés, Roberto Villavicencio, Daniel E Berli, Stella M Pezzotto

Introduction: Nutritional exposure is considered the main environmental influence that contributes to gallstone disease (GD).

Aim: The aim of this study was to determine food intakes patters and estimate risk of GD.

Methods: A nested case-control study was carried out within the framework of a previous screening study conducted on a representative sample in Rosario, Argentina. Participants underwent a personal interview. Average amount of each food intake and quantity nutrients were estimated applying a food-frequency questionnaire. Food consumption patterns were identified by principal component analysis, and logistic regression analysis was used to estimate risks.

Results: The sample was conformed by 51 cases and 69 controls. Two dietary patterns were identified. Cases were characterised by the unhealthy intake pattern (high intakes of animal fats, sugar, cereals, grains, cold cuts, processed meats, chicken with skin, fat beef and low intake of red vegetables and yellows, cabbages, fruits and fish).

Conclusion: Controls were characterised by the healthy intake pattern (high intake of skinless chicken, nuts, lean beef, vitamin A and C rich fruits, and low consumption of chicken with skin, green leaves vegetables and sprouts). The unhealthy pattern showed an increased risk of developing GD while healthy patter behaved as a protective factor.

简介:营养暴露被认为是导致胆石症(GD)的主要环境因素:营养暴露被认为是导致胆石症(GD)的主要环境因素。目的:本研究的目的是确定食物摄入模式,并估计患胆石症的风险:方法:在先前对阿根廷罗萨里奥的代表性样本进行筛查研究的框架内,开展了一项巢式病例对照研究。 参与者接受了个人访谈。通过食物频率问卷估算了每种食物的平均摄入量和营养素含量。通过主成分分析确定食物消费模式,并使用逻辑回归分析估计风险:结果:样本中有 51 例病例和 69 例对照。确定了两种饮食模式。病例以不健康的摄入模式为特征(动物脂肪、糖、谷物、谷物、冷盘、加工肉类、带皮鸡肉、肥牛肉的摄入量高,红色蔬菜和黄色蔬菜、卷心菜、水果和鱼的摄入量低):对照组的特点是健康摄入模式(多摄入去皮鸡肉、坚果、瘦牛肉、富含维生素 A 和 C 的水果,少摄入带皮鸡肉、绿叶蔬菜和芽菜)。不健康的摄入模式会增加罹患广东话的风险,而健康的摄入模式则是一种保护因素。
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引用次数: 0
[Retroperitoneal schwannoma mimicking colorectal cancer metastases: a false positive result report.] 模仿结直肠癌转移的腹膜后分裂瘤:假阳性结果报告。
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.38014
Juan Bautista Del Valle, Juan Pablo Campana, Melina Paula Valeo Chulvi, Pablo Daniel Roitman

Introduction: schwannomas are benign and common soft tissue tumors. They are usually asymptomatic and are discovered for other reasons.

Materials: we present the case of an 82-year-old male patient with a recent diagnosis of moderately differentiated adenocarcinoma of the colon and a hypermetabolic periaortic nodule as an incidental finding.

Results: percutaneous biopsy of the periaortic nodule confirmed the diagnosis of schwannoma. At one year of follow-up, growth of the schwannoma has been demonstrated. There are no signs of progression of his oncological disease.

Conclusions: schwannomas are benign tumors, rarely found in the retroperitoneum and can be sources of false-positive positron emission tomography results.

导言:许旺瘤是常见的良性软组织肿瘤。它们通常没有症状,因其他原因而被发现。材料与方法:本病例是一名 82 岁的男性患者,最近被诊断为结肠中度分化腺癌,偶然发现主动脉周围有一个高代谢结节。结果:主动脉周围结节经皮活检确诊为裂隙瘤。在一年的随访中,发现裂隙瘤有生长。她的肿瘤疾病没有进展迹象。结论:分裂瘤是一种良性肿瘤,在腹膜后不常见,可能是正电子发射断层扫描假阳性结果的来源。
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引用次数: 0
[Feverphobia: Frecuency and related factors associated] [发烧恐惧症:发病率和相关因素]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.42845
Jorge Kassisse, Jennifer Pirul Pineda, Gerardo Weisstaub, Susan Castillo Pérez, Rodrigo Vasquez de Kartzow

Introduction: Fever is common in childhood and there is a high level of concern on behalf of caregivers to manage it, this is called "feverphobia".

Objective: The objective was to evaluate the presence of feverphobia and associated factors in the study population. Methods: observational, cross-sectional, prospective, and analytical study during 2021 to 2022 through an ad hoc survey self-administered to parents and/or caregivers of patients under 6 years of age who consulted the emergency room of the Dr. Roberto del Río Children's Hospital in Santiago, Chile. The association between sociodemographic variables, knowledge, attitudes, and fears regarding febrile children was analyzed by Chi square and Fisher’s test in addition to univariate logistic regression analysis.

Results: A total of 381 surveys were carried out. 98% presented some degree of feverphobia. A fever below 38°C was defined by 40.6%. Physical measures were used by 56% of caregivers. The main sequelae feared were convulsions in 82% and 42.7% reported that it could be lethal. A total of 92.1% used unreliable sources of information and 66% had never received education from health personnel on this subject. Logistic regression showed that being a parent, basic or high school level and a thermal threshold below 38°C were the most associated variables.

Conclusions: Feverphobia is a current phenomenon in our population and health education to the parents and caregivers could prevent it.

导言:发烧是儿童时期的常见病,护理人员会高度关注如何处理发烧,这就是所谓的 "发烧恐惧症":目的:评估研究人群中是否存在发烧恐惧症及其相关因素。方法:在 2021 年至 2022 年期间,通过向在智利圣地亚哥罗伯托-德尔里奥博士儿童医院急诊室就诊的 6 岁以下患者的父母和/或看护人发放特别调查问卷,进行观察性、横断面、前瞻性和分析性研究。除了进行单变量逻辑回归分析外,还通过卡方检验和费雪检验分析了发热儿童的社会人口学变量、知识、态度和恐惧之间的关联:共进行了 381 次调查。98%的人有不同程度的发烧恐惧症。40.6%的人认为发烧低于 38°C。56%的护理人员采取了物理措施。82%的人担心的主要后遗症是抽搐,42.7%的人表示发烧可能致命。92.1%的人使用不可靠的信息来源,66%的人从未接受过医务人员在这方面的教育。逻辑回归显示,父母、基础教育或高中教育水平以及38°C以下的热阈值是最相关的变量:发烧恐惧症是目前我国人口中的一种现象,对父母和看护人进行健康教育可以预防发烧恐惧症。
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引用次数: 0
[Psychological impact on primary caregivers of family members undergoing palliative treatmenta review on quality of life] [接受姑息治疗的家庭成员的主要照顾者的心理影响a 生活质量回顾]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.44824
Macarena Aberg Cobo, Ramiro Moscardi, Javiera Ortega

Primary caregivers of family members undergoing palliative care provide significant care, and as a result, their quality of life may be adversely affected. A systematic review was conducted to synthesize the evidence on caregiver’s quality of life. Pubmed database and the digital library of the Universidad Católica Argentina were used. Thirteen articles were reviewed that addressed the following topics: general quality of life, impact on physical, emotional, social and spiritual dimensions, relationship between caregiver gender and quality of life. It is evident in the literature reviewed the importance of an adequate assessment of signs and symptoms in family caregivers in order to provide comprehensive assistance to promote their quality of life.

接受姑息关怀的家庭成员的主要照护者提供了重要的照护,因此他们的生活质量可能会受到不利影响。为了综合有关照顾者生活质量的证据,我们进行了一项系统性综述。研究使用了 Pubmed 数据库和阿根廷天主教大学数字图书馆。所查阅的 13 篇文章涉及以下主题:一般生活质量,对身体、情感、社会和精神层面的影响,照顾者性别与生活质量之间的关系。从所查阅的文献中可以明显看出,对家庭照顾者的体征和症状进行充分评估的重要性,以便提供全面的帮助,提高他们的生活质量。
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引用次数: 0
[Percutaneous radiofrequency ablation of osteoid osteoma: results from 9 years of experience in a third-level center.] [经皮射频消融骨样骨瘤:一家三级中心 9 年的经验成果]
Q3 Medicine Pub Date : 2024-06-28 DOI: 10.31053/1853.0605.v81.n2.42451
Miguel Agustin Duva, Juan Bautista Del Valle, Lorena Savluk, Matías Adrián Borensztein

Introduction: Osteoid osteoma is a benign bone tumor that accounts for roughly 2-3% of primary bone tumors and up to 10-12% of benigns bone neoplasms. It is most commonly seen in young adults, and shows male predominance. Over the last years, minimally invasive thermal ablation techniques such as radiofrequency ablation have gained popularity over classical surgery. In this study we evaluate results and complications of CT guided osteoid osteoma radiofrequency ablation.

Materials and methods: In this retrospective cohort study all patients that were diagnosed with osteoid osteoma and treated using radiofrequency ablation between January 2014 and December 2022 were included. Pain was assessed using Visual Analog Scale (VAS) pre and post procedure. Technical success was established as positioning of the radiofrequency electrode in the nidus. Primary clinical success was defined as absence of pain after one radiofrequency session. All patients that required a second radiofrequency ablation were included in the overall clinical success group.

Results: During the studied period, 61 osteoid osteoma radiofrequency ablations were performed. Fiftyseven of them were included in this study, 32 were men and 25 female. Pre procedure median pain was 9 according to VAS score. Only 23 patients were treated as outpatient, the rest stayed in hospital for 24 hours. Median follow up time was 21,7 months (SD 8,3). Biopsy was performed in 52 patients. Technical success was accomplished in 57 patients (100%). Primary clinical success was 80,7% (46 patients). Those who continued with pain or had recurrence after a symptoms free period (11 patients), were treated with a second radiofrequency ablation, achieving an overall success rate of 94,7%. Only one patient suffered a minor complication (1,7%).

Conclusion: CT guided osteoid osteoma radiofrequency ablation is a safe, effective and low complication rate procedure, that can be performed on an outpatient basis. We believe it should be considered as a first line treatment option for osteoid osteoma.

导言:骨样骨瘤是一种良性骨肿瘤,约占原发性骨肿瘤的 2-3%,占良性骨肿瘤的 10-12%。骨样骨瘤多见于青壮年,男性居多。近年来,射频消融等微创热消融技术比传统手术更受欢迎。在这项研究中,我们评估了 CT 引导下类骨骨瘤射频消融术的效果和并发症:在这项回顾性队列研究中,纳入了2014年1月至2022年12月期间被诊断为类骨骨瘤并接受射频消融治疗的所有患者。采用视觉模拟量表(VAS)对术前和术后疼痛进行评估。射频电极定位在瘤巢内即为技术成功。一次射频治疗后无疼痛为临床初步成功。所有需要进行第二次射频消融的患者都被纳入临床成功组:结果:在研究期间,共进行了 61 例骨样骨瘤射频消融术。其中 57 例被纳入本研究,32 例为男性,25 例为女性。根据 VAS 评分,术前疼痛中位数为 9。只有 23 名患者在门诊接受了治疗,其余患者住院 24 小时。中位随访时间为 21.7 个月(标清 8.3)。对 52 名患者进行了活组织检查。57名患者(100%)技术成功。初步临床成功率为 80.7%(46 例患者)。在无症状期后仍有疼痛或症状复发的患者(11 例)接受了第二次射频消融治疗,总体成功率为 94.7%。只有一名患者出现了轻微并发症(1.7%):CT引导下的骨样骨瘤射频消融术是一种安全、有效、并发症发生率低的手术,可在门诊进行。我们认为,应将其作为骨样骨瘤的一线治疗方案。
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引用次数: 0
[Cirrhotic cardiomyopathy – Clinically fact or academic curiosity? Review: Part 1: definition, epidemiology, pathology and clinical manifestations] 肝硬化心肌病--临床现实还是学术好奇?回顾。
Q3 Medicine Pub Date : 2024-03-27 DOI: 10.31053/1853.0605.v81.n1.44416
Hugo Ramos, Mario Altieri

Severe cirrhosis affecting myocardial function provokes a syndrome called Cirrhotic Cardiomyopathy, defined as cardiac disfunction associated with hepatic cirrhosis in the absence of other known cardiac disease. The prevalence is variable according different groups of investigation owing to the latent or subclinical course until a stressful situation unmask it such as surgery, hemorrhage, infection, hepatic transplant or transjugular intrahepatic porto-systemic shunt. We aimed to review the definition, pathology, pathophysiology, clinical manifestations, diagnostic criteria, images, clinical relevance, pharmacological treatment and hepatic transplantation.

晚期肝硬化可导致心肌改变,从而构成肝硬化心肌病综合征,该综合征被定义为在无原有心脏病的情况下,与肝硬化相关的心功能障碍。根据不同研究小组的报告,肝硬化心肌病综合征的发病率不尽相同,因为在手术、大出血、感染、肝移植或经颈静脉肝内门体肝内分流术等应激情况发生之前,肝硬化心肌病综合征可能处于亚临床或潜伏状态。本综述旨在讨论该病的定义、解剖病理学基础、病理生理学、临床表现、诊断标准、影像学检查的重要性、临床意义、药物治疗和肝移植。
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引用次数: 0
Late-onset familial amyloidosis polyneuropathy associated with c.186G>C in transthyretin. 与转甲状腺素 c.186G>C 相关的晚发性家族性淀粉样变性多发性神经病。
Q3 Medicine Pub Date : 2024-03-27 DOI: 10.31053/1853.0605.v81.n1.40992
Eugenia Conti, Sebastián Menazzi, Ana Mariel Finkelsteyn, María de Lourdes Figuerola

Introduction: The most common form of hereditary amyloidosis is associated with variants of transthyretin (TTR). Familial amyloidosis polyneuropathy associated with variants of TTR (FAP-TTR) is an infrequent, multisystemic disease, with predominant involvement of the peripheral nervous system. More than 130 pathogenic variants have been identified so far and most of them are amyloidogenic, being Val30Met the most frequently described.

Case report: A 74 year-old male was evaluated for progressive decreased sensitivity and associated loss of strength in four limbs in the previous two years, needing assistance for walking. Areflexia, bilateral tibialis anterior and gastrocnemius atrophy, bilateral anesthesia and apalesthesia were found in lower limbs. Bilateral hypoesthesia was reported in upper limbs. No painful dysesthesia, hyperalgesia or allodynia were found. DNA sequencing of the TTR gene led to the detection of the variant c.186G>C in heterozygous state. The resulting variant (Glu62Asp), located in the critical functional domain, has not been published before.

Conclusion: The importance of considering late onset, sporadic FAP-TTR as a differential diagnosis of cryptogenic polyneuropathy is highlighted.

简介最常见的遗传性淀粉样变性病与转甲状腺素(TTR)变异有关。与 TTR 变体相关的家族性淀粉样变性多发性神经病(FAP-TTR)是一种不常见的多系统疾病,主要累及周围神经系统。迄今已发现 130 多种致病变体,其中大多数具有淀粉样变性,Val30Met 是最常见的变体:病例报告:一名 74 岁的男性在过去两年中因四肢的敏感性进行性下降并伴有力量丧失而接受评估,他需要人搀扶才能行走。患者下肢出现反射障碍、双侧胫骨前肌和腓肠肌萎缩、双侧麻木和麻痹。双侧上肢感觉减退。未发现痛觉障碍、痛觉减退或异动症。通过对 TTR 基因进行 DNA 测序,发现了 c.186G>C 杂合子变异体。由此产生的变异(Glu62Asp)位于关键功能域,以前从未发表过:结论:将晚发、散发性 FAP-TTR 作为隐源性多发性神经病的鉴别诊断的重要性得到了强调。
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引用次数: 0
[Predictive appendicitis scale for children under 4 years of age: Is it possible to apply artificial intelligence?] 4 岁以下儿童阑尾炎预测量表。
Q3 Medicine Pub Date : 2024-03-27 DOI: 10.31053/1853.0605.v81.n1.44316
Dayhana Arango Cárdenas, Jorge Andrés Castrillón Lozano, Ximena Areiza Ocampo

Acute appendicitis in the pediatric population is a pathology of heterogeneous presentation that is currently diagnosed using various criteria or predictive scales, which have proven not to be sufficiently accurate to be standardized, however, methods have been created to establish a more accurate diagnosis, an aspect that has been provided by artificial intelligence, which through different algorithms has the ability to show the patient's condition and the most appropriate intervention for this, thus reducing the rate of unnecessary interventions and therefore possible related complications.

儿科急性阑尾炎的病理表现多种多样,目前采用各种标准或预测量表进行诊断,但事实证明,这些标准或预测量表不够准确,无法实现标准化。 不过,人们已经创造了一些方法来建立更准确的诊断,人工智能就是其中之一,通过不同的算法,人工智能能够显示患者的病情和最合适的干预措施,从而减少不必要的干预措施,进而减少可能出现的相关并发症。
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引用次数: 0
期刊
Revista de la Facultad de Ciencias Medicas de Cordoba
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