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

Introduction: Patients hospitalized for heart failure with preserved ejection fraction (HFpEF) have a higher prevalence of anemia than those hospitalized for heart failure with reduced ejection fraction (HFpEF). However, it is unknown if this relationship is maintained in patients with chronic kidney disease, forming cardiorenal syndrome type IV.

Methods: Cross-sectional, multicenter study of patients with chronic kidney disease hospitalized for heart failure. The primary outcome was the difference in hemoglobin concentration. The secondary outcome was the difference in the prevalence of anemia.

Results: 229 patients were enrolled. Hemoglobin concentration was lower in patients with HFpEF compared to patients with HFrEF (11.1±1.8 g/dl vs 12.3±2.0 g/dl; p < 0.0001). . Presenting HFpEF was associated with a lower hemoglobin concentration (β1 = -0.90 g/dl; p = 0.001), after including the use of iron supplements, moderate to severe deterioration of glomerular filtration rate, sex and age. The prevalence of anemia was higher in patients with HFpEF compared to those with HFrEF (72.3% vs 59.8%; p = 0.0462). Belonging to the HFpEF group was not associated with anemia (OR = 1.77; p = 0.078), after including the same covariates. Exploratory, belonging to the HFpEF group was associated with moderate to severe anemia, after including the same covariates.

Conclusion: In patients with type IV cardiorenal syndrome, hemoglobin concentration is lower in patients hospitalized with HFpEF, possibly playing a role in the destabilization of these patients.

Objetives: Dermatofibrosarcoma protuberans is a sarcomatous neoplasm with low incidence. It exhibits slow growth; however, it has the capacity to involve deep tissues. Clinically, it can mimic benign lesions, presenting as thickened or atrophic plaques that slowly transform into protruding lesions. The treatment of choice is surgical excision, with Mohs micrographic surgery standing out for its advantages.

Clinical case: A 40-year-old male patient with dermatofibrosarcoma protuberans on the back underwent excision using the Mohs technique, with no tumor recurrence after two years of follow-up. Conclusion: It is important to highlight that the Mohs technique offers advantages over conventional methods, allowing for tissue optimization, ensuring clear margins, and achieving a low recurrence rate

Conclusion: It is important to highlight that the Mohs technique offers advantages over conventional methods, allowing for tissue optimization, ensuring clear margins, and achieving a low recurrence rate

Introduction: Cryptococcal meningitis (CM) frequently associates immunocompromised patients, specifically in HIV infection, and it has high mortality. Neuro-ophthalmic manifestations are rare in patients with CM, especially internuclear ophthalmoplegia (INO) or wall-eyed bilateral internuclear ophthalmoplegia (WEBINO), most of them the result of secondary vasculitis.

Case report: A 53-year-old woman with chronic hepatic failure, had sudden drowsiness, diplopia, fever, and internuclear ophthalmoplegia. MRI showed generalized leptomeningeal enhancement plus infratentorial nodular enhancement type in the midbrain and left cerebellar hemisphere. An India ink test was positive for Cryptococcus neoformans.

Conclusion: Cryptococcal meningitis causes a wide spectrum of neurological manifestations, but neuro-ophthalmological signs are infrequent. Physicians should consider that these meningitis events are capable of generating symptoms due to intra-axial involvement of the Central Nervous System (CNS) due to vasculitis.

Introduction: Self-adjusting titration (APAP) at home is accepted to define therapeutic pressure (CPAPT). The APAP device report may be insufficient to ensure adequate therapeutic response in all patients. There is no consensus on the use of oximetry during APAP titration.

Objective: To evaluate the prevalence and magnitude of residual hypoxemia (RH) in titration with APAP not monitored at home and to identify related variables.

Materials and methods: Retrospective study based on APAP titrations with coupled oximetry, arterial blood gases and spirometry test. A T90 > 10% of the night was considered significant RH. Predictors of HR were identified by logistic regression (RL).

Results: 116 cases were included. 41% in the group with RH. These were older (66.7 vs. 59.6 years, p: 0.02), lower absolute FEV1 (2.17 vs. 2.57 liters, p: 0.06), lower absolute FVC (2.9 vs. 3.3 liters, p: 0.02) and lower basal PO2 (77.3 vs. 84.2 mmHg, p: 0.04). The titration period reached 3.6 ± 1 nights, average adherence of 374 ± 88.4 minutes/night; CPAPT (cm H2O): 9.4 ± 1.8, AHIr; 3.1 ± 3.2 ev/h and leaks (liters/min): 19.7 ± 11.2. Multiple logistic regression identified age > 66 years as a predictor of RH (OR 3.32, 95% CI 1.43 - 7.69, p: 0.005) and FEV1 < 1.76 liters (OR 3.29 – IC95% 1.27 – 8.53, p: 0.0139).

Conclusions: Incompletely corrected nocturnal oximetry was observed in a significant proportion of patients with APAP. Age over 66 years and absolute FEV1 < 1.76 liters were correlated with residual hypoxemia.

Introduction: hypoglycemia is a common and multifactorial clinical condition. A rare cause is that associated with non-islet cell tumors.

Objective: to report our experience on the management of severe hypoglycemia in a patient with solitary pleural fibrous tumor and his response to pasireotide.

Clinical case: 63-year-old patient with a history of glomerulonephritis, hypothyroidism, arterial hypertension and a one-year diagnosis of solitary pleural fibrous tumor. Referred to endocrinology due to hypoglycemia for 6 months. Acromegaloid features were confirmed. Laboratory: Hct 36%, Hb 11.9 g/dl, GB 3570/mm3 (Eo 2%, Ba2%, Bac 4%, NS 36%, Li 30%, Mo 14% metamyelocytes 1%, myelocytes 11%), platelets 120,000 /mm3, ESR 10 mm, CRP 9 mg/L, TP 114%, TTPK 25 sec, blood glucose 57 mg/dL, renal function, hepatogram and lipid profile without particularities. IGF-1 84 ng/ml (VR 57 - 188), C-peptide 0.10 ng/ml (VR 1.10 - 4.40), somatotropin 0.98 ng/ml (VR up to 2.5) and basal insulin 0.4 uU/ml (VR 2.6 - 24) . IFG-2 measurement is not available in Argentina. A chest CT showed a pleural tumor measuring 13 cm. Without possibilities of surgical resection and without response to chemotherapy. Treatment was started with infusion of 25% dextrose, dexamethasone, pasireotide with good response. The patient died due to an infectious complication.

Conclusion: pasireotide could be a therapeutic alternative in cases that are not candidates for surgery or refractory to other medical treatment.

Introduction: a significant number of children suffer cognitive, physical, mental and social limitations as a result of critical illnesses and their subsequent treatment. Pollack et al. developed the functional status scale with the purpose of measuring the change in functional status during hospitalization.

Objectives: evaluate the acquired morbidity upon discharge from the Pediatric Intensive Care Unit (PICU). Specific objectives: compare mortality and acquired morbidity rates, analyze changes in functional status categories, identify the most affected domains, describe relationships between domain affection and admission diagnosis, between domain affection and age group, between morbidity and days in invasive mechanical ventilation (IMV), non-invasive ventilation and high-flow oxygen therapy.

Methodology: observational, descriptive, prospective and longitudinal study. Patients between 1 and 180 months of age requiring ventilatory support for at least 48 hours, between February 2021 and February 2024, were included.

Results: 90.9% survived, and of these, 26.9% developed acquired morbidity. The 42% of patients changed their functional status at least one point. The most affected domains were motor and feeding. Those who died had fewer days of IMV and hospitalization.

Conclusion: The incidence of acquired morbidity was higher than mortality in the analyzed period. Children who developed morbidity remained hospitalized for a longer period of time and had greater requirements and days of IMV. Increased survival makes mortality an insufficient outcome metric. More studies with longer follow-up are needed.

This study finds a gradual increase in women's age at first pregnancy, a situation that has been associated with an increased risk of adverse maternal and postpartum events. While in the mid-1970s there were 1.7 per thousand pregnant nulliparous women between 35 and 39 years old, in 2012 this figure increased to 11 per thousand pregnant women, a six-fold increase. The global prevalence of pregnant women over 35 years of age is estimated at 12.3%. Maternal and perinatal characteristics and outcomes of nulliparous women aged 40 years and older are described and compared with characteristics of nulliparous women younger than 40 years. During the time of said study, approximately 4095 nulliparous female patients who met the inclusion criteria were treated; however, a limitation was found because it was a closed population treated in a highly complex tertiary hospital, the majority with high level of schooling and middle class socioeconomic level. In conclusion, older women constitute a high-risk population whose management and follow-up would require a different approach aimed at improving maternal and postpartum outcomes.

Current beauty standards have influenced individuals to seek an aesthetically "ideal" nose, leading them to pursue non-surgical strategies like rhinomodeling using hyaluronic acid or surgical approaches such as rhinoplasty. The use of hyaluronic acid in the nose can complicate its manipulation in the event of subsequent surgical intervention and carries various risks if performed by unqualified personnel.

Objective: To compare the new cardiograph ZLogic for non-invasive measurements of Stroke volume (SV) and Cardiac output (CO) against the Minnesota cardiograph.

Methods: 86 subjects from both genders, 18-80 years old, hypertensive and healthy volunteers were included. Three hemodynamic measurements performed with each device, in an alternate fashion, using the Bland-Altman method to determine the level of agreement. Percentage error was calculated for interchangeability of both methods.

Results: Mean SV was 86.71±27.35 mL and mean CO 5.42±1.74 L/min. There was a strong correlation between measures of SV and CO obtained with both devices (r=0.99, p<0.001). Mean difference (MD) for SV was 0.65±3.08 mL (CI95%: -0.01-1.31) and 95% limits of agreement −5.39 to +6.69 mL. MD for CO was 0.05±0.17 L/min (CI95%: 0.01-0.09) and the 95% limits of agreement −0.28 to +0.38 L/min.

Conclusion: ZLogic and Minnesota cardiographs provided equivalent SV and CO values in ambulatory hypertensive patients.

Introduction: After suffering brain damage with altered consciousness, clinically stable patients are referred to rehabilitation programs. The objective of this study is to describe the results of a transdisciplinary multisensory stimulation program in adults with altered consciousness admitted to a rehabilitation center in Argentina between 2006 and 2022.

Methodology: A retrospective case series study was conducted that included 178 patients who completed the multisensory stimulation program. Consciousness was assessed with the Coma Recovery Scale – Revised (CRS-R), functional outcome with the Functional Independence Measure (FIM), and disability with the Disability Rating Scale (DRS).

Results: The majority of patients (68%) were men with a diagnosis of unresponsive wakefulness syndrome (RSVS). The median time of injury to admission was 77 days, and the average length of stay was 127 days. The median CRS-R at admission was 6 and 10 at discharge (p = 0.01). The highest percentage (61.8%) of emergence was in traumatic injuries. Patients who emerged showed a significant functional improvement, with a median FIM = 44 and DRS = 11. The stay was significantly shorter in those who emerged (70 vs. 163 days; p = 0.001).

Conclusion: These results highlight the benefit of a transdisciplinary multisensory stimulation program to improve diagnostic evaluation and promote recovery of consciousness in patients with severe brain injury.