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

The implications of Argentina's withdrawal from the world health organization

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.

Pharmaceutical-grade cannabidiol (CBD) is an alternative treatment for patients with drug-resistant epilepsy (DRE). In 2022, the Italian Hospital of Buenos Aires implemented a non-medical change (NMC) of treatment, replacing one commercial pharmaceutical-grade CBD product with another, the latter also being the initial option for new patients.

Our objective was to evaluate the clinical outcomes of the commercial product change in this population.

Methods: Retrospective cohort of DRE patients who either switched from one commercial pharmaceutical-grade CBD product to another or started treatment with the new product. The clinical response was evaluated by changes in seizure frequency, perception of change with the Patient Global Impression of Change (PGIC) scale, and safety considering discontinuation and/or the presence of adverse effects.

Results: Nineteen patients were included, 12 in the change group and 7 in the new start group (7 pediatric and 12 adults). One patient discontinued treatment due to lack of response. Among those who completed follow-up, 8 (44%) reduced seizure frequency, 6 (33%) showed no change, and 4 (22%) increased seizure frequency. According to the PGIC scale, 9 (50%) remained unchanged, 5 (28%) reported barely noticeable changes, and 4 (22%) reported improvement. Adverse events were mild and transient.

Conclusion: The new commercial pharmaceutical-grade CBD product is a safe and valid option both for substitution and initial treatment in patients with DRE. During the treatment period, patients perceived stability or improvement according to the PGIC scale.

Introduction: Tracheostomy in pediatric intensive care has a prevalence between 5% and 10% of patients on mechanical ventilation.

Objective: The objective of this study was to determine the duration and outcome of the weaning process from mechanical ventilation (MV) and the behavior according to the reason for the tracheostomy.

Methodology: Data from 59 patients under 18 years of age who received MV and underwent tracheostomy between January 2018 and March 2023 at the Juan P. Garrahan National Pediatric Hospital, Argentina, were retrospectively examined. Demographic variables, reasons for admission to the unit, days on MV, tracheostomy characteristics, and the weaning process from MV were recorded.

Results: The main reasons for tracheostomy were airway disorders (50.8%) and prolonged MV (30.5%). Notable variability was observed in the duration and success of the weaning process among different groups of patients. Patients with airway disorders showed a faster weaning (median: 1.5 days) and higher success in this process, while those with prolonged MV and neurological disorders experienced longer processes (medians: 25.5 and 28 days, respectively) and more patients required partial or total mechanical ventilation at the end of this process. The presence of diaphragmatic dysfunction was more common in those who took longer to wean.

Conclusion: The weaning from MV is a complex process, and the reason for the tracheostomy influences its progression.

Objective: To report an unusual titanium mesh cage failure after ten years of follow-up.

Clinical case: A 40-year-old woman diagnosed with low-grade spinal chondrosarcoma underwent a total en-bloc spondylenctomy (TES) surgery. This technique required a wide resection, anterior reconstruction with a titanium mesh cage (TMC), and posterior stabilization. For several years a favorable clinical outcome was achieved. After 10 years of follow-up, the patient developed acute non-traumatic low back pain without neurological repercussions. The images confirmed a rupture of the titanium cage. After ruling out tumor recurrence, the patient went through spinal instrumentation revision.

Conclusion: Isolated TMC rupture is a rare event scarcely reported in the literature. There is a strong recommendation to instrument two levels proximal and distal to the bone defect in 360° reconstructions after a TES. Stability had likely been lost over the years due to the slow resorption of the bone graft. We consider necessary studies with a higher casuistry and level of evidence to analyze the contributing factors for the event of TMC rupture.

The understanding of immunological processes associated with allergic diseases and advancements in antibody bioengineering has driven the development of specific biological therapies. Monoclonal antibodies, selectively targeting cytokines involved in the pathogenesis of allergic processes or their receptors, have emerged as a promising tool in treating various conditions, including asthma, allergic rhinitis, urticaria, and severe atopic dermatitis. Since the approval of the first anti-CD3 mouse monoclonal antibody in 1986, remarkable progress has been achieved, marked by the development of chimeric, 'humanized,' and 'fully human' antibodies. The 'humanization' of monoclonal antibodies has played a crucial role in reducing the risk of immunogenicity and minimizing adverse effects, thereby notably enhancing the safety and efficacy of these therapeutic interventions.The aim of this article is to address the characterization, development, pharmacokinetics, pharmacodynamics, and clinical utility of monoclonal antibodies, with a primary focus on allergic diseases.

Introduction: Cardiac myxomas are the most common benign neoplasms of the heart, mainly located in the left atrium. The preferred treatment is the resection of the myxoma. This method not only prevents complications but also has a low recurrence rate. Brain metastases usually occur when tumor fragments embolize and implant at the destination place.

Case presentation: We report the case of a patient with multiple brain metastases, found during follow-up, after the presentation of stroke. This case stands out because the embolization causing the brain metastasis might have occurred either during the ischemic stroke or when the cardiac myxoma was being removed. In our case, the patient was evaluated during follow-up with brain magnetic resonance imaging, finding multiple metastatic lesions. To determine the type of lesion, a biopsy was performed and the histological diagnosis, which was indicative of metastatic tissue of left atrial myxoma.

Conclusion: Patients with cardioembolism should undergo a complete diagnostic protocol to distinguish the cause of embolization, whether it is a blood clot or a tumor embolus. The treatment of choice is the resection of the myxoma, which cures the primary neurological symptoms and prevents neurological complications. However, it is essential to maintain active surveillance for a longer time for the detection and appropriate treatment of brain metastases.

Introduction: laparoscopic hepaticojejunostomy is a complex procedure indicated for different pathologies. Still, the laparoscopic approach is not the gold standard, but it is well known for its benefits regarding post operative recovery. We present our experience in 21 consecutive cases of laparoscopic hepaticojejunostomy done at King Fahad General Hospital in Jeddah.

Methods: 21 consecutives laparoscopic hepaticojejunostomies were done from January 2022 to December 2023. Gender: 10 male and 11 female, average age 46 years. The most common indication is due to multiple common bile duct stones.

Results: average surgical time: 180 minutes, average blood loss: 168 ml. According to Clavien-Dindo´s classification, we recorded one complication type: 3A. Average discharge days were 5.5; no mortality was reported.

Conclusion: We believe that the success of laparoscopic hepaticojejunostomy is related to excellent knowledge of the biliary system and an experienced surgeon in advanced laparoscopic procedures.

Hamartomas are benign tumors characterized by disorganized tissue native to a specific anatomical location. We present the case of a 61-year-old male with a history of COVID-19 infection who presented with a persistent cough. Chest tomography revealed an endobronchial lesion, which led to further investigation with a bronchoscopy. Using a cold loop, the lesion was successfully resected and pathology confirmed the diagnosis of a hamartoma.  Endobronchial resection is the preferred strategy for diagnosing and treating these tumors. This case highlights the successful management of an endobronchial hamartoma in a patient with a history of COVID-19 infection, emphasizing the importance of thorough investigation and appropriate intervention in similar cases.

Background: Thyroid dysfunction during pregnancy negatively impacts both the woman and her offspring, with the early gestational period being critical for potential repercussions. Establishing pre-conception and during-conception care strategies is crucial for favorable pregnancy outcomes.

Objective: This review aims to compile the most recent scientific evidence to guide diagnostic and therapeutic approaches based on clinical cases, including a description of thyroid physiology during pregnancy and strategies for identifying high-risk patients for treatment.

Method: This bibliographic review combined DeCS and MeSH terms from the PICOT question, spanning the period from 2015 to 2022 across 5 databases. Articles in both English and Spanish were included if they addressed the PICOT question and contributed to the explanation of two case reports.

Results: A total of 1452 articles were collected, which, following an initial elimination of duplicates and subsequent blind review based on inclusion and exclusion criteria by two reviewers, resulted in 32 articles included in this review.

Conclusions: Overt hypothyroidism is associated with adverse maternal-fetal outcomes, and its treatment improves these complications. However, in borderline conditions such as subclinical hypothyroidism, isolated hypothyroxinemia, and thyroid autoimmune conditions, uncertainty about the treatment's impact persists due to a scarcity of controlled trials. Emphasizing the importance of all physicians being familiar with this condition during gestation.