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

Introduction: Since its introduction in clinical practice in 1981, pregnancies conceived by assisted reproductive techniques (ART) are an increasing proportion of all pregnancies, presenting particular challenges.

Objective: To analyze the maternal-fetal outcomes of pregnancies conceived by ART in a single center in Argentina. Material and methods: Retrospective cohort of pregnancies conceived by ART who attended their delivery in a private university hospital through a review of records.

Results: The incidence of composite primary maternal outcome was 40,1% (282/703), with hypertensive disease of pregnancy (21%) being the most frequent presenting pathology.In the multivariate analysis, age > 40 (OR 2,79; 95%CI: 1,82-4,26), chronic hypertension (OR 10,59; 95% CI: 2,81-39,86), twin pregnancy (OR 8,94; 95% CI: 5,39 – 14,80) and oocyte donation (OR 1,54; 95% CI: 1,04 – 2,27) were significantly associated with the maternal primary outcome. The incidence of the composite neonatal fetal primary outcome was 56,7% (468/824), with a prematurity rate of 34,5% (252/803). In the multivariate analysis of the composite outcome of the neonatal fetus, twin pregnancy (OR 7,08; 95% CI: 3,48 – 14,39) and other complications related to prematurity were statistically significantly associated with the composite outcome.

Conclusions: Pregnancies conceived by ART show a significant increase in adverse maternal outcomes, mainly hypertension, and fetal and neonatal outcomes (prematurity, malformations, and admission to the intensive care unit).

Introduction: parvovirus B19 (B19V) infection during pregnancy can be transmitted to the fetus and cause serious complications such as fetal hydrops and stillbirth. The preexistence of specific IgG prevents vertical transmission. Seroprevalence in fertile age is variable (50-70%) and depends on the region/viral circulation, in addition to factors such as maternal age and frequent exposure to children.

Objectives: to determine seroprevalence for B19V in pregnant women at Hospital Universitario de Maternidad y Neonatología (HUMN), analyze its association with predictive factors and describe cases of B19V infection.

Methods: observational, cross-sectional study. Patients treated at HUMN during 2021-2022 were included and compatible demographic and clinical data were recorded. Specific IgG was quantified and its association with predictive factors was analyzed by bivariate analysis (p<0.05). In cases with signs/symptoms associated with B19V, specific IgM and viral DNA were also determined. Results: 317 cases were studied and anti-B19V IgG was detected in 214/317 (67.5%). No association was found between seroprevalence and maternal age, multiparity, cohabitation with children under 15 years of age, or presence of maternal/fetal signs/symptoms. Ten cases (10.4%) of B19V infection were identified, all of them with anemia and one with fetal hydrops and VDRL+.

Conclusion: in the population studied, B19V seroprevalence for was 67.5% and independent of the predictive factors, leaving 32.5% without evidence of exposure to the virus (susceptible to contracting the infection in the future). The detection of infection in symptomatic cases indicates the importance of investigating B19V in this group.

Tracheostomy (TQT) has emerged as a valuable alternative for patients with orotracheal intubation, especially those under prolonged mechanical ventilation (VMP), as in the case of chronic obstructive pulmonary disease (COPD). This population presents additional challenges, and the available information regarding their progression in specialized centers is limited in Argentina.A descriptive, retrospective, and cross-sectional study was conducted at Santa Catalina Neurorehabilitation Clinic between August 2015 and December 2018. Patients with COPD referred to the Intensive Care Unit (ICU), tracheostomized, and subsequently referred to the Center for Ventilation Disconnection and Rehabilitation (CDVMR) were included. Cases with missing data or derived from other CDVMRs were excluded. Clinical records and interviews were employed to collect demographic and progression data.Out of the 27 COPD patients included (4.9% of 555), the majority were males (63%) with an average age of 68.1 years. Most were admitted with AVMi, and 11 (45.8%) were successfully disconnected, while 11 (40.7%) were decannulated. Survival and home discharge were more frequent in decannulated patients (81.8% were discharged) compared to non-decannulated ones (50% deceased, and none were discharged).COPD patients undergoing TQT and VMP, who succeed in being decannulated, seem to have better prospects for survival and home discharge compared to those who do not have the cannula removed. There is a suggestion for the need for additional analytical studies to confirm these findings and improve the understanding of this specific population.

Introduction: porphyria is a rare condition in which heme metabolism is altered.

Clinical case: 29-year-old young man who goes to the emergency room with abdominal pain, vomiting and seizures. To determine the underlying cause, a brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed, confirming the presence of involvement at the parieto-occipital level. Laboratory and urine tests are positive for porphyria, with improvement and resolution of the condition through targeted treatment.

Discussion: Porphyrias are rare metabolic disorders with dominant autonomic inheritance that affect heme biosynthesis. In a minority of cases, an external factor can trigger a crisis producing abdominal and neurological symptoms. Imaging findings in acute porphyria are characteristic of PRES (posterior reversible encephalopathy syndrome), with cortico-subcortical involvement.

Conclusion: Although it is an uncommon etiology in typical PRES imaging, acute porphyria attacks should be suspected in young patients with seizure attacks without hypertension and associated abdominal pain.

Introduction: The COVID-19 pandemic in Argentina has challenged health professionals to implement teleconsultation to maintain continuity of care.

Objectives: Describe the implementation of new technologies in teleconsultation by Nutrition professionals from Entre Ríos, from the beginning of the ASPO to the new normal.Methodology: Observational, descriptive, quantitative, and cross-sectional study, in which 72 Nutrition professionals from Entre Ríos, Argentina participated through a self-administered online questionnaire. The descriptive analysis of the data was carried out in the IBM® SPSS Statistics program.

Results: 84.7% of professionals began to implement new technologies in teleconsultation since the beginning of the ASPO. Although the majority did not experience significant changes in their income, relationships with patients, or time spent in teleconsultation compared to in-person care, 78% did not receive specific training for the implementation of these technologies in remote care. Despite this challenge, 80% expressed their intention to continue with this type of care in the new normal, allocating hours of their workload for this purpose.

Conclusions: The implementation of new technologies in teleconsultation has proven to be an ally in maintaining the continuity of nutritional care since the beginning of ASPO. However, to provide a quality service, it is necessary to select the most appropriate technologies and dedicate sufficient time to planning and implementation.

Background: Hernia through Winslow's hiatus, known as Blandin's hernia, a rare but potentially life-threatening condition, represents a diagnostic and therapeutic challenge. This case report describes a successful laparoscopic approach to a cecum hernia through the foramen of Winslow in a 63-year-old female.

Case presentation: The patient presented with 24 hours of abdominal pain and nausea. Abdominal CT scan revealed a herniated cecum and terminal ileum compressing the gastric chamber and portal vein, leading to periportal edema. Laparoscopic right colectomy was performed after successful colon content evacuation via the greater gastric curvature to facilitate reduction. This was done to aid in reduction, as there were indications of non-viability in the right colon. The procedure unfolded without complications. The patient developed postoperative abdominal collections requiring percutaneous drainage but recovered well and was discharged within two weeks.

Conclusion: This case highlights the value of laparoscopy in managing foramen of Winslow hernias, offering minimally invasive benefits. Early diagnosis through imaging tools like CT is crucial for prompt surgical intervention and preventing complications like intestinal ischemia or perforation.

Introduction: The importance of knowing the impact of work on people's health has increased after the COVID-19 pandemic. Burn Out (BO) syndrome arises from the tension emerging from the conflictive interaction between the worker and his or her employment. The objective was to describe the prevalence and frequency of diagnosis of BO in the health human resources of critical services of the Bahía Blanca Municipal Hospital in the context of the COVID-19 pandemic.Methods: Descriptive, cross-sectional study. The study population was the medical and nursing staff of the Intensive Care (IT), Emergency Medicine (SMU) and Clinic services who worked with COVID-19 during 2021. The Maslach Burnout Inventory (MBI) questionnaire was used and complementary closed questions to identify, among these cases, those that were diagnosed and treated by the institution.Results: Of the 219 workers, 55.3% (121/219) were nurses. In the SMU, 25% (24/96) of respondents had BO, followed by 20.4% (11/54) in Clinic and 8.7% (6/69) in IT (p value=0.004). Only 5.5% (12/219) of the total were diagnosed with BO by the institution and of this group, two people (0.9%) had previously consulted for characteristic symptoms.Discussion: A high prevalence of BO and a marked underdiagnosis were evident at the institutional level during the pandemic. Although the IT Service had the highest demand for attention, it was the one that presented the lowest BO values in relation to other services.

Background: spinal cord injury leaves as a sequel in the acute and chronic period, deficiencies in the stability of joint functions and in the function of voluntary movement control. Those with good trunk control have a greater probability of carrying out activities of daily living by themselves; up to now, we do not have reliable tools in Argentina that evaluate trunk control in these subjects.

Objectives: to cross-culturally adapt the trunk control test to Argentinean Spanish in subjects with sequelae of spinal cord injury and to establish interobserver and intraobserver reliability.

Methodology: the subjects were admitted using a non-probabilistic convenience sampling. Subjects who were between 15 and 75 years old and had a diagnosis of spinal cord injury were included. Subjects who had: another neurological diagnosis, alteration in sensory organs, conditions that prevent the performance of the test, and psychiatric illness were excluded.

Results: 30 subjects were included for cross-cultural adaptation and 55 for reliability. Semantic modifications were made to all items and response options. The intraobserver and interobserver reliability of the scale or subdomains did not achieve a sufficient score.

Conclusion: the trunk control test was adapted cross-culturally to Argentine Spanish and interobserver and intraobserver reliability was established. The adaptation was achieved through semantic changes and the reliability was not sufficient. In the future, studies should be carried out to improve the reliability and study the validity of the tool.

Background: Surgical complications are preventable in up to 50% of cases, actually are various tools to avoid them, one of these are morbidity and mortality conferences. However, there are no guides that define their structure for them to be effective. Objective; Analyze the impact of a new modality of surgical conferences in a sector of benign biliary pathology, called quality evaluation conferences. Methodology: Descriptive observational study where the overall improvement of the sector, the decrease in complications and the quality of patient care are compared. For 6 months, a weekly quality evaluation conference was carried out. It had 5 stages; 1. Analysis of all discharged patients. 2. Review of adverse events. 3. Review of the list and order of patients in the surgical plan. 4. Reproduction of recorded surgeries and review of scientific articles. 5. Review of own scientific works in development.

Results: after implementing the conferences, there was a decrease in the number and severity of complications, as well as an improvement in the correct and timely surgical indication. Conclusion; Quality evaluation workshops as an evolution of morbidity and mortality workshops are a novel tool that, when well implemented, can help improve quality standards and in turn be used as a learning option in training centers.