bluuebunny/crossref_metadata_2025 huggingface dataset:
Páncreas heterotopico en vesícula biliar. un hallazgo incidental
Authors: Piccinni Daniel J. , Kaplan R. , Burgos A. , Rodríguez N. , Meza Vetanzo Z. , Lencina N.
Published: September 2024

Heterotopic pancreas in the gallbladder is uncommon.condition and its clinical presentation is as an intramural nodule near the cystic duct, with an incidental finding in most cases.Objective: to update Heterotopic pancreas condition in the gallblader. We reported a case of a 18-year-old female, suffering with biliar colic who was operated on with diagnosis of acute cholecystitis. Six mixed gallstones were found in the surgery and the gallbladder was distended and edematous with serosal exudate and the serosa appeared discolored and hemorrhagic. The wall was thickened with edema and hemorrhage. Microscopic findings were: congestive mucosa , edema, acute inflammatory cells and fibrin deposition on the wall and a subtle (myo)-fibroblastic proliferation. The nodule was diagnosed as macroscopic heterotopic pancreatic tissue in the gallbladder wall thickness, without neoplastic changes. Clinical presentation as acute cholecystitis has been rarely reported in the presence of heterotopic pancreatic tissue.
Efectos de ruda ssp sobre la actividad del musculo liso gastrointestinal aislado de rata
Authors: Grigorjev Carlota A. , Brizuela Nilda Y.
Published: September 2024

Ruta graveolens L. and Ruta chalepensis L. are plants used in folkloric medicine as antispasmodics, digestive and for intestinal gases. Animals used as experimental model were rates of the Wistar line, adult females, clinically healthy and with a weight average of 250 grams. We used strips of stomach and duodenum. Each one of the segments mounted on two stirrups in a bath of organ isolated with Ringer-lactate solution, at 37° C , pH: 7.3- 7.4, and bubbled with 95% O2, 5% CO2. One of the stirrups was connected vertically to the bottom of the bath and the other to a transducer of tension connected to a Beckman polygraph. We applied 500 mgs of basal tension. After the stabilization, the ethanolic extract of Ruta ssp was added in increasing doses.At 50?l/ml the tone lower 23% in small intestine and lower 27% in stomach. However at 100 ?l/ml the tone lower 32% and 35% respectively. In the other parameters the amplitude decrease 50% in the stomach at dose of 5 ?l/ml while in the small intestine the amplitude lower 60%. With 10 ?l/ml the amplitude change in both organs ( 96% in small intestine, and 75% in stomach).The frequency changes in both organs ( 32% in small intestine, and 50% in stomach) at 10 ?l/ml Rue showed decreased effects on isolated small intestine and stomach were is dose dependent, maybe we were demonstrated the effects digestive of Ruta.
Carcinomatosis colónica por carcinoma lobulillar de mama: presentación inusual de un caso
Authors: Bürgesser María Virginia , Calafat Patricia , Diller Ana
Published: September 2024

Gastrointestinal metastases are rare. May occur years after initial diagnosis and its symptoms are nonspecific, delaying its correct diagnosis and aggravating its prognosis. The most common histological subtype is lobular breast carcinoma. We present a 75-year-old woman with history of left mastectomy six years ago by infiltrating lobular carcinoma. She was treated with tamoxifen for five years. At present, there was no evidence of disease. She attended the hospital for intestinal subocclusion, being admitted for study. A barium enema revealed multiple strictures of the large bowel and a colonoscopy revealed an impassable stricture in the rectum-sigma. Due to the severity of symptoms, underwent total colectomy. The suspected diagnosis was Crohn's disease. The surgical specimen showed multiple stenosis of the light, with thickened wall and mucosa with granulations. Microscopic examination showed transmural infiltration of colonic wall by malignant cells CK7 positive and ER positive. Breast infiltrating lobular carcinoma has more special tendency to affect the digestive tract, even many years after the diagnosis of the primary tumor. In front of a patient with history of breast cancer and gastrointestinal symptoms, its mandatory to consider gastrointestinal metastases, making differential diagnosis with inflammatory bowel disease, infections or primary tumors, as the therapeutic actions are different.
Entropía aproximada del efecto placebo en ensayos clínicos con antidepresivos de nueva generación
Authors: Cuestas María Eloisa , Cuestas Eduardo
Published: September 2024

Recent research concluded that antidepressant drugs are ineffective in treating moderate or severe depression. Statistically, there are no differences between the results with active drugs or placebo. Some authors have attributed this fail to variability or irregularity of the placebo effect in depressed patients or artifacts induced by meta-analysis.This fact highlights the difficulties faced by the research of psychoactive drugs in depression and revives the debate about the usefulness of the employ of placebo in these studies. This study aimed to determine the variability of the placebo effect in antidepressant clinical trials in simple linear and nonlinear complex models. We performed a secondary analysis of data from 35 trials presented as evidence to the Food and Drug Administration (FDA) for approval of new generation antidepressants, all double-blind controlled with placebo in patients with unipolar mild or moderate depressive disorder, according to the criteria of "Diagnostic and Statistical Manual of Mental Disorders (DSM).Articles reviewed included 5133 patients . We have calculated the coefficient of variability, autocorrelation and approximate entropy of the placebo and treatment effects to determine whether the variability or regularity between different studies should be attributed to meta-analytical methods, placebo effect or ineffective treatment itself. The coefficient of variability in the placebo group was 26.49% and 18.81% in the treatment group. The placebo effect autocorrelation was within the confidential limits while the treatment group was outside showed cyclical variation. The approximate entropy value (ApEn N=35,m=2,R=2) in the placebo group was 0.5579 and 0.5744 in treatment group, leading to the conclusion that placebo effect is highly consistent and regular in complex non-linear models. The apparent variability of the placebo effect in depressed patients slould be due to artifacts induced by simple linear models analysis.
Reproducibilidad y confiabilidad de un protocolo de 4 días de monitoreo domiciliario de presión arterial con y sin exclusión del primer día
Authors: Barochiner Jessica , Cuffaro Paula E. , Aparicio Lucas S. , Elizondo Cristina M. , Giunta Diego H. , Rada Marcelo A. , Morales Margarita S. , Alfie José , Galarza Carlos R. , Waisman Gabriel D.
Published: September 2024

HBPM guidelines state that morning and evening measurements should be recorded and, to improve stability, the first day of measurements should be discarded. Our objective was to assess the reproducibility and reliability of a 4-day HBPM protocol with and without first day measurements. We analyzed a retrospective cohort of ambulatory patients who required a HBPM for diagnostic purposes or evaluation of treatment efficacy. A 4-day protocol was implemented, with daily duplicate measurements in the morning, afternoon and evening, using an OMRON 705 CP validated equipment. HBPM reproducibility was quantified by test-re-test correlations and standard deviation of differences (SDD) between BP measurements obtained during the entire 4 days, with and without exclusion of the first day. The reliability criterion was the stabilization of the mean and standard deviation (SD). We included 353 subjects with a total of 8224 BP recordings (median of 24 recordings per patient). We found a strong test-re-test correlation between days 1 to 4, which improved when we excluded the first day (p<0.001). We also found a reduction of the mean BP when we increased the number of days and a reduction of SDD when we excluded day 1. Therefore, we conclude that the exclusion of the first day of measurements improves the reproducibility and reliability of a 4-day protocol, and such two factors are not affected by the inclusion of afternoon measurements.
Lesiones placentarias de embarazos de madre adolescente en una maternidad pública de la Argentina
Authors: Hernandorena Cintia , Garcia Juan Sebastián , Cavoti Sadonio Victoria , Grandi Carlos
Published: September 2024

Introduction. In Argentina, 18.3% of all births are related to adolescent mothers. Adolescent pregnancy has been associated with an increase of adverse perinatal outcomes. Placental examination helps to identify etiology and predict recurrence of perinatal pathologies. The aim of this study was to describe placental weight and placental lesions and to estimate the risks of adolescent pregnancies compared with young adults mothers.Methods. We examined 50 placentas from adolescent mothers (<16 yrs, n = 18 and 17-19 yrs, n = 32) and 101 placentas from adults mothers between 20 and 29 years old attending the Sarda’ Maternity Hospital of Buenos Aires, Argentina. Conventional methods were used for macroscopic and histological examination.Results. No differences were found in placental weights. In half of examined placenta one or more lesions were present, predominantly in adolescents (p = 0.327). In < 16 ys placental lesions represented 77.78 % (14/18, 95% CI 54 – 91), in older teenagers 34.3% (11/32, 95% CI 20 – 51) (OR 2.26, 95% CI 1.32 – 3.38, p = 0.003), whereas in young adults figure was 41.5% (42/101, [95% CI 32 – 51]), a 1.87 (IC 95% 1.33 – 2.62, p = 0.004) and 0.83 (IC 95% 0.49 – 1.41, p = 0.469) crude risks of both adolescents’ groups compared with adults, respectively.Adjusted risk for placental lesions was four folds higher in adolescent at or below 16 years (p = 0.018). Conclusions. No differences were found in placental weights Younger teenagers (? 16 year age) have an increased risk for having placental lesions.
Efectos de anticoagulantes sobre las sinapsis inmunologicas de rosetas macrofago-linfocitarias autologas humanas
Authors: Novak Ivón T. C. , Orquera Abel D.
Published: September 2024

The contact area between a T cell and antigen-presenting cell is known as “immunological synapse” and the multiple interactions that occur leading to a “signal” for T cell activation. However, an immunological synapse can occur in different circumstances, for a variety of functions. The phenomenon of multiple immunological synapses on macrophage-lymphocyte rosette (MLR) (2, 3) refers to cellular association between human blood monocyte-derived macrophages and lymphocytes from autologous cultures total leukocytes extracted from the blood, which bind selectively forming rosettes with central macrophage and lymphocytes adhered. Inhibitors of antigen processing and presentation and monoclonal antibodies anti-Major Histocompatibility Complex Class II preclude the MLR phenomenon.Objective: As the MLR phenomenon was originally described using heparin, we studied the use of alternative anticoagulants. Materials and methods: human blood samples, anticoagulated with EDTA (ethylenediaminetetraacetic acid) (n = 10) Sodium citrate (n = 10) and controls with heparin (n = 10) healthy samples. Autologous cultures in medium TC199 (Sigma, St. Louis, MO). Culture sampleswere analysed at 72 h and 96 h. Results: In all heparin cases were observed MLRs, in sodium citrate cases, there was no viable leukocytes in cultures, and in cases with EDTA, leukocytes were observed, but the MLR phenomenon did not occur, there was no immune synapse. Conclusions: These results could be due to the chelating action of Ca2 + from the EDTA and sodium citrate as the inhibition of the leucoaccumulation of F-actin by EDTA, which affect the immune synapse in MLR phenomenon.
Impacto de la obesidad en la función reproductiva masculina
Authors: Martini Ana C. , Molina Rosa I. , Ruiz Rubén D. , Fiol de Cuneo Marta
Published: September 2024

Obesity and male infertility have increased in the last decades; therefore, a possible association between these pathologies has been explored. Studies inform that obesity may affect fertility througth different mechanisms, which alltogether could exert erectile dysfunction and/or sperm quality impairment. These include: 1) hypothalamic-pituitary-testicular (HPG) axis malfunction: obese hormonal profile is characterized by reduction of testosterone, gonadotrophins, SHBG and/or inhibin B concentrations (marker of Sertoli cells function) and hyperestrogenemy (consequence of aromatase overactivity ascribed to adipose tissue increase); 2) increased release of adipose-derived hormones: leptin increase could be responsible for some of the alterations on the HPG axis and could also exert direct deleterious effects on Leydig cells physiology, spermatogenesis and sperm function; 3) proinflammatory adipokines augmentation, higher scrotal temperature (due to fat accumulation in areas surrounding testes) and endocrine disruptors accumulation in adiposites, all of these responsible for the increase in testes oxidative stress and 4) sleep apnea, frequent in obese patients, suppresses the nocturnal testosterone rise needed for normal spermatogenesis. Finally, although controversial, all the above mentioned factors could comprise gametes quality; i.e. decrease sperm density and motility and increase DNA fragmentation, probably disturbing spermatogenesis and/or epididymal function. In summary, although obesity may impair male fertility by some/all of the described mechanisms, the fact is that only a small proportion of obese men are infertile, probably those genetically predisposed or morbidly obese. Nevertheless, it is likely that because the incidence of obesity is growing, the number of men with reduced fertility will increase as well.
El Hospital de Niños más antiguo de América
Authors: Ferrero Fernando
Published: September 2024

Considering the history of medicine, pediatrics is relatively a recent discipline and so are the institutions devoted to it. The “Spedale degli Innocenti” (Florence, 1419) was the fi rst institution devoted to child care; and is not by chance that it was an orphanage, because the “hospital” concept was then more related to hosting and careing than to health. It was in the 19th century when the pediatric hospitals, as we know them today, appear in Europe (L'Hôpital Des Enfants-Malades, Paris, 1802) and North America (Children's Hospital of Philadelphia, 1855); surprisingly “Casa Cuna” (Hospital de Niños Pedro de Elizalde, Buenos Aires, 1779) was already there, witnessing the foundation of both institutions
Tratamiento con cloranfenicol en nueve niños con disentería bacilar
Authors: Moya Martín P. , Jayo Daniel E. , López Nora C. , Graña Maria G. , Halac Eduardo
Published: September 2024

The use of chloramphenicol for the treatment of severe enteric infections is rare in paediatrics due to the risks inherent in the antibiotic itself, and its narrow spectrum of sensitivities.
Post-irradiation morphea in brest cancer: a case report
Authors: Llenas Jorge , Bringas Anahí , Nocito Jimena , Gómez Zanni Susana , Campana Ricardo , Papa Mariana
Published: September 2024

We report the case of a caucasian woman of 44 years old with no personal medical history. She was diagnosed breast carcinoma and underwent right partial mastectomy with adjuvant radiotherapy and chemotherapy. Four years after the intervention, presented a indurated plaque . Biopsy was performed and the diagnosis of morpheawas confirmed by histopathological examination.
Persistencia en el tratamiento farmacológico de la hipertensión arterial entre diferentes grupos terapéuticos y comparación entre combinaciones a dosis fijas de ara ii + bloqueantes cálcicos vs. ieca + bloqueantes cálcicos
Authors: Waisman Gabriel Darío , Garfi Leonardo Guillermo , Izbizky Gustavo Hernán , Tortellá Juan José
Published: September 2024

High blood pressure (HBP) is a prevalent and chronic disease, requiring pharmacologic and nonpharmacologic sustainable treatment to achieve control. "Persistence" is the continuity of pharmacological treatments. Knowing the persistence of antihypertensive therapy groups could help prioritize those with better results. The aim is to describe the persistence to antihypertensive therapy in a cohort of patients using different methods and compare the persistence of different pharmacological groups used for hypertension treatment.Materials and MethodsObservational, retrospective cohort using secondary databases obtained during drug dispensing and electronic hospital records from the Hospital Italiano de Buenos Aires. Adult population with diagnosed hypertension and monitoring for two years.ResultsDiuretics, beta-blockers and first generation of angiotensin converting enzyme are the groups with the largest fall in persistence. Angiotensin antagonists in monotherapy or in combination with beta-blockers and diuretic second generation showed the best results of persistence. Persistence never reached 60% at 2 years.ConclusionDespite having measure persistence through different methods the results were similar and showed low persistence to antihypertensive therapy. We found no pharmacological extra variables that could explain the persistence in different therapeutic groups.
Utilidad del micofenolato de mofetilo en la nefritis lupica
Authors: Savio Veronica , Alba Paula , Babini Alejandra M.
Published: September 2024

Mofetil mycophenolate (MM) is an immunosuppressive agent that was initially used to prevent rejection in solid organ transplantation, and was later used to treat systemic autoimmune diseases. In Systemic Lupus Erythematosus (SLE) it was initially used for the treatment of Lupus Nephropathy (LN) and is now considered an important alternative agent for LN refractory to other drugs as well as in induction therapy with promising results and lower toxicity1-3. The first studies were limited to describing series with small numbers of patients where MM was used to treat patients with Cyclophosphamide (CF) and Azathioprine (AZA) resistant disease with favorable results. Subsequently several randomised studies have shown satisfactory results in the treatment of LN in both induction of remission and maintenance compared to the use of CF and AZA6-9.The good results obtained in the treatment of NL led to the MM being used for the treatment of other manifestations of the disease, such as vasculitis, neurological, skin, haematological and signs or symptoms of disease activity in general.
Embolismo pulmonar de cemento posterior a vertebroplastia percutanea
Authors: Bedini Marianela Patricia , Albertini Ricardo Arturo , Orozco Santiago
Published: September 2024

Vertebroplasty is a minimally invasive technique for the treatment of steoporotic fractures. Within its complications is pulmonary embolism, which can be asymptomatic or with respiratory distress and may be notes by radiography or computed tomography. At present there is no guide to indicate the routine performance of imaging techniques after treatment, and all agreed on the need to start anticoagulant therapy for 3 months or so with coumarin in symptomatic or asymptomatic central emboli..
Integración temática disciplinar en medicina: una propuesta desde histología y embriología
Authors: Bassan Norberto D , D'Ottavio Alberto E
Published: September 2024

ResumenEste trabajo intenta aclarar un concepto con múltiples significados y una realidad compleja y proveer ejemplos de distinta dificultad centrados en la Histología y la Embriología, potencialmente útiles para currículos tradicionales y, esencialmente, para aquéllos en vías de transformación dentro de la Medicina en particular y de las Ciencias de la Salud en general. En ese sentido, propone secuencias lineales, ramificadas y gráficas de consolidación que, pivoteando en ambas disciplinas, pueden comprender también a otras ciencias básicas, todas de significado clave para el diagnóstico clínico. Tras registrar algunos resultados que, aunque limitados, revelarían la necesidad de su entrenamiento continuo y en complejidad creciente a lo largo de la carrera médica, se subraya su valor integrador intrínseco así como la potencialidad integradora que desarrolla en quienes las cultivan en virtud de su ligazón natural con otras disciplinas básicas. Asimismo, a la par que se reafirma la relevancia de una y otra en el grado, se vislumbran posibles variaciones en las mismas en virtud de los exponenciales avances científico-tecnológicos de la hora.  AbstractThis paper intends to clarify a concept with multiple meanings and a complex reality. It starts providing varied histological and embryological examples apt to contribute the stimulation of teacher and student imaginations in favor of a crucial skill, as thematic integration is, into the present and changing curricula in Medicine in particular and Health Sciences in general. In this sense, it offers linear and branched sequences as well as consolidation graphics which focusing in both disciplines may also include other basic ones, key for clinic diagnosis, among the competences to be developed. After registering some preliminary results revealing the need of its continuous and progressive training along the complete medical career, its own integrative value and the integrative one for their teachers due to its natural link with other basic ones is outlined, its relevance for undergraduate is reaffirmed and possible future variations for them are previewed, considering the present exponential growth of science and technology.
Síndrome de vena cava superior: forma inicial de presentacion en enfermedades neoplásicas
Authors: Pérez Maure M , Subils G , Peresin Paz R , Cazaux A , Cambursano V H , Cortes J R
Published: September 2024

Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signsand symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis).The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90% of them, thrombosis and nonmalignant conditions are another causes.The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral  circulation).Early detection improves prognosis and is based on clinical data and imaging studies.We describe 8 cases where the SVCS was the first manifestation of neoplasticdiseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis
Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba
Authors: Guarnaschelli M , Lucero N , Moreno Andreata N , Buonanotte M C , Atalah D , Deabato C , Frías I , Fuentes V , Pérez Drías J , Riccetti J , Riveros M , Sad A , Buonanotte C F
Published: September 2024

AbstractIntroduction . Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy . Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location .Objetive: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income .Material and methods . Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale . Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization .Results . The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84%) and hemorrhagic stroke 32 (16 % ) . The FR Hypertension was the most frequent ( 83.5 %), over 40% had 3 or more FR for stroke. Had complications : 32 % of patients , the respiratory infection was the most frequent (14.5 % ) . Patients with NIHSS greater than 10 points had a higher rate of complications .Conclusion . The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.
Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico
Authors: Cruz del Castillo Aaron Humberto , Cordova Fernandez José A , Ramos Lagunes Ilse , Ortiz Solana Xochitl Erendira , Vigil Perez Claudia A , García Ramos Griselda
Published: September 2024

Objective: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS).
Methodology: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). Results: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6%). SM Criteria were : low HDL: 62.9%; hypertriglyceridemia: 56.3%; obesity abdominal (OA) 90.1%, hypertension (HBP): 62.5%. The prevalence of MS was 86.6% (95% CI 83% to 89%). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9% 2.3 vs 8.5% 2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95% in 1.010 to 1.016). Conclusions: We not found differences significant glycemic level in patients with and without MS.
Seguridad de los beta 2 agonistas (?2a) en asma bronquial
Authors: Oscanoa T J
Published: September 2024

ResumenLos broncodilatadores beta 2 agonistas (?2A) forman parte muy importante en el farmacoterapia del asma bronquial, una enfermedad que avanza en el mundo de manera epidémica. Los ?2A son prescritos a millones de personas en el mundo, por consiguiente los aspectos de seguridad son de interés público. Los broncodilatadores ?2A de acción corta (Short-Acting ?2 Agonists o SABA) como salbutamol inhalatorio, según las evidencias actuales, confirman su seguridad en su uso como fármaco de rescate o a demanda. Los broncodilatadores ?2A de acción prolongada (Long-Acting ?2 Agonists o LABA) se utilizan asociados a corticoides inhalatorios, como medicamentos controladores de exacerbaciones de accesos asmáticos, por razones de seguridad los LABAs no se recomienda su uso como monoterapia. SummaryBeta 2 agonist bronchodilators (?2A) are very important part in the pharmacotherapy of bronchial asthma, a disease that progresses in the world in an epidemic way. The ?2A are prescribed to millions of people around the world, therefore the safety aspects is of public interest. Short-Acting ?2 Agonists (SABAs), such as albuterol inhaler, according to current evidence, confirming its safety when used as a quick-relief or rescue medication. The long-acting ?2 agonists (LABAs) The long-acting bronchodilators ?2A (Long acting ?2 Agonists or LABAs) are used associated with inhaled corticosteroids as controller drugs for asthma exacerbationsaccess, for safety reasons LABAs are not recommended for use as monotherapy
Síndrome de eosinofília pulmonar presentación clínica y serie de casos
Authors: Egea N , Merlo A , Esponda L , Cazaux A , Cambursano H , Cortes R
Published: September 2024

ResumenIntroducción: El síndrome de eosinofilia pulmonar se caracteriza por un grupo de patologías que presentan afección clínico – radiológica pulmonar con eosinofilia periférica o en parénquima pulmonar en su evolución. Materiales y métodos: Se describen las características de presentaciones clínico-radiológicas y evolutivas de pacientes atendidos entre 2007 y 2010 en Hospital Rawson.Resultados: Sobre 8 casos, se observó mayor número de casos en mujeres. Los signos y síntomas principales fueron tos, disnea, fiebre y sibilancias. Los hallazgos radiológicos más prevalentes fueron patrón alveolar y alveolointersticial. En la TAC el más frecuente fue el patrón en vidrio esmerilado. La eosinofilia periférica presentó valores entre 550 y 10.000 cel/mm3. Los pacientes fueron abdordados inicialmente como neumonía adquirida en la comunidad en el 62% de los casos. Los diagnósticos principales realizados fueron neumonía eosinofílica aguda y crónica, ambas con respuesta a esteroides.Conclusiones: El síndrome de eosinofilias pulmonares comparte características clínico-radiológicas comunes con entidades de mayor prevalencia, particularmente NAC. AbstractIntroduction: Pulmonary eosinophilia syndrome is characterized by a group of diseases that present clinical –radiological conditions, pulmonary eosinophilia or peripheral lung parenchyma in its evolution. We described the clinical and radiological presentation.Methods: Retrospective descriptive analysis of medical records of 7 patients between 2007 and 2010.Results: The highest numbers of cases were observed in women, with peripheral eosinophilia with values between 550 and 10,000 cells/mm3. The more frequent signs and symptoms were cough, dyspnea, fever and wheezing. The more prevalent radiological findings were alveolar interstitial and alveolar pattern. At CT scan, the most frequent pattern was ground glass. The main diagnoses made were acute and chronic eosinophilic pneumonia in equal proportions, both with response to steroids.Conclusions: The pulmonary eosinophilia syndrome shares common features with clinical and radiological entities most prevalent, particularly community-adquired pneumonia.
Epidemiología de candidemia en Córdoba. Estudio de vigilancia de cinco instituciones
Authors: Riera F. , Medeot M , Sartori L , Bergallo C , Minoli J , Vilchez V , Sánchez P , Abiega C , Pincheira C , Correa S , Bartoli C , Figueroa M , Montamat M , Spitale N , Minguez A , Caeiro J O
Published: September 2024

Resumen La incidencia de infecciones invasivas por Candida ha aumentado en forma dramática en los últimos 20 años, siendo causa importante de mortalidad en torno al 40% en los pacientes hospitalizados. Material y métodos: Se  realizó un estudio retrospectivo, basado en reportes de laboratorio de cinco hospitales de tercer nivel de la ciudad de Córdoba entre enero de 2010 y agosto de 2012, con el objetivo de conocer la epidemiología regional. Resultados: 158 pacientes con candidemia, edad promedio de 55.8 años, el 60% internados en unidades de cuidados intensivos.  Candida albicans 44%, Candida parapsilosis 22% y Candida tropicalis 12% fueron las principales especies aisladas. Candida parapsilosis estuvo comúnmente asociada a infecciones relacionadas a catéteres. Conclusiones: Esta serie local de la ciudad de Córdoba muestra que C. albicans, C. parapsilosis y  C. tropicalis son las especies mas frecuentes coincidente con el perfil de las series publicadas en Argentina y Latinoamérica. Esto puede tener implicancias para decidir que agente antifúngico usar empíricamente para tratar las candidemias.   Abstract The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40% mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. Materials and methods: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. Results: 158 patients had candidemia, the average age was 55,8 years, and 54% of patients were in the intensive care unit.  Candida albicans (44%), Candida parapsilosis (22%) and Candida tropicalis (12%) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. Conclusions: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from  Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.
Simple predictive model for early childhood caries of chilean children
Authors: Fierro Monti CLaudia , Perez Flores M , Brunotto M
Published: September 2024

ABSTRACT Introduction: Early Childhood Caries (ECC), in both industrialized and developing countries, is the most prevalent chronic disease in childhood and it is still a health public problem, affecting mainly populations considered as vulnerable, despite being preventable. Objective The purpose of this study was to obtain a simple predictive model based on risk factors for improving public health strategies for ECC prevention for 3-5 year-old children. Methods - Clinical, environmental and psycho-socio-cultural data of children (n=250) aged 3-5 years, of both genders, from the Health Centers, were recorded in a Clinical History and Behavioral Survey. Results-24% of children presented behavioral problems (bizarre behavior was the main feature observed as behavioral problems). The variables associated to dmf ?4 were: bad children temperament (OR=2.43 [1.34, 4.40]) and home stress (OR=3.14 [1.54, 6.41]). It was observed that the model for male gender has higher accuracy for ECC (AUC= 78%, p-value=0.000) than others. Conclusions- Based on the results, we proposed a model where oral hygiene, sugar intake, male gender, and difficult temperament are main factors for predicting ECC. This model could be a promising tool for cost-effective early childhood caries control. RESUMEN Introducción: Las caries temprana de la infancia (CTI), a pesar de ser una enfermedad prevenible, permanece como uno de los problemas de salud pública, tanto en países industrializados como en los que están en vías de desarrollo, afectando principalmente a poblaciones vulnerables. Objetivo: el objetivo de este trabajo fue generar un modelo sencillo basado en factores de riesgo que sea predictivo del riesgo de CTI en niños de 3-5 años de edad a fin de mejorar las estrategias  preventivas a nivel de salud pública. Métodos: Se recolectaron datos clínicos, del hogar y psico-socio-cultural de niños (n=250) de ambos sexos que concurren a centros de salud en la región del Bio Bio –Chile mediante historia clínica y encuesta de comportamiento. Resultados: 24% de los niños presentó problemas de comportamiento (un comportamiento extraño fue la principal característica observada como problema de comportamiento). Las variables asociadas a ceo ?4 fueron: mal temperamento del niño (OR=2,43 [1,34; 4,40]) y estrés del hogar (OR=3,14 [1,54; 6,41]). Se observe que el modelo estratificado por género masculino fue el que presentó la mayor precisión diagnóstica de CTI (AUC= 78%, p-valor=0.000); además Conclusiones: Proponemos un modelo donde la higiene oral, el consumo de azúcar, el género masculino y el mal temperamento son los principales factores de predictivos de CTI. Este modelo podría ser una herramienta promisoria para el costo-efectividad del control de caries temprana.
Síndrome de piernas inquietas: una amenaza a la calidad de vida
Authors: Castaño-Cárcamo Mauricio , Escobar-Córdoba Franklin , Rey de Castro Jorge
Published: September 2024

ResumenEl síndrome de piernas inquietas (SPI) es un trastorno relacionado con la necesidad imperiosa de mover las extremidades inferiores, inicia a diferentes horas del día y empeora en la noche. Es aliviado por la actividad y afecta la calidad de vida y del sueño de quienes lo padecen. A pesar de ser un trastorno común a cualquier edad, en adultos tiene una prevalencia de hasta el 10%, es poco diagnosticado por los médicos de primer nivel y especialistas, por lo cual las intervenciones diagnósticas y terapéuticas se ven retrasadas.  Lo anterior contribuye a la perpetuación de sus síntomas y empeoramiento de la calidad de vida. Ya que su diagnóstico es netamente clínico, familiarizarse con este trastorno del ciclo sueño vigilia, es fundamental para garantizar un adecuado enfoque y así descartar otras patologías que suelen confundirse con ésta entidad. El SPI posee etiología multifactorial, que abarca desde un componente genético y hereditario, denominándose SPI primario, hasta su asociación con múltiples patologías, conocido como SPI secundario. En cuanto a su tratamiento farmacológico y no farmacológico está orientado al control de los síntomas, ya que su curación no es posible, aunque ocasionalmente esta entidad puede remitir, para luego en meses o años recaer nuevamente.AbstractRestless legs syndrome is a disorder associated with the imperative need to move the legs, starting at different times of day and it gets worse at night, relieved by activity, affecting the quality of life and sleep who sufferers it. Despite being a common disorder at any age, in adults with a prevalence of up to 10%, is not diagnosed by doctors and frst level specialists that is why diagnostic and therapeutic interventions get delayed contributing to the perpetuation of symptoms and worsening quality of life. Since its diagnosis is purely clinical, getting familiar with this disorder is essential to ensure proper focus and thus rule out other diseases commonly confused with this one. Restless legs syndrome has a multi-factorial etiology that ranges from a genetic and hereditary, which are called primary restless legs syndrome, to its association with multiple pathologies, known as secondary restless legs syndrome. As for its management, drug therapy and non-drug therapy is aimed at symptom control, as its cure is not possible, although occasionally the condition can refer to later repeat in months or years.
Hernia diafragmática congénita
Authors: Luna Mirta Gricelda , Vedia Salinas Erik
Published: September 2024

La hernia diafragmática congénita de Bochdalek se produce por el cierre incompleto de la membrana pleuro-peritoneal, con pasaje de vísceras abdominales a cavidad toráccica.
Actitud de residentes de urgencias hacia la relación médico-paciente en el Hospital de Clínicas- Asunción, Paraguay
Authors: Silvero R A , Aranda G R , Cristaldo R , Recalde M E , Arias R , Presentado D , Patiño D , Acosta A A , Apuril E S , Hidalgo D , Capurro M H
Published: September 2024

ResumenIntroducción: La relación médico-paciente está alcanzando gran importancia en los últimos tiempos, se resalta su importancia en aspectos tan variados como la satisfacción, el cumplimiento, la percepción de la competencia profesional, la frecuencia de problemas legales en relación a la mala praxis e incluso el pronóstico de la enfermedad o el estado de salud general del enfermo.Objetivo: Evaluar la relación médico-paciente desde el punto de vista de residentes de urgencia.Métodos: Se realizó un estudio observacional, de tipo descriptivo. La muestra consistió en 36 médicos de diferentes sectores de las Salas de Urgencias del Hospital de Clínicas – Asunción, Paraguay. Para estudiar la relación médico-paciente se utilizó el instrumento desarrollado por RA Chavarría-Islas et al., con cuatro indicadores: Respeto, Información, Consentimiento y Esmero.Resultados: El 69,4% de los residentes poseen una relación médico-paciente regular, no obstante el 2,78% posee una relación buena, 25% una relación mala y 2,78%  una relación muy mala.Conclusión: Deficiencias en la relación médico-paciente. Es interesante invertir mayores esfuerzos para potenciar la relación médico-paciente como uno de las aristas para mejorar la atención médica, la cual es de vital importancia en los cuidados de emergencia.  Summary Introduction: The doctor-patient relationship is reaching great importance in recent times, is highlighted their importance in areas as varied as satisfaction, compliance, perception of professional competence, the frequency of legal issues relating to malpractice and even the prognosis of the disease or the general health of the patient.Objective: To evaluate the doctor-patient relationship from the point of view of residents of emergency unit.Methods: An observational, descriptive study. The sample consisted of 36 doctors from different areas of the  Emergency Rooms of the Hospital de Clínicas- Asunción, Paraguay. The patient-physician relationship was evaluated using an  instrument developed by RA Chavarria-Islas et al. with four indicators: Respect, Information, Consent and Dedication. Results: 69.4% of residents have a regular patient-physician relationship; despite the 2.78% has a good relationship, 25% bad relationship and 2.78% a very bad relationship.Conclusion: Gaps in doctor-patient relationship were found in this study.. It is interesting to invest greater efforts to enhance the doctor-patient relationship as one of the edges to improve health care, which is vital in emergency care.
Osteoporosis y estatinas, Revisión
Authors: Astesana P , Gobbi C A , Alba Paula , Yorio M A
Published: September 2024

La osteoporosis (OP) es una enfermedad ósea metabólica caracterizada por la presencia de baja masa ósea y deterioro microarquitectónico del tejido óseo, que predisponen a un incremento en la fragilidad del hueso y del riesgo de sufrir fracturas no traumáticas.La OP es considerada actualmente como un problema mayor en salud pública con más de 200 millones de personas afectadas en todo el mundo. En los últimos años, se ha reportado un incremento de su incidencia en América Latina  y según datos de la OMS, el número de fracturas que se registrarán en esta región en los próximos 50 años casi igualará a las de Estados Unidos y Europa. Actualmente se estima que más del 50% de las mujeres y del 30 % de los hombres padecerán fracturas osteoporóticas a lo largo de su vida, y que número de fracturas de cadera aumentará en todo el mundo desde 1,7 millones (año 1990) hasta más de 6 millones para el 2050. Es importante destacar, que si bien es más frecuente en mujeres que hombres, la mortalidad debido a fracturas osteoporóticas es mayor en hombres que en mujeres...
Asomatognosia como manifestación de migraña con aura. Reporte de un caso y revisión.
Authors: Scribano Parada María , Buonanotte Carlos Federico
Published: September 2024

ResumenIntroducción: Durante años el estudio de la migraña con aura ha sorprendido por la versatilidad de su forma de presentación. Las auras se manifiestan con el desarrollo gradual de síntomas neurológicos que van desde alteraciones visuales hasta trastornos de la percepción. Estos últimos son formas de presentación poco frecuentes siendo el motivo de este artículo. Caso Clínico: Se presenta el caso de una paciente de sexo femenino de 53 años con diagnóstico de migraña con aura la cual hace un relato autobiográfico de sus crisis, con especial énfasis en una variante de asomatognosia como forma de presentación. A continuación se discute sobre la asomatognosia como un fenómeno perteneciente a las alteraciones del esquema corporal y los diferentes conceptos y formas clínicas relacionados con estas y se hacer un breve repaso sobre las posibles localizaciones anatómicas de estas afecciones.  Conclusión: La migraña con aura puede manifestarse con una variada sintomatología previa al dolor. La asomatognosia es una forma infrecuente de presentación. Un campo de interés en la investigación de esta área incluyen un esfuerzo por definir  la especificidad y localización de la lesión como un método para la  mejor comprensión de cómo las lesiones a áreas muy específicas del cerebro afectan la percepción y la memoria.AbstractIntroduction: For years the study of migraine with aura was surprised by the versatility of its presentation. Auras are manifested with the gradual development of neurological symptoms ranging from visual impairment to perception disorders. The latter are rare forms of presentation being the reason for this article. Case report: the case of a female patient of 53 years diagnosed with migraine with aura which makes an autobiographical account of their crises, with special emphasis on a variant of asomatognosia as manifestation is presented. It then discusses the asomatognosia as a phenomenon belonging to the altered body image and the different concepts related to these clinical forms and a brief overview of the possible anatomical locations of these conditions do. Conclusion: Migraine with aura may manifest with varied previous symptoms before the pain. The asomatognosia is an uncommon presentation. A field of interests for research also include an effort to define the specificity and location of the lesion as a method for better understanding of how injuries to very specific areas of the brain affect perception and memory
Comparación de dos sistemas de aporte de soluciones hidroelectrolíticas para el manejo de la cetoacidosis diabética: ensayo clínico controlado y aleatorizado en niños
Authors: Ferreira Juan Pablo
Published: September 2024

Introducción: El tratamiento de la cetoacidosis diabética (CAD) requiere controles horarios de glucemia que definen modificaciones en la administración de insulina y glucosa endovenosa. En cada cambio se prepara una nueva solución endovenosa, generando retrasos y, eventualmente, errores. El sistema de dos soluciones hidroelectrolíticas (idéntica composición electrolítica, una con glucosa y otra sin) en paralelo unidas en una vía común al paciente, permite cambios inmediatos en el flujo de glucosa, con la sola modificación de los goteos.Objetivo: Comparar el tiempo requerido para la estabilización de pacientes con CAD, utilizando dos sistemas de hidratación: tradicional (1 solución hidroelectrolítica) vs. alternativo (2 soluciones hidroelectrolíticas –“two bags”-).Métodos: Ensayo clínico controlado y aleatorizado que incluyó niños de 1 a 18 años, hospitalizados por CAD (glucemia >200 mg/dl, pH <7,3, bicarbonato <15 mmol/L, glucosuria y cetonuria). Luego de la hidratación inicial, los pacientes fueron aleatorizados a uno de 2 sistemas de hidratación (tradicional o alternativo), manteniéndolo hasta la estabilización del paciente (glucemia ?250 mg/dl, pH ?7,3, bicarbonato ?15 mmol/L); el tiempo requerido en alcanzar la estabilización fue la variable de resultado.Resultados: Al incorporar 12 de los 32 sujetos previstos (6 en cada grupo­) el Comité de Monitoreo de Seguridad efectuó análisis interino preestablecido, encontrando que el tiempo en alcanzar la estabilización fue significativamente menor con el sistema alternativo (9,8±1,16 horas vs. 13,3±2,8 horas; p=0,018). Debido a la magnitud del hallazgo, se consultó al Comité de Ética, decidiendo suspender el estudio.Conclusión: El sistema alternativo (“two-bags”) permitió alcanzar la estabilización del paciente con CAD en un tiempo significativamente menor.PALABRAS CLAVE: Fluidoterapia, cetoacidosis diabética, diabetes Mellitus
Generando evidencia para mejorar la atención de los pacientes
Authors: Ferrero Fernando
Published: September 2024

Aunque originalmente establecido para serutilizado en el contexto de la educación médica,el término “medicina basada en evidencia”hoy se encuentra íntimamente ligado ala práctica diaria, entendiendo por el mismoal “grupo de principios y métodos establecidospara asegurar que en la mayor medidaposible, las decisiones médicas, guías depráctica y otras políticas se basen y seanconsistentes con buena evidencia de efectividady beneficio” .Existe consenso en que el mejor nivel de evidencialo proporcionan los estudios clínicoscontrolados aleatorizados (ECCA) o, cuandosea posible, meta-análisis que los incluyan.La posibilidad de controlar el azar y potencialesconfusores garantizan que los resultadosobtenidos en estos ECCA se relacionendirectamente con la intervención aplicada.Lamentablemente, a pesar de constituir el...