Hospital General De Aguidos Juan A. Fernandez

Purpose To describe etiologies and clinical characteristics of patients from Argentina with non-infectious uveitis (NIU). Differences between the anatomic segments involved were described as well. Methods This is a multicentric, cross-sectional study from January 2008 to March 2021. We included patients with NIU from private and public institutions. Uveitis diagnosis was made by ophthalmologists specializing in uveitis, and rheumatologists diagnosed the autoimmune conditions. Patients were classified according to the International Uveitis Study Group classification system. Results° We included 468 patients with NIU. Most of them were female (64.1%), with a mean age at diagnosis of 37.9 years (SD 17.2). Idiopathic uveitis and Vogt-Koyanagi-Harada disease (VKH) were the most frequent causes. Among anterior uveitis, the most prevalent causes were idiopathic, spondyloarthritis, juvenile idiopathic arthritis, and sarcoidosis. VKH and Behçet were predominant within the panuveitis group. Over half of the patients (57%) required immunosuppressants. Methotrexate (20.6%) and azathioprine (8.9%) were mostly used. Eleven percent of the patients needed biologics, mostly adalimumab (9.4%). Two hundred fifty-six (54.7%) patients had eye complications, and cataracts were the most frequent (30%). A comparative analysis was performed between public and private institutions. There was no difference in the causes of uveitis or complications (p = 0.38; p = 0.06, respectively). Conclusion The most prevalent causes of uveitis were VKH and idiopathic uveitis, different from the etiologies observed in the United States and Europe.

Background: Preoperative nutritional interventions, including low-calorie diets (LCDs) and very low-calorie diets (VLCDs), are commonly implemented in metabolic and bariatric surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative dietary interventions in patients undergoing bariatric surgery, with primary outcomes including perioperative complications, operative time, and length of hospital stay. Methods: A systematic review and meta-analysis were conducted, including studies that compared LCD and VLCD with regular diets in adults undergoing bariatric surgery. The primary outcomes assessed were perioperative complications, operative time, and length of hospital stay. Random- and fixed effects models were used for quantitative synthesis. Risk of bias was evaluated using the Cochrane Risk of Bias tool and ROBINS-I, while the certainty of evidence was assessed using the GRADE approach. Results: Eight trials comprising 1197 patients were included in the meta-analysis. VLCDs were associated with a significant reduction in perioperative complications (OR 0.59; 95% CI: 0.37–0.94; p = 0.03), whereas LCDs showed no significant effect on complications (OR 1.64; 95% CI: 0.71–3.78; p = 0.25). No significant reduction in operative time was observed (MD −2.64 min; 95% CI: −6.01 to 0.73; p = 0.12). Hospital stay was slightly reduced (MD −0.17 days; p = 0.0001), though the clinical significance remains uncertain. The certainty of evidence was low, primarily due to the risk of bias and small sample sizes. Conclusions: VLCDs may lower the risk of perioperative complications, while LCDs do not appear to provide this benefit. However, the evidence is limited by methodological heterogeneity and low certainty. Further high-quality studies are needed to establish optimal preoperative nutritional protocols.

Background and Aims Recalcitrant facial flat warts are caused by human papillomavirus and may persist for years despite treatment. Oral isotretinoin administered at a dose of 0.5 mg/kg/day is effective and safe. However, the adverse effects reported are dose‐dependent behaviors and they could limit their use. We aim to compare the efficacy and safety of two doses of oral isotretinoin for the treatment of recalcitrant facial flat warts and to assess the quality of life, anxiety, and depression in the individuals studied. Methods Isotretinoin 0.3 mg/kg/day or isotretinoin 0.5 mg/kg/day was administered to 21 and 19 adult patients, respectively, in a double‐blind, randomized fashion for 12 weeks. Cutaneous lesions were assessed, and adverse events, including serologic changes, were recorded. It is considered that warts were recalcitrant if the patient was treated for at least 3 years with at least two of the following options: retinoids, 5‐fluorouracil, imiquimod, and cryotherapy. In addition, quality of life, anxiety, and depression were assessed at the beginning and end of follow‐up. Results In the isotretinoin 0.3 mg/kg/day group, 35% of the patients had a complete response, and 66% had a partial response, while in the isotretinoin 0.5 mg/kg/day group, 73.7% presented a complete response, and 26.31% presented a partial response (p = 0.015). The most frequent adverse event was cheilitis. There was an elevation of aspartate aminotransferase (p = 0.020) and total bilirubin (p = 0.015) in the isotretinoin 0.5 mg/kg/day group. Improvement in the quality‐of‐life score (p = 0.0001) and a reduction in the anxiety (p = 0.00) score was observed in both groups. Conclusion Oral isotretinoin at a dose of 0.5 mg/kg/day is safe and effective for the treatment of recalcitrant facial flat warts in adults, with lower recurrence rates than 0.3 mg/kg/day. Prolonged treatment with isotretinoin for over 12 weeks in adults can increase the overall response rate. Trial Registration: Registry of ClinicalTrials.gov identifier: NTC04290572; https://classic.clinicaltrials.gov/.

The diaphragm is the primary muscle involved in the ventilatory pump, making it a vital component in mechanical ventilation. Various factors in patients who require mechanical ventilation can lead to the deterioration of the diaphragm, which is associated with increased mortality. This deterioration can arise from either excessive or insufficient support due to improper adjustment of ventilation programming variables. It is essential for healthcare professionals to make appropriate adjustments to these variables to prevent myotrauma, which negatively impacts muscle structure and function. One recognized cause of muscle injury is eccentric work of the diaphragm, which occurs when muscle contractions continue after the expiratory valve has opened. Current evidence suggests that these eccentric contractions during mechanical ventilation can be harmful. This brief review highlights and analyzes the existing evidence and offers our clinical perspective on the importance of properly adjusting ventilation programming variables, as well as the potential negative effects of eccentric diaphragm contractions in routine clinical practice.

When one initially targets the null effect and the point estimate falls close to the null, two challenges exist in rating certainty of evidence. First, when the point estimate is near the null and the data, therefore, suggests little or no effect, rating certainty in a benefit or harm is misleading. Second, since in general the narrower the confidence interval (CI) the more precise the estimate, if the CI is narrow, rating down for imprecision due simply to crossing the null is inappropriate. This paper addresses these issues and provides a solution: to revise the target of certainty rating from a non-zero effect to a little or no effect. This solution requires estimating a range in which the minimal important difference (MID) for benefit and an MID for harm might lie, and thus establishing a range that represents little or no effect. If GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) users are confident that the point estimate represents an effect less than the smallest plausible MID, they will revise their target and rate certainty to a little or no effect. If the entire CI falls within the range of little or no effect, they will not rate down for imprecision. Otherwise (if the CI includes an important effect), they will rate down. Using the solution provided in this paper GRADE users can make an optimal choice of the target of certainty rating.

Purpose Triple-negative breast cancer (TNBC) has the worst prognosis among breast cancers. Immunotherapy is a therapeutic option, but there is no biomarker to guide promising combination treatments. Mucin 4 (MUC4) favors metastasis in preclinical cancer models. This study evaluates the efficacy of soluble TNF (sTNF) neutralization to tackle MUC4 expression preventing metastasis in combination with immunotherapy, and the potential use of MUC4 as a prognostic and predictive biomarker in TNBC patients. Experimental Design To explore TNF modulation of MUC4 expression, a panel of TNBC cell lines was used. To assess the effect of sTNF blockade with a dominant negative molecule in combination with anti-PD-1 antibody on lung metastasis and overall survival (OS), 4T1 and LMM3 tumors were used. MUC4, PD-L1 and Ki-67 expression was evaluated by immunohistochemistry, and tumor infiltrating lymphocytes (TILs) were assessed by H&E staining, in a cohort of 49 early TNBC patients treated with chemotherapy. Results TNF neutralization reduces MUC4 expression in TNBC cell lines. Only the combination of sTNF blockade with anti-PD-1 antibody prevents metastasis and increases mice survival. In early TNBC patients MUC4 expression is inversely associated with TILs presence and PD-L1 and Ki-67 expression. Finally, MUC4 is associated with metastasis and is an independent biomarker of poor OS. Conclusions We proved the existence of a sTNF/MUC4 axis in TNBC that can be actionable by sTNF neutralization, preventing metastasis. We suggest that MUC4 is a suitable biomarker to guide immunotherapy in TNBC, together with the administration of sTNF blocking drugs to improve outcome.

Introducción: Staphylococcus aureus resistente a meticilina adquirido en la comunidad (SARM) es un colonizador de la piel y las mucosas humanas, y esta colonización es un factor de riesgo para las infecciones causadas por este microorganismo. Se desconoce el papel que desempeñan los caninos y felinos domésticos (CF) en la colonización humana. El objetivo de este estudio fue demostrar la asociación entre el aislamiento de SARM en muestras clínicas de infecciones de piel y tejidos blandos (IPPB) en adultos que conviven con CF. Material y métodos: Se utilizó un modelo retrospectivo de casos (IPPB con aislamiento de SARM) y controles (IPPB sin aislamiento de SARM). Se incluyeron 166 episodios de IPPB tratados en dos hospitales de Buenos Aires, Argentina, entre octubre de 2014 y enero de 2018. Las muestras se obtuvieron mediante punción a través de piel sana y el material obtenido se sembró en medios de cultivo habituales. Para la identificación bacteriana se utilizaron espectrometría de masas y nefelometría automatizada. La resistencia a la meticilina se confirmó mediante difusión con discos de cefoxitina. Se recopilaron datos sobre los hábitos de convivencia con CF y los factores de riesgo clásicos para IPPB causadas por SARM. Resultados: Los pacientes con IPPB debidas a SARM conviven más con CF (OR bruto 1.9; [1.1-3.7] p<0.05) y tienden a tener una convivencia más cercana con ellos (OR bruto 1.8; [0.99-3.43] p=0.08). En el análisis multivariable, aquellos que conviven estrechamente con CF tienen 1.3 veces más probabilidades de sufrir IPPB debidas a SARM (OR ajustado 2.32; [1.12-4.78] p<0.02). Conclusiones: Concluimos que existe una asociación entre las IPPB por SARM en humanos y la convivencia con CF.

We describe a new lineage of Chlamydia trachomatis lymphogranuloma venereum identified in Argentina, carrying ompA -genotype L4. We also present further diversification of the globally circulating L2b lineage.

Using target enrichment, RNA baits designed around a panel of bacterial sexually transmitted infections were used to fish target DNA from the clinical sample, leading to complete bacterial genome sequences.

Background The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0–2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

The advancements in cardiovascular imaging over the past two decades have been significant. The miniaturization of ultrasound devices has greatly contributed to their widespread adoption in operating rooms and intensive care units. The integration of AI-enabled tools has further transformed the field by simplifying echocardiographic evaluations and enhancing the reproducibility of hemodynamic measurements, even for less experienced operators. Speckle tracking echocardiography offers a direct, visual, and quantitative assessment of myocardial shortening, serving as a compelling alternative to traditional methods for evaluating right and left ventricular systolic function. In critically ill patients, sublingual microcirculation imaging has revealed a high prevalence of microvascular alterations, which are markers of disease severity. The use of handheld vital microscopes enables the quantification of several key parameters, including vessel density, perfusion, red blood cell velocity, and the perfused vascular density. Such metrics are useful for evaluating microcirculatory health. The development of automated software marks a significant advance toward real-time bedside microvascular assessment. These advancements could eventually allow shock resuscitation to be tailored based on microvascular responses. In parallel with imaging advances, cardiac output monitors have evolved significantly. Once cumbersome devices displaying basic numerical data in tabular form, they now feature sleek, touch-screen interfaces integrated with visual decision-support tools. These tools synthesize hemodynamic data into intuitive graphical formats, allowing clinicians to quickly grasp the determinants of circulatory shock. This visual clarity supports more efficient and accurate decision-making, which may ultimately lead to improved patient care and outcomes.

Introduction: The prevalence of polycystic ovary syndrome (PCOS) in transgender and non-binary genders assigned female at birth (TMNBG) men is controversial. Our objectives were to investigate the prevalence, phenotypic characteristics of PCOS, and cardiometabolic risk of TMNBG with and without PCOS prior to hormone therapy. Materials and methods: This was a retrospective study of 346 TMNBG adults presenting to our service for gender-affirming hormone therapy. PCOS was diagnosed according to the evidence-based international guideline for the evaluation and treatment of PCOS 2018 and the Rotterdam consensus of 2003. Results: The described transgender population had a prevalence of PCOS of 23.8%. Phenotype B was the most common one (39.1%), followed by phenotype A (33.7%). Transgender people with PCOS had statistically higher body mass index (BMI), systolic and diastolic blood pressure, plasma insulin levels, HOMA-IR, and HOMA-B than those who did not meet PCOS criteria. However, blood pressure and markers of insulin resistance were similar for both groups after controlling for BMI. Discussion: PCOS appears to be prevalent among TMNBG. Transgender people with PCOS may exhibit an unfavorable cardiometabolic risk profile compared to those without PCOS, especially due to a higher BMI. It is necessary to evaluate the specific components of PCOS before starting hormonal therapy due to the long-term implications it could have.

Introduction: The 2022-2023 Mpox outbreak in Argentina presented unique challenges due to the lack of vaccination and antiviral therapy. This study analyzed the epidemiological and clinical characteristics of cases in the Buenos Aires Metropolitan Area (MABA), examining temporal trends, HIV status, and concomitant sexually transmitted infections (STIs). Materials and methods: An ambispective, analitic, and multicenter study was conducted between September 2022 and May 2023 in HIV/STI clinics and hospitals in MABA. Cases were classified as confirmed (positive PCR) or possible (clinical and epidemiological criteria). Patients infected with MPox with and without HIV were compared. Results: 247 patients were included, 95.5% were confirmed cases. The median age was 36 years; 98% were men; 93.7% were men who have sex with men. Sexual exposure was the main transmission route (91%). The 25.2% presented concomitant STIs. The 74% were people living with HIV (PLWH), with good immuno-virological control. Common clinical manifestations included papular, pustular, and vesicular lesions; 59.4% presented >20 lesions. Rectal involvement occurred in 25.6%. Complications were observed in 9.3%, hospitalization in 6.6%, and mortality was 0.4%. PLWH showed a higher prevalence of perianal lesions and proctitis, without differences in complications and hospitalization. Discussion: The outbreak in Argentina, mainly affecting men who have sex with men living with HIV, had low mortality. No significant differences were observed in complications and hospitalization between people with and without HIV.

Objectives: to study prospectively the presence aPL on pregnant women at time of preeclampsia (PE) diagnosis in comparison with normal pregnant controls (I), to determine the association between aPL and diagnosis of severe preeclampsia and (II) to evaluate the association between the presence of aPL and severe preeclampsia before and after 34 weeks of gestations. Study Design: This prospective, interventional, and analytical study included one hundred forty women who were tested for aPL during pregnancy and separated in 2 groups based on their diagnostic status of PE. Group 1: forty normal pregnant women studied for aPL beyond 20 weeks of pregnancy, followed until the birth of a full-term new-born baby and Group 2: one hundred women studied for aPL at the time of PE onset/diagnosis. We evaluated and compared rates of aPL positivity between Group 1 and 2. Results: We compared the presence of aPL between group 1 10,0% (4/40) and group 2 34,0% (34/100). We found an association between severe PE and aPL positivity [OR= 4.63 (95% CI: 1.523 – 14.107), p =0.005]. We also found an association between LA and severe PE [OR= 6.0 (95% CI: 1.3466 – 26.7335), p =0.01]. We confirmed an association between early severe PE and the presence of aPL positivity [OR= 4,384 (95% CI: 1.3615 – 14.1206), p = 0.01]. We also found an association between late severe PE and the presence of aPL positivity [OR= 5.0 (95% CI: 1.4901 – 16.777), p = 0.008]. We compared the presence of aPL between patients with early severe PE 25,9% (19/58) and patients with late severe PE 23,8% (15/42). No significant association was found between the 2 groups. These results suggest that the positivity of aPL and gestational age are independent, and both related to their severity. Conclusion : These results suggest that the presence of aPL is associated to the severe PE. The positivity of aPL is associated to the severity of PE, independently from gestational age. We suggest including the study aPL in women with severe PE independently of prematurity.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. During severe exacerbations, COPD patients may develop acute respiratory failure (ARF), often necessitating hospital admission due to impaired gas exchange. In COPD patients, the diaphragm is subjected to an increased workload resulting from airflow limitations and geometric changes in the thorax due to pulmonary hyperinflation. Noninvasive ventilation (NIV) plays a crucial role in managing type II ARF by improving alveolar ventilation, reducing the work of breathing, minimizing the need for endotracheal intubation (ETI), and decreasing both hospital stays and mortality rates. Studies have shown that approximately 64% of patients with acute exacerbation of COPD (AECOPD) may fail NIV, primarily due to worsening respiratory function, interface intolerance, cardiovascular instability, or neurological deterioration. For patients intolerant to NIV, a trial with a high-flow nasal cannula (HFNC) is recommended. Recently, HFNC has gained popularity as a novel respiratory support system and is increasingly used in routine clinical practice for AECOPD patients. It delivers warmed, humidified, and oxygen-enriched air through a nasal cannula at flow rates of up to 60 L/min. This narrative review aims to describe the physiological effects of HFNC in the COPD population and provide an updated overview of HFNC's role in AECOPD patients requiring hospitalization.