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Retamales J, Daneri-Navarro A, Artagaveytia N, Alves da Quinta D, Abdelhay E, Podhajcer OL, Velázquez C, Giunta D, Crocamo S, Garibay-Escobar A, Del Toro-Arreola A, Rodriguez R, Aghazarian M, Alcoba E, Alonso I, Binato R, Bravo AI, Canton-Romero J, Carraro DM, Castro M, Castro-Cervantes J, Cataldi S, Camejo N, Cortes-Sanabria L, Flores-Marquez M, Laviña G, Musetti E, Caserta B, Cerda M, Colombo A, Delgadillo-Cristerna R, Dreyer Breitenbach M, Fernandez E, Fernandez J, Franco-Topete R, Gabay C, Gaete F, Gamboa J, García-Gaeta R, Gomez Del Toro M, Gonzalez-Ramirez LP, Guerrero M, Herrera-Miramontes M, Lopez-Vasquez A, Maldonado S, Morán-Mendoza A, Morgan-Villela G, Nagai MA, Navarro-Ruiz N, Oceguera-Villanueva A, Ortiz MA, Quintero J, Quintero-Ramos A, Ramirez-Rosales G, Ramos-Ramirez M, Chiquitelli Marques MM, Rivera Claisse E, Rodriguez-Gonzalez D, Romero-Gomez A, Rosales C, Salas-Gonzalez E, Sanchotena V, Segovia L, Silva-García AA, Valenzuela-Antelo O, Venegas-Godinez L, Zagame L, Gomez J, Llera AS, Müller B. Implementing Standard Diagnosis and Treatment for Locally Advanced Breast Cancer Through Global Research in Latin America: Results From a Multicountry Pragmatic Trial. JCO Glob Oncol 2024; 10:e2300216. [PMID: 38723219 DOI: 10.1200/go.23.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Breast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC). PATIENTS AND METHODS The MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery. RESULTS Overall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor-negative-human epidermal growth factor receptor 2-positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%). CONCLUSION In LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA.
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Affiliation(s)
- Javier Retamales
- Grupo Oncologico Cooperativo Chileno de Investigacion, Santiago, Chile
| | | | - Nora Artagaveytia
- Hospital Universitario de Clínicas "Manuel Quintela," Montevideo, Uruguay
| | - Daniela Alves da Quinta
- Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
- Universidad Argentina de la Empresa (UADE), Instituto de Tecnología (INTEC), Buenos Aires, Argentina
| | - Eliana Abdelhay
- Instituto Nacional de Câncer Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Diego Giunta
- Instituto Universitario Hospital Italiano de Buenos Aires-CONICET, Buenos Aires, Argentina
| | - Susanne Crocamo
- Instituto Nacional de Câncer Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Robinson Rodriguez
- Hospital Universitario de Clínicas "Manuel Quintela," Montevideo, Uruguay
| | | | - Elsa Alcoba
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | - Isabel Alonso
- Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Renata Binato
- Instituto Nacional de Câncer Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alicia I Bravo
- Hospital Regional de Agudos Eva Perón, Buenos Aires, Argentina
| | | | | | - Mónica Castro
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | | | - Natalia Camejo
- Hospital Universitario de Clínicas "Manuel Quintela," Montevideo, Uruguay
| | | | | | - Guillermo Laviña
- Hospital Universitario de Clínicas "Manuel Quintela," Montevideo, Uruguay
| | | | | | | | | | | | | | - Elmer Fernandez
- Fundación para el Progreso de la Medicina, Cordoba, Argentina
| | | | | | - Carolina Gabay
- Instituto de Oncología Angel Roffo, Buenos Aires, Argentina
| | | | - Jorge Gamboa
- Hospital Clínico San Borja Arriaran, Santiago, Chile
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cristina Rosales
- Hospital Municipal de Oncología María Curie, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Livia Zagame
- Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
| | - Jorge Gomez
- Health Sciences Center, Texas A&M University, College Station, TX
| | - Andrea S Llera
- Fundación Instituto Leloir-CONICET, Buenos Aires, Argentina
| | - Bettina Müller
- Grupo Oncologico Cooperativo Chileno de Investigacion, Santiago, Chile
- Instituto Nacional del Cáncer, Santiago, Chile
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Rojas JI, Gracia F, Parciak T, Alonso R, Becker J, Treviño-Frenk I, Alonso-Serena M, Giunta D, Abad P, Carnero-Contentti E, Carrá A, Correa-Díaz EP, Correale J, Cristiano E, Flores J, Fruns M, Galleguillos L, Garcea O, Hamuy F, Lana-Peixoto M, Navas C, Pappais-Alvarenga R, Patrucco L, Rivera V, Tenembaum S, Ysrraelit MC, Peeters LM. [Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation]. Rev Neurol 2024; 78:185-197. [PMID: 38502167 DOI: 10.33588/rn.7807.2023326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. MATERIAL AND METHODS A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. RESULTS A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. CONCLUSION The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.
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Affiliation(s)
- J I Rojas
- Hospital Alemán, Buenos Aires, Argentina
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - F Gracia
- Hospital Santo Tomás, Panamá, República de Panamá
| | - T Parciak
- Universidad Hasselt, Diepenbeek, Bélgica
| | - R Alonso
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - J Becker
- Universidad Pontificia de Rio Grande do Sul, Porto Alegre, Brasil
| | - I Treviño-Frenk
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - D Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P Abad
- Hospital Metropolitano de Quito, Quito, Ecuador
| | | | - A Carrá
- Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - E P Correa-Díaz
- Hospital Carlos Andrade Marín. Universidad Central del Ecuador, Quito, Ecuador
| | | | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - J Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - M Fruns
- Clínica Las Condes , Santiago de Chile, Chile
| | - L Galleguillos
- Clinica Alemana, Santiago de Chile, Chile
- Universidad del Desarrollo, Santiago de Chile, Chile
| | - O Garcea
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Hamuy
- Hospital IMT, Asunción, Paraguay
| | - M Lana-Peixoto
- Universidad Federal de Minas Gerais, Belo Horizonte, Brasil
| | - C Navas
- Clínica Universitaria Colombia, Bogotá, Colombia
| | | | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - V Rivera
- Universidad de Medicina Baylor, Houston, EE.UU
| | - S Tenembaum
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Carnero Contentti E, López PA, Pappolla A, Alonso R, Silva B, Deri N, Balbuena ME, Burgos M, Luetic G, Alvez Pinheiro A, Cabrera M, Hryb J, Nofal P, Pestchanker C, Vrech C, Tavolini D, Tkachuk V, Zanga G, Marrodan M, Ysrraelit MC, Correale J, Carrá A, Federico B, Garcea O, Fernandez Liguori N, Patrucco L, Cristiano E, Giunta D, Alonso Serena M, Rojas JI. Incidence of SARS-CoV-2 infection in patients with multiple sclerosis who received SARS-CoV-2 vaccines and are under treatment with high-efficacy therapies in Argentina. Neurol Sci 2024; 45:379-389. [PMID: 38159147 DOI: 10.1007/s10072-023-07282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
We aimed to evaluate the incidence of SARS-CoV-2 breakthrough infection of SARS-CoV-2 vaccines in people with MS (PwMS) on high-efficacy disease-modifying therapies (HET) included in the national MS registry in Argentina (RelevarEM). METHODS Non-interventional, retrospective cohort study that collected information directly from RelevarEM. Adult PwMS who had been treated for at least 6 months with a HET (ocrelizumab, natalizumab, alemtuzumab, cladribine) who had received at least two doses of SARS-CoV-2 vaccines available in Argentina were included. Full course of vaccination was considered after the second dose of the corresponding vaccines. Cumulative incidence of SARS-CoV-2 infection was reported for the whole cohort by Kaplan-Meier survival curves (which is expressed in percentage) as well as incidence density (which is expressed per 10.000 patients/day with 95% CI). RESULTS Two hundred twenty-eight PwMS were included. Most frequent first and second dose received was AstraZeneca vaccine, followed by Sputnik vaccine. Most frequent HETs used in included patients were cladribine in 79 (34.8%). We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina. We described the incidence rate after vaccination for every HET used, it being significantly higher for ocrelizumab compared with other HETs (p = 0.005). Only five patients presented a relapse during the follow-up period with no differences regarding the pre-vaccination period. CONCLUSIONS We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina.
| | - Pablo A López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
- Hospital Fernandez, Buenos Aires, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Geraldine Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Claudia Pestchanker
- Neurology Department, Hospital Central Dr. Ramon Carrillo, San Luis, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Jorge Correale
- Departamento de Neurología, FLENI, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
- Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Saenz A, Cicutti S, Argañaraz R, Mantese B, Giunta D. Parental sensitivity and specificity to recognize shunt malfunction in their child: a single-center prospective study. J Neurosurg Pediatr 2023; 31:406-416. [PMID: 36883624 DOI: 10.3171/2023.1.peds22520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The objective of this study was to estimate the diagnostic performance (sensitivity, specificity, positive predictive value, and negative predictive value) for recognizing ventriculoperitoneal shunt (VPS) failure in the parents of patients 0-18 years of age who attended the hospital's emergency room (ER). The second objective was to identify the factors associated with the parents' ability to recognize the shunt blockage (true positives). METHODS A prospective cohort study was conducted between 2021 and 2022 including all patients 0-18 years of age who had a VPS and attended the hospital's ER with symptoms that could correspond to VPS blockage. Parents were interviewed on admission and patients were assessed over time to discover potential VPS malfunction by surgery or follow-up. Consent was obtained from all participants. RESULTS Ninety-one patients were surveyed, and 59.3% showed evidence of a confirmed VPS blockage. Parental sensitivity was 66.7%, with a specificity of 21.6%. An association was found between parents who could correctly identify their child's shunt block and the number of symptoms of shunt failure that the parent could name (OR 2.4, p < 0.05) as well as parents who reported vomiting and headache as symptoms of shunt malfunction (OR 6, p < 0.05). Parents who knew the first and last name of their primary neurosurgeon (OR 3.5, p < 0.05) also had better diagnostic sensitivity. CONCLUSIONS Parents who are more knowledgeable of their child's disease, as well as parents who have good communication with their neurosurgeon, were found to have better diagnostic sensitivity.
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Affiliation(s)
- Amparo Saenz
- 1Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina; and
| | - Santiago Cicutti
- 1Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina; and
| | - Romina Argañaraz
- 1Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina; and
| | - Beatriz Mantese
- 1Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina; and
| | - Diego Giunta
- 2Italian Hospital University Institute, Italian Hospital of Buenos Aires, Argentina
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La Mantia M, De Monte L, Tancredi G, Giunta D, Ferrigno P, Gristina V, Galvano A, Barraco N, Rizzo S, Russo TB, Salemi D, Santoro A, Liotta R, Bertani A, Russo A, Bazan V. EP08.03-007 Spontaneous Regression in Metastatic Non-small Cell Lung Cancer: A Case Report. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Marsilli P, Funtowicz G, Epstein L, Giunta D, Peroni L, Vergara A. [Mortality in patients with dementia admitted in critical care units]. Rev Esp Geriatr Gerontol 2022; 57:150-155. [PMID: 35597699 DOI: 10.1016/j.regg.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the mortality and comorbidities associated of patients with dementia admitted to the Intensive Care Unit (ICU) on the hospitalization and at one year of follow-up. MATERIALS AND METHODS A retrospective observational cohort study was carried out between 2012 and 2017 at the Hospital Italiano de San Justo, of patients who were admitted to the ICU, these were observed up to hospitalary death, out hospital death one year of hospitalization, the disenrollment from the institution's health plan or the end of the follow-up. RESULTS A total of 163 patients were included for analysis. We recorded those 79 patients (48.47%) died one year after the hospitalization, of them 25 (15.34%) in ICU and 8 (4.91%) in general room. The most frequent causes of death were respiratory. The factors most associated with mortality were: orotracheal intubation (HR=2.01; 95% CI: 1.11-3.65; P=.02), history of leukemia (HR=8.55; 95% CI: 1.82-40.05; P≤.05), elevated Charlson (HR=1.16, 95% CI: 1.04-1.41; P=.05), and elevated APACHE II at admission (HR=1.07; 95% CI: 1.03-1.11; P≤.05). CONCLUSIONS The present study expresses the prognosis of patients with a diagnosis of dementia admitted to the ICU and that depends not only on their baseline neurological status but also on the severity at admission and comorbidities.
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Affiliation(s)
- Pablo Marsilli
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Lucas Epstein
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leticia Peroni
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Vázquez FJ, Grande Ratti MF, Posadas-Martinez ML, Elizondo CM, Giunta D, Rodríguez V. [Thromboprophylaxis in hospitalized patients: implementation of a multifacetical program]. Medicina (B Aires) 2022; 82:223-230. [PMID: 35417386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Venous thromboembolic disease is the most common preventable cause of hospital death. Despite the existence of evidence of the usefulness of thromboprophylaxis and recommendations, adherence by physicians to them is highly variable, and frequently suboptimal. The objective was to evaluate the change in the adequacy of thromboprophylaxis before and after an intervention on thromboprophylaxis with multifaceted strategies for physicians. The intervention was a 6 years institutional program with multiple strategies: passive actions such as posters and active actions as continuous medical education, adaptation of an institutional clinical practice guide and a computerized clinical decision support system. The baseline adequacy of thromboprophylaxis improved from 59% to 82% and was maintained over time. The improvement in fitness was associated with a reduction in major bleeding, particularly in patients undergoing surgery.
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Affiliation(s)
- Fernando J Vázquez
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Investigador independiente de CONICET, Argentina. E-mail:
| | - María F Grande Ratti
- área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | | | - Cristina M Elizondo
- área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Diego Giunta
- área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Viviana Rodríguez
- Departamento de Calidad, Seguridad y Gestión Clínica del IECS (Instituto de Efectividad Clínica y Sanitaria), Buenos Aires, Argentina
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Posadas-Martínez ML, Torres Gómez F, Mezzarobba D, Schutz N, Ruberto J, Dovasio F, Martinuzzo ME, Vázquez FJ, Bernaldo de Quirós F, Giunta D. Predictors of recurrence of venous thromboembolic disease after discontinuing of anticoagulation: a prospective cohort study. Medwave 2021; 21:e8504. [PMID: 34964447 DOI: 10.5867/medwave.2021.11.002068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/10/2021] [Indexed: 11/27/2022] Open
Abstract
Objective We aim to evaluate factors associated with the recurrence of thromboembolic episodes among patients with a first episode of venous thromboembolic disease during anticoagulation treatment and at least one year after treatment suspension. Methods A prospective cohort of patients with a first episode of deep vein thrombosis confirmed by Doppler ultrasound and initiated anticoagulation treatment. Participants were registered in the Institutional Registry of Thromboembolic Disease between June 2015 and March 2019. Patients with cancer, with permanent inferior vena cava filter implant, and those who refused to participate or did not provide informed consent were excluded. All patients were evaluated within treatment at 30 days and at least one year after the suspension of anticoagulation with a D-dimer study and an ultrasound. All patients were evaluated for recurrence, bleeding (major and minor), and death. Results A total of 304 patients were recruited during the study period. Seventy-three percent were female, and the median age was 80 years. The rate of recurrence rate during anticoagulation treatment was 5% (N = 16/303; 95% confidence interval: 3 to 8), and 5% during post-suspension follow-up (N = 11/202; 95%CI: 3 to 9). The overall bleeding rate was 13% (N = 39; 95%CI: 9 to 17), and 5% for major bleeding. Patients who recurred had higher basal D-dimer mean, higher neutrophils and monocytes, and a higher prevalence of age-adjusted D-dimer ratio greater than 0.5 before discontinuation. In addition, they more frequently had complete leg involvement by ultrasound and received a shorter treatment. Conclusions Although some baseline and pre-suspension parameters had a higher recurrence incidence, statistical significance was not reached, probably due to small statistical power and a short-term follow-up.
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Affiliation(s)
- María Lourdes Posadas-Martínez
- Área de investigación del servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0003-1403-7069
| | - Felipe Torres Gómez
- Área de investigación del servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Address: Teniente General Juan Domingo Perón 4190, Buenos Aires, Argentina. . ORCID: 0000-0001-6727-7416
| | - Daniela Mezzarobba
- Servicio de Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0001-5281-6704
| | - Natalia Schutz
- Servicio de Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0001-9613-4713
| | - Jesica Ruberto
- Servicio de Imágenes Diagnósticas, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0001-9613-4713
| | - Fernanda Dovasio
- Servicio de Imágenes Diagnósticas, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0001-9852-3755
| | - Marta Elba Martinuzzo
- Servicio de Hematología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0002-1281-7144
| | - Fernando Javier Vázquez
- Área de investigación del servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0003-1480-5101
| | - Fernan Bernaldo de Quirós
- Área de investigación del servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. ORCID: 0000-0002-9052-6684
| | - Diego Giunta
- Área de investigación del servicio de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Rossi LA, Piuzzi N, Giunta D, Tanoira I, Brandariz R, Pasqualini I, Ranalletta M. Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy. Arthroscopy 2021; 37:2745-2753. [PMID: 33892072 DOI: 10.1016/j.arthro.2021.03.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of subacromial platelet-rich plasma (PRP) injections in patients with refractory rotator cuff tendinopathies based on pain improvement, functional outcomes, sleep disturbances, and return to sports to the same level as before the injury. METHODS Between March 2019 and October 2019, 50 patients with rotator cuff tendinopathy refractory to conservative treatment were treated with one subacromial PRP injection in our institution. Magnetic resonance imaging was performed in all patients to confirm diagnosis. The visual analog scale (VAS) was used to evaluate pain. Range of motion, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant score were used to assess functional outcomes. Eighty percent of the patients (40 of 50 patients) and 86% of the patients (43 of 50 patients) achieved a clinically significant improvement that exceeded the substantial clinical benefit for the ASES and Constant scores, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorders. Return to sports was also evaluated. The mean follow-up was 12 months, and the mean (SD) age was 37.3 (9.3) years. RESULTS All mobility parameters evaluated improved significantly after treatment. The VAS, ASES, and Constant scores showed statistical improvement after the injection (P < .001). Sleep disturbances were resolved in 86% of the patients. Of the 32 patients who practiced sports before the injury, 84% returned to sports and 78% returned to the same level. There were no complications associated with the procedure. CONCLUSIONS In most patients with refractory rotator cuff tendinopathy, subacromial injections of leukocyte-rich PRP significantly decreased pain, improved functional outcomes, and resolved sleep disturbances. Moreover, most of the athletes returned to sports at the same level they had before the injury. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Nicolás Piuzzi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Brandariz
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Pasqualini
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kohler M, Kohler E, Vrech C, Pappolla A, Miguez J, Patrucco L, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Cristiano E, Carrá A, Steinberg J, Martinez AD, Curbelo MC, Cohen L, Alonso R, Garcea O, Pita C, Silva B, Luetic G, Deri N, Balbuena ME, Tkachuk V, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Burgos M, Leguizamon F, Knorre E, Piedrabuena R, Barboza A, Liwacki S, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya P, Recchia L, Mainella C, Silva E, Blanche J, Tizio S, Saladino ML, Caceres F, Fernandez Liguori N, Lazaro L, Zanga G, Parada Marcilla M, Fracaro ME, Pagani Cassara F, Vazquez G, Sinay V, Sgrilli G, Divi P, Jacobo M, Reich E, Cabrera LM, Menichini ML, Coppola M, Martos I, Viglione JP, Jose G, Bestoso S, Manzi R, Giunta D, Doldan ML, Alonso Serena M, Rojas JI. Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. J Clin Neurosci 2021; 89:360-364. [PMID: 34088579 DOI: 10.1016/j.jocn.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177). METHODS The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset. RESULTS A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively). CONCLUSION 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.
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Affiliation(s)
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - María C Curbelo
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina; Sanatorio Güemes, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan P Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Presidente Perón de Avellaneda, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe, Argentina
| | | | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones, Argentina
| | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Argentina
| | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | | | | | | | - Guido Vazquez
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Vladimiro Sinay
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Edgardo Reich
- Servicio de Neurologia, Hospital Municipal Dr. Julio Méndez, CABA, Argentina
| | - Lorena M Cabrera
- Servicio de Neurología - Hospital Militar Central, CABA, Argentina; Hospital Militar Campo de Mayo, CABA, Argentina
| | | | - Mariano Coppola
- Servicio de Neurología, Hospital Ramón Santamarina, Tandil, Buenos Aires, Argentina
| | - Ivan Martos
- Clinica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | | | - Gustavo Jose
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología - Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Diego Giunta
- Servicio de clínica médica, Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Maria L Doldan
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina
| | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina.
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Giunti G, Rivera-Romero O, Kool J, Bansi J, Sevillano JL, Granja-Dominguez A, Izquierdo-Ayuso G, Giunta D. Evaluation of More Stamina, a Mobile App for Fatigue Management in Persons with Multiple Sclerosis: Protocol for a Feasibility, Acceptability, and Usability Study. JMIR Res Protoc 2020; 9:e18196. [PMID: 32749995 PMCID: PMC7435635 DOI: 10.2196/18196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the world's most common neurologic disorders leading to severe disability in young adults. MS-related fatigue directly impacts on the quality of life and activity levels of people with MS. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions can offer tools to help symptom management. Following a user-centered design and evidence-based process, an mHealth solution called More Stamina was created to help persons with MS manage their fatigue. OBJECTIVE The overall study aims are to explore the feasibility, acceptability, and usability of More Stamina, a mobile app for fatigue self-management for persons with MS. METHODS A mixed-methods, multicenter study will be used to assess the feasibility, acceptability, and usability of More Stamina. The study will take place during the third and fourth quarters of 2020 (Q3-Q4 2020) in 3 locations: Argentina, Spain, and Switzerland. A longitudinal cohort study will take place, and think-aloud protocols, open-ended interviews, and short answer questionnaires will be used. Persons with MS will be recruited from the different locations. This study seeks to enroll at least 20 patients that meet the criteria from each site for the longitudinal cohort study (total n=60). RESULTS Ethical approval has been granted in Argentina and is pending in Spain and Switzerland. Outcomes will be published in peer-reviewed medical journals and presented at international conferences. CONCLUSIONS Findings from this study will be used to help understand the role that mHealth can play in fatigue management in MS. TRIAL REGISTRATION ClinicalTrials.gov NCT04244214; https://clinicaltrials.gov/ct2/show/NCT04244214. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/18196.
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Affiliation(s)
| | | | - Jan Kool
- Kliniken Valens, Valens, Switzerland
| | | | | | | | | | - Diego Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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12
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Cristiano E, Rojas JI, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Curbelo MC, Deri N, Fernandez Liguori N, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Luetic GG, Maglio I, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Tkachuk V, Villa A, Vrech C, Ysrraelit MC, Correale J. Consensus recommendations on the management of multiple sclerosis patients in Argentina. J Neurol Sci 2020; 409:116609. [DOI: 10.1016/j.jns.2019.116609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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13
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Rojas JI, Alonso Serena M, Garcea O, Patrucco L, Carrá A, Correale J, Vrech C, Pappolla A, Miguez J, Doldan ML, Silveira F, Alonso R, Cohen L, Pita C, Silva BA, Fiol M, Gaitán MI, Marrodan M, Negrotto L, Ysrraelit MC, Deri N, Luetic G, Caride A, Carnero Contentti E, Lopez PA, Pettinicchi JP, Curbelo C, Martinez AD, Steinberg JD, Balbuena ME, Tkachuk V, Burgos M, Knorre E, Leguizamon F, Piedrabuena R, Liwacki SDV, Barboza AG, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya PA, Silva E, Blanche J, Tizio S, Caceres F, Saladino ML, Zanga G, Fracaro ME, Sgrilli G, Pagani Cassara F, Vazquez G, Sinay V, Menichini ML, Lazaro L, Cabrera LM, Bestoso S, Divi P, Jacobo M, Kohler E, Kohler M, Giunta D, Mainella C, Manzi R, Parada Marcilla M, Viglione JP, Martos I, Reich E, Jose G, Cristiano E, Fernández Liguori N. Multiple sclerosis and neuromyelitis optica spectrum disorders in Argentina: comparing baseline data from the Argentinean MS Registry (RelevarEM). Neurol Sci 2020; 41:1513-1519. [DOI: 10.1007/s10072-019-04230-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
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Trinks J, Marciano S, Esposito I, Franco A, Mascardi MF, Mendizabal M, Livellara B, Arrigo D, Calzetta P, Vujacich C, Giunta D, Gadano A, Flichman D. The genetic variability of hepatitis B virus subgenotype F1b precore/core gene is related to the outcome of the acute infection. Virus Res 2019; 277:197840. [PMID: 31846615 DOI: 10.1016/j.virusres.2019.197840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023]
Abstract
AIM To assess the association of viral and host genetic variability with the outcome of acute infection with hepatitis B virus subgenotype F1b (HBV/F1b). METHODS The cohort consisted of 26 patients with acute HBV/F1b infection who exhibit different outcomes: spontaneous resolution (n = 10), progression to chronic hepatitis (n = 10) and acute liver failure (n = 6). HLA SNPs (rs3077, rs9277542, rs2856718 and rs7453920) were determined. The S gene and core promoter/precore/core region were direct sequenced, and this latter region was also ultra-deep sequenced. Mean number of mutations, mutation rate, Shannon entropy, positive selection sites and mutational patterns of quasispecies were compared between groups. RESULTS HLA SNPs were associated with spontaneous resolution or progression to chronic hepatitis, but not with the development of acute liver failure. The mean number of mutations in the S gene was similar among the three groups. Patients with spontaneous resolution had the lowest number of mutations, mutation rates and Shannon entropy values in the precore/core compared to the other two groups. Ten positive selection sites mapped on HLA-restricted epitopes were related to progression to chronic hepatitis and acute liver failure. Mutations T1753C, A1762T, G1764A, C1766T, T1768A G1896A, G2092T and T2107C were associated with acute liver failure and progression to chronic hepatitis. CONCLUSION Highly heterogeneous and complex HBV precore/core carrying specific point mutations, combined with the host HLA background, were associated with a worse clinical outcome of acute HBV/F1b infection.
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Affiliation(s)
- Julieta Trinks
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB) - CONICET - Instituto Universitario del Hospital Italiano (IUHI) - Hospital Italiano (HIBA), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
| | - Sebastián Marciano
- Sección de Hepatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Isabella Esposito
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB) - CONICET - Instituto Universitario del Hospital Italiano (IUHI) - Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Alejandra Franco
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB) - CONICET - Instituto Universitario del Hospital Italiano (IUHI) - Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Maria Florencia Mascardi
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB) - CONICET - Instituto Universitario del Hospital Italiano (IUHI) - Hospital Italiano (HIBA), Buenos Aires, Argentina
| | - Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Beatriz Livellara
- Laboratorio Central, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Arrigo
- Laboratorio Central, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Calzetta
- División de Gastroenterología, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Claudia Vujacich
- Fundación Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina
| | - Diego Giunta
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Área de Investigación de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrián Gadano
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB) - CONICET - Instituto Universitario del Hospital Italiano (IUHI) - Hospital Italiano (HIBA), Buenos Aires, Argentina; Sección de Hepatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Flichman
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
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Congiu S, Migliano M, Giunta D, Dolci G, Gramenzi A, Vicennati V, Pirini M, Ambrosini V, Trevisani F, Daddi N. EP1.09-06 An Unusual Diagnostic Case of Hypoglycemia: A Different Perspective of the Doege-Potter Syndrome. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rojas JI, Carrá A, Correale J, Cristiano E, Fernández Liguori N, Alonso R, Alvez Pinheiro A, Balbuena ME, Barboza AG, Bestoso S, Blaya PA, Burgos M, Cabrera LM, Caride A, Carnero Contentti E, Cohen L, Curbelo C, Deri N, Divi P, Fiol M, Fracaro ME, Gaitán MI, Hryb J, Jacobo M, Knorre E, Leguizamon F, Giunta D, Alonso Serena M, Doldan ML, De Lio GF, Liwacki SDV, Lopez PA, Luetic G, Mainella C, Manzi R, Marrodan M, Martinez AD, Miguez J, Negrotto L, Nofal P, Parada Marcilla M, Pettinicchi JP, Silva BA, Silva E, Silveira F, Steinberg JD, Tavolini D, Tizio S, Tkachuk V, Vazquez G, Volman G, Vrech C, Ysrraelit MC, Zanga G, Garcea O, Patrucco L. The Argentinean multiple sclerosis registry (RelevarEM): Methodological aspects and directions. Mult Scler Relat Disord 2019; 32:133-137. [DOI: 10.1016/j.msard.2019.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
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Barochiner J, Posadas Martínez ML, Martínez R, Giunta D. Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring. J Clin Hypertens (Greenwich) 2019; 21:877-883. [PMID: 31215143 DOI: 10.1111/jch.13596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002-0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03-0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29-0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Lourdes Posadas Martínez
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Rinaldi A, Dell'Amore A, Pastore S, Rocca A, Giunta D, Palazzini M, Manes A, Dardi F, Gotti E, Galiè N. Double Lungtransplantation In Patients with End-Stage Pulmonary Arterial Hypertension or End-Stage Inoperable Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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de Santibañes M, Glinka J, Pelegrini P, Alvarez FA, Elizondo C, Giunta D, Barcan L, Simoncini L, Dominguez NC, Ardiles V, Mazza O, Claria RS, de Santibañes E, Pekolj J. Extended antibiotic therapy versus placebo after laparoscopic cholecystectomy for mild and moderate acute calculous cholecystitis: A randomized double-blind clinical trial. Surgery 2018; 164:S0039-6060(18)30030-8. [PMID: 29506881 DOI: 10.1016/j.surg.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute calculous cholecystitis (ACC) is the most common complication of cholelithiasis. Laparoscopic cholecystectomy (LC) is the gold standard treatment in mild and moderate forms. Currently there is consensus for the use of antibiotics in the preoperative phase of ACC. However, the need for antibiotic therapy after surgery remains undefined with a low level of scientific evidence. METHODS The CHART (Cholecystectomy Antibiotic Randomised Trial) study is a single-center, prospective, double blind, and randomized trial. Patients with mild to moderate ACC operated by LC were randomly assigned to receive antibiotic (amoxicillin/clavulanic acid) or placebo treatment for 5 consecutive days. The primary endpoint was postoperative infectious complications. Secondary endpoints were as follows: (1) duration of hospital stay, (2) readmissions, (3) reintervention, and (4) overall mortality. RESULTS In the per-protocol analysis, 6 of 104 patients (5.8%) in the placebo arm and 6 of 91 patients (6.6%) in the antibiotic arm developed postoperative infectious complications (absolute difference 0.82 (95% confidence interval, -5.96 to 7.61, P = .81). The median hospital stay was 3 days. There was no mortality. There were no differences regarding readmissions and reoperations between the 2 groups. CONCLUSION Although this trial failed to show noninferiority of postoperative placebo compared to antibiotic treatment after LC for mild and moderate ACC within a noninferiority margin of 5%, the use of antibiotics in the postoperative period does not seem justified, because it was not associated with a decrease in the incidence of infectious and other types of morbidity in the present study.
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Affiliation(s)
- Martín de Santibañes
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina.
| | - Juan Glinka
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Pablo Pelegrini
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Fernando A Alvarez
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Cristina Elizondo
- Department of Internal Medicine and Statistics, Hospital Italiano de Buenos, Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Department of Internal Medicine and Statistics, Hospital Italiano de Buenos, Aires, Buenos Aires, Argentina
| | - Laura Barcan
- Department of Internal Medicine and Infectology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lionel Simoncini
- Department of Pharmacy & Pharmacology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nora Cáceres Dominguez
- Department of Pharmacy & Pharmacology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Rodrigo Sanchez Claria
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos,Aires, Argentina
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Cristiano E, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Ballario C, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Carrá A, Crespo E, Curbelo MC, Deri N, Fernandez J, Fernández Liguori N, Fiol M, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Linares R, Luetic GG, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rojas JI, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Steinberg JD, Tarulla A, Vétere SA, Villa A, Vrech C, Ysrraelit MC, Correale J. Argentinean recommendations on the identification of treatment failure in relapsing remitting multiple sclerosis patients. J Neurol Sci 2018; 385:217-224. [DOI: 10.1016/j.jns.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022]
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Otero-Castro V, Bonella B, Cristaldo N, Fiorentini F, Giunta D, Massimino B, Sarapura V, Muñoz AM, Perusini A, Quirós L, Wainsztein V, Warley F, Binder F, Waisman GD, Ferreyro BL. [Extremely elevated erythrosedimentation in an adult population in the City of Buenos Aires]. Rev Chilena Infectol 2018; 34:314-318. [PMID: 29165506 DOI: 10.4067/s0716-10182017000400314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/06/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND An extremely elevated erythrosedimentation rate (ESR), defined as equal or higher than 100 mm/h, has been linked to serious underlying conditions, such as infections, connective tissue and oncologic disease. AIM To analyze a group of patients in order to determine the underlying diagnosis and the characteristics associated with extremely elevated ESR in our environment. METHODS Cross-sectional study of adult patients, who presented with at least one ESR equal or higher than 100 mm/h at Hospital Italiano, in Buenos Aires (Buenos Aires, Argentina) between January 2002 and August 2014. RESULTS During the previously stated period of time, we analyzed the results of 879 patients. All patients were over 18 years of age. The median for the ESR results was 111 mm/h (interquartile range 105-120). The most prevalent etiology of an elevated ESR was infectious (41.64%), followed by malignancies (21.62%) and autoimmune / inflammatory diseases (12.97%). The most frequent individual diagnosis found was pneumonia (11.49%), followed by undetermined causes (5.92%). CONCLUSION When comparing inpatient versus outpatient populations, the most frequent cause was infectious in the former group, while malignancies were the most frequent diagnosis in the latter.
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Affiliation(s)
| | - Belén Bonella
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Nancy Cristaldo
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Fernando Fiorentini
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Diego Giunta
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Brenda Massimino
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Valeria Sarapura
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | | | - Agustina Perusini
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Lucas Quirós
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Vanina Wainsztein
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Fernando Warley
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Fernando Binder
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
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Marciano S, Dirchwolf M, Bermudez CS, Sobenko N, Haddad L, Genre Bert F, Barcán L, Smud A, Posadas-Martínez ML, Giunta D, Gadano A. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study. Hepatol Int 2017; 12:181-190. [PMID: 29224053 DOI: 10.1007/s12072-017-9837-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 11/14/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Spontaneous bacteremia is a poorly characterized infection in patients with cirrhosis. We compared the incidence of mortality and acute kidney injury in patients with spontaneous bacterial peritonitis and spontaneous bacteremia, and identified risk factors for mortality and acute kidney injury in patients with spontaneous bacteremia. METHODS We performed a retrospective cohort study of patients with cirrhosis and spontaneous bacteremia or spontaneous bacterial peritonitis from 2008 to 2016 at Hospital Italiano, Buenos Aires. We compared the cumulative incidence of acute kidney injury and death between the two infections, and identified risk factors for these outcomes in patients with spontaneous bacteremia. RESULTS Seventy-one patients with spontaneous bacteremia and 55 patients with spontaneous bacterial peritonitis were included. Most infections were nosocomial. Overall, 26% of bacteria were resistant and 11% multi-resistant. We found no significant association between acute kidney injury [subhazard ratio (sHR) 1.05 (95% confidence interval, CI 0.67-1.63, p = 0.83)] or death [sHR 1.15 (95% CI 0.60-2.20, p = 0.68)] and type of spontaneous infection in multivariate analyses adjusting for basal Model for End-Stage Liver Disease (MELD) score. In patients with spontaneous bacteremia, baseline MELD score was independently associated with acute kidney injury [sHR 1.07 (95% CI 1.03-1.11, p = 0.001)] and death [sHR 1.07 (95% CI 1.02-1.15, p = 0.03)]. CONCLUSIONS Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.
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Affiliation(s)
- Sebastián Marciano
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina. .,Department of Research, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina.
| | - Melisa Dirchwolf
- Liver Unit, Hospital Privado de Rosario, Presidente Roca 2440, 2000, Rosario, Santa Fe, Argentina
| | - Carla S Bermudez
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Natalia Sobenko
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Leila Haddad
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Federico Genre Bert
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Laura Barcán
- Infectious Diseases Section, Internal Medicine Department, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Astrid Smud
- Infectious Diseases Section, Internal Medicine Department, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | | | - Diego Giunta
- Department of Research, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
| | - Adrián Gadano
- Liver Unit, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina.,Department of Research, Hospital Italiano, Juan Domingo Perón 4190, 1181ACH, Buenos Aires, Argentina
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Warley F, Bonella BM, Odstrcil-Bobillo MS, Otero V, Waisman G, Bendelman G, Giunta D, Peuchot V, Ungaro CM. [Hemophagocytic lymphohistiocytosis. Experience in 27 patients]. Rev Med Chil 2017; 145:344-350. [PMID: 28548191 DOI: 10.4067/s0034-98872017000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation Aim: To describe the clinical characteristics, causes and survival associated with HLH. MATERIAL AND METHODS Review of medical records of patients with HLH attended between 2004 and 2016. They were classified according to their probable cause in: associated with immunosuppression, cancer, post-infectious or idiopathic. Kaplan-Meier survival analysis was performed. RESULTS Twenty seven patients with HLH aged 18 to 87 years (59% men), were detected. Fourteen (52%) were secondary to immunosuppression, six (22%) were post-infectious, five (18%) were associated with cancer and two (7%) were of unknown cause. There were no significant differences in clinical or laboratory features between these etiologies. Within the immunosuppressed group, 12 (86%) were patients with oncologic or hematologic diseases or bone marrow transplantation. Associated cancers were mostly oncohematologic diseases. Thirty-day mortality was 53.4% (95% confidence intervals (CI) 32.7-70.3%), despite the treatment. Mortality was significantly associated with the presence of renal failure with a hazard ratio (HR) of 3.4 (95% CI of 1.2-9.9, p =0.025). Treatment of the underlying disease proved to be protective against mortality with an HR of 0.3 (95% CI 0.1 to 0.98, p = 0.046). CONCLUSIONS The prognosis of HLH could be related to the treatment of the underlying disease. The study of the pathophysiology of this syndrome will allow a better understanding and treatment.
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Affiliation(s)
- Fernando Warley
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Belén M Bonella
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | | | - Victoria Otero
- Sección Hematología, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Gabriel Waisman
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Gisela Bendelman
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Diego Giunta
- Área de Investigación en Medicina Interna, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Verónica Peuchot
- Área de Investigación en Medicina Interna, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
| | - Catalina M Ungaro
- Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
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Alfie V, Gallucci G, Boretto J, Donndorff A, Dubois JP, Benitez S, Giunta D, de Carli P. Patient-Rated Wrist Evaluation: Spanish Version and Evaluation of Its Psychometric Properties in Patients with Acute Distal Radius Fracture. J Wrist Surg 2017; 6:216-219. [PMID: 28725503 PMCID: PMC5515606 DOI: 10.1055/s-0037-1599127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Purpose The purpose of this paper is to validate a Spanish version of patient-rated wrist evaluation (PRWE) and evaluate its psychometric attributes in a population of patients with distal radius fracture. Material and Methods A translation and cross-cultural adaptation of the PRWE to Spanish (PRWE-S) was performed according to standardized guidelines. A total of 50 patients with a distal radius fracture were included during the different steps of the study. The reliability of the new instrument was assessed in terms of construct validity with the Quick DASH (Disability of the Arm, Shoulder, and Hand). Internal consistency and test-retest stability were also examined. Results The Spearman's correlation test for analysis of the criterion validity (0.75) indicates a strong positive correlation between the PRWE-S and the Quick DASH. The internal consistency according to Cronbach's α was 0.96, and the intraclass correlation coefficient was moderate (0.46). Conclusion A Spanish version of the PRWE indicated good validity and reliability in distal radius fracture patients. This valuable tool can be used in Spanish-speaking countries to evaluate various aspects as pain and function in patients with injuries of the wrist.
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Affiliation(s)
- Veronica Alfie
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gerardo Gallucci
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Boretto
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Donndorff
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juieta Puig Dubois
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sonia Benitez
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo de Carli
- Department of Hand and Upper Extremity Surgery, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Benchimol J, Boietti B, Elizondo C, Giunta D, Barrientos S, Camera L, Waisman G. ONE-YEAR MORTALITY AFTER HIP FRACTURE IN OLD AND VERY OLD PATIENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Benchimol
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - B. Boietti
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - C. Elizondo
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - D. Giunta
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - S. Barrientos
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - L. Camera
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - G. Waisman
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
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Bettini M, Chaves M, Cristiano E, Pagotto V, Perez L, Giunta D, Rugiero M. Incidence of Autoimmune Myasthenia Gravis in a Health Maintenance Organization in Buenos Aires, Argentina. Neuroepidemiology 2017. [PMID: 28641305 DOI: 10.1159/000477733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Different epidemiological studies, especially in Europe, have estimated the incidence density of myasthenia gravis (MG) to range between 1.7 and 21.3/1,000,000/person-year; however, data from regions such as Latin America are scarce. This study is aimed at estimating the incidence and prevalence of acquired MG in Buenos Aires, Argentina. METHODS The study population comprised of affiliates of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in Buenos Aires. The evaluation method for case detection included a retrospective search from January 1, 2006, through December 31, 2012. RESULTS Of the 60 cases identified, 36 (60%) were females. The median age at diagnosis was 69 years (IQR 51.5-79). The mean age at diagnosis was 63.3 years (SD ±20). A total of 28 patients (46.7%) had generalized MG and 32 had ocular MG (53.3%). Thirty five patients (58.3%) had acetylcholine receptor antibodies and 2 (3.3%) had muscle-specific receptor tyrosine kinase antibodies. The crude incidence density (ID) of MG was 61.33 per 1,000,000 person-years (95% CI 47.62-79.99). The adjusted ID for the Argentinean population was 38.8 per 1,000,000 person-years (95% CI 27.09-50.51) and for the Buenos Aires population was 47.49 (95% CI 34.73-60.25). CONCLUSIONS The results obtained are similar to those published for other geographical areas.
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Marciano S, Mauro E, Dirchwolf M, Debernardi ME, Giunta D, Pagotto V, Rojas L, Gadano A. A Dynamic Definition of Acute Kidney Injury Does not Improve Prognosis Assessment in Acutely Decompensated Patients with Cirrhosis. J Clin Exp Hepatol 2017; 7:135-143. [PMID: 28663678 PMCID: PMC5478969 DOI: 10.1016/j.jceh.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 03/01/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/OBJECTIVES to compare the prognostic accuracy for 28 and 90-day transplant-free mortality of a modified CLIF-SOFA score (including a dynamic definition of acute kidney injury) with that of the classic CLIF-SOFA score and KDIGO score for acute kidney injury in patients with acute decompensation of cirrhosis. METHODS A retrospective analysis of all admissions of acutely decompensated patients with cirrhosis was carried out from January 2012 to December 2014. Classic and modified CLIF-SOFA scores were analyzed, as well as acute kidney injury diagnosis using the KDIGO score regarding their accuracy for 28- and 90-day transplant free mortality prediction. RESULTS 108 admissions were analyzed. Acute kidney injury diagnosis was met in 37 (34%) patients. Acute-on-chronic liver failure was diagnosed in 59 (55%) patients using the classic CLIF-SOFA score; and in 64 (59%) patients using the modified CLIF-SOFA score. Both CLIF-SOFA scores were highly effective in predicting 28-day transplant-free mortality (AUCROC 0.93 and 0.92, p = 0.34) as well as 90-day transplant-free mortality (AUCROC 0.79 and 0.78, p = 0.78). Acute kidney injury diagnosis had significantly lower accuracy in mortality assessment (28 and 90-day transplant free mortality AUCROC 0.67 [p = 0.002] and 0.63 [p = 0.02]). CONCLUSIONS To our knowledge, this is the first evidence of the limited impact of modifying the fixed kidney injury definition currently used for acute-on-chronic liver failure.
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Affiliation(s)
- Sebastián Marciano
- Liver Unit, Hospital Italiano, Buenos Aires, PC 1181, Argentina,Department of Research, Hospital Italiano, Buenos Aires, PC 1181, Argentina,Address for correspondence: Sección Hepatología, Hospital Italiano de Buenos Aires, Juan Domingo Perón 4190 - PC: 1181ACH - Ciudad Autónoma de Buenos Aires, Argentina.
| | - Ezequiel Mauro
- Liver Unit, Hospital Italiano, Buenos Aires, PC 1181, Argentina
| | | | - María Emilia Debernardi
- Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Buenos Aires, PC 1431, Argentina
| | - Diego Giunta
- Department of Research, Hospital Italiano, Buenos Aires, PC 1181, Argentina
| | - Vanina Pagotto
- Department of Research, Hospital Italiano, Buenos Aires, PC 1181, Argentina
| | - Liliana Rojas
- Department of Research, Hospital Italiano, Buenos Aires, PC 1181, Argentina
| | - Adrián Gadano
- Liver Unit, Hospital Italiano, Buenos Aires, PC 1181, Argentina,Department of Research, Hospital Italiano, Buenos Aires, PC 1181, Argentina
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Vazquez FJ, Posadas-Martinez ML, Boietti B, Giunta D, Gandara E. Prevalence of Deep Vein Thrombosis in Hospitalized Patients With Suspected Pulmonary Embolism Ruled Out by Multislice CT Angiography. Clin Appl Thromb Hemost 2017; 24:360-363. [PMID: 28301914 DOI: 10.1177/1076029617696580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current evidence suggests that for outpatients with suspected pulmonary embolism (PE), multislice computed tomographic angiography (CTPA) is sufficient to rule out PE. However, the accuracy of CTPA alone has not been established for hospitalized patients. Our goal was to determine the prevalence of deep vein thrombosis (DVT) in hospitalized patients who had PE ruled out by CTPA. We conducted a prospective cohort study of patients who developed symptoms indicative of PE, after being admitted to the hospital for any reason other than PE and were evaluated with multislice CTPA. The main outcome was proximal DVT. Between November 2011 and December 2014, 191 hospitalized patients were screened. A total of 99 patients satisfied our inclusion criteria. The average length of hospitalization for this group was 14 days (range: 2-127 days). While hospitalized, 54 (28%) patients underwent a major surgical procedure and 80 (79%) were receiving thromboprophylaxis. Of the 99 patients included, 7 (7.07%; 95% confidence intervals [CIs]: 3.4-13.8) were diagnosed with a proximal DVT. The likelihood of developing a proximal DVT was higher for those with subtle and nonspontaneously reported symptoms of DVT, odds ratio [OR] was 50.93 (95% CI: 5.35-2572) and for those classified as PE likely OR was 37.54 (95% CI: 4.05-186.1). Given the prevalence of DVT in hospitalized patients with suspected PE ruled out by a negative multislice CTPA, our study suggests that compression ultrasonography would, in fact, be justified for patients with these characteristics.
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Affiliation(s)
- Fernando Javier Vazquez
- 1 Internal Medicine Department, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Boietti
- 2 Internal Medicine Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- 2 Internal Medicine Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Esteban Gandara
- 3 Internal Medicine Department, Research in Hematology Department, Hospital Privado de la Comunidad, Mar del Plata, Buenos Aires, Argentina
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Rojas JI, Patrucco L, MIguez J, Sinay V, Cassara FP, Cáceres F, Liguori NF, Saladino ML, Deri N, Jaacks G, Marcilla MP, Arrigoni MI, Correale J, Fiol M, Ysrraelit MC, Carrá A, Curbelo MC, Martinez A, Steinberg J, Bestoso S, Hryb JP, Di Pace JL, Perassolo MB, Contentti EC, Caride A, Lopez PA, Martinez C, Reich E, Giunta D, Cristiano E. Gender ratio trends over time in multiple sclerosis patients from Argentina. J Clin Neurosci 2017; 38:84-86. [PMID: 28087187 DOI: 10.1016/j.jocn.2016.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022]
Abstract
Several studies in multiple sclerosis (MS) suggest a trend of increasing disease frequency in women during the last decades. A direct comparison of gender ratio trends among MS populations from Argentina remains to be carried out. The objective of the study was to compare gender ratio trends, over a 50-year span in MS populations from Argentina. METHODS multicenter study that included patients from 14 MS Centers of Argentina. Patients with definite MS with birth years ranging from 1940 to 1989 were included. Gender ratios were calculated by five decades based on year of birth and were adjusted for the F/M born-alive ratio derived from the Argentinean national registry of births. The F/M ratios were calculated using a multivariate logistic regression per five decades by the year of birth approach. Analyses were performed using Stata 10.1. RESULTS 1069 patients were included. Gender ratios showed a significant increase from the first to the last decade in the whole MS sample (from 1.8 to 2.7; p value for trend=0.023). The Gender ratio did not show differences considering MS subtype. CONCLUSION our study showed a modest increase of the F/M ratio (from 1.8 to 2.7) over time among patients affected by MS in Argentina.
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Affiliation(s)
- J I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.
| | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - J MIguez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - V Sinay
- Instituto de Neurociencias Fundación Favaloro (INCyT), Argentina
| | - F Pagani Cassara
- Instituto de Neurociencias Fundación Favaloro (INCyT), Argentina
| | - F Cáceres
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina
| | | | - M L Saladino
- Neurosciences Institute of Buenos Aires (INEBA), Buenos Aires, Argentina
| | - N Deri
- Centro de Investigación DIABAID, Argentina
| | - G Jaacks
- Centro de Investigación DIABAID, Argentina
| | | | | | - J Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M Fiol
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - M C Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea, FLENI, Argentina
| | - A Carrá
- Hospital Británico Buenos Aires, Argentina
| | | | - A Martinez
- Hospital Británico Buenos Aires, Argentina
| | | | - S Bestoso
- Hospital Escuela "José F. De San Martín", Corrientes, Argentina
| | - J P Hryb
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - J L Di Pace
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - M B Perassolo
- Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | | | - A Caride
- Hospital Alemán, Buenos Aires, Argentina
| | - P A Lopez
- Hospital Alemán, Buenos Aires, Argentina
| | | | - E Reich
- Hospital Julio Mendez, Buenos Aires, Argentina
| | - D Giunta
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
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Cristiano E, Patrucco L, Miguez J, Giunta D, Correale J, Fiol M, Ysrraelit M, Cáceres F, Liguori NF, Saladino M, Garcea O, Silva B, Alonso R, Carrá A, Curbelo M, Martinez A, Steinberg J, Giachello S, Melcom M, Rojas J. Increasing prevalence of multiple sclerosis in Buenos Aires, Argentina. Mult Scler Relat Disord 2016; 9:91-4. [DOI: 10.1016/j.msard.2016.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
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Cristiano E, Patrucco L, Miguez J, Giunta D, Peroni J, Rojas JI. Increasing incidence of multiple sclerosis among women in Buenos Aires: a 22 year health maintenance organization based study. Neurol Sci 2016; 37:1621-6. [PMID: 27338941 DOI: 10.1007/s10072-016-2637-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/14/2016] [Indexed: 01/18/2023]
Abstract
Studies in multiple sclerosis (MS) suggest a trend of increasing disease prevalence and incidence, and especially, a disproportional increase in the incidence of multiple sclerosis in women. The objective of this study was to evaluate the incidence of MS over 22 years and to determine the ratio in incidence of men to women in a health maintenance organization from Buenos Aires, Argentina. The population was made up of all members of a hospital-based HMO affiliated between January 1992 and December 2013. Each person was followed contributing time at risk. Cases with definite diagnosis of MS were included. Incidence density was calculated with 95 % confidence intervals and compared between women and men. 165,456 subjects were followed for a total of 1,488,575 person-years, of whom 42 developed MS. Incidence density was 3/100,000 person-years (95 % CI 2.1-3.5/100,000 person-years). During this period (1992-2013), the incidence rate in women increased from 1/100,000 (95 % CI 0.8-1.6) to 4.9/100,000 (95 % CI 4.1-5.4) (p < 0.001), while in men the incidence ranged from 1.4/100,000 (95 % CI 1-1.7) to 1.8 (1.3-2.1) (p = 0.16). Incidence density during the study period increased significantly in women but not in men. This is the first report of this phenomenon in Latin America region.
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Affiliation(s)
- E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Italian Hospital of Buenos Aires, Gascón 450, C1181ACH, Buenos Aires, Argentina.
| | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Italian Hospital of Buenos Aires, Gascón 450, C1181ACH, Buenos Aires, Argentina
| | - J Miguez
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Italian Hospital of Buenos Aires, Gascón 450, C1181ACH, Buenos Aires, Argentina
| | - D Giunta
- Clinical Research Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Peroni
- Clinical Research Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Italian Hospital of Buenos Aires, Gascón 450, C1181ACH, Buenos Aires, Argentina
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Rey A, Losada C, Santillán J, Fiorentini F, Schiaffino M, Peroni HJ, Giunta D, Barcán L, Waisman G. [Pneumocystis jiroveci infection in patients with and without HIV: A comparison]. Rev Chilena Infectol 2016; 32:175-80. [PMID: 26065450 DOI: 10.4067/s0716-10182015000300006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Respiratory infection caused by Pneumocystis jiroveci is a common opportunistic infection in patients with human immunodeficiency virus (HIV) with CD4 counts < 200 cells/mm(3). However, it has also been reported in patients with other causes of immunosuppression. OBJECTIVES To compare the characteristics, severity and mortality of respiratory infection by P. jiroveci in patients with and without HIV infection. METHODS Retrospective cohort follow-up of adult patients admitted to our hospital with infection by P. jiroveci since 2006 to 2013. RESULTS We included 82 patients with respiratory infection by P. jiroveci of which 55% (45) were not infected with HIV. In this group, 68.8% (31) had diagnosis of cancer and 20% (9) received solid-organ transplant. 57.9% (26) were hospitalized in an intensive care unit. 42.2% (19) suffered multiple organ failure (MOF), 46.7% (21) required mechanical ventilation (MV) and 40.9% (18) inotropic drugs. Mortality was 33.3% (15). Statistically significant differences were observed between groups in age (p < 0.001), requirement of MV (p < 0.001) inotropic drugs (p 0.001) and MOF (p < 0.001). Mortality was higher in the HIV-positive group, reaching statistical significance (p 0.007). CONCLUSION Pneumocystis pneumonia mortality was higher in patients without HIV, who suffered more complications and progression to respiratory failure with MOF.
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Pellegrini P, Campana JP, Dietrich A, Goransky J, Glinka J, Giunta D, Barcan L, Alvarez F, Mazza O, Sánchez Claria R, Palavecino M, Arbues G, Ardiles V, de Santibañes E, Pekolj J, de Santibañes M. Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART). BMJ Open 2015; 5:e009502. [PMID: 26582405 PMCID: PMC4654351 DOI: 10.1136/bmjopen-2015-009502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. METHODS AND ANALYSIS A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. ETHICS AND DISSEMINATION This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). RESULTS The results of the trial will be reported in a peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT02057679.
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Affiliation(s)
- Pablo Pellegrini
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pablo Campana
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustín Dietrich
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jeremías Goransky
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Glinka
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Department of Internal Medicine and Statistics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Laura Barcan
- Department of Internal Medicine and Infectology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Alvarez
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Sánchez Claria
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Palavecino
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin de Santibañes
- Department of General Surgery,Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Garcia G, Bertoia A, Cameselle L, Benitez S, Giunta D, Baum A, Gonzalez Bernaldo de Quiros F. Communication problems between end-users and technicians through a Help Desk in a Health Information System. Stud Health Technol Inform 2015; 216:985. [PMID: 26262287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Communication between users and technicians is crucial for improving Help Desk performance. The objective of this study is to know and understand perceptions, and needs of users and help desk technicians. A qualitative study based on interviews was performed. The emergent topics were communication, workload and misperceptions between end-users and technicians. There are false perceptions between them that affect their interaction and work dynamics.
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Affiliation(s)
| | | | | | | | | | - Analía Baum
- Hospital Italiano de Buenos Aires, Argentina
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35
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Pintos L, Stieben A, Garcia G, Briatore A, Bertoia A, Benitez S, Giunta D, Baum A, Gonzalez Bernaldo de Quiros F. Health Information Systems: evaluation and performance of a Help Desk. Stud Health Technol Inform 2015; 210:536-540. [PMID: 25991205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED A Help Desk (HD) is crucial in a computerized hospital. OBJECTIVE to describe the performance of a HD. DESIGN retrospective cohort study. RESULTS the sociodemographic characteristics of users, as well as their relationship with the institution influence behaviour when requesting support to a HD. Also we observed a relationship between the flow of users request and the functioning of hospital services. CONCLUSIONS complexity of HD process realizes the need to identify and define standards to ensure quality of service.
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Giunti G, Baum A, Giunta D, Plazzotta F, Benitez S, Gómez A, Luna D, Bernaldo de Quiros FG. Serious Games: A Concise Overview on What They Are and Their Potential Applications to Healthcare. Stud Health Technol Inform 2015; 216:386-390. [PMID: 26262077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Younger generations are extensive users of digital devices; these technologies have always existed and have always been a part of their lives. Video games are a big part of their digital experience. User-centered design is an approach to designing systems informed by scientific knowledge of how people think, act, and coordinate to accomplish their goals. There is an emerging field of intervention research looking into using these techniques to produce video games that can be applied to healthcare. Games with the purpose of improving an individual's knowledge, skills, or attitudes in the "real" world are called "Serious Games". Before doctors and patients can consider using Serious Games as a useful solution for a health care-related problem, it is important that they first are aware of them, have a basic understanding of what they are, and what, if any, claims on their effectiveness exist. In order to bridge that gap, we have produced this concise overview to introduce physicians to the subject at hand.
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Affiliation(s)
- Guido Giunti
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Analía Baum
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Sonia Benitez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrián Gómez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Luna
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Angriman F, Ferreyro BL, Posadas-Martinez ML, Giunta D, Vazquez FJ, Vollmer WM. Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism. Clin Appl Thromb Hemost 2014; 21:539-45. [DOI: 10.1177/1076029614559772] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Since the introduction of computed tomography pulmonary angiography, isolated subsegmental pulmonary embolism has become a commonly recognized clinical problem, but its clinical relevance remains unclear. The objective of the present study was to evaluate the extent to which the simplified Wells score discriminates between patients with varying levels of risk of complications after presenting with subsegmental pulmonary embolism. Materials and Methods: Retrospective cohort study. Patients included had subsegmental pulmonary embolism (1 or multiple emboli limited to subsegmental arteries). Primary explanatory variable was the simplified Wells score, categorized as high (>4) or low (≤4). The primary outcome was time to death or new venous thromboembolism. Kaplan-Meier techniques and Cox regression analysis were used to compare the survival experience of patients with high versus low Wells score with and without adjustment for active malignancy, age, Charlson score, previous venous thromboembolism, and previous major surgery in the last 30 days. Main Results: Seventy-nine patients with subsegmental pulmonary embolism were included. Patients with a high Wells score had a 4-fold increased risk of the composite outcome (hazard ratio = 4.2, 95% confidence interval [CI] = 2.0-8.9, P < .001). Other covariates significantly associated with increased risk in univariate analyses included active malignancy, a low serum albumin, and an increased Charlson score. In multivariate Cox regression analyses adjusting for these other factors, a high Wells score remained significant (hazard ratio 5.5, 95% CI 2.4-12.6, P < .001). Conclusion: High Wells score is associated with death or new venous thromboembolism during follow-up among patients with subsegmental pulmonary embolism. Clinical trial registration: ClinicalTrials.gov number, NCT01372514.
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Affiliation(s)
- Federico Angriman
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires University, Buenos Aires, Argentina
| | - Bruno L. Ferreyro
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires University, Buenos Aires, Argentina
| | | | - Diego Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando J. Vazquez
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Boretto JG, Pacher N, Giunta D, Gallucci GL, Alfie V, De Carli P. Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures. J Hand Surg Eur Vol 2014; 39:755-60. [PMID: 24401740 DOI: 10.1177/1753193413517806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.
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Affiliation(s)
- J G Boretto
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N Pacher
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D Giunta
- Internal Medicine Research Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G L Gallucci
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Alfie
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P De Carli
- Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopedics and Traumatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Goldschmidt E, Ielpi M, Loresi M, D'adamo M, Giunta D, Carrizo A, Ajler P, Yampolsky C, Argibay P. Assessing the role of selected growth factors and cytostatic agents in anin vitromodel of human dura mater healing. Neurol Res 2014; 36:1040-6. [DOI: 10.1179/1743132814y.0000000429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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40
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Asadi N, Dolci G, Dell'Amore A, Greco D, Caroli G, Ammari C, Giunta D, Bini A, Stella F. V-046 * SURGICAL SIMULATION GUIDED NAVIGATION: A NEW APPROACH IN THORACIC SURGERY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Posadas Martinez M, Laura Martin M, González Bernaldo de Quirós F, Giunta D, Vazquez F. C0255: Immediate and Long Term Mortality in Patients with Suspected Pulmonary Embolism: Prospective Cohort in Argentina. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Posadas Martínez M, Giunta D, Sevilla S, Bernaldo de Quiros F, Gandara E, Cubilla V, Vazquez F. C0259: Prevalence of Deep Venous Thrombosis Using Bilateral Leg Ultrasound in Hospitalized Patients Evaluated for Pulmonary Embolism? A Preliminary Report. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garipe LY, Gónzalez V, Biasizzo A, Soriano JL, Perman G, Giunta D. [Food environment and space accessibility evaluation to perform physical activity in 3 socially contrasting neighbourhoods of Buenos Aires city]. Rev Fac Cien Med Univ Nac Cordoba 2014; 71:88-96. [PMID: 25647550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Due to the environmental influences on health, the goal of this study was to describe and compare the built environment in 3 socially contrasting neighbourhoods of Buenos Aires city.In 2011 a cross-sectional study was conducted in 3 socially contrasting neighbourhoods of Buenos Aires city: Recoleta (upper class), Almagro (middle class) and Constitución (lower class). Grocery stores and food stands were surveyed as well as all suitable spaces to perform physical activity. An analysis was conducted to assess the density of every food outlet per Km2 of each neighbourhood's area and per 10000 inhabitants. 2778 food stores and 149 outdoor physical activity facilities were surveyed. A higher density was observed in Constitución for fast food restaurants (Recoleta 3.6; Almagro 2.4; Constitución 6.7) and food stands (Recoleta 4.2; Almagro 1.2; Constitución 25.7) and a lower density for outdoor physical activity facilities. Population density and area density proved to be analogous. Statistically relevant differences were observed regarding the dimension of each food outlet: grocery stores, fruit stands, pubs, restaurants and food stands, as well as in the number of food stores and outdoor physical activity facilities. The information gathered in this study could be highly useful for public health policies on healthy lifestyles, and could eventually redefine the built environment in order to improve the city's equality regarding outdoor physical activity facilities and food stores.
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Goldschmidt E, Hem S, Ajler P, Ielpi M, Loresi M, Giunta D, Carrizo A, Yampolsky C, Argibay P. A new model for dura mater healing: human dural fibroblast culture. Neurol Res 2013; 35:300-7. [DOI: 10.1179/1743132812y.0000000136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Ezequiel Goldschmidt
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Santiago Hem
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Pablo Ajler
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Marcelo Ielpi
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Monica Loresi
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Diego Giunta
- Clinical Research Division Clinical Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Carrizo
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Claudio Yampolsky
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Pablo Argibay
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
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Giunta D, Briatore A, Baum A, Luna D, Waisman G, de Quiros FGB. Factors associated with nonattendance at clinical medicine scheduled outpatient appointments in a university general hospital. Patient Prefer Adherence 2013; 7:1163-70. [PMID: 24235820 PMCID: PMC3826940 DOI: 10.2147/ppa.s51841] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Nonattendance at scheduled outpatient appointments for primary care is a major health care problem worldwide. Our aim was to estimate the prevalence of nonattendance at scheduled appointments for outpatients seeking primary care, to identify associated factors and build a model that predicts nonattendance at scheduled appointments. METHODS A cohort study of adult patients, who had a scheduled outpatient appointment for primary care, was conducted between January 2010 and July 2011, at the Italian Hospital of Buenos Aires. We evaluated the history and characteristics of these patients, and their scheduling and attendance at appointments. Patients were divided into two groups: those who attended their scheduled appointments, and those who did not. We estimated the odds ratios (OR) and corresponding 95% confidence intervals (95% CI), and generated a predictive model for nonattendance, with logistic regression, using factors associated with lack of attendance, and those considered clinically relevant. Alternative models were compared using Akaike's Information Criterion. A generation cohort and a validation cohort were assigned randomly. RESULTS Of 113,716 appointments included in the study, 25,687 were missed (22.7%; 95% CI: 22.34%-22.83%). We found a statistically significant association between nonattendance and age (OR: 0.99; 95% CI: 0.99-0.99), number of issues in the personal health record (OR: 0.98; 95% CI: 0.98-0.99), time between the request for and date of appointment (OR: 1; 95% CI: 1-1), history of nonattendance (OR: 1.07; 95% CI: 1.07-1.07), appointment scheduled later than 4 pm (OR: 1.30; 95% CI: 1.24-1.35), and specific days of the week (OR: 1.00; 95% CI: 1.06-1.1). The predictive model for nonattendance included characteristics of the patient requesting the appointment, the appointment request, and the actual appointment date. The area under the receiver operating characteristic curve of the predictive model in the generation cohort was 0.892 (95% CI: 0.890-0.894). CONCLUSION Evidence related to patient characteristics, and the identification of appointments with a higher likelihood of nonattendance, should promote guided strategies to reduce the rate of nonattendance, as well as to future research on this topic. The use of predictive models could further guide management strategies to reduce the rate of nonattendance.
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Affiliation(s)
- Diego Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustina Briatore
- Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Correspondence: Agustina Briatore, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D Perón 4190 (c1181Ach), Buenos Aires, Argentina, Tel +54 11 4959200, Email
| | - Analía Baum
- Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Waisman
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernán Gonzalez Bernaldo de Quiros
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Luna D, Franco M, Plaza C, Otero C, Wassermann S, Gambarte ML, Giunta D, González Bernaldo de Quirós F. Accuracy of an electronic problem list from primary care providers and specialists. Stud Health Technol Inform 2013; 192:417-421. [PMID: 23920588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Accurate patient problem lists in Electronic Health Records (EHRs) are valuable tools for improving the quality of care, communication among professionals, facilitating research, quality measurement and the implementation of clinical decision support systems. However, problem lists are frequently inaccurate and out-of-date, and use varies widely across providers. These deficiencies limit problem list benefits. We decided to check if accuracy of problem lists-assessed at a granular level of detail-registered in EHRs depended on the specialty of the physician (primary care providers vs. specialists), and in the event that such differences did occur, whether or not accuracy had also been affected by the work environment. By using registered problems and taking the generated clinical document, we designed a cross-sectional survey following the guidelines of the Clinical Document Architecture standard. Problems registered by primary care providers have a higher level of accuracy than those registered by specialists in all settings considered (emergency unit, inpatient and outpatient). The work environment also significantly affects the accuracy level of problems registered.
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Affiliation(s)
- Daniel Luna
- Health Informatics Department, Hospital Italiano de Buenos Aires, Argentina
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Seinhart D, Camera L, Majo Bellagamba MC, Riccio P, Soriano E, Labos E, Giunta D. P1‐047: Development of dementia in a cohort of elderly frequent attenders to ambulatory health services. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Luis Camera
- Hospital Italiano Buenos AiresBuenos AiresArgentina
| | | | | | | | - Edith Labos
- Hospital Italiano Buenos AiresBuenos AiresArgentina
| | - Diego Giunta
- Hospital Italiano Buenos AiresBuenos AiresArgentina
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Videla G, Toral A, Bisonni A, Giunta D, Vicens J, Rojas JI, Norscini J, Cristiano E. First Incidence Study of Meniere's Disease (MD) in South America (P02.256). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vázquez FJ, Benchimol J, Giunta D, Cafferata C, Freixas A, Vallone M, Andresik D, Pollan J, Aprile A, Lorenzo J, Waisman G, Camera L. [Delirium in elderly inpatients. An 18 month follow-up]. Medicina (B Aires) 2010; 70:8-14. [PMID: 20228018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3%) presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home (17.3% vs. 1.5%; p < 0.002), dementia (40.4% vs. 8.8%; p < 0.001), median activity of daily living (5 vs. 6; p < 0.001), length-of-stay (7 vs. 5; p = 0.04) and mortality rate (21.2% vs. 1.5%; p < 0.001). Evaluation 18 months later showed differences between patients with and without delirium in median of activity of daily living (1/6 vs. 5/6), patients living in nursing homes (27.5% vs. 7.9%), estimated survival 35.3% (CI 95%: 24-49%) at day 569 and 49% (CI 95%: 32.9-65.4%) at day 644. The difference between survival curves was statistically significant (p = 0.027). Delirium increases morbidity and mortality during hospital stay. Elderly with delirium are at risk of worsening disability and of becoming dependent after discharge and it is a risk factor for higher mortality during the following months after discharge.
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Cristiano E, Patrucco L, Giunta D, Videla G, Soriano ER, Rojas JI. Incidence of multiple sclerosis in Buenos Aires: a 16-year health maintenance organization-based study. Eur J Neurol 2009; 17:479-82. [DOI: 10.1111/j.1468-1331.2009.02846.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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