Análisis de situación de tuberculosis en el Área Programática del Hospital General de Agudos Parmenio Piñero: Año 2017 / Analysis of tuberculosis situation at Programmatic Area of the Acute General Hospital Parmenio Piñero: 2017

El área programática del Hospital Parmenio Piñero (AP-HGAPP) se localiza en el sur de la ciudad, e incluye parte de las comunas 7, 8, 9, 10, 6 y 4. Según datos provenientes del Censo 20105, se registraron 324.179 personas viviendo en este territorio, con un porcentaje de población con Necesidades Básicas Insatisfechas de 10,4% (superior al valor promedio de CABA de 7%). Se presenta en este informe un análisis de situación de tuberculosis, tomando como eje el territorio y la población a cargo del hospital y sus centros de salud y acción comunitaria. (AU)

Tuberculosis en Área Programática del Hospital General de Agudos Parmenio Piñero: 1° semestre 2017 / Tuberculosis in the Programmatic Area of the Acute General Hospital Parmenio Piñero: First half 2017

La tuberculosis (TBC) es una enfermedad infecciosa que compromete habitualmente el sistema respiratorio, y con menor frecuencia otros aparatos. A nivel mundial representa la segunda causa infecciosa de muerte después del HIV, y en Argentina se notificaron 429 muertes en 2015. La ciudad de Buenos Aires presenta la tercera tasa de notificación de TBC más alta del país, luego de Salta y Jujuy, y dentro de CABA las comunas con mayor incidencia de TBC son la 7 y la 8, aportando una porción significativa del territorio total del área programática del Hospital Piñero. El grupo colaborativo de tuberculosis del Hospital Piñero y su área programática es un colectivo multidisciplinario de profesionales que se desempeñan en el hospital o en centros de salud, compuesto por médicos, enfermeros, trabajadoras sociales, bioquímicos, farmacéuticos y psicólogos. El trabajo en red posibilita compartir objetivos comunes, intercambiar recursos, información y experiencias de trabajo, con la finalidad de articular el proceso de atención y cuidado de las personas con tuberculosis y sus contactos familiares e institucionales. Se analizaron casos de tuberculosis (todas las localizaciones, pulmonar, extrapulmonar o ambas), confirmada bacteriológicamente o no, que iniciaron tratamiento en el Hospital Piñero y/o CeSAC del AP, o aquellos con residencia en el AP del Hospital Piñero que fueron asistidos en otras instituciones. Las fuentes de información utilizadas fueron el SNVS (Módulo C2 para datos 2015-2016; Módulo TBC para datos 2017). Para la realización de los mapas se utilizó además datos suministrados por la Gerencia Operativa de Epidemiología, que corresponden a individuos residentes en el AP del Piñero que fueron asistidos en otras instituciones. (AU)

The clinical utility of circulating neuroendocrine gene transcript analysis in well-differentiated paragangliomas and pheochromocytomas.

CONTEXT: Paragangliomas and pheochromocytomas (PPGLs) exhibit variable malignancy, which is difficult to determine by histopathology, amine measurements or tissue genetic analyses. OBJECTIVE: To evaluate whether a 51-neuroendocrine gene blood analysis has clinical utility as a diagnostic and prognostic marker. DESIGN: Prospective cohort study. Well-differentiated PPGLs (n = 32), metastatic (n = 4); SDHx mutation (n = 25); 12 biochemically active, Lanreotide treated (n = 4). Nine patients had multiple sampling. Age- and gender-matched controls and GEP-NETs (comparators). METHODS: Circulating neuroendocrine tumor mRNA measured (qPCR) with multianalyte algorithmic analysis. Metabolic, epigenomic and proliferative genes as well as somatostatin receptor expression were assessed (averaged, normalized gene expression: mean ± s.e.m.). Amines were measured by HPLC and chromogranin A by ELISA. Analyses (2-tailed): Fisher's test, non-parametric (Mann-Whitney), receiver-operator curve (ROC) and multivariate analysis (MVA). All data are presented as mean ± s.e.m. RESULTS: PPGL were NETest positive (100%). All exhibited higher scores than controls (55 ± 5% vs 8 ± 1%, P = 0.0001), similar to GEP-NETs (47 ± 5%). ROC analysis area under curve was 0.98 for differentiating PPGLs/controls (cut-off for normal: 26.7%). Mutation status was not directly linked to NETest. Genetic and molecular clustering was associated (P < 0.04) with NETest scores. Metastatic (80 ± 9%) and multicentric (64 ± 9%) disease had significantly (P < 0.04) higher scores than localized disease (43 ± 7%). Progressive disease (PD) had the highest scores (86 ± 2%) vs stable (SD, 41 ± 2%) (P < 0.0001). The area under the curve for PD from SD was 0.93 (cut-off for PD: 53%). Proliferation, epigenetic and somatostatin receptor gene expression was elevated (P < 0.03) in PD. Metabolic gene expression was decreased in SDHx mutations. Repeat NETest measurements defined clinical status in the 9 patients (6 SD and 3 PD). Amine measurement was non-informative. Multivariate analysis identified NETest >53% as an independent prognostic factor. CONCLUSION: Circulating NET transcript analysis is positive (100% diagnostic) in well-differentiated PCC/PGL, scores were elevated in progressive disease irrespective of mutation or biochemical activity and elevated levels were prognostic.

[Multifocal fractures of the mandibular symphysis. Apropos of 3 cases]. / Les fractures pluri-focales de la symphyse mandibulaire. A propos de trois cas.

Three patients presented with multiple site fractures of mandibular symphysis, associated in two cases with a bilateral subcondylar fracture. Treatment was by multiple solid osteosynthesis of mandibular body combining miniaturized screw plates and steel wire osteosynthesis. Emphasis is placed on the interest of a stable solid osteosynthesis of mandibular symphysis by screw plate, combined with osteosynthesis using a steel wire passing through the hole of a plate and into the small basilar bone fragment, allowing in this way the restitution of a perfect morphology of symphysis.

[Proposal for a numerical prognostic evaluation in intracerebral hematoma]. / Proposition pour une évaluation pronostique chiffrée dans l'hématome intra-cérébral.

From 300 cases of spontaneous intracerebral hematomas, 5 parameters are extracted they are: Age, sex, level of consciousness, localisation of hematomas and risk factors. A value, varying from 1 to 5 is attributed to each parameter, the sum of values give a score for each patient. This score allows the clinician to predict, within the early 48 hours, the vital prognosis. Survival chances are: 80% if score between 5 and 8; 60% if score between 9 and 13; 40% if score between 14 and 17; 20% if score equal or superior to 18.