Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes. / ¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

[Scores to predict the number of hospitalization days in a general ward at a tertiary hospital]. / Score predictor de días de estancia para sala común.

UNLABELLED: Although most usual admissions to hospital are in rooms in general wards, there are not scores to predict the number of hospitalization days in this area. The patients are located based on diagnosis at admission. AIM: to make scores who predict the number of hospitalization days in the general wards. METHODS: We studied all the patients who were admitted to the Italiano Hospital from march of 2004 to may of 2005 in Cordoba city (Argentina). The inclusion criteria were: more than 18 years old patients who were admitted for more than 24 hours due to clinical or surgical conditions in general wards. We evaluated 53 variables including background, toxics, physiologic and demographic data, social reports, nutritional condition, out patients previous consultations at the admission day. Died patients were not included in this score analysis. RESULTS: The number of patients included was 1003. Short hospitalization was considered when the number of the days of the hospitalization was less than 4 days and long hospitalization was more than 5 day in a general ward. We made a score with 11 main variables according to physician clinical perception. The statistical analysis was not significant in each variable studied. When we analyzed the score with 11 of them as a whole, it showed statistical significance. We divided in categories and pointing according to statistic settlements. Minimum pointing: 11; maximum: 33. Showed R2: 0,77 ( p: 0,06) between pointing and the hospitalization days. CONCLUSION: The lower scores were related with a high chance of discharge before 5 days. This score may be a simple and feasible tool for the hospital administration and for the prediction of available beds in a general wards.

Estilo de vida y factores de riesgo cardiovascular en estudiantes universitarios / Lifestyle and cardiovascular risk factors in university students

Introducción: El comienzo de los estudios universitarios está asociado a cambios en el estilo de vida que pueden predisponer a la aparición de factores de riesgo cardiovascular. Objetivo: Se evaluó la asociación entre el cambio en el estilo de vida de los estudiantes en dos años y la incidencia de Presión Arterial (PA) elevada y la obesidad central. Materiales y métodos: Estudiantes de primer año de Medicina se evaluaron en 2017 y 2019. Se midió circunferencia cintura, PA y se aplicó un score de Estilo de Vida (HOLS) que incluye Índice de Masa Corporal, hábito de fumar, consumo de alcohol, consumo de frutas y verduras y actividad física. Se expresaron los resultados en cada año, 2017 y 2019 separados por sexo. Se realizó regresión logística multivariada con PA y circunferencia cintura en 2019 como variables dependientes y cambios en el HOLS entre 2017 y 2019 como variable predictora. Resultados: La prevalencia de PA limítrofe fue más elevada en varones que en mujeres en 2017 y sin cambios en 2019. La proporción de estudiantes con obesidad central no se modificó. En 2017, en ambos sexos, se destacó el exceso de peso, bajo consumo de frutas y verduras y escasa actividad física que determinaron un bajo score HOLS (6,2). Transcurridos dos años el HOLS disminuyó en ambos sexos. Una disminución del HOLS se asoció con mayor riesgo de obesidad central comparado al HOLS que permaneció estable. No se observó asociación entre las variaciones del HOLS y PA. Conclusiones: El score aplicado es una herramienta útil para evaluar el estilo de vida de los estudiantes. Una disminución del HOLS se asoció con mayor riesgo de obesidad central

Introduction: The beginning of university studies is associated with changes in lifestyle that could create predisposition to the appearance of cardiovascular risk factors. Objective: The purpose of this study was to examine the association between two-year changes in the lifestyle and incident elevated Blood Pressure (BP) and central obesity in university students. Materials and Methods: First-year medical students were evaluated in 2017 and 2019. Waist circumference and BP were assessed. A Lifestyle Score (HOLS) was applied that included Body Mass Index, plus four behavioral factors: smoking, alcohol use, fruit/vegetable consumption, and physical activity. Multivariate logistic regression was used with BP and waist circumference in 2019 as dependent variable and HOLS change between 2017 and 2019 as the primary predictor. Results: The prevalence of borderline BP was higher in men than in women in 2017 and unchanged in 2019. The proportion of students with abdominal obesity did not change. In 2017, in both sexes, excess weight, low consumption of fruits and vegetables and little physical activity were highlighted. This determined a low HOLS score (6.2). After two years a decrease in the score was observed in both sexes. A two-year decrease in HOLS was associated with significantly greater odds of incident central obesity as compared to stable HOLS. No associations were observed between variations in HOLS and BP. Conclusion: The applied score is a tool to evaluate the lifestyle of the students. A decrease in HOLS was associated with an increased risk of central obesity

[Characteristics of patients admitted with enteral nutrition in a service of clinical medicine]. / Caracteristicas de los pacientes internados con alimentacion enteral de un servicio de clínica médica.

BACKGROUND: When a patient is unable to swallow enough calories by mouth and has his digestive tube working normally, the Enteral Nutrition (EN) is prescribed. Our aims was identify the patient who requires EN by sounding at Clinical Medical admission. METHODS: From 11/2001 to 11/ 2002; 331 patients were attended in common rooms. 50 of them (15%) required EN. Retrospective descriptive study was made, evaluating: demographic data, diagnoses, comorbilities, self-validity, staying, nosocomial complications, studies, medicaments, inter-consulting and mortality as well. RESULTS: In 50 patients under EN, 56 % were men, with an age rate of 65 years Standar Error (SE) 2.37 and daily life activity medium rate was 2 (SE) 0.35. Diagnoses at admission: Strocke 22%, acute pneumonia of community 22%, pneumonia by bronchoaspiration 10 %, acute confusional syndrome 10%, etc. Comorbilities: 54% presented 3 or more concurrent diseases, Hypertension 60 %, Dementia 28%, type 2 Diabetes and strocke 26%, iskemic cardiopathy 14%, etc. Admission time rate: 6 days (SE) 2.02, staying at intensive care unit 40%. Nosocomial complications came up in 34%, 76% ACS, 11.7% urinary tract infection, pneumonia and endovascular infection 1 each. 4 labs were required in rate (SE) 1.14, and 3 complementary studies per patient (SE) of 0.24. In ambulatory treatment they used 3 drugs as an average (SE) 0.37. The highest prescription day approached 7 as average (SE) of 0.61. At discharge they left with an average of 4 (SE) 0.39. In every case kinesiotherapy and phonoaudiology were used as well. Ther was interconsulting regarding infectology in 24%, general surgery 16%. Mortality 22%. CONCLUSION: EN is usual in clinical admission. It regards an elderly patient with lacking self-validity, who over 50% of cases presents more than three comorbilities (mostly hypertension). Facts of admission usually registered: neurological pathologies and infections. Admission length was the same as general settlers. Almost half of them needed intensive care assistance. Nosocomial complications are usually found. They are patients who require many drugs at home, while admitted and discharge time as well. In every one kinesiotherapy and phonoaudiology were applied. Mortality raised high. Unable chance to use commercial diets was not a trouble to feed them.

[Long duration of hospital stay in a clinical service]. / Internación prolongada en un servicio de clínica médica.

UNLABELLED: In order to identify determining factors and complications in illness, we evaluated patients under long period hospitalization, in a Clinical Service. METHODS: retrospective and descriptive studies. Figures were evaluated by Chi-, Fisher T and Test T, thrue variables. We call long period hospitalization to a staying of 10 days or longer. RESULTS: 322 patients were evaluated. 50 (15,5%) presented (LS) and 272 < 10 days staying. Age average was 63,8 for < 10 days and 66 for (LS). Mostly of diagnosis at admission for < 10 days were respiratory dysfunction (25%) including pneumonia (10%), urinary infection and heart failure, and for LS pneumonia 20%, acute neurological disease 18 %. The 46 % of LS required surgery vs. 20,6% (p < 1,01). The LS needed parenteral nutrition 26 % vs. 12,5% (p < 0,02). The average of maximum amount of drugs/day in staying was: 5,8 for < 10 days and 8,76 for LS (p < 0,01). Hospital complications in LS were 28 % vs. 11% (p < 0,01), mainly nosocomial pneumonia (p < 0,01) and endovascular infections (p < 0,01). Staying in ICU was 54% for LS vs. 19% (p < 0,01), and average of days in intensive care unit (ICU) was 8 in LS vs. 3 (p < 0,01). There wasn't any difference in mortality. CONCLUSION: the admission's diagnosis and the ICU's staying were the main causes of LS, but not so age and co-morbilities studied. The LS patients require more complex and expensive staying. They present more hospital complications.

[Acute confusional state in hospitalized patients]. / Síndrome confusional agudo en pacientes internados.

Delirium or acute confusional status (ACS) is a common mental disorder found in hospitalized patients. A total of 278 patients were evaluated. Of these, 30 (10.8%) developed ACS. The patients who developed ACS were 70 years of age or older, had history of stroke or dementia, as well as impairment in activities of daily living, and required enteral feeding more frequently. The infections and hip fracture were the most frequent reasons for hospitalization. The mortality in patients with ACS was significantly higher than in patients without ACS.

[Risk factors associated to upper gastrointestinal bleeding in non intensive care units]. / Factores de riesgo asociados a hemorragia digestiva alta, en sala común.

UNLABELLED: Upper gastrointestinal bleeding--UGB-, as a complication, is well studied at intensive care units (ICU), but is less known in non ICU settings. OBJECTIVES: To determine incidence and risk factors of this entity at clinical hospitalization. MATERIALS AND METHODS: A case-control study of patients with gastric ulcer disease diagnosed by endoscopy who presented with melena and hematemesis. Ten controls were taken for each case, matching sex, age and prophylaxis for gastric hemorrhage. Demographic data and other know risks factors were analyzed. RESULT: We found ten bleeding case among 35070 discharges (incidence: 2.8/10000 discharges). Mortality was not increased but the number of transfusion was higher in the bleeding group. We found an assocciation betwen UGB and systemic inflammatory response syndrome--SIRS-(OR: 9.22 IC 95% 2.98-28.17) and diabetes (OR: 7.8 IC 95% 2.3-26.8). The rest of the factors studied did not rich a statistical significance. CONCLUSIONS: UGB during clinical hospitalization is a rare complication that requires an increased staying at hospital and a great number of transfusions. It may be probably associated in a positive way with diabetes and SIRS.

[Castleman disease]. / Enfermedad de Castleman.

A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.

Valoración de técnicas de citología en mucosa bucal en pacientes con síndrome de Sjögren / Assessment of cytology techniques in oral mucosa of Sjögren's syndrome patients

Resumen El objetivo del presente trabajo es comparar dos técnicas de estudio de citología bucal, la citología exfoliativa y de impresión, para evaluar cambios en la mucosa oral que permitan el diagnóstico no invasivo de síndrome de Sjögren (SS). Pacientes: Se seleccionaron 50 pacientes apareados por sexo y edad, diagnosticados con síndrome de Sjögren según criterios del Consenso Americano-Europeo. Los pacientes fueron distribuidos en tres grupos experimentales: controles sanos (C), n = 14, boca y ojo secos sin SS (BO), n = 13, y con SS n = 23. Material y métodos: Para la citología exfoliativa se utilizó cepillo recolector de células (Citobrush) deslizándolo a lo largo de la lámina de vidrio, fijándose posteriormente en etanol al 95%. En citologías por impresión se utilizó papel de acetato de celulosa (Milipore Hawp 304®), en tiras de un cm de longitud colocadas sobre la superficie de la mucosa bucal sobre el surco vestibular superior inmovilizando el papel y presionando por tres segundos. Se tiñeron con técnica de Papanicolau (PAP). Se valoró la morfología e histomorfometría, estudiando: área citoplasmática (AC), área nuclear (AN), relación núcleo-citoplasma (N:C) y cantidad de células por milímetro cuadrado (mm2). Resultados: Ambas técnicas nos permitieron observar en C: células epiteliales pavimentosas aisladas, basófilos, núcleos centrales normales, 20 a 30 por mm2, relación N/C 1:8. En el grupo BO: células aisladas, agrupadas y plegadas, con citoplasma a predominio eosinófilo, aumento de la cantidad de células 40 por mm2, relación núcleo-citoplasma relación N/C 1:4. En los pacientes SS se observó el área nuclear con cromatina más densa, 400 células por mm2, y relación N/C 1:2 en relación a BO y C. Hubo diferencias estadísticamente significativas entre los grupos en todas las características estudiadas. Conclusión: Podríamos inferir que la citología por impresión puede ser utilizada en el diagnóstico de lesiones orales y sistémicas en pacientes con hiposalivación.

Abstract The aim of the present research project was to compare two techniques for oral cytology study (exfoliative cytology and impression cytology) in order to assess changes in oral mucosa which might allow non -invasive diagnosis of Sjögren's syndrome cases (SS). Patients: 50 patients were selected, patients were paired by age and gender, and had been diagnosed with Sjögren's syndrome according to criteria of the American-European Consensus. Patients were distributed into the following three experimental groups: healthy control group (C), n = 14, Dry mouth and eyes group without SS, (ME) n = 13, and SS group n = 23. Material and methods: A cell harvesting brush (Cytobrush) was used for the exfoliative cytology procedure, sliding it along a glass plate and later fixating harvested cells in 95% ethanol. Cellulose acetate paper (Millipore Hawp 304®) was used for the impression cytology procedure. The paper was in 1 cm long stripes which were placed on the oral mucosa surface above upper vestibular groove; stripes were immobilized and pressure was applied for three seconds. Papanicolau (PAP) technique was used for dyeing. Morphology and histomorphology were assessed studying the following: cytoplasmic area (CA), nuclear areas (NA) nucleus-cytoplasm relationship (N:C) and amount of cells per square millimeter (mm2). Results: Both techniques revealed the following in C: isolated single-layered epithelial cells, basophils, normal central nuclei, 20 to 30 per mm2, N:C ratio 1:8. In the eye and mouth group (EM): grouped and folded isolated cells, cytoplasm with eosinophilic predominance increase of cell amount to 40 per mm2, nucleus-cytoplasm relationship N/C 1:4. SS patients showed the following: nuclear area with denser chromatin, 400 cells per mm2, and 1:2 N/C relationship with respect to mouth and ears and control. Statistically significant differences wereobserved among groups in all studied characteristics. Conclusion: We can infer that impression cytology can be used in systemic and oral lesion's diagnosis in patients afflicted with hyposalivation.

Palabras del Decano - Discurso: Acto de asunción de las nuevas autoridades decanales de la Facultad de Ciencias Médicas. UNC / Dean's words - Speech: Act of inauguration of the new authorities deans of the Faculty of Medical Sciences. UNC

Discurso dado el día27 de marzo 2015, enel Salón de Actos, delPabellón Argentino,Universidad Nacional de Córdoba.

Speech given the dayMarch 27, 2015, inthe Auditorium, theArgentine Pavilion,National University Cordoba.

Aptitud física en futbol de veterano / Aptidão física no futebol de seniores / Physical fitness in veteran soccer

En las últimas décadas se ha evidenciado el impacto de laactividad física sobre la salud en diferentes poblaciones.Pero se desconoce qué impacto tienen las actividades físicasvigorosas y sistematizadas sobre la salud de los adultos.Esta investigación tuvo por objeto valorar los niveles deaptitud física de los participantes de fútbol, adulto maduro,perteneciente a la liga de veteranos de la provincia deCatamarca mayores de 50 años.Se utilizo un modelo de investigación explicativa, conun diseño no experimental, transeccional. Participaron delgrupo de fútbol de veteranos 58 deportistas, edad 52 + 3años, y del grupo control 37 personas sedentarias, de 52 + 5años. Fueron evaluados en Aptitud Física (AF), Resistencia,ergoespirometria; Fuerza Potencia test de saltar y alcanzar(SyA); Indice de Masa Corporal (BMI). Los resultadosencontrados, demuestran que el grupo de fútbol, tienemayores valores en los componentes de la aptitud física,resistencia y fuerza potencia que el grupo control, siendoestas diferencias significativas. En las variables de índice demasa corporal los valores son significativamente menores enel grupo de fútbol de veteranos, que en el grupo control. Denuestros resultados podemos concluir que los jugadores defútbol veteranos tienen una buena aptitud física.

In the last decades, the impact of physical activity on health has been shown in differentpopulations. However, the impact of energetic and systematized physical activities onadult health is unknown. The objective of this research was to assess the levels of physicalfitness of adult mature participants aged over 50 in a veteran soccer league in the provinceof Catamarca.A cross-sectional explicative research model with non-experimental design was used.In the soccer group, there were 58 veteran sportsmen, aged 52 + 3; in the control groupthere were 37 sedentary people aged 52 + 5. They were evaluated in Physical Fitness,Resistance, ergospirometry, Strength Power jump and reach test (J&R); Body Mass Index(BMI). Results found show that the soccer group has higher values in the componentsPhysical Fitness, Resistance, and Strength Power than the control group, with significantdifferences. As regards the BMI variable, values are significantly lower for the veteran soccergroup than for the control group. From our results we can come to the conclusion that theveteran soccer players have good physical fitness.