The Social Distance Impacts from COVID-19 Pandemic on the Development of Two Orders of a Concurrent Training Programme for Morbidly Obese Patients.

BACKGROUND: Although there is relevant information regarding the consequences of the coronavirus SARS-CoV-2 (COVID-19), little is known about the impact of the imposed social confinement (at home) on the development of exercise training programmes in populations with morbid obesity. AIM: To describe the effects of the imposed COVID-19 confinement on the cardiometabolic health benefits acquired through a concurrent training programme that started before the pandemic in populations with morbid obesity. METHODS: This was an experimental randomized clinical study, in which sedentary morbidly obese women were assigned 1:1 to a high-intensity interval training (HIIT) plus resistance training (RT) group (HIIT + RT; n = 11; BMI 42.1 ± 6.6) or to the same exercise dose, but in different order group of RT plus HIIT group (RT + HIIT; n = 7; BMI 47.5 ± 8.4). Both groups undertook two sessions/week. When COVID-19 confinement at home started, a post-test was applied in January 2020 (Post1) and after 20 months (Post2). The main outcomes were waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), high-density lipids (HDL-c), triglycerides (Tg), and fasting plasma glucose (FPG). RESULTS: In the HIIT + RT group, the WC showed significant increases from Post1 to Post2 (Δ + 3.1 cm, p = 0.035); in the RT + HIIT group, it decreased from Post1 to Post2 (Δ - 4.8 cm, p = 0.028). In the HIIT + RT group, SBP showed significant increases from Post1 to Post2 (Δ + 6.2 mmHg, p = 0.041); the RT + HIIT group decreased SBP from Pre0 to Post1 (Δ - 7.2 mmHg, p = 0.026) and increased DBP from Pre0 to Post1 (Δ + 8.1 mmHg, p = 0.015). Tg in the HIIT + RT group decreased from Pre0 to Post1 (Δ - 40.1 mg/dL, p = 0.023) but increased from Post1 to Post2 (Δ + 86.3 mg/dL, p < 0.0001). CONCLUSIONS: The COVID-19 social confinement worsened metabolic syndrome (MetS) outcomes that had improved from 20 weeks' RT + HIIT during the training period, such as WC, SBP, and Tg from HIIT + RT, when, worryingly, SBP increased to another more serious clinical classification in both groups.

Bloqueo interauricular avanzado en pacientes con hipertensión arterial sistémica y fibrilación auricular / Advanced interatrial block in patients with systemic arterial hypertension and atrial fibrillation

La hipertensión arterial sistémica (HTA) continúa siendo un factor de riesgo de indudable importancia en el proceso del desarrollo de la enfermedad cardiovascular y la fibrilación auricular (FA). La FA constituye la arritmia sostenida más frecuentemente detectada. Es primordial dar el énfasis necesario a la prevención y al diagnóstico precoz de enfermedades con gran impacto social, médico y económico a la salud pública. En este contexto, es importante detectar la enfermedad en estadio subclínico e identificar factores que determinen con gran confiabilidad la aparición y desarrollo de una enfermedad. El electrocardiograma (ECG) es un método auxiliar de diagnóstico seguro, económico, de fácil manejo y accesible en prácticamente todos los centros médicos, y que nos sirve para detectar diversas entidades nosológicas. El bloqueo interauricular (BIA) diagnosticado por el ECG ocurre debido a un enlentecimiento de conducción entre las aurículas derecha e izquierda a causa de un retardo en la conducción de impulsos a través del haz de Bachmann. El sustrato anatómico para BIA está producido por la remodelación auricular debido a fibrosis, induciendo disincronía interauricular. El BIA está presente hasta en un 59% de los pacientes mayores de la población general y estuvo directamente asociado a la HTA y la FA. Además, el BIA avanzado se asoció con un aumento del riesgo de unas 3 veces más de FA de nueva aparición y accidente cerebrovascular isquémico. Por lo tanto, es imprescindible realizar una investigación prospectiva adicional para determinar las estrategias óptimas en el adecuado manejo terapéutico de estos pacientes

Systemic arterial hypertension (AHT) continues to be a risk factor of undoubted importance in the process of development of cardiovascular disease and atrial fibrillation (AF). AF is the most frequently detected sustained arrhythmia. For this reason, it is essential to give the necessary emphasis to the prevention and early diagnosis of diseases with great social, medical and economic impact on public health. In this context, it is important to detect the subclinical stage disease and identify factors that determine with great reliability the appearance and development of a disease. The electrocardiogram (ECG) is a safe, inexpensive auxiliary diagnostic method, easy to use and accessible in practically all medical centers, and which serves to detect various nosological entities. The interatrial block (IAB) diagnosed by the ECG occurs due to a slowing down of conduction between the right and left atria due to a delay in the conduction of impulses through the Bachmann pathway. The anatomical substrate for IAB is produced by atrial remodeling due to fibrosis, inducing interatrial dyssynchrony. IAB is present in up to 59% of older patients in the general population and was directly associated with AHT and AF. In addition, advanced IAB was associated with a 3-fold increased risk of new-onset AF and ischemic stroke. Therefore, it is essential to carry out additional prospective research to determine the optimal strategies in the adequate therapeutic management of these patients

Bacteriemias por bacilos Gram negativos multirresistentes en neutropénicos febriles con enfermedades hematológicas / Bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematological diseases

Las infecciones por bacilos Gram negativos multiresistentes (BGN-MR) son frecuentes en nuestro hospital. Presentan limitadas opciones terapéuticas e importante impacto en la morbimortalidad y costos. Objetivo: analizar los factoes de riesgo y evolución de las bacteriemias por BGN-MR en pacientes neutropénicos febriles con patologías hematológicas. Materiales y métodos: estudio prospectivo, descriptivo y observacional de los factores de riesgo para BGN-MR en la población descripta. Se realizó análisis univariado y multivariado de variables clínicas, epidemiológicas, microbiológicas y evolutivas. Resultados: El 27 % de los episodios de neutropenia y fiebre cursaron con bacteriemias por BGN, 42 % de ellos fueron producidos por BGN-MR. En el análisis univariado, dichas bacteriemias se asociaron al uso previo de antibióticos; a las bacteriemias de brecha y neutropenias mayores a 7 días. En el análisis multivariado la bacteriemia de brecha mantuvo su significancia estadística (P<0,001; OR: 5,17; IC 95 % 2,1-12,7). Acinetobacter spp fue el BGN-MR más frecuentemente aislado incluso en los pacientes fallecidos. No se detectó el foco en el 45,9 % de los episodios. Los tratamientos inadecuados fueron significativamente más frecuentes en los pacientes con BGN-MR y la mortalidad tanto global como atribuible también se asoció significativamente al tratamiento inadecuado de las bacteriemias por BGN-MR (P<0,04;RR: 2,46;IC 95 % 1,03-5,9 y P< 0,014; RR: 3,02; IC 95 % 1,22-0,45 respectivamente). Conclusiones: Las bacteriemias por BGN-MR son frecuentes en la población estudiada en especial los que han recibido ATB previo y en las que surgen intratratamiento ATB. Recibieron con mayor frecuencia tratamiento empírico inadecuado, lo que se asoció a mayor mortalidad...

Bacterial infections by multiresistant Gram-negative bacilli (BGN-MR) are an increasing problem in our hospital with a major impact on morbidity, mortality and costs. Objective: to analize risk factors and outcome in bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematologic diseases. Material and Methods: We conducted a prospective, descriptive and observational study to describe the risk factors and outcome of BGN-MR bacteremia in these patients. Results: Twenty seven percent of neutropenia and fever episodes had Gram-negative bacilli bacteremia and 42 % of them were caused by BGN-MR. Previous use of antibioteics, breakthrough bacteremia and prolonged neutropenia (<7 days) were significant in univariate analysis. In multivariate analysis only breakthrough bacteremia was significant (P< 0.001; OR 5,17;IC 95 % 2.1-12.7). Acinetobactersppp was the most common BGN-MR isolated in blood-stream infections and in patients who died. The source of infections was unknown in 45,9 % of the episodes. Inadequate empirical therapy was most common in BGN-MR bacteremia and it was associated with increased overall and attributable mortality (P<0.04; RR: 2.46; IC 95 % 1.03-5.9 y P<0.014; RR: 3.02; IC 95 % 1.22-7.45). Conclusions: BGN-MR was frequent in neutropenic patients with hematological diseases specially in those exposed to antibiotics and in breakthroug bacteremia. Inappropiate antimicrobial therapy was common and is associated with adverse outcome...

[First Travel Medicine Center in a public hospital from Buenos Aires Province, Argentina Republic: The first 2 years of experience]. / Primer Centro de Medicina del Viajero en un hospital público de la Provincia de Buenos Aires, República Argentina: Dos años de experiencia.

INTRODUCTION: Although Buenos Aires is the biggest province in Argentina, there was no program for Travel Medicine in any public hospital until 2008, when the Travel Medicine Center (CEMEVI) was established in our hospital. OBJECTIVE: To analyze the first 24 months of experience in the CEMEVI. RESULTS: A total of 278 travelers were assisted. Most of them consulted before traveling (pre-travel visits). The most common destinations were countries in South America and urban as well as rural areas. Travelling to malaria and yellow fever endemic countries represented 35% and 16% of the total of destinations, respectively. Only 4% were post-travel interviews. CONCLUSION: It is feasible and fruitful to implement a Travel Medicine Center in the public health system.

[Pyomyositis in an immunocompetent patient]. / Piomiositis en un paciente inmunocompetente.

We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.

Primer Centro de Medicina del Viajero en un hospital público de la Provincia de Buenos Aires, República Argentina: Dos años de experiencia / First Travel Medicine Center in a public hospital from Buenos Aires Province, Argentina Republic: The first 2 years of experience

Introduction: Although Buenos Aires is the biggest province in Argentina, there was no program for Travel Medicine in any public hospital until 2008, when the Travel Medicine Center (CEMEVI) was established in our hospital. Objective: To analyze the first 24 months of experience in the CEMEVI. Results: A total of 278 travelers were assisted. Most of them consulted before traveling (pre-travel visits). The most common destinations were countries in South America and urban as well as rural areas. Travelling to malaria and yellow fever endemic countries represented 35% and 16% of the total of destinations, respectively. Only 4% were post-travel interviews. Conclusion: It is feasible and frutful to implement a Travel Medicine Center in the public health system.

Introducción: La Provincia de Buenos Aires, a pesar de ser la mayor de nuestro país, no contaba con ningún sitio de asesoramiento al viajero instalado en un hospital público, hasta que en el año 2008 se crea el Centro de Medicina del Viajero (CEMEVI) en nuestro hospital. Objetivo: analizar de manera retrospectiva los primeros 24 meses de experiencia en el CEMEVI. Resultados: Recibimos un total de 278 consultas, la mayoría durante el pre-viaje, a países de América del Sur, a sitios urbanos- rurales, de los cuales 35 y 16% de los viajeros visitaron zonas de riesgo para malaria y fiebre amarilla, respectivamente. Sólo 4% de las consultas fueron en el post-viaje. Conclusión: Es posible y fructífero implementar un Centro de Medicina del Viajero en el sector público de salud.

Piomiositis en un paciente inmunocompetente / Pyomyositis in an immunocompetent patient

We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.

Se presenta un caso de piomiositis en un varón de 59 años, inmunocompetente, producida por Staphylococcus aureus sensible a meticilina, afectando los músculos pectorales del hemitórax derecho. Fue tratado con drenaje quirúrgico y cefalexina. La piomiositis es una infección infrecuente y potencialmente seria que requiere de un reconocimiento temprano y tratamiento oportuno.

Infección Fúngica oportunista en un trabajador rural viviendo con VIH/sida / Opportunitic funal infection in a rural worker infected with HIV

Las infecciones fúngicas invasivas son una importante causa de morbimortalidad en los pacientes inmunocomprometidos. Diversos factores han producido, en los últimos años, un cambio en la epidemiología de éstas, con aislamiento de hongos infrecuentes hasta hace dos décadas (zygomicetos; Fusarium spp y Scedosporium spp), presentando un desafío diagnóstico y terapéutico. En este reporte describimos un paciente con diagnóstico reciente de VIH/sida, trabajador rural, con antecedentes de fiebre, diarrea y cuadro respiratorio, quien durante la internación presentó un cuadro de neutropenia febril, desarrollando una infección diseminada por Scedosporium prolificans, tratado con éxito con voriconazol.

Invasive fungal disease is a major cause of morbidity and mortality in immunocompromised patients. Over recent decades numerous factors have contributed to a change in the apidemiology of invasive mycoses. There have been increasing reports of infections due to new and emerging pathogens such as zygomycetes, Fusarium spp and Scedosporium spp, which pose a major diagnostic and therapeutic challenge...