Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. AIM: To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. METHODS: A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. KEY RESULTS: A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). CONCLUSIONS & INFERENCES: The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

Socioeconomic inequities of COVID-19 mortality in vulnerable Comunas of the City of Buenos Aires.

During the COVID-19 pandemic, the gap in health inequities was exposed and increased, showing how different vulnerable groups were affected. Our aim was to examine the correlation between an area-based health inequity index and mortality due to COVID-19 in people 60 years old or above in the City of Buenos Aires in 2020. We developed a Health Inequity Composite Index (HICI), including six core indicators. Each indicator value per Comuna was first standardized to a Z-score. All six Z-scores were summed into a final composite Z-score to rank the Comunas from lowest to highest social inequities. Comunas from the northern part of the city had lower inequities whereas those in the south had higher levels of inequities. COVID-19 age-standardized mortality rate in people 60 years or above was higher in the Comunas from the south and lower in those from the north. Finally, we found a strong positive correlation (Rho = 0.83, p < 0.0001 CI95% = 0.65-0.99) between HICI and age-standardized mortality rates from COVID-19 in people 60 years or above. Our finding of a strong correlation between the levels of health inequity and mortality calls for a concerted effort in narrowing or eliminating existing inequities.

Increase in use of psychiatric sick leave during COVID-19 pandemic by healthcare workers in a municipality in Argentina.

Introduction: The severe respiratory syndrome caused by the novel coronavirus has resulted in worldwide pressure on the healthcare workers attempting to treat millions of individuals ill with COVID-19, in addition to their regular duties. Objectives: To examine use of psychiatric leave by Argentinian healthcare workers during the COVID-19 pandemic, including exploring potential differences by sex. Methods: We analyzed psychiatric sick leave taken by municipal level healthcare workers in the Province of Buenos Aires, January - October 2020. We compared historical cases of psychiatric sick leave from 2015-2019 to leave requested in 2020. Results: Healthcare workers utilized 161.9% more psychiatric sick leave in 2020, with significantly more leave taken by women. Conclusions: Healthcare workers in the Argentinian municipality of Vicente Lopez took a significantly greater amount of psychiatric sick leave during the pandemic. The higher rates of psychiatric sick leave taken by women replicates other findings of higher rates of psychological symptoms in female healthcare workers.

The Impact of Absorptive Capacity on Innovation: The Mediating Role of Organizational Learning.

Although the relevant literature has already demonstrated the impact that absorptive capacity has on companies' innovation capacity, we have found few studies that analyze the role of learning capability in this relationship. The main objective of this study was to examine the role of organizational learning in this relationship. For this purpose, a quantitative research approach was used. A total of 306 valid questionnaires were obtained from small and medium-sized Spanish companies in different sectors. The collected data were analyzed using the multivariate Partial Least Square (PLS) quantitative structural equation technique. According to the result, absorption capacity turns into innovation mainly when learning capacity is involved in this process. This study provides empirical evidence of this relationship and fills this gap. It can also help organizations understand and clarify what would be the most appropriate way in to manage knowledge to improve their innovation levels.

PULSE-HF: A Simple Clinical and Geriatric Score to Predict Systolic Dysfunction in the Elderly Without Heart Failure.

To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF). PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of heart failure (HF). The objective in this population was to develop a clinical score to determine preclinical predictors of systolic dysfunction. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation. Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50%, and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; P = 0.003), cardiomegaly (OR: 3.32; P < 0.001), right bundle branch block (OR: 2.84; P = 0.011), cognitive dysfunction (OR: 2.14; P = 0.027) and NT-proBNP (OR 5.43; P < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity, and accuracy (97.17% and 91.64% respectively in ≥6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥10). We conclude that a simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.

Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults.

We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (<1) or high (>1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals.

A Multidimensional Study of Absorptive Capacity and Innovation Capacity and Their Impact on Business Performance.

The aim of this paper is to understand how absorptive capacity and innovativeness influence business performance. Most previous studies have not considered the different dimensions of absorptive capacity and innovativeness. As a consequence, they have not analyzed the relationships between these dimensions, such as potential and realized absorptive capacity (RACAP) and product and process innovation. In our study, we analyzed the relationships between each of these dimensions and their effect on organizational performance. To achieve this, in addition to the theoretical foundation provided by the working hypotheses, a questionnaire was sent to 800 CEOs of Spanish companies in different sectors, obtaining a response rate of 38.25%. Structural equation modeling was applied to test the hypotheses. This study confirms the positive effect of absorptive capacity on innovation capacity, which in turn has a positive effect on business performance. Moreover, different dimensions of absorptive capacity and innovativeness play an important role in these relationships. This study contributes to a better understanding of how potential and RACAP influence the innovativeness of firms, both in their ability to innovate products and to improve business processes. In addition, it explores how these different innovations impact business performance and provide firms with knowledge on how to invest resources to increase profits. Future research should further study the inner workings of each of the dimensions analyzed to determine the importance of each dimension for business performance.

Propuesta de un modelo SYIR modificado para predecir la cinemática de la epidemia por COVID-19 / Proposal for a modified SYIR model to predict the kinematics of the COVID-19 epidemic

In late 2019, an infection in humans by the SARS-CoV-2 virus was detected for the first time in Wuhan, China. By February, several countries had sustained viral circulation. On March 11, the World Health Organization (WHO) declared a global pandemic. Initially, one of the main concerns regarding the spread of this pathogen was the possible lack of capacity of health systems to absorb the demand for resources in a pandemic situation. At the local level, on March 19 a measure of "social, preventive and mandatory isolation" was established, from March 20 to March 31, 2020, in order to protect public health, which was later extended until March 26 April through DNU 335/2020. MEDICUS is a private medicine company with representation throughout Argentina for 48 years. 85% of its affiliates reside in the Metropolitan Area of Buenos Aires (AMBA), Argentina. The objective of this study is to propose a modified SYIR (Susceptible-Contagious-Infective-Recovered) model, with the purpose of generating a monitoring tool that can anticipate the behavior of the COVID-19 pandemic in the AMBA population of a company prepayment, and the consequences of the measures adopted by the health authorities and their compliance over time. In the case of MEDICUS, for the optimistic scenario, a start of the peak of cases is expected in the first week of June and an end in late November, with a peak in early September; the pessimistic scenario begins the peak in mid-April, reaches its maximum in late May and ends in mid-June. It presents a much larger number of cases, more concentrated in time. The moderate scenario is an intermediate of both. The COVID-19 pandemic is a huge challenge for all health systems in the world, not just for Argentina. In our study, we forecast three possible scenarios for the behavior of the pandemic (optimistic, moderate and pessimistic) that will depend on the characteristics, adherence and persistence of the isolation measures in our country. Given the current dynamics and compliance with these measures, we estimate it possible that the real measure is somewhere between the optimistic and moderate scenarios.

A fines del año 2019, se detectó por primera vez en Wuhan, China, una infección en seres humanos por el virus SARS-CoV-2. Para febrero, varios países registraban circulación viral sostenida. El 11 de marzo la Organización Mundial de la Salud (OMS) declaró la pandemia mundial. Inicialmente, una de las principales preocupaciones ante la expansión de este patógeno fue la posible falta de capacidad de los sistemas sanitarios para absorber la demanda de recursos ante una situación de pandemia. En el ámbito local, el 19 de marzo se estableció una medida de "aislamiento social, preventivo y obligatorio", desde el 20 hasta el 31 de marzo de 2020, con el fin de proteger la salud pública, que luego se extendió hasta el 26 de abril mediante el DNU 335/2020. MEDICUS es una empresa de medicina prepaga con representación en toda la Argentina desde hace 48 años. El 85% de sus afiliados reside en el Área Metropolitana de Buenos Aires (AMBA). El objetivo de este trabajo es proponer un modelo SYIR (Susceptible-Contagiado-Infectante- Recuperado) modificado, con el propósito de generar una herramienta de seguimiento que pueda anticipar el comportamiento de la pandemia de COVID-19 en la población del AMBA de una empresa prepaga, y las consecuencias de las medidas adoptadas por las autoridades sanitarias y su cumplimiento a través del tiempo. En el caso de MEDICUS, para el escenario optimista se espera un inicio del pico de casos en la primera semana de junio y una finalización a fines de noviembre, con un máximo a comienzos de septiembre; el escenario pesimista inicia el pico a mediados de abril, llega a su máximo a fines de mayo y lo termina a mediados de junio. Presenta un número mucho mayor de casos, más concentrado en el tiempo. El escenario moderado es un intermedio de ambos. La pandemia de COVID-19 es un enorme desafío para todos los sistemas de salud del mundo, no solo para el argentino. En nuestro estudio, pronosticamos tres escenarios posibles de comportamiento de la pandemia (optimista, moderado y pesimista) que dependerán de las características, la adhesión y la persistencia de las medidas de aislamiento en nuestro país. Por la dinámica actual y el cumplimiento de estas medidas, estimamos posible que la real medida se sitúe en algún punto entre el escenario optimista y el moderado

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study.

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders.

[Psychotropic drugs prescription to elderly people in the national institute of social services for retirees and pensioners of argentina (PAMI)]. / Prescripción de psicofármacos a personas mayores en el Instituto Nacional de Servicios Sociales para Jubilados y Pensionados de Argentina (PAMI).

OBJECTIVE: To analyze the prescribing pattern of psychotropic drugs to affiliates over 60 years of age at the National Institute of Social Services for Retirees and Pensioners of Argentina (PAMI). MATERIALS AND METHODS: We conducted a retrospective study of the at the National Institute of Social Services for Retirees and Pensioners of Argentina (PAMI) database on the population over 60 years of age who received at least one psychotropic drug during 2016. RESULTS: During the year 2016, 30% of the population over 60 years of age received the prescription of at least one psychotropic drug. There was a greater prescription of psychotropic drugs to women than to men (75.3% vs. 24.7%). Of the drugs prescribed, 67% were benzodiazepines, 20% were antidepressants, 9% were antipsychotics and 4% were non-benzodiazepine hypnotics. 54% of the drugs prescribed were clonazepam and alprazolam. 21% of the population received three or more prescriptions during the period studied. There was a relatively greater prescription of psychotropic drugs in the population of 75 years old or older. CONCLUSIONS: Taking into account the risks of adverse effects, interactions and the inclusion of some of these drugs among those that should not be prescribed among older adults, the high prescription rate of some of these drugs is alarming. It is necessary to develop strategies among general practitioners, specialists and also among the general population in order to reduce the prescription of psychotropic drugs.

Risk of Metachronous Advanced Neoplastic Lesions in Patients with Sporadic Sessile Serrated Adenomas Undergoing Colonoscopic Surveillance.

OBJECTIVES: The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantified. METHODS: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identified using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy. RESULTS: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were finally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 person-months, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3- and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found. CONCLUSIONS: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is influenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.

Osteomalacia inducida por tumor: hemangiopericitoma rinosinusal / Tumor-induced osteomalacia: rhinosinusal hemangiopericytoma

La osteomalacia inducida por tumor es una rara enfermedad del metabolismo óseo caracterizada por el aumento en la excreción de fosfato a nivel renal seguido de hipofosfatemia. Es causada por agentes fosfatúricos producidos por determinados tumores. La resección total del tumor resulta en la completa reversión de las anormalidades bioquímicas, la desaparición de las manifestaciones clínicas y los hallazgos en los estudios por imágenes. Presentamos el caso de un varón de 61 años con cuadro clínico y laboratorio compatibles con osteomalacia oncogénica inducida por tumor mesenquimático de localización rinosinusal. En nuestro caso el diagnóstico histológico correspondió a una neoplasia de tipo vascular: hemangiopericitoma.

Tumor-induced osteomalacia is a rare disease of bone metabolism. The characteristic of this disease is an increase in phosphate excretion followed by hypophosphatemia, due to phosphaturic agents produced by different types of tumors. Tumor resection results in complete resolution of clinical, biochemical and radiological abnormalities. We present the case of a 61 year old man with signs, symptoms and laboratory findings consistent with oncogenic osteomalacia due to a rhino-sinusal mesenchymal tumor. The histological diagnosis showed a vascular neoplasm: hemangiopericytoma.

[Tumor-induced osteomalacia: rhinosinusal hemangiopericytoma]. / Osteomalacia inducida por tumor: hemangiopericitoma rinosinusal.

Tumor-induced osteomalacia is a rare disease of bone metabolism. The characteristic of this disease is an increase in phosphate excretion followed by hypophosphatemia, due to phosphaturic agents produced by different types of tumors. Tumor resection results in complete resolution of clinical, biochemical and radiological abnormalities. We present the case of a 61 year old man with signs, symptoms and laboratory findings consistent with oncogenic osteomalacia due to a rhino-sinusal mesenchymal tumor. The histological diagnosis showed a vascular neoplasm: hemangiopericytoma.

Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: importance of immediate and prolonged continuous cardiac monitoring.

Atrial fibrillation (AF) is the major cause of cardioembolic stroke. It often remains occult when asymptomatic and paroxysmal. We hypothesized that the detection of AF after acute ischemic stroke (AIS) or transient ischemic attack (TIA) could be improved by using continuous cardiac monitoring (CCM) immediately after admission. We sought to determine the detection rate of AF by immediate in-hospital CCM after cryptogenic and noncryptogenic AIS or TIA in patients without a previous diagnosis of AF. We retrospectively studied a cohort of 155 patients with cryptogenic and noncryptogenic AIS or TIA without known AF. We compared the detection rates of newly diagnosed AF (NDAF) in patients admitted to areas with CCM and those never admitted to these areas. We developed a multiple logistic regression model for identifying predictors of NDAF. We characterized NDAF episodes and analyzed how the availability of CCM data changed secondary prevention strategies. We detected NDAF in 21 patients (13.5%). Diagnostic rates of NDAF in patients who underwent CCM and those who did not undergo CCM were 18.2% and 2.2%, respectively (P = .005). The median time from admission to recognition of NDAF was 2.0 days. Most NDAFs were paroxysmal (95.2%) and lasted less than 1 hour (85.7%). Diabetes mellitus and infarct size were predictors of NDAF. Detection of NDAF prompted the initiation of anticoagulation therapy in 8.2% of the patients admitted to areas with CCM availability. Our findings suggest that immediate and prolonged CCM significantly improves the detection of NDAF after cryptogenic and noncryptogenic AIS or TIA, and that diabetes mellitus and infarct size are significantly associated with NDAF.

[Nutritional status, systemic inflammatory response syndrome and mortality in the elderly hospitalized patient]. / El estado nutricional, la respuesta inflamatoria sistémica y la mortalidad en el anciano internado.

In order to evaluate the relationship between systemic inflammatory response and mortality in the older hospitalized patient, we developed a prospective cohort study in which we evaluated a nutritional score (SGA), years of instruction, functional status, organic failure (Marshall), presence of sepsis, comorbidities (Charlson), cognitive state (MMSE), albumin, erythrocyte sedimentation rate and mortality. Fifty two patients were included, 19 men (36.5%) and 33 women (63.5%), mean age was 80 (Interquartile Range 12.5) years. 29 (55.8%) patients were well-nourished and 23 (44.2%) malnourished, 53.8% of patients developed sepsis at admission or during hospitalization. Total nosocomial mortality was 7.7 % (n = 4) and one-year mortality was 31.8% (n = 14). Comparative analyses showed older age (80 vs. 78; p = 0.012), less years of instruction (7 vs. 8; p = 0.027), lower MMST (14 vs. 27; p = 0.017), lower previous functional status (21 vs. 32; p < 0.0001), lower albumin (3 vs. 3.35; p = 0.014) and higher organic failure score at admission (3 vs. 1; p = 0.01) with more number of affected organs (2 vs. 1; p = 0.003) in malnourished patients compared to well nourished ones. Higher incidence of sepsis -at admission or during hospitalization- (73.9% vs. 37.9%; p = 0.01) and more severe stages of sepsis were also observed in malnourished patients. One-year mortality was significantly higher in malnourished (52.2% vs. 9.5%, log rank test = 0.002). In conclusion, malnourished patients presented greater systemic inflammatory response.