Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection.

Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in CMV-seropositive KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n = 177) or RT-PCR (n = 186). The primary outcome was CMV disease. Secondarily, the CMV-related events were composed of CMV-infection and disease, which occurred first. There were no differences in 1-year cumulative incidence of CMV-disease (23.7% vs. 19.1%, p = 0.41), CMV-related events (50.8% vs. 44.1%, p = 0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, p < 0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, p = 0.48). In the Cox regression, acute rejection within 30 days was associated with an increased the risk (HR = 2.34; 95% CI = 1.12-4.89; p = 0.024), while each increase of 1 mL/min/1.73 m2 of 30-day eGFR was associated with a 2% reduction risk of CMV-disease (HR = 0.98; 95% CI = 0.97-0.99; p = 0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

Embarazo abdominal calcificado de 40 años de evolución, hallazgo incidental: Presentación de caso / Calcified Abdominal Pregnancy 40 Years of Evolution, Incidental Finding: a Case Report

Debido a la baja incidencia de embarazos ectópicos abdominales y, más aún, de la formación de litopedion, se reporta el caso de una paciente de 84 años quien consulta por cuadro clínico de colelitiasis y pancreatitis de origen biliar, con hallazgo incidental de litopedion en cavidad abdominal de más de 40 años, documentado y diagnosticado por medio de radiografía convencional de abdomen y confirmado con tomografía computarizada multidetector (TCMD). Se realizó una revisión de la literatura mundial sobre los aspectos clínicos, radiológicos y patológicos del embarazo abdominal con presentación de litopedion

Due to the low incidence of abdominal ectopic pregnancy and, even more, of the formation of lithopedion, the case of an 84-years-old female patient is presented, who was admitted with clinical symptoms of cholelithiasis and biliary pancreatitis, with an incidental finding of lithopedion in the abdominal cavity, of more than 40 years. It was documented and diagnosed using conventional abdominal radiography, and confirmed with multidetector computed tomography (MDCT). The article presents a review of world literature on the clinical, radiological and pathological features of abdominal pregnancy with lithopedion.

Conocimiento de escalas de evaluación inicial de accidente cerebrovascular por médicos de guardia en tres provincias argentinas / Awareness of initial stoke evaluation scales among emergency room physicians in three argentinian provinces

Introducción: las enfermedades cardiovasculares constituyeron en 2004 la causa más frecuente de muerte en Argentina,duplicando a las neoplasias malignas en su conjunto. El accidente cerebrovascular (ACV) representó el7,5% del total de muertes. La Asociación Americana del Corazón propone el empleo de la escala prehospitalaria delaccidente cerebrovascular de Cincinnati (CPSS) y la escala de evaluación prehospitalaria del ACV de Los Ángeles(LAPSS) para evaluar sujetos con posible ACV.Objetivos: evaluar el conocimiento de estas escalas por médicos de guardia, y su opinión respecto al valor que ellaspodrían tener sobre su práctica.Material y método: estudio prospectivo y observacional encuestando 569 médicos durante diciembre de 2008 amarzo 2009 en distintas ciudades de las provincias de Santa Fe, Entre Ríos y Chaco, Argentina.Resultados: un 32,3% manifestó conocer las escalas, pero solamente 8,4% de ellos pudo enumerar los puntos deCPSS, un 1,9% pudo hacerlo con LAPSS y el 0,7% ambas. Quienes recordaban una o ambas escalas manifestaronsentirse más seguros al evaluar un posible ACV (p= 0,02); ninguno de los que recordaban LAPSS manifestó sentirseinseguro. Quienes se sentían menos seguros fueron los que atribuyeron más beneficios a las escalas (p= 0,0003).Los no especialistas las consideraron más útiles (p= 0,005). El 89% refirió que las escalas beneficiarían su práctica.Conclusiones: ambas escalas fueron consideradas de valor por médicos de guardia para evaluar pacientes con posibleACV. Enfatizamos la necesidad de una mayor difusión de ellas a fin de mejorar el abordaje inicial de estos pacientes.

Introduction: In 2004, the most frequent cause of death in Argentina was cardiovascular disease, which almost duplicated all types of malignant neoplasm. Cerebrovascular disease caused 7.5% of total deaths. The American Heart Association proposes the use of the Cincinnati Prehospital Stroke Scale (CPSS) and Los Angeles Prehospital Stroke Screen (LAPSS) toevaluate patients with possible cerebrovascular disease. Objective: To evaluate the awareness of these scales knowledge among doctors working in emergency rooms and prehospitalconsultation, and what are their opinions about the usefulness of the scales.Material and method: Observational and prospective survey of 569 doctors from the Argentinian provinces of Santa Fe,Entre Rios, and Chaco from December 2008 to March 2009. Results: One third (32.3%) of doctors included in the mentioned survey declared to know the scales, although only 8.4% of them could enumerate CPSS points, 1.9% could enumerate LAPSS points and 0.7% remembered both CPSS andLAPSS points. Those who remembered either one or both scales felt safer evaluating a possible stroke (p= 0.02) while and no doctor who remembered LAPSS felt doubtful. Those who felt more hesitant where the doctors who adscribed more benefits to the scales (p= 0.0003). Non specialists considered scales more useful (p= 0.005). Overall, 89% of doctors admitted scales would benefit their practice. Conclusion: Both scales were highly valued by doctors on call in order to diagnose patients with possible stroke. We stress the need of a bigger widespread coverage of these scales in order to improve the initial approach for managing these patients.

[Hemorheological alterations in hypertensive patients]. / Evaluación de alteraciones hemorreológicas en pacientes hipertensos.

The aim of this study was to investigate the blood viscosity profile and to evaluate the influence of plasmatic (fibrinogen) and cellular (erythrocyte aggregation) factors in a group of hypertensive patients, compared with a normotensive group. We worked with anticoagulated blood of both non diabetic hypertensive patients (n=31), and healthy individuals (n=40). The plasmatic viscosity and whole blood determination were obtained with a cone-plate viscometer. Erythrocyte aggregation was studied by microscopical observation and quantified by an Aggregate Shape Parameter (ASP), defined as the relation projected area/perimeter. Fibrinogen was determined by the Clauss method with a coagulometer. A comparison between these groups led us to assert that whole blood viscosity was significantly higher in hypertensive patients than in the controls at all shear rates. Plasma viscosity values only showed significant differences between both groups at low shear rate (1.15 a 11.56 seg(-1)). The hypertensive patients showed irregular and amorphous aggregates so that ASP appeared significantly higher (p< 0.001) in patients with hypertension (0.69 +/- 0.11) than in healthy subjects (0.25 +/- 0.12). Fibrinogen appeared slightly higher (p<0.01) in the hypertensive group than in the normal group. Several hemorheological parameters play important roles in the pathogenesis of hypertension. Among these factors, several hemorheological parameters could be altered in hypertension (hematocrit, plasma fibrinogen level, erythrocyte deformability and aggregability, plasma and whole blood viscosity). An increased RBC aggregation has been identified as an important factor responsible for disturbing blood rheological behavior in the microcirculation. The present study demonstrates an abnormal erythrocyte aggregation, which was detected by increased ASP values that could be responsible for vascular complications in hypertension.

Comparative analysis of aggregate shapes by digitized microscopic images. Application to hypertension.

The main objective of the present work was to study modifications in RBC aggregate morphology by analyzing digitized microscopic images and compare them between healthy subjects and patients suffering from essential hypertension. Blood samples were obtained from normal subjects (n=30) and patients suffering from essential hypertension (n=20). RBC aggregate morphology was quantified using direct microscopic observation and numerical analysis of images. ASP (Aggregation Shape Parameter) defined as the ratio of the area of the projected image to its square perimeter was calculated. Other rheological parameters have been determined in order to establish the hemorheological profile of the studied hypertension states. ASP appears significantly higher (p<0.001) in patients suffering essential hypertension (0.69+/-0.11) than in normal control subjects (0.25+/-0.12). RBC aggregation is known to be responsible for the high increase in apparent blood viscosity at low shear rates. By compare ASP values with whole blood viscosity at low rate (2.30 s(-1)) a high correlation was formed between both parameters (Spearman coefficient was 0.8835 and p<0.001). The applied method is simple, direct and quantitative and provides a useful tool for measuring deviations of RBC aggregate morphology.

Vigilancia de la evolución de 6030 heridas quirúrgicas / Vigilance of the evolution of 6030 surgical wounds

Las infecciones de las heridas quirúrgicas representan una complicación que en algunos casos se asocia a muerte, por lo que el control de las mismas debe ser tarea cotidiana en los servicios de cirugía general. El sistema de vigilancia de heridas parece ser un método efectivo para disminuir las infecciones postoperatorias. Por lo anterior en 1983 se implantó el sistema de vigilancia de heridas quirúrgicas, evaluando los resultados cuatro años después. El primer año de vigilancia sirvió de línea base para analizar el conportamiento de la frecuencia de infecciones. Las heridas se catalogaron en cuatro grupos: I. herida limpia; II. herida limpia-contaminada; III. herida contaminada; IV. herida sucia. La frecuencia de infecciones durante el primer año del estudio fue de 6.3, y en el cuarto año de 4.7 por ciento. El tratamiento de las infecciones de cada grupo dio resultados satisfactorios en los grupos II, III, y IV, en que la reducción fue estadísticamente significativa; en el grupo I ayudó a mantener la frecuencia en cifras aceptables. Se recomienda la vigilancia de las heridas como método útil para el control de las infecciones