A Latin American survey on demographic aspects of hospitalized, decompensated cirrhotic patients and the resources for their management.

INTRODUCTION & OBJECTIVES: Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. METHODS: A cross sectional, multicenter survey of hospitalized cirrhotic patients. RESULTS: 377 patients, (62% males; 58±11 years) (BMI>25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR+NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population>500,000 (n=45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n=22). CONCLUSIONS: The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.

Serum 25-hydroxyvitamin D levels in hospitalized adults with community-acquired pneumonia.

INTRODUCTION: Community-acquired pneumonia (CAP) is the infectious disease with the highest number of deaths worldwide. Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. OBJECTIVE: The aim of this study was to evaluate the serum 25-hydroxyvitamin D (25OHD) levels in hospitalized adults in general room with CAP. MATERIALS AND METHODS: An observational study was carried out in 207 hospitalized adults of both sex with CAP (>18 years) from Rosario city, Argentina (32° 52' 18″S) between July 2015 and June 2016. RESULTS: In total, 167 patients were included in the data analysis [59% women (57.4 ± 19.6 years), body mass index 27.2 ± 7.8 kg/m2 ]. In brief, 63% showed unilobar infiltrate and 37% were multilobar. The CURB-65 index was 66.5% low risk, 16.0% intermediate risk and 17.5% high risk. According to Charlson comorbidity index (CCI) 53.5% had not comorbidity (CCI = 0) and 46.5% showed CCI ≥ 1. The 25OHD level was: 11.92 ± 7.6 ng/mL (51.5%: <10 ng/mL, 33.5%: 10-20 ng/mL, 13.2%: 20-30 ng/mL and 1.8%: >30 ng/mL). Higher 25OHD were found in male (female: 10.8 ± 6.7 ng/mL, male: 13.5 ± 8.5 ng/mL, P = .02) and 25OHD correlated with age (r = -.17; P = .02). 25-Hydroxyvitamin D was also correlated with CURB65 index (r = -.13; P = .049), CCI (r = -.20, P = .007) and with the 10 years of life expectative (%) (r = .19; P = .008). In addition, higher 25OHD were found with lower CCI (CCI 0 = 13.0 ± 8.2 ng/mL, CCI ≥ 1= 10.5 ± 6.7 ng/mL; P = .0093). CONCLUSIONS: Hospitalized adults with CAP have lower 25OHD levels and would be associated with the severity of CAP.

Rabdomiólisis inducida por esfuerzo físico de baja intensidad: serie de cuatro casos clínicos / Light exercise-induced rhabdomyolysis: report of four cases

La rabdomiólisis se caracteriza por la destrucción de células musculares esqueléticas con liberacióndel contenido celular a la sangre. Sus causas son múltiples, y si bien una de las más frecuentes es el esfuerzo físicoextenuante, hay casos reportados tras practicar ejercicios de baja intensidad. Objetivo: reportar cuatro casos de rabdomiólisisinducida por ejercicio de baja intensidad. Pacientes y método: estudio descriptivo de una serie de cuatrocasos de rabdomiólisis inducida por ejercicio de baja intensidad, internados en un servicio de clínica médica entrelos años 2010 y 2012. Resultados: relación hombre/mujer 3/1, edad media 45.25 años (rango 29-58), media deduración de los síntomas hasta la consulta dos días (rango 1-3). El dolor fue el síntoma más relevante. Dos pacientespresentaron insuficiencia renal aguda con una media de duración de cuatro días (3-5). El tiempo medio hasta lanormalización de los valores de CPK fue de 8.75 días. La CPK media fue de 22.928,5 U/l (rango 1.415-65.672).Los cuatro pacientes recibieron hidratación parenteral vigorosa con solución salina y tuvieron buena evolución clínica.Conclusión: es importante considerar el diagnóstico de rabdomiólisis en pacientes que consultan por síntomasmusculares luego del ejercicio, incluso si éste fue de baja intensidad, pero ante la presencia de factores de riesgocomo hipokalemia, hidratación inadecuada, sudoración excesiva, temperatura ambiente y humedad elevadas. Elpronóstico de la rabdomiólisis es bueno cuando el cuadro es tratado en forma temprana.

Rhabdomyolysis is a syndrome characterised by the destruction of skeletal muscle, and release of cellular contentsinto the circulation. The causes vary; one of the most common causes is strenuous physical exercise, but there are reportsof the syndrome after practicing low-intensity exercises. Objective: to report four cases of low intensity exercise-inducedrhabdomyolysis. Patients and methods: descriptive study of a series of four cases with low intensity exercise-inducedrhabdomyolysis, admitted to the hospital between 2010 and 2012. Results: male/female ratio 3/1, mean age 45.25 years(range 29-58), mean duration of symptoms before consultation two days (range 1-3). The most important symptom waspain. Two patients presented with acute renal failure with a mean duration of four days (3-5). The average time untilthe normalization of CPK values was 8.75 days. The average CPK was 22,928.5 U/l (range 1,415-65,672). All patients creareceivedaggressive hydration with intravenous normal saline infusión, and had good clinical outcome. Conclusion: thediagnosis of rhabdomyolysis must be considered in patients who present with muscle symptoms after exercise, even if it wasof low intensity, especially in the presence of risk factors such as hypokalemia, inadequate hydration, excessive sweating, hotand humid weather. The prognosis of rhabdomyolysis is good when it is treated early.

Elevaciones extremas de la velocidad de eritrosedimentación en pacientes internados en un hospital de mediana complejidad de la ciudad de Rosario / Extreme elevations of erythrocyte sedimentation rate in hospitalized patients at a medium complexity hospital in Rosario city, Argentina

Introducción: una elevación extrema de la velocidad de eritrosedimentación (VES) es considerada cuando su valor es mayor o igual a 100 mm/hora y se asociaría con un bajo porcentaje de falsos positivos como indicador de enfermedad. Objetivos: conocer la frecuencia de aparición de elevaciones extremas de la VES y la frecuencia de las distintas enfermedades con las que este hallazgo se asocia en pacientes adultos que ingresan al servicio de clínica médica de un hospital de mediana complejidad. Pacientes y Método: se realizó un estudio descriptivo, observacional, de corte transversal, en el Hospital Juan Bautista Alberdi de la ciudad de Rosario, que incluyó a todos los pacientes que ingresaron al servicio de Clínica Médica entre el 01/03/2008 y el 30/04/2009 y que presentaron dentro de las 24 horas del ingreso una VES mayor o igual a 100mm/hora. Resultados: durante el período estudiado ingresaron 802 pacientes, de los cuales 39 (4,86%) presentaron una elevación extrema de la VES. La VES promedio fue de 117+-14,85 mm/hora, la relación hombre/mujer de 1.05/1 y la edad promedio 48.3+-16.3 años. Las causas asociadas con la elevación extrema de la VES fueron: infección (70.45%), enfermedad renal (9.09%), neoplasias (6.82%), enfermedades autoinmunes/otras inflamatorias no infecciosas (4.55%), causas misceláneas (4.55%) y sin diagnóstico (4.55%). Conclusión: la elevación extrema de la VES es un hallazgo relativamente frecuente que se constató casi en el 5% de los pacientes que ingresaron al servicio de Clinica Médica en el período de estudio, siendo su principal causa las enfermedades infecciosas.

Intoduction: an extreme elevation of erythrocyte sedimentation rate (ESR) is considered when its value is greater than or equal to 100 mm/hour, and it is associated with a low false positive rate as a sickness index. Objectives: to determine the frequency of extreme elevations of the ESR, and to determine the frequency of various diseases with which this finding is associated in adult patients who admitted to a medium complexity hostipal. Patients and Methods: it is a descriptive, observational, cross-sectional study which included all patients who were admitted to the Juan Bautista Alberdi Hospital between March 01, 2008 and April 30, 2009 and who presented within 24 hours of admission an ESR greater than or equal to 100 mm/hour. Results: during the study period 802 patients were admitted, of which 39 (4.86%) had an extreme elevation of the ESR. The average ESR was 117+-14.85 mm/hour, the male/female ratio 1.05/1 and the average age 48.3+-16.3 years. Causes associated with extreme elevation of the ESR included: infection (70.45%), renal disease (9.09%), neoplasms (6.82%), autoinmune diseases /other non-infectious inflammatory diseases (4.55%), miscellaneous causes (4.55%) and no diagnosis (4.55%). Conclusion: extreme elevation of the ESR is a relatively common finding; it was found in almost 5% of patients admitted to the hospital, and its main cause was an infectious disease.