[Argentine registry of office blood pressure monitoring. RAMPAC study]. / Registro Argentino de Medición de la Presión Arterial en Consultorio. Estudio RAMPAC.

INTRODUCTION: Hypertension (HTN) is the leading cause of mortality and disability in the world. In Argentina, almost 44% of hypertensives do not know about their condition and this may be due to the low rate of blood pressure (BP) measurements during the office visit. Our hypothesis is that the measurement and electronic recording of BP (BPMR) is not a routine practice in Argentina. OBJECTIVE: To describe the rate of office BP measurement in Argentina. METHODS: This is a retrospective, multicentre, point prevalence study. We analysed all office visits on 9/19/2019 at 9 medical institutions in 6 provinces of Argentina. RESULTS: Two thousand and eighty-two office visits were analysed. The patients' mean age was 52.1 years (18-103), 1790 (59.7%) were female, and 702 (36.1%) were hypertensives. BP was measured in 420 visits (14.1%; 95% CI 12.8-15.4). In a multivariate logistic regression model, history of HTN (OR 1.91, P<.001) and previous cardiovascular event (OR 1.76, P<.001) were associated with more odds of BPMR. The presence of cancer was associated with fewer odds of BPMR (OR .51, P<.01). Cardiology measured BP up to 49.5% (144/291 visits), followed by internal medicine 30% (152/507 visits). CONCLUSION: BPMR during office visits is deficient in Argentina and represents a missed healthcare opportunity. Different strategies are needed to detect hypertensive patients and reduce cardiovascular events.

Clinical practice update of antifungal prophylaxis in immunocompromised children.

Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.

What do anti-Toxoplasma gondii IgA and IgG subclasses in human saliva indicate?

Diagnostic tests for toxoplasmosis are based on serological techniques due to their high sensitivity. Some IgG subclasses are related to clinical outcome in the congenital form. In this work, we determined the levels of IgG, IgA, IgG1, IgG2, IgG3 and IgG4 anti-Toxoplasma gondii antibodies in paired saliva and serum samples from 91 women by indirect ELISA using a crude extract of the RH strain. The levels of IgA, IgG2, IgG3 and IgG4 antibodies and, to a lesser extent, IgG1 did not correlate between saliva and serum, that is, most cases that were positive for one Ig class in a sample were negative or very low in the other, and vice versa. We also observed that most samples of saliva that were positive for one IgG subclass were also positive for at least 2 of the other 3; this contrasted with findings in serum, wherein each person was positive almost exclusively for one subclass, as demonstrated before by us and other researchers. Although these findings are disappointing for the use in diagnosis, the richer response in saliva might indicate local exposure to T. gondii antigens without systemic infection; thus, saliva might be reflecting a local (protective?) response against this protozoan.

Skewed Invariant Natural Killer T (iNKT) Cells, Impaired iNKT:B Cell Help and Decreased SAP Expression in Blood Lymphocytes from Patients with Common Variable Immunodeficiency.

Common variable immunodeficiency (CVID) is a syndrome with predominantly defective B cell function. However, abnormalities in the number and function of other lymphocyte subpopulations in peripheral blood (PB) have been described in most patients. We have analysed the distribution of iNKT cell subpopulations in the PB of CVID patients and the ability of these cells to provide in vitro cognate B cell help. The total of iNKT cells was reduced in the PB of CVID patients, especially CD4+, CD4-/CD8- and CCR5+/CXCR3+. These findings were associated with an enrichment of memory-like and a tendency towards a reduction in TNF-α-expressing effector iNKT cells in the peripheral blood mononuclear cells (PBMC) of CVID patients. Moreover, an accumulation of follicular helper iNKT cells in the PB of CVID patients was demonstrated. CVID αGalCer-pulsed iNKT cells are not able to induce autologous B cell proliferation although they do induce proliferation to healthy donor B cells. Interestingly, autologous and heterologous co-cultures did not differ in the amount of immunoglobulin secreted by B cells in vitro. Finally, reduced intracellular SAP expression in iNKT cells and other lymphocytes in the blood from CVID patients was observed. These results provide further insights into the immunological mechanisms underlying the iNKT cell defects and the potential targets to improve B cell help in CVID.

Vacuum therapy in erectile dysfunction--science and clinical evidence.

Vacuum therapy (VT) utilizes negative pressure to distend the corporal sinusoids and to increase the blood inflow to the penis. Depending on its purpose, VT could be used as vacuum constriction device (VCD), with the aid of an external constricting ring which is placed at the base of penis to prevent blood outflow, maintaining the erection for sexual intercourse. Also, as a vacuum erectile device (VED), without the application of a constriction ring, just increases blood oxygenation to the corpora cavernosa and for other purposes. The emerging of phosphodiesterase 5 inhibitors (PDE(5)I) for the treatment of erectile dysfunction (ED) eclipsed VCD as therapeutic choice for ED; however, widespread usage of VED as part of penile rehabilitation after radical prostatectomy and other purposes rekindle the interest for VT. The underlying hypothesis is that the artificial induction of erections shortly after surgery facilitates tissue oxygenation, reducing cavernosal fibrosis in the absence of nocturnal erections, and potentially increases the likelihood of preserving erectile function. Due to its ability to draw blood into the penis regardless of nerve disturbance, VED has become the centerpiece of penile rehabilitation protocols. Herein, we reviewed the history, mechanism, application, side effects and future direction of VT in ED.

Construction of a literature database and its use to provide probabilities for decision-analytic models of thrombolytic therapy.

Probabilities for decision-analytic models are routinely obtained from the medical literature. This study describes development and use of a literature database to facilitate obtaining probabilities for decision-analytic models of thrombolytic therapy for acute myocardial infarction. Implementation demonstrates the concept of a literature database to be both feasible and effective. Specific difficulties encountered in the evaluation of continuous variables, the potential storage of actual probabilities, and the advantage for easy growth with the literature are discussed.

Laparoscopic sigmoid colostomy for perianal Crohn's disease.

Fecal stream diversion is not an uncommonly used procedure in the treatment of symptomatic Crohn's disease of the rectum. We present a case report of a patient with documented Crohn's proctitis with multiple rectovaginal and perianal fistulas; an end sigmoid colostomy was performed as part of the management of her disease.

Efeitos da associaçäo de isoflurano com succinilcolina sobre o ritmo cardíaco em crianças: estudo comparativo com halotano / Effects of isoflurane and succinilcolina association on children cardiac rhythm: a comparative study with halothane

Vinte e cinco crianças de seis a 60 meses de idade foram submetidas a anestesia com halotano ou isoflurano mais succinilcolina e intubaçäo orotraqueal. Foram registradas as freqüencias cardíacas imediatamente a induçäo, imediatamente antes da punçäo venosa; trinta segundos após a injeçäo de succinilcolina; imediatamente após a intubaçäo orotraqueal. O aparecimento de arritmias era registrado no momento da ocorrência. A partir da induçäo, as freqüências cardíacas entre os dois grupos se diferenciaram a níveis estatisticamente significativos. Essa diferença foi principalmente devida a reduçäo no número de batimentos cardíacos nos pacientes submetidos a anestesia com halotano e acentuada com a intubaçäo orotraqueal. Embora o número de arritmias fosse maior no grupo que recebeu halotano, essa diferença näo foi estatisticamente significativa

Haemodynamic effects of sodium nitroprusside in 21 subjects with congestive heart failure.

Twenty-one patients in severe congestive heart failure refractory to conventional medical management were treated with sodium nitroprusside on 22 occasions. On 14 occasions (responders) there was significant improvement in clinical and haemodynamic indices. On 8 occasions (non-responders) hypotension developed without haemodynamic improvement and nitroprusside treatment had to be abandoned. The initial mean arterial pressure and the capillary wedge pressure tended to be higher in the responders while the cardiac index tended to be higher in the non-responders. The systemic vascular resistance was higher in the responders than in the non-responders (2560 +/- 160 vs 1800 +/- 180 dynes s cm-5, P less than 0.001). All of the responders had systemic vascular resistance greater than 1900 dynes s cm-5, while only one of the non-responders had a systemic vascular resistance in this range. Thus, a variable response to vasodilator therapy for congestive cardiac failure is documented. The favourable response appears to be limited to patients with a high systemic vascular resistance.

Preoperative radiotherapy for stage III carcinoma of the breast.

We have concluded from these observations in this pilot study that preoperative radiation therapy does not play a particularly helpful role in the management of patients who have the clinical finding of borderline operable carcinoma of the breast and it does not improve the survival rate. Patients within this category of locally advanced disease must be considered to have systemic metastatic disease at the time of diagnosis, as has previously been stressed by many. For this reason, any therapy directed to the regional area for local control must be combined with some form of systemic therapy if there is to be any hope for an increase in survival time.

Holter monitoring in the diagnosis and management of cardiac rhythm disturbances.

Dynamic, long-term electrocardiography by the Holter technique has gained a definite and important role in cardiac diagnosis. Indications for its application include the diagnosis of ischemic heart disease, the assessment of antiarrhythmic therapy, the evaluation of function of artificial pacemakers, the investigation of physiologic correlates of known arrhythmias, the evaluation of the efficacy of antianginal therapy, and the assessment of the natural history of cardiac arrhythmias in various conditions. In our hands, the technique has proved most fruitful in the uncovering of arrhythmic correlates of transient neurologic disturbances or syncope, and in the precise characterization of patients suspected of having the sick sinus syndrome.

Lipid films as transducers for detection of antigen-antibody and enzyme-substrate reactions.

The transverse electrical impedance of thin lipid films separating two aqueous saline solutions containing a small concentration of antibodies or enzymes decreases markedly and reversibly after immunological and enzymatic reactions involving such protein molecules, which presumably are adsorbed to the lipid-water interface.