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BACKGROUND: Acute myelitis is a neurological entity, often posing the problem of etiology. The two main causes are infectious or autoimmune. French Guyana is a region of the world where infectious etiologies are multiple, in particular human immunodeficiency virus infection, and autoimmune diseases appear to be emerging. The aim of our study was firstly to determine the proportion of each etiology of acute myelitis in French Guyana, and secondly to describe the clinical, paraclinical and epidemiological characteristics of autoimmune myelitis in French Guyana, with particular reference to neuromyelitis optica spectrum disorder (NMOSD). METHODS: This retrospective, observational study included all patients who presented with acute myelitis between January 2015 and August 2023 at Cayenne Hospital Center. Each patient's chart was reviewed and patients were classified according to etiology. Demographic and clinical data were collected, as well as blood, lumbar puncture, and cerebral and spinal cord magnetic resonance imaging results. RESULTS: Of the 40 patients included, immune etiology was found in 74%, including 49% with NMOSD (37% with positive anti-aquaporin-4 antibodies) compared with three patients with infectious etiology. There was no statistically significant difference in complementary examinations between immune and infectious etiologies. The prevalence of NMOSD in French Guyana was estimated at 8/100,000 (6/100,000 for patients with positive anti-aquaporin-4 antibodies). No significant difference in the geographic distribution of patients with NMOSD in French Guyana was demonstrated. CONCLUSIONS: Our results show a high proportion of autoimmune etiology of acute myelitis in French Guyana, and more particularly of NMOSD. There is a high prevalence of NMOSD, the second highest in the world after the French West Indies. Given this high proportion of autoimmune myelitis, several hypotheses can be put forward, with genetic and environmental factors in the foreground. For patients with acute myelitis in French Guyana, an immune cause is the most likely. It is therefore important to think about this and look for NMOSD in particular, without ignoring an infectious etiology.

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The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused an unprecedented pandemic in human history. To date, more than 6.5 million lives have been lost to COVID-19 (coronavirus disease 2019). Following widespread efforts for COVID-19 vaccination in Brazil, there has been a drastic reduction in COVID-19 deaths, which was particularly evident in the city of Botucatu, SP, Brazil, after a campaign to a mass vaccination. Our objective was to assess the temporal and epidemiological spread of variants of concern (VOC) of SARS-CoV-2 in the four weeks preceding the massive vaccination campaign in the municipality. After randomizing 400 samples, Next-Generation Sequencing was used to produce sequences and determine the variants. Among high-quality sequences, 98.4% belonged to the VOC Gamma, with P.1 and P.1.14 being the most prevalent lineages. P.1 was more frequent in both men and women, and in younger individuals and adults (0-59 years) compared to P.1.14. There was no correlation between the variants and the presence of comorbidities or between them and moderate to severe clinical cases of COVID-19 or death. However, P.1 was more frequent than P.1.14 in people with mild forms of the disease and in those who exhibited symptoms. In the phylogenetic analyses, a small cluster of 9 P.1.14 samples containing mutations in ORF1a: M584V and A3620V was observed, which had not been found in any Gamma sequences to date. The importance of genomic surveillance of SARS-CoV-2 is evident in assisting public health decision-making and the management of COVID-19 and other diseases.

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BACKGROUND: Home care is increasingly adopted worldwide to improve patients' quality of life and reduce the burden on hospitals. However, the risk of healthcare-related infections in home settings is a growing concern that necessitates further investigation and preventive measures. OBJECTIVES: We aimed to describe the sociodemographic and clinical profiles of home care patients, determine the incidence and management of healthcare-associated infections at home, and evaluate the risk factors. DESIGN AND SETTING: This quantitative, observational, analytical, cross-sectional study was conducted in Teresina, PI, Brazil. METHODS: Data were collected from 130 patients receiving home care between April 2016 and September 2020 in the state capital of Northeast Brazil. The data were retrospectively collected from hospital records using a previously validated form and analyzed. RESULTS: The cohort predominantly comprised men (53.1%), older adults (53.1%), and patients with neurological disorders (61.9%). Healthcare-associated infections were prevalent in 46.2% of home care patients, with respiratory infections being the most common (47.2%). Clinical diagnoses were made in 66.7% of these patients. Patients with female caregivers, with a tracheostomy, using invasive feeding devices for >6 months, and with a greater degree of dependence were more predisposed to infections. Adult patients, those with young adult caregivers, those who received long-term home care, and those who required prolonged tracheostomy were also at increased risk. CONCLUSION: This study underscores the home care patient profiles, prevalence of associated infections, and risk factors. Preventive measures and specific interventions are needed to enhance home care quality and reduce the infection risk.

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INTRODUCTION: Elevated fluoride (F-) exposure during childhood produces dental fluorosis (DF). Nails have been used for monitoring systemic F- in relation to DF. The aim of this study was to evaluate F- levels in toenails in association with DF severity in Mexican schoolchildren. MATERIALS AND METHODS: 120 schoolchildren from nonendemic areas (NEAs) and endemic F- areas (EAs) were screened for DF via the Thylstrup and Fejerskov index (TFI). Toenails were collected to quantify systemic F-. The associations between the biomarker, DF severity, tap water intake, sex, and age were analyzed. RESULTS: The mean F- in toenails in the NEAs and EAs were 0.63 ± 0.43 and 2.72 ± 1.38 mg/kg, respectively (p < 0.001). A positive correlation was observed between the biomarker and DF severity (rs = 0.755, p < 0.001). Tap water consumption and the biomarker were associated with DF severity (p < 0.001). Within TFI7-8 the mean F- level was higher in those ages 10-11 than in those ages 8-9 (p < 0.05). CONCLUSION: Systemic F- levels in toenails are associated with DF severity in Mexican schoolchildren from both the NEAs and the EAs, which reflects the ability of the biomarker to accurately record the exposure to the compound in relation to clinical damage.

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BACKGROUND: New approaches to control HPV infections and prevent progression to cervical precancer are needed. We investigate the probability of viral clearance and progression to cervical precancer in women infected with HPV16/18 without evidence of precancer at study enrollment to inform research efforts targeted at reducing cervical cancer. METHODS: We included 530 women aged 18-25 who tested HPV16/18 DNA-positive and did not have cytological evidence of high-grade-squamous-intraepithelial-lesion (HSIL) at enrollment in CVT. At each visit, clinicians collected cervical cells for cytology and HPV-DNA testing. Those with abnormal cytology were referred to colposcopy, biopsy, and treatment as needed. We estimated the probability of HPV clearance (loss of detection) and progression to intraepithelial neoplasia grades 2 or 3 or worse (CIN2+, CIN3+) based on histological findings by expert pathologists over 4-years of follow-up. RESULTS: At enrollment, there were 550 prevalently detected HPV16 and/or HPV18 infections among 530 women without cytologic HSIL. Corresponding probabilities of HPV16 and HPV18 clearance were 68.5 % (95 %CI 63.6 %-73.0 %) and 85.0 % (78.6 %-90.1 %) by 24-months and 82.1 % (78.0 %-85.7 %) and 90.2 % (84.7 %-94.2 %) by 48-months after initial detection. Risk of clearance of prevalently detected HPV16 and HPV18 infections decreased with increasing age by 12-, 24-, 36-, and 48-months after initial detection (ptrend-values≥0.31). Among the same 530 women, by 24-months and 48-months of follow-up, the corresponding probabilities of progression to CIN2+ were 5.5 % (3.8 %-7.7 %) and 13.0 % (10.4 %-16.1 %), and to CIN3+ were 2.6 % (1.5 %-4.3 %) 7.5 % (5.5 %-10.0 %). Probability of progression was 2-5 times higher in women with HPV16 infections than with HPV18. Risk of progression to CIN2+ and CIN3+ increased with increasing age during the follow-up period (ptrend-values≥0.11). CONCLUSIONS: Among young adult women without evidence of HSIL by cytology, clearance of prevalently detected HPV16/18 infection is a common event, and progression to precancer occurs infrequently but in a sizeable proportion of those with prevalent infection.

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BACKGROUND: In 2020, countries implemented universal surveillance to detect and monitor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. Although crucial for early monitoring efforts, universal surveillance is resource intensive. To understand the implications of transitioning from universal to sentinel surveillance for monitoring SARS-CoV-2 transmissibility, morbidity and mortality, and disease seriousness, we compared measures of SARS-CoV-2 reported from both surveillance strategies in Argentina, Chile, and Mexico. METHODS: We obtained weekly case counts in Argentina, Chile, and Mexico, in periods when both universal and sentinel surveillance were ongoing. To assess the countries' surveillance strategies, we measured the proportion of total sites that were included in sentinel surveillance. We compared 8 measures of SARS-CoV-2 transmissibility, morbidity and mortality, and disease seriousness between sentinel and universal surveillance and assessed the correlation between the 2 strategies for the 8 measures. Pearson and Spearman correlation was classified as very strong (rs = 0.8-1.0), strong (rs = 0.60-0.79), moderate (rs = 0.50-0.59), or poor (r < 0.50). RESULTS: The proportion of total sites included in sentinel surveillance was 5.8% for Argentina, 1.1% for Chile, and 7.6% for Mexico. A total of 21 measures were calculated (8 for Mexico, 8 for Chile, and 5 for Argentina). Of these, 17 showed consistency between the 2 surveillance strategies, with strong or very strong correlations (r = 0.66-0.99): all 8 measures for Mexico, 6 of 8 measures for Chile, and 3 of 5 measures for Argentina. Each country had ≥1 measure reflecting transmissibility and ≥1 reflecting morbidity and mortality for which the correlation was strong or very strong. Chile and Mexico also had ≥1 measure of disease seriousness for which the correlation was strong. CONCLUSIONS: Our findings suggest that the integration of SARS-CoV-2 into national sentinel surveillance can yield information comparable to that provided by nationwide universal surveillance for measures related to SARS-CoV-2 transmissibility, morbidity and mortality, and seriousness of disease.

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BACKGROUND: To better establish the value of vaccination against influenza viruses, we estimated vaccine-averted influenza illnesses among young children and older adults in Chile, Guyana, and Paraguay. METHODS: We gathered country- and target population-specific data on monthly influenza hospitalizations, vaccine coverage, and vaccine effectiveness from surveillance records and immunization registries during 2013-2018. We applied a static compartmental model to estimate differences in the number influenza-associated respiratory disease events (symptomatic nonhospitalized illnesses, medically attended illnesses, hospitalizations) in the presence and absence of influenza vaccination programs. RESULTS: Between 2013 and 2018, vaccinating 68% of children aged 6-23 months in Chile averted an annual mean of 14 617 nonhospitalized, 9426 medically attended, and 328 hospitalized influenza illnesses; vaccinating 28% of children aged 6-23 months in Paraguay averted 1115 nonhospitalized, 719 medically attended, and 25 hospitalized influenza illnesses. Vaccinating 59% of older adults in Chile averted an annual mean of 83 429 nonhospitalized, 37 079 medically attended, and 1390 hospitalized influenza illnesses; vaccinating 36% of older adults in Paraguay averted an annual mean of 3932 nonhospitalized, 1748 medically attended, and 66 hospitalized influenza illnesses. In Guyana, a hypothetical campaign vaccinating 30% of children aged <5 years could have prevented an annual 1496 nonhospitalized, 971 medically attended, and 10 hospitalized influenza illnesses. Vaccinating 30% of adults aged ≥65 years could have prevented 568 nonhospitalized, 257 medically attended, and 10 hospitalized influenza illnesses. CONCLUSIONS: Influenza vaccination averted tens of thousands of illnesses and thousands of hospitalizations in Chile and Paraguay; influenza vaccination could have had a proportional benefit in Guyana.

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Homeobox A9 promoter methylation (HOXA9) has been reported as a biomarker for early lung adenocarcinoma patients' prognosis. We aim to evaluate its prognostic value, regardless of disease stage. Using droplet digital PCR, we measured HOXA9 methylation in a cohort comprising 161 Brazilian patients. Low HOXA9 methylation was associated with higher cancer-specific survival but showed no significance after adjustment for clinical covariates. While low HOXA9 methylation was associated with earlier stages, no survival association was observed in this subset of patients. Overall, HOXA9 promoter methylation is not an independent prognostic biomarker of cancer-specific survival in Brazilian lung adenocarcinomas patients.

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BACKGROUND: Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) contributes significantly to higher weight loss at 6 to 12 months when compared to Laparoscopic Sleeve Gastrectomy (LSG) in patients with severe obesity (SO-body mass index (BMI) ≥ 50 kg/m2). However, there is still no consensus regarding the best procedure in terms of mortality and complication rates. We performed a systematic review and meta-analysis to compare the complication rates between these two surgical procedures. METHODS: PubMed, EMBASE, and Cochrane Central were searched for studies that compared LRYGB and LSG in SO patients. We pooled outcomes for mortality and complications, defined as bleeding, cardiovascular events, conversion to open procedure, and a composite endpoint of leak, abscess, fistulas, and reoperation. Length of stay and operative time were also pooled. A random-effects model was used, and statistical analyses were performed using R version 4.4.0. RESULTS: A total of 156,767 patients from 28 observational studies were included, of whom 79,324 (50.6%) underwent LRYGB and 77,443 (49.4%) LSG. Length of stay (MD 0.45; 95% CI 0.42-0.48; P < 0.01) and operative time (MD 58.88; 95% CI 37.88-79.87; P < 0.01) were lower in the LSG group. Overall, there was no difference in mortality (OR 1.28; 95% CI 0.80-2.04; P = 0.311) and in complication rates (OR 1.22; 95% CI 0.85-1.76; P = 0.287). A subgroup analysis showed lower conversion to open procedure for patients who underwent LSG (OR 2.75; 95% CI 1.90-3.98; P < 0.001), and no difference was noted in bleeding (OR 0.98; 95% CI 0.47-2.07; P = 0.965), cardiovascular events (OR 0.99; 95% CI 0.43-2.29; P = 0.983), and a composite endpoint of leak, abscess, and fistulas (OR 0.82; 95% CI 0.67-1.01; P = 0.066). CONCLUSION: Our meta-analysis suggests that there is no difference in mortality and complication rates between the two groups. However, length of stay and operative time were lower in SO patients who underwent LSG.

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BackgroundHearing loss (HL) of moderate or higher grades is common in older adults with increasing prevalence as people age, rising from 12% at the age of 60 years to over 58% at 90 years. HL in midlife is one of the main potentially modifiable risk factors for dementia. It is estimated that 7% of dementia cases globally could be avoided if this risk factor was eliminated. However, much of the research conducted has been in high-income countries even though low- and middle-income countries have the highest prevalence of dementia.ObjectiveTo study the association between HL and cognitive decline during eight years of follow-up in a Brazilian sample.MethodsParticipants from the São Paulo center of the Brazilian Longitudinal Study of Adult Health were evaluated in three study waves (2008-10, 2012-14, and 2017-19). HL was defined as pure-tone audiometry above 25 dB in the better ear. Cognitive performance was evaluated with six tests related to memory, verbal fluency, and trail-making tests. A global cognitive z-score was derived from these tests. The association between HL and cognitive decline was evaluated with linear mixed-effects models adjusted for sociodemographic, lifestyle, and clinical factors.ResultsOf 805 participants (mean age 51 ± 9 years, 52% women, 60% White), 62 had HL. During follow-up, HL was associated with faster global cognitive decline (ß = -0.012, 95% CI = -0.023; 0.000, p = 0.039).ConclusionsHL was significantly associated with a faster rate of global cognitive decline after a median follow-up of eight years in a sample of middle-income country.

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INTRODUCTION: Influenza represents a global public health challenge. Influenza vaccination is crucial for preventing complications. The World Health Organization recommends a coverage rate of at least 75% for the at-risk population. The aim of this study was to evaluate vaccination coverage among members of the Health Plan of the Hospital Italiano de Buenos Aires. MATERIALS AND METHODS: Cross-sectional study nested within a dynamic cohort. All members of the Health Plan during the influenza vaccination campaigns of 2022 and 2023 were included. The influenza vaccination rate was calculated and reported as a percentage with its respective 95% confidence interval (CI95%). Demographic variables and comorbidities were analyzed. RESULTS: The influenza vaccination rate was 12% in 2022 and 10% in 2023. Subjects aged between 6 and 23 months had the highest vaccination rates in both periods, at 43% (CI95% 41-46) in 2022 and 48% (CI95% 45-51) in 2023, followed by the population over 65 years old with a rate of 23% (CI95% 23-24) in 2022 and 18% (CI95% 18-19) in 2023. The most common comorbidities were hypertension and dyslipidemia. DISCUSSION: Influenza vaccination coverage in our population fell below the recommendations of the World Health Organization, highlighting the presence of barriers to influenza immunization.

Introducción: La gripe es un grave problema global de salud pública. La vacunación antigripal es crucial para prevenir complicaciones. La Organización Mundial de la Salud recomienda un porcentaje de cobertura de al menos 75% para la población en riesgo. El objetivo de este estudio fue evaluar la cobertura de vacunación en los afiliados al Plan de Salud del Hospital Italiano de Buenos Aires. Materiales y métodos: Estudio de corte transversal anidado en una cohorte dinámica. Se incluyeron todos los afiliados al Plan de Salud durante las campañas de vacunación antigripal de 2022 y 2023. Se calculóla tasa de vacunación antigripal y se reportócomo porcentaje con su respectivo intervalo de confianza del 95% (IC95%). Se analizaron las variables demográficas y comorbilidades. Resultados: La tasa de vacunación antigripal fue de 12% en 2022 y de 10% en el 2023. Los sujetos entre 6 y 23 meses tuvieron las tasas de vacunación más alta en ambos periodos, siendo de 43% (IC95% 41-46) en 2022 y de 48% (IC95% 45-51) en 2023, seguido de la población mayor de 65 años con una tasa de 23% (IC95% 23-24) en 2022 y 18% (IC95% 18-19) en 2023. Las comorbilidades más frecuentes fueron la hipertensión y la dislipidemia. Discusión: La cobertura de vacunación antigripal en nuestra población se situópor debajo de las recomendaciones de la Organización Mundial de la Salud poniendo de manifiesto la presencia de barreras en la inmunización antigripal.

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INTRODUCTION: SARS-CoV-2 can cause mild upper respiratory tract involvement to pulmonary disease of varying severity, as well as cardiovascular complications with increased mortality. The prevalence is similar in men and women, although there are sex differences in disease characteristics and outcome. In this study, we analyze the clinical characteristics, progression, and in-hospital outcome by sex of patients included in the RACCOVID-19 registry. MATERIALS AND METHODS: We included data from 2750 patients consecutively admitted to 50 centers in 11 provinces of the country, from May 18 to October 31, 2020. RESULTS: A total of 1541 men (60.2%) and 1018 women (39.8%) were included (p<0.001). The prevalence of cardiovascular risk factors (because of current smoking) was higher in men. During hospitalization, men had a higher incidence of cardiovascular complications (17.9% vs. 12.5%; p=0.0002) and mortality (20.8% vs. 16.8%; p=0.01). Poor performance status on hospital admission was more common in men (53.9% vs. 42.6%, p<0.0001). On multivariate analysis, male sex, the presence of hypertension and diabetes, and a history of other medical conditions were independent predictors of inhospital mortality. DISCUSSION: In the RACCOVID-19 registry, men had worse performance status and higher incidence of cardiovascular complications with higher in-hospital mortality. Male sex, hypertension, diabetes, and history of other diseases were independent predictors of in-hospital mortality.

Introducción: SARS-CoV-2 puede causar desde afección leve de la vía área superior hasta enfermedad pulmonar con diferentes niveles de gravedad, así como también complicaciones cardiovasculares, con mayor mortalidad. La prevalencia es similar en hombres y mujeres, aunque existen diferencias en cuanto a las características de la enfermedad y su evolución según el sexo. En este trabajo, se analizan las características clínicas, evolución y pronóstico intrahospitalario de los pacientes incluidos en el registro RACCOVID-19, de acuerdo al sexo. Materiales y métodos: Se incluyen datos de 2750 pacientes ingresados consecutivamente en 50 centros de 11 provincias del país, desde el 18 de mayo hasta el 31 de octubre de 2020. Resultados: Se incluyeron 1541 hombres (60.2%) y 1018 mujeres (39.8%) (p<0.001). Se observóen el sexo masculino una mayor prevalencia de factores de riesgo cardiovascular, en especial el tabaquismo. En la evolución intrahospitalaria, los varones presentaron mayor incidencia de complicaciones cardiovasculares (17.9% vs. 12.5%; p=0.0002) así como una mayor mortalidad (20.8% vs. 16.8%; p=0.01). El estado clínico comprometido fue mayor en varones (53.9 vs. 42.6%; p<0.0001). En el análisis multivariado, el sexo masculino, la presencia de hipertensión arterial, diabetes y otros antecedentes patológicos fueron predictores independientes de mortalidad hospitalaria. Discusión: Los hombres en el RACCOVID-19 presentaron peor estado clínico y más complicaciones cardiovasculares con una mayor mortalidad intrahospitalaria. El sexo masculino, la hipertensión arterial, la diabetes y la presencia de otros antecedentes patológicos fueron predictores independientes de mortalidad hospitalaria.

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INTRODUCTION: The use of antidementia drugs near the end of life remains controversial. We evaluated the prevalence of and factors associated with antidementia drug use in the last 6 months of life in older adults with dementia. MATERIALS AND METHODS: Observational retrospective study of adults ≥60 years, affiliated to the Hospital Italiano de Buenos Aires health maintenance organization, who died with a dementia diagnosis, between 2017 and 2021. The main event was the use of antidementia drugs in the 6 months prior to death. We fit a logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (CI) of baseline variables associated with antidementia drug use. RESULTS: A total of 540/1898 (28%) patients used antidementia drugs in the 6 months preceding death. Lewy body dementia (OR=1.97; 95%CI, 1.22-3.19) and Alzheimer's disease (OR=1.47; 95%CI, 1.12-1.92) were associated with higher odds of antidementia drug use. Heart failure (OR=0.65; 95%CI, 0.48-0.89), older age (OR=0.75; 95%CI, 0.68-0.81), and prior hospitalizations (OR=0.81; 95%CI, 0.70-0.93) were inversely associated with antidementia drug use. DISCUSSION: One out of three patients with dementia receive antidementia drugs in the 6 months prior to death despite limited evidence in such a scenario.

Introducción: El uso de medicaciones antidemenciales cerca del final de la vida es controvertido. Evaluamos la prevalencia de uso de drogas antidemenciales en los últimos 6 meses de vida en adultos mayores con demencia y sus factores asociados. Materiales y métodos: Estudio observacional retrospectivo de pacientes ≥60 años, afiliados al plan de salud del Hospital Italiano de Buenos Aires, que fallecieron con un diagnóstico de demencia presente entre 2017 y 2021. El evento principal fue el uso de drogas antidemenciales en los 6 meses previos a la muerte. Usamos un modelo de regresión logística para estimar odds ratio (OR) e intervalos de confianza (IC) del 95% de las variables basales asociadas al uso de antidemenciales. Resultados: Un total de 540/1898 (28%) pacientes utilizaron antidemenciales en los en los 6 meses previos a la muerte. La demencia con cuerpos de Lewy (OR=1.97; IC95%, 1.22-3.19) y la enfermedad de Alzheimer (OR=1.47; IC95%, 1.12-1.92) se asociaron con un mayor uso de drogas antidemenciales. La insuficiencia cardíaca (OR=0.65; IC95%, 0.48-0.89), la edad (OR=0.75; IC95%, 0.68-0.81) y hospitalizaciones previas (OR=0.81; IC95%, 0.70-0.93) se asociaron inversamente al uso de antidemenciales. Discusión: Uno de cada tres pacientes con demencia reciben drogas antidemenciales en los 6 meses previos a la muerte a pesar de la limitada evidencia que soporta su uso en este escenario.

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INTRODUCTION: Given the importance of reducing lowvalue care practices and acknowledging that vitamin D testing in the general population is rising despite the absence of evidence to support such conduct, we decided to investigate its overuse. MATERIALS AND METHODS: Design: cross-sectional study. DATA SOURCE: electronic medical records. POPULATION: patients aged between 18 and 64 on the Hospital Italiano de Buenos Aires Health Maintenance Organization membership list, to whom at least one test of vitamin D had been performed between July 1st and December 31st 2022. A sample of electronic medical records was manually analyzed. In the presence/suspicion of a clinical condition that counts with recommendation for Vitamin D testing, its indication was considered appropriate; however, in its absence, it was considered inappropriate. RESULTS: A total of 10 095 vitamin D tests were performed on 9623 patients (mean age 47, 78.1% female). These patients were 10% of the 97 584 HMO members aged between 18 and 64 in 2022. A hundred and sixty of the 242 patients whose electronic medical records were analyzed (66%, CI 95% 60 - 72), did not have a clinical condition that justified vitamin D testing. The most frequent clinical conditions found for testing were osteopenia in 37/242 patients (15%); osteoporosis, 13/242 (5%) and chronic kidney disease 11/242 (5%). DISCUSSION: Two-thirds of the vitamin D tests performed did not have a clinical condition that justified the practice. These findings represent an opportunity to design strategies to institutionally reduce this low-value care practice.

Introducción: Dada la importancia de reducir las prácticas de bajo valor y teniendo en cuenta que los dosajes séricos de vitamina D en la población general están aumentando, a pesar de la ausencia de evidencia que respalde dicha conducta, decidimos investigar su sobreúso. Materiales y métodos: Diseño: corte transversal. Fuente de datos: historia clínica electrónica. Población: pacientes de entre 18 y 64 años afiliados al plan de medicina prepaga del Hospital Italiano de Buenos Aires a quienes se les realizóal menos un dosaje de vitamina D en el segundo semestre de 2022. Se analizó manualmente una muestra de historias clínicas. Ante la presencia/sospecha de una condición clínica que contase con recomendación de dosaje de vitamina D, la indicación para realizarlo se consideróadecuada, mientras que ante su ausencia se consideróinapropiada. Resultados: Un total de 10 095 determinaciones de vitamina D fueron realizadas a 9623 pacientes (78% mujeres, edad media 47 años), quienes representan el 10% de la población (97 584). En 160 (66%, CI 95% 60-72) de los 242 pacientes cuyas historias clínicas fueron revisadas, no había documentada condición clínica que avalara la prueba. En 37/242 (15%) se constatóosteopenia como motivo de la determinación; en 13/242 (5%), osteoporosis y en 11/242 (5%), enfermedad renal crónica. Discusión: Dos tercios de las determinaciones de vitamina D pueden ser interpretadas como inapropiadamente indicadas. Estos datos representan una oportunidad para diseñar estrategias que reduzcan esta práctica de bajo valor a nivel institucional.

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INTRODUCTION: Type 2 diabetes (T2DM) together (along) with age and the presence of atrial fibrillation, high blood pressure, smoking, dyslipidemia (DLP), carotid stenosis, and an unhealthy lifestyle are risk factors (RF) to develop an ischemic stroke. The objective of this work was to analyze and compare risk factors and evolution of inpatients with ischemic stroke with and without T2DM. MATERIALS AND METHODS: This study was a retrospective and observational analysis. Data on habits, comorbidities, medication and laboratory parameters were collected patients' medical records hospitalized for stroke between January 1, 2022 and December 31, 2022. The sample was divided into patients with and without T2DM. RESULTS: One hundred and ninety three patients experienced stroke. The average age: 73.6 ±11.8 years. Among them, 100 patients had T2DM, displaying a higher prevalence of obesity (p= 0.000), DLP (p=0.000), and chronic kidney disease (p= 0.045). Elevated levels of glycemia (p=0.001), HbA1C (p=0.001), triglycerides (TG) (p=<0.001) and TG/HDL index (p= <0.001) as well as and lower HDL (p=<0.001) were also observed. Patients with T2DM showed lower survival (p= 0.012). DISCUSSION: Patients hospitalized for stroke with T2DM had more risk factors and higher mortality than the population without T2DM.

Introducción: La diabetes tipo 2 (DM2) junto con la edad y la presencia de fibrilación auricular, hipertensión arterial, tabaquismo, dislipidemia (DLP), estenosis carotídea, y un estilo de vida no saludable, son factores de riesgo (FR) para el desarrollo de un accidente cerebrovascular isquémico (ACVi). El objetivo de este trabajo fue analizar y comparar factores de riesgo y evolución de pacientes internados con ACV isquémico con y sin DM2. Materiales y métodos: Estudio retrospectivo y longitudinal. Se recolectaron datos (hábitos, comorbilidades, medicación y laboratorio) de las historias clínicas de pacientes internados por ACVi desde el 1 de enero de 2022 al 31 de diciembre de 2022. Se dividióla muestra en pacientes con y sin DM2. Resultados: Ciento noventa y tres pacientes presentaron ACVi. La edad promedio: 73.6 ±11.8 años; 100 pacientes tenían DM2, quienes presentaron mayor obesidad (p=<0.001, DLP (p=<0.001), enfermedad renal crónica (p=0.045). También se observómayores niveles de glucemia (p=0.001), HbA1C (p=0.001), triglicéridos (TG) (p=<0.001) e índice TG/HDL (p=<0.001) y HDL más bajo (p=<0.001). Los pacientes con DM2 presentaron menor supervivencia (p=0.012). Discusión: Los enfermos hospitalizados por accidente cerebrovascular con DM2 tuvieron más factores de riesgo y mayor mortalidad que la población sin DM2.

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INTRODUCTION: The prevalence of polycystic ovary syndrome (PCOS) in transgender and non-binary genders assigned female at birth (TMNBG) men is controversial. Our objectives were to investigate the prevalence, phenotypic characteristics of PCOS, and cardiometabolic risk of TMNBG with and without PCOS prior to hormone therapy. MATERIALS AND METHODS: This was a retrospective study of 346 TMNBG adults presenting to our service for gender-affirming hormone therapy. PCOS was diagnosed according to the evidence-based international guideline for the evaluation and treatment of PCOS 2018 and the Rotterdam consensus of 2003. RESULTS: The described transgender population had a prevalence of PCOS of 23.8%. Phenotype B was the most common one (39.1%), followed by phenotype A (33.7%). Transgender people with PCOS had statistically higher body mass index (BMI), systolic and diastolic blood pressure, plasma insulin levels, HOMA-IR, and HOMA-B than those who did not meet PCOS criteria. However, blood pressure and markers of insulin resistance were similar for both groups after controlling for BMI. DISCUSSION: PCOS appears to be prevalent among TMNBG. Transgender people with PCOS may exhibit an unfavorable cardiometabolic risk profile compared to those without PCOS, especially due to a higher BMI. It is necessary to evaluate the specific components of PCOS before starting hormonal therapy due to the long-term implications it could have.

Introducción: La prevalencia del síndrome de ovario poliquístico (SOP) en hombres trans y géneros no binarios asignados mujer al nacer (HTGNB) es controvertida. Nuestros objetivos fueron investigar la prevalencia, características fenotípicas del SOP y riesgo cardiometabólico de HTGNB con y sin SOP previo a la terapia hormonal (TH). Materiales y métodos: Este fue un estudio retrospectivo de 346 HTGNB adultos que acudieron a nuestro servicio para recibir TH de afirmación de género. El SOP se diagnosticósegún la guía internacional basada en evidencia para la evaluación y el tratamiento del SOP de 2018 y el consenso de Rotterdam de 2003. Resultados: En nuestra cohorte, el 26.6% de los HTGNB presentóSOP. El fenotipo B fue el más común (39.1%), seguido del fenotipo A (33.7%). Las personas transgénero con SOP tuvieron un índice de masa corporal (IMC), presión arterial (PA) sistólica y diastólica, niveles plasmáticos de insulina, HOMA-IR y HOMA-B, estadísticamente más altos que aquellos que no cumplían con los criterios de SOP. Sin embargo, la PA y marcadores de resistencia insulínica fueron similares para ambos grupos luego de controlar por IMC. Discusión: El SOP parece ser prevalente entre los HTGNB. Los mismos pueden exhibir un perfil de riesgo cardiometabólico desfavorable en comparación con aquellos sin SOP, sobre todo debido a un mayor IMC. Se hace necesaria la evaluación de los componentes específicos del SOP antes del inicio de la terapia hormonal por las implicancias que la misma podría tener a largo plazo.

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INTRODUCTION: The 2022-2023 Mpox outbreak in Argentina presented unique challenges due to the lack of vaccination and antiviral therapy. This study analyzed the epidemiological and clinical characteristics of cases in the Buenos Aires Metropolitan Area (MABA), examining temporal trends, HIV status, and concomitant sexually transmitted infections (STIs). MATERIALS AND METHODS: An ambispective, analitic, and multicenter study was conducted between September 2022 and May 2023 in HIV/STI clinics and hospitals in MABA. Cases were classified as confirmed (positive PCR) or possible (clinical and epidemiological criteria). Patients infected with MPox with and without HIV were compared. RESULTS: 247 patients were included, 95.5% were confirmed cases. The median age was 36 years; 98% were men; 93.7% were men who have sex with men. Sexual exposure was the main transmission route (91%). The 25.2% presented concomitant STIs. The 74% were people living with HIV (PLWH), with good immuno-virological control. Common clinical manifestations included papular, pustular, and vesicular lesions; 59.4% presented >20 lesions. Rectal involvement occurred in 25.6%. Complications were observed in 9.3%, hospitalization in 6.6%, and mortality was 0.4%. PLWH showed a higher prevalence of perianal lesions and proctitis, without differences in complications and hospitalization. DISCUSSION: The outbreak in Argentina, mainly affecting men who have sex with men living with HIV, had low mortality. No significant differences were observed in complications and hospitalization between people with and without HIV.

Introducción: El brote de Mpox en Argentina 2022-2023, presentó desafíos únicos debido a la falta de vacunación y terapia antiviral. Este estudio analizó las características epidemiológicas y clínicas de los casos en el área Metropolitana de Buenos Aires (AMBA), examinando tendencias temporales, estatus para HIV e infecciones de transmisión sexual (ITS) concomitantes. Materiales y métodos: Se realizó un estudio ambispectivo, analítico y multicéntrico entre septiembre 2022 y mayo 2023 en clínicas de HIV/ITS y hospitales del AMBA. Los casos se clasificaron como confirmados (PCR positiva) o posibles (criterios clínicos y epidemiológicos). Se compararon los pacientes infectados con MPox con y sin HIV. Resultados: Se incluyeron 247 pacientes, 95.5% fueron casos confirmados. La edad mediana fue 36 años; 98% hombres; 93.7% hombres que tienen sexo con hombres. La exposición sexual fue la principal ruta de transmisión (91%). El 25.2% presentó ITS concomitantes. El 74% eran personas viviendo con HIV (PVHIV), con buen control inmuno-virológico. Las manifestaciones clínicas comunes incluyeron lesiones papulares, pustulares y vesiculares; el 59.4% presentó >20 lesiones. La afectación rectal ocurrió en el 25.6%. Se observaron complicaciones en el 9.3%, hospitalización en el 6.6%, y una mortalidad del 0.4%. Las PVHIV mostraron mayor prevalencia de lesiones perianales y proctitis, sin diferencias en complicaciones y hospitalización. Discusión: El brote de Mpox en Argentina en 2022-2023, afectó principalmente a hombres que tienen sexo con hombres viviendo con HIV y presentó baja mortalidad. No se observaron diferencias significativas en complicaciones y hospitalización entre personas con y sin HIV.

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INTRODUCTION: Cranioencephalic traumatism (CET) is a serious public health problem worldwide. Advances in treatment have reduced mortality, increasing the demand for rehabilitation. The objective was to describe the demographic characteristics and functional outcomes in adult patients with traumatic brain injury (TBI) treated in a rehabilitation center. MATERIALS AND METHODS: Retrospective study between 2002 and 2022. Patients received 4 hours of rehabilitation daily. The level of functional independence was assessed with the Functional Independence Measure (FIM) at admission and discharge. RESULTS: 229 patients were included, the median (25-75 percentiles) time from injury to admission to rehabilitation was 56 (36-98) days; 76% were men. Mean age (standard deviation) 42 (17) years. The most frequent etiologies were car accidents and falls; 46.8% were under 40 years of age and the median length of stay was 82 days (14-132). At discharge, 79.9% of patients over 65 years of age had low to severe disability (GOS-E) and 79.5% returned home. The median (p 25-75) FIM at admission was 30 (20-55) and at discharge was 90 (58-106); a statistically significant difference was observed (p = 0.001). Differences in functional outcomes were found based on age and place of residence. DISCUSSION: In Argentina, patients admitted to rehabilitation for TBI are predominantly young men, the main cause being car accidents. The implementation of an early and intensive rehabilitation program has shown significant improvements in functional outcomes. At discharge, most patients required home supervision and assistance in daily activities.

Introducción: El traumatismo craneoencefálico (TCE) es un grave problema de salud pública a nivel global. Los avances en el tratamiento han reducido la mortalidad, incrementando la demanda en rehabilitación. El objetivo fue describir las características demográficas y resultados funcionales en pacientes adultos con lesión cerebral traumática (LCT) tratados en un centro de rehabilitación. Materiales y métodos: Estudio retrospectivo entre 2002 y 2022. Los pacientes recibieron 4 horas diarias de rehabilitación. El nivel de independencia funcional fue evaluado con la Medida de Independencia Funcional (FIM) al ingreso y al alta. Resultados: Se incluyeron 229 pacientes, la mediana (percentilos 25-75) del tiempo de lesión al ingreso a rehabilitación fue de 56 (36-98) días; 76% eran hombres. Edad media (desvío estándar) 42 (17) años. Las etiologías más frecuentes fueron accidentes automovilísticos y caídas; 46.8% tenía menos de 40 años y la mediana de estadía fue de 82 días (14-132). Al alta, el 79.9% de los pacientes mayores de 65 años presentaba discapacidad baja a grave (GOS-E) y el 79.5% regresóa su domicilio. La mediana (p 25-75) de FIM al ingreso fue 30 (20-55) y al alta fue 90 (58-106); observándose una diferencia estadísticamente significativa (p = 0.001). Se encontraron diferencias en los resultados funcionales entre la edad y lugar de residencia. Discusión: En Argentina los pacientes ingresados en rehabilitación por LCT son predominantemente hombres jóvenes, la causa principal son los accidentes automovilísticos. La implementación de un programa de rehabilitación temprano e intensivo ha demostrado mejoras significativas en los resultados funcionales. Al alta, la mayoría de los pacientes requirieron supervisión domiciliaria y asistencia en las actividades diarias.

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INTRODUCTION: Low back pain is one of the main causes of medical consultation worldwide, with heterogeneous management in the request for complementary methods. This study sought to determine the frequency and clinical and imaging characteristics of patients with low back pain in a tertiary hospital, considering the presence or absence of red flags. MATERIALS AND METHODS: A retrospective analytical study was carried out at the Private University Hospital of Córdoba. Patients over 18 years of age who consulted for the first time for low back pain between January and June 2021 were included, excluding pregnant and those without complete records. RESULTS: A total of 880 patients were included. Of these, 589 (67%) presented acute low back pain, 112 (13%) subacute and 179 (20%) chronic. Simple low back pain was the most common cause (n=652, 74%), followed by herniated disc (n=179, 20%) and spondylolisthesis (n=33, 4%). Red flags were identified in 190 (22%) patients according to American College of Radiology (ACR) criteria and in 420 (48%) according to the Agency for Health Care Policy and Research (AHCPR). Imaging studies were performed in 314 (75%) patients with AHCPR criteria and 255 (55%) with ACR criteria. Neoplasia/infection and vertebral fracture were diagnosed in 2 (2%) and 5 (9%) patients with red flags, respectively. DISCUSSION: The first consultation for low back pain represented 1.8% of consultations, with acute low back pain being more frequent. Obesity was the most common comorbidity. About half of the patients had red flags according to AHCPR and 21% according to ACR.

Introducción: La lumbalgia es una de las principales causas de consulta médica a nivel mundial, con un manejo heterogéneo en la solicitud de métodos complementarios. Este estudio buscódeterminar la frecuencia y características clínicas e imagenológicas de los pacientes con lumbalgia en un hospital de tercer nivel, considerando la presencia o ausencia de signos de alerta o banderas rojas. Meteriales y métodos: Se realizóun estudio analítico retrospectivo en el Hospital Privado Universitario de Córdoba. Se incluyeron pacientes mayores de 18 años que consultaron por primera vez por lumbalgia entre enero y junio de 2021, excluyendo embarazadas y aquellos sin registros completos. Resultados: Se incluyeron 880 pacientes. De éstos, 589 (67%) presentaron lumbalgia aguda, 112 (13%) subaguda y 179 (20%) crónica. La lumbalgia simple fue la causa más común (n=652, 74%), seguida de hernia discal (n=179, 20%) y espondilolistesis (n=33, 4%). Se identificaron banderas rojas en 190 (22%) pacientes según criterios del American College of Radiology (ACR) y en 420 (48%) según la Agency for Health Care Policy and Research (AHCPR). Se realizaron estudios de imágenes en 314 (75%) pacientes con criterios de AHCPR y en 255 (55%) con criterios de ACR. Neoplasia/infección y fractura vertebral se diagnosticaron en 2 (2%) y 5 (9%) pacientes con banderas rojas, respectivamente. Discusión: La primera consulta por lumbalgia representóel 1.8% de las consultas, siendo más frecuente la lumbalgia aguda. La obesidad fue la comorbilidad más común. Cerca de la mitad de los pacientes tenían banderas rojas según AHCPR y el 21% según ACR.

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INTRODUCTION: Malignant rhabdoid tumor (MRT) is a highly aggressive disease, mainly affecting infants and small children. MATERIAL AND METHODS: Between January 2007 and May 2021 a retrospective study was conducted at the Hospital de Pediatría J. P. Garrahan in Buenos Aires, Argentina, including 13 patients diagnosed with ERNC-MRT (extra-renal non-cerebral malignant rhabdoid tumor). Event-free survival (EFS) and overall survival (OS) were assessed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: Seven patients were less than 1 year old, all of them died. Four of 13 had metastatic disease, all of them in the lungs, 2 had locoregional lymph node involvement. Six achieved complete remission, 4 of them remained alive. Five received maintenance therapy (MT) with cyclophosphamide/vinorelbine, 4 were alive at last follow-up. Only one was studied for germline mutations, the result was negative. With a median follow-up of 126 months (range: 72-161), 3 and 5-year EFS and OS were 30.7% and 38.4%, respectively. DISCUSSION: Although the sample size is small, survival rates are similar or slightly lower than other series. Age was the main prognostic factor. All but one patient that received MT are alive, suggesting that MT might have a role in ERNC-MRT; however, the prognostic significance is not entirely clear since there are multiple confounding factors.

Introducción: El tumor rabdoide maligno (TRM) es una enfermedad altamente agresiva que afecta principalmente a lactantes y niños pequeños. Materiales y métodos: Entre enero de 2007 y mayo de 2021 se realizóun estudio retrospectivo en el Hospital de Pediatría J. P. Garrahan de Buenos Aires, Argentina, incluyendo 13 pacientes diagnosticados con tumor rabdoide maligno extrarrenal extra-cerebral. La sobrevida libre de eventos (SLE) y la sobrevida global (SG) se evaluaron mediante el método de Kaplan-Meier y se compararon mediante la prueba de rango logarítmico. Resultados: Siete pacientes tenían menos de 1 año al diagnóstico y todos fallecieron. Cuatro de 13 tenían enfermedad metastásica, todos ellos en los pulmones, 2 tenían afectación ganglionar loco-regional. Seis alcanzaron la remisión completa, 4 de ellos sobrevivieron. Cinco recibieron terapia de mantenimiento (TM) con ciclofosfamida/vinorelbine, 4 estaban vivos en el último control. Solo uno fue estudiado para mutaciones de línea germinal, el resultado fue negativo. Con una mediana de seguimiento de 126 meses (rango: 72-161), la SLE y la SG a 3 y 5 años fue de 30.7 % y 38.4 %, respectivamente. Discusión: Aunque el tamaño muestral es pequeño, las tasas de sobrevida son similares o ligeramente inferiores a otras series. La edad fue el principal factor pronóstico. El uso de TM prolongósignificativamente la sobrevida; sin embargo, la importancia pronóstica no está del todo clara ya que existen múltiples factores confundidores.