Effect of angiotensin 2 receptor blockers on chronic obstructive lung disease mortality: A retrospective cohort study.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is the fifth cause of mortality worldwide. Systemic inflammation is a crucial element in its physiopathology. As Renin-Angiotensin System is one of the main components of this inflammatory neurohumoral cascade, Angiotensin Receptor Blockers (ARBs) might have an effect on mortality in COPD patients. GOAL: To evaluate the association between ARBs treatment and mortality in COPD patients. METHODS: Retrospective cohort of patients with diagnosis of COPD from 2003 to 2013. COPD cases were detected according to the diagnosis by treating physicians in any field of the electronic clinical health records by controlled vocabulary in patients older than 18 years affiliated to the Hospital Italiano de Buenos Aires (HIBA) Health Plan. Patients were classified in two groups depending on their use of ARBs according to the hospital pharmacy records. The mortality registry of the HIBA was used to obtain the event of death. The 8 year survival experience was described using Kaplan Meier estimator and survival curve comparisons were calculated with the Cox Mantel test. Hazard Ratios (HR) were estimated using a Cox proportional risk model. A propensity score (PS) was developed for the use of ARBs. RESULTS: 1140 deaths were detected, 1063 in the no exposure group and 77 in the ARBs exposure group. The 8 year survival was 71% (CI 95% 69-72%). The survival in the non exposed group was 71% (CI 95% 69-73%) and 76% (CI 95% 0,69-0,81) in the ARBs exposed group. The unadjusted HR for mortality was 0.85 (CI 95% 0.67-1.07, p = 0.17) and the adjusted HR by PS was 0.63 (CI 95% 0.50-0.80, p < 0.001). DISCUSSION: ARBs use seems to be associated to a lower mortality in patients with COPD. Additional studies are needed to corroborate this finding.

[Telemedicine as a follow-up ambulatory strategy for COVID patients at the Hospital Italiano de San Justo]. / Telemedicina como estrategia de seguimiento ambulatorio de pacientes COVID en el Hospital Italiano de San Justo.

Introduction: Due to the COVID-19 pandemic, health systems have had to adapt to the growing demand for care. Telemedicine is a practical tool for outpatient monitoring of correctly selected patients. Materials and Methods: A descriptive study of a prospective cohort of patients under telemedicine follow-up at the Hospital Italiano de San Justo was carried out. Results: 47 days of follow-up were evaluated, a total of 1345 patients. Of these, 46.9% (n = 631) obtained a positive nasopharyngeal swab result with PCR technique and were registered in the telemedicine monitoring system, with 10.14% (n = 64) requiring a new clinical evaluation at the emergency center . Of these patients, 60.1% (n = 39) required hospitalization in a general ward (n = 39). Conclusion: It is essential to be able to generate other forms of helth care. The telemedicine system is an important tool to develop in situations of overload of the health system.

Introducción: Debido a la pandemia por COVID-19 los sistemas sanitarios han tenido que adaptarse a la demanda asistencial. La telemedicina es una herramienta práctica para poder realizar seguimiento ambulatorio de pacientes correctamente seleccionados. Materiales y Métodos: Se realizó un estudio descriptivo de una cohorte prospectiva de pacientes en seguimiento por telemedicina en el Hospital Italiano de San Justo. Resultados: Se evaluaron 47 días de seguimiento, un total de 1345 pacientes. De éstos 46,9% (n=631) obtuvieron un resultado de hisopado nasofaríngeo con técnica de PCR positivo y fueron ingresados al sistema de seguimiento por telemedicina. El 10,14% (n=64) requirió una reevaluación clínica en guardia externa. De estos pacientes el 60.1% (n=39) requirió internación en sala general (n=39). Conclusión: Es fundamental poder generar otras formas de cuidado de la salud. El sistema de telemedicina es una herramienta importante a desarrollar en situaciones de sobrecarga del sistema de salud.

Trasplante de médula ósea alogénico en un paciente con fusariosis diseminada y leucemia mieloide aguda / Allogeneic hematopoietic cell transplantation in a patient with disseminated fusariosis and acute myeloid leukemia

La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)

Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)

Evaluación de percepciones de residentes de Medicina Interna sobre las instancias de aprendizaje durante la Residencia: un estudio de corte transversal / Internal Medicine residents´ perceptions of education in the Residency Program: a cross-sectional study

Introducción: la Residencia de Medicina Interna del Hospital Italiano de Buenos Aires posee una larga trayectoria en la formación de médicos clínicos e internistas. Existe bibliografía que sugiere que las percepciones de los residentes no son consistentes con las de aquellos encargados de organizar y evaluar los programas de residencia. Nuestro objetivo es conocer las percepciones de los residentes acerca de cuáles son las instancias formativas que mejor contribuyen a la generación de conocimiento. Materiales: estudio de corte transversal utilizando una encuesta virtual que fue enviada a todos los Residentes de Medicina Interna del Hospital Italiano de Buenos Aires. Se recolectaron datos generales de los residentes y año de residencia. Posteriormente se evaluaron las diferentes instancias involucradas en el aprendizaje: pases de guardia, recorrida de internación, pases de ambulatorio, pases de internación, ateneos y, por último, los cursos superiores universitarios. Resultados: la actividad individual más reconocida por su papel en el aprendizaje fue la discusión de los pacientes durante la recorrida (18% de los residentes). En contrapartida, la participación en cursos superiores universitarios no fue elegida como estrategia útil desde el punto de vista individual. Específicamente respecto de la utilidad de los pases de guardia (realizados por los residentes de primer año y los jefes de residentes), gran parte de los participantes optó por el pase de la tarde como el momento de mayor utilidad para el aprendizaje. Conclusión: los residentes consideran que los pases de guardia de la tarde, los pases de internación y ambulatorios y los ateneos de internación son los momentos más propicios y eficaces para la adquisición de nuevo conocimiento. Dichos datos pueden resultar de utilidad en la planificación de diversas instancias educativas y servir como base para estudios similares en poblaciones disímiles. (AU)

Introduction: the Internal Medicine Program at the Hospital Italiano de Buenos Aires has long term experience in training medical physicians. There is mounting evidence suggesting that residents' perceptions about their education are not consistent with the ones of who are responsible for designing and evaluating residency programs. Our goal is to evaluate residents' perceptions on the instances that contribute the most to their training. Methods: we conducted a cross-sectional study using an online survey offered to all Internal Medicine Residents at Hospital Italiano de Buenos Aires, Argentina. Baseline characteristics of each resident were collected. We subsequently assessed residents' perceptions of different instances of the residency program: residents´ morning and evening rounds, patients´ rounds, case discussions with staff physicians, grand rounds and postgraduate courses. Results: overall, the activity that was perceived as the most relevant for their education was the residents' evening rounds (18% of the residents). Conversely, participation in postgraduate courses was not selected as an important learning resource individually. Most residents highlighted the importance of patient discussion with their chief resident during morning and evening rounds. Conclusion: residents systematically prefer patient discussion on medical rounds rather than lectures and courses. This information might prove useful in the future so as to improve Internal Medicine residency programs. (AU)