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BACKGROUND: Stress-induced hyperglycemia is a phenomenon that occurs typically in patients hospitalized for acute disease and resolves spontaneously after regression of the acute illness. However, it can also occur in diabetes patients, a fact that is sometimes overlooked. It is thus important to make a proper diabetes diagnosis if hospitalized patients with episodes of hyperglycemia with and without diabetes are studied. AIMS: To estimate the extent of the association between stress-induced hyperglycemia and in-hospital mortality in patients with hospital hyperglycemia (HH), and to explore potential differences between patients diagnosed with diabetes (HH-DBT) and those with stress-induced hyperglycemia (SH), but not diagnosed with diabetes. METHODS: A cohort of adults with hospital hyperglycemia admitted to a tertiary, university hospital in Buenos Aires, Argentina, was analyzed retrospectively. RESULTS: In the study, 2,955 patients were included and classified for analysis as 1,579 SH and 1,376 HH-DBT. Significant differences were observed in glycemic goal (35.53% SH versus 25.80% HH-DBT, p < 0.01), insulin use rate (26.66% SH versus 46.58% HH-DBT, p < 0.01), and severe hypoglycemia rate (1.32% SH versus 1.74% HH-DBT, p < 0.01). There were no differences in hypoglycemia rate (8.23% SH versus 10.53% HH-DBT) and hospital mortality. There was no increase in risk of mortality in the SH group adjusted for age, non-scheduled hospitalization, major surgical intervention, critical care, hypoglycemia, oncological disease, cardiovascular comorbidity, and prolonged hospitalization. CONCLUSIONS: In this study, we observed better glycemic control in patients with SH than in those with HH-DBT, and there was no difference in hospital mortality.

Population’s aging and the increased number of Chronic Complex Patients (CCP) in unprepared environments for this complexity among a fragmented system which has a high variability and that is centered in chronic diseases acute failure and the lack of planning in the different levels of attention, may benefit hospital readmission which is expensive and unnecessary, avoidable adverse events and mistakes related with drugs, which may diminish the patient’s level of satisfaction. This presents a scenario that poses important challenges for the health system organization and for the provision of services to improve the quality of the assistance, the patient’s satisfaction and to diminish expenses.All of these factors create the need of designing patient oriented care plans.At HIBA (Hospital Italiano de Buenos Aires), we have an integrated attention program for CCP with a Home Care focus. We follow a Home Based Primary Care Model locally defined as Home Care. The 80% of admissions from a hospitalization to Home Care Medicine are of CCP. There is a complexity due to the clinical approach and the potential intensive use of resources.The transition process has not been standardize among the different areas according to the complexity of CCP in Home Care. Nevertheless, in the clinical hospitalization area, many groups worked with different integration levels to approach these type of patients, working with episodic nonintegrated care plans.We presented this problem and the proposal was to create an interdisciplinary work team. This team was composed by the different areas involved in the attention of these CCP candidates who were to be admitted in Home care (Geriatrics, Medical Clinic, Social Services, Rehab, Pharmacy, Nursing, Home Care, Health Plan Management, Dismissal Planning Unit, Palliative Care, and Medical Informatics) to improve care’s continuity through a shared and customized care plan. The priority was to organize care goals according to the patient’s needs by using a common language and precise tools. We ranked the population and decided to intervene the group with higher risk (Chronical Complex Patients). The different involved areas decided on the assistance process for the CCP: they defined roles and a set of steps to implement in each area oriented to improve the hospital-home transition in a way that benefits safety, quality of assistance, the patient’s satisfaction and his environment and the health team.After 3 months of training, we initiated the implementation increasingly and evaluated the process indicators quarterly with the goal of assessing adhesion and the proposal’s feasibility. We reached more than a 60% in most of the interventions.The path we have been through allows us to confirm that planning the patient centered transition of CCPs to Home Care benefits the comprehensive interdisciplinary care through a common language. It also enhances the patient’s satisfaction and his environment by preparing the caregiver for the CCP’s management at home care. It makes effective communication easier among the different attention areas and it provides the possibility to create a unique shared and customized plan for the CCP by benefiting continued assistance.

Background Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. Methods A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. Results A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12–15.48; P Conclusions Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.

Hepatocellular carcinoma is the most common primary liver tumor, with 905 677 diagnosed cases and 830 180 deaths, in 2020 worldwide. In Argentina, it accounts for the 9th cause of death for cancer in men and the 10th in women. Unlike other highly-prevalent tumors, scientific evidence for most therapeutic options is limited mainly to small cohorts and retrospective studies. The aim of this study is to characterize and describe epidemiologically patients with diagnosis of hepatocellular carcinoma in the Italian Hospital of Buenos Aires during a 12-year period. Overall survival for our cohort was 58%, 46%, and 36% at 1, 3 and 5 years respectively. Average survival for patients receiving palliative treatment was 5 months, while for those who received either non-curative or curative treatment was 23 and 75 months respectively. Recurrence-free survival for those patients who underwent a curative treatment was 89%, 76% y 61% at 1, 3 and 5 years. A thorough analysis of etiology, risk factors, incidence, mortality and treatment was made. The study's importance lies in its large sample size, quantity and quality of data, and will most certainly stimulate the development of local studies in hepatocellular carcinoma.El carcinoma hepatocelular (HCC) es el tumor primario más frecuente del hígado, con 905 677 casos diagnosticados en 2020, en todo el mundo, y 830 180 muertes. Es responsable de la novena causa de muerte por cáncer en los hombres y la décima en mujeres en Argentina. A diferencia de otros tumores de alta prevalencia, la evidencia científica acerca del HCC se limita principalmente a pequeñas cohortes y estudios retrospectivos. El objetivo de este estudio fue describir epidemiológicamente a aquellos pacientes con diagnóstico de HCC en el Hospital Italiano de Buenos Aires en un periodo de 12 años. La supervivencia global para nuestra cohorte fue de 58, 46 y 36% a 1, 3 y 5 años respectivamente. El promedio de supervivencia en pacientes con tratamiento paliativo fue de 5 meses, 23 para aquellos que recibieron tratamientos no curativos y 75 meses para los que recibieron tratamientos curativos. El porcentaje de pacientes libres de enfermedad a 1, 3 y 5 años fue de 89%, 76% y 61% respectivamente. Se realizó un estudio minucioso de la etiología, factores de riesgo, incidencia, mortalidad y tratamientos realizados. Su importancia yace en su tamaño muestral, calidad y cantidad de información disponible.

IntroductionOlder adults with advanced chronic diseases require an integrated model of care that includes an adaptation of the therapeutic effort. The objective of this work was to estimate compliance with a standardized process of identification and registry of advance care planning (ACP) of patients in chronic home care (CHC) with palliative needs living in nursing homes and referred to the Hospital for COVID19.Theory/MethodsProspective cohort of patients in nursing home chronic care, >64 years, affiliated to the Health Maintenance Organization Hospital Italiano de Buenos Aires, with a diagnosis of COVID19 infection (3/15/2020 to 9/15/2020). The standardized care process uses the identification of patients with palliative needs based on the Necpal tool and registry of the advanced care planning in a central place in the electronic health record (EHR).Results30% (1032) of CHC patients live in nursing homes. 65% (374/568) of suspected cases for COVID-19 were confirmed as positive.Among COVID-19 cases: 88% were women, median age was 88 yo., 92% were admitted to the Hospital, 0.3% used invasive ventilation, 80% (295) were stratified and identified in the EHR as patients with palliative needs, 68% (199) had the ACP registered in the EHR. 32.6% of hospitalized patients met severity criteria. 1% of patients with advanced chronic diseases with severity criteria were admitted to the intensive care unit. Mortality was 25% (94/374). Of those who died, 74.4% had severity criteria (p

Introduction Polypharmacy and potentially inappropriate medications in elderly is a frequent problem doctors have to deal with. Lack of integration of care in this population is critically important due to major adverse events patients might have. The aim of this study is to describe the frequency of dispensed medicines for persons who are more than 65 y.o. From institutional pharmacies in a health Maintenance Organization during the year 2017 and identify potentially inappropriate medications (PIM).Theory/Methodsobservational cross-sectional study of secondary bases. The consumptions of medications from ambulatory pharmacies between January and December 2017 were included as the first step in an Institutional Programme for the optimization of medication in the elderly as an integrated care plan (ProPam). A ranking was made, and the most frequent ones are reported, expressed in sales units. PIM were identified according to Beers 2019. They are described as an absolute number of consumptions, they were classified according grouped by pharmacological groups.ResultsThis study was made in more than 60,000 affiliated patients to whom drugs were dispensed. 1754219 units were dispensed in the period. 30 % of them were PIM. The most dispensed drugs were antihypertensive drugs and lipid-lowering drugs.The PIMs with the highest frequency of dispensing were (position in the general ranking of sales units): 3erd position benzodiazepines and sedative hypnotics, 5 th proton-pump inhibitors, 7th non-steroidal anti-inflammatory, 11th antidepressants. When considering the PIM’s sales units: 1st aspirin 60,227 sales units; 5th omeprazole 41,578 sales units; 10th alprazolam 34571 sales units; 11th clonazepam 32,153 sales units, and 10,186 sales units for pantoprazole ranked 32nd. DiscussionAn integrated care plan has to be implemented in order to better manage medications in the elderly. Conclusion Knowing the consumption profile of our population is important to address educational interventions to doctors and patients, and to generate tools and indicators that improve the quality of life, use of health services, adverse drug reactions, hospitalizations, costs and even mortality.Lessons learnedEach instance in which the patient attends the health centre, the medication must be reconciled in an integrated manner.LimitationsWe cannot know if these patients have adverse events indeed for consuming those medications. More studies and periodic indicators can be established in order to ensure safety vigilance.Suggestions for future researchThis study is the first stage of the Programme for diminish potentially inappropriate medication in elderly, we had implemented an interdisciplinary intervention to help doctors and patients to be aware and control medication they are on. We are still in the intervention stage. We promptly will know how we diminished PIM after intervention. Nevertheless, this has to be implemented periodically in the health institutions.

Introduction Older adults who use multiple medications appear to be at higher risk of receiving a potentially inappropriate medication (PIM). Based on our work for more than a decade on good clinical practice in medical prescribing, in 2019 Hospital Italiano de Buenos Aires started PrOPAM, a programme for optimising medications for the elderly who received health care by this provider. The objective of the study was to determine the prevalence of PIM in this population in the context of the SARS-Cov-2 pandemic.Theory/MethodsObservational cross-sectional study. We assessed outpatients’ consumption of medications from ambulatory pharmacies between 03/01/2020 and 08/31/2020. Medication consumption was identified as PIM according to the Beers-19 criteria. They were grouped by pharmacological groups using the ATC classification (Anatomical, Therapeutic, and Chemical group). We determined monthly PIM consumption per patient. Three priority pharmacological groups were defined: benzodiazepines, proton pump inhibitors, and non-steroidal anti-inflammatory drugs.ResultsOut of a total of 59,123 people, 67.38% were women. The median age was 76.61 years (IQR 12.7). At least one MPI was consumed by 25,461 (43%) people in the overall period (14,724 consumed one PIM; 7,245, 2 PIM; and 3,492, 3 or more PIM). During the study period patients consuming PIM remained stable. March, 12,833 patients consumed at least one PIM, 9,234 one PIM, 2,847 consumed 2 PIM, 752 consumed 3 or more PIM. In August, 12,327 patients consumed at least one PIM, 8,577 consumed one PIM, 2,921 consumed 2 PIM, and 829 patients consumed 3 or more PIM. A total of 14,723 patients took a benzodiazepine; 10,833, a proton-pump inhibitor; and 3,339, a non-steroidal anti-inflammatory drug.Conclusion PIM remained stable during the SARS-Cov-2 pandemic in our population. Knowing the prevalence of PIM use in our population is important to conduct educational interventions to clinicians and patients. Achieving a decrease in the use of PIM could reduce the impact of adverse drug reactions, hospitalizations, costs, and even mortality.DiscussionWe must implement coordinated efforts to conciliate and deprescribe potentially inappropriate medications in the elderly population. Reinforce and optimize ongoing medical education on theory, e-tools, and interventions.Lessons learnedEach level of medical care must be an opportunity to conciliate, deprescribe, and avoid PIM, especially during emergency situations, even when using telemedicine.LimitationsPandemic context might bias our estimations and might need specific actions to reduce PIM in elderly people.Suggestions for future researchThis research area must be periodically updated in order to improve safety and quality care.

Resumen Introduccion Hay una tendencia al envejecimiento de la poblacion que se fractura la cadera. Nuestro objetivo fue comparar la supervivencia y la funcionalidad al ano, entre ancianos y muy ancianos con fractura de cadera. Material y metodos Cohorte prospectiva de pacientes incluidos en el Registro Institucional de Ancianos con Fractura de Cadera entre los anos 2014 y 2017. La poblacion se clasifico: ancianos (A) entre los 65 y 85 anos, y pacientes muy ancianos (MA) mayor o igual a 85 anos. Resultados Se incluyo a 952 pacientes, el 43% fueron A y el 57% fueron MA. De estos, hubo un 84% y un 86% de mujeres (p = 0,33) y con 2 o mas puntos en el indice de comorbilidades de Charlson (el 28 y el 31%, p = 0,36), respectivamente. Los MA fueron mas dependientes por la puntuacion de Barthel (el 34 y el 62%, p La supervivencia a un ano fue del 91% (IC del 95%, 86-93) en ancianos y del 76% (IC del 95%, 70-89) en muy ancianos. Las complicaciones intrahospitalarias fueron mas frecuentes en MA 12% (7% en A, p La edad fue un factor de riesgo independiente para la supervivencia a un ano (HR 2,11; IC del 95%, 1,36-3,29, p Conclusion La edad es un factor de riesgo para la supervivencia del grupo MA a pesar de la fragilidad y las comorbilidades. Debido a su vulnerabilidad, se debe considerar un plan de cuidado adecuado para los pacientes MA.

Background There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. Material and methods A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) Results We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P = .33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P = .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P One-year survival was 91% (95% CI 86–93) in the EP and 76% (95% CI 70–89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P Age is an independent risk factor for one-year survival (HR 2.11 (95% CI 1.36−3.29, P Conclusions Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.

Resumen Introduccion El objetivo fue estimar la incidencia de diabetes y explorar la mortalidad de pacientes hospitalizados durante el seguimiento posterior al alta, clasificados durante la misma segun el comportamiento glucemico como hiperglucemia de estres (HE) o normoglucemia (NG). Material y metodos Cohorte retrospectiva de adultos no diabeticos con HE (>140 mg/dl y HbA1c Resultados Se identificaron 3981 pacientes con NG y 884 con HE. Durante el periodo de observacion (mediana de seguimiento de 1,83 anos), hubo un total de 255 casos de diabetes y 831 muertes. La incidencia acumulada de diabetes al ano fue de 1,59% (IC95%:1,23-2,06) en NG y 7,39% (IC95% 5,70-9,56) en HE. HE se asocio significativamente con la incidencia de diabetes (HR crudo 1,33; IC95% 1,13-1,73; p 0,025), incluso despues del ajuste por edad y sexo (HR ajustado 1,38; IC95% 1,06-1,78; p 0,014). La incidencia de mortalidad al ano fue 10,07% (IC95%:9,18-11,05) en NG y 13,24% (IC95%:11,17-15,65) en HE. El sub hazard ratio de desarrollar diabetes considerando la muerte como evento competitivo fue 1,41 (IC95% 1,29-1,53; p Conclusiones La HE es un factor de riesgo para desarrollar diabetes. No hubo diferencias de mortalidad en el seguimiento, pero la muerte parece comportarse como un evento competitivo al desarrollo de diabetes en esta poblacion.

Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients.Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified "VIDA" questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes.297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94-0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09-4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.La hospitalización representa un factor que puede favorecer la pérdida de la funcionalidad. El objetivo principal de este estudio fue determinar el efecto de la funcionalidad previa a la admisión hospitalaria sobre la sobrevida al año del egreso, en pacientes adultos mayores.Este estudio de cohorte prospectiva incluyó pacientes de 65 años o mayores que fueron hospitalizados en la sala general o la unidad de terapia intensiva en un hospital universitario de la ciudad de Buenos Aires, Argentina. La funcionalidad basal fue medida a través del cuestionario VIDA modificado, el cual evalúa las actividades instrumentales de la vida diaria. Utilizamos un modelo multivariable de Cox para estimar el efecto de la funcionalidad basal sobre la sobrevida al año posterior al egreso, el cual permitió ajustar por potenciales confundidores. Además, analizamos el efecto de la funcionalidad luego del egreso hospitalario sobre la mortalidad al año del mismo.Se incluyeron 297 pacientes, de los cuales 12.8% fallecieron durante la hospitalización, y 86 pacientes (33.2%) fallecieron dentro del año del egreso hospitalario. Un aumento de un punto en la escala de la funcionalidad basal (es decir, mejor funcionalidad), se asoció a una disminución en el riesgo de muerte al año del egreso (Hazard Ratio [HR]: 0.96; Intervalo de confianza [IC] 95%: 0.94–0.98). Por ultimo, la declinación funcional posterior al egreso hospitalario se asoció a un mayor riesgo de muerte durante el seguimiento (HR: 2.19, IC 95%: 1.09–4.37).La funcionalidad previa a la hospitalización de los adultos mayores impacta en los resultados a largo plazo luego de una hospitalización.

Study Design: Retrospective study. Level of evidence III. Objective: Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous. Methods: Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated. Results: A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%. Conclusions: Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

Background Acute calculous cholecystitis (ACC) is the most common complication of cholelithiasis. Laparoscopic cholecystectomy (LC) is the gold standard treatment in mild and moderate forms. Currently there is consensus for the use of antibiotics in the preoperative phase of ACC. However, the need for antibiotic therapy after surgery remains undefined with a low level of scientific evidence. Methods The CHART (Cholecystectomy Antibiotic Randomised Trial) study is a single-center, prospective, double blind, and randomized trial. Patients with mild to moderate ACC operated by LC were randomly assigned to receive antibiotic (amoxicillin/clavulanic acid) or placebo treatment for 5 consecutive days. The primary endpoint was postoperative infectious complications. Secondary endpoints were as follows: (1) duration of hospital stay, (2) readmissions, (3) reintervention, and (4) overall mortality. Results In the per-protocol analysis, 6 of 104 patients (5.8%) in the placebo arm and 6 of 91 patients (6.6%) in the antibiotic arm developed postoperative infectious complications (absolute difference 0.82 (95% confidence interval, −5.96 to 7.61, P = .81). The median hospital stay was 3 days. There was no mortality. There were no differences regarding readmissions and reoperations between the 2 groups. Conclusion Although this trial failed to show noninferiority of postoperative placebo compared to antibiotic treatment after LC for mild and moderate ACC within a noninferiority margin of 5%, the use of antibiotics in the postoperative period does not seem justified, because it was not associated with a decrease in the incidence of infectious and other types of morbidity in the present study.

Adult liver recipients (ALR) differ from the general population with pyogenic liver abscess (PLA) as they exhibit: reconstructed biliary anatomy, recurrent hospitalizations, poor clinical condition and are subjected to immunosuppression. The aim of this study was to identify risk factors associated with PLA in ALR and to analyze the management experience of these patients.Between 1996 and 2016, 879 adult patients underwent liver transplantation (LT), 26 of whom developed PLA. Patients and controls were matched according to the time from transplant to abscess in a 1 to 5 relation. A logistic regression model was performed to establish PLA risk factors considering clusters for matched cases and controls. Risk factors were identified and a multivariate regression analysis performed.Patients with post-LT PLA were more likely to have lower BMI (p = 0.006), renal failure (p = 0.031) and to have undergone retransplantation (p = 0.002). A history of hepatic artery thrombosis (p = 0.010), the presence of Roux en-Y hepatojejunostomy (p 0.001) and longer organ ischemia time (p = 0.009) were independent predictors for the development of post-LT PLA. Five-year survival was 49% (95%CI 28-67%) and 89% (95%CI 78%-94%) for post-LT PLA and no post-LT PLA, respectively (p 0.001).history of hepatic artery thrombosis, the presence of hepatojejunostomy and a longer ischemia time represent independent predictors for the development of post-LT PLA. There was a significantly poorer survival in patients who developed post-LT PLA compared with those who did not.

Resumen Introduccion Las hernias de disco lumbares son una causa frecuente de cirugia lumbar. La recurrencia herniaria es una complicacion prevalente. Objetivo Analizar los factores de riesgo asociados a recurrencia herniaria en pacientes intervenidos por hernia discal lumbar en nuestra institucion. Materiales y metodos Se analizaron en forma retrospectiva una serie de 177 microdiscectomias lumbares entre 2010 y 2014; se excluyeron pacientes con cirugias previas, hernias foraminales y extraforaminales. Los pacientes con recurrencia herniaria constituyeron el grupo de casos y los que no presentaron recurrencia fueron el grupo control; se analizo: sexo, edad, indice de masa corporal, nivel, degeneracion facetaria, altura discal y protrusion discal. Resultados Hubo 177 pacientes con microdiscectomia lumbar, de los cuales 30 (16%) presentaron recurrencia herniaria; de ellos, 27 fueron reoperados. Entre los factores de riesgo asociados a recurrencia observamos mayor indice de altura discal, mayor porcentaje de canal ocupado por la hernia y mayor presencia de cambios degenerativos facetarios; no observamos diferencias en cuanto al sexo, indice de masa corporal y edad. Discusion Estudios previos muestran el aumento de altura discal y pacientes jovenes como posibles factores asociados a recidiva. Conclusion En nuestra serie encontramos que el mayor indice de altura discal, el porcentaje de canal ocupado por la hernia y los cambios degenerativos facetarios se asociaron a recurrencia herniaria.

Introduction Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. Objective To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Materials and methods Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. Results 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. Discussion Previous studies show increased disc height and young patients as possible factors associated with recurrence. Conclusion In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence.

Crowding in Emergency Departments (ED), results from the imbalance between the simultaneous demand for health care and the ability of the system to respond. The NEDOCS scale (National Emergency Department Crowding Scale) measures the degree of crowding in an ED. Aim: To describe ED Crowding characteristics, using the NEDOCS scale, in an Argentinean hospital. Material and Methods: A retrospective cohort study was conducted with all adult patient consultations between July 2013 and July 2014 at the ED of Hospital Italiano de Buenos Aires. We included all hours in the analysis period (365 days x 24 h = 8,760). The NEDOCS value was calculated for each hour using an automatic algorithm and was quantified in a six points score. Levels 4 (overcrowded), 5 (severely overcrowded) and 6 (dangerously overcrowded) were defined as overcrowding. Contour plots analysis was applied to identify patterns. Results: During the study period, 124,758 visits to the ED were registered. Overcrowding was present in 57.7% (5,055) of the analyzed hours. A predominance of scores between four and five was observed between 10:00 and 24:00 hours. The months with predominance of overcrowding were June, July and August (southern winter). Conclusions: The calculation of the NEDOCS score and the analysis of its temporal distribution are highly relevant to identify opportunities for improvement and to develop mechanisms to prevent the highest categories of overcrowding

Background Around 47–74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. Results Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p

The Hereditary Hemorrhagic Telangiectasia (HHT) is a rare autosomal dominant vascular dysplasia that affects 1-5000 individuals worldwide. Is characterized by fragile mucocutaneous telangiectasia and vascular malformations in organs such as brain, lungs, liver and the gastrointestinal tract. Nose and gastrointestinal bleeding are remarkable, leading to frequent iron deficiency anemia (IDA) or life threatening bleeding episodes. Venous thromboembolic events (VTE) in HHT are probably more frequent than general population due to high plasmatic levels of FVIII specially in clinical conditions like long time immobilization due to brain abscesses or severe anemia. Additionally, in those patients with pulmonary fistula, the thromboembolic events can produce paradoxal strokes. On the other hand, almost all HHT medical treatments usually used to treat HHT related bleeding could produce thromboembolic disease. Anticoagulation (ACO) in this bleeding condition is a challenge, nevertheless, almost 50% can tolerate it well. Objective: To report the incidence of VTE in the HHT population. Methods: Ambispective cohort of adult based on the Institutional Registry of HHT. VTE was defined as the first episode of pulmonary embolism (PE), deep venous thrombosis (VTE) or thrombosis in the fistula sac or the progression of a prior event after its first 48 hs despite anticoagulation. Result: Over 524 patients 394 adults with HHT confirmed by Curazao criteria or positive genetic test and complete data were included. There were 18 VTE events 4.6% (CI95% 2.7-6.8%), 9 DVT (2.3% IC95% 1.2-4.4%) and 3 PE (0.7% IC95% 0.13-2%). The female gender represents 72%. The median age at the event was 67 years (IIQ 25-75% 56-73). Five patients (27%) were on ACO prior to the event, mainly for atrial fibrillation, and 3(18%) suffered a previous VTE. The most frequent risk factors were recent hospitalization (44%) and iron deficiency anemia (44%), immobility (33%), recent surgery (18%), as well as cancer (5%) and recent travel (5%) patient each.Fifteen (83%) patients received ACO, 10(55%) received LMH followed by acenocumarol, 3(30%) of which had to be stopped due to nose or gastrointestinal bleeding.In 5 (27%) a cava vein filter were inserted, of which 3 are under anticoagulation therapy. Conclusion: VTE incidence in our study was significantly higher than reported in general population at similar age. However, the inclusion of more symptomatic and serious HHT patients could be selection bias. The low number of patients, may influence the results. IDA and hospitalization were the most important associated conditions. Most patients tolerated well the anticoagulation therapy. Disclosures No relevant conflicts of interest to declare.

Background: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hip fracture is a common complication of osteoporosis in elderly patients. Hip fracture substantially increases the risk of death and major morbidity in the elderly patients. Limited data regarding hip fracture are available from Latin America and Argentina. The purpose of this project is to create an institutional registry of elderly patients with hip fracture in order to obtain data that reveal the impact of this disease in our environment, allowing us to evaluate different strategies of patient’s care and clinical outcomes. Objective: To describe the implementation of an institutional registry of elderly patients with hip fracture in Argentina. Methods: In this article, we described the creation, implementation, and data management of a prospective registry of elderly patients with hip fracture. The registry contains information on baseline demographics, comorbidities, laboratory, and radiological data. Follow-up at 3 and 12 months postfracture is done by phone interview to assess physical function, readmissions, and morbi-mortality. Clinical Trials registry number NCT02279550. Conclusion: In this project, we have created a hip fracture registry. We hope that this registry will provide valuable data that can lead us to new lines of research, addressed to answer questions raised in clinical practice.

The aim of this study is to report the effects of autologous PRP injections on time to return to play and recurrence rate after acute grade 2 muscle injuries in recreational and competitive athletes.Seventy-five patients diagnosed with acute muscle injuries were randomly allocated to autologous PRP therapy combined with a rehabilitation programme or a rehabilitation programme only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and recurrence rates were evaluated.Patients in the PRP group achieved full recovery significantly earlier than controls (P = 0.001). The mean time to return to play was 21.1 ± 3.1 days and 25 ± 2.8 days for the PRP and control groups, respectively (P = 0.001). Significantly lower pain severity scores were observed in the PRP group throughout the study. The difference in the recurrence rate after 2-year-follow-up was not statistically significant between groups.A single PRP injection combined with a rehabilitation programme significantly shortened time to return to sports compared to a rehabilitation programme only. Recurrence rate was not significantly different between groups.I.

Background A 48-year-old man with a recent diagnosis of multiple myeloma and rapidly progressive oliguric end-stage renal disease requiring hemodialysis, presented with a serum calcium concentration of 3.4 mmol/l (13.6 mg/dl). Investigations Serum laboratory analysis, electroencephalogram, MRI of the brain and bone marrow, and kidney biopsies. Diagnosis Hypercalcemia secondary to multiple myeloma. Management Short-term intravenous disodium pamidronate therapy (30 mg daily) and daily monitoring of serum calcium concentration.

We aimed to compare atenolol versus bisoprolol regarding general hemodynamics, central-peripheral blood pressure (BP), pulse wave parameters, and arterial stiffness. In this open-label, crossover study, we recruited 19 hypertensives, untreated or with stable monotherapy. Patients were randomized to receive atenolol (25-50 mg) or bisoprolol (2.5-5 mg), and then switched medications after 4 weeks. Studies were performed at baseline and after each drug period. In pulse wave analyses, both drugs significantly increased augmentation index (P < .01) and ejection duration (P < .02), and reduced heart rate (P < .001), brachial systolic BP (P ≤ .01), brachial diastolic BP (P ≤ .001), and central diastolic BP (P ≤ .001), but not central systolic BP (P ≥ .06). Impedance cardiographic assessment showed a significantly increased stroke volume (P ≤ .02). There were no significant differences in the effects between drugs. In conclusion, atenolol and bisoprolol show similar hemodynamic characteristics. Failure to decrease central systolic BP results from bradycardia with increased stroke volume and an earlier reflected aortic wave.

Cardiovascular risk factors (CRF) were widely described as related to dementia. There are very few studies regarding this association in FTD. The objective of the study was to compare the frequency of CRF in our population with FTD and controls. 100 consecutive subjects with FTD diagnosis according to Lund-Manchester clinical criteria and 200 controls matched by age and sex were included between January 2003 to February 2007 at the Cognitive and Behavior Unit of Hospital Italiano de Buenos Aires. Clinical evaluation, laboratory tests, brain images (CT/MRI), neuropsychological and neuropsychiatric assessment were performed. Multiple regression analysis was performed to analyze the association in CRF between FTD patients vs. controls. The mean age in FTD was 69.7 ± 0.9 vs. 70.1 ± 0.8 in controls (p 0.12). No difference in gender was observed between cases and controls. No differences were identified between patients and controls regarding hypertension (HTA) (65% vs. 67,3% p 0.44); dyslipidemia (57% vs. 54.7% p 0.74); obesity (39% vs. 27.6% p 0.14) and hypothyroidism (26% vs. 17.1% p 0.1). A significant difference was observed for Diabetes Mellitus (39% vs. 22.6% p 0.001). In our population, Diabetes Mellitus was associated as an independent risk factor for FTD. To our knowledge this is the first report in which CRF were evaluated prospectively in FTD patients. More studies are needed to confirm this finding in larger populations.

SummaryVenous thromboembolism (VTE) is a frequent complication following major abdominal surgery. The use of low-molecular-weight heparins (LMWH) to prevent thrombotic events in these patients is a common and well documented practice. However, there is some controversy surrounding the duration of the prophylaxis, as it has been suggested that the risk persists for several weeks after surgery.The objective of this meta-analysis is to systematically review the clinical studies that compared safety and efficacy of extended use of LMWH (for three to four weeks after surgery) versus conventional in-hospital prophylaxis. An electronic data base search was performed. Only randomized, controlled studies were eligible. Data on the incidence of deep vein thrombosis (DVT), VTE and bleeding were extracted. Only three studies fulfilled the inclusion criteria. The indication for surgery was neoplastic disease in 70.6% (780/1104) of patients. The administration of extended LMWH prophylaxis significantly reduced the incidence of VTE, 5.93% (23/388) versus 13.6% (55/405), RR 0.44 (CI 95% 0.28 – 0.7); DVT 5.93% (23/388) versus 12.9% (52/402), RR 0.46 (CI 95% 0,29 – 0,74); proximal DVT 1% (4/388) versus 4.72% (19/402), RR 0.24 (CI 95% 0.09 – 0,67). We found no significant difference in major or minor bleeding between the two groups: 3.85% (21/545) in the extended thrombo-prophylaxis (ETP) group versus 3.48% (19/559) in the conventional prophylaxis group; RR 1.12 (CI 95% 0.61 – 2.06). There was no heterogeneity between the studies. We conclude that ETP with LMWH should be considered as a safe and useful strategy to prevent VTE in high-risk major abdominal surgery.

El “gobierno del cambio” apostó a una continuidad de políticas económicas y políticas laborales del pasado. Aunque en su estilo de hacer política, con base de la mercadotecnia y del marketing, trató de conformar un imaginario público de que sí estaba trabajando para una transformación de los problemas estratégicos del país, pero todo quedó en cambios cosméticos que, pese a su superficialidad, se convirtieron en una condición para las acciones de los grupos políticos de oposición.