Medicina
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Review
[Recommendations For The Management Of Spontaneous Intracerebral Hemorrhage During Hospitalization].
Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracerebral hemorrhage during hospitalization. ⋯ Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.
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Unlike medications that contain fixed-dose combinations, such as those recommended by clinical guidelines for treating high blood pressure, the so-called polypills contain several drugs that simultaneously treat two or more cardiovascular conditions or risk factors. They were proposed 2 decades ago, both for primary and secondary prevention with the hypothesis that they could have wide dissemination and population penetration, improving the use of therapeutics with proven benefits individually, thanks to an increase in patient adherence by reducing the number of daily tablets and also by having an equal or lower cost. ⋯ Additionally, we review the clinical messages of the HOPE-3 trial, which aim to control two of the most prevalent conditions, such as high blood pressure and high cholesterol, through a combination of candesartan, hydrochlorothiazide and rosuvastatin. Finally, we propose its potential indication in a heterogeneous health system such as that of our country, both at the population level based on intermediate or low risk, determined intuitively or using a risk calculator, as well as in the personalized care that is practiced in many health scenarios.
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Multicenter Study
[Incidence and clinical characteristics of patients with ST-elevation acute myocardial infarction without obstructive coronary disease (MINOCA)].
MINOCA is an acute myocardial infarction without obstructive coronary disease, this definition was recently incorporated into the 4th universal definition of myocardial infarction. However, since it is an unconventional ischemic coronary syndrome in clinical practice, its etiology is very complex to elucidate and requires a differential diagnosis process to rule out other causes of cardiac injury. The objective of this study is to characterize patients with acute myocardial infarction without significant obstructive lesions included in the Argentine Registry of STsegment Elevation Myocardial Infarction (ARGEN-IAM-ST). ⋯ There was no predominance of the female gender as in other series. In-hospital mortality is high despite not having significant coronary disease. It is worth mentioning the low use of dual antiaggregating and statins.
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Trans man is a biological female person with male gender identity, who can choose to receive a genderaffirming hormone treatment with testosterone. So far, the effects of this treatment on reproduction are unclear. Anti-müllerian hormone levels were evaluated in trans men during short-term testosterone treatment. ⋯ By the time of the semi-ünnual or annual control of the hormonal firming treatment, all the individuals managed to reach testosterone levels within the reference range of the male population (3-9 ng/ml). However, no significant differences were observed in antimüllerian hormone levels(p 0.7630) before and after 6 to 12 months of starting treatment with testosterone. Our study revealed that, despite the high biological variability of the antimüllerian hormone, no significant changes in its levels were observed during the firming hormone treatment in trans men.
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Since May 2022, monkeypox cases have been reported in non-endemic countries with different characteristics from the traditional description of the disease, predominantly in men who have sex with men, with possible sexual transmission and with no documentation of mortality to date. We report what would be the first patient diagnosed in Argentina with no travel nexus to countries with viral circulation. Young, bisexual man, on antiretroviral HIV pre-exposure prophylaxis, whose presentation was exudative pharyngitis with no other documented aetiology and lymphadenopathy that progressed to necrosis, presence of characteristic asynchronous lesions on the face, neck, abdomen, extremities, and genitals, in a total of no more than 25. ⋯ The finding of the virus in semen, already reported in other publications, is still not enough to confirm the sexual route as a form of transmission. In conclusion: Our case warns about other possible forms of presentation of epidemic monkeypox and the need to increase the level of suspicion for its early detection as a strategy to prevent dissemination and protect vulnerable groups. Even more information is required to determine the sexual transmission of this disease.