Buenos Aires, Argentina
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Eizmendi I.,University of San Pablo - CEU | Eizmendi I.,Hospital Donostia | Almendral J.,University of San Pablo - CEU | Hadid C.,University of San Pablo - CEU | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2012

We describe the case of a 61-year-old woman who underwent successful catheter cryoablation of a symptomatic Hisian ectopy. Diagnosis was based on features of the HV interval assessed from a bipolar recording during mapping. The location of the arrhythmic focus was identified using simultaneous unipolar and bipolar recordings of the His electrogram. This case report highlights the use of 2 new criteria for the diagnosis and mapping of Hisian ectopy, and the successful use of cryothermia for the ablation of extrasystoles arising from the His bundle. © 2011 Wiley Periodicals, Inc.


Escobar G.I.,National Laboratories And Insts Of Health Administration Anlis Dr Cg Malbran | Jacob N.R.,Hospital Cosme Argerich | Lopez G.,National University of Lomas de Zamora | Ayala S.M.,National Laboratories And Insts Of Health Administration Anlis Dr Cg Malbran | And 2 more authors.
Comparative Immunology, Microbiology and Infectious Diseases | Year: 2013

Seventeen workers in a pig slaughterhouse with signs and symptoms compatible with brucellosis were clinically examined at the outpatient service of different health institutions and studied by serological tests during the period 2005-2011. Eleven blood cultures were taken and six Brucella suis strains were isolated, three biovar 1 and three with atypical characteristics. In order to confirm that these cases had no common source, a variable number of tandem repeat (VNTR) analyses were performed on 5 of the 6 strains whose results showed substantial heterogeneity in the genotypes, thereby demonstrating that the immediate origin was not the same. Two hundred adult pigs admitted for slaughter at the plant were sampled by convenience and tested by buffered antigen plate test (BPAT), serum agglutination test (SAT) and 2-mercapto-ethanol test (MET). Seven of 62 males (11%) and 25/138 (18%) females tested positive. The study results contribute information on risk scenarios for packing plant workers and underscore the need to improve plant workers' education on appropriate containment measures and to actively screen animals for swine brucellosis. © 2013 Elsevier Ltd.


Macchia A.,Gesica Foundation Grupo Of Estudio Of Investigacion Clinica En Argentina | Macchia A.,Hospital Aleman | Rodriguez Moncalvo J.J.,Hospital Maria Ferrer | Kleinert M.,Hospital Cosme Argerich | And 7 more authors.
European Respiratory Journal | Year: 2012

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ≥60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ≥60-yr-old patients with clinically and spirometryconfirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients. Copyright©ERS 2012.


PubMed | Instituto Privado Of Especialidades Pediatricas Y Gineco Obstetricas, Hospital Cosme Argerich, Hospital Municipal Nuestra Senora del Carmen, Hospital Jose Ramon Vidal and 2 more.
Type: Journal Article | Journal: Diabetes & metabolic syndrome | Year: 2016

Obesity and its complications are emerging in an epidemic manner in Latin American countries.To estimate the prevalence of Cardio-Metabolic Risk Factors (CMRFs) and Metabolic Syndrome (MS) in overweight/obese (OW/OB) and normal weight (NW) adolescents and to examine the associated variables.A cross-sectional comparative study was conducted in two groups of children, between 10 and 19 years of age, in seven Argentine provinces. A survey on dietary habits, physical activity, anthropometric and biochemical data was collected to identify CMRF and MS. The WHO definition adapted to children was used.1009 children were assessed; 398 were male (39.4%), 601 (59.6%) were NW and 408 (40.4%) were OW/OB. The OW/OB had a significantly higher proportion of values defined as CMRF: 3.7% impaired fasting glucose >110mg/dl; 27.9% insulin >15 or 20U/l as they were pubertal/prepubertal; 53.2% Homeostatic Model Assessment (HOMA)>2.5; 45.6% High Density Lipoprotein (HDL)<40mg/dl; 37.7% TG>110mg/dl and 13.5% hypertension (SBP and/or diastolic Blood Pressure percentile >90). Prevalence of the MS in OW/OB patients was 40.3%. The MS was not observed in NW children. Significant differences were found for: family history of OW/OB, birth weight (BW), age at menarche, presence of acanthosis nigricans, waist circumference (WC) >90th percentile. The WC was positively correlated with BP, TG, insulin, HOMA and Body mass index Z score and negatively with HDL in the study population.We confirm obesity as a major determinant of CMRF and MS (40%), especially fat centralization. We stress the need to address obesity prevention plans in children and adolescents.


Lucero N.E.,National Laboratories And Institutes Of Health Administration Anlis Dr C G Malbran | Maldonado P.I.,Hospital Juan A Fernandez | Kaufman S.,Hospital Juan A Fernandez | Escobar G.I.,National Laboratories And Institutes Of Health Administration Anlis Dr C G Malbran | And 2 more authors.
Vector-Borne and Zoonotic Diseases | Year: 2010

From the blood culture of an HIV-positive patient with a febrile syndrome (CD4 count 385 cells/μL and viral load nondetectable), Brucella canis was isolated. The patient was presumptively infected from his dogs, which tested positive, and showed good outcome after the therapy with doxycycline- ciprofloxacin, and the HIV infection would seem not to have been influenced by brucellosis. To our knowledge, no other case of B. canis in the setting of HIV infection has been reported in the literature, and the emerging zoonotic potential of the disease in urban areas should be considered. © Copyright 2010, Mary Ann Liebert, Inc..


PubMed | University of the Republic of Uruguay, Hospital Britanico, University of Malaga, Hospital Cosme Argerich and 3 more.
Type: Journal Article | Journal: Liver international : official journal of the International Association for the Study of the Liver | Year: 2016

Cyproterone acetate (CPA), an anti-androgenic drug for prostate cancer, has been associated with drug-induced liver injury (DILI). We aim to expand the knowledge on the spectrum of phenotypes and outcomes of CPA-induced DILI.Twenty-two males (70 8 years; range 54-83) developing liver damage as a result of CPA therapy (dose: 150 50 mg/day; range 50-200) were included. Severity index and causality by RUCAM were assessed.From 1993 to 2013, 22 patients were retrieved. Latency was 163 97 days. Most patients were symptomatic, showing hepatocellular injury (91%) and jaundice. Liver tests at onset were: ALT 18 13 ULN, ALP 0.7 0.7 ULN and total serum bilirubin 14 10 mg/dl. International normalized ratio values higher than 1.5 were observed in 14 (66%) patients. Severity was mild in 1 case (4%), moderate in 7 (32%), severe in 11 (50%) and fatal in 3 (14%). Five patients developed ascitis, and four encephalopathy. One patient had a liver injury that resembled autoimmune hepatitis. Eleven (50%) were hospitalized. Nineteen patients recovered after CPA withdrawal, although three required steroid therapy (two of them had high ANA titres). Liver biopsy was performed in seven patients (two hepatocellular collapse, one submassive necrosis, two cholestatic hepatitis, one cirrhosis with iron overload and one autoimmune hepatitis). RUCAM category was highly probable in 19 (86%), probable in 1 (4%), and possible in 2 (9%).CPA-induced liver injury is severe and can be fatal, and may occasionally resemble autoimmune DILI. The benefit/risk ratio of this drug should be thoroughly assessed in each patient.


Dunovits C.,Hospital Cosme Argerich
Vertex (Buenos Aires, Argentina) | Year: 2012

Psychiatric manifestations in epilepsy allow us to explore the relationship between brain and behaviour, brain and the mind and brain and personality. This article reviews the available literature taking mania in the context of epilepsy to better understand the mechanisms that underlie this sindromatic expression and to serve as a starting point to improve our comprehension of our patients' clinical presentations. Additionally, mood as a cardinal symptom of mania is questioned as its epidemiology, clinical presentation, neurobiology and anatomoclinic findings are reviewed.


Hadid C.,Hospital Cosme Argerich
Cardiology Journal | Year: 2015

Ventricular arrhythmias are responsible for the majority of sudden cardiac deaths (SCD), particularly in patients with structural heart disease. Coronary artery disease, essentially previous myocardial infarction, is the most common heart disease upon which sustained ventricular tachycardia (VT) occurs, being reentry the predominant mechanism. Other cardiac conditions, such as idiopathic dilated cardiomyopathy, Chagas disease, sarcoidosis, arrhythmogenic cardiomyopathies, and repaired congenital heart disease may also present with VT in follow-up. Analysis of the 12-lead electrocardiogram (ECG) is essential for diagnosis. There are numerous electrocardiographic criteria that suggest VT with good specificity. The ECG also guides us in locating the site of origin of the arrhythmia and the presence of underlying heart disease. The electrophysiological study provides valuable information to establish the mechanism of the arrhythmia and guide the ablation procedure, as well as to confirm the diagnosis when dubious ECG. Given the poor efficacy of antiarrhythmic drug therapy, adjunctive catheter ablation contributes to reduce the frequency of VT episodes and the number of shocks in patients implanted with a cardioverter-defibrillator (ICD). ICD therapy has proven to be effective in patients with aborted SCD or sustained VT in the presence of structural heart disease. It is the only therapy that improves survival in this patient population and its implantation is unquestioned nowadays. © 2015 Via Medica.


Murage K.P.,Indiana University | Ball C.G.,Indiana University | Zyromski N.J.,Indiana University | Nakeeb A.,Indiana University | And 3 more authors.
Surgery | Year: 2010

Background: Disconnected left pancreatic remnant (DLPR) presents clinically as a pancreatic fistula, pseudocyst, or obstructive pancreatitis. Optimal operative treatment, either distal pancreatectomy (DP) or internal drainage (ID), remains unknown. This paper critically evaluates our operative experience in patients with DLPR. Methods: A retrospective analysis of a consecutive case series from a single, high-volume institution was carried out. A total of 76 patients with radiographic-confirmed DLPR (computed tomography + endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography) who had operations between November 1995 and September 2008 were included. Pancreas preservation (the use of ID) was our default unless anatomic, physiologic, or technical factors precluded it. Follow-up to July 2009 was done (median follow-up, 22 months). Standard statistical methodology was used (P < .05 = statistical significance). Results: The mean age of this cohort was 52 years (range, 18-85); 57% of the patients were male. A total of 59 (73%) had acute pancreatitis, whereas 17 (22%) had chronic pancreatitis. Presentation was pseudocyst in 53%, pancreatic fistula in 34%, and obstructive pancreatitis in 13%. Resection (DP) and drainage (ID) options were utilized equally for each clinical presentation as follows: pseudocyst, 60/40; pancreatic fistula, 50/50; or obstructive pancreatitis, 50/50. The strongest driver for DP (92%) was a small pancreatic remnant and splenic vein thrombosis. In contrast, large pancreatic remnants had ID 70% of the time. No differences in short- or long-term outcomes between DP or ID options were identified. Conclusion: Using anatomic, physiologic, and technical factors to guide operative choice in DLPR, we report a 74% success rate with DP and an 82% success rate with ID at a median follow-up of 22 months. A pancreatic remnant size >6 cm favored ID options over resection. © 2010 Mosby, Inc. All rights reserved.


PubMed | Hospital Cosme Argerich
Type: Journal Article | Journal: Journal of the International Association of Providers of AIDS Care | Year: 2016

The use of alternative medicines, including herbs, is common among HIV-positive patients, even in those on antiretroviral treatment. Equisetum arvense, known as horsetail, is mainly used for its diuretic properties. There are limited data about the pharmacological properties of this compound and the potential drug-herb interactions. The authors report 2 cases in which a possible drug-herb interaction may have led to virological breakthrough in patients who were maintained on the same regimen for many years, including lamivudine (3TC)/zidovudine (ZDV)/efavirenz (EFV) and emtricitabine (FTC)/tenofovir (TDF)/EFV, respectively. Therefore, a drug-herb interaction may be expected when these agents are taken concurrently. Until additional data are available, the authors advise clinicians to avoid this combination when possible.

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