Hospital Britanico

Buenos Aires, Argentina

Hospital Britanico

Buenos Aires, Argentina
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Fernandez N.,Hospital Britanico | Reggiardo M.V.,Hospital Provincial del Centenario Sanatorio Americano
Annals of Hepatology | Year: 2010

Background. Efficacy and safety of Pegylated Interferon alfa (PegIFN)-Ribavirin (RBV) for the treatment of chronic hepatitis C (CHC) in routine clinical practice seems to be comparable with results of randomized-controlled trials. Aims. To evaluate the efficacy, tolerability and safety of CHC treatment with PegIFN + RBV in "real world" patients in Argentina and to analyze factors associated with SVR. Methods. Medical records of patients treated according to current guidelines from 2001 to 2008 were reviewed. Results. 235 patients were included and 80.8% completed treatment. Discontinuation occurred in 7.6% due to adverse events (AE), and 1.2% dropped-out treatment. Overall SVR was 60.8%. Multivariate analysis demonstrated that being naive (p 0.031) and low basal viral load (p 0.006) were associated with SVR, whereas F3-F4 (p 0.001) and elevated ALT (p 0.023) were associated with non-response. 80% of planned doses completed was associated with 74% SVR (p <0.001). At least one AE was reported in 93.6% of the patients: neutropenia in 27.6%, thrombocytopenia in 15.3%, anemia in 38.7%, psychiatric symptoms in 63.4%, thyroid dysfunction in 10.2%. Conclusion. Efficacy, tolerability and safety of treatment of CHC in daily practice in Argentina are similar to those reported in randomized controlled trials.

Terg R.,Hospital Bonorino Udaondo | Casciato P.,Hospital Italiano | Garbe C.,Hospital Alejandro Posadas | Cartier M.,Hospital Bonorino Udaondo | And 12 more authors.
Journal of Hepatology | Year: 2015

Background & Aim Retrospective studies show an association between proton pump inhibitor (PPI) therapy and spontaneous bacterial peritonitis (SBP). We investigate the relationship between PPI and SBP in decompensated cirrhotic patients in a large nationwide prospective study. Methods Seven hundred seventy patients with a diagnosis of decompensated cirrhosis were admitted consecutively in 23 hospitals in Argentina from March 2011 to April 2012; the patients were carefully investigated for PPI consumption in the previous 3 months. In total, 251 patients were excluded because of active gastrointestinal hemorrhage, antibiotic use during the preceding weeks, HIV-positive status and immunosuppressive therapy. Results Two hundred twenty-six out of 519 patients (43.5%) had received PPI therapy within the last 3 months. In 135 patients, PPIs were administered for longer than 2 weeks. A bacterial infection was shown in 255 patients (49.1%). SBP was diagnosed in 95 patients out of 394 patients with ascites (24.7%). There was no significant difference in the rate of PPI consumption between the infected and the non-infected patients (44.3% vs. 42.8%) or between the SBP patients and the patients with ascites without SBP (46% vs. 42%). In the SBP patients, the duration of PPI administration did not influence the rate of SBP occurrence. The type of bacteria and the origin of SBP infection were similar in the patients with and without PPI. Conclusion In the current large, multicenter, prospective study, PPI therapy, specifically evaluated at admission of consecutive cirrhotic patients, was not associated with a higher risk of SBP. © 2014 European Association for the Study of the Liver.

Duvoux C.,Service dHepatologie | Firpi R.,University of Florida | Grazi G.L.,Instituto Nazionale Dei Tumori Regina Elena | Levy G.,University of Toronto | And 2 more authors.
Transplant International | Year: 2013

Recurrence of hepatitis C virus infection following liver transplantation (LT) for hepatitis C is universal. After LT, hepatitis C is associated with accelerated fibrosis progression and reduced graft and patient survival. Furthermore, responses to antiviral therapy in patients with recurrent hepatitis C virus post-transplant are consistently sub-optimal. Calcineurin inhibitors (CNIs) like cyclosporine A (CsA) and tacrolimus continue to dominate immunosuppressive regimens in this population; however, there is still uncertainty as to whether either offers an advantage in terms of patient outcomes. Although tacrolimus demonstrates improved efficacy in the general LT population, differences have begun to emerge between these agents regarding diabetogenic potential, antiviral activity, and fibrosis progression in patients with hepatitis C. This review critically evaluates the existing literature, providing an overview of the reported differences, concluding that despite conflicting evidence, a potential benefit of CsA in patients with hepatitis C is supported by the data and warrants further investigation. Future studies examining the role of CNIs in hepatitis C virus-positive LT recipients are required to accurately examine the effects of CNIs on outcomes such as fibrosis progression, survival, and effects on response to antiviral therapy, to provide robust information that allows clinicians to make an informed choice concerning which CNI is best for their patients. © 2013 The Authors Transplant International © 2013 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.

Rami-Porta R.,University of Barcelona | Bolejack V.,Cancer Research And Biostatistics | Crowley J.,Cancer Research And Biostatistics | Ball D.,Peter MacCallum Cancer Center | And 7 more authors.
Journal of Thoracic Oncology | Year: 2015

Introduction: An international database was collected to inform the 8th edition of the anatomic classification of lung cancer. The present analyses concern its primary tumor (T) component. Methods: From 1999 to 2010, 77,156 evaluable patients, 70,967 with non-small-cell lung cancer, were collected; and 33,115 had either a clinical or a pathological classification, known tumor size, sufficient T information, and no metastases. Survival was measured from date of diagnosis or surgery for clinically and pathologically staged tumors. Tumor-size cutpoints were evaluated by the running log-rank statistics. T descriptors were evaluated in a multivariate Cox regression analysis adjusted for age, gender, histological type, and geographic region. Results: The 3-cm cutpoint significantly separates T1 from T2. From 1 to 5 cm, each centimeter separates tumors of significantly different prognosis. Prognosis of tumors greater than 5 cm but less than or equal to 7 cm is equivalent to T3, and that of those greater than 7 cm to T4. Bronchial involvement less than 2 cm from carina, but without involving it, and total atelectasis/pneumonitis have a T2 prognosis. Involvement of the diaphragm has a T4 prognosis. Invasion of the mediastinal pleura is a descriptor seldom used. Conclusions: Recommended changes are as follows: to subclassify T1 into T1a (≤1 cm), T1b (>1 to ≤2 cm), and T1c (>2 to ≤3 cm); to subclassify T2 into T2a (>3 to ≤4 cm) and T2b (>4 to ≤5 cm); to reclassify tumors greater than 5 to less than or equal to 7 cm as T3; to reclassify tumors greater than 7 cm as T4; to group involvement of main bronchus as T2 regardless of distance from carina; to group partial and total atelectasis/pneumonitis as T2; to reclassify diaphragm invasion as T4; and to delete mediastinal pleura invasion as a T descriptor. © 2015 by the International Association for the Study of Lung Cancer.

Mosovich J.H.,Hospital Naval Buenos Aires Cirujano Mayor Dr Pedro Mallo | Young P.,Hospital Britanico
Medicina (Argentina) | Year: 2012

Olindias sambaquiensis jellyfish sting occurs frequently in Buenos Aires province coast beaches. Among five hundred and one thousand stings by jellyfish are reported each season at Monte Hermoso, a beach village in the South of Buenos Aires province. The skin damage provoked because of its highly irritant effect poses a serious issue related to tourism development. A total number of 49 cases that were examined during the first hour after the sting were enrolled in Monte Hermoso during January 1998. Twenty eight were males (57.1%). The average age was 16 ± 4.1 (range 5-80). Of them, 54% showed linear erythema-edematous lesions, 28% showed predominantly erythematous lesions, and in 18% the injuries were erythema-edematous plaques. In 73% of the cases the lesions were located in lower limbs. We had hereby redefined cutaneous lesions produced by O. sambaquiensis, its evolution, its dimensions and most frequent localizations. Besides, it has been typified and quantified the pain it provokes and other signs and symptoms that go with the sting during the posterior hour, during the first 24 hours, and after 30 days. We described the therapeutic conducts used in our coasts and we assessed the effectiveness of some of them in pain control, and finally we propose a therapeutic scheme for this sting.

Jimenez-Ruiz C.A.,Smoking Cessation Service | Barrios M.,Hospital Britanico | Pena S.,Hospital Britanico | Cicero A.,Smoking Cessation Service | And 3 more authors.
Mayo Clinic Proceedings | Year: 2013

Varenicline is a partial agonist of a4b2 nicotinic acetylcholine receptors. It is effective at dosages of 2 mg/d for 12 weeks, but not for all smokers. It is possible that increasing the dose can increase the drug efficacy. We reviewed the clinical records of consecutive smokers who had been treated in 2 smoking cessation services with varenicline at doses of 3 mg/d. In all cases, the treatment program consisted of a combination of behavioral therapy and drug treatment. Varenicline was prescribed at a standard dosage for 8 weeks. After 8 weeks of treatment, the dose was increased to 3 mg/d if patients tolerated varenicline well and continued smoking or, in spite of not smoking, if they experienced severe withdrawal symptoms. The sample included 73 patients, of whom 52 continued to smoke at 8 weeks and 21 stopped smoking but reported severe withdrawal discomfort. Carbon monoxide-validated continuous abstinence rates from week 9 to week 24 were 40% and 48% in these 2 subgroups, respectively. The increase in dosage was associated with adverse events in 22 patients (30%). These were mostly mild and included nausea, vomiting, abnormal dreams, and insomnia. Only 2 patients discontinued treatment (both because of nausea and vomiting). Thus, we conclude that increasing the varenicline dose in smokers who do not respond to the standard dose after 8 weeks of treatment is associated with limited adverse events and high success rates. © 2013 Mayo Foundation for Medical Education and Research.

Castro M.,Instituto Angel H Roffo | Grau L.,Tumor Markers Group | Puerta P.,Tumor Markers Group | Gimenez L.,Instituto Angel H Roffo | And 3 more authors.
Journal of Translational Medicine | Year: 2010

Background: Changes in DNA methylation of crucial cancer genes including tumor suppressors can occur early in carcinogenesis, being potentially important early indicators of cancer. The objective of this study was to examine a multiplexed approach to assess the methylation of tumor suppressor genes as tumor stratification and clinical outcome prognostic biomarkers for lung cancer.Methods: A multicandidate probe panel interrogated DNA for aberrant methylation status in 18 tumor suppressor genes in lung cancer using a methylation-specific multiplex ligation-dependent probe amplification assay (MS-MLPA). Lung cancer cell lines (n = 7), and primary lung tumors (n = 54) were examined using MS-MLPA.Results: Genes frequently methylated in lung cancer cell lines including SCGB3A1, ID4, CCND2 were found among the most commonly methylated in the lung tumors analyzed. HLTF, BNIP3, H2AFX, CACNA1G, TGIF, ID4 and CACNA1A were identified as novel tumor suppressor candidates methylated in lung tumors. The most frequently methylated genes in lung tumors were SCGB3A1 and DLC1 (both 50.0%). Methylation rates for ID4, DCL1, BNIP3, H2AFX, CACNA1G and TIMP3 were significantly different between squamous and adenocarcinomas. Methylation of RUNX3, SCGB3A1, SFRP4, and DLC1 was significantly associated with the extent of the disease when comparing localized versus metastatic tumors. Moreover, methylation of HTLF, SFRP5 and TIMP3 were significantly associated with overall survival.Conclusions: MS-MLPA can be used for classification of certain types of lung tumors and clinical outcome prediction. This latter is clinically relevant by offering an adjunct strategy for the clinical management of lung cancer patients. © 2010 Castro et al; licensee BioMed Central Ltd.

Valle E.E.D.,University of Salvador | Negri A.L.,University of Salvador | Spivacow F.R.,University of Salvador | Rosende G.,Hospital Fernandez | And 2 more authors.
Urological Research | Year: 2012

It is known that several metabolic abnormalities that favor stone formation have a strong dependence on environmental and nutritional factors. The incidence and prevalence of kidney stone is increasing while there has been a parallel growth in the overweight/obesity rate, and epidemiologic studies have shown a signiWcant association between overweight/obesity and increased nephrolithiasis risk. The aim of this study was to assess if metabolic abnormalities observed in stone patients diVer in relation to their BMI. We evaluated 817 renal stone formers (459 men and 358 woman) in an outpatient setting. They were all studied with a standard protocol (two 24 h urine collections and serum parameters) and classiWed according to their BMI in normal, overweight and obese and according to age in <50 or >50 year old. In the whole population we found that 58.7% were either overweight or obese: 39.4% (n = 322) were OW and 19.3% (n = 158) were OB. The proportion of overweight was signiWcantly higher among men than women. In women of all ages regardless of BMI, hypercalciuria was the most prevalent diagnosis. Hyperuricosuria increased its prevalence signiWcantly only in overweight and obese women <50 years of age (p < 0.01). Hypercalciuria was the predominant diagnosis in normal weight men of both age groups. Hyperuricosuria was the most frequent abnormality in overweight and obese men followed by gouty diathesis and both increased their prevalence signiWcantly from normal weight to obesity and in both age groups (p < 0.05 and <0.01). We conclude that the only abnormalities that increased their prevalence signiWcantly with increasing BMI were hyperuricosuria and gouty diathesis, the Wrst one in men of all ages and women under 50 years of age, while the second one only in men. © Springer-Verlag 2011.

Young P.,Hospital Britanico
Revista Medica de Chile | Year: 2014

Appendicitis is a common cause of acute abdominal pain. It is caused by the obstruction of the cecal lumen and can evolve to perforation and peritonitis. This article reviews the initial description and history of appendicitis and describes the signs and symptoms used for diagnosis. In today's medicine, where technology plays an important role, the value of anamnesis and physical examination should be stressed as useful tools.

There are various region-specific challenges to the diagnosis and effective treatment of venous thromboembolism in Latin America. Clear guidance for physicians and patient education could improve adherence to existing guidelines. This review examines available information on the burden of pulmonary embolism and deep vein thrombosis in Latin America and the regional issues surrounding the diagnosis and treatment of pulmonary embolism and deep vein thrombosis. Potential barriers to appropriate care, as well as treatment options and limitations on their use, are discussed. Finally, an algorithmic approach to the diagnosis and treatment of venous thromboembolismin ambulatory patients is proposed and care pathways for patients with pulmonary embolism and deep vein thrombosis are outlined for primary care providers in Latin America. © 2016 CLINICS.

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