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Ayus J.C.,Director of Clinical Research | Ayus J.C.,Hospital Italiano | Caputo D.,Hospital Alejandro Posadas | Heguilen R.,Hospital Fernandez | And 2 more authors.
American Journal of Kidney Diseases | Year: 2015

Background 3% sodium chloride solution is the accepted treatment for hyponatremic encephalopathy, but evidence-based guidelines for its use are lacking. Study Design A case series. Setting & Participants Adult patients presenting to the emergency department of a university hospital with hyponatremic encephalopathy, defined as serum sodium level < 130 mEq/L with neurologic symptoms of increased intracranial pressure without other apparent cause, and treated with a continuous infusion of 500 mL of 3% sodium chloride solution over 6 hours through a peripheral vein. Predictors Hyponatremic encephalopathy defined as serum sodium level < 130 mEq/L with neurologic symptoms of increased intracranial pressure without other apparent cause. Outcomes Change in serum sodium level within 48 hours, improvement in neurologic symptoms, and clinical evidence of cerebral demyelination, permanent neurologic injury, or death within 6 months' posttreatment follow-up. Results There were 71 episodes of hyponatremic encephalopathy in 64 individuals. Comorbid conditions were present in 86% of individuals. Baseline mean serum sodium level was 114.1 ± 0.8 (SEM) mEq/L and increased to 117.9 ± 1.3, 121.2 ± 1.2, 123.9 ± 1.0, and 128.3 ± 0.8 mEq/L at 3, 12, 24, and 48 hours following the initiation of 3% sodium chloride solution treatment, respectively. There was a marked improvement in central nervous system symptoms within hours of therapy in 69 of 71 (97%) episodes. There were 12 deaths, all of which occurred following the resolution of hyponatremic encephalopathy and were related to comorbid conditions, with 75% of deaths related to sepsis. No patient developed neurologic symptoms consistent with cerebral demyelination at any point during the 6-month follow-up period. Limitations Lack of a comparison group and follow-up neuroimaging studies. Number of cases is too small to provide definitive assessment of the safety of this protocol. Conclusions 3% sodium chloride solution was effective in reversing the symptoms of hyponatremic encephalopathy in the emergency department without producing neurologic injury related to cerebral demyelination on long-term follow-up in this case series. © 2015 National Kidney Foundation, Inc.


Preti M.,University of Turin | Scurry J.,Anatomical Pathologist | Marchitelli C.E.,Hospital Italiano | Micheletti L.,University of Turin
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2014

Vulvar intraepithelial neoplasia (VIN) is a high-grade intraepithelial squamous lesion and precursor of invasive squamous cell carcinoma (SCC). The 2004 International Society for the Study of Vulvovaginal Disease (ISSVD) classification distinguished two types of VIN: usual type (human papillomavirus (HPV)-related) and differentiated type (not HPV-related). The incidence of usual-type VIN is higher in younger women, while differentiated-type VIN is more common in older patients with chronic dermatologic conditions. Differentiated-type VIN has a greater invasive potential and shorter time between diagnosis and SCC than usual-type VIN. The diagnosis of VIN is carried out by identifying a lesion by visual inspection and confirming by performing a biopsy. Screening tests are not available. Patients with usual-type VIN are at a higher risk of developing another HPV-related malignancy of the anogenital tract; therefore, examination from the cervix to the perianal area is mandatory. The therapeutic approach to VIN balances the invasive potential with the need to be as conservative as possible. Current prophylactic HPV vaccines offer protection against usual-type VIN and related invasive carcinoma. © 2014 Elsevier Ltd.


Morey A.F.,Southwestern Medical School | Watkin N.,St Georges Hospital | Shenfeld O.,Shaare Zedek Medical Center | Eltahawy E.,Ain Shams University | Giudice C.,Hospital Italiano
Urology | Year: 2014

The management of primary and recurrent bulbar urethral stricture disease has been a source of controversy with the choice being between endoscopic urethrotomy and open urethroplasty. Further debate exists with regard to the choice of urethroplasty - either excision and primary anastomosis (EPA) or augmentation with a graft or flap. Using PubMed, a 35-year literature search was conducted (1975-2010) for peer-reviewed articles on bulbar strictures treated using EPA. Exclusions included articles with <10 patients, duplications, reviews, or in which the cohort was mixed and the data could not be separately analyzed. Seventeen articles fulfilled the criteria with a total of 1234 patients. Overall success was 93.8%. Reported complications were <5%, and there was no evidence of persistent loss of sexual function. The authors conclude that EPA is associated with a high success rate with low complication rate. Our recommendation is that it should be performed in patients with short isolated bulbar strictures, when expected success rates of other procedures are <90%. © 2014 Elsevier Inc.


Hersh W.,Oregon Health And Science University | Margolis A.,Federacion Medica del Interior FEMI | Quiros F.,Hospital Italiano Of Buenos Aires Hiba | Otero P.,Hospital Italiano
Health Affairs | Year: 2010

Information and communication technology can be used to improve the quality and safety of health care and to lower costs. But in both developed and developing countries, there is an inadequate supply of skilled individuals who have the technical skills to use this technology to improve health care. Some studies project workforce needs of tens of thousands in English-speaking developed countries, but it is not known what size workforce will be required in the developing world. It is important to identify and develop the skills, training, and competencies-consistent with local cultures, languages, and health systems-that will be needed to realize the full benefits of these technologies. We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed. © 2010 Project HOPE-The People-to-People Health Foundation, Inc.


Leborgne F.,Hospital Italiano | Fowler J.,University of Wisconsin - Medical School | Leborgne J.H.,Hospital Italiano | Mezzera J.,Hospital Italiano
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: Now that the follow-up time has exceeded 5 years, an estimate of the α/β ratio can be presented. The additional late outcomes in patients treated with three-dimensional conformal external beam radiotherapy for localized prostate cancer using a hypofractionated vs. a standard fractionation regimen are reported from this prospective nonrandomized contemporary comparison. Methods and Materials: A total of 114 nonrandomized patients chose hypofractionation delivered in 20 fractions of 3 Gy or 3.15 Gy (mean 3.06 Gy) for localized prostate cancer within a median overall time of 32 days (range, 29-49) using four fractions weekly. A total of 160 comparable patients were contemporarily treated within a median of 55 days (range 49-66). The median follow-up was 66 months (range, 24-95) for the hypofractionated arm and 63 months (range, 36-92) for the standard arm. The percentage of patients in the low-, medium-, and high-risk groups was 36%, 46%, and 18% in the hypofractionated arm and 44%, 50%, and 6% in standard arm (2 Gy), respectively. Results: The 5-year actuarial biochemical absence of disease (prostate-specific antigen nadir + 2 ng/mL) and disease-free survival rate was the same at 89% in both arms, making the α/β calculation unambiguous. The point ratio of α/β was 1.86 (95% confidence interval, 0.7-5.1 Gy). The 95% confidence interval was determined entirely by the binomial confidence limits in the numbers of patients. Rectal reactions of grade 3 and 4 occurred in 1 of 114 (hypofractionated) and 2 of 160 (standard) patients. Conclusions: The presented three-dimensional conformal regimen was acceptable, and the α/β value was 1.8, in agreement with other very recent low meta-analyses (reviewed in the "Discussion" section). © 2012 Elsevier Inc.


Rozenfeld P.,National University of La Plata | Neumann P.M.,Hospital Italiano
Current Pharmaceutical Biotechnology | Year: 2011

Fabry disease is an X-linked lysosomal storage disorder (LSD) due to deficiency of the enzyme α-galactosidase A (GLA). Absent or reduced enzyme activity leads to impaired catabolism of neutral glycosphingolipids, particularly globotriaosylceramide (Gb3), resulting in intracellular deposition of such lipids. Clinical manifestations in hemizygote males include angiokeratoma, hypohydrosis, acroparesthesia, abdominal pain, proteinuria, renal insufficiency, left ventricular hypertrophy and cerebrovascular accidents. Heterozygote women may present with mild to severe signs and symptoms. Since year 2001, enzyme replacement therapy (ERT) is the only specific treatment for Fabry disease. The beneficial effect of ERT on different organs/systems has been extensively evaluated, and an improvement in renal function, cardiac mass and quality of life has been reported. Different treatment approaches are currently on development. One of them implies the use of the active-site-specific chaperone 1-deoxygalactonojirimycin that acts facilitating folding of mutant GLA in the endoplasmic reticulum and increasing its lysosomal residual activity. Reduction of Gb3 deposits has been shown in lymphoblasts from Fabry patients with missense mutations and transgenic mouse model expressing a missense mutation GLA. Gene therapy has been also developed as a potential option for treatment of Fabry disease. This review will discuss these novel therapeutic options along with their advantages and limitations. © 2011 Bentham Science Publishers Ltd.


Lifschitz C.,Hospital Italiano
Acta Scientiarum Polonorum, Technologia Alimentaria | Year: 2012

The purpose of this review is to present information regarding new effects for certain nutrients other than those traditionally known. Zinc has been found to prevent and reduce the duration of common colds. In developing countries, zinc has been shown to reduce the duration and severity of diarrhea and even decrease relapses. Iron supplementation in iron deficient children, has been shown to improve several aspects of brain function. In studies where iron was given to the mother, 3 of 5 randomized, controlled trials showed a beneficial effect of iron supplementation on the Psychomotor Development Index at some time points, whereas 2 did not. The chances for infants supplemented with docosahexaenoic acid in the first year of life of having at least 1 event of allergic manifestation or upper respiratory infection or at least 1 event of wheezing/asthma, wheezing/asthma/atopic dermatitis, any allergy, or an upper respiratory tract infection during the first 3 years of life were significantly lower than in the non supplemented group. Epidemiological studies have established a relationship between low levels of serum vitamin D and reduced lung function in healthy adults and asthma onset and severity in children. There was a trend for an independent association between higher levels of maternal circulating 25(OH)D3 levels in pregnancy and decreased odds of lower respiratory tract infections in offspring. © Copyright by Wydawnictwo Uniwersytetu Przyrodniczego w Poznaniu.


Orsi M.,Hospital Italiano
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina) | Year: 2011

To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. The decrease in GER parameters that is observed after a mean of 22.8 mos. of age is at the expense of non AR. This finding may have an impact on the choice and results of therapeutic modalities in children versus that in infants.


Lifschitz C.,Hospital Italiano
Annals of Nutrition and Metabolism | Year: 2015

Approximately 5-20% of children worldwide suffer from atopic dermatitis (AD), a kind of dermatitis characterized as an inflammatory, relapsing, noncontagious and itchy skin disorder. Children often develop AD during their first year of life. An increased rate of sensitization to both food and aeroallergens has been shown to coexist in patients with AD. Sensitization to well-known allergens such as cow's milk protein can occur on average in 50% of children with AD. In general, quality of life (QoL) is perceived as the quality of an individual's daily life, that is, an assessment of their well-being or lack thereof. QoL is a broad concept that includes such things as standard of living, community, and family life. Patients with skin diseases experience a wide range of symptoms ranging from trivial problems to major handicaps which affect their lives. The misery of living with AD cannot be overstated for it may have a profoundly negative effect on the health-related QoL of children and their families in many cases. Physicians taking care of children with AD should consult parents on how their child's illness has impacted their lifestyle and recommend professional intervention if deemed necessary. © 2015 S. Karger AG, Basel.


Marciano S.,Hospital Italiano | Gadano A.C.,Hospital Italiano
Liver International | Year: 2014

The standard of care (SOC) for hepatitis C virus (HCV) genotype 2 is pegylated interferon (PEG-IFN) plus ribavirin (RBV). Even though most patients can be cured with this therapy after 24 weeks, tailoring treatment can improve its safety and efficacy in special populations. Thus, shortening treatment together with a weight-based RBV dosing approach has been considered satisfactory in patients with positive predictors of response. With the development of the direct antiviral agents (DAAs), shorter, better tolerated and more efficient treatments for HCV genotype 2 will become available, including interferon-free regimens. Until these new treatments are released, the decision to treat patients with HCV genotype 2 with currently approved drugs or to wait for future options must be made, taking into account the stage of fibrosis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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