Servicio de Clinica Medica

Rosario del Tala, Argentina

Servicio de Clinica Medica

Rosario del Tala, Argentina
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Seculini Patino C.E.,Servicio de Clinica Medica | Pascualini M.F.,Servicio de Dermatologia | Tabares A.H.,Hospital Privado Centro Medico Of Cordoba | Tabares A.H.,Instituto Universitario Of Ciencias Biomedicas Of Cordoba Iucbc
Medicina (Argentina) | Year: 2015

Successful treatment with fondaparinux in heparin-induced thrombocytopenia and thrombosis. Heparin induced thrombocytopenia (HIT) is an immune-mediated adverse reaction characterized by thrombocytopenia and paradoxical arterial or venous thrombosis, due to the formation IgG antibodies directed to a multimolecular complex of heparin-platelet factor 4 (PF4). Fondaparinux is a selective factor Xa inhibitor with little affinity for PF4 and thus less likely to induce an immune response, making fondaparinux a potentially use - ful drug for the treatment of HIT. Herein we report the case of a 73 years old woman with HIT associated with arterial and venous thrombosis that was successfully treated with fondaparinux, with normalization of the platelet countand without progression of thrombosis. © 2015 Instituto de Investigaciones Medicas. All rights reserved.


Daza Lopez J.L.,University of Buenos Aires | Segovia F.,University of Buenos Aires | Abeledo D.,Servicio de Clinica Medica | De Rosa M.,University of Buenos Aires | And 2 more authors.
Revista de Nefrologia, Dialisis y Trasplante | Year: 2016

Introduction: Although focal lupus nephritis (FLN) with extracapillary proliferation (ECP) is usually found in renal biopsies, little is known about its course. This study was carried out to investigate the correlation of clinical, histological and laboratory findings in these patients’ progress. Objective: To analyze focal or diffuse proliferative lupus nephritis biopsies (class III and IV, according to WHO) and their development regarding the level of extracapillary proliferation throughout a period of 10 years at Hospital de Clínicas ‘José de San Martín’. Methods: In this retrospective observational study, 147 patients with class III or IV GN were observed for 10 years. According to the degree of extracapillary proliferation, they were divided into the following groups: group 1 (5%-<25% of crescents, n=33), group 2 (25%-50% of crescents, n=34) and group 3 [>50% of crescents, i.e. diffuse proliferative nephritis (DPN), n=20]. Patients suffering from class III and IV lupus nephritis with no extracapillary proliferation formed the control group (n=60). After one year, clinical and laboratory findings as well as the development of the condition among the four groups were compared to assess their level of remission. Complete remission was considered as defined in KDIGO 2012 Guideline. A univariate logistic regression analysis and a subsequent multivariate one were performed. Results: There were 124 women (84.35%) and 23 men (15.65%) with an average age of 35±10. The average age in the control group was 32±10. The univariate analysis showed a greater number of patients who achieved complete remission in the control group with an odds ratio of 0.05 (0.02-0.12) p=0.001, whereas in the 3 groups with extracapillary proliferation fewer patients reached this state, even in group 1, which had an odds ratio of 7.61 (2.42-23.9) and p=0.001. The multivariate analysis revealed that the persistent protein in the urine after 6 months was statistically significant for not achieving complete remission, the odds ratio being 2.81 (1.58-5.0) and p=0.001. Conclusion: The presence of various degrees of crescent formation in class III and IV proliferative lupus nephritis (PLN) shown in the histological findings and the persistent protein in the urine at 6 months constitute independent factors for not achieving complete remission after one year. © 2016, Asociacion Regional de Dialisi y Transplantes Renales. All rights reserved.


Graziadio M.,Servicio de Clinica Medica | Medina N.,Servicio de Clinica Medica | Amato M.,Servicio de Clinica Medica | del Carmen Ardaiz M.,Hospital Ramos Mejia | And 2 more authors.
Medicina (Argentina) | Year: 2012

Primary bone lymphoma is a rare disease, which usually has a different presentation and evolution than lymphomas of other locations. We are presenting a case of primary bone lymphoma of rapid growth, in cranial and sternal locations. In its evolution, once the excision of the primary lesion of the skull was performed, the patient presented new lesions of rapid growth at the skull and femur level, and progression of pre-sternal lesion. With large B-cell diffuse non-Hodgkin lymphoma pathology, the patient initiated R-CHOPP (cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab) with rapid reduction of all lesions without evidence of progression after the six cycles.


Cornistein W.,Servicio de Infectologia | Mora A.,Servicio de Infectologia | Orellana N.,Laboratorio Of Bacteriologia | Capparelli F.J.,Servicio de Clinica Medica | Del Castillo M.,Servicio de Infectologia
Enfermedades Infecciosas y Microbiologia Clinica | Year: 2013

Introduction: Nosocomial fungal infections have increased significantly in the last decade. Candida detection in clinical specimens can mean either colonization or an infection which can be local (muguet) or invasive. Knowledge of the species helps in choosing the best treatment. The aims of this study were to determine the frequency and distribution of Candida species detected in clinical samples, to analyze the clinical characteristics of the involved population and to determine the risk factors for Candida non-albicans species. Methods: Retrospective, observational. Period: 2006-2010. Inclusion criteria: all isolates of Candida in clinical specimens from patients hospitalized - at least 48 hours in a neurological center. We analyzed epidemiological characteristics, co morbidities, risk factors, factors associated with Candida non-albicans detection, antifungal treatment, development of adverse events and mortality. Results: Candida spp. was isolated from 321 clinical specimens: 139 (43.3%) were C. albicans and 182 (56.7%) Candida non-albicans. The distribution of the sample was: urine 122 (Candida non-albicans 67.2%), airway 81, oropharynx 45 (C. albicans) and candidemia 40 (Candida non-albicans 75%). The most frequent co-morbidity was solid tumor (35.5%). The main risk factors were antibiotic therapy (85.5%), steroid therapy (61.7%) and in ICU at diagnosis (61.6%). The analysis of risk factors and the isolation of Candida non-albicans shows that chemotherapy, previous surgery, treatment with aminopenicillins, carbapenems and glycopeptides were statistically significant (P <.05). There is a trend in neutropenic patients (P =.055) and in ICU at diagnosis (P =.076). Overall survival was 71%. Conclusions: Candida species distribution varies with the type of sample analyzed. Non-albicans species make up the majority of the isolates. The identification of the species involved per sample helps to optimize treatment. The high frequency of isolation of Candida in patients on steroids and antibiotics and admitted to ICU, is worth pointing out. Patients with previous surgery, treated with the aforementioned antibiotics or chemotherapy, could receive non-azole antifungals in the initial empirical treatment strategy. © 2013 Elsevier España, S.L. All rights reserved.


Setti S.A.,Hospital Escuela Eva Peron | Meoli J.E.,Hospital Escuela Eva Peron | Jacob H.R.,Servicio de Clinica Medica | Rodriguez M.E.,Hospital Escuela Eva Peron
Neurologica Argentina | Year: 2016

Introduction: Creutzfeldt-Jakob disease (CJD) is a transmissible spongiform encephalopathy due to the accumulation of altered prion protein isoform (PrPsc) in the brain. The typical clinical symptoms are rapidly progressive dementia, ataxia, myoclonus, electroencephalogram (EEG) alterations, with positive 14-3-3 protein in cerebrospinal fluid and changes in magnetic resonance imaging (MRI). The definitive diagnosis is done anatomopathologically. Case report: A 64 year old female patient who presented with rapid progressive ataxia, visual disturbances, dysarthria, dysdiadochokinesia, dysmetria and axial dystonia. She also presented with apraxia, atrophy, myoclonus and seizures. She died 4 months after onset, with severe motor deterioration, rigidity, flexed posture and low cognitive-behavioral impairment. We did an anatomopathological study in addition to molecular biology. Conclusions: We present a “defined” case study of ECJ with infrequent symptoms of ataxia, myoclonus, but with no cognitive deterioration for its genotype (M/V1). Despite inconclusive 14-3-3 protein levels and atypical EEG, our diagnosis was mainly guided by the rapid onset of symptoms, in which high-field MRI (with the appropriate sequences) were key in showing typical images and in defining the diagnosis. © 2016 Sociedad Neurológica Argentina. Published by Elsevier España, S.L.U. All rights reserved.


Setti S.A.,Hospital Escuela Eva Peron | Meoli J.E.,Hospital Escuela Eva Peron | Jacob H.R.,Servicio de Clinica Medica | Rodriguez M.E.,Hospital Escuela Eva Peron
Neurologia Argentina | Year: 2016

Introduction: Creutzfeldt-Jakob disease (CJD) is a transmissible spongiform encephalopathy due to the accumulation of altered prion protein isoform (PrPsc) in the brain. The typical clinical symptoms are rapidly progressive dementia, ataxia, myoclonus, electroencephalogram (EEG) alterations, with positive 14-3-3 protein in cerebrospinal fluid and changes in magnetic resonance imaging (MRI). The definitive diagnosis is done anatomopathologically. Case report: A 64 year old female patient who presented with rapid progressive ataxia, visual disturbances, dysarthria, dysdiadochokinesia, dysmetria and axial dystonia. She also presented with apraxia, atrophy, myoclonus and seizures. She died 4 months after onset, with severe motor deterioration, rigidity, flexed posture and low cognitive-behavioral impairment. We did an anatomopathological study in addition to molecular biology. Conclusions: We present a "defined" case study of ECJ with infrequent symptoms of ataxia, myoclonus, but with no cognitive deterioration for its genotype (M/V1). Despite inconclusive 14-3-3 protein levels and atypical EEG, our diagnosis was mainly guided by the rapid onset of symptoms, in which high-field MRI (with the appropriate sequences) were key in showing typical images and in defining the diagnosis. © 2016 Sociedad Neurológica Argentina.


Ferraris F.,Servicio de Pediatria | Beratarrechea A.,Servicio de Clinica Medica | Llera J.,Hospital Italiano Of Buenos Aires | Marchetti M.,Hospital Italiano Of Buenos Aires | Perman G.,Servicio de Clinica Medica
Archivos Argentinos de Pediatria | Year: 2011

Objectives. To evaluate the distribution and analyze the use of resources and direct medical costs in children and adolescents diagnosed with a chronic disease and compare them with healthy children of the same age from a health insurer perspective. Methods. We analyzed the resources used and direct medical costs generated during 2008 in 21-year-old patients or younger affiliated to a health plan of community hospital in Buenos Aires, Argentina. We compared the outcomes of patients with at least one chronic disease as defined by Stein with healthy patients from a health insurer perspective with a one year time horizon. The costs were expressed in U.S. dollars for 2008. Results. We identified 1885 children and adolescents with chronic illness, accounting for 6.7% of the total pediatric population studied. This group had a greater number and length of hospitalization, greater use of medications, practices and medical consultations than the healthy pediatric population. The mean total annual costs were US$ 501 (95% CI: 419-583) and US$ 212 (95% CI: 188-236), respectively (p < 0.001). Overweight, obesity and asthma, even with relatively low or moderate costs per patient, generated almost 39% of the total costs of chronic diseases due to its high prevalence. Conclusion. The pediatric population with diagnosis of at least one chronic disease had significantly greater utilization of medical services and increased costs in all areas studied. It is also important to recognize that diseases of low or moderate cost per patient, but highly prevalent, generate the largest share of expenditure of chronic diseases in the population.


Buonanotte C.F.,Servicio de Neurologia | Yapur A.,Servicio de Clinica Medica | Buonanotte M.C.,Servicio de Neurologia
Neurologica Argentina | Year: 2015

The trigeminal autonomic headaches are primary headaches infrequently presentation and share several common features such as autonomic signs and poor response to treatment. Within this group the SUNCT has failed to respond to a specific medication. Most treatments are reported cases. Lamotrigine, gabapentin and parenteral lidocaine are the strategies of choice. We report the case of a patient with a favorable response to levetiracetam opening another therapeutic opportunity. © 2014 Sociedad Neurológica Argentina. Published by Elsevier España, S.L.U. All rights reserved.


PubMed | Servicio de Clinica Medica
Type: Case Reports | Journal: Medicina | Year: 2015

A 54-year-old man, with a history of Cushings disease diagnosed 32 years earlier, presented with edema, asthenia and general malaise. Abnormal laboratory studies depicted hypokalemia and metabolic alkalosis. A CT scan of the chest revealed a 33 cm tumor in the anterior mediastinum. The pathology was consistent with a thymic carcinoid. These findings led to a diagnosis of biochemical Cushings syndrome secondary to ectopic secretion of ACTH. Thus, this patient suffered twice of Cushings syndrome. The first instance was the consequence of an ACTH--secreting pituitary adenoma and the second of an ectopic secretion of ACTH. To the best of our knowledge this is the first such case reported in the medical literature.


PubMed | Servicio de Clinica Medica
Type: Case Reports | Journal: Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia | Year: 2012

We report a case of pyomyositis in a 59 year-old immunocompetent male patient caused by methicillin-susceptible Staphylococcus aureus. A CT scan of the chest demonstrated a lesion of the pectoral muscles. The patient was treated with surgical drainage and cephalexin. Pyomyositis is a rare and potentially serious infection that requires early recognition and prompt treatment.

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