[Mortality in patients with dementia admitted in critical care units]. / Mortalidad en pacientes con demencia que cursaron internación en unidades de cuidados críticos.

OBJECTIVE: To determine the mortality and comorbidities associated of patients with dementia admitted to the Intensive Care Unit (ICU) on the hospitalization and at one year of follow-up. MATERIALS AND METHODS: A retrospective observational cohort study was carried out between 2012 and 2017 at the Hospital Italiano de San Justo, of patients who were admitted to the ICU, these were observed up to hospitalary death, out hospital death one year of hospitalization, the disenrollment from the institution's health plan or the end of the follow-up. RESULTS: A total of 163 patients were included for analysis. We recorded those 79 patients (48.47%) died one year after the hospitalization, of them 25 (15.34%) in ICU and 8 (4.91%) in general room. The most frequent causes of death were respiratory. The factors most associated with mortality were: orotracheal intubation (HR=2.01; 95% CI: 1.11-3.65; P=.02), history of leukemia (HR=8.55; 95% CI: 1.82-40.05; P≤.05), elevated Charlson (HR=1.16, 95% CI: 1.04-1.41; P=.05), and elevated APACHE II at admission (HR=1.07; 95% CI: 1.03-1.11; P≤.05). CONCLUSIONS: The present study expresses the prognosis of patients with a diagnosis of dementia admitted to the ICU and that depends not only on their baseline neurological status but also on the severity at admission and comorbidities.

Mortalidad en pacientes con demencia que cursaron internación en unidades de cuidados críticos / Mortality in patients with dementia admitted in critical care units

Objetivo: Determinar la morbimortalidad asociada de los pacientes con demencia internados en la Unidad de Cuidados Intensivos (UCI) durante el período de hospitalización y al año de seguimiento.Materiales y métodos: Se realizó un estudio de cohorte retrospectiva entre los años 2012 y 2017 en el Hospital Italiano de San Justo, de pacientes con diagnóstico previo de demencia que cursaron internación en la UCI; estos fueron observados hasta la muerte intrahospitalaria, la muerte extrahospitalaria al año de internación índice, la desafiliación del plan prepago de la institución o el final del seguimiento.Resultados: Se incluyeron 163 pacientes para el análisis. Se registró que 79 pacientes (48,47%) fallecieron al año de la internación índice; de ellos, 25 (15,34%) en UCI y 8 (4,91%) en sala general. Las causas más frecuentes de muerte fueron de índole respiratoria. Los factores que más se asociaron a mortalidad fueron: intubación orotraqueal (HR = 2,01; IC95%: 1,11-3,65; p = 0,02), antecedente de leucemia (HR = 8,55; IC95%: 1,82-40,05; p ≤ 0,05), Charlson elevado (HR = 1,16, IC95%: 1,04-1,41; p = 0,05) y APACHE II elevado al ingreso (HR = 1,07; IC95%: 1,03-1,11; p ≤ 0,05).Conclusiones: El presente estudio expone el pronóstico desfavorable de los pacientes con diagnóstico de demencia ingresados en UCI y que además el mismo depende no solo de su estado neurológico basal, sino también de la gravedad al ingreso y de las comorbilidades asociadas. (AU)

Objective: To determine the mortality and comorbidities associated of patients with dementia admitted to the Intensive Care Unit (ICU) on the hospitalization and at one year of follow-up.Materials and methods: A retrospective observational cohort study was carried out between 2012 and 2017 at the Hospital Italiano de San Justo, of patients who were admitted to the ICU, these were observed up to hospitalary death, out hospital death one year of hospitalization, the disenrollment from the institution's health plan or the end of the follow-up.Results: A total of 163 patients were included for analysis. We recorded those 79 patients (48.47%) died one year after the hospitalization, of them 25 (15.34%) in ICU and 8 (4.91%) in general room. The most frequent causes of death were respiratory. The factors most associated with mortality were: orotracheal intubation (HR=2.01; 95% CI: 1.11-3.65; P=.02), history of leukemia (HR=8.55; 95% CI: 1.82-40.05; P≤.05), elevated Charlson (HR=1.16, 95% CI: 1.04-1.41; P=.05), and elevated APACHE II at admission (HR=1.07; 95% CI: 1.03-1.11; P≤.05).Conclusions: The present study expresses the prognosis of patients with a diagnosis of dementia admitted to the ICU and that depends not only on their baseline neurological status but also on the severity at admission and comorbidities. (AU)

A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia.

BACKGROUND: Convalescent plasma is frequently administered to patients with Covid-19 and has been reported, largely on the basis of observational data, to improve clinical outcomes. Minimal data are available from adequately powered randomized, controlled trials. METHODS: We randomly assigned hospitalized adult patients with severe Covid-19 pneumonia in a 2:1 ratio to receive convalescent plasma or placebo. The primary outcome was the patient's clinical status 30 days after the intervention, as measured on a six-point ordinal scale ranging from total recovery to death. RESULTS: A total of 228 patients were assigned to receive convalescent plasma and 105 to receive placebo. The median time from the onset of symptoms to enrollment in the trial was 8 days (interquartile range, 5 to 10), and hypoxemia was the most frequent severity criterion for enrollment. The infused convalescent plasma had a median titer of 1:3200 of total SARS-CoV-2 antibodies (interquartile range, 1:800 to 1:3200). No patients were lost to follow-up. At day 30 day, no significant difference was noted between the convalescent plasma group and the placebo group in the distribution of clinical outcomes according to the ordinal scale (odds ratio, 0.83; 95% confidence interval [CI], 0.52 to 1.35; P = 0.46). Overall mortality was 10.96% in the convalescent plasma group and 11.43% in the placebo group, for a risk difference of -0.46 percentage points (95% CI, -7.8 to 6.8). Total SARS-CoV-2 antibody titers tended to be higher in the convalescent plasma group at day 2 after the intervention. Adverse events and serious adverse events were similar in the two groups. CONCLUSIONS: No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo. (PlasmAr ClinicalTrials.gov number, NCT04383535.).

[Telemedicine as a follow-up ambulatory strategy for COVID patients at the Hospital Italiano de San Justo]. / Telemedicina como estrategia de seguimiento ambulatorio de pacientes COVID en el Hospital Italiano de San Justo.

Introduction: Due to the COVID-19 pandemic, health systems have had to adapt to the growing demand for care. Telemedicine is a practical tool for outpatient monitoring of correctly selected patients. Materials and Methods: A descriptive study of a prospective cohort of patients under telemedicine follow-up at the Hospital Italiano de San Justo was carried out. Results: 47 days of follow-up were evaluated, a total of 1345 patients. Of these, 46.9% (n = 631) obtained a positive nasopharyngeal swab result with PCR technique and were registered in the telemedicine monitoring system, with 10.14% (n = 64) requiring a new clinical evaluation at the emergency center . Of these patients, 60.1% (n = 39) required hospitalization in a general ward (n = 39). Conclusion: It is essential to be able to generate other forms of helth care. The telemedicine system is an important tool to develop in situations of overload of the health system.

Introducción: Debido a la pandemia por COVID-19 los sistemas sanitarios han tenido que adaptarse a la demanda asistencial. La telemedicina es una herramienta práctica para poder realizar seguimiento ambulatorio de pacientes correctamente seleccionados. Materiales y Métodos: Se realizó un estudio descriptivo de una cohorte prospectiva de pacientes en seguimiento por telemedicina en el Hospital Italiano de San Justo. Resultados: Se evaluaron 47 días de seguimiento, un total de 1345 pacientes. De éstos 46,9% (n=631) obtuvieron un resultado de hisopado nasofaríngeo con técnica de PCR positivo y fueron ingresados al sistema de seguimiento por telemedicina. El 10,14% (n=64) requirió una reevaluación clínica en guardia externa. De estos pacientes el 60.1% (n=39) requirió internación en sala general (n=39). Conclusión: Es fundamental poder generar otras formas de cuidado de la salud. El sistema de telemedicina es una herramienta importante a desarrollar en situaciones de sobrecarga del sistema de salud.

Características clínicas de la enfermedad por Coronavirus 2019 en un centro de Argentina. Cohorte retrospective / Clinical characteristics of Coronavirus Disease 2019 in a single center of Argentina. Retrospective cohort

Resumen La enfermedad por coronavirus (COVID-19) es un problema prioritario de salud. El objetivo del trabajo fue evaluar las características clínicas, evolución y gravedad de COVID-19 en un centro hospitalario de tercer nivel de la provincia de Buenos Aires, Argentina. Se realizó un estudio de cohorte retrospectiva de pacientes con COVID-19, entre el 3 de marzo y 21 de junio de 2020. Se evaluaron las características en función de la presencia o ausencia de neumonía y de la gravedad de la enfermedad. Se incluyeron 101 pacientes, la mediana de edad fue de 42 años y el 53% mujeres. Los síntomas más frecuentes fueron: fiebre 66% y tos 57%. La disnea y la fiebre se asociaron a la presencia de neumonía. Las comorbilidades más prevalentes fueron: hipertensión 22%, obesidad 18%, enfermedad cardiovascular 7% y enfermedad respiratoria crónica 7%. Los hallazgos de laboratorio más comunes fueron: linfopenia 55%, dímero-D elevado 38% y plaquetopenia 20%. El 26% presentó neumonía y el 24% fue personal de salud. En el 24% de los casos se necesitó más de una muestra de RT-PCR para el diagnóstico. Un valor moderado-alto del Índice de severidad de neumonía (PSI) fue más frecuente en la neumonía grave que en la leve (63 contra 17%, p 0.032). Se registró una mortalidad del 5%. Las características clínicas, la gravedad y evolución fueron similares a las descritas a nivel mundial. Destacamos la proporción elevada del personal de salud infectado, la tasa de falsos negativos de la RT-PCR y la utilidad del PSI para discriminar la gravedad de la neumonía.

Abstract Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

[Clinical characteristics of coronavirus disease 2019 in a single center of Argentina. Retrospective cohort]. / Características clínicas de la enfermedad por coronavirus 2019 en un centro de Argentina. Cohorte retrospectiva.

Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

La enfermedad por coronavirus (COVID-19) es un problema prioritario de salud. El objetivo del trabajo fue evaluar las características clínicas, evolución y gravedad de COVID-19 en un centro hospitalario de tercer nivel de la provincia de Buenos Aires, Argentina. Se realizó un estudio de cohorte retrospectiva de pacientes con COVID-19, entre el 3 de marzo y 21 de junio de 2020. Se evaluaron las características en función de la presencia o ausencia de neumonía y de la gravedad de la enfermedad. Se incluyeron 101 pacientes, la mediana de edad fue de 42 años y el 53% mujeres. Los síntomas más frecuentes fueron: fiebre 66% y tos 57%. La disnea y la fiebre se asociaron a la presencia de neumonía. Las comorbilidades más prevalentes fueron: hipertensión 22%, obesidad 18%, enfermedad cardiovascular 7% y enfermedad respiratoria crónica 7%. Los hallazgos de laboratorio más comunes fueron: linfopenia 55%, dímero-D elevado 38% y plaquetopenia 20%. El 26% presentó neumonía y el 24% fue personal de salud. En el 24% de los casos se necesitó más de una muestra de RT-PCR para el diagnóstico. Un valor moderado-alto del Índice de severidad de neumonía (PSI) fue más frecuente en la neumonía grave que en la leve (63 contra 17%, p 0.032). Se registró una mortalidad del 5%. Las características clínicas, la gravedad y evolución fueron similares a las descritas a nivel mundial. Destacamos la proporción elevada del personal de salud infectado, la tasa de falsos negativos de la RT-PCR y la utilidad del PSI para discriminar la gravedad de la neumonía.

[Nodular hepatic lesions secondary to multiple myeloma]. / Compromiso nodular hepático secundario a mieloma múltiple.

Multiple myeloma is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. Myelomatous nodular lesions of the liver are infrequent. We describe 3 cases with histological confirmation and we review the bibliography.

Compromiso nodular hepático secundario a mieloma múltiple / Nodular hepatic lesions secondary to multiple myeloma

El mieloma múltiple (MM) es una enfermedad maligna caracterizada por una proliferación clonal de células plasmáticas atípicas en la médula ósea, que produce una inmunoglobulina (Ig) con estructura homogénea en la sangre y/o en la orina (cadenas livianas). El compromiso del parénquima hepático con masa ocupante en los pacientes con MM es excepcional. Describimos 3 casos clínicos confirmados histológicamente. La ecografía y la tomografía computarizada tienen una sensibilidad intermedia y las imágenes no son patognomónicas, por lo tanto es necesaria la confirmación a través de la biopsia. Se desconoce la implicancia pronóstica de este hallazgo.

Multiple myeloma is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. Myelomatous nodular lesions of the liver are infrequent. We describe 3 cases with histological confirmation and we review the bibliography.