Secuelas respiratorias clínicas, funcionales y tomográficas de pacientes hospitalizados por Covid-19 al año del diagnóstico: ESTUDIO SECUELAR-19 / Clinical, functional and tomographic respiratory sequels of patients hospitalized for COVID-19 at one year of diag nosis: SECUELAR-19 TRIAL

Resumen Introducción : Hay información escasa sobre evolución a largo plazo de pacientes hospitalizados por neumo nía COVID-19 moderada (NM) y grave (NG). El objetivo del estudio fue determinar impacto clínico, funcional respiratorio y tomográfico (TACAR) luego del alta a 12 meses del diagnóstico. Métodos : análisis según grupos NM y NG, desatura dores (PD) en prueba de caminata 6 min (PC6M) y patrón tomográfico símil fibrótico (SF). Comparamos resultados a 3 y 12 meses de seguimiento. Resultados : 194 pacientes enrolados, evaluados al año: 103 (53% ): masculinos (62.4%), edad 57.7 ± 10.9 años, comorbilidades (hipertensión arterial 38.8%, dia betes 29.6%, antecedentes respiratorios-AR- 18.4%). Com paramos variables a los 3 y 12 meses (media/DE): CVF 84%(19) a 88(19) (p = 0.01); 27% tuvo CVF<80% al año. En PC6M: 426 metros (108) a 447(92) (p = < 0.01). El 12.8% fue PD al año. NG tuvo mayor SF (40% vs. 27.9% p = 0.021). SF se relacionó con CVF <80% (p = 0.004) en toda la co horte, y NG (p < 0.001). Al año en análisis multivariado se asoció a CVF <80%, AR (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) y patrón SF (OR 3.51, 1.25-9.88). PD se asoció a AR (OR 12.2, 2.41-61.85). Discusión : Se observó mejoría en todas las variables al año. Pero al año persisten alteraciones funcionales y tomográficas en <50% de los pacientes. El subgrupo de PD se relacionó a AR. Es importante el seguimiento protocolizado de los pacientes hospitalizados, especial mente los grupos NG, PD y SF.

Abstract Introduction : There is scarce information on longterm evolution of hospitalized patients with moderate (MP) and severe (SP) COVID-19 pneumonia. Objective: to de termine clinical, respiratory function, and tomographic (HRCT) impact after being discharged 12 months after diagnosis. Methods : Analysis according to MP and SP, desatura tor patients (DP) in 6-minute walking test (6MWT) and HRCT fibrotic-like pattern (FLP). Results compared at 3 and 12 months of follow-up. Results : 194 patients enrolled and one year later 103 (53%) were evaluated: gender male (62.4%), age 57.7 ± 10.9 years, comorbidities (arterial hypertension 38.8%, diabetes 29.6%, and respiratory diseases-RD-18.4%). Variables compared 3 months to 12 months (mean/SD): FVC: 84%( 19) to 88%( 19) (p= 0.01). A 27% of patients had FVC<80% at one year. In 6MWT:426 (108) to 447 (92) (p = <0.01). 12.8% are DP in one year. SP had a greater FLP than MP (40% vs. 27.9%, p = 0.021). The FLP group was related to FVC < 80% (p = 0.004) in all patients but only in SP (p < 0.001). After one year, in multivariate analysis, FVC < 80% was associated with RD (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) and FLP (OR 3.51, 1.25-9.88). DP were associated with RD (OR 12.2, 2.41-61.85). Discussion : Improvement was observed in all vari ables when comparing 3 to 12 months. However, after one year, functional and tomographic alterations persist in less than 50% of patients. DP subgroup was related to RD. Protocolled follow-up of hospitalized patients is important, especially in SP, DP, and FLP groups.

[Clinical, functional and tomographic respiratory sequels of patients hospitalized for COVID-19 at one year of diagnosis: SECUELAR-19 TRIAL]. / Secuelas respiratorias clínicas, funcionales y tomográficas de pacientes hospitalizados por COVID-19 al año del diagnóstico: ESTUDIO SECUELAR-19.

INTRODUCTION: There is scarce information on longterm evolution of hospitalized patients with moderate (MP) and severe (SP) COVID-19 pneumonia. OBJECTIVE: to determine clinical, respiratory function, and tomographic (HRCT) impact after being discharged 12 months after diagnosis. METHODS: Analysis according to MP and SP, desaturator patients (DP) in 6-minute walking test (6MWT) and HRCT fibrotic-like pattern (FLP). Results compared at 3 and 12 months of follow-up. RESULTS: 194 patients enrolled and one year later 103 (53%) were evaluated: gender male (62.4%), age 57.7 ± 10.9 years, comorbidities (arterial hypertension 38.8%, diabetes 29.6%, and respiratory diseases-RD-18.4%). Variables compared 3 months to 12 months (mean/SD): FVC: 84%( 19) to 88%( 19) (p= 0.01). A 27% of patients had FVC<80% at one year. In 6MWT:426 (108) to 447 (92) (p = <0.01). 12.8% are DP in one year. SP had a greater FLP than MP (40% vs. 27.9%, p = 0.021). The FLP group was related to FVC < 80% (p = 0.004) in all patients but only in SP (p < 0.001). After one year, in multivariate analysis, FVC < 80% was associated with RD (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) and FLP (OR 3.51, 1.25-9.88). DP were associated with RD (OR 12.2, 2.41-61.85). DISCUSSION: Improvement was observed in all variables when comparing 3 to 12 months. However, after one year, functional and tomographic alterations persist in less than 50% of patients. DP subgroup was related to RD. Protocolled follow-up of hospitalized patients is important, especially in SP, DP, and FLP groups.

Introducción: Hay información escasa sobre evolución a largo plazo de pacientes hospitalizados por neumonía COVID-19 moderada (NM) y grave (NG). El objetivo del estudio fue determinar impacto clínico, funcional respiratorio y tomográfico (TACAR) luego del alta a 12 meses del diagnóstico. Métodos: análisis según grupos NM y NG, desaturadores (PD) en prueba de caminata 6 min (PC6M) y patrón tomográfico símil fibrótico (SF). Comparamos resultados a 3 y 12 meses de seguimiento. Resultados: 194 pacientes enrolados, evaluados al año: 103 (53% ): masculinos (62.4%), edad 57.7 ± 10.9 años, comorbilidades (hipertensión arterial 38.8%, diabetes 29.6%, antecedentes respiratorios-AR-18.4%). Comparamos variables a los 3 y 12 meses (media/DE): CVF 84%(19) a 88(19) (p = 0.01); 27% tuvo CVF<80% al año. En PC6M: 426 metros (108) a 447(92) (p = < 0.01). El 12.8% fue PD al año. NG tuvo mayor SF (40% vs. 27.9% p = 0.021). SF se relacionó con CVF <80% (p = 0.004) en toda la cohorte, y NG (p < 0.001). Al año en análisis multivariado se asoció a CVF <80%, AR (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) y patrón SF (OR 3.51, 1.25-9.88). PD se asoció a AR (OR 12.2, 2.41-61.85). Discusión: Se observó mejoría en todas las variables al año. Pero al año persisten alteraciones funcionales y tomográficas en <50% de los pacientes. El subgrupo de PD se relacionó a AR. Es importante el seguimiento protocolizado de los pacientes hospitalizados, especialmente los grupos NG, PD y SF.

Alternative technique for the injection of fluocinolone acetonide (FAc) intravitreal implant (Iluvien®) in case of leakage of its injector.

PURPOSE: To show an alternative surgical technique for the introduction of the intravitreal fluocinolone acetonide (FAc) implant (Iluvien®) into the vitreous cavity using a 23-gauge (G) trocar if it is retained during its implantation in the subconjunctival space. METHODS: We describe the surgical procedure performed to solve the complication: The FAc implant was extracted from the subconjunctival space using flat retinal forceps. A 23-G trocar was inserted 3,5 mm to the limbus. The same flat retinal forceps were used to take the FAc implant and introduce it into the vitreous cavity using a 23-G trocar. RESULTS: The patient's best corrected visual acuity (BCVA) (Snellen) improved from 20/200 to 20/63 and the central macular thickness (CMT) was reduced from 610 microns (µm) to 215 µm after one week of the FAc implantation. He remained stable after 3 months of follow-up, with a BCVA of 20/63 and a CMT of 191 µm. His intraocular pressure (IOP) remained stable and the integrity of the implant was checked by indirect ophthalmoscopy. CONCLUSION: The introduction of the intravitreal FAc implant using a 23-gauge trocar constitutes a valid alternative if it is retained during its implantation in the subconjunctival space.The functionality of the implant remained intact in our patient.

Moraxella nonliquefaciens superinfecting herpes simplex keratitis.

INTRODUCTION: Moraxella nonliquefaciens (M. nonliquefaciens) is a low pathogenicity microorganism, which rarely causes ocular infections, unless there is a predisposing factor. The main clinical manifestation of M. nonliquefaciens ocular infections is endophthalmitis and only five cases of corneal infection have been reported. This work shows an update in M. nonliquefaciens corneal infections, and the first reported case of keratitis due to M. nonliquefaciens superinfecting herpes simplex infection. CASE REPORT: A 84-year old woman with worsening of her herpes simplex keratitis, diagnosed, and treated 2 days before. The slit lamp showed deep paracentral infiltrate and hypopyon. A corneal sample was collected for culture prior to initiation of empiric antibiotic therapy with vancomycin and ceftazidime fortified, oral acyclovir, and cyclopentolate. The strain was identified as M. nonliquefaciens and topical antibiotic therapy was adjusted to ciprofloxacin and ceftazidime. After 2 weeks, the epithelial defect and the infiltrate were resolved and prednisolone was added to the regimen. As the corneal oedema and neovascularization decreased, acyclovir, and prednisolone were slowly tapered. About 4 months later, the visual outcome was 20/50 and the ophthalmic examination showed a clear cornea with a paracentral leucoma. CONCLUSION: Keratitis due to M. nonliquefaciens is rare and should be suspected in patients with local predisposing factors such as corneal damage or previous corneal infection. Prompt and appropriate combined treatment for the predisposing lesions and the keratitis may improve the prognosis and avoid a more aggressive approach.

Aneurisma tuberculoso de aorta abdominal / Tuberculous Abdominal Aortic Aneurysm

El aneurisma micótico surge de la destrucción infecciosa de la pared arterial y se diagnostica cuando hay un aneurisma en el contexto de inflamación y hemocultivos o biopsia positivos, aunque esto no es un requisito excluyente. Los agentes etiológicos de mayor frecuencia son bacterias (Staphylococcus, Salmonella)2 pero también se han notificado hongos (Aspergillus niger). La tuberculosis puede afectar cualquier órgano de la economía, el compromiso arterial es una complicación rara y potencialmente mortal, puede ocurrir por extensión directa de un foco adyacente o por diseminación hematógena o linfangítica de lesiones primarias. El compromiso en los grandes vasos puede presentarse de diversas formas, incluyendo pólipos, aortoarteritis estenosante y formación de aneurismas o pseudoaneurismas, siendo esta última la más común. Presentamos el diagnóstico de aneurisma de aorta abdominal infrarrenal con trombo intramural y pseudoaneurisma de aorta renal izquierda como hallazgo incidental en una paciente con tuberculosis ganglionar.

The mycotic aneurysm arises from the infectious destruction of the arterial wall and is diagnosed when there is an aneurysm within the context of inflammation and positive blood cultures or biopsies, though this is not an essential requirement. The most common etiologic agents are bacteria (Staphylococcus, Salmonella)2, but fungi have also been reported (Aspergillus niger). Tuberculosis may affect any organ of the body; arterial compromise is a rare and potentially mortal complication that may occur by direct extension of an adjacent infected site or by bloodstream or lymphangitic dissemination of primary lesions. The great vessels may be compromised in different ways, including polyps, stenotic aortoarteritis and formation of aneurysms or pseudoaneurysms, being the latter the most common one. We present the diagnosis of infrarenal abdominal aortic aneurysm with intramural thrombus and left renal aortic pseudoaneurysm as incidental finding in a patient with nodal tuberculosis.

Proptosis and a Dermal Lesion as the Presenting Sign of Lung Adenocarcinoma.

The purpose is to describe a clinical case of orbital metastases as the presentation sign of the primary tumor, and the importance of a multidisciplinary diagnosis. A 70-year-old man attended the Ophthalmology Department referring ocular pain. Mild proptosis and a dermal lesion in the neck were noticed. Biopsy of the dermal lesion and systemic work-up were compatible with lung adenocarcinoma with metastatic dissemination. After one cycle of palliative chemotherapy, patient's medical condition worsened, and he eventually died. Although rare, orbital symptoms can be the initial clinical presentation preceding the diagnosis of the primary silent lung neoplasm. Ophthalmologist has an important role in diagnoses of metastatic orbital cancer. Involvement of the multidisciplinary team is important for diagnosis and treatment.

Initial clinical management of symptomatic adult patients during influenza A (H1N1) epidemics.

BACKGROUND: Pandemic influenza A (H1N1) has emerged rapidly in Argentina since May 2009. Preliminary comparisons with seasonal influenza suggest that H1N1 disproportionately affects younger patients, generally causing mild disease, but in a minority of cases can be lethal. OBJECTIVE: The aim of this study was to develop a clinical tool for the initial management of patients with influenza-like syndrome, within the context of the novel H1N1 virus epidemic, to detect patients who need further investigation (e.g., chest X-ray study) for the diagnosis of pneumonia. METHODS: We prospectively studied 1090 consecutive patients with influenza-like syndrome for a period of 15 days. Based on the presence of inspiratory crackles and the level of transcutaneous pulse oximetry, we selected 217 patients requiring chest X-ray study, and pneumonia was confirmed in all of these patients. RESULTS: Among the patients with pneumonia, 132 viral diagnostic tests were available, from which specimens tested by real-time reverse-transcriptase polymerase-chain reaction (RTPCR) were positive for H1N1 in 61 patients (46%). Comparison between RTPCR-positive and RTPCR-negative patients did not show any significant difference. Eighty-seven randomly selected patients with influenza-like syndrome, but without crackles and with O(2) saturation>96%, received chest X-ray studies; none demonstrated pulmonary infiltrates. CONCLUSION: Within the context of an influenza epidemic with the new H1N1 virus, the use of two simple and accessible clinical signs permits a rapid differentiation between those patients requiring close monitoring vs. those with mild and self-resolving disease.

Direct repair of spondylolysis using a new pedicle screw hook fixation: clinical and CT-assessed study: an analysis of 19 patients.

OBJECTIVE: A prospective analysis of 19 consecutive cases of spondylolysis repair using a new hook screw device is presented. The objective of the study was to assess the clinical, radiologic, and computed tomography (CT) scan outcomes to establish the indications of isthmic repair in the treatment of spondylolysis. METHODS: Nineteen patients treated with a new segmental pedicle screw hook fixation were followed up for a minimum of 2 years (mean 30 months, range 24-48 months). Mean age was 20.5 years (range 13-29 years). All lytic defects were bilateral and located at L5, except for one at L3. CT scans were obtained at 6 months and 1 year postoperatively. CT scans were performed using both traditional and reverse gantry angled cuts to assess the healing of the defect. Fusion was considered to be present when trabeculae passed across the lytic defect. CT scan images were not considered conclusive until 1 year after surgery, because in two cases, trabecular pass across the pars was observed on only one side after 6 months, becoming bilateral 1 year postoperatively. CONCLUSIONS: Twelve of 13 patients who were 20 years or younger at the time of the study (average age 17.2 years) had fusion (92%), whereas in the group of 6 patients age 21 and older (average age 27.5 years), no cases of fusion were observed. Clinical outcome was excellent to good in 15 patients, fair in 3 cases, and poor in 1. The group of patients age 20 or younger had significantly better clinical results (84% excellent or good) (P = 0.00097) than those obtained in the group of patients age 21 and older (66% excellent or good) (P = 0.016). According to the current findings, the authors believe that segmental pedicle screw hook fixation is a useful alternative in the treatment of spondylolysis in adolescents but do not recommend this procedure in patients over age 20.