Helios Salud

Objetivo: Analizar si existen variables clínico-demográficas, de laboratorio o de programación de la ventilación mecánica invasiva (VMI) asociadas a la presencia de hiperoxia durante las primeras 24 horas de VMI. El objetivo secundario fue describir la evolución de la hiperoxia y la presión arterial de oxígeno (PaO2) durante la primera semana de VMI. Materiales y métodos: Se llevó a cabo un estudio observacional, analítico y retrospectivo. Se incluyeron sujetos mayores de 18 años con más de 12 horas de VMI. Se registraron variables clínico-demográficas al ingreso. Las variables de programación de la VMI y los gases arteriales se registraron durante la primera semana. La variable de resultado primaria fue la presencia de hiperoxia, y la variable secundaria fue la evolución de la hiperoxia durante la primera semana. Se definió hiperoxia como PaO2 > 100 mmHg. Resultados: Se analizaron 116 sujetos, de los cuales 55 (47,4 %) presentaron hiperoxia en las primeras 24 horas de VMI. Al día 7 de VMI, permanecían ventilados 23 sujetos (19,8 %); de ellos, 5 (21,7 %) presentaban hiperoxia. El análisis multivariado de regresión logística evidenció que la presión arterial de dióxido de carbono (PaCO₂) se asoció de manera independiente con menor probabilidad de hiperoxia (OR 0,92; IC 95 %: 0,87–0,97). Conclusión: Valores más elevados de PaCO2 se asociaron a una menor probabilidad de desarrollar hiperoxia. La frecuencia de sujetos con hiperoxia se redujo durante la primera semana de VMI.

BackgroundMultidetector row computed tomography coronary angiography (MDCT-CA) has become a useful diagnostic tool for the direct quantification of coronary stenosis, for identifying coronary anomalies and for the assessment of coronary artery bypass grafts. Despite its clinical value has been questioned due to the effective radiation dose (ERD) received by each patient, radiation exposure is similar to other studies. However, different strategies are permanently tested in order to reduce the ERD maintaining adequate and diagnostic image quality. Objectives To determine the image quality and effective radiation dose (ERD) of prospective electrocardiogram-gated multidetector row computed tomography coronary angiography (PMDCT- CA) (the x-ray beam is turned on for only a short portion of diastole) compared to retrospective ECG gating (RMDCT-CA) (the x-ray beam is turned on throughout the cardiac cycle) and a preliminary approach of its diagnostic accuracy compared to digital invasive coronary angiography (CA). Material and MethodsFifty consecutive patients with suspected coronary artery disease and sinus rhythm were evaluated with PMDCT-CA and compared to a control group who underwent RMDCT-CA. Image quality was analyzed by two reviewers. Interobserver concordance and ERD were determined. The diagnostic accuracy of PMDCT-CA compared to CA to detect coronary artery stenosis > 50% was assessed in 30 patients. ResultsThere were no significant differences in the image quality between both groups. Agreement between the reviewers for segment image quality scores was k = 0.92. Mean ERD was 3.5 mSv for PMDCT-CA compared to 9.7 and 12.9 mSv for RMDCT-CA with and without tube current modulation, respectively. Individual analysis including all segments showed that the sensitivity, specificity, positive predictive value and negative predictive value of PMDCT- CA for the detection of coronary stenosis were 94.74%, 81.82%, 90% and 90%, respectively. ConclusionOur initial experience demonstrated that use of PMDCT-CA has similar subjective image quality scores with a substantial reduction ERD when compared to use of RMDCT-CA in a selected population.

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Pneumoperitoneum, the presence of free air in the abdominal cavity, is a known complication of percutaneous gastrostomy tube placement. While often benign and self-limiting, persistent or symptomatic pneumoperitoneum may indicate underlying gastrostomy dysfunction or gastrointestinal perforation, requiring prompt recognition and intervention. We report the case of a 19-year-old patient admitted to the Intensive Care Unit after a high-impact trauma, who developed abdominal pain and distension following percutaneous gastrostomy placement. Bedside ultrasound revealed the presence of reverberation artifacts consistent with free intraperitoneal air, with dynamic changes observed upon probe pressure, suggesting a shifting phenomenon. Computed tomography (CT) confirmed extensive pneumoperitoneum, and surgical exploration identified gastrostomy tube leakage, necessitating repositioning. The patient had an uneventful postoperative course. This case highlights the role of point-of-care ultrasound as a valuable bedside tool for the early detection of pneumoperitoneum, particularly in critically ill patients. While CT remains the gold standard, ultrasound provides a rapid, non-invasive, and radiation-free alternative for initial assessment, facilitating timely diagnosis and management.

Breastfeeding in newborn infants born to people living with HIV continues to be a controversial issue. However, there is numerous evidence that reveals that in the context of sustained virological suppression, the risk of postnatal HIV transmission through breast milk is less than 1%. From the activism of people with HIV, civil society and the medical and scientific community, there is a demand for reopening the issue, with the purpose of defining new guidelines for the feeding of children born to people with HIV. This review analyzes the available scientific evidence and the current knowledge gaps regarding breastfeeding in HIV situations and proposes an institutional approach and shared decision-making modality for HIV-positive pregnant people who wish to breastfeed.

Fabry disease is an X-linked trait due to pathogenic variants in the GLA gene, causing deficient GLA enzyme activity, and producing a chronic accumulation of globotriaosylceramide and its derivative globotriaosylsphingosine (LysoGb3) in tissues and fluids. Conflicting or discordant results of interpretation of multiple variants in GLA were reported in literature. The aim of this article is to report the spectrum of GLA variants in Argentine population, as well as the revised interpretation of variants classification. Moreover, we intend to find a possible correlation between biochemical parameters, clinical manifestations and genetic variants of adult male Fabry patients that could be of help for interpretation of variants. Blood samples from patients with clinical suspicion of Fabry disease were evaluated for specific laboratory tests: alfa-galactosidase A enzyme activity, LysoGb3 and GLA genetic test. There are 44 males with pathogenic GLA variants which showed deficient enzyme activity. Among them, thirty-two presented the classic phenotype (72%) and twelve the late onset clinical features (28%). Mean percentage of enzyme activity was 0.9% for classical patients and 3.2% for later onset ones. LysoGb3 values were increased in all males, with classic patients showing considerable higher values than that of late onset. Our results showed that the combined analysis of the clinical picture, leukocyte enzyme activity, globotriaosylsphingosine concentration and a detailed exhaustive study of the genetic variant lead to a definite diagnosis in those cases previously interpreted as of unknown significance, together with a revised interpretation of the phenotype.

Real-world data on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) fixed-dose combination from resource-constrained settings like Latin America are limited. We conducted an observational retrospective cohort study of treatment-naive (TN, n=315) and treatment-experienced (TE, n= 2356) people living with HIV prescribed BIC/FTC/TAF in Argentina from 10/2019 to 12/2021, with 24 and 48-week follow-up data analyzed for virological suppression, persistence, safety, and metabolic parameters. Patient-reported outcomes were assessed via across-sectional online survey. Baseline characteristics: median age 45 years, 72.2% male, 99.6% Hispanic/Latino ethnicity. Treatment per sistence at 48 weeks was 99.3% (TN) and 99.5% (TE). Virological suppression rates (<200/<50 copies/mL) at 24 weeks were 97.4/88% (TN) and 99/97% (TE). At 48 weeks were 100/92% (TN) and 99/97% (TE). In the TE group, triglycerides decreased with no other lipid changes. In TN, mild total/LDL/HDL cholesterol increases occurred. eGFR mildly decreased in both groups. The online survey (n=536) showed 91.5% reported no medication concerns. Median quality of life scores were 90 (TN) and 88 (TE). Most reported no self-care, activity, mobility, pain/discomfort, or anxiety/depression issues. BIC/FTC/TAF demonstrated high persistence, safety, virological efficacy, and favorable metabolic profile over 48 weeks. The cross-sectional survey indicated high treatment satisfaction and good quality of life in this cohort from Argentina.

BackgroundShiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a severe condition mainly affecting children. It is one of the leading causes of acute kidney injury in the pediatric population. There is no established therapy for this disease. INM004 is an anti-Shiga toxin composed of equine polyclonal antibodies. This study is aimed at assessing the safety, pharmacokinetics, and efficacy of INM004 in pediatric patients with STEC-HUS.MethodsPhase 2, open-label clinical trial with an historical control arm. Patients in the treatment arm received two doses of INM004. The primary endpoints were the safety profile, pharmacokinetics, and efficacy (dialysis days) of INM004. Secondary endpoints included other kidney and extrarenal outcomes. Propensity score matching was used for efficacy comparisons between arms.ResultsFifty-seven and 125 patients were enrolled in the treatment and control arm, respectively. After propensity score matching, 52 patients remained in each arm. INM004 was well-tolerated. Eight adverse events were considered possibly related, none of which were serious or severe. In the primary efficacy endpoint, patients of the treatment arm presented a non-statistically significant difference of two dialysis days. On secondary endpoints, non-statistically significant trends toward fewer patients needing dialysis and dialysis for more than 10 days, and shorter time to glomerular filtration rate normalization, were observed favoring the treatment arm.ConclusionsINM004 showed an adequate safety profile. Efficacy non-statistically significant trends suggesting a beneficial effect in the amelioration of kidney injury were observed. These results encourage the conduction of a phase 3 study of INM004 in pediatric patients with STEC-HUS.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

There are no reports in LATAM related to longitudinal humoral and cellular response to adenovirus based COVID-19 vaccines in people with Multiple Sclerosis (pwMS) under different disease modifying therapies (DMTs) and neutralization of the Omicron and Wuhan variants of SARS-COV-2. IgG anti- SARS-COV-2 spike titer were measured in a cohort of 101 pwMS under fingolimod, dimethyl fumarate, cladribine and antiCD20, as well as 28 healthy controls (HC) were measured 6 weeks after vaccination with 2nd dose (Sputnik V or AZD1222) and 3nd dose (homologous or heterologous schedule). Neutralizing capacity was against Omicron (BA.1) and Wuhan (D614G) variants and pseudotyped particles and Cellular response were analyzed. Multivariate regression analysis showed anti-cd20 (β= -,349, 95% CI: -3655.6 - -369.01, p=0.017) and fingolimod (β=-,399, 95% CI: -3363.8 - -250.9, p=0.023) treatments as an independent factor associated with low antibody response (r2 adjusted=0.157). After the 2nd dose we found a correlation between total and neutralizing titers against D614G (rho=0.6; p<0.001; slope 0.8, 95%CI:0.4-1.3), with no differences between DMTs. Neutralization capacity was lower for BA.1 (slope 0.3, 95%CI:0.1-0.4). After the 3rd dose, neutralization of BA.1 improved (slope: 0.9 95%CI:0.6-1.2), without differences between DMTs. A fraction of pwMS generated anti-Spike CD4+ and CD8+ T cell response. In contrast, pwMS under antiCD20 generated CD8+TNF+IL2+ response without differences with HC, even in the absence of humoral response. The 3rd dose significantly increased the neutralization against the Omicron, as observed in the immunocompetent population. Findings regarding humoral and cellular response are consistent with previous reports.