Hospital Alemán

Despite treatment, many hypertensive patients with coronary heart disease (CHD) have blood pressure (BP) that remains above guideline targets. However, less is known about patients in whom on-treatment BP is below target and major European guidelines differ substantially in their recommendations for such patients. Specifically, 2023 European Society of Hypertension (ESH) guidelines provide a Class 3 recommendation to proactively avoid BP below target whereas 2024 European Society of Cardiology (ESC) guidelines do not. Between 2020 and 2023, adults hospitalised in the previous 6-24 months with incident or recurrent CHD were sampled in 14 countries from all six WHO regions and invited for a standardised interview and examination as part of the International Action on Secondary and Primary Prevention by Intervention to Reduce Events (INTERASPIRE) study. We measured seated BP twice using an automated oscillometric device after 5 min of rest. We defined participants as having BP above target (BP ≥130/80 mm Hg), at target (BP 120-129/70-79 mm Hg) or below target (<120/70 mm Hg); according to both 2023 ESH and 2024 ESC guidelines. Among 4548 participants (21.1% female), the mean age (±SD) was 60.0 (±10.3) years. At a median (IQR) of 1.05 (0.76-1.45) years after index CHD hospitalisation, 10.3% of patients had BP readings within the target range of 120-129/70-79 mm Hg, with 53.9% above target and 35.7% below target. Patients with below-target BP were more likely to have heart failure (13.6% vs 10.0%, p=0.041) and estimated glomerular filtration rate <60 mL/min/1.73 m² (18.9% vs 10.7%, p<0.001), when compared with those at target. They were also statistically more likely to be severely frail (p=0.030). The median number of BP-lowering medications did not differ significantly between the 3 BP target groups. Cumulative dosing of BP-lowering medications in the below-target group was also not more intensive than that in the at-target group. More than one-third of INTERASPIRE patients with CHD presented with BP <120/70 mm Hg, which is below target per current European hypertension guidelines. Further research is needed in this population to resolve discordant guideline recommendations and determine whether de-escalation of BP-lowering therapies is beneficial or even harmful in this setting.

Introduction: Evidence about outcomes in ECMO in trauma-related ARDS from middle-income countries is absent, and mortality scores have never been validated in this environment. We characterised outcomes and complications of poly-traumatised adults treated with ECMO and assessed the accuracy of APACHE II, Injury Severity Score (ISS) and RESP score. Methods: We conducted an ambispective, multicentre cohort across four Argentine ECMO centres (2015-2024). All adults (≥18 yr) cannulated for refractory hypoxaemia after polytrauma were included. Pre-defined variables—demographics, injury pattern, ECMO configuration/duration, anticoagulation strategy and International Society on Thrombosis and Haemostasis (ISTH) bleeding categories—were extracted from electronic charts. Survivors underwent structured telephone follow-up with EQ-5D-3L and Katz Index. Model performance for in-hospital mortality was quantified by AUROC (discrimination) and Brier score + Spiegelhalter z (calibration). Institutional review boards approved the protocol, and survivors provided informed consent. Results: Thirty-two patients (mean age 32 ± 16 yr; 84 % male) received ECMO—31 venovenous, 1 veno-arterial. Median ISS was 34 (IQR 25–50); 63 % had concomitant traumatic brain injury. Time from intubation to cannulation was 4 d (1–6) and ECMO ran for 7 d (3–11). Heparin was administered in 59 %. Device-related events were common: oxygenator/circuit thrombosis 22 %, deep-vein thrombosis 19 %, any bleeding 28 % (major 16 %). Overall in-hospital mortality was 40.6 % (95 % CI 24–59) and occurred early (ECMO day 3 [1–7] vs 9.5 [6–11.8] in survivors, p = 0.009). Prognostic scores performed only moderately: ISS AUROC 0.63/Brier 0.224, RESP 0.56/0.240, APACHE II 0.54/0.241; pairwise AUROC differences were non-significant (p = 0.75). Nineteen patients survived to discharge; 11 (58 %) were interviewed a median 7 yr later. Median EQ-5D utility was 0.74 (0.65–0.83) and Katz 6 (5–6), yet chronic pain persisted in 55 % and anxiety/depression in 73 %. Conclusions: In this first Latin-American series, ECMO delivered 59 % long-term survival with high functional independence, but bleeding/thrombotic burdens were substantial and existing scores predicted mortality poorly. Trauma-specific risk models and structured post-ICU rehabilitation are urgently needed.

Autoimmune blistering diseases (AIBDs) in children and adolescents present a major challenge in diagnosis and management because of their rarity and the presence of other differential diagnoses with blistering. They are potentially serious, and timely diagnosis and optimal management can help prevent morbidity related to both the diseases and their treatments. The Autoimmune Blistering Diseases Task Force of the European Academy of Dermatology and Venereology (EADV) has initiated evidence-based, expert-informed clinical guidelines for the diagnosis, treatment and monitoring of paediatric AIBDs. A writing group conducted a systematic review of the available literature on AIBDs in children and adolescents, and since there is limited strong evidence in the literature, recommendations were formulated by consensus over three rounds of structured feedback and revision by the Core Group and Expert Group of the task force (32 voting experts; >75% agreement threshold). Although all AIBDs-including intra-epidermal and subepidermal blistering disorders-are reported in children, linear IgA dermatosis (LAD) is the most common (42-83%). The diagnostic approach in the paediatric age group does not differ from that in adults. Treatment recommendations are tailored to paediatric patients, taking into account developmental pharmacokinetics, potential adverse effects and the impact of disease and therapy on quality of life. These guidelines provide the first comprehensive, paediatric-focused framework for the diagnosis and management of AIBDs. Implementing the recommendations should harmonize care, reduce treatment-related toxicity and improve quality of life for affected children while steering future research towards critical knowledge gaps.

Los pacientes con linfoma difuso de células grandes B (DLBCL) refractarios primarios o que recaen precozmente constituyen un subgrupo de pacientes de pronóstico desfavorable a los cuales la inmunoquimioterapia de rescate convencional les ofrece pobres resultados. El CD 19 es una glicoproteína transmembrana que se expresa en diversos estadios del desarrollo de la célula B cumpliendo un rol trascendente en señales de sobrevida y proliferación de las células B malignas. Tafasitamab es un anticuerpo monoclonal que luego de unirse al CD 19 promueve la lisis de los linfocitos B a través de la citotoxicidad celular dependiente de anticuerpos y la fagocitosis, además de la inducción de muerte celular directa por apoptosis. Su acción se sinergiza al asociarse con lenalidomida, la cual incrementa la citotoxicidad celular dependiente de Ac y la mediada por células NK. La combinación de tafasitamab y lenalidomida se ha mostrado activa en el tratamiento de pacientes con DLBCL R/R luego de 1 a 3 líneas previas de tratamiento sistémico no candidatos a trasplante o que lo hubieran rechazado. En el estudio L-Mind, tafasitamab se administró en dosis de 12 mg/kg los días 1, 8, 15 y 22 durante los tres primeros ciclos (+ una dosis de carga en el día 4 del primer ciclo), y en los días 1 y 15 en los ciclos 4 al 12. Dicha monoterapia se mantenía hasta progresión de enfermedad o toxicidad inaceptable. La lenalidomida se administró en dosis de 25 mg/día x 21 días, en ciclos cada 28 días, por un máximo de 12 ciclos. La serie de pacientes tratados en el estudio L-Mind incluyó 81 pacientes, los que en el seguimiento extendido a 5 años mostraron una respuesta objetiva del 57.5 %, con 41.3 % de remisiones completas (RC) y 16.3 % de respuestas parciales (RP). Con una mediana de seguimiento de 44 meses, la mediana de duración de la respuesta no fue alcanzada, y las medianas de sobrevida libre de progresión (SLP) y sobrevida global (SG) fueron de 11.6 y 33.5 meses respectivamente. Las reacciones adversas más frecuentes fueron: infecciones (73 %, siendo de grados 3-4 en el 28 %), neutropenia (51 %, grados 3-4 en el 49 %), astenia (40 %), anemia (36 %, grados 3-4 del 7 %), diarrea (36 %) y trombocitopenia (31 %, grados 3-4 del 17 %), tos (26 %), edema periférico (24 %), pirexia (24 %) y disminución del apetito (22 %). La incidencia de eventos adversos no hematológicos durante la monoterapia con tafasitamab (sin lenalidomida) descendió al menos un 10 % y la incidencia de eventos adversos hematológicos descendió al menos un 20 % de los casos, sin episodios de neutropenia febril en la etapa de monoterapia con tafasitamab. La conclusión del estudio fue que la combinación de tafasitamab + lenalidomida fue bien tolerada, con una alta proporción de pacientes con DLBCL R/R inelegibles para trasplante autólogo que alcanzaron RC, lo cual convierte al esquema en una nueva opción terapéutica en este escenario de pacientes. En base a los resultados del estudio L-MIND, la combinación recibió la aprobación acelerada en julio de 2020 en Estados Unidos y una autorización condicional en Europa en agosto de 2021, siendo aprobada en la Argentina por la agencia regulatoria nacional en 2025. Se detallan las recomendaciones prácticas para el manejo de la droga y los ajustes de dosis frente a eventos adversos. En base a estos resultados de eficacia y seguridad, se están explorando nuevas combinaciones de Tafasitamab así como su uso en otras líneas terapéuticas más precoces.

Abstract Background Single-anastomosis duodenal-ileal bypass and duodeno-ileal bipartition are effective metabolic surgeries but remain technically demanding due to the complexity and risk of duodeno-ileal anastomotic leaks.. Magnetic compression anastomosis using Self-Forming Magnets (SFM) offers a simplified, sutureless alternative that may reduce procedural risk. This study evaluated the feasibility, safety, and four-year outcomes of the SFM Sutureless Neodymium Anastomosis Procedure (SNAP) in patients with obesity and type 2 diabetes mellitus (T2DM). Methods This prospective, single-center study included patients with obesity and T2DM. The SNAP technique involved endoscopic and laparoscopic deployment of SFMs to create a duodeno-ileal anastomosis without sutures or staples. Primary endpoint was change in hemoglobin A1c (HbA1c) through 48 months. Secondary endpoints included percent total weight loss (%TWL) and safety outcomes. Results Fourteen patients (age 48 ± 9 years; 50% female; baseline BMI 40.4 ± 3.7 kg/m²) underwent successful SNAP creation (technical success 100%). Mean procedural time was 68 ± 20 minutes. No adverse events occurred. HbA1c significantly decreased from 8.3 ± 1.3% to 6.4 ± 0.6%, 6.6 ± 1.2%, 6.4 ± 1.5%, and 6.9 ± 1.8% at 12, 24, 36, and 48 months, respectively (all p &lt; 0.05). Corresponding %TWL was 13.4 ± 8.6%, 14.2 ± 11.5%, 15.6 ± 13.6%, and 13.5 ± 12.9%. Conclusions SFM-assisted duodeno-ileal bipartition using the SNAP technique is feasible, safe, and durable, producing clinically meaningful and sustained weight loss and glycemic improvement over four years. This magnet-based, sutureless approach may represent a less invasive alternative to conventional duodeno-ileal anastomosis in metabolic surgery.

One of the challenges in managing patients with hantavirus infection is accurately identifying individuals who are at risk of developing severe disease. Prompt identification of these patients can facilitate critical decisions, such as early referral to an intensive care unit. The identified prognostic factors could be of utility in guiding medical care to enhance the management of hantavirus infection. To identify and evaluate prognostic factors associated with mortality in hantavirus infection. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-reported systematic review following Cochrane guidance adapted for prognosis. We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Biblioteca Virtual de Saúde or Lilac and EMBASE, from 1 January 1993 to 2 October 2025. We included studies evaluating individual prognostic factors or risk assessment models of New World hantavirus infections, with no restrictions on study design, publication status or language. When feasible, we conducted meta-analyses for prognostic factors using the inverse variance-based method with random effect model. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. We included 25 studies with a total of 7284 participants. We identified the following prognostic factors for which we found moderate to high certainty that are associated with increased mortality: age over 18 years, female sex, rural residence, elevated creatinine levels, increased haematocrit, signs of bleeding and the presence of infiltrates on chest radiographs. Our systematic review identified prognostic factors for mortality in patients with New World hantavirus infection. These factors can inform clinicians in making more informed management decisions. Furthermore, our findings lay the groundwork for the future development of a clinical prognostic model, potentially enhancing patient care and outcomes. CRD42021225823.

Abstract Background Mucosal healing (MH) is a key therapeutic target in Crohn’s disease (CD), yet endoscopy may underestimate residual inflammation. Cross-sectional imaging often reveals persistent transmural activity despite MH, and the long-term significance of transmural healing (TH) and its prognostic value require further investigation. This study aimed to assess the prognostic significance and clinical impact of transmural healing in Crohn’s disease. Methods We conducted a retrospective single-center cohort study including adults with confirmed CD who underwent magnetic resonance enterography (MRE), Doppler ultrasound (US), or CT enterography between Sept 2014 and Oct 2024, with ≥1 year of follow-up. Demographics, treatments, and disease course were retrieved. Univariate and multivariate analyses assessed associations between TH and adverse outcomes. Kaplan-Meier survival analysis evaluated long-term outcomes; curves were compared using the log-rank test. p &amp;lt; 0.05 was considered significant. Results Of 514 CD patients, 92 met inclusion criteria. Mean age was 48 years (range 19–77), 35% were female, and median disease duration was 12 years. Median follow-up was 42 months (range 12–122). Ileal disease was present in 53.3%, ileocolonic in 45.7%. Behavior was non-stricturing/non-penetrating in 52.2%, stricturing in 40.2%, penetrating in 7.6%; perianal disease in 19.6%. Thirty-eight percent had prior bowel resection. At evaluation, 68% received biologics, 41.3% had prior anti-TNF exposure, and 15.2% used corticosteroids. MRE was performed in 70.7%, CT enterography in 4.3%, Doppler US in 25%; 27.2% had &amp;gt;1 modality. TH was achieved in 42.4%. In univariate analysis, compared to those without TH, patients with TH had lower rates of clinical relapse (12.8% vs 58.5%, p &amp;lt; 0.001), corticosteroid use (2.6% vs 20.8%, p = 0.010), treatment optimization (5.1% vs 24.5%, p = 0.013), and escalation (10.3% vs 60.4%, p &amp;lt; 0.001). Kaplan-Meier curves confirmed that patients achieving TH had a lower risk of clinical relapse (log-rank p &amp;lt; 0.01) [Figure 1]. On multivariate analysis, TH was independently associated with reduced risk of relapse, therapy intensification, and corticosteroid use (HR 0.28, 95% CI 0.11–0.72, p = 0.008). Conclusion In this cohort of patients with longstanding CD, TH was associated with improved long-term outcomes. These findings support the inclusion of TH as a therapeutic target in future CD consensus guidelines. However, prospective randomized studies are required to assess the impact of TH on CD management. Conflict of interest: Abarca, Lucia: No conflict of interest Gómez, Estanislao Jesus: No conflict of interest Marturano, Maria Victoria: No conflict of interest Baron, Pablo Ezequiel: No conflict of interest Grana, Maria Florencia: No conflict of interest Gonzalez, Raquel Analia: No conflict of interest

Introduction &amp; Objectives Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with comorbidities, including major adverse cardiovascular (CV) events (MACE), venous thromboembolism (VTE), and malignancy (excluding nonmelanoma skin cancer [exNMSC]). Incidence of MACE, VTE, and malignancy (exNMSC) was comparable to or lower than background rates reported in US AD population. We evaluated long-term incidence rates of MACE, VTE, and malignancy (exNMSC) by CV risk category among patients with AD with up to 6 years of UPA treatment. Materials &amp; Methods Data were pooled from the phase 3, randomized, double-blind, multicenter, placebo-controlled Measure Up 1 &amp; 2 (NCT03569293, NCT03607422) and AD Up (NCT03568318) trials. AD patients were randomized 1:1:1 to once-daily oral UPA 15 mg, UPA 30 mg, or placebo. After the 16-week double-blind treatment period, patients receiving UPA continued their assigned treatment, while patients treated with placebo were rerandomized 1:1 to UPA 15 mg or 30 mg. Incidence rates for MACE (CV death, nonfatal myocardial infarction, or nonfatal stroke), VTE (deep vein thrombosis or pulmonary embolism [fatal and nonfatal]), and malignancy (exNMSC) were evaluated as exposure-adjusted incidence rates per 100 patient-years (n/100 PY). MACE, VTE, and malignancy (exNMSC) background rates in the general US AD population were assessed in a retrospective observational claims-based analysis from Optum’s deidentified Clinformatics Data Mart database; this real-world reference population included patients with an AD diagnosis during the study period (March 2017–September 2024) determined by International Classification of Diseases 9th or 10th edition codes (≥ 1 inpatient or ≥ 2 outpatient claims for AD), and age restrictions from the UPA studies (12–75 years) were implemented. Background rates were weighted to mimic the age and sex distribution in the combined UPA trial population. Cohort stratification was based on the presence of CV risk factors at baseline (0 vs ≥ 1); UPA phase 3 data were further stratified by 1 vs 2 CV risk factors. CV risk factors included prior CV event, hypertension, diabetes mellitus, tobacco/nicotine use (current and former), elevated low-density lipoprotein cholesterol, or lowered high-density lipoprotein cholesterol. Results 2683 UPA-treated patients were included (UPA 15 mg, n = 1337, PY = 4435.2; UPA 30 mg, n = 1346, PY = 4752.5). MACE, VTE, and malignancy (exNMSC) background rates from the claims-based study were evaluated in 50,447 patients with AD. Long-term incidence rates in patients with up to 6 years of UPA treatment were low for MACE and VTE (all ≤ 0.2 n/100 PY) and malignancy (exNMSC; all ≤ 0.7 n/100 PY) and similar for patients who had 0 vs ≥ 1 CV risk factor. Rates from UPA phase 3 studies were similar to real-world US incidence rates in patients with AD. Rates remained low when UPA-treated patients were stratified by 1 vs 2 CV risk factors. Conclusion Incidence rates of MACE, VTE, and malignancy (exNMSC) in patients with moderate-to-severe AD who received up to 6 years of UPA treatment remained low and consistent with those observed in the overall population of patients with AD, regardless of CV risk category.

Abstract Introduction Artificial neural networks are predictive algorithms with higher discriminative ability than models derived from conventional logistic regression. Aim To compare the discriminative ability of an algorithm developed by an artificial neural network and the GRACE score for the prediction of mortality in acute coronary syndromes (ACS). Material/Methods :A database with consecutively included patients of acute coronary syndromes from a Community Hospital was analyzed. 57 variables were analyzed (50 cofactors and 7 covariates): demographic data, cardiovascular risk factors, cardiovascular and non-cardiovascular history, pre-admission medication, pre-admission procedures, vital signs at admission, admission Killip class , electrocardiographic patterns, peak levels of serum troponin T, serum creatinine, blood glucose, white blood cell count at admission, left ventricular function determined by echocardiography, invasive procedures and clinical events during hospitalization. Neural network models were trained with different methods (multilayer perceptron or radial basis), neural architectures and activation functions to select the best performing algorithm. The sample was subdivided into a 70% neural network training subpopulation and another 30% for validation. The areas under the ROC curve of the neural network and the GRACE score were compared using De Long's test. Calibration or goodness-of-fit analysis was performed by Hosmer Lemeshow test. Sensitivity analysis was performed to identify the variables with the highest independent normalized importance for the model. The SPSS 23.0 Statistics program was used for statistical analysis and neural network modeling. The end point of the analysis was hospital mortality. Results A total of 1818 ACS patients were analyzed. The best performing neural network model was the multilayer perceptron, with an architecture composed of a hidden layer with 4 neurons, tangent hyperbolic activation function of the in the hidden layer neurons and softmax of those in the output layer. The area under the ROC curve of the resulting algorithm for death prediction was 0.98 (95% CI 0.97-0.99). The GRACE score had an area under the ROC curve of 0.88 (95% CI 0.77-0.90). The comparison between both areas by De Long test showed significant differences: p&amp;lt;0.001. Calibration or goodness of fit showed better correlation between observed and calculated events (lower dispersion or residual values) with the neural networks chi-square 1.9 p= 0.78 with respect to the GRACE chi-square score of 4.9, p 0.06. The variables with the highest independent normalized importance in the artificial neural network model were serum creatinine (100%) and troponin T elevation (82%), Conclusions According to the present analysis, both the discriminatory capacity of hospital mortality as well as the calibration or goodness of fit of the artificial neural networks are significantly superior to the GRACE score.