Hospital Italiano La Plata

BackgroundControversy exists regarding the temporal changes in lipid levels after an acute coronary syndrome (ACS). In our country, there is limited information about the basal characteristics of the lipid profile and the variability of its components after an ACS, and it does not include direct measuring of LDL-C or apolipoproteins. Objectives1) To analyze the changes in lipoprotein and apolipoprotein levels in a group of patients hospitalized with ACS, and 2) to describe the basal lipid profile and compare it with that of a healthy population. Material and MethodsPlasma levels of total cholesterol (TC), LDL-C, HDL-C, ApoB and ApoA were measured at admission, 18 hours and 42 hours in patients hospitalized with ACS. None of the participants were taking lipid-lowering drugs or received them within 48 hours after hospitalization. ResultsA total of 31 patients were included (mean age 61 years, 87% were men, 51% with Q-wave AMI, 19% with non Q- wave AMI and 30% with unstable angina). Plasma levels of TC, non HDL-C and LDL-C presented a significant reduction during hospitalization (mean ± standard deviation at admission, 18 hours and 42 hours, p value): TC (218±53, 206±40 and 194±41; p=0,005), non HDL-C (180±54, 169.8±40 and 157.6±39; p=0,01), LDL-C (136±30, 134±33 and 127±37; p=0.01). ApoB and HDL-C levels did not change in a significant fashion. Baseline ApoA levels corresponded to the 5th percentile of a healthy population and there was an early and significant reduction during hospitalization (115±21, 108±18 and 106±3; p=0,01). ConclusionsIn patients with ACS basal lipid profile should be evaluated at the moment of hospitalization. ApoB levels remained stable and might be used to select the therapeutic strategy. Reverse cholesterol transport was affected in more than 50% of the population.

Abstract Introduction Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) dysfunction and right heart failure. RV adaptation to increased afterload is a key prognostic factor. Traditional echocardiographic parameters offer insight but may not fully capture RV remodeling complexity. Phenotypic classifications combining RV size, contractility, and ventricular-arterial coupling may improve risk stratification. Methods A multicenter prospective cohort study was conducted in patients with de novo diagnosis of PAH as part of the TREPostinil Subcutáneo a LARgo Plazo en Hipertensión Pulmonar registry (TREPAR-HP). Six right ventricular (RV) phenotypes (A–F) were evaluated based on the RV basal diameter, fractional area change (FAC), and the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). This classification ranges from a normal and adapted RV (phenotypes A–C) to severe dysfunction and dilation (phenotypes D–F). Results Figure 1 shows the distribution of phenotypes. In a cohort of 93 patients (mean age 46.7 years, 86% women), the most common etiology was idiopathic (57%). Most patients presented with functional class III (62.4%) and received dual therapy (86%). Height (p=0.002), right atrial area (p=0.001), RV basal diameter (p<0.001), and TAPSE (p<0.001) showed significant differences between groups. The median BNP was 290.27 pg/mL, and the average cardiac output was 4.38 L/min (p=0.012). These findings highlight the functional and hemodynamic burden of the cohort. Figure 2 shows the distribution of phenotypes with respect to risk classification according to REVEAL. Conclusion RV phenotypic classification reveals distinct adaptation patterns in PAH. Advanced phenotypes (D–F) showed worse functional class, larger right atrial areas, and greater RV dysfunction. This approach may enhance risk stratification and guide management, underscoring the importance of early detection of RV maladaptation Figure 1. Distribution of phenotypes. Figure 2. distribution of phenotypes with respect to risk classification according to REVEAL.

Introduction: Journal Clubs (JCs) are educational spaces where participants meet periodically to analyze and discuss scientific articles. One of the main challenges is ensuring that these activities are motivating, add value to training programs, and remain sustainable over time. Since 2009, a JC has been operating in the Department of Internal Medicine, and its most recent experience is described in this study. Development: The period analyzed was from December 2023 to August 2024, involving 56 residents from the Department and fellowship trainees from 17 sections, with between one and four members per year. The format included 60-minute in-person meetings held every two weeks, during which a different scientific article was discussed each month. Coordination was carried out by a team composed of an expert in internal medicine, a research methodology expert —who remained constant— and at least two residents or fellows, who rotated monthly. Each group selected an article, circulated it via email along with complementary educational materials and a guiding question set. Meetings emphasized interaction and debate. At the end of each session, a feedback form was distributed to gather input on the most valued aspects and areas for improvement. Results: During the study period, 18 meetings were held, with an average attendance of 30 participants, most of them residents. The topics mainly focused on research methodology. Participants appreciated the variety of articles, the interdisciplinary perspective, and the collaborative work in small groups. Suggestions included the need for a more clinical approach and stratifying sessions according to knowledge level. Conclusion: The JC was perceived as a valuable and engaging activity, sustained over time with good attendance. Although participation was not mandatory, it promoted the development of critical reading skills and strengthened the practice of evidence-based medicine. Improvements are planned for future editions.

Why do we need organ dysfunction scores? Intensive care medicine is characterized by providing organ support to dysfunctional or failing organs during acute or acute-on-chronic illness. Organ dysfunction may present in isolation or combination and occur at different times during critical illness in each patient. Although intensivists are trained to recognize and respond promptly to […]

ABSTRACTThis retrospective multicenter study aimed to compare outcomes and evaluate risks associated with allogeneic hematopoietic cell transplantation (allo‐HCT) in myelodysplastic syndrome patients aged ≥ 65 versus < 65 years in Latin America, across 38 transplant centers (1988–2023). Of the 441 patients, 70 (16%) were ≥ 65 years (median age 68 ± 3.7). At 5 years, overall survival (OS) was 49.3% in patients ≥ 65 vs. 56.7% in those < 65 (p = 0.49), and progression‐free survival (PFS) was 48.4% vs. 56.2% (p = 0.40). The cumulative incidence of relapse was 13.6%, and non‐relapse mortality (NRM) 33.8%. After propensity score matching, no significant differences were observed between the age groups in OS (HR = 1.16; 95% CI: 0.76–1.77; p = 0.488), NRM (HR = 1.03; 95% CI: 0.64–1.67; p = 0.90) or PFS (HR = 1.20; 95% CI: 0.779–1.83; p = 0.40). PFS in patients ≥ 65 years was associated with high‐risk IPSS‐R stratification (p = 0.0056). The age group ≥ 65 years conferred higher risk of relapse compared to patients aged < 65 years (HR = 2.77; 95% CI: 1.07–7.15; p = 0.035). In patients ≥ 65 years, prevalence risk was associated to male sex, reduced‐intensity conditioning, mobilized blood cells, and prior treatment, while in those < 65 years, to complications and chronic GVHD (p < 0.05). HCT is feasible in elderly patients. However, age may influence disease progression in very high‐risk elderly patients and risk of relapse after transplantation.