Hospital Privado

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.

Abstract Background Epidemiological and phenotypic variability across regions for IBD is well recognised; however, data from Latin America (LATAM) remain limited. Furthermore, specific data Crohn’s Disease (CD) related perianal fistula (PF-CD), a severe phenotype of CD is not available from across LATAM countries. This study aimed to compare the demographic, clinical, and phenotypic characteristics of PF-CD across four LATAM cohorts. Methods A retrospective study was conducted including patients with an established diagnosis of PF-CD from Argentina (N = 75), Chile (N = 49), Colombia (N = 145), and Peru (N = 22). Variables assessed included age at fistula diagnosis, CD duration prior to fistula onset, and prior exposure to immunomodulators and corticosteroids. Inter-country comparisons were performed using the chi-square test for categorical variables and the Kruskal–Wallis test for continuous variables. Results Based on the demographic profile described in Table 1, the cohort included 291 patients with a median age of 30 years at Crohn’s disease diagnosis and 31 years at PF-CD diagnosis, with a predominance of non-stricturing, non-penetrating disease (55%) and colonic or ileocolonic involvement (79%). As shown in Table 2, the median delay from CD diagnosis to PF-CD onset was 21 months [6–48], with substantial variation across countries. Overall, 54% of fistulas were classified as simple and 46% as complex. Active proctitis was present in 44% of patients, with the highest proportions observed in Argentina and Peru. Proctectomy was required in 3% of the cohort, though with notable inter-country variation. These findings highlight the clinical heterogeneity of PF-CD across Latin American settings. Conclusion This multicentre LATAM analysis demonstrates substantial inter-country variability in PF-CD presentation, including differences in disease behaviour, fistula complexity, and time to fistula development. Nearly half of patients presented with complex fistulas, and active proctitis was frequent across cohorts. These results underscore the importance of improving early detection and optimising multidisciplinary management. Overall, the findings highlight the phenotypic heterogeneity of PF-CD in Latin America and support the need for region-specific clinical strategies. Conflict of interest: Dr. Pavez, Carolina: No conflict of interest Juliao Baños, Fabián: No conflict of interest Balderramo, Domingo Cesar: No conflict of interest Cedron Cheng, Hugo Guillermo: No conflict of interest Hernandez-Rocha, Cristian: No conflict of interest Parra Izquierdo, Leidy Viviana: None Osorio, Laura: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Puentes-Manosalva, Fabian: No conflict of interest Pizarro, Paula A.: No conflict of interest Etchevers, Maria Josefina: No conflict of interest Sobrero, Maria Josefina: No conflict of interest Montero, Joaquin: No conflict of interest Gil, Anibal Hector: No conflict of interest Sanchez, Maria Belen: No conflict of interest Sambuelli, Alicia: no Balaban, Ezequiel: No conflict of interest Rohwain, María José: No conflict of interest Alvarez-lobos, Manuel: No Conflicts Bellolio, Felipe: No conflict of interest Sepúlveda, Ignacia: No conflict of interest Hernandez, Elisa: No conflict of interest Pérez, Tamara: No conflict of interest Estay, Camila: No conflict of interest Rojas, René: No conflict of interest Sepulveda, Rolando: No conflict of interest Perez Alfaro, Ignacio: No conflict of interest Paredes Mendez, Juan: No conflict of interest Cervera Caballero, Luis: No conflict of interest Sebastian, Shaji: No conflict of interest Catalàn-Serra, Ignacio: No conflict of interest

To identify and summarize all primary studies addressing clinical results of patients undergoing denervation surgery for hand and wrist conditions. We searched seven electronic databases, including MEDLINE (Ovid MEDLINE ALL, 1946 to present), Embase (OVID, 1974 to present), and the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We included any primary study addressing clinical outcomes of patients undergoing denervation surgery of the hand and wrist, regardless of their design or language. Two independent authors screened the studies. Three reviewers extracted the data, and two assessed the risk of bias using the MINORS score. 72 studies were included in this review, 65 already published, and seven ongoing studies. Most studies are of low level of evidence, and the majority (66%) were performed in Europe. Forty-three studies (60%) reported outcomes on wrist denervation surgery, 16 on first carpometacarpal denervation surgery, and nine on digit joints denervation. Overall, hand and wrist denervation surgery seems to be a safe, pain-relieving, and motion-preserving treatment option for painful arthropathy. Nevertheless, surgeons must advise patients that revision surgery could be needed. High-quality, prospective, comparative studies are missing for wrist and hand denervation to provide strong evidence-based recommendations.

Introducción: Se presenta una técnica quirúrgica innovadora para la reconstrucción de una mano con amputación transmetacarpiana, que consiste en el alargamiento del cuarto rayo mediante el uso del segundo metatarsiano a modo de injerto óseo no vascularizado para lograr una pinza oponente funcional, como complemento de la transferencia del segundo dedo del pie a la mano; esto permite resolver el desafío de reconstruir una mano metacarpiana en un tiempo quirúrgico y con una única transferencia, evitando complicaciones en otros sitios dadores de injerto óseo. Se muestran también los resultados funcionales y estéticos obtenidos en nuestro único caso hasta el momento. No se encontraron reportes bibliográficos de una técnica similar para resolver este problema. Conclusiones: El retiro del metatarsiano del dedo donante en el pie permite un mejor cierre del espacio intermetatarsiano con menos riesgo de complicaciones y sirve como injerto óseo no vascularizado para otorgar un macizo de oposición al dedo del pie transferido. Esto simplifica el acto quirúrgico y disminuye el riesgo de complicaciones.

This study assessed sarilumab in treating patients with polyarticular-course juvenile idiopathic arthritis (pcJIA). This phase 2b, open-label study (NCT02776735) consisted of three sequential parts (each with a core-treatment and extension phase). During part 1, three doses were assessed in two weight groups (group A/B: ≥30-60 kg/≥10 to <30 kg) to select the optimal dose with regard to pharmacokinetics, safety and efficacy were evaluated in latter parts. During the extension phase of part 1, patients initially assigned to the selected optimal dose continued on this dose; the remaining patients were switched to this selected dose. Patients in parts 2 and 3 received the selected dose from baseline. The primary endpoint was pharmacokinetic exposure (area under the serum concentration versus time curve during a dose interval Շ of 2 weeks [AUC0-Շ], maximum serum concentration observed [Cmax], and concentrations observed before treatment administration during repeated dosing [Ctrough]). Safety and efficacy were assessed. The mean age of treated patients (N = 101; 76.2% female) was 9.4 years. Of the evaluated doses in part 1, dose 2 (group A/B: 3.0/4.0 mg/kg every 2 weeks [q2w]) was selected. In patients receiving the selected dose from baseline (n = 73), Cmax, AUC0-14 days and Ctrough at steady state in group A/B were 27.1/40.4 mg/L, 276/395-day*mg/L, and 9.57/14.4 mg/L, respectively. At week 48, the JIA-American College of Rheumatology 30%, 50%, 70%, and 90% improvement criteria rates were 100%, 100%, 93.8%, and 76.6%, respectively. Adverse events were reported in 70 of 73 patients (95.9%). Twenty-seven patients (37%) experienced grade 3/4 neutropenia; there were no associated infections. No deaths occurred. In patients with pcJIA receiving the selected dose from baseline, pharmacokinetic exposure was comparable to a dose of 200 mg q2w for adults with rheumatoid arthritis. Clinically relevant improvements were observed in disease activity, with safety being consistent with the known profile of sarilumab.

Hospital Privado Centro Medico de Cordoba. Cordoba, Argentina 1 Servicio de Cardiologia 2 Clinica Medica MTSAC Miembro Titular de la Sociedad Argentina de Cardiologia e-mail: aletreras@hotmail.com Hasta un cuarto de la poblacion general puede tener foramen oval permeable (FOP), como tambien alrededor del 30% de los pacientes con accidente cerebrovascular criptogenico (ACVC). (1) Existen evidencias de la asociacion entre la presencia de FOP y ACVC tanto en jovenes como en mayores de 55 anos. (2) Al evaluar a estos pacientes, la determinacion del tamano o el grado de gravedad del FOP, asi como la presencia de lesiones asociadas (p. ej., aneurisma del septum interauricular), tiene relevancia clinica. Si bien el ecocardiograma transesofagico (ETE) es el metodo de referencia para el diagnostico, el Doppler transcraneal simultaneo puede ser de utilidad para la cuantificacion del FOP. (3) Se presentan imagenes de un paciente masculino de 70 anos, hipertenso con historia de crisis isquemica transitoria (CIT) 5 anos atras y estenosis carotidea derecha del 40%, tratado con aspirina. Dos anos despues tuvo un nuevo episodio de CIT, del que se recupero integramente. En la actualidad se interna por paresia de hemicuerpo izquierdo; un nuevo eco-Doppler de vasos del cuello mostro ateromatosis carotidea sin progresion de la enfermedad. Se realizo un ETE combinado con ecoDoppler transcraneal con contraste, donde se observo un FOP grande (pasaje de derecha a izquierda con maniobra de Valsalva mayor de 20 burbujas) (Figura 1) con aneurisma del septum interauricular y efecto shower en el Doppler transcraneal de la arteria cerebral media (Figura 2). A pesar de la ausencia de evidencia clara, (1) debido a la presencia de cortocircuito de derecha a izquierda y a la recurrencia de eventos isquemicos, se aconsejo el cierre percutaneo del FOP. Fig. 1. Ecocardiograma transesofagico con pasaje de burbujas (flecha). AD: Auricula derecha. AI: Auricula izquierda.