Hospital Universitario Austral

Introduction: Children with cancer frequently experience clinical deterioration events (CDEs), with high mortality and resource utilization, yet limitations of life-sustaining interventions (LLI) remain poorly characterized. Understanding these practices can guide resource allocation and promote goal-concordant care. We hypothesized limited LLI among critically ill children with cancer in Latin America. Methods: Proyecto EVAT is a collaborative to improve early identification of CDEs in children with cancer. Participating hospitals registered CDE characteristics, outcomes, and LLI. Patients with pre-existing LLI were excluded. Treatment-related mortality (TRM) was defined as death from any cause other than cancer progression or relapse. Registry data from April 1, 2017 through December 31, 2024 were included, with each hospitalization used as the unit of analysis. Chi-squared tests evaluated associations between LLI and mortality, TRM, and oncologic diagnoses. Univariate logistic regression estimated the odds of LLI by cancer type. Results: A total of 4490 CDEs occurred during 3993 hospitalizations among 3592 patients at 73 hospitals in 18 countries. LLI were used in 7.6% of hospitalizations, with wide variability across hospitals (range 0 -100%), mainly due to cancer progression (70%). Overall, 32% of hospitalizations resulted in death with 91% during the CDE. Among deaths, 41% occurred within 48 hours of CDE start and 82% were due to TRM. LLI were more common among non-survivors (14% vs 5% survivors, p< 0.0001), in deaths due to cancer progression (37% vs 9% in TRM, p< 0.0001), and in deaths occurring >48 hours after CDE start (21% vs 4% in deaths < 48 hrs since CDE start, p< 0.0001). Compared to patients with hematologic malignancies, those with CNS (OR=3.6, 95% CI [2.5, 5.2], p< 0.0001) and solid tumors (OR=1.8, 95% CI [1.4, 2.4], p< 0.0001) had higher odds of using LLI. Conclusions: LLI use is infrequent among children with cancer experiencing CDEs, even among those who died, suggesting missed opportunities for goal-concordant care. When used, LLI were more often due to cancer progression, suggesting perceived prognosis, rather than severity of acute illness, drives LLI decisions. Despite higher mortality, palliative care principles are underutilized in cancer treatment-related critical illness.

Total knee arthroplasty (TKA) provides substantial pain relief and functional improvement in advanced knee osteoarthritis, yet up to 20% of patients remain dissatisfied despite technically successful procedures. Traditional preoperative assessments overlook psychological determinants influencing surgical decision-making and postoperative satisfaction. Prospect Theory—emphasizing loss aversion and perceived gains—offers a novel behavioral framework to explain these outcomes. A retrospective observational study included 500 patients with Kellgren–Lawrence grade III–IV osteoarthritis; 300 underwent TKA and 200 declined surgery. Preoperative and postoperative assessments included EQ-5D, Satisfaction With Life Scale (SWLS), and Global Perceived Effect (GPE). Psychological parameters were evaluated using a Prospect Theory–based model quantifying perceived gains, perceived risks, and loss aversion (α = 0.88, β = 0.88, λ = 2.25). Statistical analyses comprised t-tests, chi-square tests, correlations, and logistic regression to identify predictors of surgical decision and satisfaction. Patients who declined surgery demonstrated higher loss aversion (7.1 ± 1.9) compared to surgical patients (4.3 ± 2.1, p < 0.001). Perceived gain scores were greater in the TKA group (8.2 ± 1.4 vs. 5.9 ± 1.6, p < 0.001). Loss aversion correlated negatively with surgical acceptance (r = –0.655, p < 0.001), while perceived gain correlated positively (r = 0.746, p < 0.001). Among surgical patients, EQ-5D mobility improved from 0.41 ± 0.22 to 0.78 ± 0.19, pain decreased by –3.4 points, and anxiety/depression by –2.1 points (all p < 0.001). Logistic regression identified loss aversion (OR 0.62, 95% CI 0.51–0.74) and perceived gain (OR 1.48, 95% CI 1.28–1.71) as independent predictors of surgical acceptance. Overall satisfaction was 82% at 12 months. Psychological factors, particularly loss aversion and perceived gains, significantly influence both the decision to undergo TKA and postoperative satisfaction. The Prospect Theory–based model accurately predicted surgical acceptance and recovery trajectories, underscoring the potential of integrating behavioral economics into preoperative counseling and shared decision-making. • Up to 20% of TKA patients remain dissatisfied despite technical success. • Prospect Theory explains decision-making through loss aversion and perceived gains. • Higher loss aversion was strongly linked to declining surgery. • Perceived gains predicted surgical acceptance and postoperative satisfaction. • A Prospect Theory model accurately predicted decisions and recovery outcomes. • Integrating behavioral economics may improve counseling and reduce dissatisfaction.

In November 2021, the Surviving Sepsis Campaign (SSC) published an update to its 2016 guidelines and recommendations. Subsequently, during the CIMU 2022 (33rd World Congress on Emergency Medicine, held in March 2022 in Guadalajara, Mexico), the 2021 SSC Guidelines were reviewed and analyzed from the perspective of emergency physicians (EPs). The experts involved in this task also reached consensus and published several key points of greatest interest and concern to EPs regarding the management of patients with severe infection or sepsis in hospital emergency departments (EDs). These points included several improvement proposals developed by GTLATINFURG (Latin American Working Group for Improving Infection Care in Emergency Departments) and formally presented in what became known as the "Guadalajara Declaration." That document outlined complementary or alternative considerations to the 2021 SSC Guidelines. The first proposal was to "develop guidelines aimed at detecting, preventing progression, and managing patients with severe infection and sepsis in EDs." Since then-and owing to numerous original research studies and review articles published by the GT-LATINFURG and INFURG-SEMES groups (Infection Study Group of the Spanish Society of Emergency Medicine)-we can now claim that there is scientific evidence generated in EDs themselves, or at least that existing evidence has been reviewed while considering the specific role of EPs. The main aim of this consensus document, as the initial presentation of the first proposal of the Guadalajara Declaration, is to analyze-based on routine clinical practice, experience, available evidence, and the perspective of ED physicians-several key issues and controversies in order to establish recommendations through expert consensus grounded in current scientific evidence.

ABSTRACTMucopolysaccharidosis II is a rare, X‐linked disease, with very few reports of affected female patients. Natural history data describe a predominantly male population, and appropriate disease characterization in female patients is lacking. This analysis explores the somatic disease burden and clinical progression of female patients with MPS II enrolled in the Hunter Outcome Survey (HOS; NCT03292887), a global disease registry. In total, 15 female patients were identified, representing 1.1% of the total patients in HOS. The median ages at first symptom onset and diagnosis were 1.8 and 3.1 years, respectively. A total of 8/14 (57.1%) of patients had cognitive impairment at the latest visit. X‐chromosome abnormalities were reported in two patients. Most patients (11/15, 73.3%) had received at least one dose of idursulfase, which was generally well tolerated; no serious adverse events during follow‐up were considered treatment‐related. Musculoskeletal and ear symptoms were present in all 14 patients with data recorded. Almost all females also experienced neurological, abdominal/gastrointestinal, and pulmonary disease, similar to the symptomatology reported in males. Most patients underwent surgery (41 procedures in 12 patients). Two participants had a male sibling with MPS II who was also enrolled in HOS. Both sibling sets had missense variants and demonstrated several differences in signs/symptoms between the male and female siblings. Notably, only the female siblings displayed cognitive impairment. This report illustrates the disease burden in female patients with MPS II, helping to inform clinicians about the likely prognosis for this extremely rare subgroup of patients.

BackgroundChronic psychosocial stress (CPSS) has been proposed as a risk factor for cardiovascular disease (CVD); yet there are not conclusive studies supporting this theory due to the complexity and the lack of objective assessment measures, together with the absence of homogeneous reactions towards CPSS. Objectives To determine the presence of an association between low resilience (LR) to chronic PSS and hypertension and target organ damage in untreated outpatients undergoing a routine health examination, and to determine whether this association is related to the pattern of neurohumoral activation. Material and MethodsWe conducted a preliminary observational and cross-sectional study that enrolled 53 consecutive patients, 32 men and 21 women. The patients answered two questionnaires: one measured CPSS and the other the Connor-Davidson Resilience Scale. Patients were divided into four groups: 1, no CPSS and normal resilience (NR); 2, no CPPS and low resilience (LR) 3, with CPSS and NR; 4 with CPSS and LR. Results The prevalence of hypertension and increased waist circumference (IWC) was greater in group 4 (p&lt;0.001 and p=0.05, respectively). The plasma levels of norepinephrine, cortisol and vanillyl mandelic acid were slightly increased in group 4, yet these differences were not significant. A logistic regression model was used to control for confounding in order to determine whether CPPS together with LR constitute a risk factor for the development of hypertension; odds ratio, 10.9, 95% CI: 1.7-65.2. ConclusionsThese preliminary data suggest that subjects with CPPS and LR have high risk for the development of hypertension.

WU-KONG1B (ClinicalTrials.gov identifier: NCT03974022) is a multinational phase II, dose-randomized study to assess the antitumor efficacy of sunvozertinib in pretreated patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations (exon20ins). Eligible patients with advanced-stage EGFR exon20ins NSCLC were randomly assigned by 1:1 ratio to receive sunvozertinib 200 mg or 300 mg once daily (200 and 300 mg-rand cohorts). After predefined interim analysis, additional patients were enrolled and treated with the 300 mg dose once daily. The primary end point was blinded independent review committee (IRC)-assessed confirmed objective response rate (cORR), and the key secondary end point was duration of response (DoR). Among 85, 89, and 107 efficacy-evaluable patients in 200 mg-rand, 300 mg-rand, and 300 mg-all (including randomly assigned and nonrandomized patients) cohorts, the cORRs were 45.9% (97.5% CI, 33.6% to 58.5%), 47.2% (97.5% CI, 35.1% to 59.5%), and 45.8% (97.5% CI, 34.8% to 57.0%), respectively, per IRC assessment. The predefined null hypothesis was rejected with statistical significance (P < .0001). Comparing 300 and 200 mg-rand cohorts, higher cORRs were observed in patients with baseline brain metastasis (52.4% v 28.6%) and previous amivantamab treatment (41.7% v 25%), as well as longer DoR (13.8 v 11.1 months). At 200 and 300 mg once daily, the most common treatment-related adverse events with grade ≥3 included diarrhea (2.2% v 18%), blood creatine phosphokinase increased (6.6% v 12.6%), and anemia (4.4% v 6.3%). Sunvozertinib is efficacious at both 200 and 300 mg once daily in treating platinum-pretreated patients with advanced EGFR exon20ins NSCLC. The treatment-related adverse events of sunvozertinib were consistent with an EGFR tyrosine kinase inhibitor, with a more favorable safety profile at 200 mg than 300 mg once daily.

A major barrier to hepatitis C virus (HCV) elimination is the failure to ensure that individuals complete the HCV care cascade after they test positive for HCV RNA and/or antibody. Microelimination programmes support protocols that reengage patients with care/treatment. We describe 18 microelimination programmes aimed at identifying persons who were diagnosed but untreated/not cured and reconnecting them to care. Here, we report the programmes' effectiveness, identify key challenges and suggest best practices for future initiatives. Pooled and individual programme data (available as of 31 January 2024) were assessed. Each programme had a retrospective phase in which medical/laboratory records were searched within a specified date range for patients who were positive for HCV antibody and/or RNA at last testing. In a prospective phase, programmes attempted to reengage these patients with care. Across the 18 programmes worldwide, 82 006 individuals were identified as eligible for follow-up. Overall, 21 235 people were selected for attempted contact, and 5308 were relinked to care. In 17 programmes reporting treatment data, 51% (1513 of 2976) of relinked patients initiated treatment. Four programmes used innovative care models and achieved treatment initiation rates ≥ 80%. Amongst patients with results available, 89% (643 of 722) who initiated treatment achieved HCV cure. Challenges included the inability to contact people and missed appointments. Systematic screening of medical/laboratory records was effective in identifying patients who had been lost to follow-up, and the use of innovative care models, such as test-and-treat or decentralised approaches, resulted in higher treatment numbers.

This report describes the rare case of a patient with autoimmune hemolytic anemia due to cryoagglutinins secondary to Mycoplasma pneumoniae infection, coexisting with pernicious anemia. A 56-year-old man presented with a ten-day history of cough and mucocutaneous pallor. Laboratory studies revealed megaloblastic anemia with low vitamin B12 levels, positive antibodies against intrinsic factor and parietal cells, as well as hemolysis parameters and a positive direct Coombs test for complement (C3d) with cryoagglutinins active at low temperatures. M. pneumoniae infection was confirmed by indirect immunofluorescence for IgM and IgG. Intramuscular B complex supplementation and doxycycline were administered for 14 days, improving hemoglobin and other hematological parameters within four weeks. This case highlights the diagnostic complexity in patients with rare hemolytic anemias in the context of atypical infections and underscores the importance of a multidisciplinary approach for their diagnosis and appropriate treatment. The coexistence of cryoagglutinin-mediated autoimmune hemolytic anemia and pernicious anemia poses diagnostic and therapeutic challenges that are relevant to clinical practice.