Instituto Médico DAMIC

En las últimas décadas surgió bastante evidencia de calidad en el tratamiento de la hipertensión arterial (HTA) en el ámbito ambulatorio, pero no así en el contexto de la guardia médica. Es muy frecuente la atención de pacientes con HTA en los servicios de emergencia (SE) y su manejo sigue siendo motivo de incertidumbre a la hora de actuar. Es importante que el médico de guardia esté consciente que lo que tiene que tratar es un cuadro clínico, no una cifra y que muchas veces “menos es más”, ya que el tratamiento sin justificación clínica conlleva a iatrogenia.

Background: Health-related quality of life (HRQL) is reduced in patients with heart failure with preserved ejection fraction (HFpEF). However, the extent to which HRQL outcomes are related to cardiac structure and function in patients with HFpEF is not well understood. Methods: We examined the association between baseline echocardiographic measures and longitudinal Kansas City Cardiomyopathy Questionnaire (KCCQ) measures in patients with HFpEF in the PARAGON-HF trial using longitudinal regression models adjusted for age, sex, baseline KCCQ score, randomization, and other important clinical confounders. Results: Among 1,094 patients with baseline KCCQ data at randomization and a baseline echocardiogram within 6 months of enrollment, the mean age was 74 years and 53% were women. Over 3 years, 78% completed KCCQ measures at baseline, 12, 24, and 36 months. Missing values for non-survivors (n=116) were imputed as zero to avoid survival bias. Posterior wall thickness, septal E/e’, and right ventricular (RV) end diastolic area were negatively associated with the KCCQ Overall Summary Score, and a similar pattern of associations was observed for the KCCQ Clinical Summary Score (Table). Pulmonary artery systolic pressure was additionally negatively associated with the KCCQ Total Symptom Score. Notably, left ventricular (LV) size, septal wall thickness, LV ejection fraction, LV strain, and left atrial size were not significantly associated with longitudinal changes in KCCQ. Conclusion: In patients with HFpEF, increased LV posterior wall thickness, elevated LV filling pressure, elevated pulmonary pressure, and RV enlargement - together suggestive of more advanced diastolic dysfunction - are associated with a decline in KCCQ scores and may influence future worsening of quality of life.

Introduction: Prostate cancer (PCa) is the second most frequent type of cancer in men; diagnosis is reached through prostate biopsy, an invasive procedure, so efforts are made to avoid unnecessary ones by improving them and optimizing current biomarkers. Among existing biomarkers, prostate -specific antigen (PSA) Density (PSAD), a PSA derivative, is considered a feasible biomarker for PCa Objective: This study aimed to evaluate different PSA derivatives as well as determine whether PSAD with a cut-off point of 0.12 was more accurate than the widely used value of 0.15 to recognize patients suffering from prostate cancer. Material and methods: Retrospective study of 391 patients aged 40 years or more, who underwent prostate biopsy at Fundacion Urologica Cordoba para la Docencia e Investigacion Medica (FUCDIM) , from November 2010 to July 2014. Sensitivity and specificity for the PSAD cut-off point of 0.12 were estimated. Diagnostic accuracy was evaluated through Receiver Operating Characteristic (ROC) curves and the Area Under the Curve. PSAD was compared to total PSA, free/total PSA index, and (free/total PSA)/PSAD. Results: Significantly higher mean values were found in terms of total PSA, PSAD, and F/T PSA in patients with confirmed diagnoses of PCa. PSAD with a cut-off point greater than 0.12 detected a significantly higher percentage of cancer, 80%, p=0.0001, compared to the control group. Furthermore, the strength of association determined that patients with PSAD greater than 0.12 were 3 times more likely to belong to the PCa group. Conclusion: Total PSA, PSAD, and F/T PSA in patients with cancer yielded significantly higher mean values. The best biomarker to predict prostate cancer by biopsy was PSAD, with a cut-off point of 0.12. These results indicate the need to develop further investigations in diverse geographic areas to define the best local cut-off points for PSAD. Our results demonstrate that the established cut-off point of 0.15 could be appropriate for European men but appears to be too high for American and low for Asian males.

This document constitutes the second section A of the Third Argentine Consensus on the Management of Bipolar Disorders, focused on synthesizing the most updated evidence on therapeutic approaches for adult patients. The aim of this section (2A) is to provide therapeutic recommendations for managing bipolar disorders in adults. In addition, the scope of this current manuscript outlines recommendations on the use of treatment guidelines, levels of evidence available to support these recommendations, general considerations for the treatment of bipolar disorders, the so-called pseudoresistance and adherence to treatment, general considerations on psychological therapies, as well as long term treatment of bipolar disorders.

Objetivo: Comprobar si el grado de autoeficacia (AE) para dejar de fumar es diferente segn quin remita al fumador a la consulta de tabaquismo y evaluar si el grado de AE medida segn procedencia tiene impacto en el resultado (xito o fracaso). Mtodo: Estudio observacional, longitudinal (cohorte prospectiva), multicntrico, en consultas para dejar de fumar de Espaa y Argentina. Para valorar la motivacin, fueron utilizados test cuantitativos (Richmond, Henry Mondor de Paris y Khimji Watts) y una escala semicuantitativa. La AE se midi con una pregunta de dos cuestionarios distintos (pregunta 4 del cuestionario de Richmond y pregunta 3 del cuestionario de Khimji-Watts). El anlisis estadstico incluy modelos descriptivos, de asociacin y de regresin. Resultados: Muestra de 182 sujetos (90 [49,5%] mujeres, edad media 51,4 aos [DE: 11; IC 26-77]). Con la pregunta 3 de AE del test Khimji-Watts se encontr asociacin con la procedencia en los varones: acudir por voluntad propia incrementa la AE frente a los que acuden enviados desde atencin primaria o desde otras especialidades. Ninguna de las variables de AE present asociacin con el resultado en dejar de fumar, pero las mujeres que acudieron por voluntad propia o enviadas desde atencin primaria tienen ms probabilidades de dejar de fumar. Los varones procedentes de otras especialidades y con edades medias

The Third Argentine Consensus on the management of bipolar disorders (TB) is an initiative of the Argentine Association of Biological Psychiatry (AAPB). As a reference document, this consensus pursues two main objectives: on the one hand, to summarize and systematize the best available evidence on the comprehensive management of this pathology; on the other, to provide a useful, up-to-date instrument for psychiatrists, multidisciplinary teams dedicated to mental health, and government agencies. During a period of approximately six months of work -that is, from May to October 2022- a committee of experts made up of 18 professionals and representatives of the three most important Psychiatry and Mental Health associations in Argentina (that is, the AAPB, the Argentine Association of Psychiatrists, AAP, and the Association of Argentine Psychiatrists, APSA) have focused on updating the information regarding TB. Finally, this document was prepared as a result of an exhaustive review of the bibliography published to date, which was strategically divided into three parts: the first deals with the generalities of TB; the second deals with the comprehensive treatment of the pathology; finally, the third analyzes TB in the context of special situations.

BackgroundHigh triglyceride levels are associated with increased cardiovascular risk, but whether reductions in these levels would lower the incidence of cardiovascular events is uncertain. Pemafibrate, a selective peroxisome proliferator–activated receptor α modulator, reduces triglyceride levels and improves other lipid levels.MethodsIn a multinational, double-blind, randomized, controlled trial, we assigned patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg per deciliter), and high-density lipoprotein (HDL) cholesterol levels of 40 mg per deciliter or lower to receive pemafibrate (0.2-mg tablets twice daily) or matching placebo. Eligible patients were receiving guideline-directed lipid-lowering therapy or could not receive statin therapy without adverse effects and had low-density lipoprotein (LDL) cholesterol levels of 100 mg per deciliter or lower. The primary efficacy end point was a composite of nonfatal myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes.ResultsAmong 10,497 patients (66.9% with previous cardiovascular disease), the median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. The median follow-up was 3.4 years. As compared with placebo, the effects of pemafibrate on lipid levels at 4 months were −26.2% for triglycerides, −25.8% for very-low-density lipoprotein (VLDL) cholesterol, −25.6% for remnant cholesterol (cholesterol transported in triglyceride-rich lipoproteins after lipolysis and lipoprotein remodeling), −27.6% for apolipoprotein C-III, and 4.8% for apolipoprotein B. A primary end-point event occurred in 572 patients in the pemafibrate group and in 560 of those in the placebo group (hazard ratio, 1.03; 95% confidence interval, 0.91 to 1.15), with no apparent effect modification in any prespecified subgroup. The overall incidence of serious adverse events did not differ significantly between the groups, but pemafibrate was associated with a higher incidence of adverse renal events and venous thromboembolism and a lower incidence of nonalcoholic fatty liver disease.ConclusionsAmong patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo, although pemafibrate lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels. (Funded by the Kowa Research Institute; PROMINENT ClinicalTrials.gov number, NCT03071692.)