Introduction: Lateral epicondylitis is one of the most common musculoskeletal conditions in people who perform repetitive manual tasks. It causes persistent pain and functional limitation of the affected upper limb, with a strong impact on work activity. Radial shock wave therapy has been incorporated in recent years as a noninvasive therapeutic alternative for treating persistent chronic tendinopathies, such as lateral epicondylitis. Objective: To evaluate the tolerability, presence of adverse effects, and effectiveness of radial shock wave therapy on pain and function in workers with occupational lateral epicondylitis. Method: An analytical, experimental, longitudinal, prospective, single-cohort study was conducted, including 26 workers treated at the Hospital Banco de Seguros del Estado with a clinical and imaging diagnosis of lateral epicondylitis. The intervention consisted of three weekly sessions of radial shock wave therapy. Tolerability and the presence of adverse effects, as well as their duration and possible complications, were systematically recorded in tables. Pain was also assessed using the visual analog scale (VAS), and function was assessed using the QuickDASH questionnaire, before and after treatment. Results: The therapy studied was well tolerated by all participants. The adverse effects recorded were few, mild, and transient. A decrease in pain and a significant improvement in function were observed at the end of the treatment series, with large effect sizes. Conclusions: Radial shock wave therapy proved to be a safe, well-tolerated, and clinically effective intervention for the treatment of occupational lateral epicondylitis.
Introduction: Anti-Sm antibodies (Ab.) are highly specific for the diagnosis of systemic lupus erythematosus (SLE), al-though they occur infrequently. In cases of suspected systemic autoimmune disease, several guidelines recommend a stepwise testing protocol which, in clinical practice, is not always followed. The laboratory of the Asociaci & oacute;n Espa & ntilde;ola (Montevideo, Uruguay) began using the chemiluminescence method (CLIA), occasionally observing unexpected anti-3m reactivities. Objectives: The objectives were to determine the optimal cut-off of the CLIA method and to compare its diagnostic per-formance with ELISA for the detection of anti-Sm antibodies. Materials and methods: The CLIA cut-off was compared with ELISA and indirect immunofluorescence (IIF, ANA HEp 2) using a reference material. Anti-Sm antibodies were determined by CLIA and ELISA in 40 patient sera. Sensitivity, spec-ificity, positive predictive value (PPV), negative predictive value (NPV), and the optimal CLIA cut-off were calculated by ROC curve analysis. In addition, chi-square, Cohen's kappa coefficient, and R2 between CLIA and ELISA were calculated. Results: The cut-offs found were: IIF 1/4096, CLIA 1/1024, and ELISA 1/512. The sensitivity of both CLIA and ELISA was 95%, whereas specificity was 93% and 100%, respectively. The PPV of CLIA and ELISA was 76% and 100%, respec-tively, and the NPV was 93% and 95%, respectively. The optimal CLIA cut-off was 41.5 CU (85% sensitivity and 96% specificity), chi-square was 18.2 (p < 0.01) , the kappa coefficient was 0.65 (p < 0.01) , and the R2 coefficient was 0.33 (p = 1.92 * 10 <^> n - 16) , Conclusions: CLIA may be used as an alternative to ELISA for the detection of anti-Sm antibodies, provided that the meth-od cut-off is adjusted to the population of each laboratory, using IIF, ANA HEp-2 either in parallel or in a stepwise manner.
Introduction: Spinal cord stimulation (SCS) is a well-established technique for the treatment of certain types of refractory chronic pain. There are currently no publications on the outcomes obtained in our setting. The aim of this study was to analyse the efficacy and safety of SCS in the first case series in Uruguay. Materials and methods: All patients implanted with a spinal cord stimulator between July 2020 and May 2025 were retrospectively included. To analyse treatment efficacy, pre-and postoperative values for pain intensity (visual analogue scale), disability level (Oswestry Disability Index) and opioid consumption (OMED: oral morphine equivalent dose) were compared. Parametric and non-parametric tests were applied to compare means and determine statistical significance. Adverse events were described for the safety analysis. Results: Epidural electrodes were implanted in 25 patients. There were 18 cases of failed back surgery syndrome, 6 of neuropathic pain (NP) and 1 of complex regional pain syndrome. Overall, 82 degrees%o of patients responded to SCS. Axial low back pain decreased from 6.4 to 2.5 points; radicular/neuropathic pain, from 8.2 to 3.5; disability scores, from 64 degrees%o to 27 degrees%o; and OMED, from 193 to 54 mg/day. All these differences were statistically significant (p < 0.05). Nine adverse events occurred, 2 of which were serious and required explantation. Conclusions: Spinal cord stimulation was effective in reducing pain intensity, disability level and opioid consumption in the Uruguayan population studied. Prospective studies with a larger number of patients are needed to validate the findings of this preliminary analysis.
Introduction: Viral pneumonitis is the main cause of hospital admission in patients with COVID-19. Timely post-discharge follow-up should be performed to diagnose and manage the main respiratory complications. Objective: To describe the clinical, radiological, and functional follow-up after hospital discharge for COVID-19 pneumonitis. Materials and methods: Observational, analytical, retrospective study. Hospitalised patients from January to July 2021 with a discharge diagnosis of COVID-19 pneumonitis were included. Follow-up was conducted both by telephone and in person, including clinical, imaging, and spirometric assessment in those with dyspnoea and/or abnormal imaging at 8 weeks after discharge. Results: n=590 patients, 355 men. Age: 52 +/- 14 (mean +/- SD) years. Comorbidities: hypertension (34 degrees%o), obesity (18 degrees%o), chronic respiratory diseases (17 degrees%o), diabetes (16 degrees%o), smoking (12 degrees%o). Admission to the intensive care unit n=73 (12 degrees%o); high-flow oxygen therapy n=52 (9%), non-invasive mechanical ventilation n=19 (3%), and invasive mechanical ventilation n=14 (2%). Eleven percent developed severe disease. Obesity/overweight was significantly associated with severe disease (OR 2.33; 95% CI 1.32-4.10; p=0.004). Severe disease was associated with a higher likelihood of discharge with home oxygen (OR 2.05; 95% CI 1.19-3.53; p=0.008). Twenty-three percent required oxygen therapy at discharge. Corticosteroid therapy for more than 10 days: n=119 (20%). At 4-8 weeks, 62% had persistent symptoms, with dyspnoea being the most frequent (24%). At 4-12 weeks, 31% showed persistent radiological abnormalities. Eighteen percent (n=33) of spirometry tests performed were abnormal, with a predominance of a restrictive pattern (28/33). Conclusions: A significant proportion of patients hospitalised for COVID-19 pneumonia presented clinical, radiological, and functional respiratory sequelae during post-discharge follow-up. Initial severity and obesity/overweight were associated with worse outcomes. These results support the implementation of structured respiratory follow-up programmes in this population.
Introduction: Anxiety and depression are common mental disorders among hospitalised patients and are associated with increased emotional distress and difficulties in the course of illness. The aim of this study was to analyse the frequency of anxious and depressive symptoms in patients admitted to intermediate care wards at the Hospital de Clinicas "Dr. Manuel Quintela" between July and October 2024, and to explore their relationship with clinical and sociodemographic variables. Materials and methods: An observational, descriptive, cross-sectional, and correlational study was designed. The sample consisted of 143 adult patients. An ad hoc sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Results: The prevalence of anxiety was 45.5% and that of depression was 23.7%, being higher in women. A moderate association was observed between depression and chronic obstructive pulmonary disease (COPD), and no significant associations were found with length of hospital stay or with most of the chronic conditions evaluated. Conclusions: The findings reinforce the need to implement systematic mental health assessment strategies during hospitalisation, with an emphasis on the early recognition of emotional symptoms.
Introduction: In recent years, an increase in infections caused by multidrug-resistant (MDR) bacteria has been observed worldwide. Objective: To describe the frequency and the microbiological and clinical characteristics of hospitalised children under 15 years of age at Centro Hospitalario Pereira Rossell (CHPR) with invasive bacterial disease (IBD) caused by MDR bacteria between 1 January 2018 and 31 December 2022. Methodology: Observational, retrospective study. Patients with MDR bacterial isolates identified in microbiological studies were included. Results: Thirty patients were included, 73% of whom were under 3 years of age. Eighty-seven per cent had risk factors. Sixty-seven per cent of the infections were nosocomial, and 60% occurred in intensive care units. Seventy-three percent of the isolates were obtained from blood cultures. Eighty-three percent corresponded to Gram-negative bacteria, with Klebsiella pneumoniae being the most frequent. In 16.7% of cases, methicillin-resistant Staphylococcus aureus (MRSA) was isolated. All Gram-negative bacteria were resistant to third-generation cephalosporins, and 80% were susceptible to amikacin. Four of the five MRSA isolates showed constitutive resistance to clindamycin; all were susceptible to trimethoprim-sulfamethoxazole and vancomycin. Twenty-six point six percent required intensive care. The case fatality rate was 10%. Conclusions: Most infections caused by MDR bacteria are associated with healthcare, occur in intensive care units, affect young children with multiple comorbidities and risk factors, and are associated with high lethality. Extended-spectrum beta-lactamase-producing Enterobacterales and MRSA represented the main threats.
Introduction: Envenomation by venomous snakes of the Bothrops genus is relatively common in Uruguay and can cause a consumption coagulopathy that may lead to severe bleeding. Treatment requires the early administration of antivenom (AV). No deaths have been recorded since the 1980s. We report a case of fatal intracranial hemorrhage following a Bothrops bite. Clinical case: An 84-year-old man. At night, in a suburban area (seaside resort), he suffered a bite to the left lower limb in the posterior region of the leg; the animal was not identified. He sought medical care twice within less than two hours after a suspected snakebite, presenting with edema and local pain, and was discharged. Twelve hours later he returned due to vomiting, and the patient was found to be in a coma. Two puncture marks were observed in the posterior region of the left leg. Airway bleeding and hematuria were noted. Brain CT scan showed parenchymal, subarachnoid, and intraventricular hemorrhage, right temporal herniation, and brainstem compromise. Incoagulable blood. Serum creatinine 1.6 mg/dL. Neurosurgery and antivenom administration were ruled out. The patient died within 5 hours after consultation with the Toxicology Information and Advisory Center (CIAT) and approximately 24 hours after the accident. Discussion: This represents the first fatal case reported in Uruguay after 36 years. The low mortality rate is attributed to early consultation with the Toxicology Information and Advisory Center (CIAT), rapid access to antivenom, and ongoing education and prevention strategies within the healthcare sector.
The Uruguayan regulation requires serological RhD determination for all maternal-neonatal dyads. Fetal RHD genotyping in maternal blood, performed with a nationally developed kit, allows for the identification of same-group maternal-fetal dyads, which could potentially prevent anti-D immunoglobulin prophylaxis. This was a prospective, descriptive, single-cohort, multicenter study of 92 RhD-negative, non-alloimmunized pregnant women with a single-fetus pregnancy. A peripheral blood sample was collected between weeks 17 and 28 of gestation. An ATGen Laboratory kit was used via real-time multiplex PCR with TaqMan probes, allowing for simultaneous and differential amplification of three regions of the RHD gene (exons 5, 7 and 10). The results were compared with serological RhD determination in neonatal cord blood. Out of 92 samples, 5 were discarded (2 from RhD-positive mothers and 3 with pre-analytical issues). Fifty-seven samples were positive for the three evaluated exons, with concordant Ct values and meeting the adequacy criteria defined in the insert (Cts <= 37). For these 57 maternal samples, their neonate was positive via post-birth serological RhD antigen testing. The samples negative for the fetal RHD gene (n=30) were negative for the 3 exons of the kit, and it was confirmed that the RhD antigen in the cord blood was negative. The nationally produced molecular kit identified the three fetal exons in maternal plasma with 100% sensitivity and specificity, incorporating this new technology in Uruguay.
Malignant intestinal obstruction is a complex condition that poses a challenge for palliative care teams. Its symptoms have a physical and emotional impact on the patient, as well as on their environment. Rapid deterioration is usually associated with a poor prognosis of the disease. We present a case report of a 41-year-old patient with malignant small bowel obstruction, whose management was led by the Palliative Care team. During the course of the clinical condition, different drugs were used, including analgesics, steroids, gastrointestinal motility-promoting agents, and antisecretory agents. The use of somatostatin analogues, both immediate-and long-acting, is highlighted, achieving symptom remission that allowed clinical stabilisation for the 25 days following their administration, until the patient's death.
Introduction: Primary central nervous system (CNS) tumors represent the second most frequent cause of cancer in childhood. National data specifically focused on pediatric CNS tumors remain limited. Objective: To describe the frequency and the clinical, epidemiological, and outcome characteristics of patients under 15 years of age with CNS tumors treated at the Pediatric Hemato-Oncology Service of Pereira Rossell Hospital between 2017 and 2021. Results: A total of 42 patients were included, 59.5% male, with a median age at diagnosis of 6 years. The most common tumor location was infratentorial (52.4%). The predominant symptoms were headache, vomiting, and decompensated intracranial hypertension. The time from symptom onset to diagnosis ranged from 0 to 365 days (median 16.5). Astrocytomas (26.2%) and medulloblastomas (23.8%) were the most frequent histological types. Treatment included surgery in 85.7% of cases, chemotherapy in 55%, and radiotherapy in 29%. Overall survival at three years was 62.5%, with no significant differences according to tumor location. Discussion: The epidemiological profile observed is consistent with international series. This study provides the first national description and highlights the need to optimize diagnostic times, incorporate molecular studies, and strengthen comprehensive follow-up, focusing not only on survival but also on quality of life.
