INTRODUCTION:The COVID-19 pandemic exposed inequalities in mortality across territories. Northern Argentina, characterized by high social vulnerability and active international borders, despite formal closures, may have favored the spread of the virus. OBJECTIVE:To identify high-mortality clusters (HMC) due to COVID-19 among older adults (≥60 years) between 2020-2022, in relation to socioeconomic conditions and the border strip (FF). MATERIALS AND METHODS:A population-based ecological study of COVID-19 deaths was conducted in provinces with international border strips. Spatial and space-time scan analyses were applied to detect highmortality clusters (HMC). The relationship between these clusters, socioeconomic indicators, and location within the border strip was evaluated. RESULTS:Between 2020 and 2022, 12 968 deaths were recorded among older adults. In 2020, HMC were located in Salta and Jujuy (RR=3.6). In 2021, clusters shifted to Chaco and Formosa, in areas bordering Paraguay. In 2022, they concentrated in Corrientes and Misiones (RR=1.6-1.8). Population density was associated with clusters in 2020. Over the entire period, 41% of HMC were located within the FF. CONCLUSION:In 2020, the departments connected to Bolivia through road corridors showed higher mortality, and the expansion observed in 2021 coincided with the increase in deaths in Paraguay. Several studies have reported the persistence of informal or illegal border crossings, which may have sustained active cross-border circulation. These findings highlight the importance of regional cooperation and the need to strengthen epidemiological surveillance in border areas.
In recent decades, family configurations have undergone significant transformations, with growing recognition of companion animals as meaningful members of the affective environment. This phenomenon has given rise to new forms of organization known as multispecies families. The objective of this article is to analyze, through a conceptual narrative review with an applied proposal, the clinical relevance of the human-animal bond in hospital settings and its potential incorporation into biopsychosocial assessment. Literature published between 2010 and 2025 was reviewed, prioritizing clinical, psychosocial and public health studies on the human-animal bond, social support, hospitalization, adherence, discharge planning and family assessment tools. The search was narrative in scope and was not designed as a systematic review or as a PRISMA-based strategy. Available evidence suggests that companion animals may influence emotional coping, continuity of care, self-care routines and decision-making during illness. We propose adapting classic tools, such as the genogram and ecomap, to systematically record the presence, role and care needs of companion animals. This proposal does not aim to establish universal normative recommendations, but rather to offer an initial, cautious and contextual clinical tool to broaden understanding of the patient's real support environment.
Analytical observational studies are useful for evaluating the effects of interventions when randomized controlled trials are not feasible. However, the absence of randomization introduces confounding by indication, as external factors known as confounders may be associated both with the probability of receiving a treatment and with the occurrence of an outcome (without being part of the causal pathway), potentially distorting observed results. Among the available strategies to adjust for potential confounders and emulate randomization, the Propensity Score (PS) is one of the most widely used methods. It is defined as the probability of receiving an intervention given a specific set of covariates, which should be selected based on causal considerations and followed by rigorous assessment of covariate balance between groups using standardized differences and graphical tools.The PS can be implemented through several approaches, including direct adjustment, stratification, matching, or inverse probability of treatment weighting (IPTW). Each technique yields different types of estimands (conditional or marginal) depending on the analytic objective. Although these methods do not guarantee causal inference on their own, they represent robust approaches for reducing confounding in observational studies, underscoring the importance of their proper understanding and application.
An 89-year-old female patient was diagnosed with stage IVA cervical carcinoma with bladder involvement and a concomitant perianal squamous cell carcinoma and perianal lesions, HPV positive. Due to a significant decline in quality of life (Scale ECOG 3), she initiated radiotherapy without chemosensitization. She completed a pelvic radiotherapy regimen of 4600 cGy, resulting in an improved performance status (ECOG 0), although anal lesions persisted. Given this finding, electrochemotherapy was initiated. Two sessions were administered over four months, with minimal adverse effects and no negative impact on the quality of life. The patient achieved a complete response according to RECIST criteria. Nine months post-electrochemotherapy, MRI showed no evidence of distant pelvic disease, locoregional lymphadenopathy, or anorectal, vaginal or perianal involvement.
INTRODUCTION:Percutaneous treatment is currently the method of choice for ostium secundum atrial septal defects (OS-ASD) treatment. However, this procedure may be associated with an increased incidence of atrioventricular block. The incidence of these events could be related to the design of the device used. MATERIALS AND METHODS:This study featured a retrospective and analytical design. Consecutive patients with OS-ASD who underwent percutaneous treatment between July 2020 and June 2025 were included. The presence of a new atrioventricular conduction block (AVB) of any degree, was classified as an adverse effect. RESULTS:A total of 157 patients were included, with a median age of 8 years (5-15 years). Implantation was successful in 98.7% of patients. Three patients (1.9%) experienced AVB. Two cases were first-degree AVB, which resolved at 6 and 60 days respectively, and one was complete AVB, which resolved upon device removal. Multivariate logistic regression analysis determined that the size of the implanted device waist (OR 1.39 IC 95% 1.11- 1.97; p= 0.04) was independently associated with AVB. CONCLUSION:The prevalence of AVB after percutaneous treatment of OS-ASD with Nit-Occlud devices is rare. Devices with larger waist diameters were associated with a higher risk of AVB.
INTRODUCTION:Late diagnosis (LD) of HIV infection, defined as a CD4+ cell count below 350 cells/uL or the presence of an AIDS-defining illness, remains a major public health problem due to its association with increased morbidity, mortality, and ongoing transmission. We aimed to identify factors associated with LD among individuals with a new HIV diagnosis. MATERIALS AND METHODS:We conducted an observational mixed-methods study including adults with a recent HIV diagnosis consecutively enrolled at a referral hospital in Buenos Aires between October 2023 and January 2025. Quantitative analyses evaluated factors associated with LD, while qualitative interviews explored barriers to HIV testing and healthcare access. RESULTS:A total of 102 patients were included (median age 32 years; median CD4+ count 294 cells/uL). Late diagnosis was observed in 59.8% of cases. Seven patients died from AIDS-related causes, all in the LD group. Older age and heterosexual orientation were independently associated with LD. Notably, 36.1% of participants had at least one healthcare visit in the year prior to diagnosis, representing missed opportunities for testing. During follow-up, 92.2% achieved viral suppression at six months, with no new AIDS-defining events. Qualitative findings identified self-perceived good health, low awareness of HIV testing, and perceived exclusion from healthcare services as barriers to timely diagnosis. CONCLUSION:More than half of patients were diagnosed late, with frequent missed opportunities for earlier detection. These findings support the need for expanded and targeted HIV testing strategies to reduce preventable morbidity and mortality.
Vaccination has transformed child health worldwide, preventing millions of deaths from infectious diseases. Early life immune responses differ from adults due to the relative immaturity of innate and adaptive immunity, making early-life vaccination critical for individual and population-level protection. Vaccines mimic natural infection to induce targeted, controlled, and safe immune activation, promoting both effector responses and long-term immune memory while avoiding the risks of disease. Trained immunity, a form of innate immune memory induced by live attenuated vaccines, further enhances non-specific and heterologous protection in early life. Evidence consistently shows that pediatric vaccination is safe, does not overload the immune system, and is essential for individual health, herd immunity, and the prevention of disease resurgence. This communication highlights the immune mechanisms underlying vaccine responses, the distinctive features of the pediatric immune system, the public health impact of vaccination programs, and provides recommendations for optimizing immunization strategies.
INTRODUCTION:Patients discharged with a diagnosis of acute coronary syndrome (ACS) are at increased risk for recurrent cardiovascular events. Improved adherence to treatment has been associated with better outcomes. The objective of this study was to evaluate the effect of an educational intervention on medication adherence in patients following ACS. MATERIALS AND METHODS:A single-center, randomized, open-label, controlled clinical trial with parallel groups and a six-month follow-up. RESULTS:Sixty-three patients were randomized to the mixed educational intervention group and sixty-nine to the control group. Baseline characteristics were similar between groups: 82.6% were male, with a median age of 56 years (IQR 51-61), 73.5% had completed primary education. Mean ejection fraction (EF) was 47.7% (SD 12.33). Most patients were discharged with more than four medications, with a median of seven (IQR 6.0-8.0) tablets per day. At one month, adherence was 80.0% in the intervention group and 66.2% in the control group (RR 1.21; 95% CI 0.97-1.50; p = 0.12). At three months, adherence was 79.7% vs. 77.4% (RR 1.03; 95% CI 0.85-1.24; p = 0.94), and at six months -the primary endpoint- 73.3% vs. 71.9% (RR 1.02; 95% CI 0.82-1.27; p = 1.00). No significant differences were observed between groups in the occurrence of clinical events. CONCLUSION:The educational intervention was well accepted and feasible to implement, but it did not result in improved medication adherence or a reduction in clinical events over the medium term.
INTRODUCTION:Scurvy is a disease caused by vitamin C deficiency, historically rare but reemerging in children with restrictive diets. Diagnosis is often delayed due to nonspecific symptoms and low clinical suspicion. The aim of this study was to describe the clinical and nutritional characteristics of patients with scurvy treated at a high-complexity pediatric hospital, in order to raise awareness about its reappearance as a severe manifestation of food selectivity and its strong association with neurodevelopmental disorders. MATERIALS AND METHODS:A retrospective descriptive study was conducted at a high-complexity pediatric hospital between June 2018 and April 2024. Patients with a diagnosis of scurvy confirmed by clinical response to treatment were included. Demographic, anthropometric, dietary, biochemical, and radiological data were collected. RESULTS:Twenty-one patients were evaluated (median age: 4.4 years; 86% male), all with food selectivity; 80% had autism spectrum disorder. Nutritional status varied. Eighty percent required hospitalization. The most frequent symptoms were lower limb pain, difficulty walking, petechiae, and gingivitis. Fifty percent had positive acute-phase reactants, and 80% had compatible radiological findings. The average symptom duration before diagnosis was 38 days. Treatment with 1 g/day of oral vitamin C led to symptom resolution within 48-96 hours. CONCLUSION:Scurvy should be considered in children with restrictive diets, even in those with normal or excessive weight. Early clinical suspicion allows unnecessary studies to be avoided and enables rapid recovery through appropriate treatment.
Lithopedion is a rare outcome of ectopic pregnancy in which a nonviable fetus undergoes calcification and is retained within the abdominal cavity, often remaining asymptomatic for decades. Some 330 cases have been reported in the medical literature. While modern imaging techniques and early surgical intervention have made the condition extremely rare, it persists in populations with limited healthcare access. We present the case of a 70-year-old woman undergoing omentoplasty for postoperative mediastinitis, during which a lithopedion of approximately 12- to 13-weeks' gestational age was incidentally discovered and removed from the greater omentum. The specimen had been retained for an estimated 20 to 30 years. This case highlights the potential for lithopedia to remain clinically silent, appearing as diagnostic curiosities during unrelated procedures. Differential diagnoses for calcified abdominal masses include benign or malignant tumors and nonneoplastic conditions. Surgical removal is the treatment of choice, unless risks are prohibitive.
We present the case of a 76-year-old woman, with a history of smoking and dyslipidemia, who was admitted with acute heart failure associated with a holosystolic murmur. The electrocardiogram showed an anterior ST-segment elevation myocardial infarction, and transthoracic echocardiography revealed an apical ventricular septal defect. An intra-aortic balloon pump was inserted for hemodynamic support prior to coronary angiography, which revealed occlusion of the left anterior descending artery and multivessel disease. Septal repair and coronary revascularization were subsequently performed. During the procedure, an intraventricular thrombus was identified. The postoperative course was satisfactory. On follow-up, cardiac magnetic resonance imaging confirmed persistence of an apical thrombus, and prolonged anticoagulation with rivaroxaban was indicated. This case highlights the importance of early diagnosis with echocardiography, the role of cardiac magnetic resonance imaging in thrombus detection, and the need for a multidisciplinary approach in the management of mechanical complications of acute myocardial infarction.
INTRODUCTION:The consumption of energy drinks (EDs) has risen in recent years and is associated with numerous health concerns. This study aims to evaluate the effects of EDs consumption on blood glucose, HbA1c, hematological, coagulation parameters, and liver markers in mice. MATERIALS AND METHODS:Twenty mice were equally divided into two groups; one group served as a control and the other was given EDs. After four months, blood glucose, HbA1c, hematological, coagulation profile, and liver markers were analyzed using an unpaired t-test. RESULTS:Results showed that mice fed EDs had higher blood glucose and HbA1c. In addition, platelet count was lower, whereas levels of prothrombin time, activated partial thromboplastin time, international normalized ratio and D-dimer were higher in ED-treated group, with reduced levels of fibrinogen. Results showed that levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase were significantly higher in ED-treated mice, while total protein and albumin were reduced. CONCLUSION:These data suggest that the intake of EDs potentially increases the risk of type 2 diabetes mellitus and coagulation abnormalities.
INTRODUCTION:The impact of mild hyperprolactinemia (serum prolactin <50 ng/mL) on assisted reproductive outcomes remains controversial. For that reason, we aimed to compare pregnancy and live birth rates in a cohort of women with untreated mild hyperprolactinemia versus women with normal prolactin levels (<26.5 ng/mL) undergoing high complexity assisted reproductive techniques. MATERIALS AND METHODS:This was a retrospective study conducted between 2011 and 2021, including women under 40 years of age with infertility due to tubal factor, male factor, or unexplained infertility (UI) who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Pregnancy and live birth rates were compared between two groups: women with normal prolactin levels and those with untreated mild hyperprolactinemia (not receiving dopamine agonist therapy). RESULTS:A total of 242 patients were included; 82% (n=199) had normal prolactin levels and 18% (n=43) had mild hyperprolactinemia. Of these, 31.1% (n=76) underwent IVF and 68.9% (n=166) underwent ICSI. The pregnancy rate was 37.8% (n=74) in the normal prolactin group and 67.5% (n=27) in the mild hyperprolactinemia group (p=0.001). After adjusting for overweight status, age, and infertility etiology, women with mild hyperprolactinemia had threefold higher odds of achieving pregnancy compared with those with normal prolactin levels (p=0.004). No significant differences were observed in live birth rates between groups (p=0.4). CONCLUSION:In women undergoing IVF or ICSI, mild hyperprolactinemia did not adversely affect assisted fertilization outcomes. On the contrary, it was associated with a significantly higher pregnancy rate.
Tuberculosis with simultaneous pulmonary, vertebral, and cerebral involvement is observed episodically in HIV-negative patients, thus requiring evaluation of the entire cerebrospinal axis and a multidisciplinary approach. We report the case of a 54-year-old man who presented with a three-month history of productive cough, constitutional symptoms, dyspnea, and lower back pain. Bilateral pulmonary cavitary lesions, pleural thickening, dorsal spondylitis (T10-T11) with fracture, compression, and edema of these vertebral bodies, paravertebral fluid collections partially compressing the spinal cord, and multiple focal cerebral and cerebellar lesions were identified. Sputum was positive for acid-fast bacilli (AFB), and molecular testing confirmed tuberculosis susceptible to isoniazid and rifampicin. First-line antituberculosis treatment and spinal stabilization surgery were performed, including T10 corpectomy and titanium mesh placement. The patient's recovery was favorable. We emphasize the importance of suspecting disseminated tuberculosis in non-HIV patients and highlight the value of the clinical-surgical approach and multidisciplinary follow-up.
