Introducción: Se define como Rinosinusitis (RS) a la inflamación de la mucosa nasal y senos paranasales, siendo una patología habitual en la población pediátrica. Se clasifica como aguda cuando su duración es menor a 4 semanas y en cuanto a la etiología con mayor frecuencia se debe a virus o bacterias. En la historia natural de la Rinosinusitis aguda bacteriana (RAB), sin un tratamiento oportuno pueden presentarse complicaciones y aunque infrecuentes, acarrean una importante morbimortalidad. Objetivo: Describir dos casos de complicaciones asociadas a RAB, tratadas en nuestro centro, enfocados en el abordaje diagnóstico y terapéutico. Presentación de casos: Caso clínico n° 1: paciente masculino de 7 años sin antecedentes con diagnóstico de sinusitis maxilar y frontoetmoidal izquierda complicada con osteomielitis, absceso intracraneal epidural izquierdo y celulitis orbitaria izquierda que cumplió internación y tratamiento antibiótico endovenoso por 3 semanas, con posterior alta y tratamiento antibiótico oral completando 6 semanas con recuperación completa sin secuelas. Caso clínico n°2: paciente femenina de 11 años con antecedentes de atopia que consulta por tumefacción frontal y fiebre, con diagnóstico de Tumor blando de Pott y bacteriemia por S. pyogenes, que cumplió un total de 5 días de internación y 15 de antibioticoterapia con posterior mejoría. Discusión: Solo el 1% de las RAB presenta alguna complicación durante su evolución, estas comprometen por vía directa o hematógena los tejidos y órganos circundantes (órbita, sistema nervioso central o tejido óseo), el abordaje diagnóstico, requiere en la mayor parte de los casos de la realización de una tomografía axial computada con contraste de las estructuras involucradas y el tratamiento es multidisciplinario combinando antibioticoterapia y en algunos casos abordaje quirúrgico para su resolución. Conclusiones: Si bien la frecuencia de las complicaciones asociadas a RAB es baja, cuando están presentes acarrean un aumento en la morbimortalidad. Por ello, el diagnóstico oportuno y el tratamiento adecuado son cruciales para disminuir los efectos deletéreos de este grupo particular de patologías.
Objetivo: Describir los resultados clínicos del uso de tofacitinib genérico en pacientes con artritis reumatoidea (AR) que lo iniciaron de novo o realizaron un cambio no médico desde la formulación original. Métodos: Cohorte retrospectiva de adultos con AR que iniciaron tofacitinib genérico (JANVAX®) o cambiaron desde tofacitinib original (XELJANZ®). Se siguieron hasta la interrupción del tratamiento, fallecimiento, o fin de seguimiento (12 meses). La eficacia se evaluó con la escala DAS28-ESR utilizando un modelos de efectos mixtos. El grupo de cambio fue evaluado a 0, 6 y 12 meses; el grupo de inicio a los 0, 3, 6 y 12 meses. La seguridad fue evaluada por eventos adversos. Resultados: Se incluyeron 42 pacientes con AR (24 de cambio y 18 de inicio). Nueve pacientes interrumpieron el tratamiento. En el grupo de cambio, el DAS28-ESR se mantuvo estable (2,96; 3,08; 3,10; p = 0,70). En el de inicio, mejoró significativamente (5,3; 3,42; 3,49; 3,31; p < 0,001). No se informaron eventos cardiovasculares mayores (MACE). Se registró un fallecimiento de causa no identificada, tres infecciones graves, un tromboembolismo pulmonar y un diagnóstico de neoplasia maligna durante el seguimiento. Conclusiones: El cambio no médico a tofacitinib genérico y el inicio de tratamiento se asociaron con buena respuesta clínica en términos de efectividad y sin evidencia de nuevos problemas de seguridad. Sin embargo, el tamaño muestral limitado requiere de estudios adicionales para confirmar estos resultados.
Objetivos: Analizar la evolución de la sífilis adquirida en población juvenil en la Provincia de Buenos Aires entre 2014 y 2023, con foco en las regiones sanitarias del conurbano bonaerense, identificando desigualdades territoriales, de grupos de edad y de género en los niveles de notificación. Métodos:Se realizó un estudio observacional y ecológico utilizando datos del Sistema Nacional de Vigilancia de la Salud. Se construyeron tasas específicas de notificación por sexo y grupos de edad (15–24 y 25–34 años), con desagregación por región sanitaria. Resultados:Se observó un aumento sostenido de las tasas de notificación de sífilis hasta 2019, seguido de un descenso abrupto en 2020 asociado a la pandemia de COVID-19, y una recuperación parcial en los años siguientes. Se identificaron brechas territoriales, por grupo de edad y de género en los niveles de notificación, así como potenciales dificultades en el acceso al diagnóstico entre personas jóvenes. Conclusiones: Los hallazgos evidencian la necesidad de fortalecer la atención primaria, mejorar los sistemas de vigilancia epidemiológica a nivel local y promover intervenciones con enfoque de género y territorial. Estas acciones son clave para abordar las inequidades estructurales que atraviesan la salud sexual juvenil.
Neurological manifestations in dengue infection are atypical; even more so are cases of stroke, which have only been reported rarely. We present the case of a 41-year-old male patient who developed focal neurological deficit during his dengue infection. The patient had no known comorbidities. He presented with fever, headache, myalgia, and biochemical results showed thrombocytopenia. A plain brain CT scan did not reveal any lesions, leading to the diagnosis of ischemic stroke in the context of dengue infection. He showed improvement in neurological symptoms correlated with increasing platelet counts. Such association has been described in other reports of ischemic stroke due to dengue, possibly explained by immunomediated effects leading to a vasculitic condition. The aim of this work is to contribute to the existing evidence on this entity.
Objetivo: Analizar los principales factores que influyen en la elección de una residencia del equipo de salud desde la perspectiva del riesgo, con el fin de ofrecer un marco conceptual que facilite una toma de decisiones informada por parte de quienes inician su formación de posgrado. Métodos: Se realizó una revisión narrativa de la literatura publicada entre 2000 y 2024, en español e inglés, mediante búsquedas en bases de datos como Medline y Latindex, así como en documentos oficiales y sitios web institucionales. Se aplicó una estrategia de categorización temática inductiva, identificando seis dimensiones analíticas del riesgo. El proceso fue desarrollado de forma independiente por los autores, siguiendo los lineamientos éticos de la Declaración de Helsinki y los criterios SANRA. Resultados: El análisis permitió identificar seis componentes clave del riesgo percibido al momento de elegir una residencia: remuneración, historia institucional, estructura del programa, nivel de satisfacción, localización geográfica y oportunidades formativas. Cada uno de estos aspectos implica ventajas y desafíos específicos que deben ser evaluados por quienes se encuentran en proceso de selección. La revisión ofrece herramientas prácticas e información útil para orientar esa decisión. Conclusión: La elección de una residencia en salud constituye un proceso complejo que implica múltiples riesgos. Conocer y analizar de manera crítica los factores involucrados —a partir de fuentes confiables y diversas— permite reducir la incertidumbre y orientar decisiones más ajustadas a las expectativas personales y profesionales. El enfoque propuesto puede servir como guía para aspirantes, tutores y decisores institucionales.
La Profesora Dra Marta Fiol, es la primera mujer elegida en la histoiria de la Facultad de Ciencias Mëdicas de la Universidad Nacional de Córdoba, como Decana de Medicina
Guyon’s canal syndrome is an uncommon distal ulnar neuropathy caused by compression within the wrist. We report a case of delayed ulnar nerve entrapment secondary to post-traumatic fibrosis, diagnosed nine years after wrist injury and surgery. High-resolution ultrasonography demonstrated focal nerve compression within Guyon’s canal adjacent to fibrotic tissue. The patient presented with chronic sensory deficits and hypothenar atrophy. Conservative treatment led to partial symptom control. This case highlights delayed post-surgical fibrosis as a potential cause of Guyon’s canal syndrome and underscores the diagnostic value of ultrasound in chronic compressive neuropathies.
Background: Inequalities in oral health care among people with disabilities are a global challenge. Objective: To determine the oral health status and the different preventive/therapeutic actions performed on patients with different types of disabilities. Materials and Methods: A retrospective study of patients with disabilities, of both sexes, treated at the Interdisciplinary Dental Care Service for Patients with Disabilities, FO-UNC, between 2012 and 2023 (project approved by the Academic Research Council of the Faculty of Dentistry-UNC). Results: Data were collected from n=193 patient medical records. 84.6% presented poor/fair oral hygiene. 28.6% had an anterior open bite, and the same percentage showed an anterior covered bite. Other pathologies observed were hypodontia, microdontia, and andontia. 4.92% presented incorrect phonation, and 21.3% atypical swallowing. A total of 2.17% had supernumerary teeth. The average number of missing, extracted, and filled caries per patient varied across different tooth surfaces; while the average number of extracted and filled caries was 4 cavities (range 0–18). Clean and motivation procedures were performed in 70% of cases. Other types of dental treatments included extractions, root canals, and dental surgeries. Eighty-five percent of patients attended care for only half or less of a visit. Conclusions: Patients with disabilities presented with poor oral health, including a high number of cavities and poor oral hygiene. Many of them are likely unable to follow the dentist's instructions adequately, either due to economic or accessibility issues, or because the underlying pathology has worsened.
Introdução: A estratificação de risco na COVID-19 é crucial. O objetivo foi avaliar e comparar o desempenho de escores prognósticos para seus respectivos desfechos (mortalidade ou progressão para gravidade) em pacientes hospitalizados durante a primeira e a segunda onda pandêmica em Córdoba, Argentina. Materiais e métodos: Estudo de coorte retrospectivo em um hospital de nível terciário. Foram incluídos adultos com pneumonia por COVID-19. A evolução foi comparada entre a primeira (março/2020-fevereiro/2021) e a segunda onda (março/2021-dezembro/2021). A discriminação de cada escore para seu desfecho específico (mortalidade em 28/30 dias ou progressão) foi avaliada por meio de análise da curva ROC. Resultados: De 1176 pacientes, a mortalidade em 30 dias foi menor na segunda onda (16.9% vs. 28.8%; p<0.001). O escore 4C e o PSI/PORT mostraram a melhor discriminação para mortalidade (AUC ~0.84) de forma estável em ambas as ondas. Em pacientes sem doença grave inicial, o CALL Score demonstrou uma discriminação aceitável para predizer a progressão para gravidade (AUC 1ª onda: 0.71; 2ª onda: 0.67). Conclusão: Existiram diferenças significativas no perfil dos pacientes e na mortalidade entre as duas ondas. Os escores prognósticos para mortalidade (4C, PSI/PORT) e para progressão (CALL Score) mantiveram sua validade clínica em diferentes ondas pandêmicas. Demonstraram ser ferramentas robustas para a estratificação de risco de acordo com seus respectivos desfechos, apesar das mudanças no perfil dos pacientes e do estado de vacinação.
Objectives: Eccrine porocarcinoma is a rare malignant adnexal tumor derived from the eccrine sweat glands, with metastatic potential. It primarily affects elderly individuals, and its most common location is in the head and neck region. Clinically, it presents as a solitary, nodular, erythematous-violaceous tumor. Its diagnosis can be challenging due to its clinical and histopathological variability. The objective of this case report is to describe a case of eccrine porocarcinoma in an unusual location and analyze its diagnostic and therapeutic approach. Case Report: We present the case of a 59-year-old male patient who sought medical attention due to an asymptomatic lesion on the dorsum of the right foot, evolving over three months. On physical examination, a 1.5 cm diameter tumor with a brownish coloration and lobulated exophytic appearance was observed. Dermoscopy revealed erythematous and whitish areas. An incisional biopsy was performed, and histopathological analysis revealed an in situ porocarcinoma originating from a poroma. Immunohistochemistry confirmed positivity for EMA, CEA, and p63. A complete excision of the lesion was performed, with free margins and no evidence of recurrence to date. Conclusion: Eccrine porocarcinoma is a rare cutaneous neoplasm but has aggressive potential. Its diagnosis requires a comprehensive approach based on clinical evaluation, histopathology, and immunohistochemistry. Complete excision with free margins is the treatment of choice, although other therapies may be considered in advanced cases. Periodic follow-up is essential for early detection of recurrences and metastases.
Objectives: Describe the clinical case of a RICH that was diagnosed in uterus, normally in obstetric ultrasounds they are often confused with arteriovenous malformations and other congenital tumors. The differential diagnosis of these entities is important, since they have a different evolution, prognosis and treatment. Clinical case: The clinical case of a RICH with incipient signs of heart failure is presented, it required an interdisciplinary approach with dermatologists, neonatologists, obstetricians and specialists in diagnostic imaging, to define diagnosis, conduct and follow-up. Postnatal follow-up was performed until complete and spontaneous involution, leaving almost no sequelae, despite the large size of the tumor. Conclusion: It is important to take into consideration the diagnosis of RICH, among intrauterine high-flow vascular tumors, so as not to perform unnecessary interventions.
Objective: To describe the clinical presentation, surgical management, and reconstruction of maxillary odontogenic myxomas through two case reports, and to propose a comprehensive management algorithm to guide diagnosis and treatment decisions. Case presentation: This study reports two cases treated at Piñero Hospital with resection and reconstruction using temporalis muscle flaps. Diagnosis was confirmed by clinical, radiological, and histopathological examinations. The first case involved a 36-year-old female with a multilobulated osteolytic lesion in the upper jaw; follow-up at 27 months showed no recurrence. The second case, a 27-year-old male, presented a large, aggressive osteolytic lesion; 32-month follow-up demonstrated successful healing without relapse. Conclusion: Maxillary odontogenic myxomas require individualized, multidisciplinary management. The proposed algorithm, integrating tumor size, extension, surgical approaches, and reconstruction options, offers a practical decision-making tool to improve clinical outcomes.
A 21-year-old man presented with blood in his semen and was diagnosed with Persistent Müllerian Duct Syndrome (PMDS). This rare genetic condition occurs due to insufficient Anti-Müllerian Hormone (AMH) production or AMH insensitivity, resulting in the presence of female internal organs in genetically male individuals. PMDS is often discovered incidentally during surgery for undescended testes or infertility treatment. A variety of imaging techniques, including MRI, can assist in diagnosing PMDS. The condition poses an increased risk of malignancy in both the testes and Müllerian structures. Treatment generally involves the surgical removal of Müllerian remnants, often through laparoscopy.
Objective:This study aims to present a clinical case of Multiple Myeloma (MM) with an unusual oral presentation, highlighting the importance of oral surveillance in the comprehensive diagnosis of hematological diseases. Clinical Case:The case of a 70-year-old female patient who attended the Department of Stomatology "A" of the Faculty of Dentistry (Universidad Nacional de Córdoba) with bimaxillary gingival lesions of 6 months of evolution is presented. The patient, with no known medical history, presented significant weight loss and severe systemic symptoms. On clinical examination, painful gingival hyperplastic masses were observed, with generalized tooth mobility. Orthopantomography and tomography revealed alveolar resorption and osteolytic areas. Laboratory tests showed anemia, leukopenia, thrombocytopenia, and elevated inflammatory markers. The biopsy revealed a proliferation of monoclonal plasma cells positive for CD38 and kappa chains, leading to the diagnosis of MM. The patient was referred to oncohematology, but died quickly. Conclusion:This case highlights the importance of early recognition of oral manifestations of MM, which can be a diagnostic challenge due to their similarity to other common oral conditions. Timely identification of these lesions by dentists may be crucial to reduce the morbidity and mortality associated with this hematological disease.
Objective:To describe the ventilatory management strategies used for the treatment of refractory hypoxemia in the postoperative period of liver transplantation in pediatric patients with hepatopulmonary syndrome, also considering postoperative complications, duration of ventilatory support, and length of stay in the intensive care unit Materials and methods:An observational, descriptive, retrospective, and longitudinal study was conducted. All pediatric patients with HPS who underwent liver transplantation at Garrahan Hospital (Argentina) during 2023 were included. Diagnosis was established according to the criteria of the International Liver Transplantation Society. Ventilatory strategies, use of inhaled nitric oxide, individualized titration of PEEP and FiO₂, assessment of respiratory effort, and use of non-invasive ventilatory support after extubation were analyzed. Results: The cohort included three patients aged 20 to 168 months. All required invasive mechanical ventilation for 4 to 15 days and iNO for 8 to 19 days. Post-extubation non-invasive ventilation was implemented in all cases, lasting 2 to 17 days, allowing safe transition to low-flow oxygen therapy without associated respiratory complications such as atelectasis or secretion retention. ICU stay ranged from 16 to 34 days. Different recovery patterns were identified, highlighting the importance of dynamic adjustment of PEEP and FiO₂ and close monitoring of respiratory muscle function. Conclusion:The implementation of stepwise strategies, including prolonged and adjusted use of inhaled nitric oxide, higher levels of PEEP and FiO₂, quantification of respiratory effort, and systematic use of post-extubation non-invasive ventilation, allowed optimization of oxygenation, prevention of severe respiratory complications, and guidance of ventilator weaning.
Se presentan 90 pacientes con cáncer de mama, estadios Jy 1/ inicial, tratadas con cuadrantectornía más vaciamiento axilar de todos los niveles ganglionares y radioterapia posoperatoria, y con 2 años (como mínimo) de control posterior. La frecuencia de recidiva fue de 4,4 % en la mama y de 2,2 % en los ganglios supraclat'iculares. Las características de la recidiva locorregional en estas condiciones difiere ampliamente de las que presentan posinastectoinía en cuanto a evolución, tratamiento e pronóstico. La recidiva mamaria se resolvió con la mastectomía simple, mientras que las adenopatías supraelaviculares se comportaron en forma similar a la generalización de la enfermedad.
Paciente de sexo femenino de 60 años de edad, obe- sa, que ingresó el 1919186 por arritmia ventricular grave, pérdida de conciencia, eritema y prurito generalizados. Dos meses antes había comenzado con astenia, edemas en ambas piernas, precordialgias atípicas y palpitaciones. En esa oporliunidad se le diagnosticó arritmia ventricular y fue medicada con metildigoxina, 0.1 mg/ día: furosemida. 20 mg/día: allopurinol 300 mg/día: amiodarona. 200 mg/día. y gemfihrozil. 600 mg/día. La paciente refi rió intolerancia a la medicación, caracterizada por náuseas, vómitos y malestar general luego de su ingesta. En tres ocasiones presentó episodioi potímicos.
Continuous Positive Airway Pressure (CPAP) is the treatment of choice for OSA. Objectives: To analyze and correlate the subjective symptoms of daytime sleepiness, depression, and anxiety before and after CPAP treatment. A retrospective, observational, longitudinal study was conducted. Data were extracted from questionnaires completed three times. The first questionnaire was submitted at the time of a nocturnal PSG with diagnostic oximetry. The second and third were administered during the nocturnal PSG with oximetry and titration with Auto-CPAP. The Epworth Sleepiness Scale, the Self-Report Anxiety Scale, and Beck Depression Inventory were used. Results: We found a significant decrease in the Epworth Sleepiness Scale over the years, but we found no differences in the scale for anxiety (p=0.45) and none for depression (p=0.52). Conclusion: The analysis of mood trauma and daytime sleepiness in patients using CPAP demonstrated that daytime sleepiness is reduced with the use of the device, but this was not the case with markers of mood trauma. Physicians should be aware of our discomfort to understand the magnitude of the benefit they can obtain from CPAP therapy on sleepiness and to inform decision-making in medical care.
Objective:To describe the diagnostic and therapeutic approach to a case of intramyocardial dissecting hematoma (IDH), a rare complication of acute myocardial infarction, highlighting the value of multimodal imaging in its identification and management. Case report:We present the case of a 50-year-old man who presented to the emergency department with chest pain and dyspnea of 12 hours duration. The electrocardiogram revealed an anterior myocardial infarction, and coronary angiography showed occlusion of the left anterior descending artery, which was treated with angioplasty. During hospitalization, transthoracic echocardiography revealed a hypoechoic mass at the apex, raising the differential diagnosis of intramyocardial hematoma, pseudoaneurysm, or mural thrombus. A cardiac computed tomography scan was performed, which ruled out complete rupture or pseudoaneurysm but did not allow for a definitive distinction. Subsequently, cardiac magnetic resonance imaging confirmed the presence of a hematoma contained within the myocardium, without epicardial rupture, and with surrounding areas of transmural fibrosis. Given the patient’s clinical stability and absence of signs of progression, an initial conservative treatment approach was chosen, with close clinical and imaging follow-up. Conclusion:IDH is a rare and potentially serious complication of acute myocardial infarction. Its diagnosis can be challenging and requires a multimodal approach. Cardiac magnetic resonance provides accurate tissue characterization that allows differentiation of intramyocardial dissecting hematoma from other similar entities and plays a key role in clinical decision-making. In stable patients, conservative management may be safe and effective.
