Introduction Respiratory syncytial virus (RSV) is an increasingly recognised cause of morbidity and mortality in older adults. However, data on RSV burden in Latin American countries remain limited. We aim to describe the clinical characteristics and outcomes of RSV infection in non-severely immunocompromised adults receiving care at a tertiary hospital in Argentina. Methods We conducted a retrospective cohort study including adults aged ≥60 years, or ≥50 with comorbidities, diagnosed with RSV between January 2013 and December 2019. The primary outcome was clinical status at days 0, 7, and 30 after diagnosis. Secondary outcomes included 30-day mortality, hospitalisation, ICU admission, and healthcare utilisation. Results Of 262 patients included (median age: 82 years), 77.5% were hospitalised at diagnosis. The most common symptoms were cough (62.2%) and dyspnea (58.0%), with abnormal chest imaging in 55.8% of cases. Lower respiratory tract infection (LRTI) was present in 63.7% and severe LRTI in 53.4%. At 30 days, only 57.3% had fully recovered. The 30-day all-cause mortality was 7.6%. ICU admission occurred in 27.1% of patients. Factors associated with worse clinical outcomes included age >85 years, history of heart disease, hypoxemia, abnormal imaging, and ICU admission. Conclusions RSV infection in adults is associated with a significant clinical burden and considerable functional impairment. At 30 days post-diagnosis, only 57.3% of patients had been discharged and returned to normal activities. These findings underscore the need for improved preventive strategies and strengthened surveillance in this population.

La edad está asociada con un aumento de la prevalencia de múltiples enfermedades y también con un deterioro de la reserva funcional y fisiológica. Los pacientes adultos mayores tienen un riesgo aumentado para el desarrollo de complicaciones frente a cirugías y diversas prácticas oncológicas. Los procesos de toma de decisiones en muchos casos son complejos, y la detección de toda esta comorbilidad geriátrica no está contemplada en muchos de los modelos clásicos para predicción de riesgo. En este artículo se describe una herramienta de evaluación geriátrica integral dirigida a la detección de riesgos para prácticas y procedimientos (DRIPP) en el adulto mayor, que fue desarrollada y se utiliza en el ámbito del Hospital Italiano de Buenos Aires. El objetivo de DRIPP es la detección de factores de riesgo clínicos y geriátricos asociados con malos resultados, a partir del cual se generan recomendaciones específicas de manejo, que aportan mayor información para el buen desarrollo del proceso de consentimiento informado y la toma de decisiones. Su integración transversal y longitudinal con las diferentes disciplinas e instancias para el seguimiento del paciente es una característica esencial que se traduce en ventajas asistenciales y académicas

Abstract Background The incidence and mortality of respiratory virus infections (RVI) in patients receiving a Hematopoietic Stem Cell Transplant (HCT) is variable, and changes depending on place, year and season. They can present as upper respiratory tract infection (URTI) or lower respiratory tract infection (LRTI), with the latter having a worse prognosis. There is no data from Argentina in the adult population. Objectives: estimate the incidence of RVI in the year after HCT and associate risk factors for clinical evolution, progression from URTI infection to LRTI, requirement for Intensive Care Unit (ICU) and mortality. Flow chart of HCT recipients and respiratory events, with a diagnosis of respiratory viral infection within one year after transplant. Methods retrospective cohort study of the population of patients receiving HCT from 11/2011 to 12/2019. The patients were followed for one year, and for one month after each RVI. Kaplan-Meier curve of the incidence of IRVA according to type of HCT. Results Out of 476 HCT with 30.7% allogeneic, 99 confirmed RVI were detected. The Cumulative Incidence at 100 days post-transplant was 1.99 (95% CI 1,0 - 3,95) per 100 patients, while at one year, it was 28.81 per 100 patients (95% CI 24.32 - 33). ,93). The HR of RVI in allogeneic HCT was 2.45 (95% CI 1.72-3.51; p < 0.001) compared to autologous. Also was lower in lymphoma 0.5 (95% CI 0.29 - 0.85) and Multiple Myeloma 0.36 (95% CI 0.22 - 0.58) compared to leukemia (p < 0.001) as the underlying disease. Although there were differences in the clinical status and characteristics evaluated at the diagnosis of RVI, no relevant associations were found at day 7 of follow-up. 53.5% of RVI events presented as URTI, and 16.9% progressed to LRTI. An association was found between male sex, OR of 0.20 (95% CI 0.06-0.73; p< 0.001) and the occurrence of the event beyond 28 days after transplant, 0.27 (95% CI 0.08 -0.95; p=0.045), while RVI in hospitalized patients had an OR of 5.71 (95% CI 1.61-20.24; p=0.006) for progression. Only 16% required ICU, there was an association between age over 65 years, event before 28 days post HCT, myeloablative conditioning, use of corticosteroids at the time of the event, RVI during hospitalization and hypoxemia and requiring ICU. Mortality was 2.1% (95% CI 0.67-6.32) within 30 days of RVI. Conclusion The Cumulative Incidence was similar to other reports, however the mortality was lower. Disclosures All Authors: No reported disclosures

Introducción: la afectación cardíaca es la principal causa de morbilidad y mortalidad de la amiloidosis, sobre todo en la debida a cadenas livianas (AL) y a transtirretina, en ambos tipos: salvaje y hereditaria. Objetivos: estimar la prevalencia y la mortalidad de los pacientes con evidencia de compromiso amiloidótico cardíaco en pacientes con diagnóstico de amiloidosis. Métodos: una cohorte ambispectiva clínica, que incluyó a todos los pacientes consecutivos que tenían evidencia de amiloidosis del Registro Institucional de Amiloidosis en el Hospital Italiano de Buenos Aires, durante el período 01/2007-03/2013. Los criterios de diagnóstico de amiloidosis cardíaca fueron previamente especificados. La mortalidad por amiloidosis cardíaca se determinó con una combinación de evaluación activa y pasiva. El tiempo de supervivencia se evaluó con el estimador de Kaplan-Meier. Se utilizó el software SPSS versión 19. Resultados: el Registro incluyó a 126 pacientes y la prevalencia de amiloidosis cardíaca fue del 40% (IC 31-49%). En ese 40% (50/126) de pacientes confirmados y con sospecha de amiloidosis cardíaca, la mediana de edad fue de 72 años (IQR 79-81) y el 26% eran mujeres (13/50). La mortalidad global de los pacientes con afectación cardíaca fue del 20% (11/50), la mediana de supervivencia fue de 1782 días de seguimiento (IC 95%, 1365-2199). Se confirmó el 47% de los pacientes con afectación cardíaca por amiloidosis mediante biopsia. Las principales razones para el diagnóstico fueron: sospecha clínica 82,4% (42/50), estudios complementarios 67% (34/50), derivado con diagnóstico 6% (3/50). Conclusiones: la prevalencia de afectación cardíaca y mortalidad en pacientes con amiloidosis fue elevada. Los avances en el diagnóstico de amiloidosis permitirán en el futuro detectar pacientes con alto riesgo de mortalidad de causa cardíaca en nuestro país

Acute-on-chronic liver failure (ACLF) is a major clinical event in cirrhosis that is characterized by high mortality rates and a short window for liver transplantation. N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a prognostic biomarker in cirrhosis. However, its accuracy in predicting the development of ACLF or mortality in candidates for liver transplantation remains unknown. This observational, retrospective, single-center study included 277 consecutive patients with cirrhosis who were listed for liver transplantation between 2014 and 2020 in Hospital Italiano, Buenos Aires, Argentina. Clinical data, including sarcopenia, serum cystatin C (CysC), and NT-proBNP levels, were collected at listing. The median MELD-Na and NT-proBNP levels at the time of listing were 16 points (13-22) and 123 (58-257) pg/mL, respectively. High NT-proBNP levels (≥125 pg/mL) were associated with the development of ACLF (subhazard ratio: 4.00, 95% CI: 1.76-9.10; p <0.001) and mortality (subhazard ratio: 3.89, 95% CI: 1.28-11.79, p =0.02) after adjusting for MELD-Na and CysC. Patients with NT-proBNP ≥125 pg/mL showed a significantly higher incidence of ACLF at 3 months (28.5% vs. 3.6%; p <0.001) and 12 months (49.2% vs. 6.1%; p <0.001). Mortality in the waiting list at 1 year was also significantly higher in patients with NT-proBNP ≥125 pg/mL (22.3% vs. 4%; p <0.001). Serum NT-proBNP emerges as a promising prognostic biomarker for ACLF development and mortality in patients with cirrhosis on the waiting list. Its integration into clinical practice could facilitate preventive interventions and improve prioritization on the waiting list.

Antecedentes: la amiloidosis es una enfermedad sistémica que resulta del depósito de proteínas mal plegadas; en la amiloidosis de cadena ligera de la inmunoglobulina (AL), las fibrillas están compuestas de fragmentos de cadenas ligeras monoclonales. En la Argentina, la densidad de incidencia de amiloidosis AL es 4,54 cada millón de personas/año. Caso: paciente femenina de 71 años que consulta por dolor neural localizado en miembro superior izquierdo, asociado a edemas en ambos miembros inferiores y disnea de esfuerzo, pérdida de peso, constipación y macroglosia. Al examen físico presenta tensión arterial de 100/60 mm Hg; está afebril, saturando 98% de aire ambiente; peso de 46 kg y un índice de masa corporal de 18,9. Se constatan cadenas livianas libres Kappa: 5,8 mg/L, Lambda: 430 mg/L y con relación K/L: 0,13 mg/L y un ProBNP de 1686 pg/mL. La biopsia de grasa abdominal informó depósitos de amiloide, tinción de rojo Congo positivo. Resonancia magnética (RM) de corazón con contraste (gadolinio), compatible con amiloidosis cardíaca. La tomografía computarizada (TC) de tórax demostró un área de consolidación en lóbulo superior del pulmón derecho, rojo Congo positivo focal. Ante el diagnóstico de amiloidosis AL se realiza tratamiento con CYBORD. Se consolidó el tratamiento con un trasplante autólogo de médula ósea. Discusión: la afectación cardíaca es la principal causa de morbilidad y mortalidad dentro de la amiloidosis

The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate treatment expansion based on the WHO guidelines. Treatment-naïve CHB patients from Argentina, Brazil, Chile and Uruguay referred to evaluation between January 2010 and June 2024 were retrospectively included. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. A total of 719 patients with CHB, treatment naïve, were included (67.1% male; median age: 50.4 years; HBeAg-positive: 36.3%). The median HBV-DNA level was 43,000 (IQR 633-110,000,000) IU/mL, median ALT was 41 (IQR 23-99) U/L, 47.0% had an APRI > 0.5 and 21.1% had cirrhosis. According to country-specific guidelines, 56.9% (95% CI: 53.2-60.5) met the criteria for treatment. Antiviral treatment was initiated in 84.3% of eligible patients. The proportion of patients meeting treatment criteria under the WHO guidelines increased to 67.3% (95% CI: 63.8-70.6), resulting in a 10.4% (95% CI: 8.1-12.8) increase in treatment candidacy. Treatment expansion was significantly higher in women (15.2%; 95% CI: 10.2-20.1) than in men (8.1%; 95% CI: 5.4-10.7). According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.

Introducción: En el Hospital Italiano de Buenos Aires se realizó una campaña de vacunación masiva destinada al personal de la institución durante mayo de 2009. Objetivo: Medir síntomas gripales asociados a la vacunación en personal de salud. Métodos: Estudio de cohorte. Se compararon, mediante riesgo relativo, las incidencias de los síntomas gripales informados para la semana epidemiológica 20, por 400 vacunados durante dicha semana y 400 no vacunados, apareados por edad, sexo y profesión. Los síntomas comunicados dentro de las 48 horas posteriores a la vacunación se consideraron secundarios a ella. Resultados: Fueron encuestados 583 (72.5%) de los cuales 281 vacunados y 302 no vacunados: edad media 36 (DS 11) vs. 35.2 (DS 10.5); mujeres 54% vs. 57% y médicos 21% vs. 18%. En la semana de vacunación presentaron fiebre 12.46% vs. 6.95% (RR 1.79, IC95% 1.07-3), coriza 24.2% vs. 17.22% (RR 1.41 IC95% 1.02-1.94), odinofagia 11.74% vs. 0.33% (RR 35.47 IC 95% 4.88-257), dolor corporal 18.86% vs. 14.57% (RR 1.29 IC 95% 0.9-1.87) vacunados y no vacunados, respectivamente. Se atribuyen a la vacuna: dolor corporal 9.25% (IC95% 6.3-13.6), coriza 8.19% (IC95% 5.4-12.31); fiebre 6.78% (IC95% 4.31-10.6) y odinofagia 4.27% (IC 95% 2.42-7.5). Y dolor de brazo 65%. Los médicos no informaron mayor frecuencia de síntomas gripales. Discusión: En la literatura, la odinofagia y la coriza no están asociadas a la vacunación, la frecuencia de los otros síntomas a las 48 horas fue similar a la informada. Conclusión: El síndrome gripal fue descripto con mayor frecuencia entre los vacunados y puede ser resultado de un sesgo de reporte

La amiloidosis es una enfermedad sistémica que resulta del depósito de proteínas habitualmente mal plegadas en forma de material fibrilar amorfo en diversos tejidos, y puede causar disfunción progresiva de estos. La prevalencia de amiloidosis varía según la población considerada y el tipo de amiloide. En la Argentina, poco se conoce la situación actual. Por otro lado, los recursos para hacer diagnóstico definitivo son limitados y presentar un desafío al médico tratante en cuanto al diagnóstico, tratamiento y pronóstico. No encontramos datos de prevalencia, evolución o pronóstico de Amiloidosis en nuestro país. No existen tampoco registros vigentes de amiloidosis de todas las causas nacionales o en Latinoamérica que pudieran describir el comportamiento de esta enfermedad en nuestro medio. Se consideró fundamental la creación de un sistema de seguimiento que genere datos de evolución y pronóstico. El Registro Institucional de Amiloidosis es un sistema organizado de recolección de datos sistemáticos, de una gran cantidad de pacientes de manera rápida y eficiente, sobre la amiloidosis. Desde el 2010, el Hospital Italiano creó el Registro Institucional de amiloidosis del Hospital Italiano con el fin de un mayor entendimiento y caracterización de la historia natural de esta enfermedad por medio de un amplio estudio de pacientes. Los datos pueden ser utilizados para desarrollar las nuevas directrices de tratamiento y recomendaciones, e informar y educar a los médicos sobre el manejo de esta enfermedad. Actualmente, la baja sospecha y los recursos limitados para hacer diagnóstico definitivo, representan un desafío al médico en la tipificación, tratamiento y pronóstico acorde

Background: Outpatient non-attendance is a frequent and relevant problem in healthcare systems, reflecting both quality of care and access equity. Despite its relevance, its temporal trends and potential variations remain understudied. Objectives: To analyze trends in non-attendance percentage for scheduled outpatient visits from 2016 to 2024 and identify significant changes overall and within subgroups. Methods: This ecological time-series study included in-person scheduled medical appointments, using secondary data from the Hospital Italiano de Buenos Aires. The study period was divided into pre-pandemic (January 2016–February 2020) and post-pandemic (January 2021–December 2024). The percentage of non-attendance was estimated for all appointments and for subgroups of sex, age, medical speciality, and healthcare payer. Joinpoint regression models are used to evaluate trends and calculate the monthly percentual change (MPC). Results: Among 15 747 265 scheduled outpatient appointments, the non-attendance percentage was 26.86% (95% CI 26.84%-26.88%). The percentage declined pre-pandemic, from 29.1% (2016) to 21.44% (2024), with a decreasing trend (MPC = -0.10; P < .01). Post-pandemic trends showed an average MPC of -0.65 (P = 0.55), with joinpoints in December 2022, May 2023, and December 2023. Subgroup trends mirrored global findings, with higher non-attendance percentages in females, surgical specialties, and private payers. The lowest percentages occurred in adults over 65. Discussion: Non-attendance varied annually, showing distinct pre- and post-pandemic patterns. Fluctuations may reflect the pandemic’s impact and broader socioeconomic factors, highlighting barriers to access and the effectiveness of the system.

La amiloidosis es una de las causas más comunes de polineuropatía junto con la diabetes mellitus y el alcoholismo. Se presentan dos casos de polineuropatía de fibras finas secundarias a amiloidosis. El primer caso es el de un hombre con polineuropatía amiloidótica familiar (FAP) que consulta por dolor quemante distal de instalación brusca, antecedentes de hipotensión ortostática, disfunción eréctil refractaria a tratamiento y desequilibrios gastrointestinales. El segundo caso es el de una mujer con amiloidosis sistémica que se presenta con dolor neuropático en las extremidades inferiores, diarrea y fiebre durante cuatro semanas con un examen neurológico y un EMG normal

Huespe, Iván1; Giannasi, Sergio2; Acosta, Katia2; Pawlowski, Thomas3; Hoque, Md3; Nagourney, Jason3; Giunta, Diego2; Avila, Debora4; Prado, Eduardo5; Carboni Bisso, Indalecio4; Carini, Federico6 Author Information

Background Liver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment. Methods Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group. Results Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4–73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4–74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3–99.9%). Conclusion Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.

With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis. METHODS:We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility. RESULTS:The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%). CONCLUSION:This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.

Conflict of interest: No Introduction and Objectives: The lack of data on bacterial susceptibility in urinary tract infections (UTI) among patients complicates empirical antibiotic selection. Aims: To assess the antibiotic susceptibility of UTI-causing bacteria in patients with cirrhosis and recommend appropriate antibiotic therapy. Patients / Materials and Methods: Cross-sectional study using data from the prospective registry of bacterial infections in adult patients with cirrhosis in Argentina and Uruguay. We included episodes of culture-positive UTI in patients hospitalized for this condition or who developed a UTI during their stay. Antibiotic susceptibility patterns and recommendations are presented according to the site of acquisition. According to our definition, empirical antibiotic treatment should aim to cover roughly 80% of anticipated bacteria in stable patients and 90% in critically-ill patients. Results and Discussion: A total of 278 episodes were included, involving 227 patients recruited from 20 centers between Dec/2020 and July/2024. Of these, 97% (n=269) were monobacterial, and 3% (n=9) involved infections with two bacteria, resulting in 287 isolates. The most frequent isolates were enterobacteria, especially E. coli (43%), notably in community-acquired (CA) UTI (60%); K. pneumoniae accounted for 28% of the isolates, rising to 40% in nosocomial UTI. The most frequent Gram-positive cocci was enterococcus (14%). The table displays the susceptibility patterns for various antibiotics and highlights those suitable for empirical treatment according to the observed coverage. Multidrug resistance was observed in 52% (CI95: 46-58) of episodes: 40% (CI95: 32-50) in community-acquired and 68% (CI95: 57-77) in nosocomial infections. It is concerning that half of UTI are caused by multidrug-resistant organisms, and that only combinations of broad-spectrum antibiotics offer adequate coverage for nosocomial infections. Conclusions: For the first time in Latin America, we provide high-quality data to guide empirical antibiotic recommendations for UTI in patients with cirrhosis.

Treating cancer-associated venous thromboembolism (CAT) with anticoagulation prevents recurrent venous thromboembolism (rVTE), but increases bleeding risk. To compare incidence of rVTE, major bleeding, and all-cause mortality for rivaroxaban versus low molecular weight heparin (LMWH) in patients with CAT. We developed a cohort study using Swedish national registers 2013–2019. Patients with CAT (venous thromboembolism within 6 months of cancer diagnosis) were included. Those with other indications or with high bleeding risk cancers were excluded (according to guidelines). Follow-up was from index-CAT until outcome, death, emigration, or end of study. Incidence rates (IR) per 1000 person-years with 95