Five-year bio-monitoring of aquatic ecosystems near Artigas Antarctic Scientific Base, King George Island

Fildes Peninsula, in King George Island, Antarctica, has a great concentration of international facilities, and it has clearly been affected by human activities. The objective of this 5-year study was to assess the impact of anthropogenic activities on the bacterial abundance in water bodies close to Artigas Antarctic Scientific Base (BCAA, in Spanish Base Científica Antártica Artigas). Water samples from areas under different human influence (Uruguay Lake, nearby ponds, and meltwater from Collins Glacier) were aseptically collected and refrigerated until processed. The number of heterotrophic bacteria and Pseudomonas spp. was analyzed using a culture-dependent approach. Physico-chemical properties of the water samples (temperature, pH, and conductivity) were also determined. Results showed that water from the highly affected area, Uruguay Lake, where the pump that provides water to the BCAA is located, did not suffer significant fluctuations in heterotrophic bacterial abundance (104–105 CFU∙mL−1); however, Pseudomonas abundance increased until becoming the predominant population. In other water samples, the number of heterotrophic bacteria and Pseudomonas gradually increased during this 5-year study, by 2014 reaching similar values to those observed for Uruguay Lake. The implications of human activities on Antarctic bacterial abundance are discussed

The Use of a Disclosing Agent During Resective Periodontal Surgery for Improved Removal of Biofilm

A total removal of the bacterial deposits is one of the main challenges of periodontal therapy. A surgical approach is sometimes required in order to allow a correct access to the areas not thoroughly reached during the initial therapy. The present study focuses on the surgical scaling effectiveness in root deposits removal; the potential support of a disclosing agent during this procedure is also evaluated. Forty surgical periodontal patients were randomly divided between surgeries where the operator was informed about a final examination of the residual root deposits and surgeries where the operator was not informed. Straight after scaling procedures a supervisor recorded the O’Leary Plaque Index of the exposed roots by mean of a disclosing agent and the percentage of teeth with residual biofilm. After the stained deposits removal, a second chromatic examination was performed and new data were collected. Mann-Whitney U-test and Wilcoxon test for paired samples were used for comparisons respectively between the two surgery groups and the first and the second chromatic examination; one-sided p-value was set at 0.05. At first examination no significant differences between the two groups were observed regarding Plaque Index (p=0.24) and percentages of teeth with residual biofilm (p=0.07). The 100% removal of roots deposits was never achieved during the study but a significant reduction of 80% of root deposits was observed between first and second examination (p=0.0001). Since root deposits removal during periodontal surgery resulted always suboptimal, the use of a disclosing agent during this procedure could be a useful and practical aid

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Heart Transplantation in Adult Patients with Congenital Heart Disease

Background: Over recent decades, congenital heart disease (CHD) patients have posed new challenges in the management ofcomplications, both of the original condition as of the corrective surgeries that have allowed them to reach adulthood.Objective: The aim of this study was to report the outcomes and evolution of CHD patients who had been evaluated fortransplantation in a tertiary care center.Using the institutional database, data from 11 patients with different congenital diseases were evaluated for transplantation.A total of 5 patients underwent transplantation, with a 1.6-year survival rate of 80%. Mortality rate was 66% for patients whowere on the waiting list but were not transplanted, and 35% for those who were ruled out due to comorbidities.Conclusion: Heart transplantation in CHD adult patients present a higher periprocedural risk than in patients with acquiredheart diseases. However, those who survive the first post-transplant year have an excellent long-term outcome.Introducción: En las últimas décadas los pacientes con cardiopatías congénitas (CC) han presentando nuevos desafíos en elmanejo de las complicaciones, tanto de la patología originaria como de las cirugías correctoras que les han permitido llegara la adultez.Objetivo: Comunicar los resultados y la evolución de los pacientes con CC que hayan sido evaluados para trasplante en uncentro de alta complejidad.Se utilizó la base de datos institucional, y se analizaron los datos de 11 pacientes evaluados para trasplante con diversaspatologías congénitas. Accedieron al trasplante 5 de ellos con una sobrevida a 1,6 años del 80%. Los pacientes que se hallaban en lista y no se trasplantaron tuvieron una mortalidad del 66%, y los descartados por comorbilidades presentaron unamortalidad del 35%.Conclusión: El trasplante cardíaco en adultos con CC tiene un riesgo periprocedimiento más elevado que para las cardiopatíasadquiridas (CA). No obstante, los que sobreviven el primer año postrasplante tienen una excelente evolución a largo plazo

Cost-Effectiveness Analysis of Alternative Strategies for the Management of Patients with Cryptogenic Stroke and Patent Foramen Ovale

Background Patent foramen ovale (PFO) has been associated with cryptogenicstroke (CS). There are still some controversies aboutthe best treatment to prevent recurrences in patients withCS and PFO. Our region lacks cost-utility analysis of themanagement of these patients.ObjectivesTo construct a decision model for the management of patientswith CS and PFO and to establish the cost-utility ratio ofthree alternative strategies.Material and MethodsWe conducted a cost-utility analysis based on a decision treewith a time horizon of 4 years considering three strategies:aspirin (ASA), anticoagulants (AC) or percutaneous deviceclosure of the PFO. The benefits were expressed in QALYs.A payment threshold of ARS $28,000 was established and asensitivity analysis was performed.ResultsAnticoagulants were more expensive compared to ASA (additionalcost of ARS$1,315) and produced less benefits (incremental(QALY –0.063). Percutaneous device closure had anadditional cost of ARS $89,876 per QALY gained compared toASA. This cost exceeds the predetermined payment threshold.After performing the sensitivity analysis, ASA remained asthe strategy with the best cost-utility ratio; however, whenthe probability of recurrences with this drug increases to35$1.356/QALY.ConclusionAccording to this model, in patients with CS and PFO, ASAwould be the strategy with the best cost-utility ratio in ourenvironment unless recurrences develop; in this case the useof anticoagulants would be more appropriate.Antecedentes El foramen oval permeable (FOP) se ha asociado con el accidente cerebrovascular criptogénico(ACVC). El mejor tratamiento para evitar la recidiva en pacientes con ACVC y FOP es controversial.No existen datos de costo-utilidad en nuestra región para el manejo de estos pacientes.ObjetivosConstruir un modelo de decisión para el manejo de pacientes con ACVC y FOP y establecerla relación costo-utilidad de tres estrategias alternativas.Material y métodosSe realizó un análisis de costo-utilidad basado en un árbol de decisión con un horizontetemporal de 4 años considerando tres estrategias: aspirina (AAS), anticoagulación (ACO) ocierre percutáneo del FOP con dispositivo. Los beneficios se expresaron en QALYs. Se fijó unumbral de pago de $28.000 argentinos y se realizó un análisis de sensibilidad.ResultadosEn comparación con la AAS, la anticoagulación fue más costosa ($1.315 adicionales) y generómenos beneficios (QALY incremental –0,063). El cierre con dispositivo comparado con eltratamiento con AAS costaría $89.876 adicionales por QALY ganado. Dicho monto supera elumbral de pago predeterminado. Luego del análisis de sensibilidad, la AAS se mantuvo comola estrategia con mejor relación costo-utilidad, salvo cuando la probabilidad de recidiva conesta droga aumenta al 35$1.356/QALY.ConclusiónDe acuerdo con este modelo, para pacientes con ACVC y FOP, la AAS sería la estrategia conmejor relación costo-utilidad en nuestro medio, salvo cuando la probabilidad de eventos seeleva sustancialmente, en cuyo caso sería apropiado el uso de anticoagulantes

Metas de colesterol LDL en pacientes sometidos a revascularización periférica

Background: Patients with peripheral vascular disease represent a group at high risk of cardiovascular events, and must therefore achieve the secondary prevention goals recommended in the guidelines. Objectives: Primary: To determine what percentage of patients undergoing peripheral revascularization surgery reached LDL cholesterol goals at 6 months of the  intervention compared with patients undergoing coronary artery bypass grafting. Secondary: To determine the percentage of patients reaching these levels at 18 months of follow-up, the percentage of patients with total cholesterol dosage and lipid fraction (LDL-C, HDL-C and TG) assessment at 6 and 18 months of follow-up and the percentage of statin use during the previous year and during the long term follow-up after surgery. Methods: The degree of lipid control in a retrospective cohort of patients undergoing peripheral revascularization surgery was compared with another group of patients undergoing coronary artery bypass grafting at 6 months and 18 months of the procedure. Results: A total of 468 individuals, 98 undergoing surgery for peripheral vascular disease and 370 for coronary artery disease were followed up for a period of 18 months. Mean LDL-C at 6 months of surgery was significantly higher in the vascular than in the coronary patients (98.8±35 mg/dl vs. 84.7±25 mg/dl, p=0.001), but lost significance at 18 months (93.3±23 mg/dl vs. 88±26 mg/ dl, p=0.25). The percentage of patients achieving LDL-C targets <100 mg/dl was 27.5% vs. 48.6% (p <0.0001) at 6 months in the vascular and coronary patients, respectively, and 22.5% vs. 37.3% (p=0.006) at 18 months. Conclusion: A lower percentage of patients undergoing surgical procedures for peripheral revascularization achieve LDL-C targets compared with those undergoing coronary revascularization.Introducción. Los pacientes con enfermedad vascular periférica representan un grupo de alto riesgo de eventos cardiovasculares por lo que deben alcanzar metas de prevención secundaria de enfermedad cardiovascular. Objetivos. Determinar qué porcentaje de pacientes sin antecedentes de enfermedad coronaria sometidos a cirugía vascular (CV) alcanzan las metas de colesterol luego de ser intervenidos en relación a  pacientes sometidos a cirugía de revascularización miocárdica (CRM) electiva. Materiales y Métodos Se comparó el grado de control de dislipemia de una cohorte retrospectiva de  pacientes sometidos a CV sin antecedentes clínicos de enfermedad coronaria en relación a pacientes sometidos a cirugía de revascularización coronaria. Resultados. Se siguieron 468 individuos, 98 operados de CV y 370 de CRM por un periodo de 18 meses. La media de LDL a los 6 meses de la cirugía fue significativamente menor en los coronarios que en los vasculares (84.7±25  vs. 98.8±35 mg/dl; p=0.001). Esta diferencia se mantuvo a los 12 meses post operatorio (91,6±28.5 vs. 102 ±39; p=0.04) pero se pierde a los 18 meses  (88±26 vs 93.3±23 mg/dl; p=0.25) La tasa de alcance de metas de LDL <100mg/dl a 6 meses en vasculares y coronarios fue 27,5% vs 48.6%; p<0.0001; OR 2.4 (1.4-4.0), a 12 meses 26.5% vs 35.1%; p=0.10; OR 1.3(0.8-2.3) y a 18 meses 22.5% vs 37.3%; p=0.006; OR 1.7(1.01-2.9). Conclusiones. Los pacientes sometidos a procedimientos de revascularización periférica son controlados menos intensamente y alcanzan en menor medida las metas de C-LDL que los pacientes sometidos a CRM

Cardiac Amyloidosis with Dynamic Subaortic Obstruction

La amiloidosis es una enfermedad infiltrativa sistémica que  compromete el corazón y representa una causa importante de miocardiopatía restrictiva. En esta presentación se describe el caso de una paciente con insuficiencia cardíaca (IC) secundaria a miocardiopatía infiltrativa por depósito amiloide y obstrucción dinámica del tracto de salida del ventrículo izquierdo. El diagnóstico hematológico fue de mieloma múltiple por cadenas livianas y se demostró amiloidosis en dos tejidos extracardíacos.(resumen completo en pdf

Características clínicas y evolutivas del síndrome de Takotsubo en un Hospital Universitario

Background: Takotsubo syndrome (TS) is a reversible cardiomyopathy with many different forms of presentations. There is no local data of TS published so far. Methods: One hundred and fifteen patients with either primary or secondary TS were retrospectively studied at Hospital Italiano de Buenos Aires from 2005 to 2017. The purpose of the study was to assess the clinical features of this population during hospitalization. Results: Median of age was 78 years (64-84); 90 % of patients were female, and 22% had associated coronary artery disease. Fiftyseven percent of cases were primary TS, 31 % experienced an emotional trigger and 44 % had a physical origin. The presentation syndrome was as follows: 9 % shock, 12 % heart failure, 70 % mimicking acute coronary syndrome, 5 % stroke/peripheral embolism and 4 % arrhythmias. Median ejection fraction at admission was 40 % (36-50) and recovery from admission to discharge [median hospital stay: 4 days (3-8)] was 20 %, p <0.001. In-hospital mortality was 4/115 cases (3.48 %). In univariate analysis, shock compared with other forms of presentation (p=0.0035) and secondary TS (p=0.020) were associated with higher in-hospital mortality. There was a direct relationship between in-hospital mortality and maximum NT-pro-BNP levels (p= 0.0082) and white cell count (p=0.0101). In addition, in-hospital mortality was inversely associated with hematocrit (p=0.0084) and with ECG abnormalities at admission; i.e. patients who died during hospitalization had more frequently normal ECG at admission, (p<0.001). Conclusion: Compared with international registries, this single center population had more comorbidities, but similar in-hospital mortality rates.Introducción: El síndrome de Takotsubo (ST) es una miocardiopatía reversible que tiene diversas formas de presentación. Hasta el momento no se han publicado datos de ST en nuestro medio. Material y Métodos: Desde el 2005 al 2017 se incluyeron a 115 pacientes con diagnóstico de ST primario o secundario en el Hospital Italiano de Buenos Aires. El objetivo fue evaluar las características clínicas del ST durante la internación. Resultados: La mediana de edad de la población fue de 78 años (64-84), el 90% eran mujeres, y el 22% presentó enfermedad coronaria asociada. El 57% eran ST primarios, 31% tuvieron un gatillo emocional y 44%, físico. El síndrome de presentación fue como shock: 9%, insuficiencia cardiaca 12%, “tipo SCA” 70%, ACV/embolia 5% y, arritmias, 4%. La mediana de Fey al ingreso fue del 40% (36-50) y su recuperación, desde el ingreso al alta (mediana de internación de 4 días, 3-8), fue del 20%, p < 0.001. La mortalidad hospitalaria fue de 4/115 (3,48%). En el análisis univariado, las variables asociadas a mayor mortalidad fueron: shock respecto a otras formas de presentación (p = 0.0035) y ST secundario respecto al primario, p = 0.020. Además, existió una relación directa entre la mortalidad y los niveles de NT-pro-BNP máximo (p = 0.0082) y glóbulos blancos (p = 0.0101).   Asimismo, la mortalidad hospitalaria mostró una relación inversa con el hematocrito (p = 0.0084) y con las alteraciones en el ECG de ingreso; es decir, que los pacientes que fallecieron durante la internación tuvieron ECG normal al ingreso con mayor frecuencia (p < 0.001). Conclusión: En este registro unicéntrico se observó que los pacientes tuvieron más comorbilidades y similar mortalidad respecto a registros internacionales