1,720,987 research outputs found
Primary Renal Synovial Sarcoma and Clinical and Pathological Findings: a Systematic Review
No full textPurpose of Review: To update epidemiological, diagnostic, and therapeutic information on primary synovial sarcoma of the kidney. Recent Findings: A total of 96 studies were analyzed; age at presentation was 38.6±14.2 years, predominant location of tumor was right kidney; frequent reported symptoms at diagnosis were hematuria and pain. For definitive diagnosis, cytogenetic technique was used. Detected oncogene was available in 37.8% cases with fusion of SS18-SSX in most patients. Surgery is treatment of choice, with adjuvant chemotherapy; most frequently ifosfamide-based associated with doxorubicin or epirubicin. Overall median survival was 34 months. Mortality was 29% of the cases which reported death and the recurrence rate was 39.8%. Risk of death was increased in patients with metastases at diagnosis Summary: Primary RSS occurs more often in young men. RSS often presents with symptoms and in an advanced stage. Surgical treatment is the most commonly used and chemotherapy for advanced or recurrent treatment.Fil: Blas, Leandro. Hospital Alemán; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin
The Right to a Dignified Death in Argentina
No full textIn this chapter we describe and analyse the public debates on death with dignity in Argentina, from the first attempts to regulate the rights of terminally ill patients to the political process that resulted in the death with dignity Act. Based on documentary sources and sociology of public problems approach we discuss the process of legal change regarding treatment refusal at the end of life. After a short sketch of the history of the debates on death with dignity, we discuss the social and political factors that led to a legal change regarding death with dignity. We posit that the political context and how the debate on end-oflife care was introduced into the public domain explain the legal changes and ethical concerns related to a death with dignity in Argentina.Fil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Luxardo, Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Roberti, Javier Eugenio. Finaer (foundation For Research And Assistance In Kidney Disease); Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin
Negotiating treatment and managing expectations in chronic kidney disease: A qualitative study in Argentina
No full textObjectives: To describe how patients with CKD negotiated assigned responsibilities in the management of their disease, resulting in potential relational nonadherence. Methods: Qualitative study performed in two healthcare facilities in Buenos Aires, Argentina, including 50 patients and 14 healthcare providers. We conducted semistructured interviews which were analysed using a frame of reference with concepts of Burden of Treatment and Cognitive Authority theories. Findings: Adherence to treatment defined “good patients”. Patients needed to negotiate starting treatment, its modality and dialysis schedule, although most patients felt they did not participate in the decision process and that providers did not acknowledge implications of these decisions on their routine. Some patients skipped dialysis if concerns were not attended. Regularly, patients negotiated frequency of visits, doses, dietary restrictions and redefined relationships with their support networks, sometimes with devasting effects. As a result of overwhelming uncertainty some patients refused enrolling into a transplant program. When the frequency of complications increased, patients considered abandoning dialysis. Conclusion: When patients perceived demands were excessive or conflicting, they entered into negotiations. Relationally induced nonadherence may arise when professionals do not or cannot enter into negotiations over patients’ beliefs or knowledge about what is possible for them to do.Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: May, Carl R.. London School of Hygiene and Tropical Medicine; Reino Unid
Kidney failure, status passage, and the transitional nature of living with the disease: A qualitative study in Argentina
No full textThe span of kidney failure (KF) has been extended by advances in treatment. To elucidate the lived experiences of people with KF, we draw on Glaser and Strauss’s theory of status passage. Semi-structured interviews were conducted with 50 patients with KF and 14 health professionals, from two healthcare facilities in Buenos Aires, Argentina. The theory informed on the temporal dimensions of people’s passages and dimensions related to what actors know of this passage. We described the status passage as a sequence of transitions (starting dialysis, receiving a transplant, returning to dialysis) that have devastating effects on patient’s roles, and are accompanied with fear and experience of wasting time. Temporal aspects were crucial and planning was useless; indeed, timing of statuses was uncertain. With a transplant, certain roles and capacities could be regained. Some patients were not aware of the chronic nature of the disease and the ultimate reversibility of the transplant. Control over the passage was minimal because of the unpredictable prognosis of the disease but patients employed strategies to regain it. Control was even more limited for people who migrated to receive a treatment; whose lives were completely altered. Status passage theory signaled the overwhelming impact of the passage on all aspects of people’s lives, the uncertainty of the transitions, lack of control and awareness of essential aspects, and unexpected aspects of desirability, adding to our understanding of how people experience this disease and its treatments.Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Blas, Leandro. Hospital Aleman; ArgentinaFil: May, Carl. London School of Hygiene and Tropical Medicine; Reino Unid
How do social and economic vulnerabilities shape the work of participating in care? Everyday experiences of people living with kidney failure in Argentina
No full textBackground: A new chronic patient has emerged, with a burden of symptoms and treatment. Patients with kidney failure (KF) require complex and expensive treatments, and in underresourced contexts, they struggle to obtain quality and timely care, even in countries with universal health coverage. We describe how, in such a setting, social structural factors and control over services placed by the system affect the burden of treatment of patients. Method: This qualitative study was undertaken in Buenos Aires, Argentina. Semistructured interviews were conducted with patients with KF (n = 50) and health professionals (n = 14) caring for these patients. Additionally, three types of health coverage were included: public health, social security and private healthcare, with diverse socioeconomic backgrounds. Findings: Patients' agency to meet demands is extended by relational networks with redistributed responsibilities and roles. Networks provided logistical, financial, emotional support; indeed, patients with limited networks were susceptible to rapid health deterioration, as treatment interruptions could not be identified in time. Control over services translated into scarce information about treatment options, changing dialysis schedules, lack of contact with transplant teams, and new rules to access medication or make requests. For any type of coverage, there was an economic burden related to noncovered medication, copayments, travel, caregivers, specialized diets, and moving to a city offering treatment. Many patients reported economic difficulties that prevented them from even affording meals. Hardships worsened by unemployment because of the disease. Some patients had migrated seeking treatment, leaving everything behind, but could not return without risking their life. Transplanted patients often needed to re-enter the labor market against a background of high unemployment rates. Conclusion: While health policy and practices encourage self-management, the patient may not have the capacity to meet the system's demands. A better understanding of BoT could contribute to improving how patients experience their illness.Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Blas, Leandro. Kyushu University; JapónFil: May, Carl. University of London; Reino Unid
Signet ring cell carcinoma of the prostate: report of 5 cases and literature review
No full textOBJETIVO: El carcinoma de células en anillo de sello (CPAS) de la próstata es un tumor muy raro y agresivo. Está compuesto por células que son similares alos tumores de células del anillo de sello del tracto gastrointestinal. El diagnóstico requiere histopatología y también la eliminación de los adenocarcinomas de otros órganos. Hasta donde sabemos se han publicado 157 casos en la literatura. MATERIAL Y MÉTODOS: Realizamos una búsqueda retrospectiva en los registros de tumores del Hospital Alemán de Buenos Aires para identificar todos los tumores de próstatadesde1990. Analizamos las siguientes variables: edad de presentación, mediana de antígeno prostático específico(PSA), estadio oncológico al diagnóstico y supervivencia global entre otras. También se revisó los tratamientos instaurados y se comparó esta serie de casos con la literatura existente. RESULTADOS: Identificamos 5 casos con CPAS. En nuestra serie encontramos: edad promedio de 77,8 años (DE3,2),mediana de PSA 18 ng / ml (rango 10.6-331 ng / ml), 3/5 (60%) enfermedad localizada y 2/5 (40%) con enfermedad a distancia en el momento del diagnóstico. Mediana de supervivencia de 23 meses. Comparando con otras series encontramos pacientes de mayor edad y menor mediana de supervivencia. CONCLUSIONES. El carcinoma primario de células enanillos de la próstata es una variante histológica rara y agresiva de los adenocarcinomas de próstata. El tratamiento del adenocarcinoma primario de células en anillos de sellos de la próstata es el mismo que el adeno carcinoma clásico con énfasis en el tratamiento multimodal agresivo.Fil: Blas, Leandro. Hospital Alemán; ArgentinaFil: Vitagliano, Gonzalo. Hospital Alemán; ArgentinaFil: Rios Pita, Hernando. Hospital Alemán; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Hospital Alemán; ArgentinaFil: Guglielmi, Juan Manuel. Hospital Alemán; ArgentinaFil: Ameri, Carlos. Hospital Alemán; Argentin
Amyotrophic lateral sclerosis in Argentina: unveiling the burden of treatment through patient and caregiver perspectives
No full textPurpose: To examine the burden of treatment (BoT) experienced by people with Amyotrophic Lateral Sclerosis (ALS) in Argentina.Methods: Qualitative methodological design based on semi-structured interviews. Nineteen semi-structured interviews were conducted (PwALS = 7, informal caregivers= 12). The interview guides were designed based on the literature and BoT theory. Data were analysed following a framework analysis approach.Results: The research highlighted the arduous journey toward obtaining a diagnosis, marked by delays influenced by healthcare system inefficiencies, lack of disease awareness and pandemic-related anxiety. Receiving the diagnosis was a destabilising experience, triggering the need to reframe self-identity, a new reality. As the disease progressed, patients encountered significant challenges in their daily activities and basic tasks, affecting their ability to work, communicate, and manage personal care. The burden extended beyond the patients to their primary caregivers. Access to specialised care, bureaucratic complexities in securing treatment, and the financial impact of managing the disease posed substantial challenges.Conclusion: The findings offer valuable insights into the experiences of PwALS and their caregivers in Argentina. They underscore the need for increased disease awareness, improved access to specialised care, and enhanced support networks to alleviate the burdens PwALS and their families face.Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Ini, Natalí. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Villarejo, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Belizán, María. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Roberti, Javier Eugenio. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin
Transesophageal Echocardiographic Assessment in Patients with Severe Respiratory Distress due to COVID-19 in the Prone Position: A Feasibility Study
No full textBackground and aim: Our aim was to assess the feasibility, safety, and utility of implementing transesophageal echocardiographic screening in patients with coronavirus disease-2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), receiving mechanical ventilation (MV) and in prone position (PP). Methods: Prospective observational study performed in an intensive care unit; patients 18 years, with ARDS, invasive MV, in PP were included. A total of 87 patients were included. Results: There was no need to change ventilator settings, hemodynamic support, or any difficulties with the insertion of the ultrasonographic probe. Mean duration of transesophageal echocardiography (TEE) was 20 minutes. No displacement of the orotracheal tube, vomiting, or gastrointestinal bleeding was observed. Frequent complication was displacement of the nasogastric tube in 41 (47%) patients. Severe right ventricular (RV) dysfunction was detected in 21 (24%) patients and acute cor pulmonale was diagnosed in 36 (41%) patients. Conclusion: Our results show the importance of assessing RV function during the course of severe respiratory distress and the value of TEE for hemodynamic assessment in PP.Fil: Sosa, Ariel Fernando. Hospital Aleman; ArgentinaFil: Wehit, Jeanette. Hospital Aleman; ArgentinaFil: Merlo, Pablo. Hospital Aleman; ArgentinaFil: Matarrese, Agustín. Hospital Aleman; ArgentinaFil: Torti, Bárbara. Hospital Aleman; ArgentinaFil: Roberti, Javier Eugenio. Hospital Alemán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: César, Germán. Hospital Aleman; ArgentinaFil: Martínez, Juan Ruiz. Hospital Aleman; ArgentinaFil: Osatnik, Javier. Hospital Alemán; ArgentinaFil: Soliman Aboumarie, Hatem. Harefield Hospital; Reino Unid
Cardiac tamponade and myocarditis in a patient with acute SARS-CoV-2 infection
Full text linkDescribimos una paciente con COVID-19, con derrame pericárdico, taponamiento cardíaco y depresión miocárdica grave. Mujer de 51 años, sin enfermedad previa, COVID-19 leve que presentó tres episodios de síncope en domicilio. El electrocardiograma mostró ritmo sinusal, ST de concavidad superior difuso 2 mv; en la tomografía se observó derrame pericárdico y parénquima pulmonar normal. Ingresó a terapia intensiva con shock y requerimiento de asistencia ventilatoria mecánica (AVM). En el ecocardiograma se observó derrame pericárdico y taponamiento; se realizó drenaje. El ecocardiograma transesofágico mostró deterioro moderado de función sistólica biventricular; strain longitudinal global –14.2%, Fey estimada: 43%; deformación global circunferencial: –10.1%. A los 7 días del ingreso, la tomografía reveló infiltrados bilaterales y engrosamiento pericárdico con realce post-contraste y derrame pericárdico leve. El día 12 posterior al ingreso, se suspendió el soporte inotrópico; y la paciente, hemodinámicamente estable, se desvinculó de la AVM.We describe a patient with COVID-19, with pericardial effusion, cardiac tamponade and severe myocardial depression. A 51-year-old woman, previously healthy, with mild COVID-19 presented with three episodes of syncope. She was admitted to the emergency room. An electrocardiogram showed sinus rhythm, diffuse superior concavity ST 2 mv; a CT scan showed pericardial effusion, without lung pathological findings. Due to shock, dyspnoea and encephalopathy, the patient was admitted to intensive care, where she received vasopressor support and mechanical ventilation. A bedside ultrasound showed pericardial effusion and tamponade; drainage was performed; transoesophageal ultrasound showed moderate deterioration of biventricular systolic function; global longitudinal strain –14.2%, estimated Fey 43%; global circumferential strain –10.1%. Seven days after admission, CT scan revealed bilateral infiltrates and pericardial thickening with post-contrast enhancement and mild pericardial effusion. On day 12 post admission, inotropic support was discontinued; patient on mechanical ventilation weaning and haemodynamically stable.Fil: Flores Cevallos, Samantha S.. Hospital Aleman; ArgentinaFil: Ruiz Martínez, Juan José. Hospital Aleman; ArgentinaFil: Duran, Ana L.. Hospital Aleman; ArgentinaFil: Roberti, Javier Eugenio. Hospital Aleman; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Sosa, Fernando A.. Hospital Aleman; Argentin
Promoting immunization equity in Latin America and the Caribbean: Case studies, lessons learned, and their implication for COVID-19 vaccine equity
No full textIn 2020, the World Health Organization launched the Immunization Agenda 2030: A Global Strategy to Leave No One Behind, which prioritizes high equitable immunization coverage at the national level and in all districts. Achieving high and homogenous immunization coverage, which is all the more important within the current context of the COVID-19 pandemic and vaccine rollout, requires the strengthening of existing immunization activities and innovative approach to immunization promotion. This research applied a descriptive case study methodology to document the implementation of strategic multi-level alliances to promote equitable immunization access and demand in Colombia, Guyana, and Sucre, Bolivia. Data collection, carried out between September 2019 and March 2020, included documentary reviews, semi-structured interviews, focus groups, and site visits accompanied by discussions with relevant stakeholders. Case studies provide valuable examples of people-centered, partnership-based, country-owned, and data-guided approaches to promoting equitable immunization coverage, including multi-level partnerships to build technical capacity for the identification and measurement of social inequalities impacting immunization in Colombia; intersectoral and community collaboration for pro-equity emergency response to regional vaccine preventable disease outbreaks in Guyana; and strategic alliances with the education sector and civil society organizations for the introduction of the human papilloma virus (HPV) vaccine in Sucre, Bolivia. Lessons learned highlight avenues for improving the impact of multi-level, equity-focused capacity building, particularly at the local level; optimizing the use of data and resources, partnerships, and community and stakeholder education and empowerment. While impact studies are needed to better understand the quantitative contributions of such strategic alliances, these case studies illustrate their practical significance and reinforce the value of multi-level, intersectoral collaboration for enhancing equitable immunization access and demand. The experiences of Colombia, Guyana, and Sucre, Bolivia provide evidence-based insight to support pro-equity immunization program planning to ensure that no one is left behind and that everyone, everywhere receives the benefits of vaccines, both routine and for COVID-19.Fil: Chan, Isabella L.. No especifíca;Fil: Mowson, Robin. No especifíca;Fil: Alonso, Juan Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Contreras, Marcela. No especifíca;Fil: Velandia González, Martha. No especifíca
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