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Hypertension continues to be the leading cause of death and disability in the industrialized world, with a high level of unawareness and unacceptably poor control rates. Therefore, the Argentinian Society of Hypertension, in association with the May Measurement Month (MMM) charity, implemented an awareness campaign during May 2021. A voluntary cross-sectional survey was carried out during the month of May 2021 in public spaces and health centres across 29 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg based on the mean of the second and third of three BP measurements or in those volunteers on treatment for high BP. Statistical analysis including multiple imputation followed the MMM protocol. A total of 26 070 individuals (average age 53.4 years, 14 816 women and 11 254 men) were evaluated. The age- and sex-standardized mean BP was 125.1/77.6 mmHg. Of all participants, 54.4% had hypertension. Although 79.8% of the hypertensive participants were aware of their condition and 76.9% were on antihypertensive treatment, only 42.5% of all individuals with hypertension had their BP controlled (<140/90 mmHg). Of those on antihypertensive medication, 55.3% were controlled. The low level of hypertension control highlights the critical need for community-based prevention strategies to increase the awareness and control of hypertension, thereby reducing the enormous health burden attributed to this condition.

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Introducción: la osteomielitis crónica no bacteriana (CNO) es una enfermedad autoinflamatoria ósea y se manifiesta con un amplio espectro clínico, presentándose con afectación monofocal o multifocal. Dado que no es siempre multifocal o recurrente, o ambas, fue propuesto que CNO se utilice como un término que comprenda a todas las presentaciones y la osteomielitis multifocal crónica recurrente (CRMO) se utilice para formas recurrentes y multifocales. Objetivo: presentar un caso clínico inédito, de baja prevalencia a nivel mundial, en una adolescente portadora de una enfermedad autoinflamatoria ósea que planteó desafíos diagnósticos y terapéuticos. Descripción: adolescente, mujer, 11 años, previamente sana que se presentó con dorso-lumbalgia invalidante de un mes de evolución, sin otra sintomatología asociada. Tras varias consultas en emergencia, ingresa a planta de internación pediátrica del Hospital Central de las Fuerzas Armadas (HCFFAA) en octubre de 2021. Resonancia nuclear magnética (RNM) de columna evidencia foco de edema óseo en cuerpo de T11, hemograma normal; VES 48 mm/h, ANA, anti-DNA, FR y HLA B27 negativos. Resultados: luego de descartar procesos infecciosos, oncohematológicos y una vez obtenido el resultado de una biopsia por punción ósea que evidenciaba elementos inflamatorios, se llegó al diagnóstico de CNO en el mes de febrero de 2022, tiempo récord comparando este caso con la literatura internacional. El diagnóstico de esta entidad clínica promedio a nivel mundial es de 12 meses.

Introduction: chronic Non-Bacterial Osteomyelitis (CNO) is an autoinflammatory bone disease that presents a broad clinical spectrum with monofocal or multifocal involvement. Since it is not always multifocal and/or recurrent, it was proposed that CNO be used as a term that encompasses all presentations and Chronic Recurrent Multifocal Osteomyelitis (CRMO) for recurrent and multifocal forms. Objective: to present an unprecedented low prevalence clinical case of an adolescent carrier of an autoinflammatory bone disease that posed diagnostic and therapeutic challenges. Description: a previously healthy female adolescent, 11 years old presented disabling lower back pain for a month without other associated symptoms. After several emergency consultations, she was admitted to the pediatric hospitalization at the Armed Forces Hospital (HCFFAA) in October 2021. A spine MRI showed a T11 body bone edema focus, normal blood count; ESR 48 mm/h, ANA, Anti DNA, RF and negative HLA B27. Results: after ruling out infectious and oncohematological processes, and once the result of a bone puncture biopsy was obtained, which showed inflammatory elements, an ONC diagnosis was made in February 2022, a record time comparing this case with the international literature. The average diagnosis of this clinical condition worldwide is 12 months.

Introdução: a Osteomielite Crônica Não Bacteriana (CNO) é uma doença óssea autoinflamatória, manifestando-se com amplo espectro clínico, apresentando-se com acometimento monofocal ou multifocal. Como nem sempre é multifocal e/ou recorrente, foi proposto que CNO seja usado como um termo que engloba todas as apresentações e Osteomielite Multifocal Recorrente Crônica (OMC) e que seja usado para formas recorrentes e multifocais. Objetivo: apresentar um caso clínico inédito, de baixa prevalência mundial, no caso de uma adolescente portadora de uma doença óssea autoinflamatória que representou desafios diagnósticos e terapêuticos. Descrição: adolescente do sexo feminino, 11 anos, previamente saudável, apresentava há um mês dorso-lombalgia incapacitante sem outros sintomas associados. Após várias consultas de urgência, foi internada na enfermaria pediátrica do Hospital Central das Forças Armadas (HCFFAA) em outubro de 2021. RM da coluna mostra foco de edema ósseo no corpo de T11, hemograma normal; ESR 48 mm/h, ANA, Anti DNA, RF e HLA B27 negativos. Resultados: após a exclusão de processos infecciosos e onco-hematológicos e obtido o resultado de uma biópsia por punção óssea, que evidenciou elementos inflamatórios, o diagnóstico de CNO foi feito em fevereiro de 2022, tempo recorde comparando este caso com a literatura internacional. A média de diagnóstico dessa entidade clínica no mundo é de 12 meses.

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The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.

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Abstract Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

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The objective was to evaluate the association between the severity of histopathological lesions caused by Mycobacterium avium subspecies paratuberculosis (MAP) infection and the molecular diversity of this pathogen. Blood, ileum, and mesenteric lymph node samples were collected at slaughter, from 1,352 adult cattle [source population 1 (SP1)]. In addition, 42 dairy herds (n = 4,963 cows) were followed for 2 years, and samples from compatible paratuberculosis clinical cases [source population 2 (SP2)] were collected. MAP infection was confirmed using an ELISA test, liquid media culture, and PCR. Isolates were genotyped using five MIRU-VNTR markers. Tissues from confirmed samples were subjected to a histopathological examination. A histopathological severity score (HSS) system was developed and used to grade (0 to 5) the magnitude of lesions caused by MAP. In general, the HSS system assesses the number of foci and degree of macrophage infiltration, together with the presence of multinucleated giant cells (MGCs) and acid-fast bacilli (AFB), in addition to the fusion of the intestinal villi and hyperplasia of the crypts. Despite the large sampling effort, only 79 MAP isolates were successfully genotyped, where 19 different haplotypes were described. A mixed-effect Poisson regression model was used to assess the relationship between haplotypes and HSS values. The model was controlled by animal age, and the farm was used as a random effect. Haplotypes were grouped based on their relative frequency: the most frequent haplotype (group i, 49.4%), the second most frequent haplotype (group ii, 12.7%), and all other haplotypes (group iii, 37.9%). Model outputs indicated that group i had significantly higher HSS values than group iii. In addition, group i was also associated with higher optical density (OD) values of the ELISA test. These results support the existence of differences in pathogenicity between MAP haplotypes. However, results were based on a relatively small sample size; thus, these should be taken with caution. Despite this, study findings suggest that haplotypes would be associated with differences in disease progression, where the dominant haplotype tends to generate more severe lesions, which could be linked to a greater shed of MAP cells than non-dominant haplotypes, increasing their chances of transmission.

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Hypertension mediated organ damage (HMOD) refers to structural or functional changes in arteries or target organs that can be present in long-standing hypertension, but it can be also found in naïve never treated patients. Traditionally, cardiovascular risk is stratified with charts or calculators that tend to underestimate the real cardiovascular risk. The diagnosis of HMOD automatically reclassifies patients to the highest level of cardiovascular risk. Subclinical HMOD can be present already at the diagnosis of hypertension and more than 25% of hypertensives are misclassified with the routine tests recommended by hypertension guidelines. Whether HMOD regression improves cardiovascular outcomes has never been investigated in randomized clinical trials and remains controversial. However, different drugs have been probed with promising results in high cardiovascular risk patients, such as the new antidiabetic or the novel non-steroid mineralocorticoid antagonists. Accordingly, trials have shown that lowering blood pressure reduces cardiovascular events. In this narrative review, we will discuss the role of HMOD in cardiovascular risk stratification, the different types of organ damage, and the evidence available to define whether HMOD can be used as a therapeutic target.

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We present the case of transient left ventricular dysfunction secondary to impaired left coronary artery filling after aortopulmonary window repair, caused by intraoperative diagnosis of anomalous left coronary artery from pulmonary artery. Immediate recognition and repair allowed for uneventful recovery of the patient.

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Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique.

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The Argentinean Society of Hypertension, in agreement with the May Measurement Month (MMM) initiative of the International Society of Hypertension, implemented for the third consecutive year a hypertension screening campaign. A volunteer cross-sectional survey was carried out in public spaces and health centres during the month of May 2019 across 33 cities in Argentina. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg based on the mean of the second and third BP measurements, or in those on treatment for high BP. A total of 94 523 individuals (53.9 ± 17.8 years old, 55 231women and 39 292 men), were evaluated. The age and sex standardized mean BP was 124.7/77.2 mmHg. Among participants, 34.7% were overweight (25-29.9 m/kg2) and 28.7% had obesity (≥30 m/kg2). Individuals identified as being overweight had BP 3/2 mmHg higher and individuals with obesity 6/4 mmHg higher than those with normal weight. The prevalence of hypertension was 52.5%. Although 81.1% were aware and 77.7% were on antihypertensive treatment, only 46.0% of all individuals with hypertension had their BP controlled. Moreover, 19.8% of those not on any antihypertensive medication were found with raised BP. The low level of control of hypertension generates the critical need for the development of community-based prevention strategies reinforcing strategies to increase the awareness and control of hypertension.

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INTRODUCCIÓN Hay poca información sobre el Síndrome post terapia intensiva en los pacientes con COVID-19 en nuestro país. OBJETIVOS Explorar los resultados funcionales, cognitivos y psíquicos a los 30 días del alta hospitalaria en los pacientes con COVID-19 que requirieron ventilación mecánica invasiva. MÉTODOSEstudio de cohorte prospectiva. Se incluyeron pacientes mayores de 18 años con síndrome de distres respiratorio agudo asociado a COVID-19, y que requirieron ventilación mecánica invasiva en dos UCIs de Buenos Aires. Medimos el deterioro funcional, cognitivo y psíquico con el índice de Barthel, el test Montreal Cognitive Assessment, el Patient Health Questionnaire-9 y el General Anxiety Disorder-7. Evento primario Sndrome post terapia intensiva a 30 días. Evento secundario Mortalidad a los 60 días. Discusión Se incluyeron 33 pacientes, la mediana de edad fue de 69 años (59­74) y 24 (72%) fueron hombres. La mortalidad a los 60 días fue 36 % (11/33 pacientes). La regresión de Cox identificó a la diabetes (HR 6.97 (IC 95 % 1.8-26.3)) y el Apache II (1.18 (1.07­1.30)) como predictores independientes de mortalidad.

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