Evidencia actualizacion en la práctica ambulatoria

Precision prevention: new frontier or new breach?

Karin Kopitowski — 2025-03-13

Precision prevention seeks to personalize prevention strategies using advanced risk prediction models rather than applying general recommendations to the entire population. Even though it could improve outcomes and reduce unnecessary tests, its implementation poses significant challenges. In this article, the author invites us to reflect on the dilemmas posed by recommendations based on this innovative concept, highlighting the importance of contemplating the risks of increasing the healthcare system's burden and worsening access inequalities within the population.

Dengue care in an emergency service during 2023 and 2024

Luz Guadalupe Ibañez — 2025-03-14

Background. In 2024, Argentina faced the worst dengue outbreak in its history within a context marked by high healthcare costs and resource scarcity. Although regulations allowed for case confirmation through epidemiological linkage without confirmatory tests, its application was inconsistent across different settings.

Objective. To describe the characteristics, resource usage, and clinical outcomes of patients with suspected dengue attended during the first quarter of 2024, comparing data with the same period in 2023.

Methods. A retrospective observational study, using secondary data obtained from electronic medical records from a private university hospital in Buenos Aires, Argentina. Emergency department consultations of adult patients with suspected dengue fever were identified from the Mandatory Notification Form of the National Health Surveillance System. At an institutional level, during the 2024 outbreak, confirmation via epidemiological linkage was enabled without requiring confirmatory tests. Meanwhile, laboratory testing was restricted to patients with warning signs, risk factors, or severe cases.

Results. In 2023, 186 patients with suspected dengue were detected; in 2024, this number increased to 1,617. The majority were young adults, with an increase in the clinical presentation of headache, retro-orbital pain, and nausea/vomiting. Confirmed cases increased from 111 to 443. Laboratory tests performed within 30 days decreased from 82.79% to 49.65%. During 2024, 652/1,617 patients (40.32%) received a diagnostic method for dengue confirmation. Follow-up visits decreased at 2 and 7 days (p=0.01). No hospitalizations or deaths due to dengue were recorded.

Conclusions. This study showed a significant increase in dengue cases at an emergency department during the 2024 outbreak. Despite the scarcity of resources and the reduction in serological testing, healthcare was appropriately adjusted to the emergency situation, with no increase in adverse outcomes such as hospitalizations or deaths.

De la escucha al alivio: enfoques prácticos en el manejo del insomnio (parte II)

Nicole Crimer — 2025-02-21

This article addresses treatment options for chronic insomnia in adults, emphasizing the need for a comprehensive and personalized approach. Treatment should consider not only the underlying causes but also the individual characteristics of each patient, their preferences, and their context. We examine both pharmacological strategies, including the use of medications such as benzodiazepines and non-benzodiazepine drugs and non-pharmacological therapies. The text highlights the importance of tailoring treatments to each patient's specific needs, recognizing that there is no one-size-fits-all solution. This flexible, person-centered approach seeks not only to alleviate the symptoms of insomnia but also to prevent its adverse effects on mental and physical health, promoting a comprehensive improvement in quality of life.

Diagnostic performance of red flags to identify vertebral fracture in patients with low-back pain

Melina Muñoz — 2025-03-31

Limited performance of breath test for diagnosing small intestinal bacterial overgrowth

Agostina Risso — 2025-03-31

Small intestinal bacterial overgrowth is a common cause of nonspecific gastrointestinal discomfort that can be challenging for physicians and patients to manage. The breath test is increasingly used to establish the diagnosis, although there is controversy about its accuracy. Because gastrointestinal symptoms can be caused by various conditions, having a reliable diagnostic test would allow physicians to order it when appropriate, interpret its results adequately, and prescribe treatment promptly. However, after conducting a literature search and a critical analysis of the currently available evidence, the author concludes that the overall performance of the breath test is not optimal, and therefore, it should not be used systematically or in isolation to diagnose small intestinal bacterial overgrowth in a primary health care setting.

Pitavastatin could prevent cardiovascular events in people living with HIV

Ezequiel Priano — 2025-02-19

Update on USPSTF osteoporosis screening recommendation

Sebastian Sguiglia — 2025-03-13

Effectiveness and safety of new antidiabetic drugs

Jose Ignacio Gimutky — 2025-01-02

Tirzepatide showed promising results in patients with heart failure with preserved ejection fraction and obesity

Karin Kopitowski — 2025-02-04