Evidencia actualizacion en la práctica ambulatoria https://evidencia.org.ar/index.php/Evidencia <p><strong>EVIDENCIA - ACTUALIZACIÓN EN LA PRÁCTICA AMBULATORIA</strong></p> <p><strong><span style="font-weight: 400;">Evidencia is an independent, open-access journal, available in digital format, quarterly basis since 1997 by </span></strong><a href="https://www.fundacionmf.org.ar/"><strong>Fundación MF</strong></a>. It is endorsed by&nbsp; <a href="https://instituto.hospitalitaliano.org.ar/"><strong>Universidad Hospital Italiano de Buenos Aires</strong></a>.</p> <p><span style="font-weight: 400;">Its purpose is to contribute to the continuing education and scientific updating of Spanish-speaking health professionals working in the field of outpatient care. The website contains independent, high-quality, up-to-date, easily summarised on relevant topics in outpatient care.</span></p> Fundación MF es-ES Evidencia actualizacion en la práctica ambulatoria 1667-5703 Precision prevention: new frontier or new breach? https://evidencia.org.ar/index.php/Evidencia/article/view/7154 <p>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.</p> Karin Kopitowski Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-03-13 2025-03-13 28 1 e007154 e007154 10.51987/evidencia.v28i2.7154 Dengue care in an emergency service during 2023 and 2024 https://evidencia.org.ar/index.php/Evidencia/article/view/7139 <div data-id="p-252dc4a7a33a"><strong>Background.</strong> 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.</div> <div data-id="p-55866b8fde63"><strong>Objective</strong>. 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.</div> <div data-id="p-cbdcb319c12c"><strong>Methods.</strong> 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.</div> <div data-id="p-811dd3ea101c"><strong>Results.</strong> 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.</div> <div data-id="paragraph-5"><strong>Conclusions.</strong> 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.</div> Luz Guadalupe Ibañez Martina Carla Ricasoli Gabriela Alejandra Blugerman Emilio Felipe Huaier Arriazu Marisa Sanchez Vanina Stanek Bernardo Julio Martinez Ana Soledad Pedretti Maria Florencia Grande Ratti Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-03-14 2025-03-14 28 1 e007139 e007139 10.51987/evidencia.v28i2.7139 De la escucha al alivio: enfoques prácticos en el manejo del insomnio (parte II) https://evidencia.org.ar/index.php/Evidencia/article/view/7144 <p>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.</p> Nicole Crimer Cecilia Calvo Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-02-21 2025-02-21 28 1 e007144 e007144 10.51987/evidencia.v28i2.7144 Diagnostic performance of red flags to identify vertebral fracture in patients with low-back pain https://evidencia.org.ar/index.php/Evidencia/article/view/7155 Melina Muñoz Aldana Martínez Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-03-31 2025-03-31 28 1 e007155 e007155 10.51987/evidencia.v28i2.7155 Limited performance of breath test for diagnosing small intestinal bacterial overgrowth https://evidencia.org.ar/index.php/Evidencia/article/view/7147 <p>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.</p> Agostina Risso Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-03-31 2025-03-31 28 1 e007147 e007147 10.51987/evidencia.v28i2.7147 Pitavastatin could prevent cardiovascular events in people living with HIV https://evidencia.org.ar/index.php/Evidencia/article/view/7146 Ezequiel Priano Sabrina Natalia Negri Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-02-19 2025-02-19 28 1 e007146 e007146 10.51987/evidencia.v28i2.7146 Update on USPSTF osteoporosis screening recommendation https://evidencia.org.ar/index.php/Evidencia/article/view/7156 Sebastian Sguiglia Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-03-13 2025-03-13 28 1 e007156 e007156 10.51987/evidencia.v28i2.7156 Effectiveness and safety of new antidiabetic drugs https://evidencia.org.ar/index.php/Evidencia/article/view/7141 Jose Ignacio Gimutky Copyright (c) 2024 Evidencia - actualizacion en la práctica ambulatoria 2025-01-02 2025-01-02 28 1 e007141 e007141 10.51987/evidencia.v28i1.7141 Tirzepatide showed promising results in patients with heart failure with preserved ejection fraction and obesity https://evidencia.org.ar/index.php/Evidencia/article/view/7151 Karin Kopitowski Valeria Vietto Copyright (c) 2025 Evidencia actualizacion en la práctica ambulatoria 2025-02-04 2025-02-04 28 1 e007151 e007151 10.51987/evidencia.v28i2.7151