Publications by authors named "Diego Caruso"

13 Publications

  • Page 1 of 1

PULSE-HF: A simple clinical and geriatric score to predict systolic dysfunction in the elderly without heart failure.

Curr Probl Cardiol 2021 Nov 21:101066. Epub 2021 Nov 21.

Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina; Geriatric Unit, Hospital Alemán, Buenos Aires, Argentina.

Objective: To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF).

Patients And Methods: PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of HF. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation.

Results: Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50% and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; p=0.003), cardiomegaly (OR: 3.32; p < 0.001), right bundle branch block (OR: 2.84; p=0.011), cognitive dysfunction (OR: 2.14; p=0.027) and NT-proBNP (OR 5.43; p < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity and accuracy (97.17% and 91.64% respectively in ≥ 6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥ 10).

Conclusion: A simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.101066DOI Listing
November 2021

Predictors of adherence and persistence to disease-modifying therapies in Multiple Sclerosis.

Ther Adv Neurol Disord 2021 5;14:17562864211031099. Epub 2021 Oct 5.

Department of Internal Medicine, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina.

Background And Aims: In multiple sclerosis (MS), non-adherence/non-persistence is related to suboptimal response to treatment, including disease relapses and the need for more expensive healthcare. The aim of this study was to identify predictors related to adherence to disease modifying therapies (DMTs) in a cohort of Argentinian MS patients.

Methods: We conducted a cross-sectional study at the National Medical Care Program from Argentina. MS patients with at least one claim for a DMT from 1 January 2017 to 1 October 2017 were identified. A telephone survey was performed to assess clinical and demographic factors. The medication possession ratio (MPR) was used to estimate adherence; MPR <80% defined non-adherence. Associations were studied using a logistic regression model.

Results: Our database included 648 MS patients. A total of 360 patients (60% females, mean age 55.3 years) accepted to participate. Of these, 308 (85.5%) patients were receiving DMT at the time of the survey. Some 198 (63.7%) were receiving injectable therapies. Optimal adherence was 47.7%. Adherence was associated with oral medication [odds ratio (OR) 1.83 95% confidence interval (CI) 1.13-3.00,  = 0.014]. A factor related to oral drugs was higher educational level (OR 2.86 95%CI 1.41-5.81,  = 0.004).

Conclusion: This real-world study showed better adherence and persistence on treatment with oral therapies in MS patients in Argentina.
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http://dx.doi.org/10.1177/17562864211031099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495537PMC
October 2021

[Pneumatic lithotripsy vs Holmium: YAG Laser lithotripsy for the treatment of ureteral stones.]

Arch Esp Urol 2021 Oct;74(8):768-773

Departamento de Urología. Instituto Argentino de Diagnóstico y Tratamiento. Buenos Aires. Argentina. Hospital de Clínicas José de San Martín. Buenos Aires. Argentina.

Objective: Pneumatic lithotripsy (PL) and Ho: YAG laser lithotripsy (LL) are the most widely accepted methods in the endoscopic treatment of ureteral lithiasis. The objective is to compare efficacy and safety of pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the treatment of ureteral lithiasis.

Material And Methods: Prospective, single-blind, multicenter study. Adult patients were recruited from August 2017 to March 2019, in 23 institutions throughout Argentina. Patient demographics, stone characteristics, presence of double J stent prior to the intervention, stonefree rate (SF) and postoperative complications were evaluated and analyzed.

Results: A total of 366 patients with ureteral lithiasis were included, 204 in the PL group and 162 in the LL group. The SF rate was significantly higher in the LL group (77% vs. 92%), OR 3 .43 (1.76 to 6.70). The complication rate was significantly lower in the LL group (9.8% vs. 2.5%), OR 0.23 (0.07 to 0.71). In the multivariate analysis, the use of Ho: YAG energy, the location of the lithiasis in the distal ureter, and the preoperative placement of double J stent, were found to be predictors of SF status.

Conclusions: Ho: YAG laser lithotripsy has a higher stone-free rate and a lower complication rate compared to pneumatic lithotripsy.
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October 2021

[Adherence to treatment of multiple sclerosis in a health care program].

Medicina (B Aires) 2021 ;81(3):311-317

Departamento de Neurología, Unidad Asistencial Por más Salud Dr. César Milstein, Buenos Aires, Argentina.

Adherence to prescribed treatment in chronic diseases, as occurs in multiple sclerosis (MS), is a critical factor for a successful therapeutic response. The objective of this study was to evalua te the association between demographic variables and adherence to treatment of the population of MS patients in Argentina. A retrospective cohort study of MS patients who received treatment with disease-modifying drugs, included in the drug dispensing database of the National Care Medical Program: PAMI (Programa Asistencia Médica Integral), was conducted. Optimal adherence was defined as an acquisition of the drug greater than 80% during a 9-month follow-up. A total of 648 patients were included, mean age 55 years (IQR 46-64), 59.4% women. The mean adherence to treatment was 67% (IQR 44-89) and optimal adherence was documented only in 35.5% of cases. Adherence to injectable medications was 10% lower than that of oral drugs (p = 0.0001) and the use of original brands was associated with 7.4% greater adherence than with generic drugs (p = 0.001). In conclusion, adherence to treatment has been suboptimal. In the Patagonian region, the use of injectables and generic drugs was associated with lower adherence to therapy. These data are very important in order to planning socio-sanitary programs that aim to increase therapeutic adherence.
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June 2021

An Artificial Intelligence Tool for Image Simulation in Rhinoplasty.

Facial Plast Surg 2021 May 29. Epub 2021 May 29.

Clinical Research Department, Hospital Dr. César Milstein, affiliated with the University of Buenos Aires, Buenos Aires, Argentina.

During rhinoplasty consultations, surgeons typically create a computer simulation of the expected result. An artificial intelligence model (AIM) can learn a surgeon's style and criteria and generate the simulation automatically. The objective of this study is to determine if an AIM is capable of imitating a surgeon's criteria to generate simulated images of an aesthetic rhinoplasty surgery. This is a cross-sectional survey study of resident and specialist doctors in otolaryngology conducted in the month of November 2019 during a rhinoplasty conference. Sequential images of rhinoplasty simulations created by a surgeon and by an AIM were shown at random. Participants used a seven-point Likert scale to evaluate their level of agreement with the simulation images they were shown, with 1 indicating total disagreement and 7 total agreement. Ninety-seven of 122 doctors agreed to participate in the survey. The median level of agreement between the participant and the surgeon was 6 (interquartile range or IQR 5-7); between the participant and the AIM it was 5 (IQR 4-6), -value < 0.0001. The evaluators were in total or partial agreement with the results of the AIM's simulation 68.4% of the time (95% confidence interval or CI 64.9-71.7). They were in total or partial agreement with the surgeon's simulation 77.3% of the time (95% CI 74.2-80.3). An AIM can emulate a surgeon's aesthetic criteria to generate a computer-simulated image of rhinoplasty. This can allow patients to have a realistic approximation of the possible results of a rhinoplasty ahead of an in-person consultation. The level of evidence of the study is 4.
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http://dx.doi.org/10.1055/s-0041-1729911DOI Listing
May 2021

[Preoperative double J stent placement in the endoscopic treatment of ureteral and renal Stone: A multicenter, national study.]

Arch Esp Urol 2021 May;74(4):389-396

Oficina de Investigación. Confederación Americana de Urología (CAU). Departamento de Cirugía/Urología. Escuela de Medicina. Universidad del Valle. Cali. Colombia.

Objective: Aim of our study was to evaluate the effectiveness and safety of the preoperative placement of JJ stent compared to not doing in patients undergoing ureteroscopy for ureteral and kidney stone.

Materials And Methods: Prospective, observational, multicenter study. Adult patients, who underwent ureteroscopy treatment for ureteral and kidney stone, were recruited from August 2017 to March 2019, in 23 Argentine institutions. The variables analyzed included: demographic data, stone size and location, stone-free rate (SFR) and complications.

Results: 580 patients were included. 473 with ureteral stone (309 with and 164 without prior JJ stent) and 107 with kidney stone (77 with and 30 without prior JJ stent). The SFR was higher in the group with previous JJ stent, both in the treatment of ureteral stone (82.2% vs. 90.9%, OR 2.15 (1.17 to 3.96)), and in the treatment of kidney stone (73.3% vs. 89.6%, OR 3.14 (1.02 to 9.61)). No differences were established in the complication rate both in the treatment of ureteral stone (6.1 vs. 6.1%, OR 0.98 (0.45 to 2.19)) and in the treatment of kidney stone (6.7 vs. 5.2%, OR 0.76 (0.13 a 4.46)).

Conclusions: The preoperative placement of JJ stent, increases SFR in the treatment of ureteral and kidney stone, but not decrease the complication rate.
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May 2021

RBD-specific polyclonal F(ab´) fragments of equine antibodies in patients with moderate to severe COVID-19 disease: A randomized, multicenter, double-blind, placebo-controlled, adaptive phase 2/3 clinical trial.

EClinicalMedicine 2021 Apr 11;34:100843. Epub 2021 Apr 11.

mAbxience, Manuel Pombo Angulo 28, 3rd floor, Madrid 28050, Spain.

Background: passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2.

Methods: we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984).

Findings: between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 ( = 118) or placebo ( = 123). Median age was 54 years old, 65•1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5•28% [-3•95; 14•50];  = 0•15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14•2 (± 0•7) days in the INM005 group and 16•3 (± 0•7) days in the placebo group, hazard ratio 1•31 (95% CI 1•0 to 1•74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6•9% the INM005 group and 11•4% in the placebo group (risk difference [95% IC]: 0•57 [0•24 to 1•37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported.

Interpretation: Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease.
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http://dx.doi.org/10.1016/j.eclinm.2021.100843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037439PMC
April 2021

Baseline Functional Status and One-year Mortality After Hospital Admission in Elderly Patients: a prospective cohort study.

Rev Fac Cien Med Univ Nac Cordoba 2020 08 21;77(3):143-148. Epub 2020 Aug 21.

Unidad Asistencial Dr. Cesar Milstein.

Introduction: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients.

Methods: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified "VIDA" questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes.

Results: 297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94-0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09-4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.
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http://dx.doi.org/10.31053/1853.0605.v77.n3.28771DOI Listing
August 2020

[Dual antiplatelet therapy for secondary stroke prevention in patients with acute ischemic stroke. CIERTO group recommendation].

Medicina (B Aires) 2019 ;79(4):315-321

Grupo CIERTO (Club interhospitalario de lectura crítica para recomendar basados en pruebas), Buenos Aires, Argentina. E-mail:

One of the main pillars of acute ischemic stroke management is antiplatelet therapy. Different treatment schemes have been compared, suggesting that the combination of multiple antiplatelet drugs is associated with a reduced risk of stroke recurrence. However, it has also been associated with an increased risk of bleeding complications which, in the long term, surpass the mentioned benefits. However, considering that most stroke recurrences occur i n the short term, a time limited double antiplatelet scheme could result in significant benefits to patients with acute ischemic stroke. On this basis, we conducted a rapid systematic review of the literature in order to evaluate the effects of a short-term double antiplatelet therapy both on stroke recurrence and complications. All trials comparing double versus single antiplatelet therapy in patients with acute ischemic stroke were included. Results showed that double therapy reduces recurrence risk but probably marginally increases major bleeding complications. We suggest double antiplatelet therapy for the initial management of patients with minor (Score NIH < or equal to 3 or transient isquemic attack -TIA) acute ischemic stroke.
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September 2019

Outpatient minor oral surgery in patients with hemophilia: A case series of 23 patients.

J Clin Exp Dent 2019 Apr 1;11(4):e395-e399. Epub 2019 Apr 1.

MD. Hemophilia and Complex Coagulopathies Department Staff, Dr. César Milstein Hospital, Argentina.

Hemophilia is an inherited coagulation disorder characterized by deficiency of the coagulation factor VIII or IX. When the management of hemostasis is inadequate, these patients are at high risk of experiencing intra and postoperative bleedings after tooth extractions. Coagulation factor replacement therapy allows performing most surgical procedures safely, although the factor levels and length of treatment have not been clearly determined. In this study, we present our experience in a retrospective series of 112 ambulatory tooth extractions under local anesthesia in 23 patients with hemophilia using a coagulation factor replacement therapy in combination with tranexamic acid. The results obtained with this protocol were satisfactory and only one episode of mild postoperative bleeding occurred after seven days in a patient who did not have good treatment compliance. Hemophilia, factor replacement therapy, tooth extractions, postoperative complications.
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http://dx.doi.org/10.4317/jced.55506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522108PMC
April 2019

[Cross-cultural adaptation of the “barriers to incontinence care seeking questionnaire” in a elderly women population in an outpatient clinic.]

Rev Fac Cien Med Univ Nac Cordoba 2019 02 27;76(1):3-10. Epub 2019 Feb 27.

"Universidad de Buenos Aires".

Introduction: Urinary incontinence is a very frequent pathology in the female population, however it remains a hidden health problem. The main objective of the work is to cross-culturally adapt the BISC-Q questionnaire to be use spanish speaking population. Material and method: The cross-cultural adaptation of the Questionnaire (BICS-Q) was carried out in the following stages: initial translation, synthesis of the translations, retro-translation, expert committee, pre-test and review of the adaptation process by the researchers. Then, a content validation was carried out through a survey looking for new barriers that were not part of the original questionnaire. The responses of the patients were unified and categorized within the 5 original domains. Women over 65 years of age were included in an outpatient specialized center for older adults. Results: The survey included 164 women, 56% reported urine losses in the last 12 months, of which 71% never consulted the doctor about this problem. The answers about the barriers to consult were predominantly related to ignorance of the disease, shame and misconceptions about the treatment. The responses of the patients were unified and categorized within the 5 original domains. The new questionnaire retains three of the five domains of the BICS-Q, the domain "costs" and "related to the site" was removed and a new one was added on "lack of information". Conclusions: The Argentine version of the BICS-Q questionnaire is an instrument adapted for the evaluation of barriers to medical consultation due to urinary incontinence in spanish speaking women over 65 years of age.

Material And Method: The cross-cultural adaptation of the Questionnaire (BICS-Q) was carried out in the following stages: initial translation, synthesis of the translations, retro-translation, expert committee, pre-test and review of the adaptation process by the researchers. Then, a content validation was carried out through a survey looking for new barriers that were not part of the original questionnaire. The responses of the patients were unified and categorized within the 5 original domains. Women over 65 years of age were included in an outpatient specialized center for older adults. Results: The survey included 164 women, 56% reported urine losses in the last 12 months, of which 71% never consulted the doctor about this problem. The answers about the barriers to consult were predominantly related to ignorance of the disease, shame and misconceptions about the treatment. The responses of the patients were unified and categorized within the 5 original domains. The new questionnaire retains three of the five domains of the BICS-Q, the domain "costs" and "related to the site" was removed and a new one was added on "lack of information". Conclusions: The Argentine version of the BICS-Q questionnaire is an instrument adapted for the evaluation of barriers to medical consultation due to urinary incontinence in spanish speaking women over 65 years of age.

Results: The survey included 164 women, 56% reported urine losses in the last 12 months, of which 71% never consulted the doctor about this problem. The answers about the barriers to consult were predominantly related to ignorance of the disease, shame and misconceptions about the treatment. The responses of the patients were unified and categorized within the 5 original domains. The new questionnaire retains three of the five domains of the BICS-Q, the domain "costs" and "related to the site" was removed and a new one was added on "lack of information". Conclusions: The Argentine version of the BICS-Q questionnaire is an instrument adapted for the evaluation of barriers to medical consultation due to urinary incontinence in spanish speaking women over 65 years of age.

Conclusions: The Argentine version of the BICS-Q questionnaire is an instrument adapted for the evaluation of barriers to medical consultation due to urinary incontinence in spanish speaking women over 65 years of age.
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http://dx.doi.org/10.31053/1853.0605.v76.n1.21088DOI Listing
February 2019

[Cross-cultural validation and telephonic reliability of modified "VIDA" questionnaire].

Medicina (B Aires) 2016 ;76(3):153-8

Centro de Salud de San Ignacio, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Osakidetza Servicio Vasco de Salud, País Vasco, España.

Instrumental activities scales allow the assessment of the functional status of the elderly; however, those currently used have gender bias and insufficient cross-cultural validation. The main objectives of this study were to perform the cross-cultural validation of the modified "VIDA: Daily living of the elderly questionnaire", created in Spain, into the Spanish spoken language in the City of Buenos Aires, and to evaluate its telephonic reliability. The secondary objective was to assess the concurrent validity of the modified VIDA questionnaire with the Lawton and Brody scale. The experts discussion group assessed the questionnaire vocabulary and proposed modifications according to the local language. We performed a pilot study to evaluate its comprehension, vocabulary and length. Afterwards we interviewed patients in person and after 14 days by telephone. We analyzed the global, inter and intra-observer reliability in both, the in person and the telephonic questionnaire, obtaining intra-class correlation coefficients of 0.95 (CI 95% 0.91-0.99), 0.99 (CI 95% 0.97-1.00) and 0.94 (IC 95% 0.87-1.00) respectively. Additionally, we obtained a very good correlation in both modalities between the modified VIDA questionnaire and the Lawton and Brody scale, with no differences regarding the patient's gender. In conclusion, the modified VIDA questionnaire was cross-culturally adapted in Buenos Aires City. Its implementation is reliable and valid both in person and by telephone.
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August 2018

Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study.

Cerebrovasc Dis 2015 8;39(2):87-93. Epub 2015 Jan 8.

Department of Internal Medicine, Hospital Dr. César Milstein associated with University of Buenos Aires, Buenos Aires, Argentina.

Background And Purpose: Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire.

Methods: We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression.

Results: Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21).

Conclusions: These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.
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http://dx.doi.org/10.1159/000369962DOI Listing
October 2015
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