Hospital In Argentina Research Articles

P-0064 - Definitive Concurrent Chemoradiation for Patients with Esophageal Squamous Cell Carcinoma. Experience at a Public Hospital in Argentina

Background: Definitive concurrent chemoradiation (CCRT) has become a standard therapeutic alternative for patients (pts) with esophageal squamous cell carcinoma (ESCC). Studies with this strategy using platin/fluoropyrimidine-based chemotherapy have shown median survival of 17 to 19 months, and 5 years survival comparable with surgery, allowing organ preservation. Methods: We performed a retrospective study of pts with ESCC treated with definitive CCRT between 2002 and 2012. Our chemotherapy schedules were: cisplatin 20 mg/m2 day 1 to 3 plus bolus 5FU 300 mg/m2 day 1 to 3 plus leucovorin 20 mg/m2 day 1 to 3 every 2 weeks for 3 cycles, or paclitaxel 50 mg/m2 plus carboplatin AUC 2 day 1, 8, 15, 22, 29 and 35, both schedules given concurrently with RT (median dose: 60 Gy). Results: 223 consecutive patients were included in the analysis with a median follow up of 20.4 months. Median age 63 years, 54% male, 72% and 30% with history of smoking and alcohol respectively. Stage at diagnosis: II (60, 1%), III (35, 4%) and IV (4, 5%). Most of the pts had performance status 1. Histology was moderately differentiated in 63%. Primary tumor was localized more frequently in medium (52%) and inferior (32%) esophagus. More than 85% of the pts had severe dysphagia at diagnosis. In 75% of pts a feeding tube was inserted before treatment. Treatment was temporary interrupted in 50, 2% of pts (due to social reasons, problems with the RT equipment and toxicity). Four patients died during treatment. Grade III-IV toxicity was uncommon (mucositis 9%, neutropenia 8.6%, asthenia 6.3%). At the end of CCRT, complete relief of dysphagia was achieved in 47.5%, partial relief in 24% and only 8.3% of pts suffered progression of dysphagia. 52% of patients were interpreted as clinical complete responders (clinical, endoscopic and radiological evaluation). In 14 of 16 pts treated with carboplatin and paclitaxel based CCRT a clinical complete response was achieved. Median survival was 26 months (m). In the multivariate analysis, clinical complete response (43 vs 16m, p = 0.0001), relief of dysphagia (25 vs 9m, p = 0.0003) and no interruption of CCRT (26 vs 12m, p = 0.0003) had statistical impact in survival. Conclusion: In our population of pts with ESCC, definitive concurrent chemoradioterapy without surgery had a safety profile and efficacy comparable to other international series. We consider this approach as a standard option in our clinical practice. Efforts must be done to avoid interruptions of treatment to improve the rate of clinical complete response.

Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

Serratia marcescens causes health care-associated infections with important morbidity and mortality. Particularly, outbreaks produced by multidrug-resistant isolates of this species, which is already naturally resistant to several antibiotics, including colistin, are usually described with high rates of fatal outcomes throughout the world. Thus, it is important to survey factors associated with increasing frequency and/or emergence of multidrug-resistant S. marcescens nosocomial infections. We report the investigation and control of an outbreak with 40% mortality due to multidrug-resistant S. marcescens infections that happened from November 2007 to April 2008 after treatment with colistin for Acinetobacter baumannii meningitis was started at hospital H1 in 2005. Since that year, the epidemiological pattern of frequently recovered species has changed, with an increase of S. marcescens and Proteus mirabilis infections in 2006 in concordance with a significant decrease of the numbers of P. aeruginosa and A. baumannii isolates. A single pulsed-field gel electrophoresis (PFGE) cluster of S. marcescens isolates was identified during the outbreak. When this cluster was compared with S. marcescens strains (n = 21) from 10 other hospitals (1997 to 2010), it was also identified in both sporadic and outbreak isolates circulating in 4 hospitals in Argentina. In132::ISCR1::blaCTX-M-2 was associated with the multidrug-resistant cluster with epidemic behavior when isolated from outbreaks. Standard infection control interventions interrupted transmission of this cluster even when treatment with colistin continued in several wards of hospital H1 until now. Optimizing use of colistin should be achieved simultaneously with improved infection control to prevent the emergence of species naturally resistant to colistin, such as S. marcescens and P. mirabilis.

Early detection of neonatal cholestasis by stool color card screening.

The objective of this study was to identify, by early screening, one-month old infants with acholic or hypocholic stools for the early detection of biliary atresia and other causes of neonatal cholestasis. The study was essentially exploratory (observational, prospective, statistically underpowered and with no clinical intervention) and used a color card screening of all newborns attending the first month of life checkup from 1999 to 2002 in a public hospital in Argentina. Of 12 484 newborn infants, 4239 were examined at their first month of life checkup visit with the stool color card. Eighteen infants were identified with hypocholic stools, of whom only four were proven to have cholestasis. Although no case of biliary atresia was detected, screening by stool color cards proved useful for the detection of other causes of neonatal cholestasis.

Performance of infrared ear and forehead thermometers: a comparative study in 205 febrile and afebrile children

This study compared readings from two professional-grade, commercially available infrared (IR) thermometers, the ThermoScan® PRO 4000 prewarmed tip ear thermometer and the Temporal Scanner(™) TAT-5000 temporal artery thermometer. The repeatability and precision of readings from IR thermometers for professional use were questioned in the past, but in recent years, these types of thermometers have been technologically improved, so their ability to replicate standard temperature readings reliably should be re-examined. Febrile and afebrile children were recruited from the emergency department, overflow treatment areas and the paediatric intensive care unit of a large hospital in Argentina. Each child had a randomised sequence of seven temperature readings, including three from the ear, three from the forehead or behind the ear and one reference oral or rectal reading. Temperature readings were taken with the ThermoScan PRO 4000, the Temporal Scanner TAT-5000 and the monitor mode of SureTemp® Plus, a widely used professional-grade contact thermometer, for reference. Of 205 children, 46% were febrile, per reference thermometer readings. While mean ThermoScan PRO 4000 febrile measurements did not differ significantly from reference, mean Temporal Scanner TAT-5000 febrile measurements were significantly lower (by a mean of 0·42 °C) than the reference. Overall bias of the ThermoScan PRO 4000 was significantly lower than that of the Temporal Scanner TAT-5000; repeatability was 1·5 times higher, and overall false-negative rate was about a third that of Temporal Scanner TAT-5000, when compared to the reference. This study indicates that the ThermoScan PRO 4000 provides measurements closer to those of a professional-grade contact thermometer when compared to the Temporal Scanner TAT-5000. The odds of misclassifying a febrile child as non-febrile were about threefold higher with the Temporal Scanner TAT-5000 temporal artery thermometer than with the ThermoScan® PRO 4000 ear thermometer.

Análisis de la prescripción de medicamentos en una comunidad geriátrica Argentina

Although polypharmacy may be justified in elderly patients with multiple diseases, it may be dangerous, especially when it includes potentially inappropriate medications (PIM). To identify inappropriate medication and factors associated with the most relevant prescriptions among older people. Cross-sectional observational analysis of drugs prescribed during the first trimester of 2010 to 179 older adults aged 77 ± 8 years (98 women), living in a geriatric reference hospital in Argentina. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2012. The mean number of drugs prescribed per individual was 6.1 ± 2.7. The most commonly used drugs were anti-ulcer agents (58.1%), agents acting on the renin-angiotensin system (54.2%), antithrombotic medications (50.8%) and benzodiazepines (50.8 %). The use of antacids and anti-ulcer agents, psychotropic drugs and PIM was significantly higher among patients using six or more drugs daily, compared to the less medicated group (odds ratio (OR) = 6.8, 95% confidence intervals (CI) 3.5-13.2; OR=15.0, 95%CI 5.9-38.4; OR=5.0; 95%IC 2.6-9.8, respectively). Thirty one percent of participants using non-steroidal anti-inflammatory drugs, were not receiving medications for gastric protection. One to four drugs included in the Beers list were prescribed to 66% of participants. Despite the high prevalence of use of antacids and anti-ulcer agents, these drugs were not prescribed to a significant proportion of patients using non-steroidal anti-inflammatory drugs. Strategies to optimize pharmacotherapy in the elderly population are urgently required.

TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence.

Objective. To assess a text messaging intervention to promote tuberculosis (TB) treatment adherence. Methods. A mixed-methods pilot study was conducted within a public pulmonary-specialized hospital in Argentina. Patients newly diagnosed with TB who were 18 or older, and had mobile phone access were recruited and randomized to usual care plus either medication calendar (n = 19) or text messaging intervention (n = 18) for the first two months of treatment. Primary outcomes were feasibility and acceptability; secondary outcomes explored initial efficacy. Results. Feasibility was evidenced by high access to mobile phones, familiarity with texting, most phones limited to basic features, a low rate of participant refusal, and many describing suboptimal TB understanding. Acceptability was evidenced by participants indicating feeling cared for, supported, responsible for their treatment, and many self-reporting adherence without a reminder. Participants in the texting group self-reported adherence on average 77% of the days whereas only 53% in calendar group returned diaries. Exploring initial efficacy, microscopy testing was low and treatment outcomes were similar in both groups. Conclusion. The texting intervention was well accepted and feasible with greater reporting of adherence using text messaging than the diary. Further evaluation of the texting intervention is warranted.

Cardiac Pediatric Transplantation in a Public Hospital in Argentina. Eleven Years Experience

Cardiac Pediatric Transplantation in a Public Hospital in Argentina. Eleven Years Experience

Using Infection Surveillance to Improve the Quality of Care in a Cancer Unit in a Children's Hospital in Argentina

Access to data on infections and their risk factors provide an objective guide for quality improvement and infection prevention. Collecting, communicating and acting on the results of the analysis is the cornerstone for prevention and control of healthcare associated infections (HAI). We report the institutional response to the information obtained through use of the surveillance tool and the infectious outcomes.

Infection Prevention and Control Program in a Public Pediatric Hospital in Argentina: Opportunities for Improvement

Infection prevention and control (IPC) programs are essential in hospitals to deliver safe care and decrease costs. In low-income countries, most public hospital budgets cannot fully support IPC programs, and the infection preventionists (IP) are too overworked to perform all of their duties. In addition, although IPC programs save lives and money in the longer term, necessary resources inevitably compete with the immediate needs of the hospital.

Seasonal Variation and Trends in Stroke Hospitalizations and Mortality in a South American Community Hospital

Numerous studies have reported the presence of temporal variations in biological processes. Seasonal variation (SV) in stroke has been widely studied, but little data have been published on this phenomenon in the Southern Hemisphere, and there have been no studies reported from Argentina. The goals of the present study were to describe the SV of admissions and deaths for stroke and examine trends in stroke morbidity and mortality over a 3-year period in a community hospital in Argentina. Hospital discharge reports from the electronic database of vital statistics between 1999 and 2001 were examined retrospectively. Patients who had a main discharge diagnosis of stroke (ischemic or hemorrhagic) or cerebrovascular accident (International Classification of Diseases, Ninth Revision codes 431, 432, 434, and 436) were selected. The study sample included 1382 hospitalizations by stroke (3.5% of all admissions). In-hospital mortality demonstrated a winter peak (25.5% vs 17% in summer; P = .001). The crude seasonal stroke attack rate (ischemic and hemorrhagic) was highest in winter (164 per 100,000 population; 95% CI, 159-169 per 100,000) and lowest in summer (124 per 100,000; 95% CI, 120-127 per 100,000; P = .008). Stroke admissions followed a seasonal pattern, with a winter-spring predominance (P = .008). Our data indicate a clear SV in stroke deaths and admissions in this region of Argentina. The existence of SV in stroke raises a different hypothesis about the rationale of HF admissions and provides information for the organization of care and resource allocation.

Comparative in vitro efficacies of ethanol-, EDTA- and levofloxacin-based catheter lock solutions on eradication of Stenotrophomonas maltophilia biofilms

The aim of this study was to compare the in vitro activity of ethanol, EDTA and levofloxacin (Levo), alone or in combination, on biofilms of Stenotrophomonas maltophilia recovered from patients with catheter-related bloodstream infections (CRBSIs) at a university hospital in Argentina. First, 24 and 48 h biofilms were formed in microtitre plates and challenged with 25 or 40 % ethanol for 1 h. Biofilms, of the 14 local isolates and from the reference strain K279a, were eradicated after both treatments as shown by plate counts and the regrowth technique. Second, 24 h biofilms of all isolates were established in silicone catheter segments and challenged with 25 or 40 % ethanol, Levo (2.5 mg ml(-1)), EDTA (30 mg ml(-1)), 25 % ethanol-EDTA or Levo-EDTA for 1, 3 and 24 h. Viable counts of biofilms treated for 1 h with 25 or 40 % ethanol or 25 % ethanol-EDTA were under the limit of detection. Killing of biofilms by Levo or Levo-EDTA was gradual and it was only after 24 h of treatment that no differences could be seen between the effects of these catheter lock solutions (CLSs) and those of ethanol (P>0.05). Levo-EDTA, in combination, did not act synergistically against biofilms. After 24 h of exposure, EDTA did not eradicate biofilms but reduced biofilm survival rates to 1-5 %. The effect of the different CLSs on biomass reduction, estimated by crystal violet staining, was highly dependent on the isolate, and the most effective agents were 25 and 40 % ethanol. Our results suggest that when used as a CLS for short periods, ethanol at low concentrations, alone or in combination with a chelator, can decontaminate the line from S. maltophilia in cases of CRBSI and help, in conjunction with systemic antibiotics, in the retention of precious vascular catheters.

Sa1335 Accuracy of the Antibodies Against Synthetic Deaminated Gliadin Peptides for the Diagnosis of Celiac Disease in a General Community Hospital in Argentina: Are so Sensitive for Patients With Low Pretest Probability?

Sa1335 Accuracy of the Antibodies Against Synthetic Deaminated Gliadin Peptides for the Diagnosis of Celiac Disease in a General Community Hospital in Argentina: Are so Sensitive for Patients With Low Pretest Probability?

Hospital volume and mortality of very low-birthweight infants in South America.

To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America. Birth-registry data for infants born in 1982-2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile. Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed. Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals. Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits--more than 80 percent decrease in mortality rates--are with volume increases from low to medium or medium-high levels (from ≤ 25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121-144 annual VLBW infant range--about 90 percent decrease in mortality rates compared to <25 VLBW infants annually. Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries.

Small Plasmids Harboring qnrB19 : a Model for Plasmid Evolution Mediated by Site-Specific Recombination at oriT and Xer Sites

Plasmids pPAB19-1, pPAB19-2, pPAB19-3, and pPAB19-4, isolated from Salmonella and Escherichia coli clinical strains from hospitals in Argentina, were completely sequenced. These plasmids include the qnrB19 gene and are 2,699, 3,082, 2,989, and 2,702 nucleotides long, respectively, and they share extensive homology among themselves and with other previously described small qnrB19-harboring plasmids. The genetic environment of qnrB19 in all four plasmids is identical to that in these other plasmids and in transposons such as Tn2012, Tn5387, and Tn5387-like. Nucleotide sequence comparisons among these and previously described plasmids showed a variable region characterized by being flanked by an oriT locus and a Xer recombination site. We propose that this arrangement could play a role in the evolution of plasmids and present a model for DNA swapping between plasmid molecules mediated by site-specific recombination events at oriT and a Xer target site.

To Improve Postgraduate Training: Medical Residents′ Input in Residency Quality Improvement

The "Open Space Technology" (OST) is an innovative group process introduced by Harrison Owen in 1997. There is some evidence for its effectiveness in education quality improvement. However, its application in higher education has not been reported. Our objective was to apply a modified OST as a quality improvement tool in a postgraduate training quality improvement program at a university hospital in Argentina. OST is a method in which a program's participants propose and discuss topics of their interest with an aim that had been defined for them by coordinators. After proposing and writing down themes important to improving the quality of their postgraduate training, residents were divided into small groups to discuss the suggested topics for 90 minutes. They then reconvened in the large group and presented the conclusions of their small group discussions. Thirty-six percent of residents (75/208) participated in one of the two OST sessions. Topics suggested by participants were similar in both sessions: (1) work hours, (2) work conditions, (3) residency curriculum, (4) residents' duties, (5) salaries, (6) professional burnout, (7) patient care load, and (8) interdisciplinary activities. In only four hours, residents were able to share their concerns and proposals for improving the quality of their residencies with their faculty. Most of the topics they suggested were subsequently included in the program's quality improvement agenda.

Horizontal Gene Transfer and Assortative Recombination within the Acinetobacter baumannii Clinical Population Provide Genetic Diversity at the Single carO Gene, Encoding a Major Outer Membrane Protein Channel

We described previously the presence in Acinetobacter baumannii of a novel outer membrane (OM) protein, CarO, which functions as an L-ornithine OM channel and whose loss was concomitant with increased carbapenem resistance among clonally related nosocomial isolates of this opportunistic pathogen. Here, we describe the existence of extensive genetic diversity at the carO gene within the A. baumannii clinical population. The systematic analysis of carO sequences from A. baumannii isolates obtained from public hospitals in Argentina revealed the existence of four highly polymorphic carO variants among them. Sequence polymorphism between the different A. baumannii CarO variants was concentrated in three well-defined protein regions that superimposed mostly to predicted surface-exposed loops. Polymorphism among A. baumannii CarO variants was manifested in differential electrophoretic mobilities, antigenic properties, abilities to form stable oligomeric structures, and l-ornithine influx abilities through the A. baumannii OM under in vivo conditions. Incongruence between the phylogenies of the clinical A. baumannii isolates analyzed and those of the carO variants they harbor suggests the existence of assortative (entire-gene) carO recombinational exchange within the A. baumannii population. Exchange of carO variants possessing differential characteristics mediated by horizontal gene transfer may constitute an A. baumannii population strategy to survive radically changing environmental conditions, such as the leap from inanimate sources to human hosts and vice versa, persistence in a compromised host, and/or survival in health care facilities.

A Multicenter Study of Bipolar Disorder among Emergency Department Patients in Latin-American Countries

This multicenter study estimated the prevalence of bipolar disorder (BPD) among emergency department (ED) patients in Latin America. To identify patients with BPD, a combination of DSM IV-criteria interview and the Mood Disorder Questionnaire (MDQ) was used. Data from 1,505 patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico was analyzed. The prevalence ofBPD in this sample was 5.2% (95% CI = 4.5% to 6.9%). The mean age was 37 years (response rate of 83.0%). Compared to non-BPD patients, BPD patients were more likely to report asthma (16.7% vs. 9%), thyroid problems (12.8% vs. 5.8%), seizures (23.1% vs. 3.0%), obesity (39.7% vs. 26.9%), alcohol abuse (30.8% vs. 10.0%), attention deficit hyperactivity disorders (50.0% vs. 12.0%), depression (81.6% vs. 45.7%), obsessive compulsive disorder (20.1% vs. 3.0%), panic disorders (23.1% vs. 12.3%), phobic disorders (11.2% vs. 3.1%), and any anxiety disorder (82.1 % vs. 41.8%; all p < or = 0.05). Suicidal plans and attempts were also significant higher in the bipolar group (11.5% vs. 2.8% and 10.3% vs. 1.8% respectively). Multivariate analysis identified ADHD, depression, alcohol abuse, anxiety disorder, and last month suicide plans and attempts to be independently associated with BPD. Our study supports that BPD is prevalent in ED in Latin-American countries and that comorbidity is the rule, not the exception. Patients presenting at ED with irritability, anxiety, pressure speech, euphoria, with suicidal tendencies, involved in risky behaviors, alcohol abuse, dependence or those with history of mental health hospitalization in the past 12 months must be assessed for comorbid BPD.

Using Uniject to increase the use of prophylactic oxytocin for management of the third stage of labor in Latin America

Objective To evaluate a multifaceted intervention for effectiveness in increasing the use of prophylactic oxytocin by birth attendants (obstetricians, midwives, and nurses) working in small maternity hospitals in Argentina. Methods A before-and-after quasi-experimental study was conducted in 5 small maternity hospitals. The study intervention consisted of training birth attendants in the active management of the third stage of labor, distributing oxytocin in Uniject (Hipofisina BIOL Uniject; Laboratorios BIOL, Buenos Aires, Argentina), and using posters as reminders. The primary outcome was the rate of prophylactic oxytocin use in the 6 months before and the 6 months of the intervention period. Secondary outcomes included use of controlled cord traction and uterine massage, and birth attendants' acceptance of the use of oxytocin in Uniject. Results The use of prophylactic oxytocin showed a median rate of 14.6% at baseline and 85.6% during the intervention period. 96% of birth attendants reported that the Uniject device facilitated oxytocin 1administration. Discussion Prophylactic oxytocin in the third stage of labor is a beneficial intervention with current low use, particularly in low- and middle-income countries. If the results shown in the present study were further replicated, this strategy could be an effective method for improving prophylactic oxytocin use in other similar Latin American hospitals.

Tu1545 Risk of Colorectal Polyps in Patients With Skin Lesions, a Prospective Case-Control Pilot Study

Risk of Colorectal Polyps in Patients With Skin Lesions, a Prospective Case-Control Pilot Study Jose M. Mella, Raquel Gonzalez, Carolina Fischer, Guillermo Nicolas Panigadi, Lisandro Pereyra, Pablo Luna, Kamelia Losada, Veronica L. Llorca, Margarita Larralde, Sandra Lencinas, Mario A. Medrano, Silvia C. Pedreira, Daniel G. Cimmino, Luis A. Boerr Hospital Aleman, Buenos Aires, Argentina Introduction: Skin lesions such as acrochordons (skin tags), seborrhoeic keratoses, and lentigines have been proposed as markers for adenomatous polyps of the colon, but controversy remains. Aim: To assess the risk of colorectal polyps, adenomas and advanced neoplastic lesions (ANL: villous component 75%, size 10 mm, or high grade dysplasia) in patients with acrochordons, seborrhoeic keratoses, and lentigines in a private community hospital in Argentina. Materials and methods. During February 2010, all patients who underwent a colonoscopy were prospectively assessed by a dermatologist, before the endoscopy procedure, to determine the presence of these skin lesions. Those with previous colonoscopies, incomplete colonoscopies, inadequate intestinal cleansing, or colonic surgeries were excluded. Endoscopists were blind to the dermatologic findings. A case-control study was carried out. Patients with skin lesions were defined as “cases”, and those without them as “controls”. The risk of presenting the mentioned colonic lesions was analyzed, measured in odds ratio (OR) and its corresponding confidence intervals 95% (CI). Results: 42 patients were analyzed; the media age was 59 12 years old (range 29-83), 71% were women. Skin tags were found in 23 patients (55%), seborrhoeic keratoses in 20 patients (48%), and lentigines in 10 patients (24%). Colonic polyps were detected in 21 patients (50%); 14 patients (33%) had adenomas and 7 patients (17%) had ANL. There were no significant differences in the prevalence of adenomatous lesions, neither ANL nor colorectal cancer in those patients with skin tags (OR 1.15 CI 0.33-4.07, OR 1.12 CI 0.24-5.19, OR 2.7 CI 0.34-20, respectively), in those with seborrhoeic keratoses (OR 0.75 CI 0.212.65, OR 3.33 CI 0.64-16.88, OR 3.70, CI 0.47-27.8, respectively), and in those with lentigines (OR 0.16 CI 0.02-1.15, OR 0.48 CI 0.07-3.63, p 0.56, respectively) comparing with those without them. Conclusion: The results of this preliminary study did not show a higher risk of colorectal adenomas or ANL in patients with these lesions. The mere presence of these skin lesions would not be used as an indication for screening colonoscopy.

Enfermedades que simulan polimialgia reumática

Objective To examine the main clinical and laboratory data of patients initially diagnosed with polymyalgia rheumatica (PMR), which then developed another conditions. Material and methods We reviewed the clinical records of patients diagnosed with PMR in three hospitals in Argentina. Patients had a diagnosis of PMR if they met the following criteria: age ≥ 50 years, erythrocyte sedimentation rate (ESR) at the time of diagnosis > 40 mm, persistent pain and stiffness of at least one month of evolution in two of the following areas: neck, shoulders or proximal arms, hips or proximal lower limbs. Special attention was paid to symptoms or signs of “alarm” (beginning or during disease progression) for suspecting the presence of other non PMR disease within a period of ≤ 12 months. Results Sixteen of the 200 patients (8%) had other diseases during follow up. Malignancies (n = 4) and rheumatic diseases (n = 4) were the most common entities, in addition to infective endocarditis (n = 1), narrow cervical canal (n = 1), Parkinson's disease (n = 1), statin-related myalgia (n = 1), hypothyroidism (n = 1), vitamin D deficiency (n = 1) and Calcium Pyrophosphate Deposition Disease (CPDD) (n = 2). The average length change of diagnosis was 4.5 ± 3 months. Ten patients had no response to steroids and two had persistently elevated ESR. Conclusion In this study we highlight the importance of recognizing signs and symptoms along with laboratory data and lack of response to treatment as suspects for the diagnosis of other disease manifestations in patients with PMR symptoms.