Colombia Medica最新文献

Case description: The first human case in urban ambient of infection by Rickettsia parkeri Atlantic Rainforest strain in an 8-year-old male patient is presented.

Clinical findings: The patient reporting a tick bite presented with fever (38 °C), myalgia, abdominal pain, arthralgia, and mild lymphadenopathy in the right axilla. A lesion was observed at the tick-bite site.

Treatment and results: A biopsy sample was obtained from the tick bite area for diagnosis by PCR and sequencing of the DNA fragment, resulting in 100% homology towards Rickettsia parkeri Atlantic Rainforest strain reported in human cases in Brazil. Treatment consisted of 100 mg of doxycycline for 10 days, with symptoms ceasing 24 hours after the start of treatment.

Clinical relevance: We report the first case of rickettsiosis by Rickettsia parkeri in an urban area in Mexico. Infection is considered mild to moderate, but it is unusual in urban environments. Medics should be concerned about the clinical manifestations associated with tick bites, particularly when lymphadenopathy is present.

Cutaneous leishmaniasis is a neglected tropical disease caused by Leishmania species and transmitted through the bite of infected female sandflies. It primarily affects the skin and mucous membranes, with a broad spectrum of clinical manifestations that depend mainly on the host's immune response. The immune balance between Th1, Th17, and Th2 pathways plays a pivotal role in disease progression and outcome. Hyperergic responses (Th1/Th17) are associated with localized and mucosal forms, while anergic responses (Th2/Treg) underline disseminated and diffuse cutaneous forms. Despite its global prevalence, particularly in tropical and subtropical regions, cutaneous leishmaniasis remains underdiagnosed and mismanaged due to a lack of awareness of its immunopathogenesis, clinical diversity, and diagnostic limitations. Treatment continues to rely primarily on pentavalent antimonial compounds, which have significant toxicity, underscoring the urgent need for safer and more effective therapeutic alternatives. This narrative review aims to examine the immune response, clinical manifestations, diagnostic methods, and medical management strategies for cutaneous leishmaniasis. Understanding the complex interplay between immune responses and clinical manifestations is essential for improving diagnosis and treatment.

Background: Children and adolescents (CHI) who experience child abuse face serious consequences for their physical, mental, and social development (perpetuation of violence, poverty, and inequality). The WHO recognizes this as a public health problem, highlighting the need to heal complex trauma and ensure its non-repetition. Although an intersectoral pathway in Colombia exists involving health, protection, and justice, the lack of specialized centers leads to revictimization, reprocessing, and failures in comprehensive care. Additionally, the Ministry of Health guidelines do not include outpatient protocols for trauma healing.

Methods: In response, the Universidad del Valle and the Hospital Universitario del Valle Evaristo García (HUV) at Cali, Colombia developed an innovative program based on the ecological model of health, the WHO INSPIRE strategy, and the Convention on the Rights of the Child.

Results: The Social Pediatrics Unit offers person-centered interprofessional care, integrating clinical actions and actions from the justice and protection sectors, preventing revictimization, improving processes, and ensuring trauma healing. The narrative describes the challenges to program sustainability, lessons learned from the model's implementation, and intersectoral work.

Conclusions: After providing care to 3,602 children and adolescents, 1,454 of whom suffered child abuse, it can be concluded that these programs are essential for breaking cycles of violence, demonstrating that comprehensive, person-centered, and evidence-based care can mitigate the impact of child abuse on the individual and the region.

Background: Youth hospitalized for violence-related injuries remain at high risk of rehospitalization and death from subsequent violent events. This study describes the results of the first hospital-based intervention program (HVIP) for the prevention of youth violence in Colombia.

Methods: Data were obtained from the prospective registry of the Transforming the Circle of Violence (TCV) Program at a high-complexity university hospital. The registry includes young people who survived trauma-related injuries and were admitted to the Hospital-based Violence Intervention Program (HVIP) during hospitalization. Data were collected between May 1, 2018 and June 30, 2023, and included demographic and outcome variables. The program is attended by a multidisciplinary team of psychological, emotional and spiritual support, and once they leave the hospital, the support continues, including school support and personal development.

Results: In a period of 5 years, 290 young people between 13 and 29 years old, average age 20 years, 93% of them male, 75% had low schooling and 89% with dysfunctional families entered the TCV-HUV Registry. The reentry rate dropped from 40% to 10%, death rates from 20% to 3% and recidivism in delinquent activities dropped from 50% before the program to 10% for the years 2019 and 2023 respectively.

Conclusion: The HVIP implemented at HUV in Cali, Colombia, appears to reduce the risk of readmission and death from new violence-related injuries, and to decrease recidivism in violent or criminal activities among young people hospitalized for interpersonal violence. LEVEL OF EVIDENCE: II - III.

Case description: We report the case of a 77-year-old male who presented with a three-week history of constitutional symptoms, accompanied by an indurated epigastric mass measuring 10 × 7 cm with a 4 cm phlyctenae, exhibiting local and systemic inflammatory responses.

Clinical findings: Abdominal computed tomography demonstrated focal thickening of the transverse colon with a poorly defined inflammatory lesion extending to the abdominal wall and a collection suggestive of colo-cutaneous fistula. The clinical and imaging findings raised a strong suspicion of malignancy. Microbiological culture from drainage material isolated Actinomyces shaaliae georgiae, further reinforcing the suspicion of neoplastic disease due to the tumor-like presentation.

Treatment and outcomes: Initial management included antimicrobial therapy and percutaneous drainage. Surgical exploration revealed a stony hard mass without cleavage planes, adherent to adjacent organs. Histopathological examination excluded malignancy, confirming an infectious process caused by A. shaaliae georgiae. The patient received prolonged antibiotic therapy, resulting in a favorable clinical outcome.

Clinical relevance: To our knowledge, this represents the first reported case of abdominal actinomycosis caused by A. shaaliae georgiae with this unique presentation. Actinomycotic lesions form purulent foci surrounded by extensive fibrosis, creating tumor-like masses that clinically and radiologically mimic neoplastic processes. This case expands the clinical spectrum and microbiological repertoire of A. shaaliae georgiae, emphasizing the critical importance of maintaining high clinical suspicion, implementing multidisciplinary diagnostic approaches, and ensuring appropriate antimicrobial management in abdominal actinomycosis to avoid unnecessary surgical interventions and improve patient outcomes.

Objectives: This study aimed to investigate whether serum Interleukin 36 gamma (IL-36γ) levels in pediatric allergic rhinitis patients correlate with disease severity (mild, moderate, severe) and duration (intermittent, persistent). Additionally, we assessed the potential of IL-36γ as a biomarker and its role in disease pathogenesis to inform future treatment strategies.

Methods: In this cross-sectional observational study, pediatric allergic rhinitis patients from outpatient clinics were compared with healthy controls. Serum IL-36γ levels were measured from blood samples and analyzed across subgroups based on disease severity and duration.

Results: Fifty patients with allergic rhinitis and forty controls were included. IL-36γ levels were higher in the patient group with borderline significance (p= 0.050). Female patients had significantly higher IL-36γ levels than male controls (p= 0.044).

Conclusions: This is the first study to evaluate IL-36γ levels in pediatric allergic rhinitis. Although the difference between groups showed borderline significance, larger studies may confirm these findings. The observed gender-related difference suggests IL-36γ could be a potential biomarker. Additionally, a significant negative correlation with total IgE and a nonsignificant negative correlation with eosinophil counts were noted.

Background: Although hormone therapy is a cornerstone in the treatment of breast cancer, low therapeutic adherence is commonly reported, and there is limited evidence on the predictors that contributes to improving adherence in this population.

Objective: To identify factors associated with adherence to hormone therapy in women with breast cancer, in an oncology clinic in Medellín-Colombia (2019- 2023).

Methods: Cross-sectional analytical study. Women >18 years old with hormone receptor-positive breast cancer who were undergoing hormone therapy were included. The MMAS-8 scale was used to measure and classify therapeutic adherence into three levels: low, medium, and high. Data was analyzed by multinomial logistic regression.

Results: One hundred seventy-eight patients with a median age of 64.0 years were included. 50.0% were treated with tamoxifen. The prevalence of non-adherence was 48.9%. 70.2% had adverse effects of hormone therapy, and forgetfulness was the main reason for discontinuation (76.19%). Age was associated with therapeutic adherence, with older women being the most adherent (83.5%). Women with adverse effects, stage III-IV, low socioeconomic and educational level, and a lack of support network had lower therapeutic adherence.

Conclusions: A high prevalence of moderate and low therapeutic adherence is demonstrated in younger women from lower socioeconomic and educational backgrounds. Preventive strategies are needed to mitigate factors that negatively influence therapeutic adherence.

Objective: To describe obstetric outcomes associated with the use of dinoprostone and its effectiveness in cervical ripening in pregnant women with hypertensive disorders of pregnancy compared to normotensive pregnant women.

Methods: A retrospective cohort study was conducted at a tertiary-level hospital in Medellín, Colombia (March 2020 - October 2024). The study included pregnant women with singleton pregnancies, beyond 30 weeks of gestation, with a live fetus in cephalic presentation, and undergoing cervical ripening with dinoprostone vaginal insert. Women were excluded if they had used other ripening methods, had a favorable cervix at admission, or had an unclassified hypertensive disorder. Primary outcomes included successful cervical ripening, vaginal delivery, time to favorable Bishop score and to delivery, and indications for cesarean section. Adverse events considered were placental abruption, non-reassuring fetal status, tachysystole, and worsening of hypertensive condition.

Results: A total of 400 patients were included (200 with hypertensive disorders, of whom 100 had severe preeclampsia). The success rate of cervical ripening was similar between patients with hypertensive disorders and healthy women (crude RR: 0.95, 95% CI: 0.88-1.03; adjusted RR for gestational age, maternal age, and parity 0.96, 95% CI: 0.88-1.04). The vaginal delivery rate was also similar (44% vs. 55%, p= 0.16). The median time to favorable Bishop score and to delivery was comparable between normotensive and hypertensive groups, even in severe cases. Cesarean delivery was mainly due to failed ripening and medical decision. Adverse events, except for tachysystole, were more frequent in the hypertensive group but did not reach statistical significance.

Conclusion: Dinoprostone is effective in hypertensive pregnant women, including those receiving magnesium sulfate, with no significant differences compared to normotensive women.