Colombia Medica最新文献

Case description: A 35-year-old woman with a history of intrauterine device use for family planning presented with a spontaneously conceived heterotopic pregnancy.

Clinical findings: The patient developed a ruptured cornual ectopic pregnancy, leading to hemodynamic instability and an acute abdomen, while concurrently carrying a viable intrauterine pregnancy.

Treatment and outcome: A laparoscopic intervention was performed to manage the ruptured ectopic pregnancy. The surgical technique employed minimized the impact on maternal blood volume, ensuring patient stabilization and favorable progression of the intrauterine pregnancy.

Clinical relevance: Heterotopic pregnancy is the coexistence of gestation in two different implantation sites, both intrauterine and extrauterine. This condition is associated with significant maternal morbidity and mortality. Management remains a challenge due to the lack of consensus and limited clinical experience. The primary goal is maternal stabilization while preserving the intrauterine pregnancy whenever possible. This case highlights the importance of modern surgical strategies tailored to optimize maternal and fetal outcomes.

Introduction: The one-minute sit-to-stand test (1min-STST) is a practical assessment tool for measuring functional ability. Reference values are currently unavailable for populations residing at high altitudes.

Aims: This study to establish reference values for the 1min-STST in people living at high altitudes by sex and age range. Additionally, we correlate the variables analyzed with the number of repetitions obtained in the tests.

Methods: Multicenter cross-sectional research was conducted, collecting data from two cities at high altitudes. Healthy adults between 18 and 80 years old were recruited. Anthropometric measurements, physical activity levels, smoking habits, and the number of repetitions during the 1min-STST were recorded. A multiple linear regression was performed to determine the predictive equations by sex. The stepwise method was used to generate the predictive model.

Results: As many as 400 healthy subjects (58% women) were included. Participants had a median (P25-P75) height of 1.62 (1.56-1.68) cm, a weight of 63.0 (57.8-70.1) kg, and a BMI of 24.2 (22.5-26.0) kg/m². The predictive equations were: 1minSTST_Men=19.833 - (age* 0.168) + (height * 0.204) - (weight * 0.122); 1minSTST_Women= 27.845 - (age * 0.198) + (height * 0.145) - (weight* 0.094).

Conclusion: The reference values for 1min-STST were determined for the healthy population aged 18-80 years living at high altitudes.

Introduction: The available clinical practice guidelines on tuberculosis infection are not exclusive to the pediatric population.

Objective: To formulate evidence-based recommendations for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia.

Methods: A multidisciplinary development panel (composed by clinical and field experts, researchers, and methodologists who declared conflicts of interests), including patient representatives, and decision-makers formulated 10 questions and prioritized outcomes related to diagnosis (clinical evaluation, chest X-ray, and interferon-gamma release assays-IGRA), treatment (efficacy of regimens in different clinical scenarios), and follow-up (monitoring and strategies to increase adherence) for children exposed to tuberculosis. We conducted systematic literature reviews to identify guidelines, systematic reviews, and primary studies. We assessed these sources' quality and risk of bias with specific tools. We synthesized the evidence narratively and, in some cases, performed de novo meta-analyses (diagnostic and network meta-analyses). We evaluated the certainty of evidence using the GRADE system. We used the GRADE evidence-to-recommendation framework to formulate the recommendations.

Results: We recommend 1) the use of IGRA tests to identify tuberculosis infection and chest X-rays to screen for active tuberculosis in children exposed to tuberculosis, 2) short instead of extended regimens for children with and without immunosuppression, 3) levofloxacin or susceptibility-guided regimens in cases of contact with drug-resistant tuberculosis, 4) monthly clinical follow-up during the treatment, 5) the implementation of comprehensive approaches to identify barriers to encourage treatment adherence.

Conclusions: The guideline panel provides context-specific, evidence-based recommendations for assessing and treating children exposed to tuberculosis in Colombia.

Objective: To identify demographic, psychosocial, and life cycle risk factors for suicides in the Colombian Coffee zone between second half of 2017 and the end of 2019.

Methods: A matched case-control design. A sample of 176 individuals, of which 101 were suicides (cases) and 75 were deaths by road traffic accidents (controls); psychological autopsies were used for research purposes. Penalized maximum likelihood logistic regression analyzes were conducted, indicating odds ratio of suicide, adjusting for sex, age group, province of legal autopsy and source of data. Logistic regressions were applied in three blocks: mental health issues, psychoactive substance use, and adversities during the life course. Statistical analysis was done with Stata®.

Results: 78.2% of cases and 84.0% of controls were male. The mean age of cases was 39 years, and of controls, 43 years. The key risk factors for suicide, at p <0.05, were forced labor during adolescence (OR: 32.41), financial dependence (OR: 4.3), verbal or physical abuse from the partner (OR: 10.28), any mental disorder (OR: 26.14), previous suicide attempt (OR: 11.64; p= 0.061), and record of major depressive disorder (OR: 24.86). A protective factor was death of a close relative at some point in life (OR: 0.34; p= 0.073).

Conclusions: Forced labor in adolescence, verbal and physical abuse from the partner, financial dependence on others, any mental disorder, major depressive disorder, and previous suicide attempts were risk factors of suicide; the death of any close relative at some point in life was a protective factor of suicide.

Background: Sinonasal lesions are common benign masses with overlapping clinical and histopathological features. Extracellular matrix proteins such as periostin, fibronectin, and tenascin-C play key roles in tissue remodeling and inflammation, yet their distinct expression profiles in these lesions remain poorly defined.

Aim: This study aimed to compare the immunohistochemical staining patterns of periostin, fibronectin, and tenascin-C in sinonasal lesions to elucidate their roles in pathogenesis and enhance differential diagnosis.

Methods: In this retrospective study, pathological specimens from 70 patients who underwent surgery for sinonasal polyps were analyzed. Immunohistochemical expression of periostin, fibronectin, and tenascin-C was assessed separately in epithelial and stromal compartments using a semi-quantitative scoring system. Associations between staining patterns and lesion types were evaluated using multinomial logistic regression.

Results: The cohort had a male-to-female ratio of 5:2 with a mean age of approximately 40 years. Nasal polyps demonstrated significantly higher stromal periostin staining compared to both antrochoanal polyps and inverted papillomas. Conversely, antrochoanal polyps exhibited significantly elevated epithelial periostin expression relative to inverted papillomas. Fibronectin expression was markedly increased in nasal polyps, especially in the stroma, supporting its role in inflammatory tissue remodeling. Tenascin-C expression did not differ significantly among the lesion types.

Conclusion: Differential expression of periostin and fibronectin suggests distinct pathogenic mechanisms in sinonasal lesions. The compartment-specific staining patterns of periostin, along with the prominent fibronectin expression in nasal polyps, suggest these biomarkers could serve as valuable diagnostic tools and potential therapeutic targets. Further research is needed to explore these pathways in sinonasal disease management.

Background: E-cigarettes have been extensively marketed and popularized worldwide despite their harmful effects. To effectively plan and implement preventive measures, comprehensive analyses are needed to understand the influence of individual and contextual factors on their use.

Objective: This study aimed to analyze the influence of poverty and demographic and socioeconomic patterns on e-cigarette use in Colombia.

Methods: This study is based on a secondary analysis of the 2019 Colombian Survey on Psychoactive Substance Use, which included 49,756 individuals aged between 12 and 68. State-level multidimensional poverty and individual health-related, socioeconomic, and demographic characteristics were analyzed. Two-level regression models adjusted for the individual and contextual effects.

Results: The prevalence of vaping was 4.4% (95% CI: 4.2%-4.6%), with substantial variation across departments, ranging from 0.0% to 9.6%. In the multilevel models, younger age, male sex, technical or higher education, middle-income stratum, not contributing economically to the household, affiliation with the subsidized health scheme, history of tobacco smoking, alcohol consumption, and self-reported use of other drugs were all significantly associated with vaping. The estimated median odds ratio for multidimensional poverty was 1.23 (95% CI: 1.14-1.33; p= 0.012).

Conclusions: E-cigarette use in Colombia is a health risk and an indicator of social vulnerability that is influenced by structural determinants. Urgent action from health authorities, the education system, regulatory bodies, and civil society is needed to prevent the normalization of vaping among youth. If left unaddressed, vaping could worsen health inequalities and lead to chronic addiction-related disorders in underserved communities.

Case description: A 23-year-old male patient, with no relevant medical history, who received direct contusion to the lower limbs at the level of the thighs due to a fall from a sheet bending machine.

Clinical findings: Clinical and radiographic findings compatible with bilateral comminuted sub-trochanteric fractures, with extension towards the diaphysis in both, with a Trauma Severity Index of 16.

Treatment and outcome: Favorable clinical and radiological outcome after early definitive surgical stabilization of both extremities with cephalomedullary nails, rehabilitation with physical therapy and clinical follow-up.

Clinical relevance: High energy trauma, due to different causes, constitutes a challenge for all health personnel, due to the patient's own conditions, the individual inflammatory response, the associated musculoskeletal injuries, some not detected at the beginning, and additionally in other systems. Patients with bilateral femur fractures may present the conditions listed above, which requires early identification of the risks of respiratory and multi-organ failure, knowledge of their metabolic status and definition of their clinical situation, considered potentially or truly critical, which even with timely treatment Mortality figures of 6.9% to 27% are found. According to defined parameters, early and definitive osteosynthesis of fractures can be performed, but its characteristics may represent difficulties for surgical planning.

Introduction: The gold standard test for diagnosing sleep-disordered breathing is polysomnography; however, its limited availability has led to the emergence of alternatives such as polygraphy, which is more accessible and cost-effective.

Objective: To analyze the association between underlying conditions and obstructive sleep apnea-hypopnea syndrome in children with suspected sleep-disordered breathing.

Methods: Retrospective cross-sectional study. Polygraphy studies of hospitalized children aged ≥1 year with suspected sleep-disordered breathing were included. Demographic, clinical, and polygraphic variables were collected. A logistic regression analysis was performed to evaluate the presence of obstructive sleep apnea-hypopnea syndrome according to underlying conditions.

Results: Of 1,000 polygraphy studies, 407 were analyzed. The median age was 8.2 years (range 4.1-12.2), with 56% male patients. The main diagnoses were neurological impairment (19.4%), neuromuscular diseases (16.0%), upper airway obstruction (15.5%), and chronic lung disease (15.5%). Abnormal polygraphy was found in 56.0% of cases, with obstructive sleep apnea syndrome classified as mild in 63.0%, moderate in 21.0%, and severe in 16.0%, with obesity and neuromuscular diseases being most prominent. Significant differences were found in age (p=0.001) and apnea-hypopnea index (p=0.002) across diagnostic categories. Children with Down syndrome had a 5.5-fold higher risk of obstructive sleep apnea-hypopnea syndrome compared to those with chronic lung disease.

Conclusions: There was a high prevalence of obstructive sleep apnea-hypopnea syndrome, particularly in children with obesity and neuromuscular diseases. Patients with Down syndrome had a higher risk of obstructive sleep apnea-hypopnea syndrome compared to those with chronic lung disease. Polygraphy is a potentially implementable tool in healthcare centers with similar characteristics.