Leg ulcers represent a global health challenge, especially affecting women and older individuals, leading to significant morbidity and a decrease in the quality of life. Its inter-disciplinary management puts economic strain on health systems. Dermatologists are frequently consulted; however, data on factors associated with healing are scarce. To provide data on factors associated with improvement of leg ulcers. A retrospective cohort study approved by CES University Human Research Ethics Committee, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was carried out. Medical records of patients with lower limb ulcers referred to the Dermatology Service of a tertiary hospital in Medellín, Colombia, between 2015 and 2022 were reviewed. Entry was defined as the dermatological consultation, with follow-up until specialised discharge. Among 207 patients, 63.8% (n = 132) were women, with an average age of 64 years, and 40% had previously had ulcers. Co-morbidities, such as hypertension, diabetes, anaemia, malnutrition, and internal malignancy, were associated with a lower probability of improvement. Deeper ulcers were statistically significantly associated with a poor response to treatment. Specific topical and systemic treatments were positively correlated with improvement. Several factors highlight the need for timely recognition of lower limb ulcers. A poor response to treatment correlates with pain, ulcer depth, diabetes, and malnutrition, emphasising the need for multi-disciplinary management for effective results.
Introducción En artritis reumatoide (AR), espondiloartritis axial (EspAax) y artritis psoriásica (APs), el control sostenido de la actividad de la enfermedad con fármacos biológicos e inhibidores de la cinasa Janus (JAK) plantea decisiones prácticas sobre reducción del tratamiento. La evidencia es heterogénea en definiciones, esquemas y rescate, lo que dificulta estandarizar conductas en la práctica clínica. Objetivo Generar recomendaciones basadas en la evidencia y la experiencia clínica para la reducción y descontinuación de fármacos biológicos e inhibidores de JAK en adultos con AR, EspAax y APs en Colombia, dirigidas a reumatólogos y tomadores de decisión del sistema de salud. Métodos Se realizó un consenso colombiano de expertos mediante técnica Delphi y con síntesis estructurada de evidencia. Se buscaron publicaciones en Medline/PubMed y LILACS, se complementó con repositorios de guías y sociedades científicas, y se priorizó la evidencia reciente. Cada enunciado se calificó en escala Likert de cinco puntos y el consenso se definió, a priori, como ≥ 70% de acuerdo. Los ítems sin consenso se ajustaron tras discusión y se volvieron a votar. Resultados El panel aprobó 29 declaraciones, organizadas en definiciones y metas, elegibilidad, estrategia de reducción, seguimiento y manejo de recaída. La recomendación central fue realizar reducción gradual, individualizada y reversible, generalmente preferible a la suspensión completa. El tiempo mínimo de control sostenido antes de iniciar la reducción del tratamiento se definió en seis a 12 meses para AR y en 12 meses o más para EspAax y APs. El primer paso de la estrategia de reducción consistió en una disminución del 25% de la dosis total, ya fuese mediante reducción de dosis o ampliación de los intervalos de administración. La progresión a etapas posteriores solo se consideró si se mantenía el objetivo terapéutico durante al menos seis meses. Asimismo, se establecieron acciones de rescate específicas en casos de recaída según la enfermedad y la gravedad de las manifestaciones clínicas. Conclusiones Estas recomendaciones operativas facilitan decisiones consistentes para la reducción de terapias avanzadas en Colombia e integran clinimetría validada, decisión compartida, seguimiento estructurado y rescate predefinido.
BackgroundSepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and carries high short-term mortality despite timely antimicrobials and organ support. Adsorptive hemofilters such as the oXiris® membrane have been proposed as adjuncts during continuous renal replacement therapy (CRRT), but their patient-centered benefit remains uncertain.MethodsWe performed a retrospective matched cohort study within a dynamic cohort of consecutive adults with septic shock and SA-AKI requiring CRRT in a tertiary ICU in Medellín, Colombia (November 2020 - May 2023). Exposure was the hemofilter used at CRRT initiation (oXiris® vs standard AN69ST). Patients were matched 2:1 without replacement using nearest-neighbor propensity scores based on age, Sequential Organ Failure Assessment (SOFA) score at ICU admission, time from ICU admission to CRRT initiation, and infection source. The primary outcome was 28-day all-cause mortality from ICU admission. Secondary outcomes included ventilator-free days and ICU–free days at day 28, CRRT duration, and ICU length of stay. Prespecified sensitivity analyses excluded COVID-19 cases and used inverse probability of treatment weighting (IPTW). Exploratory analyses assessed early changes in SOFA, lactate, PaO2/FiO2, mean arterial pressure, vasopressor dose, and C-reactive protein.ResultsAfter matching, 81 patients were included (53 standard filters and 28 oXiris®); 3 oXiris®- patients were unmatched. Twenty-eight-day mortality was 69.8% (37/53) with standard filters and 67.9% (19/28) with oXiris®. The adjusted risk ratio (RR) for oXiris® was 0.95 (95% CI, 0.71-1.28; P = 0.76), with an absolute risk difference of -2.0% (95% CI, -23.2% to 19.3%). After excluding COVID-19 cases (n = 61), the adjusted RR was 1.05 (95% CI, 0.71-1.54; P = 0.81). IPTW analyses were directionally similar but considered secondary. Early physiologic changes showed no clear between-group differences.ConclusionsIn adults with septic shock and SA-AKI requiring CRRT, oXiris® use was not associated with lower 28-day mortality compared with standard AN69ST filters. Secondary and exploratory finding should be interpreted cautiously given residual confounding and data limitations. Randomized trials with standardized protocols are needed to identify potential benefiting subgroups.
