BackgroundTelemedicine has improved access to healthcare, reduced costs, and minimized infection risks, particularly during the COVID-19 pandemic. Teleophthalmology may enhance access to eye care, but its adoption remains limited by barriers such as inadequate training and insufficient infrastructure.ObjectivesTo assess perceptions, self-reported ophthalmologic confidence, and perceived barriers related to teleophthalmology among Colombian general practitioners.MethodsWe conducted a cross-sectional online survey between February and May 2024 using a 31-question questionnaire covering demographics, prior training, telemedicine experiences, ophthalmologic confidence, and teleophthalmology perceptions. Composite Likert-based scores were categorized into three levels. Internal consistency was assessed using Cronbach's alpha, and associations were evaluated using chi-square tests and multivariable binary logistic regression.ResultsAmong 489 participants, most were women (62.2%), aged 21–30 years (70.1%), and had 0–5 years of professional experience (65.6%). Undergraduate telemedicine training was uncommon (9.0%), and prior teleophthalmology experience was rare (1.8%). Confidence in ophthalmologic knowledge was mostly moderate (45.6%), whereas 57.3% reported positive perceptions of teleophthalmology. In adjusted analyses, greater undergraduate ophthalmology training was independently associated with high ophthalmologic confidence, with a dose-response pattern, including 51–100 h (aOR: 8.82, 95% CI: 2.88–27.08) and >100 h (aOR: 14.71, 95% CI: 3.86–55.97). Prior experience providing telemedicine consultations was also associated with high confidence (aOR: 1.92, 95% CI: 1.16–3.18). Moderate ophthalmologic confidence was independently associated with positive teleophthalmology perception (aOR: 2.46, 95% CI: 1.60–3.80).ConclusionsColombian general practitioners showed generally favorable perceptions of teleophthalmology despite limited prior exposure and persistent concerns regarding privacy, workload, job security, training, and implementation readiness. Strengthening ophthalmology and telemedicine training, together with digital readiness, may support teleophthalmology integration into routine practice.
Over- and undertreatment of chronic diseases are common. In this context, real-world data on the use of levothyroxine are limited. The aim was to determine the patterns of use, persistence, effectiveness, safety, clinical inertia, and adherence related to levothyroxine treatment in a group of patients with thyroid disease in Colombia. This was an observational study of patients treated with levothyroxine. Clinical records were reviewed, and the minimum patient follow-up was one year. Descriptive, bivariate and multivariate analyses were performed. A total of 398 patients were identified; the median age was 53.5 years, and 71.1
BACKGROUND:Heart failure with improved ejection fraction (HFimpEF) is characterized by recovery of left ventricular systolic function after treatment for heart failure with reduced ejection fraction. The safety of withdrawing guideline-directed medical therapy (GDMT) after recovery remains uncertain. OBJECTIVE:To evaluate the effects of GDMT withdrawal versus continuation in patients with recovered or improved left ventricular systolic function. METHODS:A systematic review was conducted according to PRISMA 2020 guidelines. MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials were searched through March 2025. Comparative studies evaluating GDMT withdrawal versus continuation in HFimpEF were included. The primary outcome was relapse of left ventricular systolic dysfunction. Secondary outcomes were heart failure hospitalization, mortality, and quality of life. RESULTS:Eight studies were included. Relapse of left ventricular dysfunction occurred in up to 58% of patients after therapy withdrawal in recovered dilated cardiomyopathy, whereas most patients with atrial fibrillation-mediated cardiomyopathy maintained preserved ventricular function during short-term follow-up. In a meta-analysis of three prospective studies (n = 133), GDMT withdrawal was associated with a significantly increased risk of relapse compared with continued therapy (OR 15.37, 95% CI 2.75-85.82; I2 = 0%). Observational studies consistently reported higher rates of heart failure hospitalization and adverse cardiovascular outcomes after treatment withdrawal. CONCLUSIONS:GDMT withdrawal may increase the risk of recurrent ventricular dysfunction and adverse cardiovascular outcomes in HFimpEF. The available evidence supports continuation of therapy in most patients, although further randomized studies are needed to identify patients who may safely discontinue treatment.
Hepatopleural fistula (HPF) is an abnormal communication between the pleural cavity and the hepatobiliary system; it is uncommon and carries relevant morbidity. Reported etiologies include thoracoabdominal trauma, liver abscess of different causes, biliary stenosis or obstruction, postsurgical iatrogenesis, and even congenital anomalies. We present the case of a 37-year-old woman with six months of right upper-quadrant pain and intermittent fever. Contrast-enhanced computed tomography (CT) showed a liver abscess; percutaneous drainage achieved initial improvement. One month later, she presented with exertional dyspnoea, productive cough, and fever. Studies demonstrated a loculated right pleural effusion and a persistent abscess, with imaging signs of hepatopleural communication suggestive of HPF. A pleural tube was placed with an initial 2,000 mL output, followed by posterolateral thoracotomy with decortication and fistula closure, plus anterior and posterior chest drainage. The course was favorable with resolution of infection and discharge with imaging follow-up. This case underscores the need for high clinical suspicion in unresolved liver abscesses progressing to empyema and supports timely surgical management in the absence of biliary obstruction, complemented by targeted antibiotics.
Mobile phones are essential tools worldwide, including for the academic training of medical students. However, their role in Latin America (LATAM) remains underexplored. This study aimed to evaluate cell phone use and its applicability in the academic training of medical students in LATAM. A cross-sectional online survey was conducted among undergraduate medical students from seven Latin American countries between December 2023 and February 2024. The study assessed academic smartphone use across five types of applications: medical apps, knowledge updating apps, academic podcast apps, video streaming apps, and social media apps. A total of 1,590 medical students participated, with 63.6
