Introduction: Microvascular complications are the main consequence of the diabetes mellitus (DM) progression. These complications significantly affect quality of life and increase the mortality rate of these patients. Diabetic neuropathy, retinopathy, and nephropathy are the most frequent microvascular complications. Objective: To describe the progression of the major diabetic microvascular complications over a period >1 year since their diagnosis in patients treated at a regional hospital in northern Peru. Materials and methods: This retrospective, longitudinal, descriptive study was conducted using data from 185 patients diagnosed with at least one of the major diabetic microvascular complications (i.e., diabetic nephropathy, neuropathy, and retinopathy) treated during 2023 at the Regional Hospital of Cajamarca, Peru. Information regarding the clinical stage or phase of each complication was collected at 5 different time points: at diagnosis, at 3, 6, and 12 months, and at the last evaluation since diagnosis. To assess the progression of diabetic nephropathy, neuropathy, and retinopathy, the measures of these microvascular complications (i.e., frequency or proportion of patients in the different stages or phases of the condition) were compared across the multiple time points using Friedman and Cochran’s Q tests. Results: Most patients were women (61.62%), with a median age of 60 years (IQR: 50.50–69) (older adults: 50.81%). The mean age at diagnosis was 52.24 ± 12.61 years, and the median time elapsed since DM diagnosis was 6 years [IQR: 2–9]. Diabetic neuropathy was the most common complication (58.92%), followed by diabetic retinopathy (40.00%). The progression of diabetic nephropathy between the time of its diagnosis (stage 1: 81.36; stage 2: 8.47%; stage 3: 8.47%) and the last evaluation (23.81%, 49.21%, 22.22%) was statistically significant (p<0.001). This was also the case for diabetic nephropathy (79.82% in the subclinical phase and 20.18% in the clinical phase at the time of diagnosis vs. 38.46% and 51.28% at the last assessment [>1 year since diagnosis], p<0.001). Conclusion: A statistically significant worsening of diabetic neuropathy and diabetic nephropathy was observed between the time of complication diagnosis and the last evaluation (>1 year since diagnosis). The prevalence of each of the three microvascular complications was high, particularly diabetic neuropathy.
Introduction: The NUTrition COMPetence (NUTCOMP) questionnaire is an instrument for assessing primary care (PC) physicians’ self-perceived competencies when providing nutritional care to patients with chronic diseases. Objective: To determine the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire for assessing nutritional care competencies among PC physicians. Materials and Methods: Cross-cultural validation study. After the NUTCOMP was translated and culturally adapted into Colombian Spanish, the instrument was administered to 40 PC physicians from a hospital in Neiva (Colombia). It was administered again three weeks later to assess test-retest reliability. Content validity was determined by expert judgment; inter-rater agreement was analyzed using Kendall’s coefficient of concordance; internal consistency was assessed using Cronbach’s alpha; and test-retest reliability was assessed using the intraclass correlation coefficient (ICC). As in the validation study of the original instrument, only sections 1–4 (constructs) were considered to assess the validity and reliability of the Colombian Spanish version of the NUTCOMP questionnaire. Results: Compared to the original, the Colombian Spanish version of the NUTCOMP questionnaire contains 7 additional items (4 in Section 2 and 3 in Section 3) and 2 new sections, although the latter two can be omitted, as they are not included in the calculation of the total score, nor were they considered in the assessment of the instrument’s validity and reliability. Very high content validity (Kendall’s W: 0.93), excellent internal consistency (α =0.931), and excellent test-retest reliability (CCI: 0.931) were observed. Conclusion: The Colombian Spanish version of the NUTCOMP questionnaire demonstrated very high content validity, excellent internal consistency, and excellent test-retest reliability for assessing nutritional care competencies among primary care physicians.
Introduction: Respiratory infections are a major cause of mortality worldwide. The literature on the prevalence of respiratory viruses in children and adolescents with symptoms of acute respiratory infection (ARI) in Mexico is scarce, and there is no official data available. Objective: To determine the prevalence of respiratory viruses in pediatric population (<17 years) treated at a public hospital in Mexico City for symptoms consistent with ARIs between 2020 and 2023, and to explore the factors associated with the presence of these viruses. Materials and methods: An analytical cross-sectional study was conducted using data from 253 pediatric patients who were admitted to the Hospital Juárez de México between March 30, 2020, and May 9, 2023, after presenting with symptoms consistent with ARI. Bivariate analyses were performed to evaluate the differences between patients who tested positive for one or more respiratory viruses and those who tested negative (Pearson’s chi-square test or Fisher’s exact test and Mann-Whitney U test), the association between the presence of various symptoms and the detection of at least one respiratory virus, and the association between the clinical and epidemiological variables considered and the presence of different respiratory viruses (Pearson’s chi-square test and calculation of prevalence ratios with their respective 95% confidence intervals). Results: The median age of the patients was 3 years (IQR: 7 years), and 52.17% were male. The RT-PCR test was positive for 41.89% of patients, and enterovirus/rhinovirus (13.04%) and RSV (9.09%) were the most common respiratory viruses. SARS-CoV-2 was detected in only 2.77%. Fever (75.10%) and cough (68.38%) were the most common signs and symptoms consistent with viral respiratory infection. A positive and statistically significant association was found between having pneumonia and the presence of enterovirus/rhinovirus (PR: 2.14; p<0.001) and between being between 1 and 4 years old and the presence of enterovirus/rhinovirus and parainfluenza (PR: 1.64; p=0.02 and PR: 1.78; p=0.04). Hospitalization requirement and the presence of SARS-CoV-2 were negatively associated (PR: 0.75; p=0.004). The following clinical symptoms or signs were significantly associated with the detection of at least one respiratory virus: cough, dyspnea, rhinorrhea, polypnea, and vomiting (p<0.05). Conclusion: At least one respiratory virus was detected in approximately 40% of patients, with enteroviruses and rhinoviruses being the most common. Cough, dyspnea, rhinorrhea, polypnea, and vomiting were associated with the presence of respiratory viruses. A positive association was observed between a pneumonia diagnosis and the presence of rhinovirus/enterovirus and between being between 1 and 4 years of age and the detection of rhinovirus/enterovirus and parainfluenza; a negative association was also observed between hospitalization requirement and the presence of SARS-CoV-2.
Introducción. La satisfacción con estudiar medicina podría estar influida por el dominio del inglés y la edad de los estudiantes. Sin embargo, la exploración de las relaciones indirectas entre estas variables es limitada. Objetivo. Analizar si la edad de los estudiantes universitarios mediatiza la asociación entre el nivel de inglés y la satisfacción con estudiar medicina. Materiales y método. Estudio transversal analítico basado en datos secundarios. Se usó la base de datos de una encuesta aplicada entre octubre y noviembre de 2020 a 2 301 estudiantes de primer y quinto año de medicina en Argentina. Se evaluó la asociación entre el nivel de inglés y la satisfacción con estudiar medicina, considerando la edad como mediadora y ajustando por covariables sociodemográficas. Se empleó el modelo 4 de PROCESS de Hayes con remuestreo bootstrap (5 000 muestras) y se creó un diagrama acíclico dirigido para representar visualmente las relaciones causales planteadas. Resultados. La edad promedio de los estudiantes fue 23.67 años, 79.10% eran mujeres, 72.10% declararon tener un nivel de dominio intermedio/avanzado del inglés y 77.31% expresaron estar satisfechos con estudiar medicina. El nivel dominio del inglés se asoció significativamente con menor edad (B=-1; p<0.001), mientras que pertenecer a un año de estudio superior (quinto año vs. primero año) y tener hijos se asociaron con una mayor edad (B=1; p<0.001 y B=10; p<0.001). Otras variables asociadas con mayor edad incluyeron estado civil, sexo y estudiar en una universidad privada. El modelo explicó el 45.7% de la varianza en la edad (R2=0.457; p<0.001). En el modelo de regresión logística, la edad se asoció negativamente con la satisfacción con estudiar medicina (B=-0,041; p=0.002) y el nivel de dominio del inglés no mostró un efecto directo (B=0.051; p=0.653). El análisis de mediación evidenció un efecto indirecto significativo del nivel de dominio del inglés sobre la satisfacción con estudiar medicina a través de la edad (B=0.052; BootSE=0.019; IC95%: 0.018 a 0.094), confirmando su papel mediador. Conclusiones. El nivel de dominio del inglés se asoció indirectamente con la satisfacción con estudiar medicina y esta asociación estuvo mediada por la edad.
Introduction: Comamonas testosteroni is an opportunistic Gram-negative bacillus considered an emerging pathogen. Although few cases had been documented until 2022, there has recently been an increase in reports, primarily involving bacteremia. Case presentation: A 58-year-old male was admitted to the ICU of a hospital in Duitama, Colombia, due to a hemorrhagic stroke that required management with ventriculostomy and subsequent decompressive craniectomy for intracranial hypertension. Given the presence of aspiration pneumonia, antibiotic therapy with ampicillin/sulbactam and clindamycin was initiated for 7 days. On day 10 of hospitalization, cefepime treatment was started for 10 days due to intermittent fever. Additionally, tracheostomy and gastrostomy were performed as the patient continued to require respiratory support. On day 22, due to persistent fever, meropenem therapy was initiated. On day 24, samples were taken for blood cultures (ventriculostomy wound secretion) and bacterial culture (tracheostomy secretion), which were positive for carbapenemase-producing Klebsiella pneumoniae and carbapenemase-producing Proteus mirabilis, respectively, leading to the adjustment of meropenem on day 27. On day 40, given the lack of clinical improvement and suspected phlebitis in the left upper limb as the source of infection, treatment was started with trimethoprim/sulfamethoxazole (160/800 mg orally every 8 hours for 7 days). Several tests were requested, including a blood culture and a urine culture, the latter of which was positive for P. mirabilis; tracheostomy was removed. On day 46, following the identification of Bordetella bronchiseptica resistant to cefazolin and amikacin in the blood culture, antibiotic therapy continued without adjustments. A new blood culture sample was taken for microorganism identification using MALDI-TOF mass spectrometry, which detected C. testosteroni. No adjustments were made to the antibiotic treatment, and after gradual clinical improvement the patient was discharged on day 56. At a follow-up appointment 12 days after discharge, the gastrostomy was removed and no signs of infection were observed. However, no neurological improvement was documented. Conclusion. Despite its low virulence, C. testosteroni should be considered in patients with nosocomial infections, especially during prolonged stays.
Introduction: Fahr’s syndrome is a rare neurological disorder characterized by symmetrical and bilateral calcifications in different brain regions. When this syndrome is secondary to postoperative hypoparathyroidism, clinical manifestations usually appear many years after thyroidectomy. Case presentation: A 71-year-old female was admitted to the emergency department of a tertiary care hospital in Pasto (Colombia) due to progressive dysarthria, trismus, gait disturbance, visual hallucinations, and behavioral changes over the past week. The patient had undergone a total thyroidectomy 15 years prior to the consultation and was being treated for hypothyroidism with levothyroxine; however, she had not been evaluated by an endocrinologist since the surgery. Admission laboratory tests revealed severe hypocalcemia, hyperphosphatemia, and hypoparathyroidism. A head computed tomography (CT) scan showed symmetrical calcifications in the basal ganglia and cerebellum. Based on these findings and the history of thyroidectomy, she was diagnosed with Fahr’s syndrome. Intravenous treatment with calcium gluconate, potassium chloride, and magnesium sulfate was initiated, which, after a few days, was gradually switched to oral administration of calcium carbonate, calcitriol, and potassium chloride. As her motor and neuropsychiatric symptoms progressively improved, she was discharged five days after admission with instructions to continue the pharmacological treatment and attend periodic follow-up visits. At a follow-up appointment three weeks after discharge, a significant improvement in gait, mental status, and behavior was observed; follow-up tests showed normal calcium and phosphorus levels. Oral treatment has been maintained with periodic adjustments, and the patient continues to attend regular check-ups. Conclusion: Diagnosing Fahr’s syndrome in late symptomatic clinical stages requires high clinical suspicion. This case highlights the need for periodic and ongoing endocrinology follow-up after thyroidectomy and demonstrates that appropriate treatment of biochemical abnormalities can significantly improve a patient’s quality of life.
In heavy industry, continuous exposure to high noise levels compels workers to repeatedly raise their voices to communicate, causing vocal fatigue and dysphonia. In the metallurgical industry, where machinery generating constant, high-intensity noise is used, workers face higher vocal effort demands because communication is fundamental for operational safety. This can lead to voice disorders that impact physical health and, consequently, occupational performance. This article describes the experience gained during the development of a social and community wellness project focused on improving vocal health in a noisy work environment, namely a metallurgical company. The objective is to reflect on the importance of designing and implementing voice care protocols in noisy work environments, recognizing that voice protection must be a priority in heavy industry occupational health programs and that a comprehensive approach to the factors affecting the voice in these work environments requires an interdisciplinary approach involving specialists in occupational health and safety and speech-language pathology.
Introduction: Medical students who engage in scientific research activities are more likely to produce scientific work and achieve better academic performance. Objective: To determine the association between publishing in peer-reviewed scientific journals and performance on the medical internship admission exam in hospitals of the Peruvian Social Security System (EsSalud). Materials and methods: Cross-sectional analytical study including medical students who took the medical internship admission exam at EsSalud hospitals in 2018 and 2019. Publications were identified through searches on Google Scholar and PubMed. Regression models and generalized linear models with a binomial distribution were used to assess the association between having published at least one article in a peer-reviewed scientific journal prior to the internship and exam score. Results: Of the 1 465 students evaluated, 53.17% were male, 57.27% studied at public universities, and only 7.17% had published at least one article in peer-reviewed scientific journals. Students with at least one publication scored, on average, one point higher on the exam (β Coeff.: 1.02, 95%CI: 0.64-1.39; p=0.001). Furthermore, having published at least one article before the internship was associated with a 27% and 20% higher prevalence of achieving scores above the average (aPR: 1.27, 95%CI: 1.17-1.38; p=0.001) and in the top tertile (aPR: 1.20, 95%CI: 1.09-1.32; p=0.001), respectively. Conclusions: Publishing at least one article in peer-reviewed scientific journals before the internship was associated with better performance on the medical internship admission exam at EsSalud hospitals in Peru, with a higher prevalence of scores above the average and in the top tertile.
Introduction: Long COVID is an emerging global health issue characterized by multiple adverse outcomes, frequently resulting in the onset of several conditions, including Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Objective: To analyze the prevalence of ME/CFS symptoms (duration >6 months) among patients with long COVID. Materials and methods: This systematic review adhered to the PRISMA 2020 guidelines (PROSPERO registration: CDR42024557707). In May 2024, a systematic search was conducted in Medline, EBSCOhost, Scopus, and Web of Science to identify studies reporting data on the presence of ME/CFS symptoms in long COVID patients (>6 months post-infection). Manual searches were also performed in Google Scholar. Study quality was assessed using the Newcastle-Ottawa scale. ME/CFS symptoms were classified according to the Institute of Medicine (IOM) 2015 diagnostic criteria. Results: Eleven studies were included in the review: 10 cohorts (7 prospective, 3 retrospective) and 1 cross-sectional study. The aggregate sample size was 453 586 persons with long COVID. The most frequent ME/CFS symptoms in these patients were fatigue (56.99%), cognitive impairment (44.54%), post-exertional malaise (41.55%), unrefreshing sleep (41.08%), new-onset severe headaches following SARS-CoV-2 infection (31.21%), and myalgia (20.59%). Conversely, the least prevalent symptoms were lymph node tenderness or swelling (5.38%), sensitivity to light and sound (4.75%), and nausea (0.17%). No studies reported patients with chills, night sweats, or food allergies or sensitivities. Conclusion: A considerable proportion of patients with long COVID met the IOM 2015 criteria for ME/CFS. Fatigue, cognitive impairment, post-exertional malaise, unrefreshing sleep, and new-onset severe headaches following SARS-CoV-2 infection were the most frequent symptoms, with prevalences >41% in individual studies. The observed methodological heterogeneity highlights the need for multicenter longitudinal studies to determine the prevalence of ME/CFS and its symptoms in this population and, thus, to guide therapeutic interventions.
Introduction: Laryngeal tuberculosis (LTB) accounts for less than 1% of all tuberculosis cases. Its diagnosis is complex due to its non-specific clinical manifestations in the larynx. Case presentation: A 78-year-old man presented to the emergency room of a hospital in Bogotá D.C. (Colombia) with exertional dyspnea, dry cough, dysphonia, odynophagia, and dysphagia over the last 3 months, with worsening of respiratory symptoms in the last 24 hours. Admission laboratory tests showed an elevated D-dimer level; therefore, due to suspected pulmonary thromboembolism, a contrast-enhanced CT chest angiography was performed. No signs of thromboembolism were observed, but centrilobular lung micronodules, a tree-in-bud pattern, and changes related to previous pulmonary fibrosis were observed. Due to the risk of aspiration, a nasopharyngoscopy was performed, finding leukoplakia on the right ventricular fold and the right vocal fold. Based on these findings, a biopsy of the lesions, acid-fast bacilli (AFB) staining, and a PCR test for Mycobacterium tuberculosis were requested, all of which were positive. Antituberculosis therapy (RHZE 150/75/400/275 mg) was initiated 5 days after diagnosis once his condition was stabilized; the biopsy was postponed for the same reason. Given the favorable response, he was discharged 4 days after starting treatment. A follow-up nasolaryngoscopy at 30 days showed a significant reduction in the pseudotumoral lesions on the ventricular fold and complete resolution on the vocal fold. At the 3-month follow-up, respiratory symptoms had improved considerably. Conclusion: Although it is a very rare condition, LTB should be considered as a differential diagnosis in patients with non-specific symptoms (such as dysphonia, dysphagia, and odynophagia) and laryngeal lesions, even in countries without a high TB burden like Colombia. Timely initiation of anti-tuberculosis therapy is essential to prevent serious complications, given the excellent and rapid response to this treatment.
Chile is home to a rich diversity of cultures, resulting in tensions and barriers in the provision of and access to health services. Furthermore, the training of health professionals is based on a biomedical model that reduces, compartmentalizes, and objectifies the health-illness process. Therefore, the objective of this essay is to reflect on the role of the service-learning (SL) methodology in the training of health professionals within the intercultural context of Chile. Given its nature, implementing SL in the training of these professionals in the country could help promote the acknowledgement of worldviews on health and medical approaches and practices that differ from Western medicine, in support of truly inclusive and accessible intercultural health care for minority groups, such as indigenous peoples and migrants. Moreover, active learning and reflective thinking derived from proactive and culturally contextualized involvement in real-world environments required by SL could contribute to a significant transformation of future health professionals’ practices, leading to the collective development and implementation of health plans and programs alongside health professionals and health service users belonging to these minority cultural groups.
Introduction: Since chronic obstructive pulmonary disease (COPD) is a systemic disease, patients with this condition may present cognitive impairment. In Colombia, there are no studies on the prevalence of cognitive impairment, including mild cognitive impairment (MCI), in this population. Objectives: To determine the prevalence of MCI in patients with severe or very severe COPD treated at a primary care center in Bogotá, Colombia. Materials and Methods: Cross-sectional study conducted on 139 patients with severe or very severe COPD treated at a primary care center in Bogotá between May 2019 and March 2020. The Montreal Cognitive Assessment (MoCA) was administered, along with an ad hoc questionnaire covering sociodemographic variables. Information on FEV1, FEV1/FVC ratio, PaO2, and the degree of hypoxemia was also obtained from medical records. Two cutoff points for MCI were considered: <26 and <21. The latter cutoff was utilized because it has been specifically recommended for the Colombian older adult population. The association between MCI according to each cutoff point, sex, and educational level was explored using the chi-square test of independence with calculation of crude Odds Ratios. Results: The mean age of the patients was 72.07 years, 51.80% were women, 51.79% had a low socioeconomic level, 79.14% had basic primary education, and 54.68% had severe hypoxemia. Regarding the MoCA score, 49.64% of participants scored <26 and 17.27% scored <21. The most compromised cognitive domains were delayed recall and visuospatial/executive ability, as 54.68% and 38.13% of participants obtained ≤2 points, respectively. Having only primary education was significantly associated with a higher risk of MCI, especially at the <21 cutoff point (OR: 7.33, 95%CI: 1.08-315.22, p=0.02). Conclusion: Nearly half of the evaluated patients with COPD presented MCI when using the cutoff point recommended by the MoCA instrument (<26). These findings support the need to include systematic cognitive evaluation in the comprehensive management of this population, using sensitive instruments such as the MoCA. Finally, having a low educational level (primary education only) increased the probability of MCI.
Estimado editor: La infección por Helicobacter pylori es una infección bacteriana que afecta a casi la mitad de la población mundial, aunque su prevalencia varía según la ubicación y las condiciones sanitarias. 1-4 H. pylori es la causa más frecuente de gastritis crónica, que en algunos casos puede progresar a enfermedades gastrointestinales graves como úlcera péptica gástrica duodenal y cáncer gástrico. 4 Dada su alta prevalencia y su serio impacto en la salud, esta bacteria se ha convertido en un tema principal de estudio en la gastroenterología; de hecho, en las últimasdos décadas la producción científica sobre H. pylori ha aumentado de manera constante y se ha diversificado hacia temas como resistencia antimicrobiana, estrategias de erradicación, cáncer gástrico e interacción con la microbiota.5
Introduction: Population aging represents one of the greatest challenges for healthcare systems worldwide. However, most studies describing the characteristics of this population have been conducted in community settings only. Objective: To describe the sociodemographic and clinical characteristics of individuals aged 60 years and older hospitalized in a clinic in southwestern Colombia Materials and methods: A retrospective observational study was conducted using hospitalization data from patients aged 60 years and older admitted between 2021 and 2022 to the Clínica Sebastián de Belalcázar (Cali, Colombia). Information was obtained from the institution’s Diagnosis-Related Groups (DRGs) database, a patient grouping methodology based on criteria of clinical similarity and healthcare resource utilization. Results: A total of 3 130 hospital admissions were included in the analysis, corresponding to 2 527 patients. The median age was 79 years, and the median length of hospital stay was 5 days. Patients were female in 58.27% of the hospitalizations, admitted through the emergency department in 65.68%, and required medical management only in 64.15%. The median Charlson Comorbidity Index score was 2; in 77.42% of the hospitalizations, the patient had at least one comorbidity, in 69.90% the mortality risk was extreme, and in 55.7% the risk of prolonged stay was high. Readmission (defined as admission through the emergency department within 30 days of discharge from the last hospitalization for a related cause) was required in 411 hospitalizations. The most frequent diagnostic categories and DRGs were digestive system diseases (18.75%) and infectious diseases (16.67%), and COVID-19 (12.71%) and pneumonia and pneumonitis (4.31%), respectively. The mortality rate was 17.29% (n=437). Conclusion: Individuals aged 60 years and older hospitalized in an clinic in southwestern Colombia between 2021 and 2022 were characterized by a very advanced age and a slight female predominance. In most hospitalizations, patients were admitted through the emergency department and presented with at least one comorbidity and a high risk of mortality. Although the duration of hospitalization was shorter than that reported in the literature, the mortality rate was high.
Introduction: Neonatal jaundice due to unconjugated hyperbilirubinemia is a common condition in both preterm and term neonates (60-80%). Although it is mild and transient (physiological) in most cases, its severe form (pathological jaundice) requires hospitalization to prevent serious complications such as bilirubin encephalopathy or kernicterus and associated permanent neurological sequelae. Objective: To determine the factors associated with pathological jaundice in a national referral hospital in Peru. Materials and methods: A retrospective case-control study with a 1:1 ratio was conducted in 128 neonates with jaundice treated at a hospital in Lima (Peru) during 2023. Cases were defined as neonates with pathological jaundice (hospitalization) and controls as neonates with physiological jaundice (without hospitalization). To identify the factors associated with pathological jaundice, a bivariate analysis(Chi-square test), and a multivariate analysis (logistic regression) were performed. Results: Neonates born by cesarean section had a lower probability of developing pathological neonatal jaundice (OR: 0.338, p=0.008) compared with those born by vaginal delivery. On the other hand, the presence of neonatal dehydration and ABO incompatibility were significantly associated with a higher probability of this condition (OR: 17.941, p<0.0001; OR: 2.778, p=0.034). Factors such as gestational age, obstetric trauma, sex, Rh incompatibility, and neonatal infections were not significantly associated with the development of pathological jaundice. Conclusions: Neonatal dehydration and ABO incompatibility were risk factors for pathological jaundice in Peruvian neonates treated for jaundice at a national referral hospital. Conversely, cesarean delivery acted as a protective factor.
Señor editor:En un reciente artículo publicado en la Revista de la Facultad de Medicina, Marcell-Vásquez et al. 1 identificaron los factores asociados con un nivel adecuado de conocimientos sobre diabetes mellitus tipo 2 (DMT2) en pacientes con este diagnóstico atendidos en servicios ambulatorios de Bogotá, realizando una importante contribución al conocimiento actual sobre los aspectos que afectan la comprensión de la enfermedad en esta población. De igual forma, la importancia del tema y el amplio tamaño de la muestra (n=1 068) fortalecen aún másla influencia de este estudio en el contexto clínico. No obstante, queremos resaltar algunas consideraciones metodológicas que deben tenerse en cuenta para interpretar con exactitud los resultados y guiarfuturas investigaciones.
Introduction: Excess body fat is an independent risk factor for high blood pressure. However, this relationship has been scarcely explored in large population groups. Objective: To evaluate the association between body fat percentage (BF%) and elevated mean arterial pressure (MAP) in Peruvian adults. Materials and methods: Analytical, cross-sectional study based on data from 28 611 Peruvian adults who participated in the Encuesta Nacional Demográfica De Salud Familiar - 2022 (National Demographic and Family Health Survey 2022). To evaluate the association between BF% and elevated MAP, a bivariate analysis (chi-square test with Cramer's V and odds ratio [OR] calculation) and a multivariate analysis (binary linear logistic regression model with backward elimination) were performed. The correlation between BF% and MAP (Spearman’s correlation coefficient) was also evaluated. Results: Of the 28 611 records included, 57.40% were women and 56.18% had a high BF%. The average MAP was significantly higher in individuals with a high BF% in both women (88.37 vs. 80.27) and men (95.51 vs. 87.01). In the bivariate analysis, having a high BF% was significantly associated with a higher probability of elevated MAP in women (OR=4.897; p<0.001, V=0.294) and men (OR=4.064; p<0.001, V=0.336). In the multivariate analysis, having a high BF% increased the probability of having high BP by 2.6 (OR=2.65; p<0.001) and 2.15 (OR=2.150; p<0.001) times in men and women, respectively. The correlation between BF% and MAP was moderate in women (Rho=0.464) and men (Rho=0.441). Conclusions: BF% was independently associated with a higher probability of elevated MAP in Peruvian adults.
Introduction: X-linked hypophosphatemic rickets is a rare disease (1.7-4.8 cases per 100 000 population) characterized by inadequate bone mineralization due to a genetic alteration of phosphorus metabolism. Case presentation: A girl aged 2 years and 6 months was taken to the orthopedic service of a tertiary care hospital in Bucaramanga (Colombia) due to gait disturbances, limping, and pain in the right foot. Physical examination revealed bilateral genu varum of 10°, limitation of extreme hip abduction, bilateral clinodactyly in the fifth toe, bilateral flat feet, weight of 11 kg, and height of 79 cm (less than the percentile 3 in the CDC height-for-age growth charts). Laboratory tests showed hypophosphatemia, elevated alkaline phosphatase, and hyperphosphaturia, suggesting hypophosphatemic rickets. The patient received conventional treatment with orthophosphate salts and calcitriol, noting fluctuations in her condition with periods of symptom remission and periods of exacerbation, as well as increased body deformity. At 5 years of age, genetic analysis confirmed the diagnosis of X-linked dominant hypophosphatemic rickets, with pathogenic variant c.1158G>A heterozygous in the PHEX gene. At 9 years 8 months of age, treatment with burosumab was started, achieving an improvement of symptoms and growth velocity. The patient continues to attend periodic check-ups. Conclusion: This case demonstrates that supplementation with calcitriol and orthophosphate salts can be a suitable treatment option for XHL provided there is good adherence. However, treatment with burosumab showed greater effectiveness, with remarkable improvement only six months after its implementation and with appropriate adherence.
Dear Editor: The first cases of medication-related osteonecrosis of the jaw (MRONJ) were reported in 2003 and were associated with the use of bisphosphonates.1 Since then, multiple advances have been made regarding its definition, classification, diagnosis, and treatment, but several controversies have also emerged.2
Introduction: Multimorbidity is defined as the coexistence of two or more chronic diseases in an individual. It poses a significant burden on public health care due to its association with an increased risk of premature death, a high degree of disability, and significant use of medical services. Grouping these patients into clinical profiles could help to optimize their management. Objective: To establish the clinical profiles of patients with multimorbidity treated via the telemedicine home care program of the Hospital Alma Máter de Antioquia (HAMA) located in Medellín (Colombia). Materials and methods: Cross-sectional study conducted using data from 2 035 adult patients with multimorbidity enrolled in the HAMA home care program who had access to health care services via telemedicine at least once between January 2017 and December 2023. Patients were grouped into clinical profiles (clusters) using the k-means clustering algorithm and based on the following variables: age, sex, diagnosis of arterial hypertension (AHT), type 2 diabetes mellitus (DM2), chronic kidney disease (CKD) and stage, chronic obstructive pulmonary disease, cancer, mental or neurodegenerative disease, disability, functional class, use of anticoagulants, type of telemedicine service used, and prior assessment by the internal medicine service via telexpertise. The optimal number of clusters (k) was determined using the elbow method. Results: According to the elbow method, the optimal value of k in the K-means clustering algorithm was 4, so patients were grouped into 4 clusters or clinical profiles. Cluster 0 corresponded to men and women with CKD, AHT, and DM2, without a disability but with functional class 4. Cluster 1 was formed by men with mental or neurodegenerative disease and CKD, with a disability, and functional class 4. Cluster 2 included women with mental or neurodegenerative disease and CKD, with a disability, and functional class 4. Finally, cluster 3 was comprised of women and men with CKD, AHT, and DM2, with functional class 2. Conclusion: Four clinical profiles were identified, characterized by sex, combination of chronic diseases, functional class, and presence of a disability. This classification may contribute to the use of specific program services such as evaluation by internal medicine specialists via tele-expertise.
