Objective: To identify changes in cytokine concentration in the plasma of patients with IPF and healthy controls residing in Bogotá. Methods: Peripheral blood samples were taken from 13 patients over 60 years old with a diagnosis of IPF and 13 healthy counterparts. Plasma separation was performed and stored at -20°C. Cytokines were measured using the Human TH1/TH2 Cytometric Bead Array (CBA). This work was approved by the ethics and research committee of the Fundación Neumológica Colombiana. Results: Patients with Idiopathic Pulmonary Fibrosis (IPF) showed increased levels of cytokines such us IL-4, INF-γ and IL-6 compared to healthy older adults. Conclusions: Inflammaging has been associated with the development and coexistence of multiple non-communicable chronic diseases that have a higher incidence after the age of 65. The involvement of adaptive immunity in the pathogenesis of IPF has been described as an imbalance in the Th1/Th2 lymphocyte response. IL-4 stimulation favors the phenotypic shift to M2 macrophages and Th2 cells, along with the promotion of pro-fibrotic environments by Innate lymphoid cells type 2 (ILC-2).
El síndrome neuroléptico maligno (SNM) es una reacción adversa grave, potencialmente mortal, y clásicamente asociada al uso de antipsicóticos. Su presentación en la población pediátrica es infrecuente y la literatura sobre agentes causales atípicos, no neurolépticos, es limitada. Se presenta un caso de síndrome neuroléptico maligno-like en un paciente pediátrico expuesto a carbamazepina y fluoxetina, en el cual se destaca los desafíos en el diagnóstico diferencial y el manejo clínico. Es un paciente masculino de 11 años con secuelas neurológicas, quien desarrolló un cuadro caracterizado por fiebre elevada, rigidez muscular severa, inestabilidad autonómica y alteración del estado de conciencia tras el manejo con carbamazepina y fluoxetina. El diagnóstico se estableció con base en los criterios clínicos y la exclusión de otras etiologías. Se suspendieron los fármacos sospechosos y se instauró un tratamiento de soporte intensivo que incluyó benzodiacepinas y un agonista dopaminérgico (bromocriptina), con lo que se logró una mejoría clínica progresiva. Este caso subraya la importancia de considerar el SNM en el diagnóstico diferencial de emergencias hipertérmicas en pediatría, incluso en ausencia de exposición a antipsicóticos típicos. Un alto índice de sospecha es crucial para un diagnóstico y tratamiento oportunos, lo cual es determinante para disminuir la morbimortalidad asociada a esta entidad.
Objective: Augmentation mammoplasty is one of the most performed surgeries in the world. Capsular contracture is one of the most frequent complications, for which different associated factors have been evaluated and tools have been sought to reduce its incidence. The aim of this research was to describe characteristics and outcomes in pacientes who developed capsular contracture in a center in Medellin. Methods: A descriptive longitudinal study was carried out over a 3-year period with patients who presented capsular contracture in the first postoperative year and who required surgical management. Results: It was found that the use of smooth implants corresponded to 54,3 %, nanotextured implants 34,3 % and textured implants 8,6 %. The irrigation of the implants with saline solution was the most used in 51,4 %, antibiotic mixtures in 40 %, isodine in 20 % and hydrogen peroxide in 2,9%. The implant location was 42,9 % in the retromuscular plane, 37,1 % dual plane and 11,4 % subglandular, periareolar incision in 54,3 %, periareolar and vertical incision in 20 %, inframammary sulcus in 5,7 % and inverted T in 20 %. Patients who required reintervention during the first postoperative year underwent conservative management in 37,1 %, implant exchange in 54,3 % and explantation in 8,6 %. Conclusions: The results obtained in this study were compared with data described in the literature, finding great concordance between them; however, two facets of this study were not found.
Malignant Neuroleptic Syndrome (MNS) is a severe, potentially life threatening adverse reaction, classically associated with the use of antipsychotics. Its occurrence in the pediatric population is rare, and the literature on atypical, non neuroleptic causal agents is limited. We present a case of malignant neuroleptic syndrome like reaction in a pediatric patient exposed to carbamazepine and fluoxetine, highlighting the challenges in differential diagnosis and clinical management. The patient was an 11 year old male with neurological sequelae, who developed a clinical picture characterized by high fever, severe muscle rigidity, autonomic instability, and altered consciousness following treatment with carbamazepine and fluoxetine. The diagnosis was established based on clinical criteria and exclusion of other etiologies. The suspected drugs were discontinued, and intensive supportive treatment was initiated, including benzodiazepines and a dopaminergic agonist (bromocriptine), leading to progressive clinical improvement. This case underscores the importance of considering MNS in the differential diagnosis of hyperthermic emergencies in pediatrics, even in the absence of exposure to typical antipsychotics. A high index of suspicion is crucial for timely diagnosis and treatment, which is decisive in reducing the morbidity and mortality associated with this entity.
Objective: Acute coronary syndrome is a highly prevalent disease worldwide with multiple risk factors. However, its association with socio-economic status has not been clearly documented. Methods: Systematically assessment of the relationship between low socio-economic status and acute coronary syndrome. A systematic literature review was conducted from 2015 to 2024. Results: The best available evidence on the association between socioeconomic status and coronary syndrome was evaluated, considering that these articles classified their population minimally in high and low socio-economic status. Of the 36 initial studies, 7 met criteria for selection and analysis. Conclusions: Low socioeconomic status was found to be associated with a higher risk of developing acute coronary syndrome, however, the extension of new studies in Latin America is considered relevant, due to the lack of external validity that the analyzed articles.
Objective: To identify changes in cytokine concentration in the plasma of patients with IPF and healthy controls residing in Bogotá. Methods: Peripheral blood samples were taken from 13 patients over 60 years old with a diagnosis of IPF and 13 healthy counterparts. Plasma separation was performed and stored at -20°C. Cytokines were measured using the Human TH1/TH2 Cytometric Bead Array (CBA). This work was approved by the ethics and research committee of the Fundación Neumológica Colombiana. Results: Patients with Idiopathic Pulmonary Fibrosis (IPF) showed increased levels of cytokines such us IL-4, INF-γ and IL-6 compared to healthy older adults. Conclusions: Inflammaging has been associated with the development and coexistence of multiple non-communicable chronic diseases that have a higher incidence after the age of 65. The involvement of adaptive immunity in the pathogenesis of IPF has been described as an imbalance in the Th1/Th2 lymphocyte response. IL-4 stimulation favors the phenotypic shift to M2 macrophages and Th2 cells, along with the promotion of pro-fibrotic environments by Innate lymphoid cells type 2 (ILC-2).
Objective: To describe the factors related to the mortality of minors under five years due to Acute Respiratory Infection in Antioquia during 2022. Methods: Cross-sectional descriptive study. It includes the universe of Notification Cards number 591 of children under five years who died of verified ARI and their respective Analysis Unit. Information collection after approval by the Ethics Committee of the Educational Institution and the Sectional Health Secretariat of Antioquia. The information was analyzed in the statistical software Jamovi 2.3. Results: 53.5% of the deceased children were boys, a third of whom lived in populated centers or rural areas. 60.6% belonged to socioeconomic strata 1 and 2 and were enrolled in subsidized health care, while the rest were not affiliated with the health system. 10.7% were from indigenous communities. 39.3% of the mothers had no schooling, and 75% of the deaths occurred in hospitals. Related factors were identified: caregiver ignorance of warning signs and symptoms, failure to comply with actions induced by demand by health personnel, poor quality of care received, and caregivers' delay in seeking timely care. Conclusions: Social determinants of health such as poverty and low maternal schooling increase the risk of death due to Acute Respiratory Infection in children under five years in Antioquia.
Objective: To analyze the validity, reliability and invariance of the Double Sexual Standard questionnaire in a sample of Colombian and Mexican adolescents and young adults. Methods: The participants were 1,906 individuals, of whom 795 were men (41,7 %) and 1111 were women (58,2 %), aged between 15 and 28 (M = 20,16; SD = 2,28). The 61,1 % of the sample were Colombian and 38,8% were Mexican. The Sexual Double Standard Scale was used, which allows for the evaluation of more permissive acceptance when judging the sexual behavior of men than that of women. Results: Although the original questionnaire has a unidimensional structure, exploratory factor analysis yielded two factors, which were named: factor 1 (condescending sexual behavior toward men) and factor 2 (strict sexual behavior toward women), explaining 51,7 % of the variance. This new version has adequate reliability. Furthermore, confirmatory factor analysis was used to verify this new version, and the fit indices were adequate (0,908). The Differential Functioning (DIF) of the 10 items (DIF) was evaluated to identify whether the probability of responding differently to the double standard sexual behavior items in the Mexican and Colombian populations was concentrated. Item 8 showed a problematic pattern, with a significant uniform and non-uniform DIF in favor of Mexico. Similarly, item 3 showed non-uniform DIF, suggesting that it discriminates differently between the two countries. Likewise, statistically significant differences were found in condescending sexual behavior toward men and strict sexual behavior toward women, with Colombian men scoring higher than Mexican men. Conclusions: The results of this research provide a valid and standardized measurement tool for the study of sexual double standards and the development of promotion and prevention programs for related issues such as intimate partner violence, sexism, and gender studies in sex education.
Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare and devastating genetic disorder characterized by premature aging. This condition is caused by an autosomal dominant mutation in the LMNA gene, which leads to the production of the defective protein progerin, responsible for cellular changes that induce accelerated aging. The first signs of HGPS usually appear between 6 and 12 months of age, with clinical manifestations such as growth delay, loss of body fat, alopecia, and bone abnormalities. As the disease progresses, severe cardiovascular problems develop, primarily atherosclerosis and fibrosis, leading to death from heart failure or myocardial infarction at an average age of 14.5 years. Diagnosis is confirmed by genetic sequencing for the c.1824C>T mutation in LMNA. Although there is no cure, the farnesylation inhibitor lonafarnib has been shown to improve quality of life and extend survival. The study of HGPS provides a unique window into understanding aging, as it shares molecular mechanisms with natural senescence, such as mitochondrial dysfunction and oxidative stress. Research on HGPS not only deepens our knowledge of this disease but also opens new therapeutic pathways for age-related conditions.
Leishmaniasis is a disease of worldwide distribution and Colombia contributes significantly to this statistic. Meglumine antimoniate (Glucantime®) has classically been the treatment of choice; however, these antimonials can have a high degree of toxicity and can be potentially fatal. We present the case of an elderly patient who at the end of treatment for cutaneous leishmaniasis presented cardiac toxicity and electrolyte alterations, generating a prolonged QT syndrome with the subsequent development of multiple episodes of monomorphic and polymorphic ventricular tachycardia, requiring electric shocks and transvenous pacemaker positioning for rhythm control. The importance of this report lies in the need to recognize the signs and symptoms suggestive of toxicity and the management provided.
Disorders secondary to vitamin B12 deficiency encompass neuropsychiatric and hematologic symptoms. They represent a diagnostic challenge. We present the case of a 57-year-old female with chronic diarrhea associated with quadriparesis, proprioceptive and vibratory deficit, and gait impairment secondary to intestinal malabsorption syndrome and vitamin B12 deficiency. Parenteral supplementation was initiated with partial improvement; however, the patient was readmitted due to persistent symptoms, requiring the reassumption of supplementation, which led to the progressive recovery of neurological function. Hyperreflexia, hypopalesthesia and sensory ataxia have been reported as manifestations of subacute combined degeneration (SCD) secondary to vitamin B12 deficiency. Vitamin B12 replacement therapy leads to symptoms improvement, underscoring the importance of timely diagnosis and management.
Objective: To characterize patients with metastatic hormone-sensitive prostate cancer (mHSPC) treated in an outpatient oncology care institution in Medellín-Colombia.Methods: An observational, retrospective study with survival analysis. Patients with mHSPC who initiated treatment at our institution after December 2013 were included. Progression-free survival (PFS), including radiographic or serological progression, and overall survival (OS) were calculated with the Kaplan-Meier method. Subgroup analyses were carried out according to received therapy for mHSPC and tumour burden. Differences were evaluated through the log-rank test. A p-value <0.05 was considered statistically significant.Results: Data of 111 patients with mHSPC were analysed. The median follow-up was 32.2 months (IQR:15.9-47.5). The median age was 68.9 years (IQR:63.4-78.2). High tumour burden accounted for 73.9 %. The most used treatment modalities included ADT monotherapy (30.6 %), and ADT in combination with docetaxel (34.2 %). Median PFS and OS was 24.2 (95 %CI:19.0-29.5) and 53.5 months (95 % CI:45.3-61.7), respectively. In low metastatic volume patients, median PFS in the ADT monotherapy group and ADT plus other therapy group was 22.5 (CI95 %: 11.0-34.0) and 30.5 months (CI95 %:8.7-52.3), respectively (P=0.035). There was no significant difference between groups in OS.Conclusion: Comparable survival rates between our population and those described in controlled clinical trials were found.
Objective: To identify patients’ knowledge and needs regarding pharmaceutical care services in drugstores, pharmacies-drugstores, and outpatient pharmaceutical services in Antioquia, Colombia. Methods: A descriptive cross-sectional study was conducted with users of pharmaceutical establishments and outpatient pharmaceutical services. A semi-structured interview was designed, divided into three parts: sociodemographic characteristics, knowledge and perceived needs, and use of Information and Communication Technologies.Results: Of the 30 people interviewed, 53.3 % were users of Pharmaceutical Establishments (Drugstores, Pharmacies-Drugstores) and 46.7 % were users of Pharmaceutical Services. 100 % of the users of Pharmaceutical Establishments visited to acquire medications and other products, while 100 % of the users of Pharmaceutical Services visited solely to collect medications. Regarding knowledge about pharmaceutical care services, 10 % of the respondents correctly defined dispensing, while 6.7 % adequately defined health education. In contrast, 26.7 % agreed with the definition of pharmacovigilance. Additionally, regarding access to dispensing and health education services, respondents reported accessing these services at rates of 30 % and 10 %, respectively. Meanwhile, 96.7 % of the respondents stated they did not access pharmacovigilance services.Conclusions: Obstacles were identified in the provision of information and care, such as the willingness and knowledge of staff, their lack of time, and a focus on sales. These findings highlight the need to improve staff training and patient care.
Objective: psoriatic arthritis, as a manifestation of psoriatic disease, is a chronic and inflammatory condition, with articular symptoms, dactylitis, enthesitis and changes in the skin and nails. Despite the existence of various treatment recommendations, the factors determining the treatment response in the Latin American population have not been clarified. The aim of this study was to describe the characteristics of patients with psoriatic arthritis and identify the differences in the response to treatment and its impact on quality of life in a medical center in Medellín.Methods: medical records of 114 patients with psoriatic disease and arthritis were analyzed to evaluate sociodemographic, clinical, treatment, and clinimetric variables. A univariate analysis was carried out for quantitative and qualitative variables and a bivariate analysis was carried out to evaluate differences between variables, comparing them using the Chi-squared test.Results: a significant difference was observed between affiliation to the EPS contribu-tory regime (p 0.041) and initial treatment with biologicals (p 0.044). There is a negative association between psoriasis vulgaris and axial arthritis (OR 0.11; 95 % CI 0.0269–0.476; p< 0.001) and between nail psoriasis and axial arthritis (OR 0.20; 95 % CI 0.0567–0.767; p=0.011). High levels of total and LDL cholesterol were related to a lower probability of achieving a 90 % of improvement according to the scale PASI 90 (p<0.05). Lower hemoglobin is related to worse therapeutic response (p<0.05).Conclusion: men were the most affected with a higher association with comorbidities and cardiovascular risk. Methotrexate is the most used medication associated with an improvement in quality of life. Biological medications were positively associated with achieving a PASI 90 goal.
Objective: Teenage pregnancy is defined as gestation in women between 15 and 19 years of age. This article aims to analyze the behavior of adolescent pregnancy based on public policies and sexual and reproductive health strategies in Medellín, Antioquia and Colombia between 2012 to 2022. Methods: Research was carried out through reviews and documentary analysis of sexual and reproductive health policies and strategies, and the compilation of secondary information sources obtained from DANE based on epidemiological estimators such as the percentage of teenage pregnancies, percentage of live births to mothers aged 15 to 19, and the total number of cases of teenage pregnancy at the municipal, departmental, and national levels. Results: A total of 106 813 articles, reports, and documents were obtained from the databases. For the writing of the documentary analysis, 30 were finally selected. 14 corresponded to articles on strategies to impact teenage pregnancy, three were government technical documents, seven were public policies, and six were other related norms. All of these demonstrate the impact of policies and strategies on sexual and reproductive health in the social, family, and community environment. Conclusion: The set of public policies and strategies implemented in the city of Medellín positively impact indicators related to teenage pregnancy; however, there is a need to continue improving and emphasize citizen participation and education in sexual and reproductive health.
Primary melanoma of the urethra is a rare entity among mucosal malignant melanomas. It has a poor prognosis due to the delay in its diagnosis. The only curative treatment is a surgical approach with safe margins. The objective is to report a case of a second primary melanoma of the urethra presented 17 years after a first primary melanoma of the urethra that received surgical management with negative margins, with no evidence of relapse at 7 years of follow-up, as well as to alert the need to perform endoscopic follow-up of these patients in search of another lesion.
Soccer goalkeepers, as a result of new game systems, are exposed to risk factors and particular musculoskeletal injuries. Among the members of a soccer team, goalkeepers are the ones who report the lowest number of injuries, however, their absenteeism due to injury usually has important sporting and financial implications for the team, which is why it is necessary to design prevention proposals adjusted to this new reality. The purpose of the narrative review article was to establish the main musculoskeletal injuries, the risk factors and current trends in their prevention in soccer goalkeepers. The information collected allowed us to establish that there is a diversity of injuries and risk factors that affect archers and that also currently the generation of studies aimed at the design of prevention strategies, plans, programs or models, which seek to specifically reduce the risk of injury in archers is very scarce, the current trend corresponds mostly to studies aimed at validating existing plans and models, with very few addressing new risk assessment strategies and the design of prevention strategies. It is necessary to delve into the development of injury prevention programs in soccer goalkeepers based on epidemiological assessment, on the assessment of own risks and on the assessment of the roles that goalkeepers currently fulfill as a product of the competition systems in the field of world football.
Objective: psoriatic arthritis, as a manifestation of psoriatic disease, is a chronic and inflammatory condition, with articular symptoms, dactylitis, enthesitis and changes in the skin and nails. Despite the existence of various treatment recommendations, the factors determining the treatment response in the Latin American population have not been clarified. The aim of this study was to describe the characteristics of patients with psoriatic arthritis and identify the differences in the response to treatment and its impact on quality of life in a medical center in Medellín. Methods: medical records of 114 patients with psoriatic disease and arthritis were analyzed to evaluate sociodemographic, clinical, treatment, and clinimetric variables. A univariate analysis was carried out for quantitative and qualitative variables and a bivariate analysis was carried out to evaluate differences between variables, comparing them using the Chi-squared test.Results: a significant difference was observed between affiliation to the EPS contribu-tory regime (p 0.041) and initial treatment with biologicals (p 0.044). There is a negative association between psoriasis vulgaris and axial arthritis (OR 0.11; 95 % CI 0.0269–0.476; p< 0.001) and between nail psoriasis and axial arthritis (OR 0.20; 95 % CI 0.0567–0.767; p=0.011). High levels of total and LDL cholesterol were related to a lower probability of achieving a 90 % of improvement according to the scale PASI 90 (p<0.05). Lower hemoglobin is related to worse therapeutic response (p<0.05).Conclusion:men were the most affected with a higher association with comorbidities and cardiovascular risk. Methotrexate is the most used medication associated with an improvement in quality of life. Biological medications were positively associated with achieving a PASI 90 goal.
Objective: To identify patients’ knowledge and needs regarding pharmaceutical care services in drugstores, pharmacies-drugstores, and outpatient pharmaceutical services in Antioquia, Colombia.Methods: A descriptive cross-sectional study was conducted with users of pharmaceutical establishments and outpatient pharmaceutical services. A semi-structured interview was designed, divided into three parts: sociodemographic characteristics, knowledge and perceived needs, and use of Information and Communication Technologies. Results: Of the 30 people interviewed, 53.3 % were users of Pharmaceutical Establish-ments (Drugstores, Pharmacies-Drugstores) and 46.7 % were users of Pharmaceutical Services. 100 % of the users of Pharmaceutical Establishments visited to acquire medi-cations and other products, while 100 % of the users of Pharmaceutical Services visited solely to collect medications. Regarding knowledge about pharmaceutical care services, 10 % of the respondents correctly defined dispensing, while 6.7 % adequately defined health education. In contrast, 26.7 % agreed with the definition of pharmacovigilance. Additionally, regarding access to dispensing and health education services, respondents reported accessing these services at rates of 30 % and 10 %, respectively. Meanwhile, 96.7 % of the respondents stated they did not access pharmacovigilance services.Conclusions: Obstacles were identified in the provision of information and care, such as the willingness and knowledge of staff, their lack of time, and a focus on sales. These findings highlight the need to improve staff training and patient care.
Soccer goalkeepers, as a result of new game systems, are exposed to risk factors and particular musculoskeletal injuries. Among the members of a soccer team, goalkeepers are the ones who report the lowest number of injuries, however, their absenteeism due to injury usually has important sporting and financial implications for the team, which is why it is necessary to design prevention proposals adjusted to this new reality. The purpose of the narrative review article was to establish the main musculoskeletal inju-ries, the risk factors and current trends in their prevention in soccer goalkeepers. The information collected allowed us to establish that there is a diversity of injuries and risk factors that affect archers and that also currently the generation of studies aimed at the design of prevention strategies, plans, programs or models, which seek to specifically reduce the risk of injury in archers is very scarce, the current trend corresponds mostly to studies aimed at validating existing plans and models, with very few addressing new risk assessment strategies and the design of prevention strategies. It is necessary to delve into the development of injury prevention programs in soccer goalkeepers based on epidemiological assessment, on the assessment of own risks and on the assessment of the roles that goalkeepers currently fulfill as a product of the competition systems in the field of world football.
