ISSN 2422-3344 | e-ISSN 2665-2552 Revista Navarra Medica (online ISSN 2665-2552) is published biannually (2 issues per year) in open access electronic format, led by the Centro de Investigaciones e Innovación UNINAVARRA - CIINA - Fundación Universitaria Navarra - UNINAVARRA.
Psychometric properties of the Copenhagen Burnout Inventory (CBI) for measuring burnout among healthcare personnel at the Hernando Moncaleano Perdomo University Hospital in Neiva
Introduction: Burnout syndrome represents a major concern in the healthcare sector due to its significant impact on workers’ mental health and the quality of care provided. Traditionally, it has been assessed using the Maslach Burnout Inventory (MBI-HSS); however, its Spanish versions have shown limitations in reliability and validity, highlighting the need for more accurate instruments. The Copenhagen Burnout Inventory (CBI) was developed to address these shortcomings and has demonstrated robust psychometric properties in various international contexts. This study aimed to determine the reliability and validity of the CBI for assessing burnout among healthcare personnel in Colombia. Methodology: An observational cross-sectional study was conducted with a sample of 510 healthcare workers from the Hernando Moncaleano Perdomo University Hospital in Neiva, Colombia, who voluntarily participated. Data were obtained from a previously collected institutional database. Reliability was evaluated using Cronbach’s alpha coefficient, and construct validity was tested through confirmatory factor analysis. Item discrimination and response option difficulty thresholds were also examined to verify the instrument’s suitability for the target population. Results: The CBI demonstrated high internal consistency (α = 0.89–0.92). The original factorial structure was not fully confirmed due to the inadequate performance of item 13, which showed a low factor loading and a high measurement error. After excluding this item, model fit indices improved notably (CFI and TLI ≥ 0.95; RMSEA ≤ 0.05), supporting the adequacy of the modified model. Conclusion: The CBI proved to be a valid, reliable, and practical tool for assessing burnout in the southern Colombian healthcare professionals. Revision or exclusion of item 13 is recommended to enhance the instrument’s performance and applicability in the local context.
Copyright (c) 2025 Ninis Beatriz Yance restrepo MD, Oscar Javier Caquimbo Cubillos MD https://creativecommons.org/licenses/by-nc/4.0
Evaluation of the neonatal metabolic screening program at Hernando Moncaleano Perdomo university hHospital in Neiva
Introduction: Basic neonatal metabolic screening (NMS) is an essential public health strategy for the early detection of disorders that can affect newborn development if not promptly treated. This study evaluated the NMS program at the Hernando Moncaleano Perdomo University Hospital in Neiva during 2022-2023. Materials and Methods: Observational and descriptive study conducted in neonates who underwent basic neonatal metabolic screening (BNMS). A univariate analysis of the data was performed, using information obtained from medical records and laboratory registries. Newborns under one month of age were included, while those who had died or were born outside the institution were excluded. Results: A total of 980 patients were analyzed, representing 20.12% of all births in the institution. The median age at the time of sample collection was 2.7 days (IQR: 1–2 days), with 62.45% of samples collected before two days of life. No positive cases were detected for phenylketonuria, galactosemia, congenital adrenal hyperplasia, or biotinidase deficiency. However, three cases of cystic fibrosis were identified (1 per 1,623 births), along with one case of sickle cell trait (1 per 4,878 births). Conclusion: The low NMS coverage highlights the need to address barriers that limit access. Strengthening education for healthcare professionals and families is essential to ensure timely sample collection and reduce false results. Additionally, an effective clinical follow-up is required to confirm diagnoses and ensure access to specialized treatments.
Copyright (c) 2025 Arlez Muñoz-Uribe, Henry Barreto-Bermúdez https://creativecommons.org/licenses/by-nc/4.0
Conscientious objection in Voluntary Termination of Pregnancy: A Colombian constitutional jurisprudential review
The Honorable Colombian Constitutional Court has established uniform jurisprudence regarding conscientious objection, guaranteeing the protection of the right of health professionals directly involved in the practice of abortion or feticide (induced fetal death) in the voluntary termination of pregnancy (VTP) of pregnant women who meet the criteria established in ruling C-355 of 2006, in the following cases: (i) when the pregnancy poses a risk to the life or health of the woman, (ii) when there is a severe fetal malformation that makes life unviable, and (iii) when the pregnancy is the result of conduct constituting carnal access or sexual intercourse without consent, abuse, or non-consensual artificial insemination or transfer of fertilized ovum (1). It is important to highlight the efforts of our Constitutional Court to define the scope of the exercise of conscientious objection, both for health professionals and for judicial operators. Through these rulings, the Court unifies criteria and clarifies the potential conflict between the rights to freedom of conscience and to VTP, providing a basis for judicial decision-making and serving as a guideline for public policies aimed at ensuring the prevention of unsafe abortion in Colombia, considering the legislature’s reluctance to promote a bill regulating VTP and conscientious objection
voluntary termination of pregnancy (VTP)
Copyright (c) 2025 Néstor Farid Montiel https://creativecommons.org/licenses/by-nc/4.0
Gunshot wound to the head in pediatric patient. A case report and review of the literature
Background: Traumatic brain injury is a serious pathology around the world. Incidence has been reported close to 200 cases per 100.000 people worldwide. In Colombia, the burden of injuries impacts more in the economically active Head injury, pediatric neurosurgery, neurosurgery, traumatic brain injury, case report. male population between 12 and 45. The wounds caused by projectile’s guns are common in the daily practice of neurotrauma care, being aware of their high mortality. Gunshot wounds of the head are usually fatal and have poor neurological prognosis. Case presentation: This case details the presentation of a pediatric patient who entered a University Hospital in Colombia after suffering a gunshot wound in the skull. The patient was admitted in poor general conditions, stuporous, hypotensive and with active bleeding, with a gunshot injury in the right frontal region. The neurologic exam had a decreased mentality (Glasgow Coma Scale of 4 / 5), with right pupil of 2mm, non-reactive, left pupil 3mm, weakly reactive. A computed tomography showed the trajectory of the projectile, an intracranial hemorrhage, cerebral edema and deviation of the midline greater than 10mm. The patient was taken to surgery. A bilateral cranial decompression of the frontal, temporal, and parietal with debridement were performed, as a damage control procedure. Satisfactory neurological outcome. Conclusion: It is necessary to perform studies that support the scientific evidence on the best option for the management of penetrating gunshot wounds in the skull in the pediatric population.
Copyright (c) 2025 Jose D. Charry, Juan S. Calle-Toro, Sebastián Serrano, Juan P. Solano https://creativecommons.org/licenses/by-nc/4.0
Juvenile trabecular skull ossifying fibroma: case report
Background: Bone fibroids are very rare intraosseous benign lesions that generally affect craniofacial structures and onset between aged 10 and 15 years. Case presentation: An 8-year-old patient was admitted with a history of skull trauma by a traffic accident 2 years ago, it is evidence of a mass in the right frontoparietal region of slow growth associated with intermittent global headache of one year duration. The neurosurgery service evaluates the patient with diagnostic imaging and considers candidate for surgical management of the lesion. With final report of pathology of juvenile ossicle fibroma trabecularis of skull in right frontal bone. This type of benign tumors are extremely rare. Conclusion: Neuroimaging is the main tool to perform the diagnosis, and the most appropriate behavior is surgical resection, having a favorable prognosis. They are a challenge because the final diagnosis is provided by the histopathology study.
Copyright (c) 2025 Jose D. Charry, Juan S. Calle-Toro, Cristian Rincón-Guio, Camilo Calvache, Jorman H. Tejada, Juan P. Solano https://creativecommons.org/licenses/by-nc/4.0
Validation of trauma scales: experience at a trauma care enter in southern Colombia
Introduction: trauma is a public health problem that affects millions of people each year, generating a high rate of disability and mortality in young patients. Trauma scales are used to predict the prognosis of multiple trauma patients on admission to the emergency room. The use of these tools forces health personnel to be skilled in their interpretation, and thus direct management. The objective of the research is to validate the different trauma scales in patients managed in a hospital in Colombia. Methodology: descriptive, observational, cross-sectional study of multiple trauma patients who were admitted to a trauma center between January and December 2019. The shock index (SI) was determined as a prognostic variable that generated two groups: group A (SI less than 0.9) and group B (IS greater than 0.9), in relation to this, the clinical findings were evaluated and the Injury Severity Index (ISS), Revised Trauma Score (RTS) and the Glasgow Coma Scale were evaluated. Results: 180 patients were analyzed, 56.6 % presented SI less than 0.9 and 43.3 % greater than 0.9. The ISS for group A yielded a mean of 13.7, however, the patients who died in that group had an ISS greater than 24. The mean RTS was 7.2. The mean GCS was 11.7 and those patients who died had GCS less than 9. The overall mortality in group A was 16.6 %. For group B, mortality was 80.7 %, the behavior of the ISS was greater than 30.9, the RTS presented a mean of 6.3 and the average of the GCS was 8.2. Conclusion: it was determined that the Shock Index allows predicting an unfavorable prognosis in trauma patients, which is correlated and validated when applying the ISS and GCS in the emergency room.
Copyright (c) 2025 Sergio A. Cristancho-Losada , Sammy Felipe Castellanos-Rojas, Jose D. Charry https://creativecommons.org/licenses/by-nc/4.0
Shock index as a predictor of mortality in trauma patients during the first 72 hours
Introduction: Trauma is a public health problem that affects millions of people every year, generating a high rate of disability and mortality in young patients, for this reason the use of prognostic tools such as the shock index (IS) would allow attention timely and effective emergency services by identifying tissue hypoperfusion parameters and clinical outcomes. Methods: A descriptive, cross-sectional observational study was carried out in polytraumatized patients who were admitted from January 2019 to December 2019 in a University hospital in Colombia. The variables were evaluated, and the result was determined according to the shock index, generating a dichotomous variable with two groups: group A, with an index less than 0,9, and group B, with one greater than 0.9; a univariate analysis was done. Measures of central tendency and dispersion were calculated for continuous variables. Results: 180 patients were analyzed, 56,6 % (102) is less than 0,9 and 43,3 % (78), greater than 0.9. The average age for group A was 38,7 years and, for group B, 30,2 years. Mortality at 72 hours was 16,6 % in group A and 80,7 % in group B. for a total of 44,4 %. Survival at 72 hours for group A was 83,3 % and for B 19,2 %, out of a total of 55,5 %. Conclusion: SI facilitates the choice of treatments according to the state of severity, since a score greater than 0.9 is associated with mortality; aspect that would prioritize emergency care by medical personnel, in patients who are apparently stable, but according to the IS have a poor prognosis. The results suggest that this index may be useful in predicting adverse outcomes and in defining fluid resuscitation.
Copyright (c) 2025 Sergio A. Cristancho-Losada , Sammy Felipe Castellanos-Rojas https://creativecommons.org/licenses/by-nc/4.0
Validation of the DENVER Score for predicting multiple organ failure in Trauma Patients Treated at a University Hospital in Colombia
Introduction: Trauma is one of the pathologies that generate the greatest disability and mortality in Latin America. The aim of this study was to evaluate the usefulness of the DENVER classification to predict multiorgan failure in trauma victims who were treated in a university hospital in southern Colombia. Materials and Methods: A database of traumatized patients who entered the emergency department between 2012 and 2015 was built. The effectiveness of the DENVER scale to predict multiorgan failure in trauma patients was evaluated, a univariate analysis was performed. Measures of central tendency and dispersion were calculated for the continuous variables, statistical confidence tests were applied, a p <0.05 was considered as significant. Results: In total, 598 patients were analyzed. The mean age was 24.6 years (range 16 - 58). The median of the GCS was 5 (range 3-12), 86.7 % were men, 83.4 % had blunt trauma, of the patients who entered the institution 12.5 % had multiorgan failure, the overall mortality was 5.7%, the DENVER scale predicted multi-organ failure in 87.5 %. Conclusion: Trauma is a public health problem, it is a frequent pathology in our hospital, multiorganic failure is a complication that occurs in trauma victims, DENVER is a model that has been described with the objective of identifying patients early that can develop multiorganic dysfunction syndrome and
Copyright (c) 2025 Sergio A. Cristancho-Losada , Jose D. Charry, Roberto J. Rodriguez https://creativecommons.org/licenses/by-nc/4.0
From the Stethoscope to the Silicon-Scope: Bedside Ultrasound as the Fourth Pillar of Physical Examination
For centuries, the physical examination has been the cornerstone of the physician-patient relationship, relying on sensory acuity and clinical intuition. Today, emerging technologies—particularly point-of-care ultrasound (POCUS)—are expanding this paradigm without replacing it. This article reviews the transformative role of POCUS as the fourth pillar of clinical assessment, complementing inspection, palpation, and auscultation by providing an immediate, safe, and quantifiable window into the human body. We detail its diagnostic, therapeutic, and educational benefits in adult and pediatric cardiology, alongside challenges for global implementation. Through a critical and humanistic lens, we argue that the true value of these tools lies not merely in their technology, but in their ability to enhance clinical empathy, optimize decision-making, and democratize access to more precise and patient-centered care.
Copyright (c) 2025 David Fernando Ortiz-Pérez, Juan Diego Emiliani-Cortes, Natalia Sofía Torres-Herrera, Mario Enrique Montoya-Jaramillo https://creativecommons.org/licenses/by-nc/4.0
DIAGNOSTIC TOOLS FOR DRUG-INDUCED LIVER INJURY IN ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Objective: To assess the accuracy and validity of diagnostic tools for DILI in patients with acute liver failure, comparing their sensitivity, specificity, and clinical utility. Methods: A systematic review and meta-analysis were conducted on observational studies involving adults with acute liver failure. Three studies (563 patients) were included, analyzing the performance of the RUCAM, DILIN, and NMPA scoring systems. The main outcomes were the sensitivity, specificity, and predictive values of these tools. Results: The DILIN system exhibited the highest sensitivity (95.1%) but a low specificity (23.9%), while NMPA excelled in specificity (99.2%) and showed a positive predictive value of 90.7%. RUCAM demonstrated an intermediate balance with a sensitivity of 90.5% and a specificity of 56%. The most common symptoms of DILI included jaundice (66%), nausea (63%), and abdominal pain (49%). Conclusion: DILIN is effective for the early detection of DILI, though its low specificity may result in false positives. NMPA is more suitable for confirming diagnoses due to its high specificity. Integrating these tools with the development of specific biomarkers and combined diagnostic algorithms could enhance diagnostic accuracy and optimize the management of DILI in acute liver failure.
Copyright (c) 2025 Carlos Hernán Calderón-Franco, Óscar Iván Cujiño-Ibarra, Arlen Mauricio Marquez-Galindo, Natalia Fernanda Calderón-Lopez, Diego Mauricio Aponte-Martín https://creativecommons.org/licenses/by-nc/4.0
Amyotrophic Lateral Sclerosis, forgotten symptoms: case report
Amyotrophic lateral sclerosis (ALS) is characterized by being a neurological pathology with progressive neurodegenerative compromise in first and second motor neurons at the pyramidal pathway, markedly producing muscle weakness and motor disability. It can present a non-motor compromise in up to 50% of patients at the time of diagnosis, such as changes in behavior, cognitive alteration, autonomic symptoms, alterations in swallowing, voice and parkinsonism. We present the clinical case of female 70-year-old patient in whom a suspicion of ALS is made during an outpatient consultation of the neurology service with subsequent confirmation of the diagnosis with electrodiagnostic studies.
Copyright (c) 2025 Ferney Samuel Contento-Anaya, Mario Enrique Montoya-Jaramillo, Elizabeth Avendaño-Arango, David Fernando Ortiz-Pérez, Edgard Eliud Castillo-Támara https://creativecommons.org/licenses/by-nc/4.0
Biological Therapies in Severe Asthma, Case Report and Literature Review.
Uncontrolled severe asthma represents a significant burden for healthcare systems, with patients exhibiting type 2 inflammation (high T2 endotype) being among the most challenging to manage. In recent years, biological therapies have revolutionized the approach to this condition. We present the case of a 47-year-old woman diagnosed with moderate asthma since 2017, who progressed to refractory severe T2 asthma. Despite multiple treatment regimens with bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists, she experienced frequent exacerbations, hospitalizations, and persistent symptoms. Laboratory workup revealed elevated sputum eosinophils (15,635 UI/mL), total serum IgE, and FeNO levels, along with severe obstructive pattern on spirometry and a significant bronchodilator response. Due to lack of control with standard therapies, treatment with Dupilumab (200 mg subcutaneously every two weeks) was initiated, along with combination inhaled therapy and antihistamines. At the two-year follow-up, the patient showed marked clinical improvement, with no new exacerbations or hospitalizations, improved spirometric function (FEV1), and sustained reduction of inflammatory biomarkers. The identification of inflammatory endotypes and the use of biomarkers enable a precision medicine approach, optimizing the management of severe asthma. This case highlights the real-world effectiveness of Dupilumab and underscores the importance of its timely and sustained implementation in appropriate patients.
Copyright (c) 2025 Ricardo Andrés Donado-Botero, David Fernando Ortiz-Pérez, María Fernanda Ahumada-Hernández, Marianella Peréz-Rubio, Karina Margarita Ibañez-Sanchez, Isabella Alejandra Mesa-Beltrán, Valentina Porto-Eljaiek, Mateo Andrés Martínez-Eljach https://creativecommons.org/licenses/by-nc/4.0
Nephrotoxicity induced by amphotericin B deoxycholate in adult patients
Amphotericin B is a polyene antifungal used to treat invasive fungal infections and leishmaniasis. Its main adverse effect is nephrotoxicity, followed by electrolyte imbalances and infusion-related reactions. To minimize these effects, lipid formulations are recommended; however, due to their high cost, many healthcare systems favor the use of the deoxycholate form. A literature review was conducted across multiple databases to identify factors associated with nephrotoxicity induced by amphotericin B deoxycholate. The most common adverse effects were elevated nitrogenous waste products and hypokalemia, followed by anemia, infusion site pain, and phlebitis. Major risk factors included cumulative drug dose, prolonged treatment duration, advanced age, pharmacological immunosuppression, and concurrent use of other nephrotoxic drugs. The most effective preventive strategies were aggressive hydration to increase diuresis, electrolyte replacement—particularly potassium supplementation—and, in some cases, discontinuation of the drug.
Copyright (c) 2025 Ana María Orjuela-Camargo, Laura Natalia Quintana-Murillo, Giovanni Caviedes-Pérez https://creativecommons.org/licenses/by-nc/4.0
Introduction: Amyloidosis is a group of diseases caused by the deposition of misfolded proteins in various organs, potentially leading to bleeding — a rare but serious complication. Case: A 41-year-old man with AL kappa amyloidosis presented with spontaneous intra-abdominal bleeding, associated with coagulation factor deficiencies and hemostatic alterations. Despite transfusion support, antifibrinolytics, and vitamin K administration, the patient’s condition worsened, and he died. Discussion: Bleeding in amyloidosis may result from multiple combined mechanisms, such as acquired coagulation factor deficiencies and vascular dysfunction, making management challenging. Conclusions: Although rare, bleeding in amyloidosis can be fatal; early recognition and comprehensive treatment are essential.
Copyright (c) 2025 Cristina Zurique-Sanchez, Leonardo Solis-Parra, Fabio De la Hoz-Guerra, Marina Zurique-Sánchez, Marina Sánchez-Sanabria, Evelin Herrera https://creativecommons.org/licenses/by-nc/4.0
Klatskin tumor: brief review of the literature and case presentation
Cholangiocarcinomas are malignant neoplasms of the biliary tract and represent the second most common form of liver cancer. The perihilar type, known as Klatskin tumor, arises at the junction of the right and left hepatic ducts and accounts for up to 50% of cases. Although its incidence in Western countries is low (0.3–3.5 cases per 100,000 population), it has increased over the past decade, particularly among older men. We report the case of a 54-year-old male presenting with diffuse abdominal pain, fever, and jaundice, initially diagnosed with biliary sepsis. Magnetic resonance cholangiopancreatography (MRCP) revealed hepatomegaly, liver nodules, and mild biliary dilation. SpyGlass cholangioscopy confirmed a Bismuth type IV Klatskin tumor, deemed unresectable due to vascular invasion. ERCP allowed placement of biliary stents, and endoscopic biopsy confirmed stage IV disease with liver metastases. Management included antibiotics, hemodynamic support, and palliative care due to acute liver failure. This case highlights the aggressiveness of advanced perihilar cholangiocarcinoma and underscores the importance of early diagnosis, accurate staging, and multidisciplinary management.
Copyright (c) 2025 María José Insignares-Osorio, Marycela Díaz-Periñan , Ligia Rosa Cuello-Pacheco , Chelsy Amaris-Calvano , Eduardo Antonio Martínez-Bula , Mario Enrique Montoya Jaramillo , David Fernando Ortiz-Pérez https://creativecommons.org/licenses/by-nc/4.0
Under the skin: the clinical enigma of calcinosis cutis
This article addresses calcinosis cutis, defined as the ectopic deposition of insoluble calcium salts in the dermis and subcutaneous tissue. It can be caused by a variety of mechanisms. It is classified according to etiology as dystrophic (secondary to tissue disruption in the presence of normocalcemia), metastatic (due to alterations in calcium and phosphate metabolism), iatrogenic, and idiopathic. Clinically, it can manifest as asymptomatic subcutaneous nodules or painful ulcerated plaques with calcium exudate, and is particularly complicated in patients with collagen diseases such as systemic sclerosis or juvenile dermatomyositis. We describe the case of a 57-year-old woman with systemic sclerosis who, for the past three months, has presented multiple firm nodules on the anterior aspect of her right knee, without inflammatory signs and with normal calcium and phosphorus levels. The diagnosis, corroborated by clinical and radiographic findings, underscores the importance of a multidisciplinary approach and early recognition to avoid complications and unnecessary procedures.
Copyright (c) 2025 Daniela Lucía Bula-García, Juan Diego Emiliani-Cortés, David Fernando Ortiz-Pérez, Mario Enrique Montoya-Jaramillo https://creativecommons.org/licenses/by-nc/4.0
Decoding the Vascular Code: Angiectasias and Lower Gastrointestinal Bleeding—A Case Report
Introduction: Gastrointestinal angiectasias are vascular malformations that can cause recurrent bleeding, especially in older adults. Objective: To describe the case of a patient with severe anemia secondary to colonic angiectasia and its successful treatment. Methods: A 78-year-old male patient, attended at a tertiary level hospital, presented severe anemia (hemoglobin: 7.1 g/dL). Endoscopic studies were performed: an esophagogastroduodenoscopy, which was normal except for a mild antral gastropathy, and a colonoscopy, in which an angiectasia of approximately 4 mm was detected. Results: The vascular lesion identified at colonoscopy was treated by endoscopic argon plasma ablation, achieving complete resolution of the gastrointestinal bleeding. Conclusion: Angiectasis should be considered in the diagnosis of gastrointestinal bleeding in older adults; therapeutic endoscopy is effective for its management.
Copyright (c) 2025 David Fernando Ortiz-Pérez, Guillermo Olaya-Villarreal , Jorge Armando Yepes-Caro , Jean Carlos Pinto-Angarita, Fernando Luis García-Del Risco https://creativecommons.org/licenses/by-nc/4.0
Frequency of symptomatic hypotension in hospitalized patients with HFrEF treated with NRA: retrospective analysis in a university hospital
Introduction: Heart failure with reduced ejection fraction (HFrEF) is one of the leading causes of cardiovascular morbidity and mortality. Treatment with angiotensin receptor-neprilysin inhibitors (ARNIs) has shown benefits in reducing clinical events; however, their use may be associated with adverse effects. Methods: Observational, retrospective, and analytical study conducted at a hospital in Bogotá between January 2023 and January 2024. The study included 100 adult patients with HFrEF (left ventricular ejection fraction <45%) treated with ARNIs, excluding those with a history of hypotension or contraindications to their use. Results: The median age was 68 years, with a male predominance (74%). Orthostatic hypotension occurred in 25% of patients, a frequency higher than that reported in previous clinical studies. Variables significantly associated with adverse effects included baseline potassium levels (p = 0.041), duration of treatment (p = 0.005), and length of hospital stay (p < 0.001). Associations were also observed with decreased glomerular filtration rate, arterial hypertension, and adjustments in the therapeutic regimen. Conclusions: The frequency of symptomatic hypotension was higher than that reported in pivotal studies, especially among patients with comorbidities. These findings highlight the importance of individualizing dosing and closely monitoring vulnerable populations.
Copyright (c) 2025 Carlos Darío Agudelo-Castañeda, Luis Carlos Chávez-Borja, Carlos Hernán Calderón-Franco https://creativecommons.org/licenses/by-nc/4.0
Review: Care, vulnerability and interdependencies. New political challenges. María Teresa Martín Palomo
The book Cuidado, vulnerabilidad e interdependencias. Nuevos retos políticos (2016) by María Teresa Martín Palomo, is a key work for the study of care from an interdisciplinary perspective. The author, with extensive experience in gender studies and social policy, articulates concepts such as interdependence and vulnerability, based on qualitative and ethnographic analysis. Throughout six chapters, the book addresses care from the perspective of gender, the materiality of domestic work, its moral and emotional dimension, the role of the State in social policies and the need for an ethics of care based on interdependence and affection. This work invites us to rethink care as a central element in the construction of fairer and more equitable societies.
Copyright (c) 2024 Anderson Yamid Álvarez-Plazas https://creativecommons.org/licenses/by-nc/4.0
Immune-mediated microangiopathy manifestations mediated by complement in a patient with antiphospholipid syndrome. Case report
A case report is presented from a hospital in the city of Bogota, Colombia, on a 21-year-old patient with multiple early gestational losses associated with high blood pressure that was difficult to manage and required monitoring in the intensive care unit. Subsequently, she presented neurological deterioration due to intraparenchymal hemorrhages, being considered a possible thrombotic etiology secondary to antiphospholipid syndrome. In this report, we compile the diagnostic criteria for antiphospholipid syndrome and the factors that could explain the clinical events presented, which represent a challenge in medical practice.
Copyright (c) 2024 Aníbal Cortés-Bravo, Carlos Hernán Calderón Franco https://creativecommons.org/licenses/by-nc/4.0
Post-COVID-19 respiratory sequelae: study of critical and intermediate patients in a high complexity clinic in Neiva (2020-2021)
Background: COVID-19 infection, caused by SARS-CoV-2, has generated a significant impact on respiratory health globally, with a high percentage of hospitalized patients developing long-term pulmonary sequelae, especially in those with severe disease requiring intensive care. Objective: to identify and analyze the persistent respiratory sequelae in patients who were hospitalized in a high complexity clinic in Neiva, Colombia, during the period between 2020 and 2021. Methods: a descriptive and retrospective study was carried out based on the review of 285 medical records. Results: 72.2% of patients hospitalized for COVID-19 developed long-term respiratory sequelae after hospital discharge, with dyspnea (45.6%) and pulmonary fibrosis (24.9%) being the most frequent. A significant relationship was identified between length of ICU stay, prolonged use of mechanical ventilation and the development of pulmonary fibrosis. In addition, comorbidities such as hypertension and diabetes were associated as important risk factors for the development of these sequelae. Conclusion: it is imperative to establish pulmonary rehabilitation programs and ensure prolonged follow-up in post-COVID-19 patients in order to mitigate the impact of sequelae and optimize their quality of life. This study provides valuable insight into the situation in a previously under-researched region, contributing to the growing body of knowledge about COVID-19-associated respiratory sequelae in critical care settings.
Copyright (c) 2024 Sergio Julián Perdomo Reyes, Diana Cecilia Mojomboy Palechor, Valentina Pastrana Trujillo, Dayana Valentina Rodríguez https://creativecommons.org/licenses/by-nc/4.0
Ashman's phenomenon: a crucial finding to avoid misdiagnosis
The Ashman phenomenon, first described in 1947 by Gouaux and Ashman, is an intraventricular conduction aberration that typically occurs during atrial fibrillation and other supraventricular tachyarrhythmias. This phenomenon is characterized by the presence of aberrant QRS complexes, usually with right bundle branch block (RBBB) morphology, resulting from the interaction between consecutive long and short R-R interval cycles. The physiological basis lies in the variability of the relative refractory period of the cardiac conduction system, where a long cycle precedes a short cycle, prolonging the refractory period and favoring aberrant conduction. Ashman's phenomenon can be clinically relevant, as it is often confused with premature ventricular complexes or ventricular tachycardia, which could lead to misdiagnosis and inappropriate therapy.
Copyright (c) 2024 Juan Diego Emiliani-Cortés, David Fernando Ortiz-Pérez, Mario Enrique Montoya-Jaramillo https://creativecommons.org/licenses/by-nc/4.0
Pulmonary manifestations in lupus, spontaneous pneumothorax, a case report
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by an immune-mediated inflammatory process that affects multiple organs, with renal involvement in approximately 40% of cases and pulmonary involvement in a range of 20% to 90%. We present the case of a 33-year-old female patient diagnosed with SLE nine years ago, with adequate medical follow-up and no toxicological history. She consulted for respiratory symptoms of two months of evolution, treated twice as pneumonia, which worsened ten days prior to her admission. Symptoms included dry cough, dyspnea on moderate exertion and pleuritic pain in the right hemithorax. Physical examination showed decreased breath sounds and tympanism on percussion in the right hemithorax. The diagnosis of spontaneous hydropneumothorax was established, with the identification of subpleural cysts in both lung fields. Infectious etiology was ruled out and the condition was attributed to lupus reactivity, requiring treatment with corticosteroid pulses and closed thoracostomy. SLE can generate pulmonary manifestations throughout its evolution, so it is essential to consider this possibility and to perform an exhaustive evaluation in patients with persistent respiratory symptoms.
Copyright (c) 2024 Elías José Zakzuk-Martínez , Mario Enrique Montoya-Jaramillo, Ricardo Andrés Donado-Botero, Beatriz Elena Suárez-Romero, Cristina Rivera-Hernández, David Fernando Ortiz-Pérez https://creativecommons.org/licenses/by-nc/4.0
Relationship of dermatomyositis and deep vein thrombosis: Case report
Dermatomyositis is an inflammatory myopathy of autoimmune etiology, characterized by symmetrical involvement of muscle groups, generally proximal. This condition can present progressive deterioration affecting the mobility of certain muscle groups, and can also present with other complications, such as vascular involvement, which predisposes to thrombus formation. We present the case of a 40-year-old patient admitted for progressive deterioration of strength in the lower limbs, who was diagnosed with dermatomyositis based on quadriceps muscle biopsy findings. Subsequently, he presented a deep vein thrombosis associated with the disease.
Copyright (c) 2024 Ferney Samuel Contento-Anaya , Ricardo Andrés Donado-Botero, Mario Enrique Montoya-Jaramillo , Camilo Andrés Arango, Maria José Santana-Ruiz , Valentina Porto-Eljaiek , María Paula Chimbi-Bru, María de los Ángeles Díaz-Rosales, David Fernando Ortiz-Pérez https://creativecommons.org/licenses/by-nc/4.0
III cranial nerve palsy associated with intracranial aneurysm: case report and management review
Intracranial aneurysms, with a prevalence of 3.2%, are a significant cause of subarachnoid hemorrhage and severe neurological deficits. Saccular aneurysms account for approximately 90% of cases, with advanced age, female sex, hypertension and smoking being common risk factors. This case describes a 68-year-old female patient who presented with severe headache and palpebral ptosis. Diagnostic studies confirmed the presence of a saccular aneurysm in the left posterior communicating artery, which was successfully treated by endovascular embolization. Clinical, diagnostic and therapeutic aspects are discussed in the context of a multidisciplinary approach.
Copyright (c) 2024 Beatriz Elena Suárez-Romero, Mario Enrique Montoya-Jaramillo , David Fernando Ortiz-Pérez, Elías José Zakzuk-Martínez , Valentina Coderque-Sepúlveda https://creativecommons.org/licenses/by-nc/4.0
Study on body composition and glycemic control in type 1 diabetes: insulin infusion therapy and continuous monitoring
Introduction: the increase in overweight and obesity represents an increasingly frequent challenge in people with type 1 diabetes mellitus (DM1). These conditions can negatively impact metabolic management, increasing the risk of associated complications. Objective: to establish changes in body composition and glycemic control in patients with DM1 after three months of initiating therapy with continuous subcutaneous insulin infusion (CSII) plus CGM. Materials and methods: the changes that occurred 3 months after initiating therapy with continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) were analyzed in a group of patients (n=30). Parameters related to body composition (weight, height, body mass index, body fat percentage, muscle mass and visceral fat), glycemic control (HbA1c, coefficient of variation and time in range -TIR), as well as the amount of insulin used and carbohydrates consumed were evaluated. Results: a total of 29 patients with DM1 completed three months of treatment with CSII and CGM. At the end of follow-up, a reduction in median HbA1c was observed from 7.5% (RIC 7 - 8.7) to 6.8% (RIC 6.7% - 7.1%) (p<0.0001). In addition, the TIR within the target range (70 - 180 mg/dl) increased from 70% (RIC 57% - 78%) to 79 % (RIC 68% - 85%) (p = 0.0080). There were no significant changes in body composition indicators or in the daily amount of insulin administered. Conclusion: in patients with DM1 who received CSII and CGM for a period of three months, no relevant changes in body composition were identified. However, an improvement in glycemic control was evidenced, reflected in a decrease in HbA1c and an increase in time within the target glycemic range.
Copyright (c) 2024 Carlos Javier Vizcaino Guerrero, Adriana Medina Orjuela, Diana Carolina Coral Coral, Julio Edil Benítez Montes, Carlos Hernán Calderón Franco, Amina Luz Ely Páez https://creativecommons.org/licenses/by-nc/4.0
Hepatic tuberculosis as the first manifestation of miliary tuberculosis, case report
Tuberculosis (TB) infection is a major public health problem worldwide, being the most common opportunistic infection in people infected with human immunodeficiency virus (HIV) and the leading cause of death in patients in low- and middle-income countries, such as Colombia. The interaction between Mycobacterium tuberculosis and HIV has been widely studied due to the diversity of clinical manifestations associated with the compromise of cellular immunity. Among these are atypical manifestations, such as hepatic tuberculosis, which represents less than 1% of extrapulmonary TB cases. In this context, we present a case of hepatic tuberculosis reported in a TB referral center in Bogotá, Colombia, being one of the few documented cases in the country.
Copyright (c) 2024 Andrea Córdoba-Guzmán, Estefanía Vargas-Reales, Daniela Alejandra Gómez-Mahecha, Oscar Alberto Sáenz-Morales, Carlos Hernán Calderón-Franco https://creativecommons.org/licenses/by-nc/4.0
Clinical and humanistic explorations in medicine
Copyright (c) 2023 Thiago Andrés Navarro Álvarez https://creativecommons.org/licenses/by-nc/4.0
Non-variceal upper gastrointestinal hemorrhage secondary to severe dengue: A case report
Dengue is an emerging infectious disease with high prevalence in tropical and subtropical areas and a significant public health impact. The virus is transmitted mainly by Aedes aegypti and Aedes albopictus mosquitoes. Although most cases are mild, severe dengue can lead to hemorrhage, shock, and death. We present the case of a 19-year-old female patient with confirmed dengue who presented with an episode of gastrointestinal tract hemorrhage characterized by frank hematemesis. Platelet transfusions, tranexamic acid and fluid management were performed and she progressively stabilized. This case underscores the importance of early identification and management of severe complications of dengue to reduce adverse outcomes.
Copyright (c) 2024 David Fernando Ortiz-Pérez, Mario Enrique Montoya-Jaramillo , Ricardo Andrés Donado-Botero, Elías José Zakzuk-Martínez , Carlos Mauricio De La Peña-Pérez, Jesús José Daza-Iguarán, Sebastián Andrés Montes-Oliver https://creativecommons.org/licenses/by-nc/4.0
Characterization of the ferrokinetic profile of patients with chronic kidney disease
Background: Chronic Kidney Disease (CKD) is a progressive pathology that significantly affects quality of life and is associated with complications such as iron deficiency and anemia. This study analyzes the ferrokinetic profile in patients with CKD, evaluating factors such as ferritin levels and transferrin saturation. Objective: to describe the demographic and clinical particularities of patients diagnosed with Chronic Kidney Disease (CKD) stages 2 to 5, as well as their ferrokinetic profile. Methods: a cross-sectional observational study was conducted in a hospital in Bogota. The sample included 139 patients over 18 years of age with a diagnosis of CKD and evaluation of the ferrokinetic profile. Demographic, clinical and laboratory results were collected. Results: the mean age was 68.2 years, predominantly male (66.9%). There was a high prevalence of iron deficiency (57.2%), associated with elevated ferritin levels (372.9 ± 363.3 mg/dL) and low transferrin saturation (19.2 ± 13%). The most frequent comorbidities were type 2 diabetes mellitus (33%) and coronary heart disease (42.4%). Mortality was 14.4%. Conclusions: iron deficiency is frequent in patients with CKD and is associated with inflammation and erythropoietin deficiency, which increases the burden of morbidity and mortality. Adequate management of iron deficiency and comorbidities is essential to improve the prognosis in this population, highlighting the importance of a comprehensive approach in its treatment.
Copyright (c) 2024 Carlos Hernán Calderón-Franco, María José Castro-Salas, Juan David López-Restrepo, Johanis Yuleidi Polo-Bossio, Lorena Marcela Ramírez-González, Gary A. Baquero-Lopera https://creativecommons.org/licenses/by-nc/4.0