Fundación Universitaria Sanitas

To provide recommendations for the most appropriate endovascular intervention of femoropopliteal (FP) arterial disease based on plaque characterization. A panel of 22 physicians from multiple disciplines participated in a modified Delphi consensus, leveraging the RAND/UCLA Appropriateness Method. Panelists engaged in 2 rounds of voting, following a literature review, with an in-person discussion prior to the second round of voting. A rigorous statistical approach was used to analyze the points of agreement and disagreement. Consensus-based recommendations on the most appropriate endovascular approaches for treating patients with FP lesions, stratified by lesion morphology, were generated. Overall, 490 individual items were included in the voting, 458 (93%) of which achieved consensus and 32 (7%) were nonconsensus items, based on a priori criteria under the following categories: (a) recommendations on method for determining plaque morphology, (b) preferred endovascular devices for vessel preparation and definitive treatment stratified by (i) plaque morphology and (ii) Tosaka classification of in-stent restenosis, and (c) vessel preparation device safety-related considerations. This international, multidisciplinary consensus provides evidence- and expert-informed recommendations for vessel preparation and definitive treatment of FP arterial disease, tailored to plaque morphology. These consensus recommendations aim to support clinical decision making and promote best interventional practices by serving as an expert opinion supplement to existing guideline-based care pathways.

Background/Objectives: To determine and validate the cluster trajectory model by dynamic subphenotypes of vital signs in infecti ons and prediction of 30-day mortality. Methods: We conducted a prospective study in the emergency department of Clínica Colombia with patients with suspected infection. Clinical data, vital signs, and 30-day mortality were collected. Vital signs were measured within the first 24 h of admission, and patients were classified according to a vital signs trajectory model into four groups: A, B, C, and D. Results: The final cohort consisted of 625 patients, and the subphenotypes, according to the vital signs, were as follows: A-2.66% (all vital signs altered), B-9.2% (at least one alteration, predominantly hypertension), C-19% (minimal or no alteration, control), D-69.2% (only arterial hypotension). The primary outcome was mortality. Overall mortality was 8.6%, being higher in group A followed by D, B and C (p = 0.009). The risk increased progressively in groups B (OR = 2.87, CI 95%: 0.62-13.25), D (OR = 4.77, CI 95%: 1.46-15.58), and A (OR = 8.33, CI 95%: 1.54-45.05). Group A presented more frequently with pneumonia (p = 0.002), CNS infections (p = 0.021), mechanical ventilation (p < 0.001), and vasopressor support (p < 0.001). Significant differences among groups were found in leukocytosis (B vs. C p = 0.026), neutrophilia (B vs. C p = 0.001 and B vs. D p = 0.042), lymphocytosis (B vs. D p = 0.002), neutrophil/lymphocyte ratio (A vs. C p = 0. 010), lactate (C vs. D p = 0.044), anemia (B vs. D p = 0.013 and C vs. D p = 0.001), and CRP (A vs. C p = 0.004, B vs. C p < 0.001 and C vs. D p < 0.001). Conclusions: Patients with suspected infection and more altered vital signs have higher mortality (group A) and benefit from earlier interventions by sepsis teams in the emergency department.

BackgroundThe available evidence regarding the sequential performance of gastrointestinal tract restoration and abdominal wall reconstruction in two surgical stages during a single hospitalization is limited and is based primarily on case series. In this study, we present our experience with the aim of describing the outcomes obtained in the repair of complex abdominal wall defects and the restoration of intestinal continuity using a two-stage approach within the same hospital stay.MethodsCase series of patients who underwent elective surgery for gastrointestinal tract restoration, followed by abdominal wall reconstruction in a second surgical stage during the same hospitalization. Medical records of procedures performed between 2018 and 2023 were reviewed. All interventions were carried out electively by a multidisciplinary team involving the abdominal wall surgery group and colorectal surgery.ResultsA total of 30 patients were included. Both surgical procedures were completed in 73% of cases, with a mean interval of 6.3 days between the two surgeries. In 26% of patients, it was not possible to complete both procedures; the most frequent causes were anastomotic leakage and surgical site infection, each occurring in 9% of cases. The mean length of hospital stay was 14 days. The most common complications were postoperative ileus, anastomotic leakage, intestinal perforation, and deep surgical site infection.ConclusionAlthough concomitant surgery is associated with a higher risk of complications particularly in the setting of complex hernias—in appropriately selected patients, sequential procedures performed during the same hospitalization can achieve favorable outcomes, especially in stoma reversal. The implementation of prehabilitation programs and the adoption of shared decision-making models are essential to optimize outcomes and reduce associated morbidity.

Primary cardiac tumors are rare, with an incidence of less than 0.33%, and the majority are benign. Sarcomas account for approximately 75% of malignant cardiac tumors, while myxofibrosarcomas represent less than 5% of these cases, making them extremely uncommon. This case report was prepared following the CARE guidelines to ensure comprehensive and transparent reporting and aims to describe the diagnostic and therapeutic challenges of cardiac myxofibrosarcoma. A 60-year-old woman with no relevant medical history complained of epigastric pain, dyspnea, and diaphoresis, leading to a diagnosis of non-ST-elevation myocardial infarction. Transthoracic echocardiography revealed a heterogeneous 3.2 × 3.0 cm mass attached to the atrial side of the anterior mitral valve leaflet, which was subsequently surgically removed. Histological examination of the resected mass identified abundant fibrin, vascular proliferation, and sparse cellularity without definitive evidence of malignancy, suggesting an organized intracardiac thrombus as a differential diagnosis. Four months later, the patient developed progressive dyspnea, orthopnea, and fatigue. Further evaluation with cardiac magnetic resonance imaging revealed a recurrent 4.4 × 4.0 cm mass in the left atrium, obstructing mitral inflow. A second surgical resection and valve replacement were performed. The histopathological analysis identified polygonal and spindle-shaped myofibroblasts embedded in a myxoid stroma with scattered lymphocytes, plasma cells, and focal necrosis. Immunohistochemical staining showed focal positivity for Smooth Muscle Actin, CD34, and p53, with negative staining for h-caldesmon, myogenin, CKAE1/3, CD117, S100, calretinin, MDM2, calponin, D2-40, MyoD1, and CD31confirming the diagnosis of myxofibrosarcoma. Cardiac myxofibrosarcomas are rare but aggressive tumors with a potential for recurrence. This case highlights the diagnostic challenges posed by their atypical presentation and the risk of initial misdiagnosis. Regular follow-up using multimodal imaging, particularly cardiac magnetic resonance, is crucial for early detection and timely intervention of recurrence. A multidisciplinary approach involving cardiologists, radiologists, pathologists, and cardiac surgeons is essential to optimize diagnosis, treatment, and long-term outcomes.

Introducción. En la actualidad se realizan aproximadamente 160 millones de procedimientos quirúrgicos, programados en franjas convencionales. Sin embargo, la capacidad instalada es deficiente para asegurar la cobertura universal deseada en salud. Se plantea la cirugía en horario extendido como un elemento a tener en cuenta, que puede permitir un incremento en la atención. A pesar de esto, su implementación es variable y polémica, no hay lineamientos que la reglamenten ni evidencia, por lo que el objetivo de este artículo fue evaluar la percepción de los diversos actores involucrados. Métodos. Se realizó un estudio cualitativo exploratorio, con enfoque fenomenológico, mediante entrevistas semiestructuradas a diversos actores identificados de las intervenciones. Se hizo codificación y análisis inductivo y de contenido para dar significado. Resultados. Se obtuvieron 39 entrevistas, distribuidas en los cuatro grupos de actores. Se establecieron códigos únicos, categorías y subcategorías con ayuda de análisis de frecuencia, coocurrencia y relaciones derivadas de experiencias vividas durante las entrevistas. Conclusiones. Hay elementos en común mencionados por los actores que permiten evidenciar mecanismos internos de negociación para asegurar la participación en los programas. De igual forma, se presentan objeciones frente a la posibilidad de complicaciones y elementos económicos susceptibles de negociación.

Understanding help-seeking behaviors of young people with mental health concerns is crucial for developing responsive mental health services and policies. This study aimed to explore the help-seeking journeys of Colombian youth, the formal and informal services they reached out to when faced with psychological distress and the order in which these services were consulted. Additionally, it examined the differences between pathways of actual service users and those modeled by fictional characters. This study employed a mixed-methods design to explore help-seeking behaviors among Colombian youth (ages 10-19) facing mental health concerns, with a focus on service usage, sequence of access, and differences between actual (Clinical Sample, CLS) and perceived pathways (Community Sample, COS). The methodology combined semi-structured interviews, visual journey mapping, and social network analysis (SNA) to capture both qualitative and quantitative dimensions. 30 young people (53% female, median age = 16, IQR = 3) participated in interviews, of which 19 disclosed past service usage (CLS) and 11 narrated hypothetical scenarios (COS). The findings revealed the absence of a 'typical' care seeking pathway. A trend, however, was observed of prioritizing informal services, such as friends and family, as an initial step in help-seeking behavior. CLS participants reported longer and more complex service pathways, averaging 14.7 services, often involving specialists such as psychiatrists and other medical specializations, with third-party involvement (e.g., parents, educators) in initiating contact. Hypothetical journeys were shorter, with a median of 8 services, always initiated by the characters, and mostly resolved within community settings, with educators and psychologists as key sources of support. In both groups, the primary objective of help-seeking was symptom reduction; however, actual service users took two times longer (Mdn = 120, IQR = 700) to seek helpfrom the onset of symptoms than those projected on fictional characters (Mdn = 60 days, IQR = 90). The study demonstrates the importance of informal support systems regardless of youth's past service usage and help-seeking experience. It also reveals discrepancies between how help-seeking is perceived and experienced showing an underestimation of the complexity involved in finding mental health support which could potentially explain delays in help initiation and difficulties in navigating support resources.

Abstract Background Ulcerative colitis (UC) requires effective therapeutic strategies to induce and maintain remission. Upadacitinib, a selective JAK1 inhibitor, has shown strong efficacy in clinical trials; however, real-world evidence in Latin American populations remains scarce. The UPARECOL-UC study evaluated the effectiveness and safety of upadacitinib in Colombian patients with UC during induction (8–16 weeks) and maintenance (24 weeks) under routine clinical practice. Methods A prospective multicentre cohort study was conducted across Colombian reference centres including adults with confirmed UC (clinical, endoscopic, and histological criteria) who initiated upadacitinib between 2024 and 2025 for ≥8 weeks. Effectiveness outcomes included clinical response, clinical remission, and steroid-free remission. Objective biomarkers (C-reactive protein, faecal calprotectin, haemoglobin) were monitored at baseline and follow-up. Safety variables included adverse events (AEs), serious AEs, infections, and treatment discontinuation. Results A total of 47 patients were included in the induction analysis. After 8–16 weeks, clinical remission was achieved in 61.7% (29/47), with steroid-free remission in 71.4% of responders. At week 24, clinical remission increased to 90% (18/20), and steroid-free remission reached 88.2%. Endoscopic remission (Mayo 0–1) was 85% among patients reassessed endoscopically during maintenance. Significant reductions in inflammatory biomarkers were observed during follow-up, supporting clinical improvement. Colectomy occurred in 5.4% of patients during induction, with no colectomies during maintenance. Overall, 30.2% experienced any AE; acne was the most common (25.6%). Serious infections occurred in 4.7% . Treatment discontinuation due to AEs occurred in 9.3% of the cohort. No new safety signals were identified. Conclusion Upadacitinib demonstrated high real-world effectiveness for both induction and maintenance in this Colombian UC cohort, composed largely of patients with severe and treatment-refractory disease. Improvements in clinical outcomes were accompanied by significant reductions in inflammatory biomarkers. The safety profile was consistent with previous clinical and real-world data, supporting upadacitinib as an effective therapeutic option for UC in routine practice. Conflict of interest: Parra Izquierdo, Leidy Viviana: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Juliao Baños, Fabián: No conflict of interest Puentes-Manosalva, Fabian Eduardo: No conflict of interest Cuervo-Pico, Pedro-Eduardo: No conflict of interest Galiano, Maria Teresa: No conflict of interest Riveros, Javier: No conflict of interest Gomez Venegas, Alvaro: No conflict of interest Medrano-Almanza, Carlos Andres: No conflict of interest Perea, Daniel: No conflict of interest Ballesteros, Manuel: No conflict of interest Barreto Perez, Jonathan: No conflict of interest Cuadros-Mendoza, Carlos Augusto: No conflict of interest Guzman, Gerardo: No conflict of interest Gutierrez Raba, Aura: No conflict of interest Soto Mora, Jahir: No conflict of interest Dr. Frías-Ordoñez, Juan: No conflict of interest