Hospital Universitario de San Vicente Fundación

Trauma is a frequent cause of hospital admission in adults, and while arterial hypertension is common in the general population, reactive hypertension associated with trauma remains poorly studied from a therapeutic perspective. This retrospective cohort study aimed to estimate the impact of antihypertensive treatment on hypotension occurrence, in-hospital mortality, and length of stay in patients with musculoskeletal trauma. We analyzed data from a high-complexity center in Colombia between 2020 and 2024, including adults over 18 years with musculoskeletal trauma who had no previously known hypertension but presented two blood pressure readings >140/90mmHg during hospitalization. Patients were categorized into those receiving antihypertensive treatment versus no prescription. Primary outcomes were assessed using logistic, linear, and time-to-event regression models for hypotension requiring medical intervention, in-hospital death, and length of stay. Among 712 patients analyzed, most were young men (77% male, mean age 35 years) with few comorbidities (obesity 6.2%, diabetes 4.6%). Sixty percent had open fractures requiring surgical management. Antihypertensive drug exposure was significantly associated with hypotension (OR 11.9, 95% CI 5.69-26.4) but showed no significant association with in-hospital death (OR 5.18, 95% CI 0.79-39.6), length of stay (1.5 days, 95% CI -0.1 to 3.1), or time-to-discharge alive (HR 0.79, 95% CI 0.59-1.06). Our findings suggest that treating reactive hypertension in hospitalized musculoskeletal trauma patients may increase hypotension risk without improving mortality or length of stay outcomes.

La gastroenteroanastomosis guiada por ultrasonido endoscópico (GE-USE) ha emergido como una técnica innovadora y mínimamente invasiva, constituyendo una opción de manejo paliativo para pacientes que presentan síndrome de obstrucción maligna en el tracto de salida gástrico, especialmente en aquellos con carcinomas gástricos y pancreáticos localmente avanzados. Además, se ha descrito el drenaje biliar guiado por ecografía endoscópica (DB-USE) a través de un abordaje transmural gástrico o duodenal, como una técnica para el tratamiento de la obstrucción biliar maligna. Esta opción es particularmente útil cuando se anticipa que la papila duodenal será de difícil acceso debido a problemas locales, anomalías anatómicas o luego de intentos fallidos de realizar una colangiopancreatografía retrógrada endoscópica (CPRE). En este artículo se presenta el caso de un paciente con obstrucción del tracto de salida gástrico y obstrucción biliar maligna, que fue tratado con una gastroenteroanastomosis guiada por ultrasonido endoscópico secundario a una recaída de un adenocarcinoma ductal infiltrante de páncreas, que había sido inicialmente manejado con pancreatoduodenectomía proximal, reconstrucción de la vía biliar, linfadenectomía y quimioterapia adyuvante.

BACKGROUNDColorectal cancer is the third most common malignancy globally, with the liver being the predominant site of metastatic disease.AIMTo evaluate safety, feasibility, and outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR) and open liver resection (OLR) for colorectal metastasis (CRLM).METHODSThis study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Systematic searches in PubMed, EMBASE, Scopus, and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM. Two independent reviewers screened studies using predefined PICO (Population, Intervention, Comparator, Outcome) criteria, with data extraction focusing on conversion rates, operative outcomes, morbidity, mortality, and survival. Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2. Pooled analyses were performed for comparative data; noncomparative studies were narratively synthesized.RESULTSPooled evidence from two comparative systematic reviews (9792 patients) demonstrated that RLR offers distinct advantages over LLR and OLR, including significantly lower conversion rates (4.7%–6.7% vs 10.4%–12.4%, P < 0.001) and reduced intraoperative blood loss (190.8–266.8 mL vs 283.9–294.3 mL, P < 0.001) despite longer operating times (mean 304.1 vs 191.8 min). Perioperative safety and oncologic outcomes (R0 resection > 82%; 5-year overall survival: 53.1%–60.8%) were comparable across approaches. Three additional noncomparative reviews (n = 274) highlighted the technical practicability of RLR in complex cases (zero conversions in small cohorts, median 399.5 min for simultaneous resections). However, these findings were not included in pooled analyses due to the lack of comparator groups. Noncomparative data (n = 274) revealed higher upfront costs for RLR due to prolonged operating times (median 399.5 min) and the need for expensive equipment; however, no formal cost comparisons were available.CONCLUSIONRLR is a safe and feasible alternative to LLR and OLR for CRLM, demonstrating superior technical performance and comparable short-term outcomes.

Los bisfosfonatos intravenosos usados ampliamente en el manejo de la osteoporosis y de la hipercalcemia maligna son medicamentos con potencial nefrotóxico. Se pueden asociar con necrosis tubular aguda y glomeruloesclerosis focal y segmentaria. Se presenta el caso de una mujer de 79 años que posterior a la aplicación intravenosa de ácido zoledrónico para el tratamiento de su osteoporosis, desarrolló nefritis tubulointersticial aguda que le produjo una lesión renal aguda con requerimiento de terapia de reemplazo renal, con buena respuesta al tratamiento con glucocorticoides.

Chest X-Ray Interpretation in the EPICO Pediatric COVID-19 Study: Addressing MisconceptionsLuis Miguel Navarro‐Ramirez¹˒² | Pablo Vásquez‐Hoyos³˒⁴ | María Lucía Mesa‐Rubio⁵ | Melisa Naranjo Vanegas¹˒⁶ | Daniela Duarte-Montero¹˒⁷ | Claudia Burgos⁵ | Laura Melissa Mendez⁵ | María Margarita Rodriguez⁵ | Arianna Martinez⁵ | Paola Sanchez⁵ | Carolina Tovar⁵ | Gabriela Friedrich¹ | Gustavo Adolfo Triana‐Rodriguez⁸ | Mónica Royero‐Arias⁹ | Jessica Echeverry¹⁰ | Tamara Gamo¹⁰ | Luz Ángela Moreno⁴˒¹⁰ | Olga Lucía Baquero¹¹ | Luz Marina Mejía¹² | Sonia Restrepo‐Gualteros⁵ | Sergio Moreno‐Lopez¹ | Juan Gabriel Piñeros⁵ | Carlos Álvarez‐Moreno⁴˒¹³ | Alejandro Díaz‐Díaz¹⁴˒¹⁵ | Iván Felipe Gutierrez¹⁶ | Clara Galvis‐Diaz¹⁷ | José Manuel Nieto¹⁸ | Irati Gastesi¹⁹ | Cinta Moraleda¹⁹ | Alfredo Tagarro García¹⁹ | Andrea Ramirez Varela²⁰˒²¹˒²² | EPICO‐Colombia and EPICO‐AEP working groups¹ School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia ² Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA ³ Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay ⁴ School of Medicine, Universidad Nacional de Colombia, Bogotá D.C., Colombia ⁵ Department of Pediatrics, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁶ Medical Imaging & AI Group - Bioscience Center, Ayudas Diagnósticas Sura, Medellín, Antioquia, Colombia ⁷ PediAFe Research Group, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁸ Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia ⁹ Pediatric Radiology, Servicios de Salud San Vicente Fundación, Medellín, Antioquia, Colombia ¹⁰ HOMI, Fundación Hospital Infantil de la Misericordia, Bogotá D.C., Colombia ¹¹ Clínica Infantil Colsubsidio, Bogotá D.C., Colombia ¹² Instituto de Ortopedia Infantil Roosevelt, Bogotá D.C., Colombia ¹³ Clínica Universitaria Colombia, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁴ Pediatric Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia ¹⁵ Pediatric Infectious Diseases, Hospital General de Medellín, Medellín, Antioquia, Colombia ¹⁶ Pediatric Infectious Diseases, Clínica Infantil Santa Maria del Lago, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁷ Hospital Militar Central, Bogotá D.C., Colombia ¹⁸ Hospital Regional de la Orinoquía, Yopal, Casanare, Colombia ¹⁹ Fundación Investigación Biomédica Hospital Universitario 12 de Octubre (FIBH12O), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain ²⁰ Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA ²¹ Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas, USA ²² School of Public Health, Center for Health Equity, University of Texas Health Science Center at Houston, Houston, Texas, USACorresponding author: Luis Miguel Navarro-Ramirez | Lm.navarror@uniandes.edu.coAddress for reprint: Universidad de los Andes, School of Medicine, Carrera 7 # 116-05, Bogotá DC, Colombia.To the editor,We appreciate the opportunity to respond to the commentary by Daungsupawong and Wiwanitkit regarding our manuscript, “What to Look for in Chest X-Rays of Pediatric Patients With COVID-19: Insights From a Colombian Cohort” [1,2]. We thank the authors for their interest in our work and their thoughtful engagement. Several of the concerns raised in the commentary were, in fact, addressed in the original manuscript; nonetheless, we welcome the opportunity to clarify these points and provide additional context where needed.

ObjectiveTo identify factors associated with individual Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) accrual items in 1385 patients from the Latin American SLE incident cohort (GLADEL (Grupo Latino Americano Del Estudio de Lupus)).MethodsLongitudinal cohort study. SDI assessed yearly, and damage accrual defined as a SDI change in any individual item during follow-up. Sociodemographic and clinical characteristics at entry, along with regular medication use up to the month prior to each damage item accrued, were analysed using multivariate Cox proportional hazard models with time-varying hazard risk effect performed. Models for overall damage and 10 items with at least 28 patients per item are reported.ResultsNew damage was accrued by 658 patients with SLE (48%) over a median of 54 months (p25–75: 29–71) of follow-up. Mestizo ethnicity, recent SLE Disease Activity Index (SLEDAI) and immunosuppressants were predictors of overall damage accrual, while antimalarials and rural residence were protectors; mixed effects were observed for SDI >0 and glucocorticoids (GCs) use. Protectors for scarring chronic alopecia (23.7% at 7 years follow-up) included older age, longer disease duration, diagnostic delay, SDI >0 and cytotoxic use. Proteinuria >3.5 g/24 hours (11.5% at 7 years follow-up) was associated with protective factors like older age, longer disease duration and higher GCs dose, while risk factors were Mestizo ethnicity, low medical coverage, higher SLEDAI scores and cytotoxic use. In addition, Mestizo ethnicity was a risk factor for estimated glomerular filtration rate <50% and end-stage renal disease (ESRD) whereas antimalarial protected from ESRD. GCs were risk factors for pericarditis, retinal change or optic atrophy but provided protection against proteinuria >3.5 g/24 hours. Recent disease activity and cytotoxic use were significant risk factors for additional items.ConclusionsFactors associated with damage accrual differ substantially by individual SDI items. Mestizo ethnicity and recent disease activity increased renal risks, while antimalarials were protective. GCs showed mixed effects. Item-specific strategies are crucial to mitigate long-term damage.

La distrofia muscular de Duchenne es una enfermedad que se asocia a debilidad muscular progresiva y deterioro funcional. El manejo clínico, la instauración del tratamiento y el seguimiento de los pacientes dependen del estado funcional y del impacto de la enfermedad en la calidad de vida. Las escalas funcionales son instrumentos estandarizados y validados de medición, que permiten realizar un seguimiento a la evolución de la enfermedad, caracterizar el fenotipo de los pacientes, predecir la pérdida funcional y evaluar el impacto de las intervenciones. La presente revisión busca describir las escalas funcionales que, de acuerdo con la evidencia disponible, pueden ser utilizadas en pacientes con DMD.

Hemos leído con particular interés el estudio de Barón-Méndez LE, et al. 1 titulado: “Utilidad del Pediatric Appendicitis Score (PAS) para el diagnóstico de apendicitis aguda en pacientes pediátricos”, que tuvo por objetivo determinar el rendimiento del PAS en nuestra población, estratificado en categorías de bajo riesgo, intermedio y alto. A diferencia de este estudio colombiano, Salahuddin SM, et al. 2, reportaron los hallazgos histopatológicos obtenidos tras la apendicectomía, lo que permitió correlacionar de forma objetiva la clasificación PAS con la confirmación diagnóstica de apendicitis aguda. En dicha cohorte, se identificó apendicitis en el 66,6 % de los niños con PAS de bajo riesgo, 97,7 % de riesgo intermedio y 98 % de alto riesgo. Estos datos refuerzan la utilidad del PAS como herramienta predictiva, especialmente en los grupos de riesgo intermedio y alto, donde la tasa de confirmación histológica fue prácticamente concluyente. La omisión de la variable histopatológica en el estudio de Barón-Méndez LE, et al. 1 limita la validación clínica completa del PAS dentro de su muestra al no contar con un estándar diagnóstico de referencia en los pacientes operados.