ISSN: 2357-6308 (Online)| DOI: 10.18566/medupb Aims and Scope: Official publication of the School of Health Sciences of the Universidad Pontificia Bolivariana, its objective is the publication of articles of excellent quality in the themes of the basic and clinical health sciences, public health, health administration and related areas . The journal is aimed at students, teachers and researchers and is open to the participation of authors from outside the publishing entity. UPB Medicine has a biannual publication period (two issues per year: January-June and July-December). Open access declaration: Medicina UPB publishes in open access without charging a fee to the authors. When an article is published, anyone has immediate access to the full text for reading, downloading, distribution and printing without the need for registration, subscription or payment.
Editorial Academic Journal Medicina UPB, Volume 45, No. 1 (2026): January-June
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Factors related to mortality from acute respiratory infection in children under 5 years of age
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.
We present the contents of the second issue of Medicina UPB for 2025, which includes four original articles, a review article, and three case reports. The articles address topics relevant to public health in Medellín and Antioquia, including prostate cancer, adolescent pregnancy, psoriatic arthritis, access to pharmaceutical services, and sports injuries in archers, highlighting rare clinical cases with high educational value for healthcare professionals.
Copyright (c) 2025 Medicina UPB https://creativecommons.org/licenses/by-nc-nd/4.0
Cardiovascular toxicity secondary to systemic antimonials: treatment strategies
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.
Access to pharmaceutical professional services: motivations, preferences, barriers, knowledge, and use of ICT among patients in Antioquia
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.
Neuroleptic Malignant-Like Syndrome Associated with Carbamazepine and Fluoxetine: A Pediatric Case Report
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.
The issue of Medicina U.P.B. for the first half of 2025 includes five original articles and three case reports. We hope our readers will find this issue useful, as it covers a wide range of health conditions and features articles that will be of value to specialists, general practitioners, nurses, and other healthcare professionals.
Evaluation of circulating cytokines in patients with idiopathic pulmonary fibrosis in Bogota
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).
Validity, Reliability, and Invariance of the Double Sexual Standard in a Colombian and Mexican Sample
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.
Characteristics and outcomes of surgical management of capsular contracture in patients undergoing mammoplasty at an institution in the city of Medellín
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.
Relationship between the presentation of Acute Coronary Syndrome and Socioeconomic Status: Systematic Review
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. Key words: Low Socioeconomic Status; Acute Coronary Syndrome; Socioeconomic Factors; Myocardial Infarction; ST-Elevation Myocardial Infarction; Non-ST-Elevation Myocardial Infarction.
Hutchinson-Gilford Progeria as a Window into Human Aging: Genetic, Cellular, and Therapeutic Perspectives
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.
Musculoskeletal injuries, risk factors and current trends in prevention of injuries in football goalkeepers
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.
Early neurological disorder as a clinical presentation of systemic lupus erythematous with cerebral vasculitis, a rare form to debut
We present a case of a 27-year-old female patient with no past medical history of autoimmune disease, consulting for extremities weakness, hallucinations, and arthralgia, which started two weeks before. Decreased limbs strength and hallucinations were evidenced during the physical exam. The patient’s laboratory results showed a systemic inflammatory response with high ANA, low complement levels, and radiological evidence of vasculitis in cerebral arteries of medium and low caliber; as a result, treatment for Systemic Lupus Erythematous was started. Additionally, invasive mechanical ventilation was necessary due to respiratory failure with pleural and pericardial effusion. Finally, treatment produced positive results, as the patient was discharged without any neuro-logical, respiratory or systemic signs and symptoms.
Para cerrar el volumen 43 de Medicina UPB presentamos ocho artículos, cuatro de ellos investigaciones originales, tres revisiones narrativas y un reporte de caso. Esperamos que los temas médicoquirúrgicos que trae este volumen sean de interés para nuestros lectores. En este no solo se abordan varios grupos poblacionales, sino diferentes problemas de salud pública o de diagnósticos poco comunes.
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Psoriatic arthritis, treatment response, and changes in quality of life in a population treated at a reference center in Medellín
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.
Characteristics and survival outcomes in patients with hormonosensitive metastatic prostate cancer in an oncologic centre in Medellín, Colombia
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.
Subacute combined degeneration as a manifestation of vitamin B12 deficiency: Presentation of a case
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.
Profile in frail older people over 60 years of age in five Colombian cities, 2021
Objective: To establish the frailty profile of older people living in the urban areas of Bucaramanga, Medellín, Pereira, Popayán and Santa Marta in Colombia, as frail people aged 60 or over are increasingly important in primary care due to demographic change. Methods: Cross-sectional study of 2506 participants, selected through two-stage probabilistic sampling, and classified according to the FRAIL scale, to measure frailty. A multiple correspondence model was built to define the frailty-pre-frailty and non-frailty profiles. Results: The prevalence of people with frailty is 9.6%, and pre-frailty is 60.8%. These conditions were independently associated with female sex, depression, dependence for basic daily activities and falls. Similarly, the profile of pre-frail and frail elderly is determined by disability, falls, high nutritional risk, physical inactivity, being a woman and low socioeconomic status. Conclusion: Frail and pre-frail elderly people have modifiable characteristics (disability, falls, nutritional risk, physical inactivity and socioeconomic status), in order to reduce the prevalence of this condition. It is recommended that elderly people be able to enter care programs at different levels, in order to contribute to healthy aging processes.
Impact of intravaginal nystatin/dexamethasone therapy on health-related quality of life in women with candidal or mixed vulvovaginitis
Objective: To evaluate the symptoms and changes in health-related quality of life (HRQoL) in patients with candidiasis vulvovaginal or mixed infections who received intravaginal treatment with Nystatin/Dexamethasone. Methods: A before-and-after study conducted on women over 18 years of age with candidal or mixed vulvovaginitis, treated with intravaginal Nystatin/Dexamethasone as monotherapy or in combination with oral imidazole. The EQ-5D questionnaire and a symptom questionnaire were used to assess HRQoL, both of which were administered before and after treatment. Results: 236 patients were included; 150 received intravaginal Nystatin/Dexamethasone (group 1) and 86 received intravaginal Nystatin/Dexamethasone plus oral imidazole (group 2). The median age was 35 years (IQR: 27-43 years). After treatment, the time for symptom improvement was 1 to 3 days in 71.3% (group 1) and 73.3% (group 2), with a change of over 80% in most of the aspects evaluated. In the EQ-5D questionnaire, the most affected dimensions were pain (43% in group 1 vs. 30% in group 2), followed by anxiety/depression (9% in group 1 vs. 19% in group 2), with an improvement in the EQ-5D index before and after treatment in group 1 (absolute variation of 0.0589) and in group 2 (absolute variation of 0.0601). Conclusion: An early improvement in symptoms and HRQoL was observed in patients treated with intravaginal Nystatin/Dexamethasone, with no differences in outcomes between monotherapy and combination with oral imidazoles.
Characterization of adults evaluated by liaison psychiatry in the emergency department of a general hospital in Medellín, Colombia
Objective: To characterize the adult population evaluated for psychiatric emergencies, to determine trends in these consultations and to be able to design future care plans, since in Colombia there is not enough literature on the subject and the increase in emergency consultations for psychiatric causes represents a problem worldwide. Methods: A retrospective study in which the medical records of patients in the emergency department who were requested psychiatric liaison evaluation between July 2021 and July 2022, were analyzed. A descriptive analysis of the data was performed. Results: 628 medical records were analyzed. The median age was 35 years, 57.8% were female, 47.61% were unemployed. Most patients had a diagnosed psychiatric disorder, 88.88% with established pharmacological management. Additionally, 38.69% had a history of substance use disorder. The most common reasons for consultation were affective disorders and suicide attempts. Conclusion: We found that the majority of the studied population presented factors related to the development and control of psychiatric pathologies, some of which may have the potential for outpatient intervention. Considering the limited availability of mental health care to the general population, this underscores the importance of implementing primary and secondary prevention interventions to achieve better outcomes.
Related factors with ophthalmological conditions in a group of university students in the Medellín city, pre-pandemic and pandemic, 2021
Objective: identify related factors with ophthalmologic affections reported by students in a private university in Medellín, 2021. Methodology: cross sectional study with analytic intention, there were used secondary sources derived from the project Características y percepción de la presencialidad asistida por ayudas tecnológicas en una universidad privada de la ciudad de Medellín, prepandemia y en pandemia 2020-2021. Population: Registries of the 194 enquiries of the participants in the big primary study. In this case, there were explored ophthalmologic affection they have had suffered pre-pandemic and pandemic. Excluded registries with 10 % incomplete information, with imputing data and assumed original bias of the primary study. Calculated the prevalence of ophthalmologic affections, sociodemographic factors, exposition to electronic devices, academic load and made bivariate analyzes in Jamovi. Results: of 194 participants, 70 % were women, 92.8 % single, 87.1 % lived in the Metropolitan area. Refractive errors increased in 1.5 %, sore eye 22.2 %, ocular fatigue 37.7 %, tearing 8.8 % and ocular pain 16 %. During pandemic times all ophthalmologic conditions were more common in women, most people who reported affections also reported high academic burden and more than 12 hours of screen exposure. Conclusions: ophthalmologic affections, screen exposure time and high academic burden increased during pandemic period.
Characterization of gestational and congenital syphilis at a university clinic in Medellín, Colombia
Objective: to describe the clinical, epidemiological and laboratory characteristics in mothers with gestational syphilis (GS) and their newborns with highly probable congenital syphilis (CS). Methods: descriptive observational study which includes all newborns (NB) and their mothers with diagnosis of GS and GS treated at the Bolivarian University Clinic from Medellin, Colombia, from 1/01/2017 to 31/12/2021. Results: 71 NB and their mothers were diagnosed with syphilis and 22 cases of highly probable CS were identified. Of 22 pregnant women, 58.1 % were under 26 years of age and 18.1 % ≤18 years of age. All mothers were affiliated to healthcare system, however 40.1 % did not have prenatal visits. Syphilis was most commonly diagnosed in the third trimester (59 %) and the most frequent clinical presentations during pregnancy were unknown duration (45.4 %), early latent (27.2 %), and secondary (13.6 %). Obstetric ultrasound was performed in 63.6 % (14/22), of those, 37.5% reported findings suggestive of fetal syphilis. 54.5 % of the mothers received treatment with penicillin, in 16.6 % it was given up to 30 days before delivery, 16.6 % presented therapeutic failure. Treatment for the partner was not given or not recorded in 77.2 %. Of 22 NB with CS, 50% were premature, 63.6 % weighed <2500g, 72.7 % presented clinical manifestations and 7 (31.8 %) were children of adequately treated mothers. Conclusion: in this group of pregnant women, young women and adolescents predominated, there was a high misattendance to prenatal visit, late diagnosis and underreporting of treatment to their partners. Prematurity and low birth weight predominated in newborns and 7 neonates were children of mothers with adequate treatment, which suggests therapeutic failure that could be related to late treatment or stages of syphilis.
Analysis of the trend of teenage pregnancy, public policies and sexual and reproductive health strategies in Medellín, Antioquia and Colombia between 2012 and 2022
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.
Transcranial magnetic stimulation for neuropathic pain of oncological and non-oncological origin: a systematic review
Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) is a ground-breaking alternative for the treatment of neuropathic pain. rTMS is a brain stimulation technique that is noninvasive and induces electrical currents in the cortex’s nervous tissue. The aim of this study was to assess the effect of rTMS for the treatment of pain, regardless of its non-oncological or oncological origin. Methods: We performed a search in MEDLINE, CENTRAL, Embase, PsycINFO, LILACS and SCOPUS. The inclusion criteria were 1) population: men and women between 18 and 85 years-age, with neuropathic pain (oncological and non-oncological); 2) intervention: treatment with transcranial magnetic stimulation; 3) comparison: inactive control groups and parallel active interventions; and 4) outcome: primary outcome, pain modulation. Secondary outcomes, quality of life and adverse effects. The risk of bias and quality of evidence were assessed as well. Results: The search yielded 1116 articles, of which 21 met the PICO criteria. 12 randomized controlled trials (RCTs) and 9 observational studies. The total sample was 911 patients, the number of sessions varied from one single session to 15, with a mean of 3.5 sessions. Follow-up was performed between day 7 and 311.8 days, with a mean of 45 days. Pain reduction was reported in all 21 reports. Conclusion: rTMS might be an effective therapeutic choice for oncological and nononcological neuropathic pain. Evidence of moderate quality was found for pain modulation; for the quality of life the results are uncertain to determine changes, because the evidence level is very low. Additional research efforts are needed to reduce bias and improve the quality of the studies.
Beyond common ground: histoplasmosis panniculitis. A case report
Histoplasmosis is an endemic mycosis in Latin America produced by Histoplasma capsulatum. The infection is caused by inhalation of spores and the main organ involved is the lung. Skin lesions are widely variable, with panniculitis being one of the most unusual presentations. We present a patient with a history of systemic lupus erythematosus who presented panniculitis associated with disseminated histoplasmosis infection.
Findings in the 24-hour Holter (24HH) monitoring and tilt table test (TT) of patients with a post-COVID-19 condition
Objective: describe the findings in the 24-hour Holter (24HH) and the tilt table test (TT) in patients with post-COVID-19 condition (PCC) and explore their association with symptoms. Methods: a descriptive cross-sectional study that included 83 patients with PCC with 24HH or TT. By a telephone survey, we obtained demographic variables, symptoms, and comorbidities. A cardiologist and an electrophysiologist interpreted the 24HH and TT. Results: 57.6 % of the patients were women and the mean age was 48.5 years. The most common symptom were palpitations (65.1 %). 74.7 % were treated at home during the acute infection. On average, 8.4 months elapsed between the diagnosis of COVID-19 and the 24HH or TT. Of 64 24HH performed, 34 had at least one finding in patients who most frequently presented fatigue and dyspnea; the most usual discovery was sinus tachycardia at rest or with minimal effort (34 %). In 27 TT, the most reiterate findings were mixed vasovagal syncope or presyncope (48 %) and vasodepressor (22 %), dizziness/syncope was the most constant symptom in comparison to who did not have these findings. Conclusions: in PCC palpitations were the most frequent symptom, the most common findings in 24HH were having a normal test and sinus tachycardia at rest or with minimal effort. In the TT, mixed vasovagal syncope or pre-syncope was frequent.
Second primary melanoma of the urethra in the same patient 17 years later: a case report
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.
The life course approach for cervical cancer prevention: narrative review
Cervical cancer is one of the most diagnosed cancers in the world and simultaneously the most preventable since the different stages of its natural history have been fully identified and prevention strategies have been developed accordingly. However, these strategies are not reflected in the reduction of morbidity and mortality in low- and middle-income countries due to different problems, both structural and individual. This narrative review explores the interaction between the natural history of the disease, its social determinants, and the life course approach, therefore, it analyze the barriers in prevention strategies, such as vaccination against human papillomavirus (VPH), screening, and treatment of cancerous lesions, proposed in 2020 in the Global Strategy for the Elimination of Cervical Cancer, to suggest how intersectoral efforts can contribute to reduce the barriers to access in the prevention of this disease.
We appreciate the reading of the article "Ensayo clínico aleatorizado. Efecto de dos tipos de ayuno en pacientes sometidos a procedimientos de intervencionismo percutáneo bajo anestesia local en un servicio de hemodinámica en Medellín, 2019", as well as your interest in this type of study and the comments you have provided. We believe your contributions are valuable for conducting this type of research. In the following paragraphs of this manuscript, we will address the questions raised by the article.
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