Colombia Médica

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One-minute sit-to-stand test reference values in people living at high altitudes

Abstract Introduction: The one-minute sit-to-stand test (1min-STST) is a practical assessment tool for measuring functional ability. Reference values are currently unavailable for populations residing at high altitudes. This study aims to establish reference values for the 1min-STST in people living at high altitudes by sex and age range. Additionally, we correlate the variables analyzed with the number of repetitions obtained in the tests. Methods: Multicenter cross-sectional research was conducted, collecting data from two cities at high altitudes. Healthy adults between 18 and 80 years old were recruited. Anthropometric measurements, physical activity levels, smoking habits, and the number of repetitions during the 1min-STST were recorded. A multiple linear regression was performed to determine the predictive equations by sex. The stepwise method was used to generate the predictive model. Results: As many as 400 healthy subjects (58% women) were included. Participants had a median (P25-P75) height of 1.62 (1.56-1.68) cm, a weight of 63.0 (57.8-70.1) kg, and a BMI of 24.2 (22.5-26.0) kg/m2. The predictive equations were: 1minSTSTMen=19.833 - (age* 0.168) + (height * 0.204) - (weight * 0.122); 1minSTSTWomen= 27.845 - (age * 0.198) + (height * 0.145) - (weight* 0.094). Conclusion: The reference values for 1min-STST were determined for the healthy population aged 18-80 years living at high altitudes.

Resumen Introducción: La prueba de levantarse y sentarse en un minuto (1min-STST) es una herramienta práctica para evaluar la capacidad funcional. Actualmente, no existen valores de referencia para poblaciones que residen en ciudades de gran altitud. El objetivo de este estudio fue establecer valores de referencia del 1min-STST en personas que viven a gran altitud, según sexo y rango etario. Además, se analizaron las correlaciones entre las variables evaluadas y el número de repeticiones obtenidas en la prueba. Métodos: Se realizó un estudio multicéntrico de tipo transversal en dos ciudades ubicadas a gran altitud. Se reclutaron adultos sanos entre 18 y 80 años. Se registraron medidas antropométricas, niveles de actividad física, hábito tabáquico y el número de repeticiones alcanzadas en el 1min-STST. Se aplicó un análisis de regresión lineal múltiple para determinar ecuaciones predictivas diferenciadas por sexo, utilizando el método por pasos (stepwise) para seleccionar el modelo final. Resultados: Se incluyeron 400 sujetos sanos (58% mujeres). Los participantes presentaron una mediana (P25-P75) de estatura de 1.62 (1.56-1.68) m, peso de 63.0 (57.8-70.1) kg y un IMC de 24.2 (22.5-26.0) kg/m². Las ecuaciones predictivas obtenidas fueron: 1minSTSTHombres = 19.833 - (edad × 0.168) + (estatura × 0.204) - (peso × 0.122); 1minSTSTMujeres = 27.845 - (edad × 0.198) + (estatura × 0.145) - (peso × 0.094). Conclusión: Se establecieron valores de referencia para el 1min-STST en población sana de 18 a 80 años que reside en ciudades de gran altitud.

Induction of labor with dinoprostone in hypertensive disorders of pregnancy: comparative analysis with normotensive pregnant women

Abstract Objective: To describe obstetric outcomes associated with the use of dinoprostone and its effectiveness in cervical ripening in pregnant women with hypertensive disorders of pregnancy compared to normotensive pregnant women. Methods: A retrospective cohort study was conducted at a tertiary-level hospital in Medellín, Colombia (March 2020 - October 2024). The study included pregnant women with singleton pregnancies, beyond 30 weeks of gestation, with a live fetus in cephalic presentation, and undergoing cervical ripening with dinoprostone vaginal insert. Women were excluded if they had used other ripening methods, had a favorable cervix at admission, or had an unclassified hypertensive disorder. Primary outcomes included successful cervical ripening, vaginal delivery, time to favorable Bishop score and to delivery, and indications for cesarean section. Adverse events considered were placental abruption, non-reassuring fetal status, tachysystole, and worsening of hypertensive condition. Results: A total of 400 patients were included (200 with hypertensive disorders, of whom 100 had severe preeclampsia). The success rate of cervical ripening was similar between patients with hypertensive disorders and healthy women (crude RR: 0.95, 95% CI: 0.88-1.03; adjusted RR for gestational age, maternal age, and parity 0.96, 95% CI: 0.88-1.04). The vaginal delivery rate was also similar (44% vs. 55%, p= 0.16). The median time to favorable Bishop score and to delivery was comparable between normotensive and hypertensive groups, even in severe cases. Cesarean delivery was mainly due to failed ripening and medical decision. Adverse events, except for tachysystole, were more frequent in the hypertensive group but did not reach statistical significance. Conclusion: Dinoprostone is effective in hypertensive pregnant women, including those receiving magnesium sulfate, with no significant differences compared to normotensive women.

Resumen Objetivo: Describir desenlaces obstétricos asociados al uso de dinoprostona y su efectividad en la maduración cervical en gestantes con trastornos hipertensivos asociados al embarazo frente a gestantes normotensas. Métodos: Estudio de cohorte retrospectivo en hospital de tercer nivel en Medellín, Colombia (marzo 2020 - octubre 2024). Se incluyeron gestantes con embarazo único, mayores de 30 semanas, feto vivo en presentación cefálica y maduración cervical con óvulo de dinoprostona. Se excluyeron mujeres con uso de otros métodos de maduración, cérvix favorable al ingreso o trastorno hipertensivo no clasificado. Los desenlaces principales fueron maduración cervical exitosa, parto vaginal, tiempos hasta Bishop favorable y parto, e indicaciones de cesárea. Se consideraron eventos adversos como abrupcio placentario, estado fetal no tranquilizador, taquisistolia y empeoramiento hipertensivo. Resultados: Se incluyeron 400 pacientes (200 hipertensas, de éstas, 100 con preeclampsia grave). La tasa de éxito en la maduración cervical fue similar en pacientes con trastornos hipertensivos y mujeres sanas RRcrudo: 0.95, IC 95%: 0.88-1.03, RRajustado: por edad gestacional, edad materna y paridad 0.96, IC 95%: 0.88-1.04. La tasa de parto vaginal fue similar 44 y 55% (p: 0.16). La mediana de tiempo a Bishop favorable y al parto fue comparable entre normotensas e hipertensas, incluso en casos graves. La cesárea se debió principalmente a maduración fallida y decisión médica. Los eventos adversos, excepto la taquisistolia, fueron más frecuentes en hipertensas, sin significación estadística. Conclusión: La dinoprostona es eficaz en pacientes hipertensas, incluso con uso de sulfato de magnesio, sin diferencias significativas frente a normotensas

Psychological autopsy study of suicide risk factors in the Colombian Coffee Region, 2017-2019

Abstract Objective: To identify demographic, psychosocial, and life cycle risk factors for suicides in the Colombian Coffee zone between second half of 2017 and the end of 2019. Methods: A matched case-control design. A sample of 176 individuals, of which 101 were suicides (cases) and 75 were deaths by road traffic accidents (controls); psychological autopsies were used for research purposes. Penalized maximum likelihood logistic regression analyzes were conducted, indicating odds ratio of suicide, adjusting for sex, age group, province of legal autopsy and source of data. Logistic regressions were applied in three blocks: mental health issues, psychoactive substance use, and adversities during the life course. Statistical analysis was done with Stata® Results: 78.2% of cases and 84.0% of controls were male. The mean age of cases was 39 years, and of controls, 43 years. The key risk factors for suicide, at p< 0.05, were forced labor during adolescence (OR: 32.41), financial dependence (OR: 4.3), verbal or physical abuse from the partner (OR: 10.28), any mental disorder (OR: 26.14), previous suicide attempt (OR: 11.64; p= 0.061), and record of major depressive disorder (OR: 24.86). A protective factor was death of a close relative at some point in life (OR: 0.34; p= 0.073). Conclusions: Forced labor in adolescence, verbal and physical abuse from the partner, financial dependence on others, any mental disorder, major depressive disorder, and previous suicide attempts were risk factors of suicide; the death of any close relative at some point in life was a protective factor of suicide.

Resumen Objetivo: Identificar los factores demográficos, psicosociales y del ciclo de vida que aumentan el riesgo de suicidio en la zona cafetera de Colombia entre la segunda mitad de 2017 y finales de 2019. Métodos: Diseño de casos y controles emparejados. Se utilizó una muestra de 176 personas, de las cuales 101 eran muertes por suicidio (casos) y 75 eran muertes por accidentes de tránsito (controles); se utilizaron autopsias psicológicas con fines de investigación. Se realizaron análisis de regresión logística de máxima verosimilitud penalizada, que indicaban la oportunidad o ventaja relativa (OR) de suicidio, ajustando por sexo, grupo de edad, provincia de la autopsia médico-legal y fuente de los datos. Las regresiones logísticas se aplicaron en tres bloques: problemas de salud mental, consumo de sustancias psicoactivas y adversidades durante el curso de la vida. El análisis estadístico se realizó con Stata®. Resultados: El 78.2 % de los casos y el 84.0 % de los controles eran hombres. La edad media de los casos era de 39 años y la de los controles, de 43 años. Los factores de riesgo clave para el suicidio, con p< 0.05, fueron el trabajo forzoso durante la adolescencia (OR: 32.41), la dependencia económica (OR: 4.3), el maltrato verbal o físico por parte de la pareja (OR: 10.28), cualquier trastorno mental (OR: 26.14), un intento previo de suicidio (OR: 11.64; p= 0.061) y antecedentes de trastorno depresivo mayor (OR: 24.86). Un factor protector fue la muerte de un familiar cercano en algún momento de la vida (OR: 0.34; p= 0.073). Conclusiones: El trabajo forzado en la adolescencia, el abuso verbal y físico por parte de la pareja, la dependencia económica de otras personas, cualquier trastorno mental, el trastorno depresivo severo y los intentos de suicidio previos fueron factores de riesgo de suicidio; la muerte de cualquier familiar cercano en algún momento de la vida fue un factor de protección contra el suicidio.

Laparoscopic surgical alternative in the treatment of ruptured cornual heterotopic pregnancy

Abstract Case Description: A 35-year-old woman with a history of intrauterine device use for family planning presented with a spontaneously conceived heterotopic pregnancy. Clinical Findings: The patient developed a ruptured cornual ectopic pregnancy, leading to hemodynamic instability and an acute abdomen, while concurrently carrying a viable intrauterine pregnancy. Treatment and Outcome: A laparoscopic intervention was performed to manage the ruptured ectopic pregnancy. The surgical technique employed minimized the impact on maternal blood volume, ensuring patient stabilization and favorable progression of the intrauterine pregnancy. Clinical Relevance: Heterotopic pregnancy is the coexistence of gestation in two different implantation sites, both intrauterine and extrauterine. This condition is associated with significant maternal morbidity and mortality. Management remains a challenge due to the lack of consensus and limited clinical experience. The primary goal is maternal stabilization while preserving the intrauterine pregnancy whenever possible. This case highlights the importance of modern surgical strategies tailored to optimize maternal and fetal outcomes.

Resumen Descripción del Caso: Mujer de 35 años con antecedente de uso de dispositivo intrauterino para planificación familiar, quien presentó un embarazo heterotópico concebido de manera espontánea. Hallazgos Clínicos: La paciente desarrolló un embarazo ectópico cornual roto, con inestabilidad hemodinámica y abdomen agudo, asociado a un embarazo intrauterino viable. Tratamiento y Evolución: Se realizó una intervención laparoscópica para el manejo del embarazo ectópico roto. La técnica quirúrgica utilizada minimizó el impacto en la volemia materna, permitiendo la estabilización de la paciente y la evolución favorable del embarazo intrauterino. Relevancia Clínica: El embarazo heterotópico es la coexistencia de una gestación en dos sitios de implantación diferentes, tanto intrauterino como extrauterino. Esta condición está asociada con una morbilidad y mortalidad materna significativas. El manejo representa un desafío debido a la falta de consensos y a la experiencia clínica limitada. El objetivo principal es la estabilización materna, con la intención de preservar el embarazo intrauterino cuando sea posible. Este caso resalta la importancia de estrategias quirúrgicas actuales adaptadas para optimizar los resultados maternos y fetales

Clinical practice guideline for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia

Abstract Introduction: The available clinical practice guidelines on tuberculosis infection are not exclusive to the pediatric population. Objective: To formulate evidence-based recommendations for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia. Methods: A multidisciplinary development panel (composed by clinical and field experts, researchers, and methodologists who declared conflicts of interests), including patient representatives, and decision-makers formulated 10 questions and prioritized outcomes related to diagnosis (clinical evaluation, chest X-ray, and interferon-gamma release assays-IGRA), treatment (efficacy of regimens in different clinical scenarios), and follow-up (monitoring and strategies to increase adherence) for children exposed to tuberculosis. We conducted systematic literature reviews to identify guidelines, systematic reviews, and primary studies. We assessed these sources' quality and risk of bias with specific tools. We synthesized the evidence narratively and, in some cases, performed de novo meta-analyses (diagnostic and network meta-analyses). We evaluated the certainty of evidence using the GRADE system. We used the GRADE evidence-to-recommendation framework to formulate the recommendations. Results: We recommend 1) the use of IGRA tests to identify tuberculosis infection and chest X-rays to screen for active tuberculosis in children exposed to tuberculosis, 2) short instead of extended regimens for children with and without immunosuppression, 3) levofloxacin or susceptibility-guided regimens in cases of contact with drug-resistant tuberculosis, 4) monthly clinical follow-up during the treatment, 5) the implementation of comprehensive approaches to identify barriers to encourage treatment adherence. Conclusions: The guideline panel provides context-specific, evidence-based recommendations for assessing and treating children exposed to tuberculosis in Colombia.

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