Browsing by Author "Estela Zape, Jose Luis"
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Item Massive rectorrhage due to pulmonary and intestinal tuberculosis: A case report(Elsevier Ltd, 2024) Estela Zape, Jose Luis; Patiño, Leonardo Arzayus; Sanclemente Cardoza, ValeriaTuberculosis is a bacterial infection that predominantly affects the lungs, although it can also affect other organs, including the intestine. Massive rectal bleeding, characterized by severe rectal bleeding, is a rare but serious complication of intestinal tuberculosis, with an estimated incidence of 5 % of tuberculosis patients. This report describes the case of a 21-year-old woman with active tuberculosis and comorbidities such as asthma and a history of psychoactive substance use, who developed massive rectal bleeding and significant clinical deterioration, manifested by excessive bleeding and septic shock, which resulted in fatal outcome.Item Metabolic acidosis due to d-lactate in a patient with intestinal resection: Diagnostic challenges and nutritional strategies(Elsevier Ltd, 2025-01) Patiño, Leonardo Arzayus; Fuentes, Claudia Martínez; Ochoa, Olid Ivan; Estela Zape, Jose LuisIntroduction Metabolic acidosis, marked by decreased plasma bicarbonate and arterial pH, is a common complication following extensive abdominal surgeries. D-lactate acidosis presents additional diagnostic challenges due to nonspecific symptoms. Presentation of case A 65-year-old woman with hypertension and morbid obesity was admitted to the ICU for intestinal obstruction and peritonitis due to an incarcerated hernia. Extensive bowel resection required ileostomy and prolonged antibiotic therapy. She developed refractory metabolic acidosis, suspected to be D-lactate acidosis. Management included sodium bicarbonate for acid-base correction and carbohydrate restriction via enteral nutrition. Gradual carbohydrate reintroduction resolved the acidosis. After clinical stabilization, elevated D-lactate levels were confirmed, and she transitioned to an oral diet with protein supplementation. Discussion Treatment focused on carbohydrate restriction to limit D-lactate production by reducing intestinal fermentation. Fructose was initially considered for its unique absorption properties that prevent fermentation, but limited formula availability led to complete carbohydrate elimination. Complex carbohydrates were gradually reintroduced to meet metabolic requirements without worsening acidosis. Intravenous bicarbonate, probiotics, and antibiotics were employed to manage severe acidosis.Item Physical performance, functionality and risk of falls in older adults hospitalized in a psychiatric hospital in Southwestern Colombia: PHYSICAL PERFORMANCE, FUNCTIONALITY AND RISK OF FALLS(Elsevier Inc., 2025-06) Estela Zape, Jose Luis; Escobar, Angelica María Pereira; López, Wilmer Arley Criollo; Ortiz, Diana Constanza González; Carrillo, Mauricio Hernández; Navarro, Saul Diaz; Payán Salcedo, Harold AndrésAim Determine physical performance, functionality and their relationship with the risk of falls in older adult patients hospitalized in a psychiatric hospital in southwestern Colombia. Methods This cross-sectional observational study with an analytical component involved 51 patients. Univariate analysis used frequencies and percentages for categorical variables. Comparative bivariate analysis by risk of falling included the probability value. The association between functionality, physical performance and risk of falling was examined using a logistic regression model. Results The average age was 67 years (SD: 6.0), 51 % were men, 72 % had primary school education and 96 % consumed some antipsychotic medication. According to the results of the logistic model, mild-moderate dependence (OR=5.56, 95 % CI 1.24-27.00) and low physical performance are the two factors that most influence the risk of drop. Conclusion Low physical performance and mild to moderate dependence in daily activities increase the risk of falls in hospitalized older adults with mental disorders.Item Rhabdomyosarcoma in adults with severe thrombocytopenia: Challenges in clinical management and therapeutic complications(W.B. Saunders Ltd, 2025-01) Estela Zape, Jose Luis; Sanclemente Cardoza, Valeria; Arzayus Patiño, Leonardo; Noreña Buitrón, Lizeth Dayana; Espinosa, María AlejandraAlveolar rhabdomyosarcoma (ARMS) in adults is a rare condition with a poor prognosis compared to other subtypes. The management of this pathology is complex due to the lack of standardized guidelines and the limited response to multimodal treatments, including chemotherapy, radiotherapy, and surgery. We report the case of a 40-year-old male with stage IV ARMS and pulmonary metastasis, who underwent resection of right supraclavicular sarcoma and cervical lymph node dissection. He was later referred for palliative chemotherapy following an acute clinical presentation lasting two days, characterized by right facial edema, inflammation, ulceration, and severe pain. Initial treatment included ampicillin/sulbactam, trimethoprim/sulfamethoxazole, and dexamethasone. Chemotherapy with doxorubicin and ifosfamide was delayed due to thrombocytopenia, elevated D-dimer and fibrinogen levels, and an echocardiographic finding that required differentiation between thrombus and metastatic lesion. Anticoagulation with fondaparinux and transfusions were initiated, and the patient received 10 sessions of radiotherapy. During hospitalization, the patient developed orthopnea, pleural effusion, superior vena cava syndrome, and hemodynamic deterioration, necessitating vasopressor support and mechanical ventilation. Despite these interventions, the patient progressed to refractory shock, severe hypoxemia, and died from cardiac arrest. This case highlights the challenges in managing ARMS in adults with severe thrombocytopenia.