Browsing by Author "Lozada Ramos, Heiler"
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Item Central Oxygen Venous Saturation and Mortality in Patients Undergoing Coronary Artery Bypass Grafting(Dove Medical Press Ltd, 2023-06-03) Rodríguez Scarpetta, María A.; Sepúlveda Tobón, Andrés M.; Lozada Ramos, Heiler; Álzate Sánchez, Rodrigo A.; Daza Arana, Jorge E.Purpose: Central venous oxygen saturation (ScvO2) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO2 and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia. Patients and Methods: A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO2 < 60% upon admission to the intensive care unit (ICU) following surgery. The major outcome was mortality rates after 30 days. Furthermore, exposure variables were measured at preoperative, intra-operative, and postoperative time points. Results: A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO2 < 60% upon ICU admission compared with those with higher saturation levels (relative risk 4.2, 95% confidence interval: 2.4– 7.2; p = 0.001). Values were adjusted using variables such as age (> 75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (> 60 min), and intra-operative inotrope use.Item Clinical presentation and outcome of patients diagnosed with active tuberculosis in a critical care unit(2021) Lozada Ramos, Heiler; Daza Arana, Jorge EnriqueBackground: Tuberculosis is one of the infectious diseases with the highest mortality worldwide, and also results in high costs and periods of disability. Thus, it is a priority to make timely diagnoses at the Primary Care level, with the aim of initiating early treatments and reducing transmission. Method: This descriptive observational study included a series of cases of 43 patients with a confirmed diagnosis of tuberculosis after admission to intensive care unit (ICU) between 2012 and 2016. The objective of this study was to describe the sociodemographic, epidemiological, and clinical characteristics of this group of patients. Results: The age range was between 21 and 80 years; there was a predominance of male gender (53.5%), those affiliated to the subsidised health regime (90.7%), homeless people (18.6%), and those with drug dependence (35%). The main cause of admission was respiratory failure (65.2%), followed by neurological deterioration (18.6%). Almost two-thirds (65%) of the cases had pulmonary tuberculosis exclusively, and 35% had extrapulmonary tuberculosis. Furthermore, 76.7% of patients had co-infection, with human immunodeficiency virus (HIV) being the most frequent (48.8%), followed by pneumonia (34.9%). Moderate to severe malnutrition was documented in 79% of cases, and anemia was found in 95.3%. The mortality rate during the stay in ICU was 46.5%, with prevalence of male gender and prolonged stay (an average of 19 days). Conclusions: In this case series, there was a predominance of the active working population, those with drug dependence, homeless people, those who were co-infected with HIV, and those with hypoalbuminaemia, anemia, and malnutrition. In addition, around half of the patients died during hospital admission. They had septic shock, an ICU stay and ventilatory support greater than or equal to 8 days. This reflects the need to carry out studies evaluating public health strategies for the early detection of cases in groups of patients with the described characteristics, as well as the importance of always considering tuberculosis as a diagnostic possibility in the ICU.Item Cryptococcal Meningitis in an HCV-Positive and IVDU-and HIV-Negative Patient: A Case Report and Literature Review(Dove Medical Press Ltd, 2024) Lozada Ramos, Heiler; Álvarez Payares, Jorge; Daza Arana, Jorge Enrique; Salas Marín, Luisa MaríaBackground: Cryptococcal meningitis (CM) is a central nervous system (CNS) infection that occurs mainly in immunocompromised individuals such as those with human immunodeficiency virus (HIV) infection. However, the prevalence of CM in immunocompetent patients has increased. Although CM has been reported in patients with hepatitis C virus (HCV) infection, it has not yet been fully established whether there is an association between both conditions. CM has also been reported in patients with intravenous drug use (IVDU), which is related to the immunosuppression caused by these drugs. Case Presentation: We report the case of a 24-year-old man who presented with meningitis secondary to Cryptococcus gattii infection. He had a history of IVDU and HCV infection, was HIV-negative and without antiviral treatment. The patient received adequate antifungal treatment during induction, consolidation, and maintenance phases. His condition relapsed, requiring dose adjustment, with an excellent response during clinical follow-up for both meningitis and HCV infection. A brain biopsy was requested during relapse to rule out other co-infection. Conclusion: The case of an individual diagnosed with cryptococcal meningitis, who had a history of IVDU and HCV infection, is presented. The coexistence of such events could shadow the prognosis of this group of subjects, related to immunosuppression that can be caused through different pathways. Having HCV and being a IVDU simultaneously could increase the risk of Cryptococcus infection.Item Ecthyma Gangrenosum of Fungal Origin: A Case Report(S. Karger AG, 2024) León Sánchez, Germán Andrés; Lozada Ramos, Heiler; Daza Arana, Jorge Enrique; Restrepo Becerra, Andrés Darío; Varela Miranda, RubenIntroduction: Ecthyma gangrenosum (EG) is usually a dermatologic manifestation of a Pseudomonas aeruginosa infection in an immunocompromised individual but may sometimes be caused by other bacteria or fungi in an immunocompromised or nonimmunocompromised individual. Case Presentation: A 75-year-old woman with a history of high blood pressure and sequels of ischemic cerebral infarction presented with a 5-day history of general malaise, cough with yellow sputum, and respiratory distress. The patient had pale mucous membranes, temperature of 38.5°C, tachycardia, normal blood pressure, SaO2 of 85%, intercostal retractions, and severe bronchospasm upon hospital admission. No skin lesions were seen. The patient was admitted to the intensive care unit (ICU) because of her critical condition and was supported with invasive mechanical ventilation. Her blood count showed 8,100 leukocytes/mm3, neutrophils 79%, hemoglobin 10.1 g/dL, creatinine 1.1 mg/dL, and C-reactive protein 328 mg/dL. Arterial blood gases showed metabolic acidosis and moderate hypoxemia. The initial report of blood and urine cultures was negative for bacteria, and positive for influenza A H1N1. The patient was treated with oseltamivir and intravenous methylprednisolone for acute respiratory distress syndrome associated with the viral infection that occurred. Subsequently, violaceus macular and papular lesions appeared, which evolved into ulcerated lesions with erythematous border and necrotic center were seen in the anterior region of the chest and abdomen, from where Candida metapsilosis was isolated. EG was reported in this patient, who was also immunocompromised because of steroid use, had a prolonged stay in the ICU and received broad-spectrum antibiotics. Fungemia and urinary infection due to different fungi were also found. Conclusion: It is worth mentioning that EG can be caused by germs other than P. aeruginosa and fungal infections should not be ruled out.Item Immune thrombocytopenic purpura following mRNA-SARS-CoV-2 vaccination: a case report(Universidad de Santander, 2024) Lozada Ramos, Heiler; Martínez Vega, Ruth Aralí; Torcoroma García, LilianaIntroduction: Herein, it is presented a case report of a Colombian adult male patient, without any previous report of thrombocytopenia or hematological disorders, who developed a mild and chronic paucisymptomatic immune thrombocytopenic purpura, a rare complication following SARS-CoV-2 m-RNA. To the best of our knowledge, this represents the first documented case in Colombia of immune thrombocytopenic purpura associated with mRNA vaccines (BNT162b2 or mRNA-1273), with a comprehensive 2-year clinical follow-up. Case Description: The patient received the initial and second doses of the mRNA BNT162b2 vaccine in June 2021, the first booster dose in November 2021 (mRNA-1273), and the second booster dose (mRNA BNT162b2) in June 2022. Thrombocytopenia (<100 x109 platelets/L, which is the criterion to define immune thrombocytopenic purpura) was documented after the second vaccination dose and both boosters, and it improved after corticosteroid therapy. However, cycling thrombocytopenia persisted until the clinical follow-up in August 2023, with platelet count ranging from 57 to 191 x109 platelets/L (mean: 103 x109 platelets/L). Conclusion: Given that secondary immune thrombocytopenic purpura can occur following SARS-CoV-2 mRNA vaccination, systematic research to identify risk factors associated with immune thrombocytopenic purpura due to COVID-19 immunization should be conducted.Item Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia(Dove Medical Press Ltd, 2022) Daza Arana, Jorge Enrique; Lozada Ramos, Heiler; Ávila Hernández, Daniel Felipe; Ordoñez Mora, Leidy Tatiana; Sánchez, Diana PatriciaPurpose: The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft. Patients and Methods: This was an analytical retrospective case–control study. Cases were defined as subjects requiring prolonged mechanical ventilation (>48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery. Results: A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06–3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: −3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73–7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation <60% (OR 2.00; 95% CI: 1.18–3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06–84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77–4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02–6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91–6.25, p = 0.00). Conclusion: This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.Item Revascularización miocárdica: Tópicos selectos para profesionales de la salud(Editorial Universidad Santiago de Cali, 2025-03-22) Daza Arana, Jorge Enrique; Lozada Ramos, Heiler; Bernal Sánchez, José Julián; Vivas López, Luis Fernando; Sánchez Soto, Tulio Hernán; Assis Reveiz, Jorge Karim; Romero Serna, Andrés David; Lanas Zanetti, Fernando; Guevara García, Juan Guillermo; Clavijo Prado, Carlos Andrés; Medina Gallo, Luis Felipe; Edward David Buriticá Marín;Item Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience(MDPI, 2024) Bonilla Bonilla, Diana Marcela; Osorio Toro, Luis Miguel; Daza Arana, Jorge Enrique; Quintana Ospina, Jhon H.; Ávila Valencia, Juan Carlos; Lozada Ramos, HeilerBackground: Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. Methods: This is an epidemiological, retrospective, and analytical case–control study (90 cases and 360 controls). Results: Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Conclusions: Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period.Item Varicella pneumonia in an immunocompetent adult patient: Case report and review of the literature(W.B. Saunders Ltd, 2024) Arias Osorio, Carlos Felipe; Lozada Ramos, Heiler; Daza Arana, Jorge Enrique; Osorio Toro, Luis Miguel; Bonilla Bonilla, Diana MarcelaVaricella is a childhood disease characterized by its self-limiting and benign nature. However, it can also affect the adult population due to risk factors, leading to infection with numerous complications involving the central nervous system, kidneys, respiratory system, and skin. Varicella pneumonia, one of the most feared complications in adults, occurs in approximately 1 out of 400 patients with the disease. This complication primarily affects male patients with a history of heavy smoking and immunosuppression, either due to an underlying disease such as HIV and cancer, drug use, pregnancy or pulmonary disease. It is recommended that this complication should be treated with intravenous acyclovir at a dose of 10 mg/kg/8 hours. The prognosis depends on the development of respiratory failure; up to 50 % of patients with this complication require invasive mechanical ventilation. Here, we report the clinical case of an immunocompetent patient with a typical presentation of varicella that rapidly progressed to a respiratory infection requiring antiviral treatment and invasive mechanical ventilation.