Medicina - Palmira

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Aplasia cutis congénita tipo I en un recién nacido, reporte de caso
(Universidad Santiago de Cali, 2023) Aluma López, María Alexandra; Kanan, Ahmad Talat (Director); Salcedo Libreros, Luis Felipe (Codirector)
Aplasia cutis (ACC) is a congenital condition with an unusual appearance in pediatrics, especially in newborns, characterized by the absence of skin that can compromise the epidermis, dermis, and even underlying tissues such as the pericranium and meninges. ¹ A case report of a newborn clinically diagnosed with ACC is presented. According to Frieden's characteristics, it corresponds to the type 1 classification, taking into account the size and location of the lesion. The objective of this systematic review is to describe the aesthetic and functional results in a patient with ACC with conservative treatment.
Cardiomiopatía hipertrófica restrictiva en paciente joven: reporte de caso / case report
(Universidad Santiago de Cali, 2024) Murillo Aguirre, María Isabel; Rivera Duran, Laura Valentina; Zorrilla Aparicio, Juan Sebastián; Moreno, Diego Fernando (Director)
The case report presents the clinical situation of a patient diagnosed with hypertrophic cardiomyopathy with a restrictive phenotype, a rare genetic condition primarily characterized by left ventricular hypertrophy. Patients with hypertrophic cardiomyopathy are often asymptomatic, although the spectrum of disease presentation is broad. It can include manifestations such as heart failure, arrhythmias, and, in severe cases, sudden death. We present the case of a 23-year-old man diagnosed with hypertrophic cardiomyopathy with a restrictive phenotype since the age of 14, who has experienced a series of complications throughout his life. Although this phenotype is uncommon, it has significant prognostic implications and impacts quality of life. The detailed description of this case contributes to the knowledge and understanding of restrictive hypertrophic cardiomyopathy, highlighting the importance of considering this differential diagnosis in young patients with atypical cardiac symptoms.
Complicaciones en un paciente con esclerosis sistémica cutánea limitada (síndrome CREST): reporte de caso
(Universidad Santiago de Cali, 2024) Riascos Ceballos, Segundo Alex; Cedeño, Diana Vanessa; Londoño, Mario Andrés (Director)
Systemic sclerosis is a chronic, heterogeneous disease, most prevalent in middle-aged women, characterized by generalized skin and organ fibrosis, small vessel vasculopathy, and autoantibody production, with subtypes like CREST Syndrome and diffuse cutaneous scleroderma. This case report describes a 76-year-old female patient with a history of scleroderma, Raynaud's syndrome, and pulmonary hypertension, among other comorbidities. The patient was admitted to the emergency department due to fatigue, shortness of breath, and necrosis in three toes of the left foot, a manifestation considered a complication of her underlying CREST Syndrome. Despite intensive management, including immunosuppressive therapy, imaging studies, and balloon angioplasty, no clinical improvement in the necrotic lesions was achieved, ultimately requiring the amputation of the affected phalanges.
Conocimiento, actitudes y prácticas del uso del cannabis medicinal en los médicos de la ciudad de Cali en 2024 para el tratamiento del dolor neuropático crónico, y cómo se correlaciona este uso con la efectividad según la revisión sistemática revisada en Colombia por el Instituto de Evaluación de Tecnologías en Salud (IETS) en 2022
(Universidad Santiago de Cali, 2024) Rodríguez Játiva, David Ricardo; Morales Galindo, Cesar Alexander; Restrepo Zapata, Jorge Humberto (Director)
Chronic neuropathic pain is a significant public health problem that affects patients' quality of life. It is associated with disabling diseases and decreased mobility, which in turn reduces activity in daily life. In primary care, there is a lack of satisfactory tools that allow physicians to specify the type of pain, focused on the patient's needs. Treatment of this type of pain is challenging, and conventional therapies often fail to provide adequate relief. In recent years, medical cannabis has been proposed as a therapeutic option for these patients. Therefore, a descriptive cross-sectional correlational study was carried out, which showed that most physicians in Cali do not formulate this therapy due to different limitations such as: lack of knowledge regarding the benefits of THC/CBD with respect to chronic neuropathic pain, which generates certain limitations for safe use in consultation, professionals agree that lack of training is the main limitation of formulation and better training encourages the use of medical cannabis in patients with chronic neuropathic pain as an alternative to different therapies.
Criptococosis meníngea en paciente pediátrico con glomerulonefritis lúpica: reporte de caso
(Universidad Santiago de Cali, 2024) Núñez Domínguez, Jhonatan Teddy; Velásquez Ariza, Laura Daniela; Valdés Jiménez, Daniela; Salcedo Libreros, Luis Felipe (Director)
Lupus glomerulonephritis is a rare disease in childhood, complications arising from treatment with immunosuppressants can trigger opportunistic infections such as cryptococcosis that can lead to fatal outcomes. This case presents a pediatric patient with lupus glomerulonephritis managed with mycophenolate mofetil, prednisolone and hydroxychloroquine who developed meningeal cryptococcosis, confirmed by specific cerebrospinal fluid and serum tests. Antifungal therapy with liposomal amphotericin b and fluconazole showed a favorable evolution but complications subsequently arose requiring therapeutic adjustments. The findings underscore the importance of early diagnosis and the use of combination antifungal therapies in immunocompromised patients, highlighting the need for continuous monitoring and treatment adjustments according to clinical evolution. This case highlights the complexity of the management of opportunistic infections in patients with systemic lupus erythematosus (SLE), evidencing the importance of early diagnosis and the need for personalized approaches, as well as the importance of multidisciplinary management in case of infectious complications with pediatric infectologist, pediatric rheumatologist, pediatric neurologist, pediatric nephrologist and critical care physician.
Dermatomiositis clásica: reporte de caso
(Universidad Santiago de Cali, 2024) Satizabal, Leidy; Lagos, Alejandra; Moreno Moriano, Diego Fernando (Director)
Dermatomyositis (DM) is a pathology of autoimmune origin that is distinguished by variable muscle involvement and skin characteristics typical of the disease. Classical DM, clinical amyopathic DM, paraneoplastic DM, and juvenile DM are the four main recognized forms of DM. It may present systemic manifestations such as calcinosis, arthritis or interstitial lung disease. The main clinical characteristic of myositis is subacute, progressive and symmetrical muscle weakness in the proximal part of the arms and legs, which can extend to generate dysfunction in specific organs such as the gastrointestinal tract, causing dysphagia. Serum creatine kinase (CK) activity is frequently increased and they have myositis-specific antibodies (MDA-5, NXP-2, Mi-2, TIF1-γ, SAE-1). Muscle biopsy or magnetic resonance imaging is usually used as diagnostic support. Among the main pharmacological groups for the treatment of this pathology are intravenous immunoglobulin, methotrexate, steroids and mycophenolate mofetil. In this report, the case of a patient diagnosed with dermatomyositis will be presented.
Dextrocardia y bloqueo auriculoventricular completo con implantación de marcapaso en adulto mayor: reporte de caso
(Universidad Santiago de Cali, 2023) Fajardo Valdés, Natalia; Meneses Ortega, Carolina; Yela Girón, Lina Fernanda; Moreno Moriano, Diego Fernando (Director)
Distribución del volumen pulmonar mediante tomografía de impedancia eléctrica durante una maniobra de titulación de PEEP en pacientes con SDRA moderado- severo asociado con COVID-19
(Universidad Santiago de Cali, 2024) Benítez, María Camila; Lozano, María José; Segura, Alejandro (Director)
This retrospective observational study aimed to determine lung volume distribution in 21 adult patients with COVID-19-associated ARDS using an Electrical Impedance Tomography (EIT) monitor during a decremental Positive End-Expiratory Pressure (PEEP) titration maneuver. The results indicated that ventilation was better in the basal zone than the ventral zone. Optimal PEEP levels were identified in the $18-16-14 \text{ cmH}_2\text{O}$ range for high values and $12-10 \text{ cmH}_2\text{O}$ for low values, with the largest change in lung volume (peak $\Delta\text{EELI}$) occurring between $14 \text{ and } 12 \text{ cmH}_2\text{O}$. The study concludes that the PEEP range between $12 \text{ and } 14 \text{ cmH}_2\text{O}$ was optimal for improving Functional Residual Capacity in these patients, emphasizing the importance of individualized PEEP titration guided by patient physiology.
Ecthyma gangrenosum of fungal origin: case report
(Universidad Santiago de Cali, 2023) León Sánchez, Germán Andrés; Arana Domínguez, Johan Daniel (Director); Lozada Ramos, Heiler (Codirector)
Eficacia de la ciclosporina en la disminución de la mortalidad en pacientes adultos con necrólisis epidérmica tóxica. Revisión sistemática de literatura entre los años 2019 – 2024
(Universidad Santiago de Cali, 2024) Mejía Olave, Manuela Alejandra; Reina Álvarez, Lorena; Mondragón Montaño, Anderson Fabián (Director)
Toxic Epidermal Necrolysis (TEN) is a rare and life-threatening toxicoderma causing epidermal necrosis and detachment, typically due to a drug reaction. Despite the lack of specific treatment, immunomodulators and plasmapheresis have been used with conflicting results, with cyclosporine A emerging as a potential alternative. A systematic review of studies published between 2019 and 2024 identified trials using immunoglobulin, cyclosporine, and methylprednisolone, noting a 0% mortality rate in studies using cyclosporine despite extensive skin involvement (over 50%), contrasting with methylprednisolone and immunoglobulin (one death in each group) or thalidomide (83% mortality). Additionally, low doses of immunoglobulin showed a lower observed mortality (10%) than predicted (32%). Despite these findings, the study concludes that there is insufficient evidence to support the benefits of cyclosporine A in reducing mortality in adults with TEN, which remains a therapeutic challenge.
El impacto de la Musicoterapia en el estado de ánimo del paciente crítico: revisión sistemática de la literatura
(Universidad Santiago de Cali, 2024) Bejarano Alos, Laura María; Molano Agudelo, Pedro Andrés
With roots tracing back to ancient Greece and consolidation as a clinical discipline in the 20th century following the World Wars, music therapy has become a complementary intervention for well-being and health. The objective of this systematic review was to determine the impact of music therapy on the mood of critical patients, using a rigorous literature search of articles published within the last five years. After evaluating 110 studies and selecting 10 for final analysis, the findings consistently showed that music therapy was beneficial across all reviewed study models in adult and neonatal intensive care units, resulting in a significant reduction in depressive and anxious symptoms in both patients and their families, as well as a favorable impact on hospital stress. Although some clinical trials did not report clinically important effects, the therapy was safe and well-accepted, supporting its applicability and replicability for individual or group benefit in hospital settings.
Endocarditis infecciosa por Streptococo gallolyticus tipo: pasteurianus en un paciente de 13 años: caso clínico
(Universidad Santiago de Cali, 2023) Londoño Ospina, Lisa Manuela; Parra Lozada, Laura Alejandra; Guzmán Sandoval, Juan Camilo; Salcedo Libreros, Luis Felipe (Director)
Infective Endocarditis (IE) is an inflammatory and infectious process of the endocardium, primarily valvular, caused by hematogenous colonization, whose diagnosis is established through clinical presentation, blood cultures, and echocardiogram to identify the microorganism and initiate specific antibiotic treatment. The objective of this report is to describe the case of a 13-year-old male adolescent who presented with a five-day history of high fever, neck pain, severe headache, paresthesia, and altered consciousness. A transthoracic echocardiogram revealed emboli on a bicuspid aortic valve, suggesting severe insufficiency and high risk of systemic embolism. The diagnosis of IE due to Streptococcus gallolyticus pasteurianus, a causative microorganism in only 7% of IE cases, was confirmed, and antibiotic treatment with ceftriaxone and gentamicin was initiated.
Endocarditis por Streptococcus equi spp: reporte de caso
(Universidad Santiago de Cali, 2023) Imbacuan Moreno, Daniel Camilo; Villacorte Sánchez, Royman Gustavo; Quiceno Pulido, Mayerli Johana; Arana Domínguez, Johan Daniel (Director); Lozada Ramos, Heiler (Codirector)
The present case report and literature review support that, although severe human infections with Streptococcus equi spp are rare, they have a poor prognosis and lead to high patient morbidity and mortality; cases have been documented mainly in patients with close contact with animals, especially horses, and with consumption of unpasteurized dairy products. Worldwide, gram-positive bacteria account for approximately 80% of cases of native valve infective endocarditis (IE). These bacteria include Staphylococcus aureus in 35 to 40% of native IE cases, streptococci in 30 to 40% (Streptococcus viridans in approximately 20%, Streptococcus gallolyticus [formerly S. bovis] and other streptococci in approximately 15%, within this percentage streptococcus equi is included), and enterococci in 10% [2]. We present the case of a patient with infective endocarditis due to streptococcus equi spp, from which we will describe the clinical, microbiological and imaging diagnostic approach that are useful, as well as the current therapeutic approach for the management of infective endocarditis due to this germ.
Esclerodermia cutánea localizada (morfea) en un infante: reporte de caso
(Universidad Santiago de Cali, 2023) Palacio Herrera, John Edwin; Riascos Ceballos, Gloris; Rodríguez Moncaleano, Nathalya; Molano Agudelo, Pedro (Director)
Localized Scleroderma, a rare disease with an incidence of less than 3 new cases per 100,000 people annually, is the most common form in children, primarily affecting females, with an idiopathic etiology characterized by extracellular matrix alterations and collagen overproduction. This research presents the case of an 8-year-old boy with a one-year history of hyperpigmented, linear skin lesions on the left mandibular ramus and a depressed oval lesion on the left lumbar region. After receiving multiple unsuccessful treatments due to initial diagnostic uncertainty, a skin biopsy confirmed Localized Scleroderma Morphea type. The case concludes by emphasizing the need for up-to-date and accurate diagnostic knowledge regarding skin lesions and the importance of prompt differential diagnosis to initiate early and effective pharmacological treatment.
Esquizofrenia de aparición temprana en menores de 15 años: manifestaciones clínicas, diagnóstico y tratamientos eficaces revisión sistemática (2018-2023)
(Universidad Santiago de Cali, 2024) Moreno Cruz, Luis Carlos ; Alape Morales, George ; Viveros Muñoz, Jesús Arnaldo; Castro Penagos, Lilia Julieta (Directora)
The aim of this systematic review was to analyse early-onset schizophrenia, a condition that represents a significant challenge due to its impact on the psychological and social development of young patients. The importance of this study lies in the need to better understand the risk factors, diagnostic methodologies and therapeutic approaches to improve outcomes in this vulnerable population. Twenty articles on the disease were reviewed to assess the most relevant clinical and therapeutic aspects. The methodology included the selection of studies using specific inclusion and exclusion criteria, followed by a detailed analysis of the data obtained. The results indicate that factors such as the use of psychoactive substances, childhood abuse and family instability significantly increase the risk of developing early-onset paranoid schizophrenia. In addition, second-generation antipsychotics and non-pharmacological interventions, such as cognitive-behavioral therapy, have shown effectiveness in managing symptoms, improving the quality of life of patients.
Factores asociados a mortalidad en pacientes con COVID-19 y síndrome de distrés respiratorio agudo manejados con decúbito prono y ventilación mecánica invasiva
(Universidad Santiago de Cali, 2024) Hoyos de Armas, Beatriz Helena; Lozada Ramos, Heiler (Director); Daza Arana, Jorge Enrique (Director)
This observational analytical case-control study conducted in an ICU in Valle del Cauca, Colombia, aimed to identify risk factors associated with mortality in $122$ adult patients with severe COVID-19 requiring invasive mechanical ventilation and prone positioning. Despite intensive management, which has historically shown a case-fatality rate of up to $50\%$, the bivariate analysis found that age $>65$ years, lack of prior vaccination, thrombocytopenia, high SOFA score, and the need for vasopressors and inotropes were significantly associated with mortality. A multivariate logistic regression model concluded that a history of Diabetes Mellitus (OR $44.91$), COPD (OR $7.74$), autoimmune disease (OR $17.84$), incomplete COVID-19 vaccination status (OR $29.87$), requirement for vasopressors (OR $8.37$) and inotropes (OR $40.99$), and a severe Modified RALE score (OR $7.01$) were independent risk factors for mortality. The study highlights that clinical history, vaccination status, and ICU admission status significantly influence hospital mortality outcomes in severely ill COVID-19 subjects, which is crucial for alerting clinicians to the risk profile of critically ill adult patients during the acute stage of SARS-CoV-2 infection.
Fagoterapia: una nueva alternativa terapéutica en la resistencia a los antibióticos - revisión sistemática
(Universidad Santiago de Cali, 2023) Osorio Hernández, Sofía; Perea Gordillo, Laura Sofía; Arana Domínguez, Johan Daniel (Director); Molano Agudelo, Pedro (Codirector)
Discovered in 1917, bacteriophages are viruses that parasitize and lyse bacteria, releasing new phages and forming the basis of phage therapy, a non-antibiotic medical technique being investigated as an alternative to combat growing global antimicrobial resistance. Given this global challenge, a systematic review (following the PRISMA 2020 guidelines) was conducted in databases like Scopus and PubMed, including 28 articles published between 2017 and 2023. The collected evidence showed that Europe leads the research on phage therapy aimed at antibiotic resistance, highlighting its advantages such as high specificity, low cost, and low rate of side effects, along with its ability to control infections. However, phage therapy faces significant limitations hindering its widespread clinical use, including the lack of extensive studies to understand phages' genome and properties, the absence of a standard regulatory framework, and the complexity of selecting the correct bacteriophage for a specific bacterial infection.
Fiebre de Mediterráneo Familiar en una Paciente Afrodescendiente de 10 Años - Reporte de Caso
(Universidad Santiago de Cali, 2024) Perlaza Riascos, María Del Carmen; Lasso Castellanos, Karem Dayana; Alomia Lerma, Juliana; Kanan Mohamed, Talat Ahmad
Mediterranean fever is an autosomal recessive inherited autoinflammatory disease, which is more prevalent in males than in females and its age of onset is usually in people younger than 20 years in 90% of cases; however, 50% of patients may start with symptoms before the age of 10 years. The following case report shows a 10-year-old Afro-descendant patient with early onset of manifestations, with autosomal dominant mutation in the MEFV gene and other heterozygous genetic alterations. The importance of this case report lies in the unusual presentation in people of African descent, since the epidemiology of this disease is more frequent in Jewish, Armenian, Turkish and Arab people. Therefore, the information presented in this case report allows us to contribute to the knowledge of this disease, its diagnosis and manifestation in patients who are not the common phenotype or genotype of this pathology.
Gangrena de Fournier en hombre: reporte de un caso
(Universidad Santiago de Cali, 2024) Bravo Muñoz, Nicolle Dayhana; Manzano Jiménez, Sebastián; Valencia Betancourt, Rony Stiven; Romero Ortiz, Justy (Director)
This case report describes a 69-year-old male patient with a history of chronic kidney disease and type 2 diabetes mellitus who was admitted to the ICU with a diagnosis of soft tissue sepsis secondary to Fournier's gangrene, despite a one-month history of hemorrhoids. Following a physical examination revealing necrosis in the perineum and anus, a colostomy and debridement were performed immediately. In the ICU, the patient developed severe complications including septic shock, hemodynamic instability, acute respiratory failure, and acute on chronic renal failure, requiring vasoactive support, mechanical ventilation, and renal replacement therapy. Despite intensive management, the condition deteriorated, and following cardiopulmonary arrest and subsequent neurological decline, the patient passed away after the family decided to withhold further resuscitation. This case highlights the complexity and severity of Fournier's gangrene, the necessity of early and aggressive management, and the ethical considerations in high-complexity cases.
Grasa abdominal relacionada con la enfermedad de Alzheimer, revisión sistemática
(Universidad Santiago de Cali, 2024) Gutiérrez Morales, Luis Fernando; Orozco Sotelo, Carlos Arturo; Valencia Torres, Miguel; Nieto, Luis Hernesto (Director)
Recent research suggests a link between greater amounts of visceral abdominal fat in middle age and the development of Alzheimer's disease (AD), with brain changes detectable up to 15 years before the onset of memory loss symptoms. This visceral fat, the fat surrounding internal organs, has been linked to changes in cerebral MRI volumes and amyloid and tau uptake on PET scans in cognitively normal middle-aged individuals. Unlike previous studies linking BMI or obesity to dementia risk, this research establishes a direct connection between a specific fat type (visceral, not subcutaneous) and the actual pathological AD proteins. Given that the prevalence of dementia is high in regions like Colombia and is projected to affect nearly 131.8 million people globally by 2050, with one in five women and one in 10 men developing it, this early identification of a modifiable risk factor like visceral fat is crucial for addressing this major public health concern.

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