vol. 3 núm. 2 (2025): abril - junio

Chronic pain is an intersectional condition whose impact has gained more attention following the COVID-19 pandemic. Preoperative optimization in these patients presents logistical, social, and economic challenges. This study explores the implementation of Perioperative Optimization Programs (POP) as an integrated approach to improve care and outcomes for these patients. A reflective review of various articles available in scientific databases, action plans, and protocols in both Spanish and English was conducted to assess the importance of perioperative optimization and identify existing evidence for optimizing the preoperative state in chronic pain patients. The implementation of an integrated perioperative approach improves recovery and reduces risks in chronic pain patients. These programs are essential to optimizing surgical care and promoting a faster, safer recovery.

Introduction: In clinical practice worldwide, proton pump inhibitors (PPIs) are widely used due to their effectiveness in treating various gastrointestinal disorders. However, they are not without adverse reactions, and their use should be strictly guided by precise clinical indications. Indiscriminate or prolonged use can increase the risk of side effects such as nutritional deficiencies, alterations in the gut microbiota, and a higher risk of bone fractures, among others. Therefore, their prescription must be based on an individualized evaluation of the patient and aligned with the indications provided by the United States Food and Drug Administration (FDA) and the Colombian National Institute for Food and Drug Surveillance (INVIMA).Objective:To evaluate adherence to FDA and INVIMA regulations regarding the use of omeprazole in a high-complexity hospital in northeastern Colombia. Methodology:Retrospective, observational study with a quantitative approach was conducted. A total of 373 medical records were analyzed, selected through non- probabilistic convenience sampling, applying inclusion and exclusion criteria. Data collection was carried out via documentary analysis using Google Forms. Descriptive statistical methods (tables and frequency graphs) and analytical methods, including ANOVA tests and Pearson correlation, were applied to evaluate the relationship between variables such as dosage, pathologies, and prescription years, as well as adherence to FDA and INVIMA regulations.Results:A total of 373 medical records of patients admitted to the emergency department with omeprazole prescriptions between January 2020 and 2024 were analyzed. Only 1.07% of the prescriptions met the indications established by the FDA and INVIMA. The most frequent associated pathologies were COVID-19 (12%), acute myocardial infarction (9%), and community-acquired pneumonia (5.4%), all without clinical indications for omeprazole use. Prescriptions were mainly made by general practitioners and internists, with the most common dosage being 40 mg IV/day. No significant differences were found in treatment duration between different doses. There was no significant association between dosage and the treated pathology, although a significant relationship was found with gastrointestinal conditions, especially upper gastrointestinal bleeding, emesis, and abdominal pain.Conclusions:The study revealed low adherence (1.07%) to FDA and INVIMA-approved indications for IV omeprazole use in a high-complexity hospital in northeastern Colombia. Omeprazole was frequently used in conditions without regulatory support and was often prescribed inappropriately, particularly among older adults with comorbidities. Most prescriptions were made by general practitioners in emergency settings. In response, an institutional protocol was developed to optimize its use, promote patient safety, and strengthen adherence to international clinical guidelines.               

Introduction: Digital platforms facilitate various aspects of life, the lack of responsibility with these media leads adolescents to spend several hours a day browsing the internet regardless of the quality of the programs they visit, impacting their self-image and their relationship with their diet. Objective: To determine the influence of social networks on the self-image and eating behavior of adolescents between 12 and 19 years old from schools in the municipality of San Gil. Method: Quantitative cross-sectional, descriptive, correlational research with a sample of 188 adolescents, chosen at random, 4 instruments were implemented: sociodemographic characteristics, a social media addiction test, a body image scale test, and a scoff test. Results: A statistically significant association was evidenced between TCA and sex (p = 0.001), with women being the most affected, as well as between self-image and eating disorders (p = 0.000), and also between the sex of the participants and self-image (p = 0.001). Conclusions: The influence of social networks on self-image and eating behavior in adolescents was determined, finding a correlation in most of the variables.

Objetive Assess left atrial (LA) contractile function in patients with paroxysmal (AF) using strain echocardiography before and after pulmonary vein isolation (PVI) and compare them with matched controls. Methods A prospective cohort study was conducted at the National Institute of Cardiology Ignacio Chavez from May 2021 to November 2022. Patients with paroxysmal AF underwent transthoracic echocardiography (TTE) assessing LA global strain and strain in the LA reservoir, conduit, and contraction phases strains before and after PVI. Echocardiographic parameters were compared prior to and after PVI, and against matched controls. Results 15 subjects with paroxysmal AF and 15 matched controls were analyzed. Post-PVI, subjects showed significant improvements in LA global and reservoir phase strains. Compared to controls, significant echocardiographic differences were noted pre-PVI, but not post-PVI. Conclusion PVI may enhance LA strain parameters in paroxysmal AF patients, aligning them with matched controls. This suggests PVI's potential restorative effect on atrial function. Further research is warranted to validate these observations.

Introduction: Robotic surgery has transformed surgical practice worldwide due to its precision, reduced risk of complications, and shorter recovery times. However, its adoption in Colombia has been limited since the first intervention in 2010, performed by Clínica de Marly. Currently, only seven additional robots are available, all located in Bogotá, highlighting its low penetration in the country. Methods: A reflective analysis was conducted based on our experience and a review of data on the implementation of robotic surgery in Colombia. Economic, structural, and educational barriers were identified, and strategies were proposed by comparing them to successful international models. Results: The main barrier is the high cost, which is not covered by the healthcare system, restricting patient access and specialist training. Moreover, the centralization of this technology in Bogotá limits its reach in other regions. The lack of local research further perpetuates the absence of evidence supporting its broader adoption. Conclusions: Robotic surgery is a strategic tool for enhancing surgical standards in Colombia. Implementing policies to reduce costs, decentralize technology, and strengthen academic training is crucial. Overcoming these challenges could position Colombia as a regional leader in robotic surgery, benefiting both the healthcare system and patients alike.

Objective: To describe complementary and alternative therapies reported in patients with kidney disease and the effects found. Material and methods: A bibliographic search was performed in several databases: PubMed, Web of Science, RedAlyC, Scielo, Cochrane Library, and Scopus data, Medline, Embase, and EBSCO, using keywords to locate articles from the last 10 years in English and Spanish. Therapies were classified into 5 groups: complete medical systems, mind-body medicine, biological therapies, manipulative and body-based practices, and energy therapies, by means of matrices. Results: 13 articles were found in total of alternative or complementary therapies used in patients with kidney disease: 3 in medical systems, 2 in mind-body medicine, 4 in biological therapies, and 4 in manipulation-based practices and body and energy therapies. Conclusions: Of the 13 articles found 9 of them showed positive effects in the direct treatment of patients' kidney disease or symptoms, however, the groups of studies were too small to point out that these treatments really work. We found 4 articles focused not on the direct treatment of the disease or its symptoms but on the psychoemotional improvement of the patients, in which they found that the use of alternative therapies in conjunction with their treatments helped to reduce stress and anxiety.

Post-traumatic septic arthritis, a rare but serious complication of joint injuries, is characterized by the invasion of microorganisms, frequently methicillin-sensitive Staphylococcus aureus, through disruption of the skin and joint capsular barrier, triggering a severe inflammatory response that can progress to systemic complications such as acute kidney injury, septic shock, hematogenous dissemination bacteremia, and encephalopathies, among others. This case study describes a patient who, after suffering joint trauma, developed severe septic arthritis of the left knee, requiring multiple surgical interventions, long-term antibiotic therapy, and presenting with complications such as acute kidney failure and spondylodiscitis secondary to hematogenous seeding. This highlights the importance of early recognition and multidisciplinary management of this condition to minimize associated morbidity and mortality.

Introduction: Duodenal adenocarcinoma is a rare neoplasm, accounting for approximately 0.3% of gastrointestinal tumors. Its clinical presentation is often nonspecific, making its diagnosis a considerable clinical challenge. Case Report: The case of an-81 year old female patient with a history of multiple comorbidities is presented, who was recently diagnosed with intestinal-type duodenal adenocarcinoma. Due to the persistence of recurrent emetic episodes, oral intolerance, and diffuse abdominal pain, a laparoscopic gastrojejunostomy was performed with palliative intent. The procedure was successfully completed, resulting in favorable clinical progression and significant resolution of symptoms. Discussion: Duodenal adenocarcinoma requires timely surgical intervention, whether for curative or palliative intent, to optimize prognosis and improve patients' quality of life. Conclusions: Despite its low incidence, duodenal adenocarcinoma has significant clinical relevance. Early diagnosis is challenging; however, timely and appropriate intervention are key factors in improving prognosis, contributing to more favorable outcomes for patients.

Morel-Lavallée syndrome is a clinical condition not frequently seen in medical practice, with a prevalence of approximately 8.3% in acetabular fractures. It has a male predominance, with an approximate male-to-female ratio of 2:1, which could be due to the male predominance observed in multiple traumas. However, these injuries often go undiagnosed or are sometimes diagnosed later, thus underestimating their true prevalence. This article presents the clinical case of a young adult patient diagnosed with Morel-Lavallée syndrome in the left lower limb secondary to trauma to the thigh and left hip from a traffic accident. This required surgical treatment due to the functional limitation it generated and the high risk of the hematoma abscessing, leading to septic arthritis of the hip, sepsis, or irreversible functional limitations.

HIV infection attacks the immune system, and acquired immunodeficiency syndrome (AIDS) is the most advanced stage of the disease. HIV attacks the white blood cells, weakening the immune system, and this makes it easier to contract diseases such as tuberculosis, other infections, and some cancers. The intention of this narrative is to learn from nursing students what a patient goes through before, during and after receiving the diagnosis of the infection, for this purpose four meetings were planned and executed with different groups of students and different topics of conversation such as; knowledge, pre-diagnosis feelings, post-diagnosis feelings and uncertainty in the diagnosis of HIV, in order to obtain solid and varied information on the central theme. The students state that knowledge before talking about this topic is crucial to be able to imagine the feelings such as fear, anguish and uncertainty that they present in their different stages in order to reach the diagnosis. Likewise, the accompaniment of social and family support networks is essential in the patient's process, as stigma can invade the infected patient and this can lead to unfavorable decisions.