vol. 3 núm. 4 (2025): octubre - diciembre

La mayoría de las lesiones pélvicas en pacientes jóvenes se deben a traumatismos cerrados de alta energía, aunque los pacientes frágiles y adultos mayores pueden sufrir estas lesiones por un mecanismo de baja energía (es decir, una caída desde la posición de pie). Los traumatismos de alta energía aumentan la probabilidad de lesiones concomitantes, que probablemente afecten las vísceras abdominales y pélvicas. Las fracturas pélvicas representan aproximadamente el 3 por ciento de las lesiones esqueléticas; La mortalidad general por fracturas pélvicas varía del 5 al 16 por ciento, con una tasa de fracturas pélvicas inestables de aproximadamente el 8 por ciento. Las fracturas pélvicas abiertas, que comprenden del 2 al 4 por ciento de todas las fracturas pélvicas, se asocian con una tasa de mortalidad de hasta el 45- 50 por ciento. Los mecanismos más comunes de las fracturas pélvicas incluyen colisiones de vehículos de motor y accidentes de motocicleta (43 a 58 por ciento), peatones atropellados por un vehículo de motor (20 a 22 por ciento) y caídas (5 a 30 por ciento). En este caso clínico se presenta se presenta una femenina de 25 años quien presento un trauma en pelvis secundario a accidente de tránsito con posterior fractura abierta tipo IIIC de pelvis con lesión de arteria iliaca externa, vena y arteria femoral izquierda con progresión a la no viabilidad de extremidad por lo que termino en hemipelvectomia izquierda.

A fistula is an abnormal connection between two epithelialized surfaces that are normally separated, most commonly occurring secondary to infectious, inflammatory, or traumatic processes. Vagino-cutaneous fistulas are exceedingly rare, as the most frequent fistulas in this anatomical region are vesicovaginal or rectovaginal, due to the close proximity of these structures. We present the clinical case of a 36-year-old woman with a history of obesity and sedentary lifestyle who initially presented to her primary healthcare unit with pain in the gluteal and perianal region, accompanied by urinary symptoms. She was treated empirically with antibiotics for a presumed urinary tract infection and analgesics, without clinical improvement. On day 15, she attended the emergency department due to purulent vaginal discharge. Physical examination revealed a necrotic lesion measuring 5 × 5 cm in the perianal region of the left buttock, and surgical debridement confirmed a vagino-cutaneous fistula. Initial management included debridement, eschar excision, and sterile dressing coverage, followed by a second procedure for partial closure. The patient remains hospitalized under multidisciplinary management, awaiting further evaluation for additional intervention. This case highlights the importance of timely medical diagnosis and thorough physical examination during the initial consultation, and documents the rarity and complexity of vagino-cutaneous fistulas.

Bullous lung disease is a variant of emphysema characterized by the formation of air cavities larger than 1 cm, primarily associated with COPD and chronic smoking. Its complications include spontaneous pneumothorax, hemoptysis, bulla infection, and bronchopleural fistula, the latter of which is difficult to manage clinically and carries a high morbidity and mortality rate. Spontaneous pneumothorax secondary to bullous disease can be complicated by bronchopleural fistula, a rare condition outside of surgery. Persistent air leak limits conservative management and requires consideration of surgery. Video-assisted thoracoscopy and limited lung resections are effective and safe options, improving prognosis and respiratory function in selected patients. Furthermore, bronchopleural fistula secondary to spontaneous pneumothorax due to bullous disease is a rare but serious complication. Timely diagnosis and adequate surgical approach are crucial for clinical recovery and reduced morbidity and mortality in these patients. We present the case of a 63-year-old male patient with a history of COPD and chronic smoking who was admitted with a left pneumothorax initially managed with closed thoracostomy. He presented with a persistent air leak secondary to severe bullous emphysema. Due to the lack of resolution with conservative management, surgery was performed, revealing a ruptured apical bulla with a bronchopleural fistula, fibrinopurulent pleural effusion, and lung entrapment. A non-anatomical segmentectomy was performed with closure of the fistula. The postoperative outcome was favorable, and the patient was discharged on the fourth day without complications.

Introduction: Cecal volvulus is a rare cause of intestinal obstruction, characterized by the axial rotation of the cecum and ascending colon around the mesenteric vasculature. This torsion can lead to tissue necrosis and intestinal perforation. Timely diagnosis and appropriate management can reduce mortality. Case report: A 43-year-old woman presented to the emergency department with nonspecific abdominal symptoms. A computed tomography scan suggested intestinal torsion, prompting an exploratory laparotomy. A cecal volvulus with extensive necrosis was identified, necessitating a right hemicolectomy and detorsion as a damage control approach. Discussion: Cecal volvulus is a pathological condition with multiple predisposing factors, among which a history of abdominal surgery is particularly significant. Diagnosis relies on laboratory studies and imaging techniques, with abdominal computed tomography being the most sensitive and specific modality. Management is primarily surgical, ranging from detorsion to colectomy, depending on intestinal viability and the patient’s hemodynamic stability. In cases of irreversible intestinal ischemia, colectomy with or without ileostomy is necessary to mitigate damage and prevent complications. Conclusions: Cecal volvulus is a rare cause of intestinal obstruction, characterized by nonspecific symptoms and accelerated progression. Early diagnosis, as well as surgical treatment, are essential to reducing complications.

Introducción: La presente investigación se llevó a cabo en una empresa de reciclaje de Pamplona, Norte de Santander. Su objetivo principal fue Determinar la influencia de la conciencia corporal en la adaptación ocupacional de los recicladores de Pamplona, mediante estudio cuantitativo, facilitando la eficiencia en el desempeño de tareas ocupacionales. El marco teórico se fundamentó en teorías propias de la disciplina de terapia ocupacional, reconociendo que la adaptación depende de la capacidad del individuo para ajustarse a las demandas del entorno y que el desempeño ocurre como resultado de la interacción entre la persona, sus contextos y las tareas que realiza. Metodología: se empleó un enfoque cuantitativo de tipo descriptivo con diseño transversal. Los instrumentos aplicados fueron: ficha sociodemográfica, MAIA-II para conciencia corporal y OPHI-II para adaptación ocupacional; los datos fueron procesados mediante SPSSv23. Resultados: revelaron que las dimensiones perceptivas altas (Percepción y Conciencia emocional en percentil 90) no ejercen influencia protectora sobre la adaptación ocupacional. Por el contrario, las dimensiones regulatorias bajas (No distraerse, Regulación de la atención y Escucha corporal en percentil 40) ejercen influencia negativa determinante sobre la identidad y competencia ocupacional. La subescala Conciencia Emocional mostró asociación significativa con problemas en la Identidad Ocupacional (OR = 4.0; IC95% [1.02, 15.93]; p < 0.05); para Competencia Ocupacional, dos subescalas presentaron asociaciones significativas: Conciencia Emocional (OR = 28.75) No Distraerse (OR = 0.134); en el Contexto Ocupacional el patrón es idéntico al observado en la competencia ocupacional, puesto que las mismas contingencias subyacen al entorno laboral. Es así que, en las tres escalas se presentaron OR superiores a 4.0 y significancia estadística en todos los casos. Conclusión: Se concluye que la conciencia corporal influye de manera paradójica en la adaptación ocupacional: en contextos de precariedad extrema, la alta percepción interoceptiva sin acciones de autocuidado intensifica el conflicto entre necesidades corporales y demandas laborales.

Introducción: Las cicatrices post-queiloplastia representan un desafío clínico debido a su impacto estético, funcional y psicosocial. El láser fraccional de CO2 y la luz pulsada intensa (IPL) se han utilizado para optimizar la calidad de la cicatriz, pero la evidencia sigue siendo heterogénea y no existe consenso sobre la modalidad más efectiva. Métodos: Se realizó una revisión narrativa de la literatura en PubMed y Embase (2015-2025), que incluyó ensayos clínicos, revisiones sistemáticas y estudios observacionales. Los resultados clínicos clave analizados fueron grosor, textura, flexibilidad, pigmentación y vascularidad. Resultados: El láser fraccional de CO2 mostró beneficios consistentes en la reducción del grosor de las cicatrices y la mejora de la textura y la flexibilidad, con mayor eficacia al aplicarse en las primeras fases de la cicatrización. La IPL fue particularmente útil para las alteraciones pigmentarias y vasculares, con un perfil de seguridad favorable. Estudios que evalúan la combinación de CO2 e IPL, como los de Peng y Komisarek, sugieren un posible efecto sinérgico, aunque persisten limitaciones metodológicas. La heterogeneidad de los protocolos, el pequeño tamaño de las muestras y el número limitado de comparaciones directas limitan la generalización de los hallazgos. Conclusiones: El láser fraccional de CO2 presenta la evidencia más sólida para mejorar los parámetros estructurales de las cicatrices postqueiloplastia, mientras que la IPL ofrece beneficios complementarios para la pigmentación y la vascularidad. Combinar ambas terapias puede ser una estrategia prometedora, pero se necesitan ensayos controlados multicéntricos bien diseñados con protocolos estandarizados y comparaciones directas, que idealmente incorporen resultados de calidad de vida.

Introduction: Cancer is a public health problem being the second leading cause of mortality worldwide. In Mexico, the incidence was 195,499 in 2020, being breast cancer (BC) the one that most affects Mexican women. Objective: To analyze the social determinants that have the greatest impact on the quality of life (QoL) of patients with breast cancer treated in a Mexican hospital Material and methods: Analytical cross-sectional study, with patients aged 18 years and older diagnosed with BC in the last 36 months in stage I-III, who received medical care and chemotherapy at the Leon General Hospital. Three instruments were used: 1) the QLQ-30 (QLQ-30), 2) its complement for BC (QLQ-BR-23), both elaborated by the European Organisation for Research and Treatment of Cancer, and 3) questionnaire elaborated for social determinants. Results: 73 participants. Neoadjuvant chemotherapy caused more pain (p-value=0.021). Global CV score 77.62. Having a partner was associated with better sexual functioning (p=0.023), not owning a home increased breast cancer (p=0.030), lower family income increased nausea and vomiting, better body image and worse sexual functioning (p=0.020, 0.053, 0.007 respectively). Positive association with CV physical, emotional and social functioning; and concern for future (p=0.015, 0.006, 0.005 and 0.037 respectively), negatively: fatigue, pain, body image and side effects to treatment (p-value=0.004, 0.003,0.023 and 0.006 respectively). Conclusions: It was found that the factors that significantly influenced the participants' QoL were having a partner, not owning a home, and lower family income. The factors that had a negative association with participants' QoL were fatigue and pain, body image items, side effects of systemic therapy and worry about the future.

Biliary atresia is a rare hepatobiliary disease characterised by an inflammatory and destructive process with progressive obliteration and sclerosis of the intra- and extrahepatic bile ducts, leading to obstruction of bile flow and damage to the parenchyma and intrahepatic bile ducts, with subsequent liver failure and cirrhosis. The surgical treatment of choice has been Kasai portoenterostomy; however, the vast majority of patients require liver transplantation (up to 80%) due to disease progression. To date, this pathology is not subject to mandatory reporting in Colombia, so we do not have epidemiological data despite it being one of the leading causes of TH in the first years of life in the paediatric population. We describe a series of cases including six patients diagnosed with biliary atresia at a tertiary care hospital in the department of Norte de Santander, Colombia. In our work, we highlight the critical importance of early detection strategies for timely diagnosis and treatment to reduce morbidity and mortality.

Introduction: Peritoneal dialysis is a procedure that allows the purification of fluids and electrolytes in patients suffering from chronic renal failure thanks to the physiological capacities of the parietal peritoneum, whose path to development as a treatment for said pathology was marked by milestones throughout history. The peritoneal catheter is a prosthesis similar to a round tube, usually made of silicone, that can be placed using open, laparoscopic and even percutaneous surgical techniques. Objective: To make a historical account of the development over time of peritoneal dialysis, as well as to describe the various techniques in the placement of Tenckhoff catheters by endoscopic, percutaneous or open surgery, with their respective indications and contraindications. Materials and methods: A literature review was conducted in the PubMed and Google Scholar databases, both in Spanish and English, using the sole search terms "peritoneal dialysis history" and "peritoneal catheter placement techniques," limiting the search to articles published since 2013, yielding 690 results. A manual search was performed without any software support, in which fourteen articles were included based on a review of the title, abstract, and keywords.