Andrés Felipe Mora-Salamanca

Background/Objectives: Early risk stratification in acute myocardial infarction (AMI) requires accessible and cost-effective tools. Complete blood count-derived inflammatory indices may provide readily available markers of immunothrombotic activity. The objective of this study was to evaluate the association between inflammatory indices derived from the complete blood count at admission and in-hospital mortality among patients with acute myocardial infarction treated at a high-complexity cardiovascular center. Methods: We conducted a retrospective cohort analysis of prospectively collected data from adults with type 1 AMI treated at a high-complexity cardiovascular center in Colombia between 2021 and 2025. Complete blood count parameters at admission were used to calculate hematological inflammatory indices. The primary outcome was all-cause in-hospital mortality. Associations were evaluated using logistic regression models. Discrimination was assessed using ROC curves, and restricted cubic splines and sensitivity analyses were used to evaluate nonlinearity and robustness. Results: Among 3768 patients, 143 (3.8%) died during hospitalization. Non-survivors had higher NLR, SIRI, SII, and AISI values (all p < 0.001). After adjustment, SIRI (OR 1.94, 95% CI 1.62–2.32), NLR (OR 1.89, 95% CI 1.57–2.27), NPR (OR 1.86, 95% CI 1.56–2.22), and AISI (OR 1.83, 95% CI 1.53–2.19) showed the numerically largest adjusted associations with mortality. Discriminatory performance was modest, with the numerically highest AUROC observed for NPR (0.723), followed by SIRI (0.716) and NLR (0.706). Conclusions: Inflammatory indices were associated with in-hospital mortality in type 1 AMI, but their discriminatory ability was modest. These indices may serve as complementary markers of inflammatory risk.

Sexual and reproductive behaviors and mental health among indigenous peoples are influenced by structural, cultural, and territorial determinants. In Latin America, indigenous populations face inequities related to health service access, sexual education, and mental health care. We assessed the association between sexual and reproductive factors and the presence of mental health symptoms in Wayúu indigenous communities. A cross-sectional study was conducted between 2024 and 2025 in Wayúu communities in Manaure, La Guajira, Colombia. A structured survey including sociodemographic variables, sexual and reproductive history, and mental health symptoms was applied to adult Wayúu indigenous people. A composite score of mental health symptoms was constructed, and the presence of ≥3 symptoms was defined as a “high burden of mental health symptoms.” Descriptive analyses and multivariate logistic regression were performed to estimate adjusted odds ratios (OR). In total, 245 (203 women and 42 men) people participated in the study. The median age was 30 years (IQR 24–38). Forty-nine percent did not receive sex education, and 65% did not use family planning methods. Between 28% and 33% reported persistent symptoms of emotional distress. In multivariable analyses, female sex showed a non-significant association with a higher burden of mental health symptoms (aOR 2.20; 95% CI 0.91–6.19). No statistically significant associations were observed for age, lack of sex education, non-use of family planning methods, or number of children. These findings highlight the high frequency of poor sexual and reproductive health indicators and emotional distress symptoms in Wayúu communities, underscoring the need for integrated, culturally relevant approaches to sexual, reproductive, and mental health care in this population.

Background/Objectives: Indigenous children in La Guajira, Colombia, live in a context of structural vulnerability that may compromise growth and nutritional status. This study aimed to characterize anthropometric patterns and longitudinal nutritional changes in Wayúu children under five years of age. Methods: A quantitative cross-sectional analysis was conducted in 398 children from 27 Wayúu communities in Manaure, La Guajira, Colombia, with an exploratory longitudinal follow-up subgroup assessed over an 8-month period. Anthropometric measurements were obtained by trained pediatricians and classified using standard WHO growth references. Descriptive and bivariate analyses were performed for the full sample, and exploratory longitudinal changes were assessed in the follow-up subgroup. Results: At baseline, 92.46% of children presented at least one nutritional alteration, and 89.95% had malnutrition or nutritional impairment. Stunting was the most frequent condition (60.1%), whereas acute malnutrition was less common. In the exploratory longitudinal subgroup, 41.67% of children showed descriptive changes in at least one anthropometric indicator, with a significant increase in nutritional risk between visits. Older children showed significantly lower weight-for-age and height-for-age values than younger children, while no significant differences were observed by sex. Conclusions: Wayúu children under five years in Manaure show a pattern dominated by chronic growth impairment with worsening anthropometric indicators over time. These findings highlight the need for sustained, culturally adapted, and multisectoral strategies to prevent and manage childhood malnutrition in Indigenous populations.

Background/Objectives: Indigenous children in La Guajira, Colombia, live in a context of structural vulnerability that may compromise growth and nutritional status. This study aimed to characterize anthropometric patterns and longitudinal nutritional changes in Wayúu children under five years of age. Methods: We conducted a prospective cohort study in 398 children from 27 Wayúu communities in Manaure, La Guajira, over an 8-month period. Anthropometric measurements were obtained by pediatricians and classified using standard indicators based on WHO growth references. A descriptive and bivariate analysis was performed for the full sample, and longitudinal changes were evaluated in a follow-up subgroup. Results: At baseline, 92.46% of children presented at least one nutritional alteration, and 89.95% had malnutrition or developmental delay. Stunting was the most frequent condition (89.95%), whereas acute malnutrition was less common. In the longitudinal subgroup, 41.67% of children worsened in at least one indicator, with a significant increase in nutritional risk over time. Older children showed worse weight-for-age and height-for-age indicators than younger children, while no significant differences were observed by sex. Conclusions: Wayúu children under five years in Manaure show a pattern dominated by chronic, symmetrical growth impairment with worsening anthropometric trajectories over time. These findings highlight the need for sustained, culturally adapted, and multisectoral strategies to prevent and manage childhood malnutrition in Indigenous populations.

Chest radiograph (CXR) interpretation remains a fundamental yet challenging skill for undergraduate medical students, requiring both perceptual and integrative reasoning. Near-peer instruction and structured checklists have been proposed to enhance learning, but evidence from randomized designs is limited. We conducted a randomized educational trial among final-year medical students (n = 50). All participants attended a two-hour lecture on CXR interpretation delivered by intensive care medicine residents. The intervention group received additional training using a systematic checklist for image analysis. Performance was assessed through a 16-item test (interpretation and diagnosis domains). Nonparametric tests and Spearman correlations were applied; internal consistency and item discrimination were analyzed. Compared with controls, the intervention group achieved higher median scores in interpretation (6 vs. 3), diagnosis (4 vs. 3), and total score (10 vs. 6) (all p < 0.05). Interpretation and diagnosis scores were not correlated (Spearman ρ = 0.12, p = 0.40). Cronbach’s alpha was 0.592, with 56% of items showing excellent discrimination. A brief, resident-led, checklist-guided session significantly improved CXR interpretation and overall performance. Structuring perceptual search through systematic frameworks can rapidly strengthen diagnostic foundations and represents a feasible, low-cost addition to medical curricula. The online version contains supplementary material available at 10.1186/s12909-026-08971-9.

Background: Difficult weaning from mechanical ventilation remains a major challenge in intensive care units (ICUs), particularly among patients requiring prolonged respiratory support. High-flow tracheal therapy (HFTT) may improve gas exchange, humidification, and comfort in tracheostomized patients, but its clinical impact on weaning duration is uncertain. Methods: We conducted a retrospective cohort study including critically ill adult patients who underwent tracheostomy between 2020 and 2023. Patients received either HFTT or conventional oxygen therapy via tracheostomy mask. The primary outcome was post-tracheostomy mechanical ventilation duration, defined as the number of days from tracheostomy to successful ventilatory support withdrawal. Propensity score matching was performed using age, sex, Sequential Organ Failure Assessment (SOFA) score, presence of acute respiratory distress syndrome (ARDS), and sedation duration. Between-group comparisons employed parametric or nonparametric tests as appropriate, and a negative binomial regression model assessed potential associations with weaning duration. Results: Of 207 screened patients, 65 were included after matching (HFTT group = 19, tracheostomy mask group = 46). Baseline characteristics were balanced. The median post-tracheostomy weaning duration was 13 [8–19] days in the HFTT group and 11 [6–17] days in the tracheostomy mask group ( p = 0.47). Total mechanical ventilation time was longer in the HFTT group ( p = 0.02), but HFTT use was not associated with the post-tracheostomy weaning duration (β = 0.01 ± 0.22, p = 0.96). Conclusions: In this matched cohort, high-flow tracheal therapy did not shorten the weaning duration after tracheostomy compared with conventional oxygen therapy. Prospective studies are needed to clarify its optimal clinical role.

Background: Intensive care unit-acquired weakness (ICUAW) and post-intensive care syndrome (PICS) are significant complications among critically ill patients, leading to prolonged hospital stays, increased healthcare costs, and reduced quality of life. Early physical therapy in the ICU has shown promise in mitigating these adverse outcomes, yet randomized controlled trials (RCTs) evaluating the combined effects of physical, respiratory, occupational, and speech therapy initiated within the first 24–72 hours are lacking. Methods: This single center, controlled clinical trial aims to establish the efficacy and safety of an early multimodal rehabilitation program (MRP) compared with a late MRP in mechanically ventilated patients admitted to the ICU. Adult patients (≥18 years) with a Barthel score ≥70 and requiring invasive mechanical ventilation for more than 24 hours will be included. Participants will be randomly assigned to early MRP, initiated within 24 hours post-intubation, or late MRP, starting 72 hours post-intubation. The primary outcome is the duration of mechanical ventilation. Safety will be assessed by comparing the number of adverse events between groups. The MRP includes passive and active interventions from physical, speech, respiratory, and occupational therapy teams. Therapy intensity and type are adjusted according to the patient’s Richmond Agitation-Sedation Scale (RASS) score. Patients with lower RASS scores (indicating deeper sedation) will receive primarily passive interventions (e.g., passive range-of-motion exercises), while those with higher RASS scores (indicating lighter sedation or alertness) will engage in more active therapies (e.g., active-assisted exercises and functional mobility activities). For patients with RASS ≥2, occupational therapy will focus on behavioral and environmental modulation, employing calming techniques, sensory stimuli, and cognitive tasks, with family education to support spatiotemporal orientation. This adaptive approach ensures patient safety and optimizes therapy based on the patient’s current sedation level and clinical condition. Dissemination: The results will be published in peer-reviewed journals and presented at conferences. Trial registration: ClinicalTrials.gov NCT06133504. Registered on November 11, 2023.

Rationale: Sepsis triggers an unregulated immune response that can lead to multiorgan failure, with mortality rates exceeding 40% in severe cases. Lidocaine, a common local anesthetic with anti-inflammatory properties, is a promising modulator of the immune response in sepsis. This study aimed to assess the association between the intravenous administration of lidocaine and acute kidney injury (AKI) requiring dialysis in septic shock patients. Methods: We conducted a retrospective cohort study including adult patients (≥ 18 years) who were diagnosed with septic shock and admitted to the intensive care unit (ICU) at Fundación Santa Fe de Bogotá between 2016 and 2023. Patients with liver cirrhosis or cancer were excluded. Patients were divided into two groups: those receiving a lidocaine infusion (from 1.0 to 2.0 mg/kg/h) and those who were not prescribed lidocaine (control). Propensity score matching was performed to control for confounding factors, with AKI requiring dialysis as the primary outcome. Univariate analysis and logistic regression, including variables associated with the outcome (p value 0.05). Univariate analysis revealed that lidocaine infusion was associated with AKI requiring dialysis (p value = 0.021). The odds ratio was 1.75 (95% CI: 1.08-2.86), indicating a greater risk of renal complications among patients receiving lidocaine. Conclusion: This study suggests an increased risk of developing AKI requiring dialysis among septic shock patients receiving an intravenous infusion of lidocaine in the ICU. Monitoring early signs of toxicity is advised when lidocaine is used in this population, and further studies are necessary to explore its renal impact in critical care settings.

Rationale: The duration of tracheostomy weaning (time between the start of tracheostomy weaning and decannulation) is a critical factor in the management of patients in the intensive care unit. While both high-flow tracheal therapy (HFTT) and tracheostomy masks (TM) are common post-tracheostomy interventions, their impact on weaning time remains unclear. We aimed to compare the tracheostomy weaning time between patients using HFTT and those using TM. We also identified factors affecting the weaning process. Methods: We conducted a retrospective cohort study comparing adult patients (≥18 years) who underwent tracheostomy and received either HFTT or TM interventions in our intensive care unit between 2020 and 2023. A Cox proportional hazards regression model was performed to assess the association between HFTT or TM use and the tracheostomy weaning time, adjusted for clinical variables. Interaction variables were included to explore potential modifying effects. Results: In total, 159 patients were included. The median age was 63 years (IQR: 46.5-71.0) and most patients were female (58.5%). The predominantly diagnoses between both groups were neurological conditions. Both groups significantly differ in the incidence of Acute Respiratory Distress Syndrome and the number of days on mechanical ventilation. The median tracheostomy weaning time was significantly shorter in the HFTT group compared to the TM group (7.0 vs 13.0 days; p-value= 0.02); therefore prolonging significantly the ICU and hospital length of stay in the latter group. The Cox model revealed that using a TM reduced 48% the likelihood of early weaning compared to the high-flow tracheal therapy (HR: 0.52, 95% CI: 0.28-0.92, p-value= 0.03). Conclusions: Patients using high-flow tracheal cannulas experienced significantly faster tracheostomy weaning than those using tracheostomy masks. Tracheostomy mask use was independently associated with prolonged weaning times, highlighting the need for careful management of these patients. A randomized clinical trial is required to confirm these results.