Julio Ricardo Zuluaga Peña

Introducción. Las enfermedades respiratorias se están posicionando como una de las más prevalentes y la población tiende a ampliar la base de envejecimiento en el país, siendo imperativo brindar un servicio de salud integral, con especialistas que puedan atender las diversas patologías, siendo la evaluación de la densidad de personal de salud que puedan involucrarse en dicha atención, un factor clave para los procesos de planificación de talento humano en salud, para abordar de manera efectiva el incremento en la demanda de servicios y las dificultades de acceso a servicios que afectan a grupos poblacionales ubicadas en municipios pequeños y en zonas rurales dispersas. Objetivo. Estimar la densidad de especialistas en neumología en Colombia a nivel departamental y regional, entre 2011 y 2023. Materiales y métodos. Se recopiló la información de neumólogos en el país a partir de la base de datos del Registro Único Nacional del Talento Humano en Salud (ReTHUS), estimando tasas mínimas, máximas y medianas por cada 100.000 habitantes. Resultados. De acuerdo con los hallazgos, en el país la tasa de neumólogos es de menos de un especialista por 100.000 habitantes (0,4), con diferencias geográficas, siendo mayor en la región Andina (especialmente Bogotá D.C., Quindío y Risaralda) y menor en la región Amazónica. Por año, las mayores tasas se evidenciaron en 2017 y 2018. Estos resultados sugieren que es necesario que en Colombia se incremente la tasa de neumólogos, considerando los retos y desafíos que las enfermedades respiratorias y el envejecimiento imponen con el tiempo, garantizando una adecuada cobertura de atención a la población. Conclusiones. Es necesario que en Colombia se incremente la tasa de neumólogos, considerando los retos y desafíos que las enfermedades respiratorias y el envejecimiento imponen con el tiempo, siendo necesario garantizar una adecuada cobertura de la prestación del servicio.

Background/Objectives: The management of advanced HER2-positive and HER2-low breast cancer is evolving rapidly. This study aimed to generate national, evidence-based clinical recommendations for Colombia, addressing the lack of standardized local guidance. Methods: A systematic literature search (2020–2024) was conducted. The evidence was evaluated using AGREE II, RoB 2, ROBINS-I, and JBI tools. Recommendations were developed using the GRADE approach and a structured modified Delphi consensus process involving 34 national experts. Results: A total of 22 clinical recommendations were formulated. These address HER2 quantification and reporting, first-line and subsequent-line therapy, and management of brain metastases. Five recommendations (23%) were classified as strong, supported by high-certainty evidence, while 17 (77%) were conditional, reflecting the need for adaptation to local contexts and resource availability. Conclusions: This consensus provides updated, context-specific clinical guidance to optimize the care of patients with advanced HER2-positive and HER2-low breast cancer in Colombia. The recommendations are designed to standardize care, improve patient outcomes, and promote equitable access to innovative therapies within the Colombian healthcare system.

Introducción: la sarcopenia es una condición musculoesquelética de carácter progresivo, definida por la disminución de la masa y la fuerza muscular, y se estima que impacta entre el 10,0?% y el 16,0?% de la población adulta mayor a nivel mundial, deteriorando su funcionalidad, autonomía y calidad de vida. En personas con DM2, la prevalencia de sarcopenia puede alcanzar el 20,9 %, siendo más común en adultos mayores. En Colombia, la elevada carga de ambas condiciones agrava el pronóstico funcional y metabólico, lo que demanda un enfoque clínico multidisciplinario y adaptado al contexto nacional. Objetivo: Establecer recomendaciones basadas en evidencia científica para el abordaje integral de los pacientes con sarcopenia y diabetes mellitus tipo 2 en Colombia, optimizando la toma de decisiones clínicas. Metodología: Este consenso, desarrollado por la Asociación Colombiana de Endocrinología, Diabetes y Metabolismo mediante un panel de nueve expertos, siguió una metodología estructurada que incluyó la definición de preguntas PICO, búsqueda y evaluación crítica de la evidencia, y la formulación de recomendaciones mediante técnicas formales de consenso. Resultados: Se desarrollaron 35 recomendaciones para responder a 13 preguntas clínicas. La certeza de la evidencia fue entre moderada y alta, basada en guías de práctica clínica, revisiones sistemáticas y ensayos clínicos. La mayoría de las recomendaciones se clasificaron como "débil a favor", reflejando la limitada evidencia en algunas áreas. Conclusión: Este consenso proporciona orientaciones prácticas para el manejo de la sarcopenia en pacientes colombianos con DM2. Estas recomendaciones deberán ser actualizadas periódicamente a medida que surja nueva evidencia científica.

Introduction Endoscopic sleeve gastroplasty (ESG) is a minimally invasive weight loss procedure that reduces stomach volume and length using an endoscope suturing device, creating a sleeve-like shape to limit food intake and promote weight loss. ESG has been proven to be more effective in promoting weight loss than dietary and lifestyle changes, with a low incidence of complications. In Colombia, data regarding the effectiveness and safety of this procedure are lacking. Methods This descriptive, retrospective cohort study included patients who underwent ESG between January 2022 and July 2023. Demographic and clinical characteristics were descriptively analyzed. Changes in weight, Body Mass Index (BMI), and percentage of Total Body Weight Loss (%TBWL) at 1, 3, and 6 months were assessed. Results Ninety patients were included in this study. The median baseline weight was 85.5 kg, and the median BMI was 33 kg/m². Weight reduction was observed after 3 and 6 months, with weights of 73 kg and 69.5 kg, respectively (p < 0.001). %TBWL increased to 8.3%, 15.5%, and 20.0% at 1, 3, and 6 months (p < 0.001). BMI decreased to 27.4 kg/m² at the third month and 25.9 kg/m² in the sixth month, respectively (p < 0.001). Complications were mostly minor, occurring within the first month of follow-up, and included abdominal pain (21.1%), nausea (28.9%), vomiting (14.4%) and gastroesophageal reflux disease (GERD) symptoms including heartburn and regurgitation (10%). Gastrointestinal bleeding (3.3%) was less common. Conclusions ESG is a safe and effective adjuvant treatment for obesity. This study showed significant BMI and %TBWL reduction at the 3- and 6-months post-procedure follow-ups, with a low incidence of minor complications.

Contexto: el tratamiento de la enfermedad renal crónica (ERC) tiene como objetivo disminuir el riesgo de progresión de la enfermedad, el surgimiento de complicaciones y el riesgo de muerte, especialmente considerando el continuo cardiorrenal. Mediante diferentes ensayos clínicos realizados con personas diabéticas y no diabéticas, así como de otros grupos de riesgo como insuficiencia cardiaca y ERC, los antidiabéticos conocidos como inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT-2, según sus siglas en inglés) han demostrado efectos beneficiosos en los resultados renales y cardiovasculares. Objetivo: establecer recomendaciones para el manejo con iSGLT-2 para pacientes con ERC. Metodología: el consenso se desarrolló en las siguientes etapas: conformación del grupo desarrollador; definición de las preguntas objeto de investigación; búsqueda, tamización, evaluación y selección de la evidencia; elaboración de síntesis y evaluación de la evidencia; discusión en paneles formales, generación de recomendaciones y juicio de expertos; y redacción, elaboración y revisión del documento del consenso. Resultados: los 22 expertos clínicos formularon un total de 15 recomendaciones para 12 preguntas de investigación. La certeza de la evidencia varió entre moderada y alta, basada principalmente en guías de práctica clínica, revisiones sistemáticas de la literatura, ensayos clínicos y consensos de expertos. La mayoría de las recomendaciones fueron débiles a favor. Conclusiones: las recomendaciones formuladas sirven como una pauta para implementar el tratamiento de iSGLT-2 en pacientes colombianos con ERC y algunas de sus complicaciones o comorbilidades. A medida que surja nueva evidencia científica, es posible que sea necesario reconsiderar y revisar con cautela estas recomendaciones.

Background: Dysbiosis and antibiotic-associated diarrhea (AAD) are significant concerns in clinical settings. Probiotics, such as Bacillus clausii (O/C, N/R, SIN, T), a spore-forming bacterium resistant to gastrointestinal conditions and most commonly used antibiotics, emerge as a promising approach. We aim to assess the role of B. clausii in preventing AAD in children and adults during antibiotic therapy. Materials and methods: A systematic literature search was conducted across multiple databases, including MEDLINE, EMBASE, Cochrane Library, LILACS, and SciELO, up to May 2024. Studies were included if they involved B. clausii (O/C, N/R, SIN, T) administration during antibiotic treatment and reported AAD-related outcomes. Results: A total of four studies were included in the review. The studies comprised two randomized controlled trials (RCTs), one meta-analysis of RCTs, and one expert consensus. The primary outcome was the effectiveness of B. clausii (O/C, N/R, SIN, T) in reducing the incidence of diarrhea. Results showed a significant reduction in the risk of AAD and gastrointestinal symptoms in patients receiving it at a dosage of 4 × 10⁹ CFU/day for children and 6 × 10⁹ CFU/day for adolescents and adults for up to 14 days. Conclusions: B. clausii (O/C, N/R, SIN, T) appears to be an effective probiotic for preventing AAD in adults and children. It significantly improves gastrointestinal symptoms associated with antibiotic treatment, including diarrhea, nausea, and epigastric pain. Future studies are recommended to further elucidate its effectiveness in diverse populations, especially in low- and middle-income countries.

Introduction: Pulmonary Arterial Hypertension (PAH) is a clinical condition characterized by dysfunction of the pulmonary arterial endothelium that manifests with increased flow restriction in the pulmonary circulation. Numerous advances have been made in understanding the pathophysiology, risk stratification, treatment, and follow-up of patients with this disease. Among these advances is the update in the hemodynamic definition of the event, which largely determines the therapeutic actions to be followed. Due to the above, it was considered necessary to establish recommendations for managing patients with PAH, based on an approach that considers access, use, and provision of health services in Colombia. Methodology: The final document was developed in six stages: 1. Definition of the research questions and content. 2. Search, screening, selection, and evaluation of the evidence. 3. Preparation of a narrative summary of the evidence-based on the guiding questions. 4. Discussion of findings in formal panels. 5. Formulation of recommendations. 6. Writing and consolidation of the final consensus document. Results: The 34 participants reached a consensus and formulated 26 recommendations based on four thematic segments: i) definitions and diagnostic segment, ii) risk stratification segment, iii) treatment segment and iv) follow-up segment. Conclusion: The formulated recommendations will guide primary care physicians in identifying clinical suspicion of the disease and for specialists and subspecialists in confirming the diagnosis, defining the therapeutic approach, and managing patient follow-up. As new evidence emerges, these recommendations should be carefully reviewed and updated.

Dysbiosis is a clinical condition marked by altered gut microbiota resulting from external and internal host factors. It is strongly associated with gastrointestinal and extraintestinal alterations, so its symptomatology is broad and nonspecific. To date, gaps remain that limit professionals from making a timely diagnosis and prescribing the appropriate treatment. We aim to synthesize existing literature regarding clinical parameters for the early detection of patients with intestinal dysbiosis and the clinical events in which the use of probiotics as adjuvant therapy is most frequently reported. A scoping review of the literature was conducted in PubMed, Embase, Cochrane, and BVS (Biblioteca Virtual en Salud in Spanish) databases for articles published in the last 5 years. Primary studies and literature reviews related to clinical presentation, dysbiosis screening, and probiotics as adjuvant therapy for adult and pediatric patients were included. Twenty-three articles were retrieved in which the most frequently reported symptoms were abdominal distension, abdominal pain, and diarrhea. Chronic and metabolic diseases where the conditions most strongly associated with dysbiosis. Depending on symptomatology and etiology, dysbiosis is often treated with probiotics. Dysbiosis, often linked to diarrhea, should be considered with other symptoms like abdominal distension and pain, along with predisposing conditions and patient risk factors. Probiotics are commonly used as co-adjuvant treatments for antibiotic-associated diarrhea, irritable bowel syndrome, and childhood allergic diseases. The most commonly used probiotics were Weizmannia coagulans (formerly B. coagulans), Alkalihalobacillus clausii (formerly Bacillus clausii), Lacticaseibacillus rhamnosus, Limosilactobacillus reuteri, and Saccharomyces boulardii.