Diana Marcela Bonilla Bonilla

Background: Thoracentesis is pivotal in managing pleural effusion (PE), particularly in invasive mechanical ventilation (IMV), with documented improvements in respiratory mechanics, oxygenation, and hemodynamic parameters. However, its efficacy may vary based on effusion type and drained volume. Methods: A retrospective longitudinal study was conducted at a high-complexity care center in Cali, Colombia (2019–2024), including 93 (IMV) patients who underwent therapeutic thoracentesis (TT). Respiratory and hemodynamic parameters were assessed before and up to 24 h post-procedure. Stratified analysis was performed by drained volume, fluid type, and left ventricular ejection fraction (LVEF). Results: TT yielded significant improvements in fraction of inspired oxygen (FiO₂) (−4%), positive end expiratory pressure (PEEP) (−0.5 cmH₂O), and Oxygen arterial Pressure Index/Inspired Oxygen Fraction (PaO₂/FiO₂-ratio) (+27.1), with greater impact for volumes ≥500 mL and transudative PE. Patients with LVEF ≤ 40% showed increased mean arterial pressure (MAP) and PaO₂. Complication rates were low (<4%). Conclusions: TT is safe and effective in critically ill IMV patients, particularly for transudative PE and drained volumes ≥500 mL, as well as in subjects with LVEF ≤ 40%. Its positive impact on oxygenation and ventilation supports its therapeutic utility in critical care.

Background: The MitraClip device is used as an endovascular therapy for mitral valve repair in patients with severe mitral insufficiency and high surgical risk. This therapy was used for the first time in Colombia in 2013, after its authorization by the National Institute of Drug and Food Surveillance. Materials and Methods: A quantitative, observational, descriptive, longitudinal study was conducted, with an analytical component stratified by age, in adults who underwent mitral valve repair with MitraClip from March 2013 to June 2022 to determine the clinical outcomes associated with hospitalization, mortality, complications, and health-related quality of life. Results: A total of 94 patients with a mean age of 70.3± 10.3 years were evaluated, most of whom were male (65%), hypertensive (80%), and had New York Heart Association class III–IV classification (90.4%) and functional mitral insufficiency (93.6%) classified as severe (74.5%). The recurrence of all-cause hospitalization was 39.4%, of which 88% corresponded to heart failure. The immediate success of the procedure, determined as mitral insufficiency classified as ≤moderate after implantation, was 93.6% (p < 0.001). In-hospital mortality was 2.1%, mortality at 6 months was 12.8% (≤ 70 years 11.6% vs > 70 years 13.7%, p = 0.007), mortality at 1 year was 16%, and mortality at 2 years was 20.2%. The incidence of complications was low, the most frequent one being de novo atrial fibrillation (7.4%), followed by major bleeding requiring transfusion (4.3%). The Kansas City Cardiomyopathy Questionnaire scale was used, with a mean score of 69.9± 19.3. Conclusion: Percutaneous mitral valve repair with MitraClip is a safe technique that directly affects survival and quality of life. There was a low incidence of complications related to the procedure and the patient’s preoperative condition, with results comparable to those of studies carried out in Europe and the United States.

Background/Objectives: Digital twins are emerging as a transformative technology in diabetes management, promising a shift from standardized protocols to highly personalized care. This scoping review aims to systematically map the current landscape of digital twin applications in diabetes, synthesizing evidence on their implementation architectures, analytical models, performance metrics, and clinical integration strategies to identify key trends and critical gaps. Methods: A systematic search was conducted across five electronic databases in accordance with PRISMA-ScR guidelines to identify empirical studies on digital twins for diabetes. Data from the selected articles were extracted to analyze bibliographic characteristics, population data, technological components, performance outcomes, and integration levels. A narrative synthesis was performed to map the evidence. Results: Seventeen studies were included, revealing a rapid increase in publications since 2022, with a notable concentration of research in India. The technological architecture shows a convergence toward machine learning models (e.g., LSTM) powered by data from IoT devices and wearables. Certain interventional studies have reported significant clinical impacts, including HbA1c reductions of up to 1.9% and T2DM remission rates as high as 76.5% in one trial. However, major implementation barriers were identified, including fragmented interoperability standards and low rates of full integration into clinical workflows (35.3%). Conclusions: Digital twins are emerging as powerful tools that show the potential to drive significant clinical outcomes in diabetes care. However, to translate this promise into widespread practice, future efforts must focus on overcoming the critical challenges of standardized interoperability and deep clinical integration. Rigorous, independently validated, long-term trials in diverse populations are essential to confirm these promising findings.

Background and Aim: Syphilis, caused by Treponema pallidum, classically presents with genital or anal chancres; rectal involvement is rare and frequently misdiagnosed as inflammatory bowel disease or malignancy. We describe an unusually severe case of syphilitic proctitis in the setting of advanced HIV-related immunosuppression (CD4 39 cells/µL), in which targeted immunophenotyping (ERG and CD38) was a valuable adjunctive tool in the differential diagnosis. Case Presentation: A 46-year-old man with a recent history of erosive gastritis and esophageal candidiasis presented after six months of unintentional 20 kg weight loss, profound fatigue, intermittent fevers, profuse diarrhea, and two episodes of hematemesis. Workup revealed a new diagnosis of HIV infection (CD4: 39 cells/µL; viral load: 87,837 copies/mL). Contrast-enhanced CT demonstrated uniform, concentric rectal wall thickening (“target sign”). Colonoscopic biopsy showed exuberant granulation tissue and dense plasma cell infiltrates. Immunohistochemistry revealed a dense infiltrate of CD38-positive plasma cells and ERG-positive endothelial proliferation. These findings, in the context of positive serology, were highly supportive of a spirochetal etiology and helped differentiate it from potential mimics. Serology was positive for latent late syphilis (VDRL 1:64). The patient received three weekly doses of intramuscular benzathine penicillin; lumbar puncture excluded neurosyphilis. Discussion: This is among the first reported cases of syphilitic proctitis in a patient with CD4 < 50 cells/µL, where advanced immunophenotyping differentiated syphilitic inflammation from neoplastic or inflammatory mimics. Profound immunosuppression accelerates disease progression and yields atypical clinical features. Conclusion: In HIV-infected patients with chronic rectal symptoms, especially those with CD4 < 50 cells/µL, syphilitic proctitis must be considered. Integration of radiologic assessment, histopathology with ERG/CD38 staining, and serologic testing permits prompt diagnosis. Early benzathine penicillin therapy and rigorous clinical and serologic follow-up are essential to prevent complications, including neurosyphilis.

Staphylococcus aureus infections are an important cause of morbidity and mortality among patients in intensive care units (ICUs), particularly those with multiple comorbidities and critical conditions. Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains differ in resistance, clinical behavior, and prognoses, making it important to understand their effects on clinical outcomes. Comparing clinical outcomes of MRSA and MSSA infections is important. This retrospective cohort study analyzed ICU patients with confirmed S. aureus infections at a quaternary care hospital. Demographic, clinical, and comorbidity data were collected. Poisson regression was used to analyze 7-day mortality and identify adjusted risk factors. Seven-day mortality was higher in patients with MSSA than MRSA infections, with an adjusted relative risk for MRSA of 0.380 (95% confidence interval: 0.15–0.95; p = 0.039). Independent risk factors for mortality included lack of an infectious disease consultation, vascular comorbidities, such as peripheral vascular disease and cerebrovascular events, chronic kidney disease, and inotropic support requirement. Patients with MRSA infections required significantly longer ventilatory support (mean 43.5 days vs. 13 days for MSSA; p = 0.019). Staphylococcus aureus infections in ICU patients were associated with poor outcomes, particularly in patients without infectious disease consultation and those with vascular comorbidities. Mortality differences between MRSA and MSSA highlight the importance of appropriate empiric therapy and standardized protocols incorporating infectious disease consultation to improve outcomes in critically ill patients.

Background and Objectives: Actinomycosis is a rare chronic contagion caused by Actinomyces spp. known for its ability to mimic malignant processes across various anatomical locations. Its clinical presentation can often resemble malignancies, Mycobacterium tuberculosis infections, nocardiosis, fungal infections, or other granulomatous diseases. This case series presents three patients diagnosed with Actinomyces spp., highlighting the diagnostic challenges and diverse clinical manifestations of the disease. Materials and Methods: We reviewed the clinical course, diagnostic procedures, and treatment outcomes of three patients with confirmed Actinomyces spp. The first case involved a 51-year-old male with a history of rhabdomyosarcoma in remission who presented with dysphagia. Magnetic resonance imaging identified an irregularly enhancing mass in the tonsil, and subsequent tonsillectomy confirmed Actinomyces spp. The second patient, an 80-year-old female, presented with dysphagia and a sublingual mass initially suspected to be diffuse large B-cell non-Hodgkin lymphoma; however, a histopathological analysis confirmed Actinomyces spp. The third case involved a 72-year-old male with abdominal pain and an ulcerated gastric lesion, where subtotal gastrectomy and histopathological examination confirmed the diagnosis of Actinomyces spp. Results: These three cases highlight the ability of Actinomyces spp. to closely mimic malignant lesions, which significantly complicates the diagnostic process. Although personalized interventions were required for each patient, diagnoses were ultimately confirmed through histopathology. Despite these challenges, timely recognition and appropriate treatment were achieved, underscoring the need to consider Actinomyces spp. in the differential diagnosis of similar presentations. Conclusions:Actinomyces spp. remains a diagnostic challenge due to its ability to mimic a variety of malignant and contagion conditions. This case series emphasizes the need for a thorough histopathological examination and a high index of suspicion when encountering lesions with atypical presentations. Given the potential for misdiagnosis, awareness and consideration of Actinomyces spp. are crucial in the differential diagnosis of chronic contagion and mass lesions. Further studies are warranted to refine diagnostic and therapeutic approaches.

Background: Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. Methods: This is an epidemiological, retrospective, and analytical case–control study (90 cases and 360 controls). Results: Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Conclusions: Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period.

Objetivo: reportar un caso poco frecuente de síndrome de lisis tumoral (SLT) en un tumor sólido (TS) asociado al uso de pazopanib y gemcitabina.Materiales y métodos: estudio observacional descriptivo tipo reporte de caso; se realizó una búsqueda de literatura en las bases de datos PubMed, Scopus, así como en Google académico en los idiomas español e inglés.

Objetivo: describir un caso clínico interesante en oncología referente a hipercalcemia no maligna en paciente con cáncer de mama localmente avanzado.

Objetivos: describir un caso clínico atípico en oncología referente a la miocardiopatía de Takotsubo y asociado a oxaliplatino en una paciente con cáncer gástrico metastásico.