Nathalia Alejandra Montaño Argote

Introducción: la escoliosis pediátrica puede requerir corrección quirúrgica, procedimiento que conlleva un riesgo de infección del sitio operatorio (ISO). Estas infecciones suelen ser causadas por bacterias Gram positivas, especialmente Staphylococcus aureus, con resistencia relevante a meticilina. Objetivo: caracterizar las ISO en pacientes pediátricos sometidos a corrección quirúrgica de escoliosis, analizando los agentes etiológicos y sus perfiles de resistencia antimicrobiana en un centro de referencia de alta complejidad en ortopedia pediátrica y cirugía de columna de Bogotá, Colombia. Metodología: serie de casos retrospectiva de pacientes pediátricos con ISO posterior a corrección quirúrgica de escoliosis atendidos en un centro especializado de Colombia entre 2017 y 2023. Se realizó un análisis descriptivo de características clínicas, quirúrgicas y microbiológicas. Resultados: se revisaron 1.018 registros y se incluyeron 24 casos con ISO, para una incidencia de 2,36%. El 41,67% correspondió a escoliosis neuromuscular y el 58,33% presentó ISO temprana. El 70,83% requirió retiro del material. Se obtuvieron 28 aislamientos, con predominio de bacterias Gram positivas (60,71%). Staphylococcus aureus fue el microorganismo más frecuente (50%), con una resistencia a meticilina de 21,43%. En ISO tardías se mantuvo como patógeno predominante (9/10; 90%). Entre los Gram negativos, los más comunes fueron Proteus mirabilis y Pseudomonas aeruginosa. El 12,50% de los cultivos fueron polimicrobianos. La mediana del tiempo al diagnóstico fue de 50 días, con mayor concentración en el primer mes postoperatorio. Conclusiones: tras corrección quirúrgica de la escoliosis pediátrica, las ISO constituyen un desafío persistente, con predominio de Staphylococcus aureus y una elevada resistencia antimicrobiana. Se requieren estrategias optimizadas de prevención, diagnóstico y tratamiento para mejorar los desenlaces clínicos.

The intestinal microbiota has emerged as a fundamental regulator of human health, influencing physiological processes that extend far beyond the gastrointestinal tract. Growing scientific evidence indicates that alterations in microbial composition and functionality are associated with the development and progression of numerous systemic diseases, including metabolic disorders, cardiovascular disease, autoimmune conditions, inflammatory bowel disease, liver disease, and cancer. This review aimed to analyze current evidence regarding the biological mechanisms that connect intestinal microbiota with systemic pathology and to examine the potential clinical implications of microbiome-based interventions. A structured review of scientific literature published in major international biomedical databases was conducted, focusing on studies evaluating microbiota-host interactions, immune regulation, inflammatory pathways, metabolic homeostasis, and therapeutic applications. The findings demonstrate that immune dysregulation, increased intestinal permeability, chronic low-grade inflammation, and altered microbial metabolite production represent the principal mechanisms linking dysbiosis to systemic disease. Metabolic and inflammatory disorders showed the strongest associations with microbiota alterations, while growing evidence supports the role of the microbiome in cardiovascular disease, autoimmune conditions, liver disease, and oncological outcomes. Additionally, interventions such as probiotics, prebiotics, dietary modulation, synbiotics, postbiotics, and fecal microbiota-based therapies have demonstrated promising therapeutic potential. Evidence from Mexico, Colombia, and Ecuador highlights the importance of geographic and population-specific factors in shaping microbial diversity and disease susceptibility. Although important methodological and translational challenges remain, current knowledge supports the concept that intestinal microbiota represents a critical determinant of systemic health. Continued advances in microbiome research may contribute to the development of personalized preventive and therapeutic strategies across multiple medical specialties.

Bone fragility has traditionally been associated with osteoporosis and reduced bone mineral density; however, contemporary evidence indicates that fracture risk is influenced by a broader spectrum of metabolic, nutritional, endocrine, inflammatory, and musculoskeletal factors. The objective of this review was to analyze the metabolic determinants associated with bone fragility beyond osteoporosis and to examine their influence on fracture risk and recovery outcomes. A structured narrative review of scientific literature published in major biomedical databases was conducted, focusing on diabetes mellitus, chronic kidney disease, vitamin D deficiency, malnutrition, osteosarcopenia, endocrine dysfunction, and chronic inflammation. The findings demonstrated that these conditions contribute significantly to alterations in bone quality, remodeling capacity, muscle performance, and tissue repair, thereby increasing susceptibility to fragility fractures independently of bone mineral density measurements. Diabetes mellitus and chronic kidney disease emerged as major determinants of skeletal fragility due to their effects on collagen integrity, mineral metabolism, vascular function, and bone turnover. Nutritional deficiencies and inadequate vitamin D status were consistently associated with impaired mineralization, increased fall risk, and delayed fracture healing. Furthermore, osteosarcopenia highlighted the close biological relationship between bone and muscle health and its contribution to fracture susceptibility and functional decline. The evidence supports a multidimensional understanding of skeletal fragility that incorporates metabolic health into fracture prevention and management strategies. Expanding fracture risk assessment beyond traditional osteoporosis models may improve early identification of vulnerable individuals and facilitate more comprehensive approaches to prevention, treatment, and rehabilitation.

Musculoskeletal trauma remains a major contributor to disability, healthcare utilization, and socioeconomic burden worldwide. Recent advances in artificial intelligence (AI), machine learning, predictive imaging, and personalized decision-support systems have accelerated the emergence of digital orthopedics as a transformative field within trauma care. This review examines the current scientific evidence regarding the application of these technologies in the diagnosis, prognosis, and management of musculoskeletal injuries. A comprehensive analysis of contemporary literature was conducted using internationally recognized scientific databases, focusing on studies related to fracture detection, imaging interpretation, predictive analytics, risk stratification, and individualized treatment planning. The reviewed evidence indicates that AI-assisted diagnostic systems have demonstrated promising performance in fracture detection and classification across multiple imaging modalities. Furthermore, predictive models have shown increasing utility in estimating clinical outcomes, including mortality, complications, and recovery trajectories, particularly among high-risk patient populations. The findings also highlight the growing role of personalized decision-making approaches that integrate imaging, clinical, and demographic variables to support precision-oriented orthopedic care. Despite these advances, important challenges remain regarding external validation, algorithm transparency, ethical considerations, data quality, infrastructure requirements, and clinician education. Overall, the available evidence suggests that digital orthopedic technologies have significant potential to improve diagnostic accuracy, prognostic assessment, and patient-centered management in musculoskeletal trauma. Continued multidisciplinary collaboration, prospective validation, and responsible implementation strategies will be essential for maximizing the clinical benefits of these emerging technologies.