Colombia Medica

Prediction of the intramedullary nail size by fibula length in bilateral femur fractures.

Ruben Darío Hernández Salazar — 2024-12-30

Case Description
A 23-year-old male patient, with no relevant medical history, who received direct contusion to the lower limbs at the level of the thighs due to a fall from a sheet bending machine.

Clinical Findings
Clinical and radiographic findings compatible with bilateral comminuted sub-trochanteric fractures, with extension towards the diaphysis in both, with a Trauma Severity Index of 16.

Treatment and Outcome
Favorable clinical and radiological outcome after early definitive surgical stabilization of both extremities with cephalomedullary nails, rehabilitation with physical therapy and clinical follow-up.

Clinical Relevance
High energy trauma, due to different causes, constitutes a challenge for all health personnel, due to the patient's own conditions, the individual inflammatory response, the associated musculoskeletal injuries, some not detected at the beginning, and additionally in other systems. Patients with bilateral femur fractures may present the conditions listed above, which requires early identification of the risks of respiratory and multi-organ failure, knowledge of their metabolic status and definition of their clinical situation, considered potentially or truly critical, which even with timely treatment Mortality figures of 6.9% to 27% are found. According to defined parameters, early and definitive osteosynthesis of fractures can be performed, but its characteristics may represent difficulties for surgical planning.

Perıostın and fıbronectın ın nasal lesıons: key players ın polyps and ınverted papıllomas

Mehmet Birinci — 2024-12-30

Background
Sinonasal lesions are common benign masses with overlapping clinical and histopathological features. Extracellular matrix proteins such as periostin, fibronectin, and tenascin-C play key roles in tissue remodeling and inflammation, yet their distinct expression profiles in these lesions remain poorly defined.

Aim
This study aimed to compare the immunohistochemical staining patterns of periostin, fibronectin, and tenascin-C in sinonasal lesions to elucidate their roles in pathogenesis and enhance differential diagnosis.

Methods
In this retrospective study, pathological specimens from 70 patients who underwent surgery for sinonasal polyps were analyzed. Using a semi-quantitative scoring system, the immunohistochemical expression of periostin, fibronectin, and tenascin-C was assessed separately in epithelial and stromal compartments. Multinomial logistic regression analysis evaluated associations between staining patterns and lesion types.

Results
The study cohort had a male-to-female ratio of 5:2 with a mean age of approximately 40. Nasal polyps demonstrated significantly higher stromal periostin staining than antrochoanal polyps and inverted papillomas. Conversely, antrochoanal polyps exhibited significantly elevated epithelial periostin expression relative to inverted papillomas. Fibronectin expression was markedly increased in nasal polyps, particularly within the stroma, supporting its role in inflammatory tissue remodeling. In contrast, tenascin-C did not display significant differences among the lesion types.

Conclusion
The differential expression of periostin and fibronectin in sinonasal lesions underscores distinct pathogenic mechanisms that may aid in more accurate diagnosis. The compartment-specific staining patterns of periostin and the prominent fibronectin expression in nasal polyps suggest these biomarkers could serve as valuable diagnostic tools and potential therapeutic targets. Future studies should further explore these pathways to develop targeted interventions for sinonasal diseases.

Socioeconomics of e-cigarette use in Colombia: 2019 National Substance Use Survey

José Moreno-Montoya — 2024-12-30

Background
E-cigarettes have been extensively marketed and popularized worldwide despite their harmful effects. To effectively plan and implement preventive measures, comprehensive analyses are needed to understand the influence of individual and contextual factors on their use.

Objective
This study aimed to analyze the influence of poverty and demographic and socioeconomic patterns on e-cigarette use in Colombia.

Methods
This study is based on a secondary analysis of the 2019 Colombian Survey on Psychoactive Substance Use, which included 49,756 individuals aged between 12 and 68. State-level multidimensional poverty and individual health-related, socioeconomic, and demographic characteristics were analyzed. Two-level regression models adjusted for the individual and contextual effects.

Results
The prevalence of vaping was 4.4% (95% CI: 4.2%-4.6%), with substantial variation across departments, ranging from 0.0% to 9.6%. In the multilevel models, younger age, male sex, technical or higher education, middle-income stratum, not contributing economically to the household, affiliation with the subsidized health scheme, history of tobacco smoking, alcohol consumption, and self-reported use of other drugs were all significantly associated with vaping. The estimated median odds ratio for multidimensional poverty was 1.23 (95% CI: 1.14-1.33; p= 0.012).

Conclusions
E-cigarette use in Colombia is a health risk and an indicator of social vulnerability that is influenced by structural determinants. Urgent action from health authorities, the education system, regulatory bodies, and civil society is needed to prevent the normalization of vaping among youth. If left unaddressed, vaping could worsen health inequalities and lead to chronic addiction-related disorders in underserved communities.

How can we address the surge of low-quality systematic reviews and their impact on high journal rejection rates?

Marilina Santero — 2024-12-30

Journals have experienced a significant rise in submissions of systematic reviews and other types of reviews that often fall short of acceptable quality standards. These shortcomings typically stem from insufficient rigor in their methodology, reporting, or critical appraisal. As a result, these submissions are frequently rejected raising concerns about the standards authors are following when preparing such work. This growing trend of low-quality reviews not only places a burden on editorial teams but also poses a risk to the scientific community by potentially disseminating flawed or unreliable conclusions. Ensuring that articles maintain high standards is crucial for preserving the integrity of the scientific literature and facilitating evidence-based decision-making. In an effort to address this problem, this viewpoint editorial aims to offer concepts and recommendations on available tools for future authors to improve the quality of their reviews, as well as to guide readers and potential journal reviewers on how to critically interpret these articles.

Psychiatric medicalization in university life

Maria Adelaida Arboleda — 2024-12-30

In 2020, Lynn Cunningham and Wendy Ractliffe produced the documentary Medicating Normal. Based on the testimonies of four American citizens, the directors shed light on the growing prescription of psychotropic drugs for physical and psychological discomforts inherent to everyday life. These discomforts, quickly categorized under psychiatric diagnoses, legitimized the use of increasingly potent medications. The documentary invites critical reflection on the psychological, physical, and social consequences of this medicalization process, as evidenced by the experiences of its protagonists.

Medicalization, particularly in the mental health field, can be analyzed through three main dimensions proposed by Desviat (2). First is the tendency to pathologize everyday experiences such as pain, sadness, dissatisfaction, frustration, or personal limitations. Second, the equation of risk factors with illness implies a reductionist view of health. Finally, expanding diagnostic boundaries leads to an excessive inclusion of human phenomena within clinical categories.

This type of situation had already been denounced in 2010 by Allen Frances, chair of the task force that developed the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). At that time, he expressed regret for contributing to the proliferation of diagnoses among specific populations, such as attention deficit hyperactivity disorder (ADHD). He warned of even greater risks in the fifth edition, where the influence of economic and institutional interests became more evident.

Beyond the conclusions that point to the economic interests of the pharmaceutical industry and medical complicity—particularly among some psychiatrists—as noted by authors from various schools of thought, an additional point of reflection is worth considering: the place of subjective responsibility in coping with everyday discomfort, especially in contexts where competition, constant change, and high demands are the norm.