Colombia Medica

SOBRE Laparoscopic surgical alternative for the treatment of ruptured cornual heterotopic pregnancy

Sun, 30 Mar 2025 00:00:00 -0500

Case Description
A 35-year-old woman with a history of intrauterine device use for family planning presented with a spontaneously conceived heterotopic pregnancy.

Clinical Findings
The patient developed a ruptured cornual ectopic pregnancy, leading to hemodynamic instability and an acute abdomen, while concurrently carrying a viable intrauterine pregnancy.

Treatment and Outcome
A laparoscopic intervention was performed to manage the ruptured ectopic pregnancy. The surgical technique employed minimized the impact on maternal blood volume, ensuring patient stabilization and favorable progression of the intrauterine pregnancy.

Clinical Relevance
Heterotopic pregnancy is the coexistence of gestation in two different implantation sites, both intrauterine and extrauterine. This condition is associated with significant maternal morbidity and mortality. Management remains a challenge due to the lack of consensus and limited clinical experience. The primary goal is maternal stabilization while preserving the intrauterine pregnancy whenever possible. This case highlights the importance of modern surgical strategies tailored to optimize maternal and fetal outcomes.

Clinical Practice Guidelines for the evaluation, treatment and follow up of children who are contacts of patients with tuberculosis in Colombia

Sun, 30 Mar 2025 00:00:00 -0500

Introduction: The available Clinical practice guidelines (CPGs) on latent TB infection (LTBI) are not exclusive to the pediatric population.
Objective: To develop evidence-based recommendations for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis (TB) in Colombia.
Methods: A multidisciplinary development group (composed by clinical and field experts, researchers, and methodologists), including patient representatives and decision-makers formulated 10 questions and prioritized outcomes related to diagnosis (clinical evaluation, chest X-ray, and interferon-gamma release assays-IGRA), treatment (efficacy of regimens in different clinical scenarios), and follow-up (monitoring and strategies to increase adherence) for children with LTBI. We conducted systematic reviews of the literature to identify guidelines, systematic reviews, and primary studies. We assessed the quality and risk of bias of these sources using specific tools. We synthesized the evidence narratively and, in some cases, performed de novo meta-analyses (diagnostics and network meta-analyses). We evaluated the certainty of evidence using the GRADE system. We used the GRADE evidence-to-recommendation framework to formulate the recommendations
Results: We recommends the use of chest X-rays and IGRA tests in children in contact to identify active TB. We recommend short instead of long regimens for children with and without immunosuppression and susceptibility-guided regimens in cases of contact with drug-resistant TB. We recommend monthly clinical follow-up and the implementation of comprehensive approaches to identify barriers to encourage treatment adherence
Conclusions: The group provides context-specific evidence-based recommendations for children with LTBI in Colombia

One-minute sit-to-stand test reference values in people living at high altitudes

Sun, 30 Mar 2025 00:00:00 -0500

Introduction:

The one-minute sit-to-stand test (1min-STST) is a practical assessment tool for measuring functional ability. Reference values are currently unavailable for populations residing at high altitudes.

Aims:

To establish reference values for the 1min-STST in people living at high altitudes by sex and age range. Additionally, we correlate the variables analyzed with the number of repetitions obtained in the tests.

Methods:

Multicenter cross-sectional research was conducted, collecting data from two cities at high altitudes. Healthy adults between 18 and 80 years old were recruited. Anthropometric measurements, physical activity levels, smoking habits, and the number of repetitions during the 1min-STST were recorded. A multiple linear regression was performed to determine the predictive equations by sex. The stepwise method was used to generate the predictive model.

Results:

As many as 400 healthy subjects (58% women) were included. Participants had a median (P25-P75) height of 1.62 (1.56-1.68) cm, a weight of 63.0 (57.8-70.1) kg, and a BMI of 24.2 (22.5-26.0) kg/m². The predictive equations were: 1minSTST_Men=19.833 - (age* 0.168) + (height * 0.204) - (weight * 0.122); 1minSTST_Women= 27.845 - (age * 0.198) + (height * 0.145) - (weight* 0.094).

Conclusion:

The reference values for 1min-STST were determined for the healthy population aged 18-80 years living at high altitudes.

Induction of labor with dinoprostone in hypertensive disorders of pregnancy

Sun, 30 Mar 2025 00:00:00 -0500

Objective
To describe the obstetric outcomes associated with the use of dinoprostone and its effectiveness in cervical ripening in pregnant women with hypertensive disorders of pregnancy compared to normotensive pregnant women.

Methods
A retrospective cohort study was conducted at a tertiary-level hospital in Medellín, Colombia (March 2020 – October 2024). The study included pregnant women with singleton pregnancies, beyond 30 weeks of gestation, with a live fetus in cephalic presentation, and undergoing cervical ripening with dinoprostone vaginal insert. Women were excluded if they had used other ripening methods, had a cervical dilation greater than 5 cm at admission, or had an unclassified hypertensive disorder. Demographic variables, maternal comorbidities, indication for induction, and classification of the hypertensive disorder were analyzed. Primary outcomes included successful cervical ripening, vaginal delivery, time to favorable Bishop score and delivery, and indications for cesarean section. Adverse events considered were placental abruption, non-reassuring fetal status, tachysystole, and worsening of hypertensive condition.

Results
A total of 400 patients were included (200 with hypertensive disorders, of whom 100 had severe preeclampsia). The success rate of cervical ripening was similar between patients with hypertensive disorders and healthy women (crude RR 0.95, 95% CI 0.88–1.03; adjusted RR for gestational age, maternal age, and parity 0.96, 95% CI 0.88–1.04). The vaginal delivery rate was also similar (44% vs. 55%, p = 0.16). The median time to a favorable Bishop score and delivery was comparable between normotensive and hypertensive groups, even in severe cases. Cesarean delivery was mainly due to failed ripening and medical decision. Except for tachysystole, adverse events were more frequent in the hypertensive group but did not reach statistical significance.

Conclusion
Dinoprostone is effective in hypertensive pregnant women, including those receiving magnesium sulfate, with no significant differences compared to normotensive women.