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Background. The syndrome of tubulointerstitial nephritis and uveitis (TINU) is a rare oculorenal condition, mainly seen in children and women. The underlying cause of this disease is unknown. Case Presentation. We report a 24-year-old male without any past medical history, diagnosed with bilateral uveitis and azotemia. Biopsy revealed tubulointerstitial nephritis, consistent with TINU syndrome. Fluorescein angiogram revealed peripheral retinal vasculitis. Discussion. TINU is a rare disorder that needs to be distinguished from sarcoidosis, Sjogren’s disease, and tuberculosis. Treatment is indicated in patients with progressive renal insufficiency, consisting of steroid therapy. Most patients recover kidney function. Its early recognition is important to offer the best chance of organ preservation.

Pancreatic cancer is one of the most lethal neoplasms worldwide; it is aggressive in nature and has a poor prognosis. The overall survival rate for pancreatic cancer is low. Most patients present non-specific symptoms in the advanced stages, which generally leads to late diagnosis, at which point there is no option for curative surgery. The treatment of metastatic pancreatic cancer includes systemic therapy, in some cases radiotherapy, and more recently, molecular targeted therapies, which can positively impact cancer control and improve quality of life. This review provides an overview of the molecular landscape of pancreatic cancer based on the most recent literature, as well as current treatment options for patients with metastatic pancreatic cancer.

Abstract Background Although uncommon, there is increasing interest and public health concerns of the pathogen Prototheca spp, a ubiquitous achlorophilic microalgae that can affect both humans and animals. High mortality rates have been reported in immunocompromised patients with disseminated infection, but no data is available in the immunocompetent population. Case Presentation We present the case of a 59-year-old man from rural area of Colombia who was admitted to the intensive care unit due to decompensated heart failure that was difficult to medically manage, with development of septic shock and isolation of Prototheca wickerhamii from blood culture. Fluconazole and Amphotericin B were given with successful outcome. Conclusions To date, protothecosis and its virulence factors and pathogenesis remain to be fully understood, in our case the isolation of this microalga and its implication of exacerbating chronic conditions such as heart failure is unclear. The medical-scientific community is invited to study this microorganism to determine effective management strategies, as well as its timely identification, treatment, and control, to avoid fatal outcomes.

Insulin is a hormone that is composed of 51 amino acids and structurally organized as a hexamer comprising three heterodimers. Insulin is the central hormone involved in the control of glucose and lipid metabolism, aiding in processes such as body homeostasis and cell growth. Insulin is synthesized as a large preprohormone and has a leader sequence or signal peptide that appears to be responsible for transport to the endoplasmic reticulum membranes. The interaction of insulin with the kidneys is a dynamic and multicenter process, as it acts in multiple sites throughout the nephron. Insulin acts on a range of tissues, from the glomerulus to the renal tubule, by modulating different functions such as glomerular filtration, gluconeogenesis, natriuresis, glucose uptake, regulation of ion transport, and the prevention of apoptosis. On the other hand, there is sufficient evidence showing the insulin receptor’s involvement in renal functions and its responsibility for the regulation of glucose homeostasis, which enables us to understand its contribution to the insulin resistance phenomenon and its association with the progression of diabetic kidney disease.

Abstract Since the COVID-19 outbreak, millions of people have been infected with SARS-CoV-2 around the world. An area of epidemiological relevance is Latin America, tropical regions, due to the distribution of endemic diseases such as chikungunya, dengue (DENV), malaria, Zika virus, where febrile disease abounds. The early signs and symptoms of DENV and COVID-19 could be similar, making it a risk that patients may be wrongly diagnosed early during the disease. The problem increases since COVID-19 infection can lead to false positives in DENV screening tests. We present two cases of acute undifferentiated febrile syndrome that were diagnosed with SARS-CoV-2 and DENV co-infection, confirmed by ELISA and RT-PCR for both viral pathogens. The occurrence of simultaneous or overlapped infections can alter the usual clinical course, severity, or outcome of each infection. Therefore, epidemiological surveillance and intensified preparation for those scenarios must be considered, as well as further studies should be done to address cases of co-infection promptly to avoid major complications and fatal outcomes during the current pandemic. Other endemic tropical diseases should not be neglected.

Context: Acute febrile disease (AFI) in endemic tropical areas is a frequent reason for consulting the emergency services. Infection by 2 or more etiological agents may modify clinical and laboratory parameters, making diagnosis and treatment a challenge. Case report: We report the case of a patient who came from Africa and consults in Colombia, with AFI with thrombocytopenia that was eventually diagnosed to have concurrent infection with Plasmodium falciparum malaria and dengue. Conclusions: Dengue-malaria coinfection infection reports are scarce; it should be suspected in patients living or returning from areas where both diseases are endemic or during dengue outbreaks. This case serves as a reminder of this important condition that causes high morbidity and mortality if it is not early diagnosed and treated.

Renal hyperfiltration (RHF) is a prevalent phenomenon in critically ill patients characterized by augmented renal clearance (ARC) and increased of elimination of renally eliminated medications. Multiple risk factors had been described and potential mechanisms may contribute to the occurrence of this condition. RHF and ARC are associated with the risk of suboptimal exposure to antibiotics increasing the risk of treatment failure and unfavorable patient outcomes. The current review discusses the available evidence related to the RHF phenomenon, including definition, epidemiology, risk factors, pathophysiology, pharmacokinetic variability, and considerations for optimizing the dosage of antibiotics in critically ill patients.

Women who are fertile experience a significant burden from thyroid cancer. In reality, delaying childbirth is the current trend in maternity. Women who have thyroid cancer may later want to get pregnant after it has been treated, which presents a multidisciplinary issue for their doctors. A variety of specialists are frequently involved in the treatment of thyroid cancer. This review aims to address the key elements of the strategy and places special emphasis on the significance of fertility in women with thyroid cancer diagnosis and remission. We will cover topics including the role of thyroid hormones in pregnancy and fertility.

Abstract Lung adenocarcinoma is a common cancer; even though it has a strong association with previous smoking, there has been described nonsmokers‐related cases. Symptoms varies from asymptomatic to hemoptysis or pleural effusion. We describe a case of a patient who presented with painful scapula as primary manifestation of advanced pulmonary malignancy.

Abstract Percutaneous endoscopic gastrostomy (PEG) insertion is an effective endoscopic procedure for enteral feeding in patients with difficulty swallowing. Many postprocedural complications have been reported after the PEG procedure. The displacement of the transverse colon over the anterior gastric wall can predispose the patient to colonic injury and fistulae during PEG placement. Gastrocolonic fistulas represent a serious but rare complication post PEG placement. We report a 90 year old man with a background of multiple comorbidities and high preoperative risk who developed a gastrocolocutaneous fistula post PEG placement due to a colonic injury. He was successfully treated with nonoperative management.

Neuromuscular blocking agents (NMBA) are a controversial therapeutic option in the approach to the critically ill patient. They are not innocuous, and the available evidence does not support their routine use in the intensive care unit. If necessary, monitoring protocols should be established to avoid residual relaxation, adverse effects, and associated complications. This narrative review discusses the current indications for the use of NMBA and the different tools for monitoring blockade in the intensive care unit. However, expanding the use of NMBA in critical settings merits the development of prospective studies.

The increasing number of breast cancer survivors has led to a greater emphasis on issues related to quality of life (QoL). Up to 75% of women treated for breast cancer (BC) report sexual disorders. However, most oncologists are not trained to recognize which patients are at high-risk of developing sexual disorders. Female sexual dysfunction (FSD) is common in patients with BC; we found that patients without FSD prior to BC treatment are at risk of developing FSD after treatment. Treatment of early BC relies on the combination of chemotherapy, surgery, and radiation therapy. All these treatments have side effects or sequelae identified as high-risk factors for the development of FSD. The choice of less toxic treatments in each modality could reduce the risk of FSD in some cases, without affecting the risk of recurrence or effectiveness. A comprehensive approach of BC must consider FSD as a determinant factor of QoL in survivors.

IntroductionInfection by the hepatitis C virus (HCV) is an important cause of chronic liver disease, considered a public health problem worldwide with high morbidity and mortality due to limited access to diagnostic tests in developing countries. Only a small percentage know their infection status and receive timely treatment. It is critical to make diagnostic tests for HCV infection accessible and to provide timely treatment, which not only reduces the spread of infection but also stops the progression of HCV disease without symptoms.ObjectiveTo determine the prevalence of chronic infection by HCV in patients with risk factors by using rapid tests in Cartagena, Colombia, and describe their epidemiological characteristics.MethodologyA cross-sectional descriptive observational study was carried out on asymptomatic adults with risk factors for HCV infection in the city of Cartagena between December 2017 and November 2019. A rapid immunochromatographic test was performed to detect antibodies, characterizing the population.ResultsIn total, 1,023 patients were identified who met the inclusion criteria, 58.5% women and 41.4% men, obtaining nine positive results, confirming chronic infection with viral load for HCV, finding seven cases of genotype 1b and two genotype 1a.ConclusionIn our study, a prevalence of hepatitis C infection of 0.9% was found in asymptomatic individuals with risk factors, which allows us to deduce that the active search for cases in risk groups constitutes a pillar for the identification of the disease, the initiation of antiviral therapy, and decreased morbidity and mortality.

Introduction: After COVID-19 vaccination, women of reproductive age reported changes in their menstrual cycle. Materials and methods: A retrospective study was carried out after a survey on social networks that included women aged 18–41 years with normal cycles according to International Federation of Gynecology and Obstetrics and who were vaccinated (complete schedule for two doses, except J&J/Janssen or incomplete with a single dose). Women with following conditions were excluded: pregnant or lactating women; history of diseases that cause menstrual irregularities or early menopause: anorexia, bulimia, polycystic ovary syndrome, hypothyroidism, obesity, or low weight; hysterectomized or oophorectomized patients; and high performance athletes. Results: Overall, 950 women completed the survey between July and September 2021. In total, 408 women met the inclusion criteria, and 184 reported the following characteristics: frequency (normal 43.47%, infrequent 25%, and frequent 31.53%), regularity (regular 51.08%, irregular 42.93%, and absent/amenorrhea 5.97%), duration (normal 65.21%, prolonged 26.08%, absent/amenorrhea 8.69%), and volume (heavy 41.84%, light 20.65%, and absent/amenorrhea 6.52%). Conclusions: SARS-CoV-2 infection and COVID-19 vaccination can influence the menstrual cycle and cause alterations.

Abstract Angioedema is an edema of skin, mucosa, respiratory, and gastrointestinal tract, due to vascular permeability increase, resulting in plasma extravasation, which has been associated with multiple causes. We describe a case of a patient who was prescribed with enalapril and presented with symptoms suggestive of angioedema.

Context: Neuromuscular complications in the intensive care unit (ICU) are frequent, multifactorial, and clinically difficult to recognize during their acute phase. The physical examination is the starting point for identification. Case Report: We present a patient with a history of poorly controlled asthma who was admitted to the ICU with status asthmaticus. After 4 days of being under ventilatory support, he developed muscle weakness. The diagnostic approach made it possible to establish myopathic and neurological compromise through electrophysiology studies. Conclusions: ICU-acquired weakness (ICUAW) can bring long-term consequences, early identification, and management, as well as preventive measures, are essential to minimize chronic disability and morbidity.

Context: Since the end of 2019 with the identification of the new coronavirus SARS-CoV-2 and the disease it produces, named COVID-19, various manifestations have been described, initially pulmonary due to acute and severe respiratory syndromes, now systemic manifestations have been described. Case Report: We report 3 cases of patients with cardiovascular manifestations associated with SARS-CoV-2 infection, highlighting the diagnostic approach and variety of presentation, from acute myocardial infarction, myocarditis, heart failure, shock, arrhythmias to sudden death. Conclusions: Every day is more frequent to find reports of patients with cardiovascular compromise during COVID-19 affecting the development and prognosis of this disease.

Contexto: en el curso de la enfermedad del paciente cirrótico, la insuficiencia renal es un eventode mal pronóstico. Objetivo: identificar en estos pacientes los factores de riesgo de IRA, tales como: presencia deprocesos infecciosos, hipovolemia inducida por hemorragia, pérdidas gastrointestinales o renalesy agentes nefrotóxicos, ya que conocer de su aparición es primordial para dar comienzo a lasmedidas terapéuticas y las acciones profilácticas. Metodología: se realizó una búsqueda bibliográfica en las bases de datos PubMed, EMBASE,Scopus y Google académico, usando los términos MeSH como insuficiencia renal aguda, creatinina, cirrosis hepática, síndrome hepatorenal. Se obtuvieron resultados entre artículos originales, metaanálisis, reportes de casos, series de casos y revisiones de la literatura, y se escogieron 16 documentos para la elaboración de esta revisión. Resultados: los nuevos criterios definidos por el Club Internacional de Ascitis (AKI-IAC), loscuales eliminan el gasto urinario, se determinan por un aumento de la creatinina sérica?0,3mg/dL en menos de 48 horas y, mejoran el pronóstico, permitiendo realizar intervenciones opor-tunas. Conclusiones: la creatinina sigue siendo el biomarcador más utilizado en insuficiencia renalaguda (IRA), incluso en pacientes cirróticos, a pesar de sus múltiples limitaciones. Un criterio dinámico modificado a partir de los criterios de AKIN, se convierte en el patrón de oro para eldiagnóstico de IRA en cirrosis.

Acute hypercapnic ventilatory failure is becoming more frequent in critically ill patients. Hypercapnia is the elevation in the partial pressure of carbon dioxide (PaCO2) above 45 mmHg in the bloodstream. The pathophysiological mechanisms of hypercapnia include the decrease in minute volume, an increase in dead space, or an increase in carbon dioxide (CO2) production per sec. They generate a compromise at the cardiovascular, cerebral, metabolic, and respiratory levels with a high burden of morbidity and mortality. It is essential to know the triggers to provide therapy directed at the primary cause and avoid possible complications.

Alcaligenes faecalis (A. faecalis) is a Gram-negative rod rarely isolated as an infective bacterium worldwide. The first cases of infections caused by this microorganism, such as pneumonia, soft tissue infections, urinary tract infections, bacteremia, and meningitis, date back more than 40 years and are almost entirely in newborns and immunosuppressed hosts. Optimal antibiotic therapy for A. faecalis has not been well established in the literature. We report a case of an immunocompetent patient in Colombia who had meningitis due to A. faecalis after a dental procedure. It is important to know about this microorganism that nowadays could be considered a potentially emerging pathogen in immunocompetent adults.

Resumen: Introducción: El color habitual de la orina es amarillo ámbar, sin embargo, se han descrito más de 20 colores, los cuales pueden indicar una variedad de condiciones fisiológicas o patológicas. Objetivo: Describir diagnósticos diferenciales de pacientes críticos con cambios en la coloración de la orina y resaltar su relevancia clínica. Materiales y métodos: Se presenta una serie de 3 casos de cambios en la coloración urinaria secundarios a reacción medicamentosa, infección e intoxicación con fines autolíticos. Resultados: En cada caso se descartaron diagnósticos diferenciales y se dio tratamiento dirigido, con evolución favorable y resolución de la coloración. Conclusiones: Se debe individualizar el abordaje teniendo en cuenta la presentación clínica, el examen físico, los antecedentes y la epidemiología local, en aras de dar manejo oportuno y evitar el uso incorrecto de antibióticos u otras medidas que puedan impactar en la mortalidad. Abstract: Introduction: The usual color of urine is ambar yellow however, more than 20 colors have been described, which can indicate a variety of normal or pathological conditions. Objective: To describe the differential diagnoses of critically patients with changes in urine color, highlighting their clinical relevance. Materials and methods: We present a series of 3 cases of changes in urine color secondary to drug reaction, infection and intoxication with autolytic purpose. Results: In each case, differentials were ruled out, giving targeted treatment with favorable evolution and resolution of the discoloration. Conclusions: The approach should be individualized taking into account clinical presentation, physical examination, antecedents and local epidemiology; in order to provide timely management avoiding the incorrect use of antibiotics or other measures that may impact mortality.

Dressler syndrome is a form of pericarditis arising from acute injury to the myocardium or pericardium. It manifests within the tenth week post-infarction. It is noteworthy that the myocardial injury preceding the syndrome may result from cardiotomy. Thus, while the general focus is post-infarction, sources also refer to post-cardiotomy syndrome. Its pathophysiology remains uncertain, potentially involving an interaction between the complement system and affected tissue. To date, no pathognomonic signs or consensus criteria exist, posing a substantial challenge for clinicians. Diagnosis necessitates a history of myocardial or pericardial injury, in conjunction with inflammatory markers and electrocardiographic abnormalities; imaging aids in ruling out differentials and complications. Treatment is tailored based on hemodynamic stability and comorbidities. Acquaintance with this syndrome is crucial, as though it often follows a self-limiting course, a high recurrence rate impairs patients’ quality of life.

The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 to provide a more precise syndromic characterization of clinical manifestations observed in patients exposed to adjuvant substances such as biopolymers and silicone, among others. The clinical spectrum of this entity is variable, ranging from local involvement to potentially fatal immune-mediated systemic involvement. The interest in ASIA has grown in recent years, reinforcing diagnostic criteria and deepening the understanding of its pathophysiological behavior. This case report highlights a distinct range of clinical symptoms, such as general symptoms, advanced-stage chronic kidney disease, persistent hypercalcemia with suppressed parathyroid hormone (PTH), bilateral nephrocalcinosis, cutaneous calcinosis, and the presence of positive autoantibodies, emphasizing the significance of understanding this condition.

The Amplatzer septal occluder is one of several percutaneous devices used for the closure of secundum atrial septal defects. The main complications are related to the procedure, with infection being the least common. We present the case of a 67-year-old woman with a secundum atrial septal defect, who, 3 years after repair with an Amplatzer occluder, was admitted with sepsis and bacteraemia following recent hospitalization in an intensive care unit. Transoesophageal echocardiography showed the presence of a mobile echogenic structure in the left atrium suggestive of a vegetation. Few cases of late endocarditis involving the Amplatzer device have been reported, even though partial endothelization is one of the risk factors. There are no guidelines for the prevention, diagnosis or management of this complication.

Only six countries have banned the industrial use of asbestos in Latin America and the Caribbean. In fact, the industrial use of asbestos appears to be growing in this region. Asbestos is one of the most dangerous natural substances in the world, it is contained in several types of rocks (such as serpentinites, mafic and ultramafic rocks) but fibers can be released to the atmosphere both by natural and antropogenic sources. Six countries have banned the industrial use of asbestos in this region, we expected that laws established before 2007 would be less adherent to the 2007 WHO/ILO recommendations. In contrast, the Chilean law of 2001 is one of those that most adheres to international recommendations along with the Colombian law of 2021. Which means that the newest laws are not necessarily the strongest. This article aims to draw a regional overview of the laws against asbestos production in Latin America and the Caribbean, highlighting the strengths and weaknesses of each national policy. We recommend that countries that have already banned asbestos consider updating and strengthening their existing laws and develop clinical guidelines for the management, monitoring, and rehabilitation of asbestos-related diseases. The challenge of asbestos goes far beyond a prohibition law.

Introducción: la pandemia por la infección del SARS-CoV-2 o COVID-19 ha impactado de manera inimaginable los sistemas de salud a nivel mundial. La parada cardiorrespiratoria sigue siendo una emergencia médica potencialmente reversible que requiere la realización de un conjunto de maniobras destinadas a sustituir y restaurar la respiración y la circulación espontánea. Suspender una reanimación cardiopulmonar corresponde usualmente a un dilema ético-clínico que debe asumir el profesional de salud a cargo. El “fenómeno de Lázaro” es un síndrome inusual y de difícil explicación fisiopatológica definido como el retorno espontáneo de la circulación en ausencia de cualquier técnica de soporte vital o tras el cese de las maniobras de reanimación cardiopulmonar fallidas. Caso clínico: se presenta el caso de una paciente de 79 años hospitalizada en unidad de cuidados intensivos por choque séptico de origen pulmonar asociado a infección por COVID-19 quien presenta parada cardiorrespiratoria que requirió maniobras de reanimación durante 40 minutos no exitosas, declarada fallecida. Tras 20 minutos del fallecimiento presenta retorno a la circulación espontánea. Conclusión: los cambios fisiopatológicos del fenómeno de Lázaro nos recuerdan las limitaciones que tenemos para determinar cuándo finalizar la reanimación cardiopulmonar y su interrupción debe abordarse con más cuidado, especialmente en el marco de la pandemia de COVID-19.