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San Vicente de Chucurí, Colombia

Montoya S.M.,Hospital Universitario San Vicente Fundacion | Munera Garcia N.E.,University of Antioquia
Nutricion Hospitalaria | Year: 2014

Introduction: Hospital malnutrition is a multi-causal process and high prevalence. Nutritional intervention at an early stage improves prognosis of affected patients. Objective: To compare the effect of early nutritional intervention with a routine care on clinical outcome in patients with detected nutritional risk screening tool NRS Nutritional Risk Screening 2002, entering an institution of complex health. Materials and Methods: A quasi-experimental study. Was assessed in the first 48 hours of admission to 891 patients, of whom 247 were at nutritional risk, 116 were the routine care group and 54 the intervention group. We evaluated complications, hospital stay, weight loss, change in body mass index and protein-calorie adequacy. Results: Patients undergoing caloric intake had higher (1617 ± 444.5 vs 1366 ± 467.1 kcal, p = 0.002) and protein (1.2 ± 0.2 vs 0.9 ± 0.3 g, p = 0.000), average weight gain of 0.7% vs a loss of 2.3% (p = 0.000), a proportion of moderate complications 8.2% vs 25.2% (p = 0.012) and decreased time hospital stay of 2.2 days (p = 0.138) compared with routine care group. Conclusion: Early nutritional intervention in patients at nutritional risk decreased the proportion of moderate complications, improved the adequacy of energy, protein and nutritional evolution in terms of weight gain and change in BMI. The length of stay did not differ significantly.

Senior Sanchez J.M.,University of Antioquia | Senior Sanchez J.M.,Hospital Universitario San Vicente Fundacion
Iatreia | Year: 2014

We describe the clinical case of a 26 year-old woman who came to Hospital Universitario San Vicente Fundación (Medellín, Colombia) with symptoms and signs of acute heart failure. She had been previously diagnosed with chronic heart failure with reduced ejection fraction without clear origin, pulmonary thromboembolism and ischemic stroke, without optimal neurohormonal modulation. She was admitted with clinical findings of fluid overload and low tissue perfusion, with inotropic support requirement and parenteral diuretics; clinical stability was achieved with the progressive introduction of medical therapy for heart failure. For the study of the latter, heart MRI was done that showed a delayed enhancement area in the left anterior descending artery. Coronary angiography was carried out in which no significant lesions were found in the epicardial arteries. Finally, compensation of the acute heart failure was achieved, and chronic anticoagulation was started for probable thrombophilic disease, due to the recurring arterial and venous thrombotic events. © 2014, Universidad de Antioquia. All rights reserved.

We describe three patients with endogenous endophthalmitis associated with Klebsiella pneumonia liver abscess, treated at Hospital Universitario San Vicente Fundación (Medellín, Colombia). This complication is part of a syndrome described 25 years ago, whose prevalence seems to be rising: cryptogenic invasive K. pneumoniae liver abscess. Symptoms and signs, microbiological isolates, treatment, evolution and visual outcome are described for each patient. It is the first report of this disease in Colombia. © 2016, Universidad de Antioquia. All rights reserved.

Escobar P. R.M.,Hospital Universitario San Vicente Fundacion | Restrepo J. M.,University of Antioquia
Revista Colombiana de Gastroenterologia | Year: 2015

Benign esophageal strictures are a common cause of medical consultation and gastroenterological endoscopy. Usually, given their non-neoplastic nature, they have been managed with recurrent endoscopic dilation which is uncomfortable for the patient and which generates high costs due repetition. In addition, there is always the risk of esophageal perforation at every session. The use of esophageal stents for management of benign esophageal strictures is becoming increasingly more common and is promising for various etiologies. We present a case of a benign esophageal stricture secondary to infection with histoplasma capsulatum which was managed entirely with a completely covered metal stent. This led to complete resolution of the obstruction. © 2015 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.

Keynan Y.,University of Manitoba | Rueda Z.V.,Pontifical Bolivarian University | Aguilar Y.,University of Antioquia | Trajtman A.,University of Manitoba | And 2 more authors.
Cytokine | Year: 2015

We wanted to investigate the pro-inflammatory cytokine/chemokine profile associated with the etiological agents identified in HIV patients. Immunosuppressed patients admitted to two hospitals in Medellin, Colombia, with clinical and radiographic diagnosis of pneumonia were enrolled in the study. After consent, bronchoalveolar lavage (BAL) was collected for bacterial, mycobacterial and fungal diagnosis. All patients were followed for a year. A stored BAL sample was used for cytokine/chemokine detection and measurement using commercial, magnetic human cytokine bead-based 19-plex assays. Statistical analysis was performed by assigning cytokine/chemokine concentrations levels into <25 percentile (lower), 25-75 percentile (normal) and >75 percentile (higher). Principal component analysis (PCA) and Kruskal-Wallis analysis were conducted to identify the clustering of cytokines with the various infectious etiologies (fungi, Mycobacterium tuberculosis - MTB. , and bacteria). Average age of patients was 35, of whom 77% were male, and the median CD4 count of 33. cells/μl. Of the 57 HIV infected patients, in-hospital mortality was 12.3% and 33% died within a year of follow up. The PCA revealed increased IL-10, IL-12, IL-13, IL-17, Eotaxin, GCSF, MIP-1α, and MIP-1β concentrations to be associated with MTB infection. In patients with proven fungal infection, low concentrations of IL-1RA, IL-8, TNF-α and VEGF were identified. Bacterial infections displayed a distinct cytokine pattern and were not misclassified using the MTB or fungi cytokine patterns (p-value. <. 0.0001). Our results indicate a unique pattern of pro-inflammatory cytokine/chemokine, allowing differentiation between bacterial and non-bacterial pathogens. Moreover, we found distinct, if imperfectly discriminatory, cytokine/chemokine patterns associated with MTB and fungal infections. © 2015 Elsevier Ltd.

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