Artículos

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https://bonga.unisimon.edu.co/handle/20.500.12442/1558

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Chronic joint pain 3 years after chikungunya virus infection largely characterized by relapsing-remitting symptoms
(The Journal of Rheumatology Publishing, 2019) Tritsch, Sarah R.; Encinales, Liliana; Pacheco, Nelly; Cadena, Andres; Cure, Carlos; McMahon, Elizabeth; Watson, Hugh; Porras Ramirez, Alexandra; Rico Mendoza, Alejandro; Li, Guangzhao; Khurana, Kunal; Jaller-Radd, Juan Jose; Mejia Castillo, Stella; Barrios Taborda, Onaldo; Jaller Char, Alejandro; Jaller-Char, Juan Jose; Avendaño Echávez, Lil Geraldine ; Jiménez, Dennys; Gonzalez Coba, Andres; Alarcón Gómez, Magda; Ariza Orozco, Dores; Bravo, Eyda; Martinez, Victor; Guerra, Brenda; Simon, Gary; Firestein, Gary S.; Chang, Aileen Y.
Objective. To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus in a Latin American cohort. Methods. A cross-sectional follow-up of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having chikungunya virus during the 2014–2015 epidemic, and baseline and follow-up symptoms at 40 months were evaluated in serologically confirmed cases. Results. Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for chikungunya infection had persistent joint pain 3 years after infection. Participants that followed up in-person were predominantly adult (mean ± SD age 51 ± 14 years) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. Conclusion. This is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.
Clinical and Immunological Factors Associated with the Progression of Lupus Nephritis in a Population from the Colombian Caribbean
(MDPI, 2024) Vélez-Verbel, María; Aroca-Martinez, Gustavo; Vélez-Verbel, David; Domínguez-Vargas, Alex; Vallejo-Patino, Manuela; Sarmiento-Gutierrez, Joanny; Gómez-Escorcia, Lorena; Musso, Carlos G. ; González-Torres, Henry J.
Lupus nephritis represents a significant immune-mediated glomerulonephritis, constituting the most important organ involvement induced by systemic lupus erythematosus (SLE), with variable epidemiology and clinical presentation among populations. Objective: to identify clinical and immunological factors associated with the progression of lupus nephritis in a population from the Colombian Caribbean. Methods: we evaluated 401 patients diagnosed with SLE and lupus nephritis, treated at a reference center in the Colombian Caribbean, gathering data recorded in medical records. Results: A proportion of 87% were female, with a median age of 42 years. Most patients presented with proliferative classes (90%), with class IV being the most common (70%). A proportion of 52% of patients did not respond to treatment, which is described as the lack of complete or partial response, while 28% had a complete response. A significant decrease in hemoglobin, glomerular filtration rate, and proteinuria was identified by the third follow-up (p < 0.001), along with an increase in creatinine, urea, and hematuria (p < 0.001). Patients with initial proteinuria > 2 g/day were found to be 27 times more likely to be non-responders (p < 0.001). Mortality was associated with the presence of serum creatinine >1.5 mg/dL (p = 0.01) (OR: 1.61 CI 95% 0.75–3.75) and thrombocytopenia (p = 0.01) (OR: 0.36; CI 95% 0.12–0.81). Conclusions: identifying factors of progression, non-response, and mortality provides an opportunity for more targeted and personalized intervention, thereby improving care and outcomes for patients with lupus nephritis.
Infective endocarditis in the colombian caribbean region: clinical profile, microbiological insights, and risk factors for mortality
(ACADEMIA NACIONAL DE MEDICINA, 2023) Solarte Bastidas, Gabriela; Herrera Calle, Pedro; Domínguez-Vargas, Alex; Iglesias Pertuz, Shirley; González-Torres, Henry J.
Infective endocarditis (IE) is defined as the infectious and inflammatory process of the heart’s internal structures. It can be caused by a broad group of bacteria and, rarely, fungi, with potentially life-threatening consequences. Objective: To profile bacterial resistance and identify mortality risk factors in IE patients. Methods: This crosssectional study included clinically diagnosed IE patients. Sociodemographic, comorbidity, clinical, and microbiological data were recorded. Descriptive analyses, Chi-Square/Fisher’s exact tests, and Student’s t-tests examined variables in relation to IE outcomes (survival vs. mortality). Multivariate logistic regression calculated odds ratios and confidence intervals. Results: We enrolled 39 patients (mean age 51 ± 19.5 years, 54 % male). Common comorbidities included acute kidney injury (AKI) (46 %), heart failure (26 %), and ischemic stroke (21 %). Deceased patients had higher rates of fatigue (p=0.03), lower limb edema (p=0.01), and AKI (p=0.01) than survivors. Fifteen (38 %) patients had positive cultures; Staphylococcus aureus predominated in survivors (13 %) and deceased (13 %) patients (p=0.06). Multi-drug-resistant bacteria were found in six (15 %) patients, and one (2.6 %) had Extensively Drug-Resistant bacteria. Multivariate Logistic Regression indicated that lower limb edema (OR 8.6, 95 % CI 1.5–49, p=0.01), and AKI (OR 7.8, 95 % CI 1.65–37.2, p=0.01) increased mortality risk in IE patients. Conclusion: In this study, lower limb edema and AKI were significant predictors of mortality in IE patients, emphasizing their clinical importance in IE progression and resolution. Further research should explore additional variables and risk factors to enhance our ability to predict and manage outcomes in this population.
Machine learning in lupus nephritis: bridging prediction models and clinical decision-making towards personalized nephrology
(Frontiers Media, 2025) Garcia Bañol, Diego Fernando; Arias Choles, Adrianny Mahelis; Aldana Peréz, Silvia; Aroca-Martinez, Gustavo; Guido Musso, Carlos; Navarro Quiroz, Roberto; Domínguez-Vargas, Alex; Gonzalez Torres, Henry J.
Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE), affecting up to 65% of patients during the disease (1, 2). Its clinical course is heterogeneous, characterized by alternating periods of exacerbation and remission, and influenced by a complex interplay of immunological, endocrine, genetic, and environmental factors (3–5). Renal involvement ranges from subclinical disease to end-stage renal disease (ESRD), in which a generalized pro-inflammatory state accelerates renal function decline and significantly worsens patient survival (6). There is currently no definitive cure for SLE or LN. Since the 1950s, standard treatment has aimed to induce remission, suppress disease activity, reduce symptoms, preserve renal function, and maintain remission (7). Although therapeutic regimens have evolved over time (induction vs. maintenance strategies), they typically combine an immunosuppressant with an intermediate-acting glucocorticoid to prevent persistent inflammation, irreversible renal damage, and progression to ESRD (8). Multiple factors influence LN progression, including dysregulation of autoantibody production, poor adherence to therapy, excessive sun exposure (9), and socioeconomic disadvantages (10). However, these variables alone have limited predictive value for anticipating disease flares or renal deterioration (5). In this regard, machine learning (ML) algorithms offer the ability to incorporate multiple clinical and biological variables simultaneously, detect hidden patterns, and generate predictive models with greater accuracy (2). The application of ML to LN monitoring provides several potential benefits. These include timely interventions to prevent disease progression and complications (11–15), the development of personalized follow-up strategies based on patient-specific characteristics and trajectories (14–17), and the ability to identify high-risk patients who may require closer surveillance. Moreover, ML models can predict the likelihood of flares by analyzing historical and longitudinal data, enabling clinicians to implement preventive measures such as therapy adjustments or lifestyle modifications.
Tormenta tiroidea: abordaje diagnóstico y terapéutico
(Asociación Colombiana de Medicina Crítica y Cuidado lntensivo, 2025) Correa Guerrero, José; Corrales Santander, Hugo; Yepes Caro, Jorge; Bello Simanca, Jesús; Rodríguez Arrieta, Luis; Castellanos Pinedo, Alejandro; Rodríguez Garizabalo, Elguis; Dueñas Castell, Carmelo
La tormenta tiroidea (TT) es una patología infrecuente, pero potencialmente mortal si no se detecta y trata oportunamente. Se caracteriza por manifestaciones clínicas graves a nivel del sistema nervioso central, cardiovascular y gastrointestinal, asociado a niveles elevados de triyodotironina (T3) libre y tiroxina (T4) libre. Las infecciones y/o el abandono del tratamiento son los desencadenantes más frecuentes. Identificar el factor desencadenante, reducir los niveles circulantes de hormonas tiroideas, y admitir a unidad de cuidado intensivo se convierten en la piedra angular del tratamiento. En la presente revisión, basados en un escenario clínico, proporcionaremos información con respecto al abordaje diagnóstico y terapéutico de una TT. © 2024 Asociacion Colombiana de Medicina CrÍtica y Cuidado lntensivo. Publicado por Elsevier España, S.L.U. Se reservan todos los derechos, incluidos los de minería de texto y datos, entrenamiento de IA y tecnologías similares.
Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
(MDPI, 2025) Pájaro Huertas, Hernán Javier; Pantoja Echeverri, María Viviana; Martínez, Gustavo Aroca; Guido Musso, Carlos; Domínguez-Vargas, Alex; González Torres, Henry J.
Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.

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