Browsing by Autor "Roly Misael Ramos Zenteno"

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Calcifilaxis en paciente con enfermedad renal crónica, reporte de caso y revisión de la literatura
(2025) Roly Misael Ramos Zenteno; Arce Saavedra; Edson Americo Antequera Rocha; Rommer Alex Ortega Martínez
Calciphylaxis, a rare syndrome that causes skin necrosis, mainly affects patients undergoing hemodialysis; the annual incidence rate is 0.04% to 4%, and the mortality rate is 60% to 80%. The pathogenesis is multifactorial; it depends on the factors that cause calcification, such as alteration of calcium metabolism, phosphorus, hyperparathyroidism, female sex, diabetes, obesity; from the clinical point of view, calciphylaxis can progress from a painful purpura to extensive skin necrosis, causing death from sepsis. Treatment is based on wound care and elimination of the factors. Thus, a clinical case is presented of a 64-year-old woman with a history of chronic kidney disease, diabetes, criteria for urgent dialysis, presence of skin lesions on the lower limbs, with suspicion of calciphylaxis, confirmed by anatomopathology, presenting an unfavorable evolution, with an increase in the size of the skin lesions, poor prognosis and mortality.
Family satisfaction in the Intensive Care Unit: A multidimensional network analysis approach
(2025) Rommer Alex Ortega Martínez; Roly Misael Ramos Zenteno; Carmen Laura Garcés Hazou; Alejandro Pardo Ledezma; Natalia Andrea Cuadros Pariente; Niciel Poma Cruz
Introduction: Family satisfaction in the Intensive Care Unit (ICU) is a multidimensional construct for the quality of care. Understanding its structure and interrelationships requires advanced statistical analysis. The aim of this study was to explore the latent structure of family satisfaction, evaluate the instrument's reliability, and analyze its relationships. Materials and methods: A cross-sectional study was conducted with 47 patients' relatives. Cronbach's α, exploratory and confirmatory factor analysis, network analysis, latent class analysis, and a Bayesian approach were applied. Finally, mediation and moderation analyses were performed. Results: The instrument demonstrated excellent reliability (α = 0.954). Factor analysis confirmed a four-factor structure that explained 77.8% of the total variance. Network analysis identified physician skill and honest information as the most central nodes. Latent class analysis revealed three distinct profiles: highly satisfied, moderately satisfied, and dissatisfied. Bayesian analysis provided evidence that physician skill and honest communication are predictors of satisfaction. Mediation and moderation analyses showed that medical communication mediates the relationship between professional competence and satisfaction, with stronger effects in women and family members living with the patient. Discussion: The application of advanced statistical analysis allowed a comprehensive understanding of family satisfaction in the ICU, confirming its multidimensional structure. The skill of physicians, nurses, and transparent communication are the pillars of satisfaction.
Severe hypocalcemia, an atypical presentation after thyroid cancer surgery, about a case
(2024) Roly Misael Ramos Zenteno; Rommer Alex Ortega Martínez; Lineth Beatriz Nogales Grageda
Hypoparathyroidism, secondary to postoperative thyroid cancer, is characterized by hypocalcemia, hyperphosphatemia, and hypercalciuria due to low concentrations of parathyroid hormone. The prevalence in the United States is 23 to 37 cases/100,000 people/year. Complications develop in 78 % of cases after cervical surgery; 75 % resolve spontaneously in the first 6 months, while the remaining 25 % resolve permanently; no incidence data were obtained in Bolivia. Treatment requires long-term oral calcium with citrate, calcium carbonate, and vitamin D analogs (calcitriol and alfacalcidol); in complex cases, calcium can be used intravenously (calcium gluconate); Some patients do not respond to standard treatment. In this way, the unusual clinical case of a 38-year-old male patient with a history of papillary thyroid carcinoma, post-total thyroidectomy, with a clinical picture of 48 hours of evolution characterized by pain at the cervical level, associated with a Trosseau sign, is presented. (+) and frank signs of respiratory distress with laryngeal spasm, which required management in the intensive care unit (ICU), correction of severe hypocalcemia, with calcium gluconate IV and calcium plus vitamin D PO; presenting an optimal evolution, graduating on the fourth day; He was subsequently discharged from the hospital two weeks later in good general condition
Trauma cérvico-torácico por arma blanca: reporte de caso
(2023) Rommer Alex Ortega Martínez; Roly Misael Ramos Zenteno; Paola Cecilia Rodríguez Gil
Cervical trauma by sharp weapon is rare; however, due to the great clinical interest, it can lead to very important complications, such as asphyxia, massive hemorrhage and even death, especially because 10% of traumatic injuries affect the cervical region (zone 1), which, because it contains important organs and vascular bundles, has a mortality rate of 1 to 7%. Thus, we present the clinical case of a 90-year-old female patient with senile dementia, a clinical picture of 1 hour of evolution, with a wound in the right cervical region by a sharp object, with bleeding and local pain, apparently due to self-injury. The patient underwent surgery to remove the sharp object and was managed in the intensive care unit (ICU) for monitoring, presenting an optimal evolution and discharged on the third day; she was subsequently discharged home in good general condition.
Trauma traqueal por migración de material de osteosíntesis de clavícula
(2022) Roly Misael Ramos Zenteno; Cristhian J. Guzmán Salinas; Rommer Alex Ortega Martínez
El trauma traqueal que afecta la porción cervical es poco común (10 % de todas las lesiones del cuello), con mecanismo penetrante como el más frecuente y con una mortalidad elevada. El manejo adecuado del traumatismo inicial con la salvaguardia de la vía aérea es sólo una parte de la problemática que el paciente puede presentar y una de las complicaciones mayores es la estenosis traqueal. La probabilidad de detectar este tipo de complicaciones implica un adecuado seguimiento de los pacientes; de esta manera presentamos el caso de un hombre de 48 años quien acude en fecha 22/10/22, con un cuadro caracterizado por presentar dolor en región clavicular izquierda acompañado de hemoptisis y disfonía de aproximadamente 5 días de evolución que fue progresando hasta disfagia; luego el paciente fue internado e intervenido quirúrgicamente por una lesión traqueal cerrada por material de osteosíntesis con aguja de Kirschner migrado de la clavícula izquierda; a su egreso pasa a la unidad de cuidados intensivos (UCI) para su monitorización y manejo; evolucionó de manera satisfactoria y egresó a los cinco días de UCI y posteriormente fue externado a su domicilio con una evolución favorable.