Understanding and making visible the actions, activities or tasks that have a purpose or meaning in people lives is one of the objectives of occupational therapy. This discipline also seeks to demonstrate which occupations actually cause a repairing effect, which increase motivation and which strengthen the immune system. The existing relationship between occupation and well-being is one of the aspects that help understanding human occupation. Case studies that allow expanding and consolidating the therapeutic evidence are also intended.

Introduction: Breast cancer is one of the most frequent diseases in Colombia and worldwide. Thousands of women, who undergo treatment, survive and require timely and comprehensive occupational therapy intervention. This paper presents a rehabilitation case study that followed the biopsychosocial and quality of life in persons model. Case presentation: Intervention on a 64-year-old woman referred to the occupational therapy service with a diagnosis of infiltrating ductal carcinoma of the left breast with neoadjuvant radiotherapy, after modified radical mastectomy and stage III lymphedema. She presented with restricted participation and occupational performance, specifically in activities of daily living, with relevant psychosocial and socio-emotional consequences. An intervention focused on the individual, following a biopsychosocial approach, was proposed in order to apply strategies on restorative, empowerment and maintenance activities of occupational skills involved in activities of daily living. Emphasis was placed on socio-emotional, occupational biomechanics and education aspects with special care to involve the interests of women. Conclusions: Rehabilitation for breast cancer patients not only involves biomedical care but also approaches psychosocial aspects that sometimes have to be solved in advance to get results that are later evident in the health of the person. In this case, a breast prosthesis was elaborated by and for the person, using all kinds of strategies that responded to biomedical axes and well-being and health.

Introduction: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that has variable phenotypic expressivity, with manifestations ranging from cutaneous lesions to functional compromise. It manifests clinically during childhood and adolescence. The NF-1 gene encodes a protein, neurofibromin gene, which acts as a tumor suppressor under normal conditions by regulating another protein that stimulates cell growth and proliferation. In case of alteration, different tumor processes may occur, such as the one seen in a small number of cases. Case presentation: 20-year-old male patient with NF1, who presented café-au-lait spots and developed a glioblastoma, which happens infrequently. Discussion: Immunohistochemistry methods that contribute greatly to prognosis are included to achieve the confirmed diagnosis since the median overall survival of glioblastoma patients is higher in patients with NF1 than in those without said pathological entity. Conclusion: The early diagnosis of the lesions favors a timely management of NF1. These patients require a comprehensive and interdisciplinary management to achieve full rehabilitation.

Introduction: Primary systemic amyloidosis is part of the spectrum of plasma cell neoplasms, in which immunoglobulin light chains are deposited in multiple organs. However, myopathic involvement along with respiratory failure and associated multiple myeloma is a rare condition. Clinical case: This paper presents the case of a patient with systemic light chain amyloidosis who was admitted due to myopathy with respiratory failure and adynamic ileus that required intensive care. Infiltration in skin and digestive tract was confirmed by histology. The patient presented with concomitant multiple myeloma with lytic bone lesions and myeloma kidney. The patient responded well to the CyBorD scheme (cyclophosphamide, bortezomib, dexamethasone), renal function was recovered and skin lesions decreased. However, gastrointestinal and myopathic involvement was difficult to manage, requiring ventilatory support and parenteral nutrition. Discussion: Clinicians may oversee this pathology, leading to advanced stages of the disease. Currently, new chemotherapy agents and autologous transplantation may increase the survival of these patients. Conclusion: AL amyloidosis has a wide spectrum of manifestations and should be considered in differentials to reach an early diagnosis and make it treatable.

Introduction: The Herlyn-Werner-Wünderlich (HWW) syndrome is the association of three urogenital anatomic alterations of low incidence. Müllerian alterations are rare and are usually incidental findings; consequently, they are underdiagnosed and their genesis and correlation with having a higher probability of expression on the right side are unknown. Case Report: This is the case of a 17-year-old patient who consulted for severe hypogastric abdominal pain linked to foul-smelling bleeding. On physical examination, a vaginal septum was found, while complementary images showed uterus didelphys and renal agenesis, leading to diagnose HWW syndrome. Furthermore, pyometra and hematocolpus were also documented and managed with antibiotic therapy. Given the adequate response to treatment, hospital discharge was authorized with follow-up by external consultation, since the definitive management could not be provided during hospital stay. Discussion: One of the causes of recurrent abortions is the presence of this syndrome; however, when properly diagnosed, definitive treatment can be provided to reduce conceptional losses and urogenital hematopurulent collections. Conclusions: HWW syndrome is a rare malformation that increases the risk of suffering from gynecological infectious diseases or blood collections. Surgical management of the vaginal septum is a definitive treatment that improves quality of life and reduces the risk of morbidities associated with the pathology.

Introduction: Coronary fistula is defined as a connection between a coronary artery and a cardiac chamber or any segment of the systemic or pulmonary circulation. Its incidence in angiographic series and general population is very low. In general, they are asymptomatic, and rarely show hemodynamic significance. They are typically found in the right cavities, and their location in the left cavities is less frequent. Case description: 52-year-old male patient who presents with angina of effort, for which invasive stratification was performed. A coronary cameral fistula was found in the anterior descending artery to the left ventricle. Cardiac nuclear magnetic resonance was requested as a complementary study, in order to determine future therapeutic actions, but the patient failed to attend follow-up consultations. Discussion: Coronary fistulas that cause coronary artery disease are rare and the drainage of a coronary fistula to the left ventricle is even more uncommon. The pathophysiological importance of a coronary fistula is related to the volume of blood flowing and the pressure gradient through communication. Most coronary fistulas are diagnosed incidentally in cardiac catheterization. Fistulas with clinical and symptomatic significance require short-term treatment. Conclusions: In some cases, initial complementary tests in patients with clinical signs of myocardial ischemia, performed in a non-invasive manner, allow suspecting the presence of coronary fistulas. Coronary angiography continues to be the most accurate diagnostic test. Anatomical and physiological characteristics should be considered to determine if management is required and whether it will be done percutaneously or surgically.

Introduction: Topiramate is a drug used to treat various types of epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case presentation: 17-year-old female patient from Mexico City who regularly uses topiramate, quetiapine and sertraline for the management of depressive disorder. She developed normal anion gap metabolic acidosis secondary to topiramate intake. As a result, she required invasive ventilatory support due to reduced consciousness and respiratory distress. Adequate response to management with laxatives and bicarbonate was achieved, with full renal and neurological recovery. Discussion: Metabolic acidosis is the most common acid-base disorder observed in clinical practice. The difference between measurable cations and anions, known as anion gap, helps to classify the severity of acidosis. Bicarbonate losses or renal tubular disorders generate normal anion gap acidosis as opposed to acidosis resulting from an overproduction of endogenous acid or renal failure, which causes high anion gap. Topiramate is a little known cause of normal anion gap metabolic acidosis; by inhibiting carbonic anhydrase, it causes mixed renal tubular acidosis or type 3 acidosis, as a consequence of the inability to secrete hydrogen ions in the collecting tubule, and a limitation of bicarbonate reabsorption in the proximal tubule. Conclusion: Topiramate, either in therapeutic doses or in overdose, can lead to normal anion gap metabolic acidosis due to the inhibition of carbonic anhydrase in the kidneys. It is usually reversible after starting bicarbonate.

Introduction: This article addresses the general aspects (pathophysiology, embryology, clinical presentation and prognosis) of the Kartagener syndrome (KS). Case presentation: 26-year-old male patient, with a history of complicated sinusitis with cerebral abscess and secondary epilepsy, who consulted to the Hospital Universitario Nacional de Colombia due to headache, fever and mucus expectoration. The presence of situs inversus, chronic sinusitis and bronchiectasis suggested a diagnosis of primary ciliary dyskinesia and KS. Discussion: Differential diagnoses of KS should be framed in its possible causal relationship with primary ciliary dyskinesia and other diagnoses associated with secondary ciliary dysfunction, such as cystic fibrosis, immunodeficiency and anatomical-functional conditions with rhinosenopulmonary involvement. Clinical suspicion of KS occurs when the heart is auscultated on the right and the liver is palpated on the left. Confirmation is achieved through imaging methods that prove visceral heterotaxia, indirect methods related to scan of ciliary malfunction (nasal nitric oxide, video microscopy) and ciliary biopsy that demonstrates the defect of the ciliary ultrastructure. Conclusions: Respiratory infectious involvement in patients with KS is explained by the alteration of the cilia, which leads both to the malposition of some organs and to the structural and functional alteration of others.

Post-polio syndrome (PPS) is a neurological syndrome that appears decades after an acute episode of polio. This condition decreases functional capacity until completing affecting daily activities. This event occurs in 20-80% of the people who were affected by the polio virus. It is more frequent in women and a direct correlation between the risk of developing this syndrome and the severity of the sequelae of polio has been reported. The objective of this article is to present two clinical cases of patients who developed post-polio syndrome approximately forty years after the initial infection. This article seeks to question the concept of polio as a static disease, since it is a process difficult to diagnose and treat, as in both cases presented here. The psychological and functional impact of this disease on patients is regarded as a challenge for the health professional, since clinical needs must be identified and current barriers care reduced.