Autonomous University of Bucaramanga

There is a limited information available on the clinical characteristics, treatment patterns and outcomes on older patients diagnosed with Acute Myeloid Leukemia (AML) in Latin-America. This multicenter retrospective study analyzed 269 patients over 60 years of age diagnosed with AML in Colombia, using data from RENEHOC-PETHEMA registry, from 2009 to 2023. The median age at diagnosis was 70 years (Range:60–98), 55% were men, 61% had an ECOG < 2, and 75.5% had de novo AML. FLT3-ITD or NPM1 mutations were performed in 23.4% and 15.6% patients, and detected in 14.3% and 16.7% of cases, respectively. Treatment included intensive chemotherapy (IC) (36.8%), Low-Intensity Regimen Based on Low-Dose Cytarabine (LDAC-based) (12.6%), hypomethylating agents (HMAs, with/without venetoclax) (35.3%), and supportive care (15.2%). The overall survival (OS) rate was 35.2% at 1 year and 5.6% at 5 years (13.7% for IC, 9.4% for LDAC-based, and 0% for other treatments); with median OS of 8.2 months (10.6 months after IC, 8.8 months after non-IC, 8.9 months after azacitidine/decitabine, 8.2 months after azacitidine-venetoclax, and 1.9 months with supportive care). Only 1.5% of patients underwent a transplant in the first line. The Leukemia-free survival (LFS) rate was 45.8% at 1-year and 13.7% at 5-years (22.4% for IC, 9.4% and 0% for other treatments); with median LFS of 9.5 months (17.3 months after IC, 7.4 months after LDAC-based, and 10.8 months after HMA). This study provides new insights into the management of patients in Colombia, highlighting the need for a highly individualized approach in treating AML in elderly patients.

Background Patients with secondary acute myeloid leukemia who previously received hypomethylating agents for prior myeloid neoplasms (HMA‐sAML) face a dismal prognosis. Methods The authors analyze the characteristics, therapeutic approaches, and outcomes of patients with HMA‐sAML from the Programa Español para el Tratamiento de Hemopatías Malignas (PETHEMA) registry. Results A total of 479 patients were included, mostly from prior myelodysplastic syndrome (84%). Frontline therapy consisted of intensive chemotherapy (IC) in 31%, low‐dose cytarabine‐based in 19%, supportive care and clinical trial 17% each, and HMA‐based therapy in 12% and 4% in venetoclax‐based regimen. Complete remission was achieved in 95 patients (27%), with higher rate among IC and venetoclax‐based groups (44% and 41%, respectively). The median overall survival (OS) was 4.93 months, with 7.68 months for IC patients, 7.82 months after HMA monotherapy, and 4.66 months after venetoclax‐based regimens. Patients who underwent allogeneic hematopoietic stem cell transplantation in first remission (n = 33, 9%) had a better survival outcome (median OS not reached). Multivariate analyses identified age (≥65 years), Eastern Cooperative Oncology Group >2, higher white blood cell count, and adverse risk cytogenetic as adverse prognostic factors, whereas NPM1 mutation was a favorable factor. Conclusions Patients with HMA‐sAML have a poor prognosis and suboptimal outcomes with conventional treatments, including BCL2 inhibitors, highlighting the need for clinical trials targeting this population.

Background: Hereditary Angioedema is an autosomal dominant disorder caused by a lack or decrease in the function of the C1 inhibitor. It is a rare disease with low prevalence. Treatment focuses on symptom relief and short- and long-term prevention of acute attacks. Case report: 53-year-old male patient, with recurrent edema in the face, feet, scrotum, associated with abdominal pain since he was 20 years old. Patient has a history of hereditary angioedema in first-degree relatives of consanguinity. Laboratory tests showed low levels of plasma protein (antigenic), functional C1-INH and C4. The patient received several medical treatments. Given the recurrence of symptoms, prophylactic management with Lanadelumab was indicated. However, the patient presented erythema and induration at the application site with subsequent secondary generalized pruritus. For this reason, prophylaxis was suspended. Conclusion: This case of hereditary angioedema type 1 presents the difficulty in the treatment and the relapse of the patient after trying various therapies, as well as the finding of the adverse effect presented to the prophylactic medication with Lanadelumab, which has been poorly documented in the literature medical worldwide. Keywords: Hereditary angioedema type 1; Plasmatic protein; Prophylactic management; Adverse event; Lanadelumab.

In this paper, a bibliometric review is conducted on brain–computer interfaces (BCI) in non-invasive paradigms like motor imagery (MI) and steady-state visually evoked potentials (SSVEP) for applications in rehabilitation and robotics. An exploratory and descriptive approach is used in the analysis. Computational tools such as the biblioshiny application for R-Bibliometrix and VOSViewer are employed to generate data on years, sources, authors, affiliation, country, documents, co-author, co-citation, and co-occurrence. This article allows for the identification of different bibliometric indicators such as the research process, evolution, visibility, volume, influence, impact, and production in the field of brain–computer interfaces for MI and SSVEP paradigms in rehabilitation and robotics applications from 2000 to August 2024.

Introduction: Chondrosarcomas are cartilaginous tumors primarily known for metastasizing to the lungs and bones. Their spread to the central nervous system is infrequent. Case Presentation: We present the case of a 32-year-old woman with a history of pelvic/sacral grade III chondrosarcoma (L4-S2; T3N0MX; Ki67; 30%), who underwent surgical resection and radiotherapy. She presented to the emergency department with a 2-day history of thunderclap headache accompanied by fever and chills. Computed axial tomography (CT) scan revealed a left occipital intraparenchymal lesion, subsequently confirmed as suggestive of a neoplastic lesion on magnetic resonance imaging. Ten days after admission, she experienced a two-minute generalized tonic-clonic seizure episode, followed by postictal stupor, tachycardia, hypertension, and anisochoric pupils. A follow-up CT scan demonstrated progression of the metastatic lesion, with evidence of uncal and foraminal herniation. Compression of the cardiorespiratory center at the bulbar level led to her death. Conclusion: This case report offers insight into the clinical presentation, behavior, and prognosis of a metastatic brain lesion derived from grade III chondrosarcoma. It is important to correlate the patient’s medical history with imaging findings to achieve an accurate diagnosis, especially in situations where biopsy may not be feasible.

The simultaneous use of spinal cord stimulation (SCS) and an implantable cardioverter-defibrillator (ICD) is safe and effective in selected patients with refractory chest pain. Our case highlights successful pain management with SCS without compromising ICD function. Careful patient selection, low device settings, and ongoing monitoring are crucial for achieving optimal outcomes.

Background: Bruton Tyrosine Kinase inhibitors (BTKi) are targeted therapies that have demonstrated promising results in the treatment of hematological malignancies; however, they are associated with adverse cardiac events. Direct comparisons of the cardiotoxic profile between old-generation and new-generation BTKi are limited. Research Question: Are novel BTKi associated with a lower incidence of cardiac adverse events compared with ibrutinib? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing new-generation BTKi versus ibrutinib in patients with hematological malignancies. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing any new-generation BTKi with ibrutinib in patients with hematological malignancies. Outcomes included 1) risk of cardiac events; 2) atrial fibrillation (AF); 3) rate of treatment discontinuations due to AF; and 4) hypertension. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R software 4.3.1, under a random-effects model. Heterogeneity was assessed using I2 statistics. Results: We included four randomized controlled trials with 1905 patients, of whom 957 (50%) received new-generation BTKi. Age ranged from 28 to 90 years, with 1337 (70%) male patients. Prior lines of systemic therapy ranged from none to 12. Overall cardiac events were significantly lower in patients who received novel BTKi compared with those who received ibrutinib (RR 0.75; 95% CI 0.63 to 0.90; p=0.002; I2=0%; Fig.1A). New-generation BTKis were associated with a statistically significant reduction in the risk of AF (RR 0.48; 95% 0.35 to 0.64; p<0.001; I2=0% Fig.1B) and treatment discontinuation due to AF (RR 0.07; 95% CI 0.01 to 0.34; p=0.001; I2=0%), compared with ibrutinib. However, there was no statistically significant reduction in the risk of hypertension with novel BTKi relative to ibrutinib (RR 0.58; 95% CI 0.34 to 1.01; p=0.053; I2=81%). Conclusion: Our findings suggest that treatment with new-generation BTKi is associated with a significant reduction in the risk of cardiac events, AF, and AF-related treatment discontinuation compared with the old-generation BTKi.

Background: Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited. Research Question: Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy? Aims: We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation. Methods: We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics. Results: We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p<0.001; I2=44%). Conclusion: These findings suggest that PT-Cy is associated with a higher incidence of adverse cardiac events, the most common of which is heart failure/cardiomyopathy.

Purpose To demonstrate the regenerative effects of Plasma membrane rich in growth factors (PRGFm) as an adjuvant in the surgical treatment of Full-thickness macular holes (FTMH) associated with MacTel type 2 (MacTel). Methods Observational study of a consecutive case series. Type 2 MacTel patients with FTMH. Best-corrected visual acuity, optical coherence tomography (OCT) data, anatomic closure rates, and duration of follow-up were documented. Results 3 patients who met the inclusion criteria were enrolled, 2 are naïve and one is already operated with silicon oil in situ. Median follow-up was 6 months (range 6-18 months), anatomic closure rate was 100%, and median visual acuity change was 20/60 (range 20/40 - 20/100). No complications related to PRGFm were found. Conclusion PRGFm is a valuable option for the treatment of FTMH associated with MacTel type 2. Its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane.

Scholars have found that social accountability initiatives create constraints in political power, helping control corruption. However, their success has been connected to contextual factors linked to the quality of democracy. These conditions are almost nonexistent or do not exist in fragile democratic contexts like Global South countries. This chapter shows evidence that, despite the institutional challenges faced by these initiatives in the Global South, they have produced changes in local governance and how corruption is controlled. By analyzing the case of the Citizens Observatories to local councils in Colombia, this chapter sheds light on the mechanisms that help control and prevent corruption. In-depth semi-structured interviews and document analysis reveal that the observatories’ goals have helped increase transparency and accountability in Colombian municipalities.

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.

Pain, a prevalent and debilitating symptom in cancer patients, significantly diminishes the quality of life for both individuals and their families. Addressing this critical issue, our study presents the case of a 15-year-old diagnosed with synchronous multifocal multicentric osteosarcoma. We utilized radiofrequency ablation of bilateral splanchnic nerves, a strategy of multimodal pain and palliative care. This approach not only proved to be safe and effective but also markedly improved the patient's quality of life. Our findings shine a light of hope, emphasizing the paramount importance of innovative pain management in pediatric oncology, especially in the final stages of life. This case report highlights the unwavering dedication to excellence in relieving suffering, offering hope for patients grappling with cancer.

This study aimed to explore the implementation of Lean strategies in healthcare, evaluate the potential benefits, identify challenges, and highlight future research directions in the field by employing a concept-centric review bolstered by a concept analysis using Scopus and PubMed of 44 literature reviews retrieved regarding Lean healthcare implementations. The literature review consisted of five stages: formulation of guiding research questions, devising a strategic research methodology, establishing selection criteria, and categorizing and synthesizing the papers obtained. Findings indicate that Lean strategies offer the potential for improved patient outcomes, increased efficiency, and reduced costs. Besides, this work divides the main techniques into four clusters, grouping the most similar strategies: Process Evaluation and Improvement, Efficiency and Waste Reduction, Quality Assurance and Control, and Strategic Alignment and Planning. Nevertheless, findings also show that Lean healthcare implementation is not devoid of challenges, including resistance to change, the complexity of the application, and the sustainability of the implemented strategies. Healthcare organizations can utilize the findings to understand Lean strategies better, navigate potential implementation challenges, and align Lean principles with their strategic goals.

There exists a scarcity of neurocognitive research that has successfully used electrophysiology as an objective tool to assess different learning modalitiesthat are commonly used in anatomy. The objective of this study was to explore the trend in the expression of brain waves in medical students when using different didactic strategies in learning anatomy. An exploratory, observational, cross-sectional study was conducted on 22 first- semester medical students in anatomy. Using didactic strategies with different pedagogical tools such as biological models (human skulls and pig hearts) and/or digital application (Visible Body software), and different evaluation methods, students were grouped into three groups: "EOR1" students who learned using a skull and were evaluated with it; "EOV1" students who learned using a pig heart and were evaluated with the Visible Body software; and "EOV2" for students who learned through the Visible Body software and were evaluated with it. During the evaluation, each student was monitored in real-time using an electroencephalogram and the Emotiv EPOC brain-computer interface system to record the electro-physiological activity of beta (B), theta (T), and gamma (G) waves. The data obtained (the trend of the electrical activity of each wave and its relationship with students' performance in each didactic strategy) were analyzed using Pearson's correlation coefficient. Groups EOR1 and EOV1 had satisfactory results in their evaluations and showed a predominance of B waves (x=67.33) and T waves (x=57.67). Additionally, a strongly positive correlation (r=0.82) was found between the presence of B waves and the duration of T waves. Students who used three-dimensional biological models as a pedagogical tool showed a predominance of B and T waves, which are associated with sensorimotor and exploratory learning necessary for studying anatomy.