Autonomous University of Bucaramanga

Introduction: People living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) often experience discrimination from both other individuals and the health personnel who care for them. Chile has experienced a marked increase in the number of new HIV cases. Methods: Prospective cross-sectional study. The HIV/AIDS questionnaire for providers and health personnel was obtained from the International Planned Parenthood Federation, initially carrying out a pilot test and evaluating its validity. Results: A total of 784 health professionals answered the questionnaire correctly. Among them, 68.4% ( n = 536) were women, and 36.2% ( n = 284) were physicians. The study revealed that more than 90% of respondents had a positive attitude towards caring for people living with HIV, and more than 75% did not mind buying food from them or sharing services with them. Furthermore, more than 99% rejected the religiously endorsed labeling of people living with HIV/AIDS as immoral. Additionally, 95.5% ( n = 749) mentioned that they did not feel anxious about knowing whether the next patient on their care list was living with HIV, and 76.9% ( n = 603) of the respondents felt safe taking blood samples. Conclusions: Chilean health professionals have good knowledge about HIV infection and its mode transmission. Their attitudes towards people living with HIV are also generally positive.

G protein-coupled receptors are integral membrane proteins in cell signaling processes. Activation of G protein-coupled receptors by specific agonists promotes the activation of different G-proteins, activating different intracellular signaling pathways, including adenylate cyclase activation and intracellular calcium release. One of the G protein-coupled receptors studied is the kisspeptin receptor, which regulates reproduction and gonadotropin secretion. However, recent studies have shown that kisspeptin and its receptor have non-canonical roles in cell signaling and several biological systems. In the present review, we will present these different functions exerted by the kisspeptin system in different biological systems, such as the central nervous system, the cardiovascular system, and the immune system, as well as the role of this system in pathologies such as preeclampsia, diabetes, and cancer. Understanding their non-canonical roles in cell signaling may have important implications in developing new therapies for various diseases. Keywords: Kisspeptin-1 Receptor, Kisspeptins, G-protein coupled receptor, Signal Transduction, Cancer, Diabetes Mellitus, Preeclampsia.

Background Routine blood pressure (BP) self-monitoring is recommended for patients already diagnosed with hypertension. How often these patients can report their BP levels is unknown, particularly in low-and-middle income countries. Methods We surveyed (January 2021 to May 2022) representative samples of patients with established diagnosis of hypertension from 3 health care networks (involving 74 outpatient clinics) and 2 university hospitals in Bogotá, Colombia. Trained health care professionals conducted a telephone survey including questions on demographics, medical history, and general understanding about hypertension and its potential complications. The outcome variables were the self-report of participant’s BP levels (primary) and monitoring practices among participants. Results Out of 2609 consecutively contacted patients sampled from institutional records, 2323 were invited and 1566 (mean age 66.5, SD = 12.1 years, 74.4% females, 64.0% living low socio-economic strata) gave consent to participate. While 66% of participants had over 5 years of diagnosis, 39.5% had most (≥ 60%) of their follow-up visits with the same doctor. Overall, 645 (41.5%, 95%CI 39.1 -43.9) participants reported their BP levels. This proportion was independent of time from diagnosis, but higher among those of younger age, living in higher socio-economic strata, having more years of education and using more information technologies. Also, more patients reported their BP levels if seen ≥ 60% of the times by the same physician (43.4% Vs. 36.7%). Those reporting closer BP self-monitoring more often used electronic devices, received 2 + medications, and had better knowledge about hypertension. Conclusion A minority of hypertensive patients seen in Bogotá were aware of their own BP levels. Those in such capacity were in a better social position, more often seen by the same doctor, knew their condition better and handled more complex treatments. Hypertensive patients from Bogotá may benefit from a more continuous medical care, patient education programs and promoting BP home monitoring.

Background The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. Methods We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. Results In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). Conclusions The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

Introduction: The present study sought to study thrombophilias associated with venous thromboembolism during pregnancy. Methods: The present study is of a descriptive observational type in which the clinical and laboratory alterations were analyzed in a cohort of Latin American pregnant women with the denominator of thrombotic events during pregnancy. Results: The mean age was 24.5+7.6 years, of which 9 patients (10.3%) had a history of thromboembolism , 23 patients (26.4%) had had at least one fetal loss. Elevated Antiphosphatidylserine antibodies were found in 23 patients (26.4%), elevated antibodies against Beta2-Glycoprotein in 20 patients (22.9%), positive lupus anticoagulant in 16 patients (18.3%), elevated Factor VIII in 13 patients (14.94%), Elevated Factor IX in 15 patients (17.2%), Elevated Factor XI in 12 patients (13.7%), Prothrombin Mutation in 7 patients (8.07%). Conclusions: The results found here indicate the high prevalence rate of thrombophilic alterations. underdiagnosed in pregnant women.

Purpose: This study is a systematic review about the WEB device and addresses the efficacy and safety of this device for the endovascular treatment of ruptured and unruptured intracranial aneurysms. Material and methods: This systematic literature review followed PRISMA-P guidelines and included studies published until 2010. PubMed and ScienceDirect databases were searched, resulting in 22 articles meeting the inclusion criteria. Results: The studies involved 1705 patients and 1224 aneurysms, predominantly wide-neck aneurysms in the middle cerebral artery, internal carotid artery, and basilar artery. The treatment success rate was 28.1%, with the WEB-SL and WEB-SLS devices being commonly used. The immediate post-treatment adequate occlusion rate was 33.3%, increasing to 49.7% at follow-up. Thromboembolic complications occurred in 6.5% of cases, while other complications were observed in 3.1% of cases. The mortality rate associated with the WEB device was low, approximately 1%. Conclusion: The WEB device demonstrates favorable outcomes in treating patients with intracranial aneurysms, with adequate occlusion rates improving over time. Thromboembolic complications are the primary concern, but overall complication and mortality rates remain low. Further research is needed to optimize device selection, standardize classification systems, and enhance long-term evaluation and training protocols.

Introduction: In young patients the spectrum of diseases that can cause a stroke is very limited. Methods: Retrospective study of a hospital in Northwestern Colombia in which the characteristics of a cohort of young patients under 40 years of age with a diagnosis of cerebrovascular disease. Medical records were reviewed during a follow-up from 2012-2022. Quantitative variables are presented as mean ± standard deviation or median according to their distribution, and qualitative variables as percentages. Results: A total of 23 patients were found, 18 female, 5 male. The average age at the time of the event was 28+11 years. Within the etiology 19 had a secondary cause of thrombophilia identified by corresponding studies. In the remaining 3, vascular malformation was found. Conclusions: the findings reported here highlight an important frequency of thrombophilic causes as responsible of stroke. We highlight the importance of a better characterization of our Latin American populations.

Post-artemisinin delayed hemolysis (PADH) is a complication in patients who recover from Plasmodium falciparum severe malaria after receiving artemisinin-based combined therapy (ACT), including artemether-lumefantrine. Here, to our knowledge, we present the first case of PADH in Latin America, in a Colombian patient after receiving artemether/lumefantrine while recovering from P. falciparum malarial hepatopathy.

Background Chronic limb-threatening ischemia (CLTI) represents the final stage of peripheral arterial disease. Approximately one-third of patients with CLTI are not eligible for conventional surgical treatments. Furthermore, patients with advanced stage of CLTI are prone to amputation and death. Thus, an effective therapeutic strategy is urgently needed. In this context, autologous bone marrow mononuclear cell (auto-BM-MNC) and allogeneic mesenchymal stem cells represent a promising therapeutic approach for treating CLTI. In this study, we compared the safety and beneficial therapeutic effect of auto-BM-MNC versus allogeneic Wharton jelly-derived mesenchymal stem cells (allo-WJ-MSCs) in diabetic patients with CLTI. Methods We performed a randomized, prospective, double-blind and controlled pilot study. Twenty-four diabetic patients in the advanced stage of CLTI (4 or 5 in Rutherford’s classification) and a transcutaneous oxygen pressure (TcPO 2 ) below 30 mmHg were randomized to receive 15 injections of (i) auto-BM-MNC (7.197 × 10 ⁶ ± 2.984 × 10 ⁶ cells/mL) ( n = 7), (ii) allo-WJ-MSCs (1.333 × 10 ⁶ cells/mL) ( n = 7) or (iii) placebo solution (1 mL) ( n = 10), which were administered into the periadventitial layer of the arterial walls under eco-Doppler guidance. The follow-up visits were at months 1, 3, 6, and 12 to evaluate the following parameters: (i) Rutherford’s classification, (ii) TcPO 2 , (iii) percentage of wound closure, (iv) pain, (v) pain-free walking distance, (vi) revascularization and limb-survival proportion, and (vii) life quality (EQ-5D questionnaire). Results No adverse events were reported. Patients with CLTI who received auto-BM-MNC and allo-WJ-MSCs presented an improvement in Rutherford’s classification, a significant increase in TcPO 2 values‬, a reduction in the lesion size in a shorter time, a decrease in the pain score and an increase in the pain-free walking distance, in comparison with the placebo group. In addition, the participants treated with auto-BM-MNC and allo-WJ-MSCs kept their limbs during the follow-up period, unlike the placebo group, which had a marked increase in amputation. Conclusions Our results showed that patients with CLTI treated with auto-BM-MNC and allo-WJ-MSCs conserved 100% of their limb during 12 months of the follow-up compared to the placebo group, where 60% of participants underwent limb amputation in different times. Furthermore, we observed a faster improvement in the allo-WJ-MSC group, unlike the auto-BM-MNC group. Trial registration This study was retrospectively registered at ClinicalTrials.gov (NCT05631444).

Singultus is the sudden onset of erratic diaphragmatic and intercostal muscle contraction immediately followed by laryngeal closure. Pathophysiology involves afferent, central and efferent components. Bilateral phrenic nerve block was performed to a 46-year-old woman with a brain tumor with persistent hiccups, with initially positive response but later symptom recurrence. Bilateral pulsed radiofrequency of the phrenic nerve was performed guided by ultrasonography (US). In the follow-up, absence of hiccups was confirmed. The patient was discharged 24 h later. Persistent or untreatable singultus is an infrequent condition that should not be dismissed. This approach is a safe, accurate and effective therapeutic approach for patient's refractory to conservative treatment. Further studies are needed to establish safety and effectiveness of the treatment.

Introduction: Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. Objective: We present an ARN case series showcasing treatment experience and results. Methodology: Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. Results: Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. Conclusions: Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. Abbreviations: ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.

Suicide is a complex and multifaceted public health issue that affects individuals from all walks of life, including healthcare professionals such as physicians. According to research, physicians have a higher risk of suicide compared to the general population, with an estimated suicide rate that is two to three times greater than that of the general population. Suicide in physicians can have devastating consequences, not only for the individual but also for their patients and colleagues. The factors contributing to suicide in physicians are numerous and often interrelated. Physicians are exposed to numerous stressors in their daily lives, including long work hours, high workload, burnout, and exposure to traumatic events. These stressors can lead to mental health problems such as depression, anxiety, and substance use disorders, which in turn can increase the risk of suicide. In addition to work-related stressors, personal factors such as relationship problems, financial stress, and a history of mental health problems can also contribute to suicide risk in physicians. Stigma and shame around seeking help for mental health issues may also prevent physicians from seeking treatment, exacerbating the problem. Understanding the complex factors that contribute to suicide in physicians is crucial for developing effective prevention strategies. For this reason, it is necessary to know the behavior of this phenomenon and the factors associated with a higher risk of suicide in this population. However, taking into account that different regions of the world vary in socioeconomic, cultural, professional, occupational, and health attributes, it is to be expected that the behavior of these risk factors will also be heterogeneous. At present, it is presumed that there is a significant gap in the evidence, due to a predominance of evidence on this topic from high-income countries. Considering the importance of having a comprehensive understanding of the risk factors for suicide in the medical population and possible strategies to mitigate this condition, the aim of this review is to analyze the most recent evidence on these factors, and to assess the quality of the evidence and gaps that need to be studied further.

Key Clinical Message Heart failure due to ANCA‐negative vasculitis, is a rare potentially life‐threatening manifestation of ANCA vasculitis. Therefore, physicians must always pay attention to this manifestation for proper disease diagnosis and treatment. Abstract Less than 10% of primary vasculitides cause cardiac dysfunction, with Takayasu's arteritis, polyarteritis nodosa, and eosinophilic granulomatosis with polyangiitis being the most common cases. However, any cardiac tissue can be affected by ANCA vasculitis. We present a case of heart failure with reduced ventricular ejection fraction due to ANCA negative‐vasculitis.

In photovoltaic system installations worldwide, the use of bifacial technology has begun to be more frequent due to the reduction of the cost gap associated with the manufacture of photovoltaic modules with bifacial technology compared to monofacial, encouraged by the technological maturation of bifacial modules. This research focuses on assessing the technical and financial viability of a photovoltaic solar system with bifacial technology, comparing 4 scenarios with different albedos (0.15, 0.2, 0.3 and 0.4) with respect to a base scenario that uses monofacial technology, the financial viability was evaluated according to three financial goodness criteria (NPV, IRR and Payback Time), where only in the scenario with albedo 0.4 were the costs associated with this land adaptation considered. The results of the research indicate that the most technically and financially viable scenario is the scenario with albedo 0.4, with an investment of $ 37,872 MCOP (3.71% more than the base scenario), an energy generated per year of 21,687 GWh/year (4.83% more than the base scenario), a net present value of $46,425 MCOP (8.42% more than the base scenario), an internal rate of return of 18.31% (1.78% more than the base scenario) and a payback time of 5.21 years (3.52% less than the base scenario).

Introduction: In the last two decades, advances in the percutaneous treatment of acute coronary syndrome have led to a reduction on its mortality, positioning percutaneous coronary intervention as the treatment of choice. The percutaneous coro- nary intervention is a challenging procedure due to its higher risk of related complications and the prevalence of multiple comorbidities. Objective: To evaluate the baseline profile and clinical outcomes over 6 months of follow-up post-per- cutaneous coronary intervention in patients older than 85 years-old submitted in the last three years to in-hospital coronary revascularization. Materials and method: This is an “all-comers” registry including patients ≥ 85 years-old treated with PCI in the last three years due to acute coronary syndrome. Results: We included 20 patients with a mean age of 90.3 years; of them, 55% female. The main comorbidities were: arterial hypertension (80%) and hyperlipidemia (58%). At the time of the intervention, 40% of the patients were diagnosed with ST-elevation coronary syndrome. Transradial percutaneous coronary intervention was performed on 70%, with successful target vessel revascularization in 90% of patients. There were 4 non-com- plicated vascular access-related bruises. Mortality was 0% over 6-months of follow-up. Conclusion: Percutaneous coronary intervention is a feasible and effective procedure with low rates of complications in patients over 85 years of age with diag- nosis of acute coronary syndrome. Keywords: Percutaneous coronary intervention. Endovascular procedures. Interventional cardiology. Aged 80 and over.

Introducción: disponer de instrumentos reproducibles que midan la actividad física y los comportamientos sedentarios es una prioridad para la vigilancia y promoción de estilos de vida saludables en niños y niñas. En esta investigación se evaluó la reproducibilidad prueba-reprueba del cuestionario poiba-¿Cómo nos movemos? en escolares colombianos. Materiales y métodos: participaron 125 estudiantes de tercer grado de primaria de una institución educativa colombiana. En dos ocasiones se aplicó el cuestionario poiba-¿Cómo nos movemos?, que evalúa la actividad física realizada para transportarse a la institución educativa y desde esta, durante el tiempo escolar (clases de educación física y recreo), extraescolar (deportiva, con entrenador) y libre. Se emplearon índices kappa y kappa ponderado en los ítems categóricos y el coeficiente de correlación intraclase con modelo de efectos mixtos en los ítems con escala cuantitativa. Resultados: en los ítems sobre actividad física en el ámbito escolar y deportivo predominaron kappas superiores a 0.70. Las preguntas sobre el transporte a la institución educativa y desde esta tuvieron coeficientes kappa cercanos a 0.90. Los ítems de tiempo frente a pantallas alcanzaron coeficientes kappa alrededor de 0.5, y los correspondientes a la hora de acostarse y levantarse obtuvieron coeficientes de correlación intraclase entre 0.40 y 0.72. Conclusiones: el cuestionario poiba-¿Cómo nos movemos? es una opción para evaluar la actividad física de escolares en el contexto latinoamericano. Los ítems sobre actividad física de transporte, en el ámbito escolar y deportivo, tuvieron los mayores índices de reproducibilidad.