Universidad El Bosque

Importance The use of hypertonic saline (HTS) vs mannitol in the control of elevated intracranial pressure (ICP) secondary to neurotrauma is debated. Objective To compare mortality and functional outcomes of treatment with 3% HTS vs 20% mannitol among children with moderate to severe traumatic brain injury (TBI) at risk of elevated ICP. Design, Setting, and Participants This prospective, multicenter cohort study was conducted between June 1, 2018, and December 31, 2022, at 28 participating pediatric intensive care units in the Pediatric Acute and Critical Care Medicine in Asia Network (PACCMAN) and the Red Colaborativa Pediátrica de Latinoamérica (LARed) in Asia, Latin America, and Europe. The study included children (aged <18 years) with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤13). Exposure Treatment with 3% HTS compared with 20% mannitol. Main Outcomes and Measures Multiple log-binomial regression analysis was performed for mortality, and multiple linear regression analysis was performed for discharge Pediatric Cerebral Performance Category (PCPC) scores and 3-month Glasgow Outcome Scale–Extended Pediatric Version (GOS-E-Peds) scores. Inverse probability of treatment weighting was also performed using the propensity score method to control for baseline imbalance between groups. Results This study included 445 children with a median age of 5.0 (IQR, 2.0-11.0) years. More than half of the patients (279 [62.7%]) were boys, and 344 (77.3%) had severe TBI. Overall, 184 children (41.3%) received 3% HTS, 82 (18.4%) received 20% mannitol, 69 (15.5%) received both agents, and 110 (24.7%) received neither agent. The mortality rate was 7.1% (13 of 184 patients) in the HTS group and 11.0% (9 of 82 patients) in the mannitol group ( P = .34). After adjusting for age, sex, presence of child abuse, time between injury and hospital arrival, lowest GCS score in the first 24 hours, and presence of extradural hemorrhage, no between-group differences in mortality, hospital discharge PCPC scores, or 3-month GOS-E-Peds scores were observed. Conclusions and Relevance In this cohort study of children with moderate to severe TBI, the use of HTS was not associated with increased survival or improved functional outcomes compared with mannitol. Future large multicenter randomized clinical trials are required to validate these findings.

Introduction Spondyloarthritis (SpA) exhibits predominantly musculoskeletal symptoms but also significant gastrointestinal (GI) and psychological manifestations. Subclinical gut inflammation is common in SpA, with frequent symptoms such as abdominal pain and diarrhea. Psychological issues like depression and anxiety are also prevalent, with a negative impact on quality of life. This study aimed to evaluate the presence of GI and psychiatric symptoms in SpA patients without inflammatory bowel disease (IBD) and their association with disease characteristics. Methods Cross-sectional study, which included SpA patients from two rheumatology outpatient clinics. Patients were assessed for GI, and depressive symptoms (PHQ-9), perceived stress (PSS-10), disease activity (ASDAS, BASDAI) and functionality (BASFI). Laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and Secretory IgA. Statistical analysis involved Spearman correlation, linear regression, and multiple correspondence discriminant analysis (MCDA). Results Among 98 SpA patients, 79.6% had axial SpA. High disease activity and functional impairment were common. 65.3% reported ≥ 2 GI symptoms, predominantly abdominal pain and diarrhea. Depression (PHQ-9 ≥ 10) was observed in 46.7% of patients, being moderate to severe in 25.0%. Depression, perceived helplessness, and lack of self-efficacy were associated with high disease activity and GI symptoms. MCDA identified strong correlations between depression, GI symptoms, and disease activity. Conclusion This study highlights the association between GI and psychological symptoms with disease activity and functionality in SpA patients. Depression and perceived helplessness are prevalent and closely associated with high disease activity and GI symptoms, suggesting the need for interdisciplinary management from early stages to improve patient outcomes.

Purpose Surgical stabilization of posterior rib fractures involving the costotransverse joint is debated, with most patients managed non-operatively. However, surgery may be indicated for respiratory failure due to altered mechanics or severe pain leading to functional limitations. Long-term outcomes related to quality of life and pulmonary function in these patients are underreported. This study aimed to describe our unique experience with the surgical stabilization of posterior rib fractures involving the costotransverse joint and to report the associated outpatient clinical outcomes. Methods An observational descriptive study was conducted at a tertiary care institution in Colombia during 2020–2024. Patients with posterior rib fractures involving the costotransverse joint who underwent surgery were included. Data collected included demographics, trauma severity, and complication rates. Primary outcomeswere mortality, postoperative complications, and implant failure. Results Eleven patients were included, with a median age of 42 years (interquartile range [IQR] 35–53). The median Injury Severity Score was 26 [IQR 21–35]. The median hospital length of stay was 13 days [IQR 10–17], Intensive care unit stay was 7 days [IQR 4–10], and invasive mechanical ventilation duration was 4 days [IQR 3–4]. One patient (9.1%) experienced a postoperative surgical site infection. Pulmonary function tests revealed a median forced vital capacity at 66% of the predicted value [IQR: 63–73%] and a median forced expiratory volume in the first second at 65% of the predicted value [IQR: 64–70%]. Quality of life assessments indicated acceptable outcomes, with a median score of 60 points [IQR 50–75]. Conclusion Surgical stabilization of posterior rib fractures involving the costotransverse joint is feasible and yields favorable outcomes, overcoming many technical hurdles. Larger studies with standardized follow-up are needed to validate these findings and establish definitive management guidelines.

Objectives While extracorporeal shockwave therapy (ESWT) may be an efficacious adjunctive treatment option for musculoskeletal injuries, current research is limited by significant heterogeneity within treatment protocols. This study aims to establish international expert consensus recommendations on ESWT terminology, parameters, procedural considerations, contraindications and side effects in the application of ESWT to sports injuries. Methods A systematic literature search was performed on the use of ESWT for musculoskeletal and sports medicine injuries to identify potential panellists, followed by the development of a steering committee-led questionnaire. A three-stage, modified Delphi questionnaire was provided to a panel of 41 international clinical and research experts across 13 countries. Panellists had the opportunity to suggest edits to existing statements or recommend additional statements in Round 1. Consensus was defined as≥75% agreement. Results All 41 panellists completed Rounds 1, 2 and 3. Consensus was reached on 69/118 statements (58.5%), including recommendations on terminology and fundamental concepts, indications for use, procedural aspects for tendinopathy and bone pathologies, treatment correlations with imaging, periprocedural and postprocedural considerations, absolute and relative contraindications and potential side effects. Of the 49 statements that did not reach consensus, 17/49 (34.7%) were related to procedural aspects of bone pathology. Conclusion This international panel presents recommendations on ESWT terminology, indications and treatment considerations to guide ESWT use and decision-making by sports medicine clinicians. While our panel supported the use of ESWT in the treatment of bone pathologies, certain procedural aspects of ESWT specific to these injuries did not reach consensus and require further investigation.

The pharmaceutical chemical industry has long used kinetic resolution to obtain high-value compounds. Organocatalysis has recently been added to this strategy, allowing for the resolution of racemic mixtures with low catalyst loadings and mild reaction conditions. This research focuses on the kinetic resolution of 1,5-dicarbonyl compounds using a retro-Michael reaction, co-catalyzed at room temperature with 20 mol % of the Jørgensen–Hayashi catalyst and PNBA. The study highlights the importance of conducting the kinetic resolution at a concentration of approximately ten millimolar (mM) to prevent the Michael retro-Michael equilibrium from affecting the process.

Interpersonal problems are common in multiple psychological disorders to the extent that they are considered a transdiagnostic process. However, they have received little attention as an outcome of psychological interventions. The aim of this study was to evaluate a four-session, individual ACT protocol focused on disrupting repetitive negative thinking (RNT) administered through teleconference to address interpersonal problems and foster interpersonal flourishing. A randomized, concurrent, multiple-baseline evaluation was conducted on 15 participants experiencing interpersonal problems for at least 6 months. Participants responded to daily measures of problematic interpersonal behavior (PIB), interpersonal flourishing (IPF), emotional symptoms, and other process outcomes, as well as traditional psychometric instruments of interpersonal problems, early maladaptive schemas (EMS), depression, and anxiety. All 15 participants completed the intervention and evaluated it as helpful at the 1-month follow-up. Most participants showed evidence of intervention effect in daily measures of PIB (85.7%) and IPF (71.4%), with design-comparable standardized mean differences of d = 0.97 and 0.94, respectively. Individual results on traditional psychometric instruments were similar but with higher effect sizes at the 1-month follow-up (d = 1.73 for interpersonal problems and d = 1.80 for EMS). Six of nine (66.7%) participants with an initial diagnosis of depression experienced a clinically significant change (CSC), whereas three of five (60%) participants initially diagnosed with generalized anxiety disorder showed CSC. In conclusion, the brief RNT-focused protocol showed promising results in reducing interpersonal problems and fostering interpersonal flourishing.

There is limited real-world evidence that evaluates the impact of monotherapy vs. combination therapy as a maintenance treatment in comorbid post-traumatic stress disorder (PTSD) in bipolar disorder (BD). Our aim was to compare lithium vs. lithium plus quetiapine in maintenance treatment in a sample of comorbid BD with PTSD. An exploratory, comparative pilot study over a 28-week period in 34 comorbid BD with PTSD patients was performed to compare monotherapy (n = 18) vs. combination therapy (n = 16) during maintenance treatment. The primary outcome was the time to event of recurrence of any mood episode. The secondary outcomes were regarding change from the baseline to endpoint in the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). A Cox regression, Kaplan-Meir survival, and mixed-effects model for repeated measures analyses were performed. Lithium plus quetiapine reduces the risk of recurrence of any mood episode. There are significant differences between baseline and endpoint for YMRS, MADRS, and CGI-BP scales in the sample. In this pilot, exploratory analysis, combination therapy during maintenance treatment for comorbid BD with PTSD may be effective in preventing recurrences of any type of mood episode.

Introduction Population longevity is a global phenomenon influenced by various factors including social, economic transitions, and medical advancements. The study focused on the population over 95 years old, adopting an approach that integrates data from the 2018 Census and geospatial analysis techniques. Methods An ecological study was conducted using anonymized microdata from the 2018 National Population and Housing Census (CNPV). Geographic analysis, choropleth maps, and Kernel density estimation were employed to identify clusters of individuals aged over 95 years. Results The study identified 43,427 individuals aged 95 years or older in Colombia, with concentrations observed in departments such as Antioquia and Bogotá. Analysis by department and municipality revealed variations in rates and sex distribution. Kernel density analysis highlighted clusters in the Valle de Tenza area and other regions. Conclusion This study sheds light on the geographical distribution of centenarians in Colombia, emphasizing clusters in certain regions. More research is needed to understand the individual and contextual factors underlying successful aging in Colombia and to inform policies to improve the quality of life of older populations.

Introduction Extant literature implicates the role of glucagon-like peptide-1 (GLP-1) and GLP-1 receptor agonists (GLP-1RAs) on modulating alcohol-associated behaviors, with a particular emphasis of these agents on neural circuits subserving reward and appetite control. Herein, we explore the potential effects of GLP-1RAs on alcohol-associated behaviors in brain regions implicated in reward processing facilitating the repurposing of these agents for the treatment and prevention of problematic drinking. Understanding how GLP-1's analogs interact with alcohol-related behaviors may underscore the development of therapeutic strategies for alcohol use disorder (AUD) and those with comorbid metabolic disorders. Methods A systematic review was conducted, wherein relevant literature was identified through Web of Science, PubMed, and OVID (MedLINE, Embase, AMED, PsycInfo, JBI EBP) from database inception to October 27th, 2024. Preclinical and clinical studies examining the association between GLP-1RAs and alcohol-related behaviors were assessed. Results Preclinical studies (n = 19) indicate that GLP-1RAs attenuate alcohol-related behaviors, with exenatide demonstrating significant dose-dependent effects in high alcohol-consuming phenotypes. Semaglutide and liraglutide are associated with reduced alcohol intake, though their effects were often transient. In human studies (n = 2) with AUD, semaglutide significantly reduced alcohol consumption, while exenatide showed mixed results, with reductions in alcohol drinking within high BMI subpopulations. Discussion Extant preclinical and clinical literature provides preliminary support for the potential therapeutic role of GLP-1RAs in attenuating alcohol consumption and preference. There is a need for large well controlled studies evaluating the effect of GLP-1RAs as a treatment strategy for behavioral modifications in individuals living with alcohol use disorder.

Intriducion: Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are resistant to third-generation cephalosporins (3GCs), carbapenems, colistin, and tigecycline, making them a major public health priority, mainly within the developing world. However, their genomic epidemiology and possible determinants of resistance remain to be elucidated. Thus, this study aimed to perform a genomic characterization of E. coli and K. pneumoniae, both of which are resistant to last-line antibiotics, isolated from humans, poultry, and a dairy farm environment within Ecuador. Methods: This study analyzed nine 3GC-resistant E. coli isolates harboring the mcr-1 gene (six from poultry farms, two from human infections, and one from dairy farm compost), together with ten isolated colistin- and carbapenem-resistant K. pneumoniae clinical samples. Results: The E. coli isolates of human origin belonged to ST609 and phylogroup A, while the poultry and compost isolates belonged to phylogroups A, B1, E, and F. Diverse STs of the K. pneumoniae isolates included ST13 (five isolates), ST258 (four isolates), and ST86 (one isolate). Within the E. coli isolates, blaCTX-M-55, blaCTX-M-65, blaCTX-M-15, and blaCTX-M-2 genes were identified. This study also identified blaCMY-2 and blaKPC-3 (the latter in a carbapenem-susceptible isolate). In E. coli, the plasmid-borne mcr-1.1 gene was identified across all E. coli isolates within an IncI2 plasmid. Tigecycline-reduced susceptibility or resistance was related to missense amino acid substitutions coded in the marA and acrA genes. Within K. pneumoiae, blaCTX-M-15 and blaCTX-M-65, on the one hand, and blaKPC-2 and blaKPC-3, on the other, were associated with 3GC and carbapenem resistance, respectively. The blaKPC-2 allele was identified in a ~10 kb Tn4401 transposon (tnpR–tnpA–istA–istB–blaKPC-2–tnpA). In K pneumoniae, sequence data and phenotypic analysis linked a nonsense amino acid substitution coded in the mgrB (K3*) gene and missense amino acid substitutions coded in the marA, acrA, arnB, eptA, pmrB, pmrJ, and phoQ genes to colistin resistance. Meanwhile, tigecycline resistance was linked to nonsense and missense amino acid substitutions coded within the ramR sequence. Additionally, this study identified several integron structures, including Int191 (5′CS-dfrA14-3′CS), which was the most prevalent integron (Int) among E. coli and K. pneumoniae isolates in this study, followed by Int0 (5′CS-3′CS) and Int18 (5′CS-dfrA1-3′CS). Conclusions: These results contribute to the genomic epidemiology of MDR E. coli and K. pneumoniae in our setting and to the worldwide epidemiology in the One Health approach.

Background Mepolizumab, an IL-5 receptor antagonist, is a targeted therapy approved for treating severe eosinophilic persistent asthma. While it offers significant clinical benefits in reducing exacerbations and improving quality of life, its high cost raises concerns about its affordability and overall value in resource-constrained settings. This study evaluates the cost-effectiveness of adding mepolizumab to standard care (SoC) compared to SoC alone in adolescents and adults with severe, uncontrolled eosinophilic asthma in Colombia. Methods We used a Markov model with a societal perspective and a lifetime horizon to estimate costs and quality-adjusted life years (QALYs). Parameters were derived from local data and existing literature. Both deterministic and probabilistic sensitivity analyses were performed to test the model’s robustness. Cost-effectiveness was assessed using a willingness-to-pay threshold of US$5,130. Results Mepolizumab demonstrated an additional 0.31 QALYs per patient compared to standard of care (SoC), with an incremental cost-effectiveness ratio (ICER) of US$25,210 per QALY gained. Sensitivity analyses showed that the price of mepolizumab was the key driver of cost-effectiveness. Over a 5-year horizon, adding mepolizumab to SoC would have a significant budgetary impact. These findings highlight the need to balance clinical benefit with affordability in resource-limited settings. Conclusion Although mepolizumab improves patients’ quality of life, it is not considered cost-effective in Colombia under the conditions of this study. The results provide valuable information for policymakers to consider when refining local clinical practice guidelines.

As the population ages worldwide, the prevalence of cataract and glaucoma combined has been increasing. It is well known that phacoemulsification with intraocular lens implantation lowers intraocular pressure (IOP) and the number of IOP-lowering medications required by the patient. Reduction in IOP seems to be greater in patients with closed-angle glaucoma than in patients with primary open angle glaucoma. Variation in the reduction of IOP can also be explained by some preoperative predictors including higher IOP before phacoemulsification, anterior chamber depth, lens thickness, lens vault, angle open distance, gonioscopy score, and iris thickness. Possible mechanisms of IOP reduction are mechanical influence of the lens removal, increased uveoscleral outflow, and increased trabecular outflow. An increasing number of studies suggest that cataract surgery, combined with MIGS, increases the effects in IOP reduction. Nonetheless, infrequent complications related to glaucoma after phacoemulsification have been reported. The most relevant are IOP spike after surgery, long-term IOP increase, the need for further glaucoma surgery, and the need for an increased number of glaucoma medications.

Some studies suggest that the respiratory microbiome of COVID-19 patients differs from that of healthy individuals, infected patients may have reduced diversity and increased levels of opportunistic bacteria, however, the role of the microbiome in fatal SARS-CoV-2 infection remains poorly understood. Our study aimed to determine whether there are differences in the respiratory microbiome between patients who recovered from COVID-19 and those who died, by characterizing the bacterial communities of both groups. A total of 24 patients who recovered from COVID-19 and 24 who died were included in the study, patient data were analyzed for signs, symptoms and clinical variables. Airway samples were collected and the 16 S rRNA variable regions V3-V4 were amplified and sequenced using the Illumina MiSeq platform. Elevated levels of blood urea nitrogen, creatinine and lactate dehydrogenase, and higher frequencies of cardiovascular disease, diabetes mellitus and renal disease were observed in patients with a fatal outcome. Compared to patients who recovered from COVID-19, patients who died exhibited a microbiome enriched in periodontal and pathogenic bacteria such as Klebsiella pneumoniae. Our results highlighted a dual relationship between SARS CoV-2 infection and an exacerbated periodontopathogen-induced immune response.

The COVID-19 pandemic significantly affected Latin America [1]. Opposite, Orthohantaviruses, zoonotic viruses causing the hantavirus pulmonary syndrome (HPS), are also the cause of severe respiratory illness in the region and Bolivia [2]. While HPS typically spreads to humans through excreta inhalation from rodents, person-to-person transmission has also been documented in Argentina and Chile. Regardless of their clinical similarities, COVID-19 has a shorter incubation period (2–14 days) (HPS, 7–45 days) [3]. Despite the pandemic impact, there is a lack of reports of Hantavirus co-infection. There are dozens of species of Hantaviruses, including Puumala and Dobrava-Belgrade viruses (known to cause Hemorrhagic Fever with Renal Syndrome, HFRS) or Sin Nombre or Andes viruses (that cause HPS). We describe a case of SARS‐CoV‐2 and Andes virus co-infection in the eastern tropical lowlands of Bolivia. A 43-year-old man, farmer in contact with rodents, without relevant pathologic records, sought care at a local hospital in 2022 for five days, presenting fever, dyspnea, cough, asthenia, tachypnea, and adynamia.

Purpose In response to the rise in suicidal behaviour and the strategies to address it, community actions represent a comprehensive approach to the factors influencing this situation. The aim of this study was to analyse the influence of mutual support on the recovery of individuals who experienced suicidal behaviour and attended community mental health groups. Methods A qualitative study was conducted in 2023. Focus groups were used as a data collection technique, followed by thematic analysis. Participants were selected based on convenience from mutual support groups registered with the Ministry of Health of Colombia. Results Two main themes were identified in the thematic analysis. The first theme, “Own Reasons Through Others,” was composed of categories such as “What Others See in Me” and “The Importance of Being in the Same Boat.” The second theme was titled “The Community as a Space for Suicide Prevention,” with categories including “Human Rights for Recovery” and “What We Can Achieve Together.” Conclusions Pluralism, understood as the integration of diverse perspectives, is crucial for addressing complex phenomena such as mental health and community interventions. The study demonstrates how mutual aid groups and their members can generate collective and policy actions effective for managing suicidal behaviour.

Background The study of spirituality has gained importance, as it correlates with mental health and coping strategies, particularly at times of vulnerability. Spirituality could therefore contribute to the development of interventions to improve people’s quality of life. Experts often base the development of interventions and treatments on instruments measuring constructs such as spiritual well-being, which requires validated, reliable instruments. Objective. This scoping review sought to summarize the evidence in the literature on the instruments available to assess spirituality in different groups and evaluate the content and psychometric properties of these instruments. Method. A search was conducted on PubMed, Virtual Health Library (VHL), Elsevier, Springer, Scopus, and Google Scholar databases, using a combination of keywords such as “spirituality,” “validation study,” and “psychometrics.” The search was restricted to studies published in English and Spanish from January 2013 to March 2023. Results. Sixty-four studies were included in this review. Two categories of analysis were established, the first being constructs related to spirituality and instruments for their measurement, in which a total of 22 conceptual constructs were found. The second was the validity and reliability of the instruments, in which it was found that most studies only assessed construct validity. Discussion and conclusion. Given the complexity of the phenomenon, many instruments lack conceptual boundaries, resulting in similarities between items in instruments measuring different constructs. Determining the attributes and dimensions for the accurate measurement of spirituality is essential.