Universidad del Rosario

Background The management of high-surgical risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high-surgical risk, alternative treatment options such as percutaneous cholecystostomy (PC) are available. There are no clear guidelines regarding the management of patients following PC. The primary aim of this study was to propose indications for PC in high-surgical risk patients with acute cholecystitis and to establish management strategies for gallbladder drainage, either as a bridge to surgery or as definitive treatment, according to available literature data. Materials and methods After a targeted literature review, International and Italian experts in the field from the Italian Society of Research in Surgery (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT), were consulted to provide their evidence-based opinions on the topic. Statements were proposed during subsequent rounds using Delphi methodology. Ten statements were provided and the final agreement is presented in this study. Results Patients with moderate acute cholecystitis, a Charlson Comorbidity Index (CCI) ≥ 6, and American Society of Anesthesiologists-Performance Status (ASA-PS) ≥ 3 who fail conservative treatment should undergo laparoscopic cholecystectomy as the first choice. For patients with severe acute cholecystitis who are at high-surgical risk, percutaneous cholecystostomy is recommended to relieve symptoms within 24–48 hours. Once the infection is controlled, we should assess which patients may be candidates for interval laparoscopic cholecystectomy. For patients selected for surgery, laparoscopic cholecystectomy is recommended at least six weeks after PC placement. In patients not suitable for surgery, such as those with CCI ≥6 and ASA-PS ≥4, percutaneous cholecystostomy should remain in place for at least three weeks, after which, following radiographic confirmation of biliary tree patency, the tube may be removed. Conclusions This study represents the first consensus on this specific topic, characterized by a unique multidisciplinary approach involving interventional radiologists, gastroenterologists, and surgeons who shared their opinions and experiences. We also believe this consensus may offer a straightforward and safe guide for clinicians when managing high-risk surgical patients with acute cholecystitis in daily clinical practice.

Humid high-elevation tropical ecosystems (HETEs), known as páramos, jalca, or moorlands, are essential for biodiversity conservation and water supply. Yet, a key question remains of how future climate change will affect their hydroclimatic spaces: the multidimensional hydroclimatic conditions in which they currently thrive. We use CMIP6-downscaled climate data to assess the potential breaching of these hydroclimatic spaces concerning the long-term means, extremes, and seasonality of temperature and precipitation. Our results show that HETEs in Northern South America will experience the largest increase in temperature and decrease in precipitation, leading to the breaching of their current hydroclimatic space by up to 100%. In the Afrotropics and Australasia, HETEs will experience a breaching of their hydroclimatic spaces related to long-term means and extremes. Our findings provide relevant information on the vulnerability of HETEs to climate change, offering insights to inform the integration of adaptation measures into policy development and management strategies for conserving these key ecosystems and their services.

Machine learning, with its capacity to leverage computational techniques for experiential learning, has profoundly influenced various disciplines, including business and management. Despite its contributions to the progress of these fields and the advent of artificial intelligence presenting new challenges, there remains ambiguity regarding the specific areas of significant advancement and those with potential for further development. This study addresses three central questions: (1) How is the intellectual landscape of machine learning in business and management research organized and structured? (2) What are the primary applications of machine learning in business administration? And (3) What strategic considerations should companies adopt to effectively leverage machine learning in their business applications? By means of co-occurrence analysis of over 9399 peer-reviewed documents retrieved from Scopus discussing machine learning in business and management, we identified fifteen clusters within the literature. This classification serves as a starting point for firms looking to integrate ML into their routines across fifteen distinct topics. Although some firms have appropriated ML, the upsurge of artificial intelligence presents new challenges, including the digital divide, infrastructure and acquisition dilemmas, security concerns especially with outsourced services, and cost-effectiveness in algorithm selection and practical applications.

Premise Key innovations within a group result in ecological divergence. Those innovations involve functional traits that may reflect the species' adaptations to environmental conditions and to interactions within the community. The subtribe Espeletiinae is considered an adaptive radiation due to their exceptional diversity. In this study, we explored the role that functional traits have in this radiation. Methods Nine functional traits (leaf and root) were measured in co‐occurring species of five páramo complexes in Colombia. We used a principal component analysis to understand the climatic differences between complexes and to define the functional space of the species. Welch's ANOVA and t ‐test were used to unveil significant differences among co‐occurring species. We also used normal mixture models (NMMs) to reassemble species based on the functional trait data. Results Páramo complexes were partially separated in climatic conditions of temperature and precipitation. Leaf traits exhibited more significant differences among co‐occurring species within each complex compared to root traits. Espeletia glandulosa was the only species that showed a species‐specific combination of traits and formed a cluster in the NMM analysis. Conclusions There is a more pronounced variation in leaf traits among co‐occurring species, suggesting a potential ecological diversity driver. We propose that there is convergence and stabilization of traits, given the colonization of similar habitats by species belonging to Espeletiinae. We highlight the need for studying the role of other functional traits in the ecological differentiation of species within this group to elucidate how they coexist and cope with environmental conditions of the páramo.

Purpose Hearing loss (HL) affects about one of every five children by the age of 18 years, and up to 60% can be related to genetic factors. The aim of this study is to present an unusual case of poor response to cochlear implantation in a child with X-linked deafness type 2. Method This case report follows the “CARE” checklist. Results The following report presents a 2-year-old child with bilateral nonsyndromic sensorineural HL with incomplete cochlear partition type III. The child has had a cochlear implant since 14 months of age. Genetic studies were performed after surgery. Next-generation sequencing analysis revealed two variants in GJB2 and POU3F4 genes. Conclusion This case study enables us to suggest auditory-verbal therapy and hearing aid trials before CI surgery in the absence of auditory dyssynchrony.

Purpose To assess the diagnostic performance of the InflammaDry test in diagnosing dry eye disease (DED) using different diagnostic criteria and across varying severities. Methods A retrospective study was conducted on 1,515 patients. Subjects were categorized into three groups: Group (1) DED based on Dry Eye Workshop-II (DEWS-II): Ocular Surface Disease Index (OSDI) ≥ 13 and at least one abnormal clinical sign (non-invasive tear break-up time [NIBUT] < 10 s, osmolarity > 308 mOsm/L, or corneal/conjunctival staining). Group (2) DED based on criteria used in prior clinical trials: OSDI > 13, Schirmer < 10 mm in 5 min, NIBUT < 10 s, and keratoconjunctival staining. Group (3) Healthy controls: OSDI ≤ 7, NIBUT ≥ 10 s, Schirmer ≥ 10 mm, and no keratoconjunctival staining. DED severity was classified using the ODISSEY European Consensus Group’s definitions into severe and non-severe. Sensitivity, specificity, and predictive values were calculated for both criteria. Results 1,363 patients were included in Group 1, 401 in Group 2, and 152 in Group 3. Sensitivity was 81.30% in the population diagnosed using previous clinical trial criteria but decreased to 69.99% when applying the DEWS-II criteria. Specificity was 38.16% in both groups, with 409/467 false negatives respectively. Conclusion InflammaDry shows good sensitivity in detecting DED in highly symptomatic cases with multiple clinical signs, but its performance decreases when broader criteria like DEWS-II are used. While valuable for detecting inflammation, routine use for DED diagnosis may lead to false negatives, especially in milder cases.

Urban water bodies serve as critical reservoirs of microbial diversity, with major implications for public health and environmental quality. This study aimed to characterize the microbial diversity of surface waters and wastewater from the Pasto River in the Colombian Andean Highlands, offering insights that may support water quality monitoring efforts. Sampling was conducted at three river sites and one wastewater location. Standard physicochemical and microbiological analyses were performed, including real-time PCR to detect protozoan pathogens Giardia spp. and Cryptosporidium spp. Metagenomic sequencing provided an in-depth taxonomic and functional profile of microbial communities through two complementary approaches: (i) read-based analysis to identify abundant families and species, both pathogenic and beneficial, and (ii) detection of health-related molecular markers, including antimicrobial resistance markers and virulence factors. Physicochemical analyses showed distinct profiles between wastewater and surface water, with wastewater exhibiting elevated levels of suspended solids (113.6 mg/L), biochemical oxygen demand (BOD, 311.2 mg/L), and chemical oxygen demand (COD, 426.7 mg/L). Real-time PCR detected Giardia spp. DNA in 75% (76/102) of the samples and Cryptosporidium spp. DNA in 94% (96/102) of samples. The metagenomic read-based profiling identified Aeromonas media as a prevalent pathogen and Polaromonas naphthalenivorans as a potential biodegradative agent. The metagenomic assembly produced 270 high-quality genomes, revealing 16 bacterial species (e. g., Acinetobacter johnsonii and Megamonas funiformis) that provided insights into fecal contaminants and native aquatic microbes. Functional profiling further revealed a high prevalence of antimicrobial resistance markers, particularly for tetracyclines, aminoglycosides, and macrolides, with the highest abundance found in wastewater samples. Additionally, virulence factors were notably present in Zoogloea ramigera. The findings underscore the value of metagenomic profiling as a comprehensive tool for water quality monitoring, facilitating the detection of pathogens, beneficial species, and molecular markers indicative of potential health risks. This approach supports continuous monitoring efforts, offering actionable data for water management strategies to safeguard public health and maintain ecological integrity.

Background Esthetic gynecology addresses the growing demand for treatments covering functional and esthetic concerns of the external genitalia, significantly impacting women's confidence and sexual relationships. While hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) have shown promise in vaginal rejuvenation, data on hybrid filler applications remain limited. Objective This narrative review examines the anatomical, structural, and psychological aspects of labia majora rejuvenation, outlining available treatment options and presenting the authors' experience with a novel HA/CaHA hybrid filler. Methods This paper combined a narrative literature review using online databases PubMed and Google Scholar, between 2015 and 2024, with the keywords: “labia majora,” “rejuvenation,” “aesthetic treatments,” and “fillers” with a case series of two patients treated with a hybrid CaHA/HA (Radiesse and Belotero Balance Merz Pharmaceuticals GmbH) filler for labia majora volume loss and laxity. Results Sixty‐day follow‐up evaluations by four experienced physicians revealed substantial improvements in labia majora esthetics. A marked improvement in skin coloration was observed in both patients, with skin appearing more even and less hyperpigmented. Both patients showed noticeable volume restoration, resulting in a fuller appearance of the labia majora. Overall aesthetic improvement was evident, as confirmed by the patients' perception. Patient‐reported genital appearance satisfaction, as measured by the GAS score, improved by a mean of 41% (pretreatment mean: 28/33; posttreatment mean: 15/33). Conclusion These two case reports and a narrative literature review suggest that a combined HA/CaHA filler may be a safe and effective treatment for labia majora rejuvenation.

Policymakers face the challenge of delivering business training programs that are high-quality, scalable, and cost-effective. This paper examines the impact of Exper-tienda, a free, smartphone-based business training application designed for Colom-bian microentrepreneurs. Using a randomised controlled trial (RCT) and leveraging local promoters from nearby universities, we evaluated the program's uptake and its effects on business practices, financial inclusion, and formalization. The study involved 994 microentrepreneurs across 10 Colombian cities, with data collected through administrative records and follow-up surveys one year after the intervention. The intervention increased app take-up by 3.97 percentage points, with no evidence of spillover effects across geographical boundaries. However, usage data reveals that the program struggled to engage users, as evidenced by low levels of interaction with the course. Moreover, we found no significant impacts on financial inclusion, formalization, business practices, or other key business outcomes. A high and unexpected attrition rate limited our ability to detect small effects, which are likely given the low levels of interaction with the app. This study is among the first to evaluate a mobile-based training intervention aimed at established microentrepreneurs who lack direct connections to the implementing organisation, providing important insights for the design and implementation of scalable digital training solutions.

Insufficient US public education and misinformation from other sources contribute to climate change (CC) denial. Public US university students in the South (Study 1) and Northeast (Studies 1 and 2) were randomly assigned to watch two educational science videos on CC (experimental condition) or flu viruses (control condition). Experimental (vs. control) condition participants reported (a) less agreement with statements reflecting CC denial (immediate post‐test [Studies 1 and 2] and delayed post‐test [Study 2]); (b) greater agreement with statements about the existence, seriousness, and human causes of CC and hope for CC interventions (immediate post‐test [Studies 1 and 2]); (c) greater intentions to support climate‐friendly US policies (immediate post‐test [Study 1]); and (d) less negative feelings about CC (delayed post‐test [Study 2]), when controlling for gender and political leaning. Implications for effectively addressing CC education among university students with relatively easy‐to‐implement, time‐efficient, and cost‐effective interventions are discussed.

Connective tissue disorders are known to cause cardiac and vascular complications. We present the case of a 37-year-old female patient with a rare Ehlers Danlos/Osteogenesis Imperfecta Overlap Syndrome, referred to cardiac surgery with aortic valve regurgitation, who underwent a successful Biological Surgical Aortic Valve Replacement (SAVR). A multidisciplinary, patient-centered, heart-team approach is essential in managing patients with rare genetic disorders to optimize postoperative outcomes. Adult cardiac surgeons must become familiar with genetic syndromes and their implications for improving perioperative outcomes.

This research examines how role models and entrepreneurial support distinctly affect the entrepreneurial intention of female vs male students in five universities located in South and Central America. Moreover, it examines how gender is related to variables such as entrepreneurial exposure, capability, intention, and subjective norms. We surveyed 1,213 undergraduate students in business-related fields using a correlational, non-experimental, cross-sectional design. We conducted an univariate and bivariate descriptive statistical analysis, followed by structural equation modeling (SEM) to assess various correlations and causal relationships. Our findings indicate that factors influencing entrepreneurial intention may differ between female and male students. Specifically, exposure to support services and role models may affect the entrepreneurial intention of female students differently than male students. Additionally, perceived behavioral control and subjective norms may not be positively correlated with entrepreneurial intention for either gender. This study provides insights into how entrepreneurial knowledge, capabilities, subjective norms, and intentions vary by gender in Latin American countries, contributing to the existing literature. It also offers gender-sensitive managerial recommendations to promote entrepreneurship in the region.

Influenza viruses are highly capable of mutating and adapting in mammalian hosts. While these viruses have been extensively studied in birds, research on their presence in bats has been limited. However, influenza viruses circulating in bats have shown notable molecular divergence. The present study aimed to characterize the phylogenetic, evolutionary, and antigenic relationships of an influenza A virus detected in the fishing bat Noctilio albiventris. As part of a pathogen surveillance study of public health interest, 159 rectal samples were collected from bats in the Colombian Caribbean. The samples were sequenced using RNA-Seq. A genome (eight viral contigs) associated with the Orthomyxoviridae family was identified in a pool. Most segments showed approximately 90% similarity with H18N11, except for the neuraminidase. Analysis of the N protein shows that occupies a basal position relative to the N11 subtype, with its divergence date estimated to be approximately 50 years earlier than the earliest reported N11 sequence. 3D modeling identified three mutations (K363R, T242K, and I139V), which may enhance interaction with the HLA-DR of bats. The analyses and antigenic divergence observed in the N protein of N. albiventris suggests the existence of a new subtype (H18N12) with unknown pathogenicity, which requires further investigation.

Background Overcrowding is a common issue in emergency departments worldwide. One condition associated with overcrowding is the Emergency Department Length of Stay(EDLOS). Prolonged EDLOS is linked to increased hospitalization costs, worsening clinical outcomes, and deterioration in patient-reported outcomes. Consequently, there is a need to reduce EDLOS, and the scientific literature reports multiple strategies aimed at this goal. Therefore, the objective of this study was to determine strategies statistically significant in reducing the EDLOS. Method A systematic search was conducted in PubMed, Scopus, the Latin American and Caribbean Health Sciences Literature (LILACS) database, and Google Scholar from January 2000 to January 2024. Studies that included patient care strategies in emergency departments to reduce EDLOS, in adults or pediatric populations, and observational or experimental studies were included. The quality of the studies was assessed using the Cochrane Collaboration's Risk of Bias tool for Interventional Studies, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. A mean difference analysis in minutes was performed using a random-effects model. Results A total of 3410 studies were identified using the search strategy with a total of 245,404 patients were analyzed. Three types of strategies were identified with results in reducing EDLOS. Interventions performed by physicians in the triage area (liaison, supervision, and advanced triage) showed a significant reduction of -21.87 min (95% CI -28.35; -15.38). The second intervention was the use of Point-of-Care Testing, which showed a reduction of -41.98 min (95% CI -98.13; 14.15). The third intervention was the creation of fast-track strategies, which documented a reduction of -21.81 min (95% CI -41.79; -1.83). Most of the studies were of the before-and-after type. The certainty of the evidence for the first intervention was moderate, while for the other two groups, it was considered low. Conclusion The presence of a physician in the triage team demonstrated a reduction in patient EDLOS, although with high heterogeneity among the analyzed studies. Similarly, the use of fast-track strategies is also significantly useful in reducing EDLOS, while POCT reduces EDLOS but not significantly.

Background Sepsis mortality can be significantly reduced with early diagnosis and appropriate treatment. It is crucial to have tools that enable the early identification of patients at high risk of sepsis mortality from the triage stage. The National Early Warning Score (NEWS) and recently the International Early Warning Score (IEWS), are widely used for this purpose. However, its oxygenation parameters are primarily validated in populations at sea level. Given that patient oxygenation varies with altitude, there is a need to investigate the applicability of this scores at different altitudes. The purpose of this study is to compare the discriminatory capacity of sepsis mortality in emergency departments between the standard NEWS and IEWS scale and a NEWS and IEWS scale adjusted for barometric pressure in Bogotá, a city located 2600 m above sea level. A prospective recruitment was conducted in the triage area of the emergency department, including all patients with suspected sepsis. The scales under evaluation were calculated. Subsequently, the sensitivity, specificity, predictive values, and areas under the curve (AUC) of each scale were assessed for mortality prediction. Results A total of 304 patients were recruited. The overall mortality rate was 19.4% and the septic shock mortality rate was 59.3%. The AUC for the standard NEWS was 0.78 (95% CI: 0.72–0.83), and for the standard IEWS was 0.81(95% CI: 0.75–0.87), altitude-adjusted NEWS, it was 0.79(95% CI: 0.73–0.84), and for the altitude-adjusted IEWS was 0.82(95% CI: 0.76–0.88). Conclusions Adjustment of oxygen saturation for altitude above sea level in NEWS (NEWSa) does not improve its predictive capacity for mortality in patients with sepsis in the emergency department, however, this same adjustment in the IEWS value significantly improves the predictive capacity compared to NEWS and NEWSa.

Background VEXAS syndrome, a recently identified systemic autoinflammatory disorder, poses new diagnostic and management challenges. Based on experience with other autoinflammatory diseases, anti-interleukin (IL)-1, anti-IL-6, anti-tumor necrosis factor (TNF) biotechnological agents, and Janus kinase inhibitors (JAKis) have been widely employed in VEXAS patients. The aim of this study is to evaluate the global effectiveness and safety of biotechnological agents and JAKis using data from the real-world context. Methods Clinical, laboratory, and therapeutic data from VEXAS patients were obtained from the international AIDA Network VEXAS registry. Results In total, 69 VEXAS patients were enrolled in the study. Among them, 12 patients (13 treatment courses) received IL-1 inhibitors, 12 patients (13 treatment courses) were administered anti-IL-6 agents, 8 patients (9 treatment courses) were treated with anti-TNF agents, and 16 patients (17 treatment courses) were treated with JAKis. A complete response was observed in 3 patients (23%) treated with anti-IL-1 agents, 2 patients (15%) receiving IL-6 inhibitors, 1 patient (11%) receiving TNF inhibitors, and 4 patients (23.5%) treated with JAKis. The mean prednisone (or equivalent) dosage significantly decreased during anti-IL-1 treatment (p = 0.01), while glucocorticoids changed during anti-IL-6, anti-TNF, and JAKi treatment in a non-significant fashion. A total of 21 patients experienced adverse events, 3 of which led to death (gut perforation, Legionnaires’ disease, and infectious pneumonia) while on JAKis; treatment withdrawal was required for 8 out of 21 patients. Conclusion IL-1 and IL-6 inhibitors, along with JAKis, represent promising therapeutic options for VEXAS patients, albeit careful monitoring is mandatory to control disease activity and ensure safety.

Background Type A aortic dissection as a highly lethal disease continues being a great challenge for cardiac surgeons worldwide. There are still unanswered questions regarding intraoperative decisions and their impact on the surgical outcomes. The aim of this study is to compare postoperative outcomes according to site of cannulation in patients with acute Type A aortic dissection (ATAAD). Methods This was a retrospective cohort study. We included all ATAAD procedures from January 2002 to November 2023. We defined groups according to site of cannulation (aorta, axillary, femoral, innominate). Data from pre-, intra-, and postoperative variables were collected. Our main outcomes were spinal cord injury (SCI), stroke rate, and in-hospital mortality. Between-group comparisons were performed using standard statistical tests and post hoc tests adjusting for multiple comparisons were performed. Results We identified 127 ATAAD procedures. Reoperation for bleeding was significantly higher in the femoral cannulation group (75%, p = 0.0006). There were no statistically significant differences in acute kidney injury rate ( p = 0.012), SCI rate ( p = 0.78), or in-hospital mortality ( p = 0.75). Our data suggest that there is a lower stroke rate in the axillary cannulation group (3.6%, p = 0.4), which did not reach statistical significance. Conclusion Choosing an adequate cannulation site is a critical step in TAAD surgery. In our series, axillary and innominate cannulation were the preferred methods with relatively low complication rates.