WWF Colombia

Background The burden of COVID-19 infections has been extensively studied in some parts of the world. However, in emerging economies and particularly in Latin America and Colombia, research is still incomplete, especially in the paediatric population. This study aims to investigate the burden of COVID-19 infections in children and adolescents in Colombia to understand the burden and outcomes of COVID-19. Methods This is a retrospective database analysis of 0–17-year-old persons diagnosed with COVID-19 and given inpatient or outpatient care at a large health maintenance organisation covering 10% of the entire population from March 2020 to January 2023. Cases were confirmed by International Classification of Diseases 10th Revision codes for COVID-19 and a lab test. The incidence rates of COVID-19 cases per 100 000 persons were calculated. With a multivariate logistic regression model adjusted for demographical and clinical characteristics, the factors related to developing severe or critical COVID-19 during the study period were identified. Results Of the 76 376 COVID-19 cases included in the analysis, the mean age was 9.8 years, about 51.5% were male, 99.6% lived in urban areas and 98.9% were unvaccinated (76.9% of the cases occurred before the vaccination of this group began on 31 October 2021). Most cases (69 528, 91%) were classified as mild, 0.9% as moderate, 8% as severe and 0.1% as critical. The most prominent comorbidities were mental health-related conditions (18.9%), chronic lung disease (13.6%) and immunocompromised condition (10.6%). 28 deaths were observed, of which 22 had at least 1 comorbidity, the most frequent being chronic lung disease and mental health conditions. Conclusion Nearly 1 in 5 cases of COVID-19 was documented in children with underlying medical conditions. Our findings underscore the need to target children with comorbidities.

Introduction Melanoma, responsible for most skin cancer deaths globally, has mortality rates expected to double by 2040. Pembrolizumab is a highly selective antibody approved for melanoma treatment and other cancers. Despite new treatments for melanoma, high treatment costs and long approval times limit patient access to new therapies. To support decision-making regarding metastatic melanoma therapies, a model was developed to calculate the number needed to treat (NNT) and the cost of preventing an event (COPE) using KEYNOTE-716 (NCT03553836) data. Method A cost-per-responder model comparing the clinical and economic impacts of pembrolizumab versus best supportive care (BSC) was developed considering a 52.8-month follow-up for recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) in patients with resected high-risk melanoma. KEYNOTE-716 RFS and DMFS survival curves were used to calculate restricted mean survival time (RMST). The RMST was used to calculate NNT (NNTRMST). The NNTRMST calculates the NNT to result in a difference in mean survival time for a death or an event. NNTRMST is subsequently used to quantify COPE outcomes. Results NNT for RFS was 5.3, reflecting the number of patients needed to treat to gain the additional difference observed in the mean RFS for resected high-risk type II (IIB and IIC) melanoma patients treated with pembrolizumab. For DMFS, the NNTRMST was 7.8. The estimated COPE to prevent an RFS or DMFS event was Mexican Peso (Mex $) 9,554,593 (2024) and Mex$13,961,427, respectively. Conclusions NNT values for RFS and DMFS data were both lower than the published average NNT value for current melanoma therapies. This demonstrated that fewer additional patients need to be treated in order to avoid a recurrence or a distant metastases event, compared to currently available melanoma therapies. The NNT and COPE highlight the clinical and economic impact of introducing pembrolizumab therapy for the treatment of patients in resected high-risk stage II melanoma.

Objective Characterize the most frequently used ICD-10 diagnoses and procedures in the population aged 13–24 receiving care at Javesalud Healthcare Service Provider (HSP) in Bogotá, Colombia. Methods A cross-sectional quantitative study was conducted. Through the statistical program R Studio, a database provided by the HSP was analyzed, considering variables such as type of identification document, sex, age, primary ICD-10 diagnosis code, and consultation date. Patients aged between 13 and 24 attended by this HSP between June 1, 2022, and June 30, 2023, for 11.802 consultations, were included in the study. Results The analysis show a difference in the number of consultations according to gender (female/male ratio of 2.1:1), with a higher number of consultations from the young adult population (aged 19–24 years), who accounted for 57.4 % of the consultations. The data obtained indicates that the most frequent procedures involve promotion and prevention activities related to sexual and reproductive health, representing approximately 15 % of the consultations. Furthermore, the prevalence of various diagnoses was distributed differently according to the sex and age of the patients. For females, the most frequent diagnoses were similar but in different proportions, unlike males, where the main reasons for consultation behavior differed for each age group. While in adolescents, there is a predominance of two subgroups: dermatological diagnoses and follow-up exams, in young adults, HIV infection counseling predominates. Conclusions Adolescents and young adults constitute a group with epidemiological characteristics of great complexity, marked by a multitude of variables and significant interpersonal diversity. Therefore, it is imperative to conduct detailed studies in this age group and, at the same time, implement strategies that contribute to the promotion of their development and future well-being.

Introduction In 2022, the world experienced a monkeypox outbreak caused by the Clade IIb strain of the virus. While this outbreak had widespread effects, more information is needed on mpox's specific impact in Colombia, particularly regarding how it is managed, its burden, and its epidemiology. This research seeks to examine the medical context, clinical presentation, and health outcomes of individuals diagnosed with mpox infection, with a particular focus on those with HIV in Colombia. Methods This retrospective study was conducted in fourteen Health institutions in Colombia based on computerized clinical records from Jan 2022 to Dec 2023. Clinical and epidemiological characteristics were collected from diagnosis until discharge (or death). Participants in the study were diagnosed through molecular methods (PCR) and their clinical evolution was tracked through hospital and/or outpatient medical records. Registered variables were based on the mpox 2023 Case Report Form (2023 - CRF) proposed by the World Health Organization. Results One thousand four hundred thirteen (1413, 97.2 % male) individuals, including 2.6 % identified as healthcare workers, were included in this study. The majority (54 %, 764/1413 individuals) were persons living with HIV (PWH) and almost one-third of them (30.1 %, n = 284) of participants had concomitant sexually transmitted diseases and HIV, with syphilis being the most prevalent (20.4 %), followed by Neisseria gonorrhoeae (16.4 %). Complications were infrequent, with cellulitis being the most common, and no individuals received mpox-specific treatment or vaccination. Although all individuals had skin lesions distributed across various body regions, differences were noted in lesion distribution among women. Those living with HIV showed higher emergency department attendance and reported having known mpox contacts. While complications were rare, with cellulitis being the most common, women living with HIV showed a higher rate of emergency room visits and known mpox contacts. Although not statistically significant, gastrointestinal, musculoskeletal, psychological, respiratory, and STI symptoms, including syphilis and urethritis, were more common in the virologically non-suppressed HIV group. At the same time, proctitis was more prevalent in the suppressed group. No significant differences were found based on CD4 count, using 200 cells/mm3 in PWH. Conclusion Over half of the participants were people living with HIV (PWH), with a significant presence of STIs like syphilis. While skin lesions and complications varied, no significant differences were linked to CD4 count or viral load suppression. Mpox symptomatology was not significantly associated with unsuppressed viral loads or low CD4 levels, highlighting the need for further research.

Purpose We aimed to investigate the surgical outcomes and clinical performance of an active osseointegration implant system that uses piezoelectric technology. Methods This national, multicenter, prospective, repeated measures study was approved by the Ethics Committee (opinion no. CEISH 0559-2019). The sample included patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD) who were eligible for osseointegrated implant surgery. Surgical parameters were assessed, along with functional and effective gain (FG and EG) and self-perception of benefits, which were evaluated between 3 and 6 months after activation. Participants also completed the Client Oriented Scale of Improvement (COSI) questionnaire to subjectively report expected and perceived benefits. Results A total of 580 participants aged 5 to 73 years were included in the study between June 2020 and April 2023. Most participants were diagnosed with CHL (58.8%), followed by MHL (28.8%) and SSD. 11.4% of the surgeries involved conversion of other devices to the piezoelectric system. The mean surgery duration was 54 min, and the mean skin thickness was 5.6 mm. Soft tissue reduction was required for 4% of the participants, while 21.2% required bone polishing. The mean PTA (pure tone average) FG was 38.6 dB for participants with CHL, 44.4 dB for those with MHL, and 66.1 dB for those with SSD. Conclusion These results confirmed the clinical safety, performance, and benefits of an innovative active transcutaneous bone conduction implant with a piezoelectric transducer design for patients with CHL, MHL, or SSD.

The Culicidae family (mosquitoes) has great relevance worldwide, due to its involvement in generating several diseases. The Department of Cauca in Colombia is characterized as a region with the influence of several vector-borne diseases. This study aims to analyze the ecological diversity and distribution of mosquitoes with potential transmitters of diseases in a particular urban area of the municipality of Santander de Quilichao. This is one of the first studies of its kind in this municipality. Mosquito collections were carried out during the rainy and dry seasons of 2022, between 17:00 to 19:00. Morphological keys were used for species identification. For the analysis of diversity comparison vs. sampling points, Simpson's index was used, a dendrogram, rarefaction curve, and non-metric multidimensional scaling (nMDS). In the statistical analysis of species-abundances, ANOVA was applied to determine if there were significant differences regarding abundance. A total of 1116 culicid specimens were collected. The 59.4% were mosquitoes of the species Aedes aegypti, 18.5% Culex quinquefasciatus, 18.2% Aedes albopictus, and 3.9% Psorophora ferox, being the rainy season important for their survival. ANOVA analysis showed that the mean abundance of Ae. aegypti was significantly different from the other species. This study is broadly consistent with other studies in the tropical American context where the abundance of Culicidae is more representative in the rainy season. The results suggest a wide presence of Aedes mosquitoes in natural and artificial habitats, showing the importance of establishing controls and permanent epidemiological surveillance in this region.

Background Sleep disturbances are prevalent in Alzheimer’s disease (AD), impacting cognition and quality of life. Trials have also shown increased subjective sleepiness with melatonin doses compared to placebo. High melatonin doses may increase drowsiness, headache, and dizziness, as indicated by a systematic review. A Phase I trial assessed the safety and tolerability of IGC‐AD1, comprising delta‐9 tetrahydrocannabinol (THC) and melatonin. Preliminary findings suggest IGC‐AD1’s safety, with fewer reports of somnolence and dizziness than placebo and no increase in sleep hours. Concerns about melatonin’s sedative properties are addressed through sleep duration assessment. Method Data is presented from a Phase 1 Multiple Ascending Dose MAD trial. Caregivers reported participant sleep hours and nocturnal awakenings during daily safety calls. Average sleep hours for each cohort were computed, calculating nightly averages over the 14‐day drug intake period, and then by cohort and treatment group (1 ml for cohort 1, 2 ml for cohort 2, and 3 ml for cohort 3). Result Variations in average sleep duration across cohorts were observed. Cohort 1 showed average sleep hours of 8.97 (active) and 8.77 (placebo), while cohort 2 exhibited averages of 8.11 (active) and 9.43 (placebo). Cohort 3 displayed averages of 7.90 (active) and 9.24 (placebo). These findings suggest that the administration of IGC‐AD1 did not meet expectations regarding increased sleep duration, despite containing melatonin. Conclusion Although exogenous melatonin is often associated with sedation, the study indicates that IGC‐AD1, containing melatonin, did not lead to the anticipated increase in sleep duration. Further research is needed to understand the underlying mechanisms and optimize therapeutic interventions for sleep disturbances in AD patients.

Background Cannabis‐based therapies have gained interest in treating different ailments in the elderly population, including severe or chronic pain, sleep disturbances, and more recently Alzheimer’s Disease. This raises the importance of understanding the influence of age on the pharmacokinetics (“PK”) of delta‐9 tetrahydrocannabinol (“THC”). IGC‐AD1 comprises THC at a low concentration and melatonin. The PK of THC/Melatonin co‐administration acquires importance since recent therapeutics employ both drugs in treating insomnia or neurodegenerative diseases in the geriatric population, where baseline PK is key to understanding possible changes because of renal or hepatic failures, and accurately adjusting doses to ensure the safety of those drugs. Method Data is presented from a Phase 1 Multiple Ascending Dose (“MAD”) study (n = 10 active), on AD patients and compared to PK data for adults. A review was performed including search results from ScienceDirect, CAS, PubMed, SpringerLink, and Google Scholar, using the terms “Pharmacokinetics”, “Absorption”, “transporter*”, “intestinal”, and “elderly”. Inclusion criteria were the indexed nature of the research, and languages (English, Spanish). No temporal inclusion‐exclusion criteria were considered. Result A dose of 2.5mg of THC reaches higher maximum plasma concentrations (Cmax = 2ng/mL), when administered together with 1.5mg of melatonin, and melatonin appears to be metabolized faster when administered with THC. When considering the relationship between the administered dose and Cmax (Cmax/dose), Cmax per dose of the co‐administered THC, 0.0008, is significantly higher than other reported PK data for oral cannabis administration 0.0003 (p<0.01). Conclusion Melatonin when administered jointly with THC could play a significant role in THC absorption and PK. We hypothesize, pending more studies, that the higher reported dose‐dependent absorption of THC may be related to the effect of melatonin on gastrointestinal transporters and efflux pumps.

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). FC, C-reactive protein (CRP), HLA-B*27 and clinical indices were assessed. Results: Positive fecal calprotectin (PFC) and high fecal calprotectin (HFC) levels were observed in 27.0% and 16.0% of patients, respectively. HFC correlated with a Bath Ankylosing Spondylitis Functional Index (BASFI) score > 4.0 (p = 0.036) and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4.0 (p = 0.047). Loss of vascular pattern in the ileum (LVPI) was observed in approximately 70.0% of patients (p = 0.005), which was associated with PFC and abdominal bloating (p = 0.020). LVPI was also linked to microscopic inflammation (p = 0.012) and PFC with abdominal pain (p = 0.007). HFC was significantly associated with alterations in the ileal mucosa (p = 0.009) and LVPI (p = 0.001). Additionally, HFC and diarrhea were associated with LVPI in 27.3% of patients (p = 0.037) and with erosions in the ileum (p = 0.031). Chronic ileal inflammation correlated with HFC (p = 0.015), ASDAS-CRP > 2.1 (p = 0.09), LVPI (p = 0.001), and villous atrophy (p = 0.014). Factorial analysis of mixed data (FAMD) identified significant associations between micro/macroscopic changes in chronic inflammation and HFC (CC = 0.837); increased levels of CRP and microscopic acute inflammation (CC = 0.792); and clinical activity scores of ASDAS-CRP and BASDAI (CC = 0.914). Conlusions: FC levels were significantly elevated in patients with SpA, particularly those with LVPI, suggesting their potential as a valuable biomarker for managing SpA when joint manifestations coincide with ileal villous atrophy. This indicates a shared immune pathway linked to chronic gut damage.

Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.

Toxoplasma gondii infections in small mammals are important because they serve as source of infection for the felids who excrete environmentally resistant oocysts in their feces. Here, the authors sought evidence for T. gondii infection in shrews and rodents in Armenia for the first time. Toxoplasma gondii DNA was detected in tissues of trapped animals using a specific PCR targeting gene with a non-coding fragment length of 529 bp. Toxoplasma gondii DNA was detected in 15 out of 137 (10.9%) samples from small mammals from 6 different localities of Armenia for the first time.

Background and objective Hypertension is the leading preventable cause of cardiovascular (CV) disease and frequently occurs with other risk factors such as elevated blood glucose and cholesterol. This study aimed to assess the control rates of blood pressure (BP), glycated haemoglobin (HbA1c), and LDL-cholesterol (LDL-C) according to CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed based on the European Society of Cardiology CV disease prevention 2021 (SCORE2&2-OP) guidelines. Results The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight or obese (73.4%). Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes, including dyslipidemia in 85.6% of patients. Hypertension was treated in 97.6% of patients and considered by investigators to be controlled in 72.8% of patients, whereas only 44.4% of patients were controlled according to guidelines. Type 2 diabetes was treated in 92.2% of patients and controlled in 55.5% according to guidelines. In the subset of patients with concomitant dyslipidemia, LDL-C was treated in 95.2% and controlled according to guidelines in 25.6% of patients. The proportion of patients controlled for both hypertension and diabetes was 24.0% and the proportion controlled on all three parameters was 9.5% (Figure). Single-pill combinations were used to treat diabetes in 39.7%, hypertension in 21.4%, and dyslipidemia in 16.8% of patients. Mean (SD) systolic and diastolic BP were 131.3 (18.0) and 77.5 (10.1)mmHg, respectively; mean (SD) HbA1c was 7.0 (1.5)%; and mean (SD) LDL-C was 91.0 (43.4)mg/dL. Conclusions This study showed a substantial unmet medical need: control rates for BP, HbA1c, and LDL-C in Colombia fell short among patients examined, emphasizing the urgency for enhanced therapeutic strategies.

Background and objective Cardiovascular (CV) risk is determined by an interplay of risk factors. The goal of the study was to assess CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed by investigators and compared to the calculated CV risk based on ESC 2021 (SCORE2&2-OP) guidelines. Results The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight/obese (73.4%), 21.4% were former smokers and 2.4%, active smokers. A combination of risk factors (male gender, age ≥65years, BMI≥30 kg/m ² , smoking) was reported for most patients: 43.8% of patients had 1 of these risk factors, 38.1% had 2 risk factors, 6.1% had 3 risk factors, and 0.2% had all 4 risk factors. Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes. Overall, 85.6% of patients had dyslipidemia, 39.7% had chronic kidney disease, and 33.8% had at least one additional CV comorbidity, mainly coronary or other arterial revascularization (18.1%) and acute coronary syndromes (13.5%). 48.4% of patients had diabetes-related target organ damage. CV risk perceived by investigators was low (0.7%), moderate (20.9%), high (35.7%) or very high (42.7%), whereas calculated CV risk according to SCORE2&2-OP was either high (34.6%) or very high (65.4%) (Figure). The prevalence of high and very high CV risk was similar when calculated according to the 2016 (SCORE1) guidelines. Investigators estimated CV risk accurately versus SCORE2&2-OP in only 41.6% of patients, while they underestimated it in 47.9% of patients. Conclusions Hypertensive patients with diabetes in Colombia are at very high risk of CV disease, but this risk is frequently underestimated by physicians. Enhancing physician education on guideline recommendations and treatment intensification could improve risk factor control.

Resumen El pueblo Kankuamo es uno de los 102 pueblos originarios de Colombia, que se encuentran en el proceso de desarrollo de estrategias para la autogestión de salud individual y colectiva. Este artículo tiene como objetivo investigar, identificar y analizar, de forma colaborativa e intercultural, los factores que influyen en el bienestar del pueblo Kankuamo, utilizando el Enfoque de Capacidades propuesto por Amartya Sen. Con este fin, se llevaron a cabo tres grupos focales con la participación de 37 personas de las 15 comunidades del resguardo Kankuamo. Las transcripciones fueron analizadas mediante un análisis temático. De los grupos focales surgieron tres temas centrales para el bienestar de los Kankuamo: (i) armonía entre la naturaleza y los seres humanos, (ii) convivencia social y (iii) autodeterminación. Estos temas reflejan los principios y valores fundamentales que guían a la comunidad hacia el bienestar, la expansión de sus capacidades, la armonía y el desarrollo integral. Los resultados sugieren que los aspectos materiales desempeñan un papel secundario en el concepto de bienestar de la comunidad Kankuamo, y además confirman que es fundamental considerar una visión colectiva de capacidades, no solo individuales, en contextos indígenas. Estudios como este pueden contribuir al desarrollo de enfoques más contextualmente apropiados para evaluar y medir la calidad de vida y el bienestar de las comunidades indígenas, incluyendo el pueblo Kankuamo.

Background In Colombia and worldwide, breast cancer (BC) is the most frequently diagnosed neoplasia and the leading cause of death from cancer among women. Studies predominantly involve hereditary and familial cases, demonstrating a gap in the literature regarding the identification of germline mutations in unselected patients from Latin-America. Identification of pathogenic/likely pathogenic (P/LP) variants is important for shaping national genetic analysis policies, genetic counseling, and early detection strategies. The present study included 400 women with unselected breast cancer (BC), in whom we analyzed ten genes, using Whole Exome Sequencing (WES), know to confer risk for BC, with the aim of determining the genomic profile of previously unreported P/LP variants in the affected population. Additionally, Multiplex Ligation-dependent Probe Amplification (MLPA) was performed to identify Large Genomic Rearrangements (LGRs) in the BRCA1/2 genes. To ascertain the functional impact of a recurrent intronic variant (ATM c.5496 + 2_5496 + 5delTAAG), a minigene assay was conducted. Results We ascertained the frequency of P/LP germline variants in BRCA2 (2.5%), ATM (1.25%), BRCA1 (0.75%), PALB2 (0.50%), CHEK2 (0.50%), BARD1 (0.25%), and RAD51D (0.25%) genes in the population of study. P/LP variants account for 6% of the total population analyzed. No LGRs were detected in our study. We identified 1.75% of recurrent variants in BRCA2 and ATM genes. One of them corresponds to the ATM c.5496 + 2_5496 + 5delTAAG. Functional validation of this variant demonstrated a splicing alteration probably modifying the Pincer domain and subsequent protein structure. Conclusion This study described for the first time the genomic profile of ten risk genes in Colombian women with unselected BC. Our findings underscore the significance of population-based research, advocating the consideration of molecular testing in all women with cancer.

Background Previous results showed the apical expression of CD71 as a receptor associated with retrotranscytosis in ileum from SpA patients without inflammatory bowel disease (IBD) and its relationship with high levels of serum SIgA (sSIgA) and activity disease. The retrotranscytosis mechanism could explain the increases of sSIgA in SpA patients; however, this process has not been confirmed yet. Objectives To confirm reverse transcytosis of SIgA through the ileum mucosa of SpA patients without inflammatory bowel disease. Methods In total, 180 patients with SpA (ASAS/criteria) were assessed by rheumatologists, of which (n=65, 36.1%) met the selection criteria and from them (n=41, 63.1%) by a gastroenterologist to perform digital chromoendoscopy with magnification for colon e ileum and histological analysis. All included patients were between 18 and 65 years old, and those patients with SpA and concomitant IBD were excluded. CD71 by an in-house indirect immunofluorescence. In all patients who showed apical expression of CD71, proximity ligation assay (PLA) was performed to confirm the interaction of CD71-SIgA. CD71-SIgA complexes were followed through their co-localization with Rab-5, Rab-7 and Rab-11A. The analysis were made using the Chi-square or Fisher’s exact test and a multiple correspondence discriminant analysis (MCDA). Results The average age of the patients included was 44,6±10.2 years, 56.1% were men, 39.0% were HLA-B*27:05 positive, 90.2% had axial involvement. Serum levels of SIgA were 62.3±24.1 gr/mL, CRP 1.7±2.4 and ESR 14.1±12.0 mm/h. Positive levels of Fecal Calprotectin (FC) (>120ng/mL) were observed in 31.7%. BASDAI >4 was found in 58.5% of patients and ASDAS-CRP >2.1 in 75.6%. Apical expression of CD71 was observed in 48.8% in ileum. CD71 expression was associated with high levels of sSIgA (p=0.05). The MCDA showed a reliability coefficient of 0.763 and showed a main dimension (Dim1) that collected serum sSIgA (CC 0.513), ASDAS-CRP >2.1 (CC 0.311), CD71 (CC 0.424), and a secondary dimension (Dim2) related to the presence of loss of the vascular pattern in the ileum (CC 0.325), FC+diarrhea (CC 0.695), FC+abdominal distension (CC 0.883) and FC+abdominal pain (CC 0.885). The apical interaction complexes of CD71-SIgA in the ileum was demonstrated through PLA. Microscopic analysis showed that CD71-SIgA complexes were co-located with Rab-5 (in the apical side) and Rab-11A (in the basal side) but not with Rab-7 which is known to mediate transport to the lysosome. Conclusion The results reveal that CD71-SIgA complexes are transported from the apical side of the epithelial barrier to the basolateral side in the ileum, confirming the reverse transcytosis of SIgA in patients with SpA. The positive correlation of CD71 in the ileum with sSIgA confirms retrotranscytosis as one of the mechanisms responsible for the high levels of SIgA in patients with SpA without IBD. These findings had not been reported before in SpA and reveal an important edge of the intestine-enthesis axis in these patients. REFERENCES NIL Acknowledgements The Ministry of Science, Technology, and Innovation - MinCiencias (Grants No. 68022 and 57442). Universidad El Bosque (PCI-2018-10300), Hospital Militar Central (Grant 2017-023), Clínicos IPS, Gastroadvanced, Fundación Instituto de Reumatología Fernando Chalem, in Bogota, Colombia and Biomedicina de Chihuahua, México. Disclosure of Interests None declared

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level. Methods A descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date. Results 200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/μL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/μL. Discussion In this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype.

The jaguar (Panthera onca) is a charismatic species considered Vulnerable in Colombia but yet largely unknown in the country. The species is mostly threatened by the continuous decline in its habitats, mostly derived from deforestation and habitat loss, additional to hunting and conflicts with humans. Thus, the future of jaguars in Colombia depends on protecting and recovering existing habitats. The aims of this study were to 1) evaluate jaguar distribution and identify the remnant patches of habitat in Colombia, 2) define an ecological connectivity network within the country, and 3) propose a priority areas portfolio for the conservation and recovery of jaguars. We used a presence background model for estimating species potential distribution and subsequently identified remaining habitat patches across the country based on land cover and species-specific ecological attributes. We then created an ecological connectivity network based on circuit theory and following a multi-criteria approach identified jaguar priority areas for conservation (JPCA) and recovery (JPRA). Jaguar potential distribution comprises 1103122.43 km², from which 56.71% maintain suitable patches of potential habitat. We identified 960 corridors between remnant patches of natural or semi-natural vegetation. Based on the criteria, JPCAs with greater importance were identified in each of the five Colombian regions. JPRAs were located mainly towards the Andean and Caribbean regions. These JPCAs and JPRAs could serve as a guide for designing and implementing management strategies for the long-term conservation and recovery of the species in Colombia.

El íleo biliar es una causa obstrucción mecánica intestinal caracterizada por presentar síntomas como dolor abdominal, ictericia y fiebre. El tratamiento de elección en estos casos está asociado al abordaje quirúrgico acorde al estado clínico del paciente. Es importante estudiar esta patología ya que su diagnóstico y tratamiento oportunos son fundamentales para evitar complicaciones graves asociadas a una gran morbilidad y mortalidad. El presente artículo describe un caso relacionado al íleo biliar.