Título del artículo:

Access Barriers and Factors Associated With Incurring Out-of-Pocket Expenses in the Putumayo Department: An Analytical Study

Introduction. Out-of-pocket (OOP) expenses are costs that can become a barrier to accessing health services. Objective. To analyze barriers and factors associated with incurring OOP expenses related to health care in the Putumayo Department, Colombia. Methods. We conducted an analytical cross-sectional study of 784 adults who sought outpatient, inpatient, or emergency care. OOP expenditure was determined using a previously validated instrument administered by trained professionals. Descriptive analyses were followed by bivariate and multivariable logistic regression analyses. Results. Median age was 43 years [Q1: 30; Q3: 61], and median OOP expenditure was 100,000 Colombian pesos (COP) [Q1: 20,000; Q3: 210,000]. Belonging to a race other than mestizo, being enrolled in the special contributory regime, residing in rural or dispersed rural areas, visiting a general practitioner (GP), having been hospitalized in the past six months, and having diabetes mellitus (DM) or hypertension (HTN) were associated with higher odds of incurring OOP expenses. Conversely, being aged ≥50 years, having secondary, technical, or university education, and having visited the emergency department (ED) in the past six months were associated with lower odds of incurring such expenses. Conclusions. Belonging to a race other than mestizo, enrollment in the contributory regime, living in rural and dispersed rural areas, consulting a GP, hospitalization in the past six months, and DM and HTN were associated with a higher probability of having incurred OOP expenses. In contrast, age ≥50 years, secondary, technical, and university education, and ED use in the past six months were associated with a lower probability of incurring these expenses.

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Revista Gerencia Y Politicas De Salud

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Adult-onset Still\'s disease presenting with atypical cutaneous findings: A case report and review of similar cases in Latin American patients

Most patients with adult-onset Still\'s disease (AOSD) present with an evanescent, salmon-colored exanthema that is more prominent during febrile peaks and is considered a major diagnostic criterion. However, over the past two decades, an increasing number of atypical cutaneous findings have been reported. Herein, we present a case of AOSD with atypical skin lesions in a Colombian woman and a review of similar cases in Latin American patients. A 21-year-old female was hospitalized for a 3-month history of intermittent fever, joint pain, and pruritic, erythematous rash. On admission, she exhibited polymorphous macules and papules (linear, urticarial) and lichenoid plaques accompanied by eyelid edema, all of which persisted after febrile peaks subsided. The patient fulfilled Yamaguchi\'s criteria for AOSD. A skin biopsy reported multiple apoptotic keratinocytes within the epidermis and a dermal perivascular inflammatory infiltrate. This histopathological pattern has been consistently associated with persistent pruritic eruptions (PPEs), which are characteristic of AOSD with atypical skin lesions. We searched six databases for AOSD cases with atypical cutaneous findings in Latin American patients. Altogether, there were 17 patients (76% female), of whom 14 underwent a skin biopsy: 42% of skin specimens exhibited distinct epidermal alterations compatible with PPEs, while the remaining 58% corresponded to urticaria, dermographism, or classic Still\'s disease rash. Our literature review showed that in Latin American patients with AOSD, atypical skin lesions can correspond to true PPEs but primarily to alternative diagnoses. A skin biopsy is a valuable tool for establishing a prompt diagnosis.

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Revista Colombiana De Reumatologia

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Unraveling the Phenotypes of Dyspnea and Leg Discomfort Symptoms During Exercise and Their Clinical Relevance: A Multicenter Real-Life Study in the Andean Region

Introdction: Dyspnea and other exertional symptoms are cornerstone elements in clinical practice, essential for diagnostic processes, risk stratification, and the effective management of respiratory diseases. Objectives: To investigate the intensity of dyspnea and leg discomfort during physical exercise and their relationships with multi-organ functional variables. Methods: A multicenter study involving 948 adult patients evaluated via integrated cardiopulmonary exercise testing (CPET). Results: Dyspnea at peak exercise showed a mean value of 6.1±3.1 and a median of 7 (IQR, 5). Leg discomfort presented a mean value of 6.3±3.1 and a median of 7 (IQR, 5). Symptoms of dyspnea and leg discomfort reached maximal intensity (i.e., 10 points) in 23% and 30% of patients, respectively, while the remaining participants exhibited submaximal symptom levels. Four phenotypes were identified at peak exercise: paucisymptomatic, peripheral, mixed, and dyspneic. These phenotypes were associated with a sequential and progressive impairment of peak work rate (Wpeak) and peak oxygen consumption (VO2peak), initially exhibiting a bimodal trend for leg discomfort and a subsequent linear inverse relationship with dyspnea. Conclusions: Four distinct phenotypes exist based on predominant exertional symptoms: paucisymptomatic, peripheral, mixed, and dyspneic. These are sequentially associated with increasingly severe grades of functional impairment. These findings warrant the orientation of rehabilitation strategies toward the specific limiting system predominantly responsible for the symptoms, thereby enhancing the therapeutic value of the intervention.

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Rehabilitacion

Título del artículo:

Ticagrelor vs. prasugrel in acute coronary syndrome: evidence from the POST-ISAR-REACT 5 era

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Revista Colombiana De Cardiologia

Título del artículo:

Insulin autoimmune syndrome (Hirata disease) with paradoxical insulin resistance: atypical presentation in a Colombian patient

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Endocrinologia Diabetes Y Nutricion

Título del artículo:

Latent tuberculosis in rheumatological patients on biologic therapy: methodological considerations and primary care perspective

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Reumatologia Clinica

Título del artículo:

Real-time degradation prognostics for proton exchange membrane fuel cells using a self-adaptive grey neural network model

Accurate prediction of performance degradation in proton exchange membrane fuel cells (PEMFCs) is essential for predictive maintenance and commercial viability. This task is challenged by data scarcity, complex operational noise, and highly dynamic conditions. Current data-driven models often require large datasets and lack adaptive optimization, compromising accuracy or efficiency. To overcome this, we propose a novel self-intelligent gradient descent search mechanism-driven grey neural network (SiGDSM-GNN). The model integrates grey system theory, adept at handling uncertain, limited data, with the nonlinear learning power of neural networks. Its key innovation is a self-intelligent mechanism that dynamically selects and adapts gradient descent strategies during training, significantly enhancing convergence and robustness. Extensive testing on three realistic PEMFC datasets—steady-state, dynamic loading with 5 kHz current ripples, and real-world vehicle operation—demonstrated superior performance. SiGDSM-GNN achieved a mean absolute percentage error of 0.11%, a noise-to-signal ratio of 0.005, and a prediction time of 0.005 s, outperforming benchmark models including optimization algorithms and deep learning hybrids. This work provides a highly accurate, data-efficient, and real-time capable framework for PEMFC degradation forecasting, advancing predictive maintenance strategies for cleaner energy systems.

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Journal of Power Sources

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Siderophores in the Rhizosphere: Enhancing Plant Nutrition and Growth

Siderophores, high-affinity iron-binding molecules produced by microorganisms, play a crucial role in plant nutrition by facilitating the uptake of iron and other essential nutrients. Several studies have shown that microbial siderophore production enhances iron solubilization, thereby promoting plant growth and resilience under adverse conditions. Other microorganisms, such as endophytic bacteria, have also been proven effective in mobilizing nutrients within plants. Research has identified microbial strains efficient in siderophore production and explored their application in sustainable agricultural systems. However, large-scale production and application pose challenges, including siderophore stability across diverse soil conditions and formulation costs. Future studies should focus on optimizing microbial strains, developing effective formulations, and evaluating environmental impacts. Integrating siderophores into sustainable agricultural practices can reduce the dependency on chemical fertilizers, thereby improving soil health and crop productivity.

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Microbial Siderophores for Agricultural Productivity Perspectives of Use in Agriculture

Título del artículo:

Plant-mediated synthesis of silver nanoparticles from Moringa oleifera against ESKAPE pathogens

The emergence of multidrug-resistant ESKAPE pathogens underscores the urgent need for sustainable and effective disinfectant solutions. This study reports the green synthesis of silver nanoparticles (AgNPs) using an aqueous leaf extract of Moringa oleifera, with emphasis on the eco-friendly nature and biocompatibility of the resulting nanomaterials. Seven distinct AgNP formulations were obtained by systematically varying synthesis parameters — including temperature and Ag2SO4 and NaOH concentrations — yielding nanoparticles with differentially tunable physicochemical properties. Characterization by UV-visible spectroscopy, dynamic light scattering (hydrodynamic diameter and polydispersity index), zeta potential, and scanning electron microscopy confirmed nanoscale particle formation. Among the synthesized formulations, AgNP 3 exhibited the highest antibacterial activity against ESKAPE pathogens, with minimum inhibitory concentrations (MICs) ranging from 11 to 43.8 μg/mL. Pharmacological interaction analysis revealed additive effects between AgNPs 5 and 6 combined with chlorhexidine against Klebsiella pneumoniae. Furthermore, AgNP 3 inhibited biofilm formation by 49–81% across three bacterial species. In vitro cytotoxicity assays using murine fibroblasts demonstrated high biocompatibility (CC50 > 150 μg/mL), supported by favorable selectivity indices (>4.6). Collectively, these findings suggest that M. oleifera-derived AgNPs may provide a basis for the future development of antimicrobial, antibiofilm, and disinfectant agents targeting pathogens associated with healthcare-associated infections (HAIs).

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Microbial Pathogenesis

Título del artículo:

Heart Failure Among 173,000 Community-Dwelling Participants From 25 Low-, Middle-, and High-Income Countries in the PURE Study

Background: Most population studies examining heart failure (HF) have been conducted in Western high-income countries (HICs), with limited comparable data from lower-income settings. Objectives: The aims of this study were to describe differences in HF incidence and 30-day, 1-year, and 5-year case fatality rates among HF patients from countries at different income levels and in different global regions and to examine the impact of common and potentially modifiable risk factors for incident HF. Methods: This analysis of the PURE (Prospective Urban Rural Epidemiology) study included 172,653 individuals from 25 HICs, upper middle-income countries (UMICs), lower middle-income countries (LMICs), and low-income countries (LICs) and 8 geographic regions of the world, followed for a median of 15 years. Age- and sex-standardized HF incidence, as well as 30-day, 1-year, and 5-year HF case fatality, were compared by income group and by geographic region. The population attributable fractions (PAFs) for incident HF related to 13 cardiometabolic, lifestyle, socioeconomic, environmental, and psychosocial risk factors were also estimated. Results: The standardized rate of incident HF was 0.39 (95% CI: 0.36-0.41) per 1,000 person-years overall; the rate was highest in UMICs (0.58; 95% CI: 0.52-0.64), followed by HICs (0.36; 95% CI: 0.30-0.43), then LMICs (0.34; 95% CI: 0.30-0.38), and then LICs (0.26; 95% CI: 0.22-0.30). Among regions, the highest HF incidence was in sub-Saharan Africa (1.18; 95% CI: 0.95- 1.41) and Europe and Central Asia (0.86; 95% CI: 0.72-1.00) and lowest in South Asia (0.19; 95% CI: 0.15-0.22). Thirty-day case fatality was highest in LICs (59%) and lowest in HICs (11%); it was highest in South Asia (63%) and sub-Saharan Africa (63%) and lowest in North America (12%). Five-year case fatality after HF diagnosis was highest in LICs (77%) and lowest in HICs (28%); it was highest in South Asia (81%) and sub-Saharan Africa (75%) and lowest in North America (25%). More than 71% of the PAF for HF was attributable to the 13 modifiable risk factors studied, the largest being hypertension (PAF = 25%). Conclusions: HF incidence and associated mortality vary substantially across countries at different levels of economic development and by geographic region. Hypertension is the largest population-level risk factor for HF globally. Preventive measures, early diagnosis, and access to guideline-directed medical therapy should be prioritized to reduce global disparities in HF incidence and mortality.

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Journal of the American College of Cardiology

Título del artículo:

Validación de los criterios ASGE 2019 en pancreatitis biliar aguda: implicaciones clínicas para la indicación de CPRM y CPRE

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Gastroenterologia Y Hepatologia

Título del artículo:

Family and extrafamily dynamics in older adults with low pharmacological treatment adherence in a heart failure program in Santander, Colombia

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Atencion Primaria

Título del artículo:

Microbial and Clinical Characteristics in Hepatobiliary Surgery Patients: Analyzing Risk Factors and Antibiotic Resistance

Introduction: Bactibilia frequently complicates biliary obstruction, especially in malignant cases with drainage, and is associated with antimicrobial resistance, thereby posing significant therapeutic challenges. This study characterized the microbiological and clinical profiles, antibiotic resistance patterns, and associated risk factors in patients undergoing hepatobiliary surgery in Colombia. Materials and Methods: We conducted a cross-sectional analytical study on 95 patients with positive bacterial cultures following surgery. The analysis included clinical and microbiological variables. For analytical purposes, patients were stratified into two groups: those with PBD and those without, allowing for the assessment of clinical and microbiological differences between the cohorts. We used chi-square tests, Student\'s t-tests, Mann-Whitney tests, and logistic regression. Results: Of the 95 patients, 61.05% were men, with a median age of 67 years. Preoperative exposure to endoscopic retrograde cholangiopancreatography was significantly higher in patients with biliary pancreatitis (73.47%; p=0.001). Escherichia coli exhibited high resistance to ampicillin/sulbactam (74.29%) and ciprofloxacin (59.46%), while piperacillin/tazobactam (89.74%). Resistance to meropenem was notably associated with female sex (odds ratio [OR: 9.55; 95% confidence interval [CI], 1.12-80.9; P=0.038) and longer ICU stay (OR: 1.12; 95% CI, 1.00-1.24; P=0.038). Discussion: This study reveals significant antibiotic resistance in E. coli and K. pneumoniae, especially in patients with preoperative biliary drainage. These findings highlight the importance of tailoring antibiotic prophylaxis based on preoperative cultures to effectively address antibiotic resistance in hepatobiliary surgery.

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Infectio

Título del artículo:

B-cell Maturation Antigen-directed Therapies versus Standard Regimens in Lenalidomide-refractory Relapsed or Refractory Multiple Myeloma After 1-3 Prior Lines: A Systematic Review and Network Meta-analysis of Phase 3 Trials

The therapeutic landscape for relapsed or refractory multiple myeloma (RRMM) has evolved with the introduction of B-cell maturation antigen (BCMA)-directed agents and novel triplet combinations; however, robust comparative evidence in lenalidomide-refractory patients with early relapse remains limited. We conducted a systematic review and network meta-analysis (NMA) of phase 3 randomized controlled trials (RCTs) comparing BCMA-targeted therapies with standard regimens in adults with RRMM after 1-3 prior lines. MEDLINE, Embase, CENTRAL, and Web of Science were searched from inception through December 2025. The primary endpoint was progression-free survival (PFS), which was quantitatively synthesized using NMA; overall survival (OS), minimal residual disease (MRD) negativity, and grade ≥3 adverse events were summarized descriptively. Ten phase 3 RCTs met the inclusion criteria. Experimental regimens consistently improved PFS compared with control arms, with hazard ratios ranging from 0.31 to 0.70 across trials. Within the connected network, anti-CD38-based triplets demonstrated the most favorable PFS estimates. Although BCMA-directed therapies showed superior efficacy in direct comparisons, including deeper responses and higher MRD negativity rates, limited network connectivity precluded robust indirect comparisons across therapeutic classes. OS data were heterogeneous and frequently immature, and safety outcomes were not quantitatively synthesized. Multiple therapeutic strategies improve PFS in lenalidomide-refractory RRMM during early relapse. Anti-CD38-based triplets remain a cornerstone of care, while BCMA-directed therapies represent a promising alternative. However, structural limitations of the evidence network warrant cautious interpretation.

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Journal of Applied Hematology