University of Valle

The Colombian-Peruvian Amazon’s global socio-ecological relevance attracts multiple organizations and technologies related to cooperation and environmental governance, configuring a complex network of interactions, relationships, and relational structures. This case study seeks to provide clarity on the complex functioning of the cooperation network in the Amazon biome, composed of institutional and technological nodes. It identified 17 thematic environmental narratives, their patterns of concordance by node (entities/institutions operating within the network), and how they influence inter-network links. Studying cooperating networks in dynamic contexts is made complex by progressive and diverse environmental threats, economic challenges, and barriers to accessing information. The article proposes a methodological approach to untangling these complexities, leveraging (a) social network analysis; (b) web scraping for data collection; (c) text mining to categorize narrative themes by node; and (d) network modeling using Exponential Random Graph Models. We propose and evaluate hypotheses on the influence of narrative concordance, contribution, homophily, and environmental-governance internal structural patterns that are important in creating network links. Study results indicate three dominating narratives: Research & Education, Communities, and Policy, revealing a higher distribution, average contribution, and significance for these discourses. Additionally, international nodes contribute predominantly to Research and Technology topics, surpassing Colombian-Peruvian nodes, suggesting a pattern of influence over these network themes. Lastly, we identify opportunities for improving system interventions for slowing the Amazon biome’s degradation, composed of a diversified, well-integrated cooperation network, and underscoring the need for environmental-policy frameworks that actively integrate local perspectives and capacities, while leveraging international networks to bridge regional limitations.

Early-onset Alzheimer's disease (EOAD) is a rare subtype of Alzheimer's, manifesting before age 65 and often linked to genetic mutations. This report describes the case of a 47-year-old Colombian man with EOAD and a novel pathogenic PSEN1 mutation, c.519G>T (p.Leu173Phe). Case description. The patient presented with a one-year history of progressive cognitive and behavioral decline, including memory impairment, disorientation, paranoia, and social withdrawal. A family history of EOAD in his mother and sister suggested a genetic etiology. Initial evaluations, including brain MRI and laboratory tests, were unremarkable, but neuropsychological testing and brain SPECT scan revealed significant cognitive deficits and hypoperfusion, consistent with EOAD. The patient experienced rapid progression of symptoms, including prosopagnosia, executive dysfunction, seizures, and behavioral disturbances. Despite symptomatic management with cholinesterase inhibitors, memantine, and antipsychotics, his condition deteriorated, culminating in severe dementia by age 55. Whole-genome analysis identified a novel likely pathogenic PSEN1 mutation (c.519G>T), which had not been previously reported. This variant, located in the third transmembrane domain of the PSEN1 protein, is hypothesized to disrupt γ-secretase activity, contributing to EOAD pathogenesis. The case highlights the phenotypic variability associated with PSEN1 mutations, including cognitive and neuropsychiatric symptoms, seizures, and parkinsonism. It underscores the importance of genetic counseling and testing in suspected familial EOAD cases, particularly in populations with known genetic predispositions. Current treatments offer limited symptomatic relief, emphasizing the need for novel therapeutic approaches. This case of EOAD with a novel PSEN1 mutation highlights the importance of early genetic and neuropsychological evaluations for diagnosis and management. Collaborative research is essential to advance understanding and develop effective treatments for rare neurodegenerative diseases.

Through a range of coping strategies, individuals seek to manage the stressors to which they are exposed, employing cognitive and behavioral responses that shape their emotional regulation of such events. Emergency first responders are routinely subjected to high-stress situations due to the nature of their duties and the continuous care of critically ill patients. This sustained exposure significantly increases their vulnerability to the development of mental health disorders, notably posttraumatic stress disorder (PTSD). The aim of this study was to determine the coping strategies used by first responders when facing critical incidents and their association with PTSD. A cross-sectional analytical study was conducted in 2022. All first responders from a volunteer fire department in a major Colombian city who voluntarily agreed to participate were included in the study. The participants were 28 ambulance crew members and 187 firefighters. Descriptive statistics were used for data analysis, and logistic regression models were applied to assess associations with PTSD. Principal components analysis was used to compute total scores, while the Lasso Method identified significant predictors. The first responders most often employed avoidance and denial as coping strategies in response to the demands of their work in the prehospital field. After witnessing devastating events, many of them turned to religion for stress relief. The study identified the use of maladaptive strategies associated with PTSD among staff, making it critical to develop training programs that help first responders cope with critical incidents by developing adaptive coping skills.

Ceftazidime/avibactam (CZA) is a promising treatment option for infections caused by carbapenem-resistant Enterobacterales (CRE). However, CZA resistance is increasingly reported worldwide, largely due to the emergence of KPC variants and increase of metallo-β-lactamases (MBL). This study describes the mechanisms associated with CZA resistance in circulating Enterobacterales isolates from Colombia, highlighting the challenge this represents for microbiological identification. Between 2021 and 2024, 68 CZA-resistant Enterobacterales isolates were identified by automated methods in seven Colombian cities. Resistance to CZA was subsequently confirmed by broth microdilution and E-test. Carbapenemase production was evaluated using phenotypic tests, such as the mCIM test, Carba NP, lateral flow assay, and qPCR (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48). Whole-genome sequencing was performed on 15 isolates that tested negative for MBL genes. Whole-genome sequencing of these 15 isolates revealed a variety of resistance determinants: six isolates harbored blaKPC-31, one blaKPC-33, one blaKPC-8, five harbored blaPAC-2, and two co-harbored blaPAC-2 and blaKPC-2. Notably, blaPAC-2 was located on an IncQ plasmid. However, some of these variants were not detected by phenotypic assays, likely due to their low or undetectable carbapenemase activity. CZA resistance in non-MBL producing Enterobacterales in Colombia is primarily mediated by the presence of blaKPC-31 and emergence of blaPAC-2. These resistance mechanisms pose significant diagnostic, therapeutic, and epidemiological challenges, as they frequently go undetected by conventional microbiological methods. In this context, enhanced molecular surveillance and improved diagnostic strategies are urgently needed to enable early detection, guide antimicrobial therapy, and support infection control and stewardship efforts.IMPORTANCEAntibiotic resistance is a serious global health threat. Ceftazidime/avibactam (CZA) is a key treatment option for multidrug-resistant (MDR) Enterobacterales often used when other antibiotics fail. However, bacteria are now developing resistance to this drug as well, making infections increasingly difficult to treat. In this study, we examined CZA-resistant bacteria from multiple cities in Colombia and found uncommon resistance genes across several bacterial species. These genes are frequently missed, as they often do not test positive due to the limitations of most routinely used laboratory tests. Importantly, some of these genes can be transferred between bacteria, increasing the likelihood of indiscriminate dissemination in the hospital setting. Therefore, our findings highlight the urgent need for improved diagnostic tools and molecular surveillance. Early detection will help physicians select effective treatments quickly and prevent the wider dissemination of these MDR-resistant bacteria.

Summary:The patient presented with a history of deep injection of a nonmedical substance (biopolymer) into the gluteal region, resulting in compression of the sciatic nerve. The surgical technique used to remove biopolymers from the subcutaneous tissue, muscle tissue, and sciatic nerve is described. A structured review of the current surgical approaches for the sciatic nerve was conducted. The preoperative evaluation, intraoperative technique, and postoperative follow-up of the clinical case are detailed. The described surgical approach effectively decompresses the sciatic nerve, removes the biopolymer material from the subcutaneous tissue and muscle tissue, and improves symptoms, cosmetic outcomes, recovery time, and the need for additional surgery. Given the limited information on the management of biopolymer removal and nerve compression, this technique represents a viable alternative, offering benefits in recovery and cosmetic outcomes.

ObjectiveTo evaluate the effectiveness of various de-implementation interventions in primary care, targeting care (treatments or tests) that provides no or limited value for patients (low value care).DesignSystematic review and meta-analysis.Data sourcesMedline and Scopus databases, from inception to 10 July 2024.Eligibility criteria for selecting studiesRandomised trials comparing de-implementation interventions with placebo or sham intervention, no intervention, or other de-implementation intervention strategies in primary care. Eligible trials provided information on the use of low value care, total volume of care, appropriate care, and health outcomes.Data extraction and synthesisTitles, abstracts, and full texts were screened, data were extracted, and risk of bias was assessed independently and in duplicate. Random effects meta-analyses were conducted, and the certainty of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results13 008 abstracts were screened and 140 were eligible for inclusion in the study. Median follow-up was 287 days (interquartile range 180-365). In 75 (54%) trials the aim was to reduce the use of antibiotics, in 42 (30%) to reduce other drug treatments, in 17 (12%) to reduce imaging, and in 15 (11%) to reduce laboratory testing. The certainty of the evidence was moderate that provider education combined with audit and feedback reduced the use of targeted low value care (odds ratio 0.73, 95% confidence interval (95% CI) 0.63 to 0.84). Provider education (0.86, 95% CI 0.72 to 1.03), audit and feedback (0.82, 0.67 to 1.00), and patient education (0.70, 0.30 to 1.66), and a combination of these strategies (point estimates for odds ratios ranging from 0.57 to 0.64) may reduce the use of targeted low value care (low certainty of evidence for all).ConclusionsThe results suggested with moderate certainty of evidence that provider education combined with audit and feedback reduced the use of targeted low value care. Individual strategies may slightly reduce the use of targeted low value care, but achieving a meaningful impact on low value care may require the use of multiple strategies. The results may be useful for patients, clinicians, policy makers, and guideline developers when deciding on future de-implementation strategies and research priorities.Systematic review registrationPROSPERO CRD42023411768.

BackgroundCardiovascular disease remains the leading cause of morbidity and mortality worldwide, with dyslipidemia playing a key role in its progression. Despite advances in lipid-lowering therapy (LLT), LDL-C (Low-Density Lipoprotein Cholesterol) goal achievement remains suboptimal. This study evaluated LDL-C goal attainment in Colombian patients with very high cardiovascular risk (CVR) due to coronary artery disease (CAD) following ESC/EAS guidelines updates.MethodsEDHIPO MARCA (Evaluación De adherencia a la terapia HIPOlipemiante en pacientes de Muy Alto Riesgo CArdiovascular) is a retrospective, multicenter study assessing LDL-C goal achievement in patients with CAD. Data were collected from previous coronary angiogram reports and medical records across 11 Colombian healthcare institutions with certified interventional cardiology services. Patients with CAD who had at least one follow-up LDL-C measurement and an LLT prescription within 12 months post-angiogram were included. LDL-C goal attainment was assessed across three periods—2011–2012, 2016–2017, and 2021–2022—corresponding to the updates of ESC/EAS guidelines (2011, 2016, and 2019, respectively). The LDL-C goals were <70 mg/dL for the first two periods and <55 mg/dL for the most recent one. LDL-C was measured or estimated using the Friedewald equation. Descriptive analyses were performed.ResultsA total of 1,788 patients were included, with a median age of 66 years (IQR: 59–74), and 70.7% were male. Hypertension (67.5%) and overweight (40.8%) were the most common comorbidities. At discharge, statins were prescribed in 84.1% (95% CI: 82.4–85.8%) of patients, increasing to 99.1% (95% CI: 98.6–99.5%) at the end of follow-up (median 6.8 months); PCSK9 inhibitors were prescribed in 1.5%, exclusively in 2019. At the end of follow-up, 36.6% (95% CI: 34.3%, 38.8%) achieved LDL-C goals. By guideline period, goal attainment was 12.1% (95% CI: 5.4%, 18.8%) in 2011, 42.3% (95% CI: 37.9%, 46.8%) in 2016, and 36.2% (95% CI: 33.5%, 38.9%) in 2019. By number of follow-ups, LDL-C goal achievement increased from 32.9% (1 follow-up) to 44.0% (4 follow-ups).ConclusionsDespite widespread LLT use, LDL-C target achievement remains suboptimal. Frequent follow-up and greater use of combination therapy beyond statins may be essential to improve lipid control in very high CVR patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12944-025-02657-9.

Lipoxins were discovered 40 years ago, and since then, their beneficial roles for human health have been confirmed in numerous studies. These small molecules belong to the eicosanoid class of compounds, which are generated metabolically by lipoxygenases. Lipoxins are released during various diseases and conditions, including but not limited to systemic inflammation, infection, asthma, cancer, diabetes, and cardiovascular disorders. Recently, several synthetic lipoxin analogs have been developed that also exhibit potent anti-inflammatory properties. In this review, we discuss the inflammation-resolving roles of lipoxins in various major diseases. Further, we summarize the latest reports on the use of synthetic lipoxins as potential therapeutic agents and discuss the role of aspirin-dependent lipoxin production in alleviating various diseases, including cancer.

Cancer during pregnancy is relatively rare. The incidence is underestimated due to the lack of international registries covering both high‐income and low‐ and middle‐income countries, and is expected to rise with increasing maternal age and increasing global adoption of cell‐free DNA testing for aneuploidy. Physiological changes during pregnancy often make the diagnosis challenging and delayed. Lack of experience and knowledge about this condition may also contribute to late diagnosis, suboptimal management, and occasionally inadvertent fetal and/or maternal harm. The principles of cancer management in pregnancy for most cancer types do not differ significantly from the non‐pregnant population. The impact of investigations for diagnosis and staging, risks of surgery, systemic chemotherapy, and/or radiotherapy on fetal well‐being and preterm birth need to be considered for treatment and management planning, in addition to maternal wishes. Working in a multidisciplinary setting, ideally with medical and radiation oncologists, surgeons, radiologists, cancer specialist nurses, geneticists, psychologists, teratologists, and clinical pharmacologists, obstetricians, obstetric physicians, neonatologists, and experienced nursing and midwifery staff helps provide optimal care for the woman. This best practice advice aims to provide recommendations on the diagnosis and management of cancer in pregnancy, which can be adopted in all resource settings.