Effectiveness and safety of once-weekly semaglutide: findings from the SEMACOL-REAL retrospective multicentric observational study in Colombia.

Introduction: Diabetes stands as one of the leading causes of death worldwide. Glucagon-like peptide-1 receptor agonists rank among the most effective medications for lowering blood glucose and body weight, as well as reducing cardiovascular risk in individuals with diabetes. Observational studies complement experimental evidence in new settings, different populations, and real-world healthcare practices. Methods: A multicentric observational study of adults with type 2 diabetes treated with once-weekly subcutaneous semaglutide in four health centers in Colombia was conducted. The protocol for the present study was not pre-registered. Results: Data from 186 patients were included. Most patients were women (57%) with a mean age of 62.8 ± 12.1 years. One year of once-weekly semaglutide usage was associated with a mean reduction in HbA1C of -1.47% (95% CI -1.76, -1.17), weight loss of -4.23 kg (95% CI -5.34, -3.12), and albumin/creatinine ratio of -18.6 mg/g (95% CI -60.2, -5.9). Approximately half the treated patients achieved a level of HbA1c ≤7% by the end of follow-up. Adverse events were rare and consistent with clinical trial safety profiles. Conclusion: In Colombia, administering semaglutide subcutaneously once a week over a 1-year period led to an average weight loss of 4.2 kg and a decrease of 1.4% in HbA1c.

Ratiometric sensing of Pnt and Yan transcription factor levels confers ultrasensitivity to photoreceptor fate transitions in Drosophila.

Cell state transitions are often triggered by large changes in the concentrations of transcription factors and therefore large differences in their stoichiometric ratios. Whether cells can elicit transitions using modest changes in the ratios of co-expressed factors is unclear. Here, we investigate how cells in the Drosophila eye resolve state transitions by quantifying the expression dynamics of the ETS transcription factors Pnt and Yan. Eye progenitor cells maintain a relatively constant ratio of Pnt/Yan protein, despite expressing both proteins with pulsatile dynamics. A rapid and sustained twofold increase in the Pnt/Yan ratio accompanies transitions to photoreceptor fates. Genetic perturbations that modestly disrupt the Pnt/Yan ratio produce fate transition defects consistent with the hypothesis that transitions are normally driven by a twofold shift in the ratio. A biophysical model based on cooperative Yan-DNA binding coupled with non-cooperative Pnt-DNA binding illustrates how twofold ratio changes could generate ultrasensitive changes in target gene transcription to drive fate transitions. Thus, coupling cell state transitions to the Pnt/Yan ratio sensitizes the system to modest fold-changes, conferring robustness and ultrasensitivity to the developmental program.

COVID-19 Disparities and Vaccine Hesitancy in Black Americans: What Ethical Lessons Can Be Learned?

OBJECTIVE: This state of the art review focuses on bioethical questions and considerations from research findings and methodological issues, including design and recruitment of participants, in studies related to COVID-19 vaccine hesitation in Black individuals. Ethical concerns identified were applied to otolaryngology with recommendations for improving health inequities within subspecialties. DATA SOURCES: An internet search through PubMed, CINAHL, and socINDEX was conducted to identify articles on COVID-19 vaccine hesitation among the Black population between 2020 and 2021. REVIEW METHODS: A systematic review approach was taken to search and analyze the research on this topic, which was coupled with expert analysis in identifying and classifying vital ethical considerations. CONCLUSIONS: The most common COVID-19 vaccine hesitation factors were related to the development of the vaccine, mistrust toward government agencies, and misconceptions about safety and side effects. These findings raised bioethical concerns around mistrust of information, low health literacy, insufficient numbers of Black participants in medical research, and the unique positions of health professionals as trusted sources. These bioethical considerations can be applied in otolaryngology and other health-related areas to aid the public in making informed medical decisions regarding treatments, which may reduce health inequalities among Black Americans and other racial and ethnic minority groups. IMPLICATIONS FOR PRACTICE: Addressing ethical questions by decreasing mistrust, tailoring information for specific populations, increasing minority representation in research, and using health professionals as primary sources for communicating health information and recommendations may improve relationships with Black communities and increase acceptance of new knowledge and therapies such as COVID-19 vaccination.

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

Incidence of post-anesthetic respiratory complications in pediatrics. Observational, single-center study in Medellin, Colombia / Incidencia de complicaciones respiratorias postanestésicas en pacientes pediátricos. Estudio observacional en un hospital en Medellín, Colombia

Abstract Introduction: Post-anesthetic complications, particularly respiratory complications, continue to be a source of concern due to their high frequency, particularly in pediatrics. Objective: To describe the incidence of respiratory complications in the post-anesthesia care unit of an intermediate complexity center during a six-month period, and to explore the variables associated with major respiratory complications. Materials and Methods: Retrospective cohort study based on clinical record reviews. The records of the post-anesthesia care unit of an intermediate complexity pediatric institution located in Medellin, Colombia, were reviewed. This center uses a nursing-based care model that includes patient extubation in the post-anesthesia care unit. Results: The records of 1181 patients were analyzed. The cumulative incidences of major complications were bronchospasm 1.44%, laryngospasm 0.68% and respiratory depression 0.59%. There were no cases of cardiac arrest or acute pulmonary edema. A history of respiratory infection less than 15 days before the procedure, rhinitis and female sex were associated with major respiratory complications. Conclusions: A low frequency of respiratory complications was found during care provided by nursing staff trained in anesthesia recovery and pediatric airway in the post-anesthesia care unit.

Resumen Introducción: Las complicaciones postanestésicas, especialmente las respiratorias, siguen siendo causa de preocupación por su alta frecuencia, en particular, en la población pediátrica. Objetivo: Describir la incidencia de complicaciones respiratorias en la unidad de cuidados postanestésicos de una institución de mediana complejidad, en un período de seis meses y explorar las variables relacionadas con las complicaciones respiratorias mayores. Materiales y métodos: Estudio de cohorte retrospectivo, basado en la valoración de historias clínicas. Se revisaron los registros de la unidad de cuidados postanestésicos de una institución pediátrica de mediana complejidad ubicada en Medellín. Esta institución utiliza un modelo de atención -basado en enfermería- que incluye la extubación del paciente en la unidad de cuidados postanestésicos. Resultados: Se analizaron los registros de 1181 pacientes. La incidencia acumulada de complicaciones mayores fue: broncoespasmo 1,44 %, laringoespasmo 0,68 % y depresión respiratoria 0,59 %. No se presentaron casos de paro cardiaco ni de edema agudo de pulmón. El antecedente de infección respiratoria menor a 15 días, rinitis y sexo femenino se asociaron con complicaciones respiratorias mayores. Conclusiones: Durante la atención en la unidad de cuidados postanestésicos por parte del personal de enfermería entrenado en la recuperación de la anestesia y de la vía aérea de los pacientes pediátricos, se encontró una baja frecuencia de complicaciones respiratorias.

Descripción del posicionamiento de una copa monobloque no cementada en el posoperatorio inmediato / Description of uncemented monobloc cup positioning in the immediate postoperative period

Introducción El posicionamiento adecuado de la copa acetabular en el reemplazo total de cadera (RTC) puede mejorar la función, reducir el desgaste, el pinzamiento y la luxación. La posición de la copa se describe como la relación espacial entre el centro de rotación de la cadera y la pelvis. El objetivo de este estudio es describir el posicionamiento de una copa monobloque no cementada en el posoperatorio inmediato de los pacientes a quienes se les realizo un RTC primario. Materiales y Métodos Estudio observacional descriptivo, los pacientes fueron operados por 4 cirujanos especialistas en cirugía de reemplazo articular de cadera en 8 clínicas, los procedimientos se realizaron entre octubre de 2015 a agosto de 2018, las medidas radiológicas fueron la inclinación, anteversión, lateralización, porcentaje de descubrimiento y espacio detrás de la copa acetabular. Resultados Los mayores porcentajes son para las copas acetabulares con inclinación de 36 a 48 grados, anteversión de 5 a 15 grados, lateralización de -2 a +2mm, porcentaje de descubrimiento del 0% y espacio detrás de la copa de 0 a 3mm. Discusión Diferentes autores han identificado zonas seguras de implantación las cuales concuerdan con los resultados de nuestro estudio. El posicionamiento adecuado de la copa acetabular monobloque no cementada se pudo lograr con una correcta indicación del implante, un abordaje quirúrgico que permitió una ubicación tridimensional idónea y un acetábulo sin alteraciones anatómicas a nivel periférico.

Background Appropriate positioning of the acetabular cup in total hip arthroplasty (THA) can improve hip function, reduce wear, impingement and dislocation. The position of the cup is described as the spatial relationship between the centre of rotation of the hip and the pelvis. The aim of this study is to describe the positioning of the uncemented monoblock cup in the immediate postoperative period in patients who underwent a primary THA. Methods Descriptive observational study. The patients were operated by 4 joints arthroplasty surgeons in 8 different hospitals, from October 2015 to August 2018. The radiological measurements were taken from the AP Pelvis Xrays of the immediate postoperative. The inclination, anteversion, lateralization, percentage of cup uncovered and the space behind the acetabular cup. Results 82.05% of the cups were in the range of inclination from 36 to 48 degrees; 85.71% had an anteversion between 5 to 15 degrees, 76.56% presented a lateralization of -2 to +2mm, 94.51% of the patients didnt have a uncover cup, and 92.67% of the cups had a space behind the cup from 0 to 3mm. Discussion In our study the highest percentage of cups were implanted with parameters agree to the safety areas reported by various authors. Adequate positioning of the uncemented monoblock acetabular cup can be achieved with a proper indication, a surgical approach that allows an ideal three-dimensional location and an acetabulum with a good peripheral rim that provides the required press-fit.

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

Microangiopatía trombótica en Lupus Eritematoso Sistémico: a propósito de tres casos / Thrombotic microangiopathy in Systemic Lupus Erythematosus: three cases report

RESUMEN Se describen tres casos de pacientes con lupus y microangiopatía. Los casos descritos representan las principales condiciones asociadas a lupus que pueden generar anemia microangiopática, como son: anemia hemolítica microangiopática, síndrome antifosfolípido con microangiopatía localizada y síndrome antifosfolípido catastrófico. La alta mortalidad que conlleva la anemia microangiopática, sin el tratamiento oportuno, hace necesario motivar a los clínicos a conocer ampliamente la enfermedad para poder reconocerla prontamente.

SUMMARY In this article, we describe three cases of lupic patients that developed microangiopathy. Those cases represent the principal etilogies of microangiopathy in Lupus such as, microangiopathic haemolytic anaemia and antiphospholipid syndrome with and without castastrofic manifestations. The clinicians must know deeply about this condition to recognize it in a timely manner.

Kaposi sarcoma incidence in females is nearly four-fold higher in the Lower Rio Grande Valley compared to the Texas average.

The Lower Rio Grande Valley (LRGV) is located on U.S.-Mexican border with a population that is 90% Hispanic [1]. Comprised of Hidalgo, Cameron, Starr and Willacy counties, this region has the highest poverty rate and one of the highest incidences of Type 2 diabetes in the United States [2-4]. Previous studies demonstrated a high prevalence of Human Herpes Virus 8 (HHV8) in the LRGV [5-7]. HHV8 infection has been causally linked to Kaposi Sarcoma (KS) [8]. Here, we retrospectively examine the incidence of KS in the LRGV in a set of HIV-negative Hispanic patients. Strikingly, the incidence of KS was higher in LRGV women compared to the Texas state average (nearly four-fold higher in McAllen-Edinburg-Pharr Metro Statistical Area). This unique profile aligns with the increased HHV8 prevalence in the LRGV, suggesting that HHV8 contributes to a high incidence of HIV-negative KS on the U.S.-Mexican border in Texas.

Autoimmune diseases and their relation with immunological, neurological and endocrinological axes.

The immune response is complex, multifactorial, individualized and often unpredictable. There are multiple interconnected systems that allow a balance between physiological autoreactive processes and pathological autoimmunity with consequent organ-specific or systemic autoimmune disease. Based on the concept of the autoimmunity mosaic, up to 50% of autoimmune disorders do not have a clear etiological factor. In order to achieve a clear understanding of the different systems that influence the development of autoimmune diseases, the clinical auto-immunologist needs a dynamic and comprehensive vision of all interconnected pathways that maintain a precise balance in the organism. This has been and will remain a challenge. Understanding the different pathophysiological processes of these diseases will be the basis for predicting different clinical spectra and has the potential to offer innovative therapeutic approaches. This paper offers a practical overview of the bidirectional communication between the immune and endocrine system and the influence this has on the development of autoimmune diseases.

Anemia hemolítica microangiopática en lupus eritematoso sistémico: revisión narrativa de la literatura / Microangiopathic hemolytic anemia in systemic lupus erythematosus: narrative review

El espectro clínico de los trastornos microangiopáticos es muy amplio y se necesitade una gran habilidad clínica para determinar el origen, especialmente en el pacientecon lupus eritematoso sistémico, en quien no solo se debe considerar púrpura trombocitopénicatrombótica asociada, sino también: síndrome antifosfolípido; generalmente del tipocatastrófico; microangiopatía localizada o hipertensión maligna.Objetivo: Describir, de acuerdo con lo reportado en la literatura; la frecuencia, las causas y lascaracterísticas clínicas de la microangiopatía trombótica en lupus eritematoso sistémico.Métodos: Revisión estructurada no sistemática de la literatura.Resultados: Se incluyeron 51 artículos (42 provenientes de la búsqueda en bases de datos y9 referenciados en estos) para la revisión de los aspectos de interés mencionados...

Rituximab for remission induction and maintenance in refractory systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with high morbidity if untreated. Sometimes, despite aggressive treatments, the disease remains active with cumulative organic damage. We conducted a retrospective and descriptive observational study of patients with SLE refractory to conventional treatment who were treated with rituximab (RTX) as remission induction therapy and maintenance. There was a significant reduction in the conventional immunosuppressive drug dose and the number of relapses of disease. RTX appeared to be effective and safe for the induction and maintenance of remission in patient with SLE refractory to conventional treatment.

Primary angiitis of the central nervous system: a report of three cases from a single colombian center.

The primary angiitis of the central nervous system (PACNS) is an entity with a very low incidence and prevalence. It is not clear why the inflammatory process of this entity is limited to the cerebral vasculature without systemic manifestations. Its clinical manifestations are very heterogeneous and make clinical diagnosis difficult. In most cases, a brain biopsy is required. Only the clinical suspicion and the ability to recognize the possible clinical and imagenological patterns of presentation make an accurate diagnosis possible. The vast majority of the treatment recommendations are given by series of case reports. The following paper described the clinical, imagenological, and histopathological characteristics of three Colombian patients with PACNS. The strategic therapeutic used in shown.

Consecuencias del embarazo adolescente en el estado civil de la madre joven: estudio piloto en Bogotá, Colombia / Consequences of Teenage Pregnancy on the Mother’s Marital Status: A Pilot Study in Bogotá, Colombia

El embarazo en las mujeres adolescentes constituye un fenómeno de interés actual. Es un hecho sociodemográfico acompañado de consecuencias importantes como el cambio de estado civil. Se plantea un estudio de tipo transversal retrospectivo descriptivo en el cual se entrevistaron 15 mujeres que fueron madres adolescentes en hospitales de Bogotá y externas. Se obtuvo información del estado civil anterior, durante, después del nacimiento del primer hijo y el actual, se observó que predomina el estado civil soltero antes de dar a luz al primer hijo. Durante el embarazo, alrededor del 40 por ciento de las entrevistadas optaron por la unión libre o el matrimonio legal. Después del nacimiento del primer hijo un 53 por ciento de las mujeres estaban con su pareja; actualmente, de las 15 entrevistadas el 60 por ciento están unidas, 33 por ciento permanecen solteras, y una minoría se encuentra separada (6,6 por ciento ). Adicionalmente, se observó que las uniones en adolescentes son en su mayoría a largo plazo, con estabilidad conyugal. El mayor porcentaje de estas uniones formales se da en estratos altos, donde el matrimonio religioso es la primera opción de unión seguida de la unión libre, mientras que el madresolterismo predomina en estratos bajos. Igualmente, se recomienda que un embarazo adolescente no debe ser sinónimo de unión; las partes deben estar totalmente seguras, y tener la suficiente madurez mental y emocional para decidir con quién deben y, por supuesto, quieran unirse, pensando en que también está en juego el futuro de su hijo.

Evolución histórica de la artroplastia total de cadera en el tratamiento de la luxación congénita inveterada

Desde los inicios de la artroplastia total de cadera, los avances vertiginosos en cuanto a la técnica quirúrgica, manejo de complicaciones y cirigía de revisión, han hecho que la indicación se extienda ahora a un grupo de pacientes cuya patología y edad limitaban el uso de un reemplazo articular. Sin embargo, los adultos con luxación congénita de cadera inveterada pueden beneficierse con esta cirugía. En esta parte, se hace una revisión biblográfica sobre las soluciones a este complejo problema en el tiempo, desde el momento en que el Sir John Charley publica sus primeros estudios, hasta el manejo actual en los grandes centros especializados en este tema.