La generación e implementación de estrategias para disminuir la transmisión de SARS-CoV-2 son un reto imperante para el país. Las estrategias deben ser dinámicas y específicas para cada región ...buscando equilibrar el impacto en la salud y en la economía. Esta tarea debe abordarse desde un enfoque interdisciplinario con el fin de estudiar la problemática de manera holística. En el presente artículo se presentan algunos hallazgos y revisiones realizadas en el marco del proyecto SISCOVID, en el cual se utilizan modelos sistémicos de simulación computacional para apoyar la toma de decisiones para el control y mitigación de la pandemia en Colombia. El proyecto está conformado por investigadores de la Universidad de Los Andes, el Centro Nacional de Consultoría (CNC) y la Universidad de Ibagué, en alianza con universidades internacionales y empresas. El proyecto ha logrado apoyar a los tomadores de decisiones en formular estrategias para disminuir la transmisión de SARS-CoV-2 en contextos urbanos en las ciudades de Barranquilla, Bogotá, Cali, Cartagena y Medellín. Palabras clave: SARS-CoV-2, Epidemiología, Prevención, Modelos sistémicos, Sistemas Complejos The development and implementation of strategies to reduce SARS-CoV2 transmission is a prevailing challenge for Colombia. These strategies ought to be dynamic and specific to each region, seeking to balance health and economic impacts. This task calls for an interdisciplinary approach to ensure a holistic view of the problem. This article presents findings and results obtained from the SISCOVID project, which used simulated systemic models to support decision making and efforts to mitigate the pandemic in Colombia. The project included researchers from Universidad de Los Andes, the Centro Nacional de Consultoría (CNC) and Universidad de Ibagué, in alliance with several international universities and companies. SISCOVID helped decision makers design strategies to reduce SARS-CoV-2 transmission in urban contexts for the cities of Barranquilla, Bogotá, Cali, Cartagena, and Medellín. Key words: SARS-CoV-2, Epidemiology, Prevention, Systemic Models, Complex Systems
Over the last few decades, there has been an increasing recognition for seagrasses' contribution to the functioning of nearshore ecosystems and climate change mitigation. Nevertheless, seagrass ...ecosystems have been deteriorating globally at an accelerating rate during recent decades. In 2017, research into the condition of eelgrass (Zostera marina) along the eastern coast of James Bay, Canada, was initiated in response to reports of eelgrass decline by the Cree First Nations of Eeyou Istchee. As part of this research, we compiled and analyzed two decades of eelgrass cover data and three decades of eelgrass monitoring data (biomass and density) to detect changes and assess possible environmental drivers. We detected a major decline in eelgrass condition between 1995 and 1999, which encompassed the entire east coast of James Bay. Surveys conducted in 2019 and 2020 indicated limited changes post‐decline, for example, low eelgrass cover (<25%), low aboveground biomass, smaller shoots than before 1995, and marginally low densities persisted at most sites. Overall, the synthesized datasets show a 40% loss of eelgrass meadows with >50% cover in eastern James Bay since 1995, representing the largest scale eelgrass decline documented in eastern Canada since the massive die‐off event that occurred in the 1930s along the North Atlantic coast. Using biomass data collected since 1982, but geographically limited to the sector of the coast near the regulated La Grande River, generalized additive modeling revealed eelgrass meadows are affected by local sea surface temperature, early ice breakup, and higher summer freshwater discharge. Our results caution against assuming subarctic seagrass ecosystems have avoided recent global declines or will benefit from ongoing climate warming.
In 2017, research into the condition of eelgrass (Zostera marina) along the eastern coast of James Bay, Canada, was initiated to respond to reports of eelgrass decline by the Cree First Nations of Eeyou Istchee. Overall, the 40% loss of eelgrass meadows with >50% cover in eastern James Bay since 1995 demonstrated from the synthesized data sets represents the largest scale eelgrass decline documented in eastern Canada since the massive die‐off event that occurred in the 1930s along the North Atlantic coast. The results caution against assuming subarctic seagrass ecosystems will benefit from ongoing climate warming.
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Background: It is well known that improvements in caregiver quality of life (QOL) could significantly impact the clinical outcome of cancer patients, which is why it is essential to study this ...population. Caregivers have extensive responsibilities, making them vulnerable to emotional, physical, social, and financial distress. Evaluation of cancer patient caregiver QOL in Latin America and validation of QOL metrics, such as the Caregiver Quality of Life Index-Cancer (CQOLC), has not yet been done in large populations. We sought to evaluate these characteristics in 5 regions in Colombia. Methods: Cancer patients (n = 165) receiving active treatment and their respective adult caregivers were evaluated. Both caregivers and patients completed a sociodemographic survey, along with the CQOLC, which was translated to Colombian Spanish and validated in a pilot cohort. CQOLC is composed of five subcategories with a total max score of 140. Higher scores are associated with better QOL. Internal consistency was determined by Cronbach’s alpha. Results: The patient’s median age was 63 years (58.8% females). The primary cancer diagnoses were breast, cervical, and lung cancer, with a median ECOG-PS of 1. 6.3% of patients did not have a caregiver, and their responses were also evaluated. The median caregiver age was 53 years (range 19-75 years, 60% females). 4.7% of caregivers were unemployed, and 59% reported financial or psychological distress. 93.8% of caregivers were family members, most frequently spouses or children. The median CQOLC score was 90 ± 15.2. The median score for each of the five subcategories “burden,” “disruptiveness,” “positive adaption,” “financial concern,” and “other” were as follows: 2, 3, 3, 3, and 3 (max score of 4). Conclusions: Most patients and caregivers were interested in participating in the study and reported no issues comprehending or answering the questions. This suggests no potential problems adapting the Spanish-translated CQOLC to future studies. Despite most caregivers reporting financial distress and low family income status, their overall CQOLC scores were relatively high compared to developing countries like the USA, potentially due to cross-cultural differences. The higher median score in the “disruptiveness” category suggests that Colombian caregivers feel strongly committed to caregiving and do not feel this activity interferes significantly with their daily life, possibly related to a sense of family responsibility and moral duty. However, the lower median score in the “burden” category indicates that caregivers feel a heavy emotional toll as a result of their caregiving role. Our results can help identify caregiver QOL areas of improvement, where government policies can be implemented to benefit both the caregiver and the patient.Keywords: caregiver burden, quality of life, Colombia, validation, CQOLC, cancer patients
Scleroglucan (SG) is resistant to harsh reservoir conditions such as high temperature, high shear stresses, and the presence of chemical substances. However, it is susceptible to biological ...degradation because bacteria use SG as a source of energy and carbon. All degradation effects lead to viscosity loss of the SG solutions, affecting their performance as an enhanced oil recovery (EOR) polymer. Recent studies have shown that nanoparticles (NPs) can mitigate these degradative effects. For this reason, the EOR performance of two new nanohybrids (NH-A and NH-B) based on carboxymethyl-scleroglucan and amino-functionalized silica nanoparticles was studied. The susceptibility of these products to chemical, mechanical, and thermal degradation was evaluated following standard procedures (API RP 63), and the microbial degradation was assessed under reservoir-relevant conditions (1311 ppm and 100 °C) using a bottle test system. The results showed that the chemical reactions for the nanohybrids obtained modified the SG triple helix configuration, impacting its viscosifying power. However, the nanohybrid solutions retained their viscosity during thermal, mechanical, and chemical degradation experiments due to the formation of a tridimensional network between the nanoparticles (NPs) and the SG. Also, NH-A and NH-B solutions exhibited bacterial control because of steric hindrances caused by nanoparticle modifications to SG. This prevents extracellular glucanases from recognizing the site of catalysis, limiting free glucose availability and generating cell death due to substrate depletion. This study provides insights into the performance of these nanohybrids and promotes their application in reservoirs with harsh conditions.
In this study, two new nanohybrids (NH-A and NH-B) were synthesized through carbodiimide-assisted coupling. The reaction was performed between carboxymethyl-scleroglucans (CMS-A and CMS-B) with ...different degrees of substitution and commercial amino-functionalized silica nanoparticles using 4-(dimethylamino)-pyridine (DMAP) and N,N'-dicyclohexylcarbodiimide (DCC) as catalysts. The morphology and properties of the nanohybrids were investigated by using transmission (TEM) and scanning electron microscopy (SEM), electron-dispersive scanning (EDS), attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FT-IR), X-ray photoelectron spectroscopy (XPS), powder X-ray diffraction (XRD), inductively coupled plasma atomic emission spectroscopy (ICP-OES), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and dynamic light scattering (DLS). The nanohybrids exhibited differences in structure due to the incorporation of polyhedral oligomeric silsesquioxane (POSS) materials. The results reveal that hybrid nanomaterials exhibit similar thermal properties but differ in morphology, chemical structure, and crystallinity properties. Finally, a viscosity study was performed on the newly obtained nanohybrid materials; viscosities of nanohybrids increased significantly in comparison to the carboxymethyl-scleroglucans, with a viscosity difference of 7.2% for NH-A and up to 32.6% for NH-B.
A transdiagnostic treatment, the Unified Protocol, is as effective as single diagnostic protocols in comorbid emotional disorders in clinical populations. However, its effects on posttraumatic stress ...disorder and other emotional disorders in individuals living in war and armed conflict contexts have not been studied.
To evaluate the efficacy of a cultural and contextual adaptation of the Unified Protocol (CXA-UP) on posttraumatic stress disorder, anxiety, and depression compared to waitlist control in individuals exposed to armed conflict in Colombia.
From April 2017 to March 2020, 200 participants 18 years and older were randomly assigned to the CXA-UP or to a waitlist condition. CXA-UP consisted of 12 to 14 twice-a-week or weekly individual 90-minute face-to-face sessions. Outcomes were assessed at baseline, posttreatment, and 3 months following treatment. Analyses were performed and compared for all randomly allocated participants (intent-to-treat ITT) and for participants who completed all sessions and posttreatment measures (per protocol PP). The study took place at an outpatient university center and included individuals who were registered in the Colombian Victims Unit meeting DSM-5 diagnostic criteria for posttraumatic stress disorder, anxiety, or depression or were severely impaired by anxiety or depression. Individuals who were receiving psychological therapy, were dependent on alcohol or drugs, were actively suicidal or had attempted suicide in the previous 2 months, had psychosis or bipolar disorder, or were cognitively impaired were excluded.
CXA-UP or waitlist.
Primary outcomes were changes in anxiety, depression, and somatic scores on the Patient Health Questionnaire and Posttraumatic Stress Disorder Checklist for DSM-5.
Among the 200 participants (160 women 80.0%; 40 men 20.0%; mean SD age, 43.1 11.9 years), 120 were randomized to treatment and 80 to waitlist. Results for primary outcomes in the ITT analysis showed a significant pretreatment-to-posttreatment reduction when comparing treatment and waitlist on the posttraumatic stress disorder checklist for DSM-5 scores (slope SE, -31.12 3.00; P < .001; Cohen d, 0.90; 90% CI, 0.63-1.19), 9-item Patient Health Questionnaire (PHQ-9) (slope SE,-11.94 1.30; P < .001; Cohen d, 0.77; 90% CI, 0.52-1.06), PHQ-anxiety (slope SE, -6.52 0.67; P < .001; Cohen d, 0.82; 90% CI, 0.49-1.15), and PHQ-somatic (slope SE, -8.31 0.92; P < .001; Cohen d, 0.75; 90% CI, 0.47-1.04).
In this study, significant reductions and large effect sizes in all measures of different emotional disorders showed efficacy of a single transdiagnostic intervention in individuals exposed to armed conflicts.
ClinicalTrials.gov Identifier: NCT03127982.
Introduction Plasmablastic lymphoma (LP) is a highly aggressive hematologic malignancy that has been recently described. Usually appears in immunocompromised patients, generally in the context of ...human immunodeficiency virus (HIV) coinfection, post-transplant status, or immunosenescence. To date, there is no standard care treatment in the first line, however, high-intensity regimens, generally EPOCH is the most described in the literature. We present the largest cohort of patients with Plasmablastic lymphoma published to date in the region, which includes patients diagnosed and treated in various medical centers in Latin America. Methods Data was collected from 11 medical centers throughout Latin America, including patients from Colombia, Argentina, Cuba, Ecuador, Mexico, and Paraguay. Data were recorded from a predetermined collection instrument, and unified in a single database. Results A total of 87 patients were diagnosed between 2008 and 2023. Twelve (n=12) were women (13.8%) and 75 men (86.2%), with an age between 18 and 76 years (median age 41 years). Most of the patients were under 50 years of age at debut (70.1%), and the majority were HIV positive (72.4%). Of the entire cohort, 82.8% presented advanced disease, only 16.1% presented early disease. Extra-nodal involvement was observed in 76 patients (87.4%), being the most frequent sites of involvement the gastrointestinal tract (33 patients - 37.9%), followed by the bone marrow and oral cavity. Among the patients who received at least one dose of therapy, the IPI was available in 72.6%, being IPI 1 6.8%, IPI 2 19.2%, IPI 3 28.8%, IPI 4: 17.8%, missing data 27.4%. Regarding the first-line treatment, most patients received EPOCH n=61 (70%). After first-line treatment, 45.9% achieved a complete response, 9 patients (10.3%) achieved a partial response, 4 patients (4.6%) stable disease, and 29.9% of patients (n= 26) had refractory disease. It is important to mention that 14 patients died without starting treatment (16%), the majority due to complications related to lymphoma. Among the patients who started therapy, with a median follow-up of 15 months, progression-free survival was 34 months (1-108), and overall survival was not reached. Median overall survival was not reached in patients who achieved complete response and was only 11 months (7.9-14.1) in patients with partial response or less (p<0.0001). In the multivariate analysis, the only independent predictor of survival was reaching a complete response with a HR of 0.007 (0.1-0.345). Conclusion To the best of our knowledge, our series is the largest in the region where we found that the most important determinant of survival is the fact of achieving a complete response after first line of treatment.
Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common B-cell non-Hodgkin lymphoma. DLBCL commonly affects patients with comorbidities and the elderly. To date, chemoimmunotherapy ...remains the standard of care for these patients. Data on patients aged ≥65 years managed in Latin America (LATAM) are scarce. Herein, we examine the clinical, treatment and outcome patterns in older patients with DLBCL, with a focus on the effect of treatment in survival outcomes. Methods: We retrospectively analyzed patients aged ≥65 years with newly diagnosed DLBCL managed at different academic institutions in 8 LATAM countries. Demographic characteristics are reported using descriptive statistics. All patients received treatment; those who completed 6 cycles and underwent either CT or PETCT at the end of therapy were considered evaluable for response. Survival curves were estimated using the Kaplan-Meier method. Logistic and Cox proportional-hazard regression models were used to evaluate parameters associated with response and survival. Results: A total of 651 patients were identified and had sufficient data for analysis; median age was 74.1 years (65-96), 335 (51.5%) were female, 400 (61.4%) had ECOG ≤1, and 426 (65.4%) had advanced disease (stage III-IV). No difference in clinical features and laboratory parameters were identified among patients aged <75 vs ≥75 years (Table). The most common first-line chemoimmunotherapy regimens used were standard dose R-CHOP (n=421, 64.7%), R-CVP (n= 74, 11.4 %), R-mini-CHOP (n= 61, 9.4%), and CHOP (n= 29, 4.5%). Eight patients (1.2%) received R-EPOCH, and 43 (6.6%) best supportive care including some receiving dexamethasone and/or rituximab monotherapy. In all patients, the overall response rate was 64.4% (complete 55.3%, partial 9.1%). Responses could not be evaluated in 219 cases (33.6%) either because of early death secondary to toxicity or lymphoma progression during therapy (n=212, 32.5%), or as a complication of patients' comorbidities (n=16, 2.5%). With a median follow up of 60 months (range 1-100), the median overall survival (OS) time was 56 months (95% CI: 38.7-73.2) with a 5-year OS rate of 50%. The causes of death were lymphoma (n=180, 27.6%), infection (n=72,11.1%), non-infectious toxicity (n=6, 0.9%), ischemic cardiopathy (n=7, 1.1%), heart failure (n=6, 0.9%), cerebrovascular event (n=6, 0.9%), and unknown in 41 cases (6.3%). Given our prior work on the impact of serum albumin in DLBCL patients, we analyzed serum albumin levels in elderly patients with DLBCL. Hypoalbuminemia (albumin <3.5mg/dL) was associated with a higher frequency of advanced disease (n=211, 37.8% vs n=152, 27.2%; p=0.005), high-risk IPI score (n=77, 14.7% vs n=62, 11%; p=0.000), and death (n=147, 22.5% vs n=128, 19.6%; p=0.000). In the univariate analysis, the factors influencing mortality were: ECOG ≤1 (p=0.000, HR 1.2595% IC: 1.0-1.4), hypoalbuminemia (serum albumin <3.5mg/dL; p=0.031, HR 1.24 95% IC: 1.02 -1.51), the use of anthracyclines (p=0.002, HR 0.63, 95 % IC: 0.47 -0.84), and no achieving a complete response (CR) to first-line treatment (p=0.000, HR 5.01 95 %IC: 4.25 -6.0. In the multivariate analysis, all factors remained statistically significant: ECOG ≤1 (p=0.000, aHR 1.3295 IC: 1.1 -1.5), hypoalbuminemia (p=0.005, aHR 1.33 95 % IC: 1.08 -1.6), the use of anthracyclines (p=0.006, aHR 0.66 95 % IC: 0.49 -0.88), and no achieving CR to first-line treatment (p=0.000, aHR 4.91 95 %IC: 4.1 -5.7. Conclusions: To our knowledge, this is one of the largest real-world studies on elderly patients with DLBCL in LATAM. In this cohort, survival rates were comparable to those previously reported in the literature. This statement was also true when evaluating the response rates to first-line therapy. We found that ECOG performance status, serum albumin levels, the use of anthracycline and response to first-line therapy were all independently associated to survival. Although the main limitation of this study is its retrospective design, we report that current practices in LATAM remain appropriate for our context and known limitations, thus, this study provides some evidence to clinicians on the therapy patterns and outcomes of such therapies in elderly patients with DLBCL living in resource-limited settings.
Introduction. Diffuse large B-cell lymphoma ( DLBCL) is the most common type of malignant lymphoid neoplasm. The international Prognostic Index (IPI) and its variants are the main prognostic tools ...used in DLBCL with value in the rituximab era. Certain molecular biomarkers and genetic signatures in DLBCL have been identified, but the cost and unavailability in Latin America ( LATAM) are an issue. Therefore, using accesible tools in LATAM is a potencially unmet need. Vlatka (2021), reported a new score (HALP: hemoglobin, albumin, lymphocytes, and platelets) for overall survival (OS) in DLBCL. These parameters are easy to access in LATAM centers. Thus, we aim to validate this novel OS score in the GELL database, and expanding database from LATAM countries. Methods. This was a retrospective analyses of patients with de novo DLBCLtreated with curative intent between 2010 and 2018. The classic 5 international prognostic index variables age, ECOG, Extranodal (EN) involvement, Lactate dehydrogenase (LDH), and advanced stage and low serum albumin defined as ≤3.5mg/dL(divided in low, 3.4-2.5 mg/dL, and very low, ≤2.4 mg/dL), as previously described by our group ( Villela,2018&2019). We also calculated the NLR considering an adverse prognostic factor >4, as previously published by us ( Beltran&Villela,2020). The HALP score was calculated using the following formula: hemoglobin(g/L) x albumin (g/L) x absolute lymphocyte count (k/μL) divided by platelets (k/μL). The ROC method was used to calculate the HALP cut-off. Demographic characteristics are reported using descriptive statistics. Cox proportional-hazard regression model was used to evaluate parameters associated with OS, and survival curves were estimated with the Kaplan-Meier (KM) method. Outcomes. 1407 patients were included, who were treated with standard RCHOP (n=1112,79%), RminiCHOP (n=93,7%), REPOCH (n=111,8%), and CHOP (n=91,6%). The median follow-up was 36 months (IQR: 7 to 56). NLR >4 was observed in 18.5%. The median HALP score was 24 (IQR, 12 to 40), and the cut-off of ≤13 (AUC 0.58;95%CI 0.56 to 0.61; p<0.0001) was considered an adverse prognostic factor, which was observed in 451 patients (32.7%). Female sex, ECOG >1, EN >1. high LDH, advance stage, low and very low albumin, and NLR>4 were associated with HALP≤13, but age was not ( Table 1). Patients with HALP ≤13 had a lower 3-years OS rate than HALP>13 (48% vs. 66%, respectively; p<0.001). Table 2 shows the univariate & multivariate analysis of the variables with independent influence on OS, including HALP & NLR. In multivariate analysis, HALP and EN involvement were left out of the model ( Harrell´s C-Index, 0.73;95%CI 0.69 to 0.76). Conclusion: NLR>4, but not HALP ≤13, could prognosticate inferior OS in LATAM patients with DLBCL treated with curative intent. The adverse prognostic value of NLR>4 should be validated prospectively in other cohort of DLBCL patients.
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