Infliximab, a chimeric monoclonal antibody that binds the tumor necrosis factor alpha (TNFalpha), is used in the treatment of rheumatoid arthritis (RA) and Crohn's disease (CD). Previous cases of ...significant secondary liver disease associated with infliximab treatment have been reported in patients with RA, CD, and psoriatic arthritis. Two additional patients with RA who developed a serious liver disease associated with infliximab treatment are reported here. A 39-year old RA patient was admitted with cholestatic liver disease after 8 months of treatment with infliximab. She had no history of hepatic diseases, exposure to hepatotoxic or illicit drugs, or alcohol abuse. A liver biopsy showed severe ductal proliferation with collapse and enucleation of the hepatocytes. Despite aggressive treatment with oral prednisolone, she developed hepatic failure. On the 45th day, a liver transplant was performed. The second patient, a 54-year old RA patient, was diagnosed with autoimmune hepatitis after 12 infliximab infusions. She fulfilled autoimmune hepatitis type 1 criteria. A liver biopsy disclosed an altered lobulillar structure with chronic inflammation and the formation of collagen bands. She was treated with prednisolone and azatioprine and a complete recovery was noted 1 month later. These cases should alert rheumatologists to the possibility of new adverse reactions (liver injury) associated with the use of TNFalpha blockers in an autoimmune setting.
Conventional phase shifting techniques have emerged as a powerful tool for evaluating the stress field in digital photoelasticity. However, the quantity of image acquisitions they require makes the ...process complex and tedious. In this paper, a computational hybrid method was developed for reducing the quantity of the image acquisitions in conventional phase shifting techniques. This study provides a novel approach to complete the set of acquisitions by performing some of them experimentally and simulating the remaining computationally. The accuracy of the results demonstrated that conventional phase shifting techniques could evaluate the stress field by performing fewer acquisitions and integrating computational procedures. These achievements represent a further step towards evaluating time-varying phenomena since the reduction of the acquisition time.
Forecasting medical costs is crucial for planning, budgeting, and efficient decision making in the health industry. This paper introduces a proposal to forecast costs through techniques such as a ...standard model of long short-term memory (LSTM); and patient grouping through k-means clustering in the Keralty group, one of Colombia’s leading healthcare companies. It is important to highlight its implications for the prediction of cost time series in the health sector from a retrospective analysis of the information of services invoiced to health companies. It starts with the selection of sociodemographic variables related to the patient, such as age, gender and marital status, and it is complemented with health variables such as patient comorbidities (cohorts) and induced variables, such as service provision frequency and time elapsed since the last consultation (hereafter referred to as “recency”). Our results suggest that greater accuracy can be achieved by first clustering and then using LSTM networks. This implies that a correct segmentation of the population according to the usage of services represented in costs must be performed beforehand. Through the analysis, a cost projection from 1 to 3 months can be conducted, allowing a comparison with historical data. The reliability of the model is validated by different metrics such as RMSE and Adjusted R2. Overall, this study is intended to be useful for healthcare managers in developing a strategy for medical cost forecasting. We conclude that the use of analytical tools allows the organization to make informed decisions and to develop strategies for optimizing resources with the identified population.
Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited ...access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.
Abstract This research was implemented in the Colombian Amazon forest area; to assess the effect of Tween-80® surfactant in the degradation of the Total Petroleum Hydrocarbons (TPH) in bioremediation ...treatments under aerobic conditions in the laboratory and pilot-scale. One control treatment, Natural Attenuation (AT) and four biostimulation treatments with leonardite with four different dosages of Tween-80® were proposed. The efficacy of organic stimulators and nonionic surfactant in soil microbiota was studied at laboratory and pilot scales, the latter in a passive aeration reactor. The test that presented a better performance was carried out with a Convective Flow Reactor (CFR) at pilot-scale. The results showed that bioremediation strategies improved the natural degradation process; the best outcomes were obtained in a treatment that includes Leonardite and Tween-80® (1.5 g/L) with 52% TPH degradation in 80 days (d).Tween-80® produced an effect in TPH solubility, and increased the production of CO2 in distinctive bioremediation treatments in both periods. The kinetics of CO2 production showed that the system required a periodic addition of a co-substrate as well as an increase of soil microbiota through the addition of compost (pilot scale). In this stage more than 76% of contaminant was degraded in 60d.
In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, ...hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission.
We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI).
A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5–47.7), critical care admission (47.2%; 95% CI, 18.5–65.8), and death (55.7%; 95% CI, 32.5–70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years.
Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age.
UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.
Resistance to ceftazidime-avibactam (CZA) due to
carbapenemase (KPC) variants is increasing worldwide. We characterized two CZA-resistant clinical
strains by antimicrobial susceptibility test, ...conjugation assays, and WGS. Isolates belonged to ST258 and ST45, and produced a KPC-31 and a novel variant KPC-197, respectively. The novel KPC variant presents a deletion of two amino acids on the Ω-loop (del_168-169_EL) and an insertion of two amino acids in position 274 (Ins_274_DS). Continued surveillance of KPC variants conferring CZA resistance in Colombia is warranted.
Latin America and the Caribbean is an endemic region for carbapenemases. Increasingly high rates of
carbapenemase (KPC) have established ceftazidime-avibactam (CZA) as an essential antimicrobial for the treatment of infections due to MDR Gram-negative pathogens. Although other countries in the region have reported the emergence of CZA-resistant KPC variants, this is the first description of such enzymes in Colombia. This finding warrants active surveillance, as dissemination of these variants could have devastating public health consequences.
Knowledge about the distribution and diversity of wetlands has become an essential tool for environmental management and policy-making. Yet, while recent estimates indicate that 27% of the area of ...Colombia is covered by wetlands and despite a number of regional studies, information about the diversity of wetlands nationally is scarce. In response, we present a national wetland classification system that is based on an ecological approach, from the perspective of wetland scientists, and which builds upon the assumptions underlying the flood pulse concept and hydrogeomorphic approach. Thus, the approach and structure of the Brazilian wetland classification system are used, with geomorphological adjustments made according to Colombia’s topography. The classification is hierarchical, multi-scale, functional, and organized according to four levels (system, macroregion, subsystem, and class), with the wetland diversity of Colombia represented nationally by 89 macrohabitats across marine-coastal, inland, and anthropogenic systems. The primary purpose of this classification is to provide integrated and organized information on the distribution and diversity of Colombian wetlands that will serve as a baseline for transparent environmental policy-making.
This work aims to contribute to the characterization and understanding ofinfragravity waves on two beaches with erosion problems. For this reason, we have used an array of ADCP and a pressure sensor ...to measure wave parameters and pressure inside and outside of the surf zone during the dry and rainy period in the beaches of Galerazamba and Manzanillo del Mar （both dissipative and eroded beaches） located in the Colombian Caribbean coast. Based on these measurements, we have carried out a spectral analysis in order to identify the frequency components that characterize the wave and its energy; thus, we identified the characteristic frequencies of iufragravity waves to finally filter the infragravity signal on each beach in different seasonal periods. Among the results of the Welch spectrum applied to surface elevation time series, we found that, the frequencies＇ energy of the sea-swell band decreases due to bottom friction and wave breaking as the wave approaches the shore, while the frequencies＇ energy of the infragravity band increases significantly. In addition, for the wavelet analysis, we could observe how the energy of the infragravity band, especially the lowest frequencies gain energy as the waves approaches the coast. Furthermore, based on the infragravity wave obtained from the extreme wave event registered during the field campaign we can conclude that the contribution of this signal is important in the erosion problems presented in the beaches of Galerazamba and Manzanillo del Mar. Finally, these results show the need to realize other studies that allow us to understand deeply, the role of infragravity waves on the morphological changes that occurs in these beaches.
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