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Unlabelled: Large language models (LLMs), like ChatGPT, are transforming the landscape of medical education. They offer a vast range of applications, such as tutoring (personalized learning), patient simulation, generation of examination questions, and streamlined access to information. The rapid advancement of medical knowledge and the need for personalized learning underscore the relevance and timeliness of exploring innovative strategies for integrating artificial intelligence (AI) into medical education. In this paper, we propose coupling evidence-based learning strategies, such as active recall and memory cues, with AI to optimize learning. These strategies include the generation of tests, mnemonics, and visual cues.

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OBJECTIVE: This study aimed to delineate the recovery patterns of regional oxygen saturation (SrO2) in pediatric cardiac surgery patients subjected to remote ischemic preconditioning (RIPC), utilizing near-infrared spectroscopy (NIRS) for quantification. It also sought to establish the correlation between these perfusion patterns and postoperative clinical outcomes. DESIGN: A prospective longitudinal observational study. SETTING: The study was conducted at Fundación Valle Del Lili, a high-complexity service provider institution in Fundación Valle Del Lili. PARTICIPANTS: Pediatric patients (younger than 18 years of age) scheduled for elective cardiac surgery requiring cardiopulmonary bypass between August 2022 and July 2023. INTERVENTIONS: RIPC was performed after anesthetic induction, involving cycles of ischemia and reperfusion on a lower limb. Monitoring included SrO2 using NIRS. MEASUREMENTS AND MAIN RESULTS: The study identified 4 distinct patterns of SrO2 during RIPC. Findings demonstrated a significant association between the negative SrO2 pattern and increased postoperative adverse events, including extended hospital stays and higher mortality, while a positive pattern was associated with better outcomes. CONCLUSIONS: Specific patterns of SrO2 response to RIPC may serve as important indicators for risk stratification in congenital heart surgery. This study illustrated the potential of NIRS in detecting hypoxic states and predicting postoperative outcomes, emphasizing the need for standardized clinical interpretation of RIPC patterns.

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Introduction Hip fracture is one of the main causes of morbidity and mortality among the elderly population. In Colombia there is a shortage of scientific literature on the perioperative management of this population of patients. Objective To describe the perioperative management of hip fracture patients at a tertiary university hospital in Cali, Colombia. Methods An observational study was conducted with relational scope of a historical cohort of patients with hip fracture who underwent surgical management between January 2018 and June 2022. A non-probability sampling method was used and contingency tables were designed aimed at describing the relationship between the patients' characteristics and the postoperative outcomes. Results 235 patients were included, of which 57 % were males. The mean age was 79 years and 49.8 % were classified as ASA III or higher. Spinal anesthesia was the most commonly used technique in 63.4 % of the cases. The most frequent outcomes were delirium in 17.9 %, and acute kidney failure in 6.8 %. 83.4 % of the patients underwent surgery within 48 hours of admission to the emergency department and intra-hospital mortality was 2.6 %. Conclusions The results of this study provide relevant information to identify opportunities for improvement and their implementation, such as the reduction in the time elapsed until surgical management and the development of care protocols in the region.

Introducción: La fractura de cadera es una de las principales causas de morbimortalidad en la población adulta mayor. En Colombia hay un déficit en la literatura científica acerca del manejo perioperatorio de esta población de pacientes. Objetivo: Describir el manejo perioperatorio de pacientes con fractura de cadera en un hospital universitario de alto nivel de complejidad de Cali, Colombia. Métodos: Se realizó un estudio observacional con alcance relacional de una cohorte histórica de pacientes con fractura de cadera, que recibieron manejo quirúrgico entre enero de 2018 y junio de 2022. Se hizo un muestreo no probabilístico y se diseñaron tablas de contingencia con el propósito de describir relaciones entre las características y los desenlaces posoperatorios. Resultados: Se incluyeron 235 pacientes de los cuales el 57 % fueron hombres. La mediana de edad fue de 79 años y el 49,8 % tenían una clasificación ASA III o mayor. La anestesia espinal fue la técnica más utilizada en el 63,4 %. Los desenlaces más frecuentes fueron el delirio en el 17,9 %, y la falla renal aguda en el 6,8 %. El 83,4 % de los pacientes fueron intervenidos quirúrgicamente antes de las 48 horas desde el ingreso a urgencias y la mortalidad intrahospitalaria fue del 2,6 %. Conclusiones: Los resultados de este estudio brindan información relevante que permite la implementación de oportunidades de mejora como disminución en los tiempos hasta el manejo quirúrgico y el desarrollo de protocolos de atención en la región.

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The effects of hypertension on perioperative outcomes are still unclear. No specific systolic or diastolic blood pressure measurement has been determined as the cutoff value to continue with a surgical plan or adjourn. This study is designed as a narrative review of the available scientific evidence on the perioperative management of hypertension. A search was conducted in Pubmed considering the title and abstract; 120 articles were pre-selected of which 55 papers were selected for full-text eligibility and 16 were excluded for a total of 39 articles including ACCF/AHA 2009 and ACC/AHA 2014 on perioperative cardiovascular care; 2013 ESH/ESC, 8 JNC, and the 2017 ACC/AHA/AAPA/ABC Guideline for the Prevention, detection, and management of hypertension in adults. Blood pressure values, target organ damage, and type of surgery should be considered for decision-making in the perioperative period. If surgery is elective, blood pressure fluctuations should be avoided and potential causes should be treated. A patient with mild hypertension with values below SBP 160 and DBP 110 mmHg may be managed in the ambulatory setting during the postoperative period, as long as the clinical conditions are favorable.

Los efectos de la hipertensión sobre los desenlaces durante el periodo perioperatorio aún no han quedado claramente establecidos. No se ha determinado una medición específica para la presión sistólica ni diastólica como punto de corte para continuar con el plan quirúrgico o suspenderlo. El presente estudio está diseñado a manera de revisión narrativa de la evidencia científica disponible sobre el manejo perioperatorio de la hipertensión. Se llevó a cabo una búsqueda en Pubmed, considerando el título y el resumen; se preseleccionaron 120 artículos, de los cuales se seleccionaron 55 para elegibilidad en texto completo y 16 se excluyeron, quedando un total de 39 artículos, incluyendo ACCF/AHA 2009 y ACC/AHA 2014 sobre el cuidado cardiovascular perioperatorio; 2013 ESH/ESC, 8 JNC, y la Guía del 2017 ACC/AHA/AAPA/ABC para la prevención, detección y manejo de la hipertensión en adultos. Se deben considerar los valores de la presión arterial, el daño a órgano diana y el tipo de cirugía para la toma de decisiones en el periodo perioperatorio. Si la cirugía es electiva, deben evitarse las fluctuaciones en la presión arterial y tratar activamente cualquiera de las causas potenciales. Un paciente con hipertensión leve, con valores por debajo de PAS 160 y PAD 110 mmHg puede manejarse de manera ambulatoria durante el período postoperatorio, siempre y cuando las condiciones clínicas sean favorables.

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Hemos leído con particular interés el manuscrito de Almenares y otros,1 titulado Discapacidad en personas mayores, donde los autores estimaron la prevalencia de discapacidad y comorbilidades en adultos mayores cubanos, evidenciando que el 75 por ciento se encontraban discapacitados entre niveles leves y moderados, observando además que las comorbilidades más prevalentes son de tipo cardiovascular y mental.1 Agradecemos a los autores por proveer tal evidencia. No obstante, consideramos necesario hacer mención de una condición indispensable de conocer y que afecta sustancialmente la capacidad funcional del paciente que supera la fase aguda de la COVID-19, sobre todo en el adulto mayor: el síndrome neurológico pos-COVID 19. El síndrome neurológico pos-COVID 19 se define como la manifestación de signos o síntomas neuropsiquiátricos tiempo después de la fase aguda de la COVID-19, en pacientes de cualquier grupo etario que presentaron o no manifestaciones neurológicas durante tal fase.2,3 Constituye un reto actual en salud pública a nivel global, debido al desconocimiento que se tiene aún sobre esta enfermedad y, principalmente, al riesgo que genera este síndrome de desencadenar trastornos cerebrovasculares o neuroinmunes.2,3 Se presume que existe mayor riesgo de presentación y/o complicación en aquellos con antecedentes personales de desórdenes neurológicos, modificando sustancialmente el pronóstico funcional a corto, mediano y largo plazo.3 Realizar el diagnóstico diferencial en atención primaria de este síndrome de cualquier otra condición similar o de presentación simultánea, es realmente un desafío. Lorenzo y otros4) llevaron a cabo un estudio donde evaluaron prospectivamente las secuelas físicas y psicológicas a 3 meses de pacientes COVID-19, evidenciando que más de 50 por ciento de los pacientes presentación afectación de la calidad de vida, y hasta un tercio permanece con manifestaciones neuropsiquiátricas de tipo ansiedad, insomnio y síndrome de estrés postraumático.4 No obstante, estos autores no utilizaron herramientas imagenológicas neuronales o neurofuncionales que permitieran descartar alguna alteración estructural o neurofisiológica, compatible con algún remanente de neuroinflamación que desencadenara el síndrome neurológico pos-COVID 19, por lo que no se puede definir con precisión la causa y persistencia de tales síntomas. Heneka y otros5 enfatizan sobre aquellos pacientes que poseen comorbilidades como la enfermedad de Alzheimer y otras demencias, cuya neuroinflamación durante la fase aguda incluso, puede empeorar el pronóstico y aumentar el riesgo de mortalidad de manera inmediata.5 Sin embargo, se espera que aquellos que presenten manifestaciones neurológicas durante la fase aguda, sean adultos mayores frágiles y tengan factores de riesgo de tipo neurovascular o neuroinmunológicos, vean reducida su capacidad funcional de forma significativa.6 En este orden de ideas, es necesario hacer énfasis e intensificar el control de factores de tipo neuro y cardiovasculares, promover la vacunación masiva y estrategias de educación en salud, realizar estricto seguimiento desde la atención primaria de adultos mayores que presentan cualquier fenotipo de la COVID-19, pero sobre todo aquellos con fenotipo severo y/o que desarrollan manifestaciones neuropsiquiátricas, e impulsar la neurorrehabilitación para intentar recuperar y mantener la capacidad funcional de aquellos con secuelas que reducen la calidad de vida(AU)

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Introduction: There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery. Methods: A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022. Results: Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4-11)) compared to the CA group (median 10.5 days (IQR: 6-25)). Likewise, there was a higher probability of discharge from the ICU in the ESPB group (HR 1.71 (95% CI: 1.05-2.79)). The ESPB group had lower opioid consumption (p < 0.05). There were no differences in time to extubation, mortality, and postoperative complications. Conclusion: ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery is feasible and associated with shorter hospital length of stay, faster ICU discharge and lower opioid consumption.

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Abstract Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain.

Resumen En cirugía cardiaca mediante esternotomía, la analgesia multimodal incluye el bloqueo bilateral continuo del plano erector de la espina (BBC-ESP). Sin embargo, existe incertidumbre sobre la efectividad de los esquemas de dosificación del anestésico local. Se busca evaluar el control del dolor proporcionado por un esquema de analgesia multimodal que incluye el BBC-ESP a la altura de T5 con ACP de bupivacaína 0,125 % en infusión y bolos de rescate. Se trata de un estudio descriptivo, serie de casos. Se reclutaron 11 pacientes adultos sometidos a cirugía cardiaca mediante esternotomía en quienes se usó analgesia multimodal que incluía BBC-ESP entre febrero y abril del 2021, en una institución de cuarto nivel. Todos los pacientes refirieron dolor, según la escala numérica (EN) ≤ 3 tanto en reposo como en movimiento, a la extubación, a las 4 y a las 12 horas. A las 24 horas el dolor fue EN ≤ 3 en el 100 % de los pacientes en reposo y en el 63,6 % en movimiento. A las 48 h el 81 % de los pacientes refirieron dolor EN ≤ 3 en reposo y en movimiento. A las 72 h todos los pacientes presentaron dolor EN ≤ 3 en reposo y 82 % en movimiento. El consumo intraoperatorio promedio de fentanilo fue de 2,35 ug/kg y de hidromorfona posoperatoria de 5,3, 4,1 y 3,3 mg a las 24, 48 y 72 horas. Así, el BBC-ESP en infusión continua más bolos de rescate permiten el control del dolor agudo intra y posoperatorio.

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Resumen: Objetivo: determinar las características y desenlaces clínicos de pacientes menores de 18 años tratados con oxigenación con membrana extracorpórea (ECMO) posterior a cirugía para la reparación o paliación de cardiopatías congénitas en un centro de referencia del suroccidente colombiano entre 2015 y 2020. Método: estudio descriptivo longitudinal con recolección retrospectiva de la información. Resultados: entre enero de 2015 y diciembre de 2020, 77 pacientes requirieron ECMO posterior a cirugía cardiaca pediátrica, con una mediana de edad de < 1 mes, mediana de peso de 4 kg, tiempo de circulación extracorpórea de 202 minutos y tiempo de pinzamiento aórtico de 95 minutos. La cardiopatía congénita más ingresada a ECMO fue el síndrome de corazón izquierdo hipoplásico (19.4%) en su posquirúrgico de Norwood (18.1%). La mediana del tiempo de ECMO fue de 111 horas. La indicación más frecuente fue la disfunción ventricular (80.5%). El 80.5% presentó complicaciones y la reintervención por sangrado fue la más frecuente (46.7%). La sobrevida a la ECMO fue del 48% y la sobrevida general al momento del alta fue de 25.97%. La edad < 1 mes (p = 0.030), el ácido láctico preECMO ≥ 5 mmol/l (p = 0.014) y el tiempo de normalización del lactato ≥ 24 horas (0.021), se asociaron a un mayor riesgo de mortalidad al egreso hospitalario. Conclusiones: la ECMO proporciona un soporte adecuado posterior a la cirugía cardiaca pediátrica. La edad < 1 mes, el ácido láctico preECMO ≥ 5 mmol/L y el tiempo de normalización del lactato ≥ 24 horas fueron las variables que se asociaron con un mal resultado y mortalidad hospitalaria.

Abstract: Objective: to determine the characteristics and clinical outcomes of patients under 18 years of age treated with extracorporeal membrane oxygenation (ECMO) after surgery for the repair or palliation of congenital heart disease. Method: longitudinal descriptive study with retrospective data collection. Results: between January 2015 and December 2020, 77 patients required ECMO after pediatric cardiac surgery with a median age of < 1 month, median weight of 4 kg, ECC time 202 minutes (IQR 125-272 minutes), aortic cross-clamp time 95 minutes. 76.6% were supported with ECMO prior to their return to the ICU. The congenital heart disease most frequently admitted to ECMO was hypoplastic left heart syndrome (19.4%) in the Norwood postoperative period (18.1%). The median time of ECMO was 111 hours. The most frequent indication was ventricular dysfunction (80.5%). 80.5% presented complications and reoperation for bleeding was the most frequent of these (46.7%). ECMO survival was 48% and overall survival at discharge was 25.97%. Age < 1 month (p = 0.030), pre-ECMO lactic acid ≥ 5 mmol/l (p = 0.014), OR 0.260 and time of normalization of lactate ≥ 24 hours (0.021), OR 0.24 were associated with a higher risk of mortality at hospital discharge. Conclusions: ECMO provides adequate support after surgery for the repair or palliation of congenital heart disease. Age < 1-month, pre-ECMO lactic acid ≥ 5 mmol/l, and lactate normalization time ≥ 24 hours were the variables that were associated with poor outcome and hospital mortality.

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In Colombia, the human papillomavirus (HPV) vaccine was launched in 2012 in the context of a school-based national vaccination program targeting girls ages 9 to 14 and offering catch-up vaccination for girls ages 14 to 17. In this study, we evaluated the program's impact on type-specific HPV infection by comparing HPV cervical prevalence among vaccinated and nonvaccinated women. This is a comparative cross-sectional study conducted 5 years after the quadrivalent HPV vaccination implementation in a sentinel Colombian City. This study included young women (18-25 years old) who had been vaccinated in the catch-up group and were attending universities and technical institutions, and women who attended primary health care facilities for Pap smear screening. The HPV prevalence of 1,287 unvaccinated women was compared with the prevalence of 1,986 vaccinated women. The prevalence of HPV16/18 infections was significantly lower in vaccinated compared with unvaccinated women (6.5% vs. 15.4%; P < 0.001), whereas for HPV6/11 infections, a decrease of 63.7% in vaccinated women (1.02% vs. 2.81%) was observed. The adjusted effectiveness to HPV16/18 was 61.4%; 95% CI, 54.3%-67.6%. However, the effectiveness against HPV16/18 was significantly higher among women vaccinated before their sexual debut 91.5%; 95% CI, 86.8-94.5, compared with effectiveness for vaccination after their sexual debut, 36.2%; 95% CI, 23.6-46.7. Five years after the introduction of HPV vaccines in Colombia, high effectiveness of HPV to prevent HPV16/18 infections is observed in the catch-up cohorts including virgin and sexually active women. PREVENTION RELEVANCE: Monitoring HPV vaccines post-licensure plays an important role in assessing the progress of immunization programs, demonstrating the impact of vaccines on the population, and providing data for policy needs. In Colombia, HPV vaccines showed effectiveness when administered before start of sexual activity, and two doses are sufficient to achieve good protection.

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OBJECTIVE: To compare the completeness and quality of information about diabetic retinopathy on Wikipedia in the world's leading spoken languages in 2020. DESIGN AND METHODS: An observational, descriptive, cross-sectional study. The information on diabetic retinopathy obtained from the free encyclopedia Wikipedia® was assessed in languages with one hundred million or more total speakers. The term "diabetic retinopathy" was accessed in the corresponding Wikipedia entry in English, while the "more languages" function gives access to other languages. The information on the sites was collected by three ophthalmologist observers. A database was created with the most important subtopics for the education of patients with diabetic retinopathy in any of its classifications, based on a 25-question survey. The results were stratified on a scale from 0 to 4. A confirming correlation was found in the statistical analysis among the observers. RESULTS: No language achieved the label "excellent"; 2 languages were rated as "fair "; 4 languages qualified as "substandard"; and 7 languages were scored as "poor." No information could be found in five languages. CONCLUSIONS: As would be expected, the quality of content is variable across different languages. However, if anyone can edit Wikipedia, health professionals can do so as well to improve the quality and quantity of information for patients.

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The frogs of the genus Pristimantis are recognized for their characteristic reproductive mode and for their incredible diversity of species, becoming the genus with the highest number of species within tetrapod vertebrates. We describe here a new species of Pristimantis from the northwestern Andes of Colombia. The species was found between 2000-2500 m.a.s.l., mostly within moss hanging of tree branches in a tropical cloud forest. It can be easily distinguished from other Pristimantis species of the western Andes by the unique black and white patterning in the ventral surface and the flanks, the hourglass-shaped dorsal folds, and the prominent conical tubercles on eyelids, heels, and outer edge of tarsus. A phylogenetic analysis further supports its status of a lineage reciprocally monophyletic to P. satagius and separated by a genetic distance of 0.03; the latter species bear whitish rather than predominantly black ventral coloration. To the best of our knowledge, this species is only known from the 2,500 ha nature reserve Mesenia-Paramillo, despite other research on this area of the country. Therefore, the species is declared vulnerable while new evidence on its distribution range is accumulated.

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Abstract Introduction: Chronic thromboembolic disease is a major cause of severe pulmonary hypertension and disabling right ventricular dysfunction. Pulmonary endarterectomy (PE) is currently considered a therapeutic option that can cure these patients. Objective: The aim of this study was to review the experience at a Colombian PE cardiovascular center, the outcomes and most frequent complications. Materials and methods: A retrospective review of PEs performed from 2009 through 2017 was conducted, which form an e-database developed for cardiovascular surgery in 2009. All intra and postoperative events were recorded, as well as the major outcomes, including mortality. Results: Twenty-one patients (12 females and 9 males) were identified, with a mean age of 48 years [interquartile range (IQR): 30-70]; 76.2% had a New York Heart Association (NYHA) functional class category III or IV, and the mean intensive care unit stay was 179hours (IQR 27-528). The most frequent perioperative complications were cardiac (right ventricular dysfunction, and biventricular dysfunction) and pulmonary (pulmonary edema and severe dysfunction disorders), with an overall mortality of 9.5%. Conclusion: Although the reported survival in this paper is similar to recently published trials, our work suggests that it is appropriate to foresee the possibility of postoperative cardiopulmonary support in these patients and to have a multidisciplinary team available, trained in caring for these events that have a negative impact on outcomes and survival of this surgical population.

Resumen Introducción: La enfermedad pulmonar tromboembólica crónica es una importante causal de hipertensión pulmonar severa y disfunción ventricular derecha incapacitante. La endarterectomía pulmonar (EP) se considera actualmente una alternativa terapéutica que ofrece curación para estos pacientes. Objetivo: Revisar la experiencia en un centro cardiovascular colombiano en EP, sus desenlaces y complicaciones más frecuentes. Materiales y métodos: Se realizó una revisión retrospectiva de EP llevadas a cabo durante 2009 a 2017 a partir de una base de datos electrónica desarrollada para cirugía cardiovascular en el año 2009. Se registraron los eventos intra y post operatorios así como los principales desenlaces incluyendo mortalidad. Resultados: Se encontraron 21 pacientes (12mujeres, 9 hombres), mediana de edad 48 años (RIQ: 30-70), el 76,2% tenían una clase funcional categoría III o IV de la New York Heart Association (NYHA), la mediana de estancia en unidad de cuidado intensivo (UCI) fue de 179 horas (RIQ 27-528). Las complicaciones perioperatorias más frecuentes fueron de tipo cardiaco (disfunción ventricular derecha y bi-ventricular) y pulmonar (edema pulmonar y alteraciones severas de la difusión), con una mortalidad global del 9.5%. Conclusión: Aunque la sobrevida reportada en este trabajo es similar a la de estudios recientemente publicados, nuestro trabajo sugiere que es conveniente prever la posibilidad de soporte cardiopulmonar postoperatorio en estos pacientes y contar con un equipo multidisciplinario entrenado en la atención de eventos que afectan negativamente los desenlaces y la sobrevida en esta subpoblación quirúrgica.

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BACKGROUND: Hispanic/Latino populations are a genetically admixed and heterogeneous group, with variable fractions of European, Indigenous American and African ancestries. The molecular profile of breast cancer has been widely described in non-Hispanic Whites but equivalent knowledge is lacking in Hispanic/Latinas. We have previously reported that the most prevalent breast cancer intrinsic subtype in Colombian women was Luminal B as defined by St. Gallen 2013 criteria. In this study we explored ancestry-associated differences in molecular profiles of Luminal B tumors among these highly admixed women. METHODS: We performed whole-transcriptome RNA-seq analysis in 42 Luminal tumors (21 Luminal A and 21 Luminal B) from Colombian women. Genetic ancestry was estimated from a panel of 80 ancestry-informative markers (AIM). We categorized patients according to Luminal subtype and to the proportion of European and Indigenous American ancestry and performed differential expression analysis comparing Luminal B against Luminal A tumors according to the assigned ancestry groups. RESULTS: We found 5 genes potentially modulated by genetic ancestry: ERBB2 (log2FC = 2.367, padj<0.01), GRB7 (log2FC = 2.327, padj<0.01), GSDMB (log2FC = 1.723, padj<0.01, MIEN1 (log2FC = 2.195, padj<0.01 and ONECUT2 (log2FC = 2.204, padj<0.01). In the replication set we found a statistical significant association between ERBB2 expression with Indigenous American ancestry (p = 0.02, B = 3.11). This association was not biased by the distribution of HER2+ tumors among the groups analyzed. CONCLUSIONS: Our results suggest that genetic ancestry in Hispanic/Latina women might modify ERBB2 gene expression in Luminal tumors. Further analyses are needed to confirm these findings and explore their prognostic value.

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Single-nucleotide polymorphisms (SNPs) in cytokine genes can affect gene expression and thereby modulate inflammation and carcinogenesis. However, the data on the association between SNPs in the interleukin 1 beta gene (IL1B) and colorectal cancer (CRC) are conflicting. We found an association between a 4-SNP haplotype block of the IL1B (-3737C/-1464G/-511T/-31C) and CRC risk, and this association was exclusively observed in individuals with a higher proportion of African ancestry, such as individuals from the Coastal Colombian region (odds ratio, OR 2.06; 95% CI 1.31-3.25; p < 0.01). Moreover, a significant interaction between this CRC risk haplotype and local African ancestry dosage was identified in locus 2q14 (p = 0.03). We conclude that Colombian individuals with high African ancestry proportions at locus 2q14 harbour more IL1B-CGTC copies and are consequently at an increased risk of CRC. This haplotype has been previously found to increase the IL1B promoter activity and is the most frequent haplotype in African Americans. Despite of limitations in the number of samples and the lack of functional analysis to examine the effect of these haplotypes on CRC cell lines, our results suggest that inflammation and ethnicity play a major role in the modulation of CRC risk.

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DNA methylation (DNAm) measured in lymphoblastoid cell lines has been repeatedly demonstrated to differ between various human populations. Due to the role that DNAm plays in controlling gene expression, these differences could significantly contribute to ethnic phenotypic differences. However, because previous studies have compared distinct ethnic groups where genetic and environmental context are confounded, their relative contribution to phenotypic differences between ethnicities remains unclear. Using DNAm assayed in whole blood and colorectal tissue of 132 admixed individuals from Colombia, we identified sites where differential DNAm levels were associated with the local ancestral genetic context. Our results are consistent with population specific DNAm being primarily driven by between population genetic differences in cis, with little environmental contribution, and with consistent effects across tissues. The findings offer new insights into a possible mechanism driving phenotypic differences among different ethnic groups, and could help explain ethnic differences in colorectal cancer incidence.

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Summary Background: the worldwide trend in agro industries is to optimize food quality and obtain safe products for human consumption. It is important to produce milk with excellent physicochemical and microbiological quality to reduce public health risks. Objective: to evaluate the physicochemical and microbiological quality of milk and udder health in northwest Colombia, through the raw milk received at a leading dairy plant in Valledupar (Colombia). Methods: a non-probability sampling and a crosssectional study were conducted. Raw milk samples from 186 beef and milk (dual purpose) farms were collected. Physicochemical parameters, mesophilic and somatic cell counts were determined. Data were analyzed by descriptive statistics using SAS software. Results: physicochemical parameters were within the normal range in accordance with Colombian Decree No. 616 of 2006. The average mesophilic and somatic cell count was 305,279 colony forming units (CFU)/mL, and 523,207 somatic cells (SC)/mL, respectively. Sixty-eight percent of the farms had somatic cell counts greater than 200,000 SC/mL, which is the threshold for bovine mastitis. Conclusion: physicochemical quality of milk was good, but there were shortcomings in microbiological quality and udder health. Therefore, efforts are required to prevent this problems and to implement excellent management practices in the farms.

Resumen Antecedentes: la tendencia mundial en prácticas agroindustriales es la obtención de alimentos de excelente calidad e inocuidad para el consumo humano. Es importante producir leche de excelente calidad fisicoquímica y microbiológica para disminuir los riesgos en salud pública. Objetivo: evaluar la calidad fisicoquímica y microbiológica de la leche asi como la salud de la ubre en el noroeste de Colombia, a traves de la leche cruda recibida en una planta procesadora de Valledupar (Colombia). Métodos: se utilizó un muestreo no probabilístico por conveniencia y un estudio de corte transversal. Muestras de leche cruda de 186 fincas doble propósito fueron recolectadas. Se determinaron parámetros fisicoquímicos, conteo de células somáticas y mesófilos. Los datos obtenidos se analizaron por estadística descriptiva mediante el programa estadístico SAS. Resultados: los parámetros fisicoquímicos se encontraron dentro de los valores normales de acuerdo al decreto 616 de 2006. El promedio del recuento de mesófilos fue de 305.279 unidades formadoras de colonia (UFC)/mL y 523.207 células somáticas (CS)/mL. En el 68% de las empresas ganaderas, el conteo de células somáticas fue mayor a 200.000 CS/mL, lo cual, es un indicio de mastitis bovina. Conclusión: la calidad fisicoquímica es buena, pero hay deficiencias en la calidad microbiológica y sanidad de la ubre, por lo cual se deben implementar excelentes prácticas de manejo y de prevención.

Resumo Antecedentes: a obtenção de alimentos de excelente qualidade e segurança para o consumo humano é uma tendência mundial. É importante produzir leite de excelente qualidade físico-química e microbiológica para reduzir os riscos na saúde pública. Objetivo: avaliar a qualidade físico-química e microbiológica do leite cru produzido no noroeste da Colômbia, recebeu em um laticínio líder em Valledupar (Colômbia). Métodos: foi utilizada uma amostragem não probabilística e um estudo transversal. Amostras de leite cru foram coletadas em 186 fazendas de dupla aptidão. Foram determinados parâmetros fisico-químicos, mesófilos e contagem de celulas somanticas. Os dados obtidos foram analisados pela estatística descritiva mediante a utilizacao do programa estadistico SAS. Resultados: os parâmetros físico-químicos foram encontrados dentro da normalidade de acordo com o decreto 616 de 2006, a média da contagem de mesólitos foi de 305.279 unidades formadoras de colónias (UFC)/mL e a contagem de células somáticas (CS) foi 523.207 CS/mL. Em 68% das empresas produtoras de gado, a contagem de células somáticas foi maior do que 200.000 CS/mL. Conclusão: a qualidade físico-química é boa, mas há falhas na qualidade microbiológica e a saúde do úbere, por isso os esforços nas fazendas devem procurar a implementação de excelentes práticas de gestão e prevenção.

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Urine sampling for HPV DNA detection has been proposed as an effective method for monitoring the impact of HPV vaccination programs; however, conflicting results have been reported. The goal of this study was to evaluate the performance of optimized urine HPV DNA testing in women aged 19 to 25 years. Optimization process included the use of first void urine, immediate mixing of urine with DNA preservative, and the concentration of all HPV DNA, including cell-free DNA fragments. Urine and cervical samples were collected from 535 young women attending cervical screening at health centers from two Colombian cities. HPV DNA detection and genotyping was performed using an HPV type-specific multiplex genotyping assay, which combines multiplex polymerase chain reaction with bead-based Luminex technology. Concordance between HPV DNA detection in urine and cervical samples was determined using kappa statistics and McNemar tests. The accuracy of HPV DNA testing in urine samples was evaluated measuring sensitivity and specificity using as reference the results obtained from cervical samples. Statistical analysis was performed using STATA11.2 software. The findings revealed an overall HPV prevalence of 60.00% in cervical samples and 64.72% in urine samples, HPV-16 being the most frequent HPV type detected in both specimens. Moreover, our results indicate that detection of HPV DNA in first void urine provides similar results to those obtained with cervical samples and can be used to monitor HPV vaccination trials and programs as evidenced by the substantial concordance found for the detection of the four vaccine types. Cancer Prev Res; 9(9); 766-71. ©2016 AACR.

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Introducción: las lesiones son eventos adversos frecuentes y significativos en la vida deportiva del futbolista. Objetivo: determinar las características de las lesiones derivadas de la práctica del fútbol en jugadores de un equipo profesional durante 1 año de competencia en la primera división del fútbol profesional colombiano. Método: se siguió prospectivamente durante 1 año a 24 jugadores de la primera categoría de un equipo de fútbol colombiano. Se realizó una valoración inicial a los jugadores que incluía la edad, peso, talla e índice de masa corporal. Diariamente el médico llenaba el formato de reporte de lesiones para cada jugador, en entrenamiento y competencia, donde consignaba fecha de la lesión, sitio anatómico lesionado, tipo de lesión, diagnóstico inicial, diagnóstico definitivo, lesión recurrente, mecanismo de lesión, causa de la lesión y días de incapacidad. Resultados: la edad promedio fue de 26,5±5 años El índice de masa corporal fue 24,57±1,06. El 50 por ciento de los jugadores se lesionaron. El 58,3 porciento de las lesiones ocurrieron durante la competencia. No se presentaron lesiones recurrentes. El sitio anatómico más afectado fue la rodilla. La mayoría de las lesiones fueron ligamentosas y musculares. El diagnóstico más frecuente fue el esguince. La mayoría de las lesiones fueron de no contacto (66,66 por ciento). El 33,33 por ciento de todas las lesiones fueron por sobreuso y el 66,66 porciento por trauma. El 50 por ciento de las lesiones fueron severas. Conclusiones: se presentaron más lesiones durante la competencia, la mitad severas, principalmente esguinces ligamentosos en miembros inferiores, de no contacto, por sobreuso y trauma(AU)

Introduction: Injuries are frequent and significant adverse events in the sporting life of soccer players. Objective: Determine the characteristics of the injuries resulting from the practice of soccer players of a professional team during 1 year of competition in the Colombian first division of professional soccer. Method: We prospectively followed for 1 year, 24 players from the first category of a Colombian soccer team. An initial assessment of players was performed including age, weight, height and BMI. Daily, the format injury report for each player was filled in by the physician, during training and competition, for consigning date of injury, injured anatomic site, type of injury, initial diagnosis, definitive diagnosis, recurrent injury, mechanism of injury, cause of injury, and disability days. Results: The mean age was 26.5 ± 5 years. The BMI was 24.57 ± 1.06. 50 percent of players were injured. 58.3 percent of injuries occurred during competition. No recurring injuries occurred. The most affected anatomical site was the knee. Most of the injuries were ligamentous and muscular. The most common diagnosis was sprained. Most of the injuries were non-contact (66.66 percent). 33.33 percent of all injuries were overuse and trauma 66.66 percent. 50 percent of the injuries were severe. Conclusions: more injuries occurred during competition, half severe, mainly in the lower limbs ligamentous sprains, non-contact, overuse and trauma(AU)

Introduction: Les lésions sont des événements fréquents et significatifs dans la vie sportive d'un footballeur. Objectifs: Le but de ce travail est de déterminer les caractéristiques des lésions souffertes par les joueurs d'une équipe de la première division de football professionnel colombien pendant un an de compétitions. Méthodes: Un suivi prospectif de 24 joueurs d'une équipe colombienne de football de première catégorie a été effectué pendant un an. Une évaluation initiale des joueurs a été réalisée tenant compte de l'âge, du poids, de la taille, et de l'indice de masse corporelle. Chaque jour le médecin remplissait le formulaire de rapport de lésions de chaque joueur, aussi en entrainement qu'en compétition, où il consignait la date de la lésion, sa localisation anatomique, le type de lésion, un diagnostic initial, un diagnostic définitif, les lésions récurrentes, le mécanisme de la lésion, ses causes, et les jours d'invalidité. Résultats: Le moyen d'âge a été 26,5 ± 5 ans. L'indice de masse corporelle a été 24,57 ± 1,06. La moitié des joueurs a été atteinte de lésions (50 pourcent). Un pourcentage significatif de ces lésions (58,3 pourcent) s'est produit en compétition. Il n'y a pas eu de lésions récurrentes. Le genou a été la partie anatomique la plus fréquemment touchée. Un grand nombre de lésions a été localisée au niveau des ligaments et des muscles. Le diagnostic le plus fréquent a été l'entorse. La majorité des lésions ont été sans contact (66,66 pourcent). Une partie de lésions a été due à l'abus (33,33 pourcent) tandis que l'autre a été due aux traumatismes (66,66 pourcent). Les lésions ont été sévères dans 50 pourcent. Conclusions: La plupart des lésions ont survenu au cours de compétitions, notamment les entorses ligamenteuses des membres inférieurs, sans contact, et dues à l'abus et aux traumatismes(AU)

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Breast cancer is the most frequent malignancy in women worldwide. Distinct intrinsic subtypes of breast cancer have different prognoses, and their relative prevalence varies significantly among ethnic groups. Little is known about the prevalence of breast cancer intrinsic subtypes and their association with clinicopathological data and genetic ancestry in Latin Americans. Immunohistochemistry surrogates from the 2013 St. Gallen International Expert Consensus were used to classify breast cancers in 301 patients from Colombia into intrinsic subtypes. We analyzed the distribution of subtypes by clinicopathological variables. Genetic ancestry was estimated from a panel of 80 ancestry informative markers. Luminal B breast cancer subtype was the most prevalent in our population (37.2%) followed by luminal A (26.3%), non-basal triple negative (NBTN) (11.6%), basal like (9%), human epidermal growth factor receptor 2 (HER2) enriched (8.6%) and unknown (7.3%). We found statistical significant differences in distribution between Colombian region (P = 0.007), age at diagnosis (P = 0.0139), grade (P < 0.001) and recurrence (P < 0.001) according to intrinsic subtype. Patients diagnosed with HER2-enriched, basal-like and NBTN breast cancer had the highest African ancestry. Future studies analyzing the molecular profiles of breast cancer in Colombian women will help us understand the molecular basis of this subtype distribution and compare the molecular characteristics of the different intrinsic subtypes in Colombian patients.

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