Título del artículo:

Life-course trajectories and modifiable risk factors for incident walking limitation and mortality in 25 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Background: Life expectancy is increasing globally, but if people are to age healthily, they must do so with fewer limitations in their daily activities. However, information on either the frequency or risk factors for limitations to walking ability or other key activities across different regions of the world is limited. Our aim was to describe the incidence, trajectories, risk factors, and population-attributable fraction of new-onset walking limitations in 25 countries at all socioeconomic levels. Methods: PURE is an ongoing, prospective cohort study. The current analysis included community-dwelling participants who lived in four high-income countries (HICs), 16 middle-income countries (MICs), and five low-income countries (LICs). Individuals aged 35–70 years at baseline who completed a baseline questionnaire about activity limitations between Jan 12, 2001, and May 6, 2019, were included in our analysis. The activity limitation screen included questions on self-reported difficulty with walking, grasping, bending, seeing close-up, seeing distance, and hearing. The primary outcome was incident walking limitation and our analytic sample comprised those with no walking limitation at baseline. We estimated the incidence rates, adjusted for age and sex, per 100 person-years in the overall PURE population, by country income level (and separately for China) and sex. We used multistate modelling to evaluate trajectories across the life course, analysed across continuous age, through three distinct sequential states: no limitation, walking limitation, and death. We used survival models to evaluate the associations of socioeconomic status, vascular and behavioural factors, community walkability, and incident adverse events, with incident walking limitations. We then calculated the population-attributable fraction of selected modifiable factors and compared the risk factors for walking limitation and mortality. Findings: 172 889 people from the PURE cohort answered questions on walking limitations at baseline, 150 221 of whom reported no walking limitation and were included in the multistate model. Of these 150 221 individuals, 122 538 had at least one follow-up assessment with walking limitations data (mean age at baseline 49·7 years [SD 9·5]; 71 424 [58·3%] female and 51 114 [41·7%] male). Mean follow-up was 14·5 years (SD 3·3). Incidence of a new walking limitation per 100 person-years was higher in LICs (3·34 [95% CI 3·27–3·41]), and lowest in China (0·58 [0·56–0·60]), compared with other MICs (1·80 [1·77–1·84]) and HICs (1·31 [1·27–1·37]). The incidence of walking limitation was higher in female participants (1·84 [1·81–1·87]) than in male participants (1·25 [1·22–1·28]). In multistate models, state transitions from no walking limitation to walking limitation and death occurred at a higher rate and earlier in LICs, where the age at which the probability of transitioning to a walking limitation was reached by an estimated one-third of people at 64 years compared with age 76 years in HICs. Female participants had a higher probability of incident walking limitation across the age spectrum compared with male participants. Many socioeconomic, vascular, and behavioural risk factors, community walkability, and incident adverse events, especially incident stroke, were associated with incident walking limitations. The population-level risk factors with the highest population-attributable fractions for walking limitation were low education (11·1% [95% CI 9·9–12·4]), obesity (5·2% [4·7–5·8]), hypertension (3·6% [2·2–5·0]), and low recreational physical activity (4·3% [2·3–6·3]), with obesity being the highest in HICs (12·9% [11·2–14·6]) and low education being the highest elsewhere. Potentially modifiable individual-level risk factors explained approximately 32·9% of the population\'s risk of walking limitations and approximately 47·4% of mortality, and four of the top five factors were shared for both outcomes (low education, low recreational activity, poor diet, and hypertension). Interpretation: Individuals in LICs had an accelerated transition to walking limitation, which was approximately 12 years earlier than those in HICs. Walking limitation and mortality shared a common set of modifiable risk factors, accounting for almost one-third of the population-level risk of walking limitations and highlighting opportunities for integrated prevention strategies in mid-life that simultaneously target disability and premature mortality across socioeconomic settings. Funding: Funding sources are listed at the end of the Article.

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Lancet Healthy Longevity

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Pedagogical innovation and critical tensions in the teaching of morphophysiology in higher education: a systematic review

In the current educational context, characterized by a continuous demand for comprehensive training of students, particularly in skills such as creative thinking and research, it is a priority to evaluate how these skills interrelate with each other, contributing to meaningful learning and social impact. The article presents a quantitative methodological approach, with a non-experimental design and a survey as an instrument. The correlations between research skills and critical thinking are analyzed, focusing on fourth grade students of the advanced cycle of the Centro de Educación Básica Alternativa San José Marello, in La Molina. Among the main findings, the positive correlation between critical thinking and pro-blematization of situations stands out, which reflects that research skills substantially improve the students’ capacity to generate their own ideas, with reflective autonomy, contributing innovation to the educational act. It is concluded that it is important to integrate these competencies into the educational curriculum, since they guide students to face social demands, to confront their changes, thus preparing them for a changing world and for their insertion into citizenship and the labor market.

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Encuentros Maracaibo

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Electro-Mechanical Dissociation in Chagas Cardiomyopathy: Comparative Analysis of Arrhythmic Burden Beyond LVEF

Background: Chronic Chagas cardiomyopathy (CCC) exhibits high arrhythmic risk despite preserved systolic function, challenging LVEF-based stratification. Methods: We performed a cross-sectional analysis of 146 heart failure patients (75 CCC, 71 Ischemic Cardiomyopathy [IC]) with comparable age, LVEF, and NT-proBNP. Results: CCC patients had a higher arrhythmic burden and NSVT prevalence (RR 4.37, 95% CI 1.67–11.39). NSVT prevalence in CCC was similar regardless of LVEF (p = 0.707). Conventional heart failure severity markers, including worse global and regional strain, were associated with NSVT in IC but not in CCC, where atrial fibrillation (p = 0.002) and ventricular aneurysms (p = 0.033) were the primary associated variables. Conclusions: Arrhythmic vulnerability in CCC appears decoupled from LVEF, suggesting that complementary substrate-based markers may improve risk stratification in this population.

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Journal of Arrhythmia

Título del artículo:

Artificial intelligence literacy in fibromyalgia: the inverse gap between informed patients and unprepared clinicians

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Reumatologia Clinica

Título del artículo:

WORK-BASED ISOMETRIC EXERCISES EFFECT ON BLOOD PRESSURE: THE EEFIT STUDY

Objective: – To evaluate the effect of two workplace isometric exercise interventions on blood pressure in hypertensive adults.Design and method: – A randomized controlled multicenter clinical trial conducted in hypertensive (>130 mmHg systolic blood pressure (SBP)) 35 to 65 years old in work places in Colombia. Participants were assigned to either of two interventions: isometric handgrip dynamometer training at 30% of maximum strength (HGD) or wall squat (WS), or to a control group following standard recommendations. The interventions were performed at the participant’s workplace and consisted of 4 sets of 2 minutes of sustained isometric contraction with 2 minutes’ rest between sets, 3 times per week for 12 weeks. SBP and diastolic blood pressure (DBP) were measured using an automatic device (Omron) with a standardized protocol before and after the 12-week intervention. Results: – Pre and post measurements were completed by 105 hypertensive participants: mean age of 45 years (SD 9.5), 63.8% of which were men. In the HGD group (n = 38) there were significant decreases in SBP [Pre: 141 mmHg (SD 7.8), Post: 127 mmHg (SD 9.1) (p < 0.001)], and in DBP [Pre: 87 mmHg (SD 5.8), Post: 82 mmHg (SD 9.5) (p < 0.001)]. There were also significant decreases in the WS-group (n = 35) in SBP [Pre: 139 mmHg (SD 7.5), Post: 126 mmHg (SD 12.4) (p < 0.001)], and in DBP [Pre: 86 mmHg (SD 5.2), Post 82 mmHg (SD 8.1) (p < 0.001)]. In the control group (n = 32), there were no significant changes in either in SBP [Pre: 140 mmHg (SD 8.4), Post: 137 mmHg (SD 12.9)], or DBP [Pre: 86 mmHg (SD 5.0), Post: 85 mmHg (SD 8.0) (p = 0.71)]. Conclusions: – Both workplace isometric training interventions resulted in significant and clinically relevant reductions in blood pressure in subjects with high blood pressure. The combination of effectiveness, modest time commitment (42 minutes per week) and ease with which the interventions can be implemented in the workplace setting makes them both attractive and practical options with minimal barriers for participation. Furthermore, WS can be performed without any equipment.

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Journal of Hypertension

Título del artículo:

Optimization of energy consumption in lighting through window-to-wall ratio (WWR) in prefabricated social housing under warm climate conditions

The influence of window-to-wall ratio (WWR) on energy consumption for lighting and visual comfort in a social housing building in Bucaramanga, Colombia, was investigated. Using parametric simulations in Design Builder, WWR between 0% and 100% were modeled in 10% increments, while structural and climatic conditions were kept constant. The results show that WWR values below 30% do not meet the minimum illuminance levels requires by Colombian regulations, while values above 70% lead to over-illumination and glare. The optimal range is between 40% and 60%, ensuring that regulations are met in most rooms. Monthly lighting energy consumption is reduced by up to 65% (approximately 650 kWh per year), and lighting uniformity is optimized. These results confirm that WWR regulation is an effective, reproducible, and cost-effective passive design strategy for increasing energy efficiency and living quality in social housing in warm climates.

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Heritage and Sustainable Development

Título del artículo:

Osteoporotic fractures prevalence in Latin American countries: A systematic review of literature and meta-analysis

Background: Osteoporotic fractures (OF), or fragility fractures, are a major cause of morbidity, mortality, and healthcare utilization worldwide. While their burden is well described in high-income countries, data in Latin America remain fragmented and poorly synthesized. Objective: To systematically review and synthesize available evidence on the prevalence of OF among adults in Latin America. Methods: We conducted a systematic review and meta-analysis of observational studies, following JBI methodology and PRISMA 2020 guidelines. MEDLINE, Scopus, Virtual Health Library, and Google Scholar were searched up to January 8, 2025. Random-effects meta-analysis with restricted maximum likelihood estimation and Hartung–Knapp adjustment was used. Subgroup and sensitivity analyses were conducted according to population type, fracture ascertainment method, age group, sex, country, setting, and fracture type. Univariable meta-regression was used to explore sources of heterogeneity. Risk of bias was assessed using the JBI checklist. Results: Twenty-two studies were included in the systematic review, and 16 contributed to the meta-analysis, comprising 1,182,219 participants and 47,954 osteoporotic fractures. The pooled prevalence of OF was 10.2% (95% CI 5.0–16.9%), with substantial heterogeneity (I2 = 100%). Prevalence varied significantly according to population type (p < 0.001), with higher estimates in clinical samples than in population-based studies, and by fracture type (p = 0.002), with vertebral fractures being the most frequent (19.1%). No overall sex differences were identified, although women had higher prevalence of vertebral and non-vertebral fractures after stratification. Meta-regression identified country and fracture type as significant contributors to heterogeneity. Conclusions: OF represent a substantial but highly heterogeneous health burden, and pooled prevalence estimates should be interpreted as indicative rather than precise estimates. Strengthening epidemiological surveillance and implementing early diagnosis and prevention strategies should be prioritized to address the growing impact of OF in the region.

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Bone

Título del artículo:

Ibero-American position statement on therapeutic recommendations for the preventive management of cardiovascular complications in latin-American patients with type 2 diabetes mellitus: consensus of the prevention council of the inter-American society of cardiology (SIAC-PREVENT)

Background: Type 2 diabetes mellitus (T2DM) affects an estimated 463 million adults worldwide, nearly 80% of whom live in low- and middle-income countries. Latin America and the Caribbean (LAC) are among the regions with the fastest-growing T2DM prevalence, with ~ 32 million affected individuals- Against this background, the SIAC Prevention Council (SIAC-PREVENT) developed regionally adapted, equity-oriented recommendations for the preventive management of cardiovascular complications in T2DM. Methods: We convened a multidisciplinary panel from across LAC and followed AGREE II and RIGHT principles. A comprehensive search (MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, SciELO, LILACS, and grey literature) from 2010 to 2025. Risk of bias was assessed using RoB 2, ROBINS-I, and AMSTAR 2; certainty of evidence was graded with GRADE. Draft recommendations were iteratively reviewed and validated in virtual meetings and an in-person consensus conference, with recorded voting procedures. Findings: In LAC, T2DM prevalence reaches 13–14% in some countries, with high disability burden. Over 80% of patients are overweight or obese; MASLD and peripheral arterial disease are common. T2DM confers a 2–4-fold increased cardiovascular risk and higher rates of stroke and heart failure. The Council proposes an integrated, risk-based strategy combining: systematic cardiovascular risk stratification; early obesity management; a four-pillar cardiorenal approach (RAS blockade, SGLT2 inhibitors, finerenone, GLP-1 receptor agonists); preferential use of SGLT2 inhibitors and GLP-1 receptor agonists in high-risk patients; strict lipid and blood pressure control; and systematic screening and management of micro- and macrovascular complications. Conclusions: This Ibero-American position statement supports an evidence-based and equity-oriented approach to preventing cardiovascular complications in people with T2DM in Latin America and the Caribbean. By prioritizing the use of SGLT2 inhibitors, GLP-1 receptor agonists, and structured multidisciplinary care adapted to the realities of local health systems, the region could substantially reduce morbidity, mortality, and the overall burden that T2DM represents for healthcare systems. These recommendations must be explicitly integrated into primary care models and existing chronic disease management programs within health systems. Achieving this potential will require deliberate actions to reduce inequalities in access—through coherent health policies, sustainable financing mechanisms, and continuous education for both healthcare professionals and patients—so that these strategies can be implemented at scale and in a sustainable manner. Likewise, it will be necessary to strengthen multidisciplinary care networks, establish quality indicators and outcome monitoring systems, and promote procurement and coverage strategies that facilitate equitable access to high-value therapies.

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Diabetology and Metabolic Syndrome

Título del artículo:

The Role of Artificial Intelligence in Cardiovascular Diseases: Advances, Challenges, and Perspectives

Cardiovascular diseases remain the leading cause of morbidity and mortality world-wide, demanding innovative approaches for prevention, diagnosis, and treatment. Artificial intelligence has emerged as a transformative tool in cardiovascular medicine by enabling the analysis of large volumes of clinical, genomic, imaging, and electrophysiological data. This editorial discusses recent advances in machine learning and deep learning applications for cardiovascular diagnosis, risk prediction, and health system optimization. It highlights evidence demonstrating superior predictive performance compared with conventional methods, particularly in electrocardio-graphic interpretation and risk stratification. The article also addresses implementation challenges, including infrastructure investment, workforce training, digital cul-ture, and the ethical use of health data. Finally, it emphasizes the need for regulatory frameworks and sustained research efforts to ensure the responsible integration of artificial intelligence into cardiovascular care.

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Revista De Investigacion E Innovacion En Ciencias De La Salud

Título del artículo:

Effects of Isometric Exercise on Cardiovascular and Metabolic Outcomes in Patients with Coronary Artery Disease: a Systematic Review

Introduction. Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Although exercise-based interventions are a cornerstone of cardiac rehabilitation, existing evidence has predominantly focused on aerobic and dynamic resistance training. In contrast, the potential role of isometric exercise in patients with CAD remains insufficiently characterized, with limited and hetero-geneous evidence regarding study designs, intervention protocols, and outcome mea-sures, despite emerging findings suggesting favorable cardiovascular and metabolic adaptations when implemented through controlled protocols. Objective. To synthesize and critically appraise the available evidence on the effects of isometric exercise training on cardiovascular and metabolic outcomes in individuals with CAD. Method. A systematic search was conducted to identify randomized controlled tri-als (RCTs) published up to March 2026 in English, Portuguese, or Spanish. The databases searched included Scopus, Web of Science, PubMed, and Embase. Two independent reviewers performed the search, study selection, and data extraction. Methodological quality and risk of bias were assessed using the PEDro scale and the Cochrane Risk of Bias 2 (RoB 2) tool, respectively. Results. A total of 136 records were identified, of which thirteen met the eligibil-ity criteria. The included studies reported both chronic and acute effects. Positive chronic adaptations were observed in cardiac structure, blood pressure, and coronary perfusion, whereas acute effects during isometric exercise included increased coronary collateral flow, reduced time and medication requirements for stress echo-cardiography, significant post-exercise hypotension, and metabolic responses characterized by a predominant reliance on carbohydrates as the primary energy substrate. The methodological quality of the included studies ranged from fair to good, while the RoB 2 assessment indicated risks of bias ranging from low to high. Conclusion. Isometric exercise (IE) was well tolerated and demonstrated both chronic and acute benefits, supporting its potential to improve cardiovascular health and enhance the efficiency of diagnostic procedures in patients with CAD.

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Revista De Investigacion E Innovacion En Ciencias De La Salud

Título del artículo:

Obesity rise plateaus in developed nations and accelerates in developing nations

Global reporting of obesity is commonly based on comparisons over multiple decades¹ and lacks a granular and systematic analysis of its dynamics. We used 4,050 population-based studies with measured height and weight data on 232 million participants to assess the worldwide dynamics of obesity from 1980 to 2024. The rise in obesity decelerated in school-aged children and adolescents throughout the 1990s in many high-income countries, and subsequently plateaued in most at age-standardized prevalences spanning 20 percentage points, from 3–4% for girls in Japan, Denmark and France to 23% for boys in the USA. There were indications of a small decline in obesity in children and adolescents in some high-income western countries (for example, Italy, Portugal and France) since the 2000s. Similar trends were seen in some countries in Central and Eastern Europe. In adults, the rise in obesity slowed down in high-income western countries about a decade after children, followed by a plateau or possibly a small reversal of the rise in some countries (for example, Spain). In most low-income and middle-income countries, the annual absolute change in prevalence has remained stable or increased over time, even though prevalence has surpassed that of high-income countries. These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries, but require policy interventions in low-income and middle-income countries.

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Nature

Título del artículo:

A Hybrid Physics-Based and Data-Driven Framework for Predicting Water Velocities in a Draining Pipeline Using Pressurised Air

Draining operations using pressurised air can produce sub-atmospheric pressures that pose a significant risk to structural integrity, given the pipe stiffness class. This research presents a modelling strategy for predicting water velocities during the occurrence of this phenomenon. The proposed approach combines a physically based hydraulic formulation with machine learning techniques for making this prediction. A calibrated rigid water column model is first employed to reproduce the transient interaction between the expanding air phase and the draining water column. Input parameters include pipe bridge height varying from 0.5 to 3.0 m, a valve loss dimensionless coefficient ranging from 2.0 to 14.0, and an initial water column length between 163.0 and 286.3 m. Subsequently, a Monte Carlo scheme is used to generate a representative dataset. A total of 28 models were assessed, among which a wide neural network demonstrated superior predictive capability, achieving root-mean-square error values between 0.043 and 0.056 m/s and coefficients of determination ranging from 0.996 to 0.997 for the validation and testing stages, respectively. Sensitivity analyses indicate that the minor loss coefficient governs the water velocity response, whereas geometric features such as the pipe bridge height exert a comparatively minor influence.

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Water Switzerland

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Contributions of the PURE Study to the Definition of a Healthy Diet for the Prevention of Cardiovascular Diseases

Cardiovascular diseases (CVD) are currently the leading cause of mortality in Latin America and worldwide. The main population-attributable risk factors for CVD are hypertension, obesity, tobacco use, low muscular strength, and diabetes, while for overall mortality they are tobacco use, hypertension, low educational attainment, obesity, and diabetes. Most of these factors are related to diet and nutrition; therefore, this study reviews the evidence supporting the development of the PURE healthy diet, based on an analysis that included data from more than 245,000 individuals across 80 countries with high-, middle-, and low-income levels. Diet quality, with an emphasis on diversifying the intake of different protective food groups, is associated with up to a 30% reduction in the risk of death from any cause and a 20% reduction in the risk of developing cardiovascular diseases. The PURE healthy diet recom-mends adequate consumption of fruits, vegetables, nuts, legumes, fish, and whole-fat dairy products (non-skimmed). The recommendations of the PURE healthy diet should be considered in the development of food policies by governments, academia, the private sector, and civil society, in order to identify solutions that account for the complexity of food systems, as well as to increase the availability, acceptability, and access to and consumption of food groups identified as protective against the risk of developing CVD.

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Revista De Investigacion E Innovacion En Ciencias De La Salud

Título del artículo:

Access Barriers and Factors Associated With Incurring Out-of-Pocket Expenses in the Putumayo Department: An Analytical Study

Introduction. Out-of-pocket (OOP) expenses are costs that can become a barrier to accessing health services. Objective. To analyze barriers and factors associated with incurring OOP expenses related to health care in the Putumayo Department, Colombia. Methods. We conducted an analytical cross-sectional study of 784 adults who sought outpatient, inpatient, or emergency care. OOP expenditure was determined using a previously validated instrument administered by trained professionals. Descriptive analyses were followed by bivariate and multivariable logistic regression analyses. Results. Median age was 43 years [Q1: 30; Q3: 61], and median OOP expenditure was 100,000 Colombian pesos (COP) [Q1: 20,000; Q3: 210,000]. Belonging to a race other than mestizo, being enrolled in the special contributory regime, residing in rural or dispersed rural areas, visiting a general practitioner (GP), having been hospitalized in the past six months, and having diabetes mellitus (DM) or hypertension (HTN) were associated with higher odds of incurring OOP expenses. Conversely, being aged ≥50 years, having secondary, technical, or university education, and having visited the emergency department (ED) in the past six months were associated with lower odds of incurring such expenses. Conclusions. Belonging to a race other than mestizo, enrollment in the contributory regime, living in rural and dispersed rural areas, consulting a GP, hospitalization in the past six months, and DM and HTN were associated with a higher probability of having incurred OOP expenses. In contrast, age ≥50 years, secondary, technical, and university education, and ED use in the past six months were associated with a lower probability of incurring these expenses.

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Revista Gerencia Y Politicas De Salud

Título del artículo:

Adult-onset Still\'s disease presenting with atypical cutaneous findings: A case report and review of similar cases in Latin American patients

Most patients with adult-onset Still\'s disease (AOSD) present with an evanescent, salmon-colored exanthema that is more prominent during febrile peaks and is considered a major diagnostic criterion. However, over the past two decades, an increasing number of atypical cutaneous findings have been reported. Herein, we present a case of AOSD with atypical skin lesions in a Colombian woman and a review of similar cases in Latin American patients. A 21-year-old female was hospitalized for a 3-month history of intermittent fever, joint pain, and pruritic, erythematous rash. On admission, she exhibited polymorphous macules and papules (linear, urticarial) and lichenoid plaques accompanied by eyelid edema, all of which persisted after febrile peaks subsided. The patient fulfilled Yamaguchi\'s criteria for AOSD. A skin biopsy reported multiple apoptotic keratinocytes within the epidermis and a dermal perivascular inflammatory infiltrate. This histopathological pattern has been consistently associated with persistent pruritic eruptions (PPEs), which are characteristic of AOSD with atypical skin lesions. We searched six databases for AOSD cases with atypical cutaneous findings in Latin American patients. Altogether, there were 17 patients (76% female), of whom 14 underwent a skin biopsy: 42% of skin specimens exhibited distinct epidermal alterations compatible with PPEs, while the remaining 58% corresponded to urticaria, dermographism, or classic Still\'s disease rash. Our literature review showed that in Latin American patients with AOSD, atypical skin lesions can correspond to true PPEs but primarily to alternative diagnoses. A skin biopsy is a valuable tool for establishing a prompt diagnosis.

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Revista Colombiana De Reumatologia

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Unraveling the Phenotypes of Dyspnea and Leg Discomfort Symptoms During Exercise and Their Clinical Relevance: A Multicenter Real-Life Study in the Andean Region

Introdction: Dyspnea and other exertional symptoms are cornerstone elements in clinical practice, essential for diagnostic processes, risk stratification, and the effective management of respiratory diseases. Objectives: To investigate the intensity of dyspnea and leg discomfort during physical exercise and their relationships with multi-organ functional variables. Methods: A multicenter study involving 948 adult patients evaluated via integrated cardiopulmonary exercise testing (CPET). Results: Dyspnea at peak exercise showed a mean value of 6.1±3.1 and a median of 7 (IQR, 5). Leg discomfort presented a mean value of 6.3±3.1 and a median of 7 (IQR, 5). Symptoms of dyspnea and leg discomfort reached maximal intensity (i.e., 10 points) in 23% and 30% of patients, respectively, while the remaining participants exhibited submaximal symptom levels. Four phenotypes were identified at peak exercise: paucisymptomatic, peripheral, mixed, and dyspneic. These phenotypes were associated with a sequential and progressive impairment of peak work rate (Wpeak) and peak oxygen consumption (VO2peak), initially exhibiting a bimodal trend for leg discomfort and a subsequent linear inverse relationship with dyspnea. Conclusions: Four distinct phenotypes exist based on predominant exertional symptoms: paucisymptomatic, peripheral, mixed, and dyspneic. These are sequentially associated with increasingly severe grades of functional impairment. These findings warrant the orientation of rehabilitation strategies toward the specific limiting system predominantly responsible for the symptoms, thereby enhancing the therapeutic value of the intervention.

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Rehabilitacion

Título del artículo:

Ticagrelor vs. prasugrel in acute coronary syndrome: evidence from the POST-ISAR-REACT 5 era

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Revista Colombiana De Cardiologia

Título del artículo:

Insulin autoimmune syndrome (Hirata disease) with paradoxical insulin resistance: atypical presentation in a Colombian patient

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Endocrinologia Diabetes Y Nutricion

Título del artículo:

Latent tuberculosis in rheumatological patients on biologic therapy: methodological considerations and primary care perspective

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Reumatologia Clinica

Título del artículo:

Real-time degradation prognostics for proton exchange membrane fuel cells using a self-adaptive grey neural network model

Accurate prediction of performance degradation in proton exchange membrane fuel cells (PEMFCs) is essential for predictive maintenance and commercial viability. This task is challenged by data scarcity, complex operational noise, and highly dynamic conditions. Current data-driven models often require large datasets and lack adaptive optimization, compromising accuracy or efficiency. To overcome this, we propose a novel self-intelligent gradient descent search mechanism-driven grey neural network (SiGDSM-GNN). The model integrates grey system theory, adept at handling uncertain, limited data, with the nonlinear learning power of neural networks. Its key innovation is a self-intelligent mechanism that dynamically selects and adapts gradient descent strategies during training, significantly enhancing convergence and robustness. Extensive testing on three realistic PEMFC datasets—steady-state, dynamic loading with 5 kHz current ripples, and real-world vehicle operation—demonstrated superior performance. SiGDSM-GNN achieved a mean absolute percentage error of 0.11%, a noise-to-signal ratio of 0.005, and a prediction time of 0.005 s, outperforming benchmark models including optimization algorithms and deep learning hybrids. This work provides a highly accurate, data-efficient, and real-time capable framework for PEMFC degradation forecasting, advancing predictive maintenance strategies for cleaner energy systems.

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Journal of Power Sources

Título del artículo:

Siderophores in the Rhizosphere: Enhancing Plant Nutrition and Growth

Siderophores, high-affinity iron-binding molecules produced by microorganisms, play a crucial role in plant nutrition by facilitating the uptake of iron and other essential nutrients. Several studies have shown that microbial siderophore production enhances iron solubilization, thereby promoting plant growth and resilience under adverse conditions. Other microorganisms, such as endophytic bacteria, have also been proven effective in mobilizing nutrients within plants. Research has identified microbial strains efficient in siderophore production and explored their application in sustainable agricultural systems. However, large-scale production and application pose challenges, including siderophore stability across diverse soil conditions and formulation costs. Future studies should focus on optimizing microbial strains, developing effective formulations, and evaluating environmental impacts. Integrating siderophores into sustainable agricultural practices can reduce the dependency on chemical fertilizers, thereby improving soil health and crop productivity.

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Microbial Siderophores for Agricultural Productivity Perspectives of Use in Agriculture

Título del artículo:

Plant-mediated synthesis of silver nanoparticles from Moringa oleifera against ESKAPE pathogens

The emergence of multidrug-resistant ESKAPE pathogens underscores the urgent need for sustainable and effective disinfectant solutions. This study reports the green synthesis of silver nanoparticles (AgNPs) using an aqueous leaf extract of Moringa oleifera, with emphasis on the eco-friendly nature and biocompatibility of the resulting nanomaterials. Seven distinct AgNP formulations were obtained by systematically varying synthesis parameters — including temperature and Ag2SO4 and NaOH concentrations — yielding nanoparticles with differentially tunable physicochemical properties. Characterization by UV-visible spectroscopy, dynamic light scattering (hydrodynamic diameter and polydispersity index), zeta potential, and scanning electron microscopy confirmed nanoscale particle formation. Among the synthesized formulations, AgNP 3 exhibited the highest antibacterial activity against ESKAPE pathogens, with minimum inhibitory concentrations (MICs) ranging from 11 to 43.8 μg/mL. Pharmacological interaction analysis revealed additive effects between AgNPs 5 and 6 combined with chlorhexidine against Klebsiella pneumoniae. Furthermore, AgNP 3 inhibited biofilm formation by 49–81% across three bacterial species. In vitro cytotoxicity assays using murine fibroblasts demonstrated high biocompatibility (CC50 > 150 μg/mL), supported by favorable selectivity indices (>4.6). Collectively, these findings suggest that M. oleifera-derived AgNPs may provide a basis for the future development of antimicrobial, antibiofilm, and disinfectant agents targeting pathogens associated with healthcare-associated infections (HAIs).

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Microbial Pathogenesis

Título del artículo:

Heart Failure Among 173,000 Community-Dwelling Participants From 25 Low-, Middle-, and High-Income Countries in the PURE Study

Background: Most population studies examining heart failure (HF) have been conducted in Western high-income countries (HICs), with limited comparable data from lower-income settings. Objectives: The aims of this study were to describe differences in HF incidence and 30-day, 1-year, and 5-year case fatality rates among HF patients from countries at different income levels and in different global regions and to examine the impact of common and potentially modifiable risk factors for incident HF. Methods: This analysis of the PURE (Prospective Urban Rural Epidemiology) study included 172,653 individuals from 25 HICs, upper middle-income countries (UMICs), lower middle-income countries (LMICs), and low-income countries (LICs) and 8 geographic regions of the world, followed for a median of 15 years. Age- and sex-standardized HF incidence, as well as 30-day, 1-year, and 5-year HF case fatality, were compared by income group and by geographic region. The population attributable fractions (PAFs) for incident HF related to 13 cardiometabolic, lifestyle, socioeconomic, environmental, and psychosocial risk factors were also estimated. Results: The standardized rate of incident HF was 0.39 (95% CI: 0.36-0.41) per 1,000 person-years overall; the rate was highest in UMICs (0.58; 95% CI: 0.52-0.64), followed by HICs (0.36; 95% CI: 0.30-0.43), then LMICs (0.34; 95% CI: 0.30-0.38), and then LICs (0.26; 95% CI: 0.22-0.30). Among regions, the highest HF incidence was in sub-Saharan Africa (1.18; 95% CI: 0.95- 1.41) and Europe and Central Asia (0.86; 95% CI: 0.72-1.00) and lowest in South Asia (0.19; 95% CI: 0.15-0.22). Thirty-day case fatality was highest in LICs (59%) and lowest in HICs (11%); it was highest in South Asia (63%) and sub-Saharan Africa (63%) and lowest in North America (12%). Five-year case fatality after HF diagnosis was highest in LICs (77%) and lowest in HICs (28%); it was highest in South Asia (81%) and sub-Saharan Africa (75%) and lowest in North America (25%). More than 71% of the PAF for HF was attributable to the 13 modifiable risk factors studied, the largest being hypertension (PAF = 25%). Conclusions: HF incidence and associated mortality vary substantially across countries at different levels of economic development and by geographic region. Hypertension is the largest population-level risk factor for HF globally. Preventive measures, early diagnosis, and access to guideline-directed medical therapy should be prioritized to reduce global disparities in HF incidence and mortality.

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Journal of the American College of Cardiology

Título del artículo:

Validación de los criterios ASGE 2019 en pancreatitis biliar aguda: implicaciones clínicas para la indicación de CPRM y CPRE

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Gastroenterologia Y Hepatologia

Título del artículo:

Family and extrafamily dynamics in older adults with low pharmacological treatment adherence in a heart failure program in Santander, Colombia

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Atencion Primaria