Título del artículo:

Sedación paliativa en cuidado domiciliario

Introduction: The palliative sedation at home is a management alternative in the control of refractory symptoms of people in end-of-life, reducing the suffering of the sick person and his/her family. Materials and methods: It’s a quantitative, descriptive, number of cases study, based on the review of clinical records of patients who received subcutaneous palliative sedation treatment as part of end-of-life care in a Palliative care home program in Bucaramanga, Colombia. It’s shown absolute and relative frequencies for qualitative variables, and measures of central tendency for quantitative variables. Results: Most patients presented dyspnea as only refractory symptom at the end-of-life, a combination of morphine and midazolam was used in most cases, and the average duration from the onset of sedation to death was 1.72 days. Discussion: Unlike other studies, the proportion of patients with oncological and non-oncological diseases was equivalent, the dyspnea continues to be the main at end-of-life, patient death occurred in less than 48 hours, which ratifies the indication for palliative sedation.

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Medicina Paliativa

Título del artículo:

Delphi Consensus on the Use of Fenofibrate as Systemic Therapy for the Prevention of Diabetic Retinopathy Progression

Background: Diabetic retinopathy remains a leading cause of preventable blindness worldwide, yet screening and management practices vary widely. Evidence suggests that systemic therapies, including fenofibrate, may slow diabetic retinopathy progression, but their use is inconsistent across clinical settings. This study aimed to establish an evidence-informed consensus among endocrinology experts on the screening, diagnosis, and treatment of diabetic retinopathy, with a particular focus on recommendations for the use of systemic therapy to prevent disease progression. Methods: A modified three-round Delphi process was conducted with 19 endocrinology experts from diverse geographic regions. A core panel of 10 experts and an extended panel of 9 reviewed and rated 19 evidence-based statements. Consensus was defined as > 75% agreement. Results: All 19 statements achieved consensus, with 14 receiving > 80% agreement. The panel endorsed frequent diabetic retinopathy screening based on diabetes type and risk level, early initiation of fenofibrate in patients with mild to moderate non-proliferative diabetic retinopathy, and continued therapy to sustain retinal protection. Fenofibrate was recognized for its pleiotropic effects, and the experts agreed that the transient rise in serum creatinine with fenofibrate is not indicative of renal damage and should not prompt discontinuation. Conclusions: This consensus highlights the need for multidisciplinary care, coordinated pathways, and patient education in diabetic retinopathy care. It also offers unified, evidence-informed recommendations for endocrinologists for the early initiation of fenofibrate to reduce diabetic retinopathy progression. While further studies are needed, these findings offer a practical framework for improving diabetic retinopathy management globally.

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Journal of Diabetes

Título del artículo:

Advancing Cardiac Rehabilitation in Latin America: INSIGHTS FROM A BIBLIOMETRIC REVIEW

Purpose: – This study, based on a bibliometric analysis in the field of cardiac rehabilitation in Latin America, aims to (1) describe the number of publications per year, journal, country affiliation, and contributing authors; (2) identify collaborative networks; and (3) determine emerging research trends. Review Methods: – A defined search strategy was implemented in Scopus for documents indexed up to September 2023. The retrieved records were analyzed using VantagePoint software (Search Technology, 15.2) to extract activity indicators (publication frequency, countries, institutions, and authors), relationship indicators (coauthorship among countries and authors), and research trends through author-included keywords in each article. Summary: – A total of 124 records were selected. The highest publication frequency was observed between 2019 and 2023, with Brazil and Canada leading in publication counts. Regarding international collaboration, studies were frequently coauthored by institutions in Brazil, Canada, Colombia, and the United States. Most records associated cardiovascular rehabilitation with cardiovascular diseases (coronary disease), exercise, and questionnaires. This investigation offers insights that are instrumental in shaping the trajectory of future studies by analyzing publication patterns and identifying potential collaborative partners in the region. Through a detailed examination of bibliometric data, it sets a foundation for advancing research agendas and fostering partnerships in cardiac rehabilitation within Latin America.

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Journal of Cardiopulmonary Rehabilitation and Prevention

Título del artículo:

Recognising the family physician in asthma and COPD guidelines: a necessary step for effective primary care implementation

Asthma and chronic obstructive pulmonary disease (COPD) are the most prevalent chronic respiratory conditions globally, with management predominantly occurring in primary care settings. International guidelines from the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have been instrumental in standardising care; however, these documents consistently use generic terminology such as “primary care physician” or “healthcare provider” without explicitly recognising the family physician as a distinct medical specialty. This omission creates a conceptual gap that may undermine guideline ownership, implementation fidelity, and coordinated care pathways—particularly in low- and middle-income countries where family physicians constitute the backbone of chronic respiratory disease management. This letter argues that explicit recognition of family physicians in future GINA and GOLD updates, alongside inclusion of family medicine representatives in guideline development committees and creation of implementation toolkits for primary care settings, would strengthen guideline relevance, enhance primary care engagement, and ultimately improve respiratory health outcomes worldwide.

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Npj Primary Care Respiratory Medicine

Título del artículo:

Perceived stress, coping strategies and associated factors among Colombian undergraduate health science students

Background: Students involved in health sciences programs usually experience high levels of stress due to the academic loads, clinical responsibilities, and emotional demands from caring for patients. This situation can negatively impact student performance. In Latin America, few studies have investigated this problem. We sought to identify the prevalence of stress perceived by health science university students in northeastern Colombia, as well as the associated factors and the relationships between these factors and individual coping strategies. Methods: We conducted an analytic cross-sectional study involving 783 undergraduate students from thirteen academic programs in the health sciences. The students completed the Spanish versions of the Perceived Stress Scale (PSS-14) and the Brief Coping Orientation Problems Experienced Inventory (COPE-28). In addition, sociodemographic variables related to lifestyle and the academic environment were collected. Frequencies and proportions were calculated for the qualitative variables, and measures of central tendency and dispersion were calculated for the quantitative variables. A backward stepwise logistic regression analysis was performed to evaluate the association between covariates and perceived stress; this was not a causal study. A p value < 0.05 was considered to indicate statistical significance. Results: The median age of the participants was 21 years (interquartile range [IQR]: 20–25), and the sample included 550 (70.2%) females. The overall mean (± Standard deviations [SD]) PSS-14 score was 27.6 (± 7.5); additionally, high levels of perceived stress were reported by 345 (44.1%) students. Having a medication-taking routine (adjusted OR [AOR] = 2.43, 95% CI: 1.59–3.71) and attending a public university (AOR = 2.58, 95% CI: 1.60–4.15) were associated with high perceived stress, whereas male sex (AOR = 0.46, 95% CI: 0.32–0.66) and engaging in physical activity (AOR = 0.70, 95% CI: 0.51–0.96) were negatively associated (protective factors) with perceived stress. Regarding coping strategies, self-distraction (AOR = 1.15, 95% CI: 1.02–1.30), behavioral disengagement (AOR = 1.17, 95% CI: 1.03–1.32) and self-blame (AOR = 1.77, 95% CI: 1.54–2.03) increased the likelihood of high perceived stress, whereas the use of informational support (AOR = 0.82, 95% CI: 0.71–0.93), positive reframing (AOR = 0.86, 95% CI: 0.76–0.98), and planning (AOR = 0.76, 95% CI: 0.66–0.88) decreased the likelihood of high perceived stress. Conclusions: High perceived stress was reported by 44.1% of the participants. Students employed different coping strategies, in which context active coping exhibited the highest mean score and substance use exhibited the lowest mean score.

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BMC Medical Education

Título del artículo:

Parasporin-2-Derived Peptide Fragments: Characterization and Synergistic Anticancer Activity with Sacha Inchi and Curcumin

Background/Objectives: Parasporin PS2Aa1, recently designated as Mpp46Aa1, is recognized for its selective anticancer activity against various human cell lines. In this study, specific regions of the native protein were fragmented, and targeted amino acid substitutions were introduced to improve cytotoxic selectivity and potency. Methods: The modified fragments were evaluated individually and in combination with curcumin, a polyphenol with well-documented anticancer properties, and Sacha inchi-derived matrices, known for their antioxidant and antiproliferative activities. Results: Experimental results demonstrated that the substituted variant designated T104L-G108W exhibited superior anticancer activity compared to the native peptide P102-K11. Synergism assays revealed that curcumin-bioconjugated peptides were more effective against the tested cell lines, whereas combinations with Sacha inchi reduced cytotoxicity, suggesting possible interference in the mechanisms of action. Functional assays, including caspase 3/7 and 9 activation, Annexin V-Cy3 staining, and cell viability analysis with 6-CFDA, confirmed increased sensitivity in SiHa and HeLa cell lines, particularly for peptide T104L-G108W. Conclusions: Collectively, these findings support the effectiveness of a substitution-based strategy in improving parasporin fragments and underscore the therapeutic potential of peptide T104L-G108W as a novel anticancer candidate. Furthermore, this study provides preliminary evidence that natural biomolecules can be optimized through targeted modifications and rational combinations, establishing a framework for the development of sustainable and selective therapeutic approaches in cancer treatment.

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Cancers

Título del artículo:

Artificial Intelligence in Family Medicine: Opportunities, Challenges, and an Ethical Roadmap for its Implementation

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Revista Cubana De Medicina General Integral

Título del artículo:

Factors associated with disease severity in hospitalized children with Staphylococcus aureus infection

Staphylococcus aureus is a common cause of serious infections in children, with the incidence of methicillin-resistant Staphylococcus aureus (MRSA) rising in recent decades. To identify the factors associated with disease severity in pediatric patients hospitalized with S. aureus infection in high-complexity institutions in Santander, Colombia. A cross-sectional study was conducted among children under 18 years of age with S. aureus infection who were hospitalized (2018-21). Clinical characteristics and outcomes were compared between MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) infections. Factors associated with severity were identified through multivariate analysis with logistic and binomial regression. One hundred fifty-four cases of S. aureus infection were included, with 75 (48.7%) being MRSA. Among community-acquired infections, 55.7% (44/79) were caused by MRSA. Pediatric intensive care unit (PICU) admission was required in 55.8% of cases, and the infection-attributable case-fatality rate (CFR) was 1.9%. MRSA infections were associated with a greater need for vasopressor/inotropic support (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.05-4.04; P = .036). Persistent bacteremia was associated with an increased PICU admission (PR 1.72; 95%CI: 1.19-2.46), mechanical ventilation (PR 8.63; 95%CI: 3.16-23.54), and vasopressor/inotropic support (PR 11.06; 95%CI: 4.59-26.58). S. aureus infections showed a high prevalence of MRSA, with a notable proportion of community-acquired cases. More than half required admission to PICU, but the infection-attributable CFR was low. MRSA infections and persistent bacteremia were associated with disease severity. These findings support the use of timely antibiotic therapy and reinforce the need for infection prevention and control strategies.

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Journal of Tropical Pediatrics

Título del artículo:

GUIDELINES AND PARAMETERS OF COOPERATION BETWEEN RUSSIA AND COLOMBIA IN THE FIELD OF EDUCATION

The article is devoted to the analysis of the indicators and parameters of cooperation between Russia and Colombia in the field of education in the context of the changing geopolitical situation and the actualization of the foreign policy of the Russian Federation. The key factors determining the relevance of educational cooperation are considered, including the internationalization of Russian education as a tool of \"soft power\", the progressive educational policy of Colombia, as well as the potential of bilateral partnership in the scientific, cultural, and economic spheres. Modern trends and promising areas for the development of integration processes – from academic mobility to the creation of joint research and educational platforms – are identified. The research underlines the importance of inter-university cooperation as a strategic tool for the formation of sustainable Russian-Colombian relations.

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Iberoamerica Russian Federation

Título del artículo:

Physical activity, sedentary behavior and screen time in young toddlers (1–2 years old) attending Spanish ECEC institutions

Objectives: This study was designed with three primary objectives: (a) to evaluate the levels of physical activity (PA) and sedentary behavior (SB) in toddlers during the school day at ECEC institutions in Spain; (b) to establish the rate of adherence to specific recommendations for total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), sleep, and screen time; and (c) to characterize the relationship between individual and socioenvironmental correlates and toddlers’ TPA, light physical activity (LPA), MVPA, and SB during the school day. Methods: This study recruited 264 toddlers (14–23 months) via convenience sampling from public ECEC institutions across three cities. PA was quantified using ActiGraph accelerometry. Sleep behavior was evaluated using the Spanish version of the Brief Infant Sleep Questionnaire (BISQ-E), which was completed by parents. Parents reported their toddler’s average screen time. Results: (a) ECEC settings significantly contribute to young children achieving daily TPA recommendations (72%), despite high sedentary time (69%) during school hours. (b) Age positively correlated with LPA (β = 0.003, 95% confidence interval (CI) [CI 0.001, 0.005], p < 0.006), MVPA (β = 0.002, 95% CI [0.000, 0.003], p = 0.004]), and TPA (β = −0.005, 95% CI [0.002, 0.008], p = 0.001) and inversely with SB (β = −0.005, 95% CI [0.0082, 0.002], p = 0.001). (c) No associations were found for gender, BMI, or other personal and social factors with any PA/SB variables. (d) Most young children (64%) exceeded screen time recommendations, while sleep guidelines were largely met (81% adherence); however, no association was between these variables and PA and SB were found. (e) After ECEC hours, unstructured outdoor recreation was strongly preferred over structured activities, and visiting a park at least three times per week was associated with MVPA (β = −0.007, 95% CI [−0.015, 0.001], p = 0.05). Conclusion: Parents need to be aware of their influence on children’s media habits, and ECEC settings should develop strategies to reduce excessive screen time. A balanced approach to PA, reduced sedentary time, and limited screen exposure—alongside healthy sleep habits supported by such routines—is consistently linked in emerging evidence to better early childhood wellbeing.

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Frontiers in Education

Título del artículo:

LLMs on the Rise: Neuro-Symbolic AI for Knowledge Graph Construction in Manufacturing (Systematic Literature Review)

Numerous digitization activities in manufacturing led to an enormous increase in available, accessible data. Knowledge graphs (KGs) become increasingly popular in this domain as they show strengths in integrating different data sources and serve as a basis for downstream tasks. Yet, constructing a KG is still a challenging and time consuming process. Neuro-symbolic AI approaches, especially with powerful LLMs, have shown promising potentials in research and industry and can support KG construction. Nevertheless, KG construction with neural methods must be aware of, or ideally even handle, the inexplicability of results when applying the KG on manufacturing downstream tasks, e.g., on tasks of reliability- or safety-relevance. This makes it interesting to evaluate the utilization of neuro-symbolic AI and LLMs in KG construction in manufacturing. To the best of our knowledge, there is no systematic literature research on neuro-symbolic AI and LLMs in KGs in manufacturing, yet. Hence, this paper conducts a systematic literature review on neuro-symbolic AI and LLMs in KG construction in manufacturing. We show a solid increase of relevant publications on manufacturing KG construction and further show that BERT embeddings, RNN encodings, especially BiLSTM, CRF decodings, and, recently, LLMs, are common components of knowledge extraction from text documents to build KGs in manufacturing. With this systematic review we support both further research as well as industry application in this field. The main question to guide this review is “Which role play neuro-symbolic AI, especially LLM approaches in knowledge graph construction for manufacturing?”.

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IEEE Access

Título del artículo:

Beyond conventional skin grafts: dermal matrices and skin substitutes for deep burns: a systematic review

Background: Deep full-thickness burns are commonly treated with early excision and split-thickness skin grafts (STSG). However, limited dermal replacement may contribute to hypertrophic scarring and contractures. Dermal matrices and skin substitutes aim to provide a vascularizable neodermis that may improve scar quality and functional outcomes.We aimed to evaluate whether dermal matrices or skin substitutes provide superior scar quality, function, and safety compared with STSG in full-thickness burns. Methods: We conducted a systematic review following PRISMA guidelines. We searched MEDLINE/PubMed, Embase, and LILACS from inception through the pre-specified cutoff date. We included randomized controlled trials in adults and children with deep full-thickness burns comparing dermal matrices/skin substitutes (single-stage or two-stage approaches) versus conventional STSG alone/standard grafting. We did not pre-specify a fixed list of products; the interventions reviewed reflect those evaluated in eligible trials. Due to clinical and methodological heterogeneity, meta-analysis was not performed. Risk of bias was assessed using RoB 2. Results: Eight randomized controlled trials were included. In one trial, Novomaix + STSG delayed healing compared with STSG alone (graft take at 5–7 days: 80% vs. 95%; P = 0.003; time to closure: 28 vs. 16 days; P = 0.004). In adults treated with an electrospun PLGA bioveil, no significant differences were observed in graft take (99.0% ± 2.5 vs. 97.9% ± 7.0) or in VSS/POSAS scores at 12 months. In severe pediatric burns, Integra improved aesthetic outcomes at 12 months (Hamilton: 5.4 ± 1.7 vs. 7.7 ± 2.6; P = 0.003). Overall, most trials were judged at high risk of bias. Conclusions: Current evidence does not support routine use of dermal matrices over STSG in acute burn management. These technologies may be beneficial in selected settings (e.g., contracture reconstruction) or when combined with cellular approaches. Future multicenter randomized trials with standardized, long-term (≥ 12 months) functional and aesthetic outcomes are needed. Level of Evidence: Level I, therapeutic study.

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European Journal of Plastic Surgery

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Soluble Major Histocompatibility Complex I-Related Chain A (sMICA)*008 Levels Associate with Smoking, Presence of Chronic Obstructive Pulmonary Disease, and Prevalence of Lung Cancer

Background: Lung cancer and chronic obstructive pulmonary disease (COPD) are morbid and mortal conditions arising from noxious endothelial stress. Soluble Major Histocompatibility Complex I Chain Related A (sMICA) is an activating ligand for the NKG2C receptor, and the soluble form indicates endothelial stress and is a mechanism for evading immune surveillance in lung cancer. We provide independent associations between sMICA*008 levels and the prevalence of lung cancer, lung cancer histologies, COPD, and risk factors for both diseases. Methods: We describe statistical associations between sMICA and demographic and clinical variables. Multivariate linear regression determined the independent associations between sMICA levels and lung cancer histology, between those with and without primary lung cancer, and prevalent COPD in participants without lung cancer. Point estimates and 95% confidence intervals are reported; p < 0.05 is considered statistically significant. Results: The cohort (n = 586 patients) included 24% female and 48% current or former smokers. Mean sMICA were 5.20 pg/mL ×10², and FEV1%-predicted of 62. sMICA levels were higher in those who smoked vs. those who did not. In Multivariate regression, non-small cell lung cancer (NSCLC) was associated with 14.2 pg/mL ×10² (95% CI 3.57 to 24.9 pg/mL ×10²) higher sMICA levels compared to those without cancer. No other histology was independently associated with higher sMICA. Primary lung cancer [12.5 pg/mL ×10² (2.85 to 22.2 pg/mL ×10²)] and COPD in those without cancer [4.38 pg/mL ×10² (0.38 to 8.39 pg/mL ×10²)] were associated with higher sMICA. Conclusions: sMICA*008 is independently associated with NSCLC, primary lung cancer, and COPD, respectively, in a cohort of current, former, and never smokers with and without lung cancer. sMICA levels were also higher in smokers. This study provides a foundation for future studies on sMICA activity in lung cancer and COPD, and assessment of sMICA as a biomarker for lung cancer cell type and risk of lung function loss in COPD.

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Journal of Clinical Medicine