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Symmetrical calcifications in the basal ganglia. Fahr’s disease in an asymptomatic patient: a case report

Fahr’s disease, also known as idiopathic basal ganglia calcification is a rare neurologic condition characterized by bilateral and symmetric calcium deposits in deep brain structures such as the basal ganglia, thalamus, and cerebellum, and may also involve the cerebral cortex. The primary form, referred to as primary familial brain calcification, is typically inherited in an autosomal dominant pattern and has been associated with mutations in genes such as SLC20A2, PDGFB, and PDGFRB, which are involved in phosphate and calcium homeostasis and in the integrity of the blood-brain barrier. On the other hand, secondary forms of Fahr’s disease may result from metabolic disorders, particularly hypoparathyroidism, pseudohypoparathyroidism, and chronic disturbances in calcium and phosphorus metabolism. Although it may present with motor (parkinsonism, dystonia, chorea), cognitive (progressive dementia), or psychiatric symptoms (mood disorders, psychosis), a significant number of patients remain clinically silent and are diagnosed incidentally through neuroimaging. In the reported case, an adult woman was evaluated for occasional headaches, with no clinically relevant personal or family history and no objective neurologic abnormalities. Cranial computed tomography (CT) revealed extensive calcifications in the basal ganglia and subcortical white matter. Metabolic testing was normal, and genetic analysis identified a pathogenic variant in the SLC20A2 gene, confirming the diagnosis of primary Fahr’s disease. This case highlights the importance of considering this entity in the differential diagnosis of suggestive radiologic findings, even in the absence of overt symptoms. Regular clinical follow-up, neuropsychological assessment, and genetic counseling for family members are essential cornerstones of comprehensive care, given the potential for delayed onset of clinical manifestations.

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Horizonte Medico

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Cardiovascular risk assessment using a new score in a cohort with familial hypercholesterolemia from northwestern Colombia

Objective: To validate the predictive performance of a new cardiovascular risk stratification model in patients with familial hypercholesterolemia (FH) without a history of atherosclerotic cardiovascular disease (ASCVD) in a population from northwestern Colombia. Materials and methods: A prospective, single-center cohort study was conducted. Patients aged ≥ 18 years with a clinical or genetic diagnosis of FH, defined by the Dutch Lipid Clinic Network Score (≥ 6 points), and without a history of acute myocardial infarction, angina, ischemic stroke, or revascularization procedures were included. Follow-up spanned over 10 years, from 2014 to 2024. High cardiovascular risk in this cohort was defined according to the American Heart Association (AHA) recommendations, considering patients as high risk if they had FH plus additional risk factors—such as hypertension, active smoking, low high-density lipoprotein cholesterol (HDL-C) levels, or elevated lipoprotein(a) [Lp(a)] levels—even in the absence of previous clinical events. Baseline clinical and biochemical variables collected included age, sex, blood pressure, smoking status, HDL-C, low-density lipoprotein cholesterol (LDL-C), and Lp(a). The primary outcome was the occurrence of major adverse cardiovascular events (MACEs). Results: Cox regression models identified independent predictors of ASCVD, including hypertension (HR: 2.1; 95 % CI: 1.3–3.2), low HDL-C (< 40 mg/dL in men and < 50 mg/dL in women) (HR: 1.9; 95 % CI: 1.1–2.9), and elevated Lp(a) (> 50 mg/dL) (HR: 2.5; 95 % CI: 1.6–3.9). The new model, termed the Familial Hypercholesterolemia Risk Score (FH-Risk-Score), incorporated these variables along with persistently elevated LDL-C (> 190 mg/dL). Additionally, it demonstrated superior discriminatory capacity for predicting 10-year ASCVD risk, with a concordance index (C-index) of 0.75 (95 % CI: 0.71–0.78), compared with the Montreal Familial Hypercholesterolemia Score (Montreal-FH-SCORE) (C = 0.71) and the Risk Estimator from the SAFEHEART (Spanish Familial Hypercholesterolemia Cohort) Study (SAFEHEART-RE) (C = 0.63). Survival analysis using Kaplan–Meier curves revealed statistically significant differences in the cumulative incidence of cardiovascular events among the low-, moderate-, and high-risk groups defined by the new score (p < 0.001). Conclusions: The FH-Risk-Score demonstrated superior predictive performance in this cohort of FH patients without prior cardiovascular events. Its clinical utility lies in enhancing risk stratification, guiding lipid-lowering therapy intensification, and supporting personalized preventive strategies in high-risk populations in accordance with AHA criteria.

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Horizonte Medico

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Lagged effect of temperature and rainfall on malaria incidence in Colombia (2013–2023): An approach with Bayesian spatiotemporal adjustment

Malaria remains a major public health challenge in Colombia, with a significant increase in cases in recent years. Climate variables—particularly temperature and rainfall—are key drivers of malaria transmission, yet their lagged, non-linear effects across space and time are poorly characterized in the Colombian context. We conducted an ecological, spatiotemporal analysis using weekly malaria case data from 970 municipalities in Colombia (2013–2023) combined with satellite-derived climate data. We applied distributed lag non-linear models (DLNMs) embedded within a Bayesian hierarchical framework using integrated nested Laplace approximation (INLA) to estimate the delayed, non-linear associations between weekly temperature and rainfall and malaria incidence, while accounting for spatial and temporal autocorrelation, forest cover, multidimensional poverty, altitude, population size, and prior case counts. Our results show that malaria risk increases non-linearly with temperature, peaking around 28 °C, with a global exposure of minimum risk (EMR) at 16.43 °C, and significant effects observed at lags of 0–6 weeks. In contrast, lower weekly rainfall was associated with higher malaria risk, with an EMR at 0.85mm. Sensitivity analyses confirmed the robustness of these findings. These results challenge previous studies about climate-driven malaria risk and highlight accelerated transmission dynamics in Colombia’s endemic zones. The identification of specific climate thresholds linked to elevated malaria incidence provides actionable evidence for climate-informed early warning systems and targeted interventions to support malaria elimination efforts in Colombia.

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Plos Global Public Health

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Geothermal Energy from High-Water Production Zones in the Eastern Venezuela Basin: Simulation Results for Reservoirs in the Orinoco Oil Belt and North of Monagas State, Venezuela

Eastern Venezuela Basin is one of the world\'s most prolific hydrocarbon basins and an ecosystem where water management poses a significant challenge for energy production in Venezuela. Several studies have explored the management and utilization of water from this basin, particularly for improved/ enhanced oil recovery. However, the efficient use of produced water for geothermal energy extraction has not been thoroughly investigated. This article aims to evaluate the feasibility of applying geothermal energy extraction technologies in mature hydrocarbon reservoirs and high-water production wells through numerical simulation. Numerical simulations using 3D sector models were conducted for a high-temperature/high-pressure reservoir in North of Monagas state (140 °C) and in a cluster of wells in the Orinoco Oil Belt (50 °C), where high-water production wells were adapted to assess heat transfer and estimate the energy output from these reservoirs. Furthermore, this article presents a detailed analysis of the sources and composition of waters in Eastern Venezuela Basin hydrocarbon reservoirs, geologic context, geothermal gradients, and key factors influencing geothermal energy applications. It also examines selected geothermal techniques suitable for deep reservoirs in North of Monagas State and shallow reservoirs in the Orinoco Oil Belt, particularly in areas with high water cuts and wells with low commercial value, for geothermal energy generation. The findings of this study suggest that medium-shallow and deep high-temperature geothermal energy techniques, together with the use of water for alternative IOR/EOR processes and exploring hydrogen production and mineral extraction are potential scenarios for water management in the Eastern Venezuela Basin. Sensitivities of key parameters such as borehole depth, reservoir temperature, and circulating flow rate were taken into account during the simulation of geothermal scenarios. Current results emphasize the need for robust studies on geological and geophysical assessments to update geothermal gradients in Eastern Venezuela Basin, as well as physical and geochemical characterization of geothermal water sources. Additionally, for the generation of geothermal energy in this basin from high water production zones, it is crucial to account for physical and geochemical reactions, such as solid precipitation, scaling, acid gases management, and designing efficient underground-to surface heat transfer. These factors directly influence the efficiency, safety, and cost-effectiveness of geothermal applications This article explores the potential use of geothermal energy as an alternative approach for water management and energy generation in complex deep compositional reservoirs and shallow reservoirs with highly viscous crude oils. This study will serve as a reference for technical and economic feasibility assessments in other field applications. The outcomes of this work will help in determining suitable geothermal energy conversion technologies and conducting feasibility analysis for future geothermal energy production in Venezuela.

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SPE Annual Technical Conference Proceedings

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Impact of SARS-CoV-2 Infection on Pulmonary Function in the PURE-Colombia Cohort: A Comparative Analysis with Pre-COVID Values and Non-COVID-19 Controls

Background: The factors driving Coronavirus disease 2019 (COVID-19) severity and its long-term respiratory sequelae remain poorly understood. This study evaluates whether baseline lung function (LF) influences COVID-related clinical outcomes, mortality, and post-infection LF decline. Methods: Data from 602 participants in the Prospective Urban Rural Epidemiology (PURE)-Colombia study were analyzed. Among these, 200 with confirmed SARS-CoV-2 infection and 402 controls (65% women; 68% aged ≥60 years). All underwent baseline spirometry prior to 2010 and follow-up testing 1–40 months post-recovery. Among infected individuals, 51 (26%) died. Spirometric parameters Forced Expiratory Volume in 1 Second (FEV1), Forced Vital Capacity (FVC), and Peak Expiratory Flow (PEF) were compared using paired t-tests and Cohen’s d. Non-parametric data were compared using Wilcoxon s (z statistic). Results: Compared to baseline LF, hospitalized COVID-19 patients showed significant declines in follow-up LF: FEV1 (2.84 vs. 2.34 L; p = 0.002), FVC (3.01 vs. 2.53 L; p = 0.006), and PEF (399 vs. 328 L; p = 0.001). Non-hospitalized COVID-19 cases showed a non-significant downward trend, while controls maintained stable LF. Risk factors for post-COVID FEV1 < 80% predicted included hospitalization, elevated waist-to-hip ratio, and incomplete or absent COVID-19 vaccination. Moderate-to-high physical activity was protective. Post-COVID PEF < 80% predicted was associated with female sex, diabetes mellitus, and subsidized healthcare enrollment. Mortality risk was elevated among individuals with low baseline LF, age > 65, male sex, hypertension, obesity, low physical activity, and reduced handgrip strength. Conclusions: Significant LF decline was observed in hospitalized COVID-19 patients, with minimal changes in outpatients and controls. Identifying clinical and demographic predictors of post-COVID LF impairment may inform targeted interventions to mitigate long-term pulmonary complications.

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Journal of Clinical Medicine