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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

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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

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

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Revista Colombiana De Cardiologia

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

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Endocrinologia Diabetes Y Nutricion

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

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Reumatologia Clinica

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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

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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