Integration of artificial intelligence and precision oncology in Latin America

Next-generation medicine encompasses different concepts related to healthcare models and technological developments. In Latin America and the Caribbean, healthcare systems are quite different between countries, and cancer control is known to be insufficient and inefficient considering socioeconomically discrepancies. Despite advancements in knowledge about the biology of different oncological diseases, the disease remains a challenge in terms of diagnosis, treatment, and prognosis for clinicians and researchers. With the development of molecular biology, better diagnosis methods, and therapeutic tools in the last years, artificial intelligence (AI) has become important, because it could improve different clinical scenarios: predicting clinically relevant parameters, cancer diagnosis, cancer research, and accelerating the growth of personalized medicine. The incorporation of AI represents an important challenge in terms of diagnosis, treatment, and prognosis for clinicians and researchers in cancer care. Therefore, some studies about AI in Latin America and the Caribbean are being conducted with the aim to improve the performance of AI in those countries. This review introduces AI in cancer care in Latin America and the Caribbean, and the advantages and promising results that it has shown in this socio-demographic context

¿Contribuyen los talleres en el Museo de Ciencias a fomentar actitudes hacia la conservación del ambiente?

Esta investigación se centró en evaluar el impacto de seis talleres sobre la adopción de actitudes deseables respecto a la conservación del ambiente y la sostenibilidad, por parte de distintos públicos visitantes de un Museo Interactivo. La metodología incluyó: a) el diseño de escalas con cuatro opciones de respuesta que se aplicaron antes y después del taller b) entrevistas telefónicas o visita a instituciones educativas, dos meses después de la visita al Museo. El análisis cuantitativo mostró que las actitudes de los participantes mejoraron en todos los talleres aunque no siempre fue estadísticamente significativo. El análisis cualitativo reveló que los participantes mostraron actitudes de compromiso y cuidado hacia el ambiente. Algunas estuvieron asociadas a los talleres y otras a actitudes desarrolladas con anterioridad al taller.This research focused on assessing the impact of six workshops on the adoption of desirable attitudes about environmental conservation and sustainability, of different group visitors of an interactive museum. The methodology included: a) the design of four-option scales that were applied before and after the workshop b) either telephone interviews or visits to schools, two months after the visit to the museum. The quantitative analysis showed that the attitudes of the participants improved in all the workshops but not all of them were statistically significant. The qualitative analysis revealed that participants demonstrated attitudes of commitment and care towards the environment. Some of these attitudes were associated with the workshops and other associated with attitudes developed prior to the workshop

Human Papillomavirus Infection and Lung Cancer

Lung cancer continues to be the most common neoplasia and represents the leading cause of cancer-related death in the world. Nonetheless, contrary to expected projections, the decrease in incidence expected by decrease in tobacco exposure has been partially halted due to an increasing amount of lung cancer cases in nonsmokers, particularly in female patients. This led to the development of new hypotheses in terms of lung cancer etiology, including the involvement of oncogenic viruses such as the human papillomavirus (HPV). HPV role in the pathophysiology of lung cancer, including adenocarcinoma and squamous cell carcinoma, is currently under research. Exposure to HPV, and the resulting infection, can occur in several possible ways, including sexual transmission and airborne fomites. Main pathogenic occurrences include alterations in inhibition of p53 and retinoblastoma. This chapter presents the current evidence as to the role of HPV in the development of lung cancer, methods to establish HPV infection, and also explores the role of predisposing factors, as well as immunological and inflammatory factors in nonsmokers. Additionally, the role of other molecular factors, such as EGFR, interleukins 6 and 10, and others, is discussed. Finally, future perspectives in this new paradigm of lung cancer in nonsmokers are broadly reviewed

BREEDING BEHAVIOR OF A REINTRODUCED PAIR OF ANDEAN CONDOR (VULTUR GRYPHUS) IN THE CENTRAL ANDES OF COLOMBIA

Abstract · Between 1989–2013, 69 Andean Condors (Vultur gryphus) were reintroduced in eight sites in the Andes of Colombia. Due to the lack of monitoring programs, little is known about the ecology and biology of these reintroduced populations. We present the first observations on a reintroduced breeding pair. For 36 months, we examined the breeding behavior of a pair of condors in a nest cave in the central Andes of Colombia. In June 2013, we observed a chick of about 6–7 months of age in the nest cave. The most remarkable outcomes of these observations are (1) that females spend more time guarding the chick whereas (2) males focus on guarding the nest cave. While the chick was in the nest cave (80 h of observations), the female was present in the vicinity of the nest cave and attended the chick for a longer time period than the male. However, in the absence of a chick or eggs (880 h of observations), the male was observed more often in the vicinity of the nest cave than the female. Nevertheless, we found no significant differences in vigilance patterns between the sexes. Intraspecific interactions of the Andean Condor with other raptors in the area were recorded during the observation period of this study. We make some predictions on the timing of reproduction of condors based on this reintroduced pair in Colombia and compare them with those reported elsewhere. Tracking released populations of condors is essential to ensure the positive impact of reintroduction efforts. Resumen · Comportamiento reproductivo de una pareja reintroducida de Cóndor Andino (Vultur gryphus) en la cordillera Central de Colombia Entre 1989–2013, 69 individuos de Cóndor Andino (Vultur gryphus) fueron liberados en ocho núcleos de repoblación en la región andina de Colombia. Debido a la falta de seguimiento de estas liberaciones, se conoce poco sobre la biología y ecología de la especie en esos núcleos de repoblación. Presentamos la primera información de seguimiento del comportamiento reproductivo de una pareja en los núcleos de repoblación. Por un periodo de 36 meses examinamos el comportamiento reproductivo de esa pareja en un nido encontrado en la cordillera Central de Colombia. En junio de 2013 registramos la presencia de un polluelo de aproximadamente seis a siete meses de edad en el nido. Mientras el polluelo estuvo en el nido (80 h de observación), la hembra permaneció dentro de la vecindad e interactuó por más tiempo con el polluelo en comparación con el macho. En ausencia de polluelo o postura (880 h de observación), el macho permaneció dentro del territorio por un mayor número de horas en comparación con la hembra, aunque estas diferencias no fueron estadísticamente significativas. Registramos interacciones interespecíficas directas entre el Cóndor Andino y rapaces que ingresaron a su área de anidación. El seguimiento de las poblaciones de cóndor liberadas es clave para garantizar el impacto positivo de los esfuerzos de reintroducción como herramienta para la conservación

Point‑of‑care ultrasound in cardiorespiratory arrest (POCUS‑CA): narrative review article.

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcomepost-print2391 K

Conceptos Básicos sobre Estimulación Cardiaca

Desde que en 1.933 se implantara el primer marcapasos externo, seguido en 1.958 del primer implante de marcapasos definitivo, millones de pacientes se han beneficiado de este dispositivo con el fin de aumentar supervivencia, mejorar calidad de vida y tratar arritmias cardiacas que, sin este dispositivo, hubieran sido incompatibles con la vida. En el año 2.009 se implantaron en España 34.103 marcapasos, y más de 400.000 en el mundo. Se ha producido un cambio significativo no sólo en los generadores y electrodos, sino también en las indicaciones de estimulación, modos de estimulación y seguimiento a través de telemetría. Actualmente, la tecnología ha puesto a disposición de la ciencia médica grandes avances de ingeniería, aportando nuevos marcapasos fisiológicos que respetan la sincronía auriculoventricular lo que ha permitido mejorar la calidad de la vida, además de la supervivencia, minimizar las complicaciones postimplante y optimizar el tratamiento de las bradiarritmias

Productive and microeconomic evaluation of commercial sources of bovine somatotropin application in dairy cows

ABSTRACT: This study was proposed with the aim to analyze productive and microeconomic responses of holstein friesian cows that were treated with one of two commercial sources of recombinant bovine somatotropin (BST-r). Thirty cows form 1 to 4 parity and 60 to 180 days in milk (DIM) were evaluated. Daily milk production was recorded; incidence of mastitis and body condition score (BCS) were measured once a month. In addition, open days (OD) were measured in not pregnant cows at the begging of the study. Milk yield variable was analyzed by a completely randomized design with a factorial 2 x 3 x 7 arrangement plus a covariable. Factors considered in the model were: calving (primiparous or multiparous); hormone treatment: group 1, BST-r1 (500 mg) + vitamin E (1665 UI) + lecitine (166.5 mg), group 2, BST-r2 (500 mg), and control group without treatment; and time (application 3 to 9). DIM at the beginning of the study was used as a covariable. Open days (OD) variable was e by a completely randomized design with a 3 x 3 factorial arrangement. Factors considered in the model were parity (2, 3 or 4) and hormone treatment (with the same three levels above mentioned). The BCS variable was analyzed by the non-parametric Kruskal-Wallis method (five times). Hormone treatment or parity did not significantly differ (p > 0.05), although number of application (p 0.05). To perform the micro economical analysis, a one-year-projected-simulation was performed for each treatment group in order to establish a benefit/cost ratio, where BST-r2 treated group exhibited the best ratio. However, hormone treatment increased OD and induced economic losses in production process.RESUMEN: Con el objetivo de analizar el desempeño productivo y reproductivo de la aplicación de dos fuentes comerciales de somatotropina bovina recombinante (BST-r) se emplearon 30 vacas de la raza holstein friesian de 1 a 4 partos y entre 60 y 180 días en leche (DEL). Se midió la producción de leche (diaria), la incidencia de mastitis y la condición corporal (CC) (mensual), y en las vacas vacías el período abierto (PA). Para la producción de leche se utilizó un diseño completamente al azar con arreglo factorial 2 x 3 x 7 y una covariable, considerando como factores el parto (primíparas y multíparas); la hormona, grupo 1, BST-r1 (500 mg) + vitamina E (1665 UI) + lecitina (166.5 mg); grupo 2, BST-r2 (500 mg); y control, sin aplicación. El factor tiempo con siete niveles (aplicación 3 a 9). Los DEL al inicio del ensayo se tomaron como una covariable. Para evaluar el PA se utilizó un diseño completamente al azar con arreglo factorial 3 x 3, considerando como factores el número de parto (2, 3 y 4) y la hormona con los mismos tres niveles mencionados anteriormente. Los valores de CC fueron analizados por el método no paramétrico de Kruskal-Wallis, evaluando cinco momentos. La incidencia de mastitis se evaluó a partir de intervalos de confianza para la proporción de cuartos afectados con mastitis clínica y con grados de afección 1, 2 y 3 cruces. La hormona y los grupos de parto no tuvieron diferencias estadísticas significativas (p > 0.05), pero sí las aplicaciones (p 0.05). Se dedujo ausencia de diferencias significativas entre todos los intervalos obtenidos para mastitis. Para el análisis microeconómico, se realizó una simulación proyectada a un año para cada uno de los grupos considerados y se estableció la relación beneficio/costo, donde el grupo que recibió BST-r2 presentó la mejor relación. No obstante, el tratamiento con la hormona aumentó el PA y generó pérdidas en producción

Cost-utility analysis of genomic profiling in early breast cancer in Colombia

Antecedentes: En Colombia, la mejor estrategia para establecer la indicación de quimioterapia adyuvante en cáncer de mama temprano (CMT) sigue siendo desconocida. Este estudio tuvo como objetivo identificar la costo-utilidad de las pruebas Oncotype DX™ (ODX) o Mammaprint™ (MMP) para establecer la necesidad de quimioterapia adyuvante. Métodos: Este estudio utilizó un modelo de análisis de decisiones adaptado para comparar el costo y los resultados de la atención entre las pruebas ODX o MMP y la atención de rutina sin pruebas ODX o MMP (quimioterapia adyuvante para todas las pacientes) en un horizonte temporal de 5 años desde la perspectiva del Sistema Nacional de Salud de Colombia (SNS; pagador). Los insumos se obtuvieron de las tarifas nacionales de costos unitarios, la literatura publicada y la base de datos de ensayos clínicos. La población de estudio incluyó mujeres con CBE con receptores hormonales positivos (HR +), HER2 negativo, ganglios linfáticos negativos (LN0) con criterios clínicos de alto riesgo de recurrencia. Las medidas de resultado fueron el cociente coste-utilidad incremental descontado (ICUR; 2021 dólares estadounidenses por año de vida ajustado por calidad [AVAC] ganado) y el beneficio monetario neto (MBN). Se realizaron análisis de sensibilidad probabilísticos (APS) y determinísticos (ASD). Resultados: ODX aumenta los AVAC en 0,05 y MMP en 0,03 con un ahorro de 2374 $y 554$ en comparación con la estrategia estándar, respectivamente, y supusieron un ahorro en el plano coste-utilidad. El NMB para ODX fue de 2203 dólares y para MMP de 416. Ambas pruebas dominan a la estrategia estándar. El análisis de sensibilidad reveló que con un umbral de 1 producto interior bruto per cápita, ODX sería rentable en el 95,5% de los casos, frente al 70,2% de casos en los que se aplicó MMP.DSA mostró que la variable con influencia significativa era el coste mensual de la quimioterapia adyuvante. El PSA reveló que ODX era una estrategia sistemáticamente superior. Conclusiones: El perfil genómico mediante pruebas ODX o MMP para definir la necesidad de tratamiento quimioterapéutico adyuvante en pacientes con HR + y HER2 -EBC es una estrategia costo-efectiva que permite al SNS colombiano mantener el presupuesto. 2023, El Autor (es).Background: In Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy. Methods: This study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed. Results: ODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and$554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was$416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy. Conclusions: Genomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 −EBC is a cost-effective strategy that allows Colombian NHS to maintain budget. © 2023, The Author(s)

MONITORING THE SEVERITY AND VARIABILITY OF BROWN RUST (Puccinia melanocephala) IN SUGARCANE VARIETIES IN THE CAUCA VALLEY, COLOMBIA

Abstract THE VARIETIES CC 85-92 and CC 84-75 are grown on more than 80% of the area planted with cane in the Colombian sugar industry; these varieties were initially resistant to brown rust disease. Brown rust has been present in Colombia since 1979. Genetic variability in Puccinia melanocephala is thought to have affected resistance in some varieties through the appearance of what are thought to be new races of the pathogen. This situation has been observed in some resistant varieties (e.g. CC [85][86][87][88][89][90][91][92], where recently the disease has occurred at low severity. Therefore, an evaluation was made of the severity and possible variability of brown rust in the varieties selected by CENICAÑA in the Cauca River Valley. Samples were taken from plants from 1-14 months of age in the varieties CC 84-75, CC 85-92, CC 93-3895, CC 92-2804 and MZC 74-275 on 91 estates (10 sugar mills). On each plantation 20 stalks were selected at random, and the third leaf from the top visible dewlap leaf was taken from each stalk. Both disease reaction and severity were evaluated. Morphological and microscopic analyses of the structures found in the rust pustules were undertaken in leaf samples taken from each variety. Simultaneously, pathogen samples were collected and molecular techniques used (focusing on initiators of the ribosomal DNA (rDNA)) to detect possible genetic variation of P. melanocephala. The results showed that the disease reaction type in the varieties evaluated was 5 or less, with severities ranging from 0-12% leaf area affected. Variety MZC 74-275 showed susceptibility, with a reaction of 6 and a severity of 20% on the estates where it was evaluated. No differences were found among the morphological structures in the samples evaluated, all of which corresponded to P. melanocephala. The results obtained from the amplification of the ITS1 and ITS2 regions of the rDNA and from the PCR-RFLP did not show differences among the samples evaluated. These results could indicate that the variation of the pathogen is not reflected in its rDNA or that the molecular technique used was not sufficiently sensitive to detect small variations in the genome. Initial results about the presence or absence of gene Bru1 and susceptibility to brown rust are discussed

Multigene Mutation Profiling and Clinical Characteristics of Small-Cell Lung Cancer in Never-Smokers vs. Heavy Smokers (Geno1.3-CLICaP)

Objectives: Lung cancer is a heterogeneous disease. Presentation and prognosis are known to vary according to several factors, such as genetic and demographic characteristics. Small-cell lung cancer incidence is increasing in never-smokers. However, the disease phenotype in this population is different compared with patients who have a smoking history.Material and Methods: To further investigate the clinical and genetic characteristics of this patient subgroup, a cohort of small cell lung cancer patients was divided into smokers (n = 10) and never/ever-smokers (n = 10). A somatic mutation profile was obtained using a comprehensive NGS assay. Clinical outcomes were compared using the Kaplan-Meier method and Cox proportional models.Results: Median age was 63 years (46–81), 40% were men, and 90% had extended disease. Smoker patients had significantly more cerebral metastases (p = 0.04) and were older (p = 0.03) compared to their non-smoker counterparts. For never/ever smokers, the main genetic mutations were TP53 (80%), RB1 (40%), CYLD (30%), and EGFR (30%). Smoker patients had more RB1 (80%, p = 0.04), CDKN2A (30%, p = 0.05), and CEBPA (30%, p = 0.05) mutations. Response rates to first-line therapy with etoposide plus cisplatin/carboplatin were 50% in smokers and 90% in never/ever smokers (p = 0.141). Median overall survival was significantly longer in never smokers compared with smokers (29.1 months [23.5–34.6] vs. 17.3 months [4.8–29.7]; p = 0.0054). Never/ever smoking history (HR 0.543, 95% CI 0.41–0.80), limited-stage disease (HR 0.56, 95% CI 0.40–0.91) and response to first-line platinum-based chemotherapy (HR 0.63, 95% CI 0.60–0.92) were independently associated with good prognosis.Conclusion: Our data supports that never/ever smoker patients with small-cell lung cancer have better prognosis compared to their smoker counterparts. Further, patients with never/ever smoking history who present with small-cell lung cancer have a different mutation profile compared with smokers, including a high frequency of EGFR, MET, and SMAD4 mutations. Further studies are required to assess whether the differential mutation profile is a consequence of a diverse pathological mechanism for disease onset