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OBJECTIVE: To evaluate the discriminative ability and calibration of the RIETE, Kuijer, and HAS-BLED models for predicting 3-month bleeding risk in patients anticoagulated for venous thromboembolism (VTE). METHODS: External validation study of a prediction model based on a retrospective cohort of patients with VTE seen at the Hospital Universitario San Ignacio, Bogotá (Colombia) between July 2021 and June 2023. The calibration of the scales was evaluated using the Hosmer-Lemeshow test and the ratio of observed to expected events (ROE) within each risk category. Discriminatory ability was assessed using the area under the curve (AUC) of a ROC curve. RESULTS: We analyzed 470 patients (median age 65 years, female sex 59.3%) with a diagnosis of deep vein thrombosis in most cases (57.4%), 5.7% bleeding events were observed. Regarding calibration, adequate calibration cannot be ruled out given the limited number of events. The discriminatory ability was limited with an area under the curve (AUC) of 0.48 (CI 0.37-0.59) for Kuijer Score, 0.58 (CI 0.47-0.70) for HAS-BLED and 0.64 (CI 0.51-0.76) for RIETE. CONCLUSION: The Kuijer, HAS-BLED, and RIETE models in patients with VTE generally do not adequately estimate the risk of bleeding at three months, with a low ability to discriminate high-risk patients. Cautious interpretation is recommended until further evidence is available.

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BACKGROUND: Fever of unknown origin (FUO) is a diagnostic challenge with highly heterogeneous causes. Its etiology can change according to the studied regions, and the chance of reaching a diagnosis depends on available resources. The aim of this study is to describe the clinical characteristics, etiology and the usefulness of diagnostic aids in cases of FUO managed over 12 years in a Colombian reference center. METHODOLOGY: Single-institution retrospective case series. All cases of FUO between 2006 and 2017 were identified with the help of an electronic medical record search software. Cases of adults with fever for more than three weeks who remained undiagnosed after three days of hospitalization are described. RESULTS: Of 1,009 cases evaluated, 112 cases met the inclusion criteria (median age 43 years, 66% men). The etiologies identified were infectious (31.2%), inflammatory (20.5%), neoplastic (14.3%), and miscellaneous (2.7%) diseases. 31.2% remained without etiological diagnosis. The most frequent conditions were tuberculosis (17%), Hodgkin's lymphoma (7.1%), systemic lupus erythematosus (6.3%), disseminated histoplasmosis, and adult Still's disease. Contrast tomography and biopsies were the studies that most frequently supported or confirmed the final diagnosis. CONCLUSIONS: This series of contemporary Latin American cases suggests that the categories of FUO etiologies are similar to those reported in studies from developed countries, with tuberculosis being the most frequent cause in our setting. Our results highlight the importance of tomography-guided invasive studies in the diagnostic approach to FUO.

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PURPOSE: The healthcare system contributes approximately 5% of global greenhouse gas emissions, yet the environmental impact of radiotherapy treatments remains inadequately assessed. MATERIAL AND METHODS: We selected all breast cancer patients (1959 patients) treated with adjuvant radiotherapy between 2015 and 2023 in one institution. We analyzed the CO2 emissions associated with travel. We also selected 60 patients randomly to analyze treatment-associated carbon emissions. We compared three different fractionation schemes: normofractionation (25-30 fractions, fx), hypofractionation (15-18fx), and ultra-hypofractionation (5-6fx). RESULTS: Our study revealed a significant reduction in carbon emissions within the 5-fractions group compared to the 15-fractions group (26.69kg vs 57.13kg, p < 0.001), saving approximately the CO2 emissions associated with the electricity consumption of an average Spanish household for 12 days, or the emissions of a passenger flying from Madrid to Barcelona. CONCLUSION: Most of the carbon footprint of radiotherapy is due to travel. Hypofractionation could be an appropriate solution to protect the environment.

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Introduction: There are multiple mechanisms by which HbA1c values can be altered in chronic kidney disease (CKD), which limits its usefulness as a strategy to assess glycemic control in this population. Methods: Concordance and agreement study between two diagnostic tests: HbA1c and glucose management indicator (GMI) measured by intermittently scanned continuous glucose monitoring (isCGM), based in a prospective cohort of patients with diabetes, CKD (glomerular filtration rate between 15 and 60 ml/min/1.73 m²), and anemia. The isCGM was performed for 3 months, and the GMI was compared with the HbA1c levels taken at the end of isCGM. Agreement was evaluated using Bland-Altman graph analysis and Lin's concordance correlation coefficient (CCC). The concordance of the measures with good glycemic control (<7%) was also evaluated. Results: A total of 74 patients were enrolled (median age 68.5 years, 51.3% female, 64.9% with CKD stage 3, hemoglobin 11.1 ± 1.2 g/l). The Bland-Altman analysis shows a mean difference between GMI and HbA1c of 0.757 ± 0.687% (95% limits of agreement: -0.590 and 2.105). Difference was greater as the values of GMI and HbA1c increased. The agreement was poor [CCC 0.477; 95% confidence interval (CI): 0.360-0.594], as well as the concordance of values with good glycemic control according to GMI versus HbA1c (67.5% versus 29.7%, p < 0.001) (Kappa 0.2430; 95% CI: 0.16-0.32). Conclusion: The HbA1c overestimates the GMI values with highly variable ranges of difference, which prevents a precise correction factor. isCGM probably is a safer option for monitoring and decision-making in this population, especially in patients treated with insulin where the risk of hypoglycemia is greater.

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INTRODUCTION: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. OBJECTIVE: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. MATERIALS AND METHODS: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometricfindings before and after 10 biofeedback sessions. RESULTS: 21 patients were included(71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence.Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapysignificantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. CONCLUSIONS: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipationand fecal incontinence; in our center, the response is similar to that of the world literature.

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Lupus enteritis denotes inflammation of the intestinal walls resulting from the influence of systemic lupus erythematosus. It represents a rare manifestation associated with notable morbidity and mortality, marked by nonspecific gastrointestinal symptoms. In this article, we present two cases of individuals experiencing severe gastrointestinal symptoms. They had a personal or familial history of autoimmunity with intestinal involvement consistent with the presentation of lupus enteritis. Following treatment with glucocorticoids and immunomodulators, both patients exhibited a satisfactory clinical evolution. While lupus enteritis remains an uncommon occurrence, its clinical significance is undeniable. Hence, it is imperative to maintain a high level of clinical suspicion to facilitate prompt diagnosis and treatment.

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Introducción: En el envejecimiento los cambios en la composición corporal se asocian con la salud y la funcionalidad. Objetivo: Determinar las características antropométricas y condición física de adultos mayores físicamente activos de la ciudad de Armenia. Materiales y método: Estudio descriptivo transversal, la valoración de la composición corporal se realizó siguiendo las indicaciones de la Sociedad Internacional de Avances en Cineantropometría, y la condición física se determinó a través de la batería Senior Fitness Test (SFT). Resultados: Se evaluaron 468 adultos mayores. En las mujeres la estatura y masa promedio fue de 1,56 m y 69,46 kg respectivamente, mientras que en los hombres el promedio fue de 1,67 m para la estatura y de 78, 29 kg para la masa. Las mujeres presentaron mayores porcentajes a nivel adiposo con respecto al muscular, ocurriendo lo contrario en los hombres, finalmente la condición física estuvo por debajo del rango normal de referencia de la batería SFT. Conclusión: En general, los adultos mayores presentaron sobrepeso, además, los diferentes indicadores evaluados tales como índice cintura cadera, índice de masa muscular, perímetro abdominal, entre otros, ponen en manifiesto que están en riesgo de moderado a altos, según la OMS, de padecer enfermedades crónicas no trasmisibles.

Introduction: Changes in body composition in aging populations are associated with their health and functionality. Objective: To determine the anthropometric characteristics and physical condition of physically active older adults from the city of Armenia. Materials and methods: A descriptive cross-sectional study. The assessment of the body composition was conducted following the guidelines of the International Society for the Advancement in Kinanthropometry. The Senior Fitness Test (SFT) battery was used to evaluate physical condition. Results: 468 older adults were evaluated. The mean height and body mass were 1.57 m and 69.46 kg for women, respectively, while the mean values for male participants were 1.67 m and 78.29 kg. Female older adults had higher percentages of adipose tissue respect to muscle tissue, whereas male participants showed the opposite pattern. Finally, physical condition was below the normal reference range of the SFT battery. Conclusion: In general terms, older adults were overweight. Based on the WHO guidelines and the various analyzed indicators (waist-hip ratio, muscle mass index, abdominal circumference, among others), older adults are at a moderate-high risk to suffer chronic non-communicable diseases.

Introdução: No envelhecimento, as alterações na composição corporal estão associadas à saúde e à funcionalidade. Objetivo: determinar as características antropométricas e a condição física de idosos fisicamente ativos na cidade da Armênia. Materiais e método: Estudo descritivo transversal, a avaliação da composição corporal foi realizada seguindo as indicações da Sociedade Internacional para Avanços em Cineantropometria, e a condição física foi determinada através da bateria Senior Fitness Test (SFT). Resultados: Foram avaliados 468 idosos. Nas mulheres, a média de altura e massa foi de 1,56 m e 69,46 kg respectivamente, enquanto nos homens a média foi de 1,67 m para altura e 78,29 kg para massa. As mulheres apresentaram maiores percentuais de nível adiposo em relação ao músculo, o oposto ocorreu nos homens; por fim, a condição física ficou abaixo da faixa de referência normal da bateria SFT. Conclusão: Em geral, os idosos apresentaram excesso de peso; além disso, os diferentes indicadores avaliados como relação cintura-quadril, índice de massa muscular, circunferência abdominal, entre outros, mostram que eles estão em risco moderado a alto, segundo a OMS de sofrem de doenças crônicas não transmissíveis.

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INTRODUCTION: Currently there is little information in Latin America on the clinical outcome and manometric evolution of patients with Achalasia undergoing peroral endoscopic myotomy (POEM). PRIMARY OUTCOME: Evaluate the manometric and clinical changes in adult patients with achalasia after peroral endoscopic myotomy at a referral center in Bogotá, Colombia. METHODS: Observational, analytical, longitudinal study. Adult patients with achalasia according to the Chicago 4.0 criteria were included. Sociodemographic, clinical and manometric variables were described. To compare the pre- and post-surgical variables, the Student's or Wilcoxon's t test was used for the quantitative variables according to their normality, and McNemar's chi-square for the qualitative variables. RESULTS: 29 patients were included, 55.17% (n=16) women, with a mean age at the time of surgery of 48.2 years (±11.33). The mean post-procedure evaluation time was 1.88±0.81 years. After the procedure, there was a significant decrease in the proportion of patients with weight loss (37.93% vs 21.43% p 0.0063), chest pain (48.28% vs 21.43, p 0.0225) and the median Eckardt score (8 (IQR 8 -9) vs 2(IQR 1-2), p <0.0001). In addition, in fourteen patients with post-surgical manometry, significant differences were found between IRP values (23.05±14.83mmHg vs 7.69±6.06mmHg, p 0.026) and in the mean lower esophageal sphincter tone (9.63±7.2mmHg vs 28.8±18.60mmHg, p 0.0238). CONCLUSION: Peroral endoscopic myotomy has a positive impact on the improvement of symptoms and of some manometric variables (IRP and LES tone) in patients with achalasia.

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RESUMEN Introducción: El tratamiento de los trastornos funcionales de la unidad anorrectal debe centrarse en la causa subyacente. La terapia de biorretroalimentación es un reentrenamiento funcional del suelo pélvico que ha demostrado su utilidad en el tratamiento del estreñimiento asociado a la disinergia y en el manejo de la incontinencia fecal. Este estudio describe las primeras experiencias con esta forma de terapia de biorretroalimentación en Colombia. Objetivo: Describir nuestra experiencia con la terapia de biorretroalimentación en la unidad de neurofisiología gastrointestinal. Materiales y métodos: Esta cohorte histórica incluyó pacientes con indicación de terapia de biorretroalimentación por estreñimiento o incontinenciafecalenlaunidaddeneurofisiologíagastrointestinalenelperiododerecolección de datos. Se describe la respuesta a la terapia comparando los hallazgos manométricos antes y después de 10 sesiones de biorretroalimentación. Resultados: Se incluyó a 21 pacientes (71,4% mujeres, el promedio de edad fue de 68, 9 con estreñimiento y 12 con incontinencia fecal. Entre los pacientes con estreñimiento hubo una mejoría significativa en el 71,4% de los que tenían hiposensibilidad rectal y en el 57,1% de los que tenían disinergia. La terapia de biorretroalimentación aumentó significativamente la tasa de expulsión del balón (11,1 frente a 66,7%, p=0,02). En pacientes con incontinencia fecal, hubo mejoría en el 50% de los que tenían hipotonía anal y en el 80% de los que tenían hiposensibilidad anal. Conclusiones: Este estudio demuestra que la terapia de biorretroalimentación tiene un impacto favorable en un alto número de pacientes con estreñimiento e incontinencia fecal, en nuestro centro, la respuesta es similar a la de la literatura mundial.

ABSTRACT Introduction: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. Objective: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. Materials and methods: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometric findings before and after 10 biofeedback sessions. Results: 21 patients were included (71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence. Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapy significantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. Conclusions: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipation and fecal incontinence; in our center, the response is similar to that of the world literature.

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Introduction: Artificial intelligence has presented exponential growth in medicine. The ChatGPT language model has been highlighted as a possible source of patient information. This study evaluates the reliability and readability of ChatGPT-generated patient information on chronic diseases in Spanish. Methods: Questions frequently asked by patients on the internet about diabetes mellitus, heart failure, rheumatoid arthritis (RA), chronic kidney disease (CKD), and systemic lupus erythematosus (SLE) were submitted to ChatGPT. Reliability was assessed by rating responses as (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, (4) completely incorrect, and divided between "good" (1 and 2) and "bad" (3 and 4). Readability was evaluated with the adapted Flesch and Szigriszt formulas. Results: And 71.67% of the answers were "good," with none qualified as "completely incorrect." Better reliability was observed in questions on diabetes and RA versus heart failure (p = 0.02). In readability, responses were "moderately difficult" (54.73, interquartile range (IQR) 51.59-58.58), with better results for CKD (median 56.1, IQR 53.5-59.1) and RA (56.4, IQR 53.7-60.7), than for heart failure responses (median 50.6, IQR 46.3-53.8). Conclusion: Our study suggests that the ChatGPT tool can be a reliable source of information in spanish for patients with chronic diseases with different reliability for some of them, however, it needs to improve the readability of its answers to be recommended as a useful tool for patients.