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Resumen: El pueblo Kankuamo es uno de los 102 pueblos originarios de Colombia, que se encuentran en el proceso de desarrollo de estrategias para la autogestión de salud individual y colectiva. Este artículo tiene como objetivo investigar, identificar y analizar, de forma colaborativa e intercultural, los factores que influyen en el bienestar del pueblo Kankuamo, utilizando el Enfoque de Capacidades propuesto por Amartya Sen. Con este fin, se llevaron a cabo tres grupos focales con la participación de 37 personas de las 15 comunidades del resguardo Kankuamo. Las transcripciones fueron analizadas mediante un análisis temático. De los grupos focales surgieron tres temas centrales para el bienestar de los Kankuamo: (i) armonía entre la naturaleza y los seres humanos, (ii) convivencia social y (iii) autodeterminación. Estos temas reflejan los principios y valores fundamentales que guían a la comunidad hacia el bienestar, la expansión de sus capacidades, la armonía y el desarrollo integral. Los resultados sugieren que los aspectos materiales desempeñan un papel secundario en el concepto de bienestar de la comunidad Kankuamo, y además confirman que es fundamental considerar una visión colectiva de capacidades, no solo individuales, en contextos indígenas. Estudios como este pueden contribuir al desarrollo de enfoques más contextualmente apropiados para evaluar y medir la calidad de vida y el bienestar de las comunidades indígenas, incluyendo el pueblo Kankuamo.

Abstract: The Kankuamo people are one of the 102 native peoples of Colombia, who are developing strategies for individual and collective health self-management. This article aims to investigate, identify and analyze, collaboratively and interculturally, the factors that influence the well-being of the Kankuamo people, using the Capabilities Approach proposed by Amartya Sen. To this end, three focus groups were conducted with the participation of 37 people from the 15 communities of the Kankuamo reservation. The transcripts were analyzed by means of a thematic analysis. Three central themes for the well-being of the Kankuamo emerged from the focus groups: (i) harmony between nature and human beings, (ii) social coexistence and (iii) self-determination. These themes reflect the fundamental principles and values that guide the community towards a good life, expansion of their capabilities, harmony and holistic development. The results suggest that material aspects play a secondary role in the Kankuamo community's concept of good life, and confirm that it is fundamental to consider a collective vision of capabilities, not only individual ones, in indigenous contexts. Studies such as this one can contribute to the development of more contextually appropriate approaches to assess and measure the quality of life and well-being of Indigenous communities, including the Kankuamo people.

Resumo: O povo Kankuamo é um dos 102 povos indígenas da Colômbia que estão em processo de desenvolvimento de estratégias para a autogestão da saúde individual e coletiva. Este artigo tem como objetivo investigar, identificar e analisar, de forma colaborativa e intercultural, os fatores que influenciam o bem-estar do povo Kankuamo, usando a Abordagem de Capacidades proposta por Amartya Sen. Para isso, foram realizados três grupos focais com a participação de 37 pessoas das 15 comunidades da reserva Kankuamo. Análise temática foi usada nas transcrições. Três temas centrais para o bem-estar dos Kankuamo emergiram dos grupos focais: (i) harmonia entre a natureza e os seres humanos, (ii) coexistência social e (iii) autodeterminação. Esses temas refletem os princípios e valores fundamentais que orientam a comunidade para o bem-estar, a expansão de suas capacidades, a harmonia e o desenvolvimento integral. Os resultados sugerem que os aspectos materiais desempenham um papel secundário no conceito de bem-estar da comunidade Kankuamo e confirmam ainda que é essencial considerar uma visão coletiva das capacidades, e não apenas individual, em contextos indígenas. Estudos como este podem contribuir para o desenvolvimento de abordagens mais adequadas ao contexto para avaliar e medir a qualidade de vida e o bem-estar das comunidades indígenas, incluindo o povo Kankuamo.

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Up to 40% of rare disorders (RD) present facial dysmorphologies, and visual assessment is commonly used for clinical diagnosis. Quantitative approaches are more objective, but mostly rely on European descent populations, disregarding diverse population ancestry. Here, we assessed the facial phenotypes of Down (DS), Morquio (MS), Noonan (NS) and Neurofibromatosis type 1 (NF1) syndromes in a Latino-American population, recording the coordinates of 18 landmarks in 2D images from 79 controls and 51 patients. We quantified facial differences using Euclidean Distance Matrix Analysis, and assessed the diagnostic accuracy of Face2Gene, an automatic deep-learning algorithm. Individuals diagnosed with DS and MS presented severe phenotypes, with 58.2% and 65.4% of significantly different facial traits. The phenotype was milder in NS (47.7%) and non-significant in NF1 (11.4%). Each syndrome presented a characteristic dysmorphology pattern, supporting the diagnostic potential of facial biomarkers. However, population-specific traits were detected in the Colombian population. Diagnostic accuracy was 100% in DS, moderate in NS (66.7%) but lower in comparison to a European population (100%), and below 10% in MS and NF1. Moreover, admixed individuals showed lower facial gestalt similarities. Our results underscore that incorporating populations with Amerindian, African and European ancestry is crucial to improve diagnostic methods of rare disorders.

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El sistema intestinal posee una capacidad regenerativa intrínseca y fisiológica que tiene lugar a partir de las células madreLgr5+ ubicadas en el fondo de las criptas intestinales, las cuales se diferencian hacia las células progenitoras secretoras y absortivas con sus respectivas células especializadas mediante la activación de señalizaciones intracelulares como Wnt, Hippo y Notch. Condiciones adversas como lesiones e infecciones tisulares inducen esta actividad regenerativa promovida por variados mecanismos que influyen en el microambiente celular. El sistema inmunológico detecta alteraciones en el tejido intestinal y, a través de la activación de células inmunocompetentes y la secreción de citoquinas proinflamatorias, favorece la desdiferenciación de células especializadas hacia células madre para desencadenar la respuesta regenerativa. En cuanto al sistema nervioso entérico, su influencia está sujeta a modificaciones en la microbiota y los hábitos alimenticios, y se encuentra determinada en gran parte, por las células gliales entéricas y la expresión de distintos marcadores de plasticidad, que permiten limitar la lesión y reparar el tejido. Por su parte, la epigenéticamodifica la expresión genética y consecuentemente, la capacidadregenerativa intestinal, variando de acuerdo a cada paciente porla influencia de factores externos como la dieta o el estadopsicobiológico. De esta forma, la respuesta regenerativa intestinalinducida por lesiones, integra múltiples mecanismos y poseeimportantes repercusiones clínicas en cuanto a EII, disbiosise incluso tumorogénesis; conocer los mecanismos que regulanesta actividad puede sentar las bases para la creación de terapias innovadoras en el mismo ámbito(AU)

The intestinal system has an intrinsic and physiological regenerative capacity that takes place from the Lgr5+ stem cells located at the bottom of the intestinal crypts, which differentiate into secretory and absorptive progenitor cells with their specialized cells by activating intracellular signalslike Wnt, Hippo and Notch. Adverse conditions such asinjuries and tissue infections induce this regenerative activity promoted by various mechanisms that influence the cellular microenvironment. The immune system senses disturbances in the intestinal tissue and, through the activation of immunocompetent cells and the secretion of proinflammatorycytokines, favors the dedifferentiation of specialized cells intostem cells to trigger the regenerative response. Regarding theenteric nervous system, its influence is subject to modificationsin the microbiota and dietary habits, and is largely determinedby enteric glial cells and the expression of different plasticitymarkers, which enable to limit injuries and repair tissue. On the other hand, epigenetics modifies genetic expressionand, consequently, intestinal regenerative capacity, varying according to each patient due to the influence of external factors such as diet or psychobiological status. There fore, the intestinal regenerative response induced by lesions integrates multiple mechanisms and has important clinical repercussions in terms of IBD, dysbiosis, and even tumorigenesis; knowing themechanisms that regulate this activity can lay the foundations for the creation of innovative therapies in the same field (AU)

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La viruela símica es una enfermedad que ocurre en los monos, sin embargo también se han presentado casos en humanos desde 1970, transformándose en una zoonosis de origen viral, la sintomatología es similar a la viruela pero menos grave. Objetivo: Proporcionar información actualizada sobre la viruela símica, situación epidemiológica, sintomatología, letalidad, diagnóstico, tratamiento y medidas de prevención Materiales y métodos: Se realizó una búsqueda de literatura científica en las bases de datos Organización Mundial de la Salud, Google Académico y PubMed, se eligieron los descriptores o palabras relacionadas con la enfermedad y se realizó la búsqueda para la descripción de reportes de casos y brotes producidas por la viruela símica. Resultados: Desde que se reportó el primer caso en humanos, han existido brotes en el continente africano, fuera de éste, se han reportados varios casos y brotes en otros países, la mayoría en los Estados Unidos. El último evento se reporta en mayo de 2022 y es de preocupación mundial, debido a la aparición en varios países no endémicos. Conclusiones: La presencia de casos de viruela símica en humanos se ha mantenido desde su aparición, la ausencia de un tratamiento específico y vacunas autorizadas para su administración, podrían generar un aumento en la morbimortalidad(AU)

Monkeypox is a disease that occurs in monkeys, however there have also been cases in humans since 1970, becoming a zoonosis of viral origin, the symptoms are similar to smallpox but less severe. Objective: To provide updated information on monkeypox, epidemiological situation, symptomatology, lethality, diagnosis, treatment and prevention measures. Materials and methods: A search of scientific literature was carried out in the World Health Organization, Google Scholar and PubMed databases. , the descriptors or words related to the disease were chosen and the search was performed for the description of case reports and outbreaks caused by monkeypox. Results: Since the first human case was reported, there have been outbreaks on the African continent, outside of Africa, several cases and outbreaks have been reported in other countries, most in the United States. The last event is reported in May 2022 and is of global concern, due to the appearance in several non-endemic countries. Conclusions: The presence of cases of monkeypox in humans has been maintained since its appearance, the absence of a specific treatment and vaccines authorized for its administration, could generate an increase in morbidity and mortality(AU)

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BACKGROUND: Estimating the burden of rheumatic diseases (RDs) requires proper evaluation of its lethal and nonlethal consequences. In Colombia, it is possible to find local data and Global Burden of Disease (GBD) reports that collect information from varied contexts and apply complex statistical models, but no on-site estimations are available. METHODS: This was a descriptive study on the burden of RD based on occurrence and mortality data in the general population during 2015, including information and prevalence estimations from the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) study. Disability-adjusted life years (DALYs) were estimated by combining measures of years of life lost (YLL) and years lived with disability (YLDs). For disability weight estimations among cases, different COPCORD responses were mapped using flowcharts to show the severity distribution according to GBD. All model parameters and results were validated through an expert consensus panel. RESULTS: Low back pain (LBP) was the RD with the greatest burden of disease, costing 606.05 (95% CI 502.76-716.58) DALYs per 100,000 inhabitants, followed by osteoarthritis (292.11; 95% CI 205.76-386.85) and rheumatoid arthritis (192.46, 95% CI 109.7-239.69). CONCLUSIONS: The burden of RD is as high in Colombia as in other countries of the region. The results offer an interesting tool for optimizing healthcare system design as well as for planning the distribution of human and economic resources to achieve early diagnosis and adequate care of these diseases.

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Mosquito-borne pathogens have spread throughout tropical regions of the Western Hemisphere causing increased burden of disease in the region. Outbreaks of dengue fever, yellow fever, chikungunya, West Nile, and Zika have occurred over the past several years. Mosquito blood-feeding patterns need to be assayed to assist in determining which vertebrates could act as hosts of these mosquito-borne pathogens and which mosquito species could act as vectors. We conducted bloodmeal analyses of mosquitoes collected at Lomas Barbudal Biological Reserve, a dry tropical forest reserve in Costa Rica. Mosquitoes were collected using backpack aspirators and light, gravid, and resting traps, and then identified morphologically. Blood-fed mosquitoes underwent DNA extraction, PCR amplification, and sequencing of the vertebrate cytochrome b and cytochrome c oxidase 1 genes to identify vertebrate bloodmeal hosts. Several mosquitoes known to vector pathogens were found including Culex (Melanoconion) erraticus Dyar & Knab (Diptera: Culicidae), Cx. (Mel.) pedroi Sirivanakarn & Belkin, Aedes (Stegomyia) albopictus Skuse, Ae. (Ochlerotatus) scapularis Rondani, Ae. (Och.) serratus Theobald, and Ae. (Och.) taeniorhynchus Wiedemann. The most common bloodmeal hosts were basilisk lizards (Basiliscus vittatus) Wiegmann (Squamata: Corytophanidae) in Culex (Linnaeus) species and white-tailed deer (Odocoileus virginianus) Zimmermann (Artiodactyla: Cervidae) in Aedes (Meigen) species. These results show the diversity of mosquito species in a tropical dry deciduous forest and identify associations between mosquito vectors and potential pathogen reservoir hosts. Our study highlights the importance of understanding interactions between vector species and their hosts that could serve as predictors for the potential emergence or resurgence of mosquito-borne pathogens in Costa Rica.

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RESUMEN Introducción: El uso de medicina complementaria y alternativa (MCA) en pacientes con enfermedades reumáticas es prevalente pero la comunicación con el reumatólogo suele ser deficiente, lo cual afecta la relación médico-paciente (RMP). Objetivos: Evaluar la asociación entre el uso de MCA y la RMP en enfermos con artritis reumatoide. Como objetivos adicionales, describir la percepción del paciente sobre la comunicación con su reumatólogo respecto al uso de MCA y el patrón de uso de las diferentes modalidades terapéuticas. Materiales y métodos: Estudio descriptivo de corte transversal. El uso de MCA y la RMP se evaluaron mediante la autoaplicación de cuestionarios validados (I-CAM-Q y PDRQ-9 respectivamente). Resultados: Se incluyó a 246 pacientes ambulatorios de una institución de tercer nivel de atención. Se encontró asociación entre una mayor satisfacción con el tratamiento y el no usar MCA, y entre el hecho de informar al reumatólogo sobre el uso de MCA con un mayor grado de acuerdo con el médico sobre el origen de los síntomas y mayor satisfacción con el tratamiento. Las modalidades más frecuentemente utilizadas fueron: quiropraxia, acupuntura y productos herbales. El 78,5% afirmaron estar de acuerdo con comunicar el uso de este tipo de medicación al reumatólogo, sin embargo, solo el 31,3% lo notificó, por temor a represalias (54,4%). Conclusiones: Pese a la alta prevalencia de uso de MCA en nuestros pacientes, la mayoría no lo comunicó al reumatólogo. Se encontró asociación entre el uso de MCA y una menor satisfacción del paciente con el tratamiento y entre la comunicación médico-paciente sobre la práctica de MCA y una mejor satisfacción con el tratamiento.

ABSTRACT Introduction: Although complementary and alternative medicine (CAM) use among patients with rheumatic diseases is extensive, discussions regarding these treatments occur rarely in the rheumatology setting, directly affecting the physician-patient relationship (PPR). Objectives: The aim of this study was to evaluate the association between patient-physician relationship and complementary and alternative medicine use. As secondary objectives, to describe the patient's perspective towards CAM use and estimate the prevalence of CAM treatments used in patients with rheumatoid arthritis. Methods and materials: A descriptive cross-sectional survey was conducted, in which CAM use and physician-patient relationship were assessed by self-reported validated questionnaires (I-CAM-Q and PDRQ-9, respectively). Results: The study included a total of 246 outpatients of a tertiary care hospital. There were no significant differences between CAM users vs. non-users, or informers vs. non-informers in terms of physician-patient relationship measured by PDQR. The most frequent used CAM treatments were: chiropractice, acupuncture, and herbal products. A large majority (78.5%) of the patients expressed agreement to the discussion of CAM use with the rheumatologist, but only 31.3% of total CAM users did so because of fear of retaliation (54.4%). Conclusion: Despite the extensive practice of CAM among patients with rheumatoid arthritis, most patients did not discuss these treatments with their physicians. Associations were found between MCA use and a lower patient's treatment satisfaction and between physician-patient communication about CAM practice and a higher patient's treatment satisfaction.

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ABSTRACT The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease.

RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

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A b s t r a c t Purpose: To describe health-related QOL (HRQOL) in patients with musculoskeletal symptoms, compared to a population with other comorbidities, and a healthy population. Methods: A cross-sectional study was carried out on an open population involved in a community-oriented program for control of rheumatic diseases (COPCORD) study in Colombia, using EQ-5D-3L for estimating QOL, and the health assessment questionnaire disability index (HAQ-DI) for functional capacity. Results: Out of the total 4020 individuals evaluated, 2274 had rheumatic diseases, 642 had non-rheumatic diseases, and 1104 were healthy subjects. Spondyloarthritis (SpA) and rheumatoid arthritis (RA) patients had more complaints regarding pain/discomfort and mobility. As for daily activities, the diseases that mostly affected them were systemic lupus erythematosus (SLE) and RA. RA and fibromyalgia (FM) patients had the worst scores as regards anxiety/depression and self-care dimensions. FM patients had the lowest QOL measured by EQ-VAS (57.7 ± 26.2). The most frequent non-rheumatic diseases were cardiovascular and mental disorders, with 20% of these patients having a moderate level of pain/discomfort and anxiety/depression. The rheumatic patients reported a decrease in functional capacity (HAQ: 0.49), in contrast to the healthy population (0.01), and the population having other diseases (0.06). Conclusion: Rheumatic disease patients in Colombia had the worst QOL compared to the healthy population and patients with other comorbidities. Rheumatic patients had greater functional limitations, even more so when having comorbidities. This study revealed potential factors of interest requiring the attention of public health authorities, and for improving patients' QOL.

RESUMEN Objetivo: Describir la calidad de vida relacionada con la salud en pacientes con síntomas musculoesqueléticos, en comparación con pacientes con enfermedades no reumáticas y una población sana. Métodos: Se realizó un estudio transversal en comunidad abierta, en personas involucradas en un programa orientado a la comunidad para el control de enfermedades reumáticas (COP-CORD) en Colombia, utilizando el EQ-5D-3L para estimar la calidad de vida y el cuestionario de evaluación de la salud (HAQ- DI) para la capacidad funcional. Resultados: Se evaluaron 4.020 individuos; 2.274 tenían enfermedades reumáticas, 642 tenían enfermedades no reumáticas y 1.104 eran sujetos sanos. Los pacientes con espondiloartritis (SpA) y artritis reumatoide (AR) tuvieron mayores quejas con respecto al dolor/malestar y la movilidad. En cuanto a las actividades diarias, los enfermos con lupus eritematoso sistémico (LES) y AR fueron los más afectados. Los pacientes con AR y fibromialgia (FM) tuvieron las peores puntuaciones en ansiedad/depresión en las dimensiones de cuidado personal. Los pacientes con FM tuvieron la calidad de vida más baja medida por EQ-VAS (57,7 ± 26,2). Las enfermedades no reumáticas más frecuentes fueron los trastornos cardiovasculares y mentales; el 20% de estos pacientes tenía un nivel moderado de dolor/malestar y ansiedad/depresión. Los pacientes reumáticos reportaron una disminución de la capacidad funcional (HAQ: 0,49); en contraste con la población sana (0,01) y la población con otras enfermedades (0,06). Conclusión: Los pacientes con enfermedades reumáticas en Colombia tuvieron la peor calidad de vida en comparación con la población sana y los pacientes con otras enfermedades. Los pacientes reumáticos tuvieron una mayor limitación funcional, incluso más que los que tenían otras enfermedades. Este estudio reveló posibles factores relacionados con las enfermedades reumáticas que requieren la atención de las autoridades de salud pública con el objetivo de mejorar la calidad de vida de los pacientes.

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