Diego Fernando Rojas-Gualdrón

Objective: To estimate time to first recurrent thrombosis and to explore the association between recurrent thrombosis and clinical, laboratory/immunological, and treatment-related factors among Colombian adults with thrombotic antiphospholipid syndrome (APS) enrolled in the ARTMEDICA autoimmune diseases program (2013–2024). Methods: We conducted a registry-based retrospective follow-up study of patients with thrombotic APS. Patients were followed from the index thrombotic event to the first recurrent arterial or venous thrombosis. Time-to-event analyses used interval-censored parametric survival regression with a log-logistic distribution. To explore factors associated with recurrence, we also applied a matched nested case–control design using conditional logistic regression. Results: We included 355 patients (mean follow-up 6.6 years), 71.0% female, median age 47 years (IQR 32–60). Primary APS accounted for 83.4% of cases, and the index event was arterial in 72.1%. During follow-up, 130 patients experienced a first thrombotic recurrence: 70.8% venous. The 10-year probability of first recurrence was 42% (95% CI 28.4–55.5%), with 20% (95% CI 10.5–29.1%) during the first 2 years. In the nested case–control, recurrent thrombosis was significantly associated with the LA + /aCL + /antiβ2GPI − profile (OR 4.8; p = 0.044), male sex (OR 1.8; p = 0.038), prior gestational death (OR 2.4; p = 0.008), and ANA positivity (OR 2.4; p = 0.015). Conclusions: The risk of recurrent thrombosis was highest during the first 2 years after the index thrombotic event, supporting an early vulnerable phase and underscoring the need for closer clinical surveillance and secondary prevention. Limitations of the study include its retrospective design, the lack of standardized anticoagulation monitoring and residual confounding. Key Points • Thrombotic APS carries a high early recurrence burden despite anticoagulation, particularly during the first 2 years after the index event. • Early identification of high-risk patients and intensive surveillance may be critical to prevent recurrent thrombosis.

Purpose: To compare diagnostic accuracy for MIH and its differential diagnosis between undergraduate dental students without previous clinical experience and paediatric dentistry specialists in active clinical practice. Methods: A cross-sectional analytical study included 70 participants: 40 s-year undergraduate dental students and 30 paediatric dentistry specialists. All participants attended an 8-h standardised training session on MIH one week before the assessment. Following this standardised training session, all participants assessed 115 validated clinical photographs presented in random order under identical conditions, classifying each image using the MIH Index. Diagnostic accuracy was estimated using the Obuchowski area under the curve (AUC) method for a non-binary gold standard, with 95% confidence intervals (95% CI). Results: Overall diagnostic accuracy was 0.887 (95% CI 0.876, 0.897) for students and 0.945 (95% CI 0.936, 0.954) for specialists. Most pairwise comparisons showed high discriminative ability, but lower AUC values were observed for diagnostically challenging pairs—particularly hypoplasia versus amelogenesis imperfecta (AUC = 0.76), atypical restorations versus atypical caries (AUC = 0.76), and hypoplasia versus non-MIH hypomineralisation defects (AUC = 0.80)—and among categories representing different clinical manifestations of MIH. Specialists outperformed students in 36 pairwise comparisons, reaching statistical significance. Conclusions: Paediatric dentistry specialists achieved higher image-based diagnostic accuracy than undergraduate students, with both groups assessed under identical conditions following the same standardised training. Certain diagnostic pairs remained challenging even for specialists. Within the specialist group, accuracy did not vary significantly by years of experience, prior MIH training, or self-reported confidence.

Aim: To evaluate the diagnostic accuracy, satisfaction and self‐confidence of dental students when classifying dental caries lesions using simulation‐based experience and photographs, and to examine whether the sequence of these interventions influences diagnostic performance. Method: A randomised crossover study was conducted with 37 second‐year undergraduate dental students. Participants were assigned to one of two intervention sequences: Photograph–Simulation‐based Experience (P–SBE) or Simulation‐based Experience–Photograph (SBE–P). Each student completed four diagnostic attempts, two with photographs and two with simulation‐based experience, using the Nyvad criteria. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUC) and pairwise discriminative accuracy (pAUC). Satisfaction and self‐confidence in learning were measured using the National League for Nursing Satisfaction and Self‐Confidence in Learning Questionnaire. Results: Simulation‐based experience demonstrated higher diagnostic accuracy than photographs in both sequences. In the P–SBE sequence, AUC increased from 79.7 (95% CI: 77.2–82.3) in the first photograph‐based attempt to 93.2 (95% CI: 91.6–94.9) in the second simulation‐based attempt. In the SBE–P sequence, AUC was also higher in the second simulation‐based attempt, reaching 89.9 (95% CI: 88.1–91.7). Students also reported greater satisfaction, higher self‐confidence and a more positive overall perception of simulation‐based experience ( p < 0.05). Conclusion: Simulation‐based experience yielded higher diagnostic accuracy than photographs in this Nyvad‐based educational context. The highest overall performance was observed when photographs preceded simulation‐based experience, supporting the progressive and complementary use of both approaches in undergraduate cariology teaching. Simulation‐based experience was also perceived as enhancing satisfaction and self‐confidence in learning.

To evaluate a two-year clinical performance of resin infiltration in anterior teeth affected by Molar Incisor Hypomineralisation (MIH), focusing on esthetic outcomes, hypersensitivity control, and patient-reported satisfaction. This retrospective observational study included 106 MIH-affected permanent incisors from children aged 7–10 years, treated at a university-based pediatric dental clinic. The primary outcome was esthetic improvement (colour match, FDI criteria). Secondary outcomes included patient-reported hypersensitivity (VAS), additional esthetic and biological properties from the FDI index, and patient and guardian satisfaction. Esthetic and biological properties, hypersensitivity, and satisfaction were recorded at 1, 12, and 24 months following resin infiltration of demarcated opacities. Data were analysed using descriptive and comparative statistics. A two-year clinical success rate of resin infiltration was 96.2% based on colour match. Hypersensitivity scores (VAS 0–10) decreased from 8 at baseline to 0 at 24 months. Success rates for esthetic and biological properties, as assessed with the FDI index, all exceeded 90%. Patient and guardian satisfaction was high at 1 and 12 months but declined at 24 months, particularly in cases with yellow-brown demarcated opacities. Resin infiltration showed high effectiveness for improving esthetic integration and colour match in anterior teeth affected by MIH, with high initial satisfaction reported by patients and guardians.

Introducción: en 2015, la Asociación Colombiana de Gastroenterología (ACG) publicó la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la infección por Helicobacter pylori en adultos. En 2025, la Asociación realizó el proceso de actualización de esta guía de acuerdo con la necesidad de actualización de las estrategias diagnósticas y terapéuticas, adaptadas a la realidad microbiológica local y a las características clínicas de la población. Materiales y métodos: el comité de guías de la ACG con el acompañamiento de epidemiólogos realizó la actualización con base en una revisión sistemática de recomendaciones de práctica y metaanálisis siguiendo las directrices de la metodología GRADE. En esta versión corta de la GPC-actualización 2025 se presenta un breve resumen de la evidencia que apoya las recomendaciones. El detalle del proceso de actualización puede consultarse en la versión completa disponible en www.gastrocol.com. Resultados: la actualización de 2025 presenta recomendaciones sobre indicaciones de tratamiento para curar el H. pylori y prevenir otras patologías, métodos diagnósticos invasivos y no invasivos, alternativas de tratamiento en las diferentes líneas y consideraciones particulares como zonas de alta resistencia, alergia a la penicilina y poblaciones especiales. Conclusión: un adecuado diagnóstico y tratamiento de la infección por H. pylori es esencial dado su rol como factor de riesgo en condiciones como gastritis crónica, úlceras pépticas, linfoma MALT gástrico y adenocarcinoma del estómago.

Objective: To analyze the 30-year trajectory of organ damage accrual and damage-free survival (DFS) in a registry-based cohort of Colombian patients with systemic lupus erythematosus (SLE) enrolled in the ARTMEDICA program for autoimmune diseases. Method: We conducted a retrospective registry-based follow-up study including patients aged ≥18 years, treated between March 2011 and August 2017, who met the 2012 SLICC classification criteria for SLE. Organ damage was assessed using the SLICC/ACR Damage Index (SDI), and disease activity and relapses were evaluated with the SLEDAI-2K. Mean annual change ratios (MACR) in SDI were estimated using multilevel generalized linear models. Parametric survival models for interval-censored data were used to assess overall and system-specific DFS. Results: A total of 559 patients were included, with a mean follow-up of 14.7 years; 96.6% were female, and the median age at diagnosis was 30 years (IQR: 20–48). The median number of relapses was 3.5 (IQR: 1–8). Mean SDI increased linearly to 1.24 (95% CI: 1.08–1.40) at 15 years and continued to 1.53 (95% CI: 1.16–1.90) at 30 years. Median organ DFS was 7.2 years (95% CI: 5.8–8.5), with substantial variability across systems. Myelopathy (MACR 2.24; 95%CI 1.26–3.98), cellular casts (MACR 2.15; 95%CI 1.09–4.22), seizures (MACR 1.82; 1.30–2.55) and disease activity (MACR 1.22; 95%CI 1.10–1.35) were associated with faster damage accrual. Conclusion: The trajectory of organ damage accrual underscores the long-term burden of SLE and the need for comprehensive interventions, particularly in patients with high-risk clinical features.

Introduction: Emerging risks at work may be caused by new information and communication technologies, such as computers. While they enhance productivity, computers can also cause new health issues in workers, such as Computer Vision Syndrome (CVS). Objective: To culturally adapt and evaluate the validity evidence of the Computer Vision Syndrome Questionnaire (CVS-Q©) for adult Colombian computer-using workers from the Rasch model approach. Materials and Methods: A quantitative, observational, cross-sectional, analytical study was conducted with a sample of 300 computer-using workers from a public university in Colombia in 2022. Rasch analyses were performed to fit response categories, items, and individuals; examine differential item functioning (DIF), dimensionality, and local independence of items; determine reliability; and produce the item-person map. Results: The CVS-Q (Colombia)© response format was adjusted to meet Linacre's guidelines for optimizing rating scale categories. All items showed infit and outfit mean-square values within the expected range. The scale was unidimensional, and the Rasch measurement explained 35.90% of the variance. Person reliability was 0.77, internal consistency was 0.88, and temporal stability reliability was 0.86. Discussion: The CVS-Q (Colombia)© assesses the frequency, intensity, and severity of sixteen signs and symptoms of CVS. Conclusion: The CVS-Q (Colombia)© is a valid and reliable scale for measuring the severity of CVS symptoms in Colombian workers.

The aim of the present systematic review was to critically evaluate the recommendations from evidencebased clinical practice guidelines (CPG) and scientific statements (SS), as well as expert consensus, related to the management of oral complications in intensive care unit (ICU) patients.A search was made in the PubMed, Scopus, Ovid/Cochrane, and LILACS databases, following the CPG identification filters from the Canadian Agency for Drugs and Technologies in Health (CADTH). Both scientific repositories and document references were incorporated as well. The critical assessment was performed by means of the AGREE-II instrument (an ideal scenario) for CPG and SS, and using the AGREEREX instrument for recommendations (ideal and local scenarios).A total of 13 related recommendations from 4 SS were included. The mean score in AGREE-II was 58.25. The mean AGREE-REX scores were 45.82 and 39.07 for the ideal and local scenarios, respectively. The included recommendations focused on the oral care assessment, and the development of prevention and execution tools with regard to respiratory infections.There is a lack of CPG following a rigorous methodology that would incorporate recommendations for oral care in ICU. Dentists are responsible for the development and improvement of recommendations from CPG and/or SS to mitigate oral complications in ICU patients.

Introduction: The COVID-19 pandemic has highlighted that healthcare workers are at a high risk of experiencing poor mental health. Objective: To examine the associations between various psychosocial factors (i.e., gender, age, income level, LGBTQIA+ status, posttraumatic growth, perceived stress, and resilience) and three clinically relevant mental health outcomes (i.e., depression, anxiety, and psychological distress) among Colombian psychologists following the most restrictive phases of the COVID-19 pandemic. Method: A cross-sectional online study was conducted between December 1st, 2021, and April 30th, 2022. Depression, anxiety, and psychological distress symptoms were assessed using the PHQ-2, the GAD-2, and the PHQ-4, respectively. Prevalences and prevalence ratios by socioeconomic and psychological variables were also estimated. Results: Of the 1,297 participants, the majority were female (78%) and had a mean age of 39.2 (SD = 11.5). In total, 27.5% reported depression, 25.4% anxiety, and 17.5% psychological distress symptoms. Depression and psychological distress were higher among females and younger psychologists. Psychological distress was higher among LGBTQIA+ psychologists. Lower posttraumatic growth and resilience and higher perceived stress were associated with higher depression, anxiety, and psychological distress symptoms. Conclusion: These findings highlight disparities in mental health outcomes among psychologists associated with varying psychosocial factors. They also highlight the need to offer psychologists resources to improve their psychological adaptation to stressful circumstances related to future public health emergencies.