Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a condition linked to severe cardiovascular and neuropsychological consequences, characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to compromised ventilation, hypoxemia, and micro-arousals. Polysomnography (PSG) serves as the gold standard for confirming OSAHS, yet its extended duration, high cost, and limited availability pose significant challenges. In this paper, we employ a range of machine learning techniques, including Neural Networks, Decision Trees, Random Forests, and Extra Trees, for OSAHS diagnosis. This approach aims to achieve a diagnostic process that is not only more accessible but also more efficient. The dataset utilized in this study consists of records from 601 adults assessed between 2014 and 2016 at a specialized sleep medical center in Colombia. This research underscores the efficacy of ensemble methods, specifically Random Forests and Extra Trees, achieving an area under the Receiver Operating Characteristic (ROC) curve of 89.2% and 89.6%, respectively. Additionally, a web application has been devised, integrating the optimal model, empowering qualified medical practitioners to make informed decisions through patient registration, an input of 18 variables, and the utilization of the Random Forests model for OSAHS screening.

Histoplasmosis presents a substantial clinical challenge globally, with a particular prevalence in South America, especially among patients with concurrent Human Immunodeficiency Virus (HIV) infection. Despite itraconazole's established efficacy, investigating alternative therapeutic approaches remains imperative. This is the largest study in our region to date, assessing the effectiveness of the less explored posaconazole treatment. This observational study, conducted at Fundación Valle del Lili (FVL) from 2016 to 2022, encompassed adults with disseminated histoplasmosis. Patients (n = 31) were treated with liposomal amphotericin B as an initial treatment, followed by consolidation treatment with posaconazole or itraconazole. Patients with single-organ cases, those lacking microbiological diagnosis, those who received initial treatment with antifungals other than liposomal Amphotericin B and those with < 6 months follow-up were excluded (Figure 1). Analyses considered population characteristics, treatments, and outcomes. Patients (average age: 45.6; 58.1% female) had common comorbidities (HIV 38.7%, solid organ transplantation 29% and oncologic disease 12.9%). Lungs (48.4%) and lymph nodes (16.1%) were commonly affected. Biopsy (64.5%) was the primary diagnostic method. Initial treatment with liposomal amphotericin B (100%) was given for 14 days on average. Follow-up indicated 71% completion with 19.4% requiring treatment modifications. Notably, 70.9% completed a posaconazole consolidation regimen over 350 days on average. Drug interactions during consolidation (80.6%) were common. No relapses occurred, and three deaths unrelated to histoplasmosis were reported. Traditionally, itraconazole has been the prevalent initial treatment; however, in our cohort, 55.9% of patients received posaconazole as the primary option. Encouragingly, posaconazole showed favorable tolerance and infection resolution, suggesting its potential as an effective and well-tolerated alternative for consolidation treatment. This finding prompts further exploration of posaconazole, potentially leading to more effective patient care and better outcomes. Histoplasmosis is a critical concern in South America, notably among human immunodeficiency virus patients, leading to high mortality rates. This study, the largest in our region, investigates the effectiveness of posaconazole as an alternative treatment to itraconazole. The results offer the potential for enhanced patient care and improved outcomes.

Objectives:To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolledT2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34).The endpoints were evaluated using analysis of variance. All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean +/- SD patient age and body weight were 55.05 +/- 7.58 years and 83.55 +/- 9.65 kg, respectively. The mean +/- SD duration ofT2DM, glycated hemoglobin (Hbk(1c)), and fasting plasma glucose (FPG) were 5.93 +/- 2.98 years, 8.1 +/- 0.53%, and 166.03 +/- 26.80 mg/dL, respectively. The grand mean changes of HbA(1c), FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA(1c) target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion . The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA(1c), but also body weight and blood pressure, with statistically significant results.

Background: Candidemia remains a significant public health challenge, with increasing resistance. Contemporary post-pandemic data from high-complexity Latin American hospitals are scarce. Methods: A retrospective study (2022–2023) was conducted in adults with candidemia at a high-complexity Colombian university hospital. Species identification and susceptibility were analyzed using VITEK^® 2 and Clinical and Laboratory Standards Institute (CLSI) criteria. Survival was estimated using Kaplan–Meier analysis. Results: Of 3483 blood cultures, 109 episodes were identified. The incidence was 1.13/1000 admissions (5.96/1000 in the Intensive care unit—ICU). Species other than Candida albicans predominated (61.5%), mainly C. tropicalis (22.9%) and C. parapsilosis (22.0%). Alarmingly, 28.6% of C. parapsilosis isolates were resistant to fluconazole. Consultation with an infectious diseases service was performed in 72.5% of cases, with a significantly higher rate among survivors (p < 0.05). Overall mortality was 52.3%, while 30-day mortality reached 42.2%. ICU patients had a cumulative mortality rate of 50% by day 30. Conclusions: Post-pandemic candidemia shows shifting species and high resistance. Key priorities include expert infectious disease consultation to optimize outcomes in non-neutropenic patients and strengthening laboratory capacity for identification and susceptibility testing to monitor rising resistance and guide effective institutional antifungal policies.

Although antiretroviral therapy (ART) is beneficial for patients with TB/HIV coinfection, there are issues associated with concomitant therapy administration such as overlapping drug toxicity profiles, drug interactions, and the possibility of developing immune reconstitution inflammatory syndrome (IRIS). The clinical experience in managing patients with TB who develop de novo HIV is poorly described in Colombia and the prevalence of IRIS in our context is unknown. This study aims to describe the clinical characteristics of patients with TB who develop de novo HIV coinfection and determine the prevalence of IRIS following treatment initiation. Retrospective, observational study. Patients in the TB program whit de novo HIV coinfection were included. A total of 39 patients were included. Most of the patients were male (64%) and of mixed race (58%) with an urban origin (92%). Smoking was documented in 24% of the patients and the Bacille Calmette-Guérin (BCG) TB vaccine was recorded in 48% of the patients. Pulmonary TB occurred in 74% of the patients, while miliary TB and lymph node involvement occurred in 26%. Meningeal TB and CNS TB were present in 15% of the patients, peritoneal TB in 18%, and pleural TB in 5.1%. More than 70% of the patients experienced weight loss and dyspnea (74% and 76%, respectively). Antiretroviral treatment was administered to 46% of the patients with EFV-AZT/3TC, to 21% with LPV/R+ABC/3TC, and to 14% with EFV+TDF/FTC. Individualized tuberculosis treatment was administered to 38.48% of the patients. Of the patients, 19% (5/27) developed IRIS, of which three developed TB-IRIS. The mortality rate was 2.6%, while the cure rate was 18%. our study sheds light on the clinical characteristics of patients with TB who develop de novo HIV coinfection in Colombia. The high prevalence of smoking and low prevalence of BCG vaccination among these patients are notable findings. Additionally, our study highlights the importance of individualized treatment for TB and the need for careful management of patients receiving ART to minimize the risk of developing IRIS. Further research is warranted to explore the prevalence of IRIS in our context and to develop strategies to reduce its incidence. All Authors: No reported disclosures