Revealing hidden biodiversity: Novel insights on reptile and amphibian distribution in western Ecuador.

We present notable distributional updates for 14 species from western Ecuador (seven amphibians and seven reptiles). Our findings include the northernmost confirmed sighting of Pristimantis kuri and the southernmost documented record of Imantodes inornatus and Lepidoblepharis buchwaldi. Additionally, we document new records and notes on the distribution range of Agalychnis spurrelli, Hyloscirtus alytolylax, Engystomops montubio, Pristimantis muricatus, Pristimantis nyctophylax, Pristimantis walkeri, Chironius flavopictus, Chironius grandisquamis, Dendrophidion graciliverpa, Ninia schmidti, and Urotheca fulviceps. These observations significantly contribute to filling information gaps in our understanding of these species' distributions. The data, derived from samples collected across diverse forested areas in the western region of Ecuador (provinces of Bolívar, Cañar, Guayas, El Oro, and Los Ríos), provide valuable insights into the ecology and conservation of these species.

Presentamos importantes actualizaciones distribucionales para 14 especies del oeste de Ecuador (siete anfibios y siete reptiles). Nuestros hallazgos incluyen el avistamiento confirmado más al norte de Pristimantis kuri y el registro documentado más al sur de Imantodes inornatus y Lepidoblepharis buchwaldi. Además, documentamos nuevos registros y notas sobre el rango de distribución de Agalychnis spurrelli, Hyloscirtus alytolylax, Engystomops montubio, Pristimantis muricatus, Pristimantis nyctophylax, Pristimantis walkeri, Chironius flavopictus, Chironius grandisquamis, Dendrophidion graciliverpa, Ninia schmidti y Urotheca fulviceps. Estas observaciones contribuyen significativamente a llenar vacíos de información en nuestra comprensión de la distribución de estas especies. Los datos, derivados de muestras recolectadas en diversas áreas forestales de la región occidental de Ecuador (provincias de Bolívar, Cañar, Guayas, El Oro y Los Ríos), proporcionan valiosos conocimientos sobre la ecología y conservación de estas especies.

Prevalence of axial spondyloarthritis in Colombia: data from the National Health Registry 2017-2021.

INTRODUCTION: Registries allow ascertaining the epidemiology of chronic diseases such as axial spondyloarthritis (axSpA). The Colombian Ministry of Health has implemented a National Health Registry (SISPRO) that collects data from each medical contact in the system, which provides close to universal coverage (around 98%). OBJECTIVE: To establish the 5-year prevalence of axSpA in Colombia, and to describe its demographics, using data from January 1st, 2017, to December 31st, 2021. METHODS: We performed an observational, cross-sectional study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to ax-SpA, based on SISPRO data. We estimated the prevalence using three approaches: (1) ankylosing spondylitis (AS) diagnoses; (2) diagnoses compatible with axSpA; and (3) diagnoses compatible with axSpA, including sacroiliitis. We calculated prevalence per 100,000 inhabitants. RESULTS: Based on our three approaches, patients with a primary diagnosis compatible with ax-SpA ranged between 12,684 and 117,648, with an estimated 5-year adjusted prevalence between 26.3 and 244 cases per 100,000 inhabitants (0.03-0.2%). The male-to-female ratio ranged between 1.2:1 and 0.4:1, which was markedly skewed towards a higher prevalence in women when we included the code for sacroiliitis. We found the highest frequency of cases in the 50-54 years group. A differential prevalence was observed between different regions in our country, particularly in regions known to have European ancestors. CONCLUSION: This is the first study that describes demographic characteristics of ax-SpA in Colombia and offers valuable information for stakeholders. Key Points • Using the official country-level health database, the prevalence of axSpA in Colombia ranges between 26.3 and 244 cases per 100,000 inhabitants (0.03% - 0.2%) • The prevalence of axSpA peaked among the 50-54 years patient group, suggesting an increased survival • Nations with a substantial admixture, such as Colombia, may present a differential prevalence of axSpA among regions within the country • Including the ICD-10 code for sacroiliitis (M46.1) in epidemiological studies probably overestimates the frequency of axSpA.

YouTube® as a source of information for Spanish-speaking patients with rheumatoid arthritis.

INTRODUCTION: Social media (SoMe) has reshaped access to health information, which may benefit patients with rheumatoid arthritis (RA), although an evaluation of the characteristics of contents for Spanish-speaking patients is lacking. We aimed to assess patient engagement, reliability, comprehensiveness, and quality of data uploaded to YouTube® for Spanish-speaking patients. METHODS: We evaluated the videos uploaded to YouTube® in Spanish about RA. Information about video length, engagement (i.e., views, likes, popularity index), time online, and the source was retrieved; we appraised reliability (DISCERN), comprehensiveness (content score), and quality (Global Quality Score) using standardized scores. RESULTS: We included 200 videos in the study and classified 67% of the videos as useful. These videos had a higher number of views (19,491 [10,132-61,162] vs. 11,208 [8183-20,538]), a longer time online (1156 [719-2254] vs. 832 [487-1708] days), and a shorter duration (6.3 [3.4-15.8] vs. 11.8 [7.4-20.3] min). Engagement parameters were similar between useful and misleading videos. Useful videos had higher reliability, comprehensiveness, and quality scores. Useful videos were mainly uploaded by independent users and government/news agencies; academic organizations offered only 15% of useful videos. CONCLUSIONS: Most of the information in YouTube® for Spanish-speaking patients with RA is useful; however, patient engagement is similar between useful and misleading content. More substantial involvement of academia in developing high-quality educational multimedia is warranted.

Comparative outcomes of direct-acting antiviral treatment in patients with HIV-Hepatitis C co-infection: insights from a single center experience in Colombia.

Background: Direct-acting antivirals (DAA) were introduced to Latin America with the aim of eliminating hepatitis C (HCV) in the region. There are scarce data on the outcomes of people living with HIV and HCV treated with these medications in Colombia. This study compares the outcomes of patients with HIV-HCV co-infection and HCV mono-infection treated with DAAs. Methods: Retrospective observational study including patients ≥18 years old with HCV infection treated with DAAs from August 2017 to December 2019 in a comprehensive center in Colombia. The main outcome was sustained virologic response (SVR). Secondary outcomes included reinfection, relapse and adverse events. Results: We included 223 individuals with HCV treated with DAAs; 142 (63.6%) individuals were mono-infected and 81 (36.3%) co-infected. Genotypes 1b (49.7%) and 4 (33.9%) were the most common. Overall SVR after DAA treatment was 96.8%. Relapse rate was 2.24%, reinfection rate was 6.28% and adverse events occurred in 27.8% of cases. SVR was comparable in patients with co- and mono-infection (95% vs 97.8%, p=0.245). Conclusion: DAA were effective in mono-infected (HCV) and co-infected (HCV/HIV) patients and reinfection was high in this last group.

Evaluation of diuretic efficiency of intravenous furosemide in patients with advanced heart failure in a heart failure clinic.

INTRODUCTION: Diuretic efficiency (DE) is an independent predictor of all-cause mortality in acute heart failure (HF) at long-term follow-up. The performance of DE in advanced HF and the outpatient scenario is unclear. METHODS: Survival function analysis on a retrospective cohort of patients with advanced HF followed at the outpatient clinic of Hospital Universitario San Ignacio (Bogotá, Colombia) between 2017 and 2021. DE was calculated as the average of total diuresis in milliliters divided by the dose of IV furosemide in milligrams for each 6-h session, considering all the sessions in which the patient received levosimendan and IV furosemide. We stratified DE in high or low using the median value of the cohort as the cutoff value. The primary outcome was a composite of all-cause mortality and HF hospitalizations during a 12-month follow-up. Kaplan-Meier curves and log-rank test were used to compare patients with high and low DE. RESULTS: In all, 41 patients (66.5 ± 13.2 years old, 75.6% men) were included in the study, with a median DE of 24.5 mL/mg. In total, 20 patients were categorized as low and 21 as high DE. The composite outcome occurred more often in the high DE group (13 versus 5, log-rank test p = 0.0385); the all-cause mortality rate was 29.2% and was more frequent in the high DE group (11 versus 1, log-rank test p = 0.0026). CONCLUSION: In patients with advanced HF on intermittent inotropic therapy, a high DE efficiency is associated with a higher risk of mortality or HF hospitalization in a 12-month follow-up period.

Prevalence of cardiovascular risk factors in a historical cohort of people living with human immunodeficiency virus during a 10-year period.

Objective: Data on the frequency of cardiovascular disease in people living with human immunodeficiency virus from low- and middle-income countries is scarce. Methods: We performed an observational study based on data from a historical cohort of people living with human immunodeficiency virus in Colombia during a 10-year follow-up to describe the prevalence of cardiovascular risk factors and their behavior according to CD4 count. Results: One thousand patients were initially included, out of which 390 had a 10-year follow-up. The mean age was 34 (standard deviation 10) years, and 90% were male. We observed an increase in the prevalence of dyslipidemia (29%-52%, p < 0.001) and obesity (1.1%-3.5%, p < 0.001). Major cardiovascular events occurred in less than 1% of patients. Patients with a CD4 count <200 cells/mm3 had a higher frequency of acute myocardial infarction and obesity. Conclusion: Over time, people living with human immunodeficiency virus present with an increasing prevalence of cardiovascular risk factors, particularly those with a lower CD4 count.

Sleep Quality, Insomnia, and Perceived Stress among Colombian Healthcare Workers during the COVID-19 Pandemic.

Objective The COVID-19 pandemic has imposed a great burden on healthcare workers worldwide. The aim of the present study was to assess sleep quality, insomnia, and perceived stress in healthcare workers of a high complexity hospital located in Bogota, Colombia. Methods Cross-sectional study in which 1,155 healthcare workers at the Hospital Universitario San Ignacio in Bogotá, Colombia were included, between September and October 2020. Using an online-based survey, self-reported variables were assessed including demographics, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and 10 item Perceived Stress Scale (PSS-10). Associations between these variables were evaluated. Results Fifty percent of the respondents were between 31 and 45 years old, and 76 percent were women. Most of the surveyed were the nursing staff. Poor sleep quality, insomnia, and high perceived stress was found in 74.9, 12.4, and 13.2%, respectively. Poor sleep quality was predominantly found in females, in the 31 to 45 years old group and in married personnel. Also, poor sleep quality was found in relation to a moderate to high perceived risk of COVID-19 infection by the family of the workers surveyed. Discussion Poor sleep quality, moderate rates of insomnia, and perceived stress were found among healthcare workers committed to COVID-19 infected patients in Colombia. The identification of workers at greater risk and the implementation of targeted interventions are called upon as the results.

COVID-19 infection during blinatumomab therapy: Is safety a dilemma?

Patients with acute lymphoblastic leukemia may be particularly vulnerable to SARS-CoV-2 infection and severe illness. The mainstay of current treatment is the use of blinatumomab in patients with refractory or relapsed B-cell precursor acute lymphoblastic leukemia. We discuss the case of a patient with relapsed acute lymphoblastic leukemia who became positive for SARS-CoV-2 during blinatumomab therapy. There are no formal recommendations on the decision to continue, withhold, or delay blinatumomab treatment in these patients. More studies exploring this issue are warranted, as SARS-CoV-2 is expected to be here to stay.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Hypopigmentation in mantled howler monkeys Alouatta palliata (gray 1849): First documented cases of whole-body leucism in South America.

The existence of hypopigmentation like leucism is the result of genetic anomalies that might be enhanced by external factors such as pollution. This anomaly may reduce survival rates. Leucism has been recorded in wildlife, but overall, it is considered very rare. There have been few records of mantled howler monkeys with leucism in Mexico and Costa Rica, but whole-body leucism in howler monkeys from South America was unknown. In this article, we report for the first-time documented cases of whole-body leucism in young individuals of mantled howler monkeys Alouatta palliata in an isolated remanent of tropical dry forest in southwestern Ecuador known as Cerro Blanco Protective Forest. In total, we found two juvenile individuals with leucism in October 2021. The report of howler monkeys with whole-body leucism may be caused by two processes: inbreeding because of isolated populations, environmental pressure caused by pollution, or the interaction of both. Our findings also reveal that hypopigmentation is becoming more frequent in howler monkey populations along its distributional range. Therefore, it is important to promote research in this field to disentangle the causes of hypopigmentation and to consider a regional management strategy for the species.

La existencia de afecciones que causan hipopigmentación, como el leucismo, son el resultado de anomalías genéticas que pueden verse potenciadas por factores externos como la contaminación. Estas anomalías puedes reducir las tasas de supervivencia. Se ha registrado leucismo en la vida silvestre, pero en general, se considera muy raro. En México y Costa Rica se ha reportado la existencia de casos aislados de monos aulladores de manto con leucismo, pero se desconocía el leucismo de cuerpo completo en monos aulladores para América del Sur. En este artículo, reportamos por primera vez casos documentados de leucismo en todo el cuerpo en individuos juveniles de monos aulladores de manto Alouatta palliata en un remanente aislado de bosque seco tropical en el suroeste de Ecuador conocido como Bosque Protector Cerro Blanco. En total, encontramos dos individuos juveniles con leucismo en octubre de 2021. Este reporte de monos aulladores con leucismo en todo el cuerpo puede ser causado por dos procesos: apareamiento dentro de individuos de la misma población causado por el aislamiento, la presión ambiental causada por la contaminación o la interacción de ambos. Nuestros hallazgos también revelan que la hipopigmentación es cada vez más frecuente en las poblaciones de monos aulladores a lo largo de su rango de distribución. Por lo tanto, es importante promover la investigación en este campo para determinar las causas de la hipopigmentación y considerar una estrategia de manejo regional para la especie. Palabras clave: aberraciones cromáticas, pérdida de conectividad, anomalías genéticas, endogamia, cambio de pigmentación en primates por contaminación, Bosque Seco del Pacífico Ecuatorial.

Educational Strategies to Promote Adherence to Treatment in Patients with Cardiovascular Disease.

INTRODUCTION: Educational material is a key strategy for primary health care promotion. PURPOSE: To design and validate educational material adapted to the population and aimed to increase knowledge about adherence to the treatment of arterial hypertension and diabetes mellitus. METHODOLOGY: Methodological study for the design of educational material for people with diabetes mellitus and high blood pressure. For the design, content validity tests were carried out, with the participation of six experts in health education and six patients with chronic diseases. Validation was performed pursuant to the attraction, understanding, engagement, and acceptance criteria. RESULTS: The validation confirmed that all items and criteria were above the minimal expected range. CONCLUSION: The design and validation of educational material provide elements that improve the education of patients about their pathologies and their adherence to treatment.

Social media as source of information for Spanish-speaking patients with systemic lupus erythematosus.

INTRODUCTION: Although patients with systemic lupus erythematosus (SLE) may benefit from health-care information in social media (SoMe), they may also be prone to misleading information. An assessment of the reliability, comprehensiveness, and quality of information uploaded to SoMe for Spanish-speaking patients with SLE is lacking. METHODS: This analytical observational study evaluates the videos uploaded to YouTube® in Spanish about SLE. Information about video length, engagement (i.e., views and likes), time on the internet, popularity index, and source was retrieved, and an evaluation on reliability, comprehensiveness, and quality was performed using standardized scores. RESULTS: One hundred eighty-six videos were included in the analysis. Most videos were considered as useful (87%) or useful patient opinion (8.1%), whereas only 2.2% were considered misleading and 2.7% as misleading patient opinion. The number of views (Median 7207 vs 113,877, p = .012), popularity index (Median 13.8 vs 168.7, p < .001), number of likes (Median 155 vs 3400, p < .001), and number of dislikes (Median 3 vs 138, p = .004) were higher for misleading videos. The videos uploaded by independent users had a higher engagement than those from government or news agencies, professional organizations or academic channels. Misleading videos and those uploaded by independent users had lower rates of reliability, comprehensiveness and quality (p < .001). CONCLUSIONS: Most of the information shown in YouTube® videos on SLE tends to be useful. However, audience engagement parameters are larger for misleading videos. Exploring the qualitative features of the most popular videos is necessary to establish what features are more engaging for the audiences and to improve the content and popularity of reliable videos on chronic diseases.

Impact of COVID-19 pandemic on patients with rheumatic diseases in Latin America.

The objective of our study was to describe knowledge, attitudes and practices of Latin-American rheumatology patients regarding management and follow-up of their disease during COVID-19 pandemic. A cross-sectional observational study was conducted using a digital anonymous survey. Rheumatic patients ≥ 18 years from non-English-speaking PANLAR countries were included. Our survey included 3502 rheumatic patients living in more than 19 Latin-American countries. Median age of patients was 45.8(36-55) years and the majority (88.9%) was female. Most frequently self-reported disease was rheumatoid arthritis (48.4%). At least one anti-rheumatic treatment was suspended by 23.4% of patients. Fear of contracting SARS-Cov2 (27.7%) and economic issues (25%) were the most common reasons for drug discontinuation. Self-rated disease activity increased from 30 (7-50) to 45 (10-70) points during the pandemic. Communication with their rheumatologist during the pandemic was required by 55.6% of patients, mainly by telephone calls (50.2%) and social network messages (47.8%). An adequate knowledge about COVID-19 was observed in 43% of patients. Patients with rheumatic diseases in Latin America were negatively affected by the COVID-19 pandemic. An increase in self-rated disease activity, a reduction in medication adherence, and hurdles for medical follow-up were reported. Teleconsultation was perceived as a valid alternative to in-person visits during the pandemic.

Renal Amyloidosis and Crohn Disease.

Background: Secondary amyloidosis, a rare complication of Crohn disease (CD), is triggered by persistent systemic inflammation. Kidney involvement is the most frequent manifestation and is often characterized by nephrotic syndrome and kidney failure. This complication usually appears in patients with long-standing disease and is associated with increased morbidity and mortality risk. Diagnosis is by microscopic amyloid observation of tissue biopsy, and when the diagnosis is confirmed, the therapeutic objective is disease activity control. Response assessment is challenging because of a lack of reliable biomarkers. Case Report: A 56-year-old male with a long-standing history of CD treated with a tumor necrosis factor-α inhibitor presented with an acute elevation of creatinine in association with clinical and laboratory markers of nephrotic syndrome. Kidney biopsy revealed renal amyloidosis. After treatment adjustment, although a stable creatinine was achieved, the patient had persistent impaired glomerular filtration rate. Conclusion: As a systemic chronic inflammatory disorder, CD may present multisystemic morbidity, for which increased awareness among gastroenterologists is warranted. Renal amyloidosis is an infrequent extraintestinal complication of CD that may lead to chronic kidney impairment. Although evidence-based treatment is lacking, disease activity control is pivotal for management.

Prevalence and Demographic Characteristics of Prostate Cancer Patients in Colombia: data from the National Health Registry from 2015 to 2019 / Prevalencia y características demográficas de pacientes con cáncer de próstata en Colombia: datos del Registro de Salud Nacional de 2015 a 2019

Background and Objective Prostate cancer is a multifactorial disease and is among the top five causes of death in men worldwide. The Colombian Ministry of Health has adopted the Integrated Information System on Social Protection (Sistema Integrado de Información de la Protección Social, SISPRO, by its Spanish acronym) registry to collect comprehensive information from the Colombian health system. The system provides close to universal coverage (around 95%). We aimed to establish the prevalence of prostate cancer in Colombia and to describe its demographics, based on data provided by SISPRO, openly available for scientific analysis. Methods Using the SISPRO data from 2015 through 2019, we analyzed the prevalence and demographic characteristics of patients diagnosed with prostate cancer. Results We identified a total of 43,862 patients with prostate cancer in the 5-year period and estimated a prevalence of 4.54 cases per 1,000 habitants, using as denominator males over 35 years old. We calculated a prevalence of early-onset prostate cancer (i.e., 35­54 years) of 0.14 per 1,000 habitants (791 cases in 5 years). The highest prevalence was observed in patients>80 years (33.45 per 1,000 habitants). The departments with the highest prevalence were Bogotá, Valle del Cauca, Risaralda, and Boyacá, and the region with the lowest prevalence was Amazonas.

Antecedentes y Objetivo El cáncer de próstata es una enfermedad multifactorial, y se encuentra entre las cinco principales causas de muerte en hombres a nivel mundial. El Ministerio de Salud de Colombia ha adoptado el Sistema Integrado de Información de la Protección Social (SISPRO) para la recopilación de la información integral del sistema de salud colombiano. El sistema proporciona una cobertura casi universal (alrededor del 95%). El objetivo de este estudio fue establecer la prevalencia del cáncer de próstata en Colombia y describir su demografía, con base en los datos proporcionados por el SISPRO, disponibles de forma abierta para el análisis científico. Métodos Utilizando los datos del SISPRO de 2015 a 2019, se analizaron la prevalencia y las características demográficas de los pacientes diagnosticados con cáncer de próstata. Resultados Se identificó un total de 43,862 pacientes con cáncer de próstata en el período de 5 años, con una prevalencia de 4,54 casos por cada mil habitantes, utilizando como denominador hombres mayores de 35 años. La prevalencia de cáncer de próstata de inicio temprano (es decir, paciente de 35 a 54 años) fue de 0.14 por mil habitantes (791 casos en 5 años). La mayor prevalencia se observó en pacientes > 80 años (33,45 por mil habitantes). Los departamentos con mayor prevalencia fueron Bogotá, Valle del Cauca, Risaralda, y Boyacá. Y la región con menor prevalencia fue Amazonas. Conclusión Describimos la prevalencia y la demografía del cáncer de próstata y el cáncer de próstata de inicio temprano en Colombia utilizando la base de datos del sistema nacional de salud. Observamos una distribución desigual de la prevalencia entre las regiones, que puede estar relacionada con factores raciales, ambientales, o de acceso, que justifican más estudios.

Automatic Pectoral Muscle Removal and Microcalcification Localization in Digital Mammograms.

OBJECTIVE: Breast cancer is the most common cancer diagnosed in women, and microcalcification (MCC) clusters act as an early indicator. Thus, the detection of MCCs plays an important role in diagnosing breast cancer. METHODS: This paper presents a methodology for mammogram preprocessing and MCC detection. The preprocessing method employs automatic artefact deletion and pectoral muscle removal based on region-growing segmentation and polynomial contour fitting. The MCC detection method uses a convolutional neural network for region-of-interest (ROI) classification, along with morphological operations and wavelet reconstruction to reduce false positives (FPs). RESULTS: The methodology was evaluated using the mini-MIAS and UTP datasets in terms of segmentation accuracy in the preprocessing phase, as well as sensitivity and the mean FP rate per image in the MCC detection phase. With the mini-MIAS dataset, the proposed methods achieved accuracy scores of 99% for breast segmentation and 95% for pectoral segmentation, a sensitivity score of 82% for MCC detection, and an FP rate per image of 3.27. With the UTP dataset, the methods achieved accuracy scores of 97% for breast segmentation and 91% for pectoral segmentation, a sensitivity score of 78% for MCC detection, and an FP rate per image of 0.74. CONCLUSIONS: The proposed preprocessing method outperformed the state-of-the-art methods for breast segmentation and achieved relatively good results for pectoral muscle removal. Furthermore, the MCC detection module achieved the highest test accuracy in identifying potential ROIs with MCCs compared to other methods.

Impact of COVID-19 Pandemic on Rheumatology Practice in Latin America.

OBJECTIVE: To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on Latin American rheumatologists from a professional, economic, and occupational point of view. METHODS: We conducted an observational cross-sectional study using an online survey sent to rheumatologists of each non-English-speaking country member of the Pan American League of Rheumatology Associations (PANLAR). A specific questionnaire was developed. RESULTS: Our survey included 1097 rheumatologists from 19 Latin American countries. Median (IQR) age of respondents was 48 (40-59) years and 618 (56.3%) were female. Duration of practice since graduation as a rheumatologist was 17 years, and 585 (53.3%) were aged < 50 years. Most rheumatologists worked in private practice (81.8%) and almost half worked in institutional outpatient centers (55%) and inpatient care (49.9%). The median number of weekly hours (IQR) of face-to-face practice before the pandemic was 27 (15-40) hours, but was reduced to 10 (5-20) hours during the pandemic. Telehealth was used by 866 (78.9%) respondents during the pandemic. Most common methods of communication were video calls (555; 50.6%), telephone calls (499; 45.5%), and WhatsApp voice calls (423; 38.6%). A reduction in monthly wages was reported by 946 (86.2%) respondents. Consultation fees also were reduced and 88 (8%) rheumatologists stated they had lost their jobs. A reduction in patient adherence to medication was reported by nearly 50% of respondents. Eighty-one (7.4%) rheumatologists received a COVID-19 diagnosis and 7 (8.6%) of them were hospitalized. CONCLUSION: The COVID-19 pandemic has reshaped rheumatology practice in Latin America and has had a profound effect on rheumatologists' behaviors and clinical practice.

Levels of Evidence Supporting the North American and European Perioperative Care Guidelines for Anesthesiologists between 2010 and 2020: A Systematic Review.

BACKGROUND: Although there are thousands of published recommendations in anesthesiology clinical practice guidelines, the extent to which these are supported by high levels of evidence is not known. This study hypothesized that most recommendations in clinical practice guidelines are supported by a low level of evidence. METHODS: A registered (Prospero CRD42020202932) systematic review was conducted of anesthesia evidence-based recommendations from the major North American and European anesthesiology societies between January 2010 and September 2020 in PubMed and EMBASE. The level of evidence A, B, or C and the strength of recommendation (strong or weak) for each recommendation was mapped using the American College of Cardiology/American Heart Association classification system or the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The outcome of interest was the proportion of recommendations supported by levels of evidence A, B, and C. Changes in the level of evidence over time were examined. Risk of bias was assessed using Appraisal of Guidelines for Research and Evaluation (AGREE) II. RESULTS: In total, 60 guidelines comprising 2,280 recommendations were reviewed. Level of evidence A supported 16% (363 of 2,280) of total recommendations and 19% (288 of 1,506) of strong recommendations. Level of evidence C supported 51% (1,160 of 2,280) of all recommendations and 50% (756 of 1,506) of strong recommendations. Of all the guidelines, 73% (44 of 60) had a low risk of bias. The proportion of recommendations supported by level of evidence A versus level of evidence C (relative risk ratio, 0.93; 95% CI, 0.18 to 4.74; P = 0.933) or level of evidence B versus level of evidence C (relative risk ratio, 1.63; 95% CI, 0.72 to 3.72; P = 0.243) did not increase in guidelines that were revised. Year of publication was also not associated with increases in the proportion of recommendations supported by level of evidence A (relative risk ratio, 1.07; 95% CI, 0.93 to 1.23; P = 0.340) or level of evidence B (relative risk ratio, 1.05; 95% CI, 0.96 to 1.15; P = 0.283) compared to level of evidence C. CONCLUSIONS: Half of the recommendations in anesthesiology clinical practice guidelines are based on a low level of evidence, and this did not change over time. These findings highlight the need for additional efforts to increase the quality of evidence used to guide decision-making in anesthesiology.