Traditional first-line treatment failure rates in neuromyelitis optica spectrum disorder patients included in the Argentinean registry (RelevarEM).

BACKGROUND: Immunosuppressive therapies as azathioprine (AZA), mycophenolate mofetil (MMF) and rituximab (RTX) are widely prescribed as first-line treatment to prevent relapses in NMOSD. However, the rate of response to these traditional therapies is unknown in Argentina. We aimed to describe and compare treatment failure rates in NMOSD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT03375177). METHODS: A retrospective cohort study was conducted in NMOSD patients included in RelevarEM (a nationwide, longitudinal, observational, non-mandatory registry of MS and NMOSD in Argentina). NMOSD patients were defined based on validate diagnostic criteria. Only NMOSD patients who received AZA or MMF for at least 6 months or RTX for at least 1 month were included. Patients who were receiving AZA, MMF, or RTX and then switched to another 1 of these 3 therapies were included if the above-mentioned criteria for each drug were fulfilled. Data on patient demographics, clinical, neuroradiological findings, and treatments administered were collected. Treatment failure was defined as any new attack/relapse that occurred despite immunosuppressive treatment. RESULTS: We included 139 NMOSD patients who were receiving AZA (n = 105), MMF (n = 5) or RTX (n = 29) with a mean follow-up time of 41.3 ± 11.4 months and median of EDSS at treatment initiation of 3. We observed a reduction in the annualized relapse rate from pre-treatment to post-treatment of 51.1 %, 48.4 %, and 79.1 % respectively with a Hazard Risk relative to RTX (95 % CI) of 1.67 (1.34-3.54, p = 0.01) for AZA and 2.01 (1.86-4.43, p = 0.008) for MMF. AZA, MMF and RTX failure was observed in 45/105 (42.8 %), 2/5 (40 %) and 3/29 (10.3 %) patients, respectively. CONCLUSIONS: Treatment failure rates were higher for AZA and MMF than RTX in Argentinean NMOSD patients in a real-world setting. High-efficacy treatment increases the opportunity to prevent attacks of NMOSD.

The needed link between open science and science diplomacy-A Latin American perspective.

The relevance of science diplomacy and open science in today's world is undeniable. Science diplomacy enables countries to jointly address pressing global challenges, such as climate change, pandemics, and food security. Open science, promoting accessible and transparent research, plays a pivotal role in this context. Nevertheless, the degree of openness is subject to specific circumstances, contingent upon varying factors, including local knowledge and resources. Latin America has not only been at the forefront of pioneering open access strategies, making it an interesting case to study, but it has also shown a tangible interest in using science diplomacy. Our research employs a mixed-methods approach, incorporating a quantitative survey involving 50 organizations and initiatives dedicated to promoting open science in Latin America, along with two qualitative focus group studies. Our primary objective is to assess if and how these entities use science diplomacy to achieve their objectives. Non-policy entities were prioritized due to their institutional stability in the region. We highlight successful strategies and delve into the existing barriers hindering the full implementation of open science principles. Our research aims to enhance collaboration between these organizations and policy and decision-makers by providing a set of recommendations in that direction. By shedding light on the current landscape and dynamics of open science in Latin America, we aspire to focus on science diplomacy, facilitate informed decision-making, and formulate policies that further propel the region along the path of openness, collaboration, and innovation in scientific research.

Epidemiological and microbiological characteristics of S. aureus pediatric infections in Colombia 2018-2021, a national multicenter study (Staphylored Colombia).

Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group. Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates. Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA. Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization.

Distinct Driver Pathway Enrichments and a High Prevalence of TSC2 Mutations in Right Colon Cancer in Chile: A Preliminary Comparative Analysis.

Colorectal cancer (CRC) is the second leading cause of cancer deaths globally. While ethnic differences in driver gene mutations have been documented, the South American population remains understudied at the genomic level, despite facing a rising burden of CRC. We analyzed tumors of 40 Chilean CRC patients (Chp) using next-generation sequencing and compared them to data from mainly Caucasian cohorts (TCGA and MSK-IMPACT). We identified 388 mutations in 96 out of 135 genes, with TP53 (45%), KRAS (30%), PIK3CA (22.5%), ATM (20%), and POLE (20%) being the most frequently mutated. TSC2 mutations were associated with right colon cancer (44.44% in RCRC vs. 6.45% in LCRC, p-value = 0.016), and overall frequency was higher compared to TCGA (p-value = 1.847 × 10-5) and MSK-IMPACT cohorts (p-value = 3.062 × 10-2). Limited sample size restricts definitive conclusions, but our data suggest potential differences in driver mutations for Chilean patients, being that the RTK-RAS oncogenic pathway is less affected and the PI3K pathway is more altered in Chp compared to TCGA (45% vs. 25.56%, respectively). The prevalence of actionable pathways and driver mutations can guide therapeutic choices, but can also impact treatment effectiveness. Thus, these findings warrant further investigation in larger Chilean cohorts to confirm these initial observations. Understanding population-specific driver mutations can guide the development of precision medicine programs for CRC patients.

Oncology nursing specialty across Latin America: struggle and achievements past and present.

BACKGROUND: Latin America (LATAM) is a large region from Mexico to southern Patagonia in Chile and includes most islands in the Caribbean where Spanish is an official language. Efforts to address nursing specialization in the care of patients with cancer throughout the cancer continuum are described in narratives of oncology nursing struggles and achievements from eight Latin American countries. METHODS: Contributions by authors from Mexico, Costa Rica, Ecuador, Brazil and Chile are complemented by interview data (in Spanish by a bilingual medical anthropologist) to share the history and present status in the Dominican Republic, Peru and Argentina. RESULTS: We present stories of the pioneers of oncology nursing and a brief description of health systems in several of the included countries to show the disparate approaches towards cancer control and the context in which the oncology nurses work. We include key demographics and cancer data from the highlighted countries. We follow with descriptions of the formation and importance of oncology nursing associations/societies and share the history of oncology nursing education efforts, scopes of practice and recommendations for improvement in oncology nursing. CONCLUSIONS: Despite the challenges, oncology nurse leaders across LATAM are determined to raise the standards of care with structured specialization education/training, and to create advanced practice oncology nursing roles. It is critical that the achievements of oncology nurses are nationally acknowledged and appropriately compensated by governments and national and local authorities. The future is now for oncology nursing to be recognized as a critical specialized healthcare workforce to effectively address the growing threat of cancer and to ensure optimal control of this public health crisis across the region.

Where does Hispanic Latin America stand in biomedical and life sciences literature production compared with other countries?

Objectives: to provide objective quantitative data about medical-related scientific production in Hispanic Latin America compared to different regions and identify demographic and political variables that could improve research. Study design: This is an analytical, observational, cross-section bibliometric study about all fields of medical-related scientific production over five years in different regions and its relationship with demographic and political variables that could impact research and the health system quality. Methods: Data on the total scientific production of all Hispanic Latin American countries and other countries representing almost 90% of mundial publications between 2017 and 2021 were retrieved from the PubMed database. Demographic and political data were obtained from open online databases. Counts of publications were rationed to population and analyzed with all other demographic, region, and language variables, using univariate Poisson regression and negative binomial regression (for over-disperse variables) analysis. Multivariate negative binomial regression was used to analyze the combined effect of variables related to the healthcare and research Sectors. Results: Hispanic Latin America increased yearly from 29,445 publications in 2017 to 47,053 in 2021. This cumulative growth of almost 60% exceeded the 36% increment in all countries' publications and was only below that of Russia and China, which grew 92% and 87%, respectively. Negative binomial regression showed that the percentage of gross income dedicated to research (IRR 2.036, 95% CI: 1.624, 2.553, p< .001), life expectancy at birth (IRR 1.444, 95% CI: 1.338, 1.558, p< .001), and the number of medical doctors per inhabitant (IRR 1.581, 95% CI: 1.17, 2.13, p = .003) positively impacted scientific production. A higher mortality associated with chronic diseases between ages 30 and 70 (IRR 0.782, 95% CI: 0.743 0.822, p< .001) and a lower population with access to medicine (IRR 0.960, 95% CI: 0.933, 0.967, p< .001) were found to impact scientific production negatively. Hispanic Latin American countries published less than 20% of those with English as their native language (p< .001). Conclusion: Hispanic Latin America has increased the gross number of publications by almost 60 % from 2017 to 2021. However, the number of publications per 100,000 inhabitants is still low compared to other countries. Our analysis highlights that this may be related to lower GDP, research investment, and less healthcare system quality.

Antimicrobial Stewardship Programs in Latin America and the Caribbean: A Story of Perseverance, Challenges, and Goals.

Antimicrobial resistance is one of the major global health threats. Antimicrobial stewardship (AMS) has been set as a priority within international action plans to combat this issue. The region of Latin America and the Caribbean are recognized for their high antimicrobial resistance rates; nevertheless, a low number of studies describing implemented interventions for this topic have been published. This review aims to provide an overview of the status of AMS in our region, focusing on the main progress achieved and describing the different published efforts made by countries towards the implementation of antimicrobial stewardship programs (ASP). Common areas of intervention included were (a) education approaches, (b) antimicrobial guideline implementation and monitoring, (c) diagnostic stewardship, (d) technological tools: electronic clinical decision support systems in AMS, (e) pharmacy-driven protocols and collaborative practice agreements, and (f) economic impact. The search demonstrated the varied interventions implemented in diverse healthcare settings; the results accentuate their influence on antimicrobial consumption, antimicrobial resistance, clinical outcomes, and direct economic impact. The integration of multiple strategies within each hospital was highlighted as an essential key to ASP success. Even though the literature found demonstrated clear progress, there is still a special need for strengthening leadership from the top down, defining goals based on needs, and gaining support through policy and financing in LAC.

The Use and Effectiveness of Ceftazidime-Avibactam in Real-World Clinical Practice: EZTEAM Study.

INTRODUCTION: Ceftazidime-avibactam has proven activity against multidrug-resistant (MDR) bacteria in clinical trials and real-world studies. This study was conducted to describe the patterns of use of ceftazidime-avibactam (including indications and associated antibiotics), and the effectiveness and safety of ceftazidime-avibactam in real-world clinical practice. METHODS: This non-interventional medical chart review study was conducted in 11 countries across the European and Latin American (LATAM) regions. Consecutive patients treated in clinical practice with at least one dose of ceftazidime-avibactam for an approved indication per country label since 01 January 2018 (or launch date in the country if posterior) were enrolled. Effectiveness analyses were conducted in patients treated with ceftazidime-avibactam for at least 72 h. RESULTS: Of the 569 eligible patients enrolled, 516 (90.7%) were treated for at least 72 h (354 patients from Europe and 162 patients from LATAM); 390 patients (75.7%) had switched from another antibiotic line for Gram-negative coverage. Infection sources were intra-abdominal, urinary, respiratory, bloodstream infections, and other infections (approximately 20% each). K. pneumoniae was the most common microorganism identified in the latest microbiological evaluation before starting ceftazidime-avibactam (59.3%). Two-thirds of microorganisms tested for susceptibility were MDR, of which 89.3% were carbapenem-resistant. The common MDR mechanisms for K. pneumoniae were carbapenemase (33.9%), oxacillinase 48 (25.2%), extended-spectrum beta-lactamase (21.5%), or metallo-beta-lactamase (14.2%) production. Without prior patient exposure, 17 isolates (mostly K. pneumoniae) were resistant to ceftazidime-avibactam. Treatment success was achieved in 77.3% of patients overall (88.3% among patients with urinary infection), regardless of first or second treatment line. In-hospital mortality rate was 23.1%. Adverse events were reported for six of the 569 patients enrolled. CONCLUSION: This study provides important real-world evidence on treatment patterns, effectiveness, and safety of ceftazidime-avibactam in clinical practice through its recruitment in the European and LATAM regions. Ceftazidime-avibactam is one of the antibiotics to consider for treatment of MDR bacteria. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03923426.

Impact of digital technologies upon teaching and learning in higher education in Latin America: an outlook on the reach, barriers, and bottlenecks.

Digital technology and literacy can heighten the transformation of teaching and learning in higher education institutions (HEIs). This study uncovers the extent to which digital technologies have been used to advance the teaching and learning process in HEIs, and the barriers and bottlenecks to why it may not have been effectively implemented across the HEIs. The study used nine selected countries in Latin America (LATAM) based on the main focus of the educators, commercial, and financial investors; to show the level of impact/implications of computer technologies on the teaching and learning processes. We applied a two-step (mixed) methodology (through a quantitative and qualitative lens) for the research investigation, using data collected from survey we administered to faculty members in HEIs across the different countries in LATAM. In turn, we implemented a Text Mining technique (sentiment and emotional valence analysis) to analyze opinions (textual data) given by the participants to help determine challenges and obstacles to using the digital technologies for teaching and learning in the region. Quantitatively, we applied a Kruskal-Wallis H-test to analyze the collected multiple choice and ranked items in the questionnaire in order to identify prominent factors that consummately influence the reach, barriers, and bottlenecks, and where the differences may lie across the different LATAM countries. The results show that the users upheld the emphasis on lack of training, infrastructures and resources, access to internet and digital platforms, as the main challenges to the teaching-learning process. The study also empirically discussed and shed light on critical factors the HEIs, particularly in LATAM, should resolve and adopt in support of the decision-making strategies, operational policies and governance, financial investments, and policymaking, at a time when "digital technologies" have become an inevitable and indispensable part of education and learning.

Stroke-related length of hospitalization trends and in-hospital mortality in Peru.

Background: Peru faces challenges to provide adequate care to stroke patients. Length of hospitalization and in-hospital mortality are two well-known indicators of stroke care. We aimed to describe the length of stay (LOS) of stroke in Peru, and to assess in-hospital mortality risk due to stroke, and subtypes. Methods: This retrospective cohort study used hospitalization registries coding with ICD-10 from 2002 to 2017 (N = 98,605) provided by the Ministry of Health; in-hospital mortality was available for 2016-2017 (N = 6,566). Stroke cases aged ≥35 years were divided into subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhage or infarction (I64). Data included stroke LOS and in-hospital mortality; socio-demographic and clinical variables. We fitted a region- and hospital level-stratified Weibull proportional hazard model to assess the in-hospital mortality. Results: The median LOS was 7 days (IQR: 4-13). Hemorrhagic strokes had median LOS longer than ischemic strokes and stroke not specified as hemorrhage or infarction (P = <0.001). The case fatality rate (CFR) of patients with stroke was 11.5% (95% CI [10-12%]). Subarachnoid hemorrhage (HR = 2.45; 95% CI [1.91-3.14]), intracerebral hemorrhage (HR = 1.95; 95% CI [1.55-2.46]), and stroke not specified as hemorrhage or infarction (HR = 1.45; 95% CI [1.16-1.81]) were associated with higher in-hospital mortality risk in comparison to ischemic strokes. Discussion: Between 2002 and 2017, LOS due to stroke has not changed in Peru in stroke patients discharged alive. Hemorrhagic cases had the longest LOS and highest in-hospital mortality risk during 2016 and 2017. The findings of our study seem to be consistent with a previous study carried out in Peru and similar to that of HIC and LMIC, also there is an increased median LOS in stroke cases managed in specialized centers. Likewise, LOS seems to depend on the type of stroke, where ischemic stroke cases have the lowest LOS. Peru needs to improve access to stroke care.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Multiple myeloma in Latin America.

INTRODUCTION: Multiple myeloma in Latin America (LATAM) face multiple challenges related to the lack of resources according to low- and middle-income in the region. AREAS COVERED: in this narrative review, several aspects of myeloma multiple epidemiology, diagnostic methods and risk stratification, medication commonly employed, and treatment results in LATAM are discussed. CONCLUSION: Patients usually are diagnosed in an advanced stage of the disease, and routine and risk evaluations are usually not ideal due to lack of access to different studies. Treatment is limited in many cases to the use of thalidomide and dexamethasone with and without cyclophosphamide. Access to autologous stem cell transplantation is far from ideal. Efforts must be made at the national health system level in our countries to offer our vast majority of MM patients a real chance to improve results in the diagnostic, risk stratification, and treatment. Currently, several groups in our region are working to make an impact in the field of MM.

Impact and future of telemedicine amidst the COVID-19 pandemic: a systematic review of the state-of-the-art in Latin America / Impacto e futuro da telemedicina em meio à pandemia de COVID-19: uma revisão sistemática do estado da arte na América Latina

Abstract Significant progress has been made in using information and communication technologies in medicine, by impacting the quality of health-care delivery system and patient care, and paving the way for ground-breaking tools for e-health and clinical decision-support systems. This study investigates the extent to which the evolution of telemedicine applications has been used to support patient care in Latin America (LATAM) amidst the pandemic. Theoretically, the study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify the impact of telemedicine in the region. Practically, the paper provides a systematic mapping study of the different domain areas and methodological progress in Telemedicine that occurred during the pandemic, and applied a text mining technique to understand the intensities of the terms expressed by the analyzed studies. The results show that while telemedicine has not been extensively used, a greater percentage of the studies report that telemedicine was effective. Approximately 70% positive emotional valence score was found. The paper also provides an empirical discussion and recommendations for the next steps in ample adoption of telemedicine.

Resumo Foram feitos progressos significativos na utilização de tecnologias de informação e comunicação na medicina, com impacto no sistema de prestação de cuidados de saúde e nos cuidados aos doentes, e abrindo caminho a ferramentas inovadoras para sistemas eletrônicos de saúde e de apoio à decisão clínica. O presente estudo investiga até que ponto o crescimento das aplicações da telemedicina tem sido utilizado para apoiar os cuidados aos doentes na América Latina (LATAM) em meio da pandemia. Teoricamente, o estudo aplicou a metodologia Preferred Reporting Items for Systematic Reviews e Meta-Analyses (PRISMA) para identificar o impacto da telemedicina na região. Na prática, o artigo apresenta um estudo de mapeamento sistemático das diferentes áreas de domínio e progresso metodológico em telemedicina que ocorreram durante a pandemia, e aplicou uma técnica de text mining para compreender as intensidades dos termos expressos pelos pesquisas analisadss. Os resultados mostram que, embora a telemedicina não tenha sido amplamente utilizada, um maior percentual de estudos informa que a telemedicina foi eficaz. Foi encontrada uma pontuação de valência emocional positiva de aproximadamente 70%. O documento também traz uma discussão empírica para os próximos passos na adoção da telemedicina.

Burden of phenylketonuria in Latin American patients: a systematic review and meta-analysis of observational studies.

BACKGROUND: Phenylketonuria (PKU) is an inborn error of metabolism caused by a deficiency of the enzyme phenylalanine hydroxylase. If untreated, the complications of PKU lead to significant neucognitive and neuropsychiatric impairments, placing a burden on both the individual's quality of life and on the healthcare system. We conducted a systematic literature review to characterize the impact of PKU on affected individuals and on healthcare resources in Latin American (LATAM) countries. METHODS: Searches of the global medical literature as well as regional and local medical literature up to September 2021. Observational studies on patients with PKU from any LATAM country. Pairs of reviewers independently screened eligible articles, extracted data from included studies, and assessed their risk of bias. RESULTS: 79 unique studies (47 cross-sectional studies, 18 case series, 12 case reports, and two cohort studies) with a total of 4090 patients were eligible. Of these studies, 20 had data available evaluating early-diagnosed PKU patients for meta-analysis of burden outcomes. Intellectual disability in the pooled studies was 18% [95% Confidence Interval (CI) 0.04-0.38; I2 = 83.7%, p = 0.0133; two studies; n = 114]. Motor delay was 15% [95% CI 0.04-0.30; I2 = 74.5%, p = 0.0083; four studies; n = 132]. Speech deficit was 35% [95% CI 0.08-0.68; I2 = 93.9%, p < 0.0001; five studies; n = 162]. CONCLUSIONS: There is currently evidence of high clinical burden in PKU patients in LATAM countries. Recognition that there are many unmet neuropsychological needs and socioeconomic challenges faced in the LATAM countries is the first step in planning cost-effective interventions.

Evaluation of adherence to treatment in patients with multiple sclerosis from Latin America.

INTRODUCTION AND AIM: Several factors have been associated with poor adherence to disease-modifying drugs (DMD). The aim of this study is to evaluate the adherence to DMD in people with multiple sclerosis (PwMS) in Argentina and Ecuador. METHODS: A cross-sectional study was performed. The study was carried out between June 2020 and October 2020, and 303 PwMS treated with DMD were included. Patients undergoing immune reconstitution treatments were excluded. Two definitions of DMD adherence were previously determined. Adherence to MS treatments was assessed using the multiple sclerosis treatment adherence questionnaire (MS-TAQ). The logistic regression model was used to evaluate factors related to adherence, and p < 0.05 was considered significant. RESULT: The mean age at study entry for patients was 40.7 ± 11.2 years, 207 (68.3%) were female, and the mean EDSS score was 2.2 ± 1.9. The overall adherence in our sample was 78.1% (79.7% in Argentina and 76% Ecuador, p = 0.23). Patients using infusion therapies significantly more often belonged to the adherent group (p = 0.042). Sharing decision-making (OR = 3.4, 95% CI: 1.7-6.9, p = 0.01), lower EDSS (OR = 0.8, 95% IC: 0.6-0.9, p = 0.004), and lower treatment duration (OR = 0.8, 95% IC: 0.6-0.9, p = 0.001) were independent predictors of adherence in our multivariate model. CONCLUSION: We found a prevalence of non-adherence similar to that previously reported. Furthermore, new factors associated with lower adherence were identified.

Polymyalgia rheumatica: A case series from Colombia and analysis of Latin America.

OBJECTIVE: Polymyalgia rheumatica (PMR) is the most common inflammatory disease in patients over 50 years. Information about the disease in Latin America (LATAM) is scarce. We aimed to evaluate a group of Colombian patients with PMR and to conduct a systematic review of PMR in LATAM. METHODS: A multicentric retrospective study was performed. Medical records of 256 PMR patients were evaluated. Patients were divided into two groups, those fulfilling the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for PMR and those who did not (i.e., clinical diagnosis). A systematic literature review and meta regression was performed comparing Colombian vs LATAM patients. RESULTS: From 256 patients, 145 (56.6%) fulfilled the 2012 EULAR/ACR criteria, and 111 (43.3%) were classified by clinical diagnosis. Inflammatory bilateral shoulder pain, pelvic girdle aching, morning stiffness >45 min, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CPR), and Methotrexate (MTX) prescription were more common in the 2012 EULAR/ACR group. None of the included patients presented overt polyautoimmunity (PolyA), whereas up to 24% exhibited latent PolyA. In addition, these patients showed high frequency of malignancy (7.59%). In the meta regression analysis, Colombian patients exhibited lower ESR levels, and were less likely to develop giant cell arteritis (GCA) as compared to the rest of LATAM data. CONCLUSION: Patients with PMR in LATAM exhibit similar phenotypes from other cohorts worldwide. Malignancy, GCA and latent PolyA should be considered in the routine clinical follow-up of patients with PMR.

An Immunoinformatics Approach for SARS-CoV-2 in Latam Populations and Multi-Epitope Vaccine Candidate Directed towards the World's Population.

The coronavirus pandemic is a major public health crisis affecting global health systems with dire socioeconomic consequences, especially in vulnerable regions such as Latin America (LATAM). There is an urgent need for a vaccine to help control contagion, reduce mortality and alleviate social costs. In this study, we propose a rational multi-epitope candidate vaccine against SARS-CoV-2. Using bioinformatics, we constructed a library of potential vaccine peptides, based on the affinity of the most common major human histocompatibility complex (HLA) I and II molecules in the LATAM population to predict immunological complexes among antigenic, non-toxic and non-allergenic peptides extracted from the conserved regions of 92 proteomes. Although HLA-C, had the greatest antigenic peptide capacity from SARS-CoV-2, HLA-B and HLA-A, could be more relevant based on COVID-19 risk of infection in LATAM countries. We also used three-dimensional structures of SARS-CoV-2 proteins to identify potential regions for antibody production. The best HLA-I and II predictions (with increased coverage in common alleles and regions evoking B lymphocyte responses) were grouped into an optimized final multi-epitope construct containing the adjuvants Beta defensin-3, TpD, and PADRE, which are recognized for invoking a safe and specific immune response. Finally, we used Molecular Dynamics to identify the multi-epitope construct which may be a stable target for TLR-4/MD-2. This would prove to be safe and provide the physicochemical requirements for conducting experimental tests around the world.

Registration pathways to accelerate regulatory assessment of innovative medicines in Latin America.

Countries worldwide have introduced new regulations to accelerate drug regulatory review to afford faster access to medicines, mainly for patients with no or limited therapeutic alternative without compromising the quality, efficacy, and safety of the drug. We mapped and analyzed accelerated regulatory pathways in 19 countries from Latin America (LATAM). Pathways included acceptance of Phase II studies, when justified, and requirement of a Certificate of Pharmaceutical Product (CPP) for regulatory submission or approval for a drug. We present a regional regulatory overview of innovative pathways to accelerate assessment of medicines by regulators to benefit patients in need. Most LATAM regulators we surveyed have implemented accelerated pathways. Adoption of good regulatory practices is key for success (World Health Organization, WHO, Good Regulatory Practices: guidelines for national regulatory authorities for medical products (World Health Organization, WHO, Good Regulatory Practices: guidelines for national regulatory authorities for medical products. World Health Organization QAS/16.686. WHO, 2016. https://www.who.int/medicines/areas/quality_safety/quality_assurance/GoodRegulatory_PracticesPublicConsult.pdf ).