Why do rural youth migrate? Evidence from Colombia and Guatemala.

Migration, from rural to urban settings is a common phenomenon in Latin America, due to social, economic, political, and other factors. Young people in search of economic and educational opportunities, financial, and social stability, have been migrating to larger urban centers, thus crafting important shifts in rural labor, generational transfer, and domestic economies. Through a systematic literature review of scientific literature, and documents from public institutions and international organizations, published between 2012 and 2022, this article addresses rural-urban migration of youth in Colombia and Guatemala's cattle sector, particularly identifying (i) driving factors, (ii) their impacts on cattle farming, and (iii) public policies implemented to counteract prejudicial effects. Results show that unemployment, lack of educational opportunities, and insecurity are the main reasons for youth migration to cities or abroad, with Mexico, the United States, and Spain being the most common destinations. Additionally, impacts on the cattle sector include shortage of labor and a perfectible generational transfer, hindering the modernization of the industry and investments in climate change adaptation and mitigation strategies. Despite various implemented public policies, the results are partial, and the issue of accelerated youth migration remains relevant. Consequently, without more effective measures adopted by national governments, the cattle sector will lag behind its regional and international competitors, deterring the achievement of the Sustainable Development Goals. As the main contribution of the study, the analysis of migration is highlighted based on its effects on a specific economic sector and not focused on its causes, as evidenced in a wide range of literature.

Phase Angle as a Predictor of Mortality in Older Patients with Hip Fracture.

The aim of our study is to determine if there is an association between phase angle obtained by bioelectrical impedance analysis (BIA) and mortality in older patients with fragility hip fractures. A prospective study of patients over 65 years old and hospitalized with a diagnosis of hip fracture was conducted. BIA was performed 24 to 48 h after surgery. Mortality was recorded, and the optimal phase angle cut-off value for predicting mortality was determined by using receiver operating characteristic (ROC) curves. A total of 262 patients were included. Of the patients studied, 10 (3.8%), 21 (8%), 39 (14.9%) and 53 (20.2%) died at 1, 3, 6 and 12 months after surgery, respectively. The phase angle cut-off for mortality at 12 months was 4.05° in women and 4.65° in men. A total of 94 patients (35.9%) were considered to have a low phase angle. After adjustment for possible confounders, mortality in patients with a low phase angle was 5.1 times higher at 1 month, 3.1 times higher at 3 months, 2.9 times higher at 6 months, and 2.8 times higher at 12 months. Phase angle is associated with prognosis in patients admitted for hip fracture regardless of age and comorbidities and can be positioned as a prognostic tool for mortality at 1, 3, 6 and 12 months.

A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality.

BACKGROUND: Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. OBJECTIVE: The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. DESIGN: Retrospective cohort study. PATIENTS: We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. MAIN MEASURES: Primary outcome was to assess risk of admission or mortality. KEY RESULTS: 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82-142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19-34.48), obesity (RR: 1.53 (1.12-2.10), chronic kidney disease (RR:2.31 (1.23-4.35), ≥ 60 years of age (RR: 1.44 (1.04-1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15-55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62-10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70-15.15), chronic respiratory disease (RR: 3.32 (1.43-7.69) and active malignancy (RR: 4.00 (1.42-11.23). CONCLUSIONS: Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.

Multiple neoplasms in patients with uveal melanoma: a systematic review.

PURPOSE: Uveal melanoma is the most prevalent intraocular malignancy in adults, derived from uveal tract melanocytes. This study focuses on the frequency and risk of second primary malignancies in UM patients. METHODS: A PubMed search (1980-2023) identified studies on SPM incidence in UM patients. From 191 references, 14 studies were chosen, focusing on UM, SPMs, and analysing data on demographics and types of neoplasms. RESULTS: Among 31,235 UM patients in 14 studies, 4695 had 4730 SPMs (15.03% prevalence). Prostate (15%), breast (12%), and colorectal (9%) cancers were most common. Digestive system malignancies were highest (19%), with colorectal cancer leading (51%). Breast and prostate cancers were prevalent in respective systems. Lung, bladder, and non-Hodgkin's lymphoma were also notable. The study observed an increasing trend in the frequency of SPMs over time, reflecting broader trends in cancer survivorship and the growing prevalence of multiple malignancies. CONCLUSION: The study highlights a significant presence of SPMs in UM patients, with an increasing trend in frequency over time, emphasizing prostate and breast cancers. This underscores the need for focused surveillance and tailored follow-up for UM survivors, considering their higher risk of additional malignancies. Future research should further investigate SPM aetiology in UM patients.

Remission and low disease activity are associated with lower healthcare costs: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.

OBJECTIVES: This study aims to determine the independent impact of definitions of remission/low disease activity (LDA) on direct/indirect costs (DCs, ICs) in a multicentre inception cohort. METHODS: Patients from 31 centres in 10 countries were enrolled within 15 months of diagnosis and assessed annually. Five mutually exclusive disease activity states (DAS) were defined as (1) remission off-treatment: clinical (c) SLEDAI-2K=0, without prednisone/immunosuppressants; (2) remission on-treatment: cSLEDAI-2K=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; (3) LDA-Toronto Cohort (TC): cSLEDAI-2K≤2, without prednisone/immunosuppressants; (4) modified lupus LDA state (mLLDAS): SLEDAI-2K≤4, no activity in major organs/systems, no new activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants and (5) active: all remaining assessments.At each assessment, patients were stratified into the most stringent DAS fulfilled and the proportion of time in a DAS since cohort entry was determined. Annual DCs/ICs (2021 Canadian dollars) were based on healthcare use and lost workforce/non-workforce productivity over the preceding year.The association between the proportion of time in a DAS and annual DC/IC was examined through multivariable random-effects linear regressions. RESULTS: 1692 patients were followed a mean of 9.7 years; 49.0% of assessments were active. Remission/LDA (per 25% increase in time in a remission/LDA state vs active) were associated with lower annual DC/IC: remission off-treatment (DC -$C1372; IC -$C2507), remission on-treatment (DC -$C973; IC -$C2604,) LDA-TC (DC -$C1158) and mLLDAS (DC -$C1040). There were no cost differences between remission/LDA states. CONCLUSIONS: Our data suggest that systemic lupus erythematosus patients who achieve remission, both off and on-therapy, and reductions in disease activity incur lower costs than those experiencing persistent disease activity.

Long-term relationships of beef and dairy cattle and greenhouse gas emissions: Application of co-integrated panel models for Latin America.

The cattle sector plays a pivotal role in the economies of numerous Latin American and Caribbean countries. However, it also exerts a significant impact on environmental degradation, including substantial contributions to greenhouse gas emissions (accounting for 23.5 % of global livestock emissions) and deforestation (70 % attributed to livestock in South America). This article aims to investigate the complex, long-term, and short-term relationships between population growth, pastureland expansion, deforestation, and the cattle sector in 15 countries across the region, focusing on their effects on greenhouse gas emissions as well as beef and dairy production. Utilizing data from FAOSTAT spanning the period from 1990 to 2019, a cointegrated panel model was developed using the Pooled Mean Group technique, resulting in the estimation of six models. The aggregate-level results for the region reveal the presence of relatively stable long-term relationships. This implies that over time, the influence of population growth, pastureland expansion, and deforestation on greenhouse gas emissions from cattle production tends to diminish in significance. This long-term behavior may be particularly pronounced in countries with more developed cattle sectors, where efforts to mitigate the environmental impacts of cattle production, such as promoting improved forage technologies, silvo-pastoral systems, grazing management practices, and the implementation of policies, regulatory frameworks, and incentives, have gained traction. These progressive countries can serve as regional benchmarks, and the lessons they have learned hold valuable insights for the sustainable intensification of cattle production in countries with less-developed cattle sectors.

Assessment and personalised advice for fatigue in systemic lupus erythematosus using an innovative digital tool: the Lupus Expert system for the Assessment of Fatigue (LEAF) study.

BACKGROUND: Fatigue is reported as the most prevalent symptom by patients with systemic lupus erythematosus (SLE). Fatigue management is complex due to its multifactorial nature. The aim of the study was to assess the usefulness of an innovative digital tool to manage fatigue in SLE, in a completely automated manner. METHODS: The «Lupus Expert System for Assessment of Fatigue¼ (LEAF) is free digital tool which measures the intensity and characteristics of fatigue and assesses disease activity, pain, insomnia, anxiety, depression, stress, fibromyalgia and physical activity using validated patient-reported instruments. Then, LEAF automatically provides personalised feedback and recommendations to cope with fatigue. RESULTS: Between May and November 2022, 1250 participants with SLE were included (95.2% women, median age 43yo (IQR: 34-51)). Significant fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue <34) was reported by 78.9% of patients. In univariate analysis, SLE participants with fatigue were more likely to be women (p=0.01), perceived their disease as more active (p<0.0001), had higher levels of pain (p<0.0001), anxiety (p<0.0001), depression (p<0.0001), insomnia (p<0.0001), stress (p<0.0001) and were more likely to screen for fibromyalgia (p<0.0001), compared with patients without significant fatigue. In multivariable analysis, parameters independently associated with fatigue were insomnia (p=0.0003), pain (p=0.002), fibromyalgia (p=0.008), self-reported active SLE (p=0.02) and stress (p=0.045). 93.2% of the participants found LEAF helpful and 92.3% would recommend it to another patient with SLE. CONCLUSION: Fatigue is commonly severe in SLE, and associated with insomnia, pain, fibromyalgia and active disease according to patients' perspective. Our study shows the usefulness of an automated digital tool to manage fatigue in SLE.

El árbol Acacia mangium (Fabaceae) facilita la recuperación de áreas mineras en la selva lluviosa del Chocó, Colombia

Introducción: Las áreas impactadas por minería en bosques tropicales requieren de la aplicación de estrategias de restauración ecológica, pero este proceso, muchas veces involucra el uso de especies vegetales exóticas, desconociendo los efectos sobre la regeneración ecológica de los sitios donde se introducen. Objetivo: Evaluar el efecto de las plantaciones de Acacia mangium (planta exótica) sobre la rehabilitación ecológica temprana (suelo y vegetación) de áreas impactadas por minería de oro a cielo abierto en la selva pluvial tropical del Chocó, Colombia. Métodos: Se seleccionaron 16 áreas mineras como unidades de muestreo (ocho reforestadas con A. mangium y ocho en sucesión natural) en dos localidades. En cada unidad de muestreo se estableció una parcela de 2 × 50 m (cuatro parcelas por escenario de muestreo y localidad), donde se analizó la fertilidad del suelo (parámetros físicos y químicos) y se cuantificó el número de individuos de cada especie de planta vascular. Resultados: Se registraron 73 especies (69 géneros, 45 familias). La densidad de individuos fue mayor en áreas de sucesión natural que en aquellas reforestadas con A. mangium; por el contrario, la riqueza y diversidad de especies fueron superiores bajo las plantaciones de A. mangium. La similitud florística fue baja entre escenarios sucesionales (especies compartidas 35.6 %). El suelo mostró mejores condiciones (especialmente, N-NHO3) en áreas con A. mangium que en áreas en regeneración natural. Conclusiones: Las plantaciones de A. mangium parecen facilitar la rehabilitación temprana de la fertilidad del suelo y la vegetación en las minas abandonadas; por lo tanto, esta especie puede jugar un papel importante para la implementación de estrategias de restauración ecológica de áreas impactadas por minería de oro a cielo abierto en el Chocó y otros sistemas forestales tropicales con condiciones ambientales y de perturbación similares.

Introduction: Mining-impacted areas in tropical forests require the application of ecological restoration strategies, but this process often involves use of exotic plant species ignoring the effects on the ecological regeneration of the sites where they are introduced. Objective: To evaluate the effect of Acacia mangium plantations (exotic plant) on early ecological rehabilitation (soil and vegetation) of areas impacted by open-pit gold mining in the tropical rain forest of Chocó, Colombia. Methods: 16 mining areas were selected as sampling units (eight reforested with A. mangium and eight in natural succession) in two locations. In each sampling unit, a 2 × 50 m plot was established (four plots per sampling scenario and locality), where soil fertility (physical and chemical parameters) was analyzed and the number of individuals of each vascular plant species was quantified. Results: 73 species (69 genera, 45 families) were recorded. The density of individuals was higher in areas of natural succession than in those reforested with A. mangium; conversely, species richness and diversity were higher under the A. mangium plantations. Floristic similarity was low between successional scenarios (shared species 35.6 %). The soil showed better conditions (especially N-NHO3) in mining areas with A. mangium than in those in natural regeneration. Conclusions: A. mangium plantations appears to facilitate the early rehabilitation of soil fertility and vegetation in abandoned mines; therefore, this species can play an important role in the implementation of ecological restoration strategies in areas impacted by open-pit gold mining in the Chocó and other tropical forest systems with similar environmental and disturbance conditions.

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis.

OBJECTIVE: To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). METHODS: A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. RESULTS: Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. CONCLUSION: The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.

In-Situ Modification of Nanofiltration Membranes Using Carbon Nanotubes for Water Treatment.

Modification of thin-film composite (TFC) nanofiltration (NF) membranes to increase permeability and improve separation performance remains a significant challenge for water scarcity. This study aimed to enhance the permeability and selectivity of two commercial polyamide (PA) NF membranes, NF90 and NF270, by modifying them with carbon nanotubes (CNTs) using microwave (MW)-assisted in-situ growth. The conducting polymer, polypyrrole (Ppy), and a ferrocene catalyst were used to facilitate the growth process. Chemical and morphological analyses confirmed that the surface of both membranes was modified. The NF270-Ppy-CNT membrane was selected for ion rejection testing due to its superior permeability compared to the NF90-Ppy-CNT. The modified NF270 membrane showed a 14% increase in ion rejection while maintaining constant water permeability. The results demonstrated that it is feasible to attach CNTs to a polymeric surface without compromising its functional properties. The Spliegler-Kedem model was employed to model the rejection and permeate flux of NF270-Ppy-CNT and NF270 membranes, which indicated that diffusive transport contributes to the modification to increase NaCl rejection. The present study provides a promising approach for modifying membranes by in-situ CNT growth to improve their performance in water treatment applications, such as desalination.

Global Subjective Assessment and Mini Nutritional Assessment Short Form Better Predict Mortality Than GLIM Malnutrition Criteria in Elderly Patients with Hip Fracture.

The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. METHODS: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. RESULTS: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3-25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3-11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02-13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3-8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35-6.7; p = 0.007] at 12 months. CONCLUSION: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.

A better self-efficacy is predictive of better health-related quality of life (HRQoL) in patients with systemic lupus erythematosus: data from the Almenara Lupus Cohort.

OBJECTIVE: To determine the possible predictive value of self-efficacy on health-related quality of life (HRQoL) in patients with SLE. METHODS: Patients with SLE from the Almenara Lupus Cohort were included. Self-efficacy was ascertained with the six domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing chronic conditions. For PROMIS domains, a score of 50 is the average for a clinical population (people with a chronic condition), a higher score indicates that the respondent has greater self-efficacy. HRQoL was ascertained with the physical and mental component summary (PCS and MCS) measures of the Short-Form 36 (SF-36). Generalised estimating equations were performed, using as outcome the PCS or MCS in the subsequent visit, and the self-efficacy domain in the previous visit; multivariable models were adjusted for possible confounders. The confounders were measured in the same visit as the self-efficacy domain. RESULTS: Two-hundred and nine patients for a total of 564 visits were included; 194 (92.8%) patients were women and mean age at diagnosis was 36.4 (14.0) years. In the multivariable models, a better PCS was predicted by a better self-efficacy for managing symptoms, managing medications and treatments and managing social interactions and general self-efficacy; a better MCS was predicted by a better self-efficacy for managing daily activities, managing symptoms, managing medications and treatments and managing social interactions. CONCLUSION: A better self-efficacy is predictive of subsequent better HRQoL, even after adjustment for possible confounders. These results should encourage clinicians to develop strategies to improve self-efficacy in patients with SLE.

Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Wildfire prediction using zero-inflated negative binomial mixed models: Application to Spain.

Wildfires have changed in recent decades. The catastrophic wildfires make it necessary to have accurate predictive models on a country scale to organize firefighting resources. In Mediterranean countries, the number of wildfires is quite high but they are mainly concentrated around summer months. Because of seasonality, there are territories where the number of fires is zero in some months and is overdispersed in others. Zero-inflated negative binomial mixed models are adapted to this type of data because they can describe patterns that explain both number of fires and their non-occurrence and also provide useful prediction tools. In addition to model-based predictions, a parametric bootstrap method is applied for estimating mean squared errors and constructing prediction intervals. The statistical methodology and developed software are applied to model and to predict number of wildfires in Spain between 2002 and 2015 by provinces and months.

A case report on cecal volvulus: Approach to management

@#Cecal volvulus is a rare cause of intestinal obstruction caused by axial twisting of the cecum that occurs in 1–1.5 % of all intestinal obstruction, with an incidence of 2.8–7.1 cases per million annually. Cecal volvulus is potentially life-threatening without prompt surgical intervention. A 57-year-old woman presented with severe abdominal pain and distention. Laboratory examinations revealed normal white blood cell count with neutrophilic predominance. Diagnosis of acute cecal volvulus was made from a “whirl sign” on abdominal computed tomography. An exploratory laparotomy confirmed the diagnosis of cecal volvulus and a segmental ileocolic resection with primary anastomosis was carried out. The patient was discharged improved and returned to her normal activities of daily living.

Pan American League of Associations for Rheumatology Guidelines for the treatment of ANCA-associated vasculitis.

Considerable variability exists in the way health-care providers treat patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in Latin America. The most frequently used treatments for ANCA-associated vasculitis are cyclophosphamide and prolonged glucocorticoid tapers; however, randomised controlled trials conducted over the past 30 years have led to the development of several evidence-based treatment alternatives for these patients. Latin America faces socioeconomic challenges that affect access to care, and the use of certain costly medications with proven efficacy ANCA-associated vasculitis is often restricted. For these reasons, the Pan American League of Associations for Rheumatology developed the first ANCA-associated vasculitis treatment guidelines tailored for Latin America. A panel of local vasculitis experts generated clinically meaningful questions related to the treatment of ANCA-associated vasculitis using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members. 21 recommendations and two expert opinion statements for the treatment of ANCA-associated vasculitis were developed, considering the current evidence and the socioeconomic characteristics of the region. These recommendations include guidance for the use of glucocorticoids, non-glucocorticoid immunosuppressants, and plasma exchange.

COVID-19 and the beef market in Latin America: An impact assessment by supply and demand.

The impact of COVID-19 on agricultural markets, especially the beef market, represents one of the greatest food security challenges the world is facing in the post-pandemic era and, for this reason, has been widely documented. This study contributes to the literature through a comprehensive impact analysis of the effects of COVID-19 on both the demand and supply of beef in Latin America and thus provides valuable information for two of the most important links of the beef value chain. Robust econometric methods and a graphic analysis were used that give solidity to the investigation. The analysis used a data panel of supply and demand variables between 2018 and 2022 derived from the US Department of Agriculture. The results suggest that the beef market was strongly affected by the pandemic related health emergency, presenting decreases in both consumption and production. These effects are transitory, however, since the analysis of the post-pandemic data revealed that consumption and production return to normal and seem to grow until smoothing out over time.

Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.

OBJECTIVE: To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. METHODS: Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Systemic Lupus Erythematosus Disease Activity Index (cSLEDAI)-2K=0, without prednisone or immunosuppressants; remission on-treatment: cSLEDAI-2K score=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; low disease activity Toronto cohort (LDA-TC): cSLEDAI-2K score of ≤2, without prednisone or immunosuppressants; modified lupus low disease activity (mLLDAS): Systemic Lupus Erythematosus Disease Activity Index-2K score of 4 with no activity in major organ/systems, no new disease activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants; active: all remaining visits. Only the most stringent definition was used per visit. Antimalarials were allowed in all. The proportion of time that patients were in a specific state at each visit since cohort entry was determined. Damage accrual was ascertained with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Univariable and multivariable generalised estimated equation negative binomial regression models were used. Time-dependent covariates were determined at the same annual visit as the disease activity state but the SDI at the subsequent visit. RESULTS: There were 1652 patients, 1464 (88.6%) female, mean age at diagnosis 34.2 (SD 13.4) years and mean follow-up time of 7.7 (SD 4.8) years. Being in remission off-treatment, remission on-treatment, LDA-TC and mLLDAS (per 25% increase) were each associated with a lower probability of damage accrual (remission off-treatment: incidence rate ratio (IRR)=0.75, 95% CI 0.70 to 0.81; remission on-treatment: IRR=0.68, 95% CI 0.62 to 0.75; LDA: IRR=0.79, 95% CI 0.68 to 0.92; and mLLDAS: IRR=0.76, 95% CI 0.65 to 0.89)). CONCLUSIONS: Remission on-treatment and off-treatment, LDA-TC and mLLDAS were associated with less damage accrual, even adjusting for possible confounders and effect modifiers.