Abstract Number ‐ 195: Impact of COVID‐19 on Stroke Treatment in Latin America

Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges.

BackgroundAlthough G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review.MethodsA systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent.ResultsThe Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent.ConclusionHaemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.

Section Editors: Marc Fisher MD Antoni Davalos MD The Food and Drug Administration (FDA) evaluates applications for new human drugs, biologics, and complex medical devices. Companies must obtain FDA approval to legally market these products. In August, the FDA gave Concentric Medical clearance to market its Merci Retriever system to “remove blood clots from the brain in patients experiencing an ischemic stroke.” Given that the FDA is charged with “protecting the public health by assuring the safety, efficacy, and security of… biological products and medical devices…, ” “advancing public health by helping to speed innovations that make medicines … more effective, safer, and more affordable,” and “helping the public get the accurate, science-based information they need to use medicines … to improve their health,”1 the FDA’s decision to approve the Merci Retriever system is of concern. The pathways to approval are reviewed by Felten et al in the accompanying article and are outlined in Figure 1. Figure 1. Potential pathways for device approval. The decision to approve the Merci Retriever was based on data from the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial; the approval was granted through the 510(k) process. The Merci Retriever system includes a flexible nickel titanium (nitinol) wire that obtains a helical shape once it is passed through the tip of the guidance catheter. In practice, the catheter/wire is passed distal to the thrombus, the catheter is removed, and the helical configuration assumed by the wire; the clot is then trapped in the helix and withdrawn from the vasculature (Figure 2). The 510(k) clearance means that the Merci Retriever was felt to be substantially equivalent to a predicate device. In this case, the predicate device was the Concentric Retriever, which itself received 510(k) clearance by the FDA in May 2001 for “use in …

Recent Trends in Income Inequality in Latin America Leonardo Gasparini (bio), Guillermo Cruces (bio), and Leopoldo Tornarolli (bio) Any assessment of the Latin American economies would be incomplete without reference to their high levels of socioeconomic inequalities. All countries in the region are characterized by large disparities of income and consumption levels, access to education, land, and basic services, and other socioeconomic variables. Inequality is a distinctive, pervasive characteristic of the region. This document presents information updated through the mid-2000s and analyzes patterns and trends of income inequality in Latin America. The measurement and analysis of inequality have long been a major topic of study for economics and other social sciences in the region. However, the scarcity of reliable and consistent microeconomic data has always been an obstacle against comprehensive assessments. Most studies are based on limited sources or are constrained to cover a single country. The United Nations Economic Commission for Latin America and the Caribbean (ECLAC), the World Bank, and the Inter-American Development Bank (IDB) have all made efforts to assemble large databases of national household surveys to support wider [End Page 147] assessments of inequality, poverty, and other socioeconomic variables. This study is mostly based on data from the Socioeconomic Database for Latin America and the Caribbean (SEDLAC), a project developed jointly by the Center for Distributive, Labor, and Social Studies (CEDLAS) and the World Bank. This database contains information on more than 200 official household surveys in twenty-five Latin American and Caribbean countries. This paper uses data for the period from 1992 to 2006. We confirm that income inequality increased in the 1990s as documented in the literature, but we also find that inequality decreased in the 2000s, suggesting a turning point from the unequalizing changes of the previous two decades. While the recent fall in income inequality is significant and widespread, it does not seem to be based on strong fundamentals. The rest of this paper is organized as follows. The discussion opens with a description of the data sources and their limitations. The subsequent section represents the core of the paper, as it documents the main patterns of income inequality in Latin America, at both the country and regional levels. The paper then takes a look inside household income, discussing inequality patterns for the distribution of individual labor and nonlabor income. We also place the Latin American evidence in international perspective, using various data sources. The final section presents our concluding remarks. The Data The main source of data for this paper is the Socioeconomic Database for Latin America and the Caribbean (SEDLAC), developed jointly by CEDLAS at the Universidad Nacional de La Plata (Argentina) and the World Bank's Latin American and Caribbean Poverty and Gender Group. This database contains information on more than 200 official household surveys in twenty-five Latin American and Caribbean countries: the seventeen countries in continental Latin America (namely, Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela) plus eight countries in the Caribbean (the Dominican Republic and seven non-Hispanic Caribbean countries). The sample represents 97 percent of the total Latin American and Caribbean population, including 100 percent in continental Latin America and 55 percent in the Caribbean. The main missing country is Cuba, which does not disclosure household survey information. Our analysis starts in the early 1990s, [End Page 148] when most countries in Latin America consolidated their household survey programs, and ends in 2006. Table 1 lists the surveys used in this study, covering the eighteen Latin American countries in the CEDLAS database. Household surveys in most countries are nationally representative, with the exception of Argentina and Uruguay (before 2006), where surveys cover only the urban population. This nonetheless represents 88 percent and 92 percent of the total population in these countries, respectively. In these two cases, we use the urban figures as proxies for the national statistics.1 Most countries experienced changes in their household surveys in the 1990s and 2000s. In many cases the geographical coverage was broadened, monthly surveys were replaced by annual ones, and the questionnaires were improved. Although these changes are certainly welcome, they pose significant...

Data sources Medline, Popline, ExtraMed, Embase and Info Latino Americo were searched for the period 1 January 1970–31 December 2000. Keywords used were “dental caries” and names of countries in Latin America and the Caribbean. Reference lists from retrieved articles were also examined for more studies. Study selection For inclusion an article had to have clearly-defined ages within the groups (5–6, 11–13 years); use the World Health Organization caries diagnostic criteria; the sample had to be reasonably representative of the general population and contain at least 30 individuals; and examiners had to be calibrated. Data extraction and synthesis For each of the two age-groupings, the caries prevalence and caries severity data were plotted against the year of study. A nonlinear regression curve was fitted to each group of results, and a linear regression analysis was done to look for a significant departure from zero of the caries-rate trend with statistical significance set at P<0.05. This was done separately for the 21 countries in Latin America and 12 countries in the Caribbean. Results The search identified 438 articles: 172 were epidemiological studies, of which 30 fulfilled the inclusion criteria. A total of 16 countries were represented. Over the last 30 years, there has been a significant decrease in caries prevalence for 11–13-year-old children in Latin America. There was also a significant decrease in caries severity for 5–6-year-olds in Latin America, and for 11–13-year-olds in Latin America and the Caribbean. Conclusions This study showed some statistically significant downward trends in dental caries between 1970 and 2000 in 16 countries in Latin America and the Caribbean.

Acute kidney injury requiring renal replacement therapy during the COVID-19 pandemic: what are our options for treating it in Latin America?

Movement dynamics: reduced dengue cases during the COVID-19 pandemic

Introduction : Acute ischemic stroke is one of the leading causes of death and disability in the lower and middle income countries (LMIC). The emergence of COVID‐19 has negatively impacted medical care, specifically AIS treatment, in many parts of the world. In this study, we investigated AIS treatment barriers in high COVID‐19 incidence regions in Latin America. Methods : In our study, we organized the 21 Latin American regions based on the number of COVID‐19 cases from the highest to the lowest. In August 2020, Brazil had the highest number of COVID‐19 cases which was 2,736,298 while Belize had the lowest number of COVID‐19 cases which was 57. Taking the top 5 countries with the highest COVID‐19 cases (Brazil, Peru, Chile, Colombia, and Argentina), we compiled a list of neurologists, neurosurgeons, and neurointerventionalists involved in stroke care. We then sent 100 of these clinicians a survey to understand the effects of the pandemic on stroke treatment in their hospitals. Following the survey, we requested the doctors to set up an interview to delve deeper into the barriers to access to AIS treatment. Out of the 100 clinicians contacted, 16 filled out the survey and 14 doctors set up an interview with us. Results : Using the survey results and the interview data, the top‐5 barriers mentioned were transportation, disease awareness, rehabilitation, shortages in staff, and fear among the public about contracting COVID‐19 at the hospital. About 62% of the doctors indicated that people are scared of coming to the hospital due to the high COVID‐19 cases. Furthermore, 60% of the doctors mentioned that there has been a lack of staff at hospitals which causes a reduction in the number of treatment procedures performed, especially mechanical thrombectomies. Moreover, 50% of the doctors said that the main barrier was transportation delay, which results in time lost before treatment. About 50% of the doctors also mentioned that most of the population does not know what AIS is or its symptoms, resulting in fewer patients seeking appropriate care. Finally, 50% of the doctors said that there has been no sufficient rehabilitation. Many rehab units/hospitals have been converted into COVID‐19 hospitals due to the large number of COVID‐19 patients. Therefore, after a patient has received stroke treatment, they have not been able to recover back to their original healthy status. These barriers have overall decreased AIS treatments in hospitals and have negatively impacted patients who have experienced AIS. Conclusions : Overall, the emergence of COVID‐19 has negatively impacted AIS treatment in regions in Latin America with the highest COVID‐19 cases. Hospitals faced several barriers during the pandemic making it difficult for staff to adjust to those specific circumstances. Based on recommendations that doctors have provided us, we are currently working with doctors in Peru to launch an app that tackles the transportation, educational, and rehabilitation barriers. This app will allow patients to connect with doctors online and perform rehabilitation exercises at the comfort of their home while also being able to learn more about stroke.

Inequalities in contraceptive use in Latin America and the Caribbean.

Epidemiology, Clinical Features and Outcomes of Peripheral T-Cell Lymphoma in Latin America

In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. A range of international and regional actors have made important policy recommendations to address the gendered implications of the COVID-19 pandemic on women's health and wellbeing since the start of the pandemic. However, national-level policy responses to the COVID-19 pandemic have been partial and inconsistent with regards to gender in both sub-Saharan Africa and Latin America, largely failing to recognise the multiple drivers of gendered health inequalities. This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.

미·중 경쟁이 중남미 경제에 미치는 영향과 시사점(An Effect of US-China Rivalry on Latin America and Its Implication)

Non-alcoholic fatty liver disease prevalence in Latin America: A systematic review and meta-analysis

Introduction: Latin America (LATAM) is among the so-called emerging regions for conducting clinical trials. Complex not-harmonized regulatory frameworks and lengthy approval timelines (among other factors) present challenges for increased LATAM trial participation. Objective: to assess LATAM contribution to clinical trials, we conducted a descriptive analysis of the region participation in practice-changing breast cancer (BC) trials. Methodology: we defined practice-changing trial as any one that supported FDA approval of a new drug or a new indication for a previously approved drug; we excluded trials that only led to approval of changes in regimen/doses. Through the FDA website we searched all drugs approved for BC treatment between January 1992 and December 2017. For each FDA-approved drug we identified applicable practice-changing trials in the latest package insert. We analyzed each applicable published article for data of interest: drug approval year, indication, participating countries, number of sites per country, trial start year of enrollment, authors per country, among others. If all these data was not available in the article we searched for it in clinicaltrials.gov. If all data was neither in the article nor clinicaltrials.gov, the trial was excluded from our analysis. Results: 31 trials that led to the approval of 17 drugs were included in our analysis. LATAM participated in 21 trials (67.7%), mean number of LATAM countries per trial = 3.3 and mean number of sites per trial = 13.5. The region participated in 90% of (neo)adjuvant and in 57% of metastatic trials. Additional data is in Table 1. As an average, LATAM contributed with 4.9% of all trial sites. Argentina, Brazil and Mexico had 84% of LATAM sites, Peru and Colombia 8%, and the remaining 8% were distributed among 15 LATAM countries. The 5-year periods with highest number of trials in the region was 2001-05 and 2006-10 (Table 2). Fifteen LATAM authors (87% from Argentina and Brazil) from a total of 530 authors (2.8%) were identified in the primary publication, none of them as first or last author. Conclusion: over the last 25 years the number of practice-changing BC trials conducted in LATAM has increased since 1990s, remained stable from 2001-10 and recently decreased. LATAM participated in the majority of (neo)adjuvant trials; longer time for enrollment and duration of these trials could explain this finding since these would allow for inclusion of regions with longer regulatory timelines. Region's contribution in terms of countries, sites and authors is minor. Disparities within LATAM countries are remarkable and, as expected, the 3 largest countries are the key contributors. A comparison with other emerging regions will be presented. LATAM participation in practice- changing BC trialsCharacteristicsTotalLATAMNumber of trials3121Mean number of sites/trial188.513.5Indication (Neo) adjuvant trials109Metastatic trials2112Drug Type Endocrine therapy105Chemotherapy64Anti HER2109CDK4/6 inhibitors42Other11 LATAM participation per 5-year periodPeriod (per year of trial enrollment start)Number of LATAM trialsLATAM sites per trial1986-1990001991-1995210.51996-2000414.32001-2005614.72006-2010614.72011-2015312.0 Citation Format: Machado A, Migliaro A, Fresco R. Latin American participation in practice-changing breast cancer trials in the last 25 years [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-15-02.

Latin America is the collective name of the American regions where languages of Latin origin are taken as the official language or the main language, south of the USA. Latin America is generally divided by the Panama Canal into Central America and South America. Latin America is adjacent to the Atlantic Ocean on the east and the Pacific Ocean on the west. Its north-south length is more than 11,000 km; the maximum east-west width is more than 5100 km, while the minimum east-west width is only 48 km, which occurs at the Isthmus of Panama. Latin America consists of more than 30 countries and territories with a population of 588 million. Latin America is an underdeveloped region dominated by the developing countries and is also the most active region with the greatest developmental potential in the world. Most countries in Latin America abound in natural resources and enjoy excellent locations, but all over Latin America, the level of economic development is still relatively low, the agricultural economy mostly plays the dominant role and the industrial economies are underdeveloped.