Countries In Central America Research Articles

Латиноамериканское направление политики Д. Трампа во внутриполитической борьбе США 2020 г.: анализ предвыборных программ кандидатов в президенты

Introduction. Donald Trump’s policy towards the Latin American region and illegal Latino migrants was often criticized by mass media. Many experts admit that over four years of his presidency U.S. cooperation with Latin American countries was severely “undermined”. This negative trend should have been the subject of discussion of candidates for the U.S. presidential election in 2020. The purpose of the article is to find out what aspects of Trump’s policy towards Latin America were used by the candidates in their campaign statements, for what he was criticized and praised. Methods and Materials. The research is based on the analysis of candidates’ election programs and speeches. Donald Trump’s annual messages to Congress are analyzed as well. The author researches the programs of those candidates who reached the final stage of the 2020 elections and those who were most popular at the beginning of 2020 but lost the primaries. In addition to general scientific research methods, the author uses methods of discourse analysis and comparative analysis. Analysis. Almost all the candidates criticized the policy of Donald Trump in different way. The main issues were President’s approaches to Mexico, Cuba, Venezuela and dealing with illegal immigrants. Trump’s policy didn’t receive explicit approval from any candidate. Among all the contenders for the post of U.S. President, only Joe Biden offered a more or less developed plan for establishing relations with the Central America countries. Results. The author showers that main directions of Trump’s policy towards Latin America were not criticized. But the methods of this policy were criticized a lot. Most part of the Latin America region generally fell out of the U.S. foreign policy discourse. And it was almost not represented in the candidates programs and speeches. This suggests that real shifts in the Latin American direction of the U.S. foreign policy will not occur in the coming years.

Evaluating Team Characteristics for Health Engagements in Three Countries in Central America: 2012-2017.

The U.S. DoD is a multidimensional agency of the government that employs health engagement activities within partner nations for medical operations, humanitarian assistance, threat reduction, and improved health outcomes toward sustainable global health and security. The composition and size of a health engagement team is critical for effective implementation; however, an ideal team makeup to achieve optimal operational readiness, health outcomes, and security cooperation objectives has not been established. This study was conducted to retrospectively describe and analyze medical mission activities in relation to ideal team characteristics in El-Salvador, Guatemala, and Honduras between 2012 and 2017. A retrospective analysis was conducted on data from unclassified versions of the Global-Theater Security Cooperation Management Information System), Overseas Humanitarian Assistance Shared Information System databases, and mission files provided by U. S. Southern Command and its component commands. Data included 565 mission activities carried out by U.S. Military health teams in the selected host nations between 2012 and 2017. The mission activities were stratified and coded into nine distinct analyzable categories with subelements including but not limited to year, country, mission type, mission duration, team size, team language capability, team joint representation, and team member skillset. The analysis identifies mission objectives in the three subcategories of operational readiness, security cooperation, and health outcomes although the analysis did not include measurement of those objectives. Global Health Engagement mission types were broken down into five categories: direct care, health project, education & training (E&T), engineering, veterinary, or a combination. Data were analyzed using Excel. A total of 414 health engagement activities were found in the data analyzed during 2012 and 2017 accounting for duplication among the sources. Team size was documented in 23.4% (n = 97); team skillset makeup in 17.1% (n = 71); 2.7% (n = 11) showed that at least one team member had language capability for the country visited; and 3.6% (n = 15) documented that professional interpretation was available. The types of health engagement activities were broken down as follows: 64.3% were direct care, 12.2% were health projects, 10.9% were engineering, 9.1% were E&T, and 1.3% were veterinary. Overall, only 20.8% (n = 86) of the missions had a clear mission objective from the three categories of security cooperation, operational readiness, and health outcomes objectives. Individually, each category of objective was noted with the following: 74 with security cooperation (17.9%), 82 with operational readiness (19.8%), and 71 with health outcome objectives (17.1%). Findings from this study reveal a broad spectrum of health and medical missions conducted in El Salvador, Guatemala, and Honduras between 2012 and 2017 by DoD. Critical elements indicative of overall team capability for successful engagement such as team size, team member skillset, global health expertise, and appropriate language capability were rarely documented. Team characteristics could not be well-correlated with the Global Health Engagement type or desired mission outcomes. In the future, deliberate crafting and preparation of health engagement teams aimed at attaining desired security cooperation impact, operational readiness development, and positive health outcomes is essential for more effective Global Health Engagement.

Genetic diversity of the endangered black-handed spider monkey <i>Ateles geoffroyi</i> (Primates: Atelidae) in a fragmented landscape of El Salvador

Spider monkeys (genus Ateles) are distributed across rainforests from southern Mexico to northern Bolivia, but at risk of extinction across much of their range. Like most members of the genus, the black-handed spider monkey, or the Central American spider monkey, Ateles geoffroyi is particularly vulnerable to anthropogenic threats, due to its inability to persist in disturbed and/or isolated forest patches and is categorized as “Endangered” by the IUCN. Within its range in El Salvador, the smallest country in Central America, the spider monkey has now been restricted to isolated patches of semi-deciduous forests, including four fragments that lie within a disturbed agricultural landscape in Jiquilisco Bay, in Southeast El Salvador. We analyzed 73 noninvasive fecal samples from spider monkeys in this region, and we were able to identify 55 individuals. We evaluated the genetic diversity and structure of the four populations using microsatellite markers. Our results show higher observed than expected heterozygosity, but low genetic diversity compared to published data on other spider monkey populations (Ho = 0.50 – 0.57 and He = 0.39 – 0.51; allelic richness with rarefaction = 2.71 – 3.22; private alleles with rarefaction = 0.18 – 0.61). We also found significant differentiation across fragments (Fst = 0.2, P<0.001) and two genetically different groups. These findings suggest the need for conservation action to reconnect forest patches, to improve the unfavorable situation of the only non-human primate in El Salvador.

“Probabilistic Landslide Hazard Methodology, an Application to a Susceptible Area to Landslides in Colombia”

A Probabilistic method was previously used to perform Probabilistic Hazard Zonation in El Salvador using a new proposed probabilistic methodology (Rodriguez, Yepes 2011). The current project is a case study that uses the same methodology and tries to cover the limitations of the previous and first application, and applied to two historically unstable landslides in Pipiral, an unstable area in the Central Region of Colombia. The susceptibility angle was used as the susceptibility function. Rainfall and earthquakes are considered as landslides triggers. Besides zonation, modeling was performed because the probability model was initially designed to do the zonation of larger areas. A database from “four countries in Central-America and Colombia” of Rainfall Induced Landslides in Fine-grained soils and a database of “historic and worldwide” Earthquake Induced Landslides, were considered to support the model. The intensity-duration-frequency (I-D-F) curves for the Pipiral-Colombia were used to define the probability of occurrence of the critical rainfall, and the seismic hazard analysis of the same area was used to define the probability of occurrence of the critical earthquake.

#3: Gram-Negative Antibacterial Resistance Prevalence at a Tertiary Care Hospital in Central America

Abstract Background Latin America has some of the highest rates of multi-drug resistant gram-negative bacteria worldwide. However, local surveillance registries to compare rates of resistance among countries are lacking, particularly in Central America. Awareness of local resistance patterns in this region is critical to improve antibiotic use and patient outcomes. We sought to measure the prevalence of resistant gram-negative bacilli (GNB) at a tertiary hospital in Guatemala. Methods We retrospectively conducted a single-center study to measure the percentage of GNB that were non-susceptible to various antibiotics between April and October of 2017. All cultures (blood, urine, cerebrospinal fluid, and other body fluids) were collected as part of routine clinical care during the study period. Duplicate isolates, defined as multiple specimens with the same organism from the same patient, were excluded. Antibiotic susceptibility testing was performed by disk diffusion method. Bacterial isolates were categorized as susceptible, intermediate, or resistant based upon the Clinical Laboratory Standard Institute 27th edition per guidance from the National Laboratory of Guatemala. Results A total of 969 unique gram-negative isolates from 818 patients were included. Urine was the most common culture type. The most frequently isolated bacteria were Escherichia coli and Klebsiella species. The percentage of GNB which were non-susceptible to individual antibiotics are detailed in Table 1. Of the isolates tested, 12 – 66% of GNB were non-susceptible to cephalosporins, 7 – 31% were non-susceptible to carbapenems, and 14 – 44% were non-susceptible to fluroquinolones. Conclusions The prevalence of multi-drug resistant GNB is high in Escuintla, Guatemala. Continued surveillance is vital to guide judicious and appropriate empiric antibiotic use in the setting of rising rates of antibiotic resistance. Local and regional resistance rates are known to vary, underlying the importance of developing more regional and national antibiotic resistance surveillance networks within Guatemala and other countries in Central America where there is a paucity of data.

T-Cell Lymphomas in Mexico: Experience of a Third Level Reference Hospital

Introduction ——- Mature T-cell lymphomas have a global incidence ranging from 9.3% to 13.4% of the total amount of non-Hodgkin lymphomas worldwide. However, in Asian and South and Central America countries, incidence has been reported up to 20%. This suggests that there is a wide range of environmental and racial factors that modify the frequency of T-cell lymphomas and its subtypes. The common subtypes of these lymphomas also have been reported to vary greatly across the world. Studies have placed the NK/T cell lymphoma as the most prevalent T-cell lymphoma of Mexico, with 40% of all T cell lymphomas diagnosed, while the US reported frequency ranges in the 5 to 6%. Our objective is to report our experience in a third level reference Hospital in northeast Mexico.Materials and Methods —- A retrospective and observational study was conducted. Utilizing the database manager Pathox, we collected all the cases of patients diagnosed with lymphoma from January 2010 to January 2017. We included in the study all cases that were diagnosed with a variant of T-cell lymphoma that had available material for revision. They were assigned to groups by sex, subtype of lymphoma in accordance to the World Health Organization (WHO) classification of lymphoid neoplasms 2016, and the anatomical location of the primary tumor. Data analysis was performed in the statistical programming environment R version 3.3.2. Descriptive statistics were reported as percentages, central tendency and dispersion statistics.Results ——— We found a total of 771 lymphomas in our study. 88 of those had a diagnosis of T-cell lymphoma. The location of the primary tumor was a lymph node in 36.26% of the cases, and in the rest of the primary tumors, the skin was the most frequent location with 57.14%; the nasal and retronasal tissue followed, with 5.49%. For the subtypes, the most frequent was mycosis fungoides (MF) (29.67%) followed by Peripheric T-cell Lymphoma, Not Otherwise Specified, (PTCL, NOS) (23.08%). NK/T-Cell lymphoma nasal type, accounted for 10.99%. Anaplastic Large Cell Lymphoma (ALCL) ALK+ (4.4%), ALCL ALK - (7.69%), Angioinmunoblastic T-cell lymphoma (AITL) (2.20%) and subcutaneous Panniculitis- like T-cell lymphoma (1.1%) were also reported. The rest of the cases were reclassified into a non T-cell lymphoma or different diagnosis. Of the IHQ stains used to for diagnosis, the most commonly used were CD20, CD4, CD3, CD7 and CD8, with an average number of IHQ stains of 4.4 per case.Conclusions — Available literature places the frequency of T-cell lymphomas between 5 and 15% for developed countries, in concordance to our frequency (11.4%). For anatomic location of the primary tumor, the most frequent location was the skin (57.14%), followed by the lymph nodes (36.26%) and the nasal tissue (5.49%), while the rest distributed among the bone marrow, soft tissues, and tonsils. Frequency was not significant among males or females. Subtype frequency predominated for MF (29.67%) and PTCL, NOS (23.08%). NK/T-cell lymphomas account for only 10.99%. Our data suggests that the environmental, geographical and race factors create wide variations in the frequency of these lymphomas and their subtypes, giving way for additional studies to find and explain this variations. DisclosuresNo relevant conflicts of interest to declare.

Migration Management and Changes in Mobility Patterns in the North and Central American Region

Since the beginning of the twenty-first century, changes have occurred in the regional dynamics of international migration and in the ways governments manage human mobility. This article argues that the migratory system connecting the three northern countries of Central America (Guatemala, El Salvador, and Honduras) with Mexico and the United States has not been accompanied by regional management of migratory flows. Instead, a succession of government plans and projects reveals a perspective marked by the effects of the “externalization” of US borders, leading to more complex migration routes and increased vulnerability of migrants. The article discusses how externalized control policies influence migratory spaces, routes, and timelines, and leave many stranded in transit countries before they eventually arrive at their intended destinations. Reconsidering the process of mobility in light of migration management policies would appropriately enlarge the traditional economic, social, cultural, and environmental factors that affect migration strategies.

Comparative analysis of regulatory framework on biobanking to inform policymakers in Central America and the Dominican Republic

Background. The clinical and scientific importance of biobanks has been highlighted. Ethical governance and regulatory oversight for biobanks should be in place to preserve and promote ethical and responsible conduct of research. Methods. This is an analytical documentary study of the regulatory scope concerning biobanks in Central America and the Dominican Republic. From the International Compilation of Human Research Standards 2020 edition of the Office of Human Research Protection Department of Health and Human Services of the United States of America identified the existing guidelines applicable to human research in each of the eight SICA member countries. Regulatory aspects searched for and the analysis was based on the recommendations set forth in Guideline 11 on the collection, storage, and use of biological materials and related data in the International Ethical Guidelines for Research Related to Human Health. Results. There is a lack of specific guidelines for the collection, use, and storage of human biological materials for research purposes, and the creation of biobanks in the countries been studied. No country in Central America and the Dominican Republic region has specific regulations for the creation of biobanks for research purposes. The term "biobank" was not found in the revised regulations. However, there are good examples of ethical governance of research in general in the region been Costa Rica, Panamá, and Guatemala examples of advances towards this direction. Conclusions. There is a need to move forward the governance and regulatory framework of biobanks in Central America and the Dominican which can be seen as an opportunity for international cooperation and regulatory collaborative agenda within this region.

Development and evaluation of physical and release properties of a tablet formulation containing dry hydroethanolic extract from Lippia alba leaves

The development of an immediate-release solid formulation which contains natural products is a challenge considering several variables. These include the physical properties of the drug, the complex composition of the herbal extracts, and its ability to be released in the body. The present study describes the development and characterization of an immediate-release tablet formulation of a hydroethanolic extract of Lippia alba (Mill.) N. E. Br. dried leaves which possess potential gastroprotective properties and sedative effects. L. alba is a Brazilian herb known as “cidreira,” and the ethnopharmacological use of the leaf infusion has been reported in many South and Central America countries. However, no study has considered phytotherapeutics containing extracts of this herb. To achieve this goal, 14 solid formulations were produced using direct compression, wet granulation, or dry granulation. These were characterized by physical tests, such as average weight, friability, hardness, and disintegration tests. The tablet formulation produced by the dry granulation of 100 mg of the L. alba extract exhibited better physical properties, and it was characterized using acteoside (verbascoside) as a chemical marker, presenting 6.9 % w/w of acteoside content per tablet, corresponding to 41.3 mg of this constituent per unit. This formulation dissolves rapidly in simulated gastric fluid without enzymes, achieving amounts >80 % after 20 min. Thus, an immediate-release tablet formulation with L. alba extract was successfully prepared.

Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study

ObjectivesDiabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of...

POS-424 Genetic Admixture of U.S. Hispanics from Central America

Chronic kidney disease of uncertain etiology (CKDu) has reached epidemic proportions in Central America in countries such as Nicaragua, Costa Rica, El Salvador and Guatemala, where it is a leading cause of premature death. CKDu mainly affects young male seasonal agricultural workers. There is some evidence for familial clustering of CKDu, with women and children also being affected, suggesting a genetic susceptibility. Understanding the ancestry admixture of affected populations can help to uncover their genetic risk to CKDu. We compared the ancestry proportions from Africa, America and Europe of 1,075 Hispanics/Latinos enrolled in a US population-based study who also reported Central America country of origin of their four grandparents. We used genotypes from a genome-wide array and reference samples from the Human Genome Diversity Project, HapMap phase 3 and 1000 Genomes project Consortium to estimate European (EUR), West African (AFR) and Native American (NAM) ancestry at genomic locations. We summarized these estimates as global proportions of ancestry. The country of grandparent origin of participants was Guatemala (n=231), Honduras (n=296), El Salvador (n=104), Nicaragua (n=414), Costa Rica (n=22), Panama (n=8). Table 1 shows the descriptive characteristics and estimated ancestries of participants. Overall, the ancestry proportions varied by country of grandparent origin with higher NAM admixture among those from Guatemala and El Salvador, and a higher AFR ancestry proportion among those from Honduras. However, the NAM ancestry proportion was high in all groups from Central America. This study is the first to compare the ancestry admixture of individuals from different countries in Central America. It provides important information on the genetic background of populations at risk of CKDu.

Seeking Safety and Humanity in the Harshest Immigration Climate in a Generation: A Review of the Literature on the Effects of Separation and Detention on Migrant and Asylum‐Seeking Children and Families in the United States during the Trump Administration

AbstractIn recent years, families with children from the Northern Triangle countries of Central America constitute a large and growing proportion of migrants and overall filed asylum claims. In an effort to deter overall immigration through the U.S.–Mexico border, the executive branch under the Trump administration has made substantial changes to federal immigration and asylum policy in recent years. Given the sensitive nature of early development and the hardship and trauma that many migrant children have experienced, immigration policies that do not prioritize child wellbeing, and in fact, neglect or harm it, can have lifelong negative consequences on physical and psychological wellbeing. In light of the scope of children and families affected by these policies and potential magnitude of their effects, the present review aimed to: 1) outline federal immigration policies under the Trump administration that primarily impacted migrant children and families; 2) review the research base regarding the effects of these policies on physical safety and health, development, mental health, family wellbeing, and education; and 3) provide policy recommendations to prevent further harm, mitigate the great harm already done, and prioritize child wellness moving forward. Findings from the review indicate that even short experiences of detention, particularly when children are separated from parents and caregivers, are associated with serious, lasting negative effects across every domain of functioning. The practices of separation, detention, and removal to temporary encampments compound traumatic experiences that migrant families are often fleeing, which in turn may set up already vulnerable children for a trajectory of continued marginalization. Future directions for research and implications for policy and practice are discussed.

Water quality assessment of six rivers of the Pacific side of Guatemala

The seas of Latin America are of great marine richness; however, river contaminants that drains to the seas, the growing human settlements around the coast, overfishing and growing agricultural activity, limit the ecosystem benefits. Guatemala is the most populous country in Central America with 17 million and the agricultural activity has been growing, mainly with monocultures that demand a large amount of water. High human population densities and intensive agricultural land use have negative impacts on the environment. In addition, Guatemala does not have a water quality regulation that allows river water quality monitoring and its effect on the oceans; therefore, the condition of its rivers and its impact on the seas is currently unknown. The objective of this research was to evaluate the quality of several rivers on the Pacific side of Guatemala using Costa Rica’s water quality regulations in conjunction with a quality index developed for that nation. It was determined that the rivers sampled for a year showed from moderate to very severe pollution. The main quality indicators that caused such contamination was due to high concentrations in fecal coliforms, phosphates and organic matter load, which vary depending on rainfalls as well as river flow changes.

1580. In Vitro Activity of Ceftazidime-Avibactam Against Enterobacterales and Pseudomonas aeruginosa Collected in Latin America as part of the ATLAS Global Surveillance Program, 2017-2019

BackgroundCeftazidime-avibactam (CAZ-AVI) is a β-lactam/non-β-lactam β-lactamase inhibitor combination with in vitro activity against Enterobacterales (Ent) and Pseudomonas aeruginosa (Psa) carrying Class A, C and some Class D β-lactamases. We examined the in vitro activity of CAZ-AVI and comparators against isolates collected in Latin America (LA) as part of the ATLAS surveillance program.MethodsNon-duplicate isolates of Ent (n=8416) and Psa (n=2521) were collected in 10 countries in Central America (CAC; Costa Rica, Dominican Republic, Guatemala, Panama [2018-2019 only]) and South America (SA; Argentina, Brazil, Chile, Colombia, Mexico, Venezuela [2017-2019]). Susceptibility testing was performed by CLSI broth microdilution and values were interpreted using CLSI 2020 breakpoints. CAZ-AVI was tested at a fixed concentration of 4 µg/mL AVI. Isolates with meropenem (MEM) MICs ≥2 µg/mL (Ent) or ≥4 µg/mL (Psa) were screened for β-lactamase genes.ResultsCAZ-AVI demonstrated potent in vitro activity against Ent collected in LA overall and in the CAC and SA subregions (95-99% susceptible (S)) that was comparable to or exceeded the activity of comparators including MEM, amikacin (AMK) and tigecycline (TGC) (Table). CAZ-AVI retained good activity against MEM non-susceptible (NS) Ent collected in SA (82% S; 6.9% of collected isolates) but activity was reduced against MEM-NS Ent from CAC (10% S; 5.7% of collected isolates), which included a high proportion of isolates carrying NDM-type metallo-β-lactamases (MBL). Among Psa, CAZ-AVI showed greater activity than the tested comparators against both all (86-92% S) and MEM-NS (61-66% S) isolates collected in LA overall and in the two subregions.Table ConclusionCAZ-AVI showed potent in vitro activity against Ent and Psa collected from patients in the CAC and SA subregions of LA. Activity was also good against MEM-NS isolates from SA but was reduced against MEM-NS Ent from CAC that included a high proportion of MBL-positive isolates. The regional and country prevalence of different carbapenem-resistance mechanisms must be considered when evaluating treatment options; however, CAZ-AVI could provide a valuable therapeutic option for treatment of infections caused by Ent and Psa in LA.DisclosuresKrystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Consultant) Maria Lavinea Valente, MD, Pfizer Brazil (Employee) Elkin Lemos, MD, PhD, Pfizer Columbia (Employee) Monique Baudrit, MD, MSc, Pfizer Costa Rica (Employee) Alvaro Quintana, MD MSc, Pfizer, Inc. (Employee) Paurus Irani, MD, Pfizer United Kingdom (Employee) Greg Stone, PhD, AztraZeneca (Shareholder, Former Employee)Pfizer, Inc. (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Consultant)Shionogi & Co., Ltd. (Independent Contractor)

Confidence as a Driver of Private Investment in Selected Countries of Central America

This paper argues that structural weaknesses may make private investment particularly sensitive to business confidence relative to other traditional investment drivers and global shocks. It gauges the importance of confidence over recent years in selected countries in Central America, including Costa Rica, the Dominican Republic, El Salvador, and Guatemala. Using a vector error correction model to carry out the empirical work, a system representing global activity and the domestic economy, including a set of investment drivers (interest rates, unit labor costs, and confidence) is analyzed. The findings suggest that confidence has been, on average, the most important driver of investment in these countries, exceeded only by global factors. Since confidence, arguably, can be influenced by policymakers’ decisions, structural reforms to improve the business climate and reduce uncertainty play an important role in promoting investment and economic growth.

Exploring the safety and efficacy of adding ketoconazole to tacrolimus in pediatric renal transplant immunosuppression.

BACKGROUNDGuatemala is a developing country in Central America with limited health resources. In order to expand successful renal transplant care to children and adolescents at the lowest possible cost, our pediatric renal transplant clinic uses a post-transplant tacrolimus-sparing strategy via inhibition of CYP3A4.AIMTo study the safety, efficacy and the associated cost reduction of ketoconazole in combination with tacrolimus in this pediatric population.METHODSA retrospective chart review was carried out among the cohort of pediatric renal transplant recipients treated at the Foundation for pediatric renal patients (Fundación para el Niño Enfermo Renal - FUNDANIER), a pediatric tertiary care renal transplant center in Guatemala City, Guatemala. Patient charts were reviewed to ascertain the number of transplant recipients who were transitioned from tacrolimus based immunosuppression to combination therapy with ketoconazole and tacrolimus. Twenty-five post-transplant patients that used ketoconazole combined with tacrolimus were identified. Anthropometric, clinical and laboratory data was collected from patient charts before and after the transition. RESULTSOf the 25 patient charts reviewed 12 (48%) patients were male and the average patient age was 13 years. Twenty-four (96%) transplants were from living donors. There was a non-significant difference between the mean tacrolimus doses six months and two months prior to ketoconazole: -0.10 ± 0.04 (95%CI: 0.007, -0.029), P = 0.23. However, the difference between the mean tacrolimus doses six months prior to ketoconazole initiation and six months after ketoconazole addition was significant: 0.06 ± 0.05 (95%CI: -0.034, -0.086) P < 0.001. All tacrolimus doses were reduced by 45% after the addition of ketoconazole. Therapeutic levels of tacrolimus ranged between 6.8-8.8 ng/mL during the study period and patients demonstrated an increase in estimated glomerular filtration rate. The combination of tacrolimus and ketoconazole resulted in a 21% reduction in cost.CONCLUSIONPatients experienced an effective dose-reduction of tacrolimus with the administration of ketoconazole. There was no relevant variations in tacrolimus serum levels, number of rejections, or significant liver toxicity. The strategy allowed a cost reduction in pediatric immunosuppressive therapy.

Interdisciplinary care of pediatric oncology patients in Central America and the Caribbean.

Interdisciplinary teamwork supports high-quality cancer care and effective utilization of limited resources. This study purposed to examine the value, structure, process, and effectiveness of interdisciplinary care (IDC) among pediatric oncology providers in low-income and middle-income countries in Central America and the Caribbean. A cross-sectional survey was disseminated to pediatric oncology providers at 5 centers participating in the Pediatric Hematology-Oncology Association of Central America. The survey included previously validated items and novel questions assessing the value (importance), structure (multidisciplinary meeting attendance), process (team climate), and effectiveness (job satisfaction, quality of care and communication) of IDC. The survey was completed by 174 providers, including 22 oncologists, 9 pathologists, 9 radiologists, 5 radiation oncologists, 12 surgeons, 35 subspecialists, 60 nurses, 20 psychosocial providers, and 2 other staff. Participants agreed that IDC benefits team members (95%) and patients (96%). IDC structure and processes varied across the region. Multidisciplinary meeting attendance differed by center (P = .005) and discipline (P < .0001). Participants who frequently attended multidisciplinary meetings reported a more positive team climate (P = .0003). Team climate was positively associated with job satisfaction (P < .001). In multivariable analyses, team climate was predictive of an improved perception of communication between professionals (P < .0001), with families (P < .0001), and with patients (P = .0005), as well as with quality of the care environment (P = .006) and overall care quality (P < .0001). Nearly all surveyed participants valued IDC, and the structure and processes supporting IDC varied by center. Associations between a collaborative professional climate, job satisfaction, and the perception of quality care encourage continued investigation and prioritization of IDC in these settings.

Inatividade física em populações indígenas residentes em zona urbana na América do Sul

Embora a inatividade física esteja relacionada ao risco aumentado de doenças crônicas não-transmissíveis, existe pouca pesquisa publicada sobre a saúde de populações indígenas em área urbana nos países da América do Sul. O presente estudo conduziu revisão sistemática da literatura investigando a inatividade física em populações indígenas residindo em área urbana na América do Sul, identificando as prevalências encontradas, o instrumento utilizado para mensuração e o país de publicação. Realizou-se busca nas bases de dados Medline, Embase, ERIC, PsycInfo, Scopus, Web of Science, Scielo, teses e dissertações considerando descritores definidos. Considerou-se como critérios de inclusão: ser estudo com dados populacionais primários ou secundários, com populações indígenas residindo em área urbana em país da América do Sul, publicados entre os anos de 2008 a 2018. Ao final, 5 registros foram analisados na íntegra e tratavam de populações indígenas no Brasil, com prevalências de inatividade física variando de 28,8% a 64,5% da população, coletadas por meio de questionários variados. Em 3 estudos a inatividade física mensurada foi maior que a registrada para a população não-indígena urbana no Brasil no ano de 2013. Constituem limitações a pouca generalização dos dados dos estudos e a diversidade dos instrumentos utilizados. A temática da inatividade física em populações indígenas em área urbana é recente e necessária a um novo conceito de saúde indígena que considere esta parcela da população. Sugere-se que futuros estudos abranjam os países do Caribe e América Central, em especial. Palavras-chave: Exercício Físico. Povos indígenas. América do Sul.

Poisonous plants of Belize: a mini toxicological review

The global increase in the use of plants for food and medicinal purposes, especially in developing countries, proffers an urgent need for toxicological studies on such plants. Results of extensive toxicological studies tend to provide safety information on toxic plants and help avert public health issues while providing safety guides to the public. Belize is a developing nation, and the only English-speaking country in Central America. More than half of the country is covered by rainforest, and many plants are consumed for food and medicinal purposes mostly without regard to the scientific toxicological characteristics of such plants. To the best of our knowledge, presently no published scientific toxicological reports exist on poisonous plants uniquely native to Belize. A careful bibliographic search was therefore conducted on published scientific reports applicable to plants native to Central America, and unpublished reports on poisonous plants of Belize to describe the toxicological information of such plants. A total of 16 plants from 7 families were identified to be toxic. The identified plants were reviewed for their toxicology. 13 plants were reported to be toxic, 2 plants were shown to be non-toxic, and no scientific studies were found for 1 plant. There is an urgent need to conduct toxicological research on plants native to Belize, especially that many such plants are used for food and medicinal purposes.

Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population

BackgroundAn epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting.MethodsWe conducted a cross-sectional study from January–August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR.ResultsThe mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)].ConclusionsReduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions.