BACKGROUND & AIMS:The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean. METHODS:We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis. RESULTS:The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 personyears for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014. CONCLUSIONS:In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status.

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The therapeutic efficacy and the incidence of early antivenom reactions (EARs) were compared in a clinical trial performed in 79 patients bitten by Bothrops sp. in Urabá, Colombia. Patients were randomized into three groups according to the antivenom administered: A (n ϭ 30, Butantan polyspecific, pepsin-digested Bothrops antivenom); B (n ϭ 27, Butantan polyspecific, whole IgG Bothrops antivenom); and C (n ϭ 22, Colombian commercial, monovalent, whole IgG Bothrops antivenom). The groups were comparable in all clinical and epidemiologic aspects; 33 patients had mild, 22 moderate, and 24 severe envenoming. At the doses used (two, four, and six vials [10 ml/vial] for mild, moderate, and severe envenomings, respectively) there were no differences between the antivenoms in restoring normal hemostatic parameters within 24 hr. The evolution of local envenoming was comparable in the three groups. Serum venom/antivenom kinetics determined by ELISA showed a complete clearance of venom levels 1 hr after treatment in mild/moderate envenomings. In severe cases, venom levels remained detectable up to 24 hr and recurrence of antigenemia was observed in some cases. Antivenom concentrations remained at high levels up to 24 hr of treatment. The incidence of EARs was significantly different in the groups: A (36.7%), B (11.1.%), and C (81.8%). There were no life-threatening anaphylactic reactions. We conclude that the efficacy of the three antivenoms was similar in neutralizing human Bothrops envenomings and that the production of whole IgG antivenoms by caprylic acid fractionation is a good alternative for reducing the incidence of EARs.

Giant kelp (Macrocystis pyrifera) is the most widely distributed kelp species on the planet, constituting one of the richest and most productive ecosystems on Earth, but detailed information on its distribution is entirely missing in some marine ecoregions, especially in the high latitudes of the Southern Hemisphere. Here, we present an algorithm based on a series of filter thresholds to detect giant kelp employing Sentinel-2 imagery. Given the overlap between the reflectances of giant kelp and intertidal green algae (Ulvophyceae), the latter are also detected on shallow rocky intertidal areas. The kelp filter algorithm was applied separately to vegetation indices, the Floating Algae Index (FAI), the Normalised Difference Vegetation Index (NDVI), and a novel formula (the Kelp Difference, KD). Training data from previously surveyed kelp forests and other coastal and ocean features were used to identify reflectance threshold values. This procedure was validated with independent field data collected with UAV imagery at a high spatial resolution and point-georeferenced sites at a low spatial resolution. When comparing UAV with Sentinel data (high-resolution validation), an average overall accuracy ≥ 0.88 and Cohen’s kappa ≥ 0.64 coefficients were found in all three indices for canopies reaching the surface with extensions greater than 1 hectare, with the KD showing the highest average kappa score (0.66). Measurements between previously surveyed georeferenced points and remotely-sensed kelp grid cells (low-resolution validation) showed that 66% of the georeferenced points had grid cells indicating kelp presence within a linear distance of 300 m. We employed the KD in our kelp filter algorithm to estimate the global extent of giant kelp and intertidal green algae per marine ecoregion and province, producing a high-resolution global map of giant kelp and intertidal green algae, powered by Google Earth Engine.

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