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[This corrects the article DOI: 10.1371/journal.pone.0255555.].

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Choosing Wisely is an initiative by the American Board of Internal Medicine (ABIM) and ABIM Foundation to deter unnecessary medical treatments and procedures. Faced with the burden of modern technologies and treatments, it is crucial to identify practices lacking value in daily care. The Latin American and Caribbean Society (SLACOM), comprising cancer control experts, deems it vital to tailor this initiative for enhancing cancer care in the region. Through a modified DELPHI methodology involving two rounds of electronic questionnaires and a hybrid meeting to discuss key points of contention, ten essential recommendations were identified and prioritised to avoid harmful oncology procedures in our region. These consensus-based recommendations, contextualised for Latin America, have been compiled and shared to benefit patients. The Scientific Committee, consisting of prominent oncologists and health experts, collaborates remotely to drive this project forward.

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OBJECTIVE: To compare the anatomical results in patients with rhegmatogenous retinal detachment, at least grade B of proliferative vitreoretinopathy, and with a trans-surgical dexamethasone implant vs the control group. We also assessed the diminution of proliferative vitreoretinopathy and the final visual acuity (VA). METHOD: The patients were evaluated clinically and with optical coherence tomography for 10 months. Logistic regression analyses were performed to evaluate the effect of the dexamethasone implant on retinal detachment. Correlational analyses were explored depending on the variables' distribution, and an independent samples t-test was used to compare the VA in both groups. RESULTS: The study included 38 eyes of patients with proliferative vitreoretinopathy: 18 with the implant and 20 for the control group. The evaluation of the main objective showed significant differences (p < 0.05) in the anatomical success between the two groups (61.1% vs. 20%, treatment vs. control); odds ratio of 6.29; 95% confidence interval: 1.5- 26.8; p = 0.013; Nagelkerke's R2 = 0.225. The t-test showed a significant difference in the final VA of the patients (t = 2.047; df = 36; p = 0.048; Cohen's d = 0.66). CONCLUSIONS: Retinal redetachment was less frequent, and better VA was observed, in patients with the dexamethasone implant in comparison with the control group.

OBJETIVO: Comparar los resultados anatómicos en pacientes con desprendimiento de retina regmatógeno, vitreorretinopatía proliferativa a partir de grado B y aplicación de implante de dexametasona transquirúrgico frente a un grupo control. También se valoraron la disminución de la vitreorretinopatía proliferativa y la agudeza visual (AV) final. MÉTODO: Los pacientes se evaluaron clínicamente y con tomografía de coherencia óptica por 10 meses. Se realizaron análisis de regresión logística para evaluar el efecto del implante en el redesprendimiento de retina. Se exploraron análisis correlacionales dependiendo de la distribución de variables y se aplicó la prueba t de muestras independientes para comparar la AV en ambos grupos. RESULTADOS: Se incluyeron 38 ojos de pacientes con vitreorretinopatía proliferativa: 18 con el implante y 20 del grupo control. La evaluación del objetivo principal mostró diferencias significativas (p < 0.05) en el éxito anatómico entre ambos grupos (61.1% en los ojos con tratamiento frente a 20% en el grupo control); razón de momios de 6.29; intervalo de confianza del 95%: 1.5- 26.8; p = 0.013; R2 de Nagelkerke = 0.225. La prueba t mostró una diferencia significativa entre la AV final de los pacientes (t = 2.047; gl = 36; p = 0.048; d de Cohen = 0.66). CONCLUSIONES: Se observó menor redesprendimiento, así como mejor AV, en los pacientes con el implante de dexametasona en comparación con el grupo control.

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Objectives: To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods: This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results: The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions: Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

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[ABSTRACT]. Objectives. To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detec- tion of renal disease. Methods. This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results. The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36–4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16–9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60–90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions. Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

[RESUMEN]. Objetivos. Determinar la prevalencia de la nefropatía de etiología desconocida en el personal de los sectores de la banana, el melón y el tomate en el noreste de Guatemala, así como la utilidad de un análisis de la cistatina C en sangre para su detección temprana. Métodos. Se llevó a cabo un estudio transversal en 462 personas que trabajan en establecimientos agrícolas entre junio y septiembre del 2021. Se utilizaron cuestionarios rellenados por las propias personas encuesta- das a fin de recopilar sus características epidemiológicas y demográficas. Se tomaron muestras de sangre para determinar las concentraciones de glucosa, creatinina y cistatina C. También se obtuvieron datos antro- pométricos y clínicos. Resultados. La prevalencia de la nefropatía de etiología desconocida, definida por una filtración glomerular (determinada con la fórmula GRF—EPI) <60 ml/min/1,73 m2, fue del 3,03% (intervalo de confianza [IC] del 95%: 1,36–4,70%); y la cifra fue significativamente mayor en el personal del sector de la banana (5,67%; IC 95%: 2,16–9,18%) que en el de los sectores del melón (p = 0,009) y del tomate (p = 0,044). Diez personas (2,16%) presentaron una reducción de la función renal (GRF—EPI 60—90 ml/min/1,73 m2). Se observó una menor variabilidad en las concentraciones de cistatina C (coeficiente de variación del 46,4%) que en las de creatinina (coeficiente de variación del 67,0%); asimismo, hubo una diferencia significativa (p <0,001) de las concentraciones de cistatina C entre las personas con un valor anormal o una reducción de la función y las que tenían una función renal normal. Conclusiones. Se recomienda la vigilancia de la salud del personal laboral del sector agrícola y la mejora de sus condiciones de trabajo, por ejemplo mediante la protección frente a la luz solar, una hidratación adecuada y un número suficiente de pausas en el trabajo. Las diferencias significativas en las concentraciones de cistatina C entre las personas con una función renal alterada o reducida y las personas con una función renal normal hacen pensar que la determinación de la cistatina C podría ser un parámetro útil para la detec- ción precoz de la nefropatía.

[RESUMO]. Objetivos. Determinar a prevalência de doença renal de etiologia desconhecida em trabalhadores que cultivam banana, melão e tomate no nordeste da Guatemala e avaliar a utilidade da dosagem sanguínea de cistatina C para detecção precoce de doença renal. Métodos. Estudo transversal realizado de junho a setembro de 2021 com 462 trabalhadores rurais em unidades produtoras agrícolas. As características epidemiológicas e demográficas dos trabalhadores foram coletadas por meio de um questionário autoadministrado. Foram obtidas amostras de sangue para dosagem de glicose, creatinina e cistatina C. Os dados antropométricos e clínicos também foram registrados. Resultados. A prevalência da doença renal de etiologia desconhecida foi de 3,03% (intervalo de confiança (IC) de 95%: 1,36-4,70%), com base em uma taxa de filtração glomerular (TFG-EPI) < 60 mL/min/1,73 m2. A prevalência foi significantemente maior em cultivadores de banana (5,67%; IC de 95%: 2,16-9,18%) do que em cultivadores de melão (p = 0,009) e de tomate (p = 0,044). Dez trabalhadores (2,16%) tinham função renal reduzida (TFG-EPI 60-90 mL/min/1,73 m2). Os níveis de cistatina C foram menos variáveis (coeficiente de variação: 46,4%) que os de creatinina (coeficiente de variação: 67,0%). Os níveis de cistatina C foram significantemente diferentes entre casos com função renal alterada ou reduzida e casos com função renal normal (p < 0,001). Conclusões. Recomenda-se a vigilância da saúde dos trabalhadores rurais ativos e a melhoria das condições de trabalho, como proteção contra o sol, hidratação adequada e intervalos de descanso suficientes. As diferenças significantes nos níveis de cistatina C entre trabalhadores com função renal alterada ou reduzida e trabalhadores com função renal normal sugerem que a cistatina C poderia ser uma medida útil para a detecção precoce da doença renal.

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ABSTRACT Objectives. To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods. This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results. The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions. Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

RESUMEN Objetivos. Determinar la prevalencia de la nefropatía de etiología desconocida en el personal de los sectores de la banana, el melón y el tomate en el noreste de Guatemala, así como la utilidad de un análisis de la cistatina C en sangre para su detección temprana. Métodos. Se llevó a cabo un estudio transversal en 462 personas que trabajan en establecimientos agrícolas entre junio y septiembre del 2021. Se utilizaron cuestionarios rellenados por las propias personas encuestadas a fin de recopilar sus características epidemiológicas y demográficas. Se tomaron muestras de sangre para determinar las concentraciones de glucosa, creatinina y cistatina C. También se obtuvieron datos antropométricos y clínicos. Resultados. La prevalencia de la nefropatía de etiología desconocida, definida por una filtración glomerular (determinada con la fórmula GRF—EPI) <60 ml/min/1,73 m2, fue del 3,03% (intervalo de confianza [IC] del 95%: 1,36-4,70%); y la cifra fue significativamente mayor en el personal del sector de la banana (5,67%; IC 95%: 2,16-9,18%) que en el de los sectores del melón (p = 0,009) y del tomate (p = 0,044). Diez personas (2,16%) presentaron una reducción de la función renal (GRF—EPI 60—90 ml/min/1,73 m2). Se observó una menor variabilidad en las concentraciones de cistatina C (coeficiente de variación del 46,4%) que en las de creatinina (coeficiente de variación del 67,0%); asimismo, hubo una diferencia significativa (p <0,001) de las concentraciones de cistatina C entre las personas con un valor anormal o una reducción de la función y las que tenían una función renal normal. Conclusiones. Se recomienda la vigilancia de la salud del personal laboral del sector agrícola y la mejora de sus condiciones de trabajo, por ejemplo mediante la protección frente a la luz solar, una hidratación adecuada y un número suficiente de pausas en el trabajo. Las diferencias significativas en las concentraciones de cistatina C entre las personas con una función renal alterada o reducida y las personas con una función renal normal hacen pensar que la determinación de la cistatina C podría ser un parámetro útil para la detección precoz de la nefropatía.

RESUMO Objetivos. Determinar a prevalência de doença renal de etiologia desconhecida em trabalhadores que cultivam banana, melão e tomate no nordeste da Guatemala e avaliar a utilidade da dosagem sanguínea de cistatina C para detecção precoce de doença renal. Métodos. Estudo transversal realizado de junho a setembro de 2021 com 462 trabalhadores rurais em unidades produtoras agrícolas. As características epidemiológicas e demográficas dos trabalhadores foram coletadas por meio de um questionário autoadministrado. Foram obtidas amostras de sangue para dosagem de glicose, creatinina e cistatina C. Os dados antropométricos e clínicos também foram registrados. Resultados. A prevalência da doença renal de etiologia desconhecida foi de 3,03% (intervalo de confiança (IC) de 95%: 1,36-4,70%), com base em uma taxa de filtração glomerular (TFG-EPI) < 60 mL/min/1,73 m2. A prevalência foi significantemente maior em cultivadores de banana (5,67%; IC de 95%: 2,16-9,18%) do que em cultivadores de melão (p = 0,009) e de tomate (p = 0,044). Dez trabalhadores (2,16%) tinham função renal reduzida (TFG-EPI 60-90 mL/min/1,73 m2). Os níveis de cistatina C foram menos variáveis (coeficiente de variação: 46,4%) que os de creatinina (coeficiente de variação: 67,0%). Os níveis de cistatina C foram significantemente diferentes entre casos com função renal alterada ou reduzida e casos com função renal normal (p < 0,001). Conclusões. Recomenda-se a vigilância da saúde dos trabalhadores rurais ativos e a melhoria das condições de trabalho, como proteção contra o sol, hidratação adequada e intervalos de descanso suficientes. As diferenças significantes nos níveis de cistatina C entre trabalhadores com função renal alterada ou reduzida e trabalhadores com função renal normal sugerem que a cistatina C poderia ser uma medida útil para a detecção precoce da doença renal.

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Resumen Reporte de un caso: Femenino de 29 años de edad sin comorbilidades, con baja visual progresiva en ojo derecho de 1 mes de evolución. A la exploración oftalmológica agudeza visual de ese ojo en 20/80, conjuntiva bulbar superior con vaso centinela, masa retroiridiana color naranja vascularizada que subluxa el cristalino hacia inferior. Por ultrabiomicroscopía se evidencia una masa en domo dependiente del cuerpo ciliar de 4.87x5.74mm con reflectividad interna media y regular. Se realiza primeramente BAAF reportando melanoma, después se hace enucleación con resultado histopatológico de melanoma amelanótico. Posterior, se realiza implante de prótesis cosmética y se encuentra en seguimiento por oncología sin presentar datos de actividad tumoral después de 4 años. Discusión: Los melanomas uveales son la causa más común de tumores malignos intraoculares primarios en adultos, localizados principalmente en coroides (90%), siendo extremadamente rara su aparición en el cuerpo ciliar (6%) e iris (4%). El abordaje de un tumor del cuerpo ciliar debe incluir una anamnesis y exploración física completa con estudios paraclínicos adecuados para poder discernir entre los diagnósticos diferenciales. El ultrasonido ocular es el estudio auxiliar más importante ya que brinda características típicas propias del tumor. El tratamiento continúa basado en el COMS con un pronóstico sombrío. Los factores de mal pronóstico son presencia de metástasis, tamaño del tumor, extensión extraocular y estirpe epitelioide. Limitaciones: No se contaban con todas las alternativas de tratamiento. Originalidad: Caso inusual en pacientes jóvenes y por su sitio.

Abstract: Case report: 29-year-old female with no comorbidities, with progressive vision loss in the right eye of 1 month's evolution. On ophthalmological examination, visual acuity was 20/80, superior bulbar conjunctiva with sentinel vessel, vascularised orange retroiridian mass generating a lens subluxation inferiorly. Ultrabiomicroscopy revealed a dome-shaped mass dependent on the ciliary body measuring 4.87x5.74mm with medium and regular internal reflectivity. A FNA was done and melanoma was reported, then enucleation was performed with histopathological findings of amelanotic melanoma. Subsequently, a cosmetic prosthesis was implanted and the patient has been followed up by oncology with no evidence of tumour activity after 4 years. Discussion: Uveal melanomas are the most common cause of primary intraocular malignant tumours in adults, mainly located in the choroid (90%), being extremely rare in the ciliary body (6%) and iris (4%). The approach to a ciliary body tumour should include a complete anamnesis and physical examination with appropriate paraclinical studies to be able to discern between differential diagnoses. Ocular ultrasound is the most important ancillary study as it provides typical features of the tumour. Treatment is still based on COMS and the prognosis remains poor. Poor prognostic factors are the presence of metastases, tumour size, extraocular extension and epithelioid lineage. Limitations: Not all treatment alternatives were available. Originality: Unusual case in young patients and because of its site.

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The jaguar (Panthera onca) is one of the most threatened carnivores in the Americas. Despite a long history of research on this charismatic species, to date there have been few systematic efforts to assess its population size and status in most countries across its distribution range. We present here the results of the two National Jaguar Surveys for Mexico, the first national censuses in any country within the species distribution. We estimated jaguar densities from field data collected at 13 localities in 2008-2010 (2010 hereafter) and 11 localities in 2016-2018 (2018 hereafter). We used the 2010 census results as the basis to develop a National Jaguar Conservation Strategy that identified critical issues for jaguar conservation in Mexico. We worked with the Mexican government to implement the conservation strategy and then evaluated its effectivity. To compare the 2010 and 2018 results, we estimated the amount of jaguar-suitable habitat in the entire country based on an ecological niche model for both periods. Suitable jaguar habitat covered ~267,063 km2 (13.9% of the country's territory) in 2010 and ~ 288,890 km2 (~14.8% of the country's territory) in 2018. Using the most conservative density values for each priority region, we estimated jaguar densities for both the high and low suitable habitats. The total jaguar population was estimated in ~4,000 individuals for 2010 census and ~4,800 for the 2018 census. The Yucatan Peninsula was the region with the largest population, around 2000 jaguars, in both censuses. Our promising results indicate that the actions we proposed in the National Jaguar Conservation Strategy, some of which have been implemented working together with the Federal Government, other NGO's, and land owners, are improving jaguar conservation in Mexico. The continuation of surveys and monitoring programs of the jaguar populations in Mexico will provide accurate information to design and implement effective, science-based conservation measures to try to ensure that robust jaguar populations remain a permanent fixture of Mexico's natural heritage.

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The incidence and the mortality of gallbladder cancer (GBC) show significant variation worldwide, with high age-standardized rates in western South America (SA). Due to the lack of effective measures for prevention, the late diagnosis and the small benefit of systemic treatment, GBC has an ominous prognosis and became an important public health problem in this part of the continent, where the most important risk factors are gallstone disease, female gender, age, ethnic groups, and low socioeconomic status. Many genetic abnormalities have been described in series from SA, some of them similar and others unique in comparison to gene alterations in GBC from other regions of the world. Prophylactic cholecystectomy (PC) is one of the strategies to decrease the mortality but its cost-effectiveness is questionable. A way to improve the performance of PC is to identify molecular risk factors that in combination with currently known ones detect patients with very high risk for developing GBC. Also, more research studies are required to better understand the epidemiology and molecular biology in order to improve the prevention and treatment of this lethal disease.

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OBJECTIVES: This is a demand-based infodemiology study using the Google Trends and AdWords tools to illustrate infodemiology's potential use in rheumatology. The study investigates three questions in North American countries: (1) What terms associated with "rheumatology" and "arthritis" do people search for on Google? (2) What is the search volume for disease-modifying antirheumatic drugs (DMARDs)? and (3) What is the search volume for the term "arthritis" compared with for "hepatitis C" and "breast cancer"? METHODS: We conducted independent searches by country and search term for 2015-2017. Seventeen DMARDs were searched for 2015 through May 2018, with the turmeric remedy included for comparison. Data were exported to Excel for further analysis, adjusted by country population, and expressed as searches per 100,000 inhabitants (SpTh). RESULTS: There were approximately 550 associated terms for "arthritis" in each country, and 5679 SpTh for DMARDs across the three countries. Searches for turmeric numbered slightly lower than for all DMARDs together in Canada and the USA, but were 70% higher in Mexico. Turmeric was also searched four times more than the most-searched biological DMARD in Canada and the USA, and 60 times more in Mexico. Arthritis was more commonly searched for in Canada than hepatitis C and breast cancer, but hepatitis C was highest in the USA and breast cancer in Mexico. Monthly trends did not show expected peaks associated with arthritis awareness campaigns. CONCLUSION: Infodemiology provides preliminary information that could help in generating hypotheses, assessing health-care interventions, or even in providing patient-centered care.

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