Situación epidemiológica de VIH a nivel global y nacional: Puesta al día / Epidemiological situation of HIV at global and national level: update

INTRODUCCIÓN: En las cuatro décadas de la epidemia por VIH, se han observado avances notables que han contribuido a una disminución progresiva en la incidencia de nuevas infecciones y en la mortalidad a nivel mundial. Sin embargo, no ha ocurrido lo mismo en Latinoamérica y en Chile. OBJETIVO: Esta revisión tiene como objetivo conocer la epidemiología actual a nivel global, latinoamericano y chileno. METODOLOGÍA: Se analizaron los informes epidemiológicos oficiales de infección por VIH emitidos por organismos nacionales e internacionales, más los estudios epidemiológicos nacionales. RESULTADOS: Se estima que 39 millones de personas viven con VIH en el mundo; no obstante, la mortalidad y la incidencia de nuevos casos han disminuido de forma notoria durante las últimas dos décadas, asociado a una expansión en al acceso a terapia antirretroviral en forma global. A diferencia del resto del mundo, América Latina presenta una tendencia de alza en las nuevas infecciones y Chile registra un aumento de 35% en nuevos casos durante los últimos 10 años, coincidiendo con un aumento en los flujos de migrantes que ha afectado a la región. Algunas estrategias preventivas como la profilaxis pre exposición se han implementa-do a un ritmo lento, tanto a nivel mundial, como latinoamericano. CONCLUSIONES: La epidemiología del VIH presenta características propias regionales y nacionales. En particular en Chile, diversos factores incluyendo déficit en políticas públicas de prevención y los recientes flujos migratorios han modelado nuestra actual epidemia. El desafío presente debe contemplar los esfuerzos multisectoriales para lograr los objetivos de ONUSIDA en esta década.

BACKGROUND: Over the course of the last four decades of global HIV epidemic, significant improvements have contributed to gradually reduce the frequency of new infections and global mortality rates. However, in Latin America particularly in Chile, new infections continue increasing. AIM: This review aims to comprehend the_epidemiology today on a worldwide, Latin American, and Chilean scale. METHODS: National epidemiology studies and official HIV reports from international and national organizations were reviewed. RESULTS: It is estimated that 39 million people live with HIV worldwide; however, mortality and the incidence of new cases have decreased markedly over the last two decades, associated with an expansion in access to antiretroviral therapy globally. In contrast to the rest of the world, Latin America shows an upward trend in new infections, with Chile registering a 35% increase in new cases over the last 10 years, coinciding with an increase in migratory flows that has occurred throughout the region. Some preventive strategies, such as pre-exposure prophylaxis, have been implemented at a slow pace, both globally and in Latin America. CONCLUSIONS: The epidemiology of HIV has regional and national characteristics. Specifically in Chile, several factors, including deficits in public prevention policies and recent migratory flows, have shaped our current epidemic. The present challenge must contemplate multisectoral efforts to achieve the UNAIDS objectives during this decade.

Prevalence and associated factors of diabetic retinopathy in Latin American countries: a scoping review / Prevalência e fatores associados à retinopatia diabética em países da América Latina: uma revisão de escopo

ABSTRACT Objective To gather the available evidence in the literature on the prevalence and associated factors of diabetic retinopathy (DR) in Latin America. Methods This scoping review was developed according to the PRISMA-ScR. Prevalence data were summarized by weighted mean, considering the type of DM and country. For the analysis of associated factors, meta-analyses were performed with the most homogeneous studies, and the ORs and their 95%CIs were calculated. Results Forty-two articles published between 2004 and 2020 were included in this study. The mean prevalence of DR ranged from 15.0% in Costa Rica to 32.7% in Brazil. Conclusion This variation may be related to the diagnostic method, age of the studied population, duration of disease, glycemic control, or other associated factors such as the presence of diabetic nephropathy or hypertension. This review discloses an important burden of DR in Latin America and highlights the need for further in-country studies.

RESUMO Objetivo O objetivo desta revisão foi reunir as evidências disponíveis na literatura sobre a prevalência e os fatores associados à retinopatia diabética na América Latina. Métodos Esta é uma revisão de escopo desenvolvida de acordo com o PRISMA-ScR. Os dados de prevalência foram resumidos por média ponderada, considerando o tipo de diabetes mellitus e o país. Para a análise dos fatores associados, foram realizadas metanálises com os estudos mais homogêneos e calculados as razões de chance e seus intervalos de confiança de 95%. Resultados Foram publicados 42 artigos entre 2004 e 2020, os quais foram incluídos neste estudo. A prevalência média de retinopatia diabética variou de 15,0%, na Costa Rica, a 32,7%, no Brasil. Conclusão Essa variação pode estar relacionada ao método de diagnóstico, à idade da população estudada, à duração da doença, ao controle glicêmico ou a outros fatores associados, como a presença de nefropatia diabética ou hipertensão. Esta revisão revelou um ônus importante da retinopatia diabética na América Latina e destaca a necessidade de mais estudos nos países.

Serotipos prevalentes de Streptococcus mutans en América Latina / Prevalent serotypes of Streptococcus mutans in Latin America

La microbiota oral está conformada por diversas especies bacterianas que en condiciones normales desempeñan una función protectora del huésped; sin embargo, cuando existe un desequilibrio en el ecosistema, estos microorganismos son capaces de producir diversas manifestaciones como lo es el caso de la caries dental, enfermedad infecciosa producida principalmente por Streptococcus mutans, patógeno capaz de desmineralizar los tejidos duros del diente mediante la fermentación de hidratos de carbono obtenidos de la dieta. Se ha identificado en la pared celular de este microorganismo ocho serotipos que intervienen en la adhesión, agregación y coagregación bacteriana. En los seres humanos S. mutans presenta los serotipos c, e y f, siendo el serotipo c el más prevalente a nivel mundial, el cual se conoce que está asociado a pacientes sanos, a diferencia del e y f que son capaces de invadir las células endoteliales de las arterias coronarias. No obstante, en los últimos años se ha logrado identificar el serotipo k que de igual manera presenta alta capacidad de invadir el endotelio humano, actuando en la patogénesis de las enfermedades cardiovasculares. El objetivo de la presente revisión bibliográfica es lograr cuantificar los serotipos prevalentes de S. mutans en América Latina (AU)

The oral microbiota is made up of various bacterial species that under normal conditions perform a protective function of the host, however, when there is an imbalance in the ecosystem, these microorganisms are capable of producing various manifestations such as caries, an infectious disease. produced mainly by Streptococcus mutans, a pathogen capable of demineralizing the hard tissues of the tooth through the fermentation of carbohydrates obtained from the diet. Eight serotypes involved in bacterial adhesion, aggregation and coaggregation have been identified in the cell wall of this microorganism. In humans, S. mutans presents serotypes c, e, and f, serotype c being the most prevalent worldwide, which is known to be associated with healthy patients, unlike e and f, which are capable of invading the endothelial cells of the coronary arteries. However, in recent years it has been possible to identify serotype k, which also has a high capacity to invade the human endothelium, acting in the pathogenesis of cardiovascular diseases. The objective of this literature review is to quantify the prevalent serotypes of S. mutans in Latin America (AU)

Quemaduras: ¿por qué prestarles especial atención a los adolescentes en América Latina y El Caribe desde un enfoque de prevención primaria en salud? / Burns: why give special attention to adolescents in Latin America and the Caribbean from a primary health prevention perspective?

La evidencia existente en materia de quemaduras en población menor de edad a nivel global se ha enfocado principalmente en niños y niñas menores de 10 años, dejando atrás al grupo etario definido como "adolescente" por la Organización Mundial de la Salud. Sin embargo, la etapa de la adolescencia presenta características propias que la diferencian de los rangos etarios menores con respecto a las quemaduras. Estas diferencias son relevantes desde una perspectiva de prevención primaria, la cual se centra en evitar la enfermedad o lesión. En este contexto, el presente artículo reflexiona en torno a los motivos por los cuales es necesario prestarles especial atención a las y los adolescentes en el marco de la prevención primaria de las quemaduras, con relevancia para Latinoamérica y El Caribe. Primero, los escenarios de quemaduras en adolescentes muchas veces se vinculan con la participación en actividades de riesgo por presión, deseabilidad social o baja percepción de los riesgos asociados. Segundo, es importante recalcar que los adolescentes pueden experimentar vulnerabilidad social, la cual los puede exponer al riesgo de sufrir una quemadura intencional o no. Tercero, el riesgo de quemaduras en adolescentes se puede asociar con la salud mental y escenarios de autolesión. Se requiere indagar en estos aspectos, tanto a través de estudios cuantitativos epidemiológicos como de estudios cualitativos, para poder diseñar e implementar estrategias de prevención primarias relevantes para este grupo de población en la región.

The existing evidence on burns in the underage population has focused mainly on children under ten years, leaving behind the age group defined as "adolescents" by the World Health Organization. However, adolescents present their own characteristics that differentiate them from their younger counterparts. These differences are relevant from a primary prevention perspective, focusing on preventing illness or injury. In this context, this article reflects on why adolescents need special attention in the primary prevention of burns in Latin America and the Caribbean. First, burn scenarios in adolescents are often linked to participation in risky activities due to pressure, social desirability, or low perception of the associated risks. Second, it is essential to emphasize that adolescents may experience social vulnerability, which entails a higher risk of suffering an intentional or unintentional burn. Third, the risk of burns in adolescents may be related to mental health and self-harm scenarios. These aspects need to be investigated through both quantitative and qualitative studies to design and implement primary prevention strategies relevant to this population group in the region.

Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review / Infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe: revisión sistemática / Dengue, zika e chikungunya na América Latina e no Caribe: revisão sistemática

ABSTRACT Objectives. To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods. The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results. Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions. The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

RESUMEN Objetivos. Caracterizar el perfil de distribución de infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe, y determinar posibles factores relacionados con el riesgo de propagación y gravedad de estas arbovirosis. Métodos. Se registró el protocolo de esta revisión en la plataforma PROSPERO. Se realizaron búsquedas en las siguientes bases de datos: Virtual Health Library, MEDLINE/PubMed y Embase. Los términos de búsqueda fueron: "zika virus" [virus del Zika], "zika virus infection" [infección por el virus del Zika], "dengue", "dengue virus" [virus del dengue], "chikungunya virus" [virus del chikunguña], "chikungunya fever" [fiebre de chikunguña], "epidemiology" [epidemiología], "observational study" [estudio observacional], "Latin America" [América Latina] y "Caribbean región" [Caribe]. Se incluyeron estudios que abordaban la distribución de estas arbovirosis y los factores de riesgo asociados con el dengue, la enfermedad por el virus del Zika y el chikunguña, publicados entre enero del 2000 y agosto del 2020 en español, inglés y portugués. Resultados. De los 95 estudios incluidos, 70 establecieron factores de riesgo, manifestaciones clínicas y resultados de las infecciones por arbovirus y 25 describieron complicaciones o muertes. La mayor frecuencia de casos confirmados fue del dengue. Brasil notificó la mayoría de los casos de infección por los tres arbovirus en el período analizado. Los factores ambientales y socioeconómicos facilitaron la proliferación y adaptación de los vectores, y se notificó que los factores relacionados con el huésped agravaban el dengue. El chikunguña causó la mayor parte de las muertes, la enfermedad por el virus del Zika causó la mayor parte de las alteraciones neurológicas y el dengue fue responsable de una mayor morbilidad, lo que llevó a una hospitalización más frecuente. Conclusiones. Esta revisión ofrece un panorama de las tres arbovirosis y de los aspectos intrínsecos de las infecciones, y pone de relieve los factores que influyen en la propagación de estos virus en las poblaciones estudiadas.

RESUMO Objetivos. Descrever a distribuição das arboviroses causadas pelo vírus da dengue, zika e chikungunya na América Latina e no Caribe e identificar possíveis fatores associados ao potencial de disseminação e à gravidade dessas infecções. Métodos. O protocolo desta revisão sistemática foi registado na plataforma PROSPERO. Foram realizadas buscas nas bases de dados Biblioteca Virtual em Saúde, MEDLINE/PubMed e Embase. Os termos de busca foram: vírus zika, infecção pelo vírus zika, dengue, vírus da dengue, vírus chikungunya, febre chikungunya, epidemiologia, estudo observacional, América Latina e região do Caribe. Foram selecionados estudos publicados em inglês, português e espanhol, entre janeiro de 2000 e agosto de 2020, que tratavam da distribuição desses arbovírus e de fatores de risco associados à dengue, à infecção pelo vírus zika e à febre chikungunya. Resultados. Dos 95 estudos selecionados, 70 descreveram fatores de risco, manifestações clínicas e desfechos das arboviroses e 25 destacaram as complicações e/ou mortes. Houve uma maior taxa de casos confirmados de dengue. O Brasil foi o país onde se registrou a maioria dos casos dessas três arboviroses no período analisado. Fatores ambientais e socioeconômicos facilitaram a proliferação e a adaptação dos vetores dos arbovírus e fatores próprios do hospedeiro são determinantes na gravidade da dengue. As mortes ocorreram principalmente nos casos de febre chikungunya, as manifestações neurológicas foram mais comuns na infecção pelo vírus zika e a dengue resultou em maior morbidade e internação hospitalar. Conclusões. Esta revisão sistemática oferece um panorama destas três arboviroses e de suas peculiaridades destacando os fatores que influenciam a disseminação destes arbovírus nas populações estudadas.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Factores socio demográficos y de estilos de vida asociados a un bajo nivel de actividad física durante el confinamiento producto del COVID-19 en adultos latinoamericanos / Factors associated with inactivity during COVID-19 confinement among Latin American adults

BACKGROUND: The confinement caused by the COVID-19 pandemic changed the lifestyles of the population affecting their levels of physical activity. AIM: To determine the factors associated with a low level of physical activity in adults during confinement during the COVID-19 pandemic. MATERIAL AND METHODS: Adults from Chile, Colombia, México and Perú were invited through social networks to answer an online survey. Questions about sociodemographic, health status and lifestyle variables were included. The level of physical activity and sedentary behavior were determined through the short version of the International Physical Activity Questionnaire (IPAQ). Results: The survey was answered by 3,362 adults aged between 18 and 60 years. Respondents more likely to be inactive were women, those with less than eight years of education, those with overweight or obesity, those who smoked at least one cigarette a day, consumed alcohol four or more times a week, slept less than six hours per day and spent more than 6 hours per day in sedentary behaviors. CONCLUSIONS: These findings provide a sociodemographic and lifestyle profile associated with physical inactivity during the period of confinement in Latin American adults. The results confirm the need to promote healthy lifestyles in the population during periods of confinement.

Association between rapid weight gain and overweight in children aged 0 to 5 years in Latin America / Associação entre ganho rápido de peso e excesso de peso em crianças de 0 a 5 anos de idade na América Latina

Abstract Objectives: to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries. Methods: cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model. Results: there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p < 0.001 for all countries. Conclusions: RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Resumo Objetivos: avaliar a prevalência do ganho rápido de peso (GRP) em crianças nascidas com peso normal e sua associação com o excesso de peso (EP) em quatro países da América Latina. Métodos: estudo transversal de inquéritos populacionais com crianças de 0 a 5 anos da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher no Brasil e da Encuesta Nacional de Demografía y Salud da Bolívia, Colômbia e Peru, selecionadas pelo peso ao nascer ≥2.500 gramas. A variável desfecho foi o EP; de exposição o GRP; e de ajuste a amamentação. Foram estimadas as prevalências, odds ratio e intervalo de confiança de 95% por regressão logística multivariada. Resultados: observou-se maior prevalência de GRP e tempo de amamentação menor do que 6 meses no Brasil e maior prevalência de EP no Brasil e Bolívia. As chances de EP quando GRP presente e ajustado por amamentação foram de 6,1 vezes (IC95% = 3,8-9,7) no Brasil; 4,4 vezes (IC95% = 3,6-5,3) na Bolívia; 6,7 vezes (IC95% = 5,5-8,2) na Colômbia; 12,2 vezes no Peru (IC95% = 9,4-15,7) e p<0,001 nos quatro países. Conclusões: o GRP em crianças nascidas com peso normal foi associado a maior chance de EP infantil nos quatro países da América Latina.

Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.

Mapping of civil society actors in 33 latin american countries, with the aim of strengthening an integrated participatory response to the pandemic and other emergencies descriptive analysis

As part of a regional effort promoted by WHO and financed by the Solidarity Fund, PAHO carried out a series of mapping actions in the region to identify civil society actors and systematize their repertoires of action within the framework of the response to COVID-19, and the countries' recovery process. It is considered essential to have information and evidence to position and strengthen Civil Society Organizations (CSOs) as relevant actors in the construction of health and the advancement of health equity, and as part of integrated responses to emergencies, more specifically in the context of the COVID-19 pandemic. The aim of this report is to show the main findings related to the CSO's characteristics and their repertories of action in a pandemic context, including all interviewed organizations across Latin America and the Caribbean which means a further step compared to previous reports.

Tendencias de búsqueda en Internet sobre dióxido de cloro en ocho países de Latinoamérica durante la pandemia por COVID-19 / Trends of Internet search about chlorine dioxide in eight Latin American countries during the COVID-19 pandemic

La infodemiología e infovigilancia son métodos informáticos para el análisis y seguimiento de los datos de Internet, y permiten tomar conciencia de las situaciones y crear políticas sanitarias. Este estudio se propuso analizar las tendencias de búsqueda de dióxido de cloro y términos equivalentes en Internet (chlorine dioxide solution, CDS; miracle mineral solution, MMS), en relación con la morbilidad y mortalidad por COVID-19 en ocho países de Latinoamérica. Para ello se utilizó Google Trends; el período examinado fue del 1ro de marzo al 25 de noviembre de 2020. Se calculó la media móvil por 7 días para el volumen relativo de búsqueda (VRB), la tasa de morbilidad y mortalidad. Para la asociación de las variables cuantitativas, se utilizó el coeficiente de correlación de Spearman con un nivel de significancia p < 0,05. El país con mayor interés de búsqueda fue Bolivia; el de menor interés, Brasil. El análisis del VRB con la tasa de morbilidad y mortalidad fue diferente entre países. Los picos máximos de VRB de Colombia y Chile, en abril, y de México, Ecuador y Bolivia, en julio, coincidieron con la emisión de alertas sanitarias sobre dióxido de cloro. La mayoría mostró una correlación significativa moderada y baja entre el VRB y el número de casos confirmados y muertes diarias por COVID-19. El comportamiento de las búsquedas, diferenciado entre países, podría indicar mayor interés por el tema dióxido de cloro en pandemia; lo cual se explicaría por la difusión de alertas sanitarias de organismos de salud internacionales, regionales y locales(AU)

Infodemiology and infovigilance are computer methods for the analysis and monitoring of Internet data, and allow awareness of situations and creation of health policies. This study aimed to analyze the search trends for chlorine dioxide and equivalent terms on the Internet (chlorine dioxide solution, CDS; miracle mineral solution, MMS), in relation to COVID-19 morbidity and mortality in eight Latin American countries. Google Trends was used for this purpose; the period reviewed was from March 1st to November 25th 2020. The 7-day moving average for relative search volume (VRB), morbidity and mortality rate were calculated. For the association of quantitative variables, the Spearman correlation coefficient was used with a significance level p < 0.05. The country with the highest search interest was Bolivia; the one with the least interest, Brazil. The analysis of the VRB with the morbidity and mortality rate was different between countries. The maximum VRB peaks of Colombia and Chile, in April, and of Mexico, Ecuador and Bolivia, in July, coincided with the issuance of health alerts on chlorine dioxide. Most showed a moderate and low significant correlation between VRB and the number of confirmed cases and daily deaths from COVID-19. The behavior of the searches, differentiated between countries, could indicate greater interest in the topic of chlorine dioxide during the pandemic; this would be explained by the dissemination of health alerts from international, regional and local health agencies(AU)

Desigualdades sociais e alimentação complementar na América Latina e no Caribe / Social inequalities and complementary feeding in Latin America and the Caribbean

Resumo Este artigo tem como objetivo avaliar o papel das desigualdades sociais nos padrões de alimentação complementar nos países da América Latina e do Caribe. Trata-se de um estudo ecológico que utilizou dados agregados de inquéritos de base populacional. A unidade de análise da pesquisa foram 16 países da América Latina e do Caribe com informações disponíveis. Foram selecionados como desfechos a prevalência dos seguintes indicadores de alimentação complementar: introdução alimentar de alimentos sólidos, semissólidos e pastosos" (IASSP), "diversidade alimentar mínima" (DAM), "frequência alimentar mínima" (FAM) e "alimentação mínima aceitável" (AMA). As diferenças da prevalência dos indicadores entre os quintis de riqueza mais ricos e mais pobres foram calculadas de forma absoluta e relativa. Comparando os quatro indicadores de alimentação complementar, o IASSP teve o melhor desempenho, com 10 países, entre os 11 avaliados, apresentando prevalência acima de 80%. O indicador com pior desempenho foi o AMA, com apenas um país, entre os oito avaliados, com prevalências acima de 60%. Na quase totalidade dos países, a população mais pobre possuía prevalências de indicadores de alimentação complementar menores que os mais ricos.

Abstract This study evaluated the role of social inequalities in complementary feeding patterns between and within countries in Latin America and the Caribbean. This ecological study employed aggregate data from population-based surveys. The units of analysis were all 16 countries in Latin America and the Caribbean for which information was available in the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) databases. The outcomes selected were the prevalences indicated by the "introduction of solid, semi-solid or soft foods" (ISSSF), "minimum dietary diversity" (MDD), "minimum meal frequency" (MMF) and "minimum acceptable diet" (MAD) standardised complementary feeding indicators recommended by the WHO and available in UNICEF databases. The differences in prevalences between the wealthiest and poorest income quintiles were calculated in absolute and relative terms. Comparing the four indicators of complementary feeding, the ISSSF showed best performance, returning prevalence above 80% in 10 of the 11 countries evaluated. The indicator showing worst performance was the MAD, with prevalence above 60% in only one of the eight countries evaluated. In almost all countries, by all indicators, prevalences of complementary feeding were lower in the poorest population groups than in the wealthiest.

Acometimento miocárdico na Doença de Chagas: uma perspectiva a partir da avaliação pela ressonância magnética cardiovascular / Myocardial involvement in Chagas Disease: from the perspective of cardiovascular magnetic ressonance assessment

A doença de Chagas representa um importante problema de saúde pública, sobretudo nos países endêmicos da América Latina. Dentre suas apresentações clínicas, a cardiomiopatia crônica é a mais frequente. De patogênese multifatorial, o acometimento miocárdico pode levar à insuficiência cardíaca, a eventos tromboembólicos, a arritmias e à morte súbita. Nesse contexto, a ressonância magnética cardiovascular é um excelente método não invasivo para a investigação do dano miocárdico e a compreensão dos mecanismos e consequências relacionados às essas lesões. Com elevada resolução espacial e capacidade de caracterização tecidual, a ressonância magnética cardiovascular proporciona análise morfofuncional altamente confiável e possibilita a identificação de marcadores de risco de eventos adversos em pacientes com doença de Chagas, sendo de grande utilidade para o diagnóstico e o acompanhamento desses indivíduos na rotina clínica. (AU)

Chagas disease represents an important public health problem, especially in endemic countries in Latin America. Chronic cardiomyopathy is its most frequent clinical presentation. Myocardial involvement has a multifactorial pathogenesis and can lead to heart failure, thromboembolic events, arrhythmias, and sudden death. In this context, cardiovascular magnetic resonance imaging (CMR) is an excellent noninvasive method for investigating myocardial damage and understanding the mechanisms and consequences of these injuries. CMR has high spatial resolution and tissue characterization capacity, enabling a highly reliable morphofunctional analysis and the identification of risk markers for adverse events in patients with Chagas disease. This exam is very useful for the diagnosis and follow-up of these patients in the routine clinical setting. (AU)

Guía de actuación y abordaje frente a intoxicación por dióxido de cloro/clorito de sodio, a partir de la experiencia de los CIAT de América Latina / Guidelines for action and approach to chlorine dioxide/sodium chlorite poisoning based on the experience of the CIATs in Latin America

Resumen El 11 de marzo de 2020, la Organización Mundial de la Salud, declaró la pandemia a nivel mundial por la COVID-19. Ante este escenario, los centros de información y asesoramiento toxicológico (CIAT) de América Latina comenzaron a recibir consultas por exposición/intoxicación a dióxido de cloro/clorito de sodio y sus compuestos relacionados, por desvío de uso, destinado a la prevención y/o tratamiento de la COVID-19 sin aval científico alguno ni contar con registro sanitario para ese fin. A través de la Red de Toxicología de América Latina y el Caribe (RETOXLAC), se comprobó que no eran hechos aislados, sino que se estaba produ ciendo el mismo fenómeno en toda la región y que existían antecedentes de intoxicaciones con dichos productos y alertas desde hace más de una década, con indicaciones no aprobadas, para el tratamiento de distintas patologías como SIDA, cáncer, esclerosis lateral amiotrófica ELA, malaria, autismo, entre otras, sin evidencia. Ante esta realidad, los CIAT presentan una revisión de los signos y síntomas observados según la vía de ingreso, basados en la comunicación de riesgo en salud; proponiéndose pruebas de apoyo al diagnóstico, algoritmo de tratamiento para las intoxicaciones y modelo de ficha clínica para la vigilancia epidemiológica de los casos atendidos. Recomendamos a las autoridades y organismos responsables, reforzar las acciones tendientes a la vigilancia, control y prevención de este tipo de intoxicaciones, producto del mal uso de un desinfectante no autorizado para fines terapéuticos/médicos.

Abstract On March 11th, 2020, the World Health Organization declared a global pandemic due to COVID-19. Faced with this sce- nario, the Poison Control Centers (CIATs for its initials in spanish) in Latin America began to receive consultations for exposure/poi- soning to chlorine dioxide/sodium chlorite and its related compounds for their use aimed to prevent or treat COVID-19 without any scientific endorsement or having a sanitary registry for that purpose. It was found through the Toxicology Network of Latin America and the Caribbean (RETOXLAC) that they were not isolated events but rather that the same phenomenon was occurring throughout the region and that there has been a history of poisoning and alerts with these products for more than a decade with unapproved indications for the treatment of different pathologies such as AIDS, cancer, amyotrophic lateral sclerosis (ALS), malaria, autism, among others, without evidence. In the light of this situation, the CIATs present a review of the signs and symptoms observed ac- cording to the route of exposure based on health risk communication; proposing tests to support the diagnosis, an algorithm for poisoning treatment, and a model of a clinical record for the epidemiological surveillance of the assisted cases. We recommend to the authorities and responsible organisms reinforce the actions aimed at surveillance, control, and prevention of this type of poisoning due to the misuse of an unauthorized disinfectant for therapeutic or medical purposes.

Prevalencia de síndrome de intestino irritable en América Latina / Irritable bowel syndrome prevalence in Latin America

El síndrome de intestino irritable es una enfermedad funcional intestinal frecuente a nivel mundial, pero con pocos estudios de prevalencia. Su diagnóstico es clínico y se basa en criterios acordados internacionalmente que han cambiado con el tiempo, actualmente regidos por el Consenso de Roma IV. Objetivo: Recabar y actualizar datos disponibles de prevalencia de América Latina para entender mejor el comportamiento regional de SII. Materiales y métodos: Se realizó una búsqueda de trabajos originales, autodefinidos de prevalencia, en las bases de datos Pubmed y Lilacs así como presentaciones en congresos de trabajos originales. Resultados: Se encontraron 27 estudios según los criterios de búsqueda establecidos. De ellos, 16 eran en población general. Dos trabajos incluyeron el estudio de prevalencia de más de una población constituyendo finalmente 22 referencias desarrolladas en 9 países. La prevalencia promedio total para América Latina fue 15,4%. La prevalencia promedio encontrada por criterios de Roma II fue 23,5%; por Roma III 11,8% y por Roma IV 6,98%. Conclusión: Esta es la primera revisión en reunir datos de prevalencia de síndrome de intestino irritable en población general de nueve países de América Latina. La prevalenci d fue amplia y los criterios diagnósticos utilizados hicieron la mayor diferencia.

Although irritable bowel syndrome is a common functional bowel disease worldwide, few prevalence studies have been published. Diagnosis is clinical and based on internationally agreed criteria that have changed over time. Currently the Rome IV Consensus is used as the international reference. Objective: collect and update available prevalence data from Latin America to better understand the regional behavior of irritable bowel syndrome. Materials and methods: a search was carried out for original works, self-defined on prevalence, in the Pubmed and Lilacs databases. Presentations or posters at congresses of original works were also considered. Results: according to the established search criteria, 27 studies were found. Of these, 16 were in the general population. Two studies included the study of the prevalence of more than one population, for which reason 22 prevalence data were obtained from 9 countries. The total average prevalence for Latin America was 15.4%. The average prevalence found by the Rome II criteria was 23.5%; by Rome III 11.8% and by Rome IV 6.98%. Conclusion: this is the first review to collect data on the prevalence of irritable bowel syndrome in the general population from nine Latin American countries. The average prevalence found was 15%. The variability was wide and the diagnostic criteria used made the biggest difference.

Promoção em saúde mental de adolescentes em países da América Latina: uma revisão integrativa da literatura / Adolescent mental health promotion in Latin American countries: an integrative literature review

Resumo A Promoção em Saúde (PS) apresenta um fortalecimento recente dentro das políticas públicas e quando se trata da infância e adolescência na América Latina (AL) observa-se ainda forte consonância com as determinações internacionais. Considerando o aumento de prevalência de sofrimento psíquico nesta faixa etária e a construção histórica política dos países latino-americanos abordar a PS se torna mais urgente. O objetivo desta pesquisa foi identificar e analisar, por meio de uma revisão integrativa da literatura, produções acadêmicas que tratam de estratégias de PS mental de adolescentes na AL e, assim, visibilizar as ações e provocar reflexões dialogadas com as críticas Sulistas, representadas pela declaração de Bogotá. Após a aplicação dos critérios de inclusão e exclusão, foram selecionados 6 estudos. Identificou-se que o principal espaço onde as ações são desenvolvidas é a escola. Além disso, como medidas potenciais foram identificadas a capacitação dos profissionais, a ação grupal e o fortalecimento da atenção primária e territorial. Discute-se que a realidade socioeconômica estruturada historicamente da AL reflete uma organização própria das ações em PS. Com isso, a visibilização das estratégias que potencializam a baixo custo uma melhora na saúde mental de adolescentes pode contribuir com a reflexão atual.

Abstract Health Promotion (HP) has recently been strengthened within public policies and still shows strong consonance with international determinations regarding childhood and adolescence in Latin America (LA). Debating HP becomes all the more urgent considering the increasing prevalence of psychological distress in this age group and the historical political construction of Latin American countries. This research aimed to identify and analyze, through an integrative review of the literature, the academic productions on strategies for mental HP of adolescents in LA and, thus, to visualize the actions and arouse reflections dialoguing with the Southern critics, represented by the Bogotá declaration. Six studies were selected after applying the inclusion and exclusion criteria. We identified that the main space where actions are developed is the school. The potential measures identified were professional training, group action, and strengthening primary and territorial care. We discussed that the historically structured socioeconomic reality of LA reflects an organization of HP actions. Furthermore, the visualization of strategies that enhance at low cost the improved mental health of adolescents can contribute to the current reflection.

Cambios epidemiológicos y actualidades sobre vacunación contra Bordetella pertussis en Latinoamérica / Epidemiologic changes and novelties on vaccination against Bordetella pertussis in Latin America

Resumen A pesar de que la tosferina (coqueluche) es una enfermedad prevenible por vacunas (EPV), la epidemiología latinoamericana muestra que hay persistencia de brotes en la región. Esta persistencia se debe, al menos en parte, a factores tales como la cobertura vacunal, la presencia de movimientos anti vacunas, la diversidad de los sistemas locales de vigilancia y la falta de una definición de caso unificada para la región. Dada la importancia de la tosferina en Latinoamérica y los cambios ocurridos en las recomendaciones para la vacunación, este manuscrito tiene como objetivo revisar los datos epidemiológicos y los cambios recientes en los calendarios de vacunación y su impacto sobre la enfermedad pediátrica por Bordetella pertussis en Latinoamérica. Los datos epidemiológicos más recientes muestran que entre regiones, países, y segmentos dentro de cada país hay heterogeneidad en la cobertura vacunal, con distintos rebrotes. Esfuerzos en la región han tratado de mejorar esta situación al introducir vacunas acelulares (aP), menos reactogénicas que las vacunas de células enteras (wP) en los calendarios vacunales. Además, algunos países han mejorado la definición de caso confirmado, al introducir la reacción de polimerasa en cadena (RPC) como criterio diagnóstico. En respuesta a las heterogeneidades de cada país y a la epidemiología actual de la región, un Comité de Expertos de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE) y la Asociación Latinoamericana de Pediatría (ALAPE) propone una definición unificada de caso y recomendaciones para mejorar la cobertura vacunal y reducir los brotes de tosferina en Latinoamérica.

Abstract Although whooping cough is a vaccine-preventable disease (VPD), its epidemiologic characteristics in Latin America shows persistence of outbreaks in the region. This persistence is due, at least in part, to the presence of antivaccine movements, the diversity of the surveillance systems, and the lack of a uniform case definition for the region. Given the importance of whooping cough in Latin America and the changes in vaccine recommendations, this manuscript aims to review epidemiologic data and recent changes in the vaccination calendars and their impact on the pediatric disease by Bordetella pertussis in Latin America. Recent epidemiological data reveal that between regions, countries, and administrative units within each country there is a marked heterogeneity of vaccine coverage, with different outbreak patterns. Efforts in the region have tried to improve this situation by introducing acellular pertussis vaccines (aP) in the vaccine calendars, which are less reactogenic than whole-cell pertussis vaccines (wP). Moreover, some countries have improved the case definition. Some countries have implemented a confirmed case definition by introducing polymerase chain reaction (PCR) as a diagnostic criterion. As a response to the heterogeneities observed within and between countries and the regional epidemiologic profiles, a Steering Committee from the Latin American Society for Pediatric Infectiology (SLIPE) and the Latin American Association of Pediatrics (ALAPE) propose a unified case definition and recommendations to improve vaccine coverage and reduce the outbreaks of whooping cough in Latin America.