Quality assurance of serologic testing for Chagas disease in a primary care setting of rural Paraguay.

The diagnosis of Chagas disease mostly relies on the use of multiple serologic tests that are often unavailable in many of the remote settings where the disease is highly prevalent. In the Teniente Irala Fernández Municipality, in central Paraguay, efforts have been made to increase the diagnostic capabilities of specific rural health centres, but no quality assurance of the results produced has been performed. We comparatively analysed the results obtained with 300 samples tested using a commercial rapid diagnostic test (RDT) and enzyme linked immunosorbent assays (ELISA) at the laboratory of the Teniente Irala Fernández Health Center (CSTIF) with those generated upon repeating the tests at an independent well-equipped research laboratory (CEDIC). A subgroup of 52 samples were further tested at Paraguay's Central Public Health Laboratory (LCSP) by means of a different technique to evaluate the diagnostic performance of the tests carried out at CSTIF. We observed an excellent agreement between the ELISA results obtained at CSTIF and CEDIC (kappa coefficients between 0.85 and 0.93 for every kit evaluated), and an overall good performance of the tests carried out at CSTIF. However, the sensitivity of one kit was lower at CSTIF (81.3 %) than at CEDIC (100 %). The individual use of an RDT to detect the infection at CSTIF showed a similar sensitivity to that obtained combining it to an ELISA test (92.3% vs 88.5, p = 1). Nonetheless, the generalizability of this result is yet limited and will require of further studies.

Economic burden of respiratory syncytial virus disease in Latin America: A systematic review.

This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.

Risk-of-bias assessment of the randomized clinical trials and systematic reviews on surgical treatments for breast cancer-related lymphedema: A mapping review.

BACKGROUND: Breast cancer treatment is the principal cause of lymphedema in the upper extremities. Breast cancer-related lymphedema (BCRL) treatments were previously based on conservative therapy; surgical treatments are alternative options that could be highly beneficial, especially for patients who are not responsive to conservative therapy. The main aim of this study was to describe and critically assess the risk of bias of randomized clinical trials (RCTs) and systematic reviews (SRs) on surgical treatment for BCRL. METHODS: We conducted an evidence mapping review according to the methodology proposed by Global Evidence Mapping (GEM). An update was done for our previous systematic search in MEDLINE, EMBASE, CENTRAL (Cochrane), and Epistemonikos from the year 2000 onward. We assessed the risk of bias for the RCTs and SRs using the RoB-2 and ROBIS tools, respectively. RESULTS: Two surgical RCTs and eight SRs were found among the 47 surgical studies that met the eligibility criteria. The overall risk-of-bias assessments of these studies were rated as some concerns (six outcomes) and high risk (three outcomes) for the measured outcomes among the RCTs and as a high risk of bias (five studies) and low risk (three studies) for the included SRs. CONCLUSIONS: The overall evidence in the literature on surgical treatment for BCRL is low, as there are few published RCTs and SRs, and the risk-of-bias assessment for the majority was rated as high risk of bias or with some concerns. High-quality studies are needed to improve evidence-based decision-making by surgeons and patients.