Pediatric COVID-19 in Argentina: a comprehensive analysis of disease and economic burden through official data and a systematic literature review.

Background: Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents. Methods: We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0-18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023. Results: A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%-28% of cases were asymptomatic, 68%-88% were mild or moderate, and 3%-10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC. Conclusion: Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.

Health and economic burden of sugar-sweetened beverages consumption in Brazil.

Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade.

Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue.

What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue. / ¿Qué necesita nuestra región para fortalecer políticas públicas sobre bebidas azucaradas? diálogo de decisores.

In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study.

OBJECTIVE: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.

[Burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El SalvadorCarga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador]. / Carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador.

Objective: To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods: A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results: A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion: A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador.

Objetivo: Estimar a carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador. Métodos: Foi utilizado um modelo de risco comparativo para estimar os efeitos sobre óbitos, eventos de saúde, anos perdidos devido a morte prematura ou vividos com incapacidade (AVAI) e custos médicos diretos atribuíveis ao consumo de bebidas açucaradas. Resultados: Um total de 520 mortes (8 por 100 00 indivíduos), 214 082 eventos de saúde (3 220 por 100 000 indivíduos) e 16 643 AVAI podem ser atribuídos ao consumo de bebidas açucaradas em El Salvador, o que representa US$ 69,35 milhões em custos médicos diretos para o ano de 2020. Os eventos de diabetes mellitus tipo 2 (DM2) atribuíveis ao consumo de bebidas açucaradas, em especial, podem representar mais de 20% do total de casos de DM2 no país. Conclusões: Um número elevado de mortes, eventos de saúde e custos pode ser atribuído ao consumo de bebidas açucaradas em El Salvador.

Carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador

[RESUMEN]. Objetivo. Estimar la carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador. Métodos. Se utilizó un modelo de riesgos comparativos para estimar los efectos en muertes, eventos de salud, años perdidos por muerte prematura y discapacidad (AVAD), y costos médicos directos atribuibles al consumo de bebidas azucaradas. Resultados. Un total de 520 muertes (8 cada 100 000 individuos), 214 082 eventos en salud (3 220 cada 100 000 individuos) y 16 643 AVAD podrían ser atribuibles al consumo de bebidas azucaradas en El Salvador, lo que representa $69,35 millones (dólar americano) en costos médicos directos para el año 2020. En particular, los eventos de diabetes tipo 2 (DBT2) atribuibles al consumo de bebidas azucaradas podrían llegar a representar más del 20% del total de casos de DBT2 para el país. Conclusión. Un elevado número de muertes, eventos y costos podrían atribuirse al consumo de bebidas azucaradas en El Salvador.

[ABSTRACT]. Objective. To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods. A comparative risk model was used to estimate the effects on deaths, health events, disabili- ty-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results. A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 indi- viduals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion. A high number of deaths, events, and costs could be attributed to the consumption of sugar-swee- tened beverages in El Salvador.

[RESUMO]. Objetivo. Estimar a carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador. Métodos. Foi utilizado um modelo de risco comparativo para estimar os efeitos sobre óbitos, eventos de saúde, anos perdidos devido a morte prematura ou vividos com incapacidade (AVAI) e custos médicos dire- tos atribuíveis ao consumo de bebidas açucaradas. Resultados. Um total de 520 mortes (8 por 100 00 indivíduos), 214 082 eventos de saúde (3 220 por 100 000 indivíduos) e 16 643 AVAI podem ser atribuídos ao consumo de bebidas açucaradas em El Salvador, o que representa US$ 69,35 milhões em custos médicos diretos para o ano de 2020. Os eventos de diabetes melli- tus tipo 2 (DM2) atribuíveis ao consumo de bebidas açucaradas, em especial, podem representar mais de 20% do total de casos de DM2 no país. Conclusões. Um número elevado de mortes, eventos de saúde e custos pode ser atribuído ao consumo de bebidas açucaradas em El Salvador.

Impact of policies restricting advertising, promotion and sponsorship of sugar-sweetened beverages. Systematic Review / Impacto de las políticas de restricción de publicidad, promoción y patrocinio de bebidas azucaradas. Revisión Sistemática

Objective.  To assess the impact of the implementation of a ban on advertising, promotion and sponsorship (PPP) of sugar-sweetened beverages (SSBs) in terms of reducing consumption, advertising exposure and relevant clinical outcomes. Material and methods A systematic review of studies published between 2001 and 2021 was conducted using the in PubMed, Embase and LILACS databases. Experimental, observational studies and economic models written in English, Portuguese or Spanish were included. Results. Sixteen studies out of 840 identified were selected. Due to outcomes heterogeneity, a meta-analysis was not possible. The interventions included comprehensive policies, general SSBs PPP restriction policies,TV advertising, promotional, point-of-sale, and school restrictions. Clinical outcomes (such as obesity, cardiovascular disease, diabetes, and cancer), economic outcomes (such as purchase, sale, cost-effectiveness, and other economic outcomes), changes in exposure, consumption, and other measures of effectiveness were assessed. Most effect measures showed decreases following the interventions. Conclusions. Policies that include PPP restrictions on SSBs can be effective in reducing consumption, especially among children and adolescents, and have a positive impact on their health.

Objetivo.  Evaluar el impacto de la implementación de la prohibición de la publicidad, promoción y patrocinio (PPP) de las bebidas azucaradas (BA) en términos de disminución de consumo, exposición publicitaria y desenlaces clínicos relevantes. Material y métodos. Revisión sistemática de estudios publicados entre 2001-2021 en bases de datos PubMed, Embase y LILACS escritos en inglés, portugués o español. Se incluyeron estudios experimentales, observacionales y modelos económicos. Resultados. Se seleccionaron 16 de 840 estudios identificados. Debido a la heterogeneidad en los desenlaces no fue posible realizar un meta-análisis. Las intervenciones incluidas correspondieron a una política integral, medidas generales de restricción de PPP de BA, restricciones de publicidad televisiva, de promociones, en punto de venta y en escuelas. Se hallaron desenlaces clínicos (obesidad, enfermedad cardiovascular, diabetes, cáncer), económicos (compra, venta, costo-efectividad, otros desenlaces económicos), cambios en la exposición, en el consumo y en otras medidas de efectividad.  La mayoría de las medidas de efecto evaluadas registraron disminuciones a partir de las intervenciones. Conclusiones. Las políticas que incluyen una restricción de la PPP de las BA resultarían efectivas, sobre todo para disminuir su consumo en NNyA, impactando positivamente en su salud.

Health and economic burden of disease of sugar-sweetened beverage consumption in four Latin American and Caribbean countries: a modelling study.

OBJECTIVE: Overweight and obesity are important contributors to the non-communicable disease burden. The consumption of sugar-sweetened beverages (SSBs) has been associated with an increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer and other conditions. The objective of this study was to estimate the burden of disease attributable to the consumption of SSBs and the costs to the healthcare systems in Argentina, Brazil, El Salvador, and Trinidad and Tobago. DESIGN: Following a systematic review of models, a comparative risk assessment framework was developed to estimate the health and economic impact associated with the consumption of SSBs. SETTING: Argentina, Brazil, El Salvador, and Trinidad and Tobago. PARTICIPANTS: Overall population. PRIMARY AND SECONDARY OUTCOME MEASURES: The model estimated the effects of SSB consumption on health through two causal pathways: one mediated by body mass index (BMI) and health conditions associated with BMI and another that reflected the independent effects of SSB consumption on T2DM and cardiovascular diseases. RESULTS: The model results indicated that for all four countries, in 1 year, SSB consumption was associated with 18 000 deaths (3.2% of the total disease-related deaths), seven million disease events (3.3% of the total disease-related events), a half-million DALYs and US$2 billion in direct medical costs. This included 1.5 million cases of overweight and obesity in children/adolescents (12% of the excess weight cases) and 2.8 million cases in adults (2.8%); 2.2 million cases of type 2 diabetes (19%); 200 000 cases of heart disease (3.8%); 124 000 strokes (3.9%); 116 000 cases of musculoskeletal disease (0.2%); 102 000 cases of kidney disease (0.9%); and 45 000 episodes of asthma (0.4%). The Trinidad and Tobago population were the most affected by disease events. CONCLUSIONS: The study results indicate that the consumption of SSBs is associated with a significant burden of disease and death in Latin America and the Caribbean.

The burden of disease and economic impact of sugar-sweetened beverages' consumption in Argentina: A modeling study.

BACKGROUND: Approximately two-thirds of Argentine adults are overweight or obese, and 11% have diabetes. Over the last two decades, all population groups have increased their consumption of ultra-processed foods and sugar-sweetened beverages (SSB). We aimed to estimate the disease burden-deaths, events, and costs to the health system-attributed to SSB consumption in Argentina. METHODS: We used a comparative risk assessment framework to estimate the health and economic impacts that would be avoided in a scenario without sugar-sweetened beverage (SSB) consumption. We calculated the direct effects on diabetes, cardiovascular disease, and BMI, and then estimated the effects of BMI on disease incidence. Finally, we applied the population attributable factor to calculate the health and economic burden avoided in Argentina in 2020. RESULTS: Our model estimated that about 4,425 deaths, 110,000 healthy life years lost to premature death and disability, more than 520,000 cases of overweight and obesity in adults, and 774,000 in children and adolescents would be attributed to SSB Consumption in Argentina. This disease burden corresponds to 23% of type-2 diabetes cases and other significant proportions of cardiovascular disease and cancer. The overweight and obesity costs attributable to SSB totaled approximately $47 million in adults and $15 million in children and adolescents. CONCLUSION: A significant number of disease cases, deaths, and health care costs could be attributed to SSB consumption in Argentina. Implementing measures to reduce the sugar content in beverages is a pending debt for the country and could lead to measurable improvements in population health, especially among children and adolescents.

¿Qué necesita nuestra región para fortalecer políticas públicas sobre bebidas azucaradas? diálogo de decisores / What does our region need in order to strengthen public policies on sugar-sweetened beverages? decision-makers' dialogue

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

In order to prioritize public policies to reduce the consumption of sugar-sweetened beverages in Argentina, Brazil, El Salvador and Trinidad and Tobago and to identify information gaps related to the burden of disease attributable to their consumption, a policy dialogue was held with government members, civil society organizations, researchers and communicators from Latin American and Caribbean countries. Presentations and deliberative workshops were conducted using semi-structured data collection tools and group discussions. The prioritized interventions were tax increases, front labeling, restriction of advertising, promotion and sponsorship, and modifications regarding the school environment. The main perceived barrier was the interference from the food industry. This dialogue among decision-makers led to the identification of priority public policies to reduce the consumption of sugar-sweetened beverages in the region.

Direct evidence gap on fixed versus adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: Systematic review and individual patient data meta-analysis.

OBJECTIVES: To determine the comparative efficacy and safety of a fixed dose of benznidazole (BZN) with an adjusted-dose for Trypanosoma cruzi-seropositive adults without cardiomyopathy. METHODS: We conducted a systematic review and individual participant data (IPD) meta-analysis following Cochrane methods, and the PRISMA-IPD statement for reporting. Randomised controlled trials (RCTs) allocating participants to fixed or adjusted doses of BZN for T. cruzi-seropositive adults without cardiomyopathy were included. We searched (December 2021) Cochrane, MEDLINE, EMBASE, LILACS and trial registries and contacted Chagas experts. Selection, data extraction, risk of bias assessment using the Cochrane tool, and a GRADE summary of finding tables were performed independently by pairs of reviewers. We conducted a random-effects IPD meta-analysis using the one-stage strategy, or, if that was impossible, the two-stage strategy. RESULTS: Five RCTs (1198 patients) were included, none directly comparing fixed with adjusted doses of BZN. Compared to placebo, BZN therapy was strongly associated with negative qPCR and sustainable parasitological clearance regardless of the type of dose and subgroup analysed. For negative qPCR, the fixed/adjusted rate of odds ratios (RORF/A ) was 8.83 (95% CI 1.02-76.48); for sustained parasitological clearance, it was 4.60 (95% CI 0.40-52.51), probably indicating at least non-inferior effect of fixed doses, with no statistically significant interactions by scheme for global and most subgroup estimations. The RORF/A for treatment interruption due to adverse events was 0.44 (95% CI 0.14-1.38), probably indicating no worse tolerance of fixed doses. CONCLUSIONS: We found no direct comparison between fixed and adjusted doses of BZN. However, fixed doses versus placebo are probably not inferior to weight-adjusted doses of BZN versus placebo in terms of parasitological efficacy and safety. Network IPD meta-analysis, through indirect comparisons, may well provide the best possible answers in the near future. REGISTRATION: The study protocol was registered in PROSPERO (CRD42019120905).

Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America.

Introduction: Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. Methods: We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model. Results: In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico. Discussion: Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.

Carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador / Burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador / Carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador

RESUMEN Objetivo. Estimar la carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador. Métodos. Se utilizó un modelo de riesgos comparativos para estimar los efectos en muertes, eventos de salud, años perdidos por muerte prematura y discapacidad (AVAD), y costos médicos directos atribuibles al consumo de bebidas azucaradas. Resultados. Un total de 520 muertes (8 cada 100 000 individuos), 214 082 eventos en salud (3 220 cada 100 000 individuos) y 16 643 AVAD podrían ser atribuibles al consumo de bebidas azucaradas en El Salvador, lo que representa $69,35 millones (dólar americano) en costos médicos directos para el año 2020. En particular, los eventos de diabetes tipo 2 (DBT2) atribuibles al consumo de bebidas azucaradas podrían llegar a representar más del 20% del total de casos de DBT2 para el país. Conclusión. Un elevado número de muertes, eventos y costos podrían atribuirse al consumo de bebidas azucaradas en El Salvador.

ABSTRACT Objective. To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. Methods. A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. Results. A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. Conclusion. A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador.

RESUMO Objetivo. Estimar a carga de morbidade e econômica atribuível ao consumo de bebidas açucaradas em El Salvador. Métodos. Foi utilizado um modelo de risco comparativo para estimar os efeitos sobre óbitos, eventos de saúde, anos perdidos devido a morte prematura ou vividos com incapacidade (AVAI) e custos médicos diretos atribuíveis ao consumo de bebidas açucaradas. Resultados. Um total de 520 mortes (8 por 100 00 indivíduos), 214 082 eventos de saúde (3 220 por 100 000 indivíduos) e 16 643 AVAI podem ser atribuídos ao consumo de bebidas açucaradas em El Salvador, o que representa US$ 69,35 milhões em custos médicos diretos para o ano de 2020. Os eventos de diabetes mellitus tipo 2 (DM2) atribuíveis ao consumo de bebidas açucaradas, em especial, podem representar mais de 20% do total de casos de DM2 no país. Conclusões. Um número elevado de mortes, eventos de saúde e custos pode ser atribuído ao consumo de bebidas açucaradas em El Salvador.

Health and economic burden of sugar-sweetened beverages consumption in Brazil / Carga sanitaria y económica del consumo de bebidas azucaradas en Brasil / Carga sanitária e econômica do consumo de bebidas açucaradas no Brasil

Abstract: Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

Resumen: Las bebidas azucaradas (BA) tienen una gran fuente de azúcar añadido y están asociadas con enfermedades no transmisibles (ENT), como la obesidad y la diabetes. Este estudio evaluó el impacto del consumo de las BA en la carga de enfermedad en Brasil, incluidas las muertes, los años de vida ajustados por discapacidad (AVAD) y los costos con la salud. Con el uso de una metodología de tres etapas, se evaluaron los efectos directos de las BA sobre la diabetes, las enfermedades cardiovasculares y el índice de masa corporal (IMC), la influencia del IMC en la incidencia de la enfermedad, y se estimó la carga económica y de salud utilizando los factores atribuibles a la población. Los resultados mostraron que el 2,7% de los casos de sobrepeso/obesidad en adultos y del 11% en niños fueron atribuibles a las BA. El consumo de las BA en Brasil generó 1.814.486 casos, 12.942 muertes, 362.088 AVAD y USD 2.915,91 millones en costos médicos relacionados con diabetes, enfermedades cardiovasculares, enfermedades oncológicas y otras ENT. Es necesario implementar políticas públicas para tratar el consumo de las BA, reconocido este como un factor de riesgo clave para las ENT.

Resumo: As bebidas açucaradas (BAs) são uma grande fonte de açúcar adicionado e estão associadas a doenças não transmissíveis (DNTs), como obesidade e diabetes. Este estudo avaliou o impacto do consumo de BAs sobre a carga de doenças no Brasil, incluindo óbitos, anos de vida ajustados por incapacidade (AVPIs) e custos de saúde. Usando uma metodologia de três estágios, examinamos os efeitos diretos das BAs sobre diabetes, doenças cardiovasculares e índice de massa corporal (IMC), a influência do IMC na incidência de doenças e estimamos o carga econômica e de saúde usando fatores atribuíveis à população. Os resultados mostraram que 2,7% dos casos de sobrepeso/obesidade em adultos e 11% em crianças foram atribuíveis a BAs. O consumo de BAs no Brasil levou a 1.814.486 casos, 12.942 mortes, 362.088 AVPIs e USD 2.915,91 milhões em custos médicos relacionados a diabetes, doenças cardiovasculares, doenças oncológicas e outras DNT. A implementação urgente de políticas públicas é crucial para enfrentar o consumo de BAs, reconhecido como um fator de risco fundamental para as DNT.

Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models.

BACKGROUND: Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions. METHODS: We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded. RESULTS: We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%). CONCLUSIONS: There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption. PROSPERO PROTOCOL NUMBER: CRD42020121025 .

Parámetros esenciales para utilizar en modelos epidemiológicos de COVID-19 en Argentina Una revisión rápida / Essential parameters for use in epidemiological models of COVID-19 in Argentina: a rapid review

INTRODUCCIÓN: Los modelos de simulación para COVID-19 requieren una serie de parámetros epidemiológicos que varían en base a cuestiones propias de cada región y al momento de la pandemia que se esté atravesando. OBJETIVO: Esta revisión rápida presenta los parámetros epidemiológicos esenciales potencialmente utilizables en Argentina. MÉTODOS: Se realizó una búsqueda en las principales bases de datos y en buscadores de artículos en estado de preimpresión (preprints) de parámetros relacionados con la propagación del virus y evolución de la enfermedad, y el uso del sistema de salud. Para revisar los artículos seleccionados se utilizó una herramienta de evaluación de calidad apropiada al diseño del estudio. RESULTADOS: De las variables relacionadas con la propagación y evolución; el período de incubación es de 5,8 días (intervalos de confianza [IC95%]: 4,83-6,85), el período de infecciosidad es de 6,25 días (IC95%: 5,09-7,51), el número básico de reproducción es de 3,32 (IC95%: 3,24-3,39), y la tasa de fatalidad en pacientes infectados fue de 0,64% (IC95%: 0,5-0,78). De las variables relacionadas con el uso del sistema de salud, el tiempo de internación hospitalaria es de 5 días (rango intercuartílico [RIC]: 3-9), el tiempo de internación en una unidad de cuidados intensivos (UCI) es de 7 días (RIC: 4-11), el porcentaje de pacientes internados que requieren de UCI es de 26% (IC95%: 20-33) y, de estos, el porcentaje que requieren de ventilación mecánica es de 69% (IC95%: 61-75). DISCUSIÒN: Estudios recientes y datos de acceso públicos a nivel nacional muestran valores distintos a los relevados de la bibliografía internacional. La información recolectada en este trabajo puede contribuir a informar futuros modelamientos y tableros de control para predecir la dinámica de la epidemia en Argentina.

Fixed vs adjusted-dose benznidazole for adults with chronic Chagas disease without cardiomyopathy: A systematic review and meta-analysis.

Chagas disease is a neglected disease that remains a public health threat, particularly in Latin America. The most important treatment options are nitroimidazole derivatives, such as nifurtimox and benznidazole (BZN). Some studies suggest that for adults seropositive to T. cruzi but without clinically evident chronic Chagas cardiomyopathy (CCC), a simple fixed-dose scheme of BZN could be equivalent to a weight-adjusted dose. We compared the efficacy and safety of a fixed dose of BZN with an adjusted dose for T. cruzi seropositive adults without CCC. We used the Cochrane methods, and reported according to the PRISMA statement. We included randomized controlled trials (RCTs) allocating participants to fixed and/or adjusted doses of BZN for T. cruzi seropositive adults without CCC. We searched (December 2019) Cochrane, MEDLINE, EMBASE, LILACS, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP), and contacted Chagas experts. Selection, data extraction, and risk of bias assessment, using the Cochrane tool, were performed independently by pairs of reviewers. Discrepancies were solved by consensus within the team. Primary outcomes were parasite-related outcomes and efficacy or patient-related safety outcomes. We conducted a meta-analysis using RevMan 5.3 software and used GRADE summary of finding tables to present the certainty of evidence by outcome. We identified 655 records through our search strategy and 10 studies (four of them ongoing) met our inclusion criteria. We did not find any study directly comparing fixed vs adjusted doses of BZN, however, some outcomes allowed subgroup comparisons between fixed and adjusted doses of BZN against placebo. Moderate-certainty evidence suggests no important subgroup differences for positive PCR at one year and for three safety outcomes (drug discontinuation, peripheral neuropathy, and mild rash). The same effect was observed for any serious adverse events (low-certainty evidence). All subgroups showed similar effects (I2 0% for all these subgroup comparisons but 32% for peripheral neuropathy), supporting the equivalence of BZN schemes. We conclude that there is no direct evidence comparing fixed and adjusted doses of BZN. Based on low to very low certainty of evidence for critical clinical outcomes and moderate certainty of evidence for important outcomes, fixed and adjusted doses may be equivalent in terms of safety and efficacy. An individual patient data network meta-analysis could better address this issue.

Periorquitis meconial: A propósito de un caso / Meconium periorchitis: A case report

La periorquitis meconial es infrecuente. En el feto, está abierto el conducto peritoneo vaginal y, ante una perforación intestinal por cualquier causa (atresia intestinal, vólvulo, entre otras), se produce una peritonitis meconial. El contenido intestinal puede pasar hacia la cavidad vaginal escrotal. La peritonitis meconial puede resolverse espontáneamente y sin consecuencias. Restos calcificados de este evento pueden quedar en la cavidad peritoneal y/o en el escroto. En el recién nacido, se observará un hidrocele y una masa palpable intraescrotal, ecográficamente heterogénea y con calcificaciones. La periorquitis meconial o vaginalitis meconial se resuelve espontáneamente. Su desconocimiento podría llevar a cirugías innecesarias en el neonato. Se presenta el caso de un paciente de 33 días de vida con una masa escrotal, en quien se realizó una cirugía exploratoria. El diagnóstico anatomopatológico fue de periorquitis meconial.

Meconium periorchitis is uncommon. In the unborn child the peritoneum vaginal canal is open and, secondary to intestinal perforation due to any cause (intestinal atresia, volvulus, and others), meconium peritonitis occurs. The intestinal content reaches the scrotal vaginal cavity. Meconium peritonitis can heal spontaneously and without consequences. Calcified remnants of this event may remain in the peritoneal cavity and/or scrotum. In the newborn, a hydrocele and scrotal mass can be observed; the ultrasound will show a heterogeneous image with calcifications. Meconium periorchitis or meconium vaginalitis resolves spontaneously. The lack of awareness of this disease could lead to unnecessary surgery in the newborn. We present a 33 days old patient with a scrotal mass in whom surgery was performed with the pathological diagnosis of meconium periorchitis.

[Meconium periorchitis: A case report]. / Periorquitis meconial: A propósito de un caso.

Meconium periorchitis is uncommon. In the unborn child the peritoneum vaginal canal is open and, secondary to intestinal perforation due to any cause (intestinal atresia, volvulus, and others), meconium peritonitis occurs. The intestinal content reaches the scrotal vaginal cavity. Meconium peritonitis can heal spontaneously and without consequences. Calcified remnants of this event may remain in the peritoneal cavity and/or scrotum. In the newborn, a hydrocele and scrotal mass can be observed; the ultrasound will show a heterogeneous image with calcifications. Meconium periorchitis or meconium vaginalitis resolves spontaneously. The lack of awareness of this disease could lead to unnecessary surgery in the newborn. We present a 33 days old patient with a scrotal mass in whom surgery was performed with the pathological diagnosis of meconium periorchitis.