Informe de situación No 41: situación epidemiológica del dengue en las américas - semana epidemiológica 41, 2024

Entre las semanas epidemiológicas (SE) 1 y 41 del 2024, se reportaron en la Región de las Américas un total de 12,167,392 casos sospechosos de dengue (incidencia acumulada de 1,274 casos por 100,000 hab). Esta cifra representa un incremento de 209% en comparación al mismo periodo del 2023 y 387% con respecto al promedio de los últimos 5 años. El gráfico 1 muestra la tendencia de los casos sospechosos de dengue a la SE 41.

Alerta Epidemiológica: sarampión en la Región de las Américas - 28 de octubre del 2024

Ante la reciente identificación de conglomerados y casos de sarampión en países de la Región de las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) recomienda a los Estados Miembros continuar fortaleciendo las actividades de vacunación, vigilancia epidemiológica y respuesta rápida, incluyendo esfuerzos especiales en poblaciones que se conocen como renuentes a la vacunación y en comunidades aledañas o que sirven de acogida a estas poblaciones. Se recomienda implementar búsquedas activas comunitarias, institucionales y de laboratorio, además de actividades complementarias de vacunación para cerrar posibles brechas de inmunidad.

Actualización epidemiológica mpox en la región de las américas: 29 de octubre del 2024

A nivel global, desde enero del 2022 hasta el 30 de septiembre del 2024, se notificaron 109.699 casos confirmados de mpox, incluidas 273 defunciones, en 123 Estados Miembros de las seis Regiones de la Organización Mundial de la Salud (OMS). En septiembre del 2024, el número de nuevos casos notificados mensualmente aumento en un 8%, en comparación con el mes de agosto. La mayoría de los casos notificados en septiembre fueron reportados en la Región de África (63,6%) y la Región de las Américas (15,5%). Desde enero y hasta el 6 de octubre del 2024 se notificaron en África 7.535 casos confirmados, incluyendo 32 defunciones, en 16 países. El país más afectado sigue siendo la República Democrática del Congo, seguido de Burundi y Nigeria. Dieciséis países de la Region de África de la OMS han notificado casos de mpox en las últimas seis semanas y se considera que hay brotes activos y en curso. El clado Ib que fue reportado en la República Democrática del Congo, del cual se identificaron casos en Burundi, Kenia, Ruanda y Uganda, y que está relacionado con la declaración del Director General de la OMS de la Emergencia de Salud Pública de Importancia Internacional (ESPII), realizada el 14 de agosto del 2024, ha sido identificado en casos confirmados fuera de la Región de África de la OMS en: Alemania (n=1 caso), India (1 caso), Suecia (1 caso) y Tailandia (1 caso).

Informe de Situación: salud y migración en la región de las américas: Septiembre 2024

Entre enero y septiembre, la OIM ha registrado 497 migrantes muertos o desaparecidos en la región de las Américas (13) y al menos 291 en tránsito marítimo por el Caribe, lo que representa un 18 % más en comparación con 2023. De los 291 al menos 142 han muerto o desaparecido en la travesía del estrecho de la Florida

Boletín bisemanal de Sarampión-Rubeola (41-42) - 19 de octubre del 2024

Entre el 2019-2023, los resultados negativos para IgM de sarampión o rubeola sigue siendo el criterio de descarte que predomina al descartar los casos sospechosos (n=74%). El 12% de los casos fueron descartados por otros diagnósticos, como dengue o reacción asociado a la vacuna. También se observa que en un 13% los casos se descartaron sin ningún criterio. En este sentido, solicitamos a los países que revisen los criterios para descartar un caso publicado en el Marco Regional, y completar todas las variables relacionadas con la clasificación final de los casos en el sistema informático

Alerta epidemiológica: detección de poliovirus (cVDPV3) en aguas residuales, consideraciones para la Región de las Américas - 14 de octubre del 2024

Tras la confirmación de poliovirus circulante derivado de la vacuna tipo 3 (cVDPV3) detectado en muestras de aguas residuales recolectadas en Guayana Francesa, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) reitera a los Estados Miembros la importancia de alcanzar y mantener una cobertura de vacunación contra la polio superior al 95% en cada distrito o municipio para minimizar el riesgo de un brote. Adicionalmente, la OPS/OMS enfatiza la necesidad de fortalecer la vigilancia epidemiológica de la parálisis flácida aguda (PFA) y actualizar los planes nacionales de preparación y respuesta ante brotes de poliovirus. Estas medidas aseguran una detección y respuesta oportunas y eficientes ante la importación del poliovirus salvaje o del poliovirus derivado de la vacuna (VDPV), o la emergencia del VDPV en cualquier país de la Región.

Alerta epidemiológica: infecciones humanas causadas por influenza aviar A (H5N1) en la Región de las Américas - 8 de octubre del 2024

La Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) hace un llamado a los Estados Miembros para trabajar de forma colaborativa e intersectorial con el fin de preservar la sanidad animal y proteger la salud pública. La OPS/OMS insta a los Estados Miembros a reforzar los esfuerzos para la implementación de protocolos que permitan la detección oportuna, notificación y respuesta rápida ante brotes en animales, así como también para la detección de casos humanos de influenza aviar A(H5N1). Además, se insta a compartir los virus con los Centros Colaboradores de la OMS de ambos sectores para fortalecer los análisis de riesgo y contar con virus candidatos vacunales.

Alerta epidemiológica: aumento de casos de dengue en la Región de las Américas - 7 de octubre del 2024

En la Región de las Américas, el número de casos de dengue registrados durante el primer semestre del 2024 superó al número de casos reportado en un año, de todos los años anteriores registrados. Hasta la semana epidemiológica 36 del 2024, 47 países y territorios de la Región de las Américas han reportado 11.732.921 casos de dengue, una cifra dos veces y medio mayor al número de casos registrados durante todo el 2023 con 4.594.823 casos de dengue. Debido al aumento de casos de dengue reportados por los países del Istmo Centroamericano y México durante el 2024 y considerando el inicio de la temporada de dengue en Sudamérica, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) alienta a los Estados Miembros a continuar sus esfuerzos en la vigilancia, diagnóstico temprano y atención oportuna de los casos de dengue y otros arbovirus, con el fin de prevenir casos graves y muertes asociadas a estas enfermedades, y especialmente a los países de Sudamérica, a revisar sus planes de respuesta frente al dengue.

Latin American adults who regularly use macrodoses of psychedelics: a cross-sectional study.

Psychedelics have a complex history marked by traditional use among indigenous cultures, early scientific interest, and subsequent prohibition. Despite their classification as controlled substances, recent decades have witnessed a resurgence of research into their therapeutic potential for various mental health conditions. However, most studies have focused on controlled clinical settings, leaving a significant gap in understanding how these substances are used in naturalistic contexts, particularly in Latin America. This study investigates the regular use of macrodoses of psychedelics among Latin American adults. We aimed to characterize the sociodemographic profiles, consumption practices, and subjective effects experienced by individuals who use psychedelics regularly. Data were collected via an online survey from 4,270 participants across several Latin American countries. Results indicated a diverse user base with varied motivations, predominantly psychological and spiritual well-being. The most frequently used substance was psilocybin mushrooms, with significant associations found between demographic variables and specific psychedelics used. The study provides new insights into the naturalistic use of psychedelics in Latin America, highlighting the need for informed, safe, and legal use frameworks.

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion.

INTRODUCTION: There are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe their prevalence for both conditions, severity of their complications and management among women in selected health facilities across 17 countries in Africa and Latin America and the Caribbean (LAC). METHODS: This is a secondary analysis of the WHO multi-country survey on abortion. Data were collected from 280 healthcare facilities across 11 countries in Africa and 6 in LAC. Sociodemographic information, signs and symptoms, management and clinical outcomes were extracted from medical records. Facility-level data on post-abortion care (PAC) capabilities were also collected, and facilities were classified accordingly. χ2 or Fisher's exact tests were used to compare categorical data. RESULTS: The total number of women with EP and MP across both regions was 9.9% (2 415/24 424) where EP accounted for 7.8% (1 904/24 424) and MP for 2.1% (511/24 424). EP presented a higher severity of complications than MP. At admission, 49.8% of EP had signs of peritoneal irritation. The most common surgical management for EP was laparotomy (87.2%) and for MP, uterine evacuation (89.8%). Facilities with higher scores in infrastructure and capability to provide PAC more frequently provided minimal invasive management using methotrexate/other medical treatment (34.9%) and laparoscopy (5.1%). CONCLUSION: In Africa and LAC, EP and MP cause significant maternal morbidity and mortality. The disparity in the provision of good quality care highlights the need to strengthen the implementation of evidence-based recommendations in the clinical and surgical management of EP and MP.

Rheumatoid arthritis in Latin America: pharmacotherapy and clinical challenges.

INTRODUCTION: Rheumatoid arthritis (RA) poses significant healthcare challenges in Latin America (LA) due to its high prevalence and unique healthcare dynamics. Despite global advancements, LA faces specific hurdles in effectively managing RA. AREAS COVERED: This review examines RA epidemiology, treatment strategies, and clinical challenges in LA. RA prevalence varies, with higher rates among indigenous populations. While conventional disease-modifying antirheumatic drugs (csDMARDs) are recommended as first-line therapy, access remains inconsistent. Biologics and targeted synthetic DMARDs are available, but biosimilars have limited accessibility, with drug prices varying significantly. Key barriers include supply interruptions, diagnosis delays, and high non-adherence rates driven by socioeconomic factors. A severe shortage of rheumatologists, particularly in rural areas, affects patient care. Cardiovascular events, comorbidities, and endemic infections further complicate RA management. EXPERT OPINION: Although RA care in LA has improved through better use of csDMARDs and advanced treatments, major challenges persist, such as a shortage of specialists, limited medical education, and fragmented healthcare systems. Expanding training programs, enhancing telemedicine, and ensuring drug supply continuity are essential. Strengthening clinical research, improving access to affordable treatments, and developing comprehensive, region-specific strategies are crucial to closing the gap between LA and more developed regions in RA care..

Vision impairment and blindness in individuals aged 60 years and older in Latin America and the Caribbean / Discapacidad visual y ceguera en personas mayores de 60 años en América Latina y el Caribe / Deficiência visual e cegueira em indivíduos com 60 anos ou mais na América Latina e no Caribe

[ABSTRACT]. Objective. To determine the prevalence and causes of vision loss and calculate the effective cataract surgery coverage (eCSC) in adults aged 60 years and older in Latin America and the Caribbean in 2020. Methods. The International Agency for the Prevention of Blindness Vision Atlas and the Rapid Assessment of Avoidable Blindness databases were used as data source. The collected data were used to estimate the prevalence and causes of vision loss in people aged 60 years and older, and to determine the eCSC. Results. The overall prevalence of moderate to severe vision impairment (MSVI) and blindness in Latin America and the Caribbean were 14.14% and 2.94%, respectively. Tropical Latin America was the subregion with the highest prevalence of blindness (3.89%) while Southern Latin America had the lowest (0.96%). For both MSVI and blindness, cataract was the main cause of vision loss. The eCSC rates showed great variation, ranging from 4.0% in Guatemala to 75.2% in Suriname. Conclusions. The prevalence of vision loss in adults aged 60 years and older in Latin America and the Caribbean was higher than previous estimates on younger groups. Cataract was the main cause of blindness, and the eCSC indicates that the outcomes from cataract surgery should be improved. Specific actions associated with improving access, integrating eye assessment with primary care programs, expanding the use of telemedicine, and improving data quality should be taken by public health authorities aiming to address vision loss in this group.

[RESUMEN]. Objetivo. Determinar la prevalencia y las causas de la pérdida de visión y calcular la cobertura efectiva de la cirugía de las cataratas en personas mayores de 60 años en América Latina y el Caribe en el 2020. Métodos. Se utilizaron como fuentes la base de datos del Atlas de la Visión de la Agencia Internacional para la Prevención de la Ceguera y la de Rapid Assessment of Avoidable Blindness [evaluación rápida de la ceguera evitable]. Los datos recopilados se utilizaron para estimar la prevalencia y las causas de la pérdida de visión en personas mayores de 60 años y para determinar la cobertura efectiva de la cirugía de las cataratas. Resultados. La prevalencia general de la discapacidad visual moderada a grave y de la ceguera en América Latina y el Caribe fue del 14,14% y el 2,94%, respectivamente. La subregión de América Latina tropical presentó la mayor prevalencia de ceguera (3,89%), mientras que la de América Latina austral registró la menor (0,96%). Tanto en el caso de la discapacidad visual moderada a grave como en el de la ceguera, la causa principal de pérdida de visión fueron las cataratas. Hubo grandes diferencias en la tasa de cobertura efectiva de la cirugía de las cataratas, con valores que iban del 4,0% en Guatemala al 75,2% en Suriname. Conclusiones. La prevalencia de la pérdida de visión en personas mayores de 60 años en América Latina y el Caribe fue superior a la indicada por las estimaciones anteriores en grupos de menor edad. Las cataratas fueron la principal causa de ceguera, y la cobertura efectiva de la cirugía de las cataratas indica la necesidad de mejorar los resultados de estas intervenciones. Las autoridades de salud pública que pretendan abordar la pérdida de visión en este grupo deben adoptar medidas específicas que se asocien a una mejora del acceso, la integración de las exploraciones oftalmológicas en los programas de atención primaria, la ampliación del uso de la telemedicina y la mejora de la calidad de los datos.

[RESUMO]. Objetivo. Determinar a prevalência e as causas da perda de visão e calcular a cobertura efetiva da cirurgia de catarata em adultos com 60 anos ou mais na América Latina e no Caribe em 2020. Métodos. Foram usadas as bases de dados do Atlas da Visão da Agência Internacional para a Prevenção da Cegueira e da Avaliação Rápida da Cegueira Evitável (RAAB, na sigla em inglês) como fonte de dados. Os dados coletados foram usados para estimar a prevalência e as causas da perda de visão em pessoas com 60 anos ou mais e para determinar a cobertura efetiva da cirurgia de catarata. Resultados. A prevalência global de deficiência visual moderada a grave e cegueira na América Latina e no Caribe foi de 14,14% e 2,94%, respectivamente. A América Latina Tropical foi a sub-região com a maior prevalência de cegueira (3,89%), ao passo que a América Latina Meridional teve a menor prevalência (0,96%). Tanto na deficiência visual moderada a grave quanto na cegueira, a catarata foi a principal causa da perda de visão. As taxas de cobertura efetiva da cirurgia de catarata variaram muito, desde 4,0% na Guatemala até 75,2% no Suriname. Conclusões. A prevalência da perda de visão em adultos com 60 anos ou mais na América Latina e no Caribe foi maior do que as estimativas anteriores em grupos de indivíduos mais jovens. A catarata foi a principal causa de cegueira, e a cobertura efetiva da cirurgia de catarata indica que os desfechos dessa cirurgia precisam ser melhorados. Medidas específicas associadas à melhoria do acesso, à integração da avaliação oftalmológica aos programas de atenção primária, à expansão do uso da telemedicina e à melhoria da qualidade dos dados devem ser adotadas pelas autoridades de saúde pública com o objetivo de enfrentar a perda de visão nesse grupo.

Evidence-based practice in respiratory healthcare professionals in Latin America: a survey of the Latin American Thoracic Association (ALAT).

Background: Evidence-based practice (EBP) is a systematic approach to professional practice using the best available evidence to make informed clinical decisions in healthcare. It is necessary to measure and identify strengths and opportunities for improvement. Objective: To assess the knowledge and application of EBP in respiratory health professionals in Latin America. Methods: A cross-sectional study was conducted. The questionnaire was distributed online to health professionals in Latin American countries. Demographic data, professional characteristics, EBP training, and questionnaire responses were collected. Descriptive and inferential statistical analyses were performed. Results: A total of 448 respiratory health professionals participated in the study. Responses were obtained from 17 countries where the majority were female, with an average age of 42. Participants included physicians, physiotherapists, nurses, respiratory therapists, speech therapists, and occupational therapists. Overall scores indicated moderate to high levels of EBP knowledge and application. However, variations were observed in different dimensions. Factors such as EBP training, reading scientific articles, and professional characteristics were associated with higher scores. Barriers to implementing EBP were identified mostly related to institutional support. Conclusions: This study provides information on the knowledge and implementation of EBP in respiratory health professionals in Latin America. Although the overall levels of knowledge and application of EBP were moderate to high, there are options for improvement, especially in addressing barriers to implementation.

Introducción: La práctica basada en evidencia (PBE) es un enfoque sistemático para la práctica profesional que utiliza la mejor evidencia para tomar decisiones informadas. Es necesario identificar fortalezas y oportunidades de mejora. Objetivo: Evaluar el conocimiento y la aplicación de la EBP en profesionales de la salud respiratoria en Latinoamérica. Métodos: Se desarrolló un estudio transversal. El cuestionario se distribuyó en línea a profesionales de la salud en países latinoamericanos. Se recopilaron datos demográficos, características profesionales, capacitación en EBP y respuestas al cuestionario. Se realizaron análisis estadísticos descriptivos e inferenciales. Resultados: Un total de 448 profesionales de la salud respiratoria participaron en el estudio. Se obtuvieron respuestas de 17 países donde la mayoría eran mujeres, con una edad promedio de 42 años. Los participantes incluyeron médicos, fisioterapeutas, enfermeras, terapeutas respiratorios, fonoaudiólogos y terapeutas ocupacionales. Las puntuaciones generales indicaron niveles moderados a altos de conocimiento y aplicación de la EBP. Sin embargo, se observaron variaciones en diferentes dimensiones. Factores como la capacitación en EBP, la lectura de artículos científicos y las características profesionales se asociaron con puntuaciones más altas. Se identificaron barreras para implementar la EBP, principalmente relacionadas con el apoyo institucional. Conclusiones: Este estudio proporciona información sobre el conocimiento y la implementación de la EBP en profesionales de la salud respiratoria en América Latina. Aunque los niveles generales de conocimiento y aplicación de la EBP fueron moderados a altos, existen opciones de mejora, especialmente en abordar las barreras.

Role of caregivers being trained in assisting in end of life care - Latin American perspective.

PURPOSE OF REVIEW: Palliative care in Latin America is evolving, but training for informal caregivers remains underexplored. This review summarizes recent interventions to educate or train caregivers in end-of-life care. RECENT FINDINGS: The literature search identified three interventions published by 2023, two with reception evaluations, all with small sample sizes and no control groups. Needs of caregivers have been more frequently described and include training on aspects of the disease, nursing skills, how to handle patients´ and own emotions; help in navigating the complex healthcare systems in Latin America; help in conversations about the end of life and dying, still taboos in the region; help in finding additional caregivers or other types of support to make the caregiving role sustainable over time for the caregiver. Interventions mainly focused on emotional support and identifying additional caregivers without guilt; two included nursing skills training. SUMMARY: There are very few formal interventions described and evaluated to assist caregivers in end-of-life care in Latin America described in the literature. This illustrates the rather invisible but very important role of these important stakeholders in the care for patients. Multidimensional interventions should be developed and evaluated to support caregivers.

Latin American Challenges and Recommendations for Poly Adenosine Diphosphate Ribose Polymerase Inhibitor Treatment in Metastatic Castration Resistant Prostate Cancer: An Expert Overview.

In Latin America, prostate cancer is the third most common cancer overall and the most common in men, with the highest mortality rate of all cancers. In 2022, there were approximately 22,985 new prostate cancer cases and 61,056 deaths from prostate cancer in the region. Patients with metastatic disease that is resistant to cure by castration now have multiple therapeutic options, including poly-ADP ribose polymerase inhibitors. These treatment advances present new challenges, such as developing monitoring protocols for early detection of disease progression to castration resistance. The Americas Health Foundation organized a 3-day meeting with 8 regional oncologists and pathologists to create a paper on metastatic castration-resistant prostate cancer diagnosis and therapy, including the new poly-ADP ribose polymerase inhibitors. The panel examined metastatic castration-resistant prostate cancer in Latin America and recommended ways to improve patient care using published literature and their expertise. Gene mutations play an important role in prostate cancer development. Precision medicine innovations highlight the importance of genotyping DNA variants and tumor biomarkers for targeted treatment. Access to appropriate genetic testing is difficult, medications are available but expensive, and there is a lack of infrastructure and regulatory frameworks that prevent patients from benefiting from innovative therapies. The panel recommends developing a population database and biobank and creating tumor tissue collection, processing, and storage facilities. Multi-stakeholder collaboration is needed to integrate the information gathered, train staff, select target populations, improve patient accessibility, and reduce the cost burden of drugs, genetic counselors, and cancer geneticists in Latin America. Collaboration is essential among healthcare professionals, policymakers, patient advocacy groups, pharmaceutical companies, and international organizations to address these challenges and needs in Latin America.

Short bowel syndrome related intestinal failure outcomes in Latin America: Insights from the RESTORE Registry.

BACKGROUND: Short bowel syndrome is considered a low prevalence disease. The scant information available about intestinal failure in Latin America was the driving force to expand this registry. METHODS: A prospective, multicenter observational registry was created for patients with chronic intestinal failure short bowel at specialized centers in Latin America. Demographics, clinical characteristics, nutrition assessment, parenteral nutrition management, intestinal rehabilitation, related complications, clinical outcome, and survival were analyzed. RESULTS: From May 2020 to July 2023, 167 patients (115 adults, 52 children) from 20 centers were enrolled. For the adults, the mean age was 37.2 ± 18 years, 48% were female, and the mean follow-up was 22.6 ± 18.3 months. The main etiology was surgical resections (postsurgical complications: 37%; ischemia: 25%); the mean intestinal length was 73 ± 55 cm. The complications were as follows: infections: 0.4/1000 catheter-days; thrombosis: 0.24/1000 catheter-days; liver disease: 2.6%. The outcomes were as follows: 28% were rehabilitated, 15% died, 9.6% were lost to follow-up, 0.9% underwent transplant, and 45.6% continued follow-up. For the children, the mean age 48 ± 52 months, 48% were female, 52% were premature. The mean follow-up was 17.2 ± 5.6 months; the mean remaining intestinal length was 38 ± 45 cm. The leading etiologies were atresia (25%), NEC (23%), and gastroschisis (21%). The complication were as follows: infections: 2/1000 catheter-days; thrombosis: 2.22/1000 catheter-day; 25% developed liver disease. The outcomes were as follows: 7.7% died, 3.8% were rehabilitated, and 88.5% continued follow-up. CONCLUSION: The RESTORE amendment served as a registry and educational tool for the participating teams. The aspiration is to objectively show current aspects of intestinal failure in the region and carry them to international standards. Including all Latin American countries and etiologies of chronic intestinal failure besides short gut would serve to complete this registry.

Cobertura para el diagnóstico y tratamiento de la apnea obstructiva del sueño en Latinoamérica: reporte del Foro Latinoamericano de Sociedades Respiratorias / Coverage for the Diagnosis and Treatment of Obstructive Sleep Apnea in Latin America: Report from the Latin American Forum of Respiratory Societies

Introducción: La Apnea Obstructiva del Sueño (AOS) es un problema de salud pública en Latinoamérica; una región que es heterogénea, con recursos diferentes y sistemas de salud diversos. El objetivo fue describir la información recabada por el Foro Latino-americano de Sociedades Respiratorias sobre el acceso y cobertura para los estudios diagnósticos y tratamiento con CPAP de los pacientes con AOS. Material y Métodos: A través de la Asociación Latinoamericana de Tórax (ALAT), se envió una encuesta a todas las sociedades miembros con preguntas sobre el acceso a diagnóstico, tratamiento y cobertura de seguros privados. Resultados: El foro contó con 15 países. Se reportó la existencia de 396 unidades formales de sueño, 82% privadas y 18% públicas; en 12 países el sistema de salud público (SSP) contrata unidades privadas para otorgar servicios. En todos los países se realiza tanto polisomnografía como poligrafía respiratoria para el diagnóstico. En 8 (53%) países, el SSP cubre el tratamiento con CPAP de la AOS (en Argentina, Guatemala y México esta cobertura es parcial); los seguros privados cubren AOS en 7/15 países. Conclusiones: En Latinoamérica, existen pocas unidades formales de sueño y la mayoría son privadas. Cerca de la mitad de los sistemas de salud pública no cubren su tratamiento y, en la mayoría de los casos, los seguros privados no ofrecen cobertura. Esto deja a nuestra población vulnerable a las complicaciones de la AOS, con un concomitante aumento de la morbimortalidad y costos en salud.

Introduction: Obstructive Sleep Apnea (OSA) is a public health problem in Latin America, which is a heterogeneous region, with different resources and diverse health systems. The objective was to describe the information collected by the Latin American Forum of Respiratory Societies on access and coverage for diagnostic studies and CPAP treatment of patients with OSA. Methods: Through the Latin American Thorax Association (ALAT, Spanish acronym), a survey was sent to all member societies with questions about access to diagnosis, treatment, and private insurance coverage. Results: The forum included 15 countries. The existence of 396 sleep medicine units was reported, 82% private and 18% public; in 12/15 countries the public health system (PHS) contracts private units to provide services. In all countries, both polysomnography and respiratory polygraphy are performed to make the diagnosis. In only 8 (53%) countries the PHS covers the treatment of OSA (in Argentina, Guatemala and Mexico this coverage is partial); private insurance coverage is in 7/15 countries.Conclusions: In Latin America there are few formal sleep units and most are private. About half of public health systems do not cover their treatment and, in most cases, private insurance does not offer coverage. This leaves our population vulnerable to the complications of OSA, with a concomitant increase in morbidity, mortality and health costs.

Recomendaciones para el manejo de la enfermedad pulmonar post tuberculosis / Recommendations for the Management of Post Tuberculosis Lung Disease

Introducción: Los esfuerzos de la lucha contra la tuberculosis (TB) se centran habitualmente en un diagnóstico precoz y un tratamiento eficaz y oportuno para romper la cadena de transmisión de Mycobacterium tuberculosis. Sin embargo, en los últimos años, coincidiendo con la asociación sindémica TB/COVID-19, han aparecido cada vez más evidencias sobre las graves secuelas clínicas, funcionales y psicosociales que puede ocasionar la TB, condición que se ha definido como enfermedad pulmonar post-tuberculosis (PTLD). Aproximadamente, un tercio de los pacientes que sobreviven a la TB se enfrentan a esto, incluyendo síntomas respiratorios persistentes con exacerbaciones episódicas, insuficiencia respiratoria crónica, trastornos emocionales y desafíos psico-sociales que impactan negativamente en la calidad de vida y enfrentan un alto costo catastrófico. Objetivo: Proporcionar un modelo compartido, orientador y científicamente válido para diagnosticar, evaluar y tratar en forma oportuna a los pacientes con PTLD (prevención, diagnóstico, tratamiento y posible rehabilitación). Metodología: Es una investigación documental que incluye revisiones sistemáticas, meta-análisis, estudios observacionales y de las directrices existentes en los últimos años al respecto, sumado a una evaluación por expertos en el tema, con el propósito de adaptarlas a las condiciones locales de cada país latinoamericano. Conclusiones: Considerando la carga mundial, particularmente, latinoamericana de TB, y la carga estimada de la PTLD, se considera urgente el desarrollo de un consenso sobre este tema. Creemos que las recomendaciones de ALAT proporcionarán la base para la formulación y adopción de directrices nacionales para el manejo del PTLD en Amé- rica Latina.

Introduction: Efforts to combat tuberculosis (TB) usually focus on early, rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, coinciding with the syndemic TB/COVID-19 association, more and more evidence has proved the serious clinical, functional and psycho-social sequelae that TB can cause. This condition has been defined as Post-Pulmonary Disease Tuberculosis (PTLD) and it affects approximately one-third of the patients who survive TB, facing persistent respiratory symptoms with episodic exacerbations, chronic respiratory failure, emotional disorders and psychosocial challenges that negatively impact their life quality, meaning a high catastrophic cost. Objective: Provide a shared, guiding and scientifically valid model to promptly diagnose, evaluate and treat patients with PTLD (prevention, diagnosis, treatment and possible rehabilitation). Methodology: It is documentary research that includes systematic reviews, meta-analysis, observational studies and the guidelines that have existed in recent years in this regard, added to an evaluation by experts, with the purpose of adapting them to local conditions of each Latin American country. Conclusions: Considering the global and, particularly, the Latin American burden of TB, and the estimated burden of PTLD, the development of a consensus document on this topic is urgent. Therefore, we think ALAT recommendations will provide the basis for the formulation and adoption of national specific guidelines for the management of PTLD in Latin America.

Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds): study protocol and statistical analysis plan for a multicentre international observational cohort study.

INTRODUCTION: Surgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries. METHODS AND ANALYSIS: LASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission. ETHICS AND DISSEMINATION: This study received approval from the Institutional Review Board of the coordinating centre (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT05934682.

Food loss and food waste research in Latin America: scoping review.

The article aims to identify stage of the food supply chain (FSC) has the greatest food loss and waste (FLW), the factors that influence and economic, social and environmental impacts in Latin America countries. We carried out a scoping review of observational studies, case reports and interventional studies in January 2023. Searches were performed in scientific databases and hand-searching of reference lists. Data on the included studies were summarized with narrative synthesis. In total 16 articles met the inclusion criteria. The greatest FLW occur in the early and middle stages of the FSC, mainly during storage. The main causes were connected to financial, managerial and operational limitations related in harvesting techniques, storage and cooling facilities, infrastructure and marketing systems. Food waste (FW) is also a result of lack of appropriate storage facilities and efficient transport systems, market fluctuations and systems. Only one study presented results on the environmental impact of FW. There is a higher occurrence of food loss, characterized by decrease in the quantity and quality of food in the first three stages of FSC.