The economic burden of Chagas disease: A systematic review

Economic burden; Chagas diseaseCàrrega econòmica; Malaltia de ChagasCarga económica; Enfermedad de ChagasBackground Chagas disease (CD) is a neglected disease affecting millions worldwide, yet little is known about its economic burden. This systematic review is part of RAISE project, a broader study that aims to estimate the global prevalence, mortality, and health and economic burden attributable to chronic CD and Chronic Chagas cardiomyopathy. The objective of this study was to assess the main costs associated with the treatment of CD in both endemic and non-endemic countries. Methods An electronic search of the Medline, Lilacs, and Embase databases was conducted until 31st, 2022, to identify and select economic studies that evaluated treatment costs of CD. No restrictions on place or language were made. Complete or partial economic analyses were included. Results Fifteen studies were included, with two-thirds referring to endemic countries. The most commonly investigated cost components were inpatient care, exams, surgeries, consultation, drugs, and pacemakers. However, significant heterogeneity in the estimation methods and presentation of data was observed, highlighting the absence of standardization in the measurement methods and cost components. The most common component analyzed using the same metric was hospitalization. The mean annual hospital cost per patient ranges from $25.47 purchasing power parity US dollars (PPP-USD) to$18,823.74 PPP-USD, and the median value was $324.44 PPP-USD. The lifetime hospital cost per patient varies from$209,44 PPP-USD for general care to $14,351.68 PPP-USD for patients with heart failure. Discussion Despite the limitations of the included studies, this study is the first systematic review of the costs of CD treatment. The findings underscore the importance of standardizing the measurement methods and cost components for estimating the economic burden of CD and improving the comparability of cost components magnitude and cost composition analysis. Finally, assessing the economic burden is essential for public policies designed to eliminate CD, given the continued neglect of this disease.This study was funded by Novartis Pharma AG as part of a research collaboration with the World Heart Federation, project number CLCZ696D2010R. The World Heart Federation funded the Universidade Federal de Minas Gerais to lead this project. During this study, P.P. received salaries from World Heart Federation, and Y.G. and M.Q. received salaries from Norvartis Pharma AG. A.L.P.R. is supported in part by National Council for Scientific and Technological Development (CNPq) (310790/2021-2 and 465518/2014-1) and by Minas Gerais Research Funding Foundation (FAPEMIG) (PPM-00428-17 and RED-00081-16). M.V.A. and K.V.M.S.N. acknowledge CNPq for the research productivity scholarships (processes 309252/2021-0 and 303459/2022-0, respectively). K.V.M.S.N. is also supported in part by FAPEMIG (PPM-00604-17). A.S.M.S. receives resources from CNPq (381587/2018-5). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

An overview on the mycoparasitic Piptocephalis (Zoopagomycota): taxonomic notes and geographic distribution with new occurrences for South America

ABSTRACT Piptocephalis includes mycoparasitic fungi, mainly targeting mucoralean species. Until now, there has been no compilation of data on the taxonomy and geographic distribution of Piptocephalis, which is a barrier to the proper identification of species of this genus by taxonomists. The present study provides an overview of Piptocephalis with taxonomic and occurrence data, in addition to reporting P. graefenhanii and P. xenophila for the first time in South America. Both species were observed parasitizing Mucor spp. The P. graefenhanii was observed growing on paca dung and P. xenophila was observed on guinea-pig dung in Recife, northeastern Brazil. Aspects of their morphology are discussed and a key for the genus is presented

HIV Aspartyl Peptidase Inhibitors Interfere with Cellular Proliferation, Ultrastructure and Macrophage Infection of Leishmania amazonensis

Submitted by Sandra Infurna ([email protected]) on 2019-01-08T13:43:09Z No. of bitstreams: 1 Ellenf_Altoe_etal_IOC_2009.pdf: 1452755 bytes, checksum: 77127a59920cef6bca71296107f6ec63 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2019-01-08T13:51:34Z (GMT) No. of bitstreams: 1 Ellenf_Altoe_etal_IOC_2009.pdf: 1452755 bytes, checksum: 77127a59920cef6bca71296107f6ec63 (MD5)Made available in DSpace on 2019-01-08T13:51:34Z (GMT). No. of bitstreams: 1 Ellenf_Altoe_etal_IOC_2009.pdf: 1452755 bytes, checksum: 77127a59920cef6bca71296107f6ec63 (MD5) Previous issue date: 2009Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Universidade Federal do Rio de Janeiro. Centro de Ciências da Saúde. Instituto de Microbiologia Prof. Paulo de Góes. Departamento de Microbiologia Geral,. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Universidade Federal do Rio de Janeiro. Centro de Ciências da Saúde. Instituto de Biofísica Carlos Chagas Filho. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Centro de Ciências da Saúde. Instituto de Microbiologia Prof. Paulo de Góes. Departamento de Microbiologia Geral,. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Centro de Ciências da Saúde. Instituto de Microbiologia Prof. Paulo de Góes. Departamento de Microbiologia Geral,. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular e Doenças Endêmicas. Rio de Janeiro, RJ. Brasil.Leishmania is the etiologic agent of leishmanisais, a protozoan disease whose pathogenic events are not well understood. Current therapy is suboptimal due to toxicity of the available therapeutic agents and the emergence of drug resistance. Compounding these problems is the increase in the number of cases of Leishmania-HIV coinfection, due to the overlap between the AIDS epidemic and leishmaniasis

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Meta-análise do impacto da fibra em detergente neutro sobre o consumo, a digestibilidade e o desempenho de vacas leiteiras em lactação

Avaliaram-se os efeitos das características químicas e da digestibilidade in vivo da FDN (DFDN) sobre o consumo, a digestibilidade e o desempenho de vacas leiteiras em confinamento utilizando-se meta-análise a partir de 285 observações de seis experimentos. Utilizaram-se dados de animais alimentados com dietas à base de silagem de milho (n = 213) ou cana-de-açúcar (n = 72). Apesar do menor teor de FDN da cana-de-açúcar (45,27% da MS) em relação à silagem de milho (54,48%), observaram-se menores consumos de MS e FDN, que refletiram em menor produção de leite. Verificou-se maior redução no comsumo de matéria seca (kg/dia) com aumento do teor de FDNf (FDN de forragem, % da MS) em dietas com canade-açúcar (332,4 g de MS para cada 1% no teor de FDNf) em relação à silagem de milho (96 g de MS para cada 1% no teor de FDNf). O maior efeito de repleção ruminal da FDN da cana-de-açúcar deve-se à fração indigestível, majoritária, apesar da maior taxa de degradação da fração potencialmente degradável da FDN em relação à silagem de milho. A produção de leite não-corrigida (PL) e corrigida para 4% de gordura (PLC) e o teor de proteína do leite reduziram linearmente com o aumento no teor de FDNf, independentemente da fonte de forragem. Porém, a PL e PLC não foram afetadas pelo nível de FDNnf (FDN de não-forragem). Os consumos de MS, FDN e NDT e o teor de gordura no leite reduziram linearmente com aumento na relação lignina:FDN, com maior amplitude em dietas à base de cana-de-açúcar em relação à silagem de milho. O consumo de MS, a produção de leite e a produção de leite corrigida reduziram linearmente e na mesma magnitude entre as fontes de forragens, com o aumento na DFDN da dieta. O efeito do teor FDN e lignina sobre o consumo, a digestibilidade e o desempenho animal depende da fonte utilizada

Balanço de nitrogênio em fêmeas leiteiras em confinamento alimentadas com concentrado à base de farelo de soja ou farelo de algodão Nitrogen use efficiency of growing dairy heifers fed concentrate rations based on soybean or cottonseed meal

Avaliou-se a influência do fornecimento de concentrados à base de farelo de soja ou farelo de algodão em dietas com silagem de milho sobre o balanço de nitrogênio e a produção de proteína microbiana em fêmeas leiteiras em crescimento. As dietas foram constituídas da combinação de dois níveis de concentrado (1 ou 2 kg) e duas fontes proteicas (farelo de soja ou farelo de algodão). Os animais que consumiram concentrado na quantidade de 2 kg/dia apresentaram maior consumo de nitrogênio total, entretanto não houve efeito significativo sobre o N-fecal, N-urinário e o balanço de nitrogênio. A interação entre o nível de concentrado e a fonte proteica influenciou o nitrogênio ureico na urina (N-urina), mas não alterou os níveis de nitrogênio ureico no plasma. Os níveis de concentrado e as fontes proteicas não afetaram as concentrações de purinas totais e alantoína na urina, a porcentagem de alantoína em relação às purinas totais, os níveis de ácido úrico na urina e nitrogênio microbiano nem a eficiência microbiana. O fornecimento de 1 ou 2 kg de concentrado contendo farelo de soja ou farelo de algodão como fontes proteicas para novilhas leiteiras em crescimento não afeta a eficiência microbiana, entretanto o fornecimento de 2 kg de concentrado aumenta a excreção de nitrogênio nas fezes.<br>The objective of this work was to evaluate effect of based-soybean or cottonseed meal concentrate rations in diets with corn silage on nitrogen balance (NB) and microbial protein production in growing dairy females. diets consisted of the combination of two levels of concentrate ration, 1 or 2 kg, and two protein sources, soybean meal or cottonseed meal. The animals that consumed 2 kg of concentrate ration showed greater total nitrogen intake, however, there was no significant effect on fecal-N, urine-N and nitrogen balance. The interaction among the concentrade levels and the protein source affected the urine uric N (N-urine) but did not change the levels of ureic nitrogen in the plasma. Levels of concentrate and protein sources did not affect concentrations of total purine and allantoin in the urine, the percentage of allantoin regarded to total purine, the levels of uric acid in the urine, microbial nitrogen neither the microbial efficiency. The supply of 1 or 2 kg of concentrate ration for growing dairy heifers, using soybean meal or cottonseed meal as protein sources does not affect microbial efficiency, although the supply of 2 kg of concentrate ration causes N waste in feces

Urea in sugarcane-based diets for dairy cows

We evaluated the effect of adding four levels (0, 4, 8 and 12 g/kg, as fed) of a mixture (9:1) of urea and ammonium sulfate (UAs) to sugarcane on feed intake and digestibility, productive performance and metabolism of nitrogen compounds of dairy cows. Twelve multiparous Holstein cows (12.6±0.5 kg/d of milk, 225±90 days in milk) were distributed in three 4 × 4 Latin squares, receiving diets with the same amount of nitrogen (125 g crude protein/kg of dry matter). Concentrate feed was supplied at a ratio of 1 kg for each 3 kg of milk produced. The sugarcane presented 21.9 ºBrix. The level of UAs did not affect intake, total digestibility of diet components, milk production or milk components. Increasing UAs level linearly increased concentration of plasma urea nitrogen (PUN), urinary excretion of nitrogen and contribution of non-urea nitrogen in the urinary excretion and linearly reduced milk production/urinary excretion of nitrogen ratio. In spite of the linear increase of PUN with increased urea, the maximum value observed (14.31 mg/dL) was below the threshold value of 20 mg/dL, above which reproductive function may be compromised. In diets with sugarcane for dairy cows with production below 15 kg/day, the UAs level may be raised from 0 to 12 g/kg natural matter without impairing performance

Urea in sugarcane-based diets for dairy cows

We evaluated the effect of adding four levels (0, 4, 8 and 12 g/kg, as fed) of a mixture (9:1) of urea and ammonium sulfate (UAs) to sugarcane on feed intake and digestibility, productive performance and metabolism of nitrogen compounds of dairy cows. Twelve multiparous Holstein cows (12.6±0.5 kg/d of milk, 225±90 days in milk) were distributed in three 4 × 4 Latin squares, receiving diets with the same amount of nitrogen (125 g crude protein/kg of dry matter). Concentrate feed was supplied at a ratio of 1 kg for each 3 kg of milk produced. The sugarcane presented 21.9 ºBrix. The level of UAs did not affect intake, total digestibility of diet components, milk production or milk components. Increasing UAs level linearly increased concentration of plasma urea nitrogen (PUN), urinary excretion of nitrogen and contribution of non-urea nitrogen in the urinary excretion and linearly reduced milk production/urinary excretion of nitrogen ratio. In spite of the linear increase of PUN with increased urea, the maximum value observed (14.31 mg/dL) was below the threshold value of 20 mg/dL, above which reproductive function may be compromised. In diets with sugarcane for dairy cows with production below 15 kg/day, the UAs level may be raised from 0 to 12 g/kg natural matter without impairing performance