Objectives To assess the economic impact of dengue in Latin America and the Caribbean using a systematic review that includes studies not previously considered by other reviews. Methods Cochrane methodology was used to conduct a systematic review of the cost of dengue in Latin America. PubMed Central, EMBASE, and the Biblioteca Virtual en Salud—which includes scientific, peer-reviewed journals not indexed by other databases—were searched from inception through August 2016. All articles that reported cost of illness data for countries in Latin America were included. Included studies underwent a methodological appraisal using a seven-question instrument designed for cost of illness studies. Extracted data were direct and indirect costs for outpatient and hospitalized cases and total cost of the disease. Values were adjusted to 2015 US dollars using the consumer price index. Results From a total of 848 initial references, 17 studies were included, mainly from Brazil, Colombia, Cuba, Mexico, and Puerto Rico; costs were available for 39 countries. The methodological appraisal showed that 70% of the studies met more than 70% of the evaluated items. The main economic impact of dengue was due to productivity costs. Average annual cost was more than US$ 3 billion. Direct costs represented over 70% of the total share for hospitalized cases. For outpatients, direct medical costs were low, but social costs were significant since indirect costs may account for up to 80% of the total cost. Conclusions Dengue fever has a significant economic impact in Latin America. It is essential to develop new public health interventions, such as dengue vaccination, to decrease the propagation of the disease and its total cost.

This estimation indicates that dulaglutide dominates liraglutide. Its ICER is, however, greater than the accepted threshold for Colombia in base case compared with glargine. By increasing population weight or glargine consumption, dulaglutide becomes cost effective compared with glargine, which could identify a niche where dulaglutide is the best option.

Objetivo: El cáncer gástrico es la segunda causa de muerte por cáncer y la quinta neoplasia más frecuente en el mundo. En Colombia, es la primera causa de mortalidad por cáncer. La incidencia y mortalidad anuales son 16,3 y 14,2/100.000 habitantes respectivamente. El objetivo de este estudio fue estimar su carga de enfermedad, medida en años de vida ajustados por discapacidad (AVAD), en Colombia.Métodos: Se desarrolló un estudio con enfoque en prevalencia para el año 2014. Para estimar la prevalencia se realizó una búsqueda en los registros del Sistema de Información en Protección Social (SISPRO), y el Departamento Administrativo Nacional de Estadística (DANE). La duración promedio de los casos prevalentes y la sobrevida estimada se obtuvieron de la literatura local. Los AVAD fueron calculados sumando los años de vida perdidos por muerte prematura (AVPM) y los años de vida vividos con discapacidad (AVVD), según metodología de la Organización Mundial de la Salud (OMS).Resultados: las prevalencias estimadas para cinco años en población mayor de 15 años fueron 40,9/100.000 en mujeres y 62,5/100.000 en hombres. El total de AVAD fue 293.418, con una tasa de 623/100.000 habitantes; 97,4% corresponden a AVPM. La tasa de AVVD y AVPM para Colombia fue 16 y 607/100.000, respectivamente.Conclusiones: los datos obtenidos de SISPRO y el DANE estiman una alta carga de enfermedad en Colombia. Es necesaria la implementación de estrategias de detección temprana del cáncer para disminuir la carga de la enfermedad y mejorar el pronóstico de los pacientes.

Background: Immune mediated cytopenias (IMC) À isolated or combined hemolytic anemia, thrombocytopenia, and neutropenia-are increasingly recognized as potentially serious complications following allogeneic hematopoietic cell transplantation (HCT) for non-malignant disorders (NMD). However, IMC incidence, severity, response to therapy, and risk factors are not well defined. Methods: Pediatric patients undergoing HCT for NMD between 2010 and 2017 at a single institution were identified, excluding those experiencing graft failure or death prior to day +100. Demographics and HCT characteristics were obtained from a prospectively-maintained database. A retrospective chart review identified cases of IMC with positive direct Coombs test, anti-platelet antibody, and/or anti-granulocyte antibody; and documented treatment and response. IMC severity was defined by months to resolution: mild (0-3), moderate (3-6), or severe (>6). Results: Of 271 NMD HCT recipients, 52 (19%) exhibited IMC at a median of 130 days post-HCT (range, 30-279); 23 (44% of cases) had multiple cell lines affected. IMC disease was mild, moderate, or severe in 44%, 25%, and 31%, respectively, with no deaths attributed to IMC. For those with moderate or severe IMC, all received steroid therapy, with a response rate of 34%. An average of 2.0 unique agents were used to achieve IMC resolution, at a median of 117 days (range 17 À 639). Univariate analysis revealed statistically significant associations between IMC and younger age at HCT (median 3.7 vs. 7.0 years, p<0.01), inherited metabolic disorder or hemoglobinopathy as indication for HCT (p<0.01), reduced toxicity conditioning (p<0.01), and use of serotherapy in conditioning (p=0.04). While presence of acute graft-versus-host disease (GvHD) was not associated, those with IMC were more likely to receive steroids for GvHD prophylaxis (p<0.01). Following HCT, a decline in peripheral blood donor CD3+ chimerism by at least 10% from day +60 to +100 was more common in those with IMC (p<0.01), with a trend toward lower peripheral blood CD3+ donor chimerism at day +100 (71% IMC vs 88.5% no IMC, p = 0.1). Lower absolute CD4 count at days +100 (median 100 vs. 163) and +180 (median 170 vs. 276) were observed (p<0.01) with no differences in CD8 or CD19. Conclusion: Immune mediated cytopenias following HCT for NMD in a large pediatric cohort was common at 19%, with limited steroid responsiveness, use of multiple immunosuppressive agents and duration of therapy exceeding 3 months for the majority affected. Patient and transplant characteristics associated with IMC were consistent with previous reports, though we expand these findings with observation of declining donor T-lymphoid chimerism and CD4 counts by day +100, prior to median onset of IMC. While, the pathogenesis of IMC post-HCT for NMD remains elusive, further research may identify approaches to prevent this HCT complication.