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Background: One of the obstacles to seeking help for suicide is its social stigma. The literature suggests that suicide knowledge could impact this stigma. The present study aims to examine levels and predictors of suicide stigma and suicide literacy among Spanish-speaking individuals from Spain and Latin America., Method: A total of 678 adults completed an online survey conducted from December 2021 to May 2022. The survey assessed sociodemographic and clinical variables, including the Literacy of Suicide Scale (LOSS-SF) and Stigma of Suicide Scale (SOSS-SF)., Results: Results showed the presence of stigmatization and a moderate level of suicide literacy. Latin Americans presented significantly more stigmatizing attitudes and lower levels of suicide literacy than Spaniards. Older age and stronger religious/spiritual beliefs were correlated with lower suicide literacy. Suicide stigma was regressed on lower suicide literacy, gender (men), stronger religious/spiritual beliefs, and lacking knowledge about how to find help. Furthermore, the region was significantly associated with the suicide glorification subscale, reporting Latin Americans' greater glorification., Conclusions: By examining these factors, we aim to foster a deeper understanding of the attitudes and beliefs toward suicide. This understanding is crucial, as it may inform the development of effective interventions and prevention strategies that are culturally sensitive and tailored to diverse populations., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

The genetic basis of severe COVID-19 has been thoroughly studied, and many genetic risk factors shared between populations have been identified. However, reduced sample sizes from non-European groups have limited the discovery of population-specific common risk loci. In this second study nested in the SCOURGE consortium, we conducted a genome-wide association study (GWAS) for COVID-19 hospitalization in admixed Americans, comprising a total of 4702 hospitalized cases recruited by SCOURGE and seven other participating studies in the COVID-19 Host Genetic Initiative. We identified four genome-wide significant associations, two of which constitute novel loci and were first discovered in Latin American populations ( BAZ2B and DDIAS ). A trans-ethnic meta-analysis revealed another novel cross-population risk locus in CREBBP . Finally, we assessed the performance of a cross-ancestry polygenic risk score in the SCOURGE admixed American cohort. This study constitutes the largest GWAS for COVID-19 hospitalization in admixed Latin Americans conducted to date. This allowed to reveal novel risk loci and emphasize the need of considering the diversity of populations in genomic research., Competing Interests: SD, RC, AL, JL, Md, IQ, RG, VN, MP, JT, JN, JA, CA, SA, VA, BA, NA, ÁA, EA, CA, MA, MA, RB, MB, MB, JB, MB, LB, MB, RB, MB, EC, CC, LC, JC, RC, MC, JC, MC, MD, AD, Vd, Ad, ED, RE, MF, MF, UF, AF, TF, MG, BG, JG, BÁ, FB, AG, JG, JG, MH, AH, MJ, ML, AB, RL, EM, CM, VM, OM, IM, MM, AM, JM, EM, PM, VC, SO, EO, MP, EP, NS, PP, PP, MP, TP, MP, GP, EP, GP, AP, SL, SR, MF, ER, FR, JR, FR, JR, PR, JS, JS, ET, AT, JT, AT, LT, MU, JV, ZY, RZ, Id, AR, PS, LR, EG, CA, EP, JR, AR, CF, PL, ÁC No competing interests declared, (© 2024, Diz-de Almeida, Cruz et al.)

The NHEPACHA Iberoamerican Network, founded on the initiative of a group of researchers from Latin American countries and Spain, aims to establish a research framework for Chagas disease that encompasses diagnosis and treatment. For this purpose, the network has created a questionnaire to gather relevant data on epidemiological, clinical, diagnostic, and therapeutic aspects of the disease. This questionnaire was developed based on a consensus of expert members of the network, with the intention of collecting high-quality standardized data, which can be used interchangeably by the different research centers that make up the NHEPACHA network. Furthermore, the network intends to offer a clinical protocol that can be embraced by other researchers, facilitating comparability among published studies, as well as the development of therapeutic response and progression markers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 González Martínez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Hypereosinophilic syndrome can produce cardiac involvement and endomyocardial fibrosis, which have a poor prognosis. However, there is limited information regarding cardiac involvement among migrants from Latin America with eosinophilia related to helminthiasis., Methods: We conducted a pilot observational study where an echocardiography was performed on migrants from Latin America with both eosinophilia (>450 cells/μL) and a diagnosis of helminth infection, and on migrants from Latin America without eosinophilia or helminth infection. Microbiological techniques included a stool microscopic examination using the Ritchie's formalin-ether technique, and a specific serology to detect Strongyloides stercoralis antibodies., Results: 37 participants were included, 20 with eosinophilia and 17 without eosinophilia. Twenty (54.1%) were men with a mean age of 41.3 (SD 14.3) years. Helminthic infections diagnosed in the group with eosinophilia were: 17 cases of S. stercoralis infection, 1 case of hookworm infection, and 2 cases of S. stercoralis and hookworm coinfection. Among participants with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness (p = 0.001) and left atrial area and volume index (p = 0.003 and p = 0.004, respectively), while showing a lower left atrial strain (p = 0.006) and E-wave deceleration time (p = 0.008). An increase was shown in both posterior and anterior mitral leaflet thickness (p = 0.0014 and p = 0.004, respectively) when compared with participants without eosinophilia., Conclusions: Migrants from Latin America with eosinophilia related to helminthic infections might present incipient echocardiographic alterations suggestive of early diastolic dysfunction, that could be related to eosinophilia-induced changes in the endomyocardium., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sempere et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

BackgroundRecent migration trends have shown a notable entry of Latin American asylum seekers to Madrid, Spain.AimTo characterise the profile of asylum-seeking Latin American migrants who are living with HIV in Spain and to outline the barriers they face in accessing HIV treatment.MethodsA prospective cohort study was conducted between 2022 and 2023 with a 6-month follow-up period. Latin American asylum seekers living with HIV were recruited mainly from non-governmental organisations and received care at an HIV clinic in a public hospital in Madrid.ResultsWe included 631 asylum seekers. The primary countries of origin were Colombia (30%), Venezuela (30%) and Peru (18%). The median age was 32 years (interquartile range (IQR): 28-37), and 553 (88%) were cis men of which 94% were men who have sex with men. Upon their arrival, 49% (n = 309) lacked social support, and 74% (n = 464) faced barriers when attempting to access the healthcare system. Upon entry in Europe, 500 (77%) participants were taking antiretroviral therapy (ART). At their first evaluation at the HIV clinic, only 386 (61%) had continued taking ART and 33% (n = 209) had detectable plasma HIV-1 RNA levels. Six months later, 99% took ART and 98% had achieved an undetectable viral load.ConclusionsLatin American asylum seekers living with HIV in Madrid, Spain encountered barriers to healthcare and to ART. One-third of these individuals presented detectable HIV viral load when assessed in the HIV clinic, highlighting this as an important public health issue.

Introduction: The frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis., Methodology: Retrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development)., Results: The study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8-5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection., Conclusions: It is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children., (© 2024. The Author(s).)

Objective: The population of Latin America harbors the highest incidence of gallstones and acute biliary pancreatitis, yet little is known about the initial management of acute pancreatitis in this large geographic region., Participants and Methods: We performed a post hoc analysis of responses from physicians based in Latin America to the international multidisciplinary survey on the initial management of acute pancreatitis. The questionnaire asked about management of patients during the first 72h after admission, related to fluid therapy, prescription of prophylactic antibiotics, feeding and nutrition, and timing of cholecystectomy. Adherence to clinical guidelines in this region was compared with the rest of the world., Results: The survey was completed by 358 participants from 19 Latin American countries (median age, 39 years [33-47]; women, 27.1%). The proportion of participants in Latin America vs. the rest of the world who chose non-compliant options with clinical guidelines were: prescription of fluid therapy rate other than moderate (42.2% vs 34.3%, P=.02); prescription of prophylactic antibiotics for severe (10.6% vs 18.0%, P=.002), necrotizing (28.5% vs 36.9%, P=.008), or systemic inflammatory response syndrome-associated (21.2% vs 30.6%, P=.002) acute pancreatitis; not starting an oral diet to patients with oral tolerance (77.9% vs 71.1%, P=.02); and delayed cholecystectomy (16.2% vs 33.8%, P<.001)., Conclusions: Surveyed physicians in Latin America are less likely to prescribe antibiotics and to delay cholecystectomy when managing patients in the initial phase of acute pancreatitis compared to physicians in the rest of the world. Feeding and nutrition appear to require the greatest improvement., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Purpose of Review: Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability in the world. The majority of diabetes deaths (> 80%) occur in low- and middle-income countries, which are predominant in Latin America. Therefore, the purpose of this article is to compare the clinical practice guideline (CPG) for the pharmacological management of T2DM in Latin America (LA) with international reference guidelines., Recent Findings: Several LA countries have recently developed CPGs. However, the quality of these guidelines is unknown according to the AGREE II tool and taking as reference three CPGs of international impact: American Diabetes Association (ADA), European Diabetes Association (EASD), and Latin American Diabetes Association (ALAD). Ten CPGs were selected for analysis. The ADA scored > 80% on the AGREE II domains and was selected as the main comparator. Eighty percent of LA CPGs were developed before 2018. Only one was not recommended (all domains < 60%). The CPGs in LA have good quality but are outdated. They have significant gaps compared to the reference. There is a need for improvement, as proposing updates every three years to maintain the best available clinical evidence in all guidelines., (© 2023. The Author(s).)

Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The "double burden of malnutrition" (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world. Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development. Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies., (Copyright © 2021 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: The purpose of this study was to describe the health-related quality of life (HRQoL) characteristics in a population at risk of developing type 2 diabetes in Barranquilla and Bogotá, Colombia., Methods: A cross-sectional study with 1135 participants older than 30 years-of-age recruited in Bogotá D.C., and Barranquilla by cluster sampling in 2018 to 2019. The Finnish Diabetes Risk Score (FINDRISC) was used to detect participants at risk of developing type 2 diabetes (T2D). HRQoL was assessed using the EQ-5D-3L questionnaire. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and their corresponding 95% confidence intervals CI)., Results: Moderate or extreme problems appeared more frequently in the dimensions of Pain/Discomfort (60.8%) and Anxiety/Depression (30.8%). The mean score of the EQ-VAS was 74.3 (± 17.3), significantly larger in the state of complete health (11111) compared with those with problems in more than one of the quality-of-life dimensions. Being female and living in Bogota D.C., were associated with greater odds of reporting problems in the Pain (OR 1.6; 95% CI 1.2-2.2) and Discomfort dimensions (OR 1.6; 95% CI 1.2-2.0) respectively and Anxiety/Depression (OR 1.9; 95% CI 1.3-2.7), (OR 9.1; 95% CI 6.6-12.4), respectively., Conclusions: As living place and sex were associated with dimensions of Pain/Discomfort and Anxiety/Depression in the HRQoL in people at risk of T2D, greater attention should be paid to these determinants of HRQoL to design and reorient strategies with a territorial and gender perspective to achieve better health outcomes. Diabetes is one of the four non-communicable diseases with increasing prevalence in the world, which has made it a serious public health problem. In Colombia, in 2019 diabetes affected 8.4% of the Colombian adult population and more than one million Colombian adults of this age group have hidden or undetected diabetes. This disease is not only characterized by increased premature mortality, loss of productivity, and economic impact, but it also involves a deterioration in the quality of life of people with diabetes with their respective families. However, very Little is known about health-related quality of life (HRQoL) in a population at risk or with prediabetes. This study has evaluated the quality of life in patients at risk of diabetes and their behavior with some variables as sociodemographic, lifestyle, history, and established their difference in two territories of the Colombian Caribbean. The results of this study indicate that the HRQoL of people at risk of type 2 diabetes is affected by factors such as gender, city, dysglycemia, medication for hypertension and education level. Therefore, greater attention should be paid to these determinants of HRQL to design and implement strategies that reduce this risk of developing type 2 diabetes, prevent prediabetes and improve the quality of life in prediabetic or diabetic patients., (© 2021. The Author(s).)

Objectives: The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recently defined the new concept of probable sarcopenia to help improve screening and prevent future sarcopenia. We investigated the prevalence of probable sarcopenia, defined as weak grip strength, in community-dwelling older Colombian adults, and examined the long-term associated conditions., Design: Cross-sectional study., Setting: Urban and rural Colombian older adults from the "Estudio Nacional de Salud, Bienestar y Envejecimiento (SABE) study"., Participants: 5237 Colombian older adults aged ≥60 years., Measurements: Probable sarcopenia was assessed following the cut-off points for weak grip strength recommended by EWGSOP2 guidelines. Odds ratios (ORs) of the relationship between long-term conditions and probable sarcopenia were determined using logistic regression., Results: The prevalence of probable sarcopenia defined as weak grip strength was 46.5% [95% confidence interval (CI), 45.1-47.8]. Physical inactivity "proxy" (OR 1.35, 95% CI 1.14-1.59); diabetes (OR 1.32, 95% CI 1.11-1.56); and arthritis, osteoarthritis, and rheumatism (OR 1.44, 95% CI 1.25-1.67) were independently associated with probable sarcopenia., Conclusions and Implications: We found that almost half of all the Colombian older adults in our sample had probable sarcopenia. Individuals with physical inactivity, diabetes, arthritis, or osteoarthritis and rheumatism had a higher prevalence of probable sarcopenia. Probable sarcopenia is clinically highly relevant, and several of the factors associated with this condition are potentially preventable, treatable, and reversible., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The use of bibliometric indicators to measure the quality of scientific journals is a general practice in all areas of science. The WoS and Scopus databases continue to be the reference sources to obtain bibliographic indicators. Others such as SciELO network offer indicators about Ibero-American science, which are scarcely collected in WoS and Scopus. The aim of this work was to analyze the association of the indicators proposed by SciELO for health sciences journals, with the most widely used impact and indicators and to study the complementarity of the existing prestige indicators., Methods: Analytical correlational study between SciELO indicators, with impact and prestige indicators from Journal Citation Report, Scopus and Web of Science. The results refer to 2018, the most recent and complete data available. Association between the qualitative variables was analyzed using the chi-square test, and the analysis of variance (ANOVA) was performed for the quantitative variables using the Tukey method as a post hoc test. To obtain the relationship between quantitative variables, Pearson's correlation coefficient was used and Spearman's coefficient for ordinal variables. The level of significance used in all the hypothesis tests was α≤0.05., Results: The SciELO Impact Factor showed a weak correlation both, with Journal Citation Report (R=0.36; p=0.003), and Scopus Cite Score (R=0.39; p=0.001). The association between the H index of the Web of Science andthe H index of Scopus with the H index of SciELO was weak in both cases (R=0.45; p<0.001 and R=0.340; p=0.003)., Conclusions: Indicators proposed by SciELO, for health journals, did not show an association with those of WoS or Scopus. The weak correlation between Impact Factor and Cite Score with SciELO Impact Factor, converts the latter into a necessary "metrics" to assess journals excluded from the "mainstream" and fundamentally those from the Latin American region. The need of using the prestige indicators to fill in the impact indicators, has not been proven in this study., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Metabolic syndrome (MS) and its components increase the risk of a number of chronic diseases. Evidence regarding its prevalence among health professionals, particularly in Latin America, is limited. The purpose of this study was to assess the overall prevalence of MS and its components among health professionals and students from five Latin American countries. Methods: A cross-sectional multicenter study entitled LATIN America METabolic Syndrome (LATINMETS) was conducted on five groups of apparently healthy volunteer subjects. Sociodemographic factors, lifestyle variables (smoking and physical activity), anthropometric measurements (weight, height, and waist circumference), standard biochemical analyses [triglycerides, glucose, and high-density lipoprotein cholesterol (HDL-C)], and blood pressure measurements were assessed. MS was diagnosed based on internationally harmonized criteria. Associations between MS components and sociodemographic, lifestyle, and anthropometric variables were analyzed using multivariate logistic regression. Results: A total of 1,032 volunteers ( n  = 316-Mexico, n  = 285-Colombia, n  = 223-Brazil, n  = 132-Paraguay, and n  = 76-Argentina) were recruited. The majority of them were women (71.9%), students (55.4%), and younger than 28 years (67.2%). The overall prevalence of age-standardized MS was 15.5% (23.1% men and 12.2% women). The majority (59.3%) presented at least one MS component, mainly abdominal obesity (29.7%) and low HDL-C levels (27.5%). After adjusting for age and sex, MS and its components were positively associated with being overweight or obese. Conclusions: MS prevalence in this study was similar to that generally found among young populations in Latin-American countries. More than half of the sample had at least one MS component, suggesting that preventive measures and treatments aimed at achieving low-risk health status are essential in this population.

Background and Objectives: A deficiency exists in the criterion-referenced cut-points for field-based cardiorespiratory fitness (CRF) in Latin American youths. The aims of the present study were two-fold: (1) To identify the ability of CRF estimated by the 20-m shuttle-run test (20mSRT) to differentiate between "healthy" and "unhealthy" phenotypes (by adiposity) in adolescents; (2) to assess the association between obesity and relative peak oxygen uptake (VO 2 peak) in a large and diverse sample of Latin American youths. In total, 72,505 adolescents aged between 13 and 15 years were recruited from Chile and Colombia (47.5% girls). Materials and Methods : The waist circumference (WC) and waist-to-height ratio (WHtR) were used to identify body adiposity markers. CRF was measured using the 20mSRT (VO 2 peak). Receiver operating characteristic curves and logistic regression were used to determine the discriminatory ability of CRF to predict body adiposity parameters. Results: For boys and girls, VO 2 peak showed a significant predictive capacity to detect body fat (area under the curve [AUC] > 0.62). The sensitivity of VO 2 peak was medium (>63%) for all age- and sex-specific cut-points, with optimal cut-points in 13- to 15-year olds for obesity identified as 43.77 mL·kg -1 ·min -1 and 38.53 mL·kg -1 ·min -1 in boys and girls, respectively. Conclusions : According to these cut-points, adolescents with low CRF were more likely to be obese either by WC or WHtR. The CRF cut-points can be used as quantitative markers for a healthier body in Latin American adolescents.

In a world that is increasingly technological and interconnected, but also more violent, overexploited and polluted, Paediatric Environmental Health (PEH) is one of the best contributions to improve global health. Few areas of the planet have a high affinity with common values and interests, such as the European Union (EU), Latin America and the Caribbean (LAC). The investments and actions of the PEH in pre- and postnatal periods during the first two decades of life will generate countless benefits in the health and well-being during the human life span. Detecting, reducing, or eliminating physical, chemical, biological and social pollutants is one of the main missions and actions of the PEH. In this special article, an update review is presented on the threats, challenges and cooperation opportunities in PEH among bio-health professionals and other social sectors involved, from the EU and LAC. New professional profiles, knowledge structures and architectures for engagement emerge. Courageous leaderships, new substantial resources, broad social changes, and the necessary collaboration between the two regions will be required to improve the health of present and future generations., (Copyright © 2018 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. From that moment on, several measures were adopted to achieve the epidemic control at both international and national levels. The WHO launched a strategic response plan based on case detection, infection control and treatment, as well as, the research and development of new vector control tools, diagnostic tests and vaccines. In Europe both surveillance and vector control systems were reinforced. The countries reporting most cases were France, Spain and the United Kingdom. In Spain, due to the high probability of case importation based on the close relationships with Latin-America, numerous measures were adopted to achieve a rapid response and an optimal control. Those included: the implementation of an active surveillance in collaboration with several experts, institutions and scientific societies; entomologic surveillance enhancement; the development of communication activities and recommendations for both healthcare workers and general population.

Serology is the preferred method to confirm a Chagas disease diagnosis and to screen blood donors. A battery of assays is often required due to the limited accuracy of single assays. The Elecsys Chagas assay is a newly developed, double-antigen sandwich assay for use on the Elecsys and cobas e immunoassay analyzers, intended to identify individuals infected with Trypanosoma cruzi , for diagnosis and screening. The performance of the Elecsys Chagas assay was evaluated in comparison with those of other widely used T. cruzi antibody assays, at multiple sites (Europe/Latin America). Relative sensitivity and specificity were assessed by using samples from blood donors, pregnant women, and hospitalized patients from regions where Chagas disease is endemic and from regions of nonendemicity. The Elecsys Chagas assay had an overall relative sensitivity of 100% ( n = 674). Overall relative specificities were 99.90% ( n = 14,681), 100% ( n = 313), and 100% ( n = 517) for samples from blood donors, pregnant women, and hospitalized patients, respectively. The analytical specificity was 99.83% ( n = 594). The Elecsys Chagas assay detected T. cruzi antibodies in two World Health Organization (WHO) standard T. cruzi reference panels (panels 09/188 and 09/186) at a 1:512 dilution, corresponding to a cutoff sensitivity of approximately 1 mIU/ml. The Elecsys Chagas assay demonstrated robust performance under routine conditions at multiple sites in Europe and Latin America. In contrast to other available Chagas assays, the Elecsys assay uses a reduced number of recombinant T. cruzi antigens, resulting in a significantly smaller number of cross-reactions and improved analytical specificity while being highly sensitive., (Copyright © 2018 Flores-Chavez et al.)

The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both transplant ID and travel medicine specialists. The guidelines provide recommendations for risk evaluation and laboratory investigation, as well as management and prevention of infection of the most relevant endemic diseases of Latin America. This summary includes a brief description of the guideline recommendations but does not include the complete rationale and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from 13 countries (Brazil, Canada, Chile, Denmark, France, Italy, Peru, Spain, Switzerland, Turkey, United Kingdom, United States, and Uruguay) representing four continents (Asia, the Americas and Europe), along with scientific and medical societies.

The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations., (Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: We aimed to perform a serological screening for T. cruzi, Strongyloides stercoralis, HIV, human T cell lymphotropic virus (HTLV) and syphilis in Latin American immigrants admitted to hospital in Spain., Methods: We have carried out a cross-sectional study of Latin American immigrants admitted to the Hospital General Universitario Alicante (Spain) from June 2012 to May 2014, where screening of Chagas disease, strongyloidiasis, HTLV, HIV and syphilis was performed by serology., Results: A total 180 patients were included in the study. Patients' median age was 38 years old, 123 (68.3%; 123/180) were female and 57 (31.7%; 57/180) male. Five of the 180 (2.5%) patients were positive for Chagas disease; associated with knowledge about Chagas disease (p=0.005), previous contact with patients with Chagas disease (p=0.04) and being Bolivian (p<0.001). Forty-two of the 157 (26.8%) patients were positive for Strongyloides serology; associated positively with being male (p<0.001), eosinophilia (p=0.001), hyper-IgE (p<0.001) and being Ecuadorian (p=0.001), and negatively associated with being Colombian (p=0.03). Positive serology of latent syphilis was found in 1.8% (3/171) of patients. Serology of HTLV was negative in all cases. No new cases of HIV infection were diagnosed., Conclusions: We propose that Latin American immigrant patients admitted to hospital in Spain be screened for strongyloidiasis, Chagas disease and syphilis by serology., (© The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.

Background: A multicenter study was conducted. A panel containing DNA from Histoplasma capsulatum, as well as negative and cross-reaction controls, was sent to five different laboratories, members of the MICOMOL network from CYTED Program., Aims: The objective was to assess the accuracy of different PCR protocols to detect H. capsulatum DNA., Methods: Seven different PCR protocols were tested. They were based on PCR techniques and used unicopy and multicopy targets., Results: Most of these protocols (4/7) were able to detect the smallest amounts of fungal DNA (10(2)fg/μl). Overall sensitivity was 86% and specificity was 100%. The protocol based on a unicopy target (SCAR220) presented lower sensitivity (43%) but 100% specificity. The real-time protocols tested were highly reproducible, sensitive, and specific. Neither false positives nor cross-reactions were detected in any protocol., Conclusions: All laboratories were able to amplify H. capsulatum DNA, and real-time PCR seems to be a promising tool to efficiently detect this pathogen in clinical samples., (Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Chagas disease is a chronic and systemic infection caused by Trypanosoma cruzi. According to estimates from WHO, 10 million people are affected by this parasite. In the last years, birthrate among the immigrant women from Latin America settled in the Comunidad Autónoma de Madrid has been increasing, and as T. cruzi can be transmitted from mother to child, in fact 11 cases of congenital Chagas disease have been confirmed. Therefore, the aim of this paper is encouraging improvements in the coverage of the anti-T. cruzi antibodies detection in pregnant women from endemic areas. By this strategy, an active search for infected pregnant women and early detection of her infected newborns could be conducted, and then an early specific treatment could be administrated. Thus, there could be an important contribution to the control of Chagas disease in non-endemic area.

Objective: To describe the incidence of new HIV diagnoses and its trend in Spain., Methods: All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends., Results: In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was <350 in 50.2% of patients. From 2004 to 2009, the mean incidence rate of new HIV diagnoses was 91.14 per million inhabitants; an increasing trend for rates in MSM, as well as a decreasing trend for the parenteral mode of transmission, were observed., Conclusions: In Spain, the epidemiology of HIV infection has changed since the mid-1990s. Currently, the most frequent transmission category is sexual transmission, particularly among MSM, and immigrants are an important part of the epidemic. Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: To describe the epidemiology of HIV and AIDS by geographical origin in the EU, 1999-2006., Methods: AIDS and HIV cases from the EU 27, Norway and Iceland reported to European Centre for Epidemiological Monitoring of AIDS were analysed., Results: Of 75,021 AIDS reports over 1999-2006, 35% were migrants. Of 2988 heterosexual AIDS reports in 2006, 50% were migrants, largely from Sub-Saharan Africa (SSA), 20% of 1404 AIDS cases in men who have sex with men (MSM) were migrants from Latin-America and Western Europe. Of 57 mother-to-child transmission (MTCT) AIDS cases, 23% were from SSA. AIDS cases decreased from 1999 to 2006 in natives (42%), Western Europeans (40%) and North Africa and Middle East (34%), but increased in people from SSA (by 89%), Eastern Europe (by 200%) and Latin-America (50%). Of 17,646 HIV infections in men and 9066 in females in 2006, 49 and 76% were migrants, largely from SSA. Of 169 MTCT infections, 41% were from SSA., Conclusion: Migrants, largely from SSA, represent a considerable proportion of AIDS and HIV reports in EU, especially among heterosexual and MTCT infections. Their contribution is higher among female reports. A substantial percentage of diagnoses in MSM are migrants, largely from Western Europe and Latin-America.

One of the most important modes of transmission of Trypanosoma cruzi infection in areas where it is not endemic is vertical transmission: from mother to child. The objective of this report is to assess the efficacy of different programmes of serological screening to monitor infection with T. cruzi in pregnant Latin American women living in Madrid (Spain). To achieve this, a retrospective study was undertaken from January 2008 to December 2010 in seven hospitals in the Autonomous Community of Madrid. Serological screening programmes were classified in two main strategies: a selective one (pregnant women from Bolivia) and a universal one (pregnant women from Latin America). A total of 3,839 pregnant women were tested and the overall prevalence was 3.96%. The rate of congenital transmission was 2.6%. The current monitoring programmes have variable coverage ranging between 26% (selective screening) and 100% (universal screening). Monitoring of pregnant women from Latin America only reaches full coverage if universal screening of pregnant women is carried out at any moment of pregnancy, including at delivery. A common national regulation is necessary in order to ensure homogenous implementation of screening.

The global economic crisis and its impact on public finances in most developed countries are giving rise to cost-containment policies in healthcare systems. Prevailing legislation on medication requires the safety, quality, and efficacy of these products. A few countries include efficiency criteria, primarily for new medication that they wish to include in public financing. The appropriate use of generic and "biosimilar medication" is very important for maintaining the financial equilibrium of the Health Services. The problem in Latin America is that not all multisource products are bioequivalent and not all countries have the resources to conduct bioequivalence studies in vivo. The European Medicines Agency in 2005 adopted guidelines on "biosimilar medicines" and thirteen of them were subsequently approved for general release. Benchmarking of this model by other countries would be important. The influence of the pharmaceutical industry on political and administrative areas is enormous and control is necessary. The pharmaceutical companies claim that they act with corporate social responsibility, therefore, they must ensure this responsibility toward society.

Genomic characterization of the genes encoding the Taenia 18 kDa/HP6 protective antigens was carried out for Taenia saginata and T. asiatica using 42 taeniid isolates comprising 23 samples of T. saginata, 13 samples of T. asiatica and 6 samples of T. solium. The corresponding sequences from all taeniid isolates were PCR-amplified with specific primers and then sequenced. All the genes, and other described taeniid gene homologues, had the same genomic structure. Surprisingly, the T. saginata TSA18 gene showed nucleotide variability within the 23 samples analyzed. This resulted in two distinct genotypes with 96% DNA sequence similarity and deduced amino acid sequences with 21 substitutions, mainly located in the second exon which contains the fibronectin type III domain. In regards to T. asiatica, the 18 kDa gene (TASI18) was very similar to the T. saginata antigen homologues, both at the DNA and deduced amino acid sequence levels, and the TSOL18 gene was conserved among T. solium isolates as previously described. The implications of these findings on the future development of taeniid vaccines are discussed., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: To identify antituberculosis treatment outcomes among the immigrant population and determine the variables associated with treatment default., Methods: We performed a prospective cohort study that included cases of tuberculosis in immigrants older than 15 years diagnosed in 15 public hospitals of the Community of Madrid in 2003. Firstly, a descriptive study was performed. Subsequently, a bivariate/multivariate analysis was performed using logistic regressions. The dependent variable was treatment default vs successful treatment., Results: Of 296 cases, 75.0% successfully completed the treatment, 8.4% defaulted, 2% died, 0.7% showed treatment failure, and 7.1% transferred out; information loss occurred in 6.8%. The variables independently associated with treatment default were female sex (odds ratio [OR]: 0.18; 95% confidence interval [95%CI]: 0.03-0.95), living with relatives (0.23 [0.08-0.66]) and moving to another autonomous community (5.52 [1.17-25.93]) compared with not moving., Conclusions: Antituberculosis treatment outcomes in the immigrant population need to be improved. To achieve this aim, healthcare coordination should be improved in the mobile population and strategies to increase treatment compliance among persons not living with relatives are required.

Objectives: To improve the understanding of serogroup Y invasive meningococcal disease (IMD) in Latin America, particularly IMD molecular epidemiology; 166 Y serogroup isolates received at the National Reference Laboratories of Argentina, Brazil, Chile, Colombia, and Costa Rica during 2000-2006 were characterized by their molecular markers., Methods: This analysis included serological assays to determine serogroup/serotype/serosubtype, DNA sequencing and genotyping of the porB and/or porA genes, multilocus sequence typing (MLST) and fetA allele determination., Results: Sixteen different antigenic combinations were observed. Sixty-two (37.3%) isolates were NT:P1.5 and 36 (21.7%) isolates were 14:NST. Thirty-two different STs appeared, but 3 STs (ST-1624, ST-23, and ST-5770) accounted for 69.9% (116) of the strains. Most of the IMD isolates belonged to the ST-23, ST-167 clonal complexes or the group composed by ST-5770 and related STs., Conclusions: Isolates obtained in Colombia and Costa Rica were similar to that of the United States, in that most sequence types belonged to the ST-23 clonal complex. IMD isolates found in Argentina appear to be the result of an independent event and did not spread from nearby countries, being the sequence type ST-1624 (ST-167 clonal complex) the most frequently found. We were unable to correlate an antigenic shift of outer membrane proteins with an increase of serogroup Y meningococcal cases in our collection of isolates.

Introduction: A growing number of immigrants are using the public health services for HIV in Spain. We describe the sociodemographic, epidemiological, and clinical characteristics of a cohort of naïve HIV-infected subjects (CoRIS cohort) according to their place of origin., Methods: CoRIS is an open, hospital-based cohort of naïve, HIV-infected persons attended in 19 hospitals from 9 of the 19 autonomous regions in Spain. We describe the characteristics of the cohort members by place of origin, and compare them with the Spanish cases identified from January 2004 to October 2006, using the chi-square and Fisher exact tests., Results: Of 2507 patients, 76.3% were men and median age was 36 years. By origin, 71.5% were Spanish, 16.0% Latin Americans (LA), 5.8% sub-Saharan Africans (SSA), 3.7% Western Europeans (WE), 1.7% Eastern Europeans (EE) and 1.4% North Africans (NA). Compared to Spaniards, there were significant differences by origin in sex, age, and transmission category. Median CD4 count at cohort entry was 352 cell/microL, with no differences according to origin. Median viral load was 48 962 copies/mL and was significantly lower for SSA. Over 11.4 months of follow-up, 57.9% initiated HAART with no differences by origin. Hepatitis C prevalence was 29.9% in Spaniards, 7.3% in Latin Americans, 11.7% in SSA, and 45.7% in EE (P<0.05). Overall, 13.4% were Mantoux-positive (28.6% in SSA and 30.8% in NA). Tuberculosis was more common among cases from EE (9.5%) and SSA (8.3%) compared to Spaniards (4.8%) (P<0.05)., Conclusions: Almost one third of naïve HIV-infected patients in CoRIS are foreign-born. Their sociodemographic, epidemiological and clinical characteristics reflect the epidemic in their places of origin. However, their immunological status at cohort entry and initiation of HAART is no different from that of Spaniards.

Objective: To identify the knowledge, attitudes and perceptions held by the Latin-American population on tuberculosis, after being discharged from hospital in the Community of Madrid., Design: Cross-sectional study., Setting: Community of Madrid., Participants: Non-institutionalised Latin-American population over 15 years old, diagnosed with tuberculosis during the year 2003 (1st January-31st December)., Measurements: A descriptive study and an analytical study were performed. The measure of association used was the odds ratio (OR) and 95% confidence intervals (95% CI), which were calculated by unconditional logistic regressions, using univariate and multivariate models. The dependent variables: to have correct knowledge of the disease and its treatments., Independent Variables: sociodemographic indicators (sex, education level, age) and clinical variables (case definition, location of the disease)., Results: A high percentage had correct knowledge of the disease (77.3%), its transmission (94.7%) and treatment (77.3%). An extra-pulmonary location was associated with a lower level of knowledge of the general characteristics of tuberculosis [OR (95% CI), 0.21 (0.05-0.85)] and its transmission [OR (95% CI) 0.05 (0-0.66)]. A high percentage of the population identified erroneous transmission routes, such as blood (42.3%); sexual fluids (50%), or utensils used for eating (81.3%)., Conclusions: After hospital discharge, a high percentage has correct knowledge about the disease, although there is a high prevalence of erroneous beliefs on its transmission. These beliefs must be taken into account in the information given to patients, since it could increase the stigmatisation and vulnerability of the patient.

This article describes the general objectives of the Regional Laboratory Network for Surveillance of Invasive Fungal Infections and Antifungal Susceptibility in Latin America. Formation of the Network was coordinated by the Essential Medicines, Vaccines, and Health Technologies Unit of the Pan American Health Organization, with the technical and financial support of the National Center for Microbiology of the Carlos III Health Institute (Spain), and the technical support of the Microbiology Department of the Dr. C. Malbrán National Institute on Infectious Diseases (Argentina) and the Microbiology Unit of the Parasitology Service of the Adolfo Lutz Institute (Brazil). The Network's principle objectives are epidemiological surveillance of invasive fungal infections through detection of antifungal resistance and identification of emergent, invasive fungal infections; establishment of norms and common protocols for early diagnosis of mycoses; and strengthening coordination, communications, and transference mechanisms among countries. The Network must be gradually implemented and must include staff training, a systematic process for sharing technology, evaluation of diagnostic techniques, identification of fungal species, and standardized tests for antifungal susceptibility.

Objective: To describe the methodology and baseline results of the Spanish cohort of naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS)., Methods: CoRIS is a multicenter, hospital-based prospective cohort of HIV sero-prevalent, retroviral-naïve subjects, over 13 years old, and seen at 17 hospitals in 8 of the 17 Autonomous Regions in Spain from January 2004 to October 2005. The socio-demographic characteristics, as well as epidemiological, clinical, laboratory and treatment data were recorded, and biological samples were collected at baseline and during follow-up., Results: A total of 1,591 subjects have been included in CoRIS; 24% are women, median age at cohort entry is 36 years, and 74% were diagnosed during 2004 or 2005. Twenty-seven percent came from countries other than Spain, mainly Latin-America (16%) and sub-Saharan Africa (5%). Thirty-two percent had completed secondary education and 16% university studies. The most frequent categories of transmission were men having sex with men (37%) and heterosexual sex (36%); only 21% were injection drug users. At cohort entry, median CD4 count was 317 cells/mm 3 and median viral load was 52,300 copies/mL; 18% were diagnosed with AIDS. Main AIDS-defining illnesses were Pneumocystis jiroveci pneumonia (6.1%), esophageal candidiasis (3.3%) and tuberculosis (extrapulmonary, 3.0% and pulmonary 2.7%). There were 35 deaths (2.2%). Thirty-three percent of patients gave a baseline sample to the BioBank., Conclusions: CoRIS offers relevant information about the current epidemiological profile of HIV infection in Spain, where sexual transmission has become predominant. The type and amount of information obtained from clinical and epidemiological data collection together with biological samples demonstrate the viability of the project, which offers many possibilities for future research.