Juan Carlos Orengo

This analysis estimated productivity losses and assessed sex disparities due to vaccine-preventable cancer deaths from hepatitis B virus (HBV) and human papillomavirus (HPV) in Latin America. The number of deaths and years of life lost (YLL) for 19 Latin American countries were sourced from the Institute for Health Metrics and Evaluation Global Burden of Disease (2019) for cervical, oral cavity, laryngeal, oropharyngeal, and HBV-related hepatic cancers. Attributable fractions were applied to estimate HPV-related mortality. The value of YLL (VYLL) was estimated using country-specific GDP per capita and discounted at 3%. Sensitivity and scenario analyses were conducted. In 2019, 38,786 vaccine-preventable cancer deaths resulted in over 1.1 million YLL and $5.9 billion VYLL across Latin America. Cervical cancer accounted for 81.6% of deaths and $4.9 billion in VYLL, with females representing 87.0% of the total VYLL. For males, hepatic cancer was the highest VYLL at $295 million and oral cavity the lowest ($94 million). AYLL was higher in females (30 years) than males (27 years). HBV- and HPV-related cancers impose a significant economic and mortality burden in Latin America, with marked sex disparities. Cervical cancer remains the dominant contributor among females, while males are disproportionately affected by head and neck and hepatic cancers. These findings underscore the need for sex-specific public health strategies, including expanded vaccination, improved screening, and timely treatment access across the region.

Human papillomavirus (HPV) is a major public health concern, responsible for multiple types of cancer. This study aimed to provide an overview of the burden and temporal trends of HPV-associated cancers in Mexico using national hospital discharge and mortality databases from 2011–2019, including cervical, vulvar, vaginal, penile, anal, oropharyngeal, oral cavity, and laryngeal cancers. Hospitalization and mortality rates per 100,000 population were estimated; HPV-attributable fractions applied, and age-standardized temporal trends evaluated using joinpoint regression. Cervical cancer was the leading contributor, accounting for 88.5% of hospitalizations and 90.9% of HPV-attributable deaths. Hospitalization rates for cervical cancer increased between 2011–2014 (APC = 7.5%, 95% CI: 2.3, 18.0), then declined (APC = −3.0%, 95% CI: −7.8, −0.9). Other HPV-associated cancers had lower hospitalization rates, generally below 1 per 100,000, except for penile and head and neck cancers in males. Significant increases in hospitalization rates were observed in males for anal cancer from 2011–2019 (APC = 7.1%, 95% CI: 0.8, 15.1) and oropharyngeal cancer from 2017–2019 (APC = 18.0%, 95% CI: 4.0, 31.6), while in females, for vaginal cancer from 2017–2019 (APC = 30.7%, 95% CI: 10.6, 45.3) and oral cavity cancer from 2011–2019 (APC = 8.4%, 95% CI: 2.4, 29.1). Mortality for most cancers showed decreasing or stable trends over the study period, except for vulvar cancer in females (AAPC = 1.9%, 95% CI: 0.4, 4.1) and oropharyngeal cancer in both sexes (AAPC = 4.0%, 95% CI: 0.7, 8.0). Across most cancers, males were hospitalized at older ages but died younger than females, except for anal cancer. Overall, the burden of HPV-associated cancers is substantial. While cervical cancer remains prevalent and requires continued elimination efforts, the rising burden of anal and oropharyngeal cancers among males, highlights the need to strengthen public health strategies and raise awareness of HPV’s broader impact across both sexes.

Antibiotic resistance is one of the greatest public health threats today, mainly due to the non-rational use of antibiotics.Acinetobacter baumanniiis an example of a microorganism with high antibiotic resistance that has developed rapidly in recent years. Consequently, only a few lastresort antibiotics, such as colistin, are currently effective against it. In this work, we propose a random agent-based computational model to describe the evolution of colistin-resistantA. baumanniiin the population of Valencia (Spain) and to predict its impact both on the whole population and by age groups. The agent- based model uses a synthetic population of individuals with a vector of characteristics or state variables. These variables change over time based on a series of random events with certain conditional probabilities. The synthetic population statistical features and the probabilities have been found in demographic and hospital databases. One of these probabilities, the probability of infection by a resistant strain, has been modeled using random differential equations. The model takes into account antibiotic consumption as the primary driving force of variation and assumes non-rewersibility of resistance as the worst-case scenario. The agent-based model calibration and the selection of a real-world representative set of solutions have been carried out using the Partide Swarm Optimization evolutionary algorithm. This approach takes into account the inherent stochasticity of the model and the uncertainty of the data. Finally, projections of the incidence and absolute cases of colistin-resistantA. baumanniihave been performed. Our results suggest that, if the same consumption pattern continues, the ervolution of the colistin-resistant strain proportion will be exponential, exceeding 50% in 2025. Additionally, the results reveal that, despite the low incidence in Valencian hospitals, the impact on people over 60 years old will be more significant in terms of the number of cases. Based on these findings, it can be deduced that colistin will cense to be an effective antibiotic in the coming years, negatively impacting the human population, especially the most advanced age groups.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007–2009) and post-PCV (2011–2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Objetivo: Estimar la proporción de sujetos con diabetes mellitus tipo 2 (DMT2) que alcanzan la meta terapéutica para HbA1C un año después del diagnóstico. Métodos: Revisión retrospectiva de historias clínicas de adultos atendidos en nueve ciudades peruanas. Se incluyeron pacientes que recibieron un diagnóstico inicial de DMT2 y tuvieron al menos un año de seguimiento. Resultados: Se incluyeron 457 sujetos (53,03% mujeres). Cuando fueron diagnosticados, la edad media fue de 55,75 años (DE ± 12,92), la media de HbA1C fue de 9,10% (DE ± 2,28). Hubo diagnóstico concomitante de hipertensión arterial o de dislipidemia en 27,13% y 52,40%, respectivamente. Al año de seguimiento, 57,76% de los sujetos alcanzó la meta de HbA1C (50 mg/dL), 48.24% para triglicéridos (<150 mg/dL), y 89,23% para presión arterial (<140/90 mmHg). Conclusiones: En este estudio en condiciones de la vida real, en adultos con DMT2 con un año de seguimiento, el logro de la meta de HbA1c (<7%) se alcanzó en el 58% de los pacientes. Si bien estos resultados son compatibles con los reportados en otros estudios de la región, se evidencia la oportunidad de mejorar el logro temprano de metas con el objetivo de optimizar los resultados a largo plazo.