Abstract Yellow fever (YF) epizootics in South America during the 21st century have an unprecedented recorded magnitude and geographical dispersion. The YF spread progressively involved areas considered previously free of risk reaching the edge of cities with large unvaccinated populations, and urban outbreaks were frequently forecasted. We critically reviewed the initial stages and enhancing contexts of YF urban epidemics since the 17th century in the Americas, and the modeling attempts of YF epidemic risk by of Aedes-Human transmission, to find common factors that increase the probability of these events in the current scenarios. The YF urban outbreaks of the past showed as necessary conditions the multiple introduction by viremic carriers clustered in time and space, coincident with population peaks of Aedes. These conditions are not met in the current outbreaks in the Americas by sylvatic YF cycles, besides the protective impact of vector control campaigns, vaccination coverage, improved surveillance, and case management. Therefore, urban Aedes-Human YF outbreaks in the Americas are still possible but with low probability or very focal transmission, while the conditions reported in the past were avoided, and the surveillance and control measures sustained, including the vaccination of the population at risk.

ABSTRACT Scorpionism is the accident resulting from the envenomation of humans by toxic scorpions. It is considered a health public problem in several tropical and subtropical regions of the world, including the Americas. The extreme venom toxicity of some species belonging to the genus Tityus has prompted the preparation of specific antivenoms in Latin America, which use is considered the only efficacious therapeutic strategy for treating scorpionism. Paraguay is inhabited by three Tityus species of reknown toxicity in neighbouring Brazil and Argentina (T. trivittatus, T. confluens, and T. bahiensis) but their sanitary importance in the country remains unknown. This review updates the list of known scorpion species in Paraguay and their distribution, and also presents data on their toxicity, with the intent to arise interest in the subject considering the recording of severe accidents in children, the possible increase in the number of scorpionism cases in the country as a result of global warming, and the need to identify effective scorpion antivenoms in the country.

RESUMEN El escorpionismo, como se conoce al accidente producido por escorpiones tóxicos en humanos, es un problema de salud pública en varias regiones del mundo, incluyendo centros urbanos de la América Tropical. La elevada toxicidad de algunas de las especies del género Tityus ha demandado la preparación de antivenenos específicos en América Latina, única estrategia terapéutica eficaz para el tratamiento de estos accidentes. En Paraguay habitan tres especies del género (T. trivittatus, T. confluens y T. bahiensis) de reconocida peligrosidad en Argentina y Brasil, pero cuya real importancia sanitaria en el país es desconocida. Ante el registro de accidentes severos y el posible escenario de un incremento epidemiológico del escorpionismo en Paraguay producto del calentamiento global, esta revisión presenta las especies conocidas del país, su distribución y datos sobre su toxicidad, a fin de sentar las bases para un necesario estudio que aclare la real magnitud del problema en el país e identifique los antivenenos antiescorpiónicos efectivos en Paraguay.

ABSTRACT Cutaneous and mucocutaneous leishmaniases are endemic in the department of Alto Paraná. In recent years, the number of cases has decreased and the first patients and positive dogs with visceral leishmaniasis have been diagnosed. In order to describe the current situation of leishmaniasis in this department and to identify the perception of political actors, agents of the health system and key community informants in relation to different forms of the disease, a documentary review about the control, diagnosis and treatment was performed. An exploratory, observational, descriptive and qualitative study with the interviewees was also carried out. In urban areas they knew the disease in all its forms, but not in rural areas, where young health officials did not identify signs or symptoms due to their high turnover while training in veterinary medicine at the rural level is limited. SENEPA works in coordination with the municipalities and the Family Health Units. The diagnosis is centralized in the Health Centers and in the Regional Hospital of Ciudad del Este, where medicines are received from the Treatment Program. The Family Health Units do not have laboratories and do not have supplies for diagnosis and treatment. The main complication for treatment is the discontinuity and the economic problems of the population to move to the city, making difficult the access to laboratory tests or other diagnostic studies that are only available there.

RESUMEN Las leishmaniosis cutánea y mucocutánea son endémicas en el departamento de Alto Paraná. En los últimos años ha disminuido el número de casos y se han diagnosticado los primeros pacientes y perros positivos con leishmaniosis visceral. Con el objetivo de describir la situación actual de las leishmaniosis en este departamento e identificar la percepción de actores políticos, agentes del sistema de salud e informantes claves de la comunidad en relación a diferentes formas de la enfermedad, se realizó una revisión documental sobre el control, diagnóstico y tratamiento, además de un estudio exploratorio observacional, descriptivo y cualitativo con los entrevistados. En zonas urbanas conocían la enfermedad en todas sus formas, no así en zonas rurales, donde los funcionarios jóvenes de salud, no identificaron signos ni síntomas debido a la alta rotación, mientras que la capacitación en las veterinarias a nivel rural es limitada. El SENEPA trabaja en coordinación con las municipalidades y las Unidades de Salud Familiar. El diagnóstico está centralizado en los Centros de Salud y en el Hospital Regional de Ciudad del Este, donde se reciben los medicamentos por parte del Programa para el tratamiento. Las Unidades de Salud Familiar no poseen laboratorios y no disponen de fichas ni de insumos para el diagnóstico y tratamiento. La principal dificultad para el tratamiento es su discontinuidad y las dificultades económicas de la población para trasladarse a la ciudad, lo que dificulta el acceso a exámenes de laboratorio u otros estudios diagnósticos que sólo ahí se brindan.

Zanthoxylum chiloperone var. angustifolium Engl., Rutaceae, is used in traditional medicine to treat fungal and protozoal infections in the central area of South America. Considering the increasing resistance of Plasmodium falciparum in malarial ridden areas, we explored the anti-plasmodial effects of three compounds isolated from Z. chiloperone. The pyranocoumarin transavicennol and the canthinone alkaloids, canthin-6-one and 5-methoxycanthin-6-one, were found to have IC50 on chloroquine/mefloquine resistant and sensitive strains of P. falciparum of 0.5-2.7, 2.0-5.3 and 5.1-10.4 ƒÊg/mL, respectively. Moreover, the formation of heme adducts by these compounds is described by a novel alternative method based on MS-CID methods. The alkylamide sanshool was also identified, for first time in this plant, in the dichloromethanic and ethanolic extracts and the extracts were found to be notably non-toxic and displayed good anti-plasmodial effects.