ABSTRACT Introduction: toxoplasmosis is a parasitosis that causes serious infections in immunocompromised patients and newborns. The serological status of the mother influences the possibility of transmission to the fetus if the infection is contracted during pregnancy. It is necessary to know the prevalence of this condition in pregnant women as a first step to carry out actions aimed at knowing the real burden of the disease and reducing this pathology. Objective: determine the IgG and IgM seroprevalence of toxoplasmosis in pregnant women and newborns from January 2017 to January 2021. Methodology: pregnant women in their immediate peripartum period and newborns up to one week of extrauterine life were included. IgG and IgM were measured in peripheral blood by the ECLIA method. The calculated sample size was 800 per group, for the study period. Results: 2524 newborns and 2029 pregnant women were included. The prevalence of IgG was 97.5 % and 97 % for pregnant women and newborns, respectively, and IgM: 4.7 % and 1.9% for women and newborns, respectively. The seroprevalence trends remained constant for IgG for both groups, while IgM showed a slight increasing trend. Conclusions: IgG seroprevalence was close to 100% in both populations, probably due to the transplacental transfer of IgG, however, a small percentage of IgM was noted, a probable marker of acute infection.

RESUMEN Introducción: la toxoplasmosis es una parasitosis que causa infecciones graves en inmunocomprometidos y recién nacidos. El estado serológico de la madre influye en la posibilidad de transmisión al feto si la infección es contraída durante el embarazo. Es necesario conocer la prevalencia de esta afección en gestantes como primer paso para realizar acciones tendientes a conocer la carga real de la enfermedad y disminuir esta patología. Objetivo: determinar la seroprevalencia IgG e IgM de toxoplasmosis de gestantes y recién nacidos periodo de enero 2017 a enero 2021. Metodología: se incluyeron las gestantes en su periodo periparto inmediato y recién nacidos hasta la semana de vida extrauterina. Se midió IgG e IgM en sangre periférica por método ECLIA. El tamaño muestral calculado fue de 800 por grupo, para el periodo de estudio. Muestreo no probabilístico de casos consecutivos. Resultados: fueron incluidos 2524 recién nacidos y 2029 gestantes. Las prevalencias de IgG fueron de 97,5 % y 97 % para gestantes y recién nacidos respectivamente, y la IgM: 4,7% y 1,9 % para mujeres y recién nacidos respectivamente. Las tendencias de las seroprevalencias se mantuvieron constantes para IgG para ambos grupos, mientras que la IgM presentó una leve tendencia al aumento. Conclusiones: la seroprevalencia de IgG fue cercana al 100 % en ambas poblaciones, probablemente debido a la transferencia transplacentaria de IgG, sin embargo, se nota un porcentaje pequeño de IgM, probable marcador de infección aguda.

ABSTRACT Introduction: Leprosy (Hansen's disease) is a neglected infectious disease that affects skin and peripheral nerves, triggering neuropathies and complications such as deformities and disabilities. Objective: determine epidemiological and clinical characteristics of patients with Leprosy in the Dermatological Specialties Center of the Ministry of Public Health and Social Welfare of Paraguay, from January 2021 to December 2022. Methodology: descriptive, observational, retrospective, cross-sectional study. Data management and analysis was carried out in an electronic spreadsheet (Excel from Microsoft Office 365 version 2405), then descriptive statistics were performed. Results: 123 cases of leprosy were diagnosed, 45 (36.58 %) were women and 78 (63.42 %) were men; the ages were between 17 and 86 years, the most affected range was 41 to 50 years. 112 cases (91.06 %) were multibacillary leprosy. The most frequent sign was infiltrated plaque, present in 88 cases (71.54 %). 58 patients (47.15 %) presented lepromatous reactions, 31 cases of type 1 (53.45 %). 34 cases (27.64 %) presented grade 1 disability and 10 cases (8.13 %) grade 2 disability. Conclusion: The profile of the patient with leprosy was male between 41 and 50 years, the majority being multibacillary cases. Early diagnosis and adequate treatment are essential to reduce the burden of the disease and disabilities.

RESUMEN Introducción: lepra (enfermedad de Hansen) es una patología infecciosa desatendida que afecta piel y nervios periféricos, desencadenando neuropatías y complicaciones como deformidades y discapacidades. Objetivos: determinar características epidemiológicas y clínicas de pacientes con lepra en el Centro de Especialidades Dermatológicas del Ministerio de Salud Pública y Bienestar Social de Paraguay, de enero 2021 a diciembre 2022. Metodología: estudio descriptivo, observacional, retrospectivo, de corte transversal. La gestión y análisis de datos se realizó en planilla electrónica (Excel del programa Microsoft Office 365 versión 2405), luego se realizó estadística descriptiva. Resultados: se diagnosticaron 123 casos de lepra, 45 (36,58 %) eran mujeres y 78 (63,42 %) varones; las edades estaban entre 17 y 86 años, el rango más afectado fue de 41 a 50 años. Eran lepra multibacilar 112 casos (91,06%). El signo más frecuente fue la placa infiltrada, presentada en 88 casos (71,54%). 58 pacientes (47,15%) presentaron reacciones lepromatosas, siendo, 31 casos de tipo 1 (53,45 %). 34 casos (27,64%) presentaron discapacidad grado 1 y 10 casos (8,13%) discapacidad grado 2. Conclusión: el perfil del paciente con lepra fue del sexo masculino entre 41 a 50 años, siendo la mayoría casos multibacilares. Es fundamentales el diagnóstico precoz y el tratamiento adecuado para reducir la carga de la enfermedad y las discapacidades.

ABSTRACT Purpose: Vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) is being increasingly adopted due to its faster operating times and lower incidence of postoperative infectious complications (IC), however, studies have been limited by small sample sizes. We hypothesize that vmPCNL is an efficacious treatment for renal stone disease with acceptable stone-free rates (SFR) and low incidence of IC. The objectives of this study were to measure SFR three months after surgery, determine the factors influencing SFR, and determine the rates of postoperative IC after vmPCNL. Materials and Methods: Seven hundred and sixty seven patients underwent vmPCNL for the treatment of renal stones > 20 mm at a single institution. Patients underwent postoperative computed tomography at three months to assess SFR. Postoperative fever and SIRS/Sepsis were recorded for individual patients. Multivariate logistics regression was performed to assess predictors of SFR. Results: The SFR was found to be 73.7% at three months. Stone burden (OR 0.39, 95% CI [0.33-0.46]) and age (OR 1.03, 95% CI [1.01-1.04]) emerged as statistically significant predictors of SFR on multivariate analysis. 5.5% of patients experienced postoperative fever, while 2.9% experienced SIRS/Sepsis. Conclusions: This is the largest continuous cohort of patients to undergo vmPCNL for stone disease and demonstrates that vmPCNL is safe and efficacious, with an SFR of 74% at three months. The incidence of postoperative fever and SIRS/Sepsis is 5.5% and 2.9% respectively. Further randomized studies with large sample sizes are required to ascertain the rates of these complications in comparison to conventional approaches. Purpose Vacuumassisted Vacuum assisted minipercutaneous mini percutaneous (vmPCNL IC, , (IC) however stonefree free (SFR surgery Methods 2 institution SIRSSepsis SIRS Sepsis Results 737 73 7 73.7 OR 039 0 39 0.39 95 0.330.46 033046 0.33 0.46 33 46 [0.33-0.46] 103 1 03 1.03 1.011.04 101104 1.01 1.04 01 04 [1.01-1.04] analysis 55 5 5.5 29 9 2.9 Conclusions 74 respectively approaches (IC 73. 3 0.3 330 0.330.4 03304 033 046 0.4 4 [0.33-0.46 10 1.0 011 1.011.0 10110 101 104 [1.01-1.04 5. 2. 0. 0.330. 0330 [0.33-0.4 1. 1.011. 1011 [1.01-1.0 0.330 [0.33-0. 1.011 [1.01-1. [0.33-0 [1.01-1 [0.33- [1.01- [0.33 [1.01 [0.3 [1.0 [0. [1. [0 [1 [

Resumen Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Resumo Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

Abstract Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Abstract Background and aims: Alcohol-attributable burdens of disease and social costs are a public health concern in Chile. Besides population-wide preventive policy, individual screening and brief counseling are effective ways to lower this burden. This study aims to estimate the national coverage and characteristics of healthcare provider-led alcohol quantity consumption screening (AQS) in Chile. Methods: The study included a random national household sample of 5,240 participants of the Chilean National Health Survey 2017. Estimates -in percentages with confidence intervals (CI)- were weighted by differences in selection probability and nonresponse rates. Logistic regressions were used to test differences between subgroups, adjusting by age, sex, area and region, adjusted for confounders. Results are shown as odds ratios (OR) with CI. Results: Last year, the national AQS prevalence was 30% (95% confidence interval (CI): 27.8-32.5), 31.6% (95% CI: 28.1-35.3), and 28.8% (95% CI: 25.7-31.9) for men and women respectively. The lowest prevalence was observed in 15 to 24 year old participants (25.1%, 95% CI: 19.8-31.1) and the highest (33%, 95% IC: 29.5-37.3) in the 45-64 year old population. Only age (odd rate (OR): 1.06, IC) and hepatotoxic drug use (OR: 1.45, IC) were associated to AQS in multivariable models. Conclusion: These results show that there are low rates of healthcare provider alcohol enquiry in the Chilean health system. Updated data and a more rigorous assessment of this subject are needed to aid in future public health policy design.

Resumen Antecedentes y objetivos: la carga de enfermedad y los costos asociados al consumo de alcohol son un problema de salud pública. Formas eficaces de combatir este problema son la detección individual y la consejería breve. El objetivo de este estudio es estimar y describir la cobertura nacional de consulta sobre consumo de alcohol (CCA) dirigida por profesionales de salud en Chile. Métodos: se incluyó una muestra nacional aleatoria de 5.240 participantes de la Encuesta Nacional de Salud de Chile 2017. Las estimaciones fueron ponderadas según diferencias en la probabilidad de selección y las tasas de falta de respuesta. Resultados expresados en porcentajes con intervalo de confianza (IC). Se realizaron regresiones logísticas univariadas por edad, sexo, zona y región, ajustadas por confundentes. Resultado expresado en odds ratio (OR) junto con IC. Resultados: la prevalencia nacional de CCA fue de 30% (IC 95 %: 27,8-32,5), y de 31,6 % (IC 95 %: 28,1-35,3) y 28,8 % (IC 95%: 25,7-31,9) para hombres y mujeres respectivamente. La prevalencia más baja fue en participantes de 15 a 24 años (25,1%, IC 95%: 19,8-31,1) y la más alta (33%, IC 95%: 29,5-37,3) en la población de 45 a 64 años. En los modelos de regresión, la edad (OR: 1,06; IC 95% 1,00-1,11, por diez años de aumento en la edad) y el uso de drogas hepatotóxicas (OR: 1,45; IC 95%: 1,10-1,90), fueron las únicas variables que se asociaron significativamente con mayor CCA. Conclusión: este estudio encontró bajos porcentajes de CCA en Chile. Hace falta estudiar a mayor profundidad esta problemática para la mejoría o generación de nuevas políticas.

Abstract Introduction The prevalence of otitis media (OM) is substantial all over the world. Epidemiological data related to the economic burden of OM globally is minimal. The present systematic review was undertaken to estimate the economic burden of this disease in various parts of the world. Objectives An extensive literature search was done using PRISMA guidelines to identify relevant studies that estimated the economic burden of OM in monetary terms. The databases searched were PubMed Central, Ovid, and Embase. The cost estimation was done for one specific year and then compared considering the inflation rate. Data Synthesis The literature search led to the inclusion of 10 studies. The studies evaluated direct and indirect costs in monetary terms. Direct costs (health system and patient perspective) ranged from USD (United States Dollar) 122.64 (Netherlands) to USD 633.6 (USA) per episode of OM. Looking at only the patient perspective, the costs ranged from USD 19.32 (Oman) to USD 80.5 (Saudi Arabia). The total costs (direct and indirect) ranged from USD 232.7 to USD 977 (UK) per episode of OM. The economic burden per year was highest in the USA (USD 5 billion). The incidence of OM episodes was found more in children < 5 years old. Introduction of pneumococcal conjugate vaccines decreased the incidence in children and now the prevalence in adults is of concern. Conclusion The economic burden of OM is relatively high globally and addressing this public health burden is important. Approaches for the prevention, diagnosis, and treatment should be undertaken by the health system to alleviate this disease burden. (OM world minimal terms Central Ovid Embase rate 1 perspective United Dollar 12264 122 64 122.6 Netherlands (Netherlands 6336 633 6 633. (USA 1932 19 32 19.3 Oman (Oman 805 80 80. Saudi Arabia. Arabia . Arabia) 2327 232 7 232. 97 UK (UK billion. billion billion) old concern important prevention diagnosis 1226 12 122. 63 193 3 19. 8 23 9 2

Resumen Introducción. La información publicada sobre la correlación entre la magnitud del efecto de todo el espectro de la calidad de vida y la gravedad de la enfermedad en pacientes con dermatitis atópica es escasa. Objetivos. Evaluar la calidad de vida con tres instrumentos diferentes y los índices de gravedad de la enfermedad en pacientes con dermatitis atópica para determinar su correlación y el tamaño del efecto del cambio. Materiales y métodos. Los datos de los pacientes se obtuvieron a partir de dos visitas. Se evaluó la información sociodemográfica y los datos relacionados con la distribución y la gravedad de la enfermedad (mediante de las escalas BSA, EASI, SCORAD, POEM, prurito) y el impacto de la dermatitis atópica en la calidad de vida utilizando el Dermatology Life Quality Index, Skindex-29 y EQ-5D. También se evaluó la correlación entre el cambio en las puntuaciones de calidad de vida y las de gravedad de la enfermedad, además del tamaño del efecto estandarizado. Resultados. Solo 139 de los 212 pacientes completaron la visita de seguimiento. El área de superficie corporal se correlacionó fuertemente con el SCORAD y el EASI, y la correlación más débil fue con el POEM. La mejor correlación del prurito medido con la escala visual análoga se halló con la alteración del sueño. El puntaje SCORAD se correlacionó altamente con el EASI mientras que la correlación más baja se encontró con el POEM. La magnitud del efecto al inicio del estudio respecto al seguimiento fue en promedio de moderada a importante. Conclusiones. Los pacientes con dermatitis atópica experimentan una carga sustancial en la calidad de vida. La actividad de la enfermedad se correlaciona mejor con las mediciones de calidad de vida cuando esta es menos grave, después de comenzar la terapia. Los índices POEM y Skindex-29 parecen ser óptimos para determinar la gravedad de la enfermedad y la calidad de vida en adultos con dermatitis atópica.

Abstract Introduction. Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. Objectives. To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. Materials and methods. Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. Results. Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. Conclusions. Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Abstract The global syndemic is an issue that is gaining notoriety in the world. The syndemic is understood as the interaction between obesity, malnutrition and climate change, that is, synergy of epidemics and complex situations, which coexist in time and place and their consequences for health. However, little is known about the relationship between the global syndemic and the consumption of ultra-processed foods (UPF). In this context, the present essay aims to reflect on the relationship established between the global syndemic and the consumption of UPA. Starting with obesity, it is known that excessive consumption of UPA is one of the main causes of this chronic non-communicable disease. However, there is also a direct relationship between malnutrition and the consumption of UPA, since people who are in a situation of food insecurity choose economically accessible foods, characterizing themselves as a double burden of malnutrition. While studies on sustainable diets advance, knowledge about the association between climate change and UPA consumption is still incipient. Although studies highlight its environmental impacts in the handling and consumption of meat, in addition to the use of pesticides, it may play a secondary role. In this sense, studies are needed that evaluate the consumption of UPA and its relationship with the global syndemic, to support the formulation of public policies aimed at improving the consumption of healthy and sustainable foods for the planet.

Resumen La sindemia global es un tema que está ganando notoriedad en el mundo. La sindemia se entiende como la interacción entre la obesidad, la desnutrición y el cambio climático, es decir, sinergia de epidemias y situaciones complejas, que coexisten en tiempo y lugar y sus consecuencias para la salud. Sin embargo, poco se sabe sobre la relación entre la sindemia global y el consumo de alimentos ultraprocesados (AUP). En este contexto, el presente ensayo tiene como objetivo reflexionar acerca de la relación que se establece entre la sindemia global y el consumo de AUP. Empezando por la obesidad, se sabe que el consumo excesivo de AUP es una de las principales causas de esta enfermedad crónica no transmisible. Sin embargo, también existe una relación directa entre desnutrición y el consumo de AUP, ya que las personas que se encuentran en situación de inseguridad alimentaria eligen alimentos económicamente accesibles, caracterizándose como una doble carga de malnutrición. Mientras avanzan los estudios sobre las dietas sostenibles, el conocimiento sobre la asociación entre el cambio climático y el consumo de AUP es aún incipiente. Aunque los estudios destacan sus impactos ambientales en el manejo y consumo de carne, además del uso de pesticidas, pudiendo jugar un papel secundario. En este sentido, se necesitan estudios que evalúen el consumo de AUP y su relación con la sindemia global, para apoyar la formulación de políticas públicas encaminadas a mejorar el consumo de alimentos saludables y sostenibles para el planeta.

RESUMEN Introducción: los pacientes con enfermedad renal crónica con requerimiento de terapia sustitutiva renal (hemodiálisis) son frecuentes en el Paraguay, lo que afecta la calidad de vida de los que la padecen. Objetivo: conocer la calidad de vida de los pacientes con enfermedad renal crónica en tratamiento hemodialítico en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional en el período 2022-2023. Metodología: observacional, descriptivo, de corte transversal realizado en el Departamento de Nefrología del Centro Médico Nacional-Hospital Nacional de Paraguay. Se incluyeron en el estudio 189 pacientes en que acudieron para tratamiento hemodialítico entre los años 2022-2023. La muestra fue censal. Para determinar la calidad de vida se utilizó el cuestionario Kidney Disease Quality of Life - 36 ítems. Los datos fueron analizados con el programa Epiinfo. Resultados: la edad media de los pacientes fue de 53 años, varones 58.2 %. El 98 % refirió la presencia de algún tipo de comorbilidad concomitante, las más frecuentes fueron diabetes Mellitus 43 % e hipertensión arterial 86 %. La media de meses en tratamiento hemodialítico fue de 20 meses. El cuestionario, Kidney Disease Quality of Life - 36 ítems, arrojó puntajes promedios menores a 50 en el componente mental (65.08) y en el componente físico (71.95) así como en la subescala carga de la enfermedad (55.55). Conclusión: la mayoría de los pacientes con enfermedad renal crónica con tratamiento hemodialítico en el Hospital Nacional evidencian una baja calidad de vida.

ABSTRACT Introduction: patients with chronic kidney disease requiring renal replacement therapy (hemodialysis) are common in Paraguay, which affects the quality of life of those who suffer from it. Objective: to know the quality of life of patients with chronic kidney disease undergoing hemodialysis treatment in the Departmento de Nefrología of the Centro Médico Nacional-Hospital Nacional in the period 2022-2023. Methodology: observational, descriptive, cross-sectional carried out in the Nephrology Department of the Centro Médico Nacional-Hospital Nacional of Paraguay. 189 patients who came for hemodialysis treatment between 2022-2023 were included in the study. The sample was census. To determine quality of life, the Kidney Disease Quality of Life questionnaire - 36 items was used. The data were analyzed with the Epi Info program. Results: the average age of the patients was 53 years, 58.2 % men. 98 % reported the presence of some type of concomitant comorbidity, the most frequent being diabetes mellitus 43 % and arterial hypertension 86 %. The average number of months on hemodialysis treatment was 20 months. The questionnaire, Kidney Disease Quality of Life - 36 items, showed average scores less than 50 in the mental component (65.08) and in the physical component (71.95) as well as in the burden of the disease subscale (55.55). Conclusion: the majority of patients with chronic kidney disease with hemodialysis treatment at the National Hospital show a low quality of life.

RESUMEN Introducción: los niños y adolescentes con enfermedad renal crónica suelen enfrentar desafíos únicos que afectan significativamente su bienestar mental. Objetivo: este estudio tuvo como objetivo evaluar el estado de salud mental de niños y adolescentes con enfermedad renal crónica que reciben atención en el Departamento de Nefrología Pediátrica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Metodología: este fue un estudio observacional descriptivo, prospectivo y transversal. Clasificamos a los participantes según factores sociodemográficos (edad, sexo, lugar de residencia, estado civil y educación de los padres, y ocupación parental) y variables clínicas (edad al diagnóstico de enfermedad renal crónica, patología subyacente, tipo de tratamiento). Las evaluaciones de salud mental utilizaron el Cuestionario Breve para el Cribado y Diagnóstico, adaptado de la Escala Infantil de Rutter. Los diagnósticos se clasificaron como no casos, casos probables sin complicaciones o casos definitivos complicados según la severidad de los síntomas. Resultados: nuestro estudio analizó a 28 jóvenes, predominantemente masculinos (57.1 %), con edades entre 2 y 17 años y una edad media de 12.3 años. Aproximadamente el 42.9 % provenía del campo, y la mitad tenía padres divorciados o separados. Clínicamente, el 42.9 % tenía enfermedad renal crónica en etapas I a III, el 17.9 % estaba en etapa IV, y el 39.3 % había recibido trasplantes de riñón. Las evaluaciones de salud mental mediante Cuestionario Breve para el Cribado y Diagnóstico revelaron que el 39.3 % no mostraba trastornos mentales probables, el 32.1 % eran casos probables sin complicaciones y el 28.6 % eran casos probables con complicaciones. La ansiedad con inhibición y los trastornos de conducta fueron los trastornos predominantes, afectando cada uno al 39.3% de los participantes. Conclusión: nuestra investigación subraya la significativa carga de trastornos de salud mental en un grupo de niños y adolescentes paraguayos con enfermedad renal crónica y la urgente necesidad de servicios de salud mental completos e integrados que estén específicamente diseñados para satisfacer las necesidades de esta población vulnerable.

ABSTRACT Introduction: children and adolescents with chronic kidney disease often face unique challenges that significantly affect their mental well-being. Objective: this study aimed to assess the mental health status of children and adolescents with chronic kidney disease receiving care at the Departamento de Nefrología Pediátrica of the Facultad de Ciencias Médicas of the Universidad Nacional de Asunción. Methodology: this was a descriptive, prospective, cross-sectional observational study. We categorized participants based on sociodemographic factors (age, sex, residence, parents' marital status and education, and parental occupation) and clinical variables (age at chronic kidney disease diagnosis, underlying pathology, treatment type). Mental health assessments utilized the Brief Questionnaire for Screening and Diagnosis, adapted from Rutter's Child Scale. Diagnoses were classified as non-cases, probable uncomplicated cases, or definite complicated cases based on symptom severity. Results: our study analyzed 28 young individuals, predominantly male (57.1 %), aged between 2 and 17 years with a mean age of 12.3 years. Approximately 42.9 % hailed from the countryside, and half had parents who were divorced or separated. Clinically, 42.9 % had chronic kidney disease stages I to III, 17.9 % were at stage IV, and 39.3 % had received kidney transplants. Mental health assessments via Brief Questionnaire for Screening and Diagnosis revealed that 39.3 % did not show probable mental disorders, 32.1 % were probable cases without complications, and 28.6 % were probable cases with complications. Anxiety with inhibition and conduct disorders were the predominant disorders, each impacting 39.3 % of participants. Conclusion: our research underlines the significant burden of mental health disorders in a group of Paraguayan children and adolescents with chronic kidney disease and the pressing need for comprehensive, integrated mental health services that are specifically designed to meet the requirements of this vulnerable population.

ABSTRACT Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

RESUMEN Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

Resumen Una nueva vacuna contra el dengue ha sido reciente mente aprobada en Argentina, y el gobierno argentino se encuentra planificando su adquisición para desarrollar una estrategia de vacunación. Mientras la enfermedad se está dirigiendo gradualmente hacia la endemicidad en algunas regiones del país, la incorporación de estas vacunas tendrá el potencial de atacar la creciente inci dencia de la enfermedad y de reducir su carga. Sin em bargo, el establecimiento de un programa de vacunación puede también ser susceptible de amenazas relaciona das con el cambio epidemiológico de la enfermedad. La selección de un grupo de edad específico para la vacunación puede resultar en un cambio en el pico de la incidencia hacia otros grupos de edad más vulnerables a las formas graves de la enfermedad, como los niños o los ancianos. Además, la percepción de protección lue go de la introducción de la vacuna en una jurisdicción puede reducir la adherencia a las actividades de control del vector, incrementando el riesgo de introducción y transmisión del virus en otras áreas no priorizadas por la estrategia de vacunación, y aumentando el riesgo de otras arbovirosis como las fiebres Zika y chikungunya. Estas y otras potenciales limitaciones para ser conside radas antes de la implementación de los programas de vacunación son discutidas en este artículo, en conjunto con una serie de recomendaciones sobre cómo abordar estas preocupaciones. Estas recomendaciones pueden resultar de utilidad para los tomadores de decisión y actores sanitarios, en esta etapa temprana del desarrollo de un programa de vacunación.

Abstract A new dengue vaccine has recently been licensed in Argentina, with the Argentine government planning to acquire it in order to develop a vaccination strategy. As the disease is gradually following a path to endemicity in some regions of the country, the incorporation of these vaccines will have the potential to tackle the grow ing incidence of the disease and to reduce the disease burden. However, the establishment of the vaccination programme may also be susceptible of threats related to the epidemiological shift of the disease. Selecting a specific age group for the vaccine may result in a change in the peak incidence to other age groups more suscep tible to severe forms of the disease, such as children or the elderly. Furthermore, the perception of protection following vaccine introduction in one jurisdiction may reduce adherence to vector control activities, increasing the risk of virus introduction and transmission in other areas not prioritised by the vaccination strategy, and the risk of other arboviral diseases such as Zika and chikun gunya fever. These and other potential limitations to be considered prior to the implementation of vaccination programmes are discussed in this article, with a series of recommendations on how to address these concerns. These recommendations can help decision makers and public health practitioners at this early stage of the vac cination programme development.

Resumo A doença cardiovascular é a causa predominante de mortalidade em escala global. A pesquisa indica que as mulheres, em comparação aos homens, apresentam maior probabilidade de apresentar doença arterial coronariana (DAC) não obstrutiva quando têm sintomas de isquemia miocárdica. Além disso, as mulheres tendem a apresentar uma maior carga de sintomas em relação aos homens e, apesar da presença de doença cardíaca isquêmica, são frequentemente tranquilizadas erroneamente devido à ausência de DAC obstrutiva. Nos casos de cardiopatia isquêmica acompanhada de sintomas de isquemia miocárdica, mas sem DAC obstrutiva, é imperativo considerar a disfunção microvascular coronariana como uma potencial causa subjacente. A disfunção microvascular coronariana, caracterizada por reserva de fluxo coronariano prejudicada resultante de anormalidades funcionais e/ou estruturais na microcirculação, está associada a desfechos cardiovasculares adversos. Modificações no estilo de vida e o uso de medicamentos antiateroscleróticos e antianginosos podem oferecer benefícios potenciais, embora sejam necessários mais ensaios clínicos para informar estratégias de tratamento. Esta revisão tem como objetivo explorar a prevalência, mecanismos subjacentes, abordagens diagnósticas e intervenções terapêuticas para disfunção microvascular coronariana. global (DAC miocárdica disso subjacente eou ou microcirculação adversos potenciais tratamento prevalência subjacentes

Abstract Cardiovascular disease is the predominant cause of mortality on a global scale. Research indicates that women exhibit a greater likelihood of presenting with non-obstructive coronary artery disease (CAD) when experiencing symptoms of myocardial ischemia in comparison to men. Additionally, women tend to experience a higher burden of symptoms relative to men, and despite the presence of ischemic heart disease, they are frequently reassured erroneously due to the absence of obstructive CAD. In cases of ischemic heart disease accompanied by symptoms of myocardial ischemia but lacking obstructive CAD, it is imperative to consider coronary microvascular dysfunction as a potential underlying cause. Coronary microvascular dysfunction, characterized by impaired coronary flow reserve resulting from functional and/or structural abnormalities in the microcirculation, is linked to adverse cardiovascular outcomes. Lifestyle modifications and the use of anti-atherosclerotic and anti-anginal medications may offer potential benefits, although further clinical trials are necessary to inform treatment strategies. This review aims to explore the prevalence, underlying mechanisms, diagnostic approaches, and therapeutic interventions for coronary microvascular dysfunction. scale nonobstructive non CAD (CAD men Additionally andor or microcirculation outcomes antiatherosclerotic anti atherosclerotic antianginal anginal benefits strategies prevalence mechanisms approaches

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken. Objectives barriers delays Methods extension P (P years C (C databases VHLLilacs VHL Lilacs VHL/Lilacs PubMed Cochrane Scopus Science limitation Results included countries vulnerability patients Conclusions COVID19 COVID 19 COVID-1 COVID1 1 COVID-

Resumo Introdução: As doenças respiratórias são uma das principais causas de doença e morte, ocupando o terceiro lugar em Portugal. Globalmente, a Doença Pulmonar Obstrutiva Crónica (DPOC) é a terceira principal causa de morte, a seguir às doenças cardiovasculares e ao acidente vascular cerebral. Identificar indivíduos de alto risco e implementar tratamento precoce é crucial devido à variabilidade dos sintomas e exacerbações na DPOC. Este estudo teve como objetivo determinar estratégias eficazes para prevenir exacerbações e complicações relacionadas. Métodos: Foi desenvolvido um estudo Delphi que envolveu 15 especialistas de diversas áreas, incluindo médicos, enfermeiros, gestores de saúde, decisores políticos, especialistas em saúde pública e representantes de organizações de pessoas com doença. Os especialistas utilizaram uma escala, variando de “Concordo” a “Discordo”, para alcançar um nível de consenso de 73,3% para cada estratégia. Foram realizadas três rodadas para abordar seis perguntas relacionadas com o diagnóstico precoce e seguimento dos doentes. A primeira ronda centrou-se na identificação dos principais desafios enfrentados pelo sistema de saúde português na gestão da DPOC, dos obstáculos na identificação e gestão das exacerbações da DPOC e das estratégias eficazes para ultrapassar as barreiras identificadas. A segunda e a terceira rondas envolveram a análise da informação recolhida e a votação de cada indicador para obter consenso. Os indicadores resultantes foram categorizados em dois grupos: barreiras, desafios e constrangimentos na gestão da DPOC e estratégias de ação para melhorar a prevenção, a referenciação e diminuir exacerbações e o peso desta doença. Resultados: De um total de 134 indicadores válidos gerados, 108 obtiveram consenso. Dos indicadores consensualizados pelos peritos, 18 dizem respeito a barreiras, desafios e constrangimentos, enquanto 90 são referentes a estratégias de ação para a DPOC. Entre as estratégias formuladas, 25 indicadores com consenso visam estratégias de prevenção, 24 indicadores com consenso têm como alvo a referenciação da DPOC e 41 indicadores com consenso concentram-se em mitigar as exacerbações da DPOC e reduzir a carga da doença. Discussão/Conclusão: Este estudo enfatiza a necessidade de investimento integrado na saúde respiratória e o reconhecimento do impacto da DPOC na vida das pessoas, nos sistemas de saúde e na economia. A prevenção e o tratamento adequado das exacerbações são cruciais para uma gestão eficaz da DPOC e para reduzir a morbidade e a mortalidade associadas. Os especialistas destacam a importância de melhorar a coordenação entre diferentes níveis de cuidados, integrar sistemas de informação e descentralizar as responsabilidades hospitalares. A pandemia da COVID-19 reforçou a importância da saúde respiratória individual e coletiva, enfatizando a necessidade de investir na promoção da saúde e na consciencialização sobre a DPOC.

Abstract Introduction: Respiratory diseases, ranking the third in Portugal, contribute significantly to illness and mortality. Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally. Identifying high-risk individuals and implementing early treatment is crucial due to the variability of COPD symptoms and exacerbations. This study aimed to identify effective strategies for preventing exacerbations and complications. Methods: A Delphi involving 15 experts was performed. Experts included physicians, nurses, health managers, policymakers, public health experts, and patient organizations. Consensus was achieved at 73.3% for each strategy using a scale ranging from “agree” to “disagree.” Three rounds were conducted to address six questions related to early diagnosis and patient follow-up. Challenges faced by the Portuguese Health System in managing COPD, obstacles in COPD exacerbation diagnosis and management, and effective strategies to overcome barriers were identified in the first round. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus, respectively. Indicators were categorized into constraints and barriers, and strategies for reducing COPD exacerbations and disease burden. Results: Out of a total of 134 valid indicators generated, 108 achieved consensus. Among the indicators agreed upon by experts, 18 pertained to barriers, challenges, and constraints, while 90 focused on action strategies for COPD. Among the strategies formulated, 25 consensus indicators target prevention strategies, 24 consensus indicators aim to enhance COPD referrals, and 41 consensus indicators focus on mitigating COPD exacerbations and reducing the overall disease burden. Discussion/Conclusion: This study emphasizes the need for integrated investment in respiratory healthcare and recognition of the impact of COPD on patients, healthcare systems, and economies. Prevention and appropriate treatment of exacerbations are crucial for effective COPD management and reducing associated morbidity and mortality. Experts highlight the importance of improving coordination between different levels of care, integrating information systems, and decentralizing hospital responsibilities. The COVID-19 pandemic has further emphasized the importance of individual and collective respiratory health, necessitating investment in health promotion and COPD awareness.