The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stands for being the most serious epidemic (so far) of the 21st century. However, only a few computational studies have investigated the molecular mechanisms underlying the neutralization of the spike protein by antibodies of different classes. Hence, bioinformatic methods were employed to unravel the factors contributing to the remarkable neutralization capacity exhibited by specific antibodies. Initially, crystallographic structures of IgA monomeric / dimeric, IgG, and IgM antibodies binding with the receptor-binding domain region of the SARS-CoV-2 spike protein were retrieved. Subsequently, rigid molecular docking and molecular dynamic simulations were performed over 100 ns with explicit water solvation. Lastly, an energy decomposition was conducted to estimate the binding affinity using the last frames from molecular dynamics. The results revealed a higher binding affinity for both monomeric and dimeric forms of IgA antibodies against the spike protein. Additionally, a greater number of hydrogen bonds were observed during their interaction with the spike protein, as well as greater structural instability along the time and especially a more thermodynamically favorable interaction affinity. In this way, the research contributes a small piece to the complex puzzle of understanding the humoral immune response induced by the SARS-CoV-2 virus. SARSCoV2 SARSCoV SARS CoV (SARS-CoV-2 so far st century However classes Hence Initially IgG receptorbinding receptor SARS-CoV- retrieved Subsequently 10 solvation Lastly dynamics Additionally way virus (SARS-CoV- SARS-CoV 1 (SARS-CoV

Abstract: The article presents the discussion of medical knowledge about yellow fever during an epidemic episode that occurred in the city of Mérida and other towns in the state of Yucatán between 1911 and 1912. This work was prepared based on the scientific reports from physicians who conducted research on this disease and malaria. The Statistical Bulletin was reviewed to contrast the figures provided by both scientists and health authorities. Regarding epidemic episodes, the reports were critical of the provisions of the health authorities because they did not constantly monitor susceptible people. On the other hand, the origin of the condition broke with the postulates in the medical literature. In addition, the clinical manifestations of the patients in the interior generated a debate on the methods for diagnosis through of laboratory analysis and therapy.

Resumen: Este artículo presenta la discusión de los conocimientos médicos sobre la fiebre amarilla durante un episodio epidémico que se presentó en la ciudad de Mérida y otros poblados del estado de Yucatán, entre los años de 1911 y 1912. Este trabajo se elaboró con base en los reportes científicos de los médicos que realizaron investigaciones sobre esta enfermedad y el paludismo. Se revisó el Boletín de Estadística para contrastar las cifras proporcionadas tanto por los científicos como por las autoridades sanitarias. En cuanto a los episodios epidémicos, los reportes eran críticos con las disposiciones de las autoridades sanitarias porque no hacían un seguimiento constante de las personas susceptibles. Por otra parte, el origen del padecimiento rompía con los postulados de la literatura médica. Además, las manifestaciones clínicas de los enfermos del interior generaron un debate sobre los métodos para el diagnóstico a través de los análisis de laboratorio y la terapéutica.

Abstract Introduction: The COVID-19 epidemic has manifested geographically as clusters of high morbidity (hot zones) and as cold spots of low incidence, which have been explained based on social variables. Objective: To characterize morbidity patterns due to COVID-19 in Costa Rica from March 2020 to May 2022 and to explain them through social determinants of health in the geographical context. Methods: An ecological study at the district level was designed with data on vaccination against COVID-19, weekly reports on speed of advance of the epidemic, development level, and other demographic data. Thematic maps were constructed, and spatial morbidity patterns were identified and characterized, which were explained using linear and geographically weighted regression models. Results: In the Greater Metropolitan Area and surrounding area, clusters of hot spots were identified, and cold spots flanked these high-incidence areas. The linear regression model, built from the variables: average number of vaccines per person, speed in weekly case reporting, social development in its economic, educational, and health dimensions, as well as the proportion of overcrowded homes and people born in the outside, explained more than 70 % of the spatial variations of the incidence of cases (crude and standardized by age and sex). The geographically weighted model corrected autocorrelation problems, improving the explanatory capacity to 82 %. Conclusions: morbidity during the COVID-19 epidemic until May 2020 was configured spatially through well-established clusters of hot and cold spots. This structure could be explained from the social determinants of health, proving that effects on morbidity are generated, differentiated territorially.

Resumen Introducción: En distintos países, la epidemia de covid-19 se ha manifestado en el espacio geográfico como conglomerados de alta morbilidad o zonas calientes, y como conglomerados de puntos fríos de baja incidencia, los que han sido explicados a partir de variables sociales. Objetivo: Caracterizar los patrones la morbilidad de covid-19 en Costa Rica entre marzo del 2020 y mayo del 2022, y explicarlos desde los determinantes sociales de la salud en el contexto geográfico. Métodos: Se diseñó un estudio ecológico a nivel distrital, con datos sobre vacunación contra covid-19, reportes semanales sobre la velocidad de avance de la epidemia, el nivel de desarrollo, y otros datos demográficos. Se construyeron mapas temáticos, se identificaron y caracterizaron los patrones geoespaciales de la morbilidad explicados a partir de modelos de regresión lineal y geográficamente ponderada. Resultados: Se identificaron conglomerados de puntos calientes en la Gran Área Metropolitana y su entorno, y puntos fríos que flanquean esta zona de alta incidencia. El modelo de regresión lineal que incluyó el promedio de vacunas por persona, la velocidad en el reporte de casos semanal, el desarrollo social en sus dimensiones económica, educacional y sanitaria, así como la proporción de viviendas hacinadas y de personas nacidas en el exterior, explicó más del 70 % de las variaciones espaciales de la incidencia de casos (bruta y estandarizada por edad y sexo). El modelo geográficamente ponderado corrigió problemas de autocorrelación mejorando la capacidad explicativa a un 82 %. Conclusiones: La morbilidad durante la epidemia de covid-19, en Costa Rica, durante el período evaluado, se configuró mediante conglomerados espaciales de puntos calientes y fríos muy bien establecidos. Esta estructura se pudo explicar desde los determinantes sociales de la salud, comprobando que se generan efectos en la morbilidad, diferenciados territorialmente.

Abstract This research analyzes three fundamental aspects of the siege of Cuautla: the reasons that motivated thousands of Cuautla residents to enlist in the insurgent ranks of priest Morelos, the causes that later led them to abandon Cuautla during the siege, as well as the measures that the royalist army set out after the siege. Two hypotheses are proposed here. The first propounds that the expansionism of the sugar estates was the main reason for rural workers to uprise. The second maintains that the motives for fleeing the military siege were hunger, bombing, epidemic, and death that the besieged endured for months. To support such stances, the processes of infidence of the deserters, located in the Infidence fund of the Archivo General de la Nación (Mexico), were analyzed through the methods of prosopography and statistics. Finally, the main findings of the article suggest that hunger was the worst enemy of the rebels in the siege of Cuautla, and that indigenous people were the main deserters while the combatants of African origin kept complete adherence to the priest Morelos.

Resumen Esta investigación analiza tres aspectos fundamentales del sitio de Cuautla: las razones que motivaron a miles de cuautlenses a enlistarse en las filas insurgentes del cura Morelos, las causas que más tarde los orillaron a abandonar Cuautla durante el asedio, así como las medidas que el ejército realista emprendió tras el sitio. Son dos las hipótesis aquí presentadas. La primera argumenta que el expansionismo de las haciendas azucareras fue la razón principal de los trabajadores rurales para rebelarse. La segunda sostiene que los móviles para huir del cerco militar fueron el hambre, el bombardeo, la epidemia y la muerte que los sitiados enfrentaron durante meses. Para sostener tales posicionamientos, los procesos de infidencia de los desertores ubicados en el fondo Infidencia del Archivo General de la Nación (México), fueron analizados desde el método de la prosopografía y la estadística. Finalmente, los principales hallazgos del artículo sugieren que el hambre fue el peor enemigo de los rebeldes en el sitio de Cuautla y que los indígenas fueron los principales desertores, mientras que los combatientes de origen africano mantuvieron una adhesión completa al cura Morelos.

Objetivo: Esse estudo teve por objetivo investigar um surto de covid-19 entre PS no serviço de nefrologia de um hospital universitário no Rio de Janeiro em março de 2020 e identificar fatores de risco para infecção pelo SARS-CoV-2. Métodos: Para caracterizar o surto em relação a tríade pessoa-lugar-tempo foi definida como população fonte uma equipe de 59 PS, que foram recrutados e submetidos a entrevistas digitais para reconhecer a ocorrência de sinais e sintomas, comorbidades, de hospitalização durante o período de 1 a 23 de março de 2020. A análise dos dados consistiu na construção e interpretação da curva epidêmica e na identificação de fatores de risco para a infecção durante o surto. Resultados: Dos 59 profissionais do serviço de nefrologia, 43 (73%) participaram do estudo. Eram predominatemente médicos (58%), do sexo feminino (67%), com idade variando de 24 a 69 anos e média de 40 anos. O surto ocorreu entre 1º de março e 23 de março de 2020 e teve pico em 12 e 13 de março. Trinta e dois participantes foram classificados com casos prováveis ​​ou confirmados de covid-19. Entre os casos predominavam mulheres (71%), com idade de 37 anos, predominantemente médicos (45%). Apenas um participante foi hospitalizado. Fatores de risco para covid-19 foram ser médico, trabalhar em outro hospital e ser mulher. Conclusão: Concluímos que houve um surto de covid-19 entre profissionais de saúde do serviço de nefrologia do HUPE em março de 2020. Foram sugeridas medidas de proteção a todos profissionais e exames para infeção para SARS-CoV-2 nos sintomáticos.

Objetivo: Este estudio tuvo como objetivo investigar un brote de covid-19 entre el personal sanitario del servicio de nefrología de un hospital universitario de Río de Janeiro en marzo de 2020 e identificar factores de riesgo para la infección por SARS-CoV-2. Métodos: Para caracterizar el brote en relación con la tríada persona-lugar-tiempo, se definió como población fuente un equipo de 59 PS, quienes fueron reclutados y sometidos a entrevistas digitales para reconocer la aparición de signos y síntomas, comorbilidades y hospitalización. durante el período del 1 al 23 de marzo de 2020. El análisis de datos consistió en construir e interpretar la curva epidémica e identificar factores de riesgo de infección durante el brote. Resultados: De los 59 profesionales del servicio de nefrología, participaron del estudio 43 (73%). Eran predominantemente médicos (58%), mujeres (67%), con edades comprendidas entre 24 y 69 años y una media de 40 años. El brote se produjo entre el 1 y el 23 de marzo de 2020 y alcanzó su punto máximo el 12 y 13 de marzo. Treinta y dos participantes fueron clasificados como casos probables o confirmados de covid-19. Entre los casos predominaron las mujeres (71%), con edad de 37 años, predominantemente médicos (45%). Sólo un participante fue hospitalizado. Los factores de riesgo para el Covid-19 fueron ser médico, trabajar en otro hospital y ser mujer. Conclusión: Concluimos que hubo un brote de covid-19 entre los profesionales de la salud del servicio de nefrología del HUPE en marzo de 2020. Se sugirieron medidas de protección para todos los profesionales y pruebas de infección por SARS-CoV-2 en pacientes sintomáticos.

Objective: This study aimed to investigate a COVID-19 outbreak among HCWs in the nephrology department of a university hospital in Rio de Janeiro in March 2020 and to identify risk factors for SARS-CoV-2 infection. Methods: To characterize the outbreak in relation to the person-place-time triad, a team of 59 HCWs was defined as the source population. They were recruited and submitted to digital interviews to recognize the occurrence of signs and symptoms, comorbidities, and hospitalization during the period from March 1 to 23, 2020. Data analysis consisted of constructing and interpreting the epidemic curve and identifying risk factors for infection during the outbreak. Results: Of the 59 professionals in the nephrology department, 43 (73%) participated in the study. They were predominantly physicians (58%), female (67%), with an age ranging from 24 to 69 years, and an average of 40 years. The outbreak occurred between March 1 and March 23, 2020, and peaked on March 12 and 13. Thirty-two participants were classified as having probable or confirmed cases of COVID-19. The majority of cases were women (71%), aged 37 years, and predominantly physicians (45%). Only one participant was hospitalized. Risk factors for COVID-19 were being a physician, working in another hospital, and being a woman. Conclusion: We conclude that there was an outbreak of COVID-19 among healthcare professionals in the nephrology department of HUPE in March 2020. Protective measures were suggested for all professionals and tests for SARS-CoV-2 infection in symptomatic individuals.

A vigilância em saúde, como vigilância de agravos e doenças, tem um escopo bastante amplo. Discutiremos aqui a face mais conhecida, que é a vigilância de doenças transmissíveis, e assumiremos como mote a pandemia causada pelo vírus SARS-CoV-2. No desenvolvimento do texto, a abordagem se amplia para uma reflexão sobre tecnologias, modelo e organização do sistema. A mais grave epidemia de nossa época, classificada como pandemia, por atingir simultaneamente todo o planeta, tem obrigado a reflexões que envolvem múltiplos campos do conhecimento. O sofrimento decorrente deve inibir a tentação de associá-la a qualquer imagem positiva, ainda que tenha havido oportunidade para aprender e, em algumas circunstâncias, testemunhar a capacidade humana de agir solidariamente. Poucas coisas são tão didáticas como tragédias e erros. Cabe explorá-los cuidadosamente e extrair a necessária retroalimentação para corrigir rumos da atuação em saúde. Neste texto, trataremos das condições que levaram a vigilância em saúde no Brasil a falhar fragorosamente em sua missão frente à emergência desencadeada pela doença do novo coronavírus 2019 e levantaremos pontos que merecem atenção em uma reestruturação do sistema de vigilância em saúde.

The term "health surveillance" encompasses a wide range of activities, including the monitoring and observation of illnesses and diseases. In this section, we will examine the most well-known aspect of health surveillance, namely the monitoring of communicable diseases. To illustrate our discussion, we will use the ongoing pandemic caused by the SARS-CoV-2 virus as a case study. As the text progresses, the focus shifts to an examination of technologies, models, and the structure of the system. The most severe epidemic of our era, classified as a pandemic due to its global impact, has compelled us to reflect on a multitude of disciplines. The resulting suffering should preclude any association with positive images, despite the opportunity to learn and, in some instances, observe the capacity of humans to act in solidarity. It is often observed that few things are as didactic as tragedies and mistakes. It is therefore important to explore them carefully to extract the necessary feedback to correct the course of action in health. In this text, we will discuss the conditions that led health surveillance in Brazil to fail miserably in its mission in the face of the emergency triggered by the novel coronavirus disease 2019. We will also present points that deserve attention in a restructuring of the health surveillance system.

Resumo As arboviroses são endêmicas em vários países e representam um preocupante problema de saúde pública. A mais importante delas é a dengue, que teve um aumento progressivo do número de casos, atingindo a marca dos milhões de casos anuais no Brasil desde a última década. Outras arboviroses de importância para a saúde pública incluem a chikungunya e a Zika, ambas causas de epidemias recentes, e a Febre Amarela, que também tem causado surtos epidêmicos em nosso país. Assim como a maioria das doenças infecciosas, as arboviroses têm o potencial de acometer os rins, por meio de diversos mecanismos que levam à injúria renal, incluindo ação direta dos vírus, inflamação sistêmica, fenômenos hemorrágicos e outras complicações, além da toxicidade de drogas utilizadas no tratamento. Neste artigo de revisão, serão abordados os aspectos epidemiológicos das principais arboviroses no Brasil e em outros países onde estas doenças são endêmicas, os aspectos clínicos e as principais alterações laboratoriais encontradas, incluindo as alterações na função renal. Como as arboviroses se comportam nos pacientes transplantados renais também será descrito. Serão também descritos os mecanismos fisiopatológicos da injúria renal associada às arboviroses e, por fim, o tratamento recomendado para cada doença e as recomendações para o suporte renal neste contexto. dengue década Zika recentes Amarela país infecciosas rins vírus sistêmica complicações revisão encontradas descrito fim contexto

Abstract Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given. problem fever decade Zika epidemics country viruses inflammation complications article found function addressed patients given

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança. décadas (DRC químicos metais, , metais) DRCnt. . (DRCnt) relacionadas disso Brasil país segurança (DRCnt

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD’s etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety. decades (CKD chemicals metals, , metals) nontraditional non traditional CKDnt. . (CKDnt) enforcement Furthermore enforcement) Brazil CKDs s country Moreover safety (CKDnt

RESUMEN Introducción: La covid-19 alteró la situación laboral y el proceso docente educativo de las universidades médicas. Además, hubo un impacto muy negativo en todas las esferas económicas y sociales del país. En el sector de la salud se reorganizaron los servicios y recursos humanos, se afectó la producción del cuadro básico de medicamentos, aumentaron las presiones sobre el sistema de salud pública y asistencia social con el correspondiente incremento de los costos de salud pública y gastos públicos. Objetivo: Describir los efectos sociales, económicos y académicos de la covid-19 en la Facultad de Medicina No. 1 de la Universidad de Ciencias Médicas en Santiago de Cuba. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, durante rebrotes de covid-19 en el periodo de enero a julio de 2021 en trabajadores disponibles y estudiantes de primero a quinto año de la facultad. Se evaluaron características generales y socioeconómicas para cada grupo, como certificados médicos y causas, días afectados, resultados de la pesquisa, y actividad formativa. Se utilizó la estadística descriptiva para el análisis y presentación de los resultados. Resultados: La incidencia de casos positivos fue baja, pero generó miles de días de incapacidad, por aislamientos e ingreso en el hogar. Se pesquisaron más de 5 000 personas sospechosas de la enfermedad, de ellos 19,9 % resultó positivo. La promoción superó 95 % en todos los años de la carrera y fue mayor al de etapa prepidémica, al igual que la eficiencia vertical. Conclusiones: Aunque hubo efectos sociales, económicos y académicos negativos, el trabajo comunitario integral contribuyó a la preservación de la salud de la población y se desarrolló el aprendizaje a distancia.

ABSTRACT Introduction: The COVID-19 altered the employment situation and the educational teaching process of medical universities. In addition, there was a very negative impact on all economic and social areas of the country. In the health sector, services and human resources were reorganized, the production of basic medicines was affected, pressures on the public health and social welfare system increased with corresponding rise in public health costs and expenditures. Objective: To describe the social, economic and academic effects of COVID-19 in the Medical Faculty No. 1 of the Medical Science University in Santiago de Cuba. Methods: An observational, descriptive, retrospective study was conducted during the reoutbreaks of COVID-19 in the period from January to July 2021 in available workers and students from the first to the fifth year of the faculty. General and socio-economic characteristics were evaluated for each group, such as medical certificates and causes, affected days, research results and training activity. Descriptive statistics were used for the analysis and presentation of results. Results: The incidence of positive cases was low, but generated thousands of days of disability due to isolation and home intake. More than 5 000 people suspected pf the disease were surveyed, 19.9 % of them positive. The promotion exceeded 95 % in all years of the major and was higher than the pre-epidemic stage, as well as the vertical efficiency. Conclusions: Although there were negative social, economic and academic effects, the integral community work contributed to the preservation of the population´s health and online classes were developed.

ABSTRACT Starting from the decline in intentional homicide in Mexico during 2023, this article analyzes the roots of the violence crisis that has plagued the country for more than fifteen years. In particular, it seeks to answer the question of the factors, events, or conditions that triggered homicidal violence in Mexico starting in 2007. The article collects the main hypotheses proposed on this issue and reviews their explanatory scope. These hypotheses are divided into three groups. The first consists of government actions that had unintended effects. These include the deployment of military operations in various regions of the country starting in December 2006, the implementation of the kingpin strategy, which involves targeting and arresting high-level drug cartel leaders, and the tightening of drug interdiction mechanisms for drugs coming from South America. The second group consists of specific events related to the proximity to the United States. These include the increase in ex-convicts deported from the United States, the rise in the number of firearms coming from the United States, and the increase in the price of cocaine. Finally, references are made to more structural conditions that preceded 2007. Specifically, political alternation and the crisis of local order manifested by the poor state of local police forces and long-term socio-economic explanations. To bring the discussion to the present moment, specifically to the year 2023, the last part of the text offers a reflection on the persistence of these factors and the future challenges that Mexico faces. This section focuses on two issues that are added to the topics reviewed in the first part of the article: the wave of migration that spread throughout 2023 and the incursion of fentanyl into the national drug market, which was exacerbated in the years following the COVID-19 epidemic.

RESUMEN Tomando como punto de partida el descenso del homicidio doloso en México durante el año 2023, este artículo analiza las raíces de la crisis de violencia que acontece en el país desde hace más de quince años. En particular, busca responder a la pregunta sobre los factores, eventos o condiciones que detonaron la violencia homicida en México a partir del año 2007. El artículo recolecta las principales hipótesis planteadas al respecto y revisa su alcance explicativo. Grosso modo éstas se dividen en tres grupos. El primero está constituido por acciones gubernamentales que tuvieron efectos no deseados. Estos son el despliegue de operativos militares en distintas regiones del país a partir de diciembre de 2006; la ejecución de la estrategia de detención de capos conocida como Kingpin Strategy y el endurecimiento de los mecanismos de interdicción de drogas provenientes de América del Sur. El segundo grupo lo forman eventos específicos relacionados a la colindancia con Estados Unidos. Éstos son aumento de ex convictos deportados de Estados Unidos, crecimiento en el número de armas provenientes de Estados Unidos y alza en el precio de la cocaína. Por último, se hace referencia a condiciones más estructurales que anteceden al 2007. En específico la alternancia política y crisis del orden local manifestado por el pobre estado de las policías locales, así como explicaciones socioeconómicas de largo alcance. Con la finalidad de llevar la discusión al momento actual, en específico al año 2023, la última parte del texto ofrece una reflexión sobre la persistencia de estos factores y los retos hacia el futuro que enfrenta México. Esta sección se centra en dos temas que se agregan a las temáticas revisadas en la primera parte del artículo: la ola migratoria que se extendió a lo largo de todo el 2023 y la incursión del fentanilo en el mercado nacional de drogas potenciada en los años que siguieron a la epidemia de COVID-19.

Resumen El accidente cerebrovascular (ACV) es la principal causa de discapacidad y la tercera causa de mortalidad en nuestro país. Argentina y la región de las Américas se encuentran atravesando el peor brote epidémico de dengue del que se tenga registro, con una importan te demanda en el sistema de salud. El dengue podría aumentar el riesgo de ACV y dada la naturaleza tiem po dependiente del manejo de esta enfermedad para reducir la morbilidad y mortalidad, y las potenciales consideraciones a tener en cuenta en los pacientes con dengue, se presenta una revisión breve de la literatura con puntos de incertidumbre y aspectos a considerar en el protocolo o código de ACV, considerando las ca racterísticas clínicas y alta demanda del sistema de salud provocada por el dengue. Se realiza también un llamado a generar evidencia sobre el manejo del ACV en pacientes con dengue.

Abstract Stroke is the leading cause of disability and the third leading cause of mortality in our country. Argentina and the Region of the Americas are going through the worst epidemic outbreak of dengue on record with significant demand on the health system. Dengue could increase the risk of stroke and given the time-dependent nature of the management of this disease to reduce morbidity and mortality and the potential considerations to be taken into account in patients with dengue, we present a focused review of the literature with points of uncer tainty and aspects to be considered in the stroke code considering the clinical characteristics and high demand of the health system caused by the dengue fever. A call is also made to generate evidence on the management of stroke in patients with dengue.

Resumen Si bien la literatura sugiere establecer reformas impositivas al tabaco más agresivas con el fin de reducir su asequibilidad y combatir la epidemia del tabaquismo, la industria tabacalera argumenta que dichas medidas afectarían a la economía del país. El objetivo del estudio es analizar la dimensión del sector tabacalero en México a través de variables clave sobre precios y marcas, así como cantidades consumidas y simular reformas al impuesto especial del tabaco. Un incremento de los impuestos al tabaco permite disminuir el consumo y aumentar la recaudación considerando elasticidades-precio del tabaco recientes. Se calculó la elasticidad al 2020 y el cambio en los precios considerando la reforma reciente de 2021 que actualizó por inflación el IEPS asi como dos reformas impositivas adicionales a los cigarros y sus marcas. Los resultados indican que un impuesto específico de un peso adicional y $1.50 pesos por cigarrillo reduciría el consumo en el rango del 21.7% al 27.7% e incrementaría la recaudación del 13.4% al 22.7%. Lo novedoso de este trabajo es que la mayor reducción en consumo se observa en las marcas de menor precio.

Abstract While literature suggests more aggressive cigarette tax reforms to reduce its affordability as well as the tobacco epidemic the tobacco industry argues that these measures, would affect the economy. The goal of this study is to analyze the size of the tobacco sector in Mexico through specific relevant variables on prices and brands and simulate different tobacco excise reforms. An increase in tobacco taxes would indeed decrease consumption and would increase revenues as well, when considering different and recent tobacco price elasticities. Elasticity was estimated for the year 2020 and changes on prices were computed by considering the most recent tobacco tax reforms in 2021 which updated the price according to rise on inflation and two additional reforms by using distinct cigarette brands. The results indicate that a specific tax of an additional peso and $1.50 pesos per cigarette would reduce consumption in the range from 21.7% to 27.7% and increase revenues from 13.4% to 22.7%. The novelty of this work is that the greatest reduction in consumption would be observed in lower-priced brands.

The South African food system is facing severe challenges as increasing hunger, rising food costs, lack of dietary diversity, child stunting, foodborne illnesses, food waste and an obesity epidemic coupled with malnutrition are observed. In this study, we aimed to establish the application of science and technology advances in the food and beverage industry in South Africa in response to food consumption pattern changes since 1994 and how they could be used to address food security challenges. We found that food consumption shifts have been towards sugar-sweetened beverages, processed and packaged food, animal-source foods and added caloric sweeteners, and away from vegetables. These dietary shifts are concerning as they relate to public health. Most commitments to improve the nutritional status of South Africans have been limited to corporate social investment strategies and should be extended into core business strategies. Furthermore, although the South African food and beverage industry has kept pace with developments in food manufacturing practices, there has been little experimentation with non-commercial novel technologies. The expert survey revealed that indigenous African crops and food waste recovery are the two most promising emerging food sources that could be available to South Africans in the shortest time frame. South Africa has many enabling drivers to become a global leader in food technology advances. However, many barriers need to be overcome for industry, academia and government to collaborate to advance novel food science and technologies to reach commercialisation. SIGNIFICANCE: • Drivers and consequences of food consumption changes in South Africa were modelled and broad food consumption trends between 1994 and 2009/2012 were identified. • For the first time, the Access to Nutrition Index methodology was applied to South African owned food companies to identify strategies to enhance nutrition practices. Companies need to do more to deliver affordable and accessible products. • Drivers and barriers in adopting advanced food science and technology were modelled. A collective ecosystem approach with industry, academia and government mobilisation around critical areas like hunger, malnutrition and poverty could be a way to tackle the failing food system.

Resumo Introdução: A epidemic intelligence (EI) assegura a deteção precoce, a avaliação e a comunicação das ameaças para a saúde pública para definir prioridades e mobilizar recursos para a investigação, vigilância, prevenção e controlo. Em Portugal, a Direção-Geral da Saúde (DGS) é responsável pela EI e publica semanalmente um relatório de ameaças para a saúde pública (RONDA) que é partilhado com a rede de autoridades de saúde, instituições e profissionais de saúde pública. As alterações nas ameaças comunicadas em relatórios periódicos de ameaças desde a COVID-19 não foram descritas anteriormente. Métodos: Comparámos as ameaças reportadas na RONDA entre 2016 a 2022 em três períodos sequenciais: antes da COVID-19 (janeiro de 2016 - março de 2020), P2 durante as restrições (abril de 2020 - fevereiro de 2022) e P3 na fase pós-aguda da COVID-19 (fevereiro de 2022 - setembro de 2022). Comparamos a frequência média mensal de ameaças não COVID-19 relatadas entre todas as ameaças relatadas nesses períodos, considerando diferentes categorias dentro do grupo de doenças, foco geográfico e fontes de informação. Resultados: As ameaças não-COVID-19 tiveram uma diminuição na frequência média mensal de reporte no Período2 (14,7 vs. 2,3 p < 0.001) em comparação com o Período1, antes da COVID-19. Houve um retorno ao padrão pré-pandêmico de notificação no Período 3 (14,67 vs. 17,63 p < 0.208) para ameaças não COVID-19 com um aumento nas doenças virais emergentes (2,20 vs. 7,62 p < 0.001). O ECDC e a OMS são as fontes de informação mais frequentes, seguidas das fontes nacionais de saúde pública. Conclusões: Durante a COVID-19, houve alterações no reporte de ameaças em Portugal. A COVID-19 possivelmente afetou a EI e os relatórios de ameaças epidémicas globais, possivelmente desviando a atenção e os recursos de outras ameaças para a pandemia. No entanto, a quantidade de ameaças que justificam o acompanhamento e a comunicação pode estar a aumentar. É necessária investigação em comunicação de ameaças detetadas no âmbito da EI a fim de assegurar que todas as ameaças relevantes são avaliadas e comunicadas de acordo com os objetivos da EI, garantindo simultaneamente o investimento em recursos e a preparação para a prevenção e resposta.

Abstract Background: Epidemic intelligence (EI) ensures early detection, assessment, and communication of public health threats. Threat reporting defines priorities and mobilize resources for surveillance, prevention, and control. In Portugal, the Directorate-General of Health (DGS) is responsible for EI and publishes a weekly public health threat report (RONDA). Changes in threats in regular threat reports since COVID-19 have not been previously described. We analysed changes in non-COVID threat reporting in the weekly threat report. Methods: Using the DGS Emergency Operations Centre’s threat reporting database, we compared threats reported in RONDAs from 2016 to 2022 in three sequential periods: P1 before COVID-19 (January 2016-March 2020), P2 during acute COVID-19 restrictions (April 2020-February 2022), and P3 in post-acute COVID-19 phase (February 2022-September 2022). We described the monthly average frequency of reports on non-COVID-19 threats in those periods considering different disease groups, geographical focus, and information sources. We estimated expected non-COVID-19 reports on threats using a forecast model fitted to the time series until March 2020 and compared observed and expected values. Results: Non-COVID-19 threats had a decrease in the monthly average frequency of reporting in period 2 (14,7 vs. 2,3 p < 0.001) compared to period 1. Using the forecast methods, there were 114 fewer non-COVID threats than the 162 expected (−70%) in period 2. In period 3, there were 105 more threats than expected (+256%). The ECDC and the WHO were the most frequent sources of information followed by national Public Health sources. Conclusions: During COVID-19, there was a decrease in reports on non-COVID threats in Portugal. COVID-19 possibly affected global EI, by shifting attention and resources from other threats to the pandemic. However, the number of threats that warrant follow-up and communication is increasing. Further research is necessary to inform the EI research and development agenda, to ensure that all relevant threats are detected, accessed, and communicated according to evolving EI objectives and priorities while resources and preparedness are guaranteed.