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.

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

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.

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.

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.

ABSTRACT Introduction: Influenza is a global threat, with high epidemic potential and affects between 5 and 15% of the world's population annually. In the hospital environment, vaccination is crucial to protect healthcare professionals. However, despite international recommendations, vaccination uptake is low due to safety concerns and/or distrust. Studies show that vaccinated professionals have lower rates of absenteeism, and when infected with the virus, they present milder symptoms. In this work, a retrospective cross-sectional observational study is carried out on the vaccination rate against this disease in a population of hospital-based workers, from 2019 to 2023. To understand the importance of vaccination against Influenza in these workers and which behavioral determinants may justify considering this evolution, we carried out a review of the challenges of vaccination among health professionals and identified key points to develop strategies with the aim of promoting adherence to vaccination campaigns. Methodology: For the observational study, vaccination data from hospital health professionals by the Occupational Health Service was used, recorded on a specific form at the time of administration. Professional category was the only variable considered. Data analysis was performed using Microsoft® Excel®. For the review, the databases Medline, Science Direct and Google Scholar were used, with the keywords "Influenza vaccine”, “health professional” and “behaviour”, selecting studies from 2010 to 2024. From the result of 1277 works, the exclusion criteria, which included vaccination for other diseases and target populations that did not include health professionals, 22 bibliographic sources were selected. To reflect the national reality, articles on the topic published by the Revista Portuguesa de Saúde Ocupacional Online were included, as well as complementary studies and reference documents. Results: The study of adherence to flu vaccination in this hospital peripheral to Lisbon, between 2019 and 2023, showed a variation in vaccination adherence, with an average of 30%, a value below the ones reported in other countries. The categories most hesitant about this vaccine were Nursing Staff and Technical Assistants; at the opposite extreme, there was greater adherence from Medical Personnel and Technical Assistants. During the COVID-19 Pandemic, an increasing number of professionals were vaccinated annually, with this trend reversing after the end of the global emergency of this disease. From the review of the literature on vaccine hesitancy, 8 of the 14 behavioral domains stand out that represent theories of behavioral change that constitute modifiable factors that influence behavior in relation to the vaccine. We approach each of them from this perspective, namely: knowledge, the environmental context and resources, social influence, beliefs and knowledge about consequences, beliefs about individual capacity, identity and social/professional role, reinforcement and emotion. Discussion: Flu vaccine hesitancy among healthcare professionals can be a cause of morbidity and mortality for patients. Understanding the barriers and motivation for healthcare professionals to adhere to flu vaccination campaigns is crucial. Professionals who are asymptomatic carriers become sources of transmission. Annual vaccination, although safe and effective, faces variability due to antigenic concordance. In Portugal, educational and communication strategies are vital, highlighting the role of health professionals as models of preventive behavior. Easy access to medical consultations and Occupational Health recommendations is associated with greater adherence. In times of pandemic, the propensity for vaccination has increased, and it is important to promote this change. Strategies adapted to the cultural context are essential to boost adherence to Influenza vaccination among healthcare professionals. Conclusion: The approach to combating barriers and promoting vaccination among healthcare professionals must involve multiple areas and multiple levels, with communication targeted at specific groups, to increase its effectiveness. The message must be adapted to different population groups and different levels of health literacy. Knowing these behavioral determinants can help develop vaccination promotion campaigns from new perspectives and finding strategies to increase vaccination coverage is crucial for Occupational Health Services. Due to the ethical characteristics of the professions involved in providing direct care to patients, there is a need to reinforce the idea that vaccination among healthcare professionals is not only for their benefit, but above all for the protection of their patients.

RESUMO Introdução: A Gripe é uma ameaça global, com alto potencial epidémico e afeta anualmente entre 5 a 15% da população mundial. No ambiente hospitalar, a vacinação é crucial para proteger os Profissionais de Saúde. No entanto, apesar das recomendações internacionais, a adesão é baixa devido a preocupações de segurança e/ou desconfiança. Estudos mostram que os profissionais vacinados têm menores taxas de absentismo e, perante infeção pelo vírus, apresentam sintomatologia mais ligeira. Neste trabalho é realizado um estudo observacional transversal retrospetivo da taxa de vacinação contra esta doença numa população de trabalhadores de base hospitalar, no período de 2019 a 2023. Para compreender a importância da vacinação contra a Influenza nestes trabalhadores e quais os determinantes comportamentais que podem justificar esta evolução, realizou-se uma revisão dos desafios da vacinação entre Profissionais de Saúde, para identificar pontos chave e elaborar estratégias com o objetivo de promover a adesão às campanhas de vacinação. Metodologia: Para o estudo observacional da taxa de adesão à vacinação contra a Gripe num hospital periférico foram utilizados os dados de vacinação dos Profissionais de Saúde disponibilizados nos registos do Serviço de Saúde Ocupacional. A categoria profissional foi a única variável considerada. A análise dos dados foi realizada com o Microsoft® Excel®. Para a revisão recorreu-se às bases de dados Medline, Science Direct, Google Scholar; com as palavras-chave "Influenza vaccine”; “health professional” e “behaviour" e filtraram-se estudos de 2010 a 2024. Resultaram 1277 trabalhos e, após aplicar os critérios de exclusão, que incluíam vacinação para outras doenças e populações alvo que não os Profissionais de Saúde, foram selecionadas 22 fontes bibliográficas. Para espelhar a realidade nacional foram incluídos os artigos sobre o tema publicados pela Revista Portuguesa de Saúde Ocupacional Online, assim como estudos complementares e documentos de referência. Resultados: O estudo da adesão à vacinação contra a Gripe neste hospital periférico a Lisboa, entre 2019 e 2023, mostrou uma variação na adesão à vacinação, com uma média de 30%, valor abaixo dos valores reportados noutros países. As categorias com maior hesitação a esta vacina foram o Pessoal de Enfermagem e os Assistentes Técnicos. Na situação oposta estavam o Pessoal Médico e os Assistentes Técnicos. Durante a Pandemia COVID-19 existiu um número crescente de profissionais vacinados anualmente, tendo esta tendência invertido após o fim da emergência global desta doença. Da revisão da bibliografia sobre a hesitação vacinal destaca-se 8 dos 14 domínios comportamentais que representam as teorias de mudança comportamental que constituem fatores modificáveis que influenciam a atitude em relação à vacina. Abordou-se sobre esta perspetiva cada um deles, nomeadamente, o conhecimento; o contexto ambiental e recursos; influência social; crenças e conhecimento sobre consequências; bem como sobre a capacidade individual; identidade e papel social/profissional; reforço e emoção. Discussão: A hesitação vacinal contra a Gripe entre Profissionais de Saúde pode ser uma causa de morbilidade e mortalidade para os doentes. Compreender as barreiras e motivação para a adesão dos Profissionais de Saúde às campanhas de vacinação contra a Gripe é crucial. Profissionais portadores assintomáticos, tornam-se fontes de transmissão. A vacinação anual, embora segura e eficaz, enfrenta variabilidade devido à concordância antigénica. Em Portugal, estratégias educacionais e de comunicação são vitais, destacando o papel dos Profissionais de Saúde como modelos de comportamento preventivo. O acesso fácil a consultas médicas e tal ser recomendado pela Saúde Ocupacional é associado a maior adesão. Em tempos de pandemia, a propensão à vacinação aumentou, importando promover esta mudança. Estratégias adaptadas ao contexto cultural são essenciais para impulsionar a adesão à vacinação contra a Gripe entre Profissionais de Saúde. Conclusão: A abordagem para combater as barreiras e promover a vacinação nos Profissionais de Saúde deve envolver múltiplas áreas e vários níveis, com uma comunicação dirigida a grupos específicos, para aumentar a sua eficácia. Deve adaptar-se a mensagem aos diferentes grupos populacionais e aos diferentes níveis de literacia em saúde. Conhecer estes determinantes comportamentais pode ajudar a desenvolver campanhas de promoção da vacinação a partir de novas perspetivas e encontrar estratégias para aumentar a cobertura vacinal é crucial para os Serviços de Saúde Ocupacional. Pelas características éticas das profissões envolvidas na prestação de cuidados diretos aos doentes, existe a necessidade de reforçar a ideia de que a vacinação entre Profissionais de Saúde não é apenas para seu benefício mas, acima de tudo, para proteção dos seus doentes.

Abstract Objectives : To monitor the oviposition activity of the mosquito Aedes aegypti and of dengue and chikungunya cases in four localities of temperate Argentina, during the 2023 epidemic. Methods : During the summer and autumn of 2023, the oviposition activity of the mosquito vector was monitored weekly using ovitraps, and the arrival of cases with dengue or chikungunya in Tandil, Olavarría, Bahía Blanca and Laprida were registered. Results : Monthly variations of the percentage of positive traps were similar in the first three locations; in Laprida the mosquito was not detected. On the con trary, a significant difference was observed in the per centage of total traps that ever tested positive in each locality, being higher in Olavarría (83.3%) than in Bahía Blanca (68.6%) and Tandil (48.7%). Regarding diseases, 18 imported cases of dengue and 3 of chikungunya were registered. In addition, the first autochthonous case of dengue in the region was recorded, being the southern most until known. Conclusion : It is essential to raise awareness and train the members of the health systems of the new regions exposed to Ae. aegypti for early detection of cases, and to the general population to enhance pre vention actions.

Resumen Objetivos : Monitorear la actividad de oviposición del mosquito Aedes aegypti y de casos de dengue y chikun gunya en cuatro localidades de Argentina templada, durante la epidemia del 2023. Métodos : Durante el verano y otoño del 2023, se mo nitoreó semanalmente mediante ovitrampas la actividad de oviposición del mosquito vector, y se registró el arribo de casos con dengue o chikungunya a Tandil, Olavarría, Bahía Blanca y Laprida. Resultados : La variación mensual del porcentaje de trampas positivas fue similar en las tres primeras localidades; en Laprida no se detectó el mosquito. Por el contrario, se observó una diferencia significativa del porcentaje de trampas que alguna vez resultó positiva en cada localidad, siendo mayor en Olavarría (83%), que en Bahía Blanca (67%) y Tandil (49%). Respecto a las enfermedades, se registraron 18 casos importados de dengue y 3 de chikungunya. Además, se registró el primer caso autóctono de dengue en la región, siendo el más austral hasta el momento. Conclusión : Es imprescindible sensibilizar y capacitar a los integrantes de los sistemas de salud de las nue vas regiones expuestas al Ae. aegypti para la detección temprana de casos, y a la población en general para potenciar las acciones de prevención.

Abstract Introduction : Combined prevention (CP) is considered the key strategy against the HIV epidemic. The objective of the study was to evaluate the perception of risk of HIV infection and the knowledge about the use of antiretro virals (ARV) for prevention, among patients who attend a Sexually Transmitted Infections (STI) clinic. Methods : A survey on personal data and perception of risk of HIV infection, knowledge about post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), was administered to patients at the time of applying doses of penicillin for the treatment of syphilis, or when taking a blood sample for STI diagnosis, between May and December, 2022. Results : 100 persons were surveyed: 43 were under 25 years of age, 67 reported male sex-gender and 33 fe males. Thirty of 91 (33%) perceived they had had some risk of infection in their lives, 19 of them in the last year; 77/96 (80%) stated that they had no knowledge about PEP, and 82/100, about PrEP. Only 22 out of 100 responded that antiretrovirals could provide benefit in preventing HIV; 26 (60%) of the 43 patients <25 years of age, and 18 of the 57 ≥ 25 years (31.6%) responded they have had two or more sexual partners in the last year. No statistically significant differences were observed related to gender and age group. Discussion : The low perception of infection risk and knowledge about the use of antiretrovirals in HIV pre vention, show the existing difficulties for the imple mentation of combined prevention (PEP-PrEP) in this population.

Resumen Introducción : La prevención combinada (PC) se con sidera la estrategia clave frente a la epidemia de HIV. El objetivo del estudio fue evaluar la percepción de riesgo de infección por HIV y el conocimiento sobre uso de antirretrovirales (ARV) para prevención, entre pacien tes que concurren a un consultorio de Infecciones de Transmisión Sexual (ITS). Métodos : Una encuesta sobre datos personales y percepción de riesgo de infección por HIV, conocimiento sobre profilaxis posterior a la exposición (PEP) y previa a la exposición (PrEP), fue administrada a pacientes al momento de aplicar dosis de penicilina para tratamiento de sífilis, o de extraer muestra de sangre para diagnós tico de ITS, entre mayo y diciembre, 2022. Resultados : De 100 personas encuestadas, 43 eran menores de 25 años, 67 reportaron sexo-género mascu lino y 33 femenino. Treinta de 91, (33%), percibían haber tenido en su vida algún riesgo de infección, 19 de ellas en el último año; 77/96 (80%) manifestaron no tener conocimiento sobre PEP, y 82/100, sobre PrEP. Solo 22% respondió que los antirretrovirales podrían brindar be neficio para prevenir el HIV; 26 (60%) de los 43 menores de 25 años, y 18 de los 57 ≥ 25 años (31.6%) respondieron haber tenido dos o más parejas sexuales el último año. No se observaron diferencias estadísticamente signifi cativas, relacionadas con género y grupo etario. Discusión : La baja percepción de riesgo de infección y del conocimiento sobre uso de antirretrovirales para prevención de HIV, evidencian las dificultades existentes en la implementación de prevención combinada (PEP-PrEP) en esta población.

RESUMEN Introducción: la leishmaniasis representa un grave problema de salud pública en diversas regiones de América Latina. Su impacto, magnitud y brotes epidémicos son consecuencia de políticas gubernamentales ineficientes. Objetivo: caracterizar una serie de casos de leishmaniasis cutánea. Métodos: se realizó una investigación descriptiva, de corte transversal, en la Universidad Nacional de San Cristóbal de Huamanga, Ayacucho, Perú, durante el período julio-septiembre de 2023. De un universo de estudio de siete pacientes, se trabajó con una muestra de igual denominación, obtenida mediante un muestreo intencional. El procesamiento de los datos se realizó con el Paquete Estadístico para las Ciencias Sociales (SPSS), versión 25,0, obteniéndose valores absolutos y porcentajes como medidas de resumen. Los resultados se presentaron en forma de textos, tablas y figuras. Resultados: los casos procedieron de cinco pueblos del distrito Ayna, provincia La Mar, departamento Ayacucho, Perú. El 71,4 % iniciaron los síntomas en el mes de marzo, en tanto cinco de los siete casos eran del sexo femenino y predominaron las lesiones en las extremidades inferiores (57,1 %). En las imágenes mostradas se observa la úlcera típica de fondo limpio, color rosado y tejido granuloso, redondeada, de bordes regulares y elevados. Conforme a los valores de laboratorio, la media para las cifras de hemoglobina resultó de 13,6 mg/dl. Conclusiones: los casos se caracterizaron por no presentar nexo epidemiológico y su presentación ocurrió en una época propicia para la proliferación de mosquitos. Las lesiones típicas permitieron el diagnóstico precoz y tratamiento oportuno.

ABSTRACT Introduction: leishmaniasis represents a serious public health problem in various regions of Latin America. Its impact, magnitude and epidemic outbreaks are a consequence of inefficient government policies. Objective: characterize a series of cases of cutaneous leishmaniasis. Methods: a descriptive, cross-sectional investigation was carried out at the National University of San Cristobal de Huamanga, Ayacucho, Peru, during the period July-September 2023. From a study universe of seven patients, we worked with a sample of the same name, obtained through intentional sampling. Data processing was carried out with the Statistical Package for the Social Sciences (SPSS), version 25.0, obtaining absolute values and percentages as summary measures. The results were presented in the form of texts, tables and figures. Results: the cases came from five towns in the Ayna district, La Mar province, Ayacucho department, Peru. Symptoms began in 71,4 % in the month of March, while five of the seven cases were female and lesions in the lower extremities predominated (57,1 %). In the images shown, the typical ulcer with a clean bottom, pink color and granular tissue, rounded, with regular and raised edges is observed. According to the values of the laboratory tests, the average hemoglobin levels were 13,6 % mg/dl. Conclusions: the cases were characterized by not presenting epidemiological links and its presentation occurred at a time conducive to the proliferation of mosquitoes. Typical lesions allowed early diagnosis and timely treatment.

Abstract We sought to understand the domestic work and care-providing activities carried out by women who fathered children with congenital Zyca virus syndrome (or microcephaly). Anchored by the ergological perspective, we conducted a study with the participation of nine mothers of children born with disabilities due to the Zyca epidemic. All the participants were from the northeast of Brazil, 28 years old on average; most of them were black and had little schooling. The results show that these women have a set of tasks to perform that go beyond the ordinary activities of conventional motherhood, requiring a know-how that is built up in practice, in interaction with health professionals and with other mothers who have similar experiences. The findings endorse the debate on care work, questioning the myth that it is unqualified and reaffirming it as a complex task that requires engagement and intelligence for carrying it out and managing it on a daily basis.

Resumo Buscamos compreender as atividades de trabalho doméstico e de cuidado desenvolvidas por mulheres mães de crianças com a síndrome congênita de Zyca vírus (ou microcefalia). Ancorados na perspetiva ergológica, realizamos um estudo com a participação de nove mães de vítimas da epidemia de Zyca que nasceram com deficiência. Todas as participantes eram do nordeste brasileiro, com média de 28 anos e, em sua maioria, eram negras e com baixa escolaridade. Os resultados revelam que essas mulheres possuem um conjunto de tarefas a desempenhar que extrapola as atividades corriqueiras da maternidade convencional, o que exige um saber-fazer que vai se constituindo na prática, na interação com profissionais da saúde e com outras mães que vivenciam experiências semelhantes. Os achados endossam o debate sobre o trabalho de cuidar, questionado o mito da sua não qualificação e repondo-o como um fazer complexo, que demanda mobilização e inteligência para a sua realização e gestão cotidiana.

Résumé Nous avons cherché à comprendre le travail domestique et les activités de soins effectués par les mères d'enfants atteints du syndrome congénital du virus Zyca (ou microcéphalie). À partir d’une perspective ergologique, nous avons mené une étude avec la participation de neuf mères de victimes de l'épidémie de Zyca nées avec des handicaps. Toutes les participantes étaient originaires du nord-est du Brésil, âgées en moyenne de 28 ans, majoritairement noires et de bas niveau de scolarité. Les résultats montrent que ces femmes ont un ensemble de tâches à accomplir qui vont au-delà des activités ordinaires de la maternité ordinaire, exigeant un savoir-faire qui se constitue en fait dans la pratique, dans l'interaction avec les professionnels de santé et avec d'autres mères qui ont des expériences similaires. Les résultats enrichissent le débat sur le travail de soins, en mettant en question le mythe selon lequel il n'est pas qualifié et en le réaffirmant comme une tâche complexe qui nécessite mobilisation et intelligence pour la mener à bien et la gérer au quotidien.

Resumen Buscamos comprender el trabajo doméstico y las actividades de cuidados que realizan las madres de niños con síndrome congénito por virus Zyca (o microcefalia). Anclados en la perspectiva ergológica, realizamos un estudio con la participación de nueve madres de víctimas de la epidemia del Zyca que nacieron con discapacidad. Todas las participantes procedían del nordeste de Brasil, tenían una media de 28 años, eran en su mayoría negras y contaban con un bajo nivel educativo. Los resultados muestran que estas mujeres realizan tareas que van más allá de las actividades ordinarias de la maternidad convencional, lo que requiere un saber hacer que se construye en la práctica, en la interacción con los profesionales de la salud y con otras madres con experiencias similares. Los resultados refrendan el debate sobre el trabajo de cuidados, cuestionando el mito de que no es cualificado y reafirmándolo como una tarea compleja que requiere movilización e inteligencia para llevarla a cabo y gestionarla a diario.