RESUMO: O objetivo deste relato é descrever o auxílio da elastografia por impulso de força de radiação acústica (ARFI) no diagnóstico de dois casos de tumores malignos da bainha dos nervos periféricos em canídeos. Ambos os pacientes apresentavam claudicação em membro torácico e já haviam sido tratados clinicamente por outros profissionais, sem resposta ao tratamento ou histórico de trauma. Ao exame físico, foi observada atrofia muscular em apenas um dos membros torácicos, nos dois casos. Foi realizado exame ultrassonográfico axilar. Na avaliação modo B, foi observada a presença de estrutura nodular, predominantemente hipoecogênica, heterogênea, irregular, não encapsulada e com reatividade adjacente, medindo aproximadamente 20.1 mm x 15.4 mm no primeiro caso e 18.3 mm x 10.7 mm no segundo caso. Foi realizada elastografia ARFI, demonstrando a presença de áreas de maior rigidez, com velocidade de ondas de cisalhamento média de 4.12 m/s (caso 1) e 4.35 m/s (caso 2), sugerindo malignidade. Em ambos os casos, foi realizada amputação do membro afetado e os nódulos removidos foram encaminhados para análise histopatológica, na qual se obteve o diagnóstico de tumor maligno da bainha de nervo periférico. Os métodos ultrassonográficos realizados nesses casos foram essenciais para o diagnóstico e conduta terapêutica. RESUMO ARFI (ARFI canídeos profissionais trauma físico torácicos axilar B nodular hipoecogênica heterogênea irregular adjacente 201 20 1 20. 154 15 4 15. 183 18 3 18. 107 10 7 10. rigidez 412 12 4.1 ms m s 435 35 4.3 2, 2 , 2) malignidade histopatológica periférico terapêutica 41 4. 43

ABSTRACT: This report described the use of acoustic radiation force impulse (ARFI) elastography in the diagnosis of two cases of canine malignant peripheral nerve sheath tumors. Both patients presented with lameness in the thoracic limb and no response to previous clinical treatment or trauma history. Physical examination revealed muscular atrophy in one of the thoracic limbs, in both dogs. B-mode axillary ultrasound showed the presence of a predominantly hypoechogenic, heterogeneous, irregular, nonencapsulated nodule with adjacent reactivity, measuring approximately 20.1 mm x 15.4 mm in the first case and 18.3 mm x 10.7 mm in the second. ARFI elastography was performed, showing areas of significant stiffness, with an average shear wave velocity of 4.12 m/s (case 1) and 4.35 m/s (case 2), suggesting malignancy. In both cases, the affected limb was amputated, and the tumors sent for histopathological analysis, which were; subsequently, diagnosed as malignant tumors of the peripheral nerve sheath. The ultrasonographic methods used were essential in the diagnosis and therapeutic conduct. ABSTRACT (ARFI history limbs dogs Bmode B mode hypoechogenic heterogeneous irregular reactivity 201 20 1 20. 154 15 4 15. 183 18 3 18. 107 10 7 10. second performed stiffness 412 12 4.1 ms m s 435 35 4.3 2, 2 , 2) malignancy amputated analysis subsequently conduct 41 4. 43

SUMMARY: There exists a scarcity of neurocognitive research that has successfully used electrophysiology as an objective tool to assess different learning modalitiesthat are commonly used in anatomy. The objective of this study was to explore the trend in the expression of brain waves in medical students when using different didactic strategies in learning anatomy. An exploratory, observational, cross-sectional study was conducted on 22 first- semester medical students in anatomy. Using didactic strategies with different pedagogical tools such as biological models (human skulls and pig hearts) and/or digital application (Visible Body software), and different evaluation methods, students were grouped into three groups: "EOR1" students who learned using a skull and were evaluated with it; "EOV1" students who learned using a pig heart and were evaluated with the Visible Body software; and "EOV2" for students who learned through the Visible Body software and were evaluated with it. During the evaluation, each student was monitored in real-time using an electroencephalogram and the Emotiv EPOC brain-computer interface system to record the electro-physiological activity of beta (B), theta (T), and gamma (G) waves. The data obtained (the trend of the electrical activity of each wave and its relationship with students' performance in each didactic strategy) were analyzed using Pearson's correlation coefficient. Groups EOR1 and EOV1 had satisfactory results in their evaluations and showed a predominance of B waves (x=67.33) and T waves (x=57.67). Additionally, a strongly positive correlation (r=0.82) was found between the presence of B waves and the duration of T waves. Students who used three-dimensional biological models as a pedagogical tool showed a predominance of B and T waves, which are associated with sensorimotor and exploratory learning necessary for studying anatomy.

RESUMEN: Son escasos los estudios de neurociencia cognitiva que permitan comprender, de manera objetiva, las manifestaciones electrofisiológicas de los estudiantes de medicina expuestos a diferentes herramientas pedagógicas utilizadas en el área de anatomía. El objetivo de este trabajo fue explorar la tendencia en la expresión de las ondas cerebrales de estudiantes de medicina, al utilizar diferentes estrategias didácticas en el aprendizaje de la anatomía. Se realizó un estudio exploratorio, observacional, de corte transversal en 22 estudiantes de medicina de primer semestre en anatomía. Utilizando estrategias didácticas con diferentes herramientas pedagógicas; como modelos biológicos (cráneos humanos y corazones porcinos) y/o aplicación digital (software Visible Body (SVB)), y diferente método de evaluación, se agruparon los estudiantes en tres grupos: “EOR1” estudiantes que aprendieron usando un cráneo y se evaluaron con este, “EOV1” estudiantes que aprendieron usando un corazón porcino y fueron evaluados con el SVB, y “EOV2” para los estudiantes que aprendieron a través del SVB y fueron evaluados con este. Durante la evaluación, cada estudiante fue monitorizado en tiempo real, utilizando un electroencefalograma y el sistema interfaz cerebro - computadora Emotiv EPOC para registrar la actividad electrofisiológica de las ondas beta (B), theta (T) y gamma (G). Los datos obtenidos (tendencia de la actividad eléctrica de cada onda y su relación con el desempeño de los estudiantes en cada estrategia didáctica) fueron analizados usando el índice de correlación de Pearson. Los grupos EOR1 y EOV1, tuvieron resultados satisfactorios en sus evaluaciones y presentaron predominio de ondas B (X=67,33) y T (X=57,67), además, se evidenció una correlación fuertemente positiva (r=0,82) entre la presencia de B y el tiempo de permanencia de T. Los estudiantes que utilizaron modelos biológicos tridimensionales como herramienta pedagógica presentaron predominio de las ondas B y T, asociadas con aprendizajes sensoriomotores y de tipo exploratorio necesarios para el estudio en anatomía.

ABSTRACT This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.

RESUMEN El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños.

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.

ABSTRACT This paper discusses some comparative analysis between the pattern of economic performances in Asia and Western Europe during 1950s-2020s through political economies perspective. The Asian and Western European economic performances are investigated through some stylized facts in the sense of economic factors. Three analyses are used to explain the general pattern of these regions. First, this study examines the pattern of GDP growth per capita during the 1950s-2020s, focusing on several countries in this region. Second, the analysis captures the pattern of linkages of economic variables in this region related to the principle of Circular and Cumulative causation (CCC) and contradiction. Third, the analysis employs a historical perspective underpinned by the results in the second analysis. This third analysis is crucial to appreciating Asia’s global economic performance and also the process of Western deterioration phenomenon through long wave, including the occurrence recession and financial crises. The institutions of globalization and neoliberalism that put the power of capital promoted a financial crisis several times during the decades of 1980s-2020. The financial crisis is depicted by contradictions in the structural linkages among economic factors in Western Europe over the period. 1950s2020s ss 1950s 2020s s regions First 1950s2020s, 2020s, Second CCC (CCC contradiction Third Asias wave crises 1980s2020. 1980s2020 1980s 2020. 2020 1980s-2020 period 1980s202 202 1980s-202 1980s20 20 1980s-20 1980s2 2 1980s-2 1980s-

RESUMO Este artigo discute algumas análises comparativas entre o padrão de desempenho econômico na Ásia e na Europa Ocidental durante os anos 1950-2020 através da perspectiva das economias políticas. Os desempenhos econômicos da Ásia e da Europa Ocidental são investigados por meio de alguns fatos estilizados no sentido de fatores econômicos. Três análises são usadas para explicar o padrão geral dessas regiões. Em primeiro lugar, este estudo examina o padrão de crescimento do PIB per capita durante os anos 1950-2020, com foco em vários países dessa região. Em segundo lugar, a análise captura o padrão de vínculos de variáveis econômicas nesta região relacionadas ao princípio da Causação Circular e Cumulativa (CCC) e contradição. Em terceiro lugar, a análise emprega uma perspectiva histórica sustentada pelos resultados da segunda análise. Esta terceira análise é crucial para apreciar o desempenho econômico global da Ásia e também o processo de deterioração do fenômeno ocidental por meio de ondas longas, incluindo a ocorrência de recessão e crises financeiras. As instituições da globalização e do neoliberalismo que colocaram o poder do capital promoveram várias vezes uma crise financeira durante as décadas de 1980-2020. A crise financeira é retratada por contradições nas ligações estruturais entre os fatores econômicos na Europa Ocidental durante o período. 19502020 1950 2020 1950-202 políticas regiões lugar 19502020, 2020, CCC (CCC contradição longas financeiras 19802020. 19802020 1980 2020. 1980-2020 período 1950202 195 202 1950-20 1980202 198 1980-202 195020 19 20 1950-2 198020 1980-20 19502 1 2 1950- 19802 1980-2 1980-

ABSTRACT Background: Stroke may produce functional and electrical heart disturbances. The underlying characteristics and mechanisms have not been fully elucidated. Objectives: To evaluate whether acute cerebral ischemia (I) and reperfusion (R) may cause cardiac dysfunction and electrocardiographic alterations in an experimental mice model. Methods: Male mice that underwent cerebral ischemia and reperfusion (I/R) were evaluated by electrocardiography (ECG) and echocardiography. Heart rate, corrected QT (QTc) interval, T-wave peak to T-wave end (Tp-Te) interval, left ventricular ejection fraction (LVEF), shortening fraction (SF) and isovolumetric relaxation time (IVRT) were analyzed. Cerebral infarct size was calculated, and neurological deficit was assessed with the Longa scale. Results: Twenty-four hours after R, a statistically significant decrease in LVEF (I/R: 66.5±1.5% vs. sham: 74.3±0.9%; p=0.002) and in SF (I/R: 42.9±1.7% vs sham: 52.3±1.7%; p=0.004) was observed. QTc interval prolongation was observed during I/R (baseline: 125.1±4.3 ms; 60 min after I: 143.8±5.2 ms; 24 h after R: 170.3±5.8 ms; p=0.002). Tp-Te interval was not prolonged during I (baseline: 25.9±1.3 ms vs. 60 min after I: 23.8±1.4 ms; p=0.999) but it was prolonged during R (24 h after R: 32.0±2.3 ms; p=0.049). Cerebral infarct size was 34.9±2.5% and survival in the I/R group was 43.3%. Conclusion: Acute cerebral ischemia induces mild left ventricular dysfunction and disturbances in ventricular repolarization which intensify within the first 24 hours after reperfusion.

RESUMEN Introducción: El accidente cerebrovascular (ACV) puede generar perturbaciones funcionales y eléctricas del corazón. Las características y mecanismos subyacentes no están completamente elucidados. Objetivo: Evaluar si la isquemia (I) y reperfusión (R) cerebral agudas ocasionan disfunción cardíaca y alteraciones electrocardiográficas en un modelo experimental en ratones. Material y Métodos: Ratones macho sometidos a isquemia y reperfusión cerebral (I/R) fueron evaluados mediante electrocardiografía (ECG) y ecocardiografía. Se analizó la frecuencia cardíaca, el intervalo QT corregido (QTc) y el intervalo entre el pico de la onda T - fin de la onda T (Tp-Te), la fracción de eyección ventricular izquierda (FEVI), la fracción de acortamiento (FA) y el tiempo de relajación isovolumétrica (TRIV). Se cuantificó el tamaño del infarto cerebral (TI), y el déficit neurológico se evaluó con la escala de Longa (EL). Resultados: Encontramos una disminución estadísticamente significativa de la FEVI a las 24 horas de R (I/R: 66,5 ± 1,5% vs. sham: 74,3 ± 0,9%; p=0,002) y la FA (I/R: 42,9 ± 1,7% vs. sham: 52,3 ± 1,7%; p=0,004). Se observó una prolongación del QTc durante la I/R (basal: 125,1 ± 4,3 ms; 60 min I: 143,8 ± 5,2 ms; 24 horas R: 170,3 ± 5,8 ms; p=0,002), sin una prolongación del Tp-Te en la I (basal: 25,9 ± 1,3 ms vs. 60 min I: 23,8 ± 1,4 ms; p=0,999) pero sí en la R (24 horas R: 32,0 ± 2,3 ms; p=0,049. El tamaño del infarto cerebral fue de 34,9 ± 2,5% y la supervivencia del grupo I/R fue del 43,3%. Conclusión: La isquemia cerebral aguda induce una disfunción ventricular izquierda leve y trastornos en la repolarización ventricular que se intensifican en las primeras 24 horas de reperfusión.

Abstract Introducción: Desde marzo del año 2020, la Organización Mundial de la Salud (OMS) declaró como pandemia al COVID-19 y esta situación representó grandes retos para los pacientes con enfermedad de Parkinson (EP). Los efectos en los cambios de las rutinas diarias, la práctica de actividades lúdicas, el relacionamiento y la salud mental, conllevaron a un deterioro secundario. Nuestro objetivo fue caracterizar el estado emocional y la calidad de vida de una cohorte de pacientes con enfermedad de Parkinson, así como explorar cuál fue la percepción de la calidad de vida en la pandemia causada por COVID-19. Métodos: Esta fue una investigación mixta que incluyó un análisis descriptivo para los datos sociodemográficos y las variables clínicas, y un análisis del discurso con base a las categorías relacionadas con la percepción de la calidad de vida de los pacientes con EP. Las categories analizadas fueron: pandemia COVID-19, cuidadores, estrategias de adaptación, manejo de la enfermedad y actividades lúdicas. Resultados: En este estudio hubo 12 pacientes, de los cuales el 75 % tenían una media de edad de 75 años (DE 2,9), donde el 50 % presentó niveles leves de ansiedad y el 41 % presentó niveles leves y graves de depresión. La calidad de vida (CV) estuvo afectada por: la movilidad 37,5 (RIC 10,6-45), seguida por el malestar corporal 25 (RIC 10,4-45,8) y la cognición 21,9 (RIC 14-34,3). El 89 % de los hombres vivía con su esposa y el 67 % de las mujeres vivían con uno de sus hijos. Discusión: La entrevista sobre la percepción de la CV durante la pandemia COVID-19 permitió comprender que la experiencia personal es fundamental para mejorar el manejo y el empoderamiento de los pacientes, cuidadores y familiares. Conclusiones: La calidad de vida es un factor mediado por dimensiones dinámicas y es afectada por la percepción subjetiva y los cambios en el entorno como la pandemia COVID-19.

Resumen Introduction: Since March 2020, the World Health Organization (WHO) declared COVID-19 as a pandemic. This crisis had big challenges for the patients with Parkinson's disease (PD), due to the effects related to changes in daily routines, the practice of leisure activities, relationships and mental health leading to secondary deterioration. Our aim was to characterize the emotional state and quality of life in a cohort of patients with Parkinson's disease as well as to explore the perception of the quality of life during the COVID-19 pandemic. Materials and methods: This investigation was conducted as an exploratory mixed study. Descriptive analysis for sociodemographic and clinical variables and, a discourse analysis was carried out based on categories related to the perception of quality of life of patients with PD. Categories analyzed were: Covid-19 pandemic, caregivers, adaptation strategies, management of the disease, and leisure activities. Results: There were twelve patients total in this study. 75% were men with a median age of 75 (SD 2.9). 50% presented mild levels of anxiety and 41% presented mild and severe depression. The QoL was affected for: mobility 37.5 (IRC 10.6-45), body discomfort 25 (IQR 10.4-45.8) and, cognition 21.9 (IQR 14-34.3). 89% lived with their wife and 67% of women lived with one of their children. Discussion: The interview about perception of QoL during Covid-19 pandemic allowed to understand that individual experiences are crucial to improve the management and empowerment the patients, caregivers and families. Conclusion: Quality of life is a factor made up of dynamic dimensions and it is influenced for subjective perspective and changes in environment as a Covid-19 pandemic.

Abstract This paper analyses Portuguese twentieth-century populist moments from a historical perspective. At the start of the current “populist wave”, pundits and academics justified the lack of support for populism in Portugal by falling back on the conservative metaphor of the “mild-mannered country” - claiming that the Portuguese were not prone to political radicalism. An examination of the country’s contemporary history reveals a different picture. Following case studies that encompass the Portuguese First Republic, the Estado Novo dictatorship, and the Carnation Revolution, we seek to demonstrate that populism in Portugal has been a force to be reckoned with.

Resumo Este artigo analisa os momentos populistas portugueses do século xx numa perspetiva histórica. No início da atual “vaga populista”, especialistas e académicos justificaram a falta de apoio ao populismo em Portugal recorrendo à metáfora conservadora do “país dos brandos costumes” - afirmando que os portugueses não eram propensos ao radicalismo político. Uma análise da história contemporânea do país revela um quadro diferente. Através de estudos de caso que englobam a Primeira República Portuguesa, a ditadura do Estado Novo e a Revolução dos Cravos, procuramos demonstrar que o populismo em Portugal tem sido uma força a ter em conta.

Abstract The COVID-19 pandemic and its socioeconomic impacts led to fears that a kind of pandemic-fuelled populism could erupt in crisis-struck societies. Through a content analysis of parliamentary debates on issues dear to populists, we explore the impact of COVID-19 on the incidence of populist rhetoric in Portugal in different moments of the pandemic and by different political parties. Our results indicate that, despite an increase of people-centrism during the first COVID-19 wave, the pandemic globally decreased the prevalence of populist rhetoric, suggesting that parties’ adoption of populist frames under a crisis may be dependent on the nature of that crisis

Resumo A pandemia da COVID-19 e os seus impactos socioeconómicos geraram receios de que, nas sociedades atingidas pela crise, pudesse irromper uma espécie de populismo alimentado pela pandemia. Através de uma análise de conteúdo de debates parlamentares sobre temas caros aos populistas, explorámos o impacto da COVID-19 na incidência da retórica populista em Portugal em diferentes momentos da pandemia e por parte de diferentes partidos políticos. Os nossos resultados indicam que, apesar de um aumento do centrismo nas pessoas durante a primeira vaga da COVID-19, a pandemia diminuiu globalmente a prevalência da retórica populista, sugerindo que a adoção de quadros populistas pelos partidos durante uma crise pode estar dependente da natureza dessa crise.

RESUMEN Introducción: En 2020, Colombia adoptó diferentes medidas para mitigar el impacto de la pandemia por Covid-19, principalmente medidas de aislamiento social y fortalecimiento en la prestación de servicios hospitalarios. Sin embargo, el país no contempló acciones para abordar los otros problemas en salud, como tampoco consideró la relevancia de la Atención Primaria en Salud (APS) para responder a la pandemia. Por lo cual se realizó una investigación para indagar por la oferta y posicionamiento de la APS entre los tomadores de decisiones para atender la emergencia de Covid-19 durante la primera ola de la pandemia y los aprendizajes para las siguientes. Metodología: De abril a junio de 2020 se realizó un estudio descriptivo exploratorio mixto en 2 fases: (1) Encuesta a tomadores de decisiones, prestadores y académicos, y (2) Grupo focal a informantes clave. Resultados: La encuesta fue respondida por 227 participantes, 41 % académicos, 34.8 % prestadores y 17.6 % funcionarios de direcciones locales de salud; el 28.2 % consideró que la APS estuvo adaptada en los territorios para diferentes programas de salud por ciclo vital y entre el 80 al 98 % que la APS debía instaurarse en el territorio para vigilancia de casos, atención ambulatoria, manejo de pacientes crónicos, atención de otros programas y educación sanitaria. En el grupo focal participaron 12 informantes claves, quienes concluyeron que desde la autoridad sanitaria se debía promover la integración de la APS de forma urgente en los territorios, y garantizar una gobernanza eficaz para lograrlo; igualmente, recomendaron intensificar la alfabetización en salud y el empoderamiento de la población para la adopción de medidas individuales y colectivas. Conclusiones: Se concluye que la APS era una oportunidad para responder a la primera ola de la pandemia, como también para subsanar los problemas actuales y anticiparse a problemas futuros. Por lo cual, la APS debe convertirse en una política de Estado.

ABSTRACT Introduction: In 2020, Colombia adopted different measures to mitigate the impact of the Covid-19 pandemic, social isolation measures and strengthening the provision of hospital services. However, the country did not contemplate actions to address other health problems, nor did it consider the relevance of Primary Health Care (PHC) to respond to the pandemic. Therefore, an investigation was done to investigate the offer and positioning of PHC among decision-makers to address the Covid-19 emergency during the first wave of the pandemic and the learning for the following ones. Methodology: From April to June 2020, a mixed exploratory descriptive study was conducted in two phases: (1) a survey of decision-makers, providers, and academics, and (2) a focus group of key informants. Results: The survey was answered by 227 participants, 41 % academics, 34.8 % providers, and 17.6 % officials from local health directorates; 28.2 % considered that PHC was adapted in the territories for different life cycle health programs, and between 80 and 98 % that PHC should be established in the territory for case surveillance, outpatient care, management of chronic patients, care of other programs and health education. Twelve key informants participated in the focus group, who concluded that the health authority should urgently promote the integration of PHC in the territories, and guarantee effective governance to achieve it; Likewise, they recommended intensifying health literacy and the empowerment of the population for the adoption of individual and collective measures. Conclusions: It is concluded that PHC was an opportunity to respond to the first wave of the pandemic, as well as to correct current problems and anticipate future problems. Therefore, PHC must become a state policy.

Resumo Introdução: a associação entre a diminuição da atividade física e o isolamento social já foi descrita na literatura, entretanto a relação do nível de adesão dos idosos às medidas protetivas durante a pandemia da covid-19 e os efeitos ocasionados pela inatividade física na condição de fragilidade permanece com expressivo hiato de conhecimento. Objetivo: analisar os efeitos do distanciamento e do isolamento sociais gerados pela pandemia da covid-19 na fragilidade em idosos e nas atividades físicas realizadas por eles da atenção primária à saúde de uma Unidade Básica de Saúde do Brasil. Materiais e método: estudo de coorte prospectivo, realizado nos domicílios e em unidades básicas de saúde. Na primeira onda, pré-pandemia, a amostra foi composta por idosos (n = 168) não frágeis. Após o seguimento médio de 762 dias, realizou-se uma segunda onda, em que se classificaram os idosos conforme o nível de exposição ao distanciamento e ao isolamento sociais (n = 100), bem como se observaram os desfechos “nível de atividade física” e “condição de fragilidade”. Aplicaram-se questionários sociodemográfico e clínico, miniexame do estado mental, marcadores de fragilidade física e grau de adesão ao distanciamento e ao isolamento sociais. Realizaram se análises estatísticas descritivas, de associação, curvas de sobrevida e regressão de riscos proporcionais. Resultados: 53 % dos idosos transicionaram para a pré-fragilidade e 21 % apresentaram diminuição de atividade física. Houve elevado percentual de baixo grau de adesão ao distanciamento e ao isolamento sociais, e não se observou associação com atividade física e fragilidade (p = 0,288; p = 0,351, respectivamente). Mulheres tiveram mais risco de se classificarem como pré-frágeis ou frágeis (2,53; IC 95 %, 1,01-6,34) e de apresentarem diminuição de atividade física (2,13; IC 95 %, 1,06-4,26). Conclusão: não houve associação entre medidas protetivas de distanciamento e isolamento social, atividade física e fragilidade. Idosos que apresentam redução do nível de atividade física devem ser estimulados à sua prática a fim de se manterem ativos e se evitar a transição para a fragilidade, para a perda de funcionalidade e para a dependência.

Resumen Introducción: la asociación entre la disminución de la actividad física y el aislamiento social ya ha sido descrita en la literatura, sin embargo la relación entre el nivel de adherencia de los ancianos a las medidas de protección durante la pandemia de covid-19 y los efectos causados por la inactividad física sobre la condición de fragilidad permanece con un importante vacío de conocimiento. Objetivo: analizar los efectos del distanciamiento y el aislamiento social generados por la pandemia de covid-19 sobre la fragilidad de los ancianos y las actividades físicas realizadas por ellos en la atención primaria de salud en una Unidad Básica de Salud en Brasil. Materiales y método: estudio de cohorte prospectivo, realizado en domicilios y en unidades de atención primaria de salud. En la primera oleada, prepandémica, la muestra estaba formada por ancianos no frágiles (n = 168). Tras un seguimiento medio de 762 días, se llevo a cabo una segunda etapa, en la que se clasifico a los ancianos en función de su nivel de exposición al distanciamiento social y al aislamiento (n = 100), así como de los resultados “nivel de actividad física” y “estado de fragilidad”. Se utilizaron cuestionarios sociodemográficos y clínicos, miniexamen del estado mental, marcadores de fragilidad física y grado de adhesión al distanciamiento y el aislamiento social. Se realizaron estadísticas descriptivas, análisis de asociación, curvas de supervivencia y regresión de riesgos proporcionales. Resultados: el 53 % de los ancianos pasaron a la situación de prefragilidad y el 21 % mostraron una disminución de la actividad física. Hubo un alto porcentaje de baja adherencia al distanciamiento social y al aislamiento, y no hubo asociación con la actividad física y la fragilidad (p = 0,288; p = 0,351, respectivamente). Las mujeres tenían un mayor riesgo de ser clasificadas como pre-frágiles o frágiles (2,53; IC 95 %, 1,01-6,34) y de mostrar una disminucion de la actividad fisica (2,13; IC 95 %, 1,06-4,26). Conclusión: no hubo asociación entre las medidas protectoras de distanciamiento social y aislamiento, actividad física y fragilidad. Se debería animar a los ancianos con un nivel reducido de actividad física a practicarla para mantenerse activos y evitar la transición a la fragilidad, la perdida de funcionalidad y la dependencia.

Abstract Introduction: The association between reduced physical activity and social isolation has been described in the literature, but the relationship between the level of adherence to protective measures among older adults during the COVID-19 pandemic and the effects of physical inactivity on frailty remains a significant knowledge gap. Objective: To analyze the effects of social distancing and isolation caused by the COVID-19 pandemic on frailty in the elderly and on their physical activities in primary health care in a basic health unit in Brazil. Materials and methods: A prospective cohort study conducted in households and basic health units. In the first wave, before the pandemic, the sample consisted of non-frail elderly (n = 168). After a mean follow-up of 762 days, a second wave was conducted in which the elderly were classified according to their level of exposure to social distancing and isolation (n = 100) and the outcomes “level of physical activity” and “frailty status” were observed. Sociodemographic and clinical questionnaires, the Mini-Mental State Examination, physical markers of frailty, and level of exposure to social distancing and isolation were used. Descriptive statistics, association, survival curves, and proportional hazards regression were used. Results: Of the elderly, 53% transitioned to pre-frailty and 21% showed a decrease in physical activity. There was a high percentage of low adherence to social distancing and isolation, and there was no association with physical activity and frailty (p = 0.288; p = 0.351, respectively). Women had a higher risk of being classified as prefrail or frail (2.53; 95% CI, 1.01-6.34) and of having a decrease in physical activity (2.13; 95% CI, 1.06-4.26). Conclusion: There was no association between protective measures of social distancing and isolation, physical activity, and frailty. Older people with reduced levels of physical activity should be encouraged to exercise to remain active and avoid the transition to frailty, functional decline, and dependency.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the virus responsible for the COVID-19 (C19) pandemic. South Africa (SA) experienced multiple periods of increased transmission. Tertiary, regional and central hospitals were overwhelmed, resulting in low acceptance rates OBJECTIVES: To compare mortality trends of patients who died in hospital from SARS-CoV-2 infection during the first three waves of infection as defined by the National Institute of Communicable Diseases of South Africa METHODS: This was a retrospective cohort study at a district level hospital of 311 adults who died within the first three waves of COVID-19. The study analysed case and crude fatality rates, baseline characteristics, symptomatology, clinical presentation and management of patients RESULTS: Waves 1, 2 and 3 yielded case fatality rates of 14.5%, 27.6% and 6.3%, respectively, and crude fatality rates of 16.7%, 33.0% and 12.2%, respectively. Black Africans were less likely to die during the third wave (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.31 - 0.94). Patients in the second wave had clinical frailty scores of <5 (OR 2.51; 95% CI 1.56 - 4.03). Obesity was most prevalent in the second wave (OR 1.87; 95% CI 1.01 - 3.46), and dyslipidaemia (OR 3.03; 95% CI 1.59 - 5.77) and ischaemic heart disease (OR 3.77; 95% CI .71 - 8.33) were most prevalent during the third wave. Severe ground glass appearance was most common during the second wave (OR 2.37; 95% CI 1.49 - 3.77). Renal impairment was most prevalent during the first wave (OR 3.28; 95% CI 1.59 - 6.77), and thrombo-embolic phenomena were less common during wave three (OR 0.12; 95% CI 0.02 - 0.91 CONCLUSION: The Beta variant was the most virulent, with the highest case and crude fatality rates in wave 2

El síncope es una consulta frecuente. Corresponde al 1 a 3% de las atenciones en Servicios de Urgencia en Estados Unidos. La causa es generalmente benigna, sin embargo, los casos de alto riesgo tienen potencial riesgo vital y deben ser identificados. En este manuscrito reportamos un caso de una paciente de 40 años presentándose con síncope que evoluciona con Torsada de puntas y luego fibrilación ventricular. La coronariografía no mostró lesiones coronarias. La ventriculografía, ecocardiografía transtorácica y la resonancia cardíaca fueron compatibles con la cardiomiopatía de Takotsubo medio ventricular. Al ECG destacaba QTc largo con la onda T invertida. Durante las primeras 48 horas presentó múltiples episodios de taquicardia ventricular polimorfa no sostenida. La paciente evolucionó con disminución del QTc y regresión de las alteraciones segmentarias. Al seguimiento a seis meses, la paciente se encontraba asintomática, sin nuevos episodios.

Syncope is a frequent consult. It's responsible for 1 to 3% of consults to the emergency room in the United States. The cause is generally benign; however, high-risk cases are potentially deadly and must be identified. We present a case report of a 40-year-old female who presents with syncope, Torsade de Pointes, and ventricular fibrillation. The coronary angiography showed no disease of the coronary arteries. The ventriculography, transthoracic echocardiogram, and cardiac magnetic resonance revealed a mid-ventricular Takotsubo cardiomyopathy. The ECG showed a prolonged QT interval with an inverted T wave. During the first 48 hours, she presented multiple episodes of non-sustained polymorphic ventricular tachycardia. The patient evolved with diminished QTc interval and regression of the wall motion abnormalities. At the 6-month follow-up the patient was asymptomatic, without new episodes.

Resumo O SARS-CoV-2 é um vírus que surgiu recentemente e causou milhões de mortes em todo o mundo. Para enfrentar a pandemia de COVID-19, necessita-se de uma análise aprofundada da replicação viral. Nosso objetivo foi examinar a carga viral em pacientes com SARS-CoV-2 durante as duas primeiras ondas de COVID-19 no Paquistão. Foram selecionados para o estudo 225.615 indivíduos suspeitos de 75 regiões diferentes do Paquistão. Os RNAs do SARS-CoV-2 foram detectados por PCR em tempo real. Durante a primeira onda de COVID-19 (período de junho a julho de 2020), a prevalência de SARS-CoV-2 foi de 20,38%. No entanto, durante a segunda onda de COVID-19 (período de novembro a dezembro de 2020), a taxa de prevalência foi de 9,41%. Durante a primeira onda de COVID-19, 96,31% dos participantes permaneceram PCR positivos por 14-21 dias, 3,39% dos indivíduos apresentaram resultados positivos por 22-35 dias, enquanto valores tardios de Ct foram observados em 0,26% dos participantes por 36-49 dias. No entanto, durante a segunda onda de COVID-19, 89,31% dos indivíduos tiveram sintomas e resultados positivos de PCR em tempo real por 14-21 dias, 9,42% apresentaram resultados positivos por 22-35 dias, enquanto resultados de valores de Ct significativamente atrasados foram observados em 1,026% dos participantes durante 36-63 dias (3,95 vezes superior à primeira onda). Em contraste com a primeira onda de COVID-19, os fatores que foram diferentes na segunda onda não foram nem virais (estirpes diferentes), nem hospedeiros (mesma população). No entanto, os fatores de tratamento mudaram significativamente. Assim como durante a segunda onda, além da azitromicina, o consumo de corticosteroide dexametasona aumentou, causando, consequentemente, negatividade tardia do valor de Ct. Isso sugere que o tratamento com corticosteroides pode estar associado ao atraso no valor de Ct ou na depuração viral. Este estudo é crucial para reconsiderar opções terapêuticas eficazes contra a COVID-19. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- mundo COVID19, COVID19 COVID 19, 19 necessitase necessita se COVID-1 Paquistão 225615 225 615 225.61 7 período 2020, 2020 , 2020) 2038 20 38 20,38% entanto 941 9 41 9,41% 9631 96 31 96,31 1421 14 21 14-2 339 3 39 3,39 2235 22 35 22-3 026 0 26 0,26 3649 36 49 36-4 8931 89 89,31 942 42 9,42 1026 1 1,026 3663 63 36-6 3,95 395 95 (3,9 onda. . onda) estirpes diferentes, diferentes) mesma população. população população) azitromicina aumentou causando consequentemente COVID19. 19. SARS-CoV COVID1 COVID- 22561 61 225.6 202 203 20,38 94 4 9,41 963 96,3 142 14- 33 3,3 223 22- 02 0,2 364 36- 893 8 89,3 9,4 102 1,02 366 6 3,9 (3, 2256 225. 20,3 96, 3, 0, 89, 9, 10 1,0 (3 20, 1, (

Abstract SARS-CoV-2 is recently emerged virus, which caused millions of deaths, all over the world. To tackle COVID-19 pandemic, there is an utmost need for in-depth analysis of viral replication. We aimed to examine viral load in SARS-CoV-2 patients during first two waves of COVID-19 in Pakistan. 225,615 suspected subjects from 75 different regions of Pakistan were selected in the study. SARS-CoV-2 RNAs were detected via real time PCR. During first wave (period of June-July, 2020) of COVID-19 the prevalence of SARS-CoV-2 was 20.38%. However, during second wave (period of November-December, 2020) of COVID-19, the rate of prevalence was 9.41%. During first wave of COVID-19 96.31% of participants remained PCR positive for 14 to 21 days, 3.39% of subjects showed positive results for 22 to 35 days, while delayed Ct values were observed among 0.26% of participants for 36 to 49 days. However, during second wave of COVID-19 89.31% of the subjects exhibited symptoms and showed real-time PCR positive results for 14 to 21 days, 9.42% showed positive results for 22 to 35 days, while significantly delayed Ct value results were observed among 1.026% of participants for 36 to 63 days (3.95 times higher than first wave). In contrast to first wave of COVID-19, the factors that were different in second wave were neither viral (different strains) nor host (same population). But treatment factors changed significantly. As during second wave besides azithromycin, corticosteroid dexamethasone consumption was increased consequently causing delayed Ct value negativity. This suggests that corticosteroid treatment might be linked with delayed Ct value or viral clearance. This study is crucial for re-considering effective therapeutic options against COVID-19. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- virus deaths world COVID19 COVID 19 COVID-1 pandemic indepth depth replication 225615 225 615 225,61 7 period JuneJuly, JuneJuly June July, July June-July 2020 2038 20 38 20.38% However NovemberDecember, NovemberDecember November December, December November-December COVID19, 19, 941 9 41 9.41% 9631 96 31 96.31 1 339 3 39 3.39 026 0 26 0.26 4 8931 89 89.31 realtime 942 42 9.42 1026 1.026 6 3.95 395 95 (3.9 wave. . wave) strains same population. population population) azithromycin negativity clearance reconsidering re considering COVID19. 19. SARS-CoV COVID1 COVID- 22561 61 225,6 202 203 20.38 94 9.41 963 96.3 33 3.3 02 0.2 893 8 89.3 9.4 102 1.02 3.9 (3. 2256 225, 20.3 96. 3. 0. 89. 9. 10 1.0 (3 20. 1. (

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.

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.