Species from Pavonia genus (Malvaceae) are traditionally used as antioxidant, n anti inflammatory and antimicrobial remedies. Previous studies have revealed their diversity of specialized metabolites widely used in the development of new medicines. This is the first study on Pavonia glazioviana Gurke, a Brazilian species known as “Malva da Chapada”. The research led to identify fifteen compounds: 132 (S) hydroxy pheophytin a; and 132(S) hydroxy 173 ethoxyphaeophorbide, n decanol, cycloart 23Z ene 3β,25 diol, cycloart 24S 25 ene 3β,24 diol, sitosterol 3 O β D glucopyranoside, stigmasterol 3 O β D glucopyranoside, quercetin, acacetin, kaempferol, tiliroside, 5 hydroxy 3,7,8,4’ tetramethoxyflavone, 5,7 dihydroxy 3,8,4’ trimethoxyflavone, 5,7 dihydroxy 4’ methoxyflavone, 5,7,4’ trihydroxy 3,8 dimethoxyflavone and 5,7,4’ trihydroxy 3 methoxyflavone. The major flavonoids were tested for their antimicrobial activity, and the compound 5,7 dihydroxy 3,8,4’ trimethoxyflavone showed strong activity against Escherichia coli (MIC = 512 μg mL1), Pseudomonas aeruginosa (MIC = 512 μg mL1), Candida albicans (MIC = 512 μg mL1), Candida tropicalis (MIC = 512 μg mL1), Candida parapsilosis (MIC = 512 μg mL1), Aspergillus flavus (MIC = 512 μg mL1) and A. fumigantus (MIC = 512 μg mL1). The total phenolic content, flavonoid content, and radical scavenging potential were determined showing its great production of phenolics and flavonoids, along with interesting radical scavenging potential (DPPH EC50 = 6.36 ± 0.029 mg mL 1). Our findings contributed to characterize P. glazioviana as a source of methoxylated flavonoids with antimicrobial potential. Malvaceae (Malvaceae antioxidant remedies medicines Gurke Malva Chapada. Chapada . Chapada” compounds 13 S (S 132S 132(S 17 ethoxyphaeophorbide decanol Z 3β25 3β 3β,2 diol 2 3β24 24 glucopyranoside quercetin acacetin kaempferol tiliroside 3,7,8,4 3784 7 8 4 tetramethoxyflavone 57 5, 3,8,4 384 methoxyflavone 5,7,4 574 38 3, MIC 51 mL1, mL1 , A mL1. content DPPH EC EC5 636 6 36 6.3 0029 0 029 0.02 1. 1 1) P 3β2 3β, 3,7,8, 378 3,8, 5,7, 63 6. 002 02 0.0 3,7,8 37 00 0. 3,7, 3,7

Abstract: Objective: To determine the antibiotic storage characteristics of families in a suburban population in Mexico. Methodology: The study approach is quantitative, observational, cross-sectional and descriptive in scope. The unit of study was families living in the area under study in a suburban zone of Mexico. Results: A total of 235 families were surveyed, within which there are different age groups, with 153 families predominantly aged between 36 and 64 years old. It was obtained that more than 70 % presented illnesses and, regarding the possibility that they had stored expired or soon to expire antibiotic drugs, 68.1 % mentioned that it was not likely. Conclusions: The significant number of adult population, the wide presence of comorbidities and various sociodemographic factors impact practices and attitudes regarding the ways in which families obtain, use, store and dispose of medications within their homes. This research seeks to contribute to the awareness and creation of various programs for the adoption of safety measures for the storage of medicines within the home, as well as to serve as a guide in the identification of optimal, efficient and effective procedures to deal with this phenomenon.

Resumo: Objetivo: Determinar as características do armazenamento de antibióticos das famílias em uma população suburbana no México. Metodologia: A abordagem do estudo é quantitativa, observacional, transversal e de escopo descritivo. A unidade de estudo foram as famílias que viviam na área de estudo de uma zona suburbana no México. Resultados: Foram pesquisadas 235 famílias, de diversas faixas etárias, das quais predominaram as idades de 36 a 64 anos em 153 famílias. Verificou-se que mais de 70% apresentavam enfermidades, e com relação à possibilidade de terem medicamentos antibióticos vencidos ou prestes a vencer armazenados, 68,1 % mencionaram que não era provável. Conclusões: O significativo número de população adulta, a ampla presença de comorbidades e vários fatores sociodemográficos impactam nas práticas e atitudes relativas às formas como as famílias obtêm, usam, armazenam e descartam medicamentos em suas residências. Esta pesquisa busca contribuir para a conscientização e a criação de vários programas para a adoção de medidas de segurança para o armazenamento de medicamentos em casa, bem como servir de guia na identificação de procedimentos ideais, eficientes e eficazes para lidar com esse fenômeno.

Resumen: Objetivo: Determinar las características de almacenamiento de los antibióticos de las familias en una población suburbana en México. Metodología: El enfoque del estudio es cuantitativo, observacional, de corte transversal y alcance descriptivo. La unidad de estudio fueron las familias que vivían en el área de estudio de una zona suburbana en México. Resultados: Se encuestaron un total de 235 familias, dentro de las cuales existen diversos grupos etarios, de los cuales predominaron las edades de entre 36 a 64 años en 153 familias. Se obtuvo que más del 70 % presentaban enfermedades y, respecto a la posibilidad de que tuviesen almacenados medicamentos antibióticos caducados o próximos a caducar, el 68.1 % mencionó que no era probable. Conclusiones: El importante número de población adulta, la amplia presencia de comorbilidades y diversos factores sociodemográficos impactan en las prácticas y actitudes en relación con las formas en que las familias obtienen, usan, almacenan y desechan los medicamentos dentro de sus hogares. Esta investigación busca contribuir a la concientización y creación de diversos programas para la adopción de medidas de seguridad para el almacenamiento de medicamentos dentro del hogar, así como servir de guía en la identificación de procedimientos óptimos, eficientes y eficaces para tratar este fenómeno.

ABSTRACT Over-the-counter medications (OTC), also known as non-prescription drugs can be dispensed without a prescription. This study aimed to analyze the pharmacological profile, risk, and quality of evidence of OTC medications registered in Brazil. The databases of ANVISA and Micromedex synthesis were consulted. The indications for use were classified according to CIAP, the medications according to ATC, and the quality of evidence according to the GRADE method. A total of 188 OTC medications were identified, comprising 376 presentations. The groups related to the digestive tract and respiratory system had the highest number of drugs, each accounting for 19%. Overall, 61% of the drugs were classified as having high or moderate evidence, and 39% as low, very low, or lacking evidence. Despite the prevalence of higher-quality evidence, restrictions need to be highlighted, as approximately 55% of the drugs have a weak recommendation, 67% may not be used by children under the age of 6, 95% lack reliable safety information during pregnancy, and 87% lack clear information regarding use during lactation. Further research on the topic, supported self-care policies, and monitoring seem essential to better understand the risks and benefits associated with OTC medications, thus ensuring a safer and evidence-based clinical practice.

RESUMO Os Medicamentos Isentos de Prescrição (MIP) ou de venda livre podem ser fornecidos sem exigência de receita. Este estudo objetivou analisar o perfil farmacológico, risco e qualidade da evidência dos MIP registrados no Brasil. Foram consultadas as bases de dados da Anvisa e a base de síntese Micromedex. As indicações de uso foram classificadas segundo Ciap, os medicamentos segundo ATC e a qualidade da evidência segundo método Grade. Foram identificados 188 MIP, com 376 apresentações. Os grupos de trato alimentar e respiratório tiveram os maiores números de fármacos, com 19% cada. No geral, 61% dos fármacos foram classificados como evidência alta ou moderada e 39% como baixa, muito baixa ou sem evidência. Apesar da prevalência de maior qualidade de evidência, as restrições precisam ser evidenciadas, pois cerca de 55% dos fármacos possuem força de recomendação fraca, 67% não podem ser utilizados por crianças menores de 6 anos, 95% não possuem informações confiáveis de segurança na gestação e 87% não possuem informações de uso na lactação. Mais pesquisas sobre o tema, políticas de autocuidado apoiado e monitoramento parecem essenciais para melhor compreender os riscos e benefícios associados aos MIP, garantindo uma prática clínica mais segura e baseada em evidências.

Abstract Background: Taza province presents enormous richness and biodiversity. Updating their medicinal plant inventories is crucial for conserving traditional knowledge, sustainable use, health and well-being, economic opportunities and collaborative research. Question: What new species and families of medicinal plants can we report by widening the ethnobotanical study area in Taza province compared to previous work? Studied species: 202 medicinal plant species. Study site and dates: 28 communities in the province of Taza (Morocco), between March and October 2021. Methods: An ethnobotanical survey including 340 interviewees using a semi-structured questionnaire. Results: 91 medicinal taxa belonging to 48 families were inventoried. 12 species including three spontaneous: Atriplex halimus L., Citrullus colocynthis L. Sch and Micromeria graeca (L.) Benth. ex Rchb. were reported for the first time. The most frequent species are respectively Salvia officinalis L., Trigonella foenum-graecum L. and Rosmarinus officinalis L. The most frequent families are respectively Lamiaceae, Asteraceae and Fabaceae. Seven new vernacular names have been listed. Most of the plants were spontaneous (55.9 %). The comparative analysis with previous work led to obtaining a checklist of 202 taxa (75 families) of which 65 have specific endemism and 77 (48 spontaneous) are on the red list. The scientific names of 28 species and nine families have been updated. Conclusions: This checklist (202 taxa) traduces the plant heritage richness of Taza province and constitutes a great database for future scientific research. The 12 newly listed species constitute an added value that deserves to be valued through ethnopharmacological studies.

Resumen: Antecedentes: La provincia de Taza presenta una enorme riqueza y biodiversidad. Actualizar sus inventarios de plantas medicinales es crucial para preservar el conocimiento tradicional. Preguntas y / o Hipótesis: ¿Qué nuevas especies y familias de plantas medicinales se pueden reportar al ampliar el área de estudio de la provincia de Taza respecto a trabajos anteriores? Especies de estudio: 202 especies medicinales. Sitio y años de estudio: 28 comunidades de Taza (Marruecos), entre marzo y octubre (2021). Métodos: Una encuesta etnobotánica que incluyó a 340 entrevistados mediante un cuestionario semiestructurado. Resultados: Se inventariaron 91 taxones medicinales pertenecientes a 48 familias. 12 especies, incluidas tres espontáneas: Atriplex halimus L., Citrullus colocynthis (L.) Sch and Micromeria graeca (L.) Benth. ex Rchb. fueron reportados por primera vez. Las especies más frecuentes son respectivamente Salvia officinalis L., Trigonella foenum-graecum L. y Rosmarinus officinalis L.. Las familias más frecuentes son respectivamente Lamiaceae, Asteraceae y Fabaceae. Se han enumerado siete nuevos nombres vernáculos. La mayoría de las plantas fueron espontáneas (55.9 %). El análisis comparativo con trabajos anteriores permitió obtener una lista de verificación de 202 taxones (75 familias) de los cuales 65 tienen endemismo específico y 77 (48 espontáneos) están en la lista roja. Se han actualizado los nombres científicos de 28 especies y nueve familias. Conclusiones: Esta lista (202 taxones) que refleja la riqueza del patrimonio vegetal de la provincia de Taza, constituye una gran base de datos para futuras investigaciones científicas. Las 12 especies merecen ser evaluadas mediante estudios etnofarmacológicos.

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

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

Resumen Introducción : En el consultorio de atención inmediata de clínica se concentra la atención de pacientes ambu latorios con enfermedades que requieren diagnóstico precoz, como la adenitis tuberculosa (AT). El objetivo fue describir las características clínicas, estudios com plementarios y procedimientos realizados a pacientes con diagnóstico confirmado por bacteriología o anatomía patológica de AT. Métodos : Estudio observacional, descriptivo, retros pectivo. Período: 2017-2023. Resultados : Se incluyeron 49 pacientes, con una mediana de edad de 31 años; 59% de sexo femenino, 22% con comorbilidades El 40% presentó adenopatías localizadas, la mayoría cervicales. La serología para HIV era positiva en 3 (6.1%). Al 73% se le ingresaron muestras para bacteriología, con aislamiento de M. tuberculosis en 71%. Al 79% se le realizó punción aspiración con aguja fina (PAAF) ganglionar; en el 48% los resultados de la citología fueron sugestivos de tuberculosis (TB). Al 77% se le realizó biopsia ganglionar, resultando en el 62% adenitis granulomatosa. Desde la primera consulta hasta el diagnóstico transcurrieron una mediana de 40 días. La mayoría de los tratamientos se iniciaron luego del resultado de la biopsia, seguido de cultivos, baciloscopia, PAAF y GeneXpert. Un paciente falleció. Discusión : La AT predominó en el sexo femenino en el grupo estudiado, coincidente con la experiencia local, la edad promedio de presentación fue 30 a 40 años. Puede afectar cualquier cadena ganglionar, aunque predomina la localización cervical, que coincide con los hallazgos de este trabajo. En nuestra serie, la demora diagnóstica desde la primera consulta fue menor a la referida en la bibliografía.

Abstract Introduction : In the clinical medicine’s immediate assistance unit, care is focused on outpatients with dis eases that require early diagnosis, such as tuberculous adenitis (TA). The aim was to describe clinical features, complementary studies and procedures performed in patients with a diagnosis confirmed by bacteriology or pathological anatomy of TA. Methods : Observational, descriptive, retrospective. Period: 2017-2023. Results : Fourty nine patients were included, with a median age of 31 years, 59% were female, 22% with comorbidities. 40% had localized lymphadenopathy, most of them cervical. HIV serology was positive in 3 cases (6.1%). Samples for bacteriology were submitted in 73%, with isolation of M. tuberculosis in 71%. Nodal fine needle aspiration (FNA) was performed in 79%, and in 48% the cytology results were suggestive of tuberculosis. Nodal biopsy was performed in 77%, with granulomatous adenitis as result in 62%. The term between admis sion and diagnosis ranged from a median of 40 days. Most treatments were started after the biopsy result, followed by culture, bacilloscopy, FNA, and GeneXpert. One patient died. Discussion : TA predominates in the female sex in the studied group, coinciding with the local experience, the average age of presentation is 30 to 40 years, can affect any lymph node region, although the cervical location predominates, which coincides with the findings of this work. In our series, the diagnostic delay from the first consultation was shorter than reported in the literature.

Abstract The use and prescription of medicinal plants and herbal medicines within the Family Health Strategy faces new and old challenges in the post-pandemic COVID-19 context. Globally, the biomedical model has strengthened as the main guiding paradigm of care. In Brazil, the increase in poverty and the disinvestment in health policies have compounded the phenomenon of misinformation. This article discusses how the availability of herbal medicine and other integrative and complementary practices have been affected in this context, based on data from two studies conducted prior to the pandemic. The first, carried out with healthcare professionals in the municipality of Rio de Janeiro, identifies conflicts between professional categories in the use and prescription of these treatments. The second, an ethnographic approach, describes how popular groups have been claiming the recognition of knowledge about medicinal plants as intangible cultural heritage. In order to avoid categorizing these practices as health misinformation, it is necessary to understand their traditional use in local contexts. postpandemic post pandemic COVID19 COVID 19 COVID-1 context Globally care Brazil misinformation first Janeiro treatments second approach heritage contexts COVID1 1 COVID-

Resumo O uso e prescrição de plantas medicinais e fitoterápicos na Estratégia Saúde da Família enfrenta novos e velhos desafios no contexto pós-pandemia de Covid-19. No mundo, o modelo biomédico se fortaleceu como principal paradigma orientador do cuidado. No Brasil, o aumento da pobreza e o desinvestimento em políticas de saúde se somaram ao fenômeno da desinformação. O artigo discute como a oferta de fitoterapia e outras práticas integrativas e complementares foram afetadas nesse contexto a partir de dados de duas pesquisas anteriores à pandemia. A primeira, realizada com profissionais de saúde no município do Rio de Janeiro, identifica os conflitos entre categorias profissionais no uso e prescrição. A segunda, uma abordagem etnográfica, descreve como grupos populares têm reivindicado o reconhecimento de saberes sobre plantas medicinais como patrimônio cultural imaterial. A fim de evitar a categorização dessas práticas como desinformação em saúde, é necessário compreender o uso tradicional em contextos locais. póspandemia pós pandemia Covid19. Covid19 Covid 19. 19 Covid-19 mundo cuidado Brasil primeira Janeiro segunda etnográfica imaterial locais Covid1 1 Covid-1 Covid-

RESUMEN Introducción: La Organización Mundial de la Salud considera al síndrome doloroso lumbar la primera causa de consulta a nivel mundial, representa un importante problema de salud por su impacto, magnitud y repercusión socioeconómica; constituye la principal causa de vivir con discapacidad durante años, genera alto costo económico por incapacidades otorgadas, gastos en medicamentos y rehabilitación. Una de las principales causas del desarrollo de esta patología es la exposición a agentes ergonómicos en el trabajo. Objetivo: Evaluar la detección del síndrome doloroso de etiología laboral en Mexicali en el año 2022, con posterioridad a una intervención educativa. Métodos: Estudio cuasi experimental en médicos familiares adscritos al Órgano de Operación Administrativa Desconcentrada de Baja California en Mexicali, a quienes se realizó una intervención educativa y posteriormente se cuantificaron los casos detectados de Síndrome doloroso lumbar de etiología laboral en Mexicali en el año 2022; analizando el historial estadístico y comparándolo con el reportado posterior a la intervención educativa. Se midió el nivel de conocimiento con un cuestionario exprofeso antes y después de la intervención. Resultados: La detección del síndrome doloroso lumbar de etiología laboral se incrementó posterior a la intervención educativa realizada en 114 médicos familiares, el nivel de conocimiento sobre esta patología incremento el promedio inicial del 94 al 100 % posterior a la intervención en las 5 unidades de medicina familiar. Sobre este síndrome predominaron: la edad de 31 a 50 años, el sexo masculino y las ocupaciones de operadores de maquinaria industrial, choferes, mecánicos y técnicos en mantenimiento. Conclusiones: La intervención educativa a los médicos de primer nivel de atención mejora la detección del síndrome doloroso lumbar de etiología laboral.

ABSTRACT Introduction: The World Health Organization considers lumbar pain syndrome the first cause of consultation worldwide, it represents an important health problem due to its impact, magnitude and socioeconomic repercussion; It constitutes the main cause of living with a disability for years, generates a high economic cost due to disabilities granted, expenses in medicines and rehabilitation. One of the main causes of the development of this pathology is exposure to ergonomic agents at work. Objective: To evaluate after an educational intervention, Pain Syndrome of occupational etiology in Mexicali in the year 2022. Methods: Quasi-experimental study in family doctors assigned to the Deconcentrated Administrative Operation Body of Baja California in Mexicali, to whom an educational intervention was carried out and subsequently the detected cases of Lumbar Pain Syndrome of occupational etiology in Mexicali in the year 2022 were quantified; analyzing the statistical history and comparing it with that reported after the educational intervention. The level of knowledge was measured with an express questionnaire before and after the intervention. Results: The detection of lumbar pain syndrome of occupational etiology increased after the educational intervention carried out in 114 family physicians, the level of knowledge about this pathology increased the initial average from 94 % to 100 % after the intervention in the 5 family medicine units. Regarding this syndrome, the following prevailed: the age of 31 to 50 years, the male sex and the occupations of industrial machinery operators, drivers, mechanics and maintenance technicians. Conclusions: The educational intervention for primary care physicians improves the detection of low back pain syndrome of occupational etiology.

The recent substantial price reductions in insulin therapy by major manufacturers prompt an examination of their impact on South Africa (SA)'s healthcare. While Eli Lilly, Novo Nordisk, and Sanofi cut prices on long-acting basal insulin, among others, significantly, these insulins are not on SA's Essential Medicines List (EML) for primary healthcare. With a high prevalence of diabetes, especially pre-diabetes, in the country, the EML's neglect of newer long-acting insulin treatments hampers effective disease management. Despite efforts by the public and private sectors, insulin therapy initiation is delayed, impacting long-term outcomes. The introduction of smart insulin pens adds a technological dimension, but concerns persist about equitable access. Urging policy-makers to re-evaluate guidelines and decolonise the EML, the article emphasises enhancing patient quality of life and reducing the disease burden.

Abstract Background: Antimicrobial resistance (AMR) is one of the greatest threats to global public health. Contributing to this process, among other factors, is the indiscriminate use of antimicrobials in community-acquired respiratory infections. Each country has implemented strategies to confront this growing phenomenon. The objective of this review was to determine Chilean initiatives to deal with Antimicrobial Resistance (AMR), antibiotic use and prescribing, and availability of susceptibility data, for the critical community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophi/us influenzae and to spot areas where more information is needed and suggest a call to action to enhance patient clinical outcomes, through a narrative review of the literature. In Chile, antibiotics sales only occur under medical prescription; however, in later years, a new consumption associated with physician drug prescription has emerged in the community, especially for penicillin derivatives, quinolones, and macrolides. Data have shown a susceptibility reduction to amoxicillin and clavulanate combination and other antibiotics against S. pneumoniae. As a consequence, the local government proposed the National Plan on Antimicrobial Resistance 2017-2020. The new version from 2021 to 2025 led to a decreasing trend in Chile's 5. pneumoniae and H. influenzae isolates. Such results highlight the importance of the development of local guidelines.

Resumen Introducción: La resistencia a antimicrobianos (RAM), es una de las mayores amenazas para la salud pública mundial. Contribuyen a este proceso, entre otros factores, el indiscriminado uso de antimicrobianos en las infecciones respiratorias adquiridas en la comunidad. Cada país ha puesto en práctica estrategias para enfrentar este creciente fenómeno. El objetivo de esta revisión fue determinar las iniciativas chilenas para abordar la RAM, el uso y la prescripción de antimicrobianos y la disponibilidad de datos de susceptibilidad para los patógenos Streptococcuspneumoniae y Haemophilus influenzae, patógenos críticos de la infección del tracto respiratorio adquirida en la comunidad (ITRAC) y detectar las áreas donde se necesita más información y sugerir un llamado a la acción para mejorar los resultados clínicos de los pacientes, a través de una revisión narrativa de la literatura. En Chile, la venta de antimicrobianos solo se realiza bajo prescripción médica; sin embargo, en los últimos años ha surgido un nuevo consumo asociado a la prescripción de medicamentos en el ámbito comunitario por parte de los médicos, especialmente para derivados de penicilina, quinolonas y macrólidos. Los datos han demostrado una reducción de la susceptibilidad in vitro a la combinación de amoxicilina y ácido clavulánico y otros antimicrobianos frente a 5. pneumoniae. En consecuencia, el gobierno local propuso el plan nacional de resistencia antimicrobiana 2017-2020. La nueva versión de 2021 a 2025 podría explicar la tendencia decreciente de aislados de 5. pneumoniae y H. influenzae en Chile. Tales resultados destacan la importancia del desarrollo de guías locales.

Abstract Objetivo: Avaliar a concordância da terapêutica com medicamentos modificadores de prognóstico (MMP) em pessoas com insuficiência cardíaca crónica com fração de ejeção reduzida (P-CICFEr), em cuidados de saúde primários (CSP) na região Centro de Portugal, com as diretrizes da Sociedade Europeia de Cardiologia (ESC) de agosto de 2021. Métodos: Estudo observacional transversal de uma amostra representativa do tamanho, intervalo de confiança de 95% e margem de erro de 8%, da população com CICFEr em 31/dezembro/2021. Foram estudados idade, sexo, ano de diagnóstico da introdução da Classificação Internacional para Cuidados Primários-2 (ICPC-2, K-77), anos desde o último ecocardiograma, MMPs para P-CICFEr e outras terapêuticas para P-CICFEr. Participaram, convidadas por conveniência, 11 Unidades de Saúde Familiar após parecer positivo da Comissão de Ética. Resultados: Num universo de n=2.381 pessoas com insuficiência cardíaca (PCIC) encontraram-se n=453 (19,0%) (P-CICFEr) estudando-se uma amostra representativa de n=133 (5,6%), n=95 homens (71,4%). Verificou-se prescrição de medicamentos inibidores do sistema renina-angiotensina-aldosterona (iSRAA) 91,0%, de betabloqueadores em 75,2%, de antagonistas mineralocorticoides em 40,6%, de inibidores da SGLT2 em 44,4%, de inibidores da neprilisina em 38,3% e de diuréticos de ansa em 72,2%. A terapêutica farmacológica quádrupla verificou-se em n=28 (21,1%) P-CICFEr e a tripla em n=38 (28,6%). Verificou-se idade média de 74,3±11,6 anos, 75,1±4,0 no homem e 76,6±6,0 na mulher, p=0,088. A mediana de tempo desde o diagnóstico ICPC-2 foi de 6,0 anos no homem e de 4,0 anos na mulher, p=0,031. O tempo mediano desde o último ecocardiograma foi de três anos, p=0,750. Conclusão: Os medicamentos modificadores de prognóstico, segundo as diretrizes mais recentes da ESC para a CICFEr, estavam subutilizados em 50,4% dos casos. Apesar dos resultados encontrados é necessária reflexão acerca das barreiras que os médicos possam encontrar para aplicar as diretrizes em P-CICFEr.

Resumo Objective: To evaluate the accordance of prognostic medicines prescription (PMP), for persons with chronic heart failure with reduced ejection fraction (P-CHFrEF), attended in primary health care units in Central Portugal, with the European Society of Cardiology (ESC) 2021 August, guidelines. To know about mean age, median time since the diagnosis and last echocardiogram performance in P-CHFrEF. Methods: Observational, cross-sectional study of a random size representative sample, 95% confidence interval, and 8% error margin of the P-CHFrEF of a population on 31st December 2021. Age, gender, year of International Classification for Primary Care-2 (ICPC-2, K-77) problem classification input data, years since the last echocardiogram, ongoing PMP and the use of other chronic heart failure (CHF) drugs were gathered. Data were obtained from 11 Portugal Primary Health Care Units, invited by convenience, after an Ethics Committee approval. Results: From a universe of n=2,381 persons with CHF, n=453 (19.0%) P-CHFrEF was found. A size representative sample of P-CHFrEF of n=133 (5.6%), n=95 males (71.4%) was studied. Prescription of a renin-angiotensin system inhibitor (RAAS-I) was ongoing in 91.0%, beta-blocker (BB) in 75.2%, mineralocorticoid antagonists (MRA) in 40.6%, inhibitors of the sodium-glucose cotransporter-2 (SGLT2i) in 44.4%, neprilisine inhibitors 38.3% and loop diuretics in 72.2%. The optimized medical quadruple therapy was established in 28 patients (21.1%) and the triple one in 38 (28.6 %). Mean age was of 74.3±11.6 years, males 73.4±11.0 and females 76.6±12.9, p=0.088. The median time since the diagnosis was 6.0 for men and 4.0 for women, p=0.031. The median time since the last echocardiogram was 3.0, p=0.750 between genders. Conclusion: According to the 2021 ESC guidelines, prognostic modifying medicines were underused for 50.4% of P-CHFrEF. Even with these results, a reflection must be made, on the barriers physicians encounter, to comply with the ESC guidelines in such patients.

ABSTRACT Introduction: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. Methods: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors’ and kidney transplant patients’ demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. Results: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159–0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687–0.926; p = 0.003] and death from any cause. Conclusion: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor. Introduction failure pre posttransplantation post DGF, , (DGF) CAD, (CAD) donor Methods 20 donors data Moreover parameters status nonDGF non groups Afterward analysis years Results pretransplant (Hb donorserum serum addition OR 0252 0 252 0.252 95%CI 95CI CI 95 0.159–0.401 01590401 159 401 0.001. 0001 0.001 . 001 0.001] 0798 798 0.798 0.687–0.926 06870926 687 926 0.003 0003 003 Conclusion pretransplantation Thus (DGF (CAD 2 025 25 0.25 9 0.159–0.40 0159040 15 40 000 0.00 00 079 79 0.79 0.687–0.92 0687092 68 92 02 0.2 0.159–0.4 015904 1 4 0.0 07 7 0.7 0.687–0.9 068709 6 0. 0.159–0. 01590 0.687–0. 06870 0.159–0 0159 0.687–0 0687 0.159– 015 0.687– 068 0.159 01 0.687 06 0.15 0.68 0.1 0.6

RESUMO Introdução: A anemia é frequente em pacientes submetidos à terapia substitutiva para insuficiência renal. A anemia nos períodos pré e pós-transplante pode estar relacionada aos desfechos do transplante renal. Portanto, o presente estudo buscou avaliar a relação entre anemia, função retardada do enxerto (FRE), disfunção crônica do enxerto renal (DCE) e óbito por qualquer causa após transplante renal de doador falecido. Métodos: Este foi um estudo retrospectivo com 206 pacientes transplantados renais de doadores falecidos. Analisamos dados demográficos de doadores falecidos e pacientes transplantados renais. Além disso, comparamos parâmetros bioquímicos, status de anemia e medicamentos entre os grupos FRE e não-FRE. Posteriormente, realizamos uma análise multivariada. Também avaliamos desfechos, como DCE em um ano e óbito em dez anos. Resultados: Observamos menor frequência de concentração de hemoglobina (Hb) pré-transplante, mas maior frequência de creatinina sérica do doador e transfusão de hemácias no período de uma semana após o transplante no grupo FRE. Além disso, houve associação independente entre a concentração de Hb antes do transplante e a FRE [OR 0,252; IC 95%: 0,159–0,401; p < 0,001]. Houve também associação entre a concentração de Hb após seis meses de transplante renal e ambos, DCE [OR 0,798; IC95%: 0,687–0,926; p = 0,003] e óbito por qualquer causa. Conclusão: Encontrou-se uma associação entre anemia pré-transplante e FRE e entre anemia seis meses após o transplante e ambos, DCE e óbito por qualquer causa. Assim, a anemia antes ou após o transplante afeta os desfechos de pacientes que foram submetidos a transplante renal de doador falecido. Introdução póstransplante pós Portanto FRE, , (FRE) (DCE falecido Métodos 20 disso bioquímicos nãoFRE. nãoFRE não não-FRE Posteriormente multivariada anos Resultados (Hb prétransplante, prétransplante transplante, OR 0,252 0252 0 252 95% 95 0,159–0,401 01590401 159 401 0,001. 0001 0,001 . 001 0,001] ambos 0,798 0798 798 IC95% IC95 0,687–0,926 06870926 687 926 0,003 0003 003 Conclusão Encontrouse Encontrou se Assim (FRE 2 0,25 025 25 9 0,159–0,40 0159040 15 40 000 0,00 00 0,79 079 79 IC9 0,687–0,92 0687092 68 92 0,2 02 0,159–0,4 015904 1 4 0,0 0,7 07 7 0,687–0,9 068709 6 0, 0,159–0, 01590 0,687–0, 06870 0,159–0 0159 0,687–0 0687 0,159– 015 0,687– 068 0,159 01 0,687 06 0,15 0,68 0,1 0,6

ABSTRACT Introduction: The discharge of hospital wastewater leads to the establishment of microorganisms from human biota in aquatic ecosystems. This is risky, as there is the possibility of horizontal gene transfer of antibiotic resistance genes from bacteria to other bacterial strains in the aquatic ecosystem and the environment in general, contributing to the expansion of bacterial resistance to antibiotics and the therapeutic ineffectiveness of these medicines. Objective: To demonstrate the environmental risk due to discharge of wastewater from a hospital into an urban river in Santa Clara, Cuba. Materials and Methods: Bacteria were isolated from sediment and soil from the banks of the Bélico river and their resistance to parenteral antibiotics for intra-hospital use employed between 2015 and 2019 was determined. If positive, the environmental risk of these medicines in terrestrial surface waters was estimated, and the resistance of in-hospital strains was assessed. Results and Discussion: All isolated bacterial strains were resistant to at least one of the parenteral antibiotics for intra-hospital use employed in the period under study. All antibiotics were environmentally risky in terrestrial surface waters. There was a high antibiotic resistance of the strains isolated from hospitalized patients. Conclusions: The discharge of untreated wastewater into the Bélico river led to the establishment of bacterial strains which can have a negative impact on the environment, including human health.

RESUMEN Introducción: El vertimiento de aguas residuales hospitalarias conduce al establecimiento de microorganismos de la biota humana en ecosistemas acuáticos. Lo anterior es riesgoso, al existir la posibilidad de transferencia génica horizontal de genes de resistencia de antibióticos de las bacterias a otras cepas bacterianas del ecosistema acuático y del ambiente en general; contribuyendo a la expansión de la resistencia bacteriana a antibióticos y la inefectividad terapéutica de estos medicamentos. Objetivo: Demostrar el riesgo ambiental por vertimiento de aguas residuales de un hospital a un río urbano en Santa Clara, Cuba. Materiales y Métodos: Se aislaron bacterias del sedimento y suelo de la ribera del río Bélico y se determinó su resistencia a los antibióticos parenterales de uso intrahospitalario empleados entre 2015 y 2019. De ser esta positiva, se estimó el riesgo ambiental de estos medicamentos en aguas superficiales terrestres y se valoró la resistencia de cepas intrahospitalarias. Resultados y Discusión: Todas las cepas bacterianas aisladas fueron resistentes al menos a uno de los antibióticos parenterales de uso intrahospitalario empleados en el período objeto de estudio. Todos los antibióticos resultaron ambientalmente riesgosos en aguas superficiales terrestres. Existió una elevada resistencia microbiana a antibióticos en las cepas aisladas de pacientes hospitalizados. Conclusiones: El vertimiento de las aguas residuales sin tratar al río Bélico, condujo al establecimiento de cepas bacterianas que pueden tener un impacto negativo en el ambiente, incluyendo la salud humana.

Abstract The relationship between the right to health and the right to adequate medical care has always been a problem. There is no doubt as to the existence of the right, but there are provisions, such as Article 26 of the ACHR, that relativize the scope of the State's obligations in this area. It is generally stated that it is not possible to fully satisfy this right. With this starting point, the international regulation of the matter is explored, and then moves on to the study of the Uruguayan Constitution and the existing health insurance. In short, for the case under study, the moderation of Article 26 is questioned, and it is concluded that the State must take charge of medicines when the individual cannot afford them.

Resumen La relación entre el derecho a la salud y a recibir una asistencia médica adecuada siempre ha sido un problema. No hay duda en cuanto a la existencia del derecho, pero hay disposiciones, como el artículo 26 de la Convención Americana de Derechos Humanos (CADH), que relativizan el alcance de las obligaciones del Estado en esta materia. En general se afirma que no es posible satisfacer este derecho en forma completa. Con este punto de partida, se explora la regulación internacional de la salud, para pasar luego al estudio de la Constitución uruguaya y del seguro médico existente. En definitiva, para el caso en estudio, se cuestiona la mesura del artículo 26 y se concluye en que el Estado debe hacerse cargo de los medicamentos cuando el individuo no pueda afrontar su costo.