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

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

RESUMEN El golpe de calor es una condición médica grave que puede provocar falla orgánica múltiple, e incluso la muerte, si no se identifica e interviene oportunamente. El objetivo es sintetizar narrativamente la mejor evidencia disponible respecto a la prevención, diagnóstico y tratamiento del golpe de calor. Se realizó una búsqueda sistemática en Pubmed/MEDLINE y en repositorios de organismos elaboradores de documentos normativos. Se incluyeron cuatro guías de práctica clínica y ocho documentos técnicos. El diagnóstico golpe de calor se basa en una temperatura corporal superior a 40°C acompañada de síntomas clínicos. La prevención se enfoca en el autocuidado, evitando la exposición excesiva al calor, manteniendo una correcta hidratación y utilizando ropa adecuada. En caso de golpe de calor, es esencial trasladar al paciente a un entorno fresco, hidratarlo y aplicar métodos de enfriamiento físico. El tratamiento se organiza en dos fases. La primera es la prehospitalaria, que incluye la estabilización, enfriamiento pasivo y líquidos intravenosos. La segunda es la hospitalaria, donde se continúa el enfriamiento hasta alcanzar los 39°C en la temperatura rectal. Se deben administrar líquidos para soporte hemodinámico y evitar los antipiréticos. En conclusión, la presente revisión narrativa ha identificado estrategias para el diagnóstico, prevención y tratamiento del golpe de calor, basado en la mejor evidencia disponible.

ABSTRACT Heat stroke is a serious medical condition that can lead to multiple organ failure and even death if not identified and intervened in a timely manner. The objective is to narratively synthesize the best available evidence regarding the prevention, diagnosis and treatment of heat stroke. A systematic search was conducted in Pubmed/MEDLINE and in repositories of standard-setting bodies. Four clinical practice guidelines and eight technical documents were included. The diagnosis of heat stroke is based on a body temperature above 40°C accompanied by clinical symptoms. Prevention focuses on self-care, avoiding excessive exposure to heat, maintaining proper hydration and wearing appropriate clothing. In case of heat stroke, it is essential to move the patient to a cool environment, hydrate and apply physical cooling methods. Treatment is organized in two phases. The first phase is pre-hospital, which includes stabilization, passive cooling and intravenous fluids. The second phase is the hospital phase, where cooling is continued until a rectal temperature of 39°C is reached. Fluids should be administered for hemodynamic support and antipyretics should be avoided. In conclusion, the present narrative review has identified strategies for the diagnosis, prevention and treatment of heat stroke, based on the best available evidence.

RESUMEN Introducción: la experiencia del uso de la plasmaféresis terapéutica en enfermedades autoinmunes e inflamatorias permitió proponerla e indicarla en combinación con fármacos biotecnológicos en el paciente con COVID-19; enfermedad caracterizada por la liberación de citocinas no controlada que activa la respuesta proinflamatoria, síndrome de insuficiencia respiratoria aguda, eventos trombóticos y fallo multiorgánico. Objetivo: describir los resultados del empleo de la plasmaféresis terapéutica combinado con los fármacos biotecnológicos cubanos en pacientes con empeoramiento de la enfermedad por COVID-19. Metodología: se realizó la investigación durante la segunda oleada de pandemia de COVID-19 en el Hospital Militar “Manuel Fajardo Rivero” durante los meses marzo y abril del año 2021. El estudio de caso involucró a 16 pacientes mayores de 18 años de edad con reacción en cadena de la polimerasa con transcriptasa inversa positivo al coronavirus 2 del síndrome respiratorio agudo severo, con deterioro de su estado clínico y de laboratorio que fueron sometidos a tratamiento de plasmaféresis y fármacos biotecnológicos cubanos: Itolizumab, Jusvinza, HeberFERON® e Intacglobin®. Resultados: el 75% de los pacientes fueron clasificados potencialmente graves. La mitad de los enfermos recibió Itolizumab y al menos una sesión de plasmaféresis terapéutica. La respuesta fue favorable, el 100% negativizó la reacción en cadena de la polimerasa con transcriptasa inversa y el dímero D se normalizó con mayor rapidez, seguido de la proteína C reactiva. Se necesitaron menos sesiones de plasmaféresis para lograr la recuperación. Conclusiones: la plasmaféresis terapéutica en pacientes con COVID-19 fue un tratamiento complementario y prometedor; combinado con los biofármacos cubanos fue innovador y necesario para reducir la carga inflamatoria-viral y lograr la recuperación del paciente con agravamiento clínico de su estado.

ABSTRACT Introduction: The experience of using therapeutic plasmapheresis in autoimmune and inflammatory diseases allowed us to propose and indicate this therapy in combination with Cuban biotechnological drugs in patients with COVID-19; a disease characterized by the uncontrolled release of cytokines that activate the proinflammatory response, acute respiratory failure syndrome, thrombotic events and multiorgan failure. Objective: To describe the results of the use of therapeutic plasmapheresis combined with Cuban biotechnological drugs in patients with worsening of COVID-19 disease. Methodology: The research was carried out during the second wave of the COVID-19 pandemic at the "Manuel Fajardo Rivero" Army Military Hospital in Villa Clara, during the months of March and April 2021. Case study involving 16 patients over 18 years of age with positive PCR-RT for SARS-CoV-2, with deterioration in their clinical and laboratory condition who underwent plasmapheresis treatment and Cuban biotechnological drugs: Itolizumab, Jusvinza, HeberFERON® e Intacglobin®. Results: 75% of the patients were classified as potentially serious. Half of the patients received Itolizumab and at least one therapeutic plasmapheresis session. The response was favorable, 100% had negative PCR-RT, and D-dimer normalized more quickly, followed by C - reactive protein. Fewer plasmapheresis sessions were needed to achieve recovery. Conclusions: Therapeutic plasmapheresis in patients with COVID-19 was a complementary and promising treatment; combined with biopharmaceuticals, innovative and necessary to reduce the inflammatory and viral load and achieve the recovery of the patient with clinical worsening of his condition.

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

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

Resumen El trabajo tuvo como objetivo determinar las microestructuras en la interfase y propiedades mecánicas de una soldadura por explosión del acero inoxidable AISI 304 y al carbono AISI 1010. Para el proceso de conformación por embutido y de la soldadura disímil del casquete esférico se utilizó una estampa, donde luego de conformado, se seleccionó como área de análisis el borde y la curvatura del mismo. Con el software SOLIDWORD se estableció la ocurrencia de la deformación y las tensiones durante el proceso. Se determinó que, la unión metalúrgica se logra con una interfase ondulada, la cual difiere de su formación en dependencia de la distancia en que ocurre la detonación, lo cual favorece el compactamiento metalúrgico, donde se origina la formación de ferrita equiaxial en el AISI 1010 y de austenita y martensita en el AISI 304, pero con tamaño de granos más pequeños producto de la onda de choque expansiva, así como la presencia de carburos del tipo M7C3 o Cr23C6. La variación de dureza determinada de 300 HV para el primero y de 450 HV en el segundo, se debe al apilamiento de los granos por deformación plástica. Las mayores deformaciones y tensiones en el casquete esférico ocurren en el radio inferior (fondo), las que se expanden hasta la pared de la estampa.

Abstract The objective the work was to determine the microstructures at the interface and mechanical properties of an explosion welding AISI 304 stainless steel and AISI 1010 carbon steel. For the drawing forming process and the dissimilar welding of the spherical cap, a stamp was used, where after forming, the edge and its curvature were selected as the analysis area. With SOLIDWORD software, the occurrence of deformation and stresses during the process was established. It was determined that the metallurgical union is achieved with a wavy interface, which differs from its formation depending on the distance at which the detonation occurs, which favors metallurgical compaction, where the formation of equiaxial ferrite in the AISI 1010 originates. And austenite and martensite in AISI 304, but with smaller grain sizes as a result the expansive shock wave, as well as the presence of carbides of the M7C3 or Cr23C6 type. The determined hardness variation of 300 HV for the first and 450 HV in the second is due to the stacking of the grains due to plastic deformation. The greatest deformations and stresses in the spherical cap occur in the lower radius (bottom), which expand to the wall of the stamp.

RESUMEN Introducción. La emergencia de COVID-19 causó una pandemia con gran impacto en la mortalidad en Perú. Objetivo. Analizar la magnitud de la mortalidad por COVID-19 e identificar algunas características sociodemográficas. Métodos. Se realizó un estudio descriptivo de tipo ecológico, se analizaron los datos de muertes por COVID-19 durante el periodo 2020-2023, así como indicadores socioeconómicos y demográficos de acceso público. Las variables incluidas en el estudio fueron año de defunción, número de muertes, sexo, grupo etario, provincia de procedencia, región natural, macrorregión, índice de desarrollo humano (IDH), necesidades básicas insatisfechas (NBI) y densidad poblacional. Resultados. Se reportaron 220628 muertes por la COVID-19, de las cuales, 219374 (99,43%) ocurrieron durante la pandemia y 1254 (0,57%) en periodo pospandemia. La tasa de mortalidad acumulada fue de 6,76 muertes/1000 habitantes. La curva de muertes por COVID-19 muestra que entre el 2020-2023 ocurrieron cinco olas siendo la de mayor mortalidad la segunda, seguida por la primera ola. La mortalidad predominó en hombres, adultos mayores (69,77%) y adultos (28,11%). La macrorregión de Lima Metropolitana y Callao tuvo las más altas tasas de mortalidad con 9,36 muertes/1000 habitantes. Las provincias con mayores tasas de mortalidad acumulada fueron las ubicadas en la costa, en quintiles con menos NBI, en quintiles de mayor IDH y en aquellas provincias con mayor densidad poblacional. Conclusiones. La pandemia COVID-19 causó elevada mortalidad en Perú, siendo mayor en varones, adultos mayores, de ciudades de costa, de mayor densidad poblacional y mejores indicadores socioeconómicos.

ABSTRACT Introduction. The COVID-19 emergency caused a pandemic with a great impact on mortality in Peru. Objective. To analyze the magnitude of mortality due to COVID-19 and identify some sociodemographic characteristics. Methods. A descriptive ecological study was carried out, analyzing data on deaths due to COVID-19 during the period 2020-2023, as well as publicly accessible socioeconomic and demographic indicators. The variables included in the study were: year of death, number of deaths, sex, age group, province of origin, natural region, macroregion, human development index (HDI), unmet basic needs (UBN) and population density. Results. 220,628 deaths due to COVID-19 were reported, of which 219,374 (99.43%) occurred during the pandemic and 1,254 (0.57%) in the post-pandemic period; The cumulative mortality rate was 6.76 deaths/1000 inhabitants. The COVID-19 death curve shows that between 2020-2023, five waves occurred, with the second wave having the highest mortality, followed by the first wave. Mortality predominated in men, older adults (69.77%) and adults (28.11%). The macroregion of Metropolitan Lima and Callao had the highest mortality rates with 9.36 deaths/1000 inhabitants. The provinces with the highest cumulative mortality rates were those located on the coast, in quintiles with less NBI, in quintiles with a higher HDI and in those provinces with a higher population density. Conclusions. The COVID-19 pandemic caused high mortality in Peru, being higher in males, older adults, from coastal cities, with higher population density and better socioeconomic indicators.

ABSTRACT During the first wave of globalization, the signing of trade treaties that contained the Most Favoured Nation clause proliferated. In this paper, we focus on the Argentine case. On the one hand, we propose that the agreements were extended by the need for governments to belong to an informal mercantile network in a world lacking multilateral institutions. On the other hand, we consider that those legal instruments were the key to commercial claims, especially when protectionism intensified toward the end of the nineteenth century, as is evidenced by the actions of the consular and diplomatic system. The main sources used are trade treaties, conventions, and protocols, as well as the Argentine Memoirs of the Ministry of Foreign and Religious Affairs.

RESUMEN Durante la Primera Globalización proliferó la firma de tratados de comercio que contenían la cláusula de Nación Más Favorecida. En este trabajo abordamos el caso argentino y, por un lado, proponemos que los acuerdos se extendieron por la necesidad de los gobiernos de pertenecer a una red informal mercantil en un mundo carente de instituciones multilaterales; por otro, consideramos que aquellos instrumentos jurídicos fueron el argumento central sobre el que se basaron los reclamos comerciales, en especial, cuando se intensificó el proteccionismo a finales del siglo XIX, tal como prueba el accionar del sistema diplomático y consular. Las fuentes utilizadas son los tratados, convenciones y protocolos comerciales, así como las Memorias del Ministerio de Relaciones Exteriores y Culto de Argentina.

Resumo O Amazonas, sofreu uma grave crise de saúde pública em decorrência da pandemia da Covid-19, apresentando taxas de letalidade acima da média estipulada pela Organização Mundial da Saúde (OMS), resultando no colapso do sistema de saúde e, inclusive, do sistema funerário na chamada primeira onda. Ante ao cenário calamitoso que se instalou no estado, medidas sanitárias de enfrentamento ao coronavírus foram adotadas, algumas restritivas e outras com relaxamento do isolamento social. Esse abrandamento sanitário repercutiu tanto na capital quanto no interior do estado e a situação voltou a agravar rapidamente, o que ensejou a segunda onda em meados de dezembro de 2020, sendo agravada de forma devastadora e caótica, em 14 de janeiro de 2021, quando a cidade de Manaus padeceu pelo desabastecimento de oxigênio nas unidades de saúde, levando a morte de muitos pacientes por asfixia. Assim, este estudo se propôs a revisitar este período crítico, descrever a conjuntura da crise de oxigênio e contribuir para o entendimento dos problemas existentes referentes à saúde do estado, por método dedutivo através de pesquisa em documentos e dados secundários de publicações nacionais e fontes governamentais. Fatores políticos e socioeconômicos contribuíram para o recrudescimento da pandemia no Brasil, e o Amazonas, de forma severa, não escapou deste contexto. As condições desfavoráveis do sistema de saúde do estado, altamente concentrado na capital, dificultam o acesso e a assistência à saúde da população residente nos demais 61 municípios e contribuíram fortemente para o agravamento da situação pandêmica no Amazonas.

Abstract Amazonas suffered a serious public health crisis as a result of the Covid-19 pandemic, which fatality rates above the average stipulated by the World Health Organization (WHO), resulting in the collapse of the health care system health and even the funeral system, in the so-called firsth wave. Faced with the calamitous scenario that has sattled in the state, sanitary measures to combat the coronavirus have been adopted, some restrictive and others with a relaxation of social isolation. This health slowdown, with repercussions both in the capital and in the interior of the state and the situation quickly deteriorated again, which gave rise to the second wave in mid-December 2020, being worsened in a devastating and chaotic way, on January 14, 2021, when the city of Manaus suffered from the lack of oxygen in health units, leading to the death of many patients from suffocation. Thus, this study proposed to revisit this critical period, describe of the oxygen crisis and contribute to the understainding of existing problems relating to the state’s health, using a deductive method throug research in documents and secondary data from national publications and government sources. Political and socioeconomic factors contributed to the resurgence of the pandemic in Brazil, and Amazonas, severely, did not escape this context. The unfavorable conditions of the state’s health system, highly concetrated in the capital, make access and health care difficult for the population residing other 61 municipalities and have contributed strongly to the worsening of the pandemic situation in Amazonas.

Abstract: The purpose of this article is to analyse the relationship between different innovation profiles, capabilities, and innovation results of manufacturing firms from Argentina. The premise that guides our research is that most of firms not performing formal R&D -92%- are a highly heterogeneous group in terms of innovative behaviour, capabilities and innovative performance. Thus, we propose to study firms’ innovation profile as a gradient that accounts for formal R&D, informal R&D, non- R&D performing firms and firms without innovation efforts. Then, the relationship between these profiles and five dimensions of firms’ capabilities -productive, organizational, connectivity, and accumulated and potential absorptive - is explored. Accordingly, the study of how these profiles correlate with firms’ innovation results -products and/or processes innovations, new marketing and/or organizational changes, patents and ratio of new product sales to total sales- is also carried out. The empirical evidence is based on Argentinean manufacturing firms with data from the second wave of the National Innovation Survey composed by around 4000 observations for the period of 2014-16. Results suggest that more complex R&D profiles require higher levels of capabilities. Moreover, there seems to be a threshold of capabilities in moving from the non-R&D to the informal R&D profile. Likewise, while informal R&D is a critical threshold to increase the probability of obtaining product, process, organization and marketing innovations, formal R&D is key to get patents and to increase the share of new products on total sales.

Resumen: El objetivo de este artículo es analizar la relación entre diferentes perfiles de innovación, capacidades y resultados de innovación en las empresas manufactureras argentinas. La premisa que guía la investigación es que la mayoría de las empresas que no desarrollan I+D -92%- son un grupo altamente heterogéneo en términos de comportamiento innovativo, capacidades y desempeño innovador. Así, proponemos estudiar el perfil de innovación de las empresas como un gradiente que incluye I+D formal, I+D informal, firmas que no realizan I+D y firmas que no realizan esfuerzos en innovación. De esta forma, es explorada la relación entre esos perfiles y cinco dimensiones de capacidades de la firma -productivas, organizacionales, de conectividad y de absorción acumulada y potencial-. Asimismo, se estudia cómo estos perfiles correlacionan con los resultados de innovación de la firma -innovaciones de producto y/o proceso, marketing y/o cambios organizacionales, patentes y ratio de nuevos productos sobre el total de ventas-. La evidencia empírica se basa en las empresas manufactureras argentinas, con datos de la segunda vuelta de la Encuesta Nacional de Innovación, que contiene alrededor de 4000 observaciones para el período 2014-16. Los resultados sugieren que los perfiles más complejos de I+D requieren mayores niveles de capacidades. Más aun, parece existir un umbral mínimo de capacidades para trasladarse del perfil que no realiza I+D al perfil de I+D informal. De la misma manera, mientras realizar I+D informal es un umbral fundamental para aumentar la probabilidad de obtener innovaciones en producto, proceso, organizacional y de marketing, la I+D formal es clave para obtener patentes y para aumentar la proporción de nuevos productos en el total de ventas.

Abstract Background: In December 2019 the first case of atypical pneumonia were reported in Wuhan-China due to SARS-CoV-2 virus. In the Andean population, adaptation mechanisms to hypoxic and hypobaric environmental condition would favor the decrease in mortality due to COVID-19. Aim: To determine whether altitude is a factor associated with mortality in COVID-19 patients in the Peruvian territory Methods: Observational case-control study analyzing secondary database. We measured association with χ2 and multivariate analysis with simple and multiple logistic regression controlling for age, sex, severity and comorbidities (95%CI). Results: We analyzed data from 616.382 patients during the second wave in 26 regions of Peru (47.7% female and 52.3% male) with an average age of 42.7 ± 18.2 years. The most frequent comorbidity was cardiovascular disease (4.5%), the most frequent symptom was cough (65.2%). In the bivariate analysis, age, sex, degree of severity and comorbidities were significant (p < 0.001; 95%CI) Multiple logistic regression showed that residing between 2,000-3,000 and 4,000-5,000 m a.s.l. provided a 62% and 32% lower probability of death compared to the population residing at less than 1,000 m a.s.l.; 95%CI OR: 0.38 (0.36-0.40) and OR 0.68 (0.59-0.80) respectively. Conclusion: In the Peruvian population, residing above 1,000 m a.s.l. is a protective factor against death from COVID-19.

Resumen Introducción: En diciembre del 2019 se reportaron los primeros casos de neumonía atípica en Wuhan - China, a causa del virus SARSCoV-2. En la población de altura, los mecanismos de adaptación a la condición ambiental hipóxica e hipobárica favorecerían la disminución de la mortalidad por COVID-19. Objetivo: Determinar si la altura es un factor asociado a mortalidad en pacientes con COVID-19 en el territorio peruano. Materiales y Métodos: Estudio de diseño de tipo ecológico analítico de base de datos secundaria. Medimos asociación con χ2 y análisis multivariado con regresión logística simple y múltiple, controlando la edad, sexo, gravedad y comorbilidades con IC 95%. Resultados: Se analizaron los datos de 616.382 pacientes durante la segunda ola en 26 regiones del Perú (47,7% de sexo femenino y 52,3% de sexo masculino) siendo la edad promedio 42,7 ± 18,2 años. La comorbilidad más frecuente fue la enfermedad cardiovascular (4,5%), el síntoma más frecuente fue la tos (65,2 %). En el análisis bivariado la edad, sexo, grado de severidad y comorbilidades fueron significativas (p < 0,001; IC95%). Mediante regresión logística múltiple se observó que residir entre 2.000-3.000 y 4.000-5.000 m s.n.m. proporcionan 62 y 32 % menos probabilidad de muerte en comparación con la población que reside a menos de 1000 m s.n.m.; IC95% OR: 0,38 (0,36-0,40) y OR 0,68 (0,59-0,80), respectivamente. Conclusión: En la población peruana residir a más de 1.000 m s.n.m. constituye un factor de protección frente a la muerte por 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-

Resumen En este artículo, se analiza el desafío al que se enfrenta China, para alcanzar su meta de lograr una alta tasa de crecimiento económico para el periodo del XIV Plan Quinquenal de Desarrollo Económico y Social (PQDEyS) 2021-2025, dado el contexto de incertidumbre que aún experimenta la economía global y las condiciones internas que registra este país, luego de atravesar la segunda ola de contagios de COVID-19 en el segundo semestre de 2022. Se plantea la hipótesis que China ha logrado registrar una tasa de crecimiento económico entre los años 2021 y 2023 acorde a la planeada en el periodo del XIV PQDEyS, gracias al uso de los instrumentos y variables de una política económica ad hoc.

Abstract This article analyzes the challenge that China faces in achieving its goal of a high economic growth rate for the XIV Five-Year Economic and Social Development Plan (FYESDP) 2021- 2025 period, given the context of uncertainty that the global economy is still experiencing, and the domestic conditions that the country is going through after the second wave of COVID-19 contagion in the second half of 2022. The hypothesis is that China has managed to register an economic growth rate in accordance with the targets planned in the XIV FYESDP period between 2021 and 2023, thanks to the use of an ad hoc of instruments and variables of the economic policy.

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.

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. Durante el desarrollo de la pandemia por SARS-CoV-2 en Antioquia se presentaron picos epidemiológicos relacionados con las variantes α, ɣ, β, μ, ƛ y δ, donde δ tuvo la mayor incidencia y prevalencia. Este linaje se considera una variante de preocupación dadas las manifestaciones clínicas que desencadena y sus características epidemiológicas. Se han informado 253 sublinajes δ en la base de datos PANGOLIN. La identificación de estos sublinajes mediante análisis genómico ha permitido rastrear su evolución y propagación. Objetivo. Caracterizar la diversidad genética de los diferentes sublinajes δ de SARSCoV-2 en Antioquia y determinar su prevalencia. Materiales y métodos. Se recopiló información sociodemográfica de 2.675 muestras y de 1.115 genomas del repositorio GISAID entre el 12 de julio de 2021 y el 18 de enero de 2022. Se seleccionaron 501 por su alto porcentaje de cobertura (>90 %) para realizar análisis filogenéticos e inferencia de frecuencias alélicas de mutaciones de interés. Resultados. Se caracterizaron 24 sublinajes donde el más prevalente fue AY.25. En este sublinaje se identificaron mutaciones de interés como L452R, P681R y P681H, que comprendían una frecuencia cercana a 0,99. Conclusiones. Este estudio permitió identificar que el sublinaje AY.25 tiene una ventaja de transmisión en comparación con los otros sublinajes δ. Esto puede estar relacionado con la presencia de las mutaciones L452R y P681R que en otros estudios se han visto asociadas con una mayor transmisibilidad, evasión del sistema inmunitario y menor eficacia de los medicamentos contra SARS-CoV-2.

Abstract Introduction. During the development of the SARS-CoV-2 pandemic in Antioquia, we experienced epidemiological peaks related to the α, ɣ, β, μ, ƛ, and δ variants. δ had the highest incidence and prevalence. This lineage is of concern due to its clinical manifestations and epidemiological characteristics. A total of 253 δ sublineages have been reported in the PANGOLIN database. The sublineage identification through genomic analysis has made it possible to trace their evolution and propagation. Objective. To characterize the genetic diversity of the different SARS-CoV-2 δ sublineages in Antioquia and to describe its prevalence. Materials and methods. We collected sociodemographic information from 2,675 samples, and obtained 1,115 genomes from the GISAID database between July 12th, 2021, and January 18th, 2022. From the analyzed genomes, 515 were selected because of their high coverage values (>90%) to perform phylogenetic analysis and to infer allele frequencies of mutations of interest. Results. We characterized 24 sublineages. The most prevalent was AY.25. Mutations of interest as L452R, P681R, and P681H were identified in this sublineage, comprising a frequency close to 0.99. Conclusions. This study identified that the AY.25 sublineage has a transmission advantage compared to the other δ sublineages. This attribute may be related to the presence of the L452R and P681R mutations associated in other studies with higher evasion of the immune system and less efficacy of drugs against SARS-CoV-2.

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