Abstract In geometrically nonlinear problems solved using the Finite Element Method (FEM), the structure response is directly influenced by the level of discretization and the nonlinear solution algorithm used. To reduce the discretization dependence, exact solutions are developed based on the deformed infinitesimal element equilibrium. To deal with the nonlinear solution problem, the two-cycle method can be used, since it is not dependent on load or displacement steps. The two-cycle method developed by Chen & Lui (1991) uses the classical geometric matrix and is not accurate for high axial loads. This happens because the geometric matrix is obtained using Hermitian polynomials which are approximate solutions. To circumvent this issue, the frame element’s tangent matrix is obtained using interpolation functions that match the homogeneous solution of the differential equation of the beam-column problem. The main objective of this study is to carry out a second order analysis of the frames and obtain equilibrium paths using the two-cycle method and the tangent stiffness matrix based on solutions of the differential equations obtained from the element’s deformed configuration. The results in terms of displacements and rotations for the examples studied are identical to the analytical solutions, showing that the combination of the two-cycle method with the exact element formulation is promising and can diminish the need for discretization. FEM, FEM , (FEM) used dependence problem twocycle two cycle steps 1991 (1991 loads issue elements s beamcolumn beam column configuration (FEM 199 (199 19 (19 1 (1 (

ABSTRACT In recent years, Latin America has been most affected by dengue fever. Paraguay is not exempt from this issue. Various efforts have been made by the health system to deal with the problem, but the expected results have not been achieved. Knowing which aspects limit the achievement of these outcomes is important to developing effective strategies. Objective: to identify barriers for proper adherence, coverage, and adoption of a communication strategy aimed at controlling Aedes aegypti breeding sites. Methods: on the basis of interviews conducted with those responsible for the execution of the strategy (adherence) and surveys applied to the beneficiary population (coverage and adoption), a cross-sectional analytical observation study was performed with the inclusion of a qualitative phenomenological component with a comprehensive interpretive perspective. Results: perceived barriers for the adherence were related to structural determinants (political, institutional, and socioeconomic barriers) and intermediate determinants (environmental, physical, and behavioral barriers). For coverage, it was observed that in the High (HER) and Low Entomological Risk (LER) neighborhoods, the main barriers were access to the Internet at home and the lack of knowledge about the awareness campaign aimed at controlling the vector breeding sites. In terms of adoption, no variables were found to be significantly associated with the HER or LER groups. It was also found that there were no meaningful differences in coverage and adoption between the two types of neighborhoods. Conclusion: there are perceived barriers for the adherence to communication strategies and other emerging ones related to vector control tasks, as well as barriers that limit coverage and adoption of the communication strategy. The information obtained will be very useful for decision-making by the health authorities.

RESUMEN Latinoamérica es una de las zonas más afectadas por el dengue en los últimos años. Paraguay no estuvo ajeno a esta problemática. Distintos esfuerzos se han hecho desde el sector salud para contrarrestarlo, pero no se han obtenido los resultados esperados. Conocer los aspectos que limitan conseguir estos resultados es importante para la elaboración de estrategias efectivas. Objetivo: Identificar barreras para adherencia, cobertura y adopción de una estrategia de comunicación orientada al control de criaderos de Aedes aegypti. Materiales y Métodos: Empleando entrevistas realizadas a funcionarios encargados de la implementación de la estrategia (adherencia) y encuestas aplicadas a la población beneficiaria (cobertura y adopción) se realizó un estudio observacional analítico tipo cross sectional con la inclusión de un componente cualitativo fenomenológico con perspectiva comprensiva interpretativa. Resultados: Las barreras percibidas para la adherencia se relacionaron con determinantes estructurales (barreras políticas, institucionales y socioeconómicas) y determinantes intermedios (barreras ambientales, físicas y conductuales). Mientras que, para la cobertura, se observó que, en los barrios de Alto (ARE) y Bajo Riesgo Entomológico (BRE) las principales barreras fueron el acceso a internet en el hogar y el no conocimiento de la campaña de comunicación orientada al control de criaderos del vector. En cuanto a la adopción, se observó que, para ambos grupos ARE y BRE ninguna variable resultó significativamente asociada. Así también, se observó que, entre ambos tipos de barrios, no se registraron diferencias significativas en la cobertura y en la adopción. Conclusión: Existen barreras percibidas para la adherencia a las estrategias de comunicación, y otras emergentes relacionadas con las tareas de control vectorial, al igual que, barreras que limitan la cobertura y la adopción de la estrategia de comunicación. La información obtenida será de gran utilidad para la toma de decisiones por parte de las autoridades sanitarias.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país. 202 2019 Preventable Model (DALYs cenários 2656 2 656 2.65 Intervalo 95% 95 1.2503.765, 12503765 1.250 3.765 , 1 250 3 765 1.250-3.765) 4816 4 816 4.81 (95 II 2.2516.947 22516947 2.251 6.947 251 6 947 2.251-6.947 60529 60 529 60.52 27.82886.258 2782886258 27.828 86.258 27 828 86 258 27.828-86.258 ano 30 1188 188 1.18 5201.820, 5201820 520 1.820 820 520-1.820) 2100 100 2.10 9233.234 9233234 923 3.234 234 923-3.234 27272 272 27.27 11.99941.675 1199941675 11.999 41.675 11 999 41 675 11.999-41.675 Concluiuse Concluiu se país 20 201 265 65 2.6 9 2503 1.2503.765 1250376 1250 1.25 3765 3.76 25 76 1.250-3.765 481 81 4.8 (9 2516 2.2516.94 2251694 2251 2.25 6947 6.94 94 2.251-6.94 6052 52 60.5 82886 27.82886.25 278288625 27828 27.82 86258 86.25 82 8 27.828-86.25 118 18 1.1 5201 5201.820 520182 1820 1.82 520-1.820 210 10 2.1 9233 9233.23 923323 92 3234 3.23 23 923-3.23 2727 27.2 99941 11.99941.67 119994167 11999 11.99 41675 41.67 99 67 11.999-41.67 26 2. 1.2503.76 125037 125 1.2 376 3.7 7 1.250-3.76 48 4. ( 2.2516.9 225169 225 2.2 694 6.9 2.251-6.9 605 5 60. 8288 27.82886.2 27828862 2782 27.8 8625 86.2 27.828-86.2 1. 5201.82 52018 182 1.8 520-1.82 21 9233.2 92332 323 3.2 923-3.2 27. 9994 11.99941.6 11999416 1199 11.9 4167 41.6 11.999-41.6 1.2503.7 12503 12 37 3. 1.250-3.7 2.2516. 22516 22 69 6. 2.251-6. 27.82886. 2782886 278 862 86. 27.828-86. 5201.8 520-1.8 9233. 32 923-3. 11.99941. 1199941 119 11. 416 41. 11.999-41. 1.2503. 1.250-3. 2.2516 2.251-6 27.82886 278288 27.828-86 5201. 520-1. 923-3 11.99941 119994 11.999-41 1.2503 1.250-3 2.251- 27.8288 27.828-8 520-1 923- 11.9994 11.999-4 1.250- 27.828- 520- 11.999-

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay. 202 2019 Model macrosimulation macro simulation model incidence disabilityadjusted disability adjusted scenarios result over g/day gday g day 2656 2 656 2,65 95% 95 (95 Interval 1,2503,765, 12503765 1,250 3,765 , 1 250 3 765 1,250-3,765) 4816 4 816 4,81 UI 2,2516,947, 22516947 2,251 6,947 251 6 947 2,251-6,947) 60529 60 529 60,52 27,82886,258 2782886258 27,828 86,258 27 828 86 258 27,828-86,258 year 30 30% 1188 188 1,18 52 1,820, 1820 1,820 820 1,820) 2100 100 2,10 9233,234, 9233234 923 3,234 234 923-3,234) 27272 272 27,27 11,99941,675 1199941675 11,999 41,675 11 999 41 675 11,999-41,675 conclusion 20 201 265 65 2,6 9 (9 2503 1,2503,765 1250376 1250 1,25 3765 3,76 25 76 1,250-3,765 481 81 4,8 2516 2,2516,947 2251694 2251 2,25 6947 6,94 94 2,251-6,947 6052 60,5 82886 27,82886,25 278288625 27828 27,82 86258 86,25 82 8 27,828-86,25 118 18 1,1 182 1,82 210 10 2,1 9233 9233,234 923323 92 3234 3,23 23 923-3,234 2727 27,2 99941 11,99941,67 119994167 11999 11,99 41675 41,67 99 67 11,999-41,67 26 2, ( 1,2503,76 125037 125 1,2 376 3,7 7 1,250-3,76 48 4, 2,2516,94 225169 225 2,2 694 6,9 2,251-6,94 605 60, 8288 27,82886,2 27828862 2782 27,8 8625 86,2 27,828-86,2 1, 1,8 21 9233,23 92332 323 3,2 923-3,23 27, 9994 11,99941,6 11999416 1199 11,9 4167 41,6 11,999-41,6 1,2503,7 12503 12 37 3, 1,250-3,7 2,2516,9 22516 22 69 6, 2,251-6,9 27,82886, 2782886 278 862 86, 27,828-86, 9233,2 32 923-3,2 11,99941, 1199941 119 11, 416 41, 11,999-41, 1,2503, 1,250-3, 2,2516, 2,251-6, 27,82886 278288 27,828-86 9233, 923-3, 11,99941 119994 11,999-41 1,2503 1,250-3 2,2516 2,251-6 27,8288 27,828-8 923-3 11,9994 11,999-4 1,250- 2,251- 27,828- 923- 11,999-

RESUMEN Introducción: Para la contención de la pandemia causada por la enfermedad del coronavirus (COVID-19) se aplicaron una serie de medidas sanitarias a toda la población, como el distanciamiento social, cierre de fronteras y cuarentena en el hogar. Dichas medidas, además, pudieron haber repercutido en un deterioro de la salud en general, un aumento del consumo de bebidas alcohólicas y otras sustancias para contrarrestar o reducir la intensidad de su respuesta a estas consecuencias. Objetivo: Determinar las características demográficas del consumo de riesgo para alcohol durante el tiempo de cuarentena estricta por la pandemia de covid-19. Metodología: Estudio observacional analítico de corte transverso tipo exploratorio. Constó de 16.538 encuestas virtuales realizadas a personas mayores de edad pertenecientes a todo el territorio nacional entre junio y septiembre del 2020. Se excluyó a 219 encuestados por no cumplir criterios de inclusión o datos incorrectamente llenados. Se determinó el consumo de riesgo mediante una prueba que calificaba el consumo por puntajes. Más de 5 puntos para hombres, más de 4 para mujeres. Resultados: 12224 participantes adultos (18-65 años) con una media de 31,9 años (±9,2), formaron parte del análisis, con predominio de participación masculina 64,5% (n=10531). El 74,9% (n=12224) proveniente del Eje Metropolitano. Según géneros, el OR fue 1,15 IC95 (1,08 - 1,23), vp=0,001. Al comparar nivel educativo, secundaria completa/incompleta, el OR fue 1,56 IC95 (1,19 - 2,06), vp=0,001. Y al comparar por ejes de residencias el OR fue 0,83 IC95 (0,77 - 0,89), vp=0,001. Discusión: Se pudo observar que, durante el tiempo de cuarentena, el consumo de alcohol crecía conforme el nivel educativo de la población aumentaba. Los hombres presentaron un consumo de riesgo mayor que los hombres. Conocer este comportamiento ayudaría a plantear acciones que ayuden a prevenir el consumo de alcohol en el grupo de mayor riesgo.

ABSTRACT Introduction: The impact of the outbreak of pandemic proportions of COVID-19 has initiated several health and social measures worldwide. Thus, there is growing concern about the consequences of preventive social confinement associated with the pandemic due to the potential increase in the consumption of alcohol and other harmful substances. Between 2010-2014, in Paraguay approximately 5% of deaths over 15 years of age are attributable to alcohol consumption and are associated with external cause injuries, cancers, liver disease, cardiovascular diseases, addictions and domestic violence. Early detection and treatment are recommended intervention strategies to prevent these consequences. Objective: To determine the demographic characteristics of alcohol risk consumption during the covid-19 pandemic quarantine period. Methods: Analytical cross-sectional, exploratory observational study. It consisted of 16,538 virtual surveys carried out on persons of legal age throughout the national territory between June and September 2020. A total of 219 respondents were excluded for not meeting the inclusion criteria or for incorrectly filled out data. Risk consumption was determined using a test that rated consumption by scores. More than 5 points for men, more than 4 for women. Results: 12224 adult participants (18-65 years old) with a mean age of 31.9 years (±9.2), were part of the analysis, with a predominance of male participation 64.5% (n=10531). The 74.9% (n=12224) came from the Metropolitan Axis. According to gender, the OR was 1.15 CI95 (1.08 - 1.23), pv=0.001. When comparing educational level, high school complete/incomplete, the OR was 1.56 CI95 (1.19 - 2.06), pv=0.001. And when comparing by axes of residence, the OR was 0.83 CI95 (0.77 - 0.89), pv=0.001. Discussion: It was observed that, during the quarantine period, alcohol consumption increased as the educational level of the population increased. Males presented a higher risk consumption than males. Knowing this behavior would help to propose actions to help prevent alcohol consumption in the most at-risk group.

RESUMEN Introducción: El consumo excesivo de sal contribuye al desarrollo de enfermedades crónicas no transmisibles como enfermedades renales, algunos tipos de cáncer y la hipertensión arterial (HTA); que, por otro lado, su excesivo consumo también actúa como principal factor de riesgo de muerte por enfermedades cardiovasculares. Objetivo: Describir las características de las prácticas alimentarias relacionadas con el consumo de sal durante el 2018. Metodología: Estudio observacional descriptivo transversal como instrumento se utilizó una encuesta virtual por Google Forms, se encuestó 269 personas de 20 años y más desde mayo y junio del 2018. Se excluyeron a cinco porque no cumplían criterios de inclusión. Resultados: Participaron 264 personas siendo el 73,1% del sexo femenino. El 31,4% tenía entre 25-29 años, 89,8% residía en el Departamento Central. El 44,7% prefiere preparaciones culinarias saladas. El 51,9% califica a la comida sin sal como saludable. El 64,4% prefiere informarse sobre temas de salud en sitios web. 72,3% cuando decide cuidar su salud con las comidas tiene en cuenta a las grasas y tipo de cocción frituras. 65,2% manifestó tener antecedentes de hipertensión arterial en el hogar y piensan que eleva la presión arterial en un 96.6%. Conclusión: Las principales características de las prácticas alimentarias relacionadas al consumo de sal de la población de estudio fueron su preferencia por las preparaciones culinarias saladas, la percepción la comida sin sal como saludable y no hallan diferencias entre el sabor de las comidas preparadas dentro y fuera de su hogar, ignoran el consumo de sal cuando deciden cuidarse con las comidas, aunque crean que la sal alimentaria eleva la presión arterial.

ABSTRACT Introduction: Excessive salt consumption contributes to the development of chronic non-communicable diseases such as kidney disease, some types of cancer and arterial hypertension (AHT); on the other hand, its excessive consumption also acts as the main risk factor for death from cardiovascular disease. Objective: To describe the characteristics of food practices related to dietary salt consumption during 2018. Methodology: Virtual cross-sectional descriptive observational survey by Google forms to 269 people aged 20 years and older from May and June 2018. Five were excluded because they did not meet inclusion criteria. Results: A total of 264 persons participated, 73.1% of whom were female. The 31.4% were between 25-29 years old, 89.8% resided in the Central Department. 44.7% preferred salty culinary preparations. 51.9% qualified food without salt as healthy. 64.4% prefer to get information about health issues on websites. 72.3%, when deciding to take care of their health with meals, consider fats and fried foods. 65.2% stated that they have a history of high blood pressure at home and think that it raises blood pressure in 96.6%. Conclusion: The main characteristics of the dietary practices related to salt consumption of the study population were their preference for salty culinary preparations, their perception of food without salt as healthy, and they found no difference between the taste of food prepared inside and outside the home, they ignore salt consumption when they decide to take care of themselves with their meals, even though they believe that dietary salt raises blood pressure.

ABSTRACT Introduction: Insufficient sleep favors weight gain and body mass index, so that the alteration of the quantity and quality of nocturnal sleep has been proposed as a factor associated with obesity and other noncommunicable diseases. Objectives: To determine the correlation between hours of sleep and Body Mass Index (BMI) in patients. Materials and methods: Observational, analytical, cross-sectional, and non-probabilistic convenience sampling design. A survey with questions adapted from the Pittsburg questionnaire was applied to 62 male and female subjects older than 19 years who attended the nutritional clinic (June-July 2021) and signed an informed consent for nutritional assessment and body composition. Spearman's nonparametric correlation test was used, and CEI-FCQ-UNA approval was obtained (CEI 670/2021). Results: 63% (n=39) were women of median age 24 years and RIC 7, 64% (n=40) were students. 53 %(n=33) were overweight and obese, with high and very high levels 81 %(n=50) of total fat mass. The median hours of sleep were 6 hours in the total population, in patients with normopeso a median of 7 hours of sleep was obtained and in patients with overweight and obesity a median of 6 hours of sleep respectively, no statistically significant correlation r=0.35 (vp=0.5038) was found between hours of sleep and BMI. Conclusion: Patients' sleep hours were not significantly correlated with their BMI.

RESUMEN Introducción: El sueño insuficiente favorece al incremento de peso e índice de masa corporal, por lo que la alteración de la cantidad y calidad del sueño nocturno ha sido propuesta como factor asociado a obesidad y otras enfermedades no transmisibles. Objetivos: Determinar la correlación entre las horas de sueño e Índice de Masa Corporal (IMC) en pacientes. Materiales y métodos: Diseño observacional, analítico, transversal y de muestreo no probabilístico por conveniencia. Se aplicó una encuesta con preguntas adaptadas del cuestionario de Pittsburg a 62 sujetos de ambos sexos mayores de 19 años que acudieron al consultorio nutricional (junio-julio 2021) y firmaron un consentimiento informado para la evaluación nutricional y composición corporal. Se empleó la prueba no paramétrica de correlación de Spearman y se contó con la aprobación del CEI-FCQ-UNA (CEI 670/2021). Resultados: El 63%(n=39) fueron mujeres de mediana 24 años y RIC 7, siendo 64%(n=40) estudiantes. El 53%(n=33) se encontraba en sobrepeso y obesidad, con niveles altos y muy altos 81%(n=50) de masa grasa total. La mediana de horas de sueño fue de 6 horas en el total de la población, en pacientes con normopeso se obtuvo una mediana de 7 horas de sueño y en pacientes con sobrepeso y obesidad una mediana de 6 horas de sueño respectivamente, no se encontró correlación estadísticamente significativa r=0,35 (vp=0,5038) entre las horas de sueño e IMC. Conclusión: Las horas de sueño de los pacientes no guardaban correlación significativa con el IMC.

Resumen Las neoplasias apendiculares se presentan hasta en el 50 % de los casos como un episodio de apendicitis aguda. Existen características demográficas, clínicas y radiológicas que aumentan las posibilidades de un tumor apendicular subyacente, sin embargo, en la mayoría de los casos, son los hallazgos intraoperatorios los que alertan al cirujano. A pesar de que el tipo histológico determina la radicalidad del manejo quirúrgico de estos pacientes, algunas características macroscópicas pueden orientar a las patologías específicas y a una conducta adecuada. En general, los objetivos del manejo quirúrgico inicial se cumplen con una resección limitada al apéndice cecal, asociada a la citología de mucina y biopsia de los implantes peritoneales si están presentes, reservando las resecciones extendidas, como hemicolectomía derecha oncológica, para los pacientes con compromiso extenso de la base o del mesenterio apendicular ante la sospecha de neoplasias neuroendocrinas o adenocarcinoma del apéndice cecal.

Abstract Appendicular neoplasms present in up to 50% of cases as an episode of acute appendicitis. There are demographic, clinical and radiological characteristics that increase the chances of an underlying appendicular tumor; however, in most cases are the intraoperative findings that alert the surgeon. Although the histological type determines the radical nature of the surgical management of these patients, some macroscopic characteristics can guide specific pathologies and appropriate behavior. In general, the objectives of initial surgical management are met with a limited resection of the cecal appendix, associated with mucin cytology and biopsy of peritoneal implants if present, reserving extended resections such as oncological right hemicolectomy for patients with extensive compromise of the base or appendicular mesentery when neuroendocrine neoplasms or adenocarcinoma of the cecal appendix are suspected.

Abstract Blast loads have been increasingly studied in the past decades, especially regarding civil structures. Until recently, the negative phase of these loads has been disregarded, but studies concluded that the effect of suction must be included. In the case of plates, nonlinearity plays an important role, and the membrane effect should also be considered. This work focuses on the influence of nonlinearity in plates subjected to blast loads. Equations were developed for the calculation of blast load parameters, considering that positive and negative phases are approximated by the Friedlander equation and cubic polynomial, respectively. The plate is modeled as a SDOF system using von Karman's theory of large displacements. The development of the nonlinear dynamic differential equation is reviewed, considering a simply supported plate, and its solution is based on fourth order Runge-Kutta numerical method. A reference example is used as a benchmark and then parametric studies are conducted, in which the influence of scaled distance, mass of explosive, and the consideration or not of the negative phase is analyzed.

ABSTRACT Introduction: Dengue is the main mosquito-borne viral disease. Every year, more than 350 million cases are reported worldwide and nearly 50% of the population is at risk of acquiring it. Paraguay is no stranger to this problem. In 2019, 11,811 cases were recorded, and Asunción was one of the most affected cities in the country. The disease is transmitted by the bite of Aedes aegypti, a mosquito that oviposits in containers inside homes, this fact has made it possible to design entomological indicators to calculate the risk of transmission. The availability of entomological information related to the spatial distribution of dengue makes it possible to build risk or heat maps, which is very useful information for the authorities and the stakeholders to design prevention and control strategies. Objective: To stratify the entomological risk for dengue transmission in the neighborhoods of Asunción, Paraguay. Methods: Retrospective observational and analytical study, employing the Survey of Rapid Aedes Index (LIRA), periodically estimated in Asunción neighborhoods between 2014 and 2018, to stratify, according to p75 and p25 percentiles, high- and low-risk neighborhoods, respectively. Results: 14 high entomological risk neighborhoods, 17 low risk neighborhoods, 33 medium risk neighborhoods and 3 neighborhoods with scores for both groups were identified. Conclusion: The spatial analysis of LIRA allows stratification of the risk of dengue transmission, which provides valuable information for targeting surveillance and control of the disease.

RESUMEN Introducción: El dengue es la principal enfermedad viral transmitida por mosquitos. Cada año se registran mundialmente más de 350 millones de casos y cerca del 50% de la población se encuentra en riesgo de adquirirla. Paraguay no es ajeno a esta problemática. En el 2019 se registraron 11.811 casos, siendo Asunción, una de las ciudades más afectadas del país. Esta enfermedad es transmitida por la picadura de Aedes aegypti, mosquito que oviposita en recipientes al interior de las viviendas, característica que ha permitido diseñar indicadores entomológicos para calcular el riesgo de transmisión. Disponer de información entomológica relacionada con la distribución espacial de dengue, posibilita la construcción de mapas de riesgo, información de gran utilidad para las autoridades encargadas del diseño de las estrategias de prevención y control de la enfermedad Objetivo: Estratificar el riesgo entomológico para la transmisión de dengue en los barrios de Asunción, Paraguay. Materiales y Métodos: Estudio observacional/analítico retrospectivo, empleando el Levantamiento de Índices Rápidos de Aedes (LIRA), estimados periódicamente en los barrios de Asunción entre 2014 y 2018, para estratificar, de acuerdo con los percentiles p75 y p25, barrios de alto y bajo riesgo, respectivamente. Resultados: Se identificaron 14 barrios de alto riesgo entomológico, 17 de bajo riesgo, 33 barrios con riesgo medio y 3 barrios que poseían puntajes para ambos grupos. Conclusión: El análisis espacial de LIRA permite estratificar el riesgo de transmisión de dengue, lo cual proporciona información valiosa para direccionar tareas de vigilancia y control de la enfermedad.

Abstract: Diabetes Mellitus is a chronic pathology of metabolic origin, which appears due to the fact that the pancreas does not produce the amount of insulin that the human body needs, or of a lower quality. In this work we tried to define the effect of the consumption of honey on the glycemia in healthy and hyperglycemic male mice induced to diabetes by alloxane. For this, four groups of six male Swiss albino mice each were used. normoglycemic with regular diet treated with water; normoglycemic with diet + honey; hyperglycemic with regular diet treated with water and finally, hyperglycemic with alloxane with diet + honey. The treatment lasted for three days. The results indicated that the hypeglycemic animals that received honey for three days showed a favorable glycemic profile, since a significant decrease in sugar level was observed in this group after 2 and 4 hours of consumption of honey. The addition of honey in the group of hyperglycemic animals with a controlled diet contributes to achieving significantly lower glycaemia than in the group of hyperglycemic animals that do not receive honey.

Resumen: La Diabetes Mellitus (DM) es una patología crónica de origen metabólico, que aparece debido a que el páncreas no produce la cantidad de insulina que el cuerpo humano necesita, o bien de una calidad inferior. En este trabajo pretendimos definir el efecto del consumo de la miel de abeja sobre la glucemia en ratones macho sanos e hiperglucémicos inducidos a diabetes por aloxano. Para ello se emplearon cuatro grupos de seis ratones albinos suizos machos cada uno. normoglucémicos con dieta regular tratados con agua; normoglucémicos con dieta + miel de abeja; hiperglicémicos con dieta regular tratados con agua y finalmente, hiperglicémicos con aloxano con dieta + miel. El tratamiento se realizó por tres días. Los resultados indicaron que los animales hipeglucémicos que recibieron la miel por tres días mostraron un perfil favorable en la glicemia, ya que se observó un descenso significativo del nivel de azúcar, en este grupo luego de 2 y 4 horas del consumo de la miel. La adición de miel de abeja en el grupo de animales hiperglicémicos con dieta controlada contribuye a alcanzar glicemias significativamente menores que en el grupo de hiperglicémicos que no reciben miel.

ABSTRACT Introduction: Obesity in children is also associated with intake of foods high in fat, sugar and sodium, so it is important to know their levels in sweets and sweet drinks. Objectives: To evaluate critical nutrient content according to the PAHO Nutrient Profile in sweet treats, salty snacks and packaged non-alcoholic sweet drinks, according to nutritional labeling information. Materials and Methods: This was a cross-sectional, descriptive, exploratory study. Content per serving of total fat (TF), saturated fats (SF) and trans-fatty acids (TrF), sodium, free sugars (FS) and artificial sweeteners (AS) in sweet, salty, and non-alcoholic sweet drinks (NASD) was evaluated according to nutritional labeling. Excessive levels were considered according to the "PAHO Nutrient Profile". Samples were obtained for convenience at two outlet stores. Packaged desserts and treats with poorly visible information were excluded. Results: We evaluated 104 foods, which were grouped in: baked foods (alfajor, muffins), chocolates, salty snacks (cheese, corn, crackers, french fries), sweet cookies, and sweet drinks (juices / soft drinks / sports drinks). In baked foods, 8/13 had excess of TF, 10/13 of SF, 4/13 of TrF, 11/13 of FS, no excess of sodium, 11/13 had AS. Among chocolates, all had excess of TF and SF, 2/10 in TrF, none of sodium, 9/10 were high in FS, 2/10 contained AS. Snacks: 14/17 were high in TF, 7/17 in SF, 1/17 in TrF, 15/17 in sodium, 4/17 in FS, 6/17 contained AS. Sweet cookies had excess TF (14/20), SF (17/20), 6/20 had excess of TrF, sodium (1/20), all had excess FS, 17/20 contained AS. In NASD (n = 44), all had excess sodium, 36/44 had excess FS, 21/44 had AS. Conclusion: Baked foods are high in fat, free sugars and sweeteners. Chocolates are high in fats and sugars. Snacks are high in sodium and fat. Cookies have excess sugar and saturated fat, 2/3 contained artificial sweeteners. Sweet drinks are high in sodium and sugars, half have artificial sweeteners.

RESUMEN Introducción: La obesidad en niños se asocia también a ingesta de alimentos ricos en grasas, azúcares y sodio, por ello es importante conocer sus niveles en golosinas y las bebidas dulces. Objetivos: Evaluar contenido de nutrientes críticos acorde al Perfil de Nutrientes de OPS en golosinas dulces, snacks salados y bebidas dulces no alcohólicas envasadas, según información del etiquetado nutricional. Materiales y Métodos: Estudio transversal, descriptivo, exploratorios. Se evaluó contenido por porción de grasas totales(GT), saturadas(GS) y trans(GTr), sodio, azúcares libres(AL) y edulcorantes artificiales(EA) en golosinas dulces, saladas, y bebidas dulces no alcohólicas (BDNA) según etiquetado nutricional. Niveles excesivos fueron considerados según "Perfil de nutrientes de OPS". Muestra fue por conveniencia obtenida en 2 bocas de expendio. Se excluyeron postres envasados y golosinas con información poco visible. Resultados: Fueron evaluados 104 alimentos agrupados en: confitería (alfajor, magdalenas), chocolates, snacks salados (queso, maíz, galletitas saladas, papas fritas), galletitas dulces, bebidas dulces (jugos/gaseosas/bebidadeportistas). En confitería, 8/13 tenían exceso de GT, 10/13 de GS, 4/13 de GTr, 11/13, de AL, ninguno exceso de sodio, 11/13 tenían EA. Entre chocolates, todos tenían exceso de GT y GS, 2/10 en GTr, ninguno sodio, 9/10 altos en AL, 2/10 contenían EA. Snacks:, 14/17 eran altos en GT, 7/17 en GS, 1/17 en GTr, 15/17 en sodio, 4/17 en AL, 6/17 contenían EA. Galletitas dulces tenían exceso de GT 14/20, de GS 17/20, 6/20 de GTr, de sodio 1/20, todos con AL,17/20 contenían EA. En BDH (n=44), todas tenían exceso de sodio, 36/44 exceso de AL, 21/44 tenían EA. Conclusión: Alimentos de confitería son altos en grasas, azúcares libres y edulcorantes.. Los chocolates son altos en grasas y azucares. Los snacks son altos en sodio y grasas. Las galletitas tienen exceso de azúcares y grasas saturadas, 2/3 contienen edulcorantes artificiales. Las bebidas dulces son altas en sodio y azucares, la mitad tiene edulcorantes artificiales.

ABSTRACT Background: This study was conducted based on the scientific evidence of the implementation of the ERAS and ACERTO protocols, of which the protocol called Enhanced Recovery was put together. It was adapted to the socioeconomic reality of the National Cancer Institute and seeks to reduce metabolic stress, the immune response and promote the patient's postoperative recovery. Objective: To compare the effect of the perioperative protocols of improved and conventional recovery on glycaemia and the percentage of lymphocytes in patients with colorectal cancer. Materials and Methods: A quasi-experimental, nonrandomized, non-masked clinical trial of 34 patients with colorectal cancer undergoing open surgery was performed. A control group with conventional management (n = 18) and the intervention group (n = 16) in whom the improved recovery protocol was applied; the outcome variable was glycemia and lymphocyte count; Likewise, other clinical variables such as complications and demographics were measured. Results: The perioperative glycemic response in patients in the study group was 42±32.09 mg/dL and 5.25±52.81mg/dL in the intervention group with p=0.009; the percentage of lymphocytes in the control group was 13.77±10.95% and 7.18±5.21% in the intervention group, with p=0.015; statistically significant. Conclusion: Applying the Improved Recovery Protocol is feasible and decreases the glycemic impact and the percentage of lymphocytes in relation to conventional management.

Resumen Introducción: Este estudio se realizó basado en las evidencias científicas de los protocolos ERAS® y ACERTO, a partir de los cuales, se armó el Protocolo de Recuperación Mejorada adaptado a las posibilidades del Instituto Nacional del Cáncer, con lo que se busca reducir el estrés metabólico, la respuesta inmunológica y favorecer la recuperación postoperatoria del paciente. Objetivo: Comparar el efecto de los protocolos perioperatorios de recuperación mejorada y convencional sobre la glicemia y el porcentaje de linfocitos en pacientes con cáncer colorrectal. Materiales y Métodos: Se realizó un ensayo clínico cuasi-experimental, no aleatorizado sin enmascaramiento, de 34 pacientes con cáncer colorrectal sometidos a cirugía abierta. Un grupo control con manejo convencional (n=18) y el grupo de intervención (n=16) en quienes se aplicó el protocolo de recuperación mejorada; la variable de resultado fue la glicemia y el recuento de linfocitos; se midieron otras variables clínicas como complicaciones y demográficas. Resultados: La diferencia glicémica entre el pre y postoperatorio en pacientes del grupo de estudio fue de 42±32,09 mg/dL y 5,25 ±52,81 mg/dL en el grupo de intervención con una p=0,009; el porcentaje de linfocitos en el grupo control fue de 13,77±10,95% y de 7,18±5,21% en el grupo de intervención, con una p=0,015; estadísticamente significativos. Conclusión: Aplicar el Protocolo de Recuperación Mejorada es factible y disminuye el impacto glicémico y el porcentaje de linfocitos en relación al manejo convencional.

Abstract Nonlinear analyses using an updated Lagrangian formulation considering the Euler-Bernoulli beam theory have been developed with consistency in the literature, with different geometric matrices depending on the nonlinear displacement parts considered in the strain tensor. When performing this type of analysis using the Timoshenko beam theory, in general, the stiffness and the geometric matrices present additional degrees of freedom. This work presents a unified approach for the development of a geometric matrix employing the Timoshenko beam theory and considering higher-order terms in the strain tensor. This matrix is obtained using shape functions calculated directly from the solution of the differential equation of the problem. The matrix is implemented in the Ftool software, and its results are compared against several matrices found in the literature, with or without higher-order terms in the strain tensor, as well as the Euler-Bernoulli or Timoshenko beam theories. Examples show that the use of the Timoshenko beam theory has a strong influence, especially when the structure has small slenderness (short members). For high axial load values, the consideration of higher-order terms in the strain tensor results in larger displacements as expected.

Resumen Introducción: El tratamiento oncológico adicional a la cirugía en los pacientes con cáncer gástrico, sigue siendo un tema de debate. Se compararon el pronóstico y las complicaciones de la quimioterapia perioperatoria con los de la quimioterapia adyuvante, para identificar el mejor esquema de tratamiento. Materiales y métodos: Se llevó a cabo un estudio longitudinal, retrospectivo y de cohorte histórica, que incluía todos pacientes que recibieron alguno de los dos esquemas de tratamiento. Los principales objetivos fueron evaluar la supervivencia y las complicaciones perioperatorias (fístula, sangrado, muerte y toxicidad) en cada grupo. Resultados: Se incluyeron 168 pacientes que cumplieron los criterios de inclusión. Comparado con el grupo de quimioterapia adyuvante, el grupo de quimioterapia perioperatoria tuvo una mayor supervivencia a 2 y 5 años (80,1 Vs. 61,2 %; 69,8 Vs. 43,6 %) (p=0,003). No hubo diferencia estadísticamente significativa en la tasa de complicaciones perioperatorias entre los dos grupos (4,11 Vs. 10,64 %) (p=0,151). Hubo un aumento en la necesidad de transfusiones en el grupo con quimioterapia perioperatoria. Discusión: La quimioterapia perioperatoria aumenta la supervivencia a largo plazo de los pacientes con cáncer gástrico localmente avanzado, sin un aumento significativo en la tasa de complicaciones perioperatorias. Hay un aumento en la necesidad de transfusiones en el grupo de quimioterapia perioperatoria, sin que esto empeore el pronóstico de los pacientes.

Abstract Introduction: Oncological management in addition to surgery in patients with gastric cancer remains a matter of debate. We conducted a retrospective longitudinal study to compare the prognosis and complications between perioperative chemotherapy and adjuvant chemotherapy to identify the best treatment scheme. Materials and methods: A longitudinal, retrospective historical cohort study was carried out that included all patients who received one of the two treatment schemes. The main objectives were to evaluate overall survival and perioperative complications (fistula, bleeding, death and toxicity) in each group. Results: 168 patients met the inclusion criteria. Compared with the adjuvant chemotherapy group, the perioperative chemotherapy group had greater survival at 2 and 5 years (80.1% vs. 61.2%, 69.8% vs. 43.6% p=0.003). There was no statistically significant difference in the rate of perioperative complications between the two groups (4.11% vs. 10.64%, p = 0.151). There was an increase in the transfusion requirement in the perioperative chemotherapy group. Discussion: Perioperative chemotherapy increases the long-term survival of patients with locally advanced gastric cancer, without a significant increase in the rate of perioperative complications. There is an increase in the transfusion requirement of the perioperative chemotherapy group without this worsening the prognosis of the patients.

ABSTRACT Obesity is the most frequent metabolic disorder, for the treatment is fundamental to change the type of food and maintain a healthy lifestyle. Misleading advertising of so-called miraculous products leads to excessive, uncontrolled consumption and without prior evaluation of the effect on weight or their possible toxicity. A preliminary investigation was designed in mice, to verify the effect of the juice of Aloe barbadensis and a commercial product on the weight of normal and obese mice induced by monosodium glutamate(MSG),after four weeks of treatment. The group of mice induced to obesity with MSGhad a weight change percentage of 160.5 ± 37.5%, while in the group with normal body weight was of 59.4 ± 12.1%, this difference was significant (p<0,001). In the obese mice that received the juice of A. barbadensis, a non-significant weight decrease of 2.8% was achieved when compared with the weight at the beginning of the intervention (p(0.05). In obese mice treated with the commercial product,an increase in weight was observed, although in a smaller proportion than the obese ones that received water (3.5% and 4.4%, respectively). The results indicated that Aloe barbadensis juice induced a greater weight loss in obese animals, compared to the commercial product, however, this is not significant in the period considered.

RESUMEN La obesidad es el trastorno metabólico más frecuente, para el tratamiento es fundamental el cambio del tipo alimentación y mantener un estilo de vida saludable. La publicidad engañosa sobre productos denominados milagrosos conlleva a un consumo desmedido, no controlado y sin previa evaluación de los resultados sobre el peso y/o la posible toxicidad de los mismos. Se diseñó una investigación preliminar en ratones, para verificar el efecto del zumo de Aloe barbadensis y un producto comercial sobre el peso de ratones normopesos y obesos inducidos por glutamato monosódico (GMS), después de cuatro semanas de tratamiento. El grupo de ratones inducidos a obesidad con GMS, presentaron un porcentaje de cambio de peso de 160,5±37,5%, mientras que en el grupo de ratones normopesos fue de 59,4±12,1%, esta diferencia resultó significativa (p<0,001). En los ratones obesos que recibieron el zumo de A.barbadensis se logró un descenso no significativo de peso de 2,8% con respecto al peso al inicio de la intervención (p (0,05). En los ratones obesos tratados con el producto comercial se observó un aumento de peso, aunque en menor proporción que los obesos que recibieron agua (3,5% y 4,4%, respectivamente). Los resultados indican que el zumo de Aloe barbadensis induce un descenso de peso mayor en los animales obesos, comparado con el producto comercial, sin embargo, esto no es significativo en el periodo de observación.