ABSTRACT The objective of the study was to identify the resistance of Mycobacterium tuberculosis to drugs in Paraguay, 2014 to 2017. A retrospective observational study was carried out. The data from the National Tuberculosis Program of Paraguay between the years 2014 to 2017 were used. All patients with a diagnosis of Tuberculosis who underwent a resistance test were included. Data were extracted in Excel and analyzed with Stata 17.0. 3429 tuberculosis patients who had a result of at least one sensitivity test were included. Resistance was found in 2.1% of patients. Resistance to Rifampicin was present in 0.3% of cases while to Izionazide in 0.6% of cases. The prevalence of resistance was higher in men 3.4 (95% CI 2.2 - 4.8) p = 0.003, who resided in the Chaco 6.0 (95% CI 3.4 - 9.7) p = 0.000, previously treated 2.7 (95% CI 1.1 - 5.1) p = 0.010. In the model, it was observed that a previously treated patient has a greater chance of having resistance OR 2.62 (95% CI 1.1 - 6.24). The prevalence of resistance of Mycobacterium tuberculosis to drugs was related to having been previously treated.

RESUMEN El objetivo del estudio fue identificar la resistencia del Mycobacterium tuberculosis a los fármacos en Paraguay, 2014 a 2017. Se realizó un estudio observacional retrospectivo. Se utilizaron los datos del Programa Nacional de Tuberculosis del Paraguay comprendidos entre los años 2014 a 2017. Se incluyeron todos los pacientes con diagnóstico de Tuberculosis que se realizaron un test de resistencia. Se extrajeron los datos en Excel y fueron analizados con Stata 17.0. Se incluyeron 3429 pacientes con tuberculosis que contaban con resultado de al menos una prueba de sensibilidad. La resistencia se encontró en 2.1% de los pacientes. La resistencia a la Rifampicina estuvo presente en el 0.3% de los casos mientras que a la Izionazida en el 0.6% de los casos. La prevalencia de resistencia fue más alta en hombres 3.4 (IC 95% 2.2 - 4.8) p=0.003, que residían en el chaco 6.0 (IC 95% 3.4 - 9.7) p=0.000, previamente tratados 2.7 (IC 95% 1.1 - 5.1) p=0.010. En el modelo se pudo observar que un paciente previamente tratado tiene mayores posibilidades de tener resistencia OR 2.62 (IC 95% 1.1 - 6.24). La prevalencia de resistencia del Mycobacterium tuberculosis a fármacos estuvo relacionada con haber sido previamente tratado.

RESUMEN La COVID-19 ha provocado una emergencia sanitaria mundial sin precedentes, afectando también negativamente a la prestación de atención a la tuberculosis (TB) en casi todos los países. Por tanto, esta investigación analiza el impacto de la COVID-19 en el control de la TB en Paraguay. Estudio descriptivo, retrospectivo, con enfoque mixto y de corte transversal. Resultados: siete de los 10 indicadores priorizados de la Estrategia “Fin de la TB” registraron resultados por debajo a lo notificado en los últimos tres años, siendo el 2020 el más afectado. Existe una brecha de 1.037 personas que no han sido diagnosticadas y tratadas por TB en Paraguay, de acuerdo a lo estimado por la Organización Mundial de la Salud (OMS) en 2020. Se analizaron 2.598 casos de TB en 2020, frente a 3.083 en el 2019, lo que representa una disminución del 15,7% en la notificación de casos; las notificaciones disminuyeron en un 24% en mujeres, 40,5% en niños y en un 19,6% de éxito de tratamiento. Se presentó una tasa de letalidad de 12%, la mayor en los últimos cuatro años. Las expertas encuestadas, opinan que la situación de la TB empeoró tras la llegada de la COVID-19 en el país, principalmente en la notificación de casos e investigación de contactos. La COVID-19 ha impactado negativamente en el control de la TB en Paraguay, esto representa un riesgo significativo en el control de la enfermedad y el avance a lo largo de los años se ve seriamente comprometido y amenaza con revertir los logros alcanzados.

ABSTRACT COVID-19 has caused an unprecedented global health emergency, also negatively affecting the delivery of tuberculosis (TB) care in almost all countries. This research therefore analyses the impact of COVID-19 on TB control in Paraguay. Descriptive, retrospective, mixed-approach, cross-sectional study. Results: seven of the 10 prioritized indicators of the "End TB Strategy" registered results below what was reported in the last three years, with 2020 being the most affected. There is a gap of 1,037 people who have not been diagnosed and treated for TB in Paraguay, as estimated by the World Health Organisation (WHO) in 2020. There were 2,598 TB cases analysed in 2020, compared to 3,083 in 2019, representing a 15.7% decrease in case notification; notifications decreased by 24% in women, 40.5% in children and 19.6% treatment success. There was a case fatality rate of 12%, the highest in the last four years. The experts surveyed were of the opinion that the TB situation worsened after the advent of COVID-19 in the country, mainly in case notification and contact investigation. COVID-19 has had a negative impact on TB control in Paraguay, which represents a significant risk for the control of the disease, and progress over the years is seriously compromised and threatens to reverse the achievements made.

Resumen El Lago de Tota es una fuente hídrica de gran importancia a nivel regional y nacional dado su valor ambiental y económico, este último representado por actividades agrícolas, pecuarias y piscícolas. Estas actividades han contribuido a la contaminación observada en la actualidad, siendo esta una problemática ambiental en constante ascenso, donde la salud, el desarrollo de las comunidades y los procesos ecológicos, se han visto afectados. De hecho, el Lago de Tota ha sido catalogado como uno de los ecosistemas más amenazados del planeta por la red mundial de humedales. A pesar de la problemática ambiental que representa la contaminación del Lago, son muy pocos los estudios que indagan acerca del daño genético generado por la exposición a los agentes tóxicos presentes en esta cuenca. A este respecto un modelo biológico óptimo para estudios de genotoxicidad lo constituye el pez cebra, dada su alta homología genética con el humano, así como su capacidad de regeneración, adaptación y respuesta inmune ante altas concentraciones de compuestos químicos como los plaguicidas. Esta revisión se enfoca en reportes recientes sobre la contaminación del Lago de Tota y en el uso de modelos biológicos para estudios de genotoxicidad.

Abstract Tota Lake is a water source of great importance at a regional and national level given its environmental and economic value, the latter represented by agricultural, livestock and fish farming activities. These activities have contributed to the contamination observed at present, being an environmental problem in constant rise, where the health, the development of the communities and the ecological processes have been affected. In fact, Lake Tota has been classified as one of the most threatened ecosystems on the planet by the global network of wetlands. Despite the environmental problems posed by the contamination of the Lake, there are very few studies that investigate the genetic damage generated by exposure to the toxic agents present in this basin. In this regard, an optimal biological model for genotoxicity studies is the zebrafish, given its high genetic homology with humans, as well as its capacity for regeneration, adaptation and immune response to high concentrations of chemical compounds such as pesticides. This review focuses on recent reports on Tota Lake contamination and the use of biological models for genotoxicity studies.

RESUMO Considerando as novas tendências para alimentação saudável, há uma necessidade de expandir este mercado. A Sociedade de Nutrição da Argentina, baseada em estudos locais e internacionais, tem sugerido que um consumo adequado de laticínios não apenas fornece o cálcio, mas também fornece compostos associados com a diminuição do risco de doenças inflamatórias crônicas. Os objetivos deste trabalho foram formular e desenvolver bebidas baseadas em suco de laranja com adição de soro de leite na forma líquida ou em pó, adoçadas de uma forma natural, e estudar as características físico-químicas, nutricionais e sensoriais. As amostras foram homogeneizadas e pasteurizadas a 85 °C por 30 minutos, e os valores de pH, acidez, conteúdo de sólidos e cor foram analisados. A escala quase certa (JAR) foi usada para avaliar as intensidades dos gostos ácidos e amargos, o sabor e os atributos de cor, sendo que uma escala hedônica de cinco pontos foi usada para avaliar a aceitabilidade global das amostras. As análises de intensidade mostraram que os gostos e a cor foram “ideais”. Com respeito à aceitabilidade global, as categorias de agradável foram apontadas com mais de 60% e apenas 10% consideraram a bebida desagradável. A bebida apresentou valores de pH, cor e conteúdo de sólidos semelhantes aos de outras bebidas cítricas, e foi avaliada como agradável pelos consumidores.

Abstract Faced with new trends in healthy eating, there is a need to expand this market. The Argentine Society of Nutrition, based on local and international studies, has suggested that an adequate intake of dairy products not only provides calcium but also provides compounds associated with a decrease in the risk of chronic inflammatory diseases. The objectives of this work were to formulate and develop beverages based on orange juice with the addition of liquid and powdered whey, sweetened naturally, and study the physicochemical, nutritional and sensory characteristics. The samples were homogenized and pasteurized at 85 °C for 30 minutes and the pH value, acidity, solids content and colour were analyzed. A just-about-right (JAR) scale was used to evaluate the intensities of the acid taste, bitter taste and flavour, and also the colour attributes, and a 5-point hedonic scale was used to evaluate the global acceptability of the samples. The intensity analyses showed that the taste and colour were “ideal”. With respect to global acceptability, the pleasant categories scored more than 60% and only 10% considered it unpleasant. The beverage presented a pH value, colour and solids content similar to those of other citrus beverages, and was rated as pleasant by the consumers.