Abstract: Introduction: The patient’s autonomy in making decisions about their life and about diagnostic and therapeutic approaches related to their health has been the object of growing social value. Then advanced directives appear to express the patient’s last will, safeguarding the Principle of Autonomy. During the undergraduate learning process, students are committed to life, and all of their training is based on technical aspects. Only a small part of the curriculum covers specific contents focused on terminal illness, when present. Medicine has evolved with important technological advances that resulted in quality-of-life improvement, but also brought a questionable extension of life, with often unjustifiable treatments and a therapeutic obstinacy to maintain life at any cost. Objective: The aim of this study is to analyze the perception of medical students about end-of-life directives. Method: A descriptive qualitative research was carried out through an individual and semi-structured interview, applied through Google forms. Due to the period of pandemic caused by the SARS-CoV-2, the survey was carried out remotely, in accordance with current national legislation. After the target was attained through sample exhaustion, the responses of 13 students were analyzed. Results: In accordance with the elements, steps and methodological criteria, the obtained information was classified and arranged into two categories: Human Dignity and Patient Autonomy; Knowledge of Advance Will Directives. Conclusion: This qualitative analysis brought to light important topics such as the regulation that guides advance will directives and principles that involve bioethics, to consolidate the respect, autonomy and dignity of the patient who is, or will be, undergoing the terminality of life.

Resumo: Introdução: A autonomia do paciente na tomada de decisões a respeito da sua vida e das condutas diagnósticas e terapêuticas na sua saúde tem sido objeto de valorização social crescente. As diretivas antecipadas de vontade surgem, então, como um meio de o paciente expressar sua última vontade, salvaguardando o princípio da autonomia. No processo de aprendizagem acadêmica, na maioria das escolas médicas, o acadêmico se compromete com a vida, e toda a sua capacitação é fundamentada em aspectos técnicos, e apenas uma pequena parte do currículo, quando presente, abrange conteúdo específico voltado para a terminalidade da vida. A medicina evoluiu com importantes avanços tecnológicos que resultaram em melhorias na qualidade de vida, porém também trouxeram um prolongamento questionável da vida, com tratamentos muitas vezes injustificáveis e com a obstinação terapêutica de manter a vida a qualquer custo. Objetivo: Este estudo teve como objetivo analisar a percepção de estudantes de Medicina sobre as diretivas antecipadas de vontade. Método: O instrumento de pesquisa foi elaborado com uma entrevista individual e semiestruturada, aplicada pela plataforma de pesquisa Google Forms. Por causa do período de pandemia pelo Sars-CoV-2, a pesquisa foi realizada de forma não presencial em conformidade com a legislação vigente nacional. Após fechamento da amostra por exaustão, analisaram-se as respostas de 13 estudantes. Resultado: Em conformidade aos elementos, passos e critérios metodológicos, as informações obtidas foram classificadas e dispostas em duas categorias: dignidade da pessoa humana e autonomia do paciente; e conhecimento sobre diretivas antecipadas de vontade. Conclusão: Essa análise qualitativa trouxe à tona importantes temas, como a regulamentação que norteia as diretivas antecipadas de vontade e os princípios que envolvem a bioética, a fim de consolidar o respeito, a autonomia e a dignidade do paciente que está, ou estará, passando pela terminalidade da vida.

Abstract The restriction or suspension of activities due to the COVID-19 pandemic has affected sectors of economic activity around the world, and the food sector has not been the exception. The research aims to analyze the export strategies implemented by Mexican exporting companies in the food industry that faced COVID -19. The information was collected through a survey with the application of a questionnaire. In the methodology, the population of Mexican agro-export producers from the MexBest (n/d) directory was identified, Cronbach’s Alpha test was carried out to evaluate the reliability of the instrument, and the representative sample size of MexBest (n/d) agro-exporting producers was determined. The results are presented through descriptive statistics, finding that 85 % of Mexican agro-export producers are planning, developing and/or implementing of export strategies.

Resumen La restricción o suspensión de actividades a causa de la pandemia por la COVID -19 ha afectado a los sectores de la economía de todo el mundo, y el sector alimentario no ha sido la excepción. Esta investigación tiene como objetivo analizar las estrategias para la exportación que implementan las empresas exportadoras mexicanas de la industria alimentaria frente a la COVID-19. La información se recolectó por medio de una encuesta con la aplicación de un cuestionario. En la metodología, se identificó la población de productores agroexportadores mexicanos del directorio MexBest (s/f), se realizó la prueba Alfa de Cronbach para evaluar la fiabilidad del instrumento y se determinó el tamaño de muestra representativa de los productores agroexportadores del MexBest (s/f). Los resultados se presentan mediante estadística descriptiva. Se encontró que 85 % de los productores agroexportadores mexicanos se ubican en la planificación, en el desarrollo y/o en la implementación de estrategias para la exportación.

Abstract Zoonotic spillover is a phenomenon characterized by the transfer of pathogens between different animal species. Most human emerging infectious diseases originate from non-human animals, and human-related environmental disturbances are the driving forces of the emergence of new human pathogens. Synthesizing the sequence of basic events involved in the emergence of new human pathogens is important for guiding the understanding, identification, and description of key aspects of human activities that can be changed to prevent new outbreaks, epidemics, and pandemics. This review synthesizes the connections between environmental disturbances and increased risk of spillover events based on the One Health perspective. Anthropogenic disturbances in the environment (e.g., deforestation, habitat fragmentation, biodiversity loss, wildlife exploitation) lead to changes in ecological niches, reduction of the dilution effect, increased contact between humans and other animals, changes in the incidence and load of pathogens in animal populations, and alterations in the abiotic factors of landscapes. These phenomena can increase the risk of spillover events and, potentially, facilitate new infectious disease outbreaks. Using Brazil as a study model, this review brings a discussion concerning anthropogenic activities in the Amazon region and their potential impacts on spillover risk and spread of emerging diseases in this region.

Resumen El consumo desmedido y la demanda energética a nivel mundial han generado la necesidad de incorporar los desechos plásticos y de origen agroindustrial a procesos de valorización, para obtener productos energéticos alternativos a partir de tratamientos termoquímicos como la pirólisis rápida, en la cual se generan productos sólidos, líquidos y gaseosos. Desarrollar metodologías que permitan realizar un reciclaje y/o aprovechamiento de residuos generados de diversas industrias, en específico, la polimérica y la agroindustrial, es de suma importancia, dada la contaminación crónica y el impacto ambiental en ecosistemas naturales, cuerpos hídricos y fauna. El objetivo de este artículo es analizar los impactos ambientales de la alta generación de residuos plásticos y agroindustriales, así como determinar la relación entre las condiciones de operación y el rendimiento y selectividad de los productos generados con las características fisicoquímicas de los catalizadores empleados en la pirólisis rápida en pro de la valorización de dichos residuos. Lo anterior se realizó mediante una revisión de la literatura en bases de datos reconocidas para obtener artículos de investigación actualizados y con validez científica. Se encontró que la pirólisis catalizada presenta una mejora respecto al rendimiento y distribución de los productos según la fase activa seleccionada en la que la naturaleza de los metales usados conduce a diversas rutas químicas y por ende, a productos ricos en hidrocarburos.

Abstract Excessive consumption and global energy demand have generated the need to incorporate plastic and agro-industrial waste into recovery processes, to obtain alternative energy products from thermochemical treatments such as rapid pyrolysis, in which solid, liquid, and gaseous products are generated. The development of methodologies for the recycling and/or recovery of waste generated from various industries, specifically polymer and agroindustrial, is of the utmost importance, given the chronic pollution and environmental impact on natural ecosystems, water bodies and fauna. The objective of this article is to analyze the environmental impacts of the high generation of plastic and agro-industrial waste, and to determine the relationship between the operating conditions and the performance and selectivity of the products generated with the physicochemical characteristics of catalysts used in rapid pyrolysis for the recovery of such waste. This was done through a review of the literature in recognized databases to obtain updated research articles with scientific validity. It was found that catalyzed pyrolysis presents an improvement with respect to the performance and distribution of the products according to the selected active phase in which the nature of the metals used leads to various chemical routes and, therefore, to hydrocarbon-rich products.

Resumo O consumo desmedido e a procura energética a nível mundial criaram a necessidade de incorporar os resíduos plásticos e de origem agro-industrial em processos de valorização, para obter produtos energéticos alternativos a partir de tratamentos termoquímicos como a pirólise rápida, na qual são gerados produtos sólidos, líquidos e gasosos. Tendo em conta a poluição crônica e o impacto ambiental nos ecossistemas naturais, é da maior importância desenvolver metodologias que permitam a reciclagem e/ou a valorização dos resíduos produzidos em diversas indústrias, nomeadamente a polimérica e a agro-industrial, corpos hídricos e fauna. O objectivo deste artigo é analisar os impactos ambientais da alta geração de resíduos plásticos e agro-industriais, bem como determinar a relação entre as condições de operação e o rendimento e a seletividade dos produtos gerados com as características físico-químicas dos catalisadores utilizados na pirólise rápida para a valorização desses resíduos. Isto foi feito através de uma revisão da literatura em bases de dados reconhecidas para obter artigos de pesquisa atualizados e com validade científica. Verificou-se que a pirólise catalisada apresenta uma melhoria relativamente ao rendimento e distribuição dos produtos segundo a fase activa seleccionada, em que a natureza dos metais usados conduz a diversas rotas químicas e, por conseguinte, a produtos ricos em hidrocarbonetos.

Abstract The ongoing COVID-19 pandemic has caught the attention of the global community and rekindled the debate about our ability to prevent and manage outbreaks, epidemics, and pandemics. Many alternatives are suggested to address these urgent issues. Some of them are quite interesting, but with little practical application in the short or medium term. To realistically control infectious diseases, human, animal, and environmental factors need to be considered together, based on the One Health perspective. In this article, we highlight the most effective initiatives for the control and prevention of infectious diseases: vaccination; environmental sanitation; vector control; social programs that encourage a reduction in the population growth; control of urbanization; safe sex stimulation; testing; treatment of sexually and vertically transmitted infections; promotion of personal hygiene practices; food safety and proper nutrition; reduction of the human contact with wildlife and livestock; reduction of social inequalities; infectious disease surveillance; and biodiversity preservation. Subsequently, this article highlights the impacts of human genetics on susceptibility to infections and disease progression, using the SARS-CoV-2 infection as a study model. Finally, actions focused on mitigation of outbreaks and epidemics and the importance of conservation of ecosystems and translational ecology as public health strategies are also discussed.

Resumen Introducción: La Electroestimulacion neuromuscular es utilizada de manera terapéutica complementaria en diferentes afecciones. Entre ellos, la rehabilitación de disfagia neurogénica. El objetivo es desarrollar una revisión integradora de la literatura sobre la aplicabilidad y eficacia en la práctica clínica sobre del uso de la electroestimulación neuromuscular en disfagia orofa-ríngea. Metodología: Para la elaboración del presente artículo la metodología utilizada es una revisión sistemática efectuada en la gestión 2020, el diseño de investigación corresponde a descriptivo, transversal, prospectivo. Desarrollo: La búsqueda en las bases de datos electrónicas arrojó 352 títulos, de los cuales 47 estudios cumplían con nuestros criterios de selección. Este método tiene como objetivo promover efectos benéficos significativos en la capacidad funcional, siendo una alternativa de tratamiento a ser utilizada lo más precozmente posible, con la premisa de prevenir la disfunción muscular. Discusión y conclusiones: Existe una disputa en diferentes factores que interfieren en el método de uso de este método, como también la complementación con técnicas convencionales. En su mayoría se ha demostrado que la electroestimulación neuromuscular acelera la mejoría de la función deglutoria en combinación con técnicas compensatorias o convencionales.

Resumo Introdução: A Eletroestimulação Neuromuscular é utilizada de forma terapêutica complementar em diferentes condições. Entre elas, a reabilitação da disfagia neuro-gênica. O objetivo é desenvolver uma revisão integrativa da literatura sobre a aplica-bilidade e eficacia na prática clínica do uso da eletroestimulação neuromuscular na disfagia orofaríngea. Metodologia: Para a elaboração deste artigo, a metodologia utilizada é uma revisão sistemática realizada na gestão 2020, o desenho da pesquisa corresponde a descritivo, transversal, prospectivo. Desenvolvimento: A busca em bases de dados eletrônicas resultou em 352 títulos, dos quais 47 estudos aten-deram aos nossos critérios de seleção. Esse método visa promover efeitos benéficos significativos na capacidade funcional, sendo uma alternativa de tratamento a ser utilizada o mais precocemente possível, com a premissa de prevenir disfunções musculares. Discussão e conclusões: Há uma disputa em diferentes fatores que interferem na forma de utilização desse método, bem como na complementação com técnicas convencionais. A maior parte do estudo demonstrou que a eletroestimulação neuromuscular acelera a melhora da função de deglutição em combinação com técnicas compensatórias ou convencionais.

Summary Introduction: Neuromuscular Electrostimulation is used in a complementary therapeutic way in different conditions. Among them, the rehabilitation of neurogenic dysphagia. The objecti-ve is to develop an integrative review from the literature of the applicability and efficacy in clinical practice about neuromuscular electrostimulation use in oropharyngeal dysphagia. Me-thodology: For the preparation of this article, the methodology used is a systematic review carried out in 2020, the research design corresponds to descriptive, cross-sectional, prospective. Development: The search in electro-nic databases yielded 352 titles, from which 47 studies fulfill our selection criteria. This method aim is to promote significant beneficial effects on functional capacity, being an alternative treatment to be used as early as possible, with the premise of preventing muscle dysfunction. Discussion and conclusions: There is a dispute in different factors that interfere in this method use, as well as the complementation with conventional techniques. In the Most cases it has been shown that neuromuscular electrostimulation accelerates the improvement of swallowing function in combina-tion with compensatory or conventional techniques.

Abstract Amazonian biodiversity is increasingly threatened due to the weakening of policies for combating deforestation, especially in Brazil. Loss of animal and plant species, many not yet known to science, is just one among many negative consequences of Amazon deforestation. Deforestation affects indigenous communities, riverside as well as urban populations, and even planetary health. Amazonia has a prominent role in regulating the Earth’s climate, with forest loss contributing to rising regional and global temperatures and intensification of extreme weather events. These climatic conditions are important drivers of emerging infectious diseases, and activities associated with deforestation contribute to the spread of disease vectors. This review presents the main impacts of Amazon deforestation on infectious-disease dynamics and public health from a One Health perspective. Because Brazil holds the largest area of Amazon rainforest, emphasis is given to the Brazilian scenario. Finally, potential solutions to mitigate deforestation and emerging infectious diseases are presented from the perspectives of researchers in different fields.

ABSTRACT Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology that allowed to achieve a TB diagnosis in patients referred to the National Institute of Neoplastic Diseases (INEN) with a presumed diagnosis of cancer between 2014 and 2016. The study included 170 patients (52.4% men) with an average age of 41.1 years; 18% presented a history of contact with TB, and 5.9% had had the disease previously. The TB was pulmonary in 22.4% and extrapulmonary in 77.7% of patients. The most frequent symptoms were respiratory, tumor, weight loss, and neurological. The cancer diagnoses most frequently discarded were lymphoma, lung cancer, and brain cancer. The lesions that suggested a neoplasm indicated an advanced clinical stage in 63.5%. Therefore, it follows that the symptoms and images associated with TB can be confused with malignant neoplasms.

RESUMEN La tuberculosis (TB) es un importante problema de salud pública que debido a la variabilidad clínica de su presentación, puede confundirse con una malignidad. El objetivo del estudio fue identificar las características clínico radiológicas y describir la metodología que permitió llegar al diagnóstico de TB en pacientes derivados con presunción diagnóstica de cáncer al Instituto Nacional de Enfermedades Neoplásicas (INEN) entre 2014 y 2016. Se incluyeron 170 pacientes (52,4 % hombres) con edad promedio de 41,1 años, 18 % presentaron antecedentes de contacto con TB y un 5,9 % tuvo previamente la enfermedad. La TB fue pulmonar en 22,4 % y extrapulmonar en 77,7 % de los pacientes. Los síntomas más frecuentes fueron respiratorios, tumoración, pérdida de peso y neurológicos. Los diagnósticos oncológicos descartados con mayor frecuencia fueron linfoma, cáncer pulmonar y cerebral. Las lesiones que sugerían una neoplasia indicaron un estadio clínico avanzado en el 63,5 %. Se concluye que los síntomas e imágenes asociados a TB pueden confundirse con neoplasias malignas.

Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology that allowed to achieve a TB diagnosis in patients referred to the National Institute of Neoplastic Diseases (INEN) with a presumed diagnosis of cancer between 2014 and 2016. The study included 170 patients (52.4% men) with an average age of 41.1 years; 18% presented a history of contact with TB, and 5.9% had had the disease previously. The TB was pulmonary in 22.4% and extrapulmonary in 77.7% of patients. The most frequent symptoms were respiratory, tumor, weight loss, and neurological. The cancer diagnoses most frequently discarded were lymphoma, lung cancer, and brain cancer. The lesions that suggested a neoplasm indicated an advanced clinical stage in 63.5%. Therefore, it follows that the symptoms and images associated with TB can be confused with malignant neoplasms.

La tuberculosis (TB) es un importante problema de salud pública que debido a la variabilidad clínica de su presentación, puede confundirse con una malignidad. El objetivo del estudio fue identificar las características clínico radiológicas y describir la metodología que permitió llegar al diagnóstico de TB en pacientes derivados con presunción diagnóstica de cáncer al Instituto Nacional de Enfermedades Neoplásicas (INEN) entre 2014 y 2016. Se incluyeron 170 pacientes (52,4 % hombres) con edad promedio de 41,1 años, 18 % presentaron antecedentes de contacto con TB y un 5,9 % tuvo previamente la enfermedad. La TB fue pulmonar en 22,4 % y extrapulmonar en 77,7 % de los pacientes. Los síntomas más frecuentes fueron respiratorios, tumoración, pérdida de peso y neurológicos. Los diagnósticos oncológicos descartados con mayor frecuencia fueron linfoma, cáncer pulmonar y cerebral. Las lesiones que sugerían una neoplasia indicaron un estadio clínico avanzado en el 63,5 %. Se concluye que los síntomas e imágenes asociados a TB pueden confundirse con neoplasias malignas.

Resumen Introducción. Un factor de riesgo durante el embarazo es la patología dental, la cual puede traer consecuencias patológicas sobre la madre y el feto. Objetivo. Describir la salud oral y los eventos patológicos relacionados en mujeres embarazadas que asistieron a controles prenatales y odontológicos en Assbasalud Empresa Social del Estado (ESE) en Manizales, Colombia, durante 2013. Materiales y métodos. Se realizó un estudio descriptivo que revisó 502 historias clínicas de gestantes que asistieron a controles prenatales y odontológicos en Assbasalud ESE en Manizales. Resultados. 75.1% de las pacientes tuvo de 1 a 3 controles odontológicos y 93.2% presentó patologías dentales durante la gestación, donde las más frecuentes fueron gingivitis (75.4%) y caries (67.6%). 21.1% no tenía dientes cariados y 30.4% contaba con dientes perdidos. Al 79% se le realizó obturación dental durante el embarazo y el 9.9% no asistió a controles odontológicos. Conclusión. En Assbasalud ESE hay buena cobertura de odontología durante los controles prenatales, con eficiente promoción y prevención de las patologías dentales durante la gestación. En consecuencia, existe baja relación entre la patología oral y las enfermedades sistémicas. Asimismo, hay un correcto plan de remisión a servicios de tercer nivel de las gestantes con riesgo de complicaciones perinatales.

Abstract Introduction: A risk factor during pregnancy is dental pathology, which can pose pathological consequences on the mother and the fetus. Objective: To describe oral health and related pathological events in pregnant women who attended prenatal and dental checkups at Assbasalud Empresa Social del Estado (ESE) in Manizales, Colombia, during 2013. Materials and methods: Descriptive study in which 502 clinical records of pregnant women who attended prenatal and dental checkups in Assbasalud ESE in Manizales were reviewed. Results: 75.1% of the patients attended between 1 and 3 dental checkups and 93.2% presented with dental pathologies during pregnancy, being gingivitis (75.4%) and cavities (67.6%) the most frequent. 21.1% of the sample did not have decayed teeth, while 30.4% had missing teeth. 79% had dental filling during pregnancy and 9.9% did not attend dental checkups. Conclusion: Assbasalud ESE offers good dental coverage during prenatal checkups though the efficient promotion and prevention of dental pathologies during pregnancy. Consequently, there is a low correlation between oral pathology and systemic diseases. In addition, a proper referral plan to third-level services is provided to pregnant women at risk of perinatal complications.