Enfermedades emergentes, pobreza y hambre / Emerging diseases, poverty and hunger

La pobreza y el hambre son elementos significativos para la prevalencia de las enfermedades emergentes, además de la ignorancia, la indigencia, las falencias sanitarias y los cambios ambientales debidos al calentamiento global. La desnutrición es consecuencia de la pobreza y ésta es causa de desnutrición. Los niños que viven en condiciones de mayor vulnerabilidad tienen un riesgo alto de morir por diarrea, neumonía y enfermedades emergentes. La mayoría son desnutridos. Su futuro en la adultez guarda relación con la desnutrición en la infancia. En el mundo 820 millones de niños padecen hambre y mueren anualmente 3 millones de menores de 5 años, según datos del Fondo de las Naciones Unidas para la Infancia. En Argentina, según datos del segundo semestre de 2022, un 39,2% de la población es pobre (Instituto Nacional de Estadísticas y Censos). El 15,5% de niños y adolescentes padecen inseguridad alimentaria y 2 millones de niños padecen hambre (Médicos sin Fronteras). La tasa de mortalidad infantil en menores de 5 años tiene una prevalencia del 0,4%. Los cambios climáticos ejercen influencia sobre la salud, produciendo cambios en la epidemiologia de las enfermedades emergentes, mientras que la insuficiente alimentación ocasiona efectos negativos sobre la salud. El calentamiento global aumenta las inundaciones y las sequías, incidiendo en la escasez de alimentos e incrementando las enfermedades emergentes. La situación debe ser revertida mediante el desarrollo sostenido de la educación, el bienestar social y los proyectos sanitarios. (AU)

Poverty and hunger are significant elements for the prevalence of emerging diseases, in addition to ignorance, indigence, sanitary deficiencies and environmental changes due to global warming. Malnutrition is a consequence of poverty and poverty is a cause of malnutrition. Children living in more vulnerable conditions are at greater risk of dying from diarrhea, pneumonia and emerging diseases. Most are malnourished. Their future in adulthood is related to malnutrition in childhood. Worldwide, 820 million children suffer from hunger and 3 million children under 5 die annually (United Nations Children's Fund). In Argentina, according to data from the second half of 2022, 39.2% of the population is poor (Instituto Nacional de Estadísticas y Censos). 15.5% of children and adolescents are food insecure and 2 million children are hungry (Médecins Sans Frontières). The infant mortality rate in children under 5 years of age has a prevalence of 0.4%. Climate change influences health, producing changes in the epidemiology of emerging diseases, while insufficient food has negative effects on health. Global warming increases floods and droughts, leading to food shortages and increasing emerging diseases. The situation must be reversed through sustained development of education, social welfare and health projects. (AU)

Estudo descritivo de casos notificados de febre maculosa em São Paulo, Rio de Janeiro e Minas Gerais entre 2007 e 2016 / Descriptive study of reported cases of spotted fever in São Paulo, Rio de Janeiro and Minas Gerais between 2007 and 2016

Resumo Introdução A febre maculosa é uma doença infecciosa aguda causada por bactérias do gênero Rickettsia e transmitida por carrapatos que pode levar à hospitalização e, eventualmente, a óbito por causa de quadros mais graves. Objetivo O objetivo deste artigo foi descrever o cenário epidemiológico da doença nas três unidades federativas de maior número de notificações e óbitos pela doença no Brasil entre 2007 e 2016. Método Estudo epidemiológico descritivo com base nos dados das fichas de investigação para a doença, sendo analisados dados demográficos, geográficos, ambientais e de hospitalização, diagnóstico e desfecho dos casos na área de estudo. Resultados Foram confirmados 953 casos da doença, em sua maioria por critérios laboratoriais, sendo observada maior prevalência entre homens com idade média de 35 anos, pouco relacionados ao ambiente de trabalho, mas amplamente relacionados ao meio urbano. Do total de casos confirmados, 64% pacientes afirmaram ter tido algum contato com carrapato, assim como com cães (36%), capivaras (20%) e equinos (19%). Conclusão Existem questionamentos a respeito da doença que não foram elucidados neste artigo, entretanto abordagens criativas, validadas e ancoradas na associação de áreas de conhecimento distintas poderão dar bons resultados se objetivamente aplicadas em ações estratégicas da gestão da saúde.

Abstract Background Spotted fever is an acute infectious disease caused by bacteria of the genus Rickettsia and transmitted by ticks, which can lead to hospitalization and, eventually, death due to more severe conditions. Objective The purpose of this article was to describe the epidemiological scenario of the disease in the three federal states with the highest number of notifications and deaths due to the disease in Brazil between 2007 and 2016. Method A descriptive epidemiological study was carried out based on data from the investigation forms for the disease, with data being analyzed on demographic, geographic, environmental, and hospitalization, diagnosis, and outcome of cases in the study area. Results 953 cases of the disease were confirmed, mostly by laboratory criteria, with a higher prevalence being observed among men with an average age of 35 years, little related to the work environment, but largely related to the urban environment. Of the total confirmed cases, 64% of patients said that they had had some contact with ticks, as well as with dogs (36%), capybaras (20%), and horses (19%). Conclusion We believe that there are questions about the disease that were not elucidated in this article, however, creative approaches, validated and anchored in the association of different areas of knowledge can give good results if objectively applied in strategic health management actions.

Presencia de Oligoryzomys microtis (Rodentia) en hábitats silvestres en Bolivia / Presence of Oligoryzomys microtis (Rodentia) in wild habitats in Bolivia

Rodents are very important organisms within ecosystems; however, some species are considered pests because they consume and damage crops and because they are vectors, hosts, or reservoirs in the transmission of emerging infectious diseases. Rodents in Bolivia are represented by 148 species, Oligoryzomys microtis (Allen, 1916) being a species of public health importance because it is considered a potential natural reservoir of the Chapare virus, which causes Chapare Hemorrhagic Fever, and it is a deadly disease for humans. Its impact on public health is still unknown. The present study consisted of recording the presence of the species O. microtis through the use of Sherman-type live capture traps for small mammals arranged in linear transects in the wild and intervened habitats of the Samuzabety community, where the Chapare virus was detected for the first time, this community is located in the Chapare Province of the department of Cochabamba, Bolivia. The species recorded were the rodents Oligoryzomys microtis (morphotype matogrossae), Proechimys brevicauda, Neacomys vargasllosai, Hylaeamys perenensis, and the marsupial Metachiurus nudicaudatus. The presence of the species O. microtis (morphotype matogrossae) in the community of Samuzabety is confirmed. This species is associated with forest habitats with nearby and surrounding crops. The species O. microtis has epidemiological relevance as it is the natural reservoir of the Río Mamoré Hantavirus and is currently considered a potential reservoir of the Chapare virus and other Arenaviruses.

Los roedores son organismos muy importantes dentro de los ecosistemas; sin embargo, algunas especies son consideradas como plagas porque consumen y dañan cultivos y porque son vectores, hospederos o reservorios en la trasmisión de enfermedades infecciosas emergentes. Los roedores en Bolivia están representados por 148 especies, entre las cuales Oligoryzomys microtis (Allen, 1916) es una especie de importancia en salud pública, debido a que es considerada como potencial reservorio natural del virus Chapare, el cual produce la fiebre hemorrágica Chapare, enfermedad mortal para el ser humano y con un impacto en la salud pública aún desconocido. En este estudio se registró la presencia de la especie O. microtis?/i>, mediante el uso de trampas de captura viva tipo Sherman para pequeños mamíferos dispuestas en transectos lineales, en los hábitats silvestres e intervenidos de la comunidad de Samuzabety, sitio en el que se detectó por primera vez el virus Chapare. Esta comunidad se encuentra ubicada en la Provincia Chapare del departamento de Cochabamba, Bolivia. Las especies registradas fueron los roedores Oligoryzomys microtis (morfotipo matogrossae), Proechimys brevicauda, Neacomys vargasllosai, Hylaeamys perenensis y el marsupial Metachiurus nudicaudatus. Se confirma la presencia de la especie O. microtis (morfotipo matogrossae) en la comunidad de Samuzabety, la cual se encuentra asociada con hábitats de bosques, con cultivos cercanos y a su alrededor. La especie O. microtis tiene relevancia epidemiológica al ser el reservorio natural del hantavirus Río Mamoré y al ser considerado actualmente como potencial reservorio del virus Chapare y de otros arenavirus.

Reverse-Transcription Loop-Mediated Isothermal Amplification and alternative protocols for lower cost, large-scale COVID-19 testing: lessons from an emerging economy / Amplificación isotérmica mediada por bucle de transcripción inversa y protocolos alternativos para pruebas COVID-19 a gran escala y de bajo costo: lecciones de una economía emergente

Abstract Introduction: Most successful cases of COVID-19 pandemic mitigation and handling have relied on extensive reverse-transcription quantitative polymerase chain reaction (RT-qPCR). However, many emerging economies have struggled with current molecular testing demands due to economic, technical and technological constraints. Objective: To define a potential diagnostic protocol to increase testing capacity in current and post-pandemic conditions. Methods: We reviewed the literature, patents and commercial applications, for alternatives. Results: We found a good potential in saliva samples, viral inactivation and quick RNA extraction by heating; the use of an isothermal technology such as loop mediated isothermal amplification (LAMP) and naked eye test-result visualization by in-tube colorimetry or turbidity. Conclusions: Saliva samples with quick RNA extraction by heating and colorimetric LAMP are promising options for countries with economic and infrastructure limitations.

Resumen Introducción: La mayoría de los casos exitosos de mitigación y manejo de la pandemia de COVID-19 se han dado mediante pruebas basadas en la reacción en cadena de la polimerasa cuantitativa (RT-qPCR por sus siglas en inglés). Sin embargo, muchas economías emergentes han tenido problemas con las demandas actuales de pruebas moleculares debido a limitaciones económicas, técnicas y tecnológicas. Objetivo: Definir un protocolo de diagnóstico potencial para aumentar la capacidad de prueba en las condiciones actuales y posteriores a la pandemia. Métodos: Revisamos la literatura, las patentes y las aplicaciones comerciales, en busca de alternativas. Resultados: Encontramos un buen potencial en muestras de saliva, inactivación viral y extracción rápida de ARN por calentamiento; el uso de una tecnología isotérmica como la amplificación isotérmica mediada por horquillas (LAMP, por sus siglas en inglés) y la visualización del resultado de la prueba a simple vista mediante colorimetría o turbidez en el tubo. Conclusiones: Las muestras de saliva con extracción rápida de ARN por calentamiento y LAMP colorimétrico son opciones prometedoras para países con limitaciones económicas y de infraestructura.

Viruela símica: zoonosis emergente con impacto global / Monkeypox: emerging zoonosis with unprecedentedglobal impact

El virus de la viruela símica es un orthopoxvirus de características zoonóticas endémico en las regiones de África Central y África Occidental, donde causa brotes desde 1970. En las últimas décadas se registró un aumento exponencial de casos, probablemente asociado a la disminución en la inmunidad conferida por la vacuna antivariólica, discontinuada luego de la erradicación de la viruela. En los últimos años se registraron casos esporádicos fuera del continente africano, siempre relacionados epidemiológicamente a la permanencia en áreas endémicas o contacto con animales infectados. Desde el 13 de mayo de 2022 se encuentra en curso el mayor brote de viruela símica registrado fuera de las áreas endémicas de África, con casos en los cinco continentes. La extensión, el impacto y la duración del brote permanecen aún inciertos.

Monkeypox virus is an orthopoxvirus with zoonotic characteristics endemic in Central and West Africa regions, where it has caused outbreaks since 1970. An exponential increase in cases has been registered in the last decades, probably associated with a decrease in the immunity conferred by the smallpox vaccine, discontinued after smallpox eradication. In recent years, sporadic cases have been reported outside the African continent, always epidemiologically related to permanence in endemic areas or contact with infected animals. Since May 13, 2022, the largest monkeypox outbreak ever reported outside Africa endemic areas, with cases on the five continents, is unfolding. The extent, impact and duration of this outbreak still remain uncertain

Comprensiones alrededor del concepto de tránsito a la vida adulta y su relación con la autonomía desde el paradigma sistémico / Understandings Around the Concept of Transition to Adulthood and its Relationship with Autonomy From the Systemic Paradigm

Resumen El presente artículo parte de la importancia que el tránsito a la vida adulta ha adquirido a lo largo del tiempo, por ser un tema de reflexión y de múltiples estudios para conocer cómo las condiciones de hoy en día permiten este proceso en los jóvenes. Este artículo es un estudio cualitativo de revisión sistemática y tuvo como objetivo describir el tránsito a la adultez desde dos perspectivas. La primera, una construcción por medio de investigaciones realizadas por varios autores, los cuales encontraron que la transición a la adultez está mediada por aspectos como la autonomía, los nuevos roles, las expectativas individuales, las demandas, entre otras. Y la segunda, una visión anclada a paradigmas emergentes y el enfoque sistémico, que plantean que el tránsito a la vida adulta se ve permeado por elementos como la desvinculación, la individuación y las dinámicas familiares. La revisión permitió concluir que las condiciones familiares y sociales en las que se desarrolla el individuo son determinantes en su tránsito a la vida adulta, favoreciendo o dificultando este proceso.

Abstract This article is based on the importance that the transition to adulthood has had over time, as it is a subject of reflection and multiple studies that aim to understand how the current conditions allow this process in young people. This is a qualitative study of systematic review and its objective is to describe the transition to adulthood from two perspectives. The first, a construction through research conducted by different authors, who found that the transition to adulthood is mediated by aspects such as autonomy, new roles, individual expectations, and demands, among others. The second one, a vision anchored to emerging paradigms and the systemic approach, which suggests that the transition to adulthood is influenced by elements such as decoupling, individuation, and family dynamics. The review made it possible to conclude that the social and family conditions in which the individual develops are determining factors in his/her transition to adulthood, either favoring or hindering this process.

Viruela del simio: Preocupación por una zoonosis emergente / Monkeypox: Concern about an emerging zoonosis

Introducción: La viruela del simio es una enfermedad zoonótica viral, causada por el poxvirus del mismo nombre; endémica de África central y occidental. Sin embargo, su presencia se ha incrementado en otras regiones del mundo durante la última década en comparación con los 40 años anteriores. Objetivo. Describir y actualizar las características etiológicas, epidemiológicas y clínicas de la viruela del simio, así como discutir el potencial riesgo de diseminación internacional. Material y Métodos. Se realizó una revisión de literatura publicada en los últimos cinco años, utilizando los descriptores Medical Subject Headings. La búsqueda se hizo en las bases de datos MEDLINE / PubMed y LILACS, sin restricciones de idioma. Se excluyeron los estudios duplicados y aquellos que no se ajustaban al objetivo de la investigación, seleccionando 47 artículos. Resultados. El virus de la viruela del simio está emparentado con el de la viruela humana (erradicada en 1979). Se transmite desde un individuo enfermo mediante gotitas de fluido respiratorio, contacto con material de lesión cutánea y fluidos corporales; o mediante fómites contaminados. Después de 6 a 13 días de incubación aparecen los síntomas, semejantes al de la viruela humana: comenzando con un proceso febril agudo y seguido de erupción cutánea en rostro y cuerpo, que cura dejando cicatrices visibles. Conclusiones. Este virus puede ocupar el nicho ecológico dejado por el virus de la viruela humana. Actualmente se ha expandido a Europa y América, por lo que ya no debe considerarse una enfermedad limitada al África, sino una amenaza sanitaria para la salud pública global.

background:Monkeypox is a viral zoonotic disease caused by the poxvirus of the same name, endemic to central and western Africa. However, its presence has increased in other regions of the world during the last decade compared to the previous 40 years.To describe and update the etiologic, Objective.epidemiologic, and clinical features of simian pox, as well as to discuss the potential risk of international spread. . Areview of Material and Methods literature published in the last five years was performed using the descriptors Medical Subject Headings. The search was performed in the MEDLINE/PubMed and LILACS data bases, without language restrictions. Duplicate studies and those that did not fit the research objective were excluded, selecting 47 articles. Results.Simian smallpox virus is related to human smallpox virus (eradicated in 1979). It is transmitted from a sick individual by respiratory fluid droplets, contact with skin lesion material and body fluids; or by contaminated fomites. After 6 to 13 days of incubation, symptoms appear, similar to those of human smallpox: beginning with an acute febrile process and followed by a cutaneous eruption on the face and body, which heals leaving visible scars. This virus may occupy the Conclusions.ecological niche left by the smallpox virus. It has now spread to Europe and America, so it should no longer be considered a disease limited to Africa, but a health threat to global public health

Zoonosis virales emergentes de impacto global / Emerging viral zoonoses of global impact

Objetivo: Analizar las principales zoonosis virales emergentes y su impacto a nivel global en la presentación de epidemias y pandemias que afectan la salud humana. Método: Se desarrolló una revisión sistemática de 15 artículos de la base de datos PubMed. Análisis de los resultados: Considerando que, en la inmensa mayoría de los casos, la intervención o control en la fuente animal podría evitar problemas ulteriores de salud pública, se hace necesario considerar y desarrollar intervenciones integradas, que tengan en cuenta las causas que interactúan y son responsables de los problemas intersectoriales de salud. Conclusión: El impacto humano en la ecología y el clima, junto con un transporte más rápido entre países y regiones, han acelerado la aparición o reaparición de patógenos zoonóticos.

Objective: To analyze the main emerging viral zoonoses and their global impact on the occurrence of epidemics and pandemics affecting human health. Methods: A systematic review of 15 articles from the PubMed database was carried out. Analysis of results: Considering that, in the vast majority of cases, intervention or control at the animal source could prevent further public health problems, it is necessary to consider and develop integrated interventions that take into account the interacting causes responsible for intersectoral health problems. Conclusion: Human impact on ecology and climate, together with more rapid transport between countries and regions, have accelerated the emergence or re-emergence of zoonotic pathogens.

Biodiversity and public health interface / Biodiversidade e a interface com a saúde pública

Abstract Alongside modernity, the human activity has been a key factor in global environmental risks, with worldwide anthropic modification being the cause of the emergence of diseases for wild and livestock animals, and even humans. In special, the increase in the spatial distribution and in the incidence of some emerging infectious diseases (EID) are directly associated to deforestation and global climate changes. Moreover, the arise of new EID agents, such as the SARS-COV-2 have been reported for the last 30 years. On the other hand, biodiversity has been shown to be a key indicator for ecosystem health, and to pose a role to increase the promotion of human public health. In neotropical regions, and in special, in Brazil, several infectious diseases have been demonstrated to be directly affected for the biodiversity loss, such as malaria, hantavirus pulmonary syndrome, yellow fever, urban arboviruses, spotted fever, amongst other. To better understand the ecosystem capacity of regulation of infectious diseases, FAPESP BIOTA program have supported researchers and research projects to increase knowledge about Brazilian biodiversity and the ecosystems, such as diversity of bird bioagents, venomous animals biodiversity, diversity of mosquitos species in forest patches inside urban areas, propagation of the yellow fever virus over fragmented forest territories, loss of ecological corridors and occurrence of spotted fever and malaria, amongst others. It is noteworthy that FAPESP BIOTA is a successful program and must be expanded as an important tool for present and future public health promotion.

Resumo Junto à modernidade, a atividade humana tem sido um fator chave ligada aos riscos ambientais globais, as modificações antrópicas em âmbito mundial têm sido causa do surgimento de doenças para os animais silvestres e domésticos, bem como para o ser humano. Em especial, o incremento na distribuição espacial e incidência de doenças infecciosas emergentes (DIE) estão diretamente associados ao desmatamento e às mudanças climáticas globais, além disso, o surgimento de novos agentes de DIE, como o SARS-COV-2, tem sido relatado nos últimos 30 anos. Por outro lado, a biodiversidade tem se mostrado um indicador chave para a saúde dos ecossistemas, além de representar um papel importante na promoção da saúde pública humana. Nas regiões neotropicais, e em especial, no Brasil, várias doenças infecciosas têm demonstrado ser diretamente afetadas pela perda de biodiversidade, como a malária, a síndrome pulmonar por hantavírus, a febre amarela, as arboviroses urbanas, a febre maculosa, entre outras. Para entender melhor a capacidade ecossistêmica de regulação de doenças infecciosas, o programa BIOTA FAPESP tem apoiado pesquisadores e projetos de pesquisa para aumentar o conhecimento sobre a biodiversidade e os ecossistemas brasileiros, como a diversidade de bioagentes de aves, a biodiversidade de animais peçonhentos, a diversidade de espécies de mosquitos em fragmentos florestais dentro de áreas urbanas, a propagação do vírus da febre amarela em território florestal fragmentado, perda e isolamento de remanescentes florestais e a ocorrência de febre maculosa e malária, entre outros. Ressalta-se que o BIOTA FAPESP é um programa de sucesso e deve ser ampliado como importante ferramenta de promoção da saúde pública presente e futura.

Expresiones del engagement en el programa peruano de vacunación contra SARS-CoV-2 / Expressions of engagement in the Peruvian vaccination program against SARS-CoV-2

La investigación estuvo enfocada en el estudio de las expresiones emergentes del engagement en el programa peruano de vacunación COVID-19. Es de tipo descriptiva, transversal y con combinación de aspectos cuantitativos y cualitativos, en sus dimensiones vigor, dedicación y absorción, medidos a través de una adaptación del cuestionario Utrecht Work Engagement Scale, validado por expertos y con una muy alta confiabilidad (0,903), realizada entre los meses de febrero a mayo de 2021, en las localidades de Huancayo y Lima. Las expresiones emergentes nacen del conocimiento adquirido de las acciones realizadas y los factores motivacionales que condujeron al desarrollo de un accionar que va más allá de lo que el ministerio pudo haber solicitado de sus trabajadores, quienes a pesar de poner en riesgo constante su salud y su vida, por ser la primera línea de contención en defensa de la enfermedad, contribuyen enormemente con la población del Perú, logrando en la actualidad un 87,3% de total aplicación de los esquemas de vacunación indicados por las autoridades sanitarias en sus pobladores, aunque ello conlleva a largas jornadas de trabajo, sin límites de horas, pero imprimiéndole altos niveles de energía, así como deseo de invertir esfuerzos en el desarrollo de la labor con una amplia resistencia mental, gran implicación al compromiso laboral y sentido de significación ante la acción realizada, lo que finalmente genera en el individuo un estado positivo en los aspectos emocional, cognitivo, afectivo, social e integral del trabajador del sistema peruano de salud(AU)

The research was focused on the study of the emerging expressions of engagement in the Peruvian COVID-19 vaccination program. It is descriptive, cross-sectional and with a combination of quantitative and qualitative aspects, in its vigor, dedication and absorption dimensions, measured through an adaptation of the Utrecht Work Engagement Scale questionnaire, validated by experts and with a very high reliability (0.903), carried out between the months of February to May 2021, in Huancayo and Lima towns. The emerging expressions are born from the knowledge acquired from the actions carried out and the motivational factors that led to the development of actions that go beyond what the ministry could have requested of its workers, who despite constantly putting their health and safety at risk life, for being the first line of containment in defense of the disease, contribute enormously to the population of Peru, currently achieving 87.3% of total application of the vaccination schemes indicated by the health authorities in its inhabitants, although this leads to long working hours, with no limits on hours, but imprinting high levels of energy, as well as the desire to invest efforts in the development of the work with a broad mental resistance, great involvement in work commitment and a sense of significance in the face of action carried out, which finally generates in the individual a positive state in the emotional, cognitive, affective, social and integral of the worker of the peruvian health system(AU)

Hormônios estrogênicos em matrizes aquáticas: revisão sistemática de literatura / Estrogen hormones in aquatic matrices: a systematic review of the literature

Os disruptores endócrinos apresentam riscos à saúde humana e ambiental mesmo em concentrações a níveis de traços. Os hormônios femininos naturais, estradiol, estriol e estrona, e o sintético etinilestradiol, fazem parte desse grupo de agentes. Nesse contexto, o presente trabalho teve como objetivo realizar uma revisão sistemática da literatura sobre estudos produzidos com o intuito de detectar e quantificar a presença dessas substâncias em matrizes aquáticas. Para tanto, foi realizada uma busca sistemática de evidências científicas em três bases de dados: Scopus, Web of Science e Biblioteca Virtual em Saúde (BVS). A busca foi realizada no período de janeiro de 2015 a janeiro de 2021, utilizando a string "(estrone OR estriol OR estradiol OR ethinylestradiol) AND (wastewater OR sewage OR river OR surface water OR drinking water OR potable water) AND (LC-MS/MS OR GC-MS/MS OR UPLC OR HPLC)". A busca resultou em 380 estudos, sendo: 61 da Scopus, 124 da Web of Science e 195 da BVS. Após a aplicação dos testes de relevância, 91 estudos foram definitivamente selecionados para extração de dados. A maioria dos artigos se dedicou à busca de estrogênios em águas superficiais, provavelmente pela importância dessa matriz. Os países asiáticos, como China e Índia, foram os que apresentaram as maiores concentrações de estrogênios naturais (E1, E2 e E3), em água potável. Altas concentrações de E1, E2 e EE2 foram verificadas em águas residuais do Brasil, Espanha e Irã; além de E1, E2 e E3 em águas superficiais da China e da África do Sul, mais precisamente da Cidade do Cabo. Nos últimos anos, os países desenvolvidos e em desenvolvimento foram os que mais investiram em pesquisas voltadas ao monitoramento dos efeitos desses contaminantes, principalmente no corpo humano. Porém, apenas a União Europeia e os Estados Unidos possuem regulamentação e estudos aprofundados com o propósito de se determinar os limites máximos aceitáveis para esses contaminantes na água. Disso, nota-se a necessidade de adoção de tecnologias de tratamento de efluentes capazes de eliminar os disruptores endócrinos e que sejam economicamente acessíveis para países em desenvolvimento e subdesenvolvidos. O que se propõe é o aprimoramento de uma medida preventiva, cuja implementação, além de promover melhoria na qualidade de vida da população - que é o que mais importa - e do meio ambiente, permita a economia de recursos públicos por minimizar a incidência de diversas doenças como cânceres, obesidade, entre outras

Endocrine disruptors pose risks to human and environmental health even at low concentrations. The natural female hormones, estradiol, estriol and estrone, and the synthetic ethinylestradiol, are part of this group of agents. In this context, the present work aimed to carry out a systematic review of the literature on studies produced with the aim of detecting and quantifying the presence of these substances in aquatic matrices. Therefore, a systematic search for scientific evidence was carried out in three databases: Scopus, Web of Science and Biblioteca Virtual em Saúde (BVS). The search was carried out from January 2015 to January 2021, using the string "(estrone OR estriol OR estradiol OR ethinylestradiol) AND (wastewater OR sewage OR river OR surface water OR drinking water OR potable water) AND (LC-MS/MS OR GC-MS/MS OR UPLC OR HPLC)". The search resulted in 380 studies, being: 61 from Scopus, 124 from Web of Science and 195 from BVS. After applying the relevance tests, 91 studies were definitively selected for data extraction. Most articles were dedicated to the search for estrogens in surface water, probably due to the importance of this matrix. Asian countries, such as China and India, were the ones with the highest concentrations of natural estrogens (E1, E2 and E3) in drinking water. High concentrations of E1, E2 and EE2 were found in wastewater from Brazil, Spain and Iran; in addition to E1, E2 and E3 in surface waters in China and South Africa, more precisely in Cape Town. In recent years, developed and developing countries have invested the most in research aimed at monitoring the effects of these contaminants, mainly on the human body. However, only the European Union and the United States have regulations and in-depth studies aimed at determining the maximum acceptable limits for these contaminants in water. From this, there is a need to adopt effluent treatment technologies capable of eliminating endocrine disruptors and that are affordable for developing and underdeveloped countries. What is proposed is the improvement of a preventive measure, whose implementation, in addition to promoting an improvement in the quality of life of the population - which is what matters most - and of the environment, allows the economy of public resources by minimizing the incidence of various diseases such as cancer, obesity, among others

Morphological alterations in human skeletal muscle cells exposed to di-(2-Ethylhexyl) Phthalate (dehp) in primary cell culture conditions / Alteraciones morfológicas en células musculares esqueléticas humanas expuestas a Ftalato de di-(2-etilhexilo) (dehp) en condiciones de cultivo celular primario

SUMMARY: Di-(2-ethylhexyl) phthalate (DEHP) is among the most common plasticizer additives that humans are in contact with daily. DEHP can be released from plastic and enter the human body, whereby it is metabolized and transformed into oxidative hydrophilic molecules. Clinical follow-ups in patients exposed to this phthalate and investigations in cultures of several cell types have provided information on its effects. For example, it is associated with inhibition of diploid human cell development and morphological changes in cultured germ cells. Although skeletal muscle represents around 50 % of the human body mass, knowledge about the effects of DEHP on this tissue is poor. Cultured skeletal muscle cells were exposed to DEHP (1 mM) for 13 days with the aim of exploring and evaluating some of the potential morphological effects. Three culture development parameters and nine cell characteristics were monitored during the bioassay. At 13 days, growth area, cell viability, and concentration of total proteins were lower in DEHP exposed than in control cells. Cell width and area, as well as the diameter of the nucleus and nucleolus, were greater in exposed cells than in control cells. These are interpreted as signs of cytotoxicity and suggest potential adverse effects on the development of skeletal muscle cells from DEHP exposure, as reported for other cell types.

RESUMEN: Diariamente los seres humanos tenemos contacto con aditivos plastificantes, el di-(2-etilhexil) ftalato (DEHP) se encuentra entre los más comunes. El DEHP puede liberarse del plástico e ingresar al cuerpo humano, donde es metabolizado y transformando en moléculas hidrofílicas oxidativas. Seguimientos en pacientes expuestos a este ftalato e investigaciones en cultivos de varios tipos celulares han aportado información sobre sus efectos. El DEHP es asociado con la inhibición del desarrollo de células humanas diploides y cambios morfológicos en células germinales en cultivo. Sin embargo, aún es poco lo que se sabe sobre los efectos en el músculo esquelético, a pesar de que este tejido representa alrededor del 50 % de la masa corporal del humano. Para explorar y evaluar algunos efectos morfológicos en células de músculo esquelético, cultivos primarios fueron expuestos a DEHP (1 mM) durante 13 días. Se dio seguimiento a tres parámetros de desarrollo del cultivo y nueve características celulares. Al término de 13 días de exposición, los valores del área de crecimiento, viabilidad celular y concentración de proteínas totales fueron inferiores con respecto a los cultivos control. Se observaron cambios morfométricos en las células expuestas. Particularmente, el ancho y área celular, así como los diámetros del núcleo y nucleolos, fueron mayores a los registros en las células control. Estos resultados se interpretan como signos de citotoxicidad y sugieren efectos potencialmente adversos en el desarrollo de las células del músculo esquelético ante una exposición al DEHP, como se ha registrado para otros tipos celulares.

Retos actuales a la enseñanza de la virología para enfrentar enfermedades emergentes / Current challenges to the teaching of virology to face emerging diseases

En los últimos años los microorganismos han generado múltiples evoluciones, provocando enfermedades y problemas agudos de salud pública. Para poder controlar las virosis es necesario conocer su biología y epidemiología, establecer tratamiento y profilaxis adecuada para su control. Para ello, es indispensable comenzar con la formación de los profesionales de la salud, en particular, los estudiantes de medicina, es necesario potenciar el desarrollo de sus habilidades y competencias, no solo dominio del conocimiento científico, si no también pueda promoverlo, transferirlo y aplicarlo con impacto en la salud colectiva y que vaya a la par de los avances tecno-científicos. Es por ello, que surge la inquietud del fórum, discusión acerca del análisis de la enseñanza de la virología para enfrentar enfermedades emergentes en función de perfil del egresado. Se realizó encuesta a los estudiantes de los últimos diez años de la carrera de medicina de UNIANDES, sobre la biología, epidemiologia, respuesta inmunológica y diagnóstico, para mencionadas áreas de conocimiento se obtuvo, tanto en la evaluación objetiva estructurada y evaluación práctica, un nivel altamente satisfactorio. En la pirámide de Miller, se alcanzó nivel tres con conocimiento y desarrollo de habilidades, destrezas y actitudes del egresado satisfactorias. Sin embargo, los profesores de Virología están de acuerdo con innovar en la docencia integrando los contenidos transversalmente a las áreas de conocimiento: enfermedades infecciosas, clínicas, patologías, epidemiología y salud pública, lo que permitirá un aprendizaje integral para realizar abordaje adecuado de caso positivos de las virosis, además de tener capacidades para establecer vigilancia epidemiológica(AU)

In recent years, microorganisms have generated multiple evolutions, causing diseases and acute public health problems. In order to control virosis, it is necessary to know their biology and epidemiology, establish adequate treatment and prophylaxis for their control. For this, it is essential to start with the training of health professionals, in particular, medical students, it is necessary to promote the development of their skills and competencies, not only mastery of scientific knowledge, but also be able to promote it, transfer it and apply it with an impact on collective health and that goes hand in hand with techno-scientific advances. That is why the concern of the forum arises, a discussion about the analysis of the teaching of virology to face emerging diseases based on the profile of the graduate. A survey was conducted to the students of the last ten years of the UNIANDES medical career, on biology, epidemiology, immunological response and diagnosis, for mentioned areas of knowledge it was obtained, both in the objective structured evaluation and practical evaluation, a level highly satisfactory. In the Miller pyramid, level three was reached with satisfactory knowledge and development of abilities, skills and attitudes of the graduate. However, Virology professors agree with innovating in teaching by integrating the content transversally to the areas of knowledge: infectious diseases, clinics, pathologies, epidemiology and public health, which will allow comprehensive learning to carry out an adequate approach to positive cases of virosis, in addition to having the capacity to establish epidemiological surveillance(AU)

Anisakis and anisakidosis: hosts and case reports in South America. Systematic review / Anisákidos y anisakidosis: reportes de caso y hospedadores en América del Sur. Revisión sistemática

Abstract Introduction: Anisakidosis is a disease caused by the consumption of raw or undercooked seafood parasitized by nematode larvae of the family Anisakidae. Even though it is a public health issue in Europe and Asia, it is relatively unknown in South America. Objective: To present case reports on anisakidosis and the intermediate hosts of Anisakis reported in South America. Materials and methods: A systematic review was conducted in Medline, Cochrane, Embase, LILACS and Scopus using a structured search of MeSH and DeCS descriptors. The search strategy included publication period: inception of each database-September 2018; languages: English, Spanish, and Portuguese; and study types: case reports and observational cross-sectional studies. The review was complemented with an unstructured search in SciELO and Google Scholar. Results: The initial search yielded 172 articles. After removing duplicates and reviewing the inclusion criteria, 69 studies were selected for full analysis: 19 case reports and 50 host records. The most reported form of anisakidosis was gastrointestinal anisakidosis with 45 cases; this infectious disease was caused by a single larva in 41 people (91.1%). Reports of 95 species of fish for human consumption parasitized by larvae of the genera Anisakis, Contracaecum, Pseudoterranova and Hysterothylacium were identified in Argentina (22 fish species), Brazil (34 species), Chile (15 species), Colombia (17 species), Ecuador (8 species), Peru (7 species), Uruguay and Venezuela (2 species each). Conclusion: Anisakidosis is a latent risk in South America, so it is necessary to establish effective regulations for efficiently controlling the appearance of this parasitic disease in the region. Furthermore, the general population should receive more information about the precautions regarding saltwater fish consumption.

Resumen Introducción. La anisakidosis es una parasitosis ocasionada por el consumo de pescado de mar crudo o semicrudo parasitado por larvas de nematodos de la familia Anisakidae. En Europa y Asia es un problema de salud pública; sin embargo, en América del Sur es poco conocida. Objetivo. Identificar los reportes de caso de anisakidosis y los hospedadores intermediarios de anisákidos reportados en América del Sur. Materiales y métodos. Se realizó una revisión sistemática en Medline, Cochrane, Embase, LILACS y Scopus mediante la búsqueda estructurada de términos MeSH y DeCS. Estrategia de búsqueda: periodo de publicación: inicio de cada base de datos-septiembre de 2018; idiomas: inglés, español y portugués; tipos de estudio: reportes de caso y estudios transversales observacionales. La revisión fue complementada con una búsqueda no estructurada en SciELO y Google Scholar. Resultados. La búsqueda inicial arrojó 172 artículos. Una vez removidos los duplicados y revisados los criterios de inclusión, se seleccionaron 69 estudios para análisis completo: 19 reportes de caso y 50 registros de hospedadores. La forma de anisakidosis más reportada fue la gastrointestinal, con 45 casos, donde la parasitosis fue causada por una larva única en 41 casos (91.1%). Se identificaron reportes de 95 especies de peces para consumo humano parasitadas por los géneros Anisakis, Contracaecum, Pseudoterranova e Hysterothylacium en los siguientes países: Argentina (22 especies), Brasil (34 especies), Chile (15 especies), Colombia (17 especies), Ecuador (8 especies), Perú (7 especies), Venezuela (4 especies) y Uruguay (2 especies). Conclusión. La anisakidosis es un riesgo latente para América del Sur, por lo que es necesario instaurar normativas efectivas para controlar su aparición en la región y brindar más información a la población general sobre las precauciones necesarias en relación con el consumo de pescado de agua salada.

Classification of the patterns of the emerging branches of the superficial cervical plexus / Clasificación de los patrones de las ramas emergentes del plexo cervical superficial

SUMMARY: The cutaneous branches of the superficial cervical plexus (SCP) emerge at variable points, from beneath the posterior margin of the sternocleidomastoid muscle and from this point radiate like "spokes of a wheel" antero-inferiorly and postero-superiorly. This study aimed to classify the emerging points of the branches of the superficial cervical plexus in relation to their location on the sternocleidomastoid muscle. In order to classify the emerging points of the superficial cervical plexus, the sternocleidomastoid muscle was first measured from mastoid process to clavicle; subsequently each branch of the superficial cervical plexus was measured from the mastoid process to their exit points. The emerging points of the superficial cervical plexus branches were classified according to Kim et al. (2002) seven categories: Type I (32 %); Type II (13 %); Type III (35 %); Type IV (13 %); Type V, VI, VII (2 %). The order in which the superficial cervical plexus branches emerged from the posterior margin of the sternocleidomastoid muscle remained constant, i.e. lesser occipital, great auricular, transverse cervical and supraclavicular nerves. Knowledge of emerging points may assist in the effective anaesthesia to all branches of the superficial cervical plexus during surgical procedures of the neck, viz. carotid endarterectomy and thyroid surgery.

RESUMEN: Las ramas cutáneas del plexo cervical superficial (SCP) emergen en puntos variables, desde el margen pos- terior del músculo esternocleidomastoideo y desde este punto inferior irradian como "radios de rueda" anteroinferior y postero-superior. Este estudio tuvo como objetivo clasificar los puntos emergentes de las ramas del plexo cervical superficial en relación a su ubicación en el músculo esternocleidomastoideo. Para clasificar los puntos emergentes del plexo cervical superficial, primero se midió el músculo esternocleidomastoideo desde el proceso mastoides hasta la clavícula; posteriormente se midió cada rama del plexo cervical superficial desde el proceso mastoideo hasta sus puntos de salida. Los puntos emergentes de las ramas del plexo cervical superficial se clasificaron según Kim et al. (2002) en siete categorías: Tipo I (32 %); Tipo II (13 %); Tipo III (35 %); Tipo IV (13 %); Tipo V, VI, VII (2 %). El orden en el que las ramas del plexo cervical superficial emergían del margen posterior del músculo esternocleidomastoideo se mantuvo constante, es decir, los nervios occipital menor, auricular magno, cervical transverso y supraclavicular. El conocimiento de los puntos emergentes puede ayudar a la anestesia eficaz de todas las ramas del plexo cervical superficial durante los procedimientos quirúrgicos del cuello, a saber, endarterectomía carotídea y cirugía de tiroides.

Descriptive study of the initial cases of Covid-19 in a city in the interior of Ceará, Brazil / Estudio descriptivo de los casos iniciales de Covid-19 en una ciudad del interior de Ceará, Brasil

Objective: to describe the sociodemographic, epidemiological and clinical characteristics of the initial cases of Covid-19 in the municipality of Sobral, Ceará, Brazil. Materials and methods: descriptive, temporal and quantitative epidemiological study, developed in the municipality of Sobral - Ceará, Brazil, with 110 confirmed cases of Covid-19. Descriptive and analytical analysis was performed, using the Chi-square test and Logistic Regression to verify the association between variables. The level of significance was set at 95% (p≤0.05). Results: it was observed that 60% of cases occurred in women, 74.5% were adults between 20 and 59 years old, 15.5% health workers and the lethality rate was 1.8%. In 58.2% of cases the main reporting unit was the hospital, 10% required hospitalization, and 64.5% were diagnosed with rapid tes. The main symptoms manifested were: cough (58.2%), fever (57.3%), sore throat (36.4%) and difficulty breathing (31.9%). There was an association between age and the presence of fever, cough and sore throat (p=0.05). Conclusion: the results suggest that older people are more susceptible to some symptoms when compared to younger people. Associated with global estimates, this work can provide subsidies for Covid-19 prevention and control actions in small and medium-sized Brazilian municipalities..(Au)

Objectivo: describir las características sociodemográficas, epidemiológicas y clínicas de los casos iniciales de Covid-19 en el municipio de Sobral, Ceará, Brasil. Materiales y métodos: estudio epidemiológico descriptivo, temporal y cuantitativo, desarrollado en el municipio de Sobral - Ceará, Brasil, con 110 casos confirmados de Covid -19. Se realizó análisis descriptivo y analítico, utilizando la prueba de chi-cuadrado y regresión logística para verificar la asociación entre variables. El nivel de significancia se estableció en 95% (p≤0.05). Resultados: se observó que el 60,0% de los casos ocurrieron en mujeres, el 74,5% eran adultos entre 20 y 59 años, el 15,5% trabajadores de la salud y la tasa de letalidad fue del 1,8%. En el 58,2% de los casos la principal unidad de notificación fue el hospital, el 10% requirió hospitalización y el 64,5% fueron diagnosticados con pruebas rápidas. Los principales síntomas manifestados fueron: tos (58,2%), fiebre (57,3%), dolor de garganta (36,4%) y dificultad para respirar (31,9%). Hubo asociación entre la edad y la presencia de fiebre, tos y dolor de garganta (p=0,05). Conclusión: los resultados sugieren que las personas mayores son más susceptibles a algunos síntomas en comparación con las personas más jóvenes. Asociado a estimaciones globales, este trabajo puede proporcionar subsidios para acciones de prevención y control de Covid-19 en municipios brasileños pequeños y medianos..(Au)

Uso da cafeína como indicador de poluição por esgoto doméstico em corpos d'água urbanos / Use of caffeine as an indicator of pollution by domestic sewage in urban water bodies

RESUMO Nos centros populacionais, os ambientes aquáticos estão em constante degradação em consequência das atividades desenvolvidas nas bacias de drenagem, sendo o despejo de esgoto doméstico uma das maiores fontes de poluição. Monitoramentos ambientais de qualidade da água refletem os poluentes gerados nas áreas de influência e dão indícios das prováveis origens. Todavia, são as substâncias de uso exclusivamente antrópico que podem comprovar a existência do lançamento de tais cargas poluidoras. Nesse contexto, o presente trabalho teve como objetivo avaliar a eficiência da cafeína como indicador de poluição por esgoto doméstico. O método analítico utilizado para a sua identificação foi a cromatografia líquida de alta eficiência. Com o intuito de relacionar os resultados obtidos para a cafeína com a diluição e as fontes difusas de poluição, foram aferidos, ainda, dados de precipitação, oxigênio dissolvido e demanda bioquímica de oxigênio. A cafeína foi encontrada em todas as amostras analisadas, com concentrações variando de 0,01 a 7,80 mg.L−1. Os maiores valores foram observados no período chuvoso, relacionados ao transbordamento e ao vazamento de esgoto doméstico. Este estudo inferiu a utilização da cafeína como eficiente indicador de poluição por esgoto doméstico.

ABSTRACT In population centers, aquatic environments are in constant degradation due to the activities carried out in watersheds, with the release of domestic sewage being one of the biggest sources of pollution. Environmental monitoring of water quality reflects the inputs generated in the areas of influence and gives evidence of likely origins. However, it is the substances for exclusively anthropic use that can prove the existence of the release of such polluting loads. In this context, the present study aimed to evaluate the efficiency of caffeine as an indicator of pollution by domestic sewage. The analytical method used for its identification was high-performance liquid chromatography (HPLC). In order to relate the results obtained for caffeine with the dilution and nonpoint sources pollution, data on precipitation, dissolved oxygen, and biochemical oxygen demand were also measured. Caffeine was found in all samples analyzed, with concentrations ranging from 0.01 to 7.80 mg.L−1. The highest values were observed in the rainy season, related to the overflow and leakage of domestic sewage. This study infered the use of caffeine as an efficient indicator of pollution by domestic sewage.

El desafío de las enfermedades (re)emergentes, los límites de la respuesta biomédica y el nuevo paradigma de salud global / The challenge of (re)emerging diseases, the limits of the biomedical response and the new paradigm of global health

Resumen Las "enfermedades infecciosas emergentes y reemergentes" constituyen una creciente amenaza para la hegemonía de la biomedicina, al suscitar no pocos interrogantes sobre la idoneidad de su discurso y prácticas para afrontar el desafío global que representan. Se analiza el proceso de construcción de esta nueva categoría nosológica, y se examinan ejemplos destacados del impacto de las enfermedades (re)emergentes en la salud pública, la seguridad alimentaria y el desarrollo humano a escala global. Se refiere a prácticas irresponsables de sectores de la industria farmacéutica y agropecuaria, determinantes en su desencadenamiento y diseminación; y a algunos fallos cruciales de enfoque y manejo de los tiempos en las políticas de salud global en relación al VIH/sida con desastrosas consecuencias para el África subsahariana.

Abstract "Emerging and reemerging infectious diseases" pose a growing threat to the hegemony of biomedicine, raising questions about whether its discourse and practices can handle the global challenge they represent. The construction of this new nosological category is analyzed in this article, which examines some notable examples of the impact of (re)emerging diseases on public health, food security and human development on a global scale. It discusses irresponsible practices by sectors of the pharmaceutical and agricultural industries which led to the emergence and spread of these diseases; and points to some crucial failures of approach and time management in global health policies on HIV/AIDS, with disastrous consequences for sub-Saharan Africa.

Historia y futuro de las pandemias / History and future of pandemics

Este artículo presenta una historia general de las epidemias históricas y de las nuevas enfermedades emergentes, señalando sus factores desencadenantes. Se afirma que las epidemias son inevitables, y que su riesgo aumenta en proporción al tamaño, la complejidad y el poder tecnológico de nuestras sociedades. La historia enseña que las epidemias han sido casi siempre desencadenadas por cambios en el ambiente ocasionados por las propias actividades humanas. Las enfermedades infecciosas son manifestación de una interacción ecológica entre la especie humana y otra especie de microorganismos. Y las epidemias son resultado del cambio en algún factor ambiental capaz de influir en esa interacción. Las catástrofes epidémicas son inevitables: en primer lugar, porque no podemos evitar formar parte de cadenas tróficas en las que comemos y somos comidos por los microbios; en segundo lugar, porque las infecciones son mecanismos evolutivos y factores reguladores del equilibrio ecológico, que regulan sobre todo el tamaño de las poblaciones; y, en tercer lugar, porque las intervenciones técnicas humanas, al modificar los equilibrios previos, crean equilibrios nuevos que son más vulnerables. De este modo las sociedades humanas son más vulnerables cuanto más complejas. Y los éxitos humanos en la modificación de condiciones ambientales conservan, o más bien aumentan, el riesgo de catástrofes epidémicas. Todas las necesarias medidas de vigilancia y control epidemiológico imaginables pueden disminuir los daños que producen las epidemias, pero nunca podrán evitarlas.

This article presents a general history of historical epidemics, and new emerging diseases, pointing out their triggers. It is claimed that epidemics are inevitable, and that their risk increases in proportion to the size, complexity, and technological power of our societies. History teaches that epidemics have almost always been triggered by changes in the environment caused by human activities themselves. Infectious diseases are manifestations of an ecological interaction between the human species and another species of microorganisms. And epidemics are the result of a change in some environmental factor capable of influencing that interaction. Epidemic catastrophes are inevitable: firstly, because we cannot help but be part of trophic chains in which we eat and are eaten by microbes; secondly, because infections are evolutionary mechanisms and regulatory factors of ecological balance, which regulate especially the size of populations; and thirdly, because human technical interventions, in changing previous balances, create new balances that are more vulnerable. In this way human societies are more vulnerable the more complex. And human successes in modifying environmental conditions retain, or rather increase, the risk of epidemic catastrophes. All necessary epidemiological surveillance and control measures imaginable can lessen the damage caused by epidemics, but they can never prevent them.