Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Desafios e perspectivas na judicialização da saúde na América Latina: considerações sobre o fenômeno no Brasil e na Colômbia / Challenges and perspectives in health judicialization: considerations on the Phenomenon in Brazil and Colombia / Desafíos y perspectivas en la judicialización en salud: consideraciones sobre el Fenómeno en Brasil y Colombia

Objetivo: O presente estudo visa a compreender como a judicialização da saúde se desenvolve como um fenômeno global, com ênfase particular nos contextos da América Latina, considerando Brasil e Colômbia. Metodologia: Adotou-se uma metodologia de revisão de literatura apoiada pela ferramenta Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa foi conduzida com descritores específicos e as estratégias de busca foram realizadas nas bases de dados PubMed, MEDLINE, Lilacs, SciELO, CRD, CDSR, BVS e BIREME. Foram selecionados artigos publicados entre 2010 e 2024 que discutem a judicialização da saúde, considerando os idiomas português, espanhol ou inglês. Resultados: A busca resultou em 455 artigos e, destes, 18 artigos atenderam aos critérios de inclusão. A análise dos artigos selecionados revela a necessidade de soluções equilibradas que respeitem os direitos individuais sem comprometer a acessibilidade e qualidade dos cuidados de saúde coletivos. São destacados os desafios impostos pela judicialização, como questões de equidade, sustentabilidade financeira dos sistemas de saúde e priorização de recursos. Conclusão: Conclui-se pela importância de uma abordagem multidisciplinar envolvendo ajustes legislativos, melhorias na gestão dos sistemas de saúde, educação para a saúde e a promoção de políticas públicas equitativas.

Objective: The present study aims to understand how the judicialization of health develops as a global phenomenon, with particular emphasis on Latin American contexts, considering Brazil, and Colombia. Methodology: A literature review methodology supported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool was adopted. The research was conducted using specific descriptors, and search strategies were carried out in the PubMed, MEDLINE, Lilacs, SciELO, CRD, CDSR, BVS, and BIREME databases. Articles published between 2010 and 2024 that discuss the judicialization of health, considering Portuguese, Spanish, or English languages, were selected. Results: The search resulted in 455 articles, of which 18 met the inclusion criteria. The analysis of the selected articles reveals the need for balanced solutions that respect individual rights without compromising the accessibility and quality of collective healthcare. The challenges imposed by judicialization are highlighted, such as issues of equity, financial sustainability of health systems, and resource prioritization. Conclusion: It concludes by emphasizing the importance of a multidisciplinary approach involving legislative adjustments, improvements in health system management, health education, and the promotion of equitable public policies.

Objetivo: El presente estudio tiene como objetivo comprender cómo se desarrolla la judicialización de la salud como un fenómeno global, con un énfasis particular en los contextos de América Latina, considerando Brasil y Colombia. Metodología: Se adoptó una metodología de revisión de literatura respaldada por la herramienta Preferred Reporting Items for Systematic Reviews and Meta-Analyses. La investigación se realizó utilizando descriptores específicos y las estrategias de búsqueda se llevaron a cabo en las bases de datos PubMed, MEDLINE, Lilacs, SciELO, CRD, CDSR, BVS y BIREME. Se seleccionaron artículos publicados entre 2010 y 2024 que discuten la judicialización de la salud, considerando los idiomas portugués, español o inglés. Resultados: La búsqueda resultó en 455 artículos, de los cuales 18 cumplieron con los criterios de inclusión. El análisis de los artículos seleccionados revela la necesidad de soluciones equilibradas que respeten los derechos individuales sin comprometer la accesibilidad y la calidad de la atención sanitaria colectiva. Se destacan los desafíos impuestos por la judicialización, como cuestiones de equidad, sostenibilidad financiera de los sistemas de salud y priorización de recursos. Conclusión: Se concluye sobre la importancia de un enfoque multidisciplinario que involucre ajustes legislativos, mejoras en la gestión de los sistemas de salud, educación para la salud y la promoción de políticas públicas equitativas.

Optimization of petroleum products distribution via pipeline systems: Modeling and computational challenges.

Optimizing the distribution of refined oil products using pipeline systems has been posing a meaningful challenge to the operations research field of exceptional economic importance for the oil and gas industry. The solution of this problem stands on the interface of chemical engineering and operations research, the former has been the most important contributor, and the latter has been paying an increasing amount of attention to its solution over the last ten years or so. The goal of this work is fourfold: to unveil the current shape of the accomplished research work on this topical area according to its descriptive analytics, to present and discuss its modeling research perspectives, to outline its emerging research trends and to trigger discussions on its future research avenues. A future research agenda should study more realistic mathematical models for the system and solution procedures that exploit their algebraic structure.

Microplastics pollution in tropical lakes: water, zooplankton, and fish in Central Mexico.

The presence of microplastics in freshwater systems can have harmful effects on the food chain. Zooplankton, especially suspension and filter feeders, can ingest microplastics, which can cause adverse effects and transfer them to higher trophic levels. Here, we analyze the presence, abundance, and distribution of microplastics in surface water, zooplankton, and fish in two tropical lakes in central Mexico. We collected water samples in triplicate at three sites in each lake and 120 fish of the genus Chirostoma. From each water sample, 300 rotifers and 150 microcrustaceans were randomly isolated and processed independently. Of the particles found in the water, zooplankton, and fish from both lakes, the fragments were the predominant ones. The total abundance of microplastics in the water column of both lakes varied between 1.2 and 17.0 items L-1. In zooplankton, fragments were found predominantly with up to 0.1 items ind-1, while in fish, up to 4.5 items ind-1 was recorded. Our results confirm the presence of microplastics in different compartments of the food webs of freshwater bodies, water column, zooplankton, and fish. Further work is required on the possible effects of these stressors at the different trophic levels.

Performance of ChatGPT in Solving Questions From the Progress Test (Brazilian National Medical Exam): A Potential Artificial Intelligence Tool in Medical Practice.

Background The use of artificial intelligence (AI) is not a recent phenomenon, but the latest advancements in this technology are making a significant impact across various fields of human knowledge. In medicine, this trend is no different, although it has developed at a slower pace. ChatGPT is an example of an AI-based algorithm capable of answering questions, interpreting phrases, and synthesizing complex information, potentially aiding and even replacing humans in various areas of social interest. Some studies have compared its performance in solving medical knowledge exams with medical students and professionals to verify AI accuracy. This study aimed to measure the performance of ChatGPT in answering questions from the Progress Test from 2021 to 2023. Methodology An observational study was conducted in which questions from the 2021 Progress Test and the regional tests (Southern Institutional Pedagogical Support Center II) of 2022 and 2023 were presented to ChatGPT 3.5. The results obtained were compared with the scores of first- to sixth-year medical students from over 120 Brazilian universities. All questions were presented sequentially, without any modification to their structure. After each question was presented, the platform's history was cleared, and the site was restarted. Results The platform achieved an average accuracy rate in 2021, 2022, and 2023 of 69.7%, 68.3%, and 67.2%, respectively, surpassing students from all medical years in the three tests evaluated, reinforcing findings in the current literature. The subject with the best score for the AI was Public Health, with a mean grade of 77.8%. Conclusions ChatGPT demonstrated the ability to answer medical questions with higher accuracy than humans, including students from the last year of medical school.

New Horizons in Antiretroviral Drug Delivery Systems for HIV Management

INTRODUCTION: Human Immunodeficiency Virus (HIV) infection is still a major global problem, whose drug treatment consists of prophylactic prevention and antiretroviral combination therapy for better pharmacological efficacy and control of the circulating virus. However, there are still pharmacological problems that need to be overcome, such as low aqueous solubility of drugs, toxicity, and low patient adherence. Drug delivery technologies can be used to overcome these barriers. OBJECTIVE: This review summarized the latest drug delivery systems for HIV treatment. Initially, an overview of the current therapy was presented, along with the problems it presents. Then, the latest drug delivery systems used to overcome the challenges imposed in conventional HIV therapy were discussed. CONCLUSION: This review examines innovative approaches for HIV treatment, where various drug delivery systems have shown significant advantages, such as high drug encapsulation, improved solubility, and enhanced bioavailability both in vitro and in vivo. Strategies like cyclodextrins, solid dispersions, microneedles, and nanoparticles are explored to address challenges in drug solubility, bioavailability, and administration routes. Despite progress, obstacles like limited clinical trials and industrial scalability hinder the widespread adoption of these formulations, emphasizing the need for further research and collaboration to optimize and ensure accessibility of innovative HIV therapies, mainly in regions where access to HIV treatment is scarce and remains a challenge.

Development of Automated Triggers in Ambulatory Settings in Brazil: Protocol for a Machine Learning-Based Design Thinking Study.

BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.

Relevance of farm-scale indicators and tools for farmers to assess sustainability of their mixed crop-ruminant livestock systems.

Ensuring the sustainability and circularity of mixed crop-ruminant livestock systems is essential if they are to deliver on the enhancement of long-term productivity and profitability with a smaller footprint. The objectives of this study were to select indicators in the environmental, economic and social dimensions of sustainability of crop-livestock systems, to assess if these indicators are relevant in the operational schedule of farmers, and to score the indicators in these farm systems. The scoring system was based on relevance to farmers, data availability, frequency of use, and policy. The study was successful in the assemblage of a suite of indicators comprising three dimensions of sustainability and the development of criteria to assess the usefulness of these indicators in crop-ruminant livestock systems in distinct agro-climatic regions across the globe. Except for ammonia emissions, indicators within the Emissions to air theme obtained high scores, as expected from mixed crop-ruminant systems in countries transitioning towards low emission production systems. Despite the inherent association between nutrient losses and water quality, the sum of scores was numerically greater for the former, attributed to a mix of economic and policy incentives. The sum of indicator scores within the Profitability theme (farm net income, expenditure and revenue) received the highest scores in the economic dimension. The Workforce theme (diversity, education, succession) stood out within the social dimension, reflecting the need for an engaged labor force that requires knowledge and skills in both crop and livestock husbandry. The development of surveys with farmers/stakeholders to assess the relevance of farm-scale indicators and tools is important to support direct actions and policies in support of sustainable mixed crop-ruminant livestock farm systems.

The Chilean exposome-based system for ecosystems (CHiESS): a framework for national data integration and analytics platform.

The double burden of diseases and scarce resources in developing countries highlight the need to change the conceptualization of health problems and translational research. Contrary to the traditional paradigm focused on genetics, the exposome paradigm proposed in 2005 that complements the genome is an innovative theory. It involves a holistic approach to understanding the complexity of the interactions between the human being's environment throughout their life and health. This paper outlines a scalable framework for exposome research, integrating diverse data sources for comprehensive public health surveillance and policy support. The Chilean exposome-based system for ecosystems (CHiESS) project proposes a conceptual model based on the ecological and One Health approaches, and the development of a technological dynamic platform for exposome research, which leverages available administrative data routinely collected by national agencies, in clinical records, and by biobanks. CHiESS considers a multilevel exposure for exposome operationalization, including the ecosystem, community, population, and individual levels. CHiESS will include four consecutive stages for development into an informatic platform: (1) environmental data integration and harmonization system, (2) clinical and omics data integration, (3) advanced analytical algorithm development, and (4) visualization interface development and targeted population-based cohort recruitment. The CHiESS platform aims to integrate and harmonize available secondary administrative data and provide a complete geospatial mapping of the external exposome. Additionally, it aims to analyze complex interactions between environmental stressors of the ecosystem and molecular processes of the human being and their effect on human health. Moreover, by identifying exposome-based hotspots, CHiESS allows the targeted and efficient recruitment of population-based cohorts for translational research and impact evaluation. Utilizing advanced technologies such as Artificial Intelligence (AI), Internet of Things (IoT), and blockchain, this framework enhances data security, real-time monitoring, and predictive analytics. The CHiESS model is adaptable for international use, promoting global health collaboration and supporting sustainable development goals.

Epitaxial growth in one dimension.

The final structure and properties of layers grown by epitaxy techniques are determined in the very early stage of the process. This review describes one-dimensional models for epitaxial growth, emphasizing the basic theoretical concepts employed to analyze nucleation and aggregation phenomena in the submonolayer regime. The main findings regarding the evolution of quantities that define the properties of the system, such as monomer and island densities, and the associated island size, gap length, and capture zone distributions are discussed, as well as the analytical tools used to evaluate them. This review provides a concise overview of the most widely used algorithms for simulating growth processes, discusses relevant experimental results, and establishes connections with existing theoretical studies.

Omics-derived biological modules reflect metabolic brain changes in Alzheimer's disease.

INTRODUCTION: Brain glucose hypometabolism, indexed by the fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) imaging, is a metabolic signature of Alzheimer's disease (AD). However, the underlying biological pathways involved in these metabolic changes remain elusive. METHODS: Here, we integrated [18F]FDG-PET images with blood and hippocampal transcriptomic data from cognitively unimpaired (CU, n = 445) and cognitively impaired (CI, n = 749) individuals using modular dimension reduction techniques and voxel-wise linear regression analysis. RESULTS: Our results showed that multiple transcriptomic modules are associated with brain [18F]FDG-PET metabolism, with the top hits being a protein serine/threonine kinase activity gene cluster (peak-t(223) = 4.86, P value < 0.001) and zinc-finger-related regulatory units (peak-t(223) = 3.90, P value < 0.001). DISCUSSION: By integrating transcriptomics with PET imaging data, we identified that serine/threonine kinase activity-associated genes and zinc-finger-related regulatory units are highly associated with brain metabolic changes in AD. HIGHLIGHTS: We conducted an integrated analysis of system-based transcriptomics and fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) at the voxel level in Alzheimer's disease (AD). The biological process of serine/threonine kinase activity was the most associated with [18F]FDG-PET in the AD brain. Serine/threonine kinase activity alterations are associated with brain vulnerable regions in AD [18F]FDG-PET. Zinc-finger transcription factor targets were associated with AD brain [18F]FDG-PET metabolism.

Qualidade dos dados antropométricos de crianças menores de cinco anos em sistemas de informação no estado de São Paulo, Brasil / The quality of the anthropometric data on children under five years of age in information systems in the State of São Paulo, Brazil

Resumo O objetivo foi analisar a qualidade dos dados antropométricos de crianças menores de cinco anos em dois sistemas de informação no estado de São Paulo. A amostra compreendeu 2.117.108 crianças do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e 748.551 do Projeto Estadual do Leite (Vivaleite). Inicialmente, avaliamos a frequência de valores faltantes e fora do espectro do equipamento, e calculamos o índice de preferência de dígito para peso. Após calcular os índices de altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I), identificamos os valores biologicamente implausíveis (VBI) e calculamos o desvio-padrão (DP). Para cada município, calculamos a média e o DP de A-I, P-I e IMC-I; e plotamos os valores de DP em função da média. A preferência de dígito no peso foi maior em crianças de 24 a 59 meses no Sisvan. A frequência de VBI para A-I (SISVAN 2,56%; Vivaleite 0,98%) foi maior do que para P-I (Sisvan 2,10%; Vivaleite 0,18%). Para o índice A-I as variações entre os municípios foram mais acentuadas no Vivaleite do que no Sisvan. A variável altura apresentou baixa confiabilidade nos dois sistemas. A variável peso apresentou qualidade satisfatória no Vivaleite e insatisfatória no Sisvan.

Abstract This paper involves the analysis of the quality of anthropometric data on children under five years of age in two information systems in the State of São Paulo. The sample included 2,117,108 children from the Food and Nutrition Surveillance System (SISVAN), and 748,551 from the State Milk Project (VIVALEITE). Initially, we evaluated the frequency of missing values and others outside the equipment spectrum and calculated the digit-to-weight preference index. After calculating height-for-age (HAZ), weight-for-age (WAZ), and body mass index-for-age (BAZ), we flagged the biologically implausible values (BIV) and calculated the standard deviation (SD). For each municipality, we calculated the mean and the SD of HAZ, WAZ, and BAZ; and plotted the SD values as a function of the mean. The digit-to-weight preference index was greater among children aged between 24 and 59 months in SISVAN. The frequency of BIV for HAZ (SISVAN 2.56%; VIVALEITE 0.98%) was higher than for WAZ (SISVAN 2.10%; VIVALEITE 0.18%). For HAZ, variations among municipalities were more pronounced in VIVALEITE than in SISVAN. The height variable presents low reliability in both systems. The weight variable reveals satisfactory quality in VIVALEITE and unsatisfactory quality in SISVAN.

Qualidade e acesso à água para consumo humano: um olhar sobre o estado do Amazonas, Brasil / Quality and access to water for human consumption: a look at the state of Amazonas, Brazil

Resumo Analisaram-se indicadores de vigilância da qualidade da água para consumo humano no Amazonas, de 2016 a 2020, utilizando 185.528 amostras provenientes de 11 microrregiões. Das amostras analisadas, 93,20% são da área urbana, 66,65% provinham do sistema público (SAA), 31,02% da Solução Alternativa Coletiva (SAC) e 2,33% da Solução de Alternativa Individual (SAI). Observou-se aumento do número de registros pelo SAA, com tendência de queda e oscilações de registros para a SAC e a SAI. Os indicadores de qualidade dos parâmetros químicos e físicos da área urbana foram superiores aos das áreas rurais e de comunidades tradicionais. A maior parte das amostras apresentou valores de pH abaixo do recomendado. Na quantificação dos parâmetros microbiológicos, identificou-se maior presença de coliformes totais e E.coli na área rural e em comunidades tradicionais. Em conclusão, verificaram-se inadequações nos parâmetros químicos, físicos e microbiológicos, assim como problemas relativos ao abastecimento, armazenamento e à vigilância da água distribuída para consumo humano. Tais achados indicam a necessidade de construir uma agenda, pela gestão pública, para o enfrentamento da insegurança hídrica e seus prováveis efeitos sobre a insegurança alimentar existente na região.

Abstract Surveillance indicators of the quality of water for human consumption in the Amazon were analysed from 2016 to 2020 using 185,528 samples from 11 microregions. Of the samples analysed, 93.20% were from urban areas, 66.65% were from the public water supply system (WSS), 31.02% were from the Collective Alternative Solution-CAS, and 2.33% from the Individual Alternative Solution-IAS. There was an increase in the number of records by the WSS, with a downwards trend and fluctuations in records for the CAS and the IAS. The quality indicators of chemical and physical parameters for urban areas were higher than those for rural areas and traditional communities. Most of the samples presented pH values below the recommended level. In the quantification of microbiological parameters, a higher presence of total coliforms and E. coli was identified in samples from rural areas and in traditional communities. In conclusion, there were inadequacies in the chemical, physical and microbiological parameters as well as problems related to the supply, storage and surveillance of water distributed for human consumption. These findings indicate the need to build an agenda for public management to address water insecurity and its likely effects on food insecurity in the region.

Estigma de identidad sexual y apoyo social entre los hombres que tienen sexo con otros hombres en Central y Asunción, Paraguay: un análisis cualitativo

Introducción: El estigma relacionado con la identidad sexual, especialmente entre HSH, sigue siendo un desafío importante en muchas culturas, este estigma puede aparecer de varias maneras, desde una discriminación explícita hasta estereotipos más discretos, y puede afectar negativamente la salud mental y emocional de quienes lo sufren. Objetivo: Analizar el estigma de identidad sexual y apoyo social entre los hombres que tienen sexo con otros hombres en Central y Asunción, Paraguay durante el 2024. Metodología: Estudio cualitativo, fenomenológico de tipo descriptivo y explicativo. Las categorías de análisis consideradas en este estudio fueron: a) Estigma y apoyo social en la comunidad en general, b) Divulgación de identidad sexual a la comunidad en general, c) Divulgación de identidad sexual a familiares y amigos y d) Estigma y apoyo social en la comunidad de LGBT. Resultados: Participaron del estudio, nueve HSH, donde los testimonios revelan el profundo anhelo de vivir con autenticidad y libertad. Los HSH en Paraguay desean poder ser ellos mismos sin temor a ser juzgados o rechazados, anhelan relaciones abiertas y honestas, y aspiran a una comunidad donde puedan compartir experiencias y apoyarse mutuamente Conclusión: Los HSH enfrentan obstáculos en su crecimiento y unión como comunidad. La ausencia de una comunidad fuerte y unida dificulta el apoyo mutuo y el desarrollo personal, además de la competencia y la falta de colaboración entre organizaciones e individuos crean un ambiente dividido, donde cada uno busca sus propios beneficios en lugar de trabajar juntos por el bien de todos.

Introduction: Stigma related to sexual identity, especially among MSM, remains a major challenge in many cultures, this stigma can appear in various ways, from explicit discrimination to more discreet stereotypes, and can negatively affect the mental and emotional health of those who suffer from it. Objective: Analyze the stigma of sexual identity and social support among men who have sex with other men in Central and Asunción, Paraguay during 2024. Methodology: Qualitative, Phenomenological Study of a descriptive and explanatory type. The analysis categories considered in this study were: a) Stigma and social support in the community in general, b) Disclosure of sexual identity to the community in general, c) Disclosure of sexual identity to family and friends and d) Stigma and social support in the LGBT community. Results: Nine MSM participated in the study, where the testimonies reveal the deep desire to live with authenticity and freedom. MSM in Paraguay want to be able to be themselves without fear of being judged or rejected, they long for open and honest relationships, and they aspire to a community where they can share experiences and support each other. Conclusion: MSM face obstacles in their growth and unity as a community. The absence of a strong and united community makes mutual support and personal development difficult, in addition to competition and lack of collaboration between organizations and individuals creating a divided environment, where everyone seeks their own benefits instead of working together for the good. of everyone.

Cyclodextrins as a Strategy for Enhancing Solubility of Therapeutic Agents for Neglected Tropical Diseases: A Systematic Review.

BACKGROUND: Neglected Tropical Diseases (NTD) are chronic infectious conditions that primarily affect marginalized populations. The chemotherapeutic arsenal available for treating NTD is limited and outdated, which poses a challenge in controlling and eradicating these diseases. This is exacerbated by the pharmaceutical industry's lack of interest in funding the development of new therapeutic alternatives. In addition, a considerable number of drugs used in NTD therapy have low aqueous solubility. To address this issue, solubility enhancement strategies, such as the use of inclusion complexes with cyclodextrins (CD) can be employed. OBJECTIVE: Therefore, this systematic review aims to present the application of CD in complexing with drugs and chemotherapeutic compounds used in the therapy of some of the most prevalent NTD worldwide and how these complexes can enhance the treatment of these diseases. METHODS: Two bibliographic databases, Science Direct and PubMed, were used to conduct the search. The selection of studies and the writing of this systematic review followed the criteria outlined by the PRISMA guidelines. RESULTS: From a total of 978 articles, 23 were selected after applying the exclusion criteria. All the studies selected were consistent with the use of CD as a strategy to increase the solubility of therapeutic agents used in NTD. CONCLUSION: The results indicate that CD can enhance the solubility of chemotherapeutic agents for the treatment of Neglected Tropical Diseases (NTD). This review presents data that clearly highlights the potential use of CD in the development of new treatments for neglected tropical diseases. It can assist in the formulation of future treatments that are more effective and safer.

Clinical, epidemiological characteristics and mortality of pregnant and postpartum women associated with COVID-19 in Brazil: cohort study.

Objective: To analyze the death of Brazilian pregnant and postpartum women due to COVID-19 or unspecific cause. Methods: This is retrospective, descriptive-exploratory, population-based study carried out with the Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) database, with pregnant and postpartum women of reproductive age who died from confirmed COVID-19 between 2020 and 2021. The chosen variables were: age, gestational period, type and number of comorbidities, skin color, using the statistical software R Foundation for Statistical Computing Platform, version 4.0.3 and Statistical Package for Social Science, version 29.0 for analysis. Results: A total of 19,333 cases of pregnant and postpartum women aged between 10 and 55 years diagnosed with SARS were identified, whether due to confirmed COVID-19 or unspecific causes. Of these, 1,279 died, these cases were classified into two groups according to the cause of death: deaths from COVID-19 (n= 1,026) and deaths from SARS of unspecific cause (n= 253). Conclusion: The risk of death increased among black and brown women, in the postpartum period and with the presence of comorbidities, mainly diabetes, cardiovascular diseases and obesity. The data presented here draw attention to the number of deaths from SARS, especially among sociodemographic profiles, precarious access to health, such as the black population. In addition, limitations in adequate access to health care are reinforced by even lower rates of ICU admissions among women who died from SARS of an unspecified cause.

Cervical Cancer in Mexico: From a Renowned Vaccination Program to Unfulfilled Needs in Treatment Access.

Mexico's national human papillomavirus (HPV) vaccination program was established in 2008, providing free access to HPV vaccines and quickly becoming an immense success story, achieving significant coverage among young Mexican females. However, despite these efforts and notable achievements, cervical cancer caused mainly by HPV remains a challenging issue among Mexican women aged 15 years or older. A critical obstacle faced by women in the country is a lack of early detection and screening resources, coupled with delays in diagnosis and treatment, exacerbated by the poor distribution of already insufficient healthcare resources. This situation creates adverse conditions for the female demographic in the country. Our editorial aims to draw attention to the urgent need to improve access to adequate prevention, screening, and treatment for cervical cancer patients in Mexico, advocating for a collective effort between the Mexican government, public health professionals, and civil society.

Key co-expressed genes correlated with blood serum parameters of pigs fed with different fatty acid profile diets.

This study investigated how gene expression is affected by dietary fatty acids (FA) by using pigs as a reliable model for studying human diseases that involve lipid metabolism. This includes changes in FA composition in the liver, blood serum parameters and overall metabolic pathways. RNA-Seq data from 32 pigs were analyzed using Weighted Gene Co-expression Network Analysis (WGCNA). Our aim was to identify changes in blood serum parameters and gene expression between diets containing 3% soybean oil (SOY3.0) and a standard pig production diet containing 1.5% soybean oil (SOY1.5). Significantly, both the SOY1.5 and SOY3.0 groups showed significant modules, with a higher number of co-expressed modules identified in the SOY3.0 group. Correlated modules and specific features were identified, including enriched terms and pathways such as the histone acetyltransferase complex, type I diabetes mellitus pathway, cholesterol metabolism, and metabolic pathways in SOY1.5, and pathways related to neurodegeneration and Alzheimer's disease in SOY3.0. The variation in co-expression observed for HDL in the groups analyzed suggests different regulatory patterns in response to the higher concentration of soybean oil. Key genes co-expressed with metabolic processes indicative of diseases such as Alzheimer's was also identified, as well as genes related to lipid transport and energy metabolism, including CCL5, PNISR, DEGS1. These findings are important for understanding the genetic and metabolic responses to dietary variation and contribute to the development of more precise nutritional strategies.

Design, construction, and validation of obstetric risk classification systems to predict intensive care unit admission.

INTRODUCTION: To develop and validate a support tool for healthcare providers, enabling them to make precise and critical decisions regarding intensive care unit (ICU) admissions for high-risk pregnant women, thus enhancing maternal outcomes. METHODS: This retrospective study involves secondary data analysis of information gathered from 9550 pregnant women, who had severe maternal morbidity (any unexpected complication during labor and delivery that leads to substantial short-term or long-term health issues for the mother), collected between 2009 and 2010 from the Brazilian Network for Surveillance of Severe Maternal Morbidity, encompassing 27 obstetric reference centers in Brazil. Machine-learning models, including decision trees, Random Forest, Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost), were employed to create a risk prediction tool for ICU admission. Subsequently, sensitivity analysis was conducted to compare the accuracy, predictive power, sensitivity, and specificity of these models, with differences analyzed using the Wilcoxon test. RESULTS: The XGBoost algorithm demonstrated superior efficiency, achieving an accuracy rate of 85%, sensitivity of 42%, specificity of 97%, and an area under the receiver operating characteristic curve of 86.7%. Notably, the estimated prevalence of ICU utilization by the model (11.6%) differed from the prevalence of ICU use from the study (21.52%). CONCLUSION: The developed risk engine yielded positive results, emphasizing the need to optimize intensive care bed utilization and objectively identify high-risk pregnant women requiring these services. This approach promises to enhance the effective and efficient management of pregnant women, particularly in resource-constrained regions worldwide. By streamlining ICU admissions for high-risk cases, healthcare providers can better allocate critical resources, ultimately contributing to improved maternal health outcomes.