Oral pathology and oral medicine in Latin American countries: current stage.

BACKGROUND: Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. MATERIAL AND METHODS: A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. RESULTS: OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). CONCLUSIONS: Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.

Care for Staff: A Novel Technical Assistance Approach to Promote Occupational Mental Health Among Healthcare Workers in Lower and Middle Income Country Settings.

BACKGROUND: Healthcare workers (HCWs) in lower- and middle-income countries (LMICs) face unique, intersectional threats to their mental health at work. Despite the existence of recommendations for multi-tiered interventions to promote and protect occupational mental health for HCWs, there remain significant challenges to implementation worldwide. METHODS: FHI 360, a global development organization, developed a novel technical assistance framework to accompany partners, including government and healthcare leaders to design, implement, improve, or evaluate any mental health and psychosocial support intervention. The EpiC Project, implemented by FHI 360, has utilized this framework in four countries (Vietnam, Philippines, Paraguay and Sri Lanka) specifically to guide the development of locally adapted occupational mental health interventions for HCWs. FINDINGS: Each country applied this framework in various project cycle phases and in their unique local contexts; all countries reported positive developments in the advancement of their chosen interventions. CONCLUSIONS/APPLICATION TO PRACTICE: With the application of an adaptable, evidence-based technical assistance framework to guide collaborative consultation for project design, implementation, improvement, and/or evaluation, locally led teams pivoted from a solely "mental health" approach to more comprehensive, evidence-based interventions that framed mental health for HCWs as an occupational health priority. This allowed for teams advising interventions in LMICs to consider unique workplace, structural and policy-level factors rather than focusing solely on individual mental health strategies.

Cultural adaptation of an intervention for caregivers of young autistic children: Community members' perspectives.

Caregivers of autistic children in low-to-middle-income countries experience many barriers to access resources to support their child's development. Caregiver training is considered an evidence-based practice and may be a cost-effective way to support caregivers of autistic children in such settings. This study focuses on the cultural adaptation of Parents Taking Action (PTA; Magaña et al., Family Process, 56, 57-74, 2017) to support caregivers of autistic children in Paraguay. We conducted focus groups and individual interviews with 28 caregivers, autistic individuals, and professionals in Paraguay to understand caregivers' needs and to explore needed cultural adaptations of PTA to achieve contextual fit. Participants identified caregivers' need for accurate and reliable information, strategies to support children's growth, and emotional support and strategies to manage stress. Additionally, participants provided recommendations for adapting PTA considering the dimensions within the Cultural Adaptation Checklist (Lee et al., International Journal of Developmental Disabilities, 2023). This study is the first step in the iterative process of culturally adapting an intervention and the process described in this study may be appropriate for culturally adapting other interventions.

Cytokine storm in Chikungunya: Can we call it multisystem inflammatory syndrome associated with Chikungunya? / Tormenta de citoquinas en Chikungunya. ¿Podemos llamarla Síndrome inflamatorio multisistémico asociado a Chikungunya?

Paraguay is currently facing a new outbreak of Chikungunya virus. This report summarizes two severe cases of Chikungunya (CHIKV) infection, confirmed by real-time reverse transcription polymerase chain reaction. We present the cases of patients with acute CHIKV infection and multisystem involvement, with fever, rash, abdominal pain, vomiting, myocarditis, and coronary artery anomalies, very similar to the cases described in MIS-C related to SARS-CoV-2 during the COVID-19 Pandemic. Both patients received IVIG and methylprednisolone, with good clinical response. In this setting of cytokine storm in Chikungunya, can we call it “Multisystem inflammatory syndrome associated with Chikungunya”?.(AU)

Paraguay se enfrenta actualmente a un nuevo brote del virus Chikungunya. Este informe resume dos casos graves de infección por Chikungunya (CHIKV), confirmados mediante reacción en cadena de la polimerasa con transcripción inversa en tiempo real. Presentamos los casos de pacientes con infección aguda por CHIKV y afectación multisistémica, con fiebre, erupción cutánea, dolor abdominal, vómitos, miocarditis y anomalías de las arterias coronarias, muy similares a los casos descritos en síndrome inflamatorio multisistémico relacionado con el SARS-CoV-2 durante la pandemia de COVID-19. Ambos pacientes recibieron IGIV y metilprednisolona, con buena respuesta clínica. En este escenario de tormenta de citoquinas en Chikungunya, ¿podemos llamarla «síndrome inflamatorio multisistémico asociado a Chikungunya»?.(AU)

Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay.

BACKGROUND: Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). METHODS: PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. RESULTS: From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm3). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). CONCLUSIONS: TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.

Producción científica de la Universidad Nacional de Asunción en bases de datos internacionales

Introducción: La difusión y visibilidad de la producción científica son cruciales para lograr un impacto significativo. En este sentido, las bases de datos con cobertura internacional juegan un papel fundamental. Objetivo: Este estudio buscó caracterizar la producción científica de la Universidad Nacional de Asunción en 2022 mediante el análisis de tres bases de datos con cobertura internacional: Web of Science, Scopus y PubMed. Metodología: El estudio empleó un enfoque bibliométrico. Los registros bibliográficos fueron recolectados entre mayo y junio de 2023 utilizando la opción de búsqueda por afiliación "Universidad Nacional de Asunción" en las tres bases de datos. Los resultados de la búsqueda fueron filtrados en base a los criterios especificados por las bases de datos, limitando la búsqueda a artículos publicados en revistas científicas en el año 2022. Resultados: Se recogieron un total de 263 artículos, la mayoría de ellos publicados en revistas de alto impacto por editoriales reconocidas internacionalmente. El autor más prolífico tenía 30 artículos publicados, y la mayoría de los trabajos reflejaban la colaboración entre autores de la UNA como coautores. En cuanto al número de artículos por título de revista, el mayor número fue de 8, 7 y 4 artículos en Web of Science, Scopus y PubMed, respectivamente. Los editores más importantes de los artículos fueron Elsevier, Springer y Wiley, entre otros. Discusión: El análisis de los 263 artículos publicados indica la fuerte presencia de la Universidad Nacional de Asunción en revistas de alto impacto y editoriales de renombre internacional, particularmente en el campo de la Psiquiatría debido a la relevancia de la pandemia en la salud mental. Destaca la colaboración internacional de los autores de la UNA, pero hay margen de mejora, como la presentación uniforme de la afiliación universitaria. La indexación de los artículos en bases de datos internacionales es crucial para la visibilidad.

Introduction: The dissemination and visibility of scientific production are crucial for achieving significant impact. In this regard, databases with international coverage play a vital role. Objective: This study aimed to characterize the scientific production of the Universidad Nacional de Asunción in 2022 by analyzing three databases with international coverage: Web of Science, Scopus, and PubMed. Methodology: The study employed a bibliometric approach. The bibliographic records were collected between May and June 2023 using the search option by affiliation "Universidad Nacional de Asunción" in the three databases. The search results were filtered based on the criteria specified by the databases, limiting the search to articles published in scientific journals in 2022. Results: A total of 263 articles were collected, with most of them published in high-impact journals by internationally recognized publishers. The most prolific author had 30 published articles, and most papers reflected collaboration between UNA authors as co-authors. Regarding the number of articles per journal title, the highest number was 8, 7, and 4 articles in Web of Science, Scopus, and PubMed, respectively. The most important publishers of the articles were Elsevier, Springer, and Wiley, among others. Discussion: The analysis of the 263 published articles indicates the strong presence of the Universidad Nacional de Asunción in high-impact journals and internationally renowned publishers, particularly in the field of Psychiatry due to the relevance of the pandemic on mental health. The international collaboration of UNA authors stands out, but there is room for improvement, such as the uniform presentation of university affiliation. The indexing of the articles in international databases is crucial for visibility.

Conocimientos y prácticas sobre sífilis materna y congénita en adolescentes embarazadas en un Hospital General de Paraguay: estudio cualitativo

Introducción: La sífilis en embarazadas, sigue siendo un gran problema de salud pública en todo el mundo, y en Paraguay, no es la excepción. La sífilis congénita puede provocar abortos, muertes fetales y neonatales, peso bajo al nacer, prematuridad y otras anomalías congénitas, el conocimiento general de la población en edad fértil es fundamental. Objetivo: Analizar los conocimientos y prácticas sobre sífilis materna y sífilis congénita en adolescentes embarazadas en un Hospital General de Paraguay. Metodología: Se realizó un estudio cualitativo, fenomenológico descriptivo. Para la recolección de datos se utilizó la entrevista, simple que fue grabada con previa autorización del participante, la conclusión y recomendación serán entregados a la institución y a las adolescentes embarazadas. Resultados: Participaron diez adolescentes, en su mayoría de 19 años de edad, cinco conocen que la sífilis se transmite a través de las relaciones sexuales, sin embargo, desconocen acerca de cómo se transmite la sífilis congénita. Cinco de las adolescentes menciona haber iniciado las relaciones sexuales a los 16 años. Dos adolescentes a los 15 años, dos a los 14 años y una a los 17 años, nueve de las adolescentes embarazadas mencionan acudir a sus controles prenatales de forma periódica. Dos aún no se han realizado el test de VDRL. Discusión: Se concluye en cuanto al conocimiento, que solo cinco de diez adolescentes conocen acerca de la sífilis, sin embargo, no conocen sobre la sífilis congénita. En cuanto a las prácticas preventivas, 10 acuden de forma periódica a sus controles prenatales.

Introduction: Syphilis in pregnant women continues to be a major public health problem throughout the world, and in Paraguay, it is no exception. Congenital syphilis can cause abortions, fetal and neonatal deaths, low birth weight, prematurity, and other congenital anomalies; general knowledge of the population of childbearing age is essential. Objective: To analyze the knowledge and practices about maternal syphilis and congenital syphilis in pregnant adolescents in a General Hospital in Paraguay. Methodology: A qualitative, descriptive phenomenological study was carried out. A simple interview was used to collect data, which was recorded with prior authorization from the participant. The conclusion and recommendation will be delivered to the institution and to the pregnant adolescents. Results: Ten adolescents participated, mostly 19 years of age, five know that syphilis is transmitted through sexual relations, however, they do not know how congenital syphilis is transmitted. Five of the adolescent's mention having started sexual relations at the age of 16. Two adolescents at 15 years old, two at 14 years old and one at 17 years old, nine of the pregnant adolescent's mention attending their prenatal check-ups periodically. Two have not yet been tested for VDRL. Discussion: It is concluded in terms of knowledge that only five out of ten adolescents know about syphilis; however, they do not know about congenital syphilis. Regarding preventive practices, 10 attend their prenatal check-ups periodically.

Puntaje final del examen de admisión según el promedio de grado de los postulantes a la convocatoria de la Comisión Nacional de Residencias Médicas Paraguay 2019-2023

Introducción: La Comisión Nacional de Residencias Médicas (CONAREM) es el principal sistema de admisión para la tutoría clínica de residencias médicas en Paraguay, avalado por Ministerio de Salud Pública y Bienestar Social. Objetivos. Determinar la relación entre el puntaje final obtenido y el promedio de grado en postulantes a convocatorias CONAREM 2019-2023. Metodología: Estudio transversal con variables sociodemográficas, académicas, puntajes del examen y puntaje final. Se aplicaron métodos descriptivos y pruebas de Kolmogórov-Smirnov, t de Student, U de Mann-Whitney, Kruskal-Wallis y correlación de Spearman; utilizando software Stata© 17.0 de StataCorp LLC. Se consideraron significativos cuando p<0.05. Resultados: De 2019 a 2023, 4.768 médicos postularon examen CONAREM. 62,12 % eran mujeres, 34,51 % tenían entre 22 y 25 años y 95,30 % estaban solteros. El promedio de grado fue 3,56  0, 49. La mayoría (69,09 %) provenían de universidades privadas. En las especialidades preferidas, clínica médica fue más común (20,31 %), luego cirugía general y pediatría (ambas 14,30 %), 39,14 % pudo acceder a especialidad preferida. El puntaje final promedio fue 67,92 (RIC 60,78 - 76,76) con diferencias significativas según edad, universidad de procedencia y año de examen. Con modelo de regresión logística se demostró que promedio de grado, edad, universidad pública y primera participación en examen estaban asociados con mayor probabilidad de obtener mejores puntajes. El modelo tenía coeficiente de ajuste de 0, 318, indicando que solo predice el 32 % de resultados. La correlación fue moderada y significativa entre puntaje final y promedio general de grado. Según universidad, la correlación fue baja y no significativa para universidades extranjeras, mientras que universidades públicas y privadas mostraron correlación moderada pero significativa. Discusión. Los mejores promedios de grado se correlacionan moderadamente con mayor probabilidad de puntajes altos y acceder a especialidades de preferencia de los médicos recientemente graduados, provenientes de universidades públicas que hayan rendido por primera vez el examen de la CONAREM.

Introduction: The National Commission of Medical Residencies (CONAREM) is the main admission system for clinical tutoring of medical residencies in Paraguay, endorsed by the Ministry of Public Health and Social Welfare. Objectives: Determine the relationship between the final score obtained and the average degree in applicants to CONAREM calls 2019-2023. Methods: Cross-sectional study with sociodemographic and academic variables, exam scores and final score. Descriptive methods and tests of Kolmogorov-Smirnov, Student's t, Mann-Whitney U, Kruskal-Wallis and Spearman's correlation were applied; using Stata© 17.0 software from StataCorp LLC. They were considered significant when p<0.05. Results: From 2019 to 2023, 4,768 doctors applied for the CONAREM exam. 62.12% had a female female, 34.51% from 22 to 25, and 95.30% were single. The grade point average was 3.56(0.49. The majority (69.09%) came from private universities. As for preferred specialties, medical clinic was more common (20.31%), then general surgery and pediatrics (both 14.30%). 39.14% could access preferred specialty. The average final score was 67.92 and significant differences were found according to age, university of origin and year of examination. With logistic regression model, it was shown that average grade, age, public university and first participation in the exam were associated with a higher probability of obtaining better scores. The model had an adjustment coefficient of 0.318, indicating that it only predicts 32% of outcomes. The correlation was moderate and significant between final score and overall grade point average. By type of university, the correlation was low and not significant for foreign universities, while public and private universities showed moderate but significant correlation. Discussion: The best grade point averages correlate moderately with higher probability of high scores and access to specialties of preference and are associated with recently graduated doctors from public universities and took the exam for the first time.

Situación del ejercicio profesional del licenciado en instrumentación y área quirúrgica en Paraguay

Introducción: en Paraguay en 1996 se crea la Escuela de Instrumentación y Área Quirúrgica, vinculada a una universidad pública, a partir del 2008 se crean otras ofertas en el sector privado. El instrumentador quirúrgico puede desempeñarse como instrumentador, circulante, coordinador general de quirófanos y coordinador de la central de esterilización. Objetivo: conocer la situación del ejercicio profesional del licenciado instrumentador quirúrgico en Paraguay. Metodología: estudio descriptivo, cuantitativo y trasversal. La muestra es de 167 licenciados, egresados de instituciones pública y privadas. Muestreo no probabilístico por conveniencia, el instrumento de recolección de datos es un cuestionario electrónico. Resultados: el 74 % son mujeres, el 50 % presenta un rango de edad de 21 a 30 años, 79,6 % egresados de una institución pública, 40 % dice tener dificultad moderada para el primer empleo. El acceso al empleo, 71 % fue por contactos personales, el 72 % se dedica a instrumentar, el 60 % tiene una antigüedad laboral de 1 a 5 años. Entre los posgrados, el 30 % posee didáctica universitaria. Discusión: instrumentador quirúrgico, reúne las exigencias para ocupar otras funciones además de instrumentar y circular en el quirófano. Igualmente, en otros estudios se evidencia menor participación en el área administrativa, docencia, mercadeo y ventas. Han trascurrido 20 años del egreso de las primeras promociones, siendo una profesión novel, poco visualizado. Es de subrayar que el estado puede ahorrar recursos económicos al contratar a instrumentadores, puesto que son expertos en los cuidados asépticos y competentes en optimizar los tiempos quirúrgicos al que se expone el paciente.

Introduction: In Paraguay the school of Instrumentation and Surgical Area was created in 1996 linked to the National University, and in 2008 onwards other offers were created in the private sector. The Surgical Instrument Technician can work as instrumentalist, circulating nurse, general coordinator of operating rooms, and coordinator of the central sterilization unit. Objective: to know the work environment of the professional and licensed Surgical Instrument Technician in Paraguay. Methodology: descriptive, quantitative and cross-sectional study. The sample is 167 graduates, graduates of public and private institutions. Non-probability sampling for convenience, the data collection instrument is an electronic questionnaire. Results: 74% are women, 50% have an age range between 21 and 30 years old, 79.6% graduated from a public institution, 40% say they have moderate difficulty finding their first job in the field. Access to employment, 71% was through personal contacts, 72% is dedicated to work as Instrument Technicians, 60% have a job seniority of 1 to 5 years. Among the postgraduates, 30% are university didactics certified. Discussion: Surgical Instrument Technicians meet the requirements to perform other functions in addition to instrumentation and circulating nurses in the operating room. Similarly, other studies show less participation in the administrative area, teaching, marketing and sales. 20 years have elapsed since the first Technicians graduated, being a new profession, not given the importance it deserves. It is noteworthy that the state can save economic resources by hiring Surgical Instrument Technicians, since they are experts in aseptic care and competent in minimizing the amount of time the patient spends in surgery.

Baja disponibilidad de recursos y apoyo para atender a personas con diabetes e hipertensión arterial en las Unidades de Salud de la Familia de Paraguay

Introducción: Paraguay asumió el reto de lograr cobertura universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud de la Familia (USF) en el primer nivel de atención. Un desafío es la atención integral ante enfermedades no transmisibles, principal causa de mortalidad en el país. Objetivo: analizar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes en el sistema nacional de salud. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Metodología: Incluyó a 761 USF de 12 regiones sanitarias agrupados en 4 ejes territoriales. Se adaptó el método de evaluación SARA de la OMS con 75 variables, aplicando un cuestionario a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de disponibilidad y preparación así como un índice que los integra. La medida continua de estos índices se categorizó en 3 grupos: suficiente >0,75 a 1; intermedio 0,5 a 0,75 y bajo <0,5. Resultados: Solo en el 38 % de las USF el índice de disponibilidad fue suficiente, en el 31,5 % para el índice de preparación y en el 31,1 % para el índice integrador SARA DM/HTA. El desempeño se asoció de forma significativa con el eje territorial no así con el área ni con la cobertura a población indígena Discusión: las USF presentaron limitaciones para la atención de personas con diabetes e hipertensión en estas regiones del país.

Introduction: Paraguay assumed the challenge of achieving universal coverage through networks based on Primary Health Care with Family Health Units (USF) at the first level of care. One challenge is comprehensive care for non-communicable diseases, the main cause of mortality in the country. Objective: to analyze the capacity of the USF to care for people with high blood pressure and diabetes in the national health system. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. Methods: It included 761 USF from 12 health regions grouped into 4 territorial axes. The WHO SARA evaluation method was adapted with 75 variables, applying a questionnaire to health professionals between November and December 2022. Availability and preparation indices were calculated as well as an index that integrates them. The continuous measurement of these indices was categorized into 3 groups: sufficient >0.75 to 1; intermediate 0.5 to 0.75 and low <0.5. Results: Only in 38.0% of the USF the availability index was sufficient, in 31.5% for the readiness index and in 31.1% for the SARA DM/HTA integrating index. The performance was significantly associated with the territorial axis, but not with the area or with the coverage of the indigenous population. Discussion: the USF presented limitations for the care of people with diabetes and hypertension in these regions of the country.

Cobertura de vacunación contra COVID-19 e influenza en personal de salud y administrativo en Paraguay

Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Epidemiological characteristics of mortality from infectious intestinal diseases (diarrhea) Paraguay (2015-2019)

Introduction: Infectious intestinal diseases (diarrhea) are a major cause of morbidity and mortality worldwide. In 2015, it constituted the ninth leading cause of death for all ages. Objective: To describe the epidemiological characteristics of mortality due to infectious intestinal diseases (diarrhea) in Paraguay from 2015 to 2019. Methods: Descriptive, ecological, cross-sectional, retrospective, and non-probabilistic sampling of consecutive cases was performed. ICD-10 deaths included cholera (A01), typhoid and paratyphoid fever (A01), shigellosis (A03), other bacterial intestinal infections (A04), other bacterial food poisoning (A05), amebiasis (A06), other intestinal diseases due to protozoa (A07), intestinal infections due to viruses (A08), and diarrhea and gastroenteritis of presumed infectious origin (A09). Open access data were obtained from the WEB page of the General Directorate of Strategic Information in Health of the MSP and BS of all the Departments of the country. Crude and adjusted rates (per 100,000 inhabitants) were calculated. Excel and EPI INFO 7.0 were used. Results: 495 deaths were registered; the highest prevalence was in 2019 (adjusted rate of 1.83) and the lowest in 2017 (1.36). The months with the highest mortality rates were January and July (9.9%). 51.72% were women (256), 30.91% were over 80 years old and 28.28% (140) were under 5 years old, average age 50.8, single 56.77% (281) and without any type of education 41.82% (207). A total of 80.61% (399) of the respondents resided in urban areas. The highest rates were registered in Boquerón (33.3) and Amambay (15.2). Diarrhea and gastroenteritis of infectious origin accounted for 95.56% of the cases (473). Discussion: There was a high percentage of mortality from infectious diarrhea. Extremes of life were the most vulnerable populations.

Introducción: Las enfermedades infecciosas intestinales (diarrea) son una causa importante de morbilidad y mortalidad a nivel mundial. En 2015, constituyeron la novena causa principal de muerte para todas las edades. Objetivo: describir las características epidemiológicas de la mortalidad por enfermedades infecciosas intestinales (diarreas) en Paraguay durante los años 2015 al 2019. Metodología: Estudio descriptivo, ecológico, transversal, retrospectivo, muestreo no probabilístico de casos consecutivos. Se consideraron los óbitos del CIE - 10, que incluyen al cólera (A01), fiebres tifoidea y paratifoidea (A01), shigelosis (A03), otras infecciones intestinales bacterianas (A04), otras intoxicaciones alimentarias bacterianas (A05), amebiasis (A06), otras enfermedades intestinales debidas a protozoarios (A07), infecciones intestinales debidas a virus (A08) y diarrea y gastroenteritis de presunto origen infeccioso (A09). Se utilizaron datos de acceso abierto de la página WEB de la Dirección General de Información Estratégica en Salud del MSP y BS de todos los Departamentos del país. Se calcularon tasas crudas y ajustadas (por 100.000 habitantes). Se utilizaron Excel y EPI INFO 7.0. Resultados: Se registraron 495 muertes, la mayor prevalencia fue en 2019 (tasa ajustada de 1,83) y menor en 2017 (1,36). Los meses con mayor mortalidad fueron enero y julio (9,9%). El 51,72% fueron mujeres (256), 30,91% mayores de 80 años y 28,28% (140) menores de 5 años, edad promedio 50,8, solteros 56,77% (281) y sin ningún tipo de educación 41,82% (207). El 80,61% (399) residía en área urbana. Las mayores tasas se registraron en Boquerón (33,3) y Amambay (15,2). El 95,56% (473) fueron diarreas y gastroenteritis de origen infeccioso. Discusión: Se registra alto porcentaje de mortalidad de diarreas de origen infeccioso. Los extremos de la vida constituyen la población más vulnerable.

Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Adherencia de adultos de la compañía Chauria para la vacunación contra la COVID-19

Introducción: La pandemia del COVID-19 ha provocado cambios que afectan a los sistemas sanitarios y al enfoque de las enfermedades infecciosas en todo el mundo. La demanda de vacunas contra el COVID-19 se encuadra en un espectro que va desde el rechazo hasta la demanda, con una aceptación pasiva en el medio. Objetivo: Determinar la adherencia de los adultos a la vacunación contra la COVID-19. Chauria-Caballero, Paraguay 2022. Metodología: Estudio observacional, descriptivo, de corte transversal, con enfoque cuantitativo. El muestreo fue no probabilístico por conveniencia. La muestra estuvo conformada por un total de 225 adultos; los datos fueron recabados por medio de una encuesta elaborada por la investigadora, los datos fueron procesados con el software EPI INFO. Resultados: La mayoría de los sujetos de estudio se vacunaron, y hubo adherencia de la población a la vacuna contra la COVID-19 en un 93 %; diversos factores influyeron en las decisiones de estos; el porcentaje de adultos no vacunados mencionan como motivos su desconfianza (69 %) y el miedo/temor a la vacunación (31 %). Discusión: El estudio encontró una alta adherencia en general, la gran mayoría de los participantes vacunados contra COVID-19, porcentajes significativos se reportaron en Chile, China y Catar, cifras muy altas con relación a la aceptación de la vacuna a nivel país, teniendo una cobertura con un porcentaje mayor a la mitad con al menos una dosis.

Introduction: The coronavirus disease (COVID-19) pandemic has caused changes that affect health systems and the approach to infectious diseases worldwide. The demand for COVID-19 vaccines falls on a spectrum from rejection to demand, with passive acceptance in between. Objective: To determine the adherence of adults to vaccination against COVID-19. Chauria-Caballero, Paraguay 2022. Methods: This was an observational, descriptive, cross-sectional study using a quantitative approach. For convenience, the sampling was non-probabilistic. The sample comprised of 225 adults. The data were collected through a survey elaborated by the researcher, and the data were processed using EPI INFO software. Results: The majority of the study subjects were vaccinated, and there was 93% adherence of the population to the COVID-19 vaccine. Various factors influenced their decisions; the percentage of unvaccinated adults mentioned their distrust (69%) and fear of vaccination (31%). Discussion: The study found high adherence in general, the vast majority of participants were vaccinated against COVID-19, with significant percentages reported in Chile, China, and Qatar, very high figures in relation to the acceptance of the vaccine at the country level, with coverage of more than half with at least one dose.

Fruits, seeds and leaves of guabijuzeiro (Myrcianthes pungens (O. Berg) D. Legrand): characteristics, uses and health benefits.

Native fruit trees have potential for use in the food and pharmaceutical industries, which is widely used in folk medicine. Guabiju, known as guabijuzeiro (Myrcianthes pungens (O. Berg) D. Legrand) is a perennial tree that belongs to the family Myrtaceae, occurring in Brazil from São Paulo to Rio Grande do Sul, and other countries like Uruguay, Bolivia, Paraguay and Argentina. This species demonstrates great commercial potential regarding the consumption of its fresh fruit or industrialized. Due to its importance is necessary to develop studies aimed at characterization (phenotypic, propagative, reproductive, chemical and nutritional), uses and applications. However, the available information has never been systematized and in this sense the objective of this review is to compile information about the species to guide further research. Regarding morphology, the guabijuzeiro is a semi-deciduous tree species, with propagation is carried out mainly through seeds and vegetative. Regarding reproductive aspects, there is a lack of studies that assess the mode of reproduction. The fruit can be consumed fresh or processed as ice cream, juice, freeze-dried or dehydrated. It is sweet and slightly acidic, low in calories, high in carbohydrates, essential fatty acids, calcium and potassium. Both the fruit, the seed and the leaves have high levels of bioactive compounds and high antioxidant capacity. The fruit pulp stands out for its carotenoids and phenolic compounds and the peel is rich in anthocyanins, especially in the mature phase, in addition to terpenoids. M. pungens has antimicrobial effects, gastroprotective activity and is promising in the prevention of neurodegenerative diseases and against the side effects of cisplatin, an anticancer agent. Finally, there is a need for further studies with this species, mainly in the characterization of the leaves, uses and applications of the fruit.

Paraguay's approach to biotechnology governance: a comprehensive guide.

This study analyzes Paraguay's biotechnology regulatory framework and its alignment with international standards amid biotechnological advancements. It also identifies areas of improvement for enhancing framework effectiveness. Through this work, we aim to provide a resource for policymakers, stakeholders, and researchers navigating Paraguay's biotechnology regulation.

Fluvial avulsions influence soil fertility in the Pantanal wetlands (Brazil).

River avulsions drive important changes in the Pantanal wetlands, owing to their role in the hydro-sedimentology of the region. Although relevant to numerous ecosystem services, few studies have analyzed the influence of river avulsions on soil fertility in the Pantanal. Here, we use the largest ongoing avulsion in the Taquari River (Caronal region) to evaluate the effects on soil fertility, considering two factors: avulsion stage (1) and aquatic-terrestrial succession (2). Since both factors are influenced by macrophyte abundance, an incident map was created through tasseled cap indices from Sentinel 2 images to guide sampling efforts in flooded soils. The mapped area was split into two zones of alluvial processes, the first from the apex of the Caronal lobe corresponding to the Taquari River megafan (TRM), and the second as the distal Paraguay River floodplain (PRF). Soil macro- and micronutrient levels were evaluated from 42 surface samples (0-0.2 m) distributed across the two alluvial process zones. The macrophyte map's overall accuracy (OA) was analyzed by a confusion matrix using the Sentinel 2 imagery. Finally, we used Random Forest regressions to determine the influence of response variables on soil attributes, including tassel indices, distance from the Caronal crevasse, macrophyte density, and an existing soil fertility map. The macrophyte map obtained an OA of 93 %. Some parameters such as pH (r = -0.62; R2 = 0.57), effective cation exchange capacity (r = -0.49; R2 = 0.79), Mn (r = -0.71; R2 = 0.6), Zn (r = -0.69; R2 = 0.54), and base saturation (r = -0.7; R2 = 0.93) were influenced by the distance or level of maturation of the avulsion stage in the TRM. Our scattering of soil collections was insufficient to test the terrestrialization hypothesis (2). The study results show that river channel avulsions influence the accumulation of mineral and organic nutrients in tropical floodplain soils, which has implications for fertility and biodiversity.

Cytokine storm in Chikungunya: Can we call it multisystem inflammatory syndrome associated with Chikungunya?

Paraguay is currently facing a new outbreak of Chikungunya virus. This report summarizes two severe cases of Chikungunya (CHIKV) infection, confirmed by real-time reverse transcription polymerase chain reaction. We present the cases of patients with acute CHIKV infection and multisystem involvement, with fever, rash, abdominal pain, vomiting, myocarditis, and coronary artery anomalies, very similar to the cases described in MIS-C related to SARS-CoV-2 during the COVID-19 Pandemic. Both patients received IVIG and methylprednisolone, with good clinical response. In this setting of cytokine storm in Chikungunya, can we call it "Multisystem inflammatory syndrome associated with Chikungunya"?.

Excess tuberculosis risk during and following incarceration in Paraguay: a retrospective cohort study.

Background: The increased risk of tuberculosis (TB) among people deprived of liberty (PDL) is due to individual and institution-level factors. We followed a cohort of PDL from 5 prisons in Paraguay to describe the risk of TB during incarceration and after they were released. Methods: We linked a 2013 national census of prisons with TB records from the TB Program from 2010 to 2021 to identify TB notifications among incarcerated and formerly incarcerated individuals. We used multivariable Cox regression models to quantify the risk of TB during and following incarceration and to identify risk factors associated with TB. Findings: Among 2996 individuals incarcerated, 451 (15.1%) were diagnosed with TB. Of these, 262 (58.1%) cases occurred during incarceration and 189 (41.9%) occurred in the community after release. In prison, the hazard ratio of developing TB was 1.97 (95% CI: 1.52-2.61) after six months of incarceration and increased to 2.78 (95% CI: 1.82-4.24) after 36 months compared with the first six months. The overall TB notification rate was 2940 per 100,000 person-years. This rate increased with the duration of incarceration from 1335 per 100,000 person-years in the first year to 8455 per 100,000 person-years after 8 years. Among former prisoners, the rate of TB decreased from 1717 in the first year after release to 593 per 100 000 person-years after 8 years of follow up. Interpretation: Our study shows the alarming risk of TB associated with prison environments in Paraguay, and how this risk persists for years following incarceration. Effective TB control measures to protect the health of people during and following incarceration are urgently needed. Funding: Paraguay National Commission of Science and Technology grant CONACYT PIN 15-705 (GS, GES, SA).

Human Papillomavirus (HPV) Infection and Risk Behavior in Vaccinated and Non-Vaccinated Paraguayan Young Women.

Cervical cancer is a global health concern and ranks fourth among the most prevalent cancers in women worldwide. Human papillomavirus (HPV) infection is a known precursor of cervical cancer and preventive measures include prophylactic vaccines. This study focused on sexually active Paraguayan women aged 18-25 years, exploring the intersection of HPV vaccination and sexual behavior. Among 254 participants, 40.9% received the Gardasil-4 vaccine, with no significant differences in sexual behavior between the vaccinated and unvaccinated sexually active groups. However, a notable decrease in the prevalence of HPV among the vaccinated women highlights the efficacy of this vaccine in reducing infections. The prevalence of any HPV type was 37.5% in vaccinated participants compared to 56.7% in unvaccinated participants (p = 0.0026). High-risk HPV types showed a significant difference, with a prevalence of 26.0% in vaccinated women compared with 52.7% in unvaccinated women (p < 0.001). Although a potential decline in genital warts was observed among the vaccinated individuals, statistical significance (p = 0.0564) was not reached. Despite the challenges in achieving high vaccination coverage, the observed reduction in HPV prevalence underscores the importance of ongoing monitoring, healthcare professional recommendations, and comprehensive risk management. These findings contribute to dispelling concerns about HPV vaccination influencing sexual behavior, advocating further large-scale research to explore the impact of vaccines on various HPV types and potential cross-protection.