[National competitive bidding analysis of osteosynthesis materials in pediatric patients with femur fractures]. / Análisis de licitación pública nacional de materiales de osteosíntesis en los pacientes pediátricos con fracturas de fémur.

INTRODUCTION: health promotion policy requires the identification of barriers to the adoption of public policies. Paraguay's national healthcare system is inequitable, expensive, and inefficient. The Ministry of Public Health and Social Welfare (MSPyBS) is the entity responsible for covering the needs of a significant portion of the population. In January 2022, the MSPyBS financed the purchase of titanium elastic nails through a National Public Tender for Osteosynthesis Materials (LPN 02/22) to provide them for free in the pediatric service. Using research as a tool, we seek to analyze the impact of the implementation of LPN 02/22 at the Trauma Hospital, believing that this action would help streamline administrative and bureaucratic processes, making them more efficient with the assistance of the hospital's human resources. MATERIAL AND METHODS: a retrospective, analytical, and comparative study conducted at a high-complexity trauma center in Asunción, Paraguay. Patients aged 4 to 14 years with an indication for stabilization with elastic nails were included. Demographic data, the mechanism of injury, time elapsed from hospital arrival to surgical treatment, length of hospital stay, and the average hospital cost were analyzed based on the daily expense of pediatric patient hospitalization. RESULTS: 52 patients, divided into 25 cases in 2021 before implementation and 27 cases after implementation. The time elapsed from hospital arrival to definitive treatment was six days in the pre-implementation period, with an average stay from admission to discharge of 7.4 days. After implementation, the time from hospital arrival to definitive treatment was 4.3 days, and the average discharge time for the Post group was six days. The potential savings per patient amount to 332 dollars, offset by the institution's implant supply cost of 197 dollars, resulting in an approximate savings of 135 dollars per patient for the ministry. CONCLUSIONS: we view the implementation of free titanium elastic nails for pediatric femur fracture patients positively. We encourage the institution to continue with similar policies and strive to achieve even greater benefits for users.

INTRODUCCIÓN: la política de promoción de la salud requiere la identificación de los obstáculos para la adopción de políticas públicas. El sistema nacional de salud de Paraguay es inequitativo, caro e ineficiente. El Ministerio de Salud Pública y Bienestar Social (MSPyBS) es el ente que cubre las necesidades de gran parte de la población. El MSPyBS en Enero del 2022 financió, mediante la Licitación Pública Nacional de Materiales de Osteosíntesis (LPN 02/22), la compra de clavos elásticos de titanio para disponer de su uso gratuito en el Servicio de Pediatría; usando a la investigación como herramienta, buscamos analizar el impacto de la implementación de la LPN 02/22 en el Hospital de Trauma, creyendo que esta acción ayudaría a dinamizar los procesos administrativos y burocráticos, haciéndolos más eficientes con la ayuda de los recursos humanos del hospital. MATERIAL Y MÉTODOS: estudio retrospectivo, analítico y comparativo, realizado en un centro de trauma de alta complejidad de Asunción, Paraguay. Fueron incluidos los pacientes con edad comprendidas entre cuatro y 14 años, con indicación de estabilización con clavos elásticos. Se analizaron los datos demográficos, el mecanismo de trauma, el tiempo transcurrido desde la llegada al hospital hasta el tratamiento quirúrgico, así como el tiempo de estadía hospitalaria. Se evaluó el costo hospitalario promedio, basados en el gasto diario de la internación de un paciente pediátrico. RESULTADOS: cincuenta y dos pacientes, separados en 25 casos en el 2021 previo a la implementación y 27 casos posterior a la implementación. El tiempo transcurrido desde la llegada al hospital hasta el tratamiento definitivo fue de seis días para la etapa previa a la implementación; el promedio desde el ingreso hasta el alta fue de 7.4 días. Desde la implementación se tuvo un transcurso de 4.3 días desde la llegada al hospital hasta el tratamiento definitivo. El egreso del grupo Post tuvo un promedio de seis días. El ahorro probable en relación con cada paciente es de 332 dólares; a esto debemos contrarrestar el monto que paga la institución para la provisión del implante (197 dólares), por lo que el ahorro del ministerio sería de aproximadamente 135 dólares por cada paciente. CONCLUSIONES: vemos como positiva la implementación de la gratuidad de los clavos elásticos de titanio en los pacientes en edad pediátrica con fractura de fémur. Alentamos a la institución a seguir con políticas similares y tratar de lograr mayores beneficios para los usuarios.

Epidemiology of Suicide Mortality in Paraguay from 2005 to 2019: A Descriptive Study.

Suicide is an important public health problem, fundamentally affecting the younger population and responding to multiple biological, psychological, and social causes. The objective of this study was to characterize changes in suicide mortality, suicide methods, and years of potential life lost from 2005 to 2019 in Paraguay. This observational, descriptive study used data from the Vital Statistics Information Subsystem of the Ministry of Public Health and Social Welfare. The average mortality rate from suicide was 4.9 per 100,000 inhabitants, with an increase from 4.2 between 2005 and 2009 to 5.8 from 2014 to 2019. Suicide was more common in men (75%) than in women. In men, the highest mortality rate was observed among those 20-24 years old, whereas in women, the ages most affected were the 15-19-year-old age group. The most-used method for suicide was hanging. The most frequent place of suicide occurrence was at home (73%). The seasonality of suicide occurrence showed a slight increase in the spring-summer months compared with autumn-winter (53% vs. 47%). The rate of potential years of life lost statistically significantly increased from 2005 to 2019. Public health measures need to be implemented to investigate the underlying reasons and implement interventions in the population to decrease suicide mortality in Paraguay.

Protección constitucional del derecho a la salud en la República del Paraguay / Constitutional protection of the right to health in the Republic of Paraguay

Con la sanción de la Constitución Nacional en 1992 de la Repúblicadel Paraguay, se declara en sus artículos 68 y 69 "que el Estado protegerá y promoverá el derecho a la salud como fundamental, proveyendo las condiciones dentro del Sistema Nacional de Salud, recursos, planes y políticas integradas al desarrollo". Este marco constitucional ha sido la base y el fundamento de la Ley 1.032/96, que crea el Sistema Nacional de Salud, el cual está compuesto por los subsectores públicos, mixtos y privados, caracterizado por un modelo segmentado y fragmentado, reglamentado por el Decreto Ley N°21.376 del año 1998 bajo la rectoría del Ministerio de Salud Pública y Bienestar Social, actualmente la salud paraguaya está fundamentada en los ejes estratégicos basados en la creación e implementación de unidades de salud familiar y se define con un enfoque basado en la atención primaria de la salud. Palabras clave: Paraguay; derecho a la salud; sistemas nacionales de salud; constitución y estatutos; atención primaria de salud

With the enactment of the National Constitution of the Republic of Paraguay in 1992, articles 68 and 69 state that "the State will protect and promote the right to health as fundamental, providing the conditions within the National Health System, resources, plans and policies integrated to development". This constitutional framework has been the basis and foundation of Law 1.032/96, which creates the National Health System, which is composed of public, mixed and private subsectors, characterized by a segmented and fragmented model, regulated by the Decree Law No. 21,376 of 1998, under the Ministry of Public Health and Social Welfare, Paraguayan health is currently based on strategic axes based on the creation and implementation of family health units and is defined with an approach based on primary health care. Key words: Paraguay; right to health; national health systems; constitutionand bylaws; primary health care

Análisis de criterios de clasificación de productos alimentarios para la aplicación del etiquetado frontal de advertencia en Paraguay, octubre del 2023

En respuesta a los compromisos asumidos a nivel internacional ante los planes de acción regionales y mundiales relacionados con la prevención de las enfermedades crónicas no transmisibles y sus factores de riesgo, el Ministerio de Salud Pública y Bienestar Social de Paraguay presentó su Plan Nacional de Acción para la Prevención y el Control de las Enfermedades Crónicas No Transmisibles 2014-2024, en el cual se compromete a reducir la exposición de la población a los factores de riesgo para este tipo de enfermedades, mediante políticas y regulaciones que favorezcan la adopción de estilos de vida saludables. El etiquetado frontal de advertencia en productos alimentarios y bebidas es una de las herramientas políticas esenciales para lograr tal objetivo y la clasificación de productos a ser regulados por esa medida debe se alinear con las recomendaciones de salud pública para que la medida pueda efectivamente mejorar la alimentación de la población y proteger la salud pública. Esa publicación presenta resultados de una comparación de criterios sugeridos en la Ley 7092/2023, recien promulgada en Paraguay, con el modelo de perfil de nutrientes de la Organización Panamerican de la Salud, que es el estándar de oro para la Región de las Américas y se basa en las recomendaciones de la OMS. La publicación busca apoyar la autoridad sanitaria nacional en definir los parámetros que definirán los productos que deben aplicar el rotulado frontal de advertencia.

[On "the remedies and medications which were given to ailing negroes:" health and death spending on slaves by the Office of the Jesuit Province of Paraguay, 1711-1745]. / Sobre "os remédios e medicinas que se haviam dado a negros enfermos": os gastos com a saúde e a morte de escravos do Ofício da Província Jesuítica do Paraguay, 1711-1745.

This text analyzes the way sick slaves were treated at the Office (ofício) of the Jesuit Province of Paraguay and Santa Catalina Farm (estancia) between 1711 and 1745. The sources consulted - Libro de cuentas del Ofício, Memoriales, and Cartas ânuas - reveal that the sickness of the enslaved people generated expenses, not only for medications, clothing, and food, but also for shrouds for their burial. As for the slaves from the Santa Catalina Farm, the sources indicate that depending on the infirmity, they were sometimes sent to Córdoba, where they were treated by laypersons trained in the healing arts, which incurred different expenses, also recorded in the ledgers.

Neste texto, analisamos o tratamento dispensado aos escravos enfermos do Ofício da Província Jesuítica do Paraguay e da Estância de Santa Catalina entre 1711 e 1745. As fontes analisadas ­ Libro de cuentas del Ofício, Memoriales e Cartas ânuas ­ revelam que o adoecimento de escravos do Ofício gerava despesas tanto com a aquisição de medicamentos, roupas e alimentos quanto com mortalhas para seu sepultamento. No caso dos escravos da Estância de Santa Catalina, observou-se que, dependendo da enfermidade, eles eram encaminhados à cidade de Córdoba, onde eram tratados por leigos treinados nas artes de curar, o que implicava despesas de outra natureza também registradas nos relatórios contábeis.

Sobre "os remédios e medicinas que se haviam dado a negros enfermos": os gastos com a saúde e a morte de escravos do Ofício da Província Jesuítica do Paraguay, 1711-1745 / On "the remedies and medications which were given to ailing negroes: "health and death spending on slaves by the Office of the Jesuit Province of Paraguay, 1711-1745

Neste texto, analisamos o tratamento dispensado aos escravos enfermos do Ofício da Província Jesuítica do Paraguay e da Estância de Santa Catalina entre 1711 e 1745. As fontes analisadas - Libro de cuentas del Ofício, Memoriales e Cartas ânuas - revelam que o adoecimento de escravos do Ofício gerava despesas tanto com a aquisição de medicamentos, roupas e alimentos quanto com mortalhas para seu sepultamento. No caso dos escravos da Estância de Santa Catalina, observou-se que, dependendo da enfermidade, eles eram encaminhados à cidade de Córdoba, onde eram tratados por leigos treinados nas artes de curar, o que implicava despesas de outra natureza também registradas nos relatórios contábeis.

Abstract This text analyzes the way sick slaves were treated at the Office (ofício) of the Jesuit Province of Paraguay and Santa Catalina Farm (estancia) between 1711 and 1745. The sources consulted - Libro de cuentas del Ofício, Memoriales, and Cartas ânuas - reveal that the sickness of the enslaved people generated expenses, not only for medications, clothing, and food, but also for shrouds for their burial. As for the slaves from the Santa Catalina Farm, the sources indicate that depending on the infirmity, they were sometimes sent to Córdoba, where they were treated by laypersons trained in the healing arts, which incurred different expenses, also recorded in the ledgers.

Evaluación de riesgo de apnea obstructiva del sueño y de la adherencia al tratamiento farmacológico en pacientes con hipertensión arterial / Risk assessment of obstructive sleep apnea and adherence to pharmacological treatment in patients with arterial hypertension

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA

Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT

Actitud hacia la Ley Anita en estudiantes de la Facultad de Ciencias de la Salud Universidad Nacional del Caaguazú, año 2021 / Attitude towards the Anita Law in students of the Facultad de Ciencias de la Salud Universidad Nacional of Caaguazú, year 2021

Introducción: la donación de órganos sigue siendo un problema incluso en aquellos sistemas más exitosos en la detección de donantes. Objetivo: identificar la actitud hacia la Ley Anita en estudiantes de la Facultad de ciencias de la salud Universidad Nacional del Caaguazú, año 2021. Metodología: estudio observacional, tipo descriptivo y de corte transversal. Se llevó a cabo en la Facultad de Ciencias de la Salud, de la Universidad Nacional de Caaguazú, en el periodo comprendido durante los meses de junio a agosto del año 2021. El instrumento fue un cuestionario de preguntas cerradas con opciones múltiples. Resultado: en cuanto a la actitud respecto a la donación de órganos el 81.9 % donaría sus órganos y el 95.1 % donaría sus órganos si es un familiar el que necesita del mismo, el 69.8 % afirmó donarían los órganos de sus familiares. La opinión de la familia es favorable para el 43.4 % es favorable mientras que el 52.2 % de la población manifestó que su religión condice con la donación de órganos. El 92.3 % está a favor de la ley Anita. Conclusión: la actitud favorable hacia la donación de órganos estuvo relacionada con la opinión favorable de la familia y de la religión, además de ser positiva para los que están de acuerdo con la donación de sangre. La opinión de la familia y la religión influye también en la actitud favorable hacia la donación de órganos de familiares, además de asociarse hacia la actitud favorable hacia la Ley Anita.

Introduction: organ donation continues to be a problem even in the most successful systems in donor detection. Objective: to identify the attitude towards the Anita Law in students at the College of Health Sciences, Universidad Nacional de Caaguazú, during 2021. Methodology: this was an observational, descriptive and cross-sectional study. It was carried out at the College of Health Sciences, Universidad Nacional de Caaguazú, from June to August, 2021. The instrument was a questionnaire of closed questions with multiple-choice answers. Result: regarding attitudes towards organ donation, 81.9 % would donate their organs and 95.1 % would donate their organs if a family member required so, 69.8 % said they would donate the organs of their relatives. Family opinions were favorable for 43.4 % while 52.2 % of the population stated that their religious denomination agrees with organ donation. 92.3 % support the Anita law. Conclusion: the favorable attitude towards organ donation was related to the favorable opinions of the family and religious denomination, in addition to being positive for those who agree with blooddonation. The opinion of the family and religious denomination also influences the favorable attitude towards family organ donation, in addition to being associated with a favorable attitude towards the Anita Law.

Respuesta a la carta al editor: Crítica al estudio factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay

[EXTRACTO]. En respuesta a la carta al editor titulada: Critica al estudio de factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay, los autores del artículo de referencia elevan a consideración la réplica sobre el contenido de esta, con el objeto de esclarecer los cuestionamientos mencionados en la misma. Respecto al primer problema mencionado en la carta al editor; el estudio utilizó el programa de inteligencia artificial (IA) que fue desarrollado por un equipo de informáticos biomédicos, neumólogos y radiólogos (imagenólogos). El programa utilizado dispone de un método de aprendizaje profundo para realizar el diagnóstico rápido de COVID-19; es decir, cuenta con un algoritmo para detectar patologías neumológicas y un algoritmo de diagnóstico de neumopatías compatibles con COVID-19. En cuanto al segundo problema mencionado en la carta al editor; el presente estudio se realizó entre marzo del 2020 y junio del 2021 en 14 hospitales de las 18 regiones sanitarias del Ministerio de Salud Pública y Bienestar Social (MSPBS), que ya contaban con al menos un tomógrafo funcionando al momento del estudio. El informe de diagnóstico del médico radiólogo y el resultado del diagnóstico por IA fueron remitidos luego a un equipo de neumólogos para su valoración, análisis, correlación y validación; los neumólogos correlacionaron los valores porcentuales del diagnóstico por IA con el resultado de los médicos radió- logos, el resultado del análisis molecular (RT-PCR) y el cuadro clínico del paciente para determinar los grados de concordancia o discordancia entre los resultados, y llegar a un diagnóstico definitivo que permitiera informar al médico del hospital donde se trataba al paciente en cuestión. Esto permitió reducir las aglomeraciones en los centros especializados y optimizar el uso de los limitados recursos disponibles. Esta respuesta se refiere a la carta disponible en: https://doi.org/10. 26633/RPSP.2022.193

Socioeconomic inequalities in health care utilization in Paraguay: Description of trends from 1999 to 2018.

OBJECTIVE: Paraguay's health care system is characterized by segmented provision and low public spending, with limited coverage and asymmetries in terms of access and quality of care. The present study provides national estimates of income-related inequality in health care utilization and trends in the country over the past two decades. METHODS: Using data from the Paraguayan Permanent Household Survey, we estimated socioeconomic inequality in health care use during the period 1999-2018. We used poverty-to-income ratio as the socioeconomic stratifier and defined health care use as having reported a health problem and subsequent health care use in the last 90 days before interview. Inequality was summarized by rank- and level-based versions of the Concentration Index for binary outcomes. RESULTS: Inequalities affecting those with lower incomes were present in all years assessed, although the magnitude of these inequalities declined over time. Inequality as expressed by the rank-based index decreased from 0.209 (95%CI 0.164; 0.253) in 1999 to 0.032 (95%CI -0.010; 0.075) in 2018. The level-based index decreased from 0.076 (95%CI -0.029; 0.182) in 1999 to 0.024 (0.002; 0.045) in 2018. Trends in both indices were generally stable from 1999 to 2009, with a noticeable decrease in 2010. The sharpest decreases relative to the 1999 baseline were observed in the period 2010-2018, reflecting changes in health care use and income distribution. Stratification by area, sex and older people suggest similar trends within subgroups. CONCLUSIONS: Decreases in inequality coincide temporally with increments in public health expenditure, removal of user fees in public health care facilities and the expansion of conditional cash-transfer programmes. Future research should disentangle the role of each of these policies in explaining the trends described.

Subjective assessment of taste and smell disfunction in patients with COVID-19 in Paraguay / Evaluación subjetiva de las alteraciones del sentido del gusto y del olfato en pacientes con COVID-19 en Paraguay

The alteration of the senses of taste and smell in relation to COVID-19 is a widely known phenomenon; however, this alteration has not been exhaustively characterized in the international literature. The following study is proposed with the aim of describing the alterations in the senses of taste and smell in relation to COVID-19 by means of their subjective evaluation. The nature of the study is observational, descriptive and cross-sectional, and was applied to patients who sought medical attention via remote consultations carried out on virtual platforms of the Service of Otorhinolaryngology and Head and Neck Surgery of the Clínicas Hospital, San Lorenzo, between the months of March and October of 2021. We included 440 patients aged 31.3 ± 9.9 years (18 to 60 years), 308 (70%) female, 388 (88%) from urban areas, with evidence of infection by SARS-CoV-2 by RT-PCR in 260 (59%), predominantly without comorbidities 232 (53%), with fever as the most frequently reported symptom 352 (80%), treated more frequently with NSAIDs 208 (47%) and/or Paracetamol 216 (49%). Both taste and smell alterations in patients who have had COVID-19 have been shown to appear more frequently 1 to 7 days after the onset of symptoms (207 for smell, 184 for taste), occurring more frequently with a total decrease of both senses (anosmia 302 and ageusia 216), recovering completely in most cases (214 and 216) and within a period of 1 to 4 weeks (140 and 130).

La alteración de los sentidos del gusto y del olfato en relación con el COVID-19 es un fenómeno ampliamente conocido, sin embargo, esta alteración no ha sido caracterizada de forma exhaustiva en la literatura internacional. Se plantea el siguiente estudio con el objetivo de describir las alteraciones del sentido del gusto y del olfato en relación con el COVID-19 a través de la evaluación subjetiva del mismo. El mismo es observacional, descriptivo, de corte transversal, aplicado a pacientes que consultaron a través de teleconsultas realizadas sobre plataformas virtuales de la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas, de San Lorenzo, durante los meses de marzo a octubre del 2021. Fueron incluidos 440 pacientes de 31,3 ± 9,9 años (18 a 60 años), 308 (70%) de sexo femenino, 388 (88%) provenientes de zona urbana, con evidencia de infección por SARS-CoV-2 por RT-PCR en 260 (59%), predominantemente sin comorbilidades 232 (53%), con fiebre como síntoma asociado al COVID-19 más frecuentemente reportado 352 (80%), tratados más frecuentemente con AINES 208 (47%) y/o Paracetamol 216 (49%). Tanto la alteración del gusto como del olfato en pacientes que han cursado con COVID-19 ha demostrado ser aparecer más frecuentemente en 1 a 7 días del inicio del cuadro (207 para el olfato. 184 para el gusto), cursando más frecuentemente con disminución total de ambos sentidos (anosmia 302 y ageusia 216), recuperándose más frecuentemente de forma total (214 y 216) y en un plazo de 1 a 4 semanas (140 y 130).

SARS-CoV-2 Variants in Paraguay: Detection and Surveillance with an Economical and Scalable Molecular Protocol.

SARS-CoV-2 variant detection relies on resource-intensive whole-genome sequencing methods. We sought to develop a scalable protocol for variant detection and surveillance in Paraguay, pairing rRT-PCR for spike mutations with Nanopore sequencing. A total of 201 acute-phase nasopharyngeal samples were included. Samples were positive for the SARS-CoV-2 N2 target and tested with the Spike SNP assay to detect mutations associated with the following variants: alpha (501Y), beta/gamma (417variant/484K/501Y), delta (452R/478K), and lambda (452Q/490S). Spike SNP calls were confirmed using amplicon (Sanger) sequencing and whole-genome (Nanopore) sequencing on a subset of samples with confirmed variant lineages. Samples had a mean N2 Ct of 20.8 (SD 5.6); 198/201 samples (98.5%) tested positive in the Spike SNP assay. The most common genotype was 417variant/484K/501Y, detected in 102/198 samples (51.5%), which was consistent with the P.1 lineage (gamma variant) in Paraguay. No mutations (K417 only) were found in 64/198 (32.3%), and K417/484K was identified in 22/198 (11.1%), consistent with P.2 (zeta). Seven samples (3.5%) tested positive for 452R without 478K, and one sample with genotype K417/501Y was confirmed as B.1.1.7 (alpha). The results were confirmed using Sanger sequencing in 181/181 samples, and variant calls were consistent with Nanopore sequencing in 29/29 samples. The Spike SNP assay could improve population-level surveillance for mutations associated with SARS-CoV-2 variants and inform the judicious use of sequencing resources.

Public health and budget impacts of switching from a trivalent to a quadrivalent inactivated influenza vaccine in Paraguay.

This study aimed to investigate the public health and economic benefit of using a quadrivalent influenza vaccine (QIV) instead of a trivalent influenza vaccine (TIV) in past seasons in Paraguay. The budget impact of switching from TIV to QIV in the Immunization Program was also evaluated. The adapted model includes two modules. The first compared retrospectively Health and Economic outcomes resulting from the use of QIV instead of TIV. The second forecast the spending and savings that would be associated with the switch from TIV to QIV. Our findings estimate that the switch from TIV to QIV during the seasons 2012 to 2017 could have prevented around 2,600 influenza cases, 67 hospitalizations and 10 deaths. An alternative scenario using standardized estimates of the burden of influenza showed that 234 influenza-related hospitalizations and 29 deaths could have been prevented. The estimated annual budget impact of a full switch from TIV to QIV was around USD1,6 million both from the payer and societal perspectives. Those results are mainly driven by vaccine prices and coverage rate. In sum, this manuscript describes how the use of QIV instead of TIV could have prevented influenza cases and subsequent complications that led to hospitalizations and deaths. This could have generated savings for the health system and society, offsetting part of the additional investment needed to switch from TIV to QIV.

Are the neglected tropical diseases under control in the tri-border region between Brazil, Argentina, and Paraguay?

INTRODUCTION: Implementation of prevention and control measures for communicable diseases in border regions can be challenging and lead to inefficient attempts to control them. We describe evidences on the strengths, weaknesses, opportunities and challenges regarding implementation of health interventions for control, prevention and treatment of selected neglected tropical diseases (NTD), a group of transmissible diseases typically prevalent in tropical countries and vulnerable populations, in the tri-border between Brazil, Argentina, and Paraguay. METHODOLOGY: A systematic literature review of observational and experimental studies was conducted, using PubMed and Bireme databases. Eligibility criteria were location (tri-border area) and subject (health interventions). RESULTS: Of a total of 595 references identified, 34 studies were included (18 pertaining to leishmaniasis, 11 to dengue, 2 to leprosy, 2 to soil-transmitted helminthiases and 1 to Chagas' disease), with an inclusion rate of 6.4%. The main strengths were the similarity of health interventions between countries and easiness of mobility and communication flows. The main weaknesses were access to rural areas and discrepancies in the number of studies between countries. As for opportunities, we identified increased tourism, economic development and recent increasing research in this field. The main challenges were the absence of studies regarding other prevalent NTD in the region and movement of goods, animals and people across borders. CONCLUSIONS: Although epidemiological studies are still needed to better understand and assess the prevalence of NTD in the area, mainly in Paraguay, these findings can inform decision-makers and health managers to plan a common strategy to address NTD.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Replicability of leptin associations with testosterone, estradiol, follicle-stimulating hormone, and luteinizing hormone in healthy Ache men of Paraguay: A multiple daily assessment.

OBJECTIVE: Associations between leptin and male reproductive hormone levels have been reported in men. However, few of these investigations have focused on associations in healthy men without obesity or overweight or nonindustrial societies. METHODS: We test hypotheses that leptin is associated with testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) within healthy Ache men, an indigenous nonindustrialized South American community using archived data. RESULTS: Archived data of serum FSH, LH, leptin, and salivary testosterone and estradiol levels collected from healthy Ache men (n = 17, mean age = 37.1 ± 14.2) on two separate days revealed leptin was correlated with FSH (D1 p = .07, D2 p = .009) and PM testosterone (TsalPM, D1 p = .05, D2 p = .05). However, controlling for age, associations with FSH were not significant. Mean comparisons and linear regression of values over 2 days resulted in leptin (t = 0.08, p = .94, r2  = .58, p = .0009), LH (t = 1.16, p = .26, r2  = .11, p = .27), FSH (U = 131.5, p = .88, r2  = .63, p = .0002), AM testosterone (TsalAM, t = 4.0, p = .001, r2  = .02, p = 0.75), and TsalPM (t = 2.99, p = .01, r2  = .56, p = .01). CONCLUSION: We conclude (a) FSH, TsalPM, and leptin levels within individual men are relatively invariant over a span of days; (b) despite small sample sizes, results suggest ecological and lifestyle variation can contribute to variation in leptin associations with male reproductive hormones.

Concepções de formadores de opinião sobre cidadania e direito à saúde na fronteira trinacional / Opinion leaders' conceptions about citizenship and the right to health on the trinational border

Resumo Pesquisa de abordagem qualitativa, que procurou compreender os sentidos atribuídos por formadores de opinião - trabalhadores da saúde coletiva, representantes de movimentos sociais, docentes universitários e jornalistas - acerca da cidadania, no âmbito da saúde, e de seu exercício na fronteira entre Brasil, Argentina e Paraguai. A coleta de dados se deu por meio de entrevista aberta a partir de duas perguntas norteadoras: O que é cidadania para você? O que ela representa em territórios de fronteira? Os resultados indicam que o exercício dos direitos fundamentais e sociais apresentam contradições próprias para quem vive em territórios fronteiriços, coexistem distintas concepções de cidadania e do seu exercício na fronteira e a noção de cidadania como atributo dos nacionais não é suficiente para a dinâmica que se estabelece nestes territórios. Conclui-se que a compreensão da fronteira como espaço de integração, e não de divisão, pode romper com a realidade edificada por uma subcidadania local, estreitando os laços humanitários e de solidariedade entre as comunidades fronteiriças, o que pode contribuir para a fruição dos direitos sociais nesta territorialidade, como o direito à saúde. Entende-se que formadores de opinião devem ser convocados ao debate visando à construção de uma agenda pública que discuta a edificação de uma cidadania internacional.

Abstract Research with a qualitative approach, which sought to understand the meanings attributed by opinion leaders - collective health workers, representatives of social movements, university professors and journalists - about citizenship, in the field of health, and its exercise on the border between Brazil, Argentina and Paraguay. Data collection took place through an open interview based on two guiding questions: What is citizenship for you? What does it represent in border territories? The results indicate that the exercise of fundamental and social rights has its own contradictions for those who live in border territories, different conceptions of citizenship and its exercise at the border coexist and the notion of citizenship as an attribute of nationals is not enough for the dynamics that are established in these territories. It is concluded that the understanding of the border as a space of integration, and not of division, can break with the reality built by a local sub-citizenship, strengthening humanitarian and solidarity ties between border communities, which can contribute to the enjoyment of rights in this territoriality, as the right to health. We understand that opinion leaders should be summoned to the debate with a view to building a public agenda that discusses the construction of international citizenship.

Hisopado endocervical en mujeres con síntomas de COVID-19 provenientes de departamentos del Paraguay / Endocervical swabbing in women with COVID-19 symptoms from departments of Paraguay

INTRODUCCIÓN: El COVID-19 es eminentemente una infección de transmisión e inicio respiratorio, se discute la existencia de otras fuentes de contagio. El receptor viral ACE2 también ha sido detectado en el útero y en la vagina; de allí se ha planteado el compromiso del virus SARS-CoV-2 sobre el sistema genitourinario y sus posibles repercusiones en el embarazo. OBJETIVO: Determinar la presencia de SARS-CoV-2 en muestras endocervicales de mujeres con COVID-19 en departamentos del Paraguay. PACIENTES Y MÉTODOS: Diseño observacional prospectivo, de corte transverso. Se reclutaron 200 mujeres desde agosto 2020 hasta febrero 2021, con no más de 48/72 h de un resultado previo positivo de hisopado nasofaríngeo para SARS-CoV-2 por retrotranscriptasa reversa-reacción en cadena de la polimerasa (en inglés rt-RT-PCR) y que aceptaron ingresar al estudio. Se llenó un cuestionario clínico epidemiológico. Las tomas de muestras se realizaron en servicios de salud del Ministerio de Salud Pública y Bienestar Social (MSP y BS), domicilios y albergues de los distintos departamentos de Paraguay. Cada paciente fue sometida a un hisopado con hisopos de dacron o citobrush endocervical para la detección de SARS-CoV-2 por rt RT-PCR. Resultados: Las mujeres estudiadas tenían una edad media de 46,5 años (IC 95% 31,5-62,5). Refirieron contagio comunitario con SARS-CoV-2 en 75,5%, 13,5% en el hogar, 8,5% en el lugar de trabajo y 1,5% en el extranjero. Las manifestaciones clínicas fueron: 30%, síndrome gripal, fiebre 22,5%, tos 20%, anosmia 15,5%, trastornos digestivos 15,5%, y otros se presentaron con menor frecuencia. Las muestras de hisopados o citobrush endocervical sometidas a rt-RT-PCR para la deteccción de SARS Cov-2, resultaron negativas en las 200 mujeres de estudio. Discusión: Cabe destacar que las muestras vaginales fueron tomadas dentro de las 24-72 h de haber obtenido un resultado positivo para SARS-CoV-2 en el hisopado nasofaríngeo y que 62,5% de las mujeres se encontraban internadas en módulos respiratorios. Se discute la razón de la negatividad de los exámenes y su trascendencia. CONCLUSIÓN: No se detectó infección con SARS-CoV-2 en la región endocervical de 200 mujeres con manifestaciones clínicas de COVID 19 y evaluadas dentro de las 48/72 h de un resultado positivo nasofaríngeo para SARS Cov-2. Los resultados en la población de estudio concuerdan con otros estudios reportados en la literatura científica.

BACKGROUND: COVID-19 is an eminently respiratory transmissible infection of respiratory initiation, the existence of other sources of contagion is discussed. The ACE2 viral receptor has also been detected in the uterus and vagina; Hence, the involvement of the SARS-CoV-2 virus on the genitourinary system and its possible repercussions on pregnancy has been raised. AIM: To determine the presence of SARS-CoV-2 in endocervical samples of women with COVID-19 in the departments of Paraguay. METHODS: Designed as a prospective observational of transverse cohort. Two hundred women were recruited from August 2020 to February 2021, with no more than 48/72 hours of a previous positive nasopharyngeal swab result for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (rt-RT-PCR) and who agreed to participate in the study. A clinical epidemiological questionnaire was completed. The samples were taken in health services of the MSPYBS (Public Ministry of Health and Social Welfare), homes and shelters in the different departments of Paraguay. Each patient underwent a swab (dacron swabs) or endocervical cytobrush for the detection of SARS-CoV-2 by rt-RT-PCR. RESULTS: Women recruited had a mean age of 46.5 years (95% CI 31,562.5). They reported contagion with SARS-CoV-2: 75.5% in the community, 13.5% at home, 8.5% in the place of work and 1.5% abroad. The clinical manifestations were: 30% flu syndrome, 22.5% fever, 20% cough, 15.5% anosmia, 15.5% digestive disorders, among other symptoms. The swabs or endocervical cytobrush samples subjected to rt-RT-PCR for the detection of SARS-CoV-2 were negative in the 200 study women. Discussion: It should be noted that the vaginal samples were taken within 24-72 hours after obtaining a positive result for SARS-CoV-2 in the nasopharyngeal swab and that 62.5% of the women were hospitalized in respiratory modules. The reason for the negativity of the exams and their significance are discussed. CONCLUSION: No SARS Cov-2 infection was detected in the endocervical region of 200 women with clinical manifestations of COVID 19 and evaluated within 48/72 hours of a positive nasopharyngeal result for SARS Cov-2. The results in the study population agree with the findings of other studies reported in the literature.

Informe anual 2020. La salud universal y la pandemia. Sistemas de salud resilientes. Paraguay

Establecida en 1902 como el organismo independiente especializado en salud del sistema interamericano, la Organización Panamericana de la Salud (OPS) ha desarrollado competencias y experiencia ampliamente reconocidas al brindar cooperación técnica a sus Estados Miembros para combatir las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, en su calidad de oficina regional de la Organización Mundial de la Salud, la OPS participa activamente en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible (ODS) a nivel de país. En este informe anual se presenta la cooperación técnica de la OPS a nivel de país en el 2020, mediante la aplicación de la estrategia de cooperación con el país, la respuesta a las necesidades y prioridades nacionales, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la Organización y los ODS. En consonancia con el tema general de "la salud universal y la pandemia: sistemas de salud resilientes", se pone de relieve la respuesta de la OPS a la pandemia de COVID-19, así como sus esfuerzos continuos en esferas prioritarias como las enfermedades transmisibles, las enfermedades no transmisibles, la salud mental, la salud a lo largo del curso de vida y las emergencias de salud. También se presenta un resumen financiero del ejercicio examinado.

Revisiting the dengue epidemic of 2011 in Paraguay: molecular epidemiology of dengue virus in the Asuncion metropolitan area.

BACKGROUND: Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen. METHODS: This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis. RESULTS: Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. CONCLUSIONS: We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.