Abstract The provision of services for comprehensive healthcare requires the involvement of various professionals with specific competencies to provide the best possible care to the population. The inclusion of nutritionists at different levels of the healthcare system is crucial to ensure comprehensive care at various stages of life. An unequal distribution of nutritionists across healthcare levels can lead to fragmented care and missed opportunities to address nutrition-related issues. Therefore, a study was conducted with the aim of describing the distribution of nutritionists in healthcare facilities according to the level of care and evaluating compliance with the human resources recommendations established by the technical standard of Nutrition and Dietetics UPSS. A descriptive and cross-sectional study was conducted using the analysis of secondary sources. Human resources data from SUSALUD for the year 2022 were used. The Technical Standard of UPSS of Nutrition and Dietetics was considered to assess compliance with human resources recommendations. Among the main findings, it was identified that 7.93% of first-level healthcare facilities have at least one nutritionist. In the second level of care, 96.35% of healthcare facilities do not comply with the human resources recommendations of the technical standard, and no third-level healthcare facility met this recommendation. The distribution of nutritionists across various levels of care in the Peruvian healthcare system is unequal. It is necessary to improve human resources planning in the Peruvian healthcare system to ensure comprehensive healthcare for the population..

Resumen La prestación de servicios para la atención integral de la salud requiere la participación de diversos profesionales con competencias específicas para brindar la mejor atención posible a la población. La inclusión del nutricionista en los diferentes niveles del sistema de salud es crucial para garantizar una atención integral en las diversas etapas de la vida. Una distribución inequitativa de nutricionistas en los niveles de atención puede conducir a una fragmentación de la atención y la pérdida de oportunidades para abordar los problemas relacionados con la alimentación y nutrición. Por ello, se desarrolló un estudio con el objetivo de describir la distribución de nutricionistas en los establecimientos de salud según el nivel de atención, y evaluar el cumplimiento de las recomendaciones de recursos humanos establecidas por la norma técnica de las UPSS de Nutrición y Dietética. Se desarrolló un estudio descriptivo y transversal, mediante el análisis de fuentes secundarias. Se utilizaron los datos de recursos humanos por IPRESS de SUSALUD, del año 2022. Se consideró la Norma técnica de UPSS de Nutrición y Dietética para evaluar el cumplimiento de las recomendaciones de recursos humanos. Entre los principales resultados, se identificó que el 7.93% de los establecimientos de salud del primer nivel de atención tienen al menos un nutricionista. En el segundo nivel de atención, el 96.35% de los establecimientos de salud no cumplen con las recomendaciones de recursos humanos de la norma técnica, y ningún establecimiento del tercer nivel de atención cumplió esta recomendación. La distribución de nutricionistas en los diversos niveles de atención del sistema de salud peruano es desigual. Es necesario mejorar la planificación de recursos humanos en el sistema de salud peruano para garantizar una atención integral de la salud a la población.

ABSTRACT The effect of including whey in the diet of rams in the fattening stage of the company SAIS Pachacutec S.A.C, located in the central mountains of Peru at an altitude of 4119 m was evaluated. In total, 120 five-month-old Corriedale male rams from the «Cabaña» (n=40), «Plantel» (n=40) and «Majada» (n=40) genetic sections were used. Rams from each section was randomly distributed into four treatment groups (n=10 per group): T1 (0%, control); T2 (15%); T3 (25%) and T4 (35% whey). The whey was added to the concentrate (bran feed). The study included 14 days of adaptation to the feed and 90 days of trial. Final weight, weight gain and carcass weight were significantly different between treatments and sections (p<0.05), being greater in T4 and in the Cabaña section (final weight: 48.7 ± 0.6 kg; weight gain: 379.4 g/day; carcass weight: 20.9 ± 1.2 kg). Carcass yield was similar between groups (43.0 ± 0.01%; p>0.05). The results suggest that, with a greater amount of whey, within of the quantities used in the study, better fattening performances of rams are obtained.

RESUMEN Se evaluó el efecto de incluir suero de leche en la dieta de carneros en la etapa de engorde de la empresa SAIS Pachacutec S.A.C, ubicada en la sierra central del Perú a una altitud de 4119 m. Se utilizaron 120 carnerillos machos Corriedale de cinco meses de edad pertenecientes a las secciones de cabaña (n=40), plantel (n=40) y majada (n=40). Cada sección fue dividida aleatoriamente en cuatro grupos (n=10 por grupo) de tratamiento: T1 (0%, testigo); T2 (15%); T3 (25%) y T4 (35% de suero de leche). El suero de leche fue adicionado al concentrado (afrechillo). Se consideraron 14 días de adaptación al alimento y 90 días de ensayo. El peso final, la ganancia de peso y el peso de carcasa fue significativamente diferente entre tratamientos y entre secciones (p<0.05), siendo mayor en T4 y en la sección Cabaña (peso final: 48.7 ± 0.6 kg; ganancia de peso: 379.4 g/día; peso de carcasa: 20.9 ± 1.2 kg). El rendimiento de carcasa fue similar entre grupos (43.0 ± 0.01%; p>0.05). Los resultados sugieren que, con una mayor cantidad de suero de leche, dentro de las cantidades empleadas en el estudio, se obtienen mejores rendimientos de engorde de carnerillos.

Resumen El objetivo fue determinar la DL50 y RC50 e inducir variación morfológica en la variedad de jamaica UAN-8 mediante rayos gamma para seleccionar plantas mutantes de interés agronómico en la generación M2. Las dosis de radiación utilizadas fueron: 0, 100, 200, 300, 400, 500, 600, 700, 800, 900 y 1 000 Gy. Los experimentos se realizaron bajo condiciones de invernadero y campo en Río Grande, Villa de Tututepec, Oaxaca, durante el año 2018. Se utilizó el diseño experimental bloques al azar con cuatro repeticiones. En M1, se evaluó la emergencia de plántula, supervivencia, altura y porcentaje de plantas con semilla. En M2, se registró la variación morfológica y se seleccionaron plantas mutantes. Los datos de supervivencia y altura de planta se analizaron mediante una regresión no lineal para determinar la dosis letal y reductiva media (DL50 y RC50). La DL50 y RC50 se encontró a 395.48 y 453.2 Gy, respectivamente. Las semillas M2 de dicha variedad produjeron plantas con variabilidad morfológica en dosis desde 100 hasta 300 Gy. De estas plantas fue posible identificar seis genotipos mutantes promisorios. El genotipo identificado como S7 L13 presentó características morfológicas deseables como mayor número de cálices rojo por planta y pubescencia ausente o muy débil, comparado con las plantas del genotipo parental.

Abstract The objective was to determine the LD50 and RC50 and induce morphological variation in the roselle variety UAN-8 by gamma rays to select mutant plants of agronomic interest in the M2 generation. The radiation doses used were: 0, 100, 200, 300, 400, 500, 600, 700, 800, 900 and 1 000 Gy. The experiments were conducted under greenhouse and field conditions in Río Grande, Villa de Tututepec, Oaxaca, in 2018. The experimental design used was randomized blocks with four repetitions. In M1, seedling emergence, survival, height and percentage of plants were evaluated. In M2, morphological variation was recorded, and mutant plants were selected. Plant survival and height data were analyzed using nonlinear regression to determine the median lethal and reductive doses (LD50 and RC50). The LD50 and RC50 were found at 395.48 and 453.2 Gy, respectively. The M2 seeds of this variety produced plants with morphological variability in doses from 100 to 300 Gy. From these plants, it was possible to identify six promising mutant genotypes. The genotype identified as S7 L13 presented desirable morphological characteristics such as a higher number of red calyces per plant and absent or very weak pubescence, compared to the plants of the parental genotype.

Abstract Objectives: The objective of the study was to verify whether (FFM), maturity status (MS) and chronological age (CA) are determinants of physical fitness performance, and to analyze FFM and physical performance aligned by CA and MS in children and adolescents. Methods: A descriptive correlational study was carried out in 863 schoolchildren. Weight, height, and waist circumference (WC) were evaluated. Body mass index (BMI), FFM, fat mass (FM), MS (Age at peak height velocity, APHV) were calculated. The physical tests of velocity 20 m, agility 5 m × 10rep, and horizontal jump (HJ) were evaluated. Results: The APHV was estimated in boys at 14.0 ± 0.36APHV and in girls at 11.96 ± 0.49APHV. The relationships between CA and APHV with FFM was r = 0.80 in boys and r = 0.44 to 0.45 in girls. The relationships between FFM and physical tests in boys were [HJ (r = 0.70), agility 5m × 10rep (r = -0.68), velocity (r = -0.61)] and in girls [HJ (r = 0.42), agility 5m × 10rep (r = -0.52), velocity (r = -0.20)]. The differences in FFM and physical fitness tests were more pronounced when aligned by APHV than by CA. Conclusion: It was verified that both FFM, CA, and APHV are determinants of physical fitness performance. In addition, the APHV should be introduced in physical education as a means of ranking physical performance among schoolchildren.

Resumen Introducción: El tromboembolismo pulmonar es una complicación reportada en la población adulta con COVID-19; sin embargo, en la población pediátrica, su descripción es limitada. Caso clínico: Se reporta el caso de un varón de 15 años con antecedente de obesidad y síndrome de Down que fue hospitalizado por neumonía COVID-19 severa. En el séptimo día de hospitalización presentó dolor torácico, hemoptisis, dificultad respiratoria y elevación del dímero D. En la angiotomografía pulmonar se encontró un extenso trombo en la arteria lobar inferior derecha. Recibió tratamiento con enoxaparina y rivaroxabán evolucionando favorablemente. La resolución al mes de tratamiento fue existosa, ya que el control tomográfico no evidenció más el trombo. Conclusiones: El tromboembolismo pulmonar es una complicación poco reportada en niños con neumonía COVID-19. El diagnóstico oportuno y tratamiento anticoagulante es importante para evitar complicaciones mortales.

Abstract Background: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda. Case report: We report the case of a 15-year-old male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. Conclusions: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.

ABSTRACT Objective Published studies have shown associations between anti-ribosomal P (anti-P) antibody and systemic lupus erythematosus with hepatic manifestations. This has been reported also in autoimmune hepatitis. However, the consistency of the latter association remains controversial. This study aimed to evaluate the frequency of anti-P antibodies in autoimmune hepatitis using two different immunoassays. Methods One-hundred and seventy-seven patients with autoimmune hepatitis were screened, and 142 were analyzed for anti-P antibody positivity. The samples were first analyzed using two different immunoassays: enzyme-linked immunosorbent assay (ELISA) and chemiluminescence and then compared with a group of 60 patients with systemic lupus erythematous. The positive samples were subjected to western blot analysis. Results Anti-P was found in 5/142 autoimmune hepatitis cases (3.5%) by chemiluminescence and in none by ELISA. Among the five chemiluminescence-positive autoimmune hepatitis samples, on anti-P western blot analysis one was negative, two were weakly positive, and two were positive. In contrast, anti-P was detected in 10/60 patients with systemic lupus erythematosus (16.7%) and presented higher chemiluminescence units than the autoimmune hepatitis samples. Conclusion A low frequency of anti-P antibodies was observed in autoimmune hepatitis, suggesting that this test is not useful for the diagnosis or management of this disease.

Abstract Objective To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. Materials and Methods A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). Results During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0–4 versus median: 3; [IQR]: 2–4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750–2,000 mL versus 1,500 mL [IQR]: 1,200–1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). Conclusion Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.

Resumo Este artigo examina a difusão de um modelo recente de governança urbana neoliberal que gerenciaria processos de urbanização neoliberal nas cidades de Lima e Callao, considerando o contexto de preparação para sediar os XVIII Jogos Pan-Americanos de Lima 2019. O artigo procura mostrar como megaeventos são utilizados como instrumentos de produção espacial, por meio de coalizões de líderes carismáticos do setor privado e de interesses imobiliários, com a intenção de transformar a cidade através da mobilização do patriotismo e do consenso. Argumenta-se que o Estado promove a urbanização neoliberal através de Parcerias Público-Privadas (PPPs).

Abstract This article examines the diffusion of a recent model of neoliberal urban governance that would manage neoliberal urbanization processes in the cities of Lima and Callao, considering the context of preparation to host the XVIII Pan American Games in Lima, in 2019. The article aims to show how mega events are used as spatial production instruments, through coalitions of charismatic private sector leaders and real estate interests, with the intention of transforming the city through the mobilization of patriotism and consensus. It is argued that the state promotes neoliberal urbanization through Public-Private Partnerships (PPPs).

Resumo Fundamento A esquistossomose é uma doença tropical negligenciada que pode levar a complicações cardiovasculares. No entanto, o envolvimento cardiovascular na esquistossomose ainda precisa ser totalmente elucidado, devido ao número limitado de casos e ausência de evidência confiável, uma vez que a doença ocorre tipicamente em locais sem infraestrutura adequada para uma coleta de dados robusta. Objetivo Esta revisão sistemática teve como objetivo avaliar as implicações cardiovasculares da esquistossomose, incluindo no diagnóstico e tratamento, e propor um algoritmo para rastrear as manifestações cardiovasculares. Métodos Foi realizada uma revisão sistemática nos bancos de dados MEDLINE/PubMed e LILACS, com busca por artigos sobre o comprometimento cardiovascular na esquistossomose. Resultados Trinta e três artigos foram considerados para esta revisão: seis artigos de revisão, uma revisão sistemática, um ensaio clínico, 14 estudos observacionais, sete relatos de casos, e quatro séries de casos. O comprometimento cardiovascular inclui um amplo espectro de condições clínicas, tais como isquemia do miocárdio, disfunção ventricular, miocardite, hipertensão arterial pulmonar, e pericardite. Conclusões As complicações cardíacas da esquistossomose podem causar incapacidade em longo prazo e morte. O monitoramento clínico, exame físico, eletrocardiograma precoce, e ecocardiograma devem ser considerados como medidas chave para detectar o envolvimento cardiovascular. Dada a ausência de um tratamento eficaz das complicações, são necessários saneamento e educação nas áreas endêmicas para a eliminação desse problema de saúde mundial.

Abstract Background Schistosomiasis is a Neglected Tropical Disease which may lead to cardiovascular (CV) complications. However, the CV involvement in schistosomiasis has yet to be fully elucidated due to the limited number of cases and lack of reliable evidence, as schistosomiasis typically occurs in locations without adequate infrastructure for robust data collection. Objective This systematic review aims to assess cardiovascular implications of schistosomiasis, including in the diagnosis and treatment, and propose an algorithm for screening of CV manifestations. Methods A systematic review was performed in the MEDLINE/PubMed and LILACS databases of articles on the CV involvement in schistosomiasis. Results Thirty-three records were considered for this review: six review articles, one systematic review, one clinical trial, 14 observational studies, seven case reports, and four cases series. CV involvement includes a wide spectrum of clinical conditions, such as myocardial ischemia, ventricular dysfunction, myocarditis, pulmonary arterial hypertension, and pericarditis. Conclusions Cardiac complications of schistosomiasis may cause long-term disability and death. Clinical monitoring, physical examination, early electrocardiogram, and echocardiogram should be considered as key measures to detect CV involvement. Due to the lack of effective treatment of complications, sanitation and education in endemic areas are necessary for the elimination of this global health problem.

Abstract Introduction: To ensure a good medical preparation and reduce the risk of mistakes, different methods and techniques for the development of clinical practice are used; cardiac examination skills decrease along the time. For this purpose simulation is implemented on the teaching process, and the impact of it on performance of cardiac auscultation should be assessed. Objective: We aimed to compare 4th-year med students’ performance and diagnostic accuracy during the cardiac examination, before and after training. Method: The sample comprised forty-six 4th year med students randomized into two groups. One group was trained with cardiac simulators and the other with patients exclusively. We assessed their ability to perform a cardiac examination and the diagnostic accuracy by using a standardized assessment checklist for a cardiac examination and then performed a statistic test to compare both groups’ performance. Results: There was a difference between both groups’ initial scores of 2 decimals (7.1 and 7.3 on a 0-10 scale). After training, we found that the patients’ trained group had an average score of 8.6 while the simulators trained group had an average score of 8.8 and higher diagnosis accuracy. Conclusions: Clinical simulation and patient training are two different ways of achieving the same goal. There are many reports that claim simulation is best to train medical students, but in this report, we did not observe a statistical difference among them. This is not however, a disadvantage. Clinical simulation offers better learning experience, shown as a tendency in the scores and better diagnostic accuracy. The lack of significant difference between the simulator/patient groups can be explained by a small sample size.

Resumen Introducción: Para asegurar una buena preparación médica y reducir el riesgo de errores, se utilizan diferentes métodos y técnicas para el desarrollo de la práctica clínica. Las habilidades de exploración cardiaca disminuyen con el tiempo, por lo cual se ha implementado la simulación en el proceso de enseñanza y debe evaluarse su impacto en el rendimiento de la auscultación cardiaca. Objetivo: Nuestro objetivo fue comparar el rendimiento y la precisión diagnóstica de los estudiantes de medicina de cuarto año durante el examen cardiaco, antes y después del entrenamiento. Método: La muestra estuvo compuesta por cuarenta y cinco estudiantes de medicina de cuarto año asignados al azar en dos grupos. Un grupo se entrenó con simuladores cardiacos y el otro exclusivamente con pacientes. En las diferentes pruebas, evaluamos su capacidad para realizar un examen cardiaco y la precisión del diagnóstico mediante el uso de una lista de verificación de evaluación estandarizada para un examen cardiaco. Luego realizamos una prueba estadística para comparar el desempeño de ambos grupos. Resultados: Hubo una diferencia entre las puntuaciones iniciales de ambos grupos de 2 decimales (7.1 y 7.3 en una escala de 0 a 10). Después del entrenamiento, encontramos que el grupo entrenado de pacientes tenía una puntuación media de 8.6, mientras que el grupo entrenado con simuladores tenía una puntuación media de 8.8 y una precisión diagnóstica más alta. Conclusiones: La simulación clínica y el entrenamiento del paciente son dos formas diferentes de lograr el mismo objetivo. Hay muchos informes de que la simulación de reclamos es mejor para capacitar a los estudiantes de medicina, pero en este informe no observamos una diferencia estadística entre ellos. Sin embargo, esto no es una desventaja. La simulación clínica ofrece una mejor experiencia de aprendizaje, que se muestra como una tendencia en los puntajes y una mejor precisión diagnóstica. La falta de diferencia significativa entre los grupos de simulador/pacientes puede explicarse por un tamaño de muestra pequeño.

Abstract: Objective: Describe the prevalence of breast cancer (BC)-associated germline pathogenic variants (PVs) among Mexican patients with triple-negative BC (TNBC). Materials and methods: The spectrum of PVs identified among patients with TNBC who were enrolled in a prospective registry and underwent genetic testing was analyzed. Results: Of 387 patients with invasive TNBC and a median age at diagnosis of 39 years (range 21-72), 113 (29%) were carriers of PVs in BC-susceptibility genes: BRCA1 (79%), BRCA2 (15%), and other (6%: ATM, BRIP1, PALB2, PTEN, RAD51C, and TP53). PV carriers were younger at BC diagnosis (37 vs. 40 years, p=0.004) than non-carriers. Conclusion: A large proportion of TNBC in Mexican patients is associated with germline PVs, the vast majority in BRCA. The incremental yield of PVs in other BC-susceptibility genes was modest, and a stepwise approach starting with BRCA testing may be justified if it is more cost-effective than multigene panel testing.

Resumen: Objetivo: Describir la prevalencia de variantes patógenas (VPs) germinales en genes asociados con cáncer de mama (CM) en pacientes mexicanos con CM triple negativo (CMTN). Material y métodos: Se analizó el espectro de VPs identificadas en pacientes con CMTN que fueron incluidos prospectivamente en un registro y se realizó un estudio genético. Resultados: Se analizó un total de 387 pacientes con una mediana de edad al diagnóstico de 39 años; 113 (29%) eran portadores de VPs en genes de susceptibilidad a CM: BRCA1 (79%), BRCA2(15%), y otros (6%: ATM, BRIP1, PALB2, PTEN, RAD51C y TP53). Los portadores de VPs eran más jóvenes al diagnóstico de CM (37 vs. 40 años, p=0.004). Conclusiones: Existe una alta prevalencia de VPs en pacientes mexicanos con CMTN y la mayoría se encuentra en genes BRCA. La realización de pruebas genéticas se puede optimizar mediante la adopción de un proceso escalonado para la detección de VPs.

Abstract The production of lactic acid from agroindustry waste products, such as whey, heavily relies on microorganisms within the genusLactobacillus. In this work, a genome-scale metabolic model was implemented from Vinay-Lara (iLca334_548), improved adding some enzymatic reactions and used to analyse metabolic fluxes ofLacticaseibacillus paracasei, which is aLactobacillusstrain isolated from whey used in the large-scale production of lactic acid. Overall, the highest rate of lactic acid productivity was 2.9 g l−1h−1, which equates to a dilution rate of 0.125 h−1, when continuous culture conditions were established. Restrictions on lactic acid production caused by exchange reactions, complex culture medium and intracellular metabolite concentrations were considered and included in the model. In total, theiLca334_548 model consisted of 1046 reactions and 959 metabolites, and flow balance analysis better predicted lactate flux than biomass. The distribution of fluxes exhibited an increase in lactate formation as biomass decreased. This finding is supported by the reactions carried out by glyceraldehyde 3-phosphate dehydrogenase, pyruvate formate lyase and ribose-5-phosphate isomerase, corroborating the modelled phenotype with experimental data. In conclusion, there is potential for the improvement of lactate production in a complex media by amino acid catabolism, especially when lactate is derived from pyruvate.

Resumo O artigo objetivou analisar conhecimentos, percepções, práticas de cuidado e Itinerrários Terapêuticos (IT) para o diagnóstico e tratamento das Infecções Sexualmente Transmissíveis (IST), com destaque para sífilis, entre Travestis e Mulheres Trans (TrMT) em Salvador, Brasil. Foram realizados 05 grupos focais e 06 entrevistas semiestruturadas com 30 TrMT. Os achados apontam amplo desconhecimento e percepções contraditórias sobre as IST, especialmente a sífilis; identificação de duas importantes trajetórias de cuidado às IST e o destaque para IT marcados por estigmas e discriminação nos serviços de saúde. Sugere-se a ampliação das ações de saúde para essa população reconhecendo suas necessidades e a construção de novas estratégias de prevenção e tratamento para IST, dialogadas com as TrMT, e garantia de autonomia, ética e sigilo na produção do cuidado.

Abstract The article aimed to analyze knowledge, perceptions, care practices and Therapeutic Itineraries (TI) for the diagnosis and treatment of Sexually Transmitted Diseases (STD), with emphasis on syphilis, among travesti and transgender women (TGW) in Salvador, Brazil. 05 focus groups and 06 semi-structured interviews with travesti/TGW were carried out with a total of 30 participants. The findings point to a wide lack of knowledge and contradictory perceptions about STD, especially syphilis; identification of two important trajectories of care for STD and the emphasis on TI marked by stigma and discrimination in health services. The expansion of health actions for this population is suggested, recognizing their needs and the construction of new prevention and treatment strategies for STD, in dialogue with the travesti/TGW, and guaranteeing autonomy, ethics and confidentiality in the production of care.

Resumen El artículo tuvo como objetivo analizar conocimientos, percepciones, prácticas de atención y Rutas Terapêuticas (RT) para el diagnóstico y tratamiento de las Enfermedades de Transmisión Sexual (ETS), con énfasis en la sífilis, entre las travestidas y mujeres trans (TrMT) en Salvador, Brasil. Se realizaron 05 grupos focales y 06 entrevistas semiestructuradas con 30 TrMT. Los hallazgos apuntan a una amplia falta de conocimiento y percepciones contradictorias sobre las ETS, especialmente la sífilis; identificación de dos importantes trayectorias de atención a las ETS y el énfasis en las RT marcadas por el estigma y la discriminación en los servicios de salud. Se sugiere ampliar las acciones de salud para esta población, reconociendo sus necesidades y la construcción de nuevas estrategias de prevención y tratamiento de las ETS, en diálogo con el TrMT, y garantizando la autonomía, ética y confidencialidad en la producción de cuidados.

RESUMEN La quema de biomasa (BB, por sus siglas en inglés) es una actividad común en los países en desarrollo e identificada como una grave amenaza de contaminación del aire. El presente trabajo evalúa por primera vez la calidad del aire de la ciudad más grande de las extensas llanuras colombianas (250.000 km2), a partir de mediciones durante tres años consecutivos (2017-2020). Aunque durante la mayor parte del año la calidad del aire en Villavicencio es buena en términos de PM10 y O3, durante la estación seca (de febrero a abril) los niveles de contaminación de ambos contaminantes superan los límites recomendados por la Organización Mundial de la Salud. La combinación del chorro de bajo nivel del Orinoco (OLLJ, por sus siglas en inglés) con las emisiones de BB de los llanos venezolanos y colombianos se identificó como la principal causa de los episodios de mala calidad del aire observados durante la estación seca en ésta ciudad. Se identificó el carbono orgánico derivado de un reanálisis como el componente principal de las altas concentraciones de PM10 durante la estación seca. Sin embargo, también se encontró que el polvo mineral y las partículas de sal marina juegan un papel importante en la mala calidad del aire observada en Villavicencio y probablemente a lo largo de la Cuenca del Río Orinoco. Finalmente se encontró que, entre noviembre y marzo, el OLLJ es un mecanismo eficiente para el transporte de contaminantes atmosféricos desde el Océano Atlántico y las llanuras de la Cuenca del Río Orinoco en Venezuela y Colombia hacia las regiones del sur de Colombia, y en ocasiones llegando a Ecuador.

ABSTRACT Biomass burning (BB) is a common activity in developing countries and has been identified as a serious air pollution threat. The present work for the first time evaluates the air quality of the largest town in the extensive Colombian savannas (250,000 km2), from measurements over three consecutive years (2017-2020). Although the air quality in Villavicencio is good in terms of PM10 and O3 for most of the year, pollution levels for both pollutants exceed the World Health Organization recommended limits during the dry season (February to April). The combination of the Orinoco low-level jet (OLLJ) and BB emissions from the Venezuelan and the Colombian savannas was identified as the main cause of poor air quality episodes during the dry season in this city. Organic carbon derived from reanalysis was identified as the main component of the high PM10 concentrations during the dry season. However, mineral dust and sea salt particles were also found to play an important role in the poor air quality observed in Villavicencio and likely along the Orinoco river basin region. Finally, between November and March, the OLLJ was found to be an efficient mechanism for the transport of air pollutants from the Atlantic Ocean and the savanna regions in the Orinoco River Basin in Venezuela and Colombia towards southern regions of Colombia, and in some cases even reaching Ecuador.

ABSTRACT This study conducted among transgender women in São Paulo, Brazil assessed the acceptability and suitability of screening sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, by sampling multiple anatomical sites (i.e. urethral, anorectal, oropharyngeal, and neovaginal), and utilizing self- or provider-collection methods. First, a convenience sample of 23 cohort participants were recruited during a scheduled study visit between October and November 2018. Data collection was through a short investigator-led quantitative survey in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams to guide self-sampling. Three supplemental focus group discussions (FGDs) with a total of 30 participants guided by semi-structured script were conducted in Portuguese between September and October 2019. All participants reported being assigned male sex at birth and self-identified with a feminine gender identity at time of study. All survey respondents (100%; n = 23) indicated willingness to provide samples for STI screening during a future study visit. Preference was for self-collection of urine samples (83%; n = 19), urethral swabs (82%; n = 18), and anorectal swabs (77%; n = 17). A lower preference for self-collection of oropharyngeal swabs (48%; n = 11) was observed. Most respondents (78%; n = 18) indicated that they would not prefer specimens to be collected by a health professional, mainly due to ‘more privacy’ (72%; n = 13). All respondents indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. In FGDs, although the collection by a health professional was described as a technically safer option for some participants, there was a preference for self-collection to avoid discomfort and embarrassment in exposing the body. Overall, this sub-study suggested acceptability among transgender women of introducing self-sampling for etiological diagnosis of STIs from potential infection sites. Uptake and usability will be explored further in a cross-sectional STI prevalence study of transgender women in Brazil.