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Since 2012-2013 influenza season, World Health Organization (who) recommends the formulation of tetravalent vaccines. Globally, many countries already use tetravalent vaccines in their national immunization programs, while in Latin America only a small number. Two Influenza b lineages co-circulate, their epidemiological behavior is unpredictable. On average they represent 22.6% of influenza cases and more than 50% in predominant seasons. The lack of concordance between recommended and circulating strains was 25 and 32% in the 2010-2017 and 2000-2013 seasons, respectively. There are no clinical differences between influenza A and B. It occurs more frequently from five to 19 years of age. Influenza b has a higher proportion of attributable deaths than influenza a (1.1 vs. 0.4%), or 2.65 (95% ci 1.18-5.94). A greater number of hospitalizations when the strains mismatch (46.3 vs. 28.5%; p

Resumen Introducción: Centroamérica experimenta una alta carga de la enfermedad por dengue aportando cerca de 8% de todos los casos del continente. Este trabajo reporta la epidemiología del dengue en la subregión en un período de 10 años. Objetivos: Documentar la epidemiología del dengue en Centro América y República Dominicana. Material y Métodos: Período de estudio: años 2005-2014. Se recopilaron y analizaron los datos de casos y muertes por dengue de los países de Centro América y República Dominicana, reportados por los Ministerios de Salud y se corroboró con los datos publicados en los boletines en línea y la base de datos interactiva de la Organización Panamericana de la Salud (OPS). Se obtuvieron estadísticas poblacionales de los Institutos Nacionales de Estadística y Censo de cada país. Resultados: Durante el período de estudio fueron notificados 1.118.464 casos de dengue. Reportados 32.431 casos graves, 888 personas fallecidas. La letalidad por caso de dengue fue en promedio 0,08%. Los cuatro serotipos de dengue circularon durante el decenio estudiado. Discusión: La información clínica y epidemiológica, indica tasas de incidencia alta, que han fluctuado en los últimos años, con co-circulación significativa de varios serotipos a la vez. Conclusiones: Se identificaron diferencias notorias en la recolección de datos de la vigilancia entre países. Se determinó un patrón epidemiológico heterogéneo. Background: Central America experiences a high burden of dengue reporting about 8% of all cases in the continent. This work reports the epidemiology of dengue in the sub region in a 10 years period. Aim: To describe the epidemiology of dengue in Central America and the Dominican Republic. Methods: Study period from 2005 to 2014. The data on dengue cases and deaths of the countries of Central America and the Dominican Republic, reported by the Ministries of Health, were compiled and analyzed and corroborated with the data published in the online bulletins and the interactive database of the Pan American Health Organization (PAHO). Population statistics were obtained from the National Statistics and Census Institutes of each country. Results: During the study period, 1,118,464 cases of dengue were notified. There were 32,431 serious cases reported, 888 people died. The lethality per case of dengue was on average 0.08%. The four dengue serotypes circulated during the decade analyzed. Discussion: Clinical and epidemiological information indicates high incidence rates, which have fluctuated in recent years, with significant co-circulation of several serotypes at the same time. Conclusions: Notorious surveillance data collection differences were identified between countries, determining a heterologous epidemiological pattern.

Resumen La neutropenia febril es una condición que puede amenazar la vida y que requiere de atención inmediata, particularmente en pacientes en que la misma está asociada a tratamientos con quimioterapia. Estos pacientes tienen un riesgo mucho mayor de desarrollar enfermedades bacterianas, y en ellos, la fiebre puede ser el único indicador de enfermedad bacteriana grave. El manejo adecuado de la neutropenia febril da énfasis en la identificación pronta de los pacientes, estratificación del riesgo y antibioterapia iniciada durante los primeros 60 min del ingreso al servicio de emergencias. No todos los niños con neutropenia febril conllevan el mismo riesgo de morbi-mortalidad, por lo que en los últimos años se han hecho esfuerzos para distinguir entre pacientes de alto riesgo en quienes se recomienda el manejo hospitalario más agresivo. En pacientes que se clasifican como de bajo riesgo se puede considerar el manejo ambulatorio inicial o después de 72 h, mientras que en aquellos de alto riesgo se recomienda hospitalizar y manejar con antimicrobianos parenterales. Febrile neutropenia is a life-threatening condition that requires immediate attention, especially in patients with chemotherapy-related neutropenia. Patients with febrile neutropenia have a much greater risk of developing bacterial disease, and fever may be the only indicator of severe bacterial infection. Adequate management of febrile neutropenia emphasizes early recognition of patients, risk stratification, and antibiotic therapy administration during the first 60 minutes of admission to an emergency room. Not all children with febrile neutropenia carry the same risk of morbidity and mortality, so in recent years, efforts have been made to distinguish between high-risk patients where more aggressive hospital management is required. In children classified as low-risk, outpatient management may be considered initially or after 72 hours, whilst high-risk patients should be hospitalized and managed with parenteral antibiotics.

As a small nation with high biodiversity and an extensive system of protected areas, Costa Rica will face particular challenges regarding food security over the next few years. Thus, whatever development model the country chooses, it must achieve a compromise between conservation and production (agricultural, energy and so on). Although the country’s malnutrition levels are below 5%, socioeconomic asymmetries - which have been increasing in recent years - put a growing proportion of the population at risk. Costa Rica also has a high disaster risk (due to volcanism, seismicity and climatic events), which is likely to be increased by climate change. Moreover, the country’s population is aging and growing very little in absolute numbers, which is also reflected in the predominance of farmers growing older. It is important to mention that the country relies heavily on food imports, mainly of basic grains, to cover the needs of its population. Food production uses a large amount of imported seed and propagating material, which are often not suited to local conditions, as well as very intensive use of agrochemicals, with negative consequences for health and the environment. Over the next few years, it will be crucial to maintain solid public higher-education and research structures in the agricultural field. Although there is no shortage of water in the country in general, water is unevenly distributed at certain times and between regions. Another important challenge is that overweight and obesity show an increasing and alarming upward trend. A comprehensive approach considering many actors and positions is required to ensure food and nutrition in Costa Rica over the next fifty years. To this end and to be consistent with a long tradition that has earned the country recognition, the government should continue with its policies to conserve protected areas and biodiversity. At the same time, it should increase productivity and yields in land with a clear agricultural vocation. This is important for reducing dependence on imported food in order to meet the basic needs of the country’s inhabitants. In order to achieve broad access to sufficient nutritious food, it is essential to reduce the gaps in the population’s socioeconomic conditions. Production systems should be more environmentally friendly by reducing the use of agrochemicals, and making more and better use of soil, and integrated pest, water resources, waste and residue-management practices. It will also be important to encourage, where possible, the use of local species or those adapted to local conditions, some of which are little known and underutilized, which are important for the diet beyond caloric intake (as a source of micronutrients, vitamins and functional compounds). This requires considering the enormous biodiversity present in the country and encouraging genetic improvement in order to reduce dependence on imported seed and propagation materials, since these were often developed for other climatic and edaphic conditions, as well as different productive systems. It is essential to achieve greater differentiation of products that follow certain quality standards in terms of production, marketing and nutritional value over the next few years, and for this to provide some form of competitive advantage. Prevention and mitigation measures must be taken against disasters that can be caused by specific events (hurricanes, volcanoes, earthquakes, etc.) or climate change. It will be important to continue the construction and maintenance of water collection, storage and supply works to reduce water shortages in particular areas and at specific times. Agricultural activity must be made attractive so that young people choose to remain in the countryside rather than migrating to cities. State funding for research on priority issues for the country must be increased, and incentives created so that the private sector also becomes interested in supporting research. It is also necessary to continue promoting high-level human resource training, preferably at top universities abroad, to promote agricultural research. Likewise, technical and vocational education must be promoted with the participation of various institutions (such as the Instituto Nacional de Aprendizaje, technical and vocational colleges and dual education). The country must consider a wide range of options for agricultural production with a view toward ensuring food and nutrition for its inhabitants. This framework must consider all the (bio)technological options, provided they do not conflict with the environment and health. It is also essential to continue and intensify programs that seek to promote healthy eating habits and encourage physical activity among the population. UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Agroalimentarias::Centro para Investigaciones en Granos y Semillas (CIGRAS) UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Agroalimentarias::Instituto de Investigaciones Agrícolas (IIA)

Las infecciones nosocomiales son una causa significativa de morbimortalidad principalmente a nivel de las Unidades de Cuidado Intensivo Neonatal (UCIN). Diferentes instrumentos pueden resultar contaminados por patógenos; entré ellos el estetoscopio adquiere gran relevancia al ser de uso generalizado y actuar como fomite en la expansión de todo, tipo de patógenos. A pesar de la recomendación de limpiar los estetoscopios antes de usarlos con cada paciente esta no es una práctica generalizada. Objetivo: Detectar el porcentaje de estetoscopios contaminados con bacterias y cuantificar la reducción de esta contaminación de acuerdo al uso de diferentes sustancias antisépticas. Evaluar la práctica de limpieza utilizada por los usuarios de estetoscopios en el Hospital Nacional de Niños (HNN) Métodos: Se obtuvieron dos cultivos del diafragma de 112 estetoscopios de uso general y de uso exclusivo para cada paciente de la UCIN. Un primer cultivó se realizó basalmente al estetoscopio y se repitió luego de su limpieza con una de estas tres sustancias: alcohol, agua y jabón o agua. Se interrogó a la población sobre la frecuencia de limpieza de su estetoscopio y de la información recibida con respecto a los estetoscopios. Resultados: El 78% de los primeros cultivos realizados fue positivo por algún germen. El 80% de los estetoscopios de los médicos estaba contaminado. Luego de la limpieza del instrumento, sólo el 15% de los cultivos control fue positivo (p