LA GESTIÓN DEL CAMBIO EN LA ATENCIÓN MÉDICA TRADICIONAL: LA TELEMEDICINA COMO NUEVO ENFOQUE DE LA ATENCIÓN MÉDICA AL PACIENTE EN HONDURAS

El objetivo del artículo es investigar sobre el uso de la telemedicina en Honduras. Para ello, se aplicó un instrumento de consulta y una entrevista, identificando los siguientes hallazgos: inexistencia de marco jurídico y de plataforma de registro único en salud interoperable, existencia de una marcada brecha digital; además, la participación del Gobierno y el Colegio Médico de Honduras como actores claves. Concluyendo en la necesidad de un marco jurídico, sistema único de salud y la reducción de brecha digital

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

The Wine Effects in Tourism Studies: Mapping the Research Referents

This research provides an empirical overview of articles and authors referring to research on wine tourism, analyzed from 2000 to 2021, and what they contribute to deepening the Sustainable Development Goals (SDGs) 8. The articles were examined through a bibliometric approach based on data from 199 records stored in the Web of Science (JCR), applying traditional bibliometric laws, and using VOSviewer for data processing and metadata. The results highlight an exponential increase in scientific production without interruptions between 2005 and 2020, with a concentration in only 35 highly cited authors, where the hegemony is held by Australia, among the co-authorship networks of worldwide relevance. The main topics observed in the literature are local development through wine tourism, sustainability and nature conservation, and strategies for sustainable development. Finally, there are six articles with great worldwide influence in wine tourism studies that maintain in their entirety the contribution made by researchers affiliated with Australian universities