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Tannins are phenolic compounds that provide benefits to ruminants due to their protein-binding affinities and antioxidant properties. However, tannins may also have negative orosensorial and postingestive effects that decrease feed intake. This study explored how lambs trade off the ingestion of crude protein (CP) with the ingestion of potentially beneficial and toxic condensed and hydrolyzable tannins, and the ensuing impacts on diet digestibility, animal performance, and blood parameters. Thirty-two lambs were housed in individual pens for 8 wk and had access to 2 isoenergetic diets that varied in the concentration of CP (High-high in protein [HP] or Low-least preferred [LP]) and the presence of a mix of condensed and hydrolyzable tannins (4% DM). Animals were assigned to 4 treatment groups (N = 8 lambs/group) and received a simultaneous offer of: HP and LP (Control); HP and LP + tannins (HP - LP+); HP+ tannins and LP (HP + LP-); and both HP and LP with tannins (HP + LP+). All lambs preferred HP over LP and they avoided tannins in the diets (P < 0.001). Dry matter and CP intake were the lowest in HP + LP- (P < 0.0001), and DMD did not differ between Control and the other groups (P > 0.05), but it was greater for HP - LP + (P < 0.0001). CP digestibility was greater for groups without tannins in HP (P < 0.0001), but average daily gain (ADG) did not differ among treatments (P > 0.05). No differences between Control and HP + LP + were found in plasma antioxidant activity, total phenolic concentration, or haptoglobin concentration (P > 0.05). Intake of tannins was HP + LP+ > HP + LP- > HP - LP + (P < 0.0001), and fecal excretion of nitrogen (N) was HP + LP+ > HP - LP+ = HP + LP- > Control (P < 0.05). In addition, intake of tannins with both diets reduced blood urea nitrogen (BUN) concentration relative to Control (P < 0.05), thus suggesting a shift in the partitioning of N excretion from urine to feces. In summary, lambs prioritized the selection of HP over LP, regardless of the presence of a tannin extract in either or both diets. Nevertheless, lambs modulated their tannin consumption as a function of the specific diet where the tannin extract was added, with increasing levels of intake as tannins were present in just LP, then in just HP, and finally in both diets. Dietary tannins did not constrain ADG and resulted in a shift in the partitioning of N excretion from urine to feces. Such shifts have been found to result in reduced production of environmental pollutants such as ammonia, nitrous oxide, and nitrates.

Tannins are plant chemicals that can provide benefits to ruminants due to their antioxidant activity and positive effects on nutrient uptake. However, tannins could also promote negative (i.e., toxic) effects on herbivores. This study explored how lambs build their diets when offered between 2 diets that varied in protein concentration (low or high), both with and without tannins (4%) and the ensuing consequences on diet digestibility, animal performance, and some blood parameters indicative of antioxidant activity and inflammation. All lambs preferred the high-over the low-protein diet, regardless of the inclusion of tannins in the diets. Digestibility of dry matter did not differ between lambs that had diet choices with or without tannins, and body weight gains were not different across all treatments. No differences were found among dietary treatment groups in blood antioxidant activity or indicators of inflammation. Tannin intake promoted a shift in the fate of nitrogen excretion from urine to feces, suggesting reductions in environmental pollutants such as ammonia, nitrous oxide, and nitrates. Thus, tannins did not promote negative impacts on animal performance with potential concomitant beneficial effects on the environment.

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OBJECTIVES: To assess the Quality of Life (QoL) of participants treated with dental bleaching using different techniques by administering two questionnaires Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), as well as the bleaching efficacy and tooth sensitivity (TS). MATERIALS AND METHODS: Secondary results for nine randomized clinical trials were included, involving 489 participants who underwent bleaching procedures. The questionnaires were applied at baseline and 30-day post-bleaching. Bleaching efficacy (ΔSGU/ΔEab) and TS were also evaluated (VAS/NRS). The effect of bleaching on aesthetic self-perception was evaluated using the Paired t-test. The Kruskal-Wallis test assessed variations by technique. Also, the correlations between questionnaires and outcomes was evaluated (α = 0.05). RESULTS: After the bleaching treatment, both questionnaire revealed significant differences compared to the baseline, regardless of the factor evaluated (p < 0.05), except for Physical pain in OHIP-14 (p = 0.53). No correlation was found between OHIP-14 and bleaching efficacy (p < 0.008). A significant correlation was found between bleaching efficacy and dental self-confidence, indicating that dental self-confidence increased as the number of SGU (ΔSGU) increased, while social impact (ΔEab) and aesthetic concern (ΔSGU) decreased. Additionally, a significant correlation was observed between TS and OHIP-14 (Physical pain). For PIDAC, both dental self-confidence and psychological impact were correlated with TS in the VAS. CONCLUSION: Subjects who underwent dental bleaching treatment improved their self-perception and dental self-confidence. Dental bleaching, besides enhancing the patient's smile, also improves their self-esteem. CLINICAL RELEVANCE: Dental bleaching, besides improving the patient's smile, also enhances their self-esteem.

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Humulus lupulus, or hops, is a vital ingredient in brewing, contributing bitterness, flavor, and aroma. The female plants produce strobiles rich in essential oils and acids, along with bioactive compounds like polyphenols, humulene, and myrcene, which offer health benefits. This study examined the aromatic profiles of five hop varieties grown in Brazil versus their countries of origin. Fifty grams of pelletized hops from each strain were collected and analyzed using HS-SPME/GC-MS to identify volatile compounds, followed by statistical analysis with PLS-DA and ANOVA. The study identified 330 volatile compounds and found significant aromatic differences among hops from different regions. For instance, H. Mittelfrüher grown in Brazil has a fruity and herbaceous profile, while the German-grown variety is more herbal and spicy. Similar variations were noted in the Magnum, Nugget, Saaz, and Sorachi Ace varieties. The findings underscore the impact of terroir on hop aromatic profiles, with Brazilian-grown hops displaying distinct profiles compared to their counterparts from their countries of origin, including variations in aromatic notes and α-acid content.

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Introduction: Health workers are exposed to a wide variety of risks in their workplaces, including psychosocial risks, which are increasingly taking on special importance, with primary health care being little studied in this area, despite having taken great responsibilities in the COVID-19 pandemic. Objectives: To analyze the relationship between psychosocial risks and quality of life in health team workers in Family Health Centers Antofagasta, Chile, in 2021, in the context of the COVID-19 pandemic. Methods: This was a quantitative study, analytical, descriptive, cross-sectional type with 78 workers from the Primary Care health team of three Family Health Centers in the city of Antofagasta. The Superintendência de Seguridad Social/Instituto Sindical de Trabajo, Ambiente y Salud 21 brief version and the World Health Organization Quality of Life instrument-Abbreviated version instrument were applied. Results: The presence of a globally high psychosocial risk stands out, being this classified as high risk/level 1. The professional groups with the highest risks were nursing technicians and nurses; regarding quality of life, the dimension with the lowest score was psychological health, with a mean of 73.6. Conclusions: A negative relationship between psychosocial risks in the workplace and workers' quality of life was evidenced In this hostile scenario, it is imperative that nurses, at a tactical and strategic level, promote workers' health, cultivate healthy work environments, promote labor relations, and exercise more empathetic leadership as care managers.

Introducción: Los trabajadores de la salud están expuestos a una gran variedad de riesgos en sus lugares de trabajos, incluyendo los riesgos psicosociales, que cada vez toman una especial importancia, siendo la atención primaria de la salud pobremente abordada en esta área, pese a que haya asumido grandes responsabilidades en la pandemia por COVID-19. Objetivos: Analizar la relación de los riesgos psicosociales y la calidad de vida en trabajadores del equipo de salud en Centros de Salud Familiar de Antofagasta, Chile, en 2021, en el contexto de la pandemia por COVID-19. Métodos: Se trata de un estudio de tipo cuantitativo, analítico, descriptivo, de corte transversal, con 78 trabajadores del equipo de salud de Atención Primaria de tres Centros de Salud Familiar de la ciudad de Antofagasta. Se aplicaron los instrumentos Superintendencia de Seguridad Social/Instituto Sindical de Trabajo, Ambiente y Salud 21 version breve y World Health Organization Quality of Life instrument-Abbreviated version. Resultados: Se destaca la presencia de un riesgo psicosocial elevado de manera global, siendo este clasificado como riesgo alto/nivel 1. Los estamentos con mayores riesgos fueron los técnicos de enfermería y enfermería; en lo referente a la calidad de vida, la dimension con menor puntaje fue la salud psicológica, con media de 73,6. Conclusiones: Se evidenció una relación negativa entre riesgos psicosociales en el lugar de trabajo y calidad de vida de los trabajadores. Ante este escenario hostil, se hace perentorio que los enfermeros, a nivel táctico y estratégico, promuevan la salud de los trabajadores, cultiven ambientes laborales saludables, favorezcan las relaciones laborales y ejerzan un liderazgo más empático como gestores del cuidado.

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OBJECTIVES: This study investigated altmetrics, citations, and field-normalized impact of dental articles reporting randomized clinical trials (RCTs) published within a one-year period. METHODS: Data were collected in 2024 from PubMed-indexed RCTs published in 2019. Dependent variables included Altmetric Attention Scores (AAS), PlumX citations, and Field-Weighted Citation Impact (FWCI). Independent variables encompassed article-, author-, and journal-related variables. Adjusted quasi-Poisson regression models were used to assess associations. Point-biserial correlation evaluated the relationship between Journal Impact Factor (JIF) and selected reporting variables. RESULTS: A total of 653 RCTs were included, with periodontology, implantology, and oral and maxillofacial surgery comprising 50.4 % of the sample. Only 28.6 % of the articles reported CONSORT use, 49.6 % pre-registered their protocol, and 68.8 % reported a sample size calculation. Most articles (63.6 %) reported no conflicts of interest, with unclear sponsorship being the most frequent (34.6 %). Regression analyses revealed significant associations for AAS, PlumX citations, and FWCI with various factors. JIF increased AAS by 17 % per unit, PlumX citations by 13 %, and FWCI by 6 %. Protocol pre-registration boosted AAS by 132 %, while mixed or no sponsorship increased PlumX citations by up to 47 %. First author H-index increased PlumX citations and FWCI by 1 % per unit, while first author continent impacted AAS, citations, and FWCI. Weak positive correlations between JIF and both protocol pre-registration and CONSORT use were observed. No significant differences were observed across different dental fields for any metric. CONCLUSION: An interplay among article-, author-, and journal-related variables collectively influenced the online attention, citations, and impact of dental RCT articles. CLINICAL SIGNIFICANCE: Understanding the factors that influence the visibility and impact of dental RCTs can guide researchers in improving the design, reporting, and dissemination of their studies, ultimately enhancing the quality and reach of dental research.

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Karate athletes strategically use lower-limb techniques in combat, with the roundhouse kick (mawashi geri) being highly effective in kumite. To quickly improve the technical performance before training or competitions, conditioning activities (CAs) are often utilized. Recently, Whole-Body Vibration (WBV) has emerged as a potential conditioning activity (CA). This study aimed to analyze the acute effects of WBV as a CA on the performance of the mawashi geri. The sample included sixteen male karate athletes. The study had a familiarization and two experimental sessions: one with WBV and the other without (NWBV), conducted randomly and counterbalanced, each preceded and followed by a mawashi geri assessment on a force platform. During the CA intervention, the participants performed four sets of isometric half-squats on a vibration platform at a frequency of 26 Hz and an amplitude of 4 mm in the WBV condition, while the platform was off in the NWBV condition. A significant reduction in the mawashi geri attack phase time was observed under the WBV condition [pre: 0.31 ± 0.03 s; post: 0.30 ± 0.03 s] compared to the NWBV condition [pre: 0.31 ± 0.04 s; post: 0.32 ± 0.03 s] (p = 0.02). However, no differences were noted regarding the impact force or other kinetic variables between the conditions. Therefore, WBV did not increase the performance of the kinetic and kinematic variables of the mawashi geri in karate athletes, but it is possible that there is a positive effect on attack time, suggesting that further studies with different vibration protocol configurations would be beneficial.

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Understanding the behavior of cyanide in rivers is of utmost importance as it has a direct impact on the health of people who depend on these water sources. Cyanide contamination from gold mining activities poses a significant environmental threat to river ecosystems, particularly in southern Ecuador. This study aimed to investigate the behavior of cyanide when it enters contact with other metals in these rivers. Simulations were conducted to determine the speciation of cyanide, mercury, arsenic, lead, and manganese in a study area, taking into account the water temperature and pH at four locations. The findings revealed that CN-and HCN(aq) species were present in the research area. Additionally, mercury-cyanide (Hg(CN)2(aq), Hg(CN)3-), and manganese-cyanide (MnCN+) complexes were identified 3 km downriver from the site where the mining activity is higher. These metal-cyanide complexes tend to dissociate quickly under weak acidic conditions, making them hazardous to the environment. This research is crucial, not only for the environment but also for human health, as it allows to predict toxicity risks for people supplied with this water source, emphasizing the potential harm to human health. This study highlights the importance of stringent regulations and effective monitoring practices to mitigate cyanide contamination and safeguard environmental and occupational health.

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Soybean is an economically important crop for animal and human nutrition. Currently, there is a lack of information on the effects of Trichoderma harzianum and Purpureocillum lilacinum on INTACTA RR PRO transgenic soybean plants. The present study evaluated the application of T. harzianum and P. lilacinum under field conditions. The results revealed a significant increase in soybean yield at 423 kg ha-1 in response to the application of P. lilacinum compared with the control treatment. In addition, the application of P. lilacinum promoted a significant increase in phosphorus levels in the plant leaves, and there were significant correlations between the increase in taxon abundance for the genus Erwinia and productivity and the average phosphorus and nitrogen content for the plant leaves, for the taxon Bacillus and nitrogen content and productivity, and for the taxon Sphingomonas and nitrogen content. The Bradyrhizobium taxon was identified in the P. lilacinum treatment as a taxon linking two different networks of taxa and is an important taxon in the microbiota. The results show that the application of the fungus P. lilacinum can increase the productivity of soybean INTACTA RR PRO and that this increase in productivity may be a function of the modulation of the microbiota composition of the plant leaves by the P. lilacinum effect.

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Seawater desalination is one of the most feasible technologies for producing fresh water to address the water scarcity scenario worldwide. However, environmental concerns about the potential impact of brine discharge on marine ecosystems hinder or delay the development of desalination projects. In addition, scientific knowledge is lacking about the impact of brine discharges on the South America Pacific coast where desalination, is being developed. This paper presents the first monitoring results of brine discharge influence areas from seawater reverse osmosis desalination plants (SWRO) on the South America Pacific coast, using Chile as case study. Our results indicate that the combination of favorable oceanographic conditions and diffusers, results in the rapid dilution of brine discharge on coastal ecosystems; showing a faster dilution than other SWRO plants in other regions, such as Mediterranean or Arabian Gulf, with similar production characteristics. Also, the increase in salinity over the natural salinity in the brine-discharge-affected area was <5 % in a radius of <100 m from the discharge points. Further, according to the published literature and on our monitoring results, we propose a number of considerations (environmental regulation, best scientifically tested measures, environmental requirements) to achieve a long-term sustainable desalination operation.

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Palm oil, derived from Elaeis guineensis, is a critical component of the global edible oil and industrial fat market. This review provides a comprehensive overview of the sustainability of the palm oil chain, focusing on industrial applications, environmental implications, and economic sustainability. The processing of palm oil, from fruit pulp to refined oil, is detailed, highlighting the importance of refining in maintaining quality and extending application ranges. While palm oil offers health benefits because of its rich fatty acid composition and antioxidant properties, its production poses significant environmental challenges. This review underscores ongoing efforts to balance technological and culinary demands with environmental stewardship and sustainable economic growth. Emerging trends, including interspecific hybrids such as E. guineensis and E. oleifera, are discussed for their potential to increase sustainability and productivity.

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Xyleborus beetles, a diverse group of ambrosia beetles, present challenges to forestry and agriculture due to their damaging burrowing behavior and symbiotic relationships with fungi. This review synthesizes current knowledge on the biology, ecology, and management of Xyleborus. We explore the beetles' life cycle, reproductive strategies, habitat preferences, and feeding habits, emphasizing their ecological and economic impacts. Control and management strategies, including preventive measures, chemical and biological control, and integrated pest management (IPM), are critically evaluated. Recent advances in molecular genetics and behavioral studies offer insights into genetic diversity, population structure, and host selection mechanisms. Despite progress, managing Xyleborus effectively remains challenging. This review identifies future research needs and highlights innovative control methods, such as biopesticides and pheromone-based trapping systems.

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Wastewater generated in dairies has a strong polluting potential and must be treated for disposal into water bodies or reuse. The objective of this work was to analyze the efficiency of removing pollutants through the processes used by a wastewater treatment plant (WWTP) of a dairy located in the state of Minas Gerais, Brazil. For this purpose, the results of the characterization analyses referring to raw and treated wastewater were interpreted. The results showed that the sequence of processes used in the WWTP (water/oil separation, dissolved air flotation, followed by biodegradation in an upflow anaerobic filter) is efficient in removing on average 99.1% of COD and 98.7% of BOD5. For treated wastewater, data on pH and concentration of total suspended solids, total ammoniacal nitrogen, surfactants, settleable solids, and oils and greases also met the standards for disposal into water bodies. For reuse in agriculture, treated wastewater can be used for irrigation, but it is recommended to additionally evaluate the Escherichia coli parameter. When evaluating the existence of linear correlation between COD and BOD5 data, it was possible to find only a moderate correlation (R2 equal to 0.7) for treated wastewater.

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Current international infant and young child (IYC) feeding recommendations consider nutrition and health but not environmental impacts. Only a handful of countries have dietary guidelines that provide quantitative recommendations for food groups of environmental concern. This study aimed to perform a narrative review of the environmental impacts of commercial milk formula compared with breastfeeding and to analyze the degree to which current country-specific IYC feeding recommendations are aligned with sustainable dietary targets. A mixed-methods review was conducted, including the following: 1) a narrative review of the environmental impact of commercial milk formula compared with breastfeeding and 2) a comparison of recommended intake of meats and dairy for children IYC based on country-specific dietary guidelines compared with the EAT-Lancet Commission dietary targets (ELCT) for children 24 mo or older and adults and if the ELCT should be adjusted for the energy needs of IYC. Formula feeding has a greater environmental impact (∼48% higher carbon footprint) than exclusive breastfeeding. Available country-specific dietary guidelines for meat and dairy products in children IYC are, in general, at or below the upper limits of the ELCT recommended ranges for older children and adults but are in most cases above the upper limit when adjusting for the energy needs of IYC. Exclusive breastfeeding should be protected and promoted not only as the healthier but also as the most sustainable alternative. Available complementary dietary feeding recommendations of nonprocessed meat and dairy fall below current ELCT for older children and adults. Given that IYC require a more nutrient-dense diet than older children and adults and considering the small quantities they consume, we recommend using the unadjusted ELCT as reference for IYC feeding while specific international consumption recommendations are developed for this age group.

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We compared the effects of lambda-cyhalothrin as the pure active ingredient and as a formulated product (Zero®), on the larval stage of the autochthonous species Boana pulchella. We evaluated ecotoxicological endpoints, behavioral and developmental alterations, and the biochemical detoxifying, neurotoxic, and oxidative stress responses, covering a wide concentration range from environmental to high application levels. Both pyrethroid preparations displayed similar ecotoxicity (median lethal concentration of ~0.5 mg/L), with the lethal effect of Zero® being more pronounced than that of the active ingredient. Sublethal behavioral alterations in natatory activity were observed at 1000 times lower concentrations, indicating the ecological hazard of tadpole exposure to this pyrethroid at environmentally relevant concentrations. Biochemical endpoints in B. pulchella larvae showed significant responses to lambda-cyhalothrin in the ng/L range; these responses were different for the pure or the formulated product, and they were variable at higher concentrations. Principal components analysis confirmed the prevalence of biochemical responses as early endpoints at the lowest lambda-cyhalothrin concentrations; the Integrated Biomarker Response Index proportionally increased with pyrethroid concentration in a similar way for the pure and the formulated products. We conclude that lambda-cyhalothrin is of concern from an environmental perspective, with particular emphasis on autochthonous anuran development. The battery of biochemical biomarkers included in our study showed a consistent integrated biomarker response, indicating that this is a potent tool for monitoring impacts on amphibians. Environ Toxicol Chem 2024;43:2134-2144. © 2024 SETAC.

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Due to their broad-spectrum antimicrobial action and ease of synthesis, silver nanoparticles (AgNP) are one of the most widely used nanomaterials in different industrial and ecological areas. AgNP are released into marine ecosystems, nevertheless, their ecotoxicological effects have been overlooked. In this study, we evaluated the toxic effects of biogenic and synthesized AgNP (AgNPIBCLP11 and AgNPSINT) on sea urchin Echinometra lucunter embryos and compared them with the metal precursor silver nitrate (AgNO3). Fertilized eggs were exposed to five concentrations of the test compounds and a negative control for 48 h under controlled conditions. The IC50-48 h of AgNPIBCLP11, AgNPSINT and AgNO3 were 0.31, 4.095, and 0.01 µg L-1, evidencing that both AgNP are less toxic than AgNO3, and that AgNPSINT is less toxic than the AgNPIBCLP11. Toxicity to E. lucunter embryos could be explained by the fact that Ag affects DNA replication and induces the formation of pores in the cellular wall, leading to apoptosis.

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Dysbiosis and acclimatization are two starkly opposing outcomes of altered holobiont associations in response to environmental pollution. This study assesses whether shifts in microbial taxonomic composition and functional profiles of the cosmopolitan sponge Hymeniacidon perlevis indicate dysbiotic or acclimatized responses to water pollution. To do so, sponge and water samples were collected in a semi-enclosed environment (San Antonio Bay, Patagonia, Argentina) from variably polluted sites (i.e., eutrophication, heavy metal contamination). We found significant differences in the microbiome of H. perlevis with respect to the pollution history of the sites. Several indicators suggested that acclimatization, rather than dysbiosis, explained the microbiome response to higher pollution: 1) the distinction of the sponge microbiome from the water microbiome; 2) low similarity between the sponge and water microbiomes at the most polluted site; 3) the change in microbiome composition between sponges from the different sites; 4) a high similarity in the microbiome among sponge individuals within sites; 5) a similar ratio of common sponge microbes to opportunistic microbes between sponges at the most and least polluted sites; and 6) a distinctive functional profile of the sponge microbiome at the most polluted site. This profile indicated a more expansive metabolic repertoire, including the degradation of pollutants and the biosynthesis of secondary metabolites, suggesting a relevant role of these microbial communities in the adaptation of the holobiont to organic pollution. Our results shed light on the rearrangement of the H. perlevis microbiome that could allow it to successfully colonize sites with high anthropogenic impact while resisting dysbiosis.

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Background: Due to the copious disposal of plastics, marine ecosystems receive a large part of this waste. Microplastics (MPs) are solid particles smaller than 5 millimeters in size. Among the plastic polymers, polystyrene (PS) is one of the most commonly used and discarded. Due to its density being greater than that of water, it accumulates in marine sediments, potentially affecting benthic communities. This study investigated the ingestion of MP and their effect on the meiofauna community of a sandy beach. Meiofauna are an important trophic link between the basal and higher trophic levels of sedimentary food webs and may therefore be substantially involved in trophic transfer of MP and their associated compounds. Methods: We incubated microcosms without addition of MP (controls) and treatments contaminated with PS MP (1-µm) in marine sediments at three nominal concentrations (103, 105, 107particles/mL), for nine days, and sampled for meiofauna with collections every three days. At each sampling time, meiofauna were collected, quantified and identified to higher-taxon level, and ingestion of MP was quantified under an epifluorescence microscope. Results: Except for Tardigrada, all meiofauna taxa (Nematoda, turbellarians, Copepoda, Nauplii, Acari and Gastrotricha) ingested MP. Absorption was strongly dose dependent, being highest at 107 particles/mL, very low at 105 particles/mL and non-demonstrable at 103 particles/mL. Nematodes accumulated MP mainly in the intestine; MP abundance in the intestine increased with increasing incubation time. The total meiofauna density and species richness were significantly lower at the lowest MP concentration, while at the highest concentration these parameters were very similar to the control. In contrast, Shannon-Wiener diversity and evenness were greater in treatments with low MP concentration. However, these results should be interpreted with caution because of the low meiofauna abundances at the lower two MP concentrations. Conclusion: At the highest MP concentration, abundance, taxonomic diversity and community structure of a beach meiofauna community were not significantly affected, suggesting that MP effects on meiofauna are at most subtle. However, lower MP concentrations did cause substantial declines in abundance and diversity, in line with previous studies at the population and community level. While we can only speculate on the underlying mechanism(s) of this counterintuitive response, results suggest that further research is needed to better understand MP effects on marine benthic communities.

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This article describes the evolving landscape of medical education in the wake of the COVID-19 pandemic, emphasizing the renewed importance of public health, mental well-being, and career choices among medical students. The pandemic has prompted a significant shift in medical student's career aspirations, highlighting the need for mental health support mechanisms within the medical education framework. Medical students' career choices are influenced directly and indirectly by the challenges and experiences of the pandemic era, which are discussed in this article under four key themes: traditional values, global health interests and disparities, developing trends, and digital healthcare. There is an urgent need to adjust medical training to the new reality and share the future directions of the medical education landscape by embracing diverse career paths in medicine, integrating technology into medical training, adapting to the changing context of medicine, and strengthening collaboration and communication. The pandemic underscores the importance of evidence-based patient care, necessitating the preparation of tomorrow's doctors to address the emerging healthcare challenges with resilience, adaptability, and a comprehensive understanding of both local and global health challenges.

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BACKGROUND: The appearance of the new coronavirus, SARS-CoV-2, in Wuhan - China, in 2019 led to the declaration of a COVID-19 pandemic by the World Health Organization. Peru confirmed its first case on March 6, 2020, prompting a significant change in medical care. PURPOSE: Our objective was to determine the impact of the COVID-19 pandemic on cancer treatment in Peru. METHODS: A retrospective analysis of hospital data from the National Institute of Neoplastic Diseases revealed substantial decreases in oncological treatments in 2020 compared to 2019. RESULTS: Oncological treatments involving bone marrow transplantation had a greater impact between the months of April and September, at -100% (p=0.003). However, treatments involving surgery in April (-95% [p≤0.001]), radiotherapy in May (-76% [p=0.002]) and chemotherapy in June (-71% [p≤0.001]) also showed significant impacts. Comparative analysis with international data revealed similar trends in cancer care interruptions in different countries. However, variations in the magnitude of the impact were observed, influenced by regional health policies and the severity of the pandemic. CONCLUSIONS: The findings underscore the challenges cancer care providers face during public health crises, requiring adaptive strategies to ensure continued access to essential treatments. Addressing these challenges requires comprehensive public health responses to mitigate the impact of future crises on cancer care systems.

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