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The objective of the article was to investigate the possible inducing factors that contributed to determine the frequency of social conflicts at the subnational level in Peru between 2016 and 2021, including income inequality, social exclusion, fiscal centralism, corruption and revocation of authorities, for which four regression models were built. Disaggregated official data from the 24 departments and the provinces of Lima and Callao were analyzed. Economic inequality was associated with the Gini coefficient. To establish the association between social conflict and the inducers, it was estimated using Spearman's Rho correlation coefficient. Statistical calculation was also employed to appreciate the collinearity between the inducers. The results showed that the revocation of subnational authorities determines 42.5% of social conflict. On the other hand, corruption and fiscal centralism determine 28.5% of the perception of suffering social exclusion. Inequality and social conflict determined 21.8% of the relevance of the execution and quality of public spending by the national government in the regions. Sixty percent of social conflicts in Peru are of an environmental nature. The population that has declared the greatest discrimination corresponds to Puno (28%). 55.6% of those surveyed consider corruption to be one of the country's main problems. Corruption and social exclusion have a negative impact on the effectiveness of economic results and promote social conflicts. Inefficient use of fiscal resources translates into low quality of services and diminished credibility of the national and subnational governments. This situation highlights the need to design public policies that reduce conflicts and promote adequate governance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lauracio Ticona, Coyla Zela, Ramos Rojas, Morales Rocha, Serruto Medina and Vargas Torres.)

In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to evaluate the effectiveness and safety of the TAK-003 tetravalent dengue vaccine in this context. A systematic review of randomized controlled trials comparing the effectiveness and safety of the vaccine with placebo in the general population was conducted. The search was carried out in Epistemonikos, and two researchers independently assessed the studies. Risk of bias was evaluated using the Cochrane Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was assessed using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the dengue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine's safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.

Political doctrines determine the formation of territorial units or geopolitical models more adequate to generate public value in subnational organizations, with positive results in the HDI, productivity indicators and national competitiveness oriented to improve the quality of public service for citizens who participate in democratic electoral processes with identity and that promote a decentralized State that does not generate development obstacles as an effect of geographical limits by departments and regional governments with inequalities in natural resources and comparative advantages, but that projects integration, better economic performance, sustainability, and sustainability for regional and national development and as an alternative to achieve political stability in Peru. The aim of this article is to explore whether the contribution of natural regions and macro-regions to sustainable development is unequal. Information from official web pages. The disparity index, analysis of variance (ANOVA) and Tukey's analysis were used. The GDP per capita of the coastal departments is 64% higher than that of the Andes and 136% higher than those of the Amazon; the HDI of the coast exceeds those regions by 31 and 19%; 44% of the urban population residing in marginal neighborhoods are on the coast, 67% in the Andes and 69% in the Amazon. The percentage of corruption is highest on the coast, followed by the Amazon. At the regional macro level, the primacy in GDP per capita and the HDI moves to the south, although the superiority of the corruption index persists in the center, followed by the south; both significantly higher than the east and north. This fact would reveal the possibility of a regional macro development without Lima and through axes of various development nodes, feasible in the era of globalization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Coyla Zela, Morales Rocha, Lauracio Ticona, Ramos Rojas, Arroyo Japura and Vargas Torres.)

Human intoxication by long-acting anticoagulant rodenticides, known as superwarfarins, causes coagulopathy that is difficult to manage. We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, evolving with epistaxis, INR of 11.6, and needing hospitalization. For seven days, serial controls of coagulation tests were carried out, with optimization of different doses of Vitamin K supplementation. The case highlights this type of anticoagulant's potency and prolonged half-life (approximately six weeks), which requires regular clinical control and satisfactory treatment adherence.