Evaluación de Viabilidad para la Implementación de Sistemas Híbridos Renovables para el Acceso a la Energía en la Región Amazónica

A Região Amazônica é caracterizada por ter uma floresta densa e heterogênea, rios caudalosos e extensos, os quais dificultam o acesso à energia elétrica, por este motivo, faz parte do Sistema Isolado (SI). O SI é composto por sistemas de menor porte não-conectadosnão conectados ao Sistema Interligado Nacional (SIN), os quais os custos de interligações são inviáveis. No cenário atual, as fontes de energia renováveis estão atraindo um grande número de pesquisadores devido à crescente escassez de combustíveis fósseis. Uma das alternativas que vêm sendo estudadas para facilitar o fornecimento de energia nessas localidades, é a utilização de sistemas híbridos renováveis de energia (SH). Dessa forma, o presente estudo visa avaliar o potencial de SH renováveis na Região Amazônica. Para isso, foi elaborado um quadro comparativo dos tipos de energia renovável com potencial de uso nos SH e uma Matriz SWOT por meio de uma revisão bibliográfica. A partir da análise desenvolvida, notou-se que há uma quantidade significativa de pontos positivos que combinadas a políticas governamentais de incentivos fiscais e de crédito podem viabilizar a implantação de híbridos de energia renovável.The Amazon Region is characterized by having a dense and heterogeneous forest, large and extensive rivers, which the access to electricity is difficult, for this reason, is insered in the Isolated System (SI). The SI is composed by smaller systems not connected to the National Interconnected System (SIN), which the costs of interconnections are not feasible. In the current scenario, renewable energy sources are attracting a large number of researchers due to the growing scarcity of fossil fuels. One of the alternatives that have been studied to facilitate the supply of energy in these localities is the use of hybrid renewable energy systems (SH). Thus, the present study aims to evaluate the potential of renewable SH in the Amazon Region. For this, a comparative table of the types of renewable energy with potential use in SH and a SWOT Matrix was elaborated through a bibliographic review. From the analysis developed, it was noticed that there are a significant number of positive points that combined with governmental incentive policies of tax and credit can make feasible the implementation of hybrids of renewable energy.La región del Amazonas se caracteriza por tener un bosque denso y heterogéneo, ríos grandes y extensos, que dificultan el acceso a la energia eléctrica, por esta razón, es parte del Sistema Aislado (SI). El SI está compuesto por sistemas más pequeños no conectados que no están conectados al Sistema Interconectado Nacional (SIN), cuyos costos de interconexiones no son factibles. En el escenario actual, las fuentes de energía renovables están atrayendo a un gran número de investigadores debido a la creciente escasez de combustibles fósiles. Una de las alternativas que se han estudiado para facilitar el suministro de energía en estas localidades es el uso de sistemas híbridos de energía renovable (SH). Por lo tanto, el presente estudio tiene como objetivo evaluar el potencial de SH renovables en la Región Amazónica. Para este propósito, se elaboró una tabla comparativa de los tipos de energía renovable con uso potencial en SH y una matriz SWOT a través de una revisión bibliográfica. A partir del análisis desarrollado, se observó que hay una cantidad significativa de puntos positivos que, combinadas con las políticas de incentivos fiscales y crediticios del gobierno, pueden hacer posible la implementación de híbridos de energía renovable

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Extensively Drug-Resistant Typhoid Fever in Pakistan

The spread of extensively drug-resistant typhoid should be an alarming sign that the world is slowly moving towards a pre-antibiotic era because of widespread overuse of antibiotics. This has become a serious concern in developing nations such as Pakistan, where antimicrobial surveillance is poor and in urgent need of strengthening. Both governmental and non-governmental organisations in Pakistan need to actively promote vaccination campaigns and healthy hygiene habits and discourage irrational use of antibiotics to prevent the mortality and morbidity associated with increasing antibiotic resistance in pathogens

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally