Auditoria implementada en el servicio de emergencia en un hospital público de Lima - 2023

La presente investigación titulada Auditoria Implementada en el Servicio de Emergencia en un hospital público de Lima – 2023, tuvo como objetivo conocer como es la efectividad de la auditoria implementada en el servicio de emergencia en un hospital público de Lima- 2023, está investigación utilizo para el propósito el enfoque cualitativo que son posibles valores numéricos de individuos y de géneros, la técnica empleada para la recolección de la información fue la entrevista y los instrumentos fueron la guía de preguntas para conocer la problemática en el servicio de emergencia en un hospital público de Lima y se llegaron las siguiente conclusiones: La auditoría implementada en un hospital público de Lima ,el personal encargado de auditar las historias clínicas no se encuentra debidamente capacitado para el correcto análisis

Porto-Sinusoidal Vascular Disease Associated to Oxaliplatin: An Entity to Think about It

Portal sinusoidal vascular disease is a presinusoidal cause of portal hypertension (PHT) of unknown etiology, characterized by typical manifestations of PHT (esophageal varices, ascites, portosystemic collaterals), plaquetopenia and splenomegaly with a gradient of portal pressure slightly increased, according to the presinusoidal nature of the PHT. A few cases in the literature have shown a relationship between oxaliplatin and the development of presinusoidal portal hypertension, years after the chemotherapy for colorectal cancer (therefore, different to sinusoidal obstruction syndrome). There are three mechanisms through which oxaliplatin can cause sinusoidal damage: 1) damage at the level of endothelial cells and stimulates the release of free radicals and depletion of glutathione transferase, with altering the integrity of the sinusoidal cells. The damage in the endothelial sinusoidal cells allows to erythrocytes to across into the Dissé space and formation of perisinusoidal fibrosis, 2) the appearance of nodular regenerative hyperplasia is favored by the chronic hypoxia of the centrilobular areas and, finally, 3) oxaliplatin can generate an obliteration of the blood capillaries and zones of parenchymal extinction. These three facts can develop, in a minority of cases, the appearance of a presinusoidal increase of portal pressure, which typically appears years after the completion of chemotherapy and sometimes is underdiagnosed until variceal bleeding, ascites or encephalopathy appear. The knowledge of this pathology is essential to be able to perform an early diagnostic and consult to the hepatologist.Funding: This research received an external funding of CI18/67/02 Acuerdo de cooperación en el programa de becas de investigación científica de IDIVAL de JANSSEN-CILAG, S.A

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Planification et conception des turbo-giratoires ::Planung und Entwurf der Turbokreisverkehr = Planning and design of turbo-roundabouts

Dans le contexte des carrefours giratoires à deux voies ou plus à l’anneau, le turbo-giratoire est un aménagement encore peu représenté et connu en Suisse alors qu’il a fait ses preuves à l’étranger, notamment aux Pays-Bas, pays précurseur dans la mise en oeuvre de ce type d’aménagement. Le turbo-giratoire, dont le nom provient de la forme géométrique de son centre similaire à celle d’une turbine, a pour principale caractéristique de proposer une séparation des flux de circulation à l’anneau, contrairement aux giratoires conventionnels dans lesquels des changements de voies peuvent s’y produire. De fait, il offre un avantage important en termes de sécurité routière notamment en réduisant de l’ordre de 50% le nombre de points de conflits, lieux potentiels d’accidents, ce qui en fait l’un de ses principaux atouts. En Suisse, ce type d’aménagement n’est encore que peu représenté et ce notamment en raison d’un vide normatif en la matière. En ce sens, ce mandat de recherche constitue la première étape afin de mieux connaître cette solution et en vue de palier au déficit normatif actuel. La présente recherche s’est tout d’abord penchée sur la littérature internationale en la matière afin de définir les éléments de base à analyser en termes de planification, de conception et de dimensionnement des turbo-giratoires. Ces éléments de base ont ensuite été analysés et évalués individuellement à l’aide d’approches théoriques (exemples : dimensionnement géométrique, équipements) ou d’approche empirique simulée (exemple : dimensionnement en capacité). Les résultats obtenus ont été confrontés aux relevés réalisés sur deux aménagements monitorés en Suisse, le turbo-giratoire de Glättimüli sur la commune de Steffisburg (canton de Berne) et l’aménagement provisoire en turbo-giratoire partiel réalisé lors des travaux du pont sur le Lavapesson sur la commune de Granges-Paccot (canton de Fribourg). Un monitoring de turbo-giratoires à l’étranger n’a pas pu être réalisé en raison de la pandémie COVID-19 et aux restrictions correspondantes de déplacements. Les informations glanées lors de l’analyse de la littérature internationale ou issues d’autres aménagements réalisés ont permis de consolider ou d’orienter les propositions et recommandations émises sur les différents éléments de base. Comparativement à un giratoire conventionnel à deux voies ou plus à l’anneau, principal aménagement en concurrence avec un turbo-giratoire, un turbo-giratoire offre les avantages suivants : amélioration notable de la sécurité routière, augmentation de la capacité sur les flux principaux. Toutefois, l’inconvénient majeur des turbo-giratoires consiste en une diminution potentielle de la capacité sur les flux secondaires. Afin de profiter pleinement des avantages de sécurité, il est conseillé d’utiliser des séparateurs de voies dans l’anneau. Cependant cela implique une emprise plus importante et des difficultés liées à l’entretien et à l’évacuation des eaux. Si ces contraintes ne sont pas résolues, une solution sans séparateurs physiques et uniquement du marquage est aussi admissible. Il faut noter que, comme tout nouvel aménagement, l’utilisation d’un turbo-giratoire nécessite une période d’adaptation des usagers et une bonne campagne de communication. Pour conclure, il ressort de ce mandat de recherche que lors de l’évaluation de la conception d’un giratoire à deux voies ou plus à l’anneau, une variante en turbo-giratoire devrait toujours être analysée et que cette solution risque d’être retenue dans la majorité des cas vis-à-vis de la variante conventionnelle, dans la mesure où elle offre un avantage considérable en termes de sécurité routière. Si les résultats de cette recherche permettront vraisemblablement d’établir une base normative pour la planification, la conception et le dimensionnement des turbo-giratoires, il est important de garder à l’esprit que des ajustements ou des validations de certains éléments (méthode de dimensionnement géométrique, méthode de dimensionnement en capacité, …) s’avèreront nécessaires sur la base d’expériences réalisées dans le contexte suisse.Im Rahmen der Kreisel mit zwei oder mehr Fahrspuren am Ring ist der Turbokreisverkehr in der Schweiz noch wenig vertretene und bekannte, während er sich im Ausland bewährt hat, insbesondere in den Niederlanden, einem Land, das bei der Umsetzung diese Entwicklung Vorreiter war. Das Hauptmerkmal des Turbokreisverkehrs, dessen Name sich von der geometrischen Form seines Zentrums ableitet, die der einer Turbine ähnelt, besteht darin, dass er im Gegensatz zu konventionell Kreisel, in denen ein Fahrstreifenwechsel möglich ist, eine Trennung der Verkehrsströme am Ring bietet. Sie bietet nämlich einen großen Vorteil in Bezug auf die Straßenverkehrssicherheit, insbesondere durch die Verringerung der Zahl der Konfliktpunkte, potenzielle Unfallstellen, um etwa 50 %, was einer ihrer Hauptvorteile ist. In der Schweiz wird solche Kreiselanalagen noch selten verwendet, was vor allem auf die fehlende Standardisierung in diesem Bereich zurückzuführen ist. In diesem Sinne stellt dieser Forschungsauftrag einen ersten Schritt dar, um besser diese Lösung zu kennen und zur Anfüllung dieses derzeitigen normativen Defizits. In der vorliegenden Untersuchung wurde zunächst die internationale Literatur zu diesem Thema untersucht, um die Grundelemente zu definieren, die bei der Planung, Gestaltung und Dimensionierung von Turbokreisverkehr zu analysieren sind. Diese Grundelemente wurden dann einzeln mit theoretischen Ansätzen (z. B. geometrische Dimensionierung, Anlagen) oder simulierten empirischen Ansätzen (z. B. Leistungsfähigkeit) analysiert und bewertet. Die Ergebnisse wurden mit den Daten von zwei Knoten in der Schweiz überwachten Anlagen verglichen, dem Turbokreisverkehr Glättimüli in der Gemeinde Steffisburg (Kanton Bern) und dem provisorischen Teilweiser- Turbokreisverkehrs, der während des Baus der Lavapesson-Brücke in der Gemeinde Granges-Paccot (Kanton Freiburg) gebaut wurde. Ein Monitoring von Turbokreisverkehr im Ausland konnte aufgrund der COVID-19-Pandemie und der entsprechenden Reisebeschränkungen nicht durchgeführt werden. Die Informationen, die aus der Analyse der internationalen Literatur oder aus anderen Projekten gewonnen wurden, haben dazu beigetragen, die Vorschläge und Empfehlungen zu den verschiedenen Grundelementen zu konsolidieren oder zu orientieren. Im Vergleich zu einem konventionellen Kreisel mit mehrstreifiger Verkehrsführung, der die Hauptkonkurrenz zum Turbokreisverkehr darstellt, bietet letzterer folgende Vorteile: deutliche Verbesserung der Verkehrssicherheit, erhöhte Kapazität auf den Hauptverkehrsströmen. Der größte Nachteil des Turbokreisels ist jedoch die potenzielle Verringerung der Kapazität bei Sekundärströmen. Um den vollen Sicherheitsnutzen zu erreichen, ist es empfohlen, Fahrbahnteiler im Ring zu verwenden. Dies bedeutet jedoch eine größere Bodenfläche und Schwierigkeiten im Zusammenhang mit dem Unterhalt und der Wasserbewertung. Wenn diese Bedingungen nicht erfüllt sind, ist auch eine Lösung ohne physische Trennung und nur mit Markierung zulässig. Es sei darauf hingewiesen, dass der Einsatz eines Turbokreisels, wie jede neue Anlage, eine Eingewöhnungsphase für die Nutzer und eine gute Kommunikationskampagne erfordert. Zusammenfassend zeigt dieser Forschungsauftrag, dass bei der Bewertung des Entwurfs eines Kreisverkehrs mit mehrstreifiger Verkehrsführung immer die Variante eines Turbokreisverkehrs untersucht werden sollte und dass diese Lösung wahrscheinlich in den meisten Fällen gegenüber der herkömmlichen Variante gewählt wird, da sie einen erheblichen Vorteil in Bezug auf die Verkehrssicherheit bietet. Obwohl die Ergebnisse dieser Untersuchung wahrscheinlich eine normative Grundlage für die Planung, Gestaltung und Dimensionierung von Turbokreisverkehr darstellen werden, ist es wichtig zu bedenken, dass sich Anpassungen oder Validierungen bestimmter Elementen (geometrische Dimensionierungsmethode, Leistungsfähigkeitsmethode, ...) auf der Grundlage von in der Schweiz durchführten Versuchen als notwendig erweisen werden.In the context of traffic roundabout with two or more lanes at the ring, the turbo-roundabout is a road construction that is still little represented and known in Switzerland, although it has proved its worth abroad, particularly in the Netherlands, a country that was a pioneer in the implementation of this type of design. The main characteristic of the turbo-roundabout, whose name comes from the geometric shape of its center like a turbine, is that it offers a separation of traffic flows at the ring, contrary to conventional roundabouts in which lane changes can occur. In fact, it offers an important advantage in terms of road safety, notably by reducing the number of conflict points, potential accident sites, by about 50%, which is one of its main advantages. In Switzerland, this type of road construction is still only rarely used, mainly due to a lack of standardization in this area. In this sense, this research mandate constitutes the first step towards overcoming this current normative deficit. The present research first examined the international literature on the subject in order to define the basic elements to be analyzed in terms of planning, conception and dimensioning concerning the turbo-roundabouts. These basic elements were then analyzed and evaluated individually using theoretical approaches (e.g., geometric design, equipment) or simulated empirical approaches (e.g., capacity design). The results obtained were compared with the data obtained from two monitored roundabouts in Switzerland, the Glättimüli turbo-roundabout in the municipality of Steffisburg (Canton of Bern) and the temporary partial turbo-roundabout built during the repair works of the Lavapesson bridge in the municipality of Granges-Paccot (Canton of Freiburg). Overseas turbo-roundabouts monitoring could not be carried out due to the COVID-19 and because of travel restrictions causes by the pandemic situation. In addition, the information gleaned from the analysis of the international literature or gleaned from other similar developments made possible to react or orient the proposals and recommendations about the various basic elements of the turbo-roundabout. Compared to a conventional roundabout with two or more lanes at the ring, the main road construction in competition with a turbo-roundabout, the latter offers the following benefits: significant improvement of road safety and potential increase in capacity on the main flows. However, the major disadvantage of turbo-roundabout is a potential decrease of the capacity concerning the secondary flows. However, it is also worth mentioning here some negative aspects of turbo-roundabouts: potential reduction in capacity on secondary flows, pre-selection before roundabout according to the chosen destination (behavior adaptation), difficulties linked to maintenance and water assessment in the presence of lane separators, requalification of the roundabout and modification of the lane assignment during maintenance works less easy. In order to take full advantage of the safety benefits, it is advisable to use lane separators in the ring. However, this situation required more space and difficulties due to the maintenance and evacuation of the water. If these constraints are not resolved, a solution without physical separator but only with marking is also admissible. It should be noticed that like any new construction development, the choice of a turbo-roundabout requires a period of adaptation for users and a good communication campaign to sensitize the users. In conclusion, this research mandate shows that when evaluating the design of a roundabout with two or more lanes at the ring, a turbo-roundabout variant should be analyzed and in most cases be given priority over the conventional roundabout, because she offers a considerable advantage in terms of road safety. If the results of this research will probably allow to establish a standardization basis for the planning, the conception and the sizing of turbo-roundabouts, it is important to keep in mind that adjustments or validations of some elements (geometrical design method, capacity design method, ...) will be necessary, on the basis of experiences in the Swiss context