Virus en sistemas acuáticos e implicaciones en salud pública

The use of the hydraulic resources by humans raised the interest on the presence of virus in aquatic systems, due to the public health risk they represent. We present a revision on the occurrence of virus in different aquatic systems, the diseases caused produced by human virus and their symptoms, including enterovirus, rotavirus, astrovirus, calicivirus, adenovirus and hepatitis A virus. Implications in public health in relation with the existing regulations for human use and consumption, as well as residual treated and reused water, are analyzed. We mention the impact of viral diseases related the water for human use and consumption, giving some idea of Mexico´s situation. The methods used for the detection of virus, as well as the common methods for water disinfection used for human with a specific focus on viral contamination. We conclude that human viruses capable to persist in the environment have severe effects, specially for infants. The results of this revision suggest that research should be conducted in Mexico and other tropical areas to know what is the situation with viral contamination in groundwater, freshwater and treated wastewater for reuse. It is relevant the evaluation of enterovirus as indicators of the presence of viral fecal contamination and bacteriophages intenting to include them in the water quality standards.El aprovechamiento de los recursos hídricos por el hombre, ha despertado interés sobre la presencia de virus en sistemas acuáticos debido al riesgo que representan para la salud pública. Se realiza una revisión sobre la presencia de virus en diferentes sistemas acuáticos, las enfermedades causadas por virus humanos y sus síntomas, incluyendo enterovirus, rotavirus, astrovirus, calicivirus, adenovirus y virus de hepatitis A. Se analizan también las implicaciones para la salud en relación con la normatividad vigente para agua de uso y consumo humano, así como para agua residual tratada y reutilizada. Se trata el impacto de las enfermedades virales relacionadas con uso y consumo de agua en la población, mencionando la situación en México. Se describen los métodos que se emplean para la detección de virus, así como los métodos más comunes de desinfección para agua de uso y consumo humano, con un enfoque específico sobre contaminación viral. Se concluye que los virus entéricos capaces de persistir en el ambiente tienen el potencial de causar efectos severos en la salud, especialmente de la población infantil. Los resultados de esta revisión sugieren que en México y otras zonas tropicales se deben realizar investigaciones para conocer cual es la situación en cuanto a contaminación viral del agua subterránea, superficial y agua residual tratada para reúso. Es relevante evaluar como agentes indicadores de contaminación viral fecal a los enterovirus y bacteriófagos con la intención de incluirlos en los estándares de calidad del agua

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)