Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Análisis metodológico del proceso de formulación y gestión de la planeación estratégica de la fundación clínica universitaria san juan de dios de la ciudad de Cartagena

Tesis (Especialista en Gerencia en Salud) – Universidad de Cartagena. Facultad de ciencias económicas. Especialización en gerencia en salud, 2012La Orden Hospitalaria San Juan de Dios inicio diálogos con el gobierno a fin de participar en uno de los más importantes proyectos sociales: La Administración de la Clínica Enrique de la Vega en la ciudad de Cartagena. El objetivo fundamental de esta obra es la de brindar atención en salud con óptimos estándares de calidad y humanización a la población del departamento de Bolívar y de los departamentos vecinos. El 19 de diciembre de 2006 nació en Cartagena la Fundación Clínica Universitaria San Juan de Dios, brindando atención en salud a la comunidad con calidad y atención integral, basados en desarrollo tecnológico e investigativo, talento humano cualificado y humanizado, bajo los valores de la Orden Hospitalaria San Juan de Dios, con una identidad y razón social de carácter universitario, que busca apoyar la formación de profesionales en salud a través de programas de pre y post grado, siendo centro de educación por excelencia, haciendo que uno de los objetivos se desarrolle y ofrezca al país un escenario de formación continua, lo anterior fundamentado en los principios de la iglesia Católica. La clínica cuenta con un número de colaboradores aproximado de 1200, vinculados a través de diferentes sistemas de contratación: cooperativas, temporales, outsourcing. En la actualidad se encuentra en proceso de habilitación de algunos servicios y acreditación, en los cuales se viene trabajando paulatinamente con las competencias laborales

Papel de Colgadura, Vol. 18

Las telas y los hilos envuelven nuestras vidas de manera permanente. Estamos tan acostumbrados a su abrigo que les damos por sentado, a tal punto que les hemos hecho invisibles, como el traje nuevo del emperador. No obstante, con telas e hilos hemos hilado e hilvanado memorias, urdido cosmovisiones, remendado economías, anudado travesías por el océano, zurcido saberes, encriptado textos en nuestros bordados o tejidos de punto y cosido afectos por siglos y siglos. Penélope tejía y destejía en tanto esperaba a Ulises, mientras que las Moiras hilaban el destino de los seres humanos al nacer, nuestras comunidades indígenas van tejiendo el pensamiento al anudar hilos en forma de espiral y elaboran mochilas.Hilos que se movilizan: Bordando presencias, Moni Paulino y Silvia Tabakam. Cosamos el parche, Juanita Prieto Macía y Daniel Martín Rincón. El arte relacional, María Viñolo Berenguel. Unión de fragmentos, Ingrid Pabón. Bordar con cuidado: entre la casa y la plaza, Yessica Paola Beltrán Hernández. Vergel, Guadalupe Gómez Verdi. Puertas pa' adentro, Kaira Romero Polanía. El ojo de la aguja, Isabel Cristina Gonzáles. Geneologías textiles: Neywia. Construyendo su misión a partir de pedazos de historias, Karen Castelblanco Villam. Molas, riqueza de una cultura, Montserrat Ordóñez. Entrevista a Meyby Ríos, Margarita Cuéllar Barona. Tejidos subterráneos, Daniel Bustos Echeverry. Entre Costuras: Autoexploraciones textiles, Laura Estefanía Valbuena Acero. ¿Quién soy yo?, yo soy Isa, Isabel Gonzáles Arango. Una trampa más, Miriam Mabel Martínez. El vestido de Ana, Alejandro Martín Maldonado. Quimera, Sebastian Reyes. El problema de la plancha, Alejandra Soler. La muñeca negra, Mary Grueso. La arpillera de mi abuela, Catalina Herrera Osorio. Costuras que cuidan: Sangre de mi sangre, América Larraín Gonzáles. ¿Es terapéutico el bordado?, Valeria Petruzzi. Tejer el duelo, Margarita Cuéllar Barona. El principio: un derecho, un revés, Neil Henry Arenas Camacho. Libertad, Yancy Castillo Jiménez. Manos de mujeres tejiendo historias. Una aproximación al hacer textil desde las labores de cuidado, Carolina Rosa Rincón Rincón. El vestido, Sandra Viviana Rodríguez Castro. Aprender desde el Hacer: 146 Las manualidades en la pedagogía Waldorf, Entrevista a Luz Elena Marulanda, Maestra Waldorf. La aguja subsersiva, Margarita Cuéllar Barona. La Moira, Luis Córdoba Solarte. Costura, maternidad y economía familiar, Iara Sofía Patiño Marroquín. La costurera, Juan David Hurtado Realpe y Daniel Stiven Cabrera Salazar, Margarita, mi flor infinita, Manuela Castro Vargas. Punto a punto: un antes y un después, Luz Karina Cometa Fajardo. Costuras: Pensando el diseño desde los textiles, Eiliana Sánchez Aldana. Querer ver, Annette Rodríguez Fiorillo. El poder de hacer, Paulina Sáchica. Vena Amoris, Juan David Cáceres Murillo. Sin prisa pero sin pausa, María Angélica Moya. Textiles que cuentan: Amor eterno, Alexandra Chocontá Piraquive. Tejiendo mientras se teje, Eliana Sánchez-Aldana. Cartas de amor, Artesanal Tecnológica. Memoria textil de un profesor universitario, Yoseth Ariza Araújo. Hacer (es), Textil (es): Deshilado: destrucción y remiendo cuidadoso en el bordado de calado, Tania Pérez-Bustos. Mi relato bordado, Diana Carolina Castaño García. Mi primer dechado, Laura Forero. Comentarios alrededor de El artesano de Richard Sennett, Diego Cagüeñas

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially