Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines

Solución salina hipertónica para tratamiento del trauma craneoencefálico en niños: revisión sistemática de la literatura

Introducción\ud La hipertensión endocraneana es la principal causa de morbimortalidad en trauma craneoencefálico. \ud Objetivo\ud Evaluar si el uso de la solución salina hipertónica en niños con trauma craneoencefálico moderado a severo disminuye la lesión secundaria.\ud \ud Materiales y métodos\ud Revisión sistemática de la literatura donde se buscaron ensayos clínicos controlados y cohortes prospectivas. Se utilizó la escala de Jadad para la calificación de los estudios. 3 estudios cumplieron los criterios de inclusión.\ud Resultados\ud La solución salina hipertónica logró una disminución de la presión intracraneana (PIC) con aumento de la volemia y la presión de perfusión cerebral (PPC) más efectiva comparada con otros líquidos utilizados en reanimación como manitol y lactato ringer (p<0,01). Se encontró que estos pacientes tuvieron una menor estancia en UCIP y requirieron menos intervenciones para disminuir la PIC (p<0,04).\ud Conclusiones \ud La solución salina hipertónica como tratamiento de la hipertensión endocraneana secundaria a trauma craneoencefálico en niños ha mostrado beneficios importantes como aumento de la volemia y consecuentemente de la PPC, disminución de la respuesta inflamatoria, estancia en UCIP y la cantidad de intervenciones necesarias para disminuir la PIC. Se necesitan más ensayos clínicos aleatorizados controlados en niños que soporten su uso como primera línea en trauma craneoencefálico.\ud Palabras clave: Solución hipertónica, trauma craneoencefálico, presión intracraneana, niños, lesión cerebra

Correlación entre el lactato arterial y el lactato venoso central en niños con sepsis

8 páginasIntroduction. Lactate is an important indicator of tissue perfusion. The objective of this study is to evaluate if there are significant differences between the arterial and central venous measurement of lactate in pediatric patients with sepsis and/or septic shock. Methods. Longitudinal retrospective observational study. Forty-two patients were included between the age of 1 month and 17 years, with a diagnosis of sepsis and septic shock, who were admitted to the intensive care unit of a university referral hospital. The lactate value obtained from an arterial blood sample and a central venous blood sample drawn simultaneously, and within 24 hours of admission to the unit, was recorded. Results. The median age was 2.3 years (RIC 0,3–15), with a predominance of males (71.4%), having a 2.5 : 1 ratio to females. Most of the patients had septic shock (78.5%) of pulmonary origin (50.0%), followed by those of gastrointestinal origin (26.1%). Using Spearman’s Rho, a 0.872 () correlation was found between arterial and venous lactate, which did not vary when adjusted for age () and the use of vasoactive drugs (). Conclusion. There is a good correlation between arterial and venous lactate in pediatric patients with sepsis and septic shock, which is not affected by demographic variables or type of vasoactive support.Introducción . El lactato es un indicador importante de la perfusión tisular. El objetivo de este estudio es evaluar si existen diferencias significativas entre la medición arterial y venosa central de lactato en pacientes pediátricos con sepsis y/o shock séptico. métodos _ Estudio observacional retrospectivo longitudinal. Se incluyeron 42 pacientes entre 1 mes y 17 años, con diagnóstico de sepsis y shock séptico, que ingresaron a la unidad de cuidados intensivos de un hospital universitario de referencia. Se registró el valor de lactato obtenido de una muestra de sangre arterial y una muestra de sangre venosa central extraídas simultáneamente, y dentro de las 24 horas de ingreso a la unidad. Resultados. La mediana de edad fue de 2,3 años (RIC 0,3-15), con predominio del sexo masculino (71,4%), teniendo una relación 2,5:1 con el sexo femenino. La mayoría de los pacientes presentaron shock séptico (78,5%) de origen pulmonar (50,0%), seguido de los de origen gastrointestinal (26,1%). Mediante el Rho de Spearman se encontró una correlación de 0,872 ( ) entre el lactato arterial y venoso, la cual no varió al ajustar por edad ( ) y el uso de fármacos vasoactivos ( ). Conclusión . Existe una buena correlación entre el lactato arterial y venoso en pacientes pediátricos con sepsis y shock séptico, que no se ve afectada por variables demográficas o tipo de soporte vasoactivo

Horizontal innovation: The core of open innovation in the construction of the dynamic capacities in the Colombian industry

This research seeks to answer an investigation question, Open innovation exists in the Colombian industry? If that so, which is the core of that open innovation? For that the DANE’s annual manufactural survey was taken with the information of 6799 companies of the of the corporate behavior in regards of development, and technological innovation of the Colombian industry. It was evidenced in the industry the existence of the open innovation, composed by the innovative company, that accomplishes to develop dynamic capacities of innovation, reflected in new products on the market, with management and support of the articulators that surround and boost the base of the creative core of innovation, meaning that the State, the university, and other facilitator actors. The study also reveals arguments to affirm that the positioning of Colombia in the first rankings in Latin America is explained by their open innovation of their environment, therefore, working on alliances and shared projects is a trend that has come to be installed in the corporate modernity

Factors Associated with Severe Acute Respiratory Infections Due to Rhinovirus/Enterovirus Complex in Children and Their Comparison with Those of Respiratory Syncytial Virus

10 páginasBackground: Acute respiratory tract infections (ARTIs) are one of the main causes of morbidity and mortality in children under the age of five worldwide. Objectives: The objective of this research was to describe the main characteristics of hospitalized patients with ARTI caused by the rhinovirus/enterovirus (RV/EV) complex and the risk factors associated with severe infection. Methods: This was a retrospective descriptive study in patients from one month to 18-years-old who had been hospitalized for ARTI between October 2015 and December 2019 at Fundación Cardioinfantil in Bogotá, Colombia, and had had an RT-PCR viral panel during their hospitalization. Rhinovirus/enterovirus infection was characterized to identify factors associated with disease severity as compared to respiratory syncytial virus (RSV). A multivariate analysis was performed, controlling for confounding factors, to identify groups at risk of developing associated acute respiratory distress syndrome (ARDS). Results: During the study period, 645 RT-PCRs were performed, with the twomain etiological agents identified being RV/EV (n = 224) and RSV (n = 68). Themedian age of patients with the RV/EV complex was 27months (IQR: 8 - 70), and sevenmonths for those with RSV (IQR: 2 - 11). Severe RV/EV complex infections required more transfers to intensive care (47% vs. 11%), showed more viral coinfection (OR: 2.13, 95% CI: 1.42 - 4.64), and had less bacterial coinfection (OR: 0.55, 95% CI: 0.31 - 0.98) than RSV infections. The RV/EV group had a higher risk of developing ARDS (OR: 3.6, 95% CI: 1.07 - 12:18), especially in premature infants (P: 0.05; exp(B), 2.99; 95% CI = 1.01 - 8.82), those with heart disease (P: 0.047; exp(B), 2.99; 95% CI = 1.01 - 8.82), and those with inborn errors of metabolism (P: 0.032; exp(B), 5 - 01; 95% CI = 1.15 - 21.81). A total of 13 patients from both study groups died (4.5%), with no differences found between the groups (RV/EV 54% vs. RSV 46%; P = 0.3). Conclusions: Respiratory infection due to RV/EV in children can frequently be severe, requiring management with intensive care therapy. When compared to RSV, this complex is more frequently associated with the development of ARDS, especially in risk groups such as those with prematurity, heart disease, or inborn errors of metabolism

A multicenter study on the clinical characteristics and outcomes among children with moderate to severe abusive head trauma

Introduction: We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT.Methods: We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients \u3c5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT.Results: 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently \u3c 2 years old (42, 89.4% vs 133, 38.6%, p \u3c 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p \u3c 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p \u3c 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p \u3c 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age \u3c2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT.Conclusions: AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT