Detecção de Enterobacteriaceae em ovos frescos de galinha para o consumo humano na cidade de Valledupar, Cesar (Colômbia)

Introduction: the Enterobacteriaceae family is the largest and most heterogeneous group of gram-negative bacilli, many of them of public health importance, associated among others with the consumption of fresh eggs, even those with intact and clean skin. Methodology: 200 eggs were obtained by sampling at 10 commercial outlets in the city of Valledupar, Cesar (Colombia), of which the shell and yolks were studied using a pre-enrichment protocol, selective enrichment and, therefore, a selective medium. differential to determine the presence of enterobacteria. Results: the presence of enterobacteria in the shell and yolks was determined in 31% of the eggs, as well as 15.5% with contamination with other microorganisms. The presence of the fungus Aspergillus fumigatus was also proven. Conclusions: the results demonstrate the presence of pathogenic agents in eggs marketed in the studied area, and the consequent need to intervene to protect consumers’ health. It is recommended that public health agents take action to intervene and conduct research in order to find out about potential health risks, as well as document cases associated with the consumption of these eggs.Introducción: la familia Enterobacteriaceae es el grupo más grande y heterogéneo de bacilos gramnegativos, muchos de ellos de importancia en salud pública, asociados entre otros al consumo de huevos frescos, aún de aquellos con cáscara indemne y limpia. Metodología: fueron obtenidos por muestreo 200 huevos en 10 expendios comerciales en la ciudad de Valledupar, Cesar (Colombia), a los cuales se les estudió la cáscara y las yemas, mediante protocolo de preenriquecimiento, enriquecimiento selectivo y, luego, medio selectivo diferencial para determinar la presencia de enterobacterias. Resultados: se determinó la presencia en cáscara y yemas de Enterobacterias en un 31,0 % de los huevos, así como 15,5 % con contaminación con otros microorganismos. Se comprobó también la presencia del hongo Aspergillus fumigatus. Conclusiones: los resultados demuestran la presencia de agentes patógenos en los huevos comercializados en el área estudiada, y la consecuente necesidad de intervenir para proteger la salud de los consumidores. Se recomienda la intervención de los actores de salud pública, para que intervengan y adelanten investigaciones para conocer potenciales riesgos para la salud, lo mismo que en la documentación de casos asociados al consumo de estos huevos.Introdução: a família Enterobacteriaceae é o maior e mais heterogêneo grupo de bacilos gram-negativos, muitos deles de importância em saúde pública, associados entre outros ao consumo de ovos frescos, mesmo daqueles com casca intacta e limpa. Metodologia: foram obtidos por amostragem 200 ovos em 10 pontos de venda comerciais na cidade de Valledupar, Cesar (Colômbia), dos quais foram estudadas a casca e as gemas por meio de protocolo de pré-enriquecimento, enriquecimento seletivo e, logo, meio seletivo diferencial para determinar a presença de enterobactérias. Resultados: determinou-se a presença de enterobactérias na casca e nas gemas em 31 % dos ovos, bem como 15,5 % com contaminação com outros microrganismos. Comprovou-se também a presença de fungo Aspergillus fumigatus. Conclusões: os resultados demonstram a presença de agentes patogênicos nos ovos comercializados na área estudada, e a consequente necessidade de intervir para proteger a saúde dos consumidores. Recomenda-se a ação dos agentes de saúde pública para que intervenham e realizem pesquisas com o objetivo de conhecer potenciais riscos para a saúde, bem como documentem casos associados ao consumo desses ovos

Distribución de microorganismos a nivel sanguíneo en perros y gatos domésticos, Valledupar, Colombia

The aim of this study was to determine the distribution of microorganisms in blood in cats and dogs admitted to a veterinary clinic in the city of Valledupar, Colombia during the period 2016-2018. In total, 957 medical records with a history of hemoparasitic or bacterial infections were analysed (847 in dogs and 110 in cats). In dogs, the seroprevalence of A. platys, Ehrlichia sp, Hepatozoon sp, Babesia sp, Trypanosoma sp and D. immitis was 51.5, 30.9, 22.3, 6.7 and 0.1%, respectively. Also, the level of 4.8% of coinfection in dogs was found. In cats, M. haemofelis was present in all cases. The diversity of microorganisms found shows the possible zoonotic risk, mainly by Anaplasma sp, Ehrlichia sp, Hepatozoon sp, Babesia sp and Trypanosoma sp, to which the owners and veterinary personnel are exposed in the city of Valledupar.El objetivo del estudio fue determinar la distribución de microorganismos a nivel sanguíneo en gatos y perros ingresados a una clínica veterinaria de la ciudad de Valledupar, Colombia durante el periodo 2016-2018. Se analizaron 957 historias médicas con antecedentes de infecciones hemoparasitarias o bacterianas (847 en perros y 110 en gatos). En perros, se encontró una seroprevalencia de A. platys, Ehrlichia sp, Hepatozoon sp, Babesia sp, Trypanosoma sp y D. immitis de 51.5, 30.9, 22.3, 6.7 y 0.1%, respectivamente. Asimismo, una coinfección en 4.8% en perros. En gatos, M. haemofelis estuvo presente en todos los casos. La diversidad de microorganismos encontrados manifiesta el posible riesgo zoonótico, principalmente por Anaplasma sp, Ehrlichia sp, Hepatozoon sp, Babesia sp y Trypanosoma sp, al que están expuestos los dueños y el personal veterinario en la ciudad de Valledupar

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 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