Frecuencia serológica y factores de riesgo asociados a Toxoplasma Gondii en gatos, de consultorios de la ciudad de Lima

Determina la frecuencia serológica y factores de riesgo de Toxoplasma gondii en gatos, de 7 consultorios de la ciudad de Lima. Para ello, se identificó el número de animales seroreactores a IgG e IgM, como la asociación de los factores epidemiológicos (sexo, edad, alimentación y hábitat). Para el estudio, se analizaron las muestras de sueros de 303 gatos de ambos sexos cuyas edades estuvieron comprendidas desde los 2 meses a más, que fueron obtenidas de siete consultorios veterinarios, ubicados en los distritos de Villa María del Triunfo, Santiago de Surco, Lurín, Surquillo, Chorrillos, El Agustino y San Juan de Luringancho. Se halló una seroprevalencia de 7.3 % (IC95% 4.6% - 10.8%) para T. gondii haciendo uso de la prueba de Hemaglutinación indirecta (HAI) con una sensibilidad de 81.6 % y una especificidad de 97.1%. De estas 22 muestras seropositivas, todas correspondía a infección crónica (IgG). Se usó la prueba de chicuadrado donde se demostró que los animales con anticuerpos anti-T. gondii estaban relacionados positivamente con el tipo de hábitat y el tipo de alimentación. En el análisis de regresión bivariado se encontró que la seroprevalencia de T. gondii en gatos que se alimentan de comida casera es 20.59 (p=0.003, IC95% 2.80 - 151.13) veces la seroprevalencia de T. gondii en gatos que se alimentan con comida balanceada; y que la seroprevalencia de T. gondii en gatos que pasan más tiempo fuera de casa es 8.59 (p=0.003, IC95% 2.04 - 36.10) veces la seroprevalencia de T. gondii en gatos que pasan más tiempo dentro de casa. Estos hallazgos confirman una moderada seroprevalencia de T. gondii en gatos de los distritos mencionados

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