Prevalencia de anticuerpos para Trypanosoma cruzi en caninos de dos municipios endémicos de Boyacá

RESÚMEN Objetivo. evaluar la prevalencia de anticuerpos anti Trypanosoma cruzi (T. cruzi) en una muestra de caninos domésticos residentes en dos municipios endémicos. Materiales y métodos. Se tomaron muestras séricas de 20 caninos procedentes de hogares donde residen mujeres gestantes seropositivas y 40 perros habitantes de hogares de mujeres gestantes seronegativas en Miraflores y Moniquira, Boyacá. El análisis se realizó mediante prueba diagnóstica rápida dipstick de InBios. Resultados. Se encontró prevalencia del 16.7% en Moniquirá y del 13.3% Miraflores respectivamente con una prevalencia general del 15% en los dos municipios. Se halló riesgo 3 veces mayor de que ocurra la infección en caninos, en los hogares donde residen gestantes seropositivas; además la infestación por pulgas y garrapatas en el animal, hábitat cercano a la vivienda, se relacionan con mayor seropositividad en el canino. Conclusiones. La raza, el sexo, la presencia de aves en la casa y al examen clínico general son considerados factores pronósticos en en la infección por Trypanosoma cruzi en caninos. Como factores protectores se identificó la desparasitación y vacunación de los animales

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

Background 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

Risk factors associated with Trypanosoma cruziexposure in domestic dogs from a rural community in Panama

Chagas disease, caused by Trypanosoma cruzi infection, is a zoonosis of humans, wild and domestic mammals,including dogs. In Panama, the main T. cruzi vector is Rhodnius pallescens, a triatomine bug whose main naturalhabitat is the royal palm, Attalea butyracea. In this paper, we present results from three T. cruzi serological tests(immunochromatographic dipstick, indirect immunofluorescence and ELISA) performed in 51 dogs from 24 housesin Trinidad de Las Minas, western Panama. We found that nine dogs were seropositive (17.6% prevalence). Dogswere 1.6 times more likely to become T. cruzi seropositive with each year of age and 11.6 times if royal palms wherepresent in the peridomiciliary area of the dog’s household or its two nearest neighbours. Mouse-baited-adhesivetraps were employed to evaluate 12 peridomestic royal palms. All palms were found infested with R. pallescens withan average of 25.50 triatomines captured per palm. Of 35 adult bugs analysed, 88.6% showed protozoa flagellates intheir intestinal contents. In addition, dogs were five times more likely to be infected by the presence of an additionaldomestic animal species in the dog’s peridomiciliary environment. Our results suggest that interventions focused onroyal palms might reduce the exposure to T. cruzi infection

Prevalencia de anticuerpos para Trypanosoma cruzi en caninos de dos municipios endémicos de Boyacá

Objetivo. evaluar la prevalencia de anticuerpos anti Trypanosoma cruzi (T. cruzi) en una muestra de caninos domésticos residentes en dos municipios endémicos. Materiales y métodos. Se tomaron muestras séricas de 20 caninos procedentes de hogares donde residen mujeres gestantes seropositivas y 40 perros habitantes de hogares de mujeres gestantes seronegativas en Miraflores y Moniquira, Boyacá. El análisis se realizó mediante prueba diagnóstica rápida dipstick de InBios. Resultados. Se encontró prevalencia del 16.7% en Moniquirá y del 13.3% Miraflores respectivamente con una prevalencia general del 15% en los dos municipios. Se halló riesgo 3 veces mayor de que ocurra la infección en caninos, en los hogares donde residen gestantes seropositivas; además la infestación por pulgas y garrapatas en el animal, hábitat cercano a la vivienda, se relacionan con mayor seropositividad en el canino. Conclusiones. La raza, el sexo, la presencia de aves en la casa y al examen clínico general son considerados factores pronósticos en en la infección por Trypanosoma cruzi en caninos. Como factores protectores se identificó la desparasitación y vacunación de los animales

Episodios de ansiedad y depresión en universitarias de Tunja (Colombia): probable asociación con uso de anticoncepción hormonal. 2012

Introduction: to asses the possible link between use of hormonal contraceptives (oral, injectable or sub dermal implants) with episodes of anxiety and depression in college students from Tunja, adjusting for other factors identified with depression in scientific literature.Materials: study of prevalence, observational, with analytic cross-sectional design. Population was defined as the female students of two universities located in Tunja. It was extracted a sample of 538 women by random sequential sampling, which prior informed consent, was applied the Hamilton Anxiety Scale, and the Beck depression scale .Statistical analysis was made using Epi-Info program.Results: the overall prevalence of depression was 18,95%, an the manifestations of anxiety one was 52,04%. We found statistically significant association between the use of hormonal methods and depression: OR = 3,31 (95% CI: 1,03-5,40, p = 0.0001). The estimate of probable association between hormonal methods and anxiety, showed a statistically significant association, although less strong: OR=1,46 (CI95% 1,03-2,05; p=0,018. It was also found association between manifestations of depression and age more than twenty years.Conclusions: findings reported show positive association, suggesting the need for healthcare providers to evaluate mental state of the young university at the time of prescribing the use of hormonal preparations as a contraceptive method.Objetivo: identificar la posible asociación entre el uso de anticonceptivos hormonales (orales, inyectables e implantes sub-dérmicos), y la ocurrencia de episodios de ansiedad y depresión en estudiantes universitarias de Tunja (Colombia), ajustado por otros factores identificados con la depresión y la ansiedad en la literatura científica.Métodos: estudio de prevalencia, observacional, con diseño de Corte Transversal, Analítico. La población: mujeres estudiantes del área de la salud, de dos universidades localizadas en Tunja; de ellas se extrajo mediante muestreo secuencial no probabilístico, una muestra de 538 mujeres, a quienes previo consentimiento informado se aplicó la Escala de Ansiedad de Hamilton y la escala de Depresión de Beck. El análisis se adelantó con el programa Epi-Info 2004.Resultados: la prevalencia global de depresión fue de 18,95% y la de manifestaciones de ansiedad de 52,04%. Se encontró asociación estadísticamente significativa entre el uso de métodos hormonales y depresión: OR= 3,31 (IC95%: 1,03-5,40; p= 0.0001). La estimación de probable asociación entre uso de métodos hormonales y ansiedad, también registró una asociación estadísticamente significativa, aunque menos sólida: OR= 1,46 (IC95% 1,03-2,05; p> 0,018). Se encontró también asociación entre las manifestaciones de depresión y edad (superior a los 20 años).Conclusiones: los hallazgos reportados muestran asociación positiva entre la anticoncepción hormonal, la depresión y la ansiedad, que sugiere la necesidad que los proveedores de salud consideren el estado mental de las jóvenes universitarias al momento de prescribir el uso de preparados hormonales, como método de anticoncepción

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

Background: 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

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged 6518 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40\ub70 (30\ub70 to 53\ub70). 1397 (66\ub79%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87\ub75%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64\ub70%) of 2088 patients were given benzodiazepines for a median of 7\ub70 days (4\ub70 to 12\ub70) and 1481 (70\ub79%) were given propofol for a median of 7\ub70 days (4\ub70 to 11\ub70). Median Richmond Agitation\u2013Sedation Scale score while on invasive mechanical ventilation was \u20134 (\u20135 to \u20133). 1704 (81\ub76%) of 2088 patients were comatose for a median of 10\ub70 days (6\ub70 to 15\ub70) and 1147 (54\ub79%) were delirious for a median of 3\ub70 days (2\ub70 to 6\ub70). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p 640\ub704), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p<0\ub70001). During the 21-day study period, patients were alive without delirium or coma for a median of 5\ub70 days (0\ub70 to 14\ub70). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p<0\ub701). 601 (28\ub78%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. Interpretation: Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. Funding: None. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section