General neurology: Current challenges and future implications

Background and purpose In the coming decades, the world will face an increasing burden of neurological disorders (ND) and an urgent need to promote brain health. These challenges contrast with an insufficient neurological workforce in most countries, as well as decreasing numbers of general neurologists and neurologists attracted to work in general neurology (GN). This white paper aims to review the current situation of GN and reflect on its future. Methods The European Academy of Neurology (EAN) task force (TF) met nine times between November 2021 and June 2023. During the 2023 EAN annual meeting, attendees were asked to answer five questions concerning the future of GN. The document was sent for suggestions and eventually approval to the board and the presidents of the 47 national societies of the EAN. Results The TF first identified four relevant current and future challenges related to GN: (i) definition, (ii) practice, (iii) education, and (iv) research. The TF then identified seven initiatives to further develop GN at both the academic and community level. Finally, the TF formulated 16 recommendations to promote GN in the future. Conclusions GN will remain essential in the coming decades to provide rapid, accessible, and comprehensive management of patients with ND that is affordable and cost-effective. There is also a need for research, education, and other initiatives aiming to facilitate improved working conditions, recognition, and prestige for those pursuing a career in GN

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

The neurology of COVID-19 revisited: A proposal from the environmental neurology specialty group of the world federation of neurology to implement international neurological registries

A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, and less frequently cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage, usually occur as part of a thrombotic state induced by viral attachment to ACE2 receptors in endothelium causing widespread endotheliitis, coagulopathy, arterial and venous thromboses. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. A frontal hypoperfusion syndrome has been identified. There are isolated reports of seizures, encephalopathy, meningitis, encephalitis, and myelitis. The neurological diseases affecting the PNS and muscle in COVID-19 are less frequent and include Guillain-Barré syndrome; Miller Fisher syndrome; polyneuritis cranialis; and rare instances of viral myopathy with rhabdomyolysis. The main conclusion of this review is the pressing need to define the neurology of COVID-19, its frequency, manifestations, neuropathology and pathogenesis. On behalf of the World Federation of Neurology we invite national and regional neurological associations to create local databases to report cases with neurological manifestations observed during the on-going pandemic. International neuroepidemiological collaboration may help define the natural history of this worldwide problem

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 5

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 5, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Investigación científica, piedra angular en la generación del conocimiento

DOI: http://dx.doi.org/10.5377/rct.v0i7.1790 Revista Ciencia y Tecnología No. 7, diciembre 2010: 11-19DOI: http://dx.doi.org/10.5377/rct.v0i7.1790 Revista Ciencia y Tecnología No. 7, diciembre 2010: 11-1

Anormalidades electroencefalográficas en pacientes pediátricos hondureños con desnutrición proteico-energética: un estudio de casos y controles

To determine and characterize the electroencephalographic findings of pediatric patients with protein-energy malnutrition using a case-control study.An analytic descriptive study was developed with a group of patients and a healthy control group during the period of February 2007, through June 2008. The forty patients were gathered from a low-class school located in Comayagüela, matching their number to the healthy control group. Each patient went through an anthropometric, neurological, and laboratorial evaluation. Digital electroencephalography (EEG) was performed to both groups, which was later blindly evaluated by two clinician neurophysiologists.42% percent (P=0.0000045) of the malnourished patients showed the following abnormal EEG tracks: a) focal discharge activity in 20%, b) slow discharge activity in 15%, c) global discharge activity in 12.5%, and d) slow global discharges in 10%. The most affected ages were between 6 and 9 years old.A high frequency of alterations on EEG tracks was found on patients with proteinenergy malnutrition, reaching a 42% compared to a healthy control group. DOI: http://dx.doi.org/10.5377/rct.v0i8.698 Revista Ciencia y Tecnología, No. 8, junio 2011 pp.21-38Se tienen como objetivos determinar y caracterizar los hallazgos electroencefalográficos en pacientes pediátricos con desnutrición proteico energética, utilizando un estudio de casos y controles. Se diseñó un estudio analítico-descriptivo con un grupo de pacientes y un grupo de controles sanos. Se realizó en el período comprendido de Febrero 2007 hasta Junio 2008.Se recolectaron los pacientes en una escuela localizada en un población marginal de Comayagüela. Se captaron 40 pacientes con desnutrición e igual número de controles sanos. Se realizó una evaluación antropométrica, neurológica y laboratorial. Se efectuaron registros de EEG digital en ambos grupos, siendo evaluados en forma ciega por dos médicos neurofisiólogos clínicos. Un 42% de los pacientes con desnutrición protéico- energética mostraron actividades electroencefalográficas anormales (P=0.0000045): a) Actividad epileptiforme focal en un 20%, b) Actividad lenta focal en un 15%, c) Actividad epileptiforme generalizada en un 12.5%, d) Actividad lenta generalizada en un 10%. Los grupos etarios más afectados fueron los que comprendían las edades entre 6- 9 años. Se encontraron frecuentes alteraciones en el trazado electroencefalográfico de los pacientes con desnutrición protéico-energética; alcanzando un 42% en comparación al grupo de controles sanos. DOI: http://dx.doi.org/10.5377/rct.v0i8.698 Revista Ciencia y Tecnología, No. 8, junio 2011 pp.21-3

Determinación de los costos de calidad en el proceso productivo del queso fresco

El objetivo principal de este proyecto es determinar los costos de calidad y los beneficios que se puedan generar al implementar un sistema de producción de acorde a las normas de calidad. El estudio se basa en el proceso productivo del queso fresco en Agroindustrias Daule, una fabrica sin fines de lucro, apoyada por iniciativa de PROTAG-ESPOL. Además de las exigencias del mercado como regulador, se analiza al mismo tiempo sus requerimientos en su rol de demandante. ¿Es la calidad una variable determinante al momento de adquirir el producto?, tomando en cuenta que actualmente se ofrece una amplia variedad de quesos que no difieren mucho en su precio, sabor, textura, entre otras cualidades Basándonos en los resultados del estudio y con una buena estrategia de comercialización, se determinan las probabilidades que tiene Agroindustrias Daule para ingresar con un producto mejorado a competir en el mercado local. Se define mediante un análisis financiero los costos que implicarían el mejorar este proceso y si los beneficios (además de económicos y sociales) que se generen a largo plazo, compensan la inversión en la que tendría que incurrir la fábrica para tener un proceso óptimo en términos de calidad

Global expansion of COVID-19 pandemic is driven by population size and airport connections

The pandemic state of COVID-19 caused by the SARS CoV-2 put the world in quarantine, led to hundreds of thousands of deaths and is causing an unprecedented economic crisis. However, COVID-19 is spreading in different rates at different countries. Here, we tested the effect of three classes of predictors, i.e., socioeconomic, climatic and transport, on the rate of daily increase of COVID-19 on its exponential phase. We found that population size and global connections, represented by countries’ importance in the global air transportation network, are the main explanations for the early growth rate of COVID-19 in different countries. Climate and socioeconomics had no significant effect in this big picture analysis. Our results indicate that the current claims that the growth rate of COVID-19 may be lower in warmer and humid countries should be taken very carefully, risking to disturb well-established and effective policy of social isolation that may help to avoid higher mortality rates due to the collapse of national health systems