Trypanosoma evansi in horses from the Colombia - Associated Infection Factors

Background: Trypanosoma evansi is the most common protozoan in tropical and subtropical regions of the world, due to its ability to maintain and be transmitted by vectors such as Stomoxys spp. and Tabanus spp. This protozoan causes high morbidity and mortality rates in horses in African, American and Asian countries. In the years 2021 and 2022, a high mortality rate was reported among horses with symptoms associated with Trypanosoma spp. in the municipality of Arauca, department of Arauca, Colombia. The investigation described here was therefore carried out, seeking to identifythe pathogens and risk factors that led to the death of the horses in this region of Colombia.Cases: Blood samples were collected from Colombian criollo horses and dogs, as were samples of ticks, flies and horseflies that infested the horses. A variety of tissue samples were removed from the horses a few min after their death for histopathological analysis. Two questionnaires were applied to obtain information about the horses and the environment in which they live. The results of the clinical examination revealed pale mucous membranes, jaundice, high fever, dehydration and lethargy. The horses were also infested with Amblyomma mixtum (17.6%) and Dermacentor nitens (82.4%) ticks, and with Tabanus pungens (74%), Tabanus spp. (26%), and Stomoxys calcitrans flies (100%), while the dogs were infested with Rhipicephalus sanguineus s.l. (77.7%) and Amblyomma mixtum (22.2%) ticks. The blood smear test results revealed the presence of Trypanosoma spp. in 66.6% (n = 4) of the horse blood samples, and in 50% (n = 1) of the dog blood samples. PCR performed to identify the Trypanosoma species confirmed the presence of T. evansi. Histological examination of the spleen revealed the involvement and dissemination of T. evansi in the tissues. The horses also showed the presence of Equine Infectious Anemia Virus (EIAV).Discussion: This is the first updated specific report of T. evansi in criollo horses in the savannah flood zone of the municipality of Arauca, Colombia. The main risk associated with T. evansi infection in horses was found to be infestation with the natural vector T. pungens and the mechanical vector S. calcitrans, which are efficient ectoparasites for the transmission of this parasite. The presence of T. evansi in dogs represents a constant risk to horses, because dogs may serve as a reservoir for the maintenance of the hemoparasite in the population under study. Another risk factor for horses could be the presence of vampire bats (Desmodus rotundus), a species of bat that has been described as a vector and reservoir of T. evansi in Colombia. The presence of EIAV antibodies in the horses under study can be attributed to the exposure of sick horses to vectors of this virus, such as Tabanus spp., S. calcitrans and inanimate needle-shaped fomites. This is the first study that identifies the coinfection of T. evansi and EIAV in horses in the floodplain region of Colombia. In view of the importance of these 2 pathologies to the health of horses, a greater number of tests and a larger animal population will be required to determine if this coinfection is the cause of the death of criollo horses in this region of Colombia. Lastly, the owners reported that pharmacological control with trypanocides has not been successful in most of the outbreaks that occurred during the years 2021 and 2022. This may suggest that Trypanosoma evansi is developing resistance to these drugs; therefore, specific studies will be required in the future to test this hypothesis.Keywords: Arauca, Equine Infectious Anemia Virus, floodplain savannah, mortality, surra

Perspectivas contemporáneas en psicología

La obra muestra diferentes teorías e investigaciones que brindan al lector una oportunidad para aproximarse a la innovación, investigación y actualización de la disciplina, debido a que expone resultados profundos, pertinentes y relevantes que juegan un papel preponderante en las necesidades, situaciones o problemáticas que afronta diariamente la psicología. Por otro lado, empodera y da estrategias al profesional en ciencias sociales y humanas para que se convierta en un centro crítico y así comprenda aspectos biológicos, psicológicos, sociales y culturales que interactúan en la cognición y el comportamiento del ser humano

Perspectivas contemporáneas en psicología

La obra muestra diferentes teorías e investigaciones que brindan al lector una oportunidad para aproximarse a la innovación, investigación y actualización de la disciplina, debido a que expone resultados profundos, pertinentes y relevantes que juegan un papel preponderante en las necesidades, situaciones o problemáticas que afronta diariamente la psicología. Por otro lado, empodera y da estrategias al profesional en ciencias sociales y humanas para que se convierta en un centro crítico y así comprenda aspectos biológicos, psicológicos, sociales y culturales que interactúan en la cognición y el comportamiento del ser humano

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Efecto del lipopolisacárido (LPS) de E. coli sobre la cantidad de células caliciformes, leucocitos y sobre la distribución de mucinas en el pulmón de cerdos postdestete

RESUMEN: El periodo postdestete en los cerdos está caracterizado por una serie de alteraciones orgánicas de tipo estructurales y funcionales, que predisponen al desarrollo de enfermedades entéricas y del tracto respiratorio. Un agente patógeno importante en este periodo es la Escherichia coli, una bacteria gram negativa que posee en su pared celular lipopolisacárido (LPS), factor patogénico importante en la presentación de procesos endotóxicos e importante activador de la respuesta inmune innata. Actualmente se desconoce el efecto de LPS sobre la distribución de mucinas en el tracto respiratorio de los cerdos y su relación con la presentación de procesos inflamatorios en el pulmón. Objetivo: determinar el efecto del LPS de E. coli sobre la distribución de las mucinas en el pulmón de lechones postdestete. Además se espera establecer el efecto de LPS sobre la respuesta leucocitaria. Metodología: Para este estudio se utilizaron tejidos incluidos en parafina obtenidos de una investigación anterior que se encuentran almacenados en el Laboratorio de Patología Animal de la Universidad de Antioquia. Las muestras se obtuvieron en un estudio experimental previo que se realizó con 52 lechones destetados a los 21 días de edad. Los animales fueron alimentados con una dieta basal adicionada con cuatro niveles de LPS (0.0, 0.3, 0.5 y 1.0 ug/mg de alimento) durante 10 días. Los cerdos se sacrificaron escalonadamente los días 1, 5, 7 y 10 postdestete y se tomaron muestras de pulmón.ABSTRACT: The postweaning period in pigs is characterized by a series of organic alterations of functional and structural type, which predispose to the development of enteric and respiratory tract diseases. An important pathogen in this period is the Escherichia coli, a gram-negative bacterium that has in its cell wall lipopolysaccharide (LPS), which is an important pathogenic factor in endotoxic processes and a potent activator of the innate immune response. The effect of LPS on the mucin distribution in the respiratory tract of pigs and their relationship with the presentation of inflammatory processes in the lung is unknown. Objective: To determine the effect of LPS of E. coli on the distribution of mucins in the lung of piglets after weaning. It is also expected to establish the effect of LPS on leukocyte response. Methodology: For this study, paraffin-embedded tissues obtained from a previous study were used. These tissues were stored at the Laboratory of Animal Pathology, University of Antioquia. The samples were obtained in a previous experimental study conducted with 52 piglets weaned at 21 days of age. The animals were fed a basal diet supplemented with four levels of LPS (0.0, 0.3, 0.5 and 1.0 ug / mg of food) for 10 days. Pigs were sacrificed stepwise days 1, 5, 7 and 10 post-weaning and lung samples were taken. In these samples, histological sections were made with a thickness of 4 um and histochemical stainings were performed to determine the number of goblet cells expressing neutral and acid mucins and the type of leukocyte infiltration, using a computerized image analysis. For statistical analysis the random block design was used on a 4 x 4 factorial arrangement. Results and discussion: In control piglets was observed a decrease in the number of goblet cells in bronchi and bronchioles, with a recovery of values for the tenth day, the LPS inhibited this recovery of this cell line and neutral mucins produced by them. In all experimental units increased acidic mucin in the bronchi on day 5 postweaning and no acidic mucins were observed in their bronchioles. In addition the higher concentrations of LPS caused a decrease in the number of neutrophils on day tenth and no effects on the amount of other leukocytes. Conclusions: LPS affects the recovery of goblet cells in the airway epithelium of the lung and decreases the number of neutrophils, altering the innate immunity in early weaning, which may favor the entry of pathogens and allergen sensitization

Trypanosoma evansi in horses from the Colombia - Associated Infection Factors

Background: Trypanosoma evansi is the most common protozoan in tropical and subtropical regions of the world, due to its ability to maintain and be transmitted by vectors such as Stomoxys spp. and Tabanus spp. This protozoan causes high morbidity and mortality rates in horses in African, American and Asian countries. In the years 2021 and 2022, a high mortality rate was reported among horses with symptoms associated with Trypanosoma spp. in the municipality of Arauca, department of Arauca, Colombia. The investigation described here was therefore carried out, seeking to identifythe pathogens and risk factors that led to the death of the horses in this region of Colombia.Cases: Blood samples were collected from Colombian criollo horses and dogs, as were samples of ticks, flies and horseflies that infested the horses. A variety of tissue samples were removed from the horses a few min after their death for histopathological analysis. Two questionnaires were applied to obtain information about the horses and the environment in which they live. The results of the clinical examination revealed pale mucous membranes, jaundice, high fever, dehydration and lethargy. The horses were also infested with Amblyomma mixtum (17.6%) and Dermacentor nitens (82.4%) ticks, and with Tabanus pungens (74%), Tabanus spp. (26%), and Stomoxys calcitrans flies (100%), while the dogs were infested with Rhipicephalus sanguineus s.l. (77.7%) and Amblyomma mixtum (22.2%) ticks. The blood smear test results revealed the presence of Trypanosoma spp. in 66.6% (n = 4) of the horse blood samples, and in 50% (n = 1) of the dog blood samples. PCR performed to identify the Trypanosoma species confirmed the presence of T. evansi. Histological examination of the spleen revealed the involvement and dissemination of T. evansi in the tissues. The horses also showed the presence of Equine Infectious Anemia Virus (EIAV).Discussion: This is the first updated specific report of T. evansi in criollo horses in the savannah flood zone of the municipality of Arauca, Colombia. The main risk associated with T. evansi infection in horses was found to be infestation with the natural vector T. pungens and the mechanical vector S. calcitrans, which are efficient ectoparasites for the transmission of this parasite. The presence of T. evansi in dogs represents a constant risk to horses, because dogs may serve as a reservoir for the maintenance of the hemoparasite in the population under study. Another risk factor for horses could be the presence of vampire bats (Desmodus rotundus), a species of bat that has been described as a vector and reservoir of T. evansi in Colombia. The presence of EIAV antibodies in the horses under study can be attributed to the exposure of sick horses to vectors of this virus, such as Tabanus spp., S. calcitrans and inanimate needle-shaped fomites. This is the first study that identifies the coinfection of T. evansi and EIAV in horses in the floodplain region of Colombia. In view of the importance of these 2 pathologies to the health of horses, a greater number of tests and a larger animal population will be required to determine if this coinfection is the cause of the death of criollo horses in this region of Colombia. Lastly, the owners reported that pharmacological control with trypanocides has not been successful in most of the outbreaks that occurred during the years 2021 and 2022. This may suggest that Trypanosoma evansi is developing resistance to these drugs; therefore, specific studies will be required in the future to test this hypothesis.Keywords: Arauca, Equine Infectious Anemia Virus, floodplain savannah, mortality, surra

Neutropenia febril en pacientes con neoplasias hematológicas de un centro de referencia en Colombia.

Objetivo: analizar las características epidemiológicas, clínicas y bacteriológicas que influyen en la supervivencia de los pacientes con neoplasias hematológicas que desarrollaron neutropenia febril posterior a quimioterapia. Materiales y métodos: estudio de corte transversal que incluyó adultos con diagnóstico de neoplasias hematológicas que presentaron neutropenia febril durante la hospitalización en el año 2014 en las sedes de Oncólogos de Occidente en Pereira, Manizales y Armenia (Colombia). Se realizaron análisis univariados y multivariados; la supervivencia se estableció según el método de Kaplan-Meier. Se estableció un valor de p <0.05. Se usó el software STATA. Se tuvo aval de bioética de la Universidad Tecnológica de Pereira. Resultados: se incluyó a 55 pacientes. La mediana de edad fue de 48 años (31- 63), 27(49%) fueron hombres. Los diagnósticos oncológicos más frecuentes fueron el linfoma no Hodgkin (29%), leucemia mieloide aguda (24%) y leucemia linfoblástica aguda (20%). La mayor letalidad se presentó en los días 21, 32 y 48. 2 La mortalidad general fue del 9% y la mortalidad por neutropenia profunda fue del 18%. Conclusión: el número de neutropenias febriles, mayor tiempo de duración de la neutropenia febril, índice de Charlson y el antecedente de ingreso a UCI son factores de riesgo para mortalidad, mientras que el uso de piperacilina-tazobactam y el incremento en la puntuación del índice de MASCC son factores protectores

Neutropenia febril asociada a quimioterapia en pacientes con neoplasias hematológicas de un centro de referencia en Colombia: características clínicas y desenlaces

Objetivo: analizar las características epidemiológicas, clínicas y bacteriológicas que influyen en la supervivencia de los pacientes con neoplasias hematológicas que desarrollaron neutropenia febril posterior a quimioterapia.Materiales y métodos: estudio de corte transversal que incluyó adultos con diagnóstico de neoplasias hematológicas que presentaron neutropenia febril durante la hospitalización en 2014 en las sedes de Oncólogos de Occidente en Pereira, Manizales y Armenia (Colombia). Se realizaron análisis univariados y multivariados; la supervivencia se estableció según el método de Kaplan-Meier. Se estableció un valor de p <0.05. Se usó el software STATA. Se tuvo aval de bioética de la Universidad Tecnológica de Pereira.Resultados: se incluyó a 55 pacientes. La mediana de edad fue de 48 años (31-63), 27(49 %) fueron hombres. Los diagnósticos oncológicos más frecuentes fueron el linfoma no Ho-dgkin (29 %), leucemia mieloide aguda (24%) y leucemia linfoblástica aguda (20 %). La mayor letalidad se presentó en los días 21, 32 y 48. La mortalidad general fue del 9 % y la mortalidad por neutropenia profunda fue del 18 %.Conclusión: el número de neutropenias febriles, mayor tiempo de duración de la neutropenia febril, índice de Charlson y el antecedente de ingreso a UCI son factores de riesgo para mortalidad, mientras que el uso de piperacilina-tazobactam y el incremento en la puntuación del índice de MASCC son factores protectores

XVII International Congress of Control Electronics and Telecommunications: "Advanced Science, Technology and Innovation to move towards a new socio-technical system: Sustainable Social Transformation"

Contenido: Approach to the diagnostic of cesarean birth using bio-inspired models. ; Design of a tool in a virtual reality environment to manipulate anatomical models. ; The effect of COVID-19 restrictions on the electricity price forecasting models. ; Depression prevention through artificial intelligence. ; State of the art in Prototypes as complements to the learning of the Colombian Sign Language (LSC). ; A computational proposal for gene expression deterministic analysis in associated disorders to depression and anxiety. ; Evaluation of postural stability from the predictability of the measurement of the center of pressure. ; Psychophysiological Analysis of Sound Stimuli.; Delphi method for the identification of relevant variables in the development of low-power photovoltaic solar projects. ; Socioeconomic impact of a refrigerator powered by a photovoltaic system in La Guajira. ; Energy Efficiency: characteristics that allow the reduction of greenhouse gases in. ; Possibilities for the implementation of a bioreactor from organic waste. ; Energy Potential with Small Hydroelectric Power Plants in Non- interconnected Zones of Colombia. ; Energy Potential in Photovoltaic Solar Solutions in Non-Interconnected Areas of Colombia. ; Photovoltaic system, towards the energy transition from home. ; Blockchain model to increase the transparency of public sector processes. ; Intelligent agricultural irrigation prescription system based on sensor networks and crop modeling. ; Design and implementation of a digital modulation classification system using intelligent algorithms. ; A mobile application proposal to minimize intermediation during agricultural process distribution of products in supply chain. ; Accompanying strategy for the social appropriation of new technologies in vulnerable agricultural communities: case in communities producing Gulupas fruits (Passiflora edulis Sims). ; Predictive model of transparency as an indicator of Public Policies. ; Smart system for recognition of ripening level in blackberry fruits. ; Project-based learning as an alternative methodology for technological education in electronics. ; Design and construction of an automated system for N. ; Four bar mechanisms (FBM) and their Software-Based applications: a reviewFT aquaponic culture of Red Carp and Crespa Lettuce. ; Intelligent search implementation for the construction of states of the art: a python application. ; Indoor and Outdoor propagation models on 5G environments: state of the art. ;The electronic detection of offenders (DOO) in the District Secretary of mobility of Bogotá: a step forward in the configuration of the concept of digital citizenship in Colombia. ; Monitoring through ICT of Mobility: technological collaborative feature to incorporate IoT in a Smart City. ; Characterization model of asphalt mixtures using digital image processing. ; Review: identification of diseases and/or pests in fruit trees through image processing techniques and artificial intelligence. ; VRS applicated to Nasa Yuwe language. ; Application of Pix2Pix for edge reconstruction in images. ; Brushless DC Motor Control System for Active Myoelectric Prosthesis. ; Implementation of a Water Conductivity Measuring System. ; 2 DOF robot programmed with MatLab® (guide and Peter Corke) and Arduino uno for writing alphabetical characters. ; Simulator of the behavior of the center of mass in a quadruped robot. ; Biomimetic prototype for flapping movement of batsContent: Contenido: Approach to the diagnostic of cesarean birth using bio-inspired models. ; Design of a tool in a virtual reality environment to manipulate anatomical models. ; The effect of COVID-19 restrictions on the electricity price forecasting models. ; Depression prevention through artificial intelligence. ; State of the art in Prototypes as complements to the learning of the Colombian Sign Language (LSC). ; A computational proposal for gene expression deterministic analysis in associated disorders to depression and anxiety. ; Evaluation of postural stability from the predictability of the measurement of the center of pressure. ; Psychophysiological Analysis of Sound Stimuli.; Delphi method for the identification of relevant variables in the development of low-power photovoltaic solar projects. ; Socioeconomic impact of a refrigerator powered by a photovoltaic system in La Guajira. ; Energy Efficiency: characteristics that allow the reduction of greenhouse gases in. ; Possibilities for the implementation of a bioreactor from organic waste. ; Energy Potential with Small Hydroelectric Power Plants in Non- interconnected Zones of Colombia. ; Energy Potential in Photovoltaic Solar Solutions in Non-Interconnected Areas of Colombia. ; Photovoltaic system, towards the energy transition from home. ; Blockchain model to increase the transparency of public sector processes. ; Intelligent agricultural irrigation prescription system based on sensor networks and crop modeling. ; Design and implementation of a digital modulation classification system using intelligent algorithms. ; A mobile application proposal to minimize intermediation during agricultural process distribution of products in supply chain. ; Accompanying strategy for the social appropriation of new technologies in vulnerable agricultural communities: case in communities producing Gulupas fruits (Passiflora edulis Sims). ; Predictive model of transparency as an indicator of Public Policies. ; Smart system for recognition of ripening level in blackberry fruits. ; Project-based learning as an alternative methodology for technological education in electronics. ; Design and construction of an automated system for N. ; Four bar mechanisms (FBM) and their Software-Based applications: a reviewFT aquaponic culture of Red Carp and Crespa Lettuce. ; Intelligent search implementation for the construction of states of the art: a python application. ; Indoor and Outdoor propagation models on 5G environments: state of the art. ;The electronic detection of offenders (DOO) in the District Secretary of mobility of Bogotá: a step forward in the configuration of the concept of digital citizenship in Colombia. ; Monitoring through ICT of Mobility: technological collaborative feature to incorporate IoT in a Smart City. ; Characterization model of asphalt mixtures using digital image processing. ; Review: identification of diseases and/or pests in fruit trees through image processing techniques and artificial intelligence. ; VRS applicated to Nasa Yuwe language. ; Application of Pix2Pix for edge reconstruction in images. ; Brushless DC Motor Control System for Active Myoelectric Prosthesis. ; Implementation of a Water Conductivity Measuring System. ; 2 DOF robot programmed with MatLab® (guide and Peter Corke) and Arduino uno for writing alphabetical characters. ; Simulator of the behavior of the center of mass in a quadruped robot. ; Biomimetic prototype for flapping movement of bat

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care