Propuesta de guía de implementación de un sistema de gestión de seguridad y salud en el trabajo basado en la norma INTE/ISO 45001:2018 para la empresa Corporación de Profesionales en Ingeniería S.A.

Proyecto de Graduación (Licenciatura en Ingeniería en Seguridad Laboral e Higiene Ambiental) Instituto Tecnológico de Costa Rica, Escuela de Ingeniería en Seguridad Laboral e Higiene Ambiental, 2019.The project was carried out in the company Corporación de Profesionales en Ingeniería S.A., dedicated to the construction sector. The objective was to develop a guide for the implementation of a Work Health and Safety Management System based on the INTE/ISO 45001: 2018 standard. For the development of the proposal, the current management of the company was initially analyzed through a review of documents, the application of the checklist based on NTP 308, a survey for managers and another for collaborators. Subsequently, the analysis of the organization's context, internal and external, is carried out through an analysis of PESTEL and finally the information is synthesized in a SWOT. Then an assessment of risks and opportunities is carried out by means of a non-participatory observation and the guidelines for the verification of conditions in the construction sector are applied in the projects to be subsequently evaluated through the risk evaluation matrix according to the standard INTE 31-06-07: 2011. After analyzing the tools, results were obtained such as the absence of a formal written commitment from management, the lack of documentation and the presence of important risks for workers in the activities they carry out. This is summarized in the current management of the company in health and safety has great opportunities for improvement and shows the need for immediate intervention measures to improve the situation, which leads to the implementation guide of a health and safety system in work to improve the working conditions of the organization.El proyecto se realizó en la empresa Corporación de Profesionales en Ingeniería S.A., dedicada al sector construcción. El objetivo fue desarrollar una guía de implementación de un Sistema de Gestión de Salud y Seguridad en el trabajo basada en la norma INTE/ISO 45001:2018. Para el desarrollo de la propuesta se analizó inicialmente la gestión actual de la empresa por medio de una revisión de documentos, la aplicación de la lista de verificación basada en la NTP 308, una encuesta para los gerentes y otra a los colaboradores. Posteriormente se realiza el análisis del contexto de la organización, interno y externo por medio de un análisis de PESTEL y por último se sintetiza la información en un FODA. Luego se realiza una evaluación de riesgos y oportunidades por medio de una observación no participativa y se aplica en los proyectos la guía de verificación de condiciones en el sector construcción para posteriormente ser valorados mediante la matriz de evaluación de riesgos según la norma INTE 31-06-07:2011. Tras el análisis de las herramientas se obtuvieron resultados como la ausencia de un compromiso formal por escrito de parte de la dirección, la inexistencia de documentación y la presencia de riesgos importantes para los trabajadores en las actividades que desarrollan. Esto se sintetiza en que la gestión actual de la empresa en salud y seguridad tiene grandes oportunidades de mejora y muestra la necesidad de medidas de intervención inmediatas para mejorar la situación, lo que conlleva a la guía de implementación de un sistema de salud y seguridad en el trabajo para mejorar las condiciones laborales de la organización

Isolated subclinical right ventricle systolic dysfunction in patients after liver transplantation

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S', or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis

Changes in electrocardiographic p wave parameters after cryoballoon ablation and their association with atrial fibrillation recurrence

Background: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence. Methods: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence. Results: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P 0.05). Conclusion: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA

Comparison of catheter-directed thrombolysis and anticoagulation in intermediate-risk pulmonary embolism: A retrospective analysis

BACKGROUND AND OBJECTIVES: The selection of escalation of care strategies for the treatment of intermediate-risk pulmonary embolism (PE) is a matter of debate. Here, we aimed to assess the features of our population treated either with anticoagulation (AC) alone or catheter-directed thrombolysis (CDT). We also sought to identify a relationship between high residual systolic pulmonary artery pressure (sPAP) and demographic and clinical variables. PATIENTS AND METHODS: The retrospective data of 30 intermediate-high-risk PE patients were analyzed. CDT was used in 14 (46.7%) cases. Enoxaparin (b. i. d) injections were administered in the AC group. In the CDT group, patients received 5 mg bolus dose of alteplase followed by 1 mg/h infusion for 24 h. Estimated sPAP at presentation and discharge was recorded. A value equal to or greater than 40 mmHg in the latter was accepted as a significant rise. RESULTS: The patients in the CDT group had a lower HAS-BLED score (2 [0-3] vs. 1 [0-3], P = 0.03). Although initial sPAP values were comparable among treatment arms, sPAP at discharge was significantly lower in the CDT group (mmHg, 42 +/- 11.2 vs. 33.6 +/- 9.7, P = 0.04). The reduction in sPAP at discharge was also significantly higher in this group. The degree of reduction in sPAP was considerably correlated with baseline sPAP (r: 63.2, P < 0.001). Finally, the baseline sPAP measurement and HAS-BLED score of the patients with high residual sPAP were significantly higher (56.6 +/- 13.1 vs. 67.3 +/- 11.3, P = 0.02, and 1 [0-3] vs. 2 [0-3], P = 0.02, respectively). CONCLUSION: CDT was preferred over AC when lower bleeding risk was anticipated for intermediate-high-risk PE patients in our sample population. Eventually, CDT provided lower discharge sPAP levels and a greater reduction in sPAP. However, the factors associated with high sPAP at discharge were only high baseline sPAP measurement and HAS-BLED score

Oktojenaryen bir hastada apiksaban tedavisi altında gelişen hemorajik plevral efüzyonun yönetimi

After verification of the relevant trial data with real-world registries, it is now a widelyaccepted fact that Non-Vitamin K oral anticoagulants (NOACs) offer at least equal efficacy aboutstroke risk reduction with less bleeding events in comparison to Vitamin K antagonists. Spontaneousserous bleeding (pericardial or pleural) is a quite rare complication of NOAC treatment which hadjust been previously reported in a few cases with dabigatran, rivaroxaban, and apixaban. Here wepresent a 72-year-old patient receiving apixaban, who was diagnosed to have a massive right pleural hemorrhagic effusion during conventional heart failure treatment. Effusion was drained immediately. Reversal of anticoagulation or blood transfusion was not required.Mevcut verilerin gerçek dünya serileriyle de desteklenmesinden sonra Non-Vitamin K oral antikoagülanların (NOAKlar), K vitamini antagonistlerine kıyasla inme riskinin azaltılmasında en az eşit etkinliği sahip olduğu ve daha az kanamaya sebep olduğu yaygın kabul gören bir gerçektir. Spontan seröz kanama (perikardiyal ya da plevral), NOAK tedavisinin oldukça nadir bir komplikasyonudur ki; daha önce dabigatran, rivaroksaban ve apiksaban ile sadece birkaç vaka bildirilmiştir. Bu bildiride, olağan kalp yetersizliği tedavisi alırken sağ taraflı belirgin hemorajik plevral efüzyon gelişen, 72 yaşında bir olgu ele alınmıştır. Olguda efüzyon hemen drene edildi ve antikoagülasyonun etkisinin kaldırılması veya transfüzyon ihtiyacı gözlenmedi

Cystatin C and uncontrolled hypertension

Objective: Increased serum level of cystatin C, a sensitive biomarker for renal function, seems to predict adverse cardiovascular events. We investigated the predictive value of serum cystatin C for controlling hypertension in an observational study.Methods: We screened 1037 adults residing in both rural and urban communities. They were grouped based on their diagnosis and control of hypertension.Results: Serum cystatin C levels in patients with uncontrolled hypertension were higher than those in patients with controlled hypertension (0.98 +/- 0.23 mg/L vs. 0.89 +/- 0.19 mg/L, p=0.001). However, serum creatinine levels were similar between these groups (0.72 +/- 0.20 mg/dL vs. 0.70 +/- 0.18 mg/dL, p=0.89). Serum cystatin C levels increased the probability of uncontrolled hypertension independent from confounding factors (odds ratio, 1.48; 95% confidence interval, 1.09-5.64; p=0.03).Conclusion: Subtle kidney dysfunction may be detected using serum cystatin C concentrations among patients with poor blood pressure control and normal serum creatinine levels

Failed transcatheter mitral valve-in-ring implantation followed by transapical valve-in-valve within the ring and ad hoc paravalvular leak closure

There is a rapid emergence of transcatheter mitral valve-invalve (TMVIV) and valve-in-ring (TMVIR) techniques as an alternative to the conventional surgical valve replacement in ineligible patients requiring repeat surgery (1).The selection of a new transcatheter heart valve (THV) for degenerated surgical valves is relatively simple; however, the selection of valves for mitral rings is more nuanced because the rigidoval or D-shaped rings will not conform to the round shape of theprosthesis, thus posing a high risk of paravalvular leak (PVL).Although prior reports have described simultaneous TMVIVand percutaneous PVL closure techniques, our case report provides the first description of simultaneous transapical valve-invalve implantation and the closure of severe PVL after a failedtransseptal valve-in-ring procedure (2, 3)

Konjenital inferior vena kava agenezi olan hastada atriyoventrikülernodal reentran taşikardisinin başarılı kateter ablasyonu

A 50-year-old womanadmitted with recurrent palpitations due tosupraventricular tachycardia previously documented by ECG. Shewas referred for electrophysiological studyand catheter ablationinitiated by introducingthe venous sheath viathe right femoral vein.However, the ablationcatheter could not be advanced through the inferior vena cava (IVC) due to resistance

Successful management of spontaneous coronary artery dissection: A case of event-free 5 years follow-up

Spontaneous coronary artery dissection (SCAD) is non-iatrogenic longitudinal separation of the coronary arterial walls, generating true and false lumens. Although it wasknownas a disease of the young females without cardiovascular risk factors, recent evidences have revealed that SCAD can also be seen in older patients having traditional risk factors for ather-osclerosis. In this report, we present a 50-year-old female patient with theSCADof left anterior descending artery (LAD) leading to anteriormyocardial infarction, ten days previously and persisting angina. She was successfully treated using intravascular ultrasound (IVUS) by stenting dissected segment. She has done well since then, and stent patency was demonstrated with coronary computed angiography (CTA) at the fifth-year follow up

Radyoterapiye bağlı kardiyak hasarlanmada strain görüntüleme, troponin-i ve beyin natriüretik peptid seviyelerinin ölçümü

WOS: 000388274800002Radiotherapy (RT) of the thorax can damage the pericardium, myocardium, heart valves, and coronary vessels, with the pericardium being the most frequently damaged. The objectives of this study were to evaluate RT-induced left ventricular dysfunction and myocardial injury by measuring cardiac biomarkers, troponin I (TnI) and brain natriuretic peptide (BNP), as well as determin cardiotoxicity and early signs of cardiovascular dysfunction using strain rate imaging (SRI) prior to and following RT. This study included 35 patients diagnosed with thoracic malignancy between January 2011 and October 2013. Of the 35 patients, 22 had left-sided lung cancer and 13 had left-sided breast cancer. SRI was performed and TnI and BNP levels were measured prior to and following RT. A total radiation dose of 40-60 Gy (mean, 54.9 +/- 8.9 Gy) was applied in lung cancer patients and 50-60 Gy (mean, 51.6 +/- 4.9 Gy) was applied in breast cancer patients. No significant difference was observed in TnI or BNP levels prior to and one month following RT. The left ventricular ejection fraction (LVEF) did not differ prior to or after the first month of RT. However, lower right ventricular strain (RVS) and left ventricular strain (LVS) SRI values were detected within the first month following RT. From the results of this study, we conclude that SRI is a sensitive method to detect RT-induced changes in cardiac function that are not typically detected by conventional echocardiographic methods and cardiac biomarkers.Radyoterapi (RT) göğüs bölgesine uygulandığında en çok perikard olmak üzere myokard, kalp damarları ve koroner damarlara za-rar verir. Bu çalışmanın amacı RT uygulanmış hastalarda sol ventrikül disfonksiyonunu ve myokard hasarını kardiyak biyobelirteçler, Troponin I (TnI) ve Beyin Natriüretik Peptip (BNP) seviyelerini ölçmek ve erken kardiyovasküler erken belirtileri strain rate görüntüleme (SRG) ile RT öncesi ve sonrası belirlemektir. Bu çalışmaya Ocak 2011 ile Ekim 2013 yılları arasında 35 toraks bölgesi kanseri alındı. Otuz beş hastanın 22'si sol meme kanseri ve 13'ü sol taraf akciğer kanseri idi. SR görüntüleme ve TnI, BNP seviyelerine tedavi öncesi ve sonrası bakıldı. Akciğer kanseri hastalarına 40-60 Gy arası (ortalama, 54.9 ± 8.9 Gy) doz ve meme kanseri hastalarına 50-60 Gy (ortalama, 51.6 ± 4.9 Gy) doz uygulandı. BNP ve TnI seviyelerinde tedavi öncesi ve sonrası istatistiki olarak bir anlamlılık görülmedi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) tedavi öncesi ve tedavi sonrası bir aylık dönemde değişmedi. Fakat, sağ ventrikül gerilimi (SVG) ve sol ventrikül gerilimi (SVG) SRG değerleri tedavi sonrası bir aylık dönemde daha düşük bulundu. Bu çalışmanın sonuçlarına göre, RT hasarının kardiyak fonksiyon üzerindeki erken sonuçlarını tespit etmek konvansiyonel ekokardiyografiye göre SR görüntüleme ile daha duyarlı bir metoddur