Surgical management of penetrating pulmonary injuries

Chest injuries were reported as early as 3000 BC in the Edwin Smith Surgical Papyrus. Ancient Greek chronicles reveal that they had anatomic knowledge of the thoracic structures. Even in the ancient world, most of the therapeutic modalities for chest wounds and traumatic pulmonary injuries were developed during wartime

Mobbing - Moral Harassment: Prospective Study in Public Hospitals of the Province of Buenos Aires, Argentina

Antecedentes: el mobbing se define como acoso, ofensa, exclusión social de alguien e interferencia negativa en sus tareas por uno o más individuos del mismo ambiente laboral. Objetivo: identificar los factores de riesgo, procedencia y análisis de la incidencia del mobbing, así como su relación con los factores de riesgo psicosociales y su afectación en los trabajadores de la salud. Material y métodos: estudio prospectivo, observacional descriptivo, con participante natural y de campo. Se utilizaron encuestas anónimas a personal sanitario incluido en las Leyes No 10.471 y No 10.430 de hospitales públicos de la provincia de Buenos Aires, durante un período de 12 meses consecutivos. Resultados: se incluyeron 147 participantes, de los cuales 101 (68,7%) fueron mujeres, 42 (28,5%) varones, y 4 (2,8%) no contestaron. El grupo más numeroso correspondió a la franja etaria 41-50 años (n = 51; 36%). La antigüedad laboral presentó una distribución bimodal de los grupos 1-5 años (27,25%) y 16-20 años (24%). El número que se consideró acosado fue de 86 agentes (58,5% de la muestra). Hubo mayor preponderancia de los superiores como los principales acosadores con 52,4% (n = 77). Conclusiones: la incidencia hallada es mayor que la informada en la literatura al comparar solo un sector laboral con la totalidad de la población activa (58,5% vs. 11,4%). Las variables sociodemográficas, como sexo, nacionalidad de origen, estado civil, nivel de estudios cursados y alcanzados y el tipo de contratación no se asociaron a una mayor incidencia de mobbing, como sí tuvieron una relación directa tanto la edad como la antigüedad, lo que confirma el acoso moral como un estresor crónico en el trabajo. Los motivos del ausentismo de naturaleza psicológica (depresión y crisis de ansiedad) producidos por el mobbing no solo afectan los síntomas psicosomáticos evaluados, sino también aumentan el ausentismo laboral, afectando la productividad de la empresa hospital.Background: mobbing is defined as harassment, offense, social exclusion of someone and negative interference in their work tasks by one or more individuals from the same work environment. Objective: to identify the risk factors, origin and analysis of the incidence of mobbing, as well as its relationship with psychosocial risk factors and their involvement in health workers. Material and methods: prospective, observational, descriptive study with natural and field participant. Anonymous surveys were used for health personnel included in Laws No. 10471 and No. 10430 from public hospitals in the province of Buenos Aires, during a 12-month period. Results: a total of 147 participants were included, 101 (68.7%) were female, 42 (28.5%) were male, and 4 (2.8%) did not answer. The largest group corresponded to the age group 41-50 years (n= 51; 36%). The age of labor presented a bimodal distribution of groups 1-5 years (27.25%) and 16-20 years (24%). The number that was considered harassed was 86 agents (58.5% of the sample). There was greater preponderance of superiors as the main stalkers with 52.4% (n= 77). Conclusions: the incidence found is greater than that reported in the literature when comparing a single labor sector with the total of the active population (58.5% vs. 11.4%). Sociodemographic variables such as gender, national origin, marital status, level of studies completed and type of recruitment, were not associated with a higher incidence of mobbing, as were age and seniority in a direct proportion, confirming moral harassment as a chronic stressor at work. The reasons for leave of absence of a psychological nature (depression and crisis of anxiety) produced by mobbing, not only affects the psychosomatic symptoms evaluated, but also increase work leaves of absence, affecting the productivity of the hospital.Facultad de Ciencias Económica

Inteligencia artificial y redes neurales artificiales

Hace tiempo que la inteligencia artificial abandonó el espectro de la ciencia ficción para filtrarse e instalarse en nuestras vidas, y está llamada a protagonizar una revolución equiparable a la que generó internet. Pero ¿qué es realmente la Inteligencia Artificial (IA)? Es la combinación de algoritmos planteados con el propósito de crear sistemas que repliquen las mismas capacidades que el ser humano

Condiciones psicofísicas en el acoso moral en el trabajo : Factores de riesgo y experiencia en hospitales públicos provinciales

El interés por estudiar el fenómeno de acoso laboral se debe a la frecuencia en que se produce, a las graves consecuencias sobre la salud de las víctimas y para las organizaciones, y fundamentalmente a la necesidad de intervención con oportunas medidas de prevención. Es por ello que interesa conocer las situaciones ligadas al mobbing, su entorno y las circunstancias en las cuales se presenta, y sus consecuencias. El presente trabajo se divide en dos apartados principales. La primera parte describe el ámbito en que se desarrolla el estudio, como es el hospital público dependiente del Ministerio de Salud de la provincia de Buenos Aires. Se trata de un sector especialmente significativo para estudiar un fenómeno que está fuertemente influenciado por aspectos contextuales y organizativos. De allí que el objetivo del presente estudio sea analizar las condiciones psicofísicas en el acoso moral en el trabajo así como los factores de riesgo en dichos hospitales. La segunda parte presenta los objetivos y la justificación del presente estudio, el método utilizado, los principales resultados obtenidos y su discusión. Se describirán las posibles explicaciones de este fenómeno, haciendo hincapié en las medidas preventivas, finalizando con las conclusiones.Facultad de Ciencias Económicas (FCE

Pericardiocentesis Followed by Thoracotomy and Repair of Penetrating Cardiac Injury Caused by Nail Gun Injury to the Heart

INTRODUCTION: Work site injuries involving high projectile tools such as nail guns can lead to catastrophic injuries. Generally, penetrating cardiac injuries are associated with a high mortality rate. PRESENTATION OF CASE: A construction worker was brought to the emergency room having sustained a nail gun injury to the chest. The patient was hypotensive, tachycardic with prominent jugular venous distention, and had a profound lactic acidosis. Bedside ultrasound confirmed the presence of pericardial fluid. Pericardiocentesis was performed twice using a central venous catheter inserted into the pericardial space, resulting in improvement in the patient\u27s hemodynamics. Thereafter he underwent left anterolateral thoracotomy and repair of a right atrial laceration. He recovered uneventfully. DISCUSSION: Penetrating cardiac injuries caused by nail guns, although rare, have been previously described. However, pericardiocentesis, while retaining a role in the management of medical causes of cardiac tamponade, has been reported only sporadically in the setting of trauma. We report a rare case of penetrating nail gun injury to the heart where pericardiocentesis was used as a temporizing measure to stabilize the patient in preparation for definitive but timely operative intervention. CONCLUSION: We propose awareness that percardiocentesis can serve as a temporary life saving measure in the setting of trauma, particularly as a bridge to definitive therapy. To our knowledge, this represents the first reported case of catheter pericardiocentesis used to stabilize a patient until definitive repair of a penetrating cardiac injury caused by a nail gun

Bringing Packed Red Blood Cells to the Point of Combat Injury: Are We There Yet?

INTRODUCTION: Hemorrhage is the leading cause of injury related pre-hospital mortality. We investigated worst case scenarios and possible requirements of Turkish Military. As we plan to use blood resources during casualty transport, the impact of transport related mechanical stress on PRBC (packed red blood cell) were analyzed. MATERIAL AND METHODS: The in vitro experiment was performed in the environmental test laboratories of ASELSAN(R). Operational vibrations of potential casualty transport mediums such as Sikorsky Helicopters, Kirpi(R) Armoured Vehicle and NATO vibration standardsoftware MIL-STD-810G were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (7 day) PRBC in a blood cooler box. The vibrations were simulated by TDS v895 Medium-Force Shaker Device. On site blood samples were analyzed at 0, 6th and 24th hours for biochemical and biomechanical analyses. RESULTS: The mean age of fresh and old PRBCs was 4.9 (SD +/- 2.2) and 32.8 (SD +/- 11.8) days, respectively. Six-hour mechanical damage of fresh PRBC was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), supernatant Hb (p=0.015) were increased and Htc levels were decreased (p=0.015) within 6 hours. Two (%13) units of fresh and none of the old PRBC were eligible for transfusion after 6 hours of mechanical stress. CONCLUSION: When the austere combat environment was simulated for 24 hours, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, a technology to overcome this mechanical damage does not seem to exist. In the light of the above data, a new national project is being performed

Assessing COVID-19-Related Excess Mortality Using Multiple Approaches—Italy, 2020–2021

Introduction: Excess mortality (EM) is a valid indicator of COVID-19’s impact on public health. Several studies regarding the estimation of EM have been conducted in Italy, and some of them have shown conflicting values. We focused on three estimation models and compared their results with respect to the same target population, which allowed us to highlight their strengths and limitations. Methods: We selected three estimation models: model 1 (Maruotti et al.) is a Negative-Binomial GLMM with seasonal patterns; model 2 (Dorrucci et al.) is a Negative Binomial GLM epidemiological approach; and model 3 (Scortichini et al.) is a quasi-Poisson GLM time-series approach with temperature distributions. We extended the time windows of the original models until December 2021, computing various EM estimates to allow for comparisons. Results: We compared the results with our benchmark, the ISS-ISTAT official estimates. Model 1 was the most consistent, model 2 was almost identical, and model 3 differed from the two. Model 1 was the most stable towards changes in the baseline years, while model 2 had a lower cross-validation RMSE. Discussion: Presently, an unambiguous explanation of EM in Italy is not possible. We provide a range that we consider sound, given the high variability associated with the use of different models. However, all three models accurately represented the spatiotemporal trends of the pandemic waves in Italy

Estimated effectiveness of a primary cycle of protein recombinant vaccine nvx-cov2373 against COVID-19

Importance: Protein recombinant vaccine NVX-CoV2373 (Novavax) against COVID-19 was authorized for its use in adults in late 2021, but evidence on its estimated effectiveness in a general population is lacking. Objective: To estimate vaccine effectiveness of a primary cycle with NVX-CoV2373 against SARS-CoV-2 infection and symptomatic COVID-19. Design, setting, and participants: Retrospective cohort study linking data from the national vaccination registry and the COVID-19 surveillance system in Italy during a period of Omicron predominance. All adults starting a primary vaccination with NVX-CoV2373 between February 28 and September 4, 2022, were included, with follow-up ending on September 25, 2022. Data were analyzed in February 2023. Exposures: Partial (1 dose only) vaccination and full vaccination (2 doses) with NVX-CoV-2373. Main outcomes and measures: Notified SARS-CoV-2 infection and symptomatic COVID-19. Poisson regression models were used to estimate effectiveness against both outcomes. Adjusted estimated vaccine effectiveness was calculated as (1 - incidence rate ratio) × 100. Results: The study included 20 903 individuals who started the primary cycle during the study period. Median (IQR) age of participants was 52 (39-61) years, 10 794 (51.6%) were female, and 20 592 participants (98.5%) had no factors associated with risk for severe COVID-19. Adjusted estimated vaccine effectiveness against notified SARS-CoV-2 infection in those partially vaccinated with NVX-CoV2373 was 23% (95% CI, 13%-33%) and was 31% (95% CI, 22%-39%) in those fully vaccinated. Estimated vaccine effectiveness against symptomatic COVID-19 was 31% (95% CI, 16%-44%) in those partially vaccinated and 50% (95% CI, 40%-58%) in those fully vaccinated. Estimated effectiveness during the first 4 months after completion of the primary cycle decreased against SARS-CoV-2 infection but remained stable against symptomatic COVID-19. Conclusions and relevance: This cohort study found that, in an Omicron-dominant period, protein recombinant vaccine NVX-CoV2373 was associated with protection against SARS-CoV-2 infection and symptomatic COVID-19. The use of this vaccine could remain an important element in reducing the impact of the SARS-CoV-2 pandemic

Characteristics of COVID-19 cases in Italy from a sex/gender perspective

Introduction: Coronavirus disease 19 (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To date, few data on clinical features and risk factors for disease severity and death by gender are available. Aim: The current study aims to describe from a sex/gender perspective the characteristics of the SARS-CoV-2 cases occurred in the Italian population from February 2020 until October 2021. Method and results: We used routinely collected data retrieved from the Italian National Surveillance System. The highest number of cases occurred among women between 40 and 59 years, followed by men in the same age groups. The proportion of deaths due to COVID-19 was higher in men (56.46%) compared to women (43.54%). Most of the observed deaths occurred in the elderly. Considering the age groups, the clinical outcomes differed between women and men in particular in cases over 80 years of age; with serious or critical conditions more frequent in men than in women. Conclusions: Our data clearly demonstrate a similar number of cases in women and men, but with more severe disease and outcome in men, thus confirming the importance to analyse the impact of sex and gender in new and emerging diseases