Frecuencia del consumo de SPA e intervención requerida en las personas privadas de la libertad del centro carcelario agrícola de Acacias-Meta 2020

El Observatorio de Drogas en Colombia resalta la importancia en la identificación temprana y el seguimiento del consumo de sustancias psicoactivas (SPA) con el objetivo de implementar estrategias para manejar esta problemática de salud mundial. Sumado a esto, la pandemia Covid-19 ha tenido un impacto considerable en la disponibilidad y consumo de dichas sustancias en los centros carcelarios del país. En este sentido, la presente investigación presenta un análisis referente a la frecuencia del consumo de SPA e intervención requerida en las personas privadas de la libertad del Centro Carcelario Agrícola de Acacias-Meta 2020. La metodología implementada en el presente trabajo de investigación se basa en un estudio cuantitativo observacional descriptivo de corte transversal. Se realizó un muestreo con 165 internos del Centro Carcelario. Posteriormente se realizó la aplicación del instrumento basado en el cuestionario de la Organización Mundial de la Salud ASSIST Versión 3.0 y se analizó la información con el programa estadístico SPSS. En el análisis del Centro Carcelario Colonia Agrícola, se observa un impacto positivo frente al consumo de sustancias psicoactivas durante la pandemia (2020) comparado con las mediciones realizadas antes misma, dado que un grupo de personas ha intentado controlar, reducir o dejar el consumo de tabaco, bebidas alcohólicas y cannabis durante Covid-19. Si bien la reducción del consumo de sustancias psicoactivas infiere resultados satisfactorios, los autores establecen la hipótesis que dicha reducción en el Centro Carcelario se debe a la oferta limitada de las sustancias y por lo tanto es necesario complementar el presente análisis con otros estudios referentes al impacto del Covid-19.The Drug Observatory in Colombia highlights the importance of early identification and monitoring of the use of psychoactive substances (PAS) in order to implement strategies to manage this global health problem. In addition to this, the Covid-19 pandemic has had a considerable impact on the availability and consumption of these substances in the country's prisons. In this sense, the present investigation presents an analysis regarding the frequency of PAS consumption and the intervention required in persons deprived of their liberty at the Acacias Agricultural Prison Center-Meta 2020. The methodology implemented in this research work is based on a quantitative observational descriptive cross-sectional study. A sampling was carried out with 165 inmates of the Prison Center. Subsequently, the application of the instrument based on the questionnaire of the World Health Organization ASSIST Version 3.0 was carried out and the information was analyzed with the statistical program SPSS. In the analysis of the Colonia Agrícola Prison Center, a positive impact is observed against the consumption of psychoactive substances during the pandemic (2020) compared to the measurements carried out before it, given that a group of people have tried to control, reduce or stop the consumption of tobacco, alcoholic beverages and cannabis during Covid-19. Although the reduction in the consumption of psychoactive substances infers satisfactory results, the authors establish the hypothesis that said reduction in the Prison Center is due to the limited supply of substances and therefore it is necessary to complement the present analysis with other studies referring to the impact of Covid-19.Introducción -- Justificación -- Marco referencial -- Marco teórico -- Marco conceptual -- Marco legal -- Marco epidemiológico -- Objetivos -- Objetivo general -- Objetivos específicos --Metodología -- Tipo de estudio y diseño -- Universo de estudio-- Población de estudio -- Selección y tamaño de la muestra -- Criterios de inclusión y exclusión -- Criterios de inclusión -- Criterios de exclusión -- Procedimiento para la recolección de la información -- Fase 1 -- Fase 2 -- Fase 3 -- Fase 4-- Fase 5 -- Fase 6-- Instrumento -- Operación de variables -- Consideraciones bioéticas del estudio -- Análisis de resultados – Discusión -- Conclusiones -- Bibliografía -- Anexos

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.status: publishe

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field