Condiciones laborales de los pacientes con ERCnT que asisten a la Unidad Nacional de Atención al Enfermo renal Crónico (Unaerc)

La enfermedad renal crónica de causa no tradicional (ERCnT) es de etiología multifactorial y no se conoce con exactitud el factor que la provoca. Se asocia a factores como trabajo agrícola, estrés térmico, deshidratación y exposición a químicos. Este estudio transversal describe las condiciones laborales de pacientes con ERCnT que asisten a terapia de hemodiálisis en Unaerc (previo al inicio del tratamiento), y los factores que pudieron predisponer la enfermedad. Se utilizó un diseño de muestreo no probabilístico por cuotas, obteniendo una muestra de 107 pacientes sin antecedentes de diabetes mellitus y < 60 años. Los resultados mostraron que el 76.6 % (82/107) fueron de género masculino, el 26.2 % (28/107), diagnosticados entre 31-40 años y el 38.3 % (41/107) provenían del departamento de Guatemala. El 24.3 % (26/107) y el 15.9 % (17/107) se dedicaban a trabajos agrícolas y al comercio, respectivamente. La mayoría (26.9 %; 7/26) de los trabajadores agrícolas se dedicaban al corte de caña de azúcar; el 57.9 % (62/107) trabajaban para una institución, donde solamente un 17.8 % (19/107) tenían contrato escrito. El 43 % (46/107) trabajaban 6 días/semana, el 57.9 % (62/107) realizaban jornadas de > 8 h/día y el 56.1 % (60/107) no tenían horas extras remuneradas. El 68.2 % (73/107) ganaba menos del salario mínimo y el 70.1 % (75/107) no recibía prestaciones laborales. El 36.4 % (39/107) estuvo expuesto a químicos, el 91.5 % (98/107) se exponía 8 h/día al sol. Solamente 83.2 % (89/107) descansaba durante la jornada laboral

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research