Caracterización y evaluación de los recursos naturales de la microcuenca cunyatupe

The microriver basin of Cunyatupe, located to the north of the city of Huaraz, in the department of Ancash-Peru; it presents/displays 5 zones of life, in addition to be within the White Mountain range of the Valley of Huaylas it has water in sufficient amount, to suitably maintain all the existing natural resources in this. With respect to the characterization of the microriver basin one was the following natural resources: Water, which it includes/understands a fluvial network that mainly has its origin in the different easts caused by the excessive erosion from cárcavas, Hidrobiológico where it was observed the presence of seaweed and worms like (Rhabditis Diplogasteroides, Dichotomosiphon, etc), Cattle dealer with bovine, ovine, equinos and pig greater cattles that is to say, Agricultural with the presence of cultivables species nutritional altoandinos like: barley, Pope, maize, wheat among others, fruit like: quince, apple, pacay and uvilla, Genetic or genetic aromatic like; Robust (Route graveolens), Ishmuna or muña (Minthostachys spp), etc, and genetic forages like: wild barley (Nassella Sp), Kikuyo (Pennisetum clandestinum), ichu (Stipa ichu), etc and finally, biological diversity with the presence of small lizards colilarga (Psammodromus algyrus), black picaflor (Metallura phoebe), among others inside d ela fauna and in addition species to flora lsecshi (cortaderia Sp), maguey (American Agave), ferns (Polistichium Sp), etc, Ecological where one took encuenta the zones from life among others, and finally the Forest resource where they honor the eucalyptus (Eucalyptus Sp), alder (Alnus Sp), pine (Pinus Sp), capulí (Serotina Prunus), quenual (Polylepis Sp), etc. In the evaluation of the natural resources of the microriver basin one was grounds by capacity of greater use of class I to the VIII, with problems due to badly the related handling of water to its contamination, due to the raising of cattles, and badly use of the irrigation water, that causes the erosion.ike: retama (spartium junceum),La microcuenca de Cunyatupe, ubicada al norte de la provincia de Huaraz, en el departamento de Ancash-Perú, presenta cinco zonas de vida. Además por hallarse dentro de la Cordillera Blanca del Callejón de Huaylas tiene agua en cantidad suficiente, para mantener adecuadamente todos los recursos naturales existentes en ella. Con respecto a la caracterización de la microcuenca, se encontraron los siguientes recursos naturales: Agua, que comprende una red fluvial que tiene su origen en las diferentes nacientes ocasionadas principalmente por la erosión excesiva de cárcavas, Hidrobiológico donde se observó la presencia de algas y gusanos como el Rhabditis diplogasteroides, Dichotomosiphon, etc., Ganadero con ganados mayores, es decir, vacunos, ovinos, equinos y porcinos, Agrícola con la presencia de especies cultivables alimenticias altoandinas como: cebada, papa, maíz, entre otros; frutales como: membrillo, manzana, pacae y uvilla, Genético, ya sea genéticos aromáticos como: ruda (Ruta graveolens), Ishmuna o muña (Minthostachys spp.), etc., y genéticos forrajes como: Kikuyo (Pennisetum clandestinum), ichu (Stipa ichu), etc., y finalmente, Diversidad biológica con la presencia de lagartijas colilarga (Psammodromus algyrus), picaflor negro (Metallura phoebe), entre otros, dentro de la fauna, y además especies de flora como: retama (Spartium junceum), secshi (Cortaderia Sp.), maguey (Agave americana), helechos (Polistichium Sp.), etc., Ecológico, donde se tomó en cuenta las zonas de vida, entre otros, y finalmente el recurso Forestal donde destacan el eucalipto (Eucalyptus Sp.), aliso (Alnus Sp.), pino (Pinus Sp.), capulí (Prunus serotina), quenual (Polylepis Sp.), etc. En la evaluación de los recursos naturales de la microcuenca, se encontraron suelos por capacidad de uso mayor de la clase II al VIII, con problemas debido al mal manejo de agua relacionados a su contaminación, debido a la crianza de ganados, y mal uso del agua de riego, que ocasiona la erosión

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes