Congenital anomalies of cardiac partitioning in infant morbidity and mortality in Guantánamo

Se realiza un estudio para determinar el comportamiento de las cardiopatías congénitas en fetos y recién nacidos vivos de gestantes atendidas en el Centro Provincial de Genética Médica durante el período enero de 2005 – diciembre de 2012. El universo está constituido por 74 fetos y recién nacidos vivos que presentaron cardiopatías congénitas con defecto del tabicamiento cardíaco. El dato primario se recogió de las historias clínicas del Centro de Genética Provincial, de los recién nacidos del Hospital General Docente “Agostinho Neto”. Predominan las anomalías de los tabiques: bulbar e interventricular en las gestantes con antecedentes de hipertensión arterial (HTA) y diabetes mellitus (DM). La estructura embrionaria más afectada fue la porción membranosa del tabique interventricular y los rebordes tronco-conales y el tratamiento más empleado fue el quirúrgico-médico.A study was carried out to determine the behavior of congenital heart defects in fetuses and live births of pregnant women attended at the Provincial Center of Medical Genetics during the period January 2005 - December 2012. The universe is constituted by 74 live fetuses and newborns who presented congenital heart defects with cardiac defect. The primary data was collected from the clinical records of the Provincial Genetics Center of newborns at the General Teaching Hospital "Agostinho Neto". Bulbar and interventricular septal defects predominate in pregnant women with a history of arterial hypertension (AHT) and diabetes mellitus (DM). The most affected embryo structure was the membranous portion of the interventricular septum and the trunk-conical ridges and the most used treatment was the surgical-medical

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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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

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

European Space: How space missions are created in European context

Large and challenging space programs like the ISS and future missions to Mars and beyond are more and more realized in a multi-national global context involving in specific European partners. European space business involves various players to balance out the mission objectives, the technical performances and configurations with the financial and schedule constraints on programmatic side. Various proposals exist regarding space exploration and the continuation of manned spaceflight after ISS, spreading from feasible low cost LEO – concepts (speaker 1, DLR system institute) to high complex stations at Moon and Mars. Furthermore, the national space agencies (speaker 2, DLR program management) united under the European Space Agency (speaker 3) are responsible to organize the industrial organization and balance the various national interests and their related funding. This iterative process leads in the end to programs entering into the realization and actual building of space qualified hardware (Phase C/D) and the launch and operations of the mission (Phase E) for which the industry is involved on System, Subsystem and Equipment level (speaker 4,5 and 6). This Panel will give you specific insight into the various roles needed to work together in a co-operative way to bring a European Space Program to a success

Intervención educativa sobre Diabetes Mellitus en pacientes diabéticos tipo II

Introducción: El escaso nivel de conocimiento de los pacientes diabéticos tipo 2 acerca de su enfermedad, puede contribuir a la aparición de complicaciones y dar al traste con la vida del paciente.Objetivo: Modificar el nivel de conocimientos sobre la clínica, complicaciones y tratamiento adecuado de la diabetes mellitus tipo 2 en la población del Consultorio No. 8del Policlínico Sur de Morón.Material y método: Se realizó un estudio de intervención educativa cuasi-experimental en adultos diabéticos tipo 2 del Consultorio No. 8 del Policlínico Sur de Morón. El universo estuvo constituido por 42 pacientes. Antes y después de la intervención se evaluaron los conocimientos de los pacientes del estudio sobre diabetes mellitus tipo 2.Resultados: Antes de ser aplicada la intervención solo el 30.95% de los pacientes tenían conocimientos sobre el tratamiento, después de esto se incrementó a 92.85%. Sobre el conocimiento de los factores de riesgos y complicaciones de esta enfermedad solo el 21.42% y 16.66% respectivamente conocía acerca del tema, pero después aumentó para un 88.09% y 92.85% en cada caso.Conclusiones: Los pacientes diabéticos incluidos en el estudio, elevaron el nivel de conocimiento sobre los temas tratados demostrándose la efectividad de la intervención