Lactato deshidrogenasa en gestantes con preeclampsia como marcador de complicaciones neonatales

La morbilidad neonatal es un problema mundialmente frecuente, la existencia de un marcador que pueda dar un indicio de predicción ayudaría con el su manejo y disminuiría la mortalidad neonatal. Objetivo: Demostrar que el lactato deshidrogenasa en gestantes con preeclampsia es un marcador de complicaciones neonatales. Método: Estudio de cohorte retrospectiva en donde se revisaron 114 historias clínicas de madres con preeclampsia, divididas según el valor del LDH (57 gestantes con LDH elevado y 57 con LDH no elevado), atendidas en el servicio de ginecología del Hospital Regional Docente de Trujillo, y en quienes se determinó la incidencia de complicaciones neonatales. Se calculó el riesgo relativo (RR) para el análisis bivariado y se realizó el análisis multivariado mediante regresión logística para el análisis de las variables intervinientes. Resultados: El LDH elevado (≥600 UI/L) y la preeclampsia con signos de severidad son factores de riesgo independiente de complicaciones neonatales luego de ajustar a las variables intervinientes. Así mismo, las gestantes con LDH elevado tienen mayor riesgo de tener hijos con restricción del crecimiento intrauterino, bajo peso al nacer, prematuridad e ingreso a unidad de cuidados intensivos neonatales. Conclusión: El lactato deshidrogenasa en gestantes con preeclampsia es un marcador de complicaciones neonatales.Neonatal morbidity is a frequent worldwide problem, the existence of a marker that can give a predictive indication would help with its management and decrease neonatal mortality. Objective: To demonstrate that lactate dehydrogenase in pregnant women with preeclampsia is a marker of neonatal complications. Method: Retrospective cohort study in which 114 medical records of mothers with preeclampsia were reviewed, divided according to the LDH value (57 pregnant women with elevated LDH and 57 with non-elevated LDH), attended in the gynecology service of Hospital Belen de Trujillo, and in whom the incidence of neonatal complications was determined. The relative risk (RR) was calculated for the bivariate analysis and the multivariate analysis was performed using logistic regression for the analysis of the intervening variables. Results: Elevated LDH (≥600 IU/L) and preeclampsia with signs of severity are independent risk factors for neonatal complications after adjusting for the intervening variables. Likewise, pregnant women with elevated LDH are at greater risk of having children with intrauterine growth restriction, low birth weight, prematurity, and admission to the neonatal intensive care unit. Conclusion: Lactate dehydrogenase in pregnant women with preeclampsia is a marker of neonatal complications.Tesi

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