Transition to the protocol IPV4 to IPV6 in a company: revision and case

Los protocolos de interconexión de redes para el direccionamiento IP, cuyos objetivos de trabajo son múltiples gracias al avance tecnológico y crecimiento exponencial del Internet, han llevado al agotamiento de direcciones de su protocolo inmediato: IPV4, así que fue necesario la creación e implementación de un nuevo protocolo de direccionamiento global: IPV6. Aunque su despliegue no ha sido inmediato se tiene previsto que gran parte de las empresas realicen este en dos años. El presente artículo tiene como finalidad presentar una guía que permita ejecutar la transición y aprovisionamiento de IPV6 dentro de las compañías; se darán pautas detalladas de los métodos de transición IPV4-IPV6, el direccionamiento y forma de asignación de IP’s y protocolos de enrutamiento. Para lo anterior se han seleccionado servicios básicos de una empresa: protocolo de configuración dinámica de host (DHCP); sistemas de nombres de dominio (DNS); el registro de eventos SYSLOG; protocolo de tiempo de red (NTP); y el servicio de correo, entre otros. Se concluye de las pruebas, que la red y los servicios funcionan aceptablemente; aplicándose la metodología en cualquier compañía siempre que se tenga en cuenta la estructura de red correspondiente.Interconnection network protocols for global single addressing, whose work objectives are multiple thanks to technological advancement and the big exponential growth of the Internet, have nowadays reached exhaustion, causing its current protocol: IPV4 to consume almost the entirety of IP addresses, so it was necessary to create and implement a new addressing protocol all over the world: IPV6. And though its deployment hasn’t been immediate, it is expected that the majority of companies carry it out within a two-year range. The purpose of this article is to present a guide which allows to execute the transition and provisioning of IPV6 within the companies; detailed guidelines regarding IPV4-IPV6 transition methods, forms of IP’s assignation and routing protocols will be given. For this, a company’s basic services have been considered, such as Dynamic Host Configuration Protocol (DHCP); Domain Name System (DNS); SYSLOG event registry; Network Time Protocol (NTP); and the MAIL service, among others. Concluding from the network tests that the services function in an acceptable way, and that the methodology can be applied in any company as long as the corresponding network structure is taken into account

Monitoring System Filling and Weight of Urban Waste Containers

En establecimientos o áreas como centros comerciales, plazoletas de comida, bancos, parques, estadios entre otros, donde existen uno o varios contenedores de basura se encontró la necesidad de ahorrar gastos y tiempo para realizar del cambio de bolsas de los contenedores de desechos por el usuario encargado del aseo, ya que en muchas ocasiones estos contenedores no están en su totalidad llenos, no tienen el peso adecuado para el cambio o el tiempo sin realizar el cambio excede 24 horas, se basó en esto para diseñar y construir un contenedor de desechos el cual monitorea constantemente el peso, llenado y tiempo de permanencia de estos. Dicho proyecto se logró a partir de la construcción de una caneca de diseño especial (Altura, Ancho, Profundidad, Tapa y fondo) la cual permitió la instalación y adecuación de dos sensores de proximidad para monitorear el peso y llenado los cuales brindan una serie de datos que son inspeccionados mediante la tarjeta de desarrollo Psoc 4 y el módulo esp8266; en caso de que alguno de los dos sensores supere por estándares y condiciones establecidas, este envía una señal de alerta a un dispositivo móvil y a su vez un correo electrónico al encargado de los contenedores. En el caso del tiempo, se determinó un periodo de deterioro de los residuos que cumplidas 24 horas se enviara de igual forma que el llenado y el peso una notificación al dispositivo móvil.In establishments or areas such as shopping malls, food plazas, banks, parks, stadiums and others, where there are one or more dumpsters the need to save costs and time for change bags waste containers found by User Manager toilet as often these containers are not entirely filled, they have the right weight for change or the time without making the change exceeds 24 hours, it was based on this to design and build a waste container the which constantly monitors the weight and time spent filling these. This project was achieved from the construction of a garbage special design (height, width, depth, top and bottom) which allowed the installation and fitting of two proximity sensors to monitor the filling weight and which provide a series of data, which are inspected by the card 4 and the development Psoc esp8266 module; if one of the two sensors exceeds standards and conditions established by, it sends a warning signal to the mobile device and turn an email to the manager of the containers. For the time period of deterioration of residues was determined 24 hours fulfilled similarly sent to the filling and weighing a notification to the mobile device

Protección multinivel de derechos humanos. Manual

Este Manual tiene como objeto el estudio de la protección multinivel de derechos humanos en América Latina desde una perspectiva comparada. Los contenidos se estructuran en cuatro grandes bloques. El primer bloque versa sobre la interpretación y protección de los derechos humanos en el marco multinivel y desarrolla un análisis conceptual de dos nociones clave: protección multinivel e interpretación de conformidad. El primer capítulo examina en qué medida puede trasladarse la noción de protección multinivel de derechos a América Latina. El segundo capítulo analiza la interpretación de los derechos constitucionales de conformidad con el derecho internacional de los derechos humanos desde la experiencia española, cuya Constitución de 1978 acuñó la cláusula de interpretación conforme en su artículo 10.2. Diversas constituciones en América Latina han incorporado cláusulas similares, y de manera reciente la Constitución Federal mexicana en la reforma de 2011. El segundo bloque, desde una perspectiva horizontal, contiene estudios sobre el sistema internacional de protección de derechos humanos, el sistema interamericano y el sistema europeo. La atención se centra en los mecanismos de garantía establecidos en cada ordenamiento. Se concluye con un capítulo sobre las relaciones recíprocas entre el sistema interamericano y el europeo. El tercer bloque analiza el Sistema Interamericano de Derechos Humanos y su relación con los sistemas jurídicos nacionales desde una perspectiva vertical. Se examinan temas centrales para el sistema de protección de derechos, como son: el requisito de agotamiento de los recursos internos; las reparaciones a las víctimas; el valor de la jurisprudencia de la Corte Interamericana de Derechos Humanos; el diálogo judicial, y en concreto la protección del derecho a la vida desde la perspectiva multinivel. Finalmente, el cuarto bloque adopta la perspectiva de los ordenamientos jurídicos nacionales para estudiar la recepción del derecho internacional de los derechos humanos en diversos países: Bolivia, Brasil, Colombia, Chile, Ecuador, España, Francia y Perú. Se solicitó a los autores que los estudios de caso siguieran la misma estructura de análisis, lo que facilita una lectura comparada.Programa financiado por la Comisión Europea. El Manual es producto de la Red de Derechos Humanos en la Educación Superior (RedDHES), un proyecto ALFA financiado por la Unión EuropeaCap. 1. ¿Protección multinivel de los derechos humanos en América Latina? Oportunidades, desafíos y riesgos / René Urueña. - Cap. 2. La interpretación de conformidad: significado y dimensión práctica (un análisis desde la Constitución española) / Alejandro Saiz Arnaiz. - Cap. 3. Sistema universal de protección de derechos humanos / Renata Bregaglio. - Cap. 4. El sistema interamericano de derechos humanos / Felipe Arias Ospina y Juliana Galindo Villareal. Cap. 5. El sistema europeo de protección de derechos humanos / Luis López Guerra. - Cap. 6. El diálogo judicial entre la Corte Interamericana de Derechos Humanos y la Corte Europea de Derechos Humanos / Laurence Burgorgue-Larsen y Nicolás Montoya Céspedes. Cap. 7. Agotamiento de los recursos internos y otras exigencias de admisibilidad / Itziar Gómez Fernández y Carmen Montesinos Padilla. Cap. 8. Aportaciones del sistema de reparaciones de la Corte Interamericana al Derecho Internacional de los Derechos Humanos / Fernando Silva. Cap. 9. El valor de la jurisprudencia de la Corte Interamericana de Derechos Humanos / George Rodrigo Bandeira Galindo. Cap. 10. Del diálogo entre las cortes supremas y la Corte Interamericana de Derechos Humanos al transconstitucionalismo en América Latina / Marcelo Neves. Cap. 11. Derecho a la vida y lo vivo como sujeto de derecho / Miguel Rábago. Cap. 12. Bolivia / Nataly Viviana Vargas Gamboa. Cap. 13. Brasil / Antonio Maués y George Galindo. Cap. 14. Colombia / María Angélica Prada. Cap. 15. Chile / Felipe Paredes. Cap. 16. España / Aida Torres Pérez. Cap. 17. Francia / Enzamaria Tramontana. Cap. 18. Perú / Renata Bregaglio

Population Genetics of Plasmodium vivax in the Peruvian Amazon.

BACKGROUND: Characterizing the parasite dynamics and population structure provides useful information to understand the dynamic of transmission and to better target control interventions. Despite considerable efforts for its control, vivax malaria remains a major health problem in Peru. In this study, we have explored the population genetics of Plasmodium vivax isolates from Iquitos, the main city in the Peruvian Amazon, and 25 neighbouring peri-urban as well as rural villages along the Iquitos-Nauta Road. METHODOLOGY/ RESULTS: From April to December 2008, 292 P. vivax isolates were collected and successfully genotyped using 14 neutral microsatellites. Analysis of the molecular data revealed a similar proportion of monoclonal and polyclonal infections in urban areas, while in rural areas monoclonal infections were predominant (p = 0.002). Multiplicity of infection was higher in urban (MOI = 1.5-2) compared to rural areas (MOI = 1) (p = 0.003). The level of genetic diversity was similar in all areas (He = 0.66-0.76, p = 0.32) though genetic differentiation between areas was substantial (PHIPT = 0.17, p<0.0001). Principal coordinate analysis showed a marked differentiation between parasites from urban and rural areas. Linkage disequilibrium was detected in all the areas ([Formula: see text] = 0.08-0.49, for all p<0.0001). Gene flow among the areas was stablished through Bayesian analysis of migration models. Recent bottleneck events were detected in 4 areas and a recent parasite expansion in one of the isolated areas. In total, 87 unique haplotypes grouped in 2 or 3 genetic clusters described a sub-structured parasite population. CONCLUSION/SIGNIFICANCE: Our study shows a sub-structured parasite population with clonal propagation, with most of its components recently affected by bottleneck events. Iquitos city is the main source of parasite spreading for all the peripheral study areas. The routes of transmission and gene flow and the reduction of the parasite population described are important from the public health perspective as well for the formulation of future control policies

Trabajo y vida indígenas en los trapiches del Nuevo Reino de Granada, 1576 – 16741

ABSTRACT: By a Crown´s rule, native workforce was forbidden inside the trapiches and sugar mills. Nonetheless, some Crown´s employees of the New Kingdom of Granada, in particular chief magistrates, avoided exerting this prohibition drastically, and allowed many indigenous people of encomiendas to pay their tributes with their labor on sugar production. This article studies both the reasons of this permissiveness and the changes that working on the trapiches generated among natives, especially those aspects linked to their community life and their consumption habits.RESUMEN: La mano de obra indígena estaba prohibida dentro de los trapiches e ingenios de azúcar por mandato de la Corona española. Sin embargo, en el Nuevo Reino de Granada los oficiales reales, especialmente los corregidores, evitaron ejercer drásticamente esta prohibición y permitieron que muchos indios de encomienda pagaran su tributación con el trabajo azucarero. En este artículo se estudian las razones de esta permisividad, así como los cambios que generó entre los indígenas trabajar en los trapiches, especialmente los aspectos vinculados a la vida comunitaria y a los hábitos de consumo de los indígenas

The Caldera. No. 25 Special Edition 2022. 70 years

Especial: Instituto Caldas, 70 años de historia En las siguientes páginas, los estudiantes rinden homenaje a nuestra querida Institución, a través, especialmente, de la Palabra. Mi eterna gratitud a cada uno de ellos, jóvenes lectores, escritores, dibujantes pero, sobre todo, Caldistas de CORAZÓN: Laura Camila Herrera, Victoria Chacón Gil, María Paula Méndez, Steven Gómez Guerrero, Constanza Narváez Solano, Yatana Zea Arenas, Carolina Valencia Neira, Valery Samara Meza, Steffy Picón Carrillo y Gabriela Portilla Castellanos.Especial 70 años. Instituto Caldas 6 Reloj Solar 2021 43 IX Concurso de Lectura en Voz Alta 46 La Cuna de Excélsior 48 Equipo de Maestros 51 Perfiles Caldistas 54 Expresiones Caldistas 58 Día Caldista 98 Galería de Imágenes 103Special: Instituto Caldas, 70 years of history In the following pages, the students pay homage to our beloved Institution, especially through the Word. My eternal gratitude to each of them, young readers, writers, cartoonists but, above all, Caldistas of HEART: Laura Camila Herrera, Victoria Chacón Gil, María Paula Méndez, Steven Gómez Guerrero, Constanza Narváez Solano, Yatana Zea Arenas, Carolina Valencia Neira, Valery Samara Meza, Steffy Picón Carrillo and Gabriela Portilla Castellanos

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

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

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