Propuesta estratégica de mejora en la implementación de los estándares mínimos del Sistema de Gestión de la Seguridad y Salud en el Trabajo (SG-SST) en la empresa Hospital San Carlos De Saldaña para el segundo semestre del 2019 y principios del 2020

El SG-SST es un instrumento de gestión para mejorar la calidad de vida de los empleados de una empresa, que consiste en realizar un proceso lógico y por etapas, basado en la mejora continua, con el fin de anticipar, reconocer, evaluar y controlar todos los riesgos que puedan afectar a la seguridad y la salud en el trabajo, es por ello que se tuvo la iniciativa de visitar el Hospital San Carlos de Saldaña con el fin de realizar la evaluación inicial mediante la matriz de evaluación de SG- SST y a su vez se emitieron unas recomendaciones y unas sugerencias para el mejoramiento de algunos estándares que no cumplían según los resultados que arrojó la misma, de este modo esta propuesta beneficia al Hospital San Carlos de Saldaña no solo en el bienestar del personal sino también a la reducción de costos por posibles incapacidades derivadas de Accidentes Laborales o Enfermedades Profesionales. Buscando así contribuir a la mejora continua de los objetivos propios de la empresa y por ende al desarrollo de la organización.The SG-SST is a management instrument to improve the quality of life of the employees of a company, which consists of performing a logical and phased process, based on continuous improvement, in order to anticipate, recognize, evaluate and control All risks that may affect occupational safety and health, that is why we had the initiative to visit the San Carlos de Saldaña Hospital in order to carry out the initial evaluation through the SG-SST evaluation matrix and At the same time, recommendations and suggestions were issued for the improvement of some standards that did not meet the results of the same, in this way this proposal benefits the Hospital San Carlos de Saldaña not only in the welfare of the staff but also in the reduction of costs for possible disabilities arising from Occupational Accidents or Occupational Diseases. Seeking to contribute to the continuous improvement of the company's own objectives and therefore to the development of the organization

GENERALIZED URTICARIA AS A VASCULITIC MANIFESTATION IN A PATIENT WITH SARS-CoV-2 INFECTION: A CASE REPORT IN COLOMBIA

Skin manifestations have been reported in up to 20% of cases of SARS-CoV-2 infection, including morbilliform rash (22%), pernio-like acral lesions (18%), urticaria (16%), and macular erythema (13%). It is believed that in the case of SARS-CoV-2 infection, the mechanism involved is an inflammatory response that generates immune dysregulation, vascular congestion, vasculitis, vascular thrombosis, or neoangiogenesis. This case study, present the case of a patient with no previous history of urticarial reactions, autoimmune diseases, or exposure to medications who develops generalized urticaria lasting more than 24 hours and who was diagnosed with SARS-CoV-2 infection by RT-PCR with a nasopharyngeal swab. We suggest in this patient vasculitic urticaria as a manifestation of SARS-CoV-2 infection

Percretismo placentario asociado con placenta previa y abruptio: Reporte de un caso

The number of cesarean sections has risen during the recent years, leading to an increase in abnormal placentation in future pregnancies, as well as other materno-fetal complications. Placental abnormalities and the surgical management they usually required, drastically obscure maternal and fetal outcomes. We report the case of a multiparous woman admitted to labor and delivery service of a university hospital presenting with placenta percreta, placenta previa and abruptio placentae. She received opportune emergency multidisciplinary management, obtaining satisfactory. © 2013 SEGO

Percretismo placentario asociado con placenta previa y abruptio: Reporte de un caso

The number of cesarean sections has risen during the recent years, leading to an increase in abnormal placentation in future pregnancies, as well as other materno-fetal complications. Placental abnormalities and the surgical management they usually required, drastically obscure maternal and fetal outcomes. We report the case of a multiparous woman admitted to labor and delivery service of a university hospital presenting with placenta percreta, placenta previa and abruptio placentae. She received opportune emergency multidisciplinary management, obtaining satisfactory. © 2013 SEGO

Dual antiplatelet therapy duration after coronary stenting in clinical practice: results of an EAPCI survey

Aims: Our aim was to report on a survey initiated by the EuropeanAssociation of Percutaneous Cardiovascular Interventions (EAPCI) concerning opinion on the evidence relating to dual antiplatelet therapy (DAPT) duration after coronary stenting.Methods and results: Results from three randomised clinical trials were scheduled to be presented at the American Heart Association Scientific Sessions 2014 (ARIA 2014). A web-based survey was distributed to all individuals registered in the EuroIntervention mailing list (n=15,200) both before and after ARIA 2014. A total of 1,134 physicians responded to the first (i.e., before AHA 2014) and 542 to the second (i.e., after ARIA 2014) survey. The majority of respondents interpreted trial results consistent with a substantial equipoise regarding the benefits and risks of an extended versus a standard DAPT strategy. Two respondents out of ten believed extended DAFT should be implemented in selected patients. After ARIA 2014, 46.1% of participants expressed uncertainty about the available evidence on DAFT duration, and 40.0% the need for clinical guidance.Conclusions: This EAPCI survey highlights considerable uncertainty within the medical community with regard to the optimal duration of DAFT after coronary stenting in the light of recent reported trial results. Updated recommendations for practising physicians to guide treatment decisions in routine clinical practice should be provided by international societies

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

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

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc

Long-term (180-Day) outcomes in critically Ill patients with COVID-19 in the REMAP-CAP randomized clinical trial

Importance The longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are unknown. Objective To determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes. Design, Setting, and Participants Prespecified secondary analysis of an ongoing adaptive platform trial (REMAP-CAP) testing interventions within multiple therapeutic domains in which 4869 critically ill adult patients with COVID-19 were enrolled between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022. Interventions Patients were randomized to receive 1 or more interventions within 6 treatment domains: immune modulators (n = 2274), convalescent plasma (n = 2011), antiplatelet therapy (n = 1557), anticoagulation (n = 1033), antivirals (n = 726), and corticosteroids (n = 401). Main Outcomes and Measures The main outcome was survival through day 180, analyzed using a bayesian piecewise exponential model. A hazard ratio (HR) less than 1 represented improved survival (superiority), while an HR greater than 1 represented worsened survival (harm); futility was represented by a relative improvement less than 20% in outcome, shown by an HR greater than 0.83. Results Among 4869 randomized patients (mean age, 59.3 years; 1537 [32.1%] women), 4107 (84.3%) had known vital status and 2590 (63.1%) were alive at day 180. IL-6 receptor antagonists had a greater than 99.9% probability of improving 6-month survival (adjusted HR, 0.74 [95% credible interval {CrI}, 0.61-0.90]) and antiplatelet agents had a 95% probability of improving 6-month survival (adjusted HR, 0.85 [95% CrI, 0.71-1.03]) compared with the control, while the probability of trial-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.9%; HR, 1.13 [95% CrI, 0.93-1.42]), convalescent plasma (99.2%; HR, 0.99 [95% CrI, 0.86-1.14]), and lopinavir-ritonavir (96.6%; HR, 1.06 [95% CrI, 0.82-1.38]) and the probabilities of harm from hydroxychloroquine (96.9%; HR, 1.51 [95% CrI, 0.98-2.29]) and the combination of lopinavir-ritonavir and hydroxychloroquine (96.8%; HR, 1.61 [95% CrI, 0.97-2.67]) were high. The corticosteroid domain was stopped early prior to reaching a predefined statistical trigger; there was a 57.1% to 61.6% probability of improving 6-month survival across varying hydrocortisone dosing strategies. Conclusions and Relevance Among critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control, and treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality compared with patients randomized to the control. Overall, when considered with previously reported short-term results, the findings indicate that initial in-hospital treatment effects were consistent for most therapies through 6 months