Case 12 : Health Operations in Emergencies (HOPE)

Dr. Harry Leonardo is the Manager of the Emergency Operations Center (EOC) at the Pan American Health Organization (PAHO) in Washington D.C. The EOC coordinates emergency relief efforts during disaster response in the PAHO region. Dr. Leonardo has developed an information-sharing platform, Health Operations in Emergencies (HOPE), to facilitate communication, enhance situational awareness, and promote collaboration amongst the stakeholders involved in disaster response. Professionals within the EOC and PAHO have reservations about HOPE. The platform has great potential, but it is unclear to what extent the relevant stakeholders have been involved in its development. Dr. Leonardo must make the best use of his resources to implement HOPE. He must formulate a strategy for testing and implementing the information-sharing platform within the organization and for introducing HOPE to all relevant stakeholders in the emergency response environment

Case 13 : Chikungunya in the Americas: Estimating the Burden of Disease and Cost of Illness

An intern at the Pan American Health Organization (PAHO) in Washington, DC is conducting an economic impact assessment of a Chikungunya epidemic in the Caribbean. PAHO would like to promote preparedness amongst PAHO member states and forecasting the economic impact may encourage governments to increase disease mitigation efforts. Chikungunya had been spreading through the Caribbean for several months and concerns about the impact of an epidemic in Jamaica were heightened by its reliance on tourism. The intern must incorporate information from a variety of sources to forecast the burden of disease and cost of illness of a Chikungunya outbreak in Jamaica

Facemask use for community protection from air pollution disasters: An ethical overview and framework to guide agency decision making

Disasters involving severe air pollution episodes create a pressing public health issue. During such emergencies, there may be pressure on agencies to provide solutions to protect affected communities. One possible intervention to reduce exposure during such crises is facemasks. Ethical values need to be considered as part of any decision-making process to assess whether to provide advice on, recommend and/or distribute any public health intervention. In this paper, we use principles from public health ethics to analyse the critical ethical issues that relate to agencies providing advice on, recommending and/or distributing facemasks in air pollution disasters, given a lack of evidence of both the specific risk of some polluting events or the effectiveness of facemasks in community settings. The need for reflection on the ethical issues raised by the possible recommendation/use of facemasks to mitigate potential health issues arising from air pollution disasters is critical as communities progressively seek personal interventions to manage perceived and actual risks. This paper develops an ethical decision-making framework to assist agency deliberations. We argue that clarity around decision-making by agencies, after using this framework, may help increase trust about the intervention and solidarity within and between populations affected by these disasters and the agencies who support public health or provide assistance during disasters

Deformación miocárdica evaluada por ecocardiografía bidimensional en pacientes lúpicos de un hospital nacional

  Background. Patients with systemic lupus erythematosus (SLE) are at high risk of cardiac compromise with high mortality. The subclinical diagnosis may improve their survival. Longitudinal myocardial deformation (strain) has been found to be useful in evaluating cardiac function in these patients. Objectives. Our aims were to evaluate myocardial function by analyzing the two-dimensional (2D) global longitudinal strain, to compare the longitudinal strain in SLE patients with controls, and to determine the correlation with SLE activity index. Material and Methods. 44 patients with SLE (50.0 ± 13 years) and 50 controls (49 ± 12 years) matched by age and sex, underwent transthoracic echocardiogram. Longitudinal strain was assessed using the speckle tracking method and SLE activity was estimated using the Systemic Lupus Erythematous Disease Activity Index (SLEDAI). A score of 4 or more, was defined as active SLE. Results. 2D global longitudinal strain was lower in patients with SLE than controls (- 17.3% ± 1.9% vs. -20%, ± 1.9% p = 0.00). The left ventricular ejection fraction (LVEF) had no specific differences in both groups in 2D (p = 0.650) or three-dimensional (3D) (p = 0.718). In lupus patients, SLEDAI ranged from 0 to 10, and 63.8% were inactive. Negative correlations were found between the SLEDAI score and 2D LVEF (Pearson's r = -0.372, p = 0.017); no correlations were found between the SLEDAI score and the 2D global longitudinal strain (Spearman's rho = - 0.091 p = 0.582). Conclusions: 2D global longitudinal strain was found to be decreased in the SLE group. This technique might can be a useful tool to assess cardiac function in these patiens.Antecedentes. Los pacientes con lupus eritematoso sistémico (LES) tienen alto riesgo de compromiso cardíaco con elevada mortalidad, por lo que el diagnóstico subclínico podría mejorar su sobrevida. Se ha observado que el strain (deformación) miocárdico longitudinal (SGL) puede ser de utilidad para la evaluación de la función cardíaca en estos pacientes. Objetivos. Evaluar la función miocárdica mediante el análisis del strain longitudinal bidimensional (2D), comparar el strain longitudinal entre pacientes con LES y controles, y determinar la correlación con el índice de actividad del LES. Material y métodos. Se estudiaron a 44 pacientes con LES (50 ±13 años) y 50 controles (49 ±12 años) pareados por edad y sexo, a quienes se les realizó un ecocardiograma transtorácico bidimensional. Se valoró el strain longitudinal mediante el método de speckle tracking, y la actividad del LES se estimó mediante el Systemic Lupus Erythematous Disease Activity Index (SLEDAI). Se definió como LES activo con una puntuación ≥ 4. Resultados. El strain longitudinal global2D fue menor en pacientes con LES que los controles (– 17,3% ± 1,9% vs. – 20%, ± 1,9%; p=0,00). No hubo diferencias en la fracción de eyección de ventrículo izquierdo entre ambos grupos, ni en 2D (p=0,650), ni en 3D (p=0,718). En los pacientes lúpicos, el SLEDAI varió entre 0 y 10, y el 63,8% estuvieron inactivos. Se halló correlaciones negativas significativas entre el puntaje de SLEDAI y la FEVI bidimensional (r de Pearson=-0,372, p=0,017); no se encontró correlación entre el puntaje de SLEDAI y el strain longitudinal global 2D (rho de Spearman=- 0,091 p =0,582). Conclusiones. El strain longitudinal global 2D se encontró disminuida en aquellos afectados con LES, lo que sugiere que podría ser una herramienta útil para evaluar la función cardíaca en estos pacientes.                                                                   &nbsp

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Uso adecuado y racional de los antibióticos

Las infecciones comunitarias y nosocomiales siguen constituyendo hoy en día una de las principales causas de morbilidad a nivel mundial; si bien las vacunas y las mejores condiciones de vida han permitido mejorar la esperanza de vida en muchas regiones del mundo, la gran mayoría de ellas sigue padeciendo de males infecciosos como tuberculosis pulmonar, malaria, enfermedad diarreica aguda, enfermedad respiratoria aguda, etc. A ello se ha sumado la aparición de numerosos y nuevas enfermedades de origen bacteriano, viral y micótico, tales como las infecciones por Legionella neumophila, campylobacter, nuevas bartonelas (B. henselae, B. quintana, B. elizabethae), MRSA (estafilococo dorado meticilinorresistente), rotavirus, calcivirus, Cyclospora cayetanensis, Cryptosporidium parvum, micobacterias atípicas, hantavirus, ébola, lassavirus, virus guanarito, vírus sabia, hafnia, edwarsiella, coronavirus (causante del SRAS), HTLV1, VIH/sida, Balamuthia mandrilaris y, últimamente, por la variedad del virus influenza H5N1 de la gripe aviar de humanos, en entre otros

Actualización sobre manejo de araneismo en Perú

La mordedura de araña es un accidente muy común e importante problema de salud pública en lugares con clima tropical y se presenta como un problema muy frecuente en algunas regiones de Latinoamérica. En Perú las especies de araña que presentan más casos de esta problemática son Loxosceles laeta, Latrodectus mactans and Phoneutria spp. El presente trabajo pretende explicar, clarificar y categorizar estas mordeduras de arañas, con el fin de dar a conocerlas para ayudar a que los profesionales de la salud tengan un mayor conocimiento sobre las mismas para un mejor manejo de los casos que se les presenten

Hochtemperatur-Kernkraftwerk GmbH (HKG). Geschaeftsbericht 1992

SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

What lessons will the covid-19 leave us? History of the new coronaviruses

Los coronavirus han estado presentes entre los humanos hace décadas, causando entre el 10 - 30% de los resfríos comunes en los humanos. Dos coronavirus han causado pandemias y alertas globales en las últimas décadas: SARS-CoV Y MERS-CoV. SARS-CoV-2 es el séptimo coronavirus en generar una infección en humanos, y el tercero en generar una pandemia. En este artículo, presentamos y comparamos la cronología, epidemiología y las medidas de control de cada una de las pandemias: SARS, MERS y COVID-19.Coronaviruses have been present in humans for decades, causing 10-30% of common colds in humans. Two coronaviruses have caused global pandemics and alerts in recent decades: SARS- CoV and MERS-CoV. SARS-CoV-2 is the seventh coronavirus to generate an infection in humans, and the third to generate a pandemic. In this article, we present and compare the chronology, epidemiology, and control measures of each of thepandemics: SARS, MERS and COVID-19