Memoria histórica del río Ocloro, Barrio Luján, San José, Costa Rica, 1960-2017

Barrio Luján se ubica al sur de la capital de Costa Rica y forma parte del distrito Catedral desde 1868. En este sector, la clase trabajadora encontró un hogar que, a pesar del creciente desarrollo urbanístico de las últimas décadas, preserva características de un barrio obrero, con actividades tradicionales que han sido heredadas de generación en generación. Además, se ha caracterizado por su organización comunal en dos grandes frentes: el desarrollo comunitario y la gestión de eventos de inundación provocados por el río Ocloro. Este río ha sufrido transformaciones a lo largo de los años, no solo por la carga de contaminación de residuos sólidos y líquidos que recibe actualmente, sino también, por las obras de entubado que ha experimentado en algunos segmentos del cauce, para intentar controlar las inundaciones. Este documento pretende describir el proceso dinámico que ha experimentado Barrio Luján, para facilitar la comprensión de la situación actual del río Ocloro y su impacto sobre el ambiente y la comunidad.Barrio Luján is a neighborhood located south of Costa Rica’s capital, being part of the Cathedral district since 1868. In this sector the working class found a home, which despite the increasing urban development of recent decades, it preserves the characteristics of a working-class neighborhood, with traditional activities passed down from generation to generation. Furthermore, it has been characterized by its communal organization on two main fronts: the community development and the flood management events caused by the Ocloro River. This river has changed over time, not only as a result of the pollution load of solid and liquid waste that it now receives, but also as a result of piping work done in some sections of the river bed, to try to control flooding. This document aims to describe the dynamic process that Barrio Luján has gone through, in order to facilitate understanding of the current situation of the Ocloro´s river and its impact on the environment and the community.Universidad Nacional, Costa RicaInstituto de Estudios Sociales en PoblaciónEscuela de Histori

Potential Pesticide Misuse in Agriculture Farms from Two Costa Rican Provinces

Pesticide misuse by farmers poses a human, animal, and environmental health hazard. Inadequate storage practices, incorrect pesticide selection, and pesticide formulation overuse were documented in agriculture farms from the Cartago and Guanacaste provinces in Costa Rica. Storage room characteristics in many farms do not follow safety standards for these facilities, as indicated by the Costa Rican Ministry of Agriculture and Livestock. Different active ingredients with herbicidal, fungicidal, insecticidal, and bactericidal action are used in crop species for which they are not recommended. These included substances belonging to the carbamate, pyridine, cyclohexanedione, pyrethroid, conazole, benzothiazinone, oxadiazine, and phthalimide chemical groups in Cartago province; and to the neonicotinoid and pyrethroid chemical groups in Guanacaste province. Many pesticide formulations are used in greater amounts than those recommended by manufacturers, among them were bifenthrin, captan, oxamyl, cypermethrin, mancozeb, dimethoate, and deltamethrin in Cartago province, and imidacloprid in Guanacaste province. These substances and their secondary metabolites have the potential to move across different environmental compartments such as water, soil, and air and negatively affect the health of community members rather than just farmers applying these formulations. Well-established pesticide education programs based on on-site visits to farmers can enhance awareness in implementing good practices and ensure rational use of these substances, with positive results in non-target organisms such as humans and ecosystem service providers as well as natural and anthropogenic ecosystems.El uso indebido de plaguicidas por parte de los agricultores supone un peligro para la salud humana, animal y ambiental. En fincas agrícolas de las provincias de Cartago y Guanacaste, en Costa Rica, se documentaron prácticas inadecuadas de almacenamiento, selección incorrecta de plaguicidas y uso excesivo de formulaciones plaguicidas. Las características de los cuartos de almacenamiento en muchas fincas no siguen las normas de seguridad para estas instalaciones indicadas por el Ministerio de Agricultura y Ganadería de Costa Rica. Diferentes ingredientes activos con acción herbicida, fungicida, insecticida y bactericida son utilizados en especies de cultivo para las cuales no son recomendados. Entre ellos se encuentran sustancias pertenecientes a los grupos químicos carbamato, piridina, ciclohexanodiona, piretroide, conazol, benzotiazolinona, oxadiazina y ftalimida en la provincia de Cartago; y a los grupos químicos neonicotinoide y piretroide en la provincia de Guanacaste. Muchas formulaciones de plaguicidas se utilizan en cantidades superiores a las recomendadas por los fabricantes, entre ellas bifentrina, captan, oxamilo, cipermetrina, mancozeb, dimetoato y deltametrina en la provincia de Cartago e imidacloprid en la provincia de Guanacaste. Estas sustancias y sus metabolitos secundarios tienen el potencial de desplazarse a través de diferentes matrices ambientales, como el agua, el suelo y el aire, y afectar negativamente a la salud de los miembros de la comunidad y no sólo de los agricultores que aplican estas formulaciones. Los programas de educación basados en visitas in situ a los agricultores, pueden mejorar la concienciación en la aplicación de buenas prácticas y garantizar un uso racional de estas sustancias, con resultados positivos en organismos no diana como los seres humanos y los proveedores de servicios ecosistémicos, así como en los ecosistemas naturales y antropogénicos.Universidad Nacional, Costa RicaEscuela de Medicina Veterinari

Censo Pandora Oeste, Valle de la Estrella, Limón 2021

IDESPOProyecto: Aportes para la gestión ciudadana ante el riesgo de inundaciones en la comunidad de Pandora Oeste en el Valle de la Estrella LimónCenso aplicado a comunidad de Pandora Oeste, Valle de la Estrella, LimónUniversidad Nacional, Costa RicaInstituto de Estudios Sociales en Població

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use