Factores asociados a trastornos musculoesqueléticos en trabajadores de limpieza del servicio de emergencia de un hospital terciario: Factors associated with musculoskeletal disorders in cleaning workers of the emergency service of a tertiary hospital

Introduction: Musculoskeletal disorders are health problems that can lead to disability. Objective: Todetermine the factors associated with the presence of musculoskeletal disorders in cleaning workers inthe emergency service of the Edgardo Rebagliati Martins National Hospital, 2019. Methods: Descriptive,observational, cross-sectional retrospective with a quantitative approach. The survey technique wasused and the instrument was the Standard Nordic Questionnaire. Descriptive and inferential statisticswere applied. Results: 129 participants, female (82.95%); median age 43 years, height 1.55m, overweightor obese (57.37%), secondary or higher education (93.80%), originating in the interior of the country(37.21%) and from Lima; 32 years lived in Lima, the median working time was 18 months, 43.41% workedin the morning and 9.30% worked in more than one place (9.30%). They presented musculoskeletal pain93.02%, pain in more than one area 75.97%, low back pain 65.12%, back pain 47.29%, neck pain (37.21%)and elbow / forearm pain 13, 18%. Only in the bivariate analysis, the working time was significant forthe presence of pain (p value=0.009). Conclusion: After performing the adjusted analysis, no factorsassociated with musculoskeletal disorders were found.Introducción: Los trastornos musculoesqueléticos son problemas de salud que pueden llevara la incapacidad. Objetivo: Determinar los factores asociados a la presencia de trastornosmusculoesqueléticos en trabajadores de limpieza del servicio de emergencia del hospital NacionalEdgardo Rebagliati Martins, año 2019. Métodos: Descriptivo, observacional, transversal retrospectivocon enfoque cuantitativo. Se utilizó la técnica de la encuesta y el instrumento fue el CuestionarioNórdico Estandarizado. Se aplicó estadística descriptiva e inferencial. Resultados: 129 participantes,de sexo femenino (82,95%); mediana de edad 43 años, talla 1,55m, con sobrepeso u obesidad (57,37%),estudios secundarios o superiores (93,80%), procedencia del interior del país (37,21 %) y de Lima;radicaban en Lima 32 años, la mediana de tiempo de trabajo fue18 meses, 43,41% trabajaban en lamañana y 9,30% laboraban en más de un lugar. Presentaron dolor musculoesquelético 93,02%, doloren más de una zona 75,97%, dolor lumbar 65,12%, dolor dorsal 47,29%, dolor en cuello (37,21%) y doloren codo/antebrazo 13,18%. Sólo en el análisis bivariado, el tiempo de trabajo fue significativo parapresencia dolor (P= 0,009). Conclusión: Tras realizar el análisis ajustado, no se encontraron factoresasociados a los trastornos musculoesqueleticos

TÉTANO POR LESIÓN CON APARATO PIROTÉCNICO

El tétanos es un trastorno del sistema nervioso caracterizado por espasmos musculares causados por una neurotóxica producida por la bacteria anaerobia Clostridium tetani , que se encuentra en el suelo, en heces humanas y de animales. La bacteria persiste como esporas resilientes, capaz de sobrevivir a la mayoría de los desinfectantes domésticos y al agua hirviendo durante varios minutos. Solo en condiciones de bajas tensiones de oxígeno las esporas germinan y las bacterias vegetativas se multiplican para secretar su neurotoxina. Se presenta el caso de un paciente varón de 66 años que ingresa a Emergencia referido de la ciudad de Huaraz, por fiebre no cuantificada, sudoración profusa, contracciones musculares en el brazo y secreción purulenta en lesiones de tórax, producto de explosión de un artículo pirotécnico. Desde su ingreso fue catalogado como tétanos, se procede a proteger vía aérea, administrar tratamiento antibiótico e inmunoglobulina antitetánica; es admitido en la unidad de cuidados intensivos (UCI), su evolución es tórpida por complicaciones secundarias. Resaltamos la vía de contagio, producida luego de la explotación de material pirotécnico y la necesidad de un manejo precoz ante lesiones, aunque raras, potencialmente productoras de infecciones severas como el tétanos. Palabras clave: Tétanos; Trauma; Explosión por pirotécnicos. (fuente: DeCS BIREME) DOI: https://doi.org/10.25176/RFMH.v17.n4.121

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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

Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults

We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals

Charged-particle multiplicity fluctuations in Pb–Pb collisions at √sNN = 2.76 TeV

Measurements of event-by-event fluctuations of charged-particle multiplicities in Pb–Pb collisions at sNN−−−√ = 2.76 TeV using the ALICE detector at the CERN Large Hadron Collider (LHC) are presented in the pseudorapidity range |η|<0.8 and transverse momentum 0.2<pT<2.0 GeV/c. The amplitude of the fluctuations is expressed in terms of the variance normalized by the mean of the multiplicity distribution. The η and pT dependences of the fluctuations and their evolution with respect to collision centrality are investigated. The multiplicity fluctuations tend to decrease from peripheral to central collisions. The results are compared to those obtained from HIJING and AMPT Monte Carlo event generators as well as to experimental data at lower collision energies. Additionally, the measured multiplicity fluctuations are discussed in the context of the isothermal compressibility of the high-density strongly-interacting system formed in central Pb–Pb collisions