Cardiogenic shock code 2023. Expert document for a multidisciplinary organization that allows quality care.

Despite the efforts made to improve the care of cardiogenic shock (CS) patients, including the development of mechanical circulatory support (MCS), the prognosis of these patients continues to be poor. In this context, CS code initiatives arise, based on providing adequate, rapid, and quality care to these patients. In this multidisciplinary document we try to justify the need to implement the SC code, defining its structure/organization, activation criteria, patient flow according to care level, and quality indicators. Our specific purposes are: a) to present the peculiarities of this condition and the lessons of infarction code and previous experiences in CS; b) to detail the structure of the teams, their logistics and the bases for the management of these patients, the choice of the type of MCS, and the moment of its implantation, and c) to address challenges to SC code implementation, including the uniqueness of the pediatric SC code. There is an urgent need to develop protocolized, multidisciplinary, and centralized care in hospitals with a large volume and experience that will minimize inequity in access to the MCS and improve the survival of these patients. Only institutional and structural support from the different administrations will allow optimizing care for CS.

Decaimiento de coliformes fecales en lagunas aireadas de plantas de tratamiento de aguas residuales en Lima metropolitana / Decay of fecal coliforms in aerated lagoons of wastewater treatment plants in metropolitan Lima

A nivel mundial, el 44% de las aguas residuales domésticas no se tratan de forma segura, la recolección y tratamiento de aguas residuales, se ha convertido en un desafío, particularmente en áreas urbanas de bajos ingresos dentro de los países en desarrollo, donde las aguas residuales pueden fluir sin tratar a transportes de aguas pluviales o canales de drenaje informales. No es raro encontrar efluentes, desechos sólidos, excretas humanas y descargas líquidas de industrias y hospitales en las aguas superficiales de muchas zonas urbanas de los países en desarrollo. El proceso de tratamiento de aguas residuales puede ser llevado en lagunas mediante reacciones tanto oxidativas como reductoras. En la capa superior de la laguna, donde las aguas residuales son aeróbicas, ocurre el mecanismo convencional de la demanda bioquímica de oxígeno aeróbico (DBO) y se produce la oxidación del amoníaco. La capa inferior de la laguna es anaerobia, y en esta zona tiene lugar la digestión de los sólidos del lodo, un intermedio, la zona facultativa permite la respiración con aceptores de electrones terminales distintos del oxígeno, esto permite reacciones como la desnitrificación. Los gases producidos en las zonas inferiores se estabilizan en la zona aeróbica por disolución oxígeno, y esto reduce los problemas de olores. Este estudio tiene como objetivo, estudiar el descenso de coliformes fecales en lagunas aireadas de plantas de tratamiento de aguas residuales en la ciudad de Lima, Perú. Los resultados señalan que la separación diferencial de las aguas tratadas, experimentó un descenso del 13 al 26% de coleiformes fecales en todas las lagunas de tratamiento(AU)

Globally, 44% of domestic wastewater is not treated safely, and wastewater collection and treatment has become a challenge, particularly in low-income urban areas within developing countries, where wastewater may flow untreated into stormwater conveyances or informal drainage channels. It is not uncommon to find effluents, solid wastes, human excreta, and liquid discharges from industries and hospitals in the surface waters of many urban areas in developing countries. The wastewater treatment process can be carried out in lagoons through both oxidative and reductive reactions. In the upper layer of the lagoon, where the wastewater is aerobic, the conventional mechanism of aerobic biochemical oxygen demand (BOD) occurs and ammonia oxidation occurs. The lower layer of the lagoon is anaerobic, and in this zone the digestion of the sludge solids takes place, an intermediate, the facultative zone allows respiration with terminal electron acceptors other than oxygen, and this allows reactions such as denitrification. The gases produced in the lower zones are stabilized in the aerobic zone by dissolving oxygen, and this reduces odor problems. The objective of this study is to study the decrease of fecal coliforms in aerated lagoons of wastewater treatment plants in the city of Lima, Peru. The results indicate that the differential separation of the treated waters experienced a decrease from 13 to 26% of fecal coleiforms in all treatment lagoons(AU)

Prevalencia del síndrome del edificio enfermo en trabajadores de la industria manufacturera / Prevalence of sick building syndrome in manufacturing industry workers

El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)

Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)

Impacto en la salud pública por el manejo inadecuado de los desechos peligrosos / Impact on public health due to improper handling of hazardous waste

La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)

Manejo y disposición de desechos sólidos en la zona industrial Lurigancho del Perú / Management and disposal of solid waste in the Lurigancho industrial zone of Peru

La presente nota científica plantea una propuesta para gestionar de manera integral el problema ocasionado por la mala disposición de los desechos sólidos en la zona industrial Lurigancho, Perú. Se basa en el modelo de operador, que considera la parte política, estratégica y regulador, de esta manera contar con indicadores, que sirvan de herramientas para la toma de decisiones en la en la gestión de residuos a las plantas industriales a partir de su control, vigilancia, información y clasificación. Esta propuesta se aplicó en doce lugares de disposición de los residuos industriales, puntos de monitoreo, con dos intervenciones, con la evaluación inicial se observó caos ambiental, con desbordamiento de los contenedores de basura, sin aprovechamiento de los residuos y proliferación de fauna nociva. Posterior a la inducción para ejecutar la propuesta, en la segunda intervención, posterior a 45 días, se precisó mejoras considerables, aplicándose recomendaciones objetivas basadas en los valores de los indicadores los que permitieron la planificación estratégica y operativa y de la programación y el control generales. Los resultados preliminares hacen suponer que esta propuesta atiende requerimientos medioambientales y de salubridad, a través de la reducción y procesamiento de los residuos, cuya inadecuada disposición puede llegar a afectar la salud humana(AU)

This scientific note presents a proposal to comprehensively manage the problem caused by poor disposal of solid waste in the Lurigancho industrial zone, Peru. It is based on the operator model, which considers the political, strategic and regulatory part, thus having indicators that serve as tools for decision-making in the management of waste at industrial plants based on its control. , surveillance, information and classification. This proposal was applied in twelve industrial waste disposal sites, monitoring points, with two interventions, with the initial evaluation environmental chaos was observed, with overflow of garbage containers, without use of waste and proliferation of harmful fauna. After the induction to execute the proposal, in the second intervention, after 45 days, considerable improvements were required, applying objective recommendations based on the values of the indicators, which allowed strategic and operational planning and general programming and control. . Preliminary results suggest that this proposal meets environmental and health requirements, through the reduction and processing of waste, whose inadequate disposal can affect human health(AU)

Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19.

Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68-121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8-31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.

Inter-laboratory validation of an ISO test method for measuring enzyme activities in soil samples using colorimetric substrates.

The evaluation of soil quality requires the use of robust methods to assess biologically based indicators. Among them, enzyme activities are used for several decades, but there is a clear need to update their measurement methods for routine use, in combining feasibility, accuracy, and reliability. To this end, the platform Biochem-Env optimized a miniaturized method to measure enzyme activities in soils using colorimetric substrates in micro-well plates. The standardization of the method was carried out within the framework of ISO/TC 190/SC 4/WG 4 "Soil quality - Biological methods" workgroup, recommending an inter-laboratory evaluation for the publication of a full ISO standard. That evaluation, managed by the platform, was based on the measurement, in six soils of contrasted physicochemical properties, of the ten soil enzyme activities described in the standard. Eight laboratories were involved in the validation study. Only 2.7% of outliers were identified from the analyses of the whole dataset. The repeatability and reproducibility of the method were determined by computing, respectively, the intra-laboratory (CVr,) and inter-laboratory (CVR) coefficients of variation for each soil and enzyme. The mean CVr ranged from 4.5% (unbuffered phosphatase) to 9.9% (α-glucosidase), illustrating a reduced variability of enzyme activities within laboratories. The mean CVR ranged from 13.8% (alkaline phosphatase) to 30.9% (unbuffered phosphatase). Despite this large CVR noticed for unbuffered phosphatase, the method was repeatable, reproducible, and sensitive. It also proved to be applicable for measuring enzyme activities in different types of soils. These results have been found successful by ISO/TC 190/SC4 and resulted in the publication of ISO 20130:2018 standard.

Autochthonous Crimean-Congo Hemorrhagic Fever in Spain.

Crimean-Congo hemorrhagic fever (CCHF) is a widely distributed, viral, tickborne disease. In Europe, cases have been reported only in the southeastern part of the continent. We report two autochthonous cases in Spain. The index patient acquired the disease through a tick bite in the province of Ávila - 300 km away from the province of Cáceres, where viral RNA from ticks was amplified in 2010. The second patient was a nurse who became infected while caring for the index patient. Both were infected with the African 3 lineage of this virus. (Funded by Red de Investigación Cooperativa en Enfermedades Tropicales [RICET] and Efficient Response to Highly Dangerous and Emerging Pathogens at EU [European Union] Level [EMERGE].).

Changes in microbial dynamics during vermicomposting of fresh and composted sewage sludge.

Municipal sewage sludge is a waste with high organic load generated in large quantities that can be treated by biodegradation techniques to reduce its risk to the environment. This research studies vermicomposting and vermicomposting after composting of sewage sludge with the earthworm specie Eisenia andrei. In order to determine the effect that earthworms cause on the microbial dynamics depending on the treatment, the structure and activity of the microbial community was assessed using phospholipid fatty acid analysis and enzyme activities, during 112days of vermicomposting of fresh and composted sewage sludge, with and without earthworms. The presence of earthworms significantly reduced microbial biomass and all microbial groups (Gram+ bacteria, Gram- bacteria and fungi), as well as cellulase and alkaline phosphatase activities. Combined composting-vermicomposting treatment showed a lesser development of earthworms, higher bacterial and fungal biomass than vermicomposting treatment and greater differences, compared with the control without earthworms, in cellulase, ß-glucosidase, alkaline and acid phosphatase. Both treatments were suitable for the stabilization of municipal sewage sludge and the combined composting-vermicomposting treatment can be a viable process for maturation of fresh compost.

Absence of protective ethnic density effect on Ecuadorian migrants' mental health in a recent migration setting: a multilevel analysis.

PURPOSE: We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. METHODS: Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). CONCLUSIONS: No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

Mental health in Ecuadorian migrants from a population-based survey: the importance of social determinants and gender roles.

PURPOSE: To describe the prevalence of and the risk factors for poor mental health in female and male Ecuadorian migrants in Spain compared to Spaniards. METHOD: Population-based survey. Probabilistic sample was obtained from the council registries. Subjects were interviewed through home visits from September 2006 to January 2007. Possible psychiatric case (PPC) was measured as score of ≥5 on the General Health Questionnaire-28 and analyzed with logistic regression. RESULTS: Of 1,122 subjects (50% Ecuadorians, and 50% women), PPC prevalence was higher in Ecuadorian (34%, 95% CI 29-40%) and Spanish women (24%, 95% CI 19-29%) compared to Ecuadorian (14%, 95% CI 10-18%) and Spanish men (12%, 95% CI 8-16%). Shared risk factors for PPC between Spanish and Ecuadorian women were: having children (OR 3.1, 95% CI 1.4-6.9), work dissatisfaction (OR 4.1, 95% CI 1.6-10.5), low salaries (OR 2.5, 95% CI 1.1-5.9), no economic support (OR 1.8, 95% CI 0.9-3.4), and no friends (OR 2.2, 95% CI 1.1-4.2). There was an effect modification between the nationality and educational level, having a confidant, and atmosphere at work. Higher education was inversely associated with PPC in Spanish women, but having university studies doubled the odds of being a PPC in Ecuadorians. Shared risk factors for PPC in Ecuadorian and Spanish men were: bad atmosphere at work (OR 2.4, 95% CI 1.3-4.4), no economic support (OR 3.5, 95% CI 1.3-9.5), no friends (OR 2.5, 95% CI 0.9-6.6), and low social support (OR 1.6, 95% CI 0.9-2.9), with effect modification between nationality and partner's emotional support. CONCLUSIONS: Mental health in Spanish and Ecuadorian women living in Spain is poorer than men. Ecuadorian women are the most disadvantaged group in terms of prevalence of and risk factors for PPC.

Cyclophosphamide-induced reversible posterior leukoencephalopathy syndrome.

Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinical radiological syndrome, characterised by acute headache, altered consciousness, seizures and hypertension. The most frequent causes are hypertensive encephalopathy, eclampsia and some immunosuppressive therapies. The pathogenesis remains unclear, but it appears to be related to altered cerebral circulation, producing oedema that can be seen on MRI, and it resolves in 2 or 3 weeks. In the present report, a possible first reported case of cyclophosphamide-induced RPLS in a 27-year-old man with high blood pressure (HBP) and glomerulonephritis caused by Goodpasture syndrome, treated with cyclophosphamide during the last month and prednisone for glomerulonephritis resulting from Goodpasture syndrome without other immunosuppressive drugs, is described.Symptoms appeared during a hypertensive crisis, but when cyclophosphamide was replaced by rituximab and hypertension was controlled, the patient did not have neurological symptoms. Almost all reported cases induced by immunosuppressive therapy or other causes were associated with hypertension as well.

[Recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics: influenza vaccination campaign 2006-2007]. / Recomendaciones del Comité Asesor de Vacunas de la Asociación Española de Pediatría: vacunación antigripal campaña 2006-2007.

The recommendations of the Spanish Association of Pediatrics on influenza vaccination in the pediatric age group for the 2006-2007 season are presented. Influenza has special characteristics in children due to the high morbidity it carries. Moreover, children constitute the most frequent source of transmission. The risk factors supporting influenza vaccination in children and the need for immunization in persons living with high-risk children are discussed. The advisability of extending vaccination in health workers, and specifically to pediatricians and medical personnel in contact with sick children is stressed. The composition of the vaccine for the 2006-2007 seasons, the schedules and dosages in children depending on age, and the contraindications to vaccination are specified. Finally, the premises required to recommend universal vaccination in young children in Spain as a strategy to reduce morbidity due to this epidemic in children and adults are discussed.

Efecto de las radiaciones electromagnéticas no ionizantes sobre la inmunidad humoral y celular en trabajadores expuestos / Non-ionizating electromagnetic radiations effects upon humoral and cellular inmunity among exposed workess

Se estudian sujetos expuestos ocupacionalmente por más de 10 años a radiaciones electromagnéticas no ionizantes. Se realizaron determinaciones de inmunocomplejos; cuantificación de inmunoglobulinas A, G y M, y prueba de roseta activa y espontánea para estudiar inmunidad humoral y celular, así como otras pruebas. Se utilizó un grupo control con edad promedio similar al grupo estudiado y no expuesto a radiaciones. Se evidenciaron cambios en la inmunidad humoral, dados por alteraciones encontradas en la IgG e IgA. Se comprobó la disminución de la roseta activa y espontánea en el grupo expuesto en relación con el grupo control

Incidencia d echlamidias trachomatis en pacientes con uretritis

Se pretende detectar las infecciones por Chlamida en pacientes masculinos con secreciones uretrales escogidos de la consuslta externa del departamento de Veneología de l Centro Sanitario de Santo Domingo, durante el período septiembre-noviembre de 1986. Se les investigó la secreción uretral a través del método de la inmunofluorescencia directa e indirecta. 45 de 100 pacientes estudiados (45%) revelaron la presencia de Chlamidia trachomatis, de los cuales 18 casos (46%) estuvieron asociados a N. gonorreae: la edad más afectada fue la de 21 a 32 años con un 71.11%, los solteros con 55.6%, el 73% correspondió a la secreción purulenta y el 26.7% a la mucoide clara. En vista de que cuando se está frente a un paciente con secrección uretral purulenta en el primer diagnóstico que se piensa es un una uretritis gonocócica, es conveniente señalar uretral purulenta en el primer diagnóstico que se piensa es un una uretritis gonocócica, es conveniente señalar, principalmente al médico jóven, que también debe valorar la uretriitis por Chlamidia