BACKGROUND: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic's impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels. METHODOLOGY: We compared first- and third-dose coverage of diphtheria-pertussis-tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed. RESULTS: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06). CONCLUSION: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels.
Beavers (Castor canadensis and C. fiber) build dams that modify catchment and pond water balances, and it has been suggested that they can be a nature-based solution for reducing flood hydrographs, enhancing low flow hydrographs and restoring hydrological functioning of degraded streams. How water moves through a beaver dam is determined by its flow state (e.g., overflow, underflow). However, current conceptual models only consider flow state as changing over the beaver site occupation-abandonment cycle. To assess whether flow state changes at shorter timescales and identify possible triggers (e.g., rainfall, animals), we integrated camera trap imagery, machine learning, water level measurements, and hydrometeorological data at beaver dams in a montane peatland in the Canadian Rocky Mountains. Contrary to current models, we found that flow states changed frequently, changing a maximum 12 times during the 139-day study period, but that changes had limited synchronicity amongst the dams in the same stream. More than two-thirds of the changes coincided with rainfall events. We observed no changes in flow state in response to beaver activity or wildlife crossings perhaps due to the camera positioning. Our findings augment the long-term oriented framework, which links changes to the occupancy cycle of a beaver pond and frequent and hydrological-driven changes. To develop realistic predictions of hydrological impacts of beaver dams, ecohydrological models should update their representation of the influence of beaver dams to include short-term dynamism of flow states and potential triggers. Our study advances the understanding of the important, yet understudied, role of beaver dams in stream restoration and climate change initiatives.
Rivers , Rodentia , Animals , Rodentia/physiology , Canada , Animals, Wild , Water
AIM: Management of diverticulitis with abscess formation in immunosuppressed patients (IMS) remains unclear. The main objective of the study was to assess short- and long-term outcomes between IMS and immunocompetent patients (IC). The secondary aim was to identify risk factors for emergency surgery. METHODS: A nationwide retrospective cohort study was performed at 29 Spanish referral centres between 2015-2019 including consecutive patients with first episode of diverticulitis classified as modified Hinchey Ib or II. IMS included immunosuppressive therapy, biologic therapy, malignant neoplasm with active chemotherapy and chronic steroid therapy. A multivariate analysis was performed to identify independent risk factors to emergency surgery in IMS. RESULTS: A total of 1395 patients were included; 118 IMS and 1277 IC. There were no significant differences in emergency surgery between IMS and IC (19.5% and 13.5%, p = 0.075) but IMS was associated with higher mortality (15.1% vs. 0.6%, p < 0.001). Similar recurrent episodes were found between IMS and IC (28% vs. 28.2%, p = 0.963). Following multivariate analysis, immunosuppressive treatment, p = 0.002; OR: 3.35 (1.57-7.15), free gas bubbles, p < 0.001; OR: 2.91 (2.01-4.21), Hinchey II, p = 0.002; OR: 1.88 (1.26-2.83), use of morphine, p < 0.001; OR: 3.08 (1.98-4.80), abscess size ≥5 cm, p = 0.001; OR: 1.97 (1.33-2.93) and leucocytosis at third day, p < 0.001; OR: 1.001 (1.001-1.002) were independently associated with emergency surgery in IMS. CONCLUSION: Nonoperative management in IMS has been shown to be safe with similar treatment failure than IC. IMS presented higher mortality in emergency surgery and similar rate of recurrent diverticulitis than IC. Identifying risk factors to emergency surgery may anticipate emergency surgery.
Diverticulitis, Colonic , Diverticulitis , Humans , Abscess/etiology , Abscess/therapy , Diverticulitis, Colonic/therapy , Diverticulitis, Colonic/complications , Retrospective Studies , Neoplasm Recurrence, Local/complications , Diverticulitis/complications
BACKGROUND: To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery. METHODS: This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed. RESULTS: Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85). CONCLUSION: Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
Abdominal Abscess , Diverticulitis , Humans , Abscess/surgery , Abscess/complications , Retrospective Studies , Abdominal Abscess/etiology , Abdominal Abscess/therapy , Nomograms , Diverticulitis/surgery , Drainage/adverse effects
Introducción: El procedimiento LIFT para las FA de localización posterior ha sido cuestionado. Sin embargo esta controversia no ha sido analizada previamente y es el objetivo de esta revisión sistemática con metaanálisis. Material y método: Revisión sistemática PRISMA, de las bases MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library y Google Scholar hasta marzo de 2020. La evaluación de la calidad y sesgos de los estudios seleccionados se ha realizado mediante la escala Newcastle-Ottawa, según la AHRQ. Se empleó el método inverso de la varianza y el modelo de efectos aleatorios. Además, se realizó un análisis de sensibilidad y sobre el sesgo de publicación mediante funnel-plot y las pruebas de Beg y Egger. Resultados: No se apreciaron diferencias significativas en el porcentaje de recurrencias entre los pacientes con fístula posterior y el resto de localizaciones (OR 1,36 [IC 95% 0,60-3,07]; p=0,46). El valor I2 fue de 77%, lo cual muestra la heterogeneidad de resultados entre los estudios elegidos. Los 9 estudios incluidos presentaron una mediana ponderada (RI) de recidiva global del 37,8% (RI 18,3-47,7%), recidiva de fístula posterior del 47,1% (RI 30,7-63,7%) y de fístula no posterior del 36,3% (RI 15,8-51,3%) (p=0,436). Ni el número de pacientes ni la diferente calidad metodológica de los estudios explican el nivel de heterogeneidad de los mismos. No se demostró sesgo de publicación. (AU)
Introduction: Efficacy of the ligation of intersphincteric fistula tract (LIFT) procedure for posterior fistula-in-ano remains under debate. However, there is scarcity of quality evidence analysing this issue. Thus, the aim of this study is to evaluate outcomes of LIFT surgery in patients with posterior anal fistula. Material and methods: Systematic review and meta-analysis to evaluate efficacy of LIFT procedure for posterior anal fistula. MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar data sources were searched for key-words (MeSH terms): LIFT OR Ligation of the intersphincteric fistula tract AND posterior anal fistula OR posterior fistula-in-ano. Original, observational and experimental, non-language restriction studies published from January 2000 to March 2020 and reporting outcomes on LIFT procedure for posterior anal fistula were reviewed. Quality and potential biases were assessed using Newcastle-Ottawa scale, following AHRQ recommendations. Additional sensitivity analysis and publication bias evaluation (Beg and Egger's tets) were performed. Results: No significant differences were found in recurrence rate among patients undergoing LIFT procedure for posterior fistula-in-ano in contrast to other locations (OR 1.36 [IC 95% 0.60-3.07]; p=.46). I2 test value was 77%, expressing a fair heterogeneity among included studies. The weighed median for overall recurrence was 37.8% (RI 18.3-47.7%); with a weighed median of 47.1% (RI 30.7 - 63.7%) and 36.3% (RI 15.8-51.3%) (p=.436) respectively for recurrence after LIFT for posterior fistula and fistula in other locations. There was not clear evidence about the sample size (n) of included studies nor the disparities in quality assessment of those, could justify the observed heterogeneity. No significant publication bias was found. (AU)
Humans , Rectal Fistula/prevention & control , Rectal Fistula/surgery , Publication Bias , MEDLINE , PubMed
INTRODUCTION: Efficacy of the ligation of intersphincteric fistula tract (LIFT) procedure for posterior fistula-in-ano remains under debate. However, there is scarcity of quality evidence analysing this issue. Thus, the aim of this study is to evaluate outcomes of LIFT surgery in patients with posterior anal fistula. MATERIAL AND METHODS: Systematic review and meta-analysis to evaluate efficacy of LIFT procedure for posterior anal fistula. MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar data sources were searched for key-words (MeSH terms): "LIFT" OR "Ligation of the intersphincteric fistula tract" AND "posterior anal fistula" OR "posterior fistula-in-ano". Original, observational and experimental, non-language restriction studies published from January 2000 to March 2020 and reporting outcomes on LIFT procedure for posterior anal fistula were reviewed. Quality and potential biases were assessed using Newcastle-Ottawa scale, following AHRQ recommendations. Additional sensitivity analysis and publication bias evaluation (Beg and Egger's tets) were performed. RESULTS: No significant differences were found in recurrence rate among patients undergoing LIFT procedure for posterior fistula-in-ano in contrast to other locations (OR 1.36 [IC 95% 0.60-3.07]; p=.46). I2 test value was 77%, expressing a fair heterogeneity among included studies. The weighed median for overall recurrence was 37.8% (RI 18.3-47.7%); with a weighed median of 47.1% (RI 30.7 - 63.7%) and 36.3% (RI 15.8-51.3%) (p=.436) respectively for recurrence after LIFT for posterior fistula and fistula in other locations. There was not clear evidence about the sample size ("n") of included studies nor the disparities in quality assessment of those, could justify the observed heterogeneity. No significant publication bias was found. CONCLUSION: This systematic review and meta-analysis suggests that there are no clear data in the literature for not performing the LIFT procedure in posteriorly located fistulas.
OBJECTIVE: To assess the impact of the incidence of late anastomotic dehiscences, defined as those occurring after the 60th post-operative day, in the final results of rectal cancer treatment. METHODS: A retrospective analysis was performed reviewing all anastomotic leakages (AL) recorded in a prospective rectal cancer database, from November 2006 to December 2015. RESULTS: The analysis included 395 (71.5%) colo-rectal anastomosis performed in 552 patients undergoing rectal cancer surgery. Overall 32 (8.1%). AL were identified: 25 (78%) early and 7 (22%) late. Late AL compared to early AL were significantly associated with: higher ASA score (p = 0.021), higher CLS score (p = 0.005), lower rectal tumours (p = 0.014), neo-adjuvant radio-chemotherapy (p = 0.028), presence of ileostomy (p = 0.013), early hospital discharge (p = 0.048) and with the need for definitive stoma creation (p = 0.003). CONCLUSIONS: Late AL can represent up to 22% of all AL; with significant long-term implications such as an increase of the requirement of definitive stoma or chronic pelvic sepsis. This findings could modify the long-term outcomes in rectal cancer published. In our experience, the late AL do not represent a distinct clinical process compared to early forms, with exception of the chronological criteria.
OBJETIVO: Valorar el impacto de la incidencia de dehiscencias anastomóticas tardías, definidas como las aparecidas después del día 60 del posoperatorio, en los resultados finales del tratamiento del cáncer de recto. MÉTODO: Estudio retrospectivo de todas las dehiscencias anastomóticas recogidas a largo plazo en un registro prospectivo de cáncer de recto entre noviembre de 2006 y diciembre de 2015. RESULTADOS: Se realizaron 395 anastomosis colorrectales en 552 pacientes con cáncer de recto (71.5%) y se diagnosticaron 32 dehiscencias anastomóticas (8.1%): 25 precoces (78%) y 7 tardías (22%). Las tardías se diferenciaron de las precoces por presentarse en pacientes con mayor puntuación ASA (p = 0.021), mayor puntuación predictiva CLS (p = 0.005), tumores más bajos (p = 0.014), neoadyuvancia (p = 0.028), ileostomía (p = 0.013), menos tiempo de estancia posoperatoria (p = 0.048) y mayor necesidad de estomas definitivos (p = 0.003). CONCLUSIONES: Las dehiscencias anastomóticas tardías pueden suponer el 22% de las dehiscencias totales y se acompañan de un aumento de estomas definitivos y de sepsis pélvica crónica que podrían empeorar los estándares publicados en cáncer de recto. En nuestra experiencia no son diferentes de las formas precoces salvo en su cronología.
Anastomotic Leak/epidemiology , Rectal Neoplasms/surgery , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome
No disponible
Humans , Female , Aged , Abscess/pathology , Abscess , Rifampin/therapeutic use , Radiography, Thoracic , Lymphadenitis/complications , Lymphadenitis/diagnosis , Abscess/complications , Medical History Taking/methods , Parotid Gland , Parotid Gland/pathology , Parotid Gland , Polymerase Chain Reaction/methods
Presenta la Ley y el Reglamento de Trasplante de Organos y Tejidos; documentos sobre la creación del ONTOT y su reglamento técnico administrativo; el reglamento para la acreditación de hospitales; las normas generales para el transplante de organos y tejidos in cluyendo las referentes a donantes cadavéricos
Ecuador , Transplants , Public Health/legislation & jurisprudence
