Operationalizing One Health: Environmental Solutions for Pandemic Prevention.

Human pressure on the environment is increasing the frequency, diversity, and spatial extent of disease outbreaks. Despite international recognition, the interconnection between the health of the environment, animals, and humans has been historically overlooked. Past and current initiatives have often neglected prevention under the One Health preparedness cycle, largely focusing on post-spillover stages. We argue that pandemic prevention initiatives have yet to produce actionable targets and indicators, connected to overarching goals, like it has been done for biodiversity loss and climate change. We show how the Driver-Pressure-State-Impact-Response framework, already employed by the Convention on Biological Diversity, can be repurposed to operationalize pandemic prevention. Global responses for pandemic prevention should strive for complementarity and synergies among initiatives, better articulating prevention under One Health. Without agreed-upon goals underpinning specific targets and interventions, current global efforts are unlikely to function at the speed and scale necessary to decrease the risk of disease outbreaks that might lead to pandemics. Threats to the environment are not always abatable, but decreasing the likelihood that environmental pressure leads to pandemics, and developing strategies to mitigate these impacts, are both attainable goals.

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

BACKGROUND: Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses. OBJECTIVES: To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation. METHODS: Prospective cohort study. We included adult patients with COVID-19-associated acute respiratory distress syndrome, invasively ventilated in two ICUs in Buenos Aires. We measured functional, cognitive and psychological impairments with Barthel index, Montreal Cognitive Assessment test, Patient Health Questionnaire-9 and General Anxiety Disorder-7. Primary outcome was post-intensive care syndrome. Secondary outcome was mortality at 60 days. RESULTS: We admitted 40 patients, median age was 69 (60-75) and mostly male (75%). Mortality at 60 days was 37%. Cox regression analysis identified diabetes and Apache II as independent predictors of mortality. Out of 22 patients studied, 14 (64%) developed PICS after discharge. With a physical, cognitive and psychological impairment in 64%, 41% and 32% of patients, respectively. Obesity, days of mechanical ventilation, Apache II, vasopressors use, delirium duration and cumulative midazolam dose were associated with functional dependence. CONCLUSIONS: We identified a high prevalence of functional, cognitive and mental impairment at 30 days after hospital discharge in COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated. The physical domain was the most frequently affected. These findings suggest the need for long-term follow-up of this population.

Clinical features of the hospitalized patients with 2009 pandemic influenza A (H1N1) in Santa Fe, Argentina.

BACKGROUND: During 2009 occurred the emergence and global spread of a novel influenza A (H1N1) virus. We describe the clinical and epidemiologic features of hospitalized patients who survived and patients who died because of pandemic 2009 influenza A (H1N1) infection reported in Santa Fe, Argentina, from May to July 2009. METHODS: Using medical charts, we collected data on 242 patients who were hospitalized with confirmed laboratory results (defined as positive by specific PCR for pandemic 2009 influenza A H1N1). RESULTS: During the study period, there were 242 cases of hospitalization or death. Of the 242, 46% were admitted to an intensive care unit (ICU) and 33·5% died. The mean age was 27·8 years for surviving and 39·6 for those who died. Twenty-eight percent of hospitalizations involved persons under the age of 15 years; 33% of the patients were between the age of 15 and 44 years; and only 3·3% were 65 years of age or older. Sixty-seven percent had an underlying medical conditions, including diabetes, obesity, heart and lung diseases, and pregnancy. Of the 242 patients, 68% had findings consistent with pneumonia. Treatment with oseltamivir was administered to 227 (93·8%) patients from which 38 received oseltamivir within 48 hours after the onset of symptoms. CONCLUSIONS: The pandemic strain caused severe illness, including pneumonia and acute respiratory distress syndrome, and resulted in ICU admissions in 46% of patients and death in 33·5%. The mean age of hospitalized infected cases was lower than is common with seasonal influenza. Underlying medical conditions were common in the 67% the evaluated patients. Patients who died had a higher prevalence of comorbidities (86·4%) than those who survived (57%), suggesting that the presence of chronic illness may increase the likelihood of death. However, the severe illness was also identified among young, healthy persons.

Bioimplantes de donantes cadavéricos para uso cardiovascular: el valor de una oportunidad / Bioimplants of cadaveric donors for cardiovascular use: value of an opportunity

La alteración anatómica del corazón, trae como consecuencia anormalidades en su funcionalidad; dependiendode la severidad de la lesión llega a ser necesario el reemplazo de algunas estructuras con un implante que puede ser de tipo biológico. Las posibilidades establecidas para el procesamiento de tejidos biológicos de uso cardiovascular, permiten disponer en la actualidad de una variedad de bioimplantes para el manejo quirúrgico de pacientes con diversas patologías. En este sentido se han desarrollado técnicas para el procesamiento, conservación y almacenamiento de tejidos, llamados homoinjertos, los cuales se obtienen de donantes cadavéricos, en los que aún se conserva viabilidad celular. Desafortunadamente, de otro lado, queda el sinsabor de ver frustrada la vida de miles de personas que por violencia u otras causas accidentales pierden su vida; aunque ello incremente las oportunidades de alivio para gran cantidad de pacientes que esperan por un implante biológico producto de un donante; es la ambivalencia que existe entre las oportunidades de salvar vidas y el costo social que representan las víctimas de la violencia que se ofrecen como donantes.

The structural alteration of the heart, entails a functional damage; depending on how severe is the lesion can benecessary the replacement of the structure with an implant that can be of a biological type. The opened possibilities to biological tissue processing for cardiovascular use, allow to have at the present time a variety of bioimplants for the surgical treatment of patients with diverse pathologies. In this sense it has been developed techniques for processing, conservation and storage of tissues, called homografts, which are obtained from cadaveric donors, in which still cellular viability is conserved. Unfortunately, of another hand, it is left the sadness to see frustrated the life of thousands of people who by violence or other accidental causes are death; although it increases the opportunities of relievement for great amount of patients who wait by biological implants derived of a donor; it is the ambivalence that exist between the opportunities to save lives and the social cost that represent the victims of the violence which they are offered like donors.