A systematic review of electrocardiographic changes in healthy high-altitude populations.

High-altitude environments are characterized by decreased atmospheric pressures at which individuals exhibit a reduced volume of maximal oxygen uptake and arterial partial pressure of oxygen, both of which lead to hypobaric hypoxia. While acute exposure may temporarily offset cardiovascular homeostasis in sea-level residents, native highlanders have become accustomed to these high-altitude conditions and often exhibit variations in normal ECG parameters. As part of the "Altitude Non-differentiated ECG Study" (ANDES) project, this paper aims to systematically review the available literature regarding ECG changes in healthy highlander populations. After searching the PubMed, Medline, and Embase databases, 286 abstracts were screened, of which 13 full-texts were ultimately included. This process was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Major ECG deviations in native healthy highlanders include right QRS axis deviation, right ventricular hypertrophy signs, and more prevalent T-wave inversion in the right precordial leads. Notably, they exhibit a prolonged QTc compared to sea-level residents, although within normal limits. Evidence about increased P-wave amplitude or duration, variations in PR interval, or greater prevalence of complete right bundle branch block is not conclusive. This review provides ECG reference standards that can be used by clinicians, who should be aware of the effects of high-altitude residence on cardiovascular health and how these may change according to age, ethnicity, and other factors.

Aggression, Micro-aggression, and Abuse Against Health Care Providers During the COVID-19 Pandemic. A Latin American Survey.

The COVID-19 pandemic has had tremendous consequences globally. Notably, increasing complaints of verbal and physical violence against health care providers have been reported. A cross-sectional electronic survey was conducted between January 11 and February 28, 2022 to delineate the violent behavior against front-line health professionals in Latin America. A total of 3544 participants from 19 countries were included. There were 58.5% women, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members. About 54.8% reported acts of abuse: 95.6% verbal abuse, 11.1% physical abuse, and 19.9% other types. Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, 56.2% considered changing their care tasks, and 33.6% considered quitting their profession. In a logistic regression model, nurses (odds ratio (OR) 1.90, P < 0.001), doctors (OR 2.11, P < 0.001), and administrative staff (OR 3.53, P = 0.005) experienced more abuse than other health workers. Women more frequently reported abuse (OR 1.56, P < 0.001), as well as those who worked directly with COVID-19 patients (OR 3.66, P < 0.001). A lower probability of abuse was observed at older ages (OR 0.95, P < 0.001). There has been a high prevalence of abuse against health personnel in Latin America during the COVID-19 pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be at elevated risk. It is imperative to develop strategies to mitigate these acts and their repercussions on the patient-provider relationship and outcomes.