Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center.

OBJECTIVES: To examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections. DESIGN: Retrospective cohort study between 2015 and 2022. SETTING: Large public healthcare system in New York City. PARTICIPANTS: All patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals. RESULTS: Of 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18). CONCLUSIONS: Patients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.

Impact of Prophylactic Antibiotic Selection on the Prevention and Bacterial Flora of Surgical Site Infections After Colorectal Surgery.

Background: Deep incisional and organ/space surgical site infections (SSIs) after colorectal surgery are associated with adverse outcomes. Multiple antibiotic regimens are recommended for peri-operative prophylaxis, with no particular regimen preferred over another. We compared the prophylaxis regimens used in patients with and without SSIs, and the impact of regimens on the flora involved in SSIs. Patients and Methods: Information was extracted from the National Healthcare Safety Network databank of patients undergoing colorectal surgery from 2015 to 2022 in a large public healthcare system in New York City. Patients with SSIs were identified, and controlling for nine variables, propensity score matching was used to create a matched control group without SSIs. Prophylactic regimens were compared between the matched groups with and without SSIs. Also, for the patients with SSIs, the impact of the prophylactic regimen on the subsequent pathogens involved the infection was examined. Results: A total of 275 patients with SSIs were compared to a matched cohort without SSIs. The prophylactic regimens were extremely similar between the SSI and control groups. Among the patients who developed SSIs, more patients who received cefoxitin had emergence of select cephalosporin-resistant Enterobacterales and Bacteroides spp. when compared with those who received ß-lactam-ß-lactamase inhibitors. Conclusions: The distribution of surgical prophylaxis regimens was remarkably similar between patients developing serious SSIs and a closely matched cohort that did not develop an SSI. However, given the downstream effects of more resistant and anaerobic flora should an infection develop, use of cefoxitin should be re-evaluated as a prophylactic agent.

Comorbilidades en pacientes con infección por Covid-19 grave posvacunación en el Hospital Juárez de México.

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Numerical simulation of optical propagation using sinc approximation.

This paper further develops a recently proposed method for computing the diffraction integrals of optics based on sinc series approximation by presenting a numerical implementation, parameter selection criteria based on rigorous error analysis, and example optical propagation simulations demonstrating those criteria. Unlike fast Fourier transform (FFT)-based methods that are based on Fourier series, such as the well-known angular spectrum method (ASM), the sinc method uses a basis that is naturally suited to problems on an infinite domain. As such, it has been shown that the sinc method avoids the problems of artificial periodicity inherent in the ASM. After a brief review of the method, the detailed error analysis we provide confirms its super-algebraic convergence and verifies the claim that the accuracy of the method is independent of wavelength, propagation distance, and observation plane discretization; it depends only on the accuracy of the source field approximation. Based on this analysis, we derive parameter selection criteria for achieving a prescribed error tolerance, which will be valuable to potential users. Numerical simulations of Gaussian beam and optical phased array propagation verify the high-order accuracy and computational efficiency of the proposed algorithms. To facilitate the reproduction of numerical results, we provide a Matlab code that implements our numerical approach for the Fresnel diffraction integral. For comparison, we also present numerical results obtained with the ASM as well as the band-limited angular spectrum method.

O programa mãe curitibana - avançando na humanização da atenção materno-infantil / The Curitibana Mother Program: humanizing child mother health care

Trata do programa Mãe Curitibana, que tem por objetivo reduzir a morbimortalidade materna e a mortalidade infantil. O Programa inova ao estabelecer a Unidade de Saúde como porta de entrada para o acolhimento à gestante, garantindo o acesso ao parto, no início do pré-natal, evitando a peregrinação às maternidades, quando do trabalho de parto. Ou seja, a mulher que procura uma Unidade de Saúde para realizar o pré-natal tem sua vinculação na maternidade onde realizará o parto, já na primeira consulta.

Human rabies: a reemerging disease in Costa Rica?

Two human rabies cases caused by a bat-associated virus variant were identified in September 2001 in Costa Rica, after a 31-year absence of the disease in humans. Both patients lived in a rural area where cattle had a high risk for bat bites, but neither person had a definitive history of being bitten by a rabid animal. Characterization of the rabies viruses from the patients showed that the reservoir was the hematophagous Vampire Bat, Desmodus rotundus, and that a sick cat was the vector.