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Objetivo: Este artículo tiene como principal objetivo determinar los factores que se vinculan con la mortalidad empresarial en la provincia de Huánuco. Metodología: Se adoptó un enfoque cuantitativo y descriptivo para analizar la mortalidad empresarial en la provincia. La muestra se seleccionó mediante un muestreo estratificado proporcional, dividiendo la población en estratos según la actividad económica y el tamaño de la empresa. Se aplicó un muestreo aleatorio simple en cada estrato, resultando en una muestra de 157 emprendedores. Resultados: Los empresarios en Huánuco perciben un impacto económico significativo, con más del 69% indicando un gran impacto. Se destaca la importancia crítica de gestionar eficazmente los factores económicos y externos para la supervivencia empresarial. Conclusión: La percepción de los empresarios en Huánuco subraya la relevancia crítica de gestionar de manera eficiente los factores económicos y externos para garantizar la supervivencia y el éxito empresarial.

RESUMO A síndrome da encefalopatia posterior reversível é uma rara síndrome clínica e radiológica caracterizada por edema vasogênico da matéria branca dos lobos occipital e parietal, que geralmente são simétricos, resultante de uma manifestação secundária de disfunção aguda do sistema cerebrovascular posterior. Descrevemos um caso de síndrome de encefalopatia posterior reversível secundária à infecção por SARS-CoV-2 em um menino de 9 anos de idade que desenvolveu insuficiência respiratória hipoxêmica aguda e necessitou de ventilação mecânica assistida. A criança desenvolveu síndrome inflamatória multissistêmica e foi monitorada na unidade de terapia intensiva pediátrica, tendo-lhe sido fornecidos ventilação mecânica e agentes vasoativos para suporte hemodinâmico. Além disso, desenvolveu manifestações clínicas pulmonares e extrapulmonares juntamente de manifestações neuropsiquiátricas que necessitavam de seguimento cuidadoso, tendo sido verificadas por ressonância magnética cerebral para intervenção oportuna. Atualmente, há poucos relatos de crianças com síndrome da encefalopatia posterior reversível associada à síndrome inflamatória multissistêmica.

Background: Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis have been described in patients with toxoplasmosis. Case report: We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions: The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.

Objetivos: Evaluar el nivel de conocimientos y prácticas en los trabajadores de salud de un Hospital Público III-1 sobre políticas y estrategias para la reducción del mercurio añadido en termómetros y tensiómetros. Métodos: Se empleó dos enfoques. El primero empleó una base de datos con encuestas aplicadas a grupos focales y entrevistas para evaluar las políticas y prácticas. El segundo enfoque, utilizo la técnica del inventario a través de la observación directa de material médico con mercurio. Resultados: El 95% de los encuestados refiere que está expuesto a materiales con mercurio. Solo un 10% conoce a quien se entrega la disposición final cuando se limpian los derrames. Este mismo porcentaje, desconoce sobre la existencia del kit de limpieza de mercurio. Además, con la prueba Chi Cuadrado x2 (p: 0,02) se determinó que existe una asociación entre el bajo nivel de conocimiento en la existencia de un kit de limpieza de mercurio y el riesgo de exposición al mismo. Asimismo, se determinó que éste riesgo tiene un OR 3,2 IC 95% (1,4-3.5) p: 0,01. Mediante el test de ANOVA (Nivel de significancia del 95% p: 0,03). Y se determinó que existe diferencia estadísticamente significativa entre los promedios de los niveles de mercurio en las áreas de emergencia, hospitalización y observación. Siendo numéricamente mayor el promedio estimado en el área de medicina, Cirugía General, Oncología y Obstetricia. Conclusión: Existe un nivel de desconocimiento en la reducción del mercurio añadido y el riesgo ocupacional en los trabajadores de salud se considera elevado.

En el año 2013, la Organización Mundial de la Salud, afirmó que una de cada tres mujeres en el mundo sufre violencia física y/o sexual por su compañero, reflejando con dicha afirmación la gravedad de la violencia familiar en el mundo. Lamentablemente las mujeres sometidas a este flagelo son propensas de sufrir enfermedades mentales y al consumo de alcohol y diversas drogas, a diferencia de mujeres que no han vivido episodios de violencia familiar. Las estadísticas también señalan que 42 % de mujeres que han sufrido violencia física y sexual por sus parejas, pueden sufrir lesiones graves y hasta morir por ello. La violencia contra las mujeres denota un problema serio de salud global, afecta significativamente tanto la salud mental, física y espiritual de las mujeres vulneradas en su dignidad y debe ser combatido centrándose en la persona de modo integral, como lo sostiene el Personalismo. De acuerdo a la realidad expresada, el propósito del presente trabajo consiste en explicar desde un enfoque personalista los fundamentos antropológicos de la dignidad de la mujer, reconociendo el valor intrínseco que posee, el mismo que se ve vulnerado en un contexto de violencia familiar.

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Background and Objectives: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI., Methods: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-appropriate Glasgow Coma Scale score ≤8) randomized to ICP-based or non-ICP-based management., Expected Outcomes: Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension., Discussion: This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Background and Objectives: The efficacy of our current approach to incorporating intracranial pressure (ICP) data into pediatric severe traumatic brain injury (sTBI) management is incompletely understood, lacking data from multicenter, prospective, randomized studies. The National Institutes of Health-supported Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial will compare outcomes from pediatric sTBI of a management protocol based on ICP monitoring vs 1 based on imaging and clinical examination without monitoring. Because no applicable comprehensive management algorithms for either cohort are available, it was necessary to develop them., Methods: A consensus conference involving the 21 intensivists and neurosurgeons from the 8 trial sites used Delphi-based methodology to formulate management algorithms for both study cohorts. We included recommendations from the latest Brain Trauma Foundation pediatric sTBI guidelines and the consensus-based adult algorithms (Seattle International Brain Injury Consensus Conference/Consensus Revised Imaging and Clinical Examination) wherever relevant. We used a consensus threshold of 80%., Results: We developed comprehensive management algorithms for monitored and nonmonitored cohort children with sTBI. We defined suspected intracranial hypertension for the nonmonitored group, set minimum number and timing of computed tomography scans, specified minimal age-adjusted mean arterial pressure and cerebral perfusion pressure targets, defined clinical neuroworsening, described minimal requisites for intensive care unit management, produced tiered management algorithms for both groups, and listed treatments not routinely used., Conclusion: We will study these protocols in the Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial in low- and middle-income countries. Second, we present them here for consideration as prototype pediatric sTBI management algorithms in the absence of published alternatives, acknowledging their limited evidentiary status. Therefore, herein, we describe our study design only, not recommended treatment protocols., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Current therapies frequently used for refractory septic shock include hydrocortisone, vasopressin, extracorporeal membrane oxygenation (ECMO) support, inodilators, levosimendan and methylene blue. The evidence for these treatments is very limited. We present a case of a 5-year-old patient with refractory septic shock, secondary to Listeria monocytogenes meningitis. She presented with status epilepticus and developed septic shock. Shock persisted despite multiple high-dose vasoactive medications. ECMO support was not available. The medical team decided to use methylene blue to revert the vasoplegia, with excellent results. Shortly after the administration, vasopressors were weaned off and the high lactate cleared. She developed severe neurological sequelae due to brain haemorrhage secondary to the Listeria meningitis. The evidence supporting methylene blue for refractory septic shock in paediatric patients is limited. This case represents the effectiveness of this therapy without secondary effects., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)