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What explains income inequality, poverty and social exclusion? The pandemic is the cause? What role have neoliberal policies played? What did the policies of the "Washington Consensus" intend? Is there a crisis? What crisis are we talking about? Who benefited and who was harmed by the policies applied during the pandemic. Why? What exits are glimpsed? What lies ahead for the social movement? These are some of the questions that we answer in this work, which focuses on Panama, but not a few countries will be reflected. ¿Qué explica la desigualdad de ingresos, pobreza y exclusión social? ¿La pandemia es la causa? ¿Qué papel han jugado las políticas neoliberales? ¿Qué pretendían las políticas del «Consenso de Washington»? ¿Hay crisis? ¿De qué crisis se habla? ¿Las políticas aplicadas durante la pandemia, a quiénes beneficiaron y a quienes perjudicaron? ¿Por qué? ¿Qué salidas se vislumbran? ¿Qué le depara al movimiento social? Son algunas de las preguntas que respondemos en este trabajo, que se centra en Panamá, pero no pocos países se verán reflejados.

Vascular surgeons of all backgrounds play an important role in providing high quality vascular surgical care in their communities. In America, with our diverse population and communities, patients presenting with vascular disease are very common and could pattern the community demographic. Often faced with the challenges of community hospital politics and demand, the vascular surgical workforce has continued to be active members in their communities, focusing on their strengths to lead vascular surgery healthcare in an environment of high patient demand. Having a varied vascular surgery workforce provides all patients afflicted by vascular disease a comfortable opportunity for compassionate and empathic vascular care. This is a significant strength of vascular care when diversity, equity, and inclusion are supported by the leadership.

Driven by dwindling incomes from coffee and tea and the need to diversify their sources of income, farmers in Kiambu County are increasingly shifting to pineapple cultivation in areas formerly dominated by coffee and tea cultivation. However, not all areas in the County are suitable for pineapple production due to spatial variability of factors affecting growth (climate, soils, topography). There is therefore a need to identify and delineate suitable areas for growing pineapples in the County. Land suitability assessment for pineapple production in Kiambu County was carried out by a combination of GIS and the Analytical Hierarchical Process (AHP) model. Using GIS, thematic maps of all factors affecting pineapple growth (soil, climate and topography) were developed showing their spatial variability within the county. The maps (of factors affecting growth) were assessed against the published optimum parameter value ranges for pineapple cultivation. AHP was used to assign ratings/weights (of importance) of the thematic layers in regard to pineapple production. The land suitability map was developed from a weighted overlay of the thematic layers in ArcGIS. The map was categorized into four classes based on pineapple cultivation's suitability; highly suitable, moderately suitable, marginally suitable, and not suitable. From the results, 38% of the (Kiambu) County is highly suitable for pineapple cultivation while 5% is not suitable. The rest of the County is moderately suitable (41%) and marginally suitable (16%). We recommend the use of these findings by agricultural extension officers for the planning and guiding farmers on where to invest in pineapple production

The present study used the American College of Surgeons National Surgical Quality Improvement Program dataset to identify the predictors of 30-day mortality for nonagenarians undergoing endovascular aortic aneurysm repair (EVAR) or open surgical repair (OSR).Patients aged90 years who had undergone abdominal aortic aneurysm repair from 2005 to 2017 were identified using procedure codes. Those with operative times 15 minutes were excluded. The demographics, preoperative comorbidities, and postoperative complications of those who had died by 30 days were compared with those of the patients alive at 30 days.A total of 1356 nonagenarians met the criteria: 1229 (90.6%) had undergone EVAR and 127 (9.4%) had undergone OSR. The overall 30-day mortality was 10.4%. The patients who had died within 30 days were significantly more likely to have undergone OSR than EVAR (40.9% vs 7.2%; P .001). They also had a greater incidence of dependent functional status (22.0% for those who had died vs 8.1% for those alive at 30 days; P .001), American Society of Anesthesiology (ASA) classification of ≥4 (81.2% vs 18.8%; P .001), perioperative blood transfusion (59.6% vs 20.3%; P .001), postoperative pneumonia (12.1% vs 2.9%; P = .001), mechanical ventilation48 hours (22.7% vs 2.6%; P .001), and acute renal failure (12.1% vs 0.5%; P .001). The EVAR group had a 30-day mortality rate of 2.6% in 1008 elective cases and 28.6% in 221 emergent cases. The OSR group had a 30-day mortality rate of 19.1% in 47 elective cases and 53.7% in 80 emergent cases. In the EVAR cohort, the 30-day mortality group had had a significantly greater incidence of dependent functional status (17% for those who had died vs 8% for those alive at 30 days; P = .004), ASA classification of ≥4 (76.4% vs 40.3%; P .001), perioperative blood transfusion (57% vs 19%; P .001), emergency surgery (71% vs 14%; P .001), and longer operative times (150 vs 128 minutes; P = .001).Nonagenarians had an incrementally increased, but acceptable, risk of 30-day mortality with EVAR in elective and emergent cases compared with that reported for octogenarians and cohorts of patients not selected for age. We found greater mortality for patients with dependent status, a higher ASA classification, emergent repair, and OSR. These preoperative risk factors could help identify the best surgical candidates. Given these results, consideration for EVAR or OSR might be reasonable for highly selected patients, especially for elective patients with a larger abdominal aortic aneurysm diameter for whom the risk of rupture is higher.

The natural history and management of intramural hematoma (IMH) has varied significantly worldwide. From the present retrospective analysis of our institutional database, we have reported the long-term results from medical and surgical management of types A and B IMH.Computed tomography reports completed at our tertiary care hospital from July 2007 to July 2020 were used to identify patients with IMH with a thickness of ≥7 mm. Those with IMH directly related to trauma, previous aortic surgery, penetrating atheromatous ulcer, dissection flap, or an iatrogenic source and those who had never received any treatment of IMH at presentation were excluded.A total of 54 patients with IMH had met the inclusion and exclusion criteria. Of the 54 patients, 24 had presented with Stanford type A. Of these 24 patients, 10 had initially undergone surgery and 14 had initially received medical treatment. Two patients in the medical group had subsequently undergone surgery. In addition, 30 patients had presented with type B IMH and had initially received medical treatment, with 3 eventually requiring surgical intervention. In-hospital survival was 90% for type A IMH treated surgically, 93% for type A IMH treated medically, and 97% for type B IMH treated medically. At the last follow-up imaging study of the medically treated patients, 36% of those with type A IMH and 31% of those with type B IMH had experienced complete resolution of IMH at 3.7 and 31.5 months respectively, without surgical intervention. The development of an aortic aneurysm at the site of a previous IMH had occurred in 18% (2 of 11) and 12% (3 of 26) of the type A medical and type B medical cohorts. The overall rate of aortic aneurysm formation in the region of IMH or in another segment was 50%. No difference was found in long-term survival between the three cohorts at a mean follow-up of 22.8 months.A role appears to exist for medical treatment with anti-impulse therapy for appropriately selected patients with type A IMH. These patients must be followed up closely clinically and radiographically for signs of deterioration in the short- and long-term phases of their care. They can achieve long-term survival similar to that of surgically treated type A IMH and medically treated type B IMH patients using this algorithm. However, they might require late surgical intervention, especially for aneurysmal disease.

This study evaluated the incidence and long-term outcomes of postoperative type 1a endoleak (PT1a) following endovascular aortic aneurysm repair (EVAR).A retrospective review of consecutive aortoiliac EVARs performed at a single institution from June 2006 to June 2012 was conducted. Patients with PT1a were identified by postoperative imaging and compared with those who did not develop a PT1a. Late outcomes were also studied of a subset of patients with PT1a who had persistent intraoperative type 1a endoleak (iT1a) on completion angiogram during EVAR that had resolved on initial follow-up imaging.Three hundred eighty-nine patients underwent EVAR with median follow-up of 87 months (interquartile range, 64-111 months). The incidence of PT1a was 8.2% (n = 32) with a median follow-up of 74 months (interquartile range, 52-138 months). Compared with the total cohort, those who developed PT1a were statistically more likely to be female (32% vs 17%; P = .03) and have a higher all-cause mortality (71% vs 40%; P .01) and aneurysm-related mortality (15.6% vs 1.7%; P .01). Median time to presentation was 52 months. Of the 32 patients with PT1a, five (15.6%) presented with aortic rupture, of which three underwent extension cuff placement, one had open graft explant, and one declined intervention. Six patients in total (18.7%) declined intervention; five of these died of nonaneurysmal causes and one remains alive. Of the 26 patients with PT1a who had intervention, 21 (80.7%) showed resolution of PT1a, and five (19.2%) had recurrence. For patients with recurrent PT1a, two had resulting aneurysm-related mortality, two endoleaks resolved after relining with an endograft, and one patient declined intervention but remains alive. Patients with PT1a who had intervention with resolution showed no significant difference in median survival estimates (140.0 months) compared with the remaining EVAR cohort (120.0 months; P = .80). Within the PT1a cohort, 6 (18.7%) had also experienced iT1a with a mean time to presentation of the late PT1a of 45 months. iT1a was associated with a significantly increased likelihood of developing a PT1a (P .01) and decreased median survival (P .01), but there was no known aneurysm-related mortality.Development of PT1a following elective EVAR is associated with increased all-cause and aneurysm-related mortality and presents an average of 52 months postoperatively. This underscores the importance of long-term surveillance. Patients with PT1a who had a successful intervention showed no significant difference in median survival. Those with iT1a had a higher risk for PT1a compared with the EVAR cohort overall and had decreased median survival, without increased aneurysm-related mortality.

Background The number of medication related incidents is common amongst children particularly when it involves the 0–4 age group. We aimed to identify the prescription errors that contributed to medication related incidents. Method Our study population included 0–16 year old inpatients from paediatric wards and NICU. We collected data on whether the key components of the drug chart were completed adequately for these inpatients. This included demographic details, legibility, correct dose, route, frequency and prescriber details. We audited 25 drug charts per week. This was first started in December 2016. In August 2017 teaching sessions on prescribing errors were offered to all juniors during their trust induction. We distributed a booklet on prescribing errors to further add to their learning. Thereafter we continued our data collection from September 2017 onwards, which is ongoing currently. Results From September 2017 onwards, the number of drug charts without errors have remained at 80% or above with the probability of this occurring by chance being 0.0156. This has resulted in the number of incidents for prescribing drug errors gradually decline, with only 1 incident reported in June 2018 Table 1. Conclusion Prescribing errors are preventable and our ongoing teaching sessions and prescribing errors booklets from August 2017 have helped reduce the number drug charts with errors at our department. We are hoping this will continue to reduce our number of medication related incidents per month.