Medicinal Plants of the Peruvian Amazon: Bioactive Phytochemicals, Mechanisms of Action, and Biosynthetic Pathways

The objective of this book chapter is to provide consolidated and updated scientific information about the medicinal plants of the Peruvian Amazon, which has a great richness of plants; many of these are used in folkloric medicine to treat several diseases. Recently, investigations have reported that these medicinal plants possess bioactive phytochemicals against several diseases such as diabetes, cancer, inflammation, infectious diseases, and several other health problems, thus corroborating some ethnopharmacological reports. The mechanism of action for selected bioactive phytochemicals was demonstrated at the molecular level as well as the metabolic pathways involved in their biosynthesis were described. Due to the large gap in scientific information revealed in this review, we formulated a series of strategies to close these scientific knowledge gaps and achieve a sustainable exploitation of medicinal plants in the Peruvian Amazon

Cefuroxime Pharmacokinetics in Pediatric Cardiovascular Surgery Patients Undergoing Cardiopulmonary Bypass

Objectives The objective of this study was to determine the pharmacokinetics of cefuroxime in children undergoing cardiopulmonary bypass (CPB) for cardiovascular surgery. Design A prospective study. Setting A tertiary pediatric teaching hospital. Participants Infants and children undergoing CPB were enrolled in the study. Intervention An initial dose (mean, 24.2 ± 1.6 mg/kg) of cefuroxime was administered before surgical incision, and a second dose (mean, 14.4 ± 7.9 mg/kg) was administered in the CPB prime solution. Serial blood samples were obtained before, during, and after the CPB process. Samples were shipped on dry ice to the analytic laboratory and concentrations determined by a validated high-performance liquid chromatography method. A 2-compartment pharmacokinetic model was fitted to the data using maximum a priori–Bayesian estimation, with weight as a covariate. Monte Carlo simulations of a single-dose (25 mg/kg pre-CPB) approach and a 2-dose (25 mg/kg pre- and 12.5-mg/kg prime solution dose) approach were performed. Measurements and Main Results Fifteen subjects (9 males/6 females) were enrolled in the study, with median (range) age and weight of 11 (3-34) months and 9.5 (4.5-15.4) kg, respectively. The median (range) duration of CPB was 136 (71-243) minutes. Median and range cefuroxime pharmacokinetic parameters were as follows: maximum concentration (Cmax) dose, 1: 328 (150-512) μg/mL; systemic clearance, 0.050 (0.041-0.058) L/h/kg; steady-state volume of distribution, 0.213 (0.081-0.423) L/kg; volume of distribution in the central compartment, 0.081 (0.046-0.162) L/kg; and elimination half-life, 3.76 (1.03-6.81) hours. The median 8-hour post–dose-simulated cefuroxime concentrations were 26.5 and 16.0 mg/L for the 2-dose and single-dose regimens, respectively. Conclusion Manufacturers recommend that pediatric doses of cefuroxime (25-50 mg/kg) can be used in infants and children undergoing CPB to maintain adequate serum concentrations for surgical-site infection prophylaxis. A second intraoperative dose, administered through the CPB circuit, provides no additional prophylactic advantage

Planeamiento estratégico para la empresa F&E Transcom S.A.

El presente documento constituye el Plan Estratégico para la empresa de Transportes F&E Transcom SA; dedicada al transporte de carga por carretera. Dicho plan es el producto de un exhaustivo análisis de los entornos externo, interno y competitivo de la empresa, cuyo resultado fue la identificación de los factores claves de éxito plasmados en las matrices de Factores externos (MEFE) y Matriz de Factores Internos (MEFI); a partir de ahí se realizó el análisis FODA (Fortalezas, Oportunidades, Debilidades y Amenazas) de la empresa; además se establecieron los objetivos de largo plazo, y con ello se escogieron las estrategias a implementar. De acuerdo al contexto y del análisis efectuado a la empresa de Transportes F&E Transcom SA, la empresa debe considerar estrategias intensivas de penetración y desarrollo de mercados. Los principales intereses de la empresa, se orientan al logro de la visión al año 2025, y están relacionados a brindar un servicio de transporte de carga de calidad, incrementar su participación en el mercado y en nuevas áreas geográficas: la zona Nor oriente y la zona Sur del país; generar rentabilidad sostenible para los accionistas, e invertir en obtener certificaciones de gestión de calidad, seguridad y medio ambiente. Por otro lado las estrategias de reingeniería de procesos permitirán reestructurar la organización para mejorar la toma de decisiones gerenciales, teniendo como principal fortaleza el conocimiento y experiencia en el sector de la actual gerencia.This document constitutes the Strategic Plan for the company of Transportes F&E Transcom SA; dedicated to the transport of cargo by road. This plan is the product of an exhaustive analysis of the external, internal and competitive environments of the company, whose result was the identification of the key success factors embodied in the matrices of External Factors (MEFE) and Matrix of Internal Factors (MEFI) ; from there the SWOT analysis (Strengths, Opportunities, Weaknesses and Threats) of the company was carried out; In addition, the long-term objectives were established, and with that the strategies to be implemented were chosen. According to the context and the analysis made to the company of Transportes F&E Transcom SA, the company must consider intensive strategies for market penetration and development. The main interests of the company, are aimed at achieving the vision by 2025, and Eare related to providing a quality cargo transport service, increasing its participation in the market and in new geographical areas: the North-East area and the South zone of the country; generate sustainable profitability for shareholders, and invest in obtaining quality management, safety and environmental certifications. On the other hand, the process reengineering strategies will allow the organization to be restructured to improve management decision making, with the main strength of knowledge and experience in the current management sector.Tesi

¿Es posible la cirugía oncoplástica de mama en el varón?: técnica de round-block para el tratamiento de un lipoma gigante

The round block oncoplastic technique has proven to be a safe surgical approach in the management of breast cancer tumours. This procedure is useful to achieve resection of large tumours while maintaining a good cosmetic outcome. Recently, the safety of this technique has allowed its use in the treatment of other pathologies without complications. On the other hand, lipomas are the most frequent tumours in the chest wall. However, only 1% of them are larger than 10cm. In giant lipomas, a complete resection is needed to allow a complete anatomopathological study. We report a case of a 50-year-old man with a soft mass in the right breast, a subpectoral lipoma of 25x23x12 cm, without invasion of adjacent vital structures was diagnosed using computed tomography (CT) scan. Due to the benign characteristics, a resection was performed using the round-block technique. The postoperative course was uneventful and the patient was discharged 24 hours after the surgery.                La técnica oncoplástica de Round-Block es un abordaje seguro y ya utilizado en la cirugía del cáncer de mama. Es utilizada en la resección de grandes tumores centrales de la mama con muy buen resultado estético. Recientemente, esta técnica también ha sido usada en la cirugía de otras patologías mamarias sin complicaciones descritas. Por otro lado, los lipomas son los tumores más frecuentes de la pared torácica. Sin embargo, solo un 1% de ellos tienen un tamaño mayor de 10cm. En estos “lipomas gigantes” una extirpación amplia es requerida para poder tener un estudio anatomopatológico definitivo. Presentamos el caso de un varón de 50 años con una masa blanda en mama derecha, en las pruebas de imagen realizadas se evidencio un lipoma de 25x23x12cm de tamaño sin invasión de las estructuras vecinas. Debido a las características benignas de la lesión, se llevó a cabo una resección mediante la técnica de Round-Block unilateral. El postoperatorio trascurrió sin incidencias y el paciente fue dado de alta a las 24h de la cirugía