Diseño de una red de transporte de datos implementado MPLS, utilizando el simulador GNS 3 para la interconexión de sitios remotos con su sitio central a través de redes privadas virtuales(VPN)

El trabajo lo realizamos sobre el Sistema Operativo Ubunto con una simulación aplicada en el programa GNS3 (Simulador grafico de redes) elegido por sus propiedades gráficas y capacidad para soportar el IOS (Internetwork Operating System) real de los router, gracias a las bases que tiene en Dynamips, PEMU (incluyendo el encapsulador) y en parte en Dynagen. GNS 3 también utiliza la tecnología SVG para proveer símbolos de alta calidad para la realización de los mágicos diseños de topologías de red. La tecnología MPLS se basa en el análisis del envío de paquetes de una red, usando conmutación de etiquetas, lo cual es la base principal de este protocolo, el manejo que MPLS da a las redes privadas virtuales (VPNs) para la interconexión de sitios remotos con sus sitios centrales al adoptar una VPN MPLS será capaz de reducir complejidad en la administración de la red, aminorar los costos, mejorando el desempeño de la red y obteniendo conectividad universal. La red privada virtual (VPN) es una tecnología de red que permite la extención de una red privada sobre una red de uso pública como lo es el internet. Las VPN basadas en MPLS superan la mayor parte de los inconvenientes de las otras tecnologías de VPN. MPLS opera entre la capa de enlace de datos (capa 2) y la capa de red (capa 3) del modelo OSI, juntando ambas capas y haciendo uso de la velocidad del envío (forwarding) y del control del enrutador (routing), de esta forma logramos la creación de nuestra topología con redes flexibles y escalables, es decir que gracias a este conjunto de herramientas y sus características logramos con éxito nuestra meta

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care