Nefrolitotomía percutánea en pacientes con trastornos de la coagulación: reporte de caso

Objective To report a case of percutaneous nephrolithotomy in patients with protein C and S deficiency. Introduction Patients with protein C and S deficiency have a high risk of thromboembolic events reporting rates of 6% and 8.4%, respectively. Case Report A 43-year-old female patient with a history of protein C and S deficiency with chronic warfarin anticoagulation for deep venous thrombosis (DVT). CT scan with full right staghorn calculi. Enoxaparin was administered bridge therapy. She was taken to right percutaneous nephrolithotomy, access was through the lower calyx. Because it was not possible to access the calculus of the middle and upper calyx it was necessary to perform a second puncture in the upper calyx, leaving the patient free of calculus. Full anticoagulation was resumed at 12 hours postoperatively without associated bleeding. Discussion Patients with protein C and S deficits are at high risk for thromboembolic events. Kefer et al. conducted a study evaluating the efficacy of bridge therapy in patients on NLP, finding that warfarin anticoagulation can be discontinued 5 days earlier and restarted 5 days after the surgical procedure without the need for enoxaparin bridging therapy. Results The protein C and S deficiency corresponds to an entity, with a very low prevalence and conditions the requirement of oral anticoagulants indefinitely. It was possible to perform a surgical procedure without hemorrhagic or thromboembolic complications. Copyright © 2019, Sociedad Colombiana de Urología

Formulación del plan estratégico de Proalimentos S.A.S. periodo 2018 - 2021

En sus 28 años de creada, Proalimentos S.A.S. no ha contado con un Plan Estratégico formulado como tal, sino que se ha adherido a las necesidades de la unidad estratégica del molino La Esmeralda; sin embargo, en los últimos años las dinámicas externas de la organización se han vuelto complejas, donde el sector arrocero demanda un nivel de competitividad muy alto para mantenerse viable, lo que sumado a la incertidumbre sobre, sí las capacidades internas de la organización son capaces de atender estas nuevas dinámicas, para asegurar un crecimiento de esta. Subsecuentemente, surgió la necesidad de formular un Plan estratégico para Proalimentos S.A.S. con el objetivo de estudiar el ambiente externo, reconociendo las oportunidades y las amenazas y en el ámbito interno las fortalezas y debilidades. Todo esto con el fin de generar una planeación estratégica que logre potencializar las oportunidades del entorno y explotar las fortalezas internas, para mejorar las debilidades que la organización tiene, como frenar las amenazas que el entorno ofrece. El presente trabajo de investigación se desarrolló en once capítulos; el primero está destinado a dar todo el soporte teórico y metodológico de la Planeación estratégica de la organización. El segundo capítulo se destinó a presentar la organización desde sus inicios hasta como opera en la actualidad; allí se detalla el organigrama, la misión, y los productos y servicios con los que cuenta actualmente la organización.MaestríaMAGISTER EN ADMINISTRACIÓ

El Comercio Justo: Factor Clave De Disminución De La Pobreza En La Provincia Los Ríos, Ecuador

This paper focuses on the results of the research carried out to determine the incidence of Fair Trade as a factor in reducing the poverty of small cocoa producers in the province of Los Rios, Ecuador. It also aimed to ascertain if there are guaranteed aid that will grant them a more direct access to the market for their products, under fairer and more equitable conditions. A mixed research design was used in the study. The qualitative activity was focused on observation, interviews, compilation of documents, registers, materials, and exchanges developed with cocoa producers to collect the information and know their criteria and opinions on the conditions and standard of living. This, however, was carried out from a quantitative point of view. The greatest amount of information was achieved through a structured survey with the application of a multivariate option questionnaire applied to a sample of 177 farmers. The main results obtained revealed that Fair Trade is a key element in reducing poverty levels as long as it is a fundamental part of the territorial development plans of Decentralized Autonomous Governments at all levels. Also, trade unions provide real support to farmers and they also assert their claims using a more continuous use of development premiums, adjustment of minimum guaranteed prices, and pre-financing

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. departamentos de caquetá, huila y tolima.

En el marco del contexto colombiano, profundamente afectado por la violencia derivada del conflicto interno, surge la necesidad de analizar y abordar de manera reflexiva y psicosocial dos casos emblemáticos: el caso Chimaia y la Masacre en El Salado. En el caso de Chimaia, se revela un escenario marcado por la violencia perpetrada por paramilitares, impactando de manera desproporcionada a las comunidades indígenas. Estas, al enfrentar desplazamientos forzados y la explotación de recursos sin protección adecuada, ilustran de manera trágica la vulnerabilidad ante la violencia. A través de narrativas personales, se desvela el impacto tanto en la cotidianidad como en el tejido sociohistórico de la comunidad, permitiendo la identificación de factores psicosociales determinantes en la violencia. En el análisis de la Masacre en El Salado, se exploran las secuelas traumáticas en las personas afectadas y su comunidad. El enfoque psicosocial resalta la importancia de considerar tanto los aspectos individuales como los colectivos al examinar eventos traumáticos, arrojando luz sobre la interacción entre elementos emocionales y socioculturales. La experiencia foto voz, enriquece el análisis con perspectivas visuales y testimonios verbales, permitiendo una comprensión más profunda de las narrativas en torno al evento traumático. En ambos casos, la perspectiva psicosocial se convierte en un pilar fundamental para comprender los factores de riesgo que contribuyen a la victimización y para proponer estrategias de intervención adecuadas. El abordaje reflexivo y la metodología de experiencia foto voz ofrecen herramientas poderosas para dar voz a las experiencias silenciadas, promoviendo así la sanación individual y comunitaria. Palabras clave: Conflicto, Violencia, Victimización, Vulnerabilidad, Factores PsicosocialesWithin the framework of the Colombian context, deeply affected by the violence derived from the internal conflict, the need arises to analyze and address two emblematic cases in a reflexive and psychosocial way: the Chimaia case and the Massacre in El Salado. In the case of Chimaia, a scenario marked by violence perpetrated by paramilitaries is revealed, disproportionately impacting indigenous communities. When faced with forced displacement and the exploitation of resources without adequate protection, these women tragically illustrate their vulnerability to violence. Through personal narratives, the impact is revealed both on daily life and on the socio-historical fabric of the community, allowing the identification of determining psychosocial factors in violence.In the analysis of the Massacre in El Salado, the traumatic consequences in the affected people and their community are explored. The psychosocial approach highlights the importance of considering both individual and collective aspects when examining traumatic events, shedding light on the interaction between emotional and sociocultural elements. The photovoice experience enriches the analysis with visual perspectives and verbal testimonies, allowing a deeper understanding of the narratives surrounding the traumatic event.In both cases, the psychosocial perspective becomes a fundamental pillar to understand the risk factors that contribute to victimization and to propose appropriate intervention strategies. The reflective approach and the photovoice experience methodology offer powerful tools to give voice to silenced experiences, thus promoting individual and community healing. Keywords: Internal Conflict, Violence, Massacre, Victimization, Emerging Psychosocial, Communitie

Olfactory response termination involves Ca2+-ATPase in vertebrate olfactory receptor neuron cilia

In vertebrate olfactory receptor neurons (ORNs), odorant-induced activation of the transduction cascade culminates in production of cyclic AMP, which opens cyclic nucleotide–gated channels in the ciliary membrane enabling Ca2+ influx. The ensuing elevation of the intraciliary Ca2+ concentration opens Ca2+-activated Cl− channels, which mediate an excitatory Cl− efflux from the cilia. In order for the response to terminate, the Cl− channel must close, which requires that the intraciliary Ca2+ concentration return to basal levels. Hitherto, the extrusion of Ca2+ from the cilia has been thought to depend principally on a Na+–Ca2+ exchanger

Procesos de aplicación conceptual y práctico de la normatividad tributaria en contextos investigativos procedimentales tributarios para el fortalecimiento de las competencias disciplinares y profesionales

La presente investigación planteó como objetivo realizar las memorias con las temáticas investigativas que se desarrollaron en el Seminario de Investigación Aplicada, con el fin de actualizar en los participantes y fortalecer sus conocimientos específicos en materia tributaria con base en los temas investigativos dispuestos y orientados por cada docente desde su inicio, elaboración, construcción y presentación ante los docentes evaluadores. Los trabajos cumplen su fin primordial con es fortalecer con los desarrollos temático de cada módulo visto en el SIA sus capacidades y competencias profesionales especialmente en el contexto tributario, en cumplimiento al requerimiento para otorgar al título de Especialistas en Gerencia Tributaria. Luego las memorias compiladas son el resultado de los trabajos presentados y evaluados oportunamente por cada docente comprometido con la calidad en cuanto a las temáticas investigativas, calidad de los contenidos, talleres teóricos prácticos, elementos metodológicos y de más lineamentos institucionales y del programa. La importancia de las memorias radica en su contenido el cual desglosa definiciones, conceptos, desarrollos teóricos prácticos, constituyéndose en un ejemplar de consulta investigativa en áreas de conocimiento fiscal y tributario en el marco de la Ley 1819 de 2016 y sus decretos reglamentarios, en síntesis al interior encontraremos fundamentos teóricos prácticos, procedimentales y resolutivos de casos especiales de Gravamen a los Movimientos Financieros, Monotributo, Renta Personas Naturales, Renta Personas Jurídicas, Procedimiento Tributario, Impuestos Distritales, Normas internacionales de Información Financiera Pymes, entre otros temas

The Challenges of the External Vote

UID/CPO/04627/2019Over the last few decades, emigrants all over the world have gained expanded voting rights. Despite the normative debates about this issue, there are few empirical studies on why states decide to implement external voting and how electoral systems perform. This chapter seeks to fill this gap by looking at the Portuguese case. Our study suggests that a combination of political and socio-economic factors explains the implementa tion of external voting. On the other hand, the interests of political parties and the low level of civil society engagement are key factors in the failure of both electoral reforms and attempts to overcome the shortcomings of external voting.publishersversionpublishe

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)