ESTUDIO DE CASO-Criterios de implementación ISO-14001:2015 Sector Ladrillero - el Rubí S.A.S Tunja Boyacá

La contaminación ambiental se ha vuelto en el mundo una problemática al cambio climático, en este caso la ladrillera El Rubí S.A.S tiene conocimiento del impacto que propagan a diario en los procesos de fabricación y así mismo abarcando los diferentes aspectos como: nivel ambiental, económico, social, Laboral, salud pública y seguridad donde se encuentra las instalaciones. Esta organización no cuenta con proyectos que ayuden a controlar problemáticas en los aspectos anteriormente mencionados, y es por ende de gran importancia tomar medidas basándose en la norma ISO 14001:2015; con objetivo de que continúen en sus actividades y que sean amistoso con el medio ambiente para que nuestras futuras generaciones gocen de un ambiente sano y saludable.Environmental pollution has become a problem in the world for climate change, in this case the brick factory El Rubí SAS is aware of the impact that they spread daily in the manufacturing processes and also covering different aspects such as: environmental, economic, social, labor, public health and safety where the facilities are located. This organization does not have projects that help to control problems in the aforementioned aspects, and therefore it is of great importance to take measures based on the ISO 14001: 2015 standard; with the objective that they continue in their activities and that they be friendly with the environment so that our future generations enjoy a healthy and healthy environment

lnteracciones medicamentosas en pacientes bajo tratamiento con itraconazol para diferentes tipos de micosis

Some studies have reported an increasing number of clinically significant interactions of itraconazole in patients receiving drugs known to have profound effects on the cytochrome P-450 enzyme system. With the purpose of determining the epidemiological, pharmacological and clinical characteristics of drug interactions in patients under therapy with itraconazole, twenty-one patients with clinical and laboratory information suspicious of interaction were included in this transversal retrospective study undertaken during the period of 199441997, Six patients presented paracoccidioidomycosis, five chromoblastomycosis, four histoplasmosis, four cryptococcosis and two aspergillosis. Most of patients had either an underlying or concurrent illness like AlDS or tuberculosis. The average dose of itraconazole was 223.8 mglday, the mean duration of therapy was 23.1 weeks and each patients received around 2.6 drugs simultaneously administered with itraconazole. Drug interaction (undetectable or non-therapeutic serum concentrations of itraconazole) was found in 18 patients and rifampin, H, blockers, antiacids and phenytoin were the most common drugs implicated. According to some published articles, the concurrent administration of these drugs and itraconazole disturbed the absorption and metabolism of this antifungal, subsequently decreased its serum concentration and provoked therapeutic failure. This study is an initial approach that will allow to establish clues for the management of patient under therapy with itraconazole and other therapies and at risk of developing drug interactions.Algunos estudios han reportado un aumento en la frecuencia e importancia de las interacciones del itraconazol en pacientes bajo polifarmacia con fármacos que afectan el sistema enzimático de la citocromo P450 y modifican el metabolismo del azol. Con el propósito de determinar las características epidemiológicas, farmacológicas y clínicas de las interacciones medicamentosas en pacientes bajo tratamiento con itraconazol para diferentes tipos de micosis, se realizó un estudio descriptivo transversal retrospectivo en el que se analizaron 21 historias clínicas de pacientes atendidos en la Corporación para Investigaciones Biológicas durante el período 1994-1997. Entre la población estudiada, seis pacientes presentaron paracoccidioidomicosis; cinco, cromoblastomicosis; cuatro, histoplasmosis; cuatro, criptococosis, y dos, aspergilosis. En promedio, la dosis de itraconazol, la duración y el número de fármacos recibidos concomitantes fueron 223,8 mgldia, 44,3 semanas y 2,7 fármacos, respectivamente. En 10 individuos, se presentaron enfermedades de base y en 15, enfermedades concomitantes. Se documentó interacción medicamentosa (niveles no detectables o no terapéuticos de itraconazol) en 18 pacientes, de los cuales 17 presentaban sospecha clínica y 14 sospecha paraclínica de interacción. El medicamento más frecuentemente involucrado con interacción fue la rifampicina, seguido de los inhibidores H, antiácidos y fenitoina. Similar a lo encontrado en otros estudios, la administración concomitante de estos fármacos con el itraconazol, reduce los niveles séricos de este último y altera la respuesta clínica al tratamiento. Este estudio es una aproximación inicial, aún no realizada en nuestra población, que permitirá establecer protocolos para el manejo y prevención de interacciones medicamentosas en pacientes en tratamiento con itraconazol y otros fármacos

I Congreso - Convergencias y divergencias. Hacia educaciones y desarrollo otros.

La presente colección, en su primera publicación, recoge la experiencia del I Congreso Internacional de Educación para el Desarrollo en Perspectiva Latinoamericana- EpDl “Convergencias y divergencias. Hacia educaciones y desarrollos otros.” organizado por el Centro de Educación para el Desarrollo-CED de UNIMINUTO, específicamente en relación con las ponencias, libros e iniciativas fotográficas presentadas en las seis líneas temáticas de este evento académico, a saber: (a) experiencias y prácticas pedagógicas; (b) acciones colectivas, movimientos y redes sociales; (c) perspectivas críticas al desarrollo; (d) producción de conocimiento; (e) diferencias, identidades y ciudadanía; (f) cuerpos, emociones y espiritualidades; a partir de éstas propuestas y en el marco de estas líneas, se reflexionó sobre las dinámicas y problemáticas derivadas del desarrollo hegemónico, así como sobre la posibilidad de diálogo entre saberes y conocimientos construidos de forma contextualizada, que permitan agenciar apuestas y proyectos alternativos disidentes en la búsqueda de “desarrollos y educaciones otras” desde América Latina

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

En Colombia, actualmente no existen parámetros claros para el diagnóstico de pacientes con talla baja, ni sobre el tratamiento de esta población con hormona de crecimiento recombinante humana (somatropina), lo cual se ve favorecido por la diversidad de programas de formación de profesionales en endocrinología pediátrica. En respuesta a esta problemática se realizó el primer acuerdo colombiano de expertos en talla baja liderado por la Asociación Colegio Colombiana de Endocrinología Pediátrica (ACCEP); este trabajo contó con la participación y el aval de expertos clínicos de importantes instituciones de salud públicas y privadas del país, además de expertos metodológicos del instituto Keralty, quienes garantizaron la estandarización del uso de la somatropina. Después de realizar una minuciosa revisión de la literatura, se propone la unificación de definiciones, un algoritmo diagnóstico, los parámetros de referencia de las pruebas bioquímicas y dinámicas, una descripción de las consideraciones de uso de la somatropina para el tratamiento de las patologías con aprobación por la entidad regulatoria de medicamentos y alimentos en Colombia y, por último, un formato de consentimiento informado y de ficha técnica del medicamento.In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinanthuman growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation,the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order tostandardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium ofclinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada deServicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private healthinstitutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia ClínicaKeralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm,biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use amongthe indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consentand a medication fact sheet available for parents and patients.https://orcid.org/0000-0002-7856-7213https://orcid.org/0000-0003-2241-7854Revista Nacional - Indexad

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, surge después de la pandemia y su imposibilidad de socializar “en persona” con los compañeros de eventuales encuentros, porque la Comprensión Lectora tenía que reinventarse para su nueva reflexión cognitiva, adaptación contextual y reconstrucción del conocimiento. Este renovado enfoque de la realidad postpandemia, concebido en el marco de la educación intercultural comunitaria, busca potencializar los entornos naturales, sociales y culturales como recursos de aprendizaje multidisciplinario a través del lenguaje animado de los cuentos. En este marco, había que dinamizar la asignatura de Comunicación Oral y Escrita, que se dicta en los Primeros Niveles de los Centros de Apoyo de Otavalo, Cayambe, Latacunga y Riobamba, mediante un eje transversal donde los estudiantes escriban fundamentados en valores de la cosmovisión andina, considerando que provienen de varios lugares de la sierra y amazonía ecuatoriana. Todo surgió del encuentro presencial de un sábado cualquiera donde los estudiantes realizaban ejercicios narrativos, logrando una apreciable respuesta de imaginación, más emotiva que la clásica tarea de las Unidades, tanto así que, pasados unos días, seguían llegando sus escritos a mi correo. Entonces nos pusimos manos a la obra, cada estudiante tendría dos opciones como Actividad Integradora, la primera consistía en escribir un cuento de su propia inspiración, y la segunda analizar un clásico para comentar sus valores y antivalores. La mayor parte de estudiantes decidió escribir su propio cuento, de donde se escogieron algunas participaciones que podrían considerarse originales, para una edición que, respetando la transcripción de la tradición oral que prima en los sectores comunitarios, nos concretamos en revisar la puntuación y ortografía para publicarlos. Con esto buscamos innovar la Actividad Integradora, por algo más práctico y operativo para configurar los Objetos de Aprendizaje que buscamos. Así nació, en medio del camino, este libro de Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, que ponemos en sus manos. Hernán Hermosa Mantilla Quito, junio de 202

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings