Proyecto de factibilidad para la exportación de papas frescas empacadas al vacío, desde el Consorcio de Productores de papa “Conpapa Chimborazo” hacia Newark – Estados Unidos periodo 2016 – 2017.

El Proyecto de factibilidad para la exportación de papas frescas empacadas al vacío,tiene como objetivo conocer la posibilidad que existe para la comercialización internacional del producto desde el Consorcio de Productores de papa Conpapa Chimborazo, Cantón Riobamba, hacia la ciudad de Newark – Estados Unidos, con la finalidad de lograr el posicionamiento del producto ecuatoriano en el mercado internacional. El estudio de mercado realizado proyectó una demanda insatisfecha de 35814 para el año 2017, en donde se podría ingresar con la oferta de la empresa, la cual es de 12150 kg del producto anualmente, puesto que el producto tendrá una aceptación favorable en el mercado destino, debido a la calidad, cantidad y precio determinado para el mismo, así mismo requiriendo a los términos de negociación internacional, Incoterms, se ha llegado al mejor acuerdo tanto para el vendedor como para el comprador; de tal forma que se faciliten las negociaciones. De esta manera el estudio financiero que se realizó, proyectó datos positivos demostrando en sus indicadores financieros: VAN (156749,18$), TIR (55%) y RB/C (7.07), que existe rentabilidad y la inversión se recuperará en dos años y cinco meses indicando ser un proyecto de gran liquidez

Use of direct oral anticoagulants for chronic thromboembolic pulmonary hypertension

OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class II/III. Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use

Genetic characteristics of patients with pulmonary arterial hypertension associated with schistosomiasis

Introdução: Vários genes, particularmente os envolvidos na via de transcrição Transforming Growth Factor beta, estão claramente associados ao risco de desenvolvimento de hipertensão arterial pulmonar. Entretanto, pouco ou quase nada se sabe sobre a existência de fatores genéticos que possam estar associados a uma das formas mais prevalentes de hipertensão arterial pulmonar no mundo, a hipertensão arterial pulmonar associada a esquistossomose (HAP-Sch). O objetivo deste estudo foi avaliar a associação dos genes já descritos na hipertensão arterial pulmonar idiopática (HAPI) com a HAP-Sch. Método: Estudo transversal, comparando amostras de pacientes seguidos no ambulatório de Circulação Pulmonar no Instituto do Coração do HCFMUSP, com diagnóstico de HAP-Sch ou HAPI. Foram avaliadas as características genéticas nestes grupos quanto à presença de variantes patogênicas dos genes:BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, andSMAD9. Resultados: Foram incluídos 69 pacientes com HAP-Sch e 74 pacientes com HAPI. O grupo HAP-Sch apresentou idade mais avançada (52.1 ± 11.8 vs 41.5 ± 15.0; p = < 0,001) e débito cardíaco mais preservado ao diagnóstico (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). Cerca de 24% dos pacientes com HAPI apresentaram resposta aguda durante o teste de vasorreatividade, enquanto nenhum paciente com HAP-Sch apresentou resposta (p =< 0.001). Pacientes com HAP-Sch apresentaram 7% de variantes patogênicas, comparado com11% dos HAPI(p=0,782). Em ambos os grupos, pacientes portadores de variantes patogênicas possuíam características clínicas e hemodinâmicas semelhantes aos demais pacientes. No grupo HAP-Sch, a sobrevida dos portadores de variantes patogênicas foi significativamente menor (p=0.035). Conclusão: A prevalência de variantes patogênicas na HAP-Sch é semelhante à encontrada na HAPI e, da mesma forma, sua presença está associada a pior prognósticoBackground: Several genes, mainly those involved with the Transforming Growth Factor ? transcription pathway, are well-defined as risk factors for developing pulmonary arterial hypertension. Nevertheless, little is known about the existence of a genetic background associated with one of the most prevalent forms of pulmonary arterial hypertension worldwide, which is schistosomiasis associated pulmonary arterial hypertension (Sch-PAH). The aim of this study was to evaluate the association of genes already described in idiopathic pulmonary arterial hypertension (IPAH) with Sch-PAH. Method: A cross-sectional study comparing samples from patients followed at the Pulmonary Circulation clinic at the Heart Institute of HCFMUSP, diagnosed as Sch-PAH or IPAH. Genetic characteristics in these groups were evaluated for the presence of pathogenic variants of the genes: BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, and SMAD9.Results: A total of 69 patients with Sch-PAH and 74 patients with IPAH were included. The Sch-PAH group presented older age (52.1 ± 11.8 vs 41.5 ± 15.0, p =< 0.001) and higher cardiac output at diagnosis (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). About 24% of patients with IPAH presented acute response during the vasoreactivity test, whereas no Sch-PAH patient presented response (p = < 0.001). Patients with PAH-Sch had 7% prevalence of pathogenic variants, compared to 11% in IPAH (p = 0.782). In both groups, patients with pathogenic variants had clinical and hemodynamic characteristics similar to the other patients. In the Sch-PAH group, the survival of patients with pathogenic variants was significantly lower (p = 0.035). Conclusion: The prevalence of pathogenic variants in Sch-PAH is similar to that found in IPAH and, likewise, its presence is associated with worse prognosi

Genetic characteristics of patients with pulmonary arterial hypertension associated with schistosomiasis

Introdução: Vários genes, particularmente os envolvidos na via de transcrição Transforming Growth Factor beta, estão claramente associados ao risco de desenvolvimento de hipertensão arterial pulmonar. Entretanto, pouco ou quase nada se sabe sobre a existência de fatores genéticos que possam estar associados a uma das formas mais prevalentes de hipertensão arterial pulmonar no mundo, a hipertensão arterial pulmonar associada a esquistossomose (HAP-Sch). O objetivo deste estudo foi avaliar a associação dos genes já descritos na hipertensão arterial pulmonar idiopática (HAPI) com a HAP-Sch. Método: Estudo transversal, comparando amostras de pacientes seguidos no ambulatório de Circulação Pulmonar no Instituto do Coração do HCFMUSP, com diagnóstico de HAP-Sch ou HAPI. Foram avaliadas as características genéticas nestes grupos quanto à presença de variantes patogênicas dos genes:BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, andSMAD9. Resultados: Foram incluídos 69 pacientes com HAP-Sch e 74 pacientes com HAPI. O grupo HAP-Sch apresentou idade mais avançada (52.1 ± 11.8 vs 41.5 ± 15.0; p = < 0,001) e débito cardíaco mais preservado ao diagnóstico (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). Cerca de 24% dos pacientes com HAPI apresentaram resposta aguda durante o teste de vasorreatividade, enquanto nenhum paciente com HAP-Sch apresentou resposta (p =< 0.001). Pacientes com HAP-Sch apresentaram 7% de variantes patogênicas, comparado com11% dos HAPI(p=0,782). Em ambos os grupos, pacientes portadores de variantes patogênicas possuíam características clínicas e hemodinâmicas semelhantes aos demais pacientes. No grupo HAP-Sch, a sobrevida dos portadores de variantes patogênicas foi significativamente menor (p=0.035). Conclusão: A prevalência de variantes patogênicas na HAP-Sch é semelhante à encontrada na HAPI e, da mesma forma, sua presença está associada a pior prognósticoBackground: Several genes, mainly those involved with the Transforming Growth Factor ? transcription pathway, are well-defined as risk factors for developing pulmonary arterial hypertension. Nevertheless, little is known about the existence of a genetic background associated with one of the most prevalent forms of pulmonary arterial hypertension worldwide, which is schistosomiasis associated pulmonary arterial hypertension (Sch-PAH). The aim of this study was to evaluate the association of genes already described in idiopathic pulmonary arterial hypertension (IPAH) with Sch-PAH. Method: A cross-sectional study comparing samples from patients followed at the Pulmonary Circulation clinic at the Heart Institute of HCFMUSP, diagnosed as Sch-PAH or IPAH. Genetic characteristics in these groups were evaluated for the presence of pathogenic variants of the genes: BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, and SMAD9.Results: A total of 69 patients with Sch-PAH and 74 patients with IPAH were included. The Sch-PAH group presented older age (52.1 ± 11.8 vs 41.5 ± 15.0, p =< 0.001) and higher cardiac output at diagnosis (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). About 24% of patients with IPAH presented acute response during the vasoreactivity test, whereas no Sch-PAH patient presented response (p = < 0.001). Patients with PAH-Sch had 7% prevalence of pathogenic variants, compared to 11% in IPAH (p = 0.782). In both groups, patients with pathogenic variants had clinical and hemodynamic characteristics similar to the other patients. In the Sch-PAH group, the survival of patients with pathogenic variants was significantly lower (p = 0.035). Conclusion: The prevalence of pathogenic variants in Sch-PAH is similar to that found in IPAH and, likewise, its presence is associated with worse prognosi

New anticoagulants for the treatment of venous thromboembolism

Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context

Reperfusion in acute pulmonary thromboembolism

ABSTRACT Acute pulmonary thromboembolism (APTE) is a highly prevalent condition (104-183 cases per 100,000 person-years) and is potentially fatal. Approximately 20% of patients with APTE are hypotensive, being considered at high risk of death. In such patients, immediate lung reperfusion is necessary in order to reduce right ventricular afterload and to restore hemodynamic stability. To reduce pulmonary vascular resistance in APTE and, consequently, to improve right ventricular function, lung reperfusion strategies have been developed over time and widely studied in recent years. In this review, we focus on advances in the indication and use of systemic thrombolytic agents, as well as lung reperfusion via endovascular and classical surgical approaches, in APTE