Evaluaci?n econ?mica y social de propuesta integral de atenci?n de enfermedades cr?nicas para un envejecimiento exitoso en pacientes adultos del Per? 2019

El envejecimiento poblacional que afecta nuestro pa?s, es el resultado de la ca?da de la tasa de fecundidad, de la mortalidad infantil y el incremento en la esperanza de vida conllevando a la transici?n epidemiol?gica con un predominio de las enfermedades cr?nicas sobre las enfermedades trasmisibles, lo que genera un incremento en el gasto en salud, ya que son de larga evoluci?n y presentan complicaciones que adem?s se caracterizan por generar discapacidad que limita a la persona para desenvolverse laboralmente. Esto se agrava por la poca cultura de prevenci?n en la poblaci?n, falta de gu?as de pr?ctica cl?nica y programas de actualizaci?n continua para el primer nivel de atenci?n, falta de oportunidad de diagn?stico y toma de decisiones terap?uticas y falta de adherencia al tratamiento. Teniendo una preocupante proyecci?n en los siguientes a?os si no se interviene en la poblaci?n susceptible. Por ello nuestra propuesta busca aportar una alternativa basada en la captaci?n de casos no diagnosticados, el seguimiento personalizado, fidelizaci?n y educaci?n continua que mitigue el impacto de las complicaciones. La evaluaci?n de todos los escenarios analizados nos da un VANS positivo por lo que la consideramos recomendable

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Phytosanitary survey in five macadamia (Macadamia integrifolia Maiden et Betche) cultivars in Colombia

6 ilus. 3 tab. 27 ref.Con el incremento de los cultivos comerciales de macadamia en la zona cafetera colombiana, se estructur? un programa de investigaci?n para evaluar el comportamiento agron?mico de las variedades cultivadas e identificar los principales problemas fitosanitarios que podr?an afectar la producci?n y causar da?o econ?mico. La investigaci?n se llev? a cabo durante 11 a?os, en la Subestaci?n Experimental de Paraguaicito (Quindio). As a consequence of the increase of the commercial area of macadamia trees in the Colombian coffee zone, a research program was created to evaluate the agronomic behavior of macadamia cultivars, and to identify the main sanitary problems that could affect production at economic levels. The research was carried out for 11 years, at the Paraguaicito (Quindio) Experimental Station

Spruce xylan/HEMA-SBA15 hybrid hydrogels as a potential scaffold for fibroblast growth and attachment

A hybrid hydrogel (GHC-SBA15) based on spruce xylan (HC), 2-hydroxyethyl methacrylate (HEMA), and mesoporous silica (SBA15) was prepared with the intended use of fibroblast attachment and growth. Xylan was functionalized with acryloyl chloride to introduce vinyl groups and was crosslinked by radical polymerization with HEMA in presence of SBA15. Infrared spectroscopy and nuclear magnetic resonance confirmed the copolymerization of HEMA with xylan. Up to 20 wt.% addition, SBA15 was homogenously incorporated in the structured hydrogel network as observed by SEM. Moreover, nitrogen adsorption–desorption, small angle X-ray scattering and transmission electron microscopy indicated that the mesoporous SBA15 framework was maintained and that the hybrid hydrogel was a physical mixture of SBA15 with the copolymer HC/HEMA. Rheological analysis revealed that addition of 20% w/w SBA15 into hydrogel enhanced significantly the mechanical properties. In addition, we demonstrate that fibroblast L929 cells grew and spread on GHC-SBA15. Cell viability was within the expected range