Habilidades de indagación científica y biohuerto en niños de 3 años de la I.E.I. Parroquial “Hogar de Nazareth”; Lima Metropolitana-2021

En esta investigación se planteó que los alumnos lograrán habilidades de indagación científica al desarrollar actividades de biohuerto, debido a que los docentes de nivel inicial realizaban pocas sesiones de aprendizaje no promoviendo el contacto directo con el medio natural, sin estimulación de la observación y el razonamiento científico. Por ello, se buscó establecer la relación entre habilidades de indagación científica y biohuerto en niños de 3 años I.E.I Parroquial “Hogar de Nazareth”; Lima etropolitana-2021. La población fue conformada por 80 alumnos, siendo una investigación de enfoque cuantitativo de tipo aplicada, nivel correlacional, diseño no experimental: transeccional. Se utilizó como técnica; la observación y la lista de cotejo, como instrumento. Concluyendo que existe relación significativa entre habilidades de indagación científica y biohuerto en niños de 3 años I.E.I Parroquial “Hogar de Nazareth”; lima metropolitana, ya que, el nivel de relación que presento indicó un valor de Rh0=0,956; lo cual, reveló una correlación alta entre las variables de indagación

Gestión comercial y distribución de productos en la empresa SAMAVI S.A.C., San Juan de Miraflores 2016

La gestión comercial y la distribución de productos en la empresa SAMAVI S.A.C., San Juan de Miraflores 2016; tiene una gestión eficiente a nivel nacional, además cuenta con procesos ya establecidos que se manejan rigurosamente de acuerdo a las Normas Internacionales. Al realizar una visita pudimos identificar 6 deficiencias, los cuales no satisfacen las necesidades de los clientes, por ejemplo: atención, tiempo, entrega del producto, retraso en la entrega, etc. En el proceso de elaboración del producto hemos observado que los aspectos más importantes para una empresa son garantizar una excelente calidad del producto por medio de un riguroso control, la utilización de una buena materia prima y la realización de un óptimo proceso de fabricación. A medida que avanzamos dentro del proceso de elaboración de la cerveza podemos ver que dentro de cada una de sus facetas existen riesgos que pueden causar desde pequeños incidentes hasta los accidentes más trágicos y lamentables, es por ello que no se escatima esfuerzo para tratar de hacer el proceso lo más seguro posible desde su inicio hasta el final. La actual variedad y calidad en la oferta es consecuencia de un mercado altamente competitivo, tanto a nivel nacional como internacional, con una gran innovación tecnológica e inversiones en promoción y publicidad.The commercial management and the distribution of products in the company SAMAVI S.A.C., San Juan de Miraflores 2016; it has an efficient management at the national level, it also has already established processes that are rigorously managed in accordance with international standards. During a visit we were able to identify 6 deficiencies, which do not meet the needs of customers, for example: attention, time, product delivey, delay in delivery, etc. In the product manufacturing process, we have observed that the most important aspects for a company are to guarantee excellent product quality through rigorous control, the use of good raw materials and the performance of an optimal manufacturing process. As we advance within the brewing process we can see that within each of its facets there are risks that can cause from small incidents to the most tragic and regrettable accidents, that is why no effort is spared to try to do the process as safe as possible from the beginning to the end. The current variety and quality of the offer is the consequence of a highly competitive market, both nationally and internationally, with great technological innovation and investments in promotion and advertising

DELIRIUM NA TERAPIA INTENSIVA: FATORES PREDISPONENTES E PREVENÇÃO DE EVENTOS ADVERSOS

Objetivo: analisar os fatores predisponentes e identificar os eventos adversos relacionados ao delirium nos pacientes internados na unidade de terapia intensiva. Método: estudo de coorte prospectivo, ocorrido entre julho e agosto de 2017. A coleta de dados foi realizada por meio de instrumento próprio, com variáveis relacionadas ao delirium. Para análises de associação, foi aplicada a razão de risco. Resultados: entre os 18 pacientes selecionados, foi identificado delirium em 7 (39%); a privação do sono e o tabagismo foram os fatores predisponentes com maior razão de risco (5 e 2.83 respectivamente) e a ocorrência de evento adverso também apresentou uma associação positiva significativa relacionada à ocorrência de delirium (RR=4,71). Conclusão: o principal evento adverso associado ao delirium foi a retirada não planejada de dispositivos invasivos. Descritores: Delírium. Segurança do paciente. Cuidados crítico

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt