Synthesis of 5-substituted 2-pyrrolidinones by coupling of organozinc reagents with cyclic N-acyliminium ions

En el presente trabajo se describe un procedimiento simple y fácil para la preparación de pirrolidinonas 5-sustituidas a partir de un acoplamiento entre iones N-aciliminio y reactivos organometálicos derivados de zincA coupling reaction between cyclic N-acyliminium ions with organozinc reagents is described. The cyclic N-acyliminium ions, generated in situ from N-substituted-5-hydroxy-2-pyrrolidinones by treatment with BF3-etherate or titanium tetrachloride, were trapped by the organozinc reagent, formed by the alkylbromide in the presence of zinc in the same reaction media. The N-substituted 5-allyl-2-pyrrolidinones generated using this method, serves as versatile intermediates for the synthesis of azabicyclic systems with indolizidine and pyrroloazepinolizidine cores

Causas de un inadecuado clima laboral en empresa electrónica

The adequate work environment within the companies of the industrial sector are fundamental for their operation in order to achieve annual goals and objectives, which bring as results a profit and growth of the organization, In short, achieving a stable and adequate work environment will help in many ways in having a stability with the human resources, decrease in resignations as well as a prompt adaptation of new personnel, clear complements that the benefit of a correct communication, a healthy work environment, motivation among provide area and team leaders, as well as an efficient recruitment process for stability and minimum staff turnover. The initial results showed that, in general terms, the main causes of a deficient work environment in the union personnel production area are: the constant movements of personnel to cells other than their operations, the few incentives and recognition for years of work. The personnel selection process is not adequate and the little communication with your supervisor The following article deals with research methodology, development as well as recommendations for an adequate work environment in a company in the electronics industry.El adecuado ambiente laboral dentro de las compañías del giro industrial es fundamentales para su funcionamiento en pro de lograr metas y objetivos anuales las cuales traen como resultados utilidades y crecimiento de la organización. En definitiva el lograr tener un clima laboral estable y adecuado ayudara de muchas maneras a mantener una estabilidad con el recurso humano, disminución de renuncias, así como una pronta adaptación de personal de nuevo ingresos, complementos  claros que dan como beneficio una correcta comunicación, ambiente laboral sano, una motivación entre compañeros de áreas y líderes de su equipo así como un eficiente proceso de reclutamiento para una estabilidad y mínima rotación de personal. Los resultados iniciales demostraron que en términos generales se muestran que las principales causas de un deficiente clima laboral en el área de producción de personal de sindicato son: los constantes movimientos de personal a celdas distintas a sus operaciones, los pocos incentivos y reconocimiento por años laborales, el proceso de selección de personal no es el adecuado y la poca comunicación con su supervisor El siguiente artículo aborda metodología de la investigación y desarrollo así como recomendaciones para un adecuado clima laboral en una empresa del ramo electrónico

Diagnóstico de la situación de las visitas a pacientes recluidos en unidades de cuidados intensivos

The visit is the space where it is possible to relate the patient, family and health personnel. To diagnose the situation of the visits to patients imprisoned in units of intensive care of Institutions Prestadoras of Health (IPS). Study descriptive, cross; the population was five intensive care units, the intrinsic sample consisted of 34 participants. respondents agreed visiting hours morning and afternoon 53%; the residence time of family members during the half-hour visit was 30%; the number of people allowed is three relatives 70%; information about the patient's progress is provided by the medical specialist 65%; 18% weakness was evident in the application of informed consent procedures make. These results serve to generate changes in the future with the attention paid to the families of critically ill patients, based on the recommendations of the American Association of Intensive Care more flexible patient visits focused on family relationship, in order to minimize anxiety produced by the gravity of their situation and environment of the Unit of Intensive care. La visita es el espacio donde es posible relacionarse el paciente, familia y personal de salud cuando los pacientes están recluidos en las Unidades de Cuidados Intensivos. Diagnosticar la situación de las visitas a pacientes recluidos en unidades de cuidados intensivos de Instituciones Prestadoras de Salud (IPS) de Barranquilla. Estudio descriptivo, transversal; la población fueron cinco unidades de cuidados intensivos, la muestra intrínseca correspondió a 34 participantes. Los resultados identificados en los encuestados coincidieron en el horario de visitas de mañana y tarde 53%; el tiempo de permanencia de los familiares durante la visita fue de media hora 30%; el número de personas permitidos es de tres familiares 70%; la información sobre la evolución del paciente la suministra el médico especialista 65%; se evidenció debilidad del 18% en la solicitud del consentimiento informado al realizar los procedimientos. Estos resultados sirven para generar cambios en el futuro con la atención prestada a los familiares de pacientes críticos, basados en las recomendaciones de la Asociación Americana de Cuidados Intensivos en visitas más flexibles centradas en la relación paciente familia, con el fin de minimizar la ansiedad producida por la gravedad de su situación y el entorno de la Unidad de Cuidados Intensivos. 

Artificial Intelligence in Medicine, Current Uses, and Future Perspectives

La inteligencia artificial (IA) es una clase de tecnología que busca desarrollar sistemas que simulen la capacidad del razonamiento humano. En el campo de la medicina actualmente se ha buscado utilizar estos sistemas en múltiples áreas como la radiología, patología, cirugía, entre otras. Algunos usos actuales incluyen la facilitación en la interpretación de estudios diagnósticos y soporte para la toma de algunas decisiones clínicas. El objetivo final de dichos sistemas es que mejoren los desenlaces de los pacientes, al igual que faciliten y optimicen los procesos en diversas áreas de la medicina. En el futuro se espera que sistemas con modelos generalistas de IA logren apoyar en la toma de decisiones médicas complejas, y faciliten procesos que actualmente son tediosos para los profesionales de la salud. A pesar de múltiples ventajas la IA cuenta con limitaciones importantes, por lo que se espera que su papel en la atención médica será más de apoyo que un reemplazo de los profesionales de la salud.Artificial intelligence is a new class that aims to simulate the human thought process. In the medical field, there has been an interest in using these systems in many areas, such as radiology, pathology, and surgery, among others. Some current uses include aiding in interpreting diverse diagnostic studies and supporting some medical decisions. The primary objectives of these systems are to improve patient outcomes and optimize medical processes in different areas. In the future, it is expected that generalist AI models will help physicians with tedious tasks and that they will be a tool for difficult medical decisions. Despite all the advantages of AI, it has its limitations; therefore, AI is not expected to replace physicians, but it will be a powerful aid.&nbsp

Multidisciplinary management of acromegaly: A consensus.

The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches. Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Diagnosis of male hypogonadism: what is low testosterone

In contrast to primary hypogonadism, whereby the rise of gonadotropin levels helps establishing a diagnosis, the diagnosis of secondary hypogonadism relies for the most part, on the identification of a low testosterone level in the right clinical context. Establishing that a patient indeed has a low testosterone level requires taking into account several physiological as well analytical aspects. The vast majority of testosterone in men circulates in plasma bound to albumin (50%), sex-steroid binding globulin (SHBG) (44%) and other proteins (4%), while only 2% is found free. The biologically active fraction consists of the free and the albumin-bound fractions. Testosterone levels are highest in the early morning and lowest during the summer. Both total and free testosterone decline with age, as SHBG levels increase. Conditions such as obesity and diabetes also result in diminished testosterone concentrations, while they are accompanied by low SHBG levels. Currently, measurement of total testosterone in hospital laboratories is usually performed on fully automated immunoassay analyzers. Although tandem mass spectrometry methods after gas or liquid chromatography are the most accurate means for testosterone measurement, they are still not widely available in most clinical laboratories. In some cases the concentration of total testosterone may not always represent a true reflection of the patient androgen status and therefore an estimate of the non-SHBG or bioavailable fraction may be a more appropriate measure. Methods of assessment of the non-SHBG-bound fraction of testosterone include estimation of the free concentration by methods including the calculation of the free androgen index (FAI), equilibrium dialysis, centrifugal ultrafiltration, direct analog RIA or calculation of the free fraction