Coronary revascularization in ischemic heart disease: lessons from observational studies and randomized clinical trials

This thesis presents an overview of clinical trials and observational studies on coronary revascularization and evaluates the results obtained with revascularization in different subsets of patients treated with percutaneous coronary intervention or coronary artery bypass graft surgery. The lessons learned from these studies are presented in three parts. Part 1: Clinical trials and observational studies on coronary revascularization. Part 2: Predictors of adverse angiographic and clinical outcome. Part 3: Special subgroups on coronary revascularizatio

Incidencia del agregado grueso del río Huallaga en diseño de mezclas de concreto simple para cimentaciones corridas

The construction in the Region San Martín is W1 problem amt to be resolved, which is aggravated by several factors including the main being the economic, for the high cost of investment needed to build a common dwelling of mto or more floors. The present thesis work provides the solution and the proper use of basic materials in bullfights foundations of housing construction. The quarry used for tests of the specimens is the quarry of Rosillo Santa, located at Km 63 Tarapoto, Juanjui road and cement to be used is cement Pacasmayo type l. Them trials is developed in the laboratory of technology of materials of the University national of Cajamarca and laboratories private, these trials consist of analysis particle size, design of mixtures, tests to the bending, compression and cutting.La Construcción en la Región San Martín es W1 problema amt por resolver, el cual se ve agravado por varios factores entre ellos el principal que es el económico, por el alto costo de inversión que se necesita para construir una vivienda común de mto o más pisos. El presente trabajo de tesis aporta la solución y el buen uso de los materiales básicos en la construcción de cimentaciones corridas de las viviendas. La cantera utilizada para los ensayos de los especímenes es la cantera de Santa Rosillo, ubicada en el Km. 63 de la carretera Tarapoto - Juanjuí y el cemento a utilizar es Cemento Pacasmayo tipo l. Los ensayos se elaboraron en el Laboratorio de Tecnología de Materiales de la Universidad Nacional de Cajamarca y laboratorios particulares, estos ensayos constan de análisis granulométrico, diseño de mezclas, pruebas a la flexión, compresión y corte.Tesi

The seedling nursery survey in Leyte Island and Northern Mindanao, the Philippines

The operation of private and government nurseries in the Philippines is not delivering high quality planting materials of a wide species base for smallholder forestry, tree farming and reforestation programs in the country. A project supported by ACIAR has been implemented in the Philippines to improve the operational effectiveness of the forest nursery sector. Surveys in the form of personal interviews, observations of the nursery set-up and assessment of seedling quality were undertaken in Leyte and Mindanao to provide baseline information for designing possible interventions. The study revealed that the low operational effectiveness of the forest nursery industry is a result of a combination of social, economic, technical and political factors. The majority of private nurseries are managed by resource constrained smallholders with little access to high quality seedling production technologies.Seedling production, both in private and government nurseries, is largely quantity-oriented and the pathway of high quality germplasm is not well developed. Currently there is no policy that regulates the quality of planting stock from the forest nursery sector. Government nurseries operate to provide free seedlings but this scheme resulted in crowding out the small-scale private nurseries, negatively affecting the operational effectiveness of the private nursery sector. It appears that improving the operational effectiveness of the forest nursery sector in the Philippines requires policy changes to re-organize the operation of private and government nurseries

2. THE SEEDLING NURSERY SURVEY IN LEYTE ISLAND AND NORTHERN MINDANAO, THE PHILIPPINES

The operation of private and government nurseries in the Philippines is not delivering high quality planting materials of a wide species base for smallholder forestry, tree farming and reforestation programs in the country. A project supported by ACIAR has been implemented in the Philippines to improve the operational effectiveness of the forest nursery sector. Surveys in the form of personal interviews, observations of the nursery set-up and assessment of seedling quality were undertaken in Leyte and Mindanao to provide baseline information for designing possible interventions. The study revealed that the low operational effectiveness of the forest nursery industry is a result of a combination of social, economic, technical and political factors. The majority of private nurseries are managed by resourceconstrained smallholders with little access to high quality seedling production technologies. Seedling production, both in private and government nurseries, is largely quantity-oriented and the pathway of high quality germplasm is not well developed. Currently there is no policy that regulates the quality of planting stock from the forest nursery sector. Government nurseries operate to provide free seedlings but this scheme resulted in crowding out the small-scale private nurseries, negatively affecting the operational effectiveness of the private nursery sector. It appears that improving the operational effectiveness of the forest nursery sector in the Philippines requires policy changes to re-organize the operation of private and government nurseries

Optimización del uso de madera en el sostenimiento de los tajeos para la reducción de costos de minado en la Unidad Minera Poderosa

La unidad minera Poderosa viene explotando por el método de minado Open Stoping. En la actividad de relleno se envía el material detrítico por medio del Scooptram de 1.5 yd3 a la chimenea para el relleno al tajo de los cortes o niveles explotados. La preparación de los puntales de 3 metros permite realizar el enrejado del buzón de la chimenea, el cual ha sido bloqueado con puntales de 7 pulgadas de diámetro, este trabajo lleva a un elevado costo producto del consumo de madera, elevando así el costo de minado. Se aprecia también el desperdicio de sobrantes al dimensionar los redondos de 7 pulgadas de diámetro. La estabilidad del macizo rocoso, tras las excavaciones como un tajeo, una galería, crucero, una rampa, etc., va depender del tipo de roca a sostener. Las masas rocosas intensamente fracturadas con zonas de falla o de corte, definitivamente necesitan que se plantee adecuadamente el tipo de sostenimiento, las condiciones de altos esfuerzos que provocan fallas del macizo rocoso en las excavaciones. El consumo de puntales de madera para el año 2021 de redondos de 7” de diámetro y 2,5 metros de longitud debe considerar el costo por puntal de madera de 15.82 dólares. El consumo total es de 1374 unidades con un costo de 21 737 dólares, se tuvo una mejora al no contar con desechos significativos que generan pérdidas en la compra de madera para el sostenimiento con puntales de seguridad. De las tablas anteriores se muestra a continuación la reducción del costo de madera utilizada en el sostenimiento con puntales en el tajeo 2150 veta Lola, el consumo dentro de un año de los redondos de 7” de diámetro con una longitud de 3 metros en comparación de 2.5 metros y la reducción del costo de madera utiliza en los puntales de seguridad en el sostenimiento como se describe en lo siguiente: En el año 2020 el costo actual con redondos de 7” de diámetro y longitud de 3 metros se tiene un costo de 27 177. 72 dólares. En el año 2021 el costo actual con redondos de 7” de diámetro y longitud de 2.5 metros se tiene un costo 21 737 dólares. La reducción del costo al comparar por medio del proveedor de madera con las características de redondos de 7 pulgadas y de longitud de 2,5 metros indican que se optimizó el costo del uso de madera para los puntales de seguridad en 5 441 dólares durante todo el año. El costo total para el año 2020 con puntales de madera con redondos de 7” de diámetro con 3 metros de longitud es de 669.40 $, el costo por tonelada es de 20.05$/t respectivamente, los costos de minado por Open Stoping para el año 2021 con puntales de seguridad de 2.5 metros El costo total para el año 2021 de los puntales de madera con redondos de 7” de diámetro con 2.5 metros de longitud es de 653.56 $, el costo por tonelada es de 19.57$/t respectivamente. Tras la evaluación de los dos escenarios: el actual y el propuesto indican que ya se está teniendo buenos resultados en el año 2021; para eso se pasó a evaluar la optimización del costo total de minado y el costo por tonelada respectivamente, el cambio en el consumo de los puntales de seguridad redondos de 7” de diámetro y de 2.5 metros de longitud, se pudo reducir el costo de minado en 15.84 $respectivamente para el año 2021, el cambio en el consumo de puntales de seguridad redondos de 7” de diámetro y de 2.5 metros de longitud, se pudo reducir el costo por tonelada en 0.47$ respectivamente para el año 2021

Comparative Analysis of Clinical Practice Guidelines for the Pharmacological Treatment of Type 2 Diabetes Mellitus in Latin America

Purpose of review: Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability in the world. The majority of diabetes deaths (> 80%) occur in low- and middle-income countries, which are predominant in Latin America. Therefore, the purpose of this article is to compare the clinical practice guideline (CPG) for the pharmacological management of T2DM in Latin America (LA) with international reference guidelines. Recent findings: Several LA countries have recently developed CPGs. However, the quality of these guidelines is unknown according to the AGREE II tool and taking as reference three CPGs of international impact: American Diabetes Association (ADA), European Diabetes Association (EASD), and Latin American Diabetes Association (ALAD). Ten CPGs were selected for analysis. The ADA scored > 80% on the AGREE II domains and was selected as the main comparator. Eighty percent of LA CPGs were developed before 2018. Only one was not recommended (all domains < 60%). The CPGs in LA have good quality but are outdated. They have significant gaps compared to the reference. There is a need for improvement, as proposing updates every three years to maintain the best available clinical evidence in all guidelines.This research was funded by SANOFI and was developed by Sapyens SAS BIC.S

Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (Platelet Glycoprotein IIb/IIIa in unstable angina: receptor suppression using integreling therapy)

BACKGROUND: The 6-month clinical outcome of patients with multivessel disease enrolled in PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) is described. Patients with complete angiography data were included; multivessel disease was stratified according to the treatment strategy applied early during hospitalization, i.e. medical treatment, percutaneous coronary intervention (PCI) (balloon), PCI (stent), or coronary artery bypass grafting (CABG). METHODS: Patients were divided into three groups according to the treatment strategy applied during the first 30 days of enrolment. Patients who did not undergo a percutaneous or surgical coronary intervention were classified as medically treated. Patients who underwent a PCI (prior to a possible CABG) were separated from those who underwent a CABG (prior to a possible PCI). The PCI group was further subdivided: patients receiving >/=1 coronary stents were separated from those in whom no stents were used. RESULTS: The mortality rate at 30 days was 6.7, 3.9, 2.4 and 4.8% for the medical treatment, PCI (balloon), PCI (stent) and CABG groups, respectively (p value = 0.002). Differences as observed at 30 days were still present at 6-month follow-up with 11.1, 5.8, 5.5 and 6.5% mortality event rates for the aforementioned groups (p value = 0.002). The 30-day myocardial infarction (MI) rate according to the opinion of the Clinical Events Committee was lower among medically than non-medically treated patients, with the highest event rate observed in the CABG group (27.7%). Approximately half of the MIs in the PCI and CABG subgroups occurred within 48 h after the procedure. CONCLUSIONS: The observed differences in clinical outcomes are explained by an imbalance in baseline characteristics and comorbid conditions between the analyzed groups of patients

One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trials

BackgroundWe aimed to provide a quantitative analysis of the 1-year clinical outcomes of patients with multisystem coronary artery disease who were included in recent randomized trials of percutaneous coronary intervention with multiple stenting versus coronary artery bypass graft surgery.MethodsAn individual patient database was composed of 4 trials (Arterial Revascularization Therapies Study, Stent or Surgery Trial, Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 2, and Medicine, Angioplasty, or Surgery Study 2) that compared percutaneous coronary intervention with multiple stenting (N = 1518) versus coronary artery bypass graft surgery (N = 1533). The primary clinical end point of this study was the combined incidence of death, myocardial infarction, and stroke at 1 year after randomization. Secondary combined end points included the incidence of repeat revascularization at 1 year. All analyses were based on the intention-to-treat principle.ResultsAfter 1 year of follow-up, 8.7% of patients randomized to percutaneous coronary intervention with multiple stenting versus 9.1% of patients randomized to coronary artery bypass graft surgery reached the primary clinical end point (hazard ratio 0.95 and 95% confidence interval 0.74’1.2). Repeat revascularization procedures occurred more frequently in patients allocated to percutaneous coronary intervention with multiple stenting compared with coronary artery bypass graft surgery (18% vs 4.4%; hazard ratio 4.4 and 95% confidence interval 3.3’5.9). The percentage of patients who were free from angina was slightly lower after percutaneous coronary intervention with multiple stenting than after coronary artery bypass graft surgery (77% vs 82%; P = .002).ConclusionsOne year after the initial procedure, percutaneous coronary intervention with multiple stenting and coronary artery bypass graft surgery provided a similar degree of protection against death, myocardial infarction, or stroke for patients with multisystem disease. Repeat revascularization procedures remain high after percutaneous coronary intervention, but the difference with coronary artery bypass graft surgery has narrowed in the era of stenting

Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program

Introduction: Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. Methods: NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. Results: The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. Conclusions: Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials (ClinicalTrials.gov: NCT04382768).Fil: Salva, Oscar. Clínica Independencia; ArgentinaFil: Doreski, Pablo A.. Fundación Respirar; ArgentinaFil: Giler, Celia S.. Clínica Independencia; ArgentinaFil: Quinodoz, Dario C.. Sanatorio de la Cañada; ArgentinaFil: Guzmán, Lucia G.. Sanatorio de la Cañada; ArgentinaFil: Muñoz, Sonia Edith. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Carrillo, Mariana Norma del Valle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Porta, Daniela Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Ambasch, Germán. Sanatorio Privado Mayo; ArgentinaFil: Coscia, Esteban. Sanatorio Privado Mayo; ArgentinaFil: Tambini Diaz, Jorge L.. Sanatorio Privado Mayo; ArgentinaFil: Bueno, Germán D.. Sanatorio Privado Mayo; ArgentinaFil: Fandi, Jorge O.. Clínica Independencia; ArgentinaFil: Maldonado, Miriam A.. Sanatorio San Roque; ArgentinaFil: Peña Chiappero, Leandro E.. Sanatori San Roque; ArgentinaFil: Fournier, Fernando. Clínica Francesa; ArgentinaFil: Pérez, Hernán A.. Sanatorio Alive; Argentina. University of Maryland; Estados UnidosFil: Quiroga, Mauro A.. Instituto Modelo de Cardiología; ArgentinaFil: Sala Mercado, Javier Agustin. Instituto Modelo de Cardiología; ArgentinaFil: Martínez Picco, Carlos. Clínica del Sol; ArgentinaFil: Beltrán, Marcelo Alejandro. Hospital Dr. Alberto Duhau; ArgentinaFil: Castillo Argañarás, Luis Fernando. Hospital Dr. Alberto Duhau; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ríos, Nicolás Martínez. Quimica Luar Srl; ArgentinaFil: Kalayan, Galia I.. Provincia de Córdoba. Ministerio de Ciencia y Técnica. Centro de Excelencia en Productos y Procesos de Córdoba; ArgentinaFil: Beltramo, Dante Miguel. Provincia de Córdoba. Ministerio de Ciencia y Técnica. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Garcia, Nestor Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Provincia de Córdoba. Ministerio de Ciencia y Técnica. Centro de Excelencia en Productos y Procesos de Córdoba; Argentin