Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Marketing como factor fundamental del Éxito Organizacional

Talking about Marketing is not a new topic, however it is a subject that should be considered a priority, which is why it represents companies, in essence the positioning of products in the market. Because marketing is an edge of the administration that is responsible for ensuring the sustainable sale of products in the market, for which it is necessary to know very well the influences of the environment on the organizations, thus achieving to leave engraved in the imaginary of the consumer the brand that you want to sell, that is, you position yourself in the market, guaranteeing that the income is safe while you are in the imaginary. Hence, that the marketing concept is often conceptualized as the tool of management to achieve a relationship close with the market, acceding to know, and apply the experiences lived, in order to maintain a close link with all its consumers. In this sense it represents the identification and knowledge of the purchase process from its initial part to the full enjoyment of the product.Hablar de Marketing no es un tema novedoso, sin embargo es una temática que debe considerarse prioritaria, por lo que representa a las empresas, en esencia el posicionamiento de los productos en el mercado. Porque el marketing es una arista de la administración que se encarga de garantizar la venta sostenible de los productos en el mercado, para lo cual se requiere conocer muy bien las influencias del entorno sobre las organizaciones, logrando de este manera dejar grabado en el imaginario del consumidor la marca que se desea vender, es decir, se posiciona en el mercado, garantizando que los ingresos sean seguros mientras estén en imaginario. De allí, que el concepto de marketing muchas veces sea conceptuado como la herramienta de la gerencia para lograr una relación estrecha con el mercado, accediendo a conocer, y aplicar las experiencias vividas, en procura de mantener un vínculo cercano con todos sus consumidores. En este sentido representa la identificación y conocimiento del proceso de compra desde su parte inicial hasta el goce pleno del producto