Identificación de riesgos para mejorar las áreas de trabajo en la empresa del sector productivo San Lucas S.A.C Chimbote-2021

Esta investigación tuvo como objetivo general identificar los riesgos para mejorar las áreas de trabajo en la empresa del sector productivo San Lucas S.A.C, la metodología empleada fue de tipo aplicado, de enfoque cuantitativo y de diseño pre experimental. En los resultados se determinó que el nivel de cumplimiento de la seguridad y salud en el trabajo dentro de la empresa es del 25%, es decir nivel bajo, además, se halló que las áreas con mayor riesgo de trabajo son el encanastillado, fileteado y etiquetado de latas; se determinó que el nivel de índice de frecuencia inicial fue 7.49, el nivel de índice de gravedad fue de 7.05 y la tasa de accidentabilidad fue 22, para ello, se implementó un plan de acción basado en la ley 29783, donde primero se elaboró la política de SST y de negativa al trabajo inseguro, se diseñó un proceso de reporte de accidentes e incidentes, se elaboró objetivos y metas donde los cumplimientos de ellos fueron al 100% según lo planificado, se elaboró el mapa de riesgo de todas las áreas de trabajo y se realizó un cronograma de capacitaciones a los trabajadores del área de producción y el cumplimiento de ellos fue del 100%. Como conclusión, se determinó que el nivel de riesgos laborales después de la aplicación del plan de acción basado en la ley 29783, el índice de frecuencia fue 0.30, el nivel de índice de gravedad fue de 0.32 y la tasa de accidentabilidad fue 1

Change in 1-year mortality after hip fracture surgery over the last decade in a European population

Objective: There are scarce data on the mortality after hip fracture surgery for patients treated in the most recent years. The objective of this study was to analyze whether the overall initiatives introduced over the last decade for elderly patients with hip fractures had a positive impact on the 1-year mortality. Methods: Patients treated during 2010–2012 were compared with patients treated during 2018–2020 for all-cause 1-year mortality. Variables influencing mortality were collected based on the literature, including demographic, comorbidity, cognitive status, and preinjury physical function. Crude mortalities were compared between periods, as well as with the expected mortality in the general population adjusted for age, gender, and year of surgery using the standardized mortality ratio (SMR). A multivariate model was used to identify mortality risk factors. Results: 591 patients older than 65 years were treated during 2010–2012 and 642 patients during 2018–2020. The mean age increased significantly between periods (78.9 vs. 82.6 years, respectively, p = 0.001) in both genders, together with an increase in comorbidity (p = 0.014). The in-hospital mortality risk had no significant difference between periods (2.5 vs. 2.0%, p = 0.339), but the 30-day mortality risk (8.3 vs. 5.5%, p = 0.031) and 1-year mortality risk (16.1 vs. 11.9%, p = 0.023) declined significantly. However, 1-year mortality in 2020 had an excess of 1.33 in SMR. Age older than 80 years, male gender, and Charlson comorbidity index > 2 were significant predictors of 1-year mortality. Conclusion: The important evolution achieved in the last decade for the management of patients with hip fracture surgery has led to a significant decline in 1-year mortality, but the 1-year mortality remains significantly higher compared to the general population of similar age and gender.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Cultura y desarrollo territorial: un análisis de las ciudades medianas españolas mediante la herramienta europea Cultural and Creative Cities Monitor

Aplicamos la herramienta Cultural and Creative Cities Monitor (MCCC) para medir el desempeño cultural de las 81 ciudades españolas de 50 000 a 100 000 habitantes y evaluamos su contribución a la comprensión de los ecosistemas culturales estudiados. Expuestas las cuestiones teóricas y las hipótesis que se pretende verificar, obtenemos primero los 29 indicadores que describen la vitalidad cultural, la economía creativa y la calidad del entorno para la cultura en cada ciudad, superando los retos planteados por las fuentes. Para conseguir el segundo objetivo, contrastamos el comportamiento de diferentes tipos de ciudades según los índices de desempeño cultural generados, particularmente el índice C3. También exploramos la relación del índice y diversas características socioeconómicas y, mediante un análisis clúster, establecemos una tipología de ciudades según el perfil dominante –vitalidad cultural, economía creativa, contexto socio espacial– en sus respectivos ecosistemas. Los resultados dejan patente que el MCCC mejora la comprensión de los ecosistemas culturales captando sus diferencias intrínsecas. Se evidencian variaciones de comportamiento entre ciudades metropolitanas, no metropolitanas o turísticas y se obtienen agrupamientos coherentes de ciudades, que pueden compartir de ese modo sus estrategias para que las políticas culturales urbanas sean una parte central de la política local

Occult Follicular Thyroid Carcinoma presenting as Primary Breast Tumor with Sternal and Skull Metastasis

Introduction: Follicular thyroid carcinoma (FTC) that initially presented as breast tumor with no previous medical history of malignancy of thyroid gland is relatively rare and may cause diagnostic confusion.Presentation of case: We report a 59-year-old Mexican woman with no prior history of malignant thyroid neoplasm that presents with pain and swelling in the upper outer quadrant of the left breast with a year of evolution. Subsequently, subcutaneous tumor was identified in left parietal region. Clinically it was thought in primary breast tumor metastasis to skull. Furthermore, computerized tomography scan identified a tumor in the deep portion of the left breast, infiltrating the sternum that subsequently was confirmed a follicular carcinoma of the thyroid gland.Conclusion: Metastatic FTC may mimic a primary breast tumor. The combined use of clinical information, histopathology and immunohistochemistry were important to establishing a correct cancer diagnosis

Plan estratégico Kallpa 2021-2025

Somos una empresa dedicada a la producción y comercialización de equipos celulares de alta tecnología; fabricamos equipos de todas las gamas con los estándares más altos del mercado en calidad de componentes y a precios competitivos muy por debajo del mercado. Tenemos plantas en Asia, Europa y Estados Unidos; en este último país se encuentra nuestra casa matriz, donde ensamblamos los celulares para el mercado americano. Sobre la base de nuestra investigación, pudimos encontrar que actualmente el mercado de dispositivos celulares se encontraba saturado con una oferta de equipos de similares características, donde no se encontraba una diferencia competitiva sustancial. Por ese motivo decidimos investigar el mercado de manera más profunda, encontrándonos con un mercado que se halla en crecimiento, y que no ha sido explotado, que es el mercado gamer, principalmente en el mercado de Estados Unidos, donde nos centraremos sobre la base de una estrategia de océano azul, buscando diferenciarnos con un equipo competitivo en lo que respecta a funcionalidad, calidad y precio acompañados de un modelo de negocio de plataforma que nos permitirá llegar a más usuarios especializados en búsqueda de estos equipos. Sobre la base de esta estrategia, nuestro plan estratégico del 2021-2025 plantea los siguientes objetivos trazados por cada área, EBITDA de 44 %, rentabilidad sobre el patrimonio (ROE) de 43 %, rentabilidad sobre las ventas (ROS) de 31 % y crecimiento de las ventas en 33 %, que nos permitirán rentabilizar la inversión de acuerdo con las decisiones planteadas en el análisis de nuestro portafolio de productos

Silk fibroin nanoparticles constitute a vector for controlled release of resveratrol in an experimental model of inflammatory bowel disease in rats.

Purpose: We aimed to evaluate the intestinal anti-inflammatory properties of silk fibroin nanoparticles, around 100 nm in size, when loaded with the stilbene compound resveratrol, in an experimental model of rat colitis. Methods: Nanoparticles were loaded with resveratrol by adsorption. The biological effects of the resveratrol-loaded nanoparticles were tested both in vitro, in a cell culture of RAW 264.7 cells (mouse macrophages), and in vivo, in the trinitrobenzenesulfonic acid model of rat colitis, when administered intracolonically. Results: The resveratrol liberation in 1× phosphate-buffered saline (PBS; pH 7.4) was characterized by fast liberation, reaching the solubility limit in 3 hours, which was maintained over a period of 80 hours. The in vitro assays revealed immunomodulatory properties exerted by these resveratrol-loaded nanoparticles since they promoted macrophage activity in basal conditions and inhibited this activity when stimulated with lipopolysaccharide. The in vivo experiments showed that after evaluation of the macroscopic symptoms, inflammatory markers, and intestinal barrier function, the fibroin nanoparticles loaded with resveratrol had a better effect than the single treatments, being similar to that produced by the glucocorticoid dexamethasone. Conclusion: Silk fibroin nanoparticles constitute an attractive strategy for the controlled release of resveratrol, showing immunomodulatory properties and intestinal anti-inflammatory effects

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk