Informe de gestión 2017-2020

Este documento reseña la gestión del Banco de la República entre 2017 y 2020, un período durante el cual el Banco logró consolidar una inflación baja y estable, con tasas de crecimiento cada vez más cercanas al potencial. A partir de marzo de 2020 se adoptaron políticas novedosas que lograron evitar una crisis profunda en medio de la pandemia del Coronavirus, un choque de enormes dimensiones para la humanidad. De otra parte, se tomaron medidas importantes tendientes a fortalecer la Administración del Banco, con un mayor control de los recursos financieros destinados a los distintos objetivos del Plan de Desarrollo. El Banco continúa siendo la institución estatal independiente que genera mayor confianza entre los colombianos por su transparencia, su ajuste a exigentes metas de resultados macroeconómicos y empresariales, y por el cumplimiento efectivo de las funciones de banca central y culturales encomendadas por la Constitución y la ley. RESUMEN EJECUTIVO La economía colombiana enfrentó en los últimos cuatro años algunos de los eventos que mayor impacto han tenido sobre su desempeño en más de un siglo. El precio internacional del petróleo cayó a menos de la tercera parte entre junio de 2014 y enero de 2016 y, nuevamente, entre septiembre de 2018 y abril de 2020; se presentaron frecuentes choques en el precio local de los alimentos, y la pandemia reciente ocasionó uno de los mayores desastres que ha padecido la humanidad en su historia. El Banco de la República (Banrep), sus directivos y empleados tuvieron que responder rápidamente a las nuevas circunstancias, un proceso que ha implicado grandes cambios en la forma como se han ejecutado y cumplido las funciones de la banca central y las del área cultural a cargo de la organización. De otra parte, el Plan Estratégico 2017-2021 sentó las bases para el nuevo programa de modernización del Banco, y en el presente Informe de gestión 2017-2020 se describen y analizan los retos enfrentados en el período y la forma en que se adaptó y modernizó la institución para hacerles frente. También se mencionan los principales desafíos que se avizoran hacia el futuro, con el fin de contribuir al diseño de los planes de la administración entrante. En este Resumen ejecutivo se presenta una síntesis del documento completo. En la sección II se hace un recuento de la situación económica de Colombia y el mundo en el cuatrienio reciente, y las medidas de política adoptadas por la Junta Directiva del Banco de la República (JDBR) para mantener la inflación baja y estable y contribuir a la recuperación del crecimiento de la economía. En la sección III se registran los avances y logros en los temas estratégicos del Plan Estratégico 2017-2021. En particular, se mencionan la política monetaria y de estabilidad financiera, la política cambiaria, la política de pagos, y otros temas relacionados con la eficiencia y eficacia en el Plan. La sección IV está dedicada a la gestión cultural, y en la sección V se describe la evolución de los temas de apoyo táctico para el logro de los objetivos del Plan: capital humano y cultura organizacional, tecnología e infraestructura; se incluye, además, un resumen de los avances en materia ambiental. En la sección VI se presentan los principales elementos de la respuesta del Banco ante la emergencia sanitaria del COVID-19. En la sección VII se describe el manejo de las reservas internacionales y se analizan el presupuesto y las utilidades del Banco. En la sección VIII se enuncian algunos desafíos futuros

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially