LA U INVESTIGA: Revista Científica. Facultad Ciencias de la Salud. Volumen 3. Número 2

En el presente volumen se distinguen varios ámbitos de la investigación en salud desde artículos asociados a la promoción de salud, prevención de enfermedades, así como investigaciones de casos clínicos que evidencia la experiencia del equipo de salud en patologías específicas. Hay que resaltar que muchos de los artículos presentados en el volumen actual corresponden a los resultados de investigaciones ejecutadas en la academia, propias de la Universidad Técnica del Norte y de otras.1._ Melanoma antebraquial derecho metastásico a pa¬red abdominal y pelvis presentación de un caso clínico. 2._ Carcinoma papilar de localizacion extratiroidea. 3._ Tumores del golfo de la yugular 4._ Estudio comparativo del desarrollo psicomotor en niños/as de 1 a 3 años del Centro Infantil del Buen Vivir “CENTRO PUCARA” y “GOTITAS DE AMOR” del cantón Antonio Ante de la provincia de Imbabura. 5._ Adaptaciones de las técnicas comunicacionales al proceso terapéutico de salud mental infantil. 6._ La dinámica de la investigación científica en la formación de los profesionales de enfermería: una aproximación al problema de investigación. 7._ Las agresiones en las parejas de enamorados en la adolescencia y el equilibrio emocional. 8._ Rasgos de personalidad y su influencia en la calidad de vida en los estudiantes de la Unidad Educativa” Las Américas” 9._ Estudio de la postura corporal y su relación con la obesidad y sobrepeso en niños de 6 a 12 años del cantón Antonio Ante de la provincia de Imbabura. 10._ Caracterización de cuidadores informales de personas con discapacidad de la provincia de Im¬babura. 11._ Intervención educativa sobre embarazo en la adolescencia en estudiantes del tercer año de bachillerato de la unidad educativa “Madre Tere¬sa Bacq” Imbabura-Ecuador. 12._ Acceso a la atención de consulta externa de los usuarios del centro de llamadas, que asisten al subcentro de salud San Antonio, Tanguarin Iba¬rra, ecuador 2016. 13._ Prevalencia de disfunción familiar en la parro¬quia urbana de Urcuquí

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

TECHO VERDE COMO MEDIDA DE MANEJO A PROBLEMÁTICA AMBIENTAL RELACIONADAS CON EL RECURSO HÍDRICO

Actualmente se consideran que las energías alternativas son tecnológicas de innovación, diseñadas para preservar y establecer un equilibrio entre el medio ambiente y la actividad humana. De igual manera, son definen como mecanismos para se implementan para enfrentar el problema de sostenibilidad y cambio climático en cualquier comunidad. Estos mecanismos pueden ser aplicados en lugares con diferentes condiciones atmosféricas, climáticas y topográficas para el aprovechamiento de los recursos naturales. Dependiendo de las necesidades de la comunidad se establecerá el tipo de estructura más adecuado, dentro de estas alternativas para el aprovechamiento de las aguas lluvias encontramos las cubiertas verdes o techos verdes, los cuales son estructuras que han tenido su auge por su fácil adaptación en cualquier superficie. Diferentes estudios han demostrado que las cubiertas verdes brindan grandes beneficios entre los cuales está la capacidad de captación de compuestos en el aire generando una reducción en los niveles de contaminación del lugar, el aumento del confort térmico al reducir la temperatura dentro de las estructuras, su capacidad de filtración natural ya que sirven como depósito de acumulación del agua de las precipitaciones. Por otra parte, genera un impacto visual agradable al presentarse una mejora en el paisaje urbano y ayuda de gran modo al manejo de la escorrentía superficial en calles y tejados cumpliendo un papel de regulador hídrico

Diplomado de profundización en Supply Chain Management y logística Ingenio Carmelita S.A.

Como parte final del Diplomado de Profundización en Supply Chain Management y Logística (opción de grado), hemos avanzado en la obtención de conocimientos muy significativos, los cuales aportan a nuestro desarrollo tanto personal como profesional, es así como en el desarrollo del presente trabajo se pretende validar los diferentes conceptos por medio del ejercicio práctico, realizando así un modelo referencial en logística, aplicándolo como ejemplo en la empresa Ingenio Carmelita S.A, llevando a cabo un enfocamiento en su proceso de producción y la adaptación a las nomas que le exigen los nuevos mercados. Como primer paso se genera una entrevista al jefe del departamento de logística de la compañía, con el objetivo final de poder conocer el estado de la parte logística aplicada, siguiendo los lineamientos propuestos en el curso relacionando una serie de trece puntos claves para así conformar un modelo referencial. Llegando así al análisis de datos correspondientes a los resultados de los puntajes generados en la entrevista de acuerdo con las respuestas otorgadas; pudiendo llegar a la presentación de propuestas para la modernización y acatamiento de recursos para modernizar los procesos logísticos y tener la compañía a la vanguardia del mercado.As a final part of the Diploma in Supply Chain Management and Logistics (Option of Degree), we have advanced in obtaining very significant knowledge, which contributes to our personal and professional development, this is how in the development of this work we aims to validate the different concepts through the practical exercise, thus making a reference model in logistics, applying it as an example in the company Ingenio Carmelita SA, carrying out a focus on its production process and adapting to the requirements of the new ones markets As a first step, an interview is generated with the head of the logistics department of the company, with the final objective of being able to know the status of the logistics part applied, following the guidelines proposed in the course relating a series of thirteen key points in order to form a referential model. Thus arriving at the analysis of data corresponding to the results of the scores generated in the interview according to the answers given; being able to arrive at the presentation of proposals for the modernization and compliance of resources to modernize the logistic processes and have the company at the forefront of the market

Tratamiento de residuos de poliestireno expandido utilizando solventes verdes

En esta investigación se realizó el tratamiento de residuos de Poliestireno expandido utilizando solventes verdes. Inicialmente se evaluó la agitación y el porcentaje de mezcla solvente verde - Poliestireno, obteniéndose diferentes soluciones que fueron analizadas cualitativamente mediante espectroscopia infrarroja. Los espectros obtenidos presentaron las bandas características de los grupos funcionales de Estireno y Poliestireno. Posteriormente se planteó una matriz de diseño factorial 23 para evaluar el efecto de la temperatura (30-80 °C), agitación (310-500 rpm) y porcentaje de mezcla (40-80 %) sobre la reducción del volumen ocupado por los residuos de EPS en el tratamiento con solventes verdes. Las muestras obtenidas fueron analizadas por espectroscopia FTIR. Finalmente se propuso un layout de una máquina con la que se busca tratar los residuos de Poliestireno expandido en los puntos primarios de generación de desechos

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Measurements of ttˉt\bar{t} differential cross-sections of highly boosted top quarks decaying to all-hadronic final states in pppp collisions at s=13 \sqrt{s}=13\, TeV using the ATLAS detector

Measurements are made of differential cross-sections of highly boosted pair-produced top quarks as a function of top-quark and $t\bar{t}$ system kinematic observables using proton--proton collisions at a center-of-mass energy of $\sqrt{s} = 13$ TeV. The data set corresponds to an integrated luminosity of $36.1$ fb$^{-1}$, recorded in 2015 and 2016 with the ATLAS detector at the CERN Large Hadron Collider. Events with two large-radius jets in the final state, one with transverse momentum $p_{\rm T} > 500$ GeV and a second with $p_{\rm T}>350$ GeV, are used for the measurement. The top-quark candidates are separated from the multijet background using jet substructure information and association with a $b$-tagged jet. The measured spectra are corrected for detector effects to a particle-level fiducial phase space and a parton-level limited phase space, and are compared to several Monte Carlo simulations by means of calculated $\chi^2$ values. The cross-section for $t\bar{t}$ production in the fiducial phase-space region is $292 \pm 7 \ \rm{(stat)} \pm 76 \rm{(syst)}$ fb, to be compared to the theoretical prediction of $384 \pm 36$ fb