Propuesta de solución para personas que, tras superar el Cáncer, presentan problemas para retomar de manera efectiva su vida laboral, social y familiar

La presente investigación nació de una inspiración al identificar una problemática social de la que lamentablemente ninguna institución o el propio Estado se han hecho cargo, y radica en las dificultades que tiene una persona que ha superado el cáncer para regresar a su vida social, laboral y familiar de manera efectiva, debido a las secuelas físicas y psicológicas propias de la enfermedad y tratamiento. Los avances tecnológicos y preventivos contra el cáncer aseguran que la tasa de sobrevivencia se incrementará año a año, por lo que gran parte de la población tendrá que enfrentarse a la problemática identificada, que afecta directamente a su calidad de vida. Con la aplicación de metodologías ágiles y apoyo de la investigación científica, se ha logrado empatizar con los pacientes de cáncer que han superado la enfermedad, con la intención de conocer sus principales miedos, frustraciones y necesidades. Tras el testeo de prototipos, se ha arribado a una propuesta que pretende crear valor, primero, generando oportunidades laborales en personas que han superado el cáncer y que actualmente son especialistas en alguna de las categorías que se proponen en la solución, y por ende, están habilitadas para aportar con su conocimiento, creando contenido audiovisual, segundo, este contenido será difundido a través de cursos usando como medio una plataforma digital para llegar al mayor número de personas que hayan pasado por un tratamiento de cáncer y que tengan dificultades para retomar su vida pasada y bienestar. La oportunidad para emprender este modelo de negocio es clara, dado que en el mercado peruano no existen empresas que brinden servicios similares, y es una innovación disruptiva ya que busca construir una comunidad colaborativa de valor, a través de la participación de diversos actores que compartan el propósito. En cuanto a la parte financiera, la tasa de retorno es del 70%, superior al 6.5% que los socios han definido como su costo de oportunidad, lo cual garantiza la rentabilidad del proyecto. Finalmente, con la implementación de la presente propuesta, se espera generar impacto sostenible en tres Objetivos de Desarrollo Social (ODS): (a) educación de calidad, (b) trabajo decente y (c) fin de la pobreza.The present investigation was born from an inspiration when identifying a social problem that unfortunately no institution or the State itself has taken charge of, and it is based on the difficulties that a person who has overcome cancer has to return to his social, work and family life in an effective way, due to the physical and psychological sequels typical of the disease and treatment. The technological and preventive advances against cancer assure that the survival rate will increase year after year, so a great part of the population will have to face the identified problem, which directly affects their quality of life. With the application of agile methodologies and support of scientific research, it has been possible to empathize with cancer patients who have overcome the disease, with the intention of knowing their main fears, frustrations and needs. After the testing of prototypes, a proposal has been arrived at that intends to create value, first, by generating job opportunities in people who have overcome cancer and are currently specialists in one of the categories proposed in the solution, and therefore, are able to contribute with their knowledge, creating audiovisual content, second, this content will be disseminated through courses using a digital platform to reach the greatest number of people who have gone through cancer treatment and who have difficulties in resuming their past lives and well-being. The opportunity to undertake this business model is clear, since in the Peruvian market there are no companies that provide similar services, and it is a disruptive innovation since it seeks to build a collaborative community of value, through the participation of various actors who share the purpose. As for the financial part, the rate of return is 70%, higher than the 6.5% that the partners have defined as their opportunity cost, which guarantees the profitability of the project. Finally, with the implementation of this proposal, it is expected to generate sustainable impact on three Social Development Objectives (ODS): (a) quality education, (b) decent work and (c) end of poverty.Tesi

Obtaining phenolic extracts from the leaf of <i>Moringa oleifera</i> Lam by using different extraction methods

Moringa oleifera Lam. it is one of the best known and widely distributed species in the world. It is considered as one of the most useful trees, with multiple benefits. One of its distinguishing characteristics is that its leaves accumulate high contents of phenolic compounds, which are investigated for their biological properties. The present investigation was developed with the aim to obtain crude ethanolic leaf extracts, with higher extraction yields and phenolic compounds, from M. oleifera by comparing four extraction methods. The influence of extraction by magnetic stirring, static extraction, extraction by Soxhlet and ultrasound-assisted extraction on the yield of crude leaf ethanolic extract and the concentration of phenolic compounds were determined. The phytochemical characterization of the extract was carried out and the chromatographic profile was determined by thin layer chromatography. A yield of 185.89 mg g-1 of dry mass and the highest concentrations of phenols in the extract (24.86 mg g-1 dry mass) were obtained by magnetic stirring. The qualitative chemical characterization of the phenolic extract of M. oleifera proved the presence of volatile coumarins, triterpenes, steroids, flavonoids, tannins and phenolic compounds detected in the phytochemical and phenolic acids analyses, glycosylated flavonoids, essential oils associated with phenols and compounds with pungent and bitter principle in thin layer chromatography. It is concluded that by the extraction method with magnetic stirring for 3 h, crude ethanolic leaf extracts of M. oleifera are obtained with high yields of extraction and concentration of phenolic compounds of varied nature. Keywords: ethanolic extracts, phenols, moringa, yiel

Actividad antimicrobiana in vitro de extractos etanólicos foliares de Moringa oleífera Lam frente a hongos fitopatógenos

This research is aimed at determining the in vitro antifungal activity of ethanolic leaf extracts of Moringa oleifera Lam against Rhizoctonia solani Kühn and Stemphylium solani Weber. For this purpose, ethanolic extracts were obtained from M. oleifera leaves and maceration with magnetic stirring was used as an extraction method. The yield of the process was 185.89 mg·g-1DM and phenol content in the extract was 24.86 mg·g-1 de DM. The in vitro antifungal activity tests were carried out through microdilutions in 96-well plates. As a result, mycelial growth inhibition was observed in both phytopathogens with the increase of the evaluated concentrations. Compared to R. solani, the highest percentage of mycelial growth inhibition was 68.15 % and 0.39 mg·ml-1 as the minimum inhibitory concentration of the extract. In the case of S. solani it was inhibited up to 63.97 % of the fungus growth and the minimum inhibitory concentration was 3.13mg·ml-1. The results demonstrate the in vitro antifungal capacity of ethanolic leaf extracts from M. oleifera against two phytopathogenic fungi.El objetivo de la presente investigación fue determinar la actividad antifúngica in vitro de extractos etanólicos foliares de Moringa oleifera Lam frente a Rhizoctonia solani Kühn y Stemphylium solani Weber. Para ello, se obtuvieron extractos etanólicos a partir de hojas de Moringa oleifera Lam y se utilizó la maceración con agitación magnética como método de extracción. El rendimiento del proceso fue 185,89 mg·g-1 de MS y el contenido de fenoles en el extracto fue 24,86 mg·g-1 de MS. Los ensayos de actividad antifúngica in vitro se realizaron mediante microdiluciones en placas de 96 pocillos; como resultado se observó la inhibición de crecimiento micelial en ambos fitopatógenos con el aumento de las concentraciones evaluadas. Frente a R. solani, el mayor porcentaje de inhibición del crecimiento micelial fue 68,15 % y 0,39 mg·ml-1 como la mínima concentración inhibitoria del extracto. En el caso de S. solani, se inhibió hasta el 63,97 % del crecimiento del hongo y la mínima concentración inhibitoria fue 3,13 mg·ml-1. Los resultados demuestran la capacidad antifúngica in vitro de extractos etanólicos foliares a partir de M. oleifera frente a dos hongos fitopatógenos

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

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

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research