Auditoría financiera al Gobierno Autónomo Descentralizado Parroquial Rural de Río Corrientes de la provincia de Pastaza, cantón Pastaza, períodos 2012 2013

El Objetivo de la presente Auditoría Financiera realizada al Gobierno Autónomo Descentralizado Parroquial Rural de Río Corrientes de la Provincia de Pastaza, Cantón Pastaza, períodos 2012-2013, es determinar la razonabilidad y confiabilidad de la información financiera. Los métodos que utilizamos para la presente investigación fueron la observación directa y las entrevistas, su desarrollo se realizó en base a cuestionarios de Control Interno, Papeles de Trabajo y Programas de Auditoría realizados a las cuentas de bancos, activos fijos, remuneraciones y anticipos, mismos que permitieron verificar el cumplimiento de las disposiciones legales y reglamentarias, aplicadas en dicha entidad y evaluar el grado de eficiencia y eficacia. Se da a conocer el dictamen de auditoría, mismo que es razonable salvo los siguientes hallazgos: Incremento de remuneraciones sin observar disposiciones legales, falta de documentos de autorización previa a las salidas de dinero, no se han ejecutado actas de constatación física a los activos fijos, no cuenta con una persona encargada del control de asistencia, y tampoco cuenta con reloj biométrico. Se recomienda dar cumplimiento a las respectivas acciones correctivas, a fin de que dichas inconsistencias puedan ser contrarrestadas tomando decisiones oportunas y de esta manera evitar seguros glosas por parte de la Contraloría General de Estado

Towards the intelligent diagnosis of hematological diseases

In traditional medicine, patient diagnosis usually implies an in depth study of its state and symptoms that a specialist has to carry out. The adaptation and customization of the medical treatment to those individual characteristics of each patient is what we know as Precision Medicine. Furthermore, in the case of multidisciplinary fields such as haematology, the identification of several diseases usually implies complex analyses in order to have a high degree of certainty in the diagnosis. A better understanding of the clinical tests and their relationship and the finding of new patterns between them will enable us to avoid a significant amount of such tests by supporting the specialist with new information. In this line, Artificial Intelligence has proven to be a useful methodology for data analytics in general whose main drawback is the need of huge amounts of data to achieve high accuracy. In the particular case of clinical data, it is widely generated in hospitals but the lack of standardization and the difficulties of availability require complex preprocessing. Therefore, we have collected 100,000 complete blood counts and developed a method to 1) automatically label textual diagnosis using deep neural networks with Long short-term memory cells. In this approach, a group of specialists has manually labelled 1,000 CBCs through a mobile application, which have then been used to feed the network in order to learn to interpret the diagnosis, and 2) to make an intelligent diagnosis of new samples in which a subset of 10,000 CBCs has been used as an input to a Support Vector Machine. In summary, in this work we present two different prototypes of architectures in order to define methods for the collection, preprocessing and intelligent classification of clinical data, focusing in haematological disease. Our proposal presents encouraging results with accuracies greater than 90% in both cases.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Impact of Covid-19 pandemic on patients with immune thrombocytopaenia

Background and Objectives: The aim of this study was to determine the impact of the COVID-19 pandemic on the lives of patients with immune thrombocytopaenia (ITP) treated at our hospital. Materials and Methods: The study was conducted in the Community of Madrid, which has the highest number of COVID-19 cases in Spain. We included 143 adult patients with ITP (130 with chronic ITP, 8 with persistent ITP, and 5 with newly diagnosed ITP). We conducted a telephone survey to collect the data and created a registry. Materials and Methods: Overall, 24 patients presented symptoms suggestive of COVID-19, which was confirmed by RT-PCR in 8 cases. The cumulative incidence of confirmed SARS-CoV-2 infection was higher in the patients with ITP than in the Madrid population. There were no differences in the disease incidence or clinical course of infection in the patients treated with immunosuppressants. Almost all of the patients reported adherence to the prescribed treatment, although 49.2% of the hospital visits were either cancelled or postponed, 17.2% because of the patients’ fear of coming to the centre. Nearly half of the cohort was considered vulnerable, and 17% had been granted a dependency or disability benefit. Conclusions: COVID-19 had a major impact on the psychosocial, occupational, and quality of care of patients with ITP.This study was supported by FIS-Fondos FEDER PI19/00631 and PI19/00772 and by the Platelet Disorder Support Associatio

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Manual therapy in the treatment of patients with hemophilia B and inhibitor

Abstract Background The main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor. Case presentation A 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality. Conclusions Until now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2