Evaluación de tres dosis de fertilizante (N, P, K) fraccionadas en el cultivo de brócoli (Brassica oleracea var italica Plenck.) bajo condiciones de invernadero

Con el objetivo de obtener uniformidad, mejor crecimiento y desarrollo, para incrementar el rendimiento con calidad y rentabilidad económica, se realizó la evaluación de tres dosis de fertilizante (N, P, K) fraccionadas en el cultivo de brócoli (Brassica oleracea var itálica Plenck) bajo condiciones de invernadero. Se realizó en el Fundo el Pacífico en Lamas con el empleó el diseño estadístico de Bloques Completamente al Azar (DBCA) con arreglo factorial de 3x2, teniendo 6 tratamientos y un testigo, con 3 repeticiones. Los tratamientos estudiados fueron dosis de fertilizantes y frecuencia de aplicación. En la evaluación de altura de planta, diámetro de tallo, diámetro de inflorescencia y peso de inflorescencia; se obtuvieron los promedios más resaltantes con el T6 (145 N - 87 P – 193,2 K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn en 3 fracciones), seguido del T3 (145 N - 87 P – 193,2K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn / 2 fracciones). Finalmente, se determinó que con el T6 (145 N - 87 P – 193,2 K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn en 3 fracciones) se obtuvo mayor rendimiento con 24 790,74 kg.ha-1 y un Beneficio/Costo de 1,27 (127% de rentabilidad)In order to obtain uniformity, better growth and development, as well as to increase yield with quality and economic profitability, the evaluation of three fractionated fertilizer doses (N, P, K) was carried out on broccoli (Brassica oleracea var italica Plenck) cultivation under greenhouse conditions. The study was conducted at Fundo el Pacífico located in the city of Lamas using the statistical technique of randomized complete block design (RCBD) with a factorial arrangement of 3x2, having 6 treatments and a control, with 3 replicates. The treatments studied were fertilizer dose and frequency of application. Regarding the evaluation of plant height, stem diameter, inflorescence diameter and inflorescence weight, the most outstanding averages were obtained with T6 (145 N - 87 P - 193.2 K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn in 3 fractions), followed by T3 (145 N - 87 P - 193.2K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn / 2 fractions). Finally, it was determined that with T6 (145 N - 87 P - 193.2 K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn in 3 fractions) the highest yield was obtained with 24 790.74 kg.ha-1 and a Benefit/Cost of 1.27 (127% profitability)

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Evaluación de tres dosis de fertilizante (N, P, K) fraccionadas en el cultivo de brócoli (Brassica oleracea var italica Plenck.) bajo condiciones de invernadero

Con el objetivo de obtener uniformidad, mejor crecimiento y desarrollo, para incrementar el rendimiento con calidad y rentabilidad económica, se realizó la evaluación de tres dosis de fertilizante (N, P, K) fraccionadas en el cultivo de brócoli (Brassica oleracea var itálica Plenck) bajo condiciones de invernadero. Se realizó en el Fundo el Pacífico en Lamas con el empleó el diseño estadístico de Bloques Completamente al Azar (DBCA) con arreglo factorial de 3x2, teniendo 6 tratamientos y un testigo, con 3 repeticiones. Los tratamientos estudiados fueron dosis de fertilizantes y frecuencia de aplicación. En la evaluación de altura de planta, diámetro de tallo, diámetro de inflorescencia y peso de inflorescencia; se obtuvieron los promedios más resaltantes con el T6 (145 N - 87 P – 193,2 K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn en 3 fracciones), seguido del T3 (145 N - 87 P – 193,2K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn / 2 fracciones). Finalmente, se determinó que con el T6 (145 N - 87 P – 193,2 K – 17,38 Mg – 36,71 S – 0,14 B – 0,19 Zn – 0,19 Mn en 3 fracciones) se obtuvo mayor rendimiento con 24 790,74 kg.ha-1 y un Beneficio/Costo de 1,27 (127% de rentabilidad)In order to obtain uniformity, better growth and development, as well as to increase yield with quality and economic profitability, the evaluation of three fractionated fertilizer doses (N, P, K) was carried out on broccoli (Brassica oleracea var italica Plenck) cultivation under greenhouse conditions. The study was conducted at Fundo el Pacífico located in the city of Lamas using the statistical technique of randomized complete block design (RCBD) with a factorial arrangement of 3x2, having 6 treatments and a control, with 3 replicates. The treatments studied were fertilizer dose and frequency of application. Regarding the evaluation of plant height, stem diameter, inflorescence diameter and inflorescence weight, the most outstanding averages were obtained with T6 (145 N - 87 P - 193.2 K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn in 3 fractions), followed by T3 (145 N - 87 P - 193.2K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn / 2 fractions). Finally, it was determined that with T6 (145 N - 87 P - 193.2 K - 17.38 Mg - 36.71 S - 0.14 B - 0.19 Zn - 0.19 Mn in 3 fractions) the highest yield was obtained with 24 790.74 kg.ha-1 and a Benefit/Cost of 1.27 (127% profitability)

Nivelación de lenguaje - HU24 201801

Descripción: Nivelación de Lenguaje es un curso de formación general, de carácter práctico, dirigido a estudiantes de primeros ciclos. Esta asignatura busca desarrollar habilidades de redacción prácticas, aterrizadas en un correlato real de escritura determinado: un correo electrónico, una publicación de Facebook, etc. Para ello, el curso se orienta a afianzar las habilidades relacionadas con la organización del texto, así como los conocimientos básicos sobre la normativa de la lengua española. Lo aprendido en esta asignatura ofrecerá al estudiante las herramientas lingüísticas básicas idóneas para desarrollarse con suficiencia en una redacción cotidiana, en un comentario en sus redes sociales o en un examen de algún curso. Propósito: El curso desarrolla la competencia de Comunicación Escrita, en el nivel 1; es decir, el estudiante es capaz de construir mensajes coherentes y sólidos que se adecúan a la situación y propósito comunicativo. Este desarrollo le permite la generación y construcción de nuevas ideas, lo cual es relevante para su vida académica y profesional. La actual sociedad de la información y el conocimiento, caracterizada por la disrupción, la innovación y la complejidad en las formas de comunicación mediadas por la tecnología, enfrenta al estudiante y al profesional a nuevos retos en las maneras de comunicar aquello que conoce y que construye. En este escenario, la competencia comunicativa escrita adquiere protagonismo como herramienta para transmitir el conocimiento creado. El curso se alinea con esta exigencia, pues contribuye a que el estudiante responda exitosamente a las demandas comunicativas del contexto académico, y a que el egresado pueda desenvolverse idóneamente en el campo profesional y laboral

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Clínica Integrada - ME210 - 202101

Curso de especialidad, de la carrera de medicina, de carácter teórico- práctico del ciclo 7, en el que los estudiantes integran conocimientos previos con la anamnesis, el examen físico y establecen el diagnostico por síndromes o problemas y el plan de trabajo. El curso de Clínica integrada busca desarrollar las competencias generales de comunicación escrita y comunicación oral(nivel 2) y las competencias específicas de práctica clínica-diagnóstico (nivel 2) y profesionalismo-sentido ético y legal y responsabilidad profesional(nivel 2). La integración de conocimientos en la historia clínica, permitirá al estudiante, plantear un adecuado diagnóstico, plan de trabajo para la atención de su futuro paciente

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

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