Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: which subfertile patients benefit from surgery?

Background: The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). Methods: From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. Results: Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in > 35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041). Conclusions: MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

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

Validez y reproducibilidad de un método para estimar la capacidad cardiorrespiratoria en adultos universitarios

Introduction: Cardiorespiratory fitness is a predictor of cardiovascular and all-cause mortality. Its assessment in different groups has clinical and public health utility.Objective: We evaluate the validity and reproducibility of a no-exercise method [National Aeronautics and Space Administration (NASA) method], to estimate maximum oxygen consumption (VO2max) in college adults.Materials and methods: This is a study of validation of a test, which included 94 healthy individuals of both sexes (18-55 years). The gold standard was ergospirometry. The validity and reproducibility were evaluated with the intraclass correlation coefficient (ICC) and the Bland-Altman analysis.Results: Among the participants, a mean age of 30.54 ± 9.33 years and a VO2max of 41.29 ± 9.54 mLO2.kg-1.min-1 was found; 48.9% were women. A mean difference of VO2max between ergospirometry and that estimated by the NASA method of 3.41 ± 5.64 mLO2.kg-1.min-1 was found. The concordance between the two methods was good with an ICC of 0.858 (95% CI 0.672-0.926). The percentage of error was 29.70%. The reproducibility of the two estimates by the NASA method was excellent with an ICC of 0.986 (95% CI 0.927-0.995).Conclusions: The NASA method is valid and reproducible to estimate VO2max in college adults; in addition, it is safe and easy to apply. Estimation of cardiorespiratory fitness is recommended to improve screening in cardiometabolic risk programs and implement timely interventions.Introducción. La capacidad física cardiorrespiratoria es un predictor de mortalidad cardiovascular y por todas las causas. Su diagnóstico en diferentes grupos tiene utilidad clínica y en salud pública.Objetivo. Evaluar la validez y reproducibilidad de un método de no ejercicio [método de la Administración Nacional de la Aeronáutica y del Espacio (NASA), por sus siglas en inglés], para estimar el consumo de oxígeno máximo (VO2máx) en adultos universitarios. Materiales y métodos. Estudio de validación de una prueba que incluyó 94 individuos sanos de ambos sexos (18-55 años). El estándar de oro fue la ergoespirometría. La validez y la reproducibilidad se evaluaron con el coeficiente de correlación intraclase (CCI) y el análisis de Bland-Altman. Resultados. Entre los participantes, se encontró una media de edad de 30,54 ± 9,33 años y de VO2máx de 41,29 ± 9,54 mLO2.kg-1.min-1; el 48,9% fueron mujeres. Se encontró una diferencia de medias de VO2máx entre la ergoespirometría y el estimado por el método NASA de 3,41 ± 5,64 mLO2.kg-1.min-1. La concordancia entre los dos métodos fue buena con un CCI de 0,858 (IC 95% 0,672-0,926). El porcentaje de error fue del 29,70%. La reproducibilidad de las dos estimaciones por el método NASA fue excelente con un CCI de 0,986 (IC 95% 0,927-0,995). Conclusiones. El método NASA es válido y reproducible para estimar el VO2máx en adultos universitarios; además, es seguro y de fácil aplicación. Se recomienda la estimación de la capacidad física cardiorespiratoria para mejorar la tamización en los programas de riesgo cardiometabólico e implementar intervenciones oportunas

Diseño de una metodología para la identificación, medición y gestión de riesgo financiero y operacional en cadenas de abastecimiento en empresas colombianas.

El proyecto Diseño de una metodología para la identificación, medición y gestión de riesgo financiero y operacional en cadenas de abastecimiento en empresas colombianas se orientó hacia la construcción de metodologías para la identificación, medición y gestión de los riesgos operacionales y financieros en cadenas de abastecimiento de diferentes tipos de empresas. Las metodologías que se desarrollaron son lo suficientemente generales para que se facilite su aplicación en diferentes tipos de organizacione

Dinámica de la actividad empresarial en Colombia.

Este libro está estructurado en la siguiente forma: los primeros cuatro capítulos explican el significado, alcances, modelo y metodología del estudio GEM. El capítulo 5 presenta los resultados de la Encuesta Nacional a Expertos en donde se analiza la situación de las 9 condiciones estructurales del entorno empresarial en Colombia. El capítulo 6 presenta un análisis de la actividad empresarial colombiana a través del modelo de la Tubería Empresarial. El capítulo 7 estudia el fenómeno de “Salidas Empresariales”. El capítulo 8 hace la caracterización de los empresarios por distintas variables y factores. El capítulo 9 presenta una caracterización de las empresas colombianas. El Capítulo 10 analiza el fenómeno de la actividad intra-empresarial. El capítulo 11 estudia el tema de financiación, y el capítulo 12 presenta las conclusiones y recomendaciones. Se incluyen en el documento varios anexos con información adicional.CONTENIDO: Introducción -- Significado y alcance -- Modelo conceptual – Metodología -- El entorno empresarial -- La tubería empresarial -- Salidas empresariales -- Los empresarios colombianos -- Las empresas colombianas -- Actividad intra-empresarial -- Fuentes de financiación -- Conclusiones y recomendaciones -- BibliografíaIncluye referencias bibliográficasGEM Colombia 2019: Universidad Icesi, Pontificia Universidad Javeriana de Cali, Universidad del Norte, Universidad EAN, Corporación Universitaria del Caribe, Universidad Cooperativa de Colombia de Bucaramanga, Corporación Universitaria Americana

Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy : which subfertile patients benefit from surgery?

The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041). MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered

GEM Colombia 2020-2021

Este reporte está organizado en siete capítulos. El primero corresponde al resumen ejecutivo. El segundo presenta las generalidades del estudio, el modelo conceptual que lo sustenta y la metodología empleada. El tercero recoge las percepciones de la población y expertos sobre el entorno empresarial. El cuarto comprende un análisis de los emprendedores, desde una óptica sociodemográfica hasta el enfoque de Talento Empresarial (META, por sus siglas en inglés). El quinto realiza una caracterización de las empresas colombianas según etapa de la actividad emprendedora, sector económico, internacionalización, financiación, entre otras variables. El sexto es un especial que aborda las implicaciones derivadas de la coyuntura del coronavirus. El séptimo y último capítulo brinda las conclusiones y recomendaciones.GEM es un proyecto de investigación ejecutado por un consorcio internacional de investigadores con el fin de monitorear la actividad emprendedora en diversos países Para 2020, el proyecto contó con la participación de más de 40 países de los cinco continentes

Oficio de historiador - Enfoques y prácticas -

El libro Oficio de historiador. Enfoques y prácticas muestra diversos panoramas reflexivos de la disciplina de la historia, según miradas interpretativas que van de los objetos del oficio de historiador hasta las apuestas de la escritura en la apertura de las potencialidades de los enfoques, a la hora de examinar las huellas de la memoria impresas en los materiales de la historia. Este libro es el resultado del análisis, corrección y puesta en obra de un gran número de ponencias de la IV Muestra Regional de Historia, realizada en Medellín en el mes de septiembre de 2012, evento que tuvo como principal propósito recordar a la historiadora fallecida Beatriz Patiño (1952-2012). El libro está integrado por tres partes, siguiendo los marcos temporales desarrollados por los autores en sus textos, según problemáticas históricas propias de los siglos XVIII, XIX y XX. La diversidad de temas abordados, los cuales revelan los enfoques y prácticas el oficio del historiador en Antioquia, manifiestan el profundo interés que ha suscitado la transición del período colonial al período republicano, la sociedad colombiana en el siglo XIX y las características de Colombia en el siglo XX. Esta organización de la obra y los abordajes de sus capítulos manifiestan una serie de orientaciones e intereses temáticos que van desde asuntos políticos, sociales y culturales hasta económicos, con trabajos de orden local, nacional, internacional y global