El Perú hacia 2062: pensando juntos el futuro

Presenta, en la primera parte, proyecciones para la economía nacional a mediano y largo plazo en base a una lectura cuidadosa de nuestra historia económica, de los pronósticos sobre el contexto económico internacional y de las transformaciones demográficas y tecnológicas que nos afectan. Resalta la especial importancia del sector minero y también las brechas que persisten entre este sector y el resto de nuestra economía. En la segunda parte, analiza la pobreza multidimensional que caracteriza a las diversas regiones del país, la cual no ha podido erradicar por sí solo el crecimiento macroeconómico; y se reflexiona sobre los desafíos que esto implica para todos. ¿Qué hacer entonces para seguir creciendo con mayor inclusión social? ¿Cómo aprovechar mejor para ello los recursos que tenemos hoy? En la tercera y cuarta partes de este trabajo, se analiza dos temas fundamentales tanto para el crecimiento económico sostenido como para la inclusión social: la educación y la infraestructura pública. La quinta sección presenta conclusiones y recomendaciones. Aunque provienen de diversas disciplinas y perspectivas académicas, los investigadores que contribuyeron a este trabajo coinciden en la observación de que el Perú siempre ha tenido ventajas para crecer económicamente

Evaluación de la expresión del gen GLP-1 (péptido 1 homologo al glucagón) en ratas inducidas a Diabetes Mellitus tipo 2 tratadas con extracto metanólico de Schkuhria pinnata (Canchalagua).

The expression of GLP-1 gene was evaluated in rats induced to type 2 Diabetes Mellitus and treated with methanol extract of Schkuhria pinnata (Canchalagua). In vivo studies were performed. Experimental type 2 diabetes was induced in 4 months age Wistar novergicus male rats by administration of Streptozotocin- Nicotinamide (65mg/kg and 330mg/kg), then, diabetes was confirmed by monitoring the glucose variation and histopathology of diabetic´s pancreas. The hypoglycemic effect of Schkuhria pinnata (Canchalagua) was evaluated during 25 days after the induction of experimental diabetes, showing a statistically significant decrease (P <0.05) in groups C, D and E (rats induced to type 2 diabetes experimental treated with Metformin 330mg/kg, methanolic extract of Canchalagua a 20 mg/kg y 40 mg/kg, respectively) since day 10, reaching normal values of glycemia at the end of the experiment. Subsequently, the GLP-1 gene expressions were evaluated in the rat distal small intestines by qPCR and the results showed that the group B expression was down-regulated by the factor 41.319 in comparison with the group A (normal rats), the group C, showed an upregulation with the factor 16.694 compared with group A, and the experimental groups D and E showed expressions up-regulated by the factors 7.292 and 7.761 in comparison with the group A.Se evaluó la expresión del gen GLP-1 en ratas inducidas a Diabetes Mellitus tipo 2 tratadas con extracto metanólico de Schkuhria pinnata (Canchalagua). Inicialmente se indujo la diabetes experimental homologa a la de tipo 2 en ratas macho Wistar novergicus de 4 meses de edad mediante la administración de Estreptozotocina-Nicotinamida, a dosis de 65mg/kg y 330mg/kg respectivamente, confirmándola mediante el monitoreo de la variación de glicemia y estudios histopatológicos en el páncreas de los ejemplares diabéticos. El efecto hipoglucemiante del extracto de Schkuhria pinnata (Canchalagua) evaluado durante los 25 días posteriores a la inducción de diabetes experimental, mostró una disminución estadísticamente significativa (P<0.05) en los grupos C, D y E (ratas inducidas a diabetes experimental tipo 2 tratadas con Metformina 330mg/kg, extracto metanólico de Canchalagua a 20 mg/kg y 40 mg/kg, respectivamente) a partir del día 10, llegando a valores normales de glicemia al finalizar el tiempo de estudio. Posteriormente, se evaluó la expresión del gen GLP-1 en el intestino delgado distal de los grupos experimentales mediante qPCR; los resultados mostraron que el grupo de ratas inducidas a diabetes experimental sin tratamiento posterior (grupo B) tuvo una inhibición de la expresión en 41.319 veces con respecto al grupo de ratas no inducidas a diabetes experimental (grupo A), mientras que los grupo C, D y E tuvieron una sobrexpresión de 16.694, 7.292 y 7.761 respectivamente, con respecto al grupo A. Los resultados hallados son consistentes con un moderado efecto del extracto de Schkuhria pinnata (Canchalagua) sobre la expresión del gen GLP-1 y además, un efecto sobre la regeneración de los islotes de Langerhans del páncreas, lo que ayuda a explicar el efecto hipoglucemiante observado

Tinkuy 2018 : los alimentos de mi comunidad, aprendiendo a vivir sanos y sin anemia. VII Encuentro Nacional de Niños y Niñas de Pueblos Originarios, Afroperuanos y de otras Tradiciones Culturales del Perú

El Ministerio de Educación, a través de la Resolución Ministerial N° 590-2014–MINEDU, encarga a la Dirección General de Educación Básica Alternativa, Intercultural Bilingüe y de Servicios Educativos en el Ámbito Rural – Digeibira, la organización del encuentro nacional de niños y niñas de pueblos originarios, afroperuanos y de otras tradiciones culturales, denominado Tinkuy. La palabra Tinkuy, proviene del quechua, significa “encuentro”. Esta actividad es un espacio de participación y de diálogo intercultural entre niños y niñas de distintos pueblos y tradiciones culturales, en el cual se promueve el respeto, reconocimiento y valoración de la diversidad cultural y lingüística a través del intercambio de sus saberes y prácticas culturales. El VII Tinkuy se tituló “Los Alimentos de mi Comunidad: Aprendiendo a vivir sanos y sin anemia”, y permitió no solo que los estudiantes participantes conocieran, reflexionen y valoren las prácticas alimenticias de sus pueblos, sino también que reconozcan la producción y preparación de los alimentos de sus comunidades e identifiquen cuáles contrarrestan la anemia. Este aprendizaje se realizó a través de proyectos liderados por los docentes de las instituciones educativas participantes en colaboración articulada con los padres de familia y los sabios de la comunidad. En dicha séptima edición, el Tinkuy contó con 39 delegaciones de estudiantes de 6to grado de primaria, de las cuales treinta y dos pertenecen a pueblos originarios andinos y amazónicos, dos delegaciones afroperuanas y cuatro delegaciones de Lima y Callao: 155 niños y niñas en total. Así mismo, este año se contó con la participación de invitados especiales, representantes del pueblo Quiché de Guatemala, de los pueblos Kichwa y Tsáchila de Ecuador. Todos los niños y niñas participantes se dieron cita en el Centro Vacacional Huampaní desde el 11 al 17 de octubre para intercambiar sus saberes y hacer posible una convivencia intercultural. En la presente memoria encontrarán un recuento de las actividades y visitas realizadas durante la semana del Tinkuy y los proyectos de aprendizaje

Tinkuy 2017 : así vivimos, nuestras prácticas culturales cotidianas. VI Encuentro Nacional de Niños y Niñas de Pueblos Originarios, Afroperuanos y de otras Tradiciones Culturales del Perú

El Ministerio de Educación, a través de la Dirección General de Educación Básica Alternativa, Intercultural Bilingüe y de Servicios Educativos en el Ámbito Rural (Digeibira) es el encargado de organizar el encuentro nacional de niños y niñas de pueblos originarios, afroperuanos y otras tradiciones culturales, conocido como Tinkuy. El Tinkuy busca promover en los niños y niñas el reconocimiento y valoración de la diversidad cultural mediante el intercambio de saberes, conocimientos y prácticas culturales visibilizando sus formas de vida, propiciando el diálogo intercultural y generando espacios para que los estudiantes expresen sus necesidades y demandas. El VI Tinkuy se denominó “Así vivimos: nuestras prácticas culturales cotidianas”, tema que propició que cientos de niños y niñas de todo el país fueran convocados y, bajo el asesoramiento de sus profesores, padres, madres y sabios de sus comunidades, organizaran sus proyectos para participar en el Tinkuy 2017. Veintisiete delegaciones de estudiantes de pueblos originarios andinos y amazónicos, tres delegaciones afroperuanas, cuatro delegaciones limeñas y un representante del pueblo mapuche (Chile), se dieron cita en el Centro Recreacional Huampaní para dar a conocer sus distintas prácticas de vida, intercambiar sus saberes y reconocer que, más allá de las diferencias, lo que los une es demostrar que es posible una convivencia intercultural en nuestro país

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

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

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