Complejo asistencial de servicios socio - culturales para Chiclayo

La tesis titulada con el nombre de ¨Complejo asistencial de servicios socioculturales para Chiclayo¨ trata de un complejo de tipología poli funcional, es decir que este proyecto estará formado por varios componentes arquitectónicos que responda a la problemática sobre el déficit del equipamiento asistencial, así como inexistencia de servicios religiosos, culturales y educativos del sector donde se ubicara dicho proyecto. Con la creación de este proyecto se ayudara a promover el desarrollo social y local brindando aquellos servicios por los cuales carece el sector para que así se pueda mejorar la calidad de vida de la población. Con la implementación del servicio asistencial se brindara la protección y atención integral que respondan a las necesidades primordiales, cumpliendo con la satisfacción de las menores y mujeres. Con la implementación del servicio religioso se impulsara una mayor integración social a través de la fe, realizando actividades de capacitación sacramental en beneficio de la comunidad para congregar a más feligreses. Con la implementación del servicio cultural se brindara talleres culturales como danza, música y teatro que ayuden a integral a la comunidad. Con la implementación del servicio educativo se podrá atender a la demanda requerida del sector en cuanto a la educación básica del nivel inicial .Tesi

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

Elderly; Infection; ProcalcitoninAnciano; Infección; ProcalcitoninaAncià; infecció; ProcalcitoninaPurpose Optimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection. Methods Within a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT). Results The expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of “biomarker-guided antibiotic stewardship” for health care providers caring for elderly patients. Conclusion Use of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.Open access funding provided by University of Basel

Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S10

COVID-19; SARS-Cov-2; Síndrome coronari agutCOVID-19; SARS-Cov-2; Síndrome coronario agudoCOVID-19; SARS-Cov-2; Acute coronary syndromeBackground: There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. Objective: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. Methods: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. Results: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). Conclusions: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortalit

Increased severity in SARS-CoV-2 infection of minorities in Spain

Introduction: With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. Material and methods: A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. Results: There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). Conclusions: COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed

Cuestionario de ejercicio basado en el modelo transteórico de la conducta en una muestra mexicana

Se elaboró un cuestionario de ejercicio basado en el modelo transteórico de cambio de la conducta propuesto por Prochaska y DiClemente. Este cuestionario fue diseñado para medir los cinco factores del modelo: precontemplación, contempla ción, preparación, acción y mantenimiento. Primero se elaboraron los reactivos para cada uno de los factores y después se llevó a cabo un análisis factorial exploratorio para analizar la estructura del cuestionario. La muestra fue de 951 participantes de cinco ciudades mexicanas, con una media de edad de 28.76 años. El análisis factorial exploratorio mostró una estructura compuesta de los cinco factores con pesos factoriales variables. Este cuestionario puede ser útil para identificar la etapa en la que una persona se encuentra en relación con hacer ejercicio, y saber qué técnicas usar en las posibles intervenciones

Clinical Outcomes and Cost Analysis of Fibula Free Flaps: A Retrospective Comparison of CAD/CAM versus Conventional Technique

(1) Background: A decrease in operative time can not only improve patient outcomes through a reduction in the risk of developing complications but can also result in cost savings. The aim of this study is to determine whether there an intraoperative time gain can be achieved by using the preoperative virtual planning of mandibular reconstruction using a free fibula flap compared with freehand plate bending and osteotomies. (2) Methods: A retrospective comparative study was carried out in the Oral and Maxillofacial Department of La Paz University Hospital, Madrid, Spain. The study compared 18 patients in the CAD/CAM group with 19 patients in the conventional freehand group. A comparison was made between the total surgical time, the comorbidities, and the hospital stay. The resource consumption was estimated using a cost analysis. (3) Results: Although CAD/CAM was a statistically more expensive procedure in the perioperative phase, no significant differences were observed in total health care costs between the two groups. There was a non-significant trend towards an increase in complications with conventional reconstruction plates compared to patient-specific plates (PSI). (4) Conclusions: CAD/CAM technology and a 3D printed cutting guide offer a significantly shorter surgical time, which is associated with a reduction in hospital days, PACU days, and complications. The cost of CAD/CAM technology is comparable to that of the conventional freehand technique

Desafíos de las metrópolis: Efectos ambientales y sociales. Tendencias geográficas II

El libro está conformado de estudios realizados por profesores-investigadores de la Universidad Autónoma del Estado de México, de la Universidad de Varsovia, así como de la Universidad Pedagógica Comisión de Educación Nacional de Cracovia. En esta obra se exponen algunas investigaciones sobre los cambios en los factores sociales, naturales, económicos y ambientales como principales desafios que presentan las zonas de México, Polonia y de contextos de Sudamérica, tales como Sao Paulo, Quito y Bogotá y ciudades medias y pequeñas.Universidad Autónoma del Estado de Méxic

1873-1874, End of a Century?: Time and Space in Valera's Pepita Jiménez, Ros de Olano's Jornadas de retorno, and Alarcón's El sombrero de tres picos and La Alpujarra

This article argues for the existence of a literature of the first Spanish Republic in the early 1870s. Valera's Pepita Jimenez makes sense in relation to this literature, rather than in comparison with 'Realism'. The literature of the first republic is distinguished by two facets: an ongoing dialogue with Ros de Olano's experiments in simultaneous compression and extension of form; and a belief that the nineteenth-century revolutionary spirit of the age has reached a critical end point, and needs reinvention that leads to Restoration politics

Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial

Objectives: To study the effect of high-risk criteria on 30-day outcomes in frail older patients with acute heart failure (AHF) discharged from an emergency department (ED) or an ED's observation and short-stay areas. Material and methods: Secondary analysis of discharge records in the Older AHF Key Data registry. We selected frail patients (aged > 70 years) discharged with AHF from EDs. Risk factors were categorized as modifiable or nonmodifiable. The outcomes were a composite endpoint for a cardiovascular event (revisits for AHF, hospitalization for AHF, or cardiovascular death) and the number of days alive out-of-hospital (DAOH) within 30 days of discharge. Results: We included 380 patients with a mean (SD) age of 86 (5.5) years (61.2% women). Modifiable risk factors were identified in 65.1%, nonmodifiable ones in 47.8%, and both types in 81.6%. The 30-day cardiovascular composite endpoint occurred in 83 patients (21.8%). The mean 30-day DAOH observed was 27.6 (6.1) days. Highrisk factors were present more often in patients who developed the cardiovascular event composite endpoint: the rates for patients with modifiable, nonmodifiable, or both types of risk were, respectively, as follows in comparison with patients not at high risk: 25.0% vs 17.2%, P = .092; 27.6% vs 16.7%, P = .010; and 24.7% vs 15.2%, P = .098). The 30-day DAOH outcome was also lower for at-risk patients, according to type of risk factor present: modifiable, 26.9 (7.0) vs 28.4 (4.4) days, P = .011; nonmodifiable, 27.1 (7.0) vs 28.0 (5.0) days, P = .127; and both, 27.1 (6.7) vs 28.8 (3.4) days, P = .005). After multivariate analysis, modifiable risk remained independently associated with fewer days alive (adjusted absolute difference in 30-day DAOH, -1.3 days (95% CI, -2.7 to -0.1 days). Nonmodifiable factors were associated with increased risk for the 30-day cardiovascular composite endpoint (adjusted absolute difference, 10.4%; 95% CI, -2.1% to 18.7%). Conclusion: Risk factors are common in frail elderly patients with AHF discharged home from hospital ED areas. Their presence is associated with a worse 30-day prognosis