Avances tecnológicos recientes en el diagnóstico y tratamiento de las enfermedades de la laringe y el tracto aerodigestivo superior

Los continuos desarrollos tecnológicos en los años recientes han permitido un mejor entendimiento de la anatomía y fisiología de los pliegues vocales y del tracto digestivo superior. Técnicas de diagnóstico como la laringoscopia de alta velocidad, la videoquimografía, la laringoscopia de acercamiento de alta resolución en la oficina y la impedanciometría esofágica con manometría, son herramientas muy importantes en la práctica clínica moderna. En lo que respecta a tratamiento, el desarrollo de equipos de laser acoplados a sistemas robóticos, fibras para la aplicación de rayos laser de diferentes longitudes de onda a sitios específicos, e instrumentos para ser usados a través de endoscopios flexibles, ampliaron las posibilidades terapéuticas, y, en casos seleccionados, las perspectivas para la ejecución de procedimientos mínimamente invasivos sin necesidad de hospitalización

Caracterización de cuatro variedades de frijol (Phaseolus vulgaris L.) por sus cualidades físicas y nutricionales. I. Aspectos metodológicos.

La semilla de las variedades de frijol: BAT 104, Bayo Río Grande, Canario 107 y Jamapa se evaluaron con el objetivo de caracterizarla mediante el análisis del contenido de proteína, L-triptofano (L-trp) y L-metionina disponible (L-met), así como sus cualidades tecnológicas. Se realizaron pruebas preliminares sobre contenido de L-met y L-trp en proteína soluble en extractos acuosos de NaCl, ácido acético y etanol empleando los métodos microbiológico y espectrofotométrico, respectivamente. Bayo Río Grande, la de mayor tiempo de cocción (98 minutos), mostró la mayor proporción en peso de testa (11,4); sin embargo, junto con BAT 104 y Jamapa fueron las de menor tamaño. BAT 104, fue la variedad en que se detectó el mayor contenido de proteína total (27,3 %) contrastando con Bayo Río Grande (23,3%). En promedio de las cuatro variedades el contenido de ambos aminoácidos resultó mayor en los extractos salinos (43 % L-met y 92 % L-trp). En consecuencia las determinaciones subsecuentes se realizaron únicamente en los extractos salinos de los materiales. Las variedades Bayo Río Grande y Canario 107 tuvieron la mayor cantidad de L-met y L-trp, respectivamente

Calidad en el sector de operadores logísticos y almacenes marítimos y fluviales en el Perú

Esta es una investigación de alcance descriptivo, con enfoque cuantitativo, que busca identificar el nivel de cumplimiento percibido en cada uno de los nueve factores de éxito del TQM en el sector operadores logísticos y almacenes marítimos y fluviales en el Perú; los cuales permiten medir el desempeño de las empresas, en cuanto a la gestión de la calidad son nueve. Estos son los siguientes: (a) Alta Gerencia, (b) Planeamiento de la Calidad, (c) Auditoría y Evaluación de la Calidad, (d) Diseño del Producto, (e) Gestión de la Calidad del Proveedor, (f) Control y Mejoramiento del Proceso, (g) Entrenamiento y Educación, y (i) Enfoque hacia la Satisfacción del Cliente. La investigación se hizo utilizando el cuestionario TQM, desarrollado por Benzaquen (2013), donde las respuestas se ajustaban a una escala tipo Likert, mediante la cual las empresas realizaron una autovaloración del nivel de cumplimiento de distintos aspectos relacionados con la calidad. La población de estudio estaba integrada por 76 elementos, por lo que se decidió hacer un censo cubriendo al 100% de las empresas que integran el sector, donde se entrevistó principalmente al Gerente General. Dado que el diseño del estudio es transeccional, los resultados que se obtuvieron solamente reflejan la situación que había entre los meses de julio y septiembre del 2014. Las conclusiones de la investigación dan a conocer que las empresas peruanas del sector operadores logísticos y almacenes marítimos y fluviales tienen un buen desempeño en cada uno de los nueve factores de la calidad, al obtener puntajes entre 4.00 y 4.05, en un rango de 1.00 a 5.00. Sin embargo, al evaluar la consistencia interna de los nueve factores de la calidad utilizando el Alfa de Cronbach se conoció que ninguno superaba los valores mínimos necesarios para poder ser analizados como índices compuestos. Este resultado no permite, por lo tanto, aplicar el modelo propuesto por Benzaquen (2014) para el sector de Operadores Logísticos y Almacenes Marítimos y Fluviales del Perú.This research is a descriptive and explanatory scope, with a quantitative approach, which seeks to identify the level of compliance perceived success factors of TQM in Logistics and Warehouse Operators Maritime and River Sector in Peru. Where success factors to measure the performance of companies in terms of quality management are the following nine: (a) senior management, (b) quality planning, (c) auditing and quality assessment (d) product design, (e) management of supplier quality, (f) control and process improvement, (g) training and education, and (i) focus on customer satisfaction. The research was conducted following the TQM methodology, developed by Benzaquen (2013), using a questionnaire, where responses were consistent with the scale of Lickert. The study population consisted of 76 elements, and therefore a census was done covering 100% of total companies from this sector, where the interview was primarily addressed to the General Manager. Since the study design is transactional, the results obtained reflect only the situation that existed between the months of July and September 2014. Findings indicate that Peruvian companies and Warehouse Logistics Operators Sector Maritime and River have a good performance in each one of the nine quality factors, obtaining scores between 4.00 and 4.05, ranging from 1.00 to 5.00. Which shows a very similar behavior in all elements. However, when assessing the internal consistency of the nine factors of quality using Cronbach's alpha there was found that none exceeded the minimum value needed to be analyzed as composite indexes. This result indicates that methodology designed by Benzaquén (2014) does not apply for the sector of logistics operators in Peru.Tesi

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 9

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 9, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

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

Proyecto Profesional 2 - IP61 - 202101

Descripción: Curso de especialidad en la carrera de ingeniería civil EPE de carácter teórico-práctico dirigido a los estudiantes del 9no ciclo. El curso Proyecto Profesional 2 busca que los estudiantes de Ingeniería Civil apliquen sus capacidades adquiridas durante todos sus estudios, en completar una investigación, que plantea resolver una problemática en una de las líneas de la carrera. Con la ayuda de un docente asesor especialista en el tema lograran redactar el informe de tesis al 75%, este informe será revisado por otro docente especialista que proporciona sugerencias de mejoras a la investigación. Por último, los estudiantes exponen ante un jurado especialista sus resultados quienes evalúan y también hacen sugerencia de mejoras a la investigación. Propósito: En el Perú actualmente existe un gran número de estudiantes de Ingeniería Civil que no cuentan con el título profesional, por no realizar la tesis de investigación, lo cual disminuye significativamente su desarrollo profesional y sus oportunidades laborales. El curso de Proyecto Profesional 2 permite que los estudiantes puedan desarrollar el 75% de la Tesis de investigación, siendo la misma certificada por un asesor y un jurado 1evaluador