Preparación de la (E,E)-piridin-2- carboxaldehido-[2- heptiltiopirimidin-4,6-dill] bishidrazona para el diseño de sistemas supramoleculares

Se diseñó y sintetizó el nuevo compuesto bishidrazónico tiopirimidínico (E,E)-Piridin-2-carboxaldehído-[2-heptiltiopirimidin-4,6-diil]bishidrazona cuya base estructural es el sistema piridina-hidrazona-tiopirimidina. La obtención de esta molécula implicó 4 etapas sintéticas, y cada uno de sus precursores, al igual que la bishidrazona, fueron caracterizados mediante espectroscopia de Resonancia Magnética Nuclear (RMN) monodimensional (1H, 13C, DEPT-135) y bidimensional (HSQC, NOESY), FT-IR, y espectrometría de masas. Una vez obtenida esta bishidrazona, se realizaron algunos estudios fotofísicos mediante espectrofotometría de ultravioleta-visible y fluorescencia en solventes de diferente polaridad. Posteriormente, se realizó la síntesis de los complejos metálicos con zinc, níquel y plomo del compuesto bishidrazónico obtenido. De los anteriores se destaca el complejo formado con zinc, para el cual se propuso una estructura, donde los iones de zinc están unidos al sistema piridina-hidrazona-pirimidina y la configuración del ligando cambia de transoide a cisoide. Una vez obtenidos los complejos metálicos, se observó su comportamiento fotofísico mediante las técnicas de espectrofotometría mencionadas. Finalmente se llevó a cabo un estudio fotoquímico de la bishidrazona sintetizada, en solventes orgánicos deuterados como CD3OD, DMSO-d6 y Acetona-d6. La obtención de los diferentes isómeros configuracionales se siguió por RMN 1H. La fotoisomerización de este sistema es una reacción consecutiva de primer orden, se calcularon las constantes cinéticas k1 y k2 de los procesos de fotoisomerización [E,E]-[E,Z] y [E,Z]-[Z,Z] respectivamente. La preparación de este compuesto bishidrazónico permitirá la obtención de sistemas supramoleculares tales como complejos heterobimetálicos, interruptores moleculares y estructuras poliméricas capaces de coordinar iones metálicos y adherirse a superficies exhibiendo una alta solubilidad en solventes orgánicos.PregradoQUÍMICO(A

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

Synthesis and coupling of [c2]daisy chain rotaxanes for the fabrication of stimuli-responsive materials

Les matériaux actionnables basés sur des machines moléculaires synthétiques ont un grand potentiel pour faire partie d'une révolution technologique permettant de relever certains défis en médecine régénérative, interfaces homme-machine, robotique, entre autres. Dans cette direction, plusieurs groupes de recherche ont investi de nombreux efforts pour coupler les machines moléculaires entre elles et avec leur environnement afin d'exploiter leur mouvement collectif (à l'échelle nanométrique) à des échelles de longueur plus élevées. Cependant, pour aller plus loin et obtenir des actions macroscopiques optimisées, il est nécessaire de contrôler précisément leur organisation spatiale en 3D sur de très longues distances. Ce travail décrit trois approches différentes pour la synthèse de matériaux qui traduisent le mouvement de leurs composants en une réponse macroscopique. Le chapitre 1 est consacré à l'état de l'art des rotaxanes bistables [c2] afin de contextualiser le lecteur. Le chapitre 2 décrit la voie de synthèse suivie pour obtenir des mésophases mécaniquement actives avec un rotaxane bistable [c2] à l'état cristallin liquide. Les chapitres 3 et 4 sont principalement consacrés à la conception et à la synthèse de monomères de rotaxanes bistables [c2] qui seront impliqués dans des polymérisations covalentes et supramoléculaires. En particulier, le chapitre 4 aborde la plupart des approches synthétiques qui ont été conçues pour obtenir des monomères de rotaxanes bistables [c2] sensibles à l'oxydoréduction, lesquels ont été utilisés pour la polymérisation et l'électrofilage de fibres. Ce dernier chapitre a été réalisé dans le cadre du projet collaboratif MAGNIFY FET-open, un consortium composé de l'Université de Groningen, de l'Université de Bologne, du Centre National de Recherche en Italie et de notre institution, le Centre National de la Recherche Scientifique.Actuating soft materials based on synthetic molecular machines has great potential to be part of a technological revolution addressing challenges in regenerative medicine, human-machine interfaces, robotics, among others. In this direction, several research groups, including ours, have invested significant efforts in coupling molecular machines with each other and their environment to extract their collective (nanometric) motion at higher length scales. However, to further advance these molecular machines and extract optimized macroscopic actuations, precise control over their spatial 3D organization over very long distances is required. This work describes three different approaches for synthesizing materials that translate the motion of their components into a macroscopic response. Chapter 1 is dedicated to the state of the art of [c2]daisy chain rotaxanes to provide context for the reader. Chapter 2 describes the synthetic pathway followed to obtain mechanically active mesophases using a liquid-crystalline [c2]daisy chain rotaxane. Chapters 3 and 4 are primarily focused on the design and synthesis of [c2]daisy chain rotaxane monomers for involvement in covalent and supramolecular polymerizations. In particular, Chapter 4 addresses most of the synthetic approaches that were developed to obtain redox-responsive poly[c2]daisy chain rotaxane monomers, which were utilized for polymerization and subsequent electrospinning into fibres. The work presented in this final chapter was conducted within the framework of the MAGNIFY FET-open collaborative project, a consortium composed of the University of Groningen, the University of Bologna, the National Research Centre in Italy, and our institution, the Centre National de la Recherche Scientifique

Business consulting de la empresa Agrícola Huarmey SAC

Las empresas agrícolas peruanas están afrontando un cambio drástico con la nueva normalidad del mercado post pandemia, así como un cambio en la regulación tributaria frente al estado peruano. Por tal motivo se deben afrontar estos grandes desafíos con soluciones ágiles y versátiles que les permita una mayor eficiencia en el sistema de producción y comercialización de los productos ofrecidos al mercado, por lo que el propósito de este trabajo de consultoría es realizar un business consulting report a Agrícola Huarmey SAC, a fin de analizar a la empresa para encontrar las deficiencias y ofrecer alternativas de solución que le permita mejorar el desempeño y rentabilidad de sus actividades a mediano y largo plazo, enfocándose específicamente en mejoras operacionales relacionadas directamente con la reducción de costos en mano de obra y uso de agroquímicos, los cuales representan el mayor porcentaje del costo de producción de la empresa. En el presente business consulting se analizaron tanto los factores internos de la empresa, como los factores externos donde se desarrolla la misma, identificando fortalezas, debilidades, oportunidades y amenazas (FODA), se realizaron entrevistas a las gerencias como al personal del fundo, obteniendo información y sensaciones de primera mano sobre las diversas áreas y actividades realizadas en cada una de ellas, para que de esta manera se pueda identificar, enlistar y priorizar los principales problemas y las causas que originan los mismos. En base al diagnóstico realizado se detectó como problema principal es la baja productividad y poca eficiencia en los costos de producción del granado por hectárea, ante ello se revisaron opciones de solución. Atreves del análisis causa-raiz y en base en el análisis externo e interno y la literatura investigada se propone como alternativa de solución la estandarización y optimización de los siguientes procesos de la empresa en el fundo de la ciudad de Ica :(a) Proceso de inicio de labores e ingreso de personal nuevo al fundo, (b) Proceso logístico de transporte del personal, y (c) Proceso de retiro de productos de almacenes.Peruvian agricultural companies are facing a drastic change with the new normality of the post-pandemic market, as well as a change in tax regulation against the Peruvian state. For this reason, these great challenges must be faced with agile and versatile solutions that allow greater efficiency in the production and marketing system of the products offered to the market, so the purpose of this consulting work is to carry out a business consulting report. to Agrícola Huarmey SAC, in order to analyze the company to find deficiencies and offer alternative solutions that allow it to improve the performance and profitability of its activities in the medium and long term, specifically focusing on operational improvements directly related to the reduction of labor costs and the use of agrochemicals, which represent the highest percentage of the company's production cost. In this business consulting, both the internal factors of the company and the external factors where it is developed were analyzed, identifying strengths, weaknesses, opportunities and threats (SWOT), interviews were conducted with the management and staff of the farm, obtaining information and first-hand sensations about the various areas and activities carried out in each one of them, so that in this way the main problems and the causes that originate them can be identified, listed and prioritized. Based on the diagnosis carried out, the main problem was detected as low productivity and little efficiency in the production costs of pomegranate per hectare, before this solution options were reviewed. Through the root-cause analysis and based on the external and internal analysis and the researched literature, the standardization and optimization of the following company processes in the Ica city estate is proposed as an alternative solution: (a) Process of start of work and entry of new personnel to the farm, (b) Logistic process for personnel transportation, and (c) Process of withdrawal of products from warehouses

Servicios ecosistémicos: un enfoque introductorio con experiencias del occidente colombiano

Con el interés de transmitir y apropiar diversas comunidades en temáticas asociadas a los servicios ecosistémicos, el presente libro entrega 15 capítulos que aproximarán al lector hacia la conceptualización y apropiación de conocimientos básicos,&nbsp; asociados a los diversos servicios ecosistémicos brindados generosamente por la naturaleza. El capítulo 1, Introducción al estado del arte de los servicios ecosistémicos en la región occidental colombiana, introduce al lector hacia la apropiación conceptual de los servicios ecosistémicos, contando experiencias relevantes del contexto colombiano. Los 14 capítulos posteriores también tendrán una fase introductoria, estudios de caso basados en experiencias del occidente colombiano y resultados de investigaciones realizadas por los autores. En estos capítulos, el lector encontrará información relevante sobre cuatro grupos de servicios ecosistémicos: abastecimiento, regulación, apoyo y culturales. Este libro es el resultado del arduo trabajo consolidado por un equipo interdisciplinario que, a partir de la integración de saberes y resultados de investigación, logró construir un material de lenguaje sencillo que se espera sea de gran utilidad para diversos lectores interesados en apropiarse del conocimiento básico, orientado hacia la familiarización y el compromiso con la protección de los ecosistemas y sus servicios

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

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

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