Estudios de caso Fuente de Oro (Meta) y Viotá (Cundinamarca)

En el presente trabajo, se logra obtener la consolidación de los temas aprendidos a lo largo del diplomado de profundización Supply Chain Management y cadenas de suministro, con la intención de aprehender los conocimientos y temas abordados dentro del curso, permitiendo así que los profesionales, apliquen conocimientos de gran relevancia dentro de la logísticos de los procesos productivos y administrativos. Adicionalmente, se podrá identificar los diferentes puntos relevantes de la Logística de distribución de productos perecederos: estudios de caso Fuente de Oro (Meta) y Viotá (Cundinamarca).In the present work, it is possible to obtain the consolidation of the topics learned throughout the Diploma of deepening Supply Chain Management and supply chains, with the intention of apprehending the knowledge and topics addressed within the course, thus allowing professionals to apply knowledge of great relevance within the logistics of productive and administrative processes. Additionally, the different relevant points of the Logistics of perishable products distribution can be identified: case studies Fuente de Oro (Meta) and Viotá (Cundinamarca)

Autosomal Dominantly Inherited Alzheimer Disease: Analysis of genetic subgroups by Machine Learning

Despite subjects with Dominantly-Inherited Alzheimer's Disease (DIAD) represent less than 1% of all Alzheimer's Disease (AD) cases, the Dominantly Inherited Alzheimer Network (DIAN) initiative constitutes a strong impact in the understanding of AD disease course with special emphasis on the presyptomatic disease phase. Until now, the 3 genes involved in DIAD pathogenesis (PSEN1, PSEN2 and APP) have been commonly merged into one group (Mutation Carriers, MC) and studied using conventional statistical analysis. Comparisons between groups using null-hypothesis testing or longitudinal regression procedures, such as the linear-mixed-effects models, have been assessed in the extant literature. Within this context, the work presented here performs a comparison between different groups of subjects by considering the 3 genes, either jointly or separately, and using tools based on Machine Learning (ML). This involves a feature selection step which makes use of ANOVA followed by Principal Component Analysis (PCA) to determine which features would be realiable for further comparison purposes. Then, the selected predictors are classified using a Support-Vector-Machine (SVM) in a nested k-Fold cross-validation resulting in maximum classification rates of 72-74% using PiB PET features, specially when comparing asymptomatic Non-Carriers (NC) subjects with asymptomatic PSEN1 Mutation-Carriers (PSEN1-MC). Results obtained from these experiments led to the idea that PSEN1-MC might be considered as a mixture of two different subgroups including: a first group whose patterns were very close to NC subjects, and a second group much more different in terms of imaging patterns. Thus, using a k-Means clustering algorithm it was determined both subgroups and a new classification scenario was conducted to validate this process. The comparison between each subgroup vs. NC subjects resulted in classification rates around 80% underscoring the importance of considering DIAN as an heterogeneous entity

Preliminary safety and efficacy of first-line pertuzumab combined with trastuzumab and taxane therapy for HER2-positive locally recurrent or metastatic breast cancer (PERUSE).

BACKGROUND: Pertuzumab combined with trastuzumab and docetaxel is the standard first-line therapy for HER2-positive metastatic breast cancer, based on results from the phase III CLEOPATRA trial. PERUSE was designed to assess the safety and efficacy of investigator-selected taxane with pertuzumab and trastuzumab in this setting. PATIENTS AND METHODS: In the ongoing multicentre single-arm phase IIIb PERUSE study, patients with inoperable HER2-positive advanced breast cancer (locally recurrent/metastatic) (LR/MBC) and no prior systemic therapy for LR/MBC (except endocrine therapy) received docetaxel, paclitaxel or nab-paclitaxel with trastuzumab [8\u2009mg/kg loading dose, then 6\u2009mg/kg every 3\u2009weeks (q3w)] and pertuzumab (840\u2009mg loading dose, then 420\u2009mg q3w) until disease progression or unacceptable toxicity. The primary end point was safety. Secondary end points included overall response rate (ORR) and progression-free survival (PFS). RESULTS: Overall, 1436 patients received at least one treatment dose (initially docetaxel in 775 patients, paclitaxel in 589, nab-paclitaxel in 65; 7 discontinued before starting taxane). Median age was 54\u2009years; 29% had received prior trastuzumab. Median treatment duration was 16\u2009months for pertuzumab and trastuzumab and 4\u2009months for taxane. Compared with docetaxel-containing therapy, paclitaxel-containing therapy was associated with more neuropathy (all-grade peripheral neuropathy 31% versus 16%) but less febrile neutropenia (1% versus 11%) and mucositis (14% versus 25%). At this preliminary analysis (52 months' median follow-up), median PFS was 20.6 [95% confidence interval (CI) 18.9-22.7] months overall (19.6, 23.0 and 18.1\u2009months with docetaxel, paclitaxel and nab-paclitaxel, respectively). ORR was 80% (95% CI 78%-82%) overall (docetaxel 79%, paclitaxel 83%, nab-paclitaxel 77%). CONCLUSIONS: Preliminary findings from PERUSE suggest that the safety and efficacy of first-line pertuzumab, trastuzumab and taxane for HER2-positive LR/MBC are consistent with results from CLEOPATRA. Paclitaxel appears to be a valid alternative taxane backbone to docetaxel, offering similar PFS and ORR with a predictable safety profile. CLINICALTRIALS.GOV: NCT01572038

Final results from the PERUSE study of first-line pertuzumab plus trastuzumab plus a taxane for HER2-positive locally recurrent or metastatic breast cancer, with a multivariable approach to guide prognostication

Background: The phase III CLinical Evaluation Of Pertuzumab And TRAstuzumab (CLEOPATRA) trial established the combination of pertuzumab, trastuzumab and docetaxel as standard first-line therapy for human epidermal growth factor receptor 2 (HER2)-positive locally recurrent/metastatic breast cancer (LR/mBC). The multicentre single-arm PERtUzumab global SafEty (PERUSE) study assessed the safety and efficacy of pertuzumab and trastuzumab combined with investigator-selected taxane in this setting. Patients and methods: Eligible patients with inoperable HER2-positive LR/mBC and no prior systemic therapy for LR/mBC (except endocrine therapy) received docetaxel, paclitaxel or nab-paclitaxel with trastuzumab and pertuzumab until disease progression or unacceptable toxicity. The primary endpoint was safety. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Prespecified subgroup analyses included subgroups according to taxane, hormone receptor (HR) status and prior trastuzumab. Exploratory univariable analyses identified potential prognostic factors; those that remained significant in multivariable analysis were used to analyse PFS and OS in subgroups with all, some or none of these factors. Results: Of 1436 treated patients, 588 (41%) initially received paclitaxel and 918 (64%) had HR-positive disease. The most common grade 653 adverse events were neutropenia (10%, mainly with docetaxel) and diarrhoea (8%). At the final analysis (median follow-up: 5.7 years), median PFS was 20.7 [95% confidence interval (CI) 18.9-23.1] months overall and was similar irrespective of HR status or taxane. Median OS was 65.3 (95% CI 60.9-70.9) months overall. OS was similar regardless of taxane backbone but was more favourable in patients with HR-positive than HR-negative LR/mBC. In exploratory analyses, trastuzumab-pretreated patients with visceral disease had the shortest median PFS (13.1 months) and OS (46.3 months). Conclusions: Mature results from PERUSE show a safety and efficacy profile consistent with results from CLEOPATRA and median OS exceeding 5 years. Results suggest that paclitaxel is a valid alternative to docetaxel as backbone chemotherapy. Exploratory analyses suggest risk factors that could guide future trial design

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Uso del software educativo JCLIC como recurso para mejorar la comprensión lectora en los estudiantes del tercer grado de educación primaria de la I.E. N° 40086 Patasagua; Tiabaya - Arequipa, 2019

En el presente trabajo de investigación realizado en la I.E. N° 40086 Patasagua; Tiabaya - Arequipa, se observa que los discentes del tercer grado de educación primaria presentan un nivel bajo en la comprensión lectora; se evidencia que leen muy poco, tienen dificultad para procesar sus pensamientos, incapacidad para razonar con contenidos verbales y carencia de estrategia lectoras, lo que trae como consecuencia pobreza del vocabulario y el poco hábito de lectura. Por tal motivo la investigación tuvo como: Objetivo principal: Determinar la variación del nivel de comprensión lectora al utilizar el software educativo Jclic como recurso para mejorar la comprensión lectora en los estudiantes del tercer grado de educación primaria de la I.E. N°40086 Patasagua; Tiabaya - Arequipa, 2019. Metodología: Es una investigación de tipo aplicativa con un diseño cuasi experimental, ya que se manipula deliberadamente una variable para estudiar sus efectos, explicar porque ocurre y en qué circunstancias, se usó como instrumento un, pre test y pos test a un grupo de estudio de 15 estudiantes del tercer grado de primaria. Es también una investigación explicativa descriptiva longitudinal retrospectiva por estudiar una variable a lo largo de un tiempo que en este caso es periódico. Se aplicó el software educativo Jclic como recurso para mejorar la comprensión lectora en los estudiantes y para la recolección de datos se dio a través de un pre test y un pos test aplicando una prueba objetiva, los mismos que fueron sometidos a un análisis estadístico con la prueba de t de Student. A través de los resultados obtenidos se demuestra que el nivel de comprensión lectora de los estudiantes del tercer grado de educación primaria en su mayoría (66.7%) antes de la aplicación del software educativo Jclic, está en el nivel de inicio y de proceso. Después de la aplicación del software educativo Jclic, el nivel de comprensión lectora que muestran los estudiantes del tercer grado de educación primaria en su mayoría (66.7%) es en logro previsto y destacado. Con estos resultados podemos decir, que existe una diferencia en la comprensión lectora y mejora en el aprendizaje de los estudiantes del tercer grado de primaria de la I.E. N° 40086 Patasagua; Tiabaya - Arequipa, al implementar el software educativo Jclic como recurso. Tal como se muestra en la prueba de hipótesis donde se concluye que existen diferencias estadísticamente significativas entre el pre test y el pos test.Tesi

Frequency and predictive factors for blank ureteroscopy, prospective observational study at the “Hospital Clínico Universidad de Chile”. 2016-2019

Introducción: la ureteroscopía hoy en día es la opción terapéutica preferida para el tratamiento de la litiasis ureteral. La ausencia de litiasis durante el intraoperatorio; es decir, la eliminación espontánea previa a la intervención está descrita en un 13.7% en reportes internacionales. En este estudio se determinó la tasa de ureteroscopía en blanco en el Hospital Clínico Universidad de Chile, así como también factores de riesgo asociados.Metodología: se incluyeron pacientes con historia de cólico renal previo y diagnóstico imagenológico con tomografía computarizada (TC) de litiasis ureteral, con indicación quirúrgica, sometidos a ureteroscopía semirrígida en un solo centro, entre los años 2016-2019. Se recolectaron a través de un formulario, datos pertinentes a tamaño, localización y densidad de la litiasis, además del tiempo de sintomatología, fecha de tomografía previo a la cirugía y la presencia o no de litiasis durante la intervención. Se analizaron las variables categóricas a través de test Chi-cuadrado y continuas con T-student.Resultados: de 156 pacientes analizados, 24 (15.4%) registraron ureteroscopías en blanco. No existió diferencia estadísticamente significativa en cuanto a edad, sexo o localización. Se pudieron determinar dos factores de riesgo asociados: 26% para el tamaño de la litiasis 30 días (p=0.006), aumentando la frecuencia en el grupo que cumplía con ambos criterios hasta un 35% (p=0.009). Conclusión: según los resultados, es fundamental el estudio preoperatorio con TC actualizada en pacientes con litiasis 30 días de antigüedad, para así reducir el riesgo de una intervención en blancoIntroduction: ureteroscopy today is the preferred therapeutic option for the treatment of ureteral lithiasis. The absence of lithiasis during the intraoperative; that is, spontaneous elimination prior to the intervention, it is described in 13.7% in international reports. In this study, the blank ureteroscopy rate was determined at the “Hospital Clínico Universidad de Chile”, as well as associated risk factors.Methodology: patients with a history of prior renal colic and computed tomography (CT) of ureteral lithiasis, with surgical indication, who underwent semi-rigid ureteroscopy in a center, between 2016-2019, were included. Data related to the size, location and density of the lithiasis were collected through a form, as well as the time of symptoms, date of tomography prior to surgery and the presence or absence of lithiasis during the intervention. Categorical variables were analyzed through Chi-square test and continuous with Student's T-test.Results: from a total of 156 patients, 24 (15.4 %) resulted in negative ureteroscopy. There was no statistic difference regarding age, gender or localization of the stone. We could determine two risk factors: 26% concerning the size of the stone, 30 days (p=0.006), increasing the risk of the group with both factors up to 35% (p=0.009).Conclusions: according to our results, an <30 days updated, CT scan its fundamental in the preoperative study of <7mm ureteral stone in order to reduce the risk of negative ureteroscop