Efecto en la calificación de riesgo por cambio de metodología en el segmento microcrédito en una Institución Financiera del Ecuador.

El trabajo desarrollado tiene como objetivo analizar la nueva Normativa de Calificación de Cartera expedida en el año 2012 por la Junta Bancaria la cual en su disposición JB-2011-1897 presentó cambios en la calificación de riesgo de los clientes de todos los segmentos de crédito, particularmente el Segmento Microempresa. Para el efecto se tomó como fuente los balances consolidados históricos de la institución financiera seleccionada, se realizaron entrevistas a los oficiales microempresa, microempresarios y se consideró importante conocer el punto de vista de la Gerente de Riesgo Financiero de la institución analizada a fin de conocer el punto de vista sobre la nueva Normativa. Se pudo identificar que el indicador de cartera vencida del Segmento Microempresa es el más alto en relación a los demás segmentos de cartera que la institución analizada presenta y esto se debe a que muchos clientes microempresa no están al día en sus pagos y desconocen la nueva Normativa de Calificación de Cartera de Créditos para lo cual en base a la investigación realizada se propone un Programa de Educación Financiera que sirva de beneficio para el público en general y para aquellas personas que estén por solicitar un crédito especialmente los microempresarios

Economic evaluation of “pulse dose” radiofrequency in the treatment of occipital neuralgia headache

Headache occipital neuralgia is an example of pain-disease for which treatment both pharmacological protocols and invasive methods are used. Among the latter, the RF (Radiofrequency) pulse-dose has been of interest for the prospects of analgesic efficacy, safety and patient compliance, although at the moment only data concerning the pulsed RF and not the RF pulse-dose, that represents its evolution, are discussed in scientific literature. The purpose of this study is a "simple" economic evaluation of this method in headache occipital neuralgia

Dinamika roda Acartia (Calanoida: Copepoda) u temperiranom plitkom estuariju (ušće rijeke Mondego) na zapadnoj obali Portugala

The purpose of this work was to review the dynamics of the Acartia species in the Mondego estuary (a temperate North-Atlantic shallow estuary in Western Portugal) in a genus integrated perspective. The Acartia genus is represented in the system by the species Acartia clausi and Acartia tonsa; the samples were taken between July 1999 and June 2000, with 63 and 125 µm mesh size nets, and between January 2003 and January 2004, with a 335 µm mesh size net, in the downstream and upstream areas of the estuary. Significant differences in abundance were found between months and sampling stations for the two species (ANOVA, P < 0.05). A. clausi dominated in the downstream estuary, registering peaks in June (156 ind. m-3) and September (73 ind. m-3); in the upstream estuary this species showed a maximum of density in September (35 ind. m-3). A. tonsa dominated in the upstream estuary with peaks of abundance occurring in December (2372 ind. m-3) and October (1056 ind. m-3) in the downstream estuary this species exhibited higher abundance in August (52 ind. m-3). The two species of the genus coexist in time exhibiting a strong spatial segregation behavior in the estuary.Cilj ovog rada je dati pregled dinamike vrsta Acartia u estuariju Mondego (temperirani sjevernoatlantski plitki estuarij u zapadnom Portugalu) za sve nađene vrste toga roda. Rod Acartia je prisutan s tri vrste: Acartia clausi, Acartia bifilosa var. inermis i Acartia tonsa; uzorci uzeti od srpnja 1999 do lipnja 2000 su dobiveni pomoću mreže veličine oka 63 i 125 µm, a od siječnja 2003 do siječnja 2004 pomoću mreže veličine oka 335 µm, u nizvodnom i uzvodnom dijelu estuarija. Nađene su znatne razlike u abundanciji dviju vrsta (ANOVA, P < 0.05). A. clausi je bila dominantna u nizvodnom estuariju s maksimumom u lipnju (156 ind. m -3) i rujnu (73 ind. m-3); u uzvodnom estuariju ova vrsta je imala maksimum gustoće u rujnu (35 ind. m-3). A. tonsa je bila dominantna u uzvodnom estuariju s makmimumom gustoće u prosincu (2372 ind. m-3) i listopadu (1056 ind. m-3). U nizvodnom estuariju ova je vrsta bila obilatije zastupljena u rujnu (52 ind. m-3). Dvije vrste se u estuariju javljaju istovremeno, ali su prostorno izrazito odijeljen

Data Management in Metagenomics: A Risk Management Approach

In eScience, where vast data collections are processed in scientific workflows, new risks and challenges are emerging. Those challenges are changing the eScience paradigm, mainly regarding digital preservation and scientific workflows. To address specific concerns with data management in these scenarios, the concept of the Data Management Plan was established, serving as a tool for enabling digital preservation in eScience research projects. We claim risk management can be jointly used with a Data Management Plan, so new risks and challenges can be easily tackled. Therefore, we propose an analysis process for eScience projects using a Data Management Plan and ISO 31000 in order to create a Risk Management Plan that can complement the Data Management Plan. The motivation, requirements and validation of this proposal are explored in the MetaGen-FRAME project, focused in Metagenomics

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Prospective comparison of a fast 1.5-T biparametric with the 3.0-T multiparametric ESUR magnetic resonance imaging protocol as a triage test for men at risk of prostate cancer.

To compare prospectively the diagnostic performance of a biparametric (T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) 1.5-T fast magnetic resonance imaging (fMRI) protocol with the standard 3.0-T multiparametric MRI (mpMRI) protocol of the European Society of Urological Imaging (ESUR) in men referred for a prostate biopsy. Ninety patients with a prostate cancer (PCa) risk of ≥10% according to the SWOP calculator 4 underwent first fMRI and then the reference mpMRI. Patients with Prostate Imaging Reporting and Data System (PI-RADS) v.2 lesions ≥3/5 on the mpMRI were scheduled for MRI/ultrasonography (US) fusion-guided prostate biopsy. Performance of fMRI was assessed using receiver-operating characteristic curve analysis and mpMRI as reference. Calculation of inter-technique agreement on PI-RADS v.2 score by Cohen's κ. The diagnostic accuracy of fMRI shown by the lesion-based analysis was excellent: area under the curve (AUC) 0.961 (P < 0.001), sensitivity 95%, specificity 97%, positive predictive value (PPV) 99%, negative predictive value (NPV) 89%. The patient-based analysis showed an AUC for fMRI of 0.975 (P < 0.001), a sensitivity of 98%, a specificity of 97%, a PPV of 98% and an NPV of 97%. Agreement on the PI-RADS score between both protocols was found to be good (κ = 0.78 [0.57; 0.99]); fMRI missing PI-RADS 4 lesions in three patients. Biopsy results showed no cancer in two patients (two cores per nodule) and Gleason 6 cancer in one patient. There was only one false-positive fMRI, with a PI-RADS score of 4, whose biopsy was negative. In the triage of men with a high risk of PCa for prostate biopsy, an f MRI protocol (1.5-T magnet, T2WI + DWI, <15 min) may safely replace the traditional ESUR 3.0-T mpMRI protocol, saving time and contrast injection

Multidisciplinary approach and anesthetic management of a surgical cancer patient with methylene tetrahydrofolate reductase deficiency: a case report and review of the literature

Introduction: Hyperhomocysteinemia is a known risk factor for myocardial infarction, stroke, peripheral vascular disease, and thrombosis. Elevated plasma homocysteine levels have been demonstrated in patients with recurrent episodes or a single episode of thrombosis. Here we describe the development of cardiovascular disease as a complication of a surgical intervention in a patient with colorectal cancer and hyperhomocysteinemia. Case presentation: A 65-year-old Caucasian man complained of pain and constipation, attributed to previously diagnosed adenocarcinoma (stage IIB) of the hepatic flexure. An anamnestic investigation showed that he had undergone two surgical interventions. During both, he suffered thrombotic postoperative complications, a deep vein thrombosis of the upper extremity after the first operation and retinal vein occlusion after the second. He was diagnosed with hyperhomocysteinemia associated with a homozygous C677T mutation of the gene encoding the enzyme methylenetetrahydrofolate reductase. Our patient was initially treated with folic acid and high-dose B vitamins. On day 7 he underwent a right hemicolectomy. Anesthesia was performed with sevoflurane in 40% O2 and without the use of nitrous oxide. Postoperatively, our patient remained on folic acid and B vitamins and was without immediate or subsequent complications. Conclusions: Neoplastic disease and related surgery followed by the administration of chemotherapeutic drugs alter the hemostatic balance in cancer patients. Those suspected of also having a thrombophilic disease require a thorough laboratory diagnostic workup, including a molecular analysis aimed at identifying the genetic mutation responsible for the hyperhomocysteinemia, as indicated. The case described in this report highlights the importance of a multidisciplinary approach that includes expertise in peri-operative anesthesia, surgery, oncology, and hematology