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La incidencia social de las Instituciones de Educación Superior (IES) asume los planteamientos de la Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura (UNESCO) de promover el bien común en la sociedad. Esto ha generado algunos debates y artículos científicos con diversas interpretaciones: Responsabilidad social universitaria (RSU), Compromiso universidad-comunidad (CUC) y Compromiso cívico (CC). Por tal razón, es relevante analizar los procesos desarrollados por las IES desde dichos planteamientos. Por ello, se realizó una revisión sistemática donde se revisaron 53 artículos publicados entre el 2017 y el 2021 provenientes de cinco bases de datos, para contrastar las orientaciones, finalidades y estrategias implementadas por las IES en diferentes contextos geográficos y culturales. Los resultados muestran que las IES comparten finalidades como: la promoción de comportamientos éticos y socialmente responsables, la promoción de valores democráticos, la promoción del desarrollo sostenible, el aprendizaje a lo largo de la vida y la promoción de habilidades para mejorar la empleabilidad. Asimismo, se concluye que la RSU, es la orientación cada vez más elegida por las IES para relacionarse con el entorno, por integrar los procesos de gestión, participación con las funciones sustantivas de la educación superior, interdependencia que busca crear impactos positivos a nivel personal y colectivo, en el horizonte del bien común expresados en comportamientos ciudadanos con criterios éticos y responsables. Palabras clave: Instituciones de educación superior, Bien común, Responsabilidad social universitaria, Compromiso universidad-comunidad, Compromiso cívico

La esofagitis necrotizante aguda es una entidad poco común que afecta sobre todo a ancianos. La presentación clínica más común es hemorragia digestiva alta. El pronóstico depende de las enfermedades de base con una mortalidad de hasta 50%. Se presenta el caso de un varón de 77 años con historia de una semana de melena, tres episodios de hematemesis y epigastralgia. La endoscopía digestiva alta reveló mucosa con necrosis en parches y fibrina en esófago medio y distal. Biopsia de esófago compatible con necrosis de mucosa.

A better understanding of the nature of crude oil compounds that preferentially interact with certain type of solids is essential to visualize solutions to challenges in oil fields, such as enhanci...

La incidencia social de las Instituciones de Educación Superior (IES) asume los planteamientos de la Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura (UNESCO) de promover el bien común en la sociedad. Esto ha generado algunos debates y artículos científicos con diversas interpretaciones: Responsabilidad social universitaria (RSU), Compromiso universidad-comunidad (CUC) y Compromiso cívico (CC). Por tal razón, es relevante analizar los procesos desarrollados por las IES desde dichos planteamientos. Por ello, se realizó una revisión sistemática donde se revisaron 53 artículos publicados entre el 2017 y el 2021 provenientes de cinco bases de datos, para contrastar las orientaciones, finalidades y estrategias implementadas por las IES en diferentes contextos geográficos y culturales. Los resultados muestran que las IES comparten finalidades como: la promoción de comportamientos éticos y socialmente responsables, la promoción de valores democráticos, la promoción del desarrollo sostenible, el aprendizaje a lo largo de la vida y la promoción de habilidades para mejorar la empleabilidad. Asimismo, se concluye que la RSU, es la orientación cada vez más elegida por las IES para relacionarse con el entorno, por integrar los procesos de gestión, participación con las funciones sustantivas de la educación superior, interdependencia que busca crear impactos positivos a nivel personal y colectivo, en el horizonte del bien común expresados en comportamientos ciudadanos con criterios éticos y responsables. Palabras clave: Instituciones de educación superior, Bien común, Responsabilidad social universitaria, Compromiso universidad-comunidad, Compromiso cívico

Introduction: Irritable bowel syndrome (IBS) is a chronic functional bowel condition with an average world prevalence of 11.2%. Is associated with multiple factors as female sex, young age, stress, anxiety and depression which can have a negative impact on quality of life. IBS in Peru is not investigated at all specially in the Andean region. The objective of this study is to determine the prevalence and associated factors of IBS in an Andean community from Peru using the Rome IV criteria. Materials and methods: Cross-sectional study in a rural community dedicated to livestock and agriculture in Peru at 3,235 meters above sea level. Questionnaires provided by the Rome Foundation as the Rome IV – Diagnostic questionnaire for adults, Irritable Bowel Syndrome - Symptom Severity Scale and Bristol stool scale were used. Results: 130 residents met the inclusion criteria. 46.9% were males with an average age of 54 years old. 11.54% presented red flags and were not included in the analysis. 13.1% were diagnosed with IBS and 52.9% presented constipation as predominant bowel pattern. 52.9% presented a mild course of the disease. In the chi-square analysis, factors as depression, anxiety, female sex, younger age, liquefied petroleum gas exposure for cooking and education achievement were statistically significant associated to IBS. In the logistic regression analysis, anxiety was the unique independent predictor factor with an OR of 9.6 (95% IC: 1.78-51.82). Conclusion: IBS is a prevalent condition in the Andean region and should be managed as a public health issue to improve quality of life. Introduction: Irritable bowel syndrome (IBS) is a chronic functional bowel condition with an average world prevalence of 11.2%. Is associated with multiple factors as female sex, young age, stress, anxiety and depression which can have a negative impact on quality of life. IBS in Peru is not investigated at all specially in the Andean region. The objective of this study is to determine the prevalence and associated factors of IBS in an Andean community from Peru using the Rome IV criteria. Materials and methods: Cross-sectional study in a rural community dedicated to livestock and agriculture in Peru at 3,235 meters above sea level. Questionnaires provided by the Rome Foundation as the Rome IV – Diagnostic questionnaire for adults, Irritable Bowel Syndrome - Symptom Severity Scale and Bristol stool scale were used. Results: 130 residents met the inclusion criteria. 46.9% were males with an average age of 54 years old. 11.54% presented red flags and were not included in the analysis. 13.1% were diagnosed with IBS and 52.9% presented constipation as predominant bowel pattern. 52.9% presented a mild course of the disease. In the chi-square analysis, factors as depression, anxiety, female sex, younger age, liquefied petroleum gas exposure for cooking and education achievement were statistically significant associated to IBS. In the logistic regression analysis, anxiety was the unique independent predictor factor with an OR of 9.6 (95% IC: 1.78-51.82). Conclusion: IBS is a prevalent condition in the Andean region and should be managed as a public health issue to improve quality of life.

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Este texto tiene como objetivo ordenar los argumentos que subyacen en la utilización de los AVAC en los estudios de coste efectividad y que condicionan así su aplicabilidad. Se reacciona de este modo a un uso poco razonado en lo que atañe a sus limitaciones a la hora de priorizar las prestaciones sanitarias. En otras palabras, los autores se muestran a favor del instrumento, pero en contra de sus entusiastas.

I conduct a survey indagating on risk perception and anti-COVID protection measures to 438 Guatemalan citizens of a high range of ages (from less than 18 to more than 60 years old) and middle to upper socio-economic level. I utilized the lottery framework developed by Holt and Laury to elicit behavior at the face of risk in two domains, financial and health. Both the survey and the risk assessments were subject to a self-other framing, in which respondents were asked to answer either on behalf of themselves or of another. Results show that Guatemalans are more risk-taking in the financial domain when deciding for themselves than for another, but both groups reported almost identical risk attitudes in the health domain. The results report a great dissociation between prosocial behavior to stop the COVID-19 spread, were people rank themselves better than others. Data also shows than being vaccinated does not increase economically active behavior, and this paper explains this in relation with the self-other dissociation found.

Este texto tiene como objetivo ordenar los argumentos que subyacen en la utilización de los AVAC en los estudios de coste efectividad y que condicionan así su aplicabilidad. Se reacciona de este modo a un uso poco razonado en lo que atañe a sus limitaciones a la hora de priorizar las prestaciones sanitarias.En otras palabras, los autores se muestran a favor del instrumento, pero en contra de sus entusiastas.

Although intestinal involvement occurs in more than half of the cases with KS that are HIV positive, it is uncommon in the classical form, as it occurs in approximately 10% of the patients. We present the case of a 60-year-old male patient with a one-year disease time characterized by having violaceous lesions on the feet and the hands, slightly pruritic and 2 months of epigastralgia and constipation with weight loss of approximately 12 percent of his total body weight. In the physical examination multiple violaceous papule-like lesions are shown on the hands and the feet, some coalescing to form plaques. Laboratory tests revealed a mild normocytic normocytic anemia, the serology for viral hepatitis B and C was negative, HIV negative and ELISA test too. An upper endoscopy was performed and multiple maculopapular and erythematous-violaceous lesions were observed in the esoph-agus, the stomach and the duodenum. In the colonoscopy, multiple lesions with similar characteristics in the ileum, throughout the colon and in the rectum were recognized. The biopsy result was compatible with the KS in all lesions and it was confirmed with the positive HVV-8 immunohis-tochemistry. This case highlights the likelihood of presenting GI SK in elderly patients with gastrointestinal compromise and cutaneous findings, HIV negatives as well as the need to realize an adequate discarding by performing endoscopic studies with the biopsies to optimize treatment.

Although intestinal involvement occurs in more than half of the cases with KS that are HIV positive, it is uncommon in the classical form, as it occurs in approximately 10% of the patients. We present the case of a 60-year-old male patient with a one-year disease time characterized by having violaceous lesions on the feet and the hands, slightly pruritic and 2 months of epigastralgia and constipation with weight loss of approximately 12 percent of his total body weight. In the physical examination multiple violaceous papule-like lesions are shown on the hands and the feet, some coalescing to form plaques. Laboratory tests revealed a mild normocytic normocytic anemia, the serology for viral hepatitis B and C was negative, HIV negative and ELISA test too. An upper endoscopy was performed and multiple maculopapular and erythematous-violaceous lesions were observed in the esoph-agus, the stomach and the duodenum. In the colonoscopy, multiple lesions with similar characteristics in the ileum, throughout the colon and in the rectum were recognized. The biopsy result was compatible with the KS in all lesions and it was confirmed with the positive HVV-8 immunohis-tochemistry. This case highlights the likelihood of presenting GI SK in elderly patients with gastrointestinal compromise and cutaneous findings, HIV negatives as well as the need to realize an adequate discarding by performing endoscopic studies with the biopsies to optimize treatment. Revisión por pares

Although intestinal involvement occurs in more than half of the cases with KS that are HIV positive, it is uncommon in the classical form, as it occurs in approximately 10% of the patients. We present the case of a 60-year-old male patient with a one-year disease time characterized by having violaceous lesions on the feet and the hands, slightly pruritic and 2 months of epigastralgia and constipation with weight loss of approximately 12 percent of his total body weight. In the physical examination multiple violaceous papule-like lesions are shown on the hands and the feet, some coalescing to form plaques. Laboratory tests revealed a mild normocytic normocytic anemia, the serology for viral hepatitis B and C was negative, HIV negative and ELISA test too. An upper endoscopy was performed and multiple maculopapular and erythematous-violaceous lesions were observed in the esophagus, the stomach and the duodenum. In the colonoscopy, multiple lesions with similar characteristics in the ileum, throughout the colon and in the rectum were recognized. The biopsy result was compatible with the KS in all lesions and it was confirmed with the positive HVV-8 immunohistochemistry. This case highlights the likelihood of presenting GI SK in elderly patients with gastrointestinal compromise and cutaneous findings, HIV negatives as well as the need to realize an adequate discarding by performing endoscopic studies with the biopsies to optimize treatment.

Resumen Hace más de 15 años que en Gaceta Sanitaria se publicó el artículo titulado «¿Qué es una tecnología sanitaria eficiente en España?». El creciente interés por fijar el precio de las nuevas tecnologías en función del valor que estas proporcionan a los sistemas de salud y la experiencia acumulada por los países de nuestro entorno hacen oportuno revisar qué es una intervención sanitaria eficiente en España en el año 2020. El análisis de coste-efectividad sigue siendo el método de referencia para maximizar los resultados en salud de la sociedad con los recursos disponibles. La interpretación de sus resultados requiere establecer unos valores de referencia que sirvan de guía sobre lo que constituye un valor razonable para el sistema sanitario. Los umbrales de eficiencia deben ser flexibles y dinámicos, y actualizarse periódicamente. Su aplicación debe estar basada en la gradualidad y la transparencia, considerando, además, otros factores que reflejen las preferencias sociales. Aunque la fijación de los umbrales corresponde a los decisores políticos, en España puede ser razonable utilizar unos valores de referencia como punto de partida que podrían estar comprendidos entre los 25.000 y los 60.000 euros por año de vida ajustado por calidad. No obstante, en la actualidad, más que la determinación de las cifras exactas de dicho umbral, la cuestión clave es si el Sistema Nacional de Salud está preparado y dispuesto a implantar un modelo de pago basado en el valor, que contribuya a lograr la gradualidad en las decisiones de financiación y, sobre todo, a mejorar la previsibilidad, la consistencia y la transparencia del proceso. Abstract Fifteen years ago, Gaceta Sanitaria published the article entitled “What is an efficient health technology in Spain?” The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process.

Highlights • Psoas abscesses are rare, with a worldwide incidence of only 12 new cases per year. • Kocher maneuver increases risk of perforation and consequent inoculation of the retroperitoneal space with microorganisms. • External contamination may occur either through use of contaminated instruments or inadequate asepsis of the surgical area., Background A psoas abscess presents a diagnostic challenge, due to its rarity, non-specific clinical manifestations and wide range of etiologies. Case report We describe a case of a secondary psoas abscess containing Staphylococus aureus following open cholecystectomy and common bile duct exploration in a woman who had no history or evidence of comorbidity. Conclusions Two possible causes of this abscess are performance of the Kocher maneuver during the surgical procedure and external contamination. This case adds cholecystectomy and cholecystitis to the list of known causes of psoas abscesses.

Introduccion: El injerto de preferencia para cirugia nasal es el cartilago septal. El Injerto de cartilago costal otorga gran material para trabajo ya que posee caracteristicas similares al cartilago septal. Este injerto se utiliza generalmente para cirugias de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la valvula nasal interna y/o externa, poca proyeccion nasal y rinoplastias de revision. Objetivo: Conocer las caracteristicas, resultados y complicaciones de las rinoplastias con injerto de cartilago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los anos 2010 y 2016. Material y metodo: Estudio retrospectivo con revision de fichas clinicas de pacientes sometidos a cirugias de reconstruccion nasal con injerto de cartilago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los anos 2010 y 2016 se realizaron 20 rinoplastias con uso de cartilago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se uso el cartilago costal en la primera cirugia. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusion: El injerto de cartilago costal es una herramienta util a la hora de enfrentarse a cirugias complicadas. La tecnica quirurgica no es dificultosa y tiene una baja tasa de complicaciones.

To evaluate the therapeutic success of endoscopic therapy with N-butyl-2-cyanoacrylate and to determine the re- bleeding and mortality rates.Prospective analytical observational study of 47 cases of patients with gastric varices who were treated with N-butyl-2-cyanoacrylate, using a 1: 1 mixture with lipiodol between 2013 and 2017 in a level III public hospital in Lima - Peru. The therapeutic indication was active hemorrhage, primary or secondary prophylaxis.Of the 47 patients, 5 (10.6%) had active hemorrhage, control was obtained in all cases, 24 (51.1%) had stigmas of recent bleeding during endoscopy. Secondary prophylaxis was performed in 16 (34%) patients and primary prophylaxis in 2 (4.7%). 59.6% required a single session with a total volume of cyanoacrylate (ml / patient) of 1.28 ± 0.44. The endoscopic finding was GOV-2 in 78.7% of the cases, IGV-1 in 12.8% and GOV-1 in 8.5%. Seven patients (14.8%) presented late re- bleeding, with successful new therapy in 6 of them, one dying due to therapy failure. Of the six (12.76%) patients who died in total, 5 (83.3%) were due to other causes. No adverse events related to the therapy were reported. No adverse events were reported. Variceal obturation was observed in 28 (59.5%) patients.Endoscopic management of gastric varices with cyanoacrylate is a safe and effective treatment, with low recurrence and mortality rates.

In lower gastrointestinal bleeding (LGIB), it is very important to stratify the risk of LGIB for a proper management.Identity the independent risk factors to mortality and severity (require critical care, prolonged hospitalization, reebleding, re hospitalization, politrasfusion, surgery for bleeding control) in LGIB.It is an analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. Independent factors were determined using binomial logistic regression.A total of 98 patients were included, of which 13 patients (13,3%) died, and 56 (57,1%) met severity criteria. The independent risk factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg, albumin lower than 2,8 g/dL.The frequency of mortality and severe LGIB is high in our population, the principal risk factors were systolic blood pressure under than 100 mm Hg, Glasgow score lower than 15, albumin lower than 2,8 g/dL. Identifying these associated factors would improve the management of LGB in the emergency room.

Objetivo: Evaluar el éxito de la terapia endoscópica con N-butil-2-cianoacrilato sobre las várices gástricas y determinar las tasas de resangrado y mortalidad. Materiales y métodos: Estudio observacional prospectivo de 47 casos de pacientes con várices gástricas que fueron tratados con N-butil-2-cianoacrilato, utilizando una dilución 1:1 con lipiodol entre febrero de 2013 a marzo de 2017 en un hospital público de nivel III en Lima- Perú. La indicación terapéutica fue hemorragia activa, profilaxis primaria o secundaria. Resultados: De los 47 pacientes, 5 (10,6%) presentaban hemorragia activa, se obtuvo control de la misma en todos los casos, 24 (51,1%) tuvieron estigmas de sangrado reciente durante la endoscopía. Se realizó profilaxis secundaria en 16 (34%) pacientes y profilaxis primaria en 2 (4,7%), 59,6% requirió una sola sesión. El volumen total de cianoacrilato (ml/paciente) promedio fue 1,28 ± 0,44. Se aplicó una sola inyección por sesión en el 87,2% de los pacientes. El hallazgo endoscópico fue GOV-2 en el 78,7% de los casos, IGV-1 en el 12,8% y GOV-1 en el 8,5%. Siete pacientes (14,8%) presentaron resangrado tardío, con nueva terapia exitosa en 6 de ellos, uno fallece por fracaso de la terapia. Seis (12,76%) pacientes fallecen en total, cinco (83,3%) por otras causas. Se realizó 18 meses de seguimiento. No se reportaron eventos adversos relacionados con la terapia. Se constata obturación en 28 (59,5%) pacientes. Conclusiones: El manejo endoscópico de várices gástricas con cianoacrilato es un tratamiento seguro y eficaz, con baja tasa de recurrencia y mortalidad.

En hemorragia digestiva baja (HDB) es muy importante estratificar el riesgo de la misma para brindar un manejo adecuado. Objetivo: Identificar los factores predictores de mortalidad y severidad en pacientes con HDB (definida como: requerimiento de unidad de cuidados críticos, control de hemorragia en sala de operaciones, estancia prolongada mayor a 9 días, resangrado, reingreso, o politransfusión más de 5 paquetes globulares). Materiales y métodos: Es un estudio observacional analítico de cohorte prospectivo, realizado entre junio del 2016 y abril del 2018 en un hospital de nivel III. Se determinó los factores predictores de mortalidad y severidad. Se evalúo la sobrevida hasta los 30 días Resultados: Se incluyó un total de 98 pacientes de los cuales 13 pacientes (13,3%) fallecieron y 56 (57,1%) cumplen criterios de severidad. El factor predictor independiente de mortalidad fue escala de Glasgow menor a 15 y los factores independientes de severidad fueron un valor de albúmina menor a 2,8 g/dl y la presión arterial sistólica menor a 100 mmhg. Conclusiones: La frecuencia de mortalidad y HDB severa es alta en nuestro estudio. La presión arterial sistólica, la escala de Glasgow y la albúmina sérica son evaluaciones que pueden permitirnos predecir durante la primera evaluación en emergencia el riesgo de severidad y mortalidad de un paciente con HDB.

La balantidiasis es una zoonosis producida por el Balantidium coli, que habita el intestino grueso del cerdo y del hombre. La infección es infrecuente en humanos y afecta principalmente al colon. Se produce con mayor frecuencia en países en desarrollo, regiones tropicales y subtropicales. La balantidiasis colónica puede presentarse en la mayoría de los casos de forma asintomática y llegar en los casos más graves como diarrea disentérica que puede complicarse con hemorragia digestiva baja e incluso perforación. Presentamos el caso de un varón de 72 años, proveniente de la sierra peruana de ocupación agricultor y criador de ganado porcino y ovino, quién acude por 3 meses de enfermedad caracterizado inicialmente por deposiciones líquidas con moco sin sangre, dolor abdominal cólico, náuseas, vómitos y en el último mes de enfermedad presenta diarrea disentérica. Se ingresa a colonoscopía por sospecha de colitis infecciosa, encontrándose en la muestra en fresco y biopsia de tejido colónico trofozoitos de Balantidium coli. Paciente recibe tratamiento con amebicida y antibacteriano sin mejoría clínica, presentando como complicación múltiples perforaciones en colon sigmoides, tratado con resección y colostomía terminal. Finalmente, paciente fallece a pesar de recibir manejo médico y quirúrgico.

The aim of this work was to evaluate the effect of the essential oils of Syzygium aromaticum, Cymbopogon citratus, Eucalyptus citriodora and Rosmarinus officinalis on the mycelial development of the fungus Colletotrichum sp. in fragments of Feijoa sellowiana fruits. The essential oils were incorporated in the PDA (Potato-Dextrose-Agar) medium in the concentrations of 250, 500 and 1000 ppm, 0 ppm (PDA only) (negative control), and fungicide fluazinam 1% (positive control). The area under the mycelial growth curve (AUMGC) and percent inhibition of mycelial growth (PIMG) were calculated. In the second evaluation, fruits fragments bordering the disease symptom were immersed in essential oils aqueous solution of S. aromaticum, C. citratus, and E. citriodora, at the concentration of 5000 ppm, 0 ppm (water only - negative control) and fluazinam 1% (positive control). The immersion times in the treatments were: 2, 4, 8, 12 and 24 hours, with subsequent incubation in Agar-Agar medium at 25°C. This evaluation was performed daily for 15 days, observing the moment of fungal germination through the emission of the mycelium. It was verified from the obtained results that all treatments reduced the fungal growth, and the essential oils of C. citratus and S. aromaticum totally inhibited its growth from the dose 500 and 1000 ppm, respectively. Regarding the test on fruit fragments, the essential oil of S. aromaticum at the immersion times of 12 and 24 hours was effective in inhibiting the fungus until the 15th day of evaluation. The aim of this work was to evaluate the effect of the essential oils of Syzygium aromaticum, Cymbopogon citratus, Eucalyptus citriodora and Rosmarinus officinalis on the mycelial development of the fungus Colletotrichum sp. in fragments of Feijoa sellowiana fruits. The essential oils were incorporated in the PDA (Potato-Dextrose-Agar) medium in the concentrations of 250, 500 and 1000 ppm, 0 ppm (PDA only) (negative control), and fungicide fluazinam 1% (positive control). The area under the mycelial growth curve (AUMGC) and percent inhibition of mycelial growth (PIMG) were calculated. In the second evaluation, fruits fragments bordering the disease symptom were immersed in essential oils aqueous solution of S. aromaticum, C. citratus, and E. citriodora, at the concentration of 5000 ppm, 0 ppm (water only - negative control) and fluazinam 1% (positive control). The immersion times in the treatments were: 2, 4, 8, 12 and 24 hours, with subsequent incubation in Agar-Agar medium at 25°C. This evaluation was performed daily for 15 days, observing the moment of fungal germination through the emission of the mycelium. It was verified from the obtained results that all treatments reduced the fungal growth, and the essential oils of C. citratus and S. aromaticum totally inhibited its growth from the dose 500 and 1000 ppm, respectively. Regarding the test on fruit fragments, the essential oil of S. aromaticum at the immersion times of 12 and 24 hours was effective in inhibiting the fungus until the 15th day of evaluation.

Implementar políticas, procesos y una herramienta de administración centralizada para la gestión de actualizaciones de software y parches de seguridad de productos Microsoft, mediante WSUS para lograr dicho objetivo. El uso de esta herramienta permitirá administrar de manera adecuada y organizada las actualizaciones y parches de seguridad de los productos Microsoft, al igual que el consumo del ancho de banda para la red interna, de tal manera que se puedan instaurar controles y ejecutar la valoración necesaria para contrarrestar las vulnerabilidades y amenazas y con ello optimizar la eficacia y eficiencia de la organización. Al tener productos Microsoft dentro de la organización que brindan servicios tanto interno como externos, su grado de criticidad para el negocio es fuerte por lo que debe tener en cuenta el uso de los tres atributos básicos de la seguridad de la información que son: la confidencialidad, integridad y disponibilidad. Guayaquil Magíster en Seguridad Informática Aplicada

Visita Técnica Internacional El siguiente informe muestra como por medio de la interculturalidad se caracteriza una población, se identifica y se conoce su realidad, integrándose de este modo con la academia bajo lineamientos como ubicación, idioma, riesgos, oportunidades, entre otros, y al final como se materializa la puesta en marcha de un proyecto, que al principio en un momento fue solamente una idea. Especialización Especialista en Formulación y Evaluación Social y Económica de Proyectos RESUMEN INTRODUCCIÓN OBJETIVOS INFORME CULTURAL INFORME ACADEMICO INFORME EMPRESARIAL CONCLUSIONES Y RECOMENDACIONES BIBLIOGRAFÍA

Bothrops asper, a highly venomous pit viper distributed from Colombia and northwestern Peru in South America to southern Mexico, is responsible for most snake bites in Central America, affecting especially young agricultural workers. A 17-year-old male from a rural area in northern Honduras was admitted at San Francisco Hospital after a B. asper bite that had occurred 3 days earlier. The puncture wounds were located on the first toe of the right foot. On the second day of admission, the patient developed dyspnea. A physical examination revealed hypoventilation of the left lung with dullness on 75% of the left lung. Left pleural effusion, approximately 90%, was observed on the chest X-ray. The patient was diagnosed with hemothorax, and a thoracostomy drained 1,350 mL of serosanguineous fluid, followed by the installation of a wet suction control system (Pleur-evac(®)). After 10 days, the patient was discharged. This case illustrates the diversity of hemorrhagic manifestations in envenomations by B. asper.

Fifteen years ago, Gaceta Sanitaria published the article entitled "What is an efficient health technology in Spain?" The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process.

Tesis-Universidad de Murcia., Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. TM 327.

The predictors proposed by the American Society of Gastrointestinal Endoscopy (ASGE) are commonly used topredict the presence and management of choledocholithiasis.To evaluate the performance and precision of thepredictors of choledocholithiasis proposed by ASGE.Prospective and longitudinal study performed ata third level hospital during January 2015 to June 2017. All patients with high and intermediate probability of choledocholithiasiswho underwent endoscopic retrograde cholangiopancreatography (ERCP) were included according to the criteria proposedby the ASGE.A total of 246 patients with suspected choledocholithiasis were analyzed. Of the 228 patients withhigh probability criteria 144 (63.2% = performance) had choledocholithiasis in ERCP with an accuracy of 62% (sensitivity:94.1% and specificity: 9.7%). Among the 18 patients with intermediate probability criteria, 9 (50% = performance) hadcholedocholithiasis with an accuracy of 38% (sensitivity: 5.9% and specificity: 90.3%). In the multivariate analysis, the presenceof stone in the bile duct by ultrasonography (OR: 1.937, 95% CI 1.048-3.580, p=0.035) and age 55 and over (OR: 2.121, 95%CI, 1.101-4.088, p=0.025) were the strongest predictors for choledocholithiasis.The application of the criteriaof the ASGE to predict the probability of choledocholithiasis, in our population has a performance greater than 50%, however,it is necessary to improve these parameters to avoid an unnecessary performance of ERCP.

The hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis (LC) which significantly diminishes the quality of life for people who suffer.To determine the prevalence and severity of HPS in patients with CH treated at the Cayetano Heredia (HCH) Hospital in the period from January to December 2015.Cross-sectional study with sample size needed to determine the point prevalence calculated in 297 patients.The prevalence of HPS in 0.7% and the identified cases were classified as mild and severe SHP.The prevalence of HPS is very low in the population of patients with liver cirrhosis treated at the Cayetano Heredia Hospital.

This chapter answers the questions: What is lean manufacturing? What is Kaizen? This chapter covers a brief description of lean manufacturing foundations, its main principles and wastes, and also the benefits companies can reach with the implementation of lean manufacturing best practices, grounded on several surveys reported in literature to analyse the impact of lean manufacturing on performance. The chapter also describes the Kaizen philosophy reflecting the concern with a continuous improvement culture, where strategic areas of generic continuous improvement behaviours are enhanced. The kaizen philosophy is also presented as an innovation driver. Moreover, the main characteristics of kaizen, the kaizen events, the requirements for continuous improvement success and a set of behavioural routines critical for long-term success with continuous improvement and development over time are offered too.

Lean manufacturing is widely used by industries mainly to mitigate and eliminate all kinds of waste and to improve productivity as a way of enhancing the competitiveness of organizations. A positive correlation between lean implementation and business performance has been highlighted in numerous researches.

Antecedentes: Habitualmente se utilizan los predictores propuestos por la Sociedad Americana de Endoscopía Gastrointestinal (ASGE) para predecir la presencia y manejo de coledocolitiasis. Objetivo: Evaluar el rendimiento y precisión de los predictores de coledocolitiasis propuestos por la ASGE. Materiales y métodos: Estudio prospectivo y longitudinal realizado en un hospital de tercer nivel desde enero del 2015 hasta junio del 2017. Se incluyeron a todos los pacientes con probabilidad alta e intermedia de coledocolitiasis y que fueron sometidos a colangiopancreatografía retrógrada endoscópica (CPRE) según los criterios propuestos por la ASGE. Resultados: Se analizó un total de 246 pacientes con sospecha de coledocolitiasis. De los 228 pacientes con criterios de alta probabilidad, 144 (63,2% = rendimiento) tenían coledocolitiasis en la CPRE con una precisión de 62% (sensibilidad: 94,1% y especificidad: 9,7%). Entre los 18 pacientes con criterios de probabilidad intermedia: 9 (50% = rendimiento) tenían coledocolitiasis con una precisión de 38% (sensibilidad: 5,9% y especificidad: 90,3%). En el análisis multivariado la presencia de cálculo en el colédoco por ecografía (OR: 1,937; IC 95% 1,048- 3,580; p=0,035) y la edad mayor de 55 años (OR: 2,121; IC 95% 1,101-4,088; p=0,025) fueron los predictores más fuertes para coledocolitiasis. Conclusiones: La aplicación de los criterios de la ASGE para predecir probabilidad de coledocolitiasis, en nuestra población tiene un rendimiento mayor del 50%; sin embargo, se necesita mejorar estos parámetros para evitar una realización innecesaria de CPRE. Background: The predictors proposed by the American Society of Gastrointestinal Endoscopy (ASGE) are commonly used to predict the presence and management of choledocholithiasis. Objective: To evaluate the performance and precision of the predictors of choledocholithiasis proposed by ASGE. Materials and methods: Prospective and longitudinal study performed at a third level hospital during January 2015 to June 2017. All patients with high and intermediate probability of choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) were included according to the criteria proposed by the ASGE. Results: A total of 246 patients with suspected choledocholithiasis were analyzed. Of the 228 patients with high probability criteria 144 (63.2% = performance) had choledocholithiasis in ERCP with an accuracy of 62% (sensitivity: 94.1% and specificity: 9.7%). Among the 18 patients with intermediate probability criteria, 9 (50% = performance) had choledocholithiasis with an accuracy of 38% (sensitivity: 5.9% and specificity: 90.3%). In the multivariate analysis, the presence of stone in the bile duct by ultrasonography (OR: 1.937, 95% CI 1.048-3.580, p=0.035) and age 55 and over (OR: 2.121, 95% CI, 1.101-4.088, p=0.025) were the strongest predictors for choledocholithiasis. Conclusions: The application of the criteria of the ASGE to predict the probability of choledocholithiasis, in our population has a performance greater than 50%, however, it is necessary to improve these parameters to avoid an unnecessary performance of ERCP.

This chapter proposes a framework to serve as a roadmap for Just in time (JIT) implementation in plants, grounded on the practical experience acquired during the implementation of a JIT plant and considering the difficulties and suggestions that emerged during the implementation process. An outlook of the JIT implementation is also included in this chapter. The chapter concludes with some final remarks and recommendations for a smooth introduction and long-lasting JIT operation in an organization.

This chapter is focused on the more visible part of JIT, providing a detailed description of a set of basic lean manufacturing tools for a successful JIT implementation. The Lean tools explored in this chapter are: 5S, Standardized Work, SMED—Single Minute Exchange of Die, and Kanban System. The chapter is enriched with a case study used to explain the application of the Lean manufacturing tools in practice. Many examples of practical applications and some worksheets are incorporated to help managers in the implementation issues. In general, for each tool a detailed description of the tool and of its elements is presented. Next, the requirements for its implementation are elaborated. Afterwards, the implementation issues are explained, followed by a demonstration of the practical application of the tool in a case study company and an exposition of the results achieved.

Náusea y vómitos persistentes, como síntoma principal de presentación de la enfermedad, es raro en hipertiroidismo. Se reporta el caso de una mujer de 76 años, que acudió por presentar náusea, vómitos persistentes y dolor abdominal. Al ingreso, se halló taquicardia, fiebre, edema de miembros inferiores, bocio difuso y abdomen doloroso a la palpación. Se realizó ecografía abdominal, endoscopía alta y tomografía abdominal que no mostraron alteraciones significativas. Inicialmente, se plantearon los diagnósticos de infección urinaria complicada y luego colangitis infecciosa; sin embargo, el uso de antibióticos y antieméticos no mejoraron el cuadro de vómitos. Finalmente, se determinaron hormonas tiroideas resultando TSH suprimido y T4 libre y T3 total elevados. Los vómitos cesaron con la administración de propanolol y tiamazol. La paciente fue dada de alta sin molestias. No se conoce el mecanismo fisiopatológico; sin embargo, el uso de beta-bloqueadores y tionamidas resuelve rápidamente el cuadro.

We present data of a contingent valuation survey, testing the effect of evaluation mode on the monetary valuation of preventing road accidents. Half of the interviewees was asked to state their willingness to pay (WTP) to reduce the risk of having only 1 type of injury (separate evaluation, SE), and the other half of the sample was asked to state their WTP for 4 types of injuries evaluated simultaneously (joint evaluation, JE). In the SE group, we observed lack of sensitivity to scope while in the JE group WTP increased with the severity of the injury prevented. However, WTP values in this group were subject to context effects. Our results suggest that the traditional explanation of the disparity between SE and JE, namely, the so-called “evaluability,” does not apply here. The paper presents new explanations based on the role of preference imprecision.

Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis.

La pancreatitis autoinmune tipo 1 es una enfermedad de baja prevalencia siendo más frecuente en varones, se encuentra incluida dentro de las enfermedades relacionadas a IgG4. Esta patología puede debutar como un síndrome colestásico y el diagnóstico se realiza según los criterios del consenso internacional para pancreatitis autoinmune (ICDC) que incluye una imagen típica, serología, compromiso de otros órganos, histología y respuesta al tratamiento con corticoides. Presentamos el caso de una mujer de 52 años con antecedente de artritis reumatoide sin tratamiento que acude con tiempo de enfermedad de 2 meses caracterizado por dolor abdominal en hipocondrio derecho de moderada intensidad asociado a ictericia, coluria, hipocolia, xeroftalmia, xerostomía y pérdida de peso de 3 kg. Al examen físico se evidencia ictericia, hipertrofia simétrica de glándulas submandibulares, leve dolor en epigastrio. En los exámenes auxiliares existe patrón colestásico con hiperbilirrubinemia a predominio directo. En los estudios de imágenes se evidencia colédoco dilatado, con aumento difuso del volumen del páncreas con captación tardía de contraste. En el estudio inmunológico se evidenció IgG4 en 610 u/L y ANA 1/640. Se inició tratamiento con corticoides con respuesta clínica y de laboratorio favorable. En conclusión, se debe sospechar de pancreatitis autoinmune ante un cuadro de dolor abdominal y colestasis extrahepática con imágenes sugestivas de páncreas inflamatorio, en el que se deben complementar los criterios ICDC para confirmar el diagnóstico.

La infección por el virus de la hepatitis C (VHC) es causa preponderante de enfermedad hepática crónica en todo el mundo. Actualmente existen pruebas como el ELISA de tercera generación, de alta sensibilidad y especificidad para detectar anticuerpos anti-VHC y prevenir la trasmisión de esta infección. Ésta ha sido introducida desde 1998 en nuestro hospital, para su utilización en donantes de sangre. Los objetivos del estudio fueron determinar la prevalencia y algunas características epidemiológicas asociadas a la infección por VHC en donantes de sangre en el H.N.C.H. Se trata de un estudio descriptivo retrospectivo, cuyos datos epidemiológicos y resultados del tamizaje general se obtuvieron de los registros del Banco de Sangre, en el período de 1998 hasta junio del 2002. El test utilizado fue el ELISA de tercera generación. En el período evaluado, se examinaron 15,009 donantes de sangre y se encontraron 122 casos positivos (prevalencia de 0.813%). La prevalencia año a año fue 14 casos de 2960 donantes en 1998 (0.47%), 25 de 3136 en 1999 (0.79%), 46 de 3311 en el 2000 (1.38%), 21 de 3730 en 2001 (0.56%) y 16 de 1872 en el 2002 (0.85%). Asimismo, 97 casos (79.5%) fueron de sexo masculino, y 25 (20.5%) del femenino. La seroprevalencia predominó en el grupo etáreo de 21 a 30 años (36.06%), y luego en el de 31 a 40 años (27.86%). 47 casos (38.5%) procedían de los distritos de Lima, Comas y San Martín de Porres. En cuanto a conductas de riesgo, 79 casos (64.5%) refirieron relaciones sexuales sin protección y 15 (12.29%) refirieron relaciones con prostitutas, reportándose sólo 4 casos (3.27%) que referían haber recibido transfusión de sangre anteriormente. En conclusión la prevalencia de infección por VHC en donantes de sangre en el H.N.C.H. desde 1998 hasta junio del 2002 es 0.813%, y la característica más frecuente encontrada es el antecedente de relaciones sexuales sin protección.

Introducción: El sindrome hepatopulmonar (SHP) es una complicación poco frecuente de la cirrosis hepática (CH) que disminuye considerablemente la calidad de vida de las personas que la padecen. Objetivos: Determinar la prevalencia y severidad del SHP en los pacientes con CH atendidos en el Hospital Nacional Cayetano Heredia (HCH) en el periodo comprendido entre enero a diciembre del 2015. Material y métodos: Estudio transversal, con tamaño de muestra necesario para determinar la prevalencia puntual calculado en 297 pacientes. Resultados: La prevalencia del SHP fue de 0,7% y los casos identificados se clasificaron como SHP leve y severo. Conclusión: La prevalencia del SHP es muy baja en la población de pacientes con cirrosis hepática atendidos en el Hospital Nacional Cayetano Heredia Introduction: The hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis (LC) which significantly diminishes the quality of life for people who suffer. Objectives: To determine the prevalence and severity of HPS in patients with CH treated at the Cayetano Heredia (HCH) Hospital in the period from January to December 2015. Materials and methods: Cross-sectional study with sample size needed to determine the point prevalence calculated in 297 patients. Results: The prevalence of HPS in 0.7% and the identified cases were classified as mild and severe SHP. Conclusion: The prevalence of HPS is very low in the population of patients with liver cirrhosis treated at the Cayetano Heredia Hospital

Reportamos el caso de una mujer de 23 años de edad con historia de dolor epigástrico, tumoración palpable que abarca el epigastrio y el hipocondrio izquierdo y un episodio de pancreatitis aguda. La tomografía computarizada reveló un quiste pancreático. El CA-125 se elevó notablemente. Se efectuó una laparotomía exploratoria encontrándose un endometrioma. La anatomía patológica mostró tejido necrótico, moco y sangre, con presencia de macrófagos con fagocitosis de hemosiderina. Se discute el cuadro clínico, la patogénesis y el tratamiento de la endometriosis pancreática. The case of a 23-year old woman with a history of epigastric pain, a palpable tumor that covered the epigastrium and the left hypochondrium, and an episode of acute pancreatitis was reported. The computerized tomography revealed a pancreatic cyst. The CA-125 increased significantly. An exploratory laparotomy was performed, finding an endometrioma. The pathological anatomy showed necrotic tissue, mucus and blood, with a presence of macrophages with hemosiderin phagocytosis. The symptoms and signs, pathogenesis and treatment of the endometriosis of the pancreas are discussed.

Introducción La prevalencia de hepatitis C varía según el área geográfica y los grupos de riesgo. Los pacientes con insuficiencia renal crónica terminal (IRCT) en diálisis constituyen un grupo importante de riesgo. En el Perú las tasas de infección por el virus de la hepatitis C (HCV) en pacientes en hemodiálisis llegan hasta 90 %, asociándose a las transfusiones y al tiempo en diálisis como factores de riesgo. Poco se sabe sobre la prevalencia de la infección por el HCV en pacientes con IRCT en terapia no dialítica. El objetivo de este estudio es conocer la prevalencia de la infección por HCV en estos pacientes y determinar los factores de riesgo. METODOLOGÍA: Estudio prospectivo, se evaluaron los anticuerpos anti-hepatitis C (anti HCV) , en los pacientes con IRCT en terapia conservadora, no dialítica, del Servicio de Nefrología del Hospital Arzobispo Loayza. RESULTADOS: Se estudiaron 99 pacientes, 54.1% varones y 45.8% de mujeres, con una edad promedio de 56.60 ± 17.9 años, con un tiempo de diagnóstico de IRC promedio de 9.28 ± 14.35 meses. La causa más frecuente de IRC fue la no identificada seguida de la diabetes. Se halló una tasa de antiHCV de 1.01 % (1 / 99) CONCLUSIÓN: Se halló una prevalencia baja de antiHCV en la población estudiada, comparable con las tasas de la población general sin IRCT.