ABSTRACT Background: Sociodemographic and sociocultural factors influence blood donation in various countries, our objective of study was to determine what are the factors that influence blood donation in Peru. The study: An observational, crosssectional study was conducted in people between 18 and 60 years at the national level, the data were analyzed using SPSS v.20 Findings: The study sample was 739 people, 50.4% men; It was determined that there is good knowledge about blood donation with a percentage greater than 50% of questions answered correctly, likewise there is a positive attitude towards blood donation Conclusions: The sociocultural factors that influence blood donation is ignorance, 40% of the participants do not know the basic requirements to be a blood donor, another factor is the false belief. because they are taking medication, they cannot donate blood (47%).

RESUMEN Introducción: Los factores sociodemográficos y socioculturales influyen en la donación de sangre en diversos países, nuestro objetivo de estudio fue determinar cuáles son los factores que influyen en la donación de sangre en el Perú. El estudio: Se realizó un estudio observacional, transversal en personas entre 18 a 60 años a nivel nacional, se analizaron los datos mediante SPSS v.20 Hallazgos: La muestra de estudio fue de 739 personas, el 50,4% hombres; se determinó que hay buen conocimiento acerca de la donación de sangre con un porcentaje mayor al 50% de preguntas contestadas correctamente, así mismo existe una actitud positiva frente a la donación de sangre Conclusiones: Los factores socioculturales que influyen en la donación de sangre es el desconocimiento, un 40% de los participantes desconoce los requisitos básicos para ser donante de sangre, otro factor es la falsa creencia que al estar tomando medicamentos no se puede donar sangre (47%).

Resumen El almidón resistente (AR) es una fracción del almidón no digerible por las α-amilasas y a diferencia de la fibra dietética, el AR es fermentado en el colon promoviendo beneficios en la salud. Dentro de los diferentes tipos de AR, el tipo 3 (AR3) se obtiene por autoclaveado y sin el uso de agentes químicos. El objetivo de este estudio fue obtener AR3 a partir de avena y evaluar su efecto a diferentes concentraciones (0, 5, 10, 15 y 20 %, p/p) sobre las propiedades reológicas de la masa, propiedades de textura de las galletas y su aceptabilidad sensorial. El análisis de perfil de textura (TPA) evidenció un incremento en la fracturabilidad, dureza, adhesividad y gomosidad. La incorporación de AR3 incrementó el módulo elástico (G´) y viscoso (G´´) en comparación con la masa control. Todos los tratamientos presentaron comportamiento elástico (G´ > G´´). La dureza en las galletas aumentó con la concentración de AR3, con valores de ≈ 8 N (control) hasta 20 N (AR3-20 %). Las pruebas sensoriales no fueron significativas entre tratamientos, aunque las galletas AR3-20 % tuvieron mayor preferencia. La adición de AR3 en la masa provocó cambios funcionales y de textura significativos que afectaron positivamente los atributos de calidad de las galletas.

Abstract Resistant starch (RS) is a portion of starch that is not digestible by α-amylases and unlike dietary fiber, RS is fermented in the colon, promoting health benefits. Among the different types of RS, type 3 (RS3) is obtained by autoclaving and without chemical agents. The objective of this work was to obtain RS3 from oats and to evaluate its effect at different concentrations (0, 5, 10, 15 and 20 % w/w) on the rheological properties of the dough, textural properties of the cookies and their sensory acceptability. Texture profile analysis (TPA) showed an increased fracturability, hardness, adhesiveness and gumminess. The incorporation of RS3 increased the elastic (G’) and viscous (G’’) modulus compared to the control dough. All treatments showed elastic behavior (G’ > G’’). Hardness in cookies increased with RS3 concentration, with values from ≈ 8 N (control) to 20 N (RS3 - 20 %). Sensory tests were not significant between treatments, although RS3-20 % cookies had a higher preference. The addition of RS3 in the dough caused significant functional and textural changes that positively affected the quality attributes of the cookies.

RESUMEN En Argentina, nitrógeno (N) y fósforo (P) y recientemente azufre (S) y cinc (Zn) son nutrientes reconocidos como limitantes de la producción de los cereales de invierno. Las decisiones de manejo de la fertilización en avena (Avena sativa L.), cebada (Hordeun vulgare L.) y trigo (Triticum aestivum L.) se realiza considerando aportes individuales de nutriente desconociendo la contribución combinada de elementos. La aplicación combinada de nutrientes mejoraría la respuesta a la fertilización comparada con el aporte individual de los elementos requiriendo su inclusión en los planteos o estrategias de manejo de la fertilización de cereales de invierno. El objetivo fue cuantificar los aportes a la producción de granos de avena, de cebada y de trigo de aplicar P, N, S, y Zn en forma individual y su relación con el uso combinado como NP y NPSZn. En 3 sitios (Tandil, San Manuel y Lobería, Argentina) y en tres cultivos (Trigo, Cebada y Avena) se realizaron experimentos de fertilización considerando aportes individuales y combinados de P, N, S y Zn. La fertilización combinada incorporando P, N, S y Zn presentó rendimientos mayores respec-to a los efectos individuales de estos nutrientes en trigo y en cebada. Los incrementos de rendimientos atribuidos a la diferencia entre la fertilización combinada sobre la suma de los efectos de fertilización individual fueron de 330 kg ha-1 en trigo y de 352 kg ha-1 en cebada. En avena, los datos disponibles no permiten determinar diferencias entre la fertilización combinada y los aportes individuales de cada nutriente. Para las condiciones evaluadas tanto en trigo como en cebada, en la decisión de fertilización con P-N-S-Zn, las fertilizaciones combinadas capturan respuestas de rendimientos adicionales a lo logrado en las respuestas a los nutrientes individuales.

ABSTRACT In Argentina, nitrogen (N) and phosphorus (P) and recently sulfur (S) and zinc (Zn) are recognized nutrients that limit the production of winter cereals. Fertilization decisions are made considering individual nutrient contributions, ignoring the combined contribution of elements. The combined application of nutrients would improve crops response to fertilization compared to the individual contribution of the elements. The objec-tive was to quantify the contributions to the production of oat (Avena sativa L.), barley (Hordeun vulgare L.) and wheat (Triticum aestivum L.) grains from either individual application of P, N, S, and Zn, or the combined use as NP and NPSZn. Fertilization experiments were carried out at three sites (Tandil, San Manuel and Lo-bería) in Argentina. Combined fertilization (NPSZn) resulted in greater yields than the that obtained with the nutrients applied alone in both wheat and barley. The yield advantage of the combined fertilization over the sum of individual fertilization effects was 330 kg ha-1 in wheat and 352 kg ha-1 in barley. In oats, the available data do not allow determining difference between individual or combined fertilization strategies. Under the conditions of this study, combined fertilization promote additional yield responses in both wheat and barley compared to that achieved with individual nutrient application.

Abstract: Background and Aims: The Clusiaceae family is known for its bioactive compounds with beneficial antioxidant and anti-inflammatory properties. The objectives of this study were to 1) identify and quantify the individual polyphenol compounds in the methanolic extract from peel, pulp and aril of the fruit of Clusia quadrangula by UPLC-MSMS, evaluate their antioxidant properties, 2) analyze the fatty acid profile, minerals composition and 3) determine the antibacterial activity against pathogenic bacteria of the methanolic extract. Methods: Physicochemical properties, antioxidants and bioactive compounds, fatty acid profile and mineral content were analyzed using a Microplate Spectrophotometer, Ultra High Performance Liquid Chromatography coupled with a triple quadrupole Mass Spectrometer, Gas Chromatography coupled with a Mass Spectrometer and Microwave Plasma Atomic Emission Spectroscopy. Key results: Twenty phenolic compounds were identified and quantified plus the precursor shikimic acid (103.55 µg/g solids). Procyanidin B2 (41.56 µg/g solids), (−)-epicatechin (34.07 µg/g solids), and ellagic acid (27.58 µg/g solids) were found in greater quantity in the methanolic extract of the pulp. Palmitic and linoleic acid were the most abundant fatty acids in the pulp, peel, and aril, and linolenic acid was present in the pulp. The pulp also exhibited the highest amount of total polyphenolic compounds (24.33 mg GAE/g) and reducing power evaluated by FRAP (18.697 mg ET/g). Analysis of the minerals revealed that all fractions are rich in magnesium, potassium, sodium, and calcium. The results showed that the methanolic extract of the different parts of the fruit had antibacterial properties against Salmonella typhi, Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis. Conclusions: These results indicate that different parts of the C. quadrangula fruit are a rich source of natural antioxidants and possess antibacterial properties. Therefore, it can be considered for use as ingredient or additive in the cosmetic, pharmaceutical, or food industries.

Resumen: Antecedentes y Objetivos: La familia Clusiaceae es conocida por sus compuestos bioactivos con propiedades antioxidantes y antiinflamatorias beneficiosas. Los objetivos de este estudio fueron: 1) identificar y cuantificar compuestos polifenólicos individuales en el extracto metanólico de cáscara, pulpa y arilo del fruto de Clusia quadrangula por UPLC-MSMS, evaluar sus propiedades antioxidantes, 2) analizar el perfil de ácidos grasos, la composición mineral y 3) determinar la actividad antibacteriana contra bacterias patógenas del extracto metanólico. Métodos: Las propiedades fisicoquímicas, antioxidantes y compuestos bioactivos, perfil de ácidos grasos y contenido de minerales fueron analizados utilizando un Espectrofotómetro de Microplaca, Cromatografía de Líquidos de Ultra Alta Resolución acoplado a un Espectrómetro de Masas triple cuadrupolo, Cromatografía de Gases acoplada a un Espectrómetro de Masas y Espectroscopia de Emisión Atómica de Plasma de Microondas. Resultados clave: Se identificaron y cuantificaron 20 compuestos fenólicos más el precursor ácido shikímico (103.55 µg/g sólidos). Procianidina B2 (41.56 µg/g sólidos), (−)-epicatequina (34.07 µg/g sólidos) y ácido elágico (27.58 µg/g sólidos) se encontraron en mayor cantidad en el extracto metanólico de la pulpa. Los ácidos palmítico y linoleico fueron los ácidos grasos más abundantes en la pulpa, cáscara y arilo, y el ácido linolénico estuvo presente en la pulpa. La pulpa también exhibió la mayor cantidad de compuestos polifenólicos totales (24.33 mg GAE/g) y poder reductor evaluado por FRAP (18.697 mg ET/g). El análisis de los minerales reveló que todas las fracciones son ricas en magnesio, potasio, sodio y calcio. Los resultados mostraron que el extracto metanólico de las diferentes partes del fruto tenían propiedades antibacterianas contra Salmonella typhi, Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis. Conclusión: Estos resultados indican que las diferentes partes del fruto de C. quadrangula son una rica fuente de antioxidantes naturales y poseen propiedades antibacterianas, por lo que se puede considerar para su uso como ingrediente o aditivo en la industria cosmética, farmacéutica o alimentaria.

RESUMEN Objetivos. Determinar los cambios en las características clínicas y desenlaces intrahospitalarios de los pacientes hospitalizados por COVID-19 en un hospital privado de Caracas durante dos años de pandemia. Materiales y métodos. Estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19. Se investigó la correspondencia entre las olas de ingresos hospitalarios con las variantes circulantes del SARS-CoV-2 en la población general del Distrito Capital y estado Miranda. Resultados. Se incluyeron 1025 pacientes (569 hombres y 456 mujeres), con edad promedio de 62,9 DE: 16,2 años. Cuatro olas de ingresos hospitalarios fueron identificadas: primera (marzo-noviembre 2020) 150/1025 (14,6%) casos; segunda (diciembre-2020 a mayo-2021) 415/1025 (40,5%) casos; tercera (junio-diciembre 2021) 344/1025 (33,6%) casos; cuarta (enero-febrero 2022) 116/1025 (11,3%) casos. La edad promedio fue mayor en la cuarta ola (primera 64,0±15,7, segunda 61,4±15,8, tercera 62,1±16,5, y cuarta ola 68,5±16,4), mientras que la proporción de pacientes masculinos (primera 66,7%, segunda 58,8%, tercera 50,3%, y cuarta 44,8%), los pacientes con enfermedad grave-crítica (primera 65,3%, segunda 57%, tercera 51,7% y cuarta 44,8%), la estadía intrahospitalaria (primera 9,1±6,0, segunda 9,0±7,3, tercera 8,8±7,7, y cuarta 6,9±5,0 días), los ingresos a la UCI (primera 23,3%, segunda 15,7%, tercera 14,0%, y cuarta 11,2%; p=0,027) y la mortalidad (primera 21.8%, segunda 10,7%, tercera 9,1%, y cuarta 7,1%; p<0,001) disminuyeron progresivamente con el tiempo. Conclusiones. Los resultados muestran menor frecuencia de casos severos y mejoría de los desenlaces intrahospitalarios en dos años de pandemia. Es probable que los cambios en las variantes circulantes, las mejoras del manejo de la enfermedad y la vacunación hayan influido sobre estos resultados.

ABSTRACT Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-November 2020) 150/1025 (14.6%) cases; second (December 2020 to May 2021) 415/1025 (40.5%) cases; third (June-December 2021) 344/1025 (33.6%) cases; fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, second: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%; p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%; p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results.

ABSTRACT Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-November 2020) 150/1025 (14.6%) cases; second (December 2020 to May 2021) 415/1025 (40.5%) cases; third (June-December 2021) 344/1025 (33.6%) cases; fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, second: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%; p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%; p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results.

RESUMEN Objetivos. Determinar los cambios en las características clínicas y desenlaces intrahospitalarios de los pacientes hospitalizados por COVID-19 en un hospital privado de Caracas durante dos años de pandemia. Materiales y métodos. Estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19. Se investigó la correspondencia entre las olas de ingresos hospitalarios con las variantes circulantes del SARS-CoV-2 en la población general del Distrito Capital y estado Miranda. Resultados. Se incluyeron 1025 pacientes (569 hombres y 456 mujeres), con edad promedio de 62,9 DE: 16,2 años. Cuatro olas de ingresos hospitalarios fueron identificadas: primera (marzo-noviembre 2020) 150/1025 (14,6%) casos; segunda (diciembre-2020 a mayo-2021) 415/1025 (40,5%) casos; tercera (junio-diciembre 2021) 344/1025 (33,6%) casos; cuarta (enero-febrero 2022) 116/1025 (11,3%) casos. La edad promedio fue mayor en la cuarta ola (primera 64,0±15,7, segunda 61,4±15,8, tercera 62,1±16,5, y cuarta ola 68,5±16,4), mientras que la proporción de pacientes masculinos (primera 66,7%, segunda 58,8%, tercera 50,3%, y cuarta 44,8%), los pacientes con enfermedad grave-crítica (primera 65,3%, segunda 57%, tercera 51,7% y cuarta 44,8%), la estadía intrahospitalaria (primera 9,1±6,0, segunda 9,0±7,3, tercera 8,8±7,7, y cuarta 6,9±5,0 días), los ingresos a la UCI (primera 23,3%, segunda 15,7%, tercera 14,0%, y cuarta 11,2%; p=0,027) y la mortalidad (primera 21.8%, segunda 10,7%, tercera 9,1%, y cuarta 7,1%; p<0,001) disminuyeron progresivamente con el tiempo. Conclusiones. Los resultados muestran menor frecuencia de casos severos y mejoría de los desenlaces intrahospitalarios en dos años de pandemia. Es probable que los cambios en las variantes circulantes, las mejoras del manejo de la enfermedad y la vacunación hayan influido sobre estos resultados.

ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

RESUMO - RACIONAL: Múltiplas são as propostas de reconstrução do trânsito digestivo após as pancreadoduodenectomias. A anastomoses biliar posicionada antes da anastomose gástrica oferece argumentos de evitar refluxo e colangite pós-operatória. OBJETIVOS: apresentar a técnica de continuidade gástrica e biliar com sequência anatômica após pancreatoduodenectomia em portadores de adenocarcinoma de pâncreas e avaliar os resultados em uma série inicial de casos. MÉTODOS: Foram utilizadas duas técnicas, uma com reconstrução em Y de Roux e pancreaticojejunostomia e outra com alça única de jejuno e pancreatogastroanastomose. Em ambos, a anastomose gástrica foi colocada antes da biliar. E análise de dados demográficos, dilatação do ducto de Wirsung e ducto biliar comum, uso de drenagem percutânea e complicações pós-operatórias. RESULTADOS: Foram operados 7 doentes: 4 homens e 3 mulheres, com média de idade de 62 anos. Todos os casos apresentavam dilatação do ducto de Wirsung e ducto biliar comum. Em 4 dos casos foi realizada drenagem biliar externa percutânea. Ocorreram 3 complicações pós-operatórias, 1 esvaziamento gástrico retardado e 2 infecções de ferida operatória. Durante o acompanhamento médio de 12 meses, não foram registrados episódios de colangite. CONCLUSÕES: Porcentagens elevadas de colangite são relatadas nas diferentes reconstruções após pancreatodudenectomias, sendo difícil atribuir de forma absoluta o refluxo como a principal etiologia. As reconstruções gástrica e biliar propostas são mais harmoniosas, além de facilitar o acesso endoscópico posterior. Seguimento tardio e número maior de casos, pode esclarecer se a etiologia da colangite pós-operatória pode ser o refluxo ou a outros fatores não relacionados à ordem das anastomoses.

ABSTRACT - BACKGROUND: Several methods have been proposed for the reconstruction of digestive transit after pancreatoduodenectomy. Biliary anastomosis positioned before gastric anastomosis helps reduce postoperative reflux and cholangitis. AIMS: The objective of this study was to present the anatomical sequence of gastric and biliary continuity after pancreatoduodenectomy in patients with pancreatic tumor and to evaluate the short- and long-term results in an initial series of cases. METHODS: Two techniques were used: one with Roux-en-Y reconstruction and pancreaticojejunostomy and the other with a single jejunal loop and pancreatogastroanastomosis. In both the cases, the gastric anastomosis was placed performed before the biliary one. An analysis of demographic data, Wirsung’s duct and common bile duct dilatation, the use of percutaneous drainage, and postoperative complications was carried out. RESULTS: A total of seven patients (four men and three women), with a mean age of 62 years, underwent surgery. All cases had Wirsung’s duct and common bile duct dilatation. A percutaneous external biliary drainage was performed in four patients. There were three postoperative complications: one related to delayed gastric emptying and two related to wound infections. During a median follow-up of 12 months, no episode of cholangitis was recorded. CONCLUSIONS: Elevated percentages of cholangitis are reported in different reconstructions after pancreatoduodenectomy, and it is difficult to conclude reflux as the main etiology. The proposed gastric and biliary reconstructions show conforming results, facilitating posterior endoscopic access. Late follow-up and large number of cases may help assess whether the etiology of postoperative cholangitis is reflux or other factors unrelated to the order of the anastomoses.

Abstract This study analyzed the import applications for unavailable vital medicines (MVND) submitted to INVIMA and the records of MVND reimbursement requests submitted to the ADRES in the 2016-2017 period. Approximately 76% of the 2,321 MVND import applications were authorized. Eighty-eight applicants, 73 therapeutic subgroups, 195 active ingredients, and 368 diagnoses were identified. Most of the patients registered in the import applications (66%) are linked to the contributory regime, to a lesser extent to the subsidized regime and the Special or exceptional regimes. The total value of the reimbursement requests related to MVND granted by lawsuits, was USD 8,577,583, equivalent to 38,483 UPCs. The results showed that the implementation of Decree N° 481/2004 has ensured access to medicines for rare diseases. However, it is not alien to the structural inequality of access to health services and medicines of the Colombian Health System, which impacts public health and the allocated budget, either because of the high cost of importing MVND or because of the lack of MVND regulation within the national market.

Resumen En este estudio se analizaron las solicitudes de importación de Medicamentos vitales no disponibles (MVND) presentadas al INVIMA y los registros de solicitudes de recobros presentados en la ADRES por MVND, en el periodo 2016-2017. De las 2321 solicitudes de importación de MVND, el 76% fueron autorizadas. Se identificaron 88 solicitantes, 73 subgrupos terapéuticos y 195 principios activos, así como 368 diagnósticos. El 66% de los pacientes registrados en las solicitudes de importación se encuentran vinculados al régimen contributivo, en menor proporción al régimen subsidiado y al régimen especial o excepcional. En solicitudes de recobros asociados a MVND por vía judicial, se observó que, el monto solicitado por recobro fue de USD 8.577.583, equivalentes a 38483 UPCs. Los resultados mostraron que la implementación del decreto 481 de 2004 ha sido útil para garantizar el acceso a medicamentos para enfermedades raras, aunque no es ajena a la inequidad estructural de acceso a servicios de salud y medicamentos del SGSSS y que generan impacto, no solo en la salud pública, si no en el presupuesto asignado, bien sea por el alto costo que implica su importación o por la falta de regulación de estos dentro del mercado nacional.

Abstract This study analyzed the import applications for unavailable vital medicines (MVND) submitted to INVIMA and the records of MVND reimbursement requests submitted to the ADRES in the 2016-2017 period. Approximately 76% of the 2,321 MVND import applications were authorized. Eighty-eight applicants, 73 therapeutic subgroups, 195 active ingredients, and 368 diagnoses were identified. Most of the patients registered in the import applications (66%) are linked to the contributory regime, to a lesser extent to the subsidized regime and the Special or exceptional regimes. The total value of the reimbursement requests related to MVND granted by lawsuits, was USD 8,577,583, equivalent to 38,483 UPCs. The results showed that the implementation of Decree N° 481/2004 has ensured access to medicines for rare diseases. However, it is not alien to the structural inequality of access to health services and medicines of the Colombian Health System, which impacts public health and the allocated budget, either because of the high cost of importing MVND or because of the lack of MVND regulation within the national market.

Resumen En este estudio se analizaron las solicitudes de importación de Medicamentos vitales no disponibles (MVND) presentadas al INVIMA y los registros de solicitudes de recobros presentados en la ADRES por MVND, en el periodo 2016-2017. De las 2321 solicitudes de importación de MVND, el 76% fueron autorizadas. Se identificaron 88 solicitantes, 73 subgrupos terapéuticos y 195 principios activos, así como 368 diagnósticos. El 66% de los pacientes registrados en las solicitudes de importación se encuentran vinculados al régimen contributivo, en menor proporción al régimen subsidiado y al régimen especial o excepcional. En solicitudes de recobros asociados a MVND por vía judicial, se observó que, el monto solicitado por recobro fue de USD 8.577.583, equivalentes a 38483 UPCs. Los resultados mostraron que la implementación del decreto 481 de 2004 ha sido útil para garantizar el acceso a medicamentos para enfermedades raras, aunque no es ajena a la inequidad estructural de acceso a servicios de salud y medicamentos del SGSSS y que generan impacto, no solo en la salud pública, si no en el presupuesto asignado, bien sea por el alto costo que implica su importación o por la falta de regulación de estos dentro del mercado nacional.

Resumen Se han presentados diversos debates con respecto a las mujeres en el ámbito laboral a nivel mundial. Por ello, el presente documento pretende analizar si existe relación de la variable cultura organizacional con la competitividad de las pequeñas y medias empresas que son dirigidas por mujeres en el municipio de Cajeme, México. Mediante la aplicación de un instrumento a 300 pymes de las cuales 129 son dirigidas por mujeres, se determinó que sí existe relación entre ambas variables y además una influye positiva y significativamente sobre la otra. Es importante reconocer que el 43% de la población pyme es dirigida por mujeres a un nivel de competencia que se influye por aspectos culturales, en Cajeme aún predomina en las mujeres el ser más tradicionalistas, son más ordenadas en sus actividades ya que lo manejan como hábitos y valores representativos y, eso las vuelve competitivas en ámbito laboral.

Abstract There has been a number of debates regarding women in the world-wide workforce. This document aims to analyze whether there is a relationship between a variable of organizational culture and the competitiveness of women-led small and medium-sized enterprises in the municipality of Cajeme, Mexico. An instrument was applied to 300 SMEs, 129 of which are run by women. It was determined that there is a relationship between the two variables, and both positively and significantly influence each other. It is important to recognize that 43% of the population of SME participants are directed by women, to a level of competence that is influenced by cultural aspects. In Cajeme, women still are predominantly traditionalist, more orderly in their activities, since they handle them as representative habits and values, which makes them competitive in the work environment.

ABSTRACT Objective: to analyze adherence to the nursing guidelines for home care of bone marrow transplant recipients from an ecosystem perspective. Method: descriptive, exploratory study with a qualitative approach, using Content Analysis for data analysis, with theoretical and philosophical ecosystem support. The interviews, carried out in bone marrow transplant services, in Brazil and Spain, were guided by an instrument developed by the researchers which contained 25 closed and ten open questions. 40 users participated who met the inclusion criteria. Data collection was carried out from July 2016 to October 2017. Results: the Orientations category emerged from the data which then gave rise to the subcategories: Interactive relational actions; and, actions and behaviors that interfered in the success of the transplant. Some users, due to excessive information at the time of discharge, were unable to assimilate or carry out the guidelines received; others, during the hospitalization phase, apprehended them and absorbed them in order to use them in the home ecosystem space after transplantation. Conclusion: part of the users followed only the guidelines that best adapted to their daily lives and, for others, after hospital discharge, they caused doubts and insecurities regarding the care to be performed at home. It is necessary for the user to identify the constituent elements of their home ecosystem and learn, through communication and information, how they interfere in post-hospital discharge care. Therefore, it is necessary to create communication and information mechanisms that enable the dynamic process between the constituent elements of the ecosystem, biotic and abiotic, so that they have interaction and sustainability and can be practiced by the user.

RESUMEN Objetivo: analizar el cumplimiento de las directrices de la enfermera para el cuidado domiciliario de los receptores de trasplante de médula ósea en una perspectiva ecosistémica. Método: descriptivo, exploratorio, con un enfoque cualitativo, utilizando el análisis de contenido para el análisis de datos, con soporte teórico y filosófico del ecosistema. Las entrevistas, realizadas en los servicios de trasplante de médula ósea, en Brasil y España, fueron guiadas por un instrumento desarrollado por los investigadores, que contenía 25 preguntas cerradas y diez abiertas. Participaron 40 usuarios que cumplieron con los criterios de inclusión. La recolección de datos se realizó entre julio de 2016 y octubre de 2017. Resultados: la categoría Orientaciones surgió de los datos y originó las subcategorías: acciones relacionales interactivas, acciones y comportamientos que interfirieron en el éxito del trasplante. Algunos usuarios, debido a la información excesiva al momento del alta, no pudieron asimilar y llevar a cabo las pautas recibidas, otros, en el curso de la fase de hospitalización, los detuvieron para absorberlos para su atención en el espacio del ecosistema del hogar en el pos trasplante. Conclusión: parte de lós usuários siguió solo las pautas que mejor se adaptaron a su vida diaria y para otros, después del alta hospitalaria, causaron dudas e inseguridades com respecto a La atención que se practica em elhogar. Es necesario que el usuario identifique los elementos constitutivos del ecosistema de su hogar y aprenda, a través de la comunicación y la información, cómo interfieren en la atención hospitalaria posterior al alta. Por lo tanto, es necesario crear mecanismos de comunicación e información que permitan el proceso dinámico entre los elementos constitutivos del ecosistema, bióticos y abióticos, para que tengan interacción y sostenibilidad y puedan ser practicados por el usuario.

RESUMO Objetivo: analisar a adesão às orientações do enfermeiro para o cuidado domiciliar do transplantado de medula óssea na perspectiva ecossistêmica. Método: descritivo, exploratório, com abordagem qualitativa, utilizando-se para a análise dos dados a Análise de Conteúdo, com apoio teórico-filosófico ecossistêmico. As entrevistas, realizadas em serviços de transplante de medula óssea, no Brasil e Espanha, foram norteadas por um instrumento elaborado pelas pesquisadoras, contendo 25 questões fechadas e dez abertas. Participaram 40 usuários que cumpriram os critérios de inclusão. A coleta de dados foi realizada de julho de 2016 a outubro de 2017. Resultados: a categoria Orientações emergiu dos dados e originou as subcategorias: Ações relacionais interativas; e, ações e comportamentos que interferiram no sucesso do transplante. Alguns usuários, por excesso de informações no momento da alta, não conseguiram assimilar e desempenhar as orientações recebidas; outros, no transcorrer da fase de internação, as apreenderam absorvê-las para o cuidado no espaço ecossistêmico domiciliar no pós-transplante. Conclusão: parte dos usuários seguiu somente as orientações que melhor se adaptaram ao seu cotidiano e, para outros, no pós-alta hospitalar, ocasionaram dúvidas e inseguranças em relação ao cuidado a ser praticado no domicílio. Faz-se necessário que o usuário identifique os elementos constituintes do seu ecossistema domiciliar e conheça, por meio da comunicação e informação, como interferem no cuidado pós alta hospitalar. Portanto, é preciso criar mecanismos de comunicação e informação que possibilitem o processo dinâmico entre os elementos constituintes do ecossistema, bióticos e abióticos, para que tenham interação e sustentabilidade e possam ser praticados pelo usuário.

ABSTRACT Introduction: Recent data suggest that robotic platform has become the most accessible minimal invasive surgery even for surgeons without previous training in laparoscopy. Laparoscopic partial nephrectomy (LPN) is a well-stablished procedure, however, with high level of complexity and long learning curve that limit its use. Objective: To describe safety, efficiency and learning curve of a single surgeon without previous experience in LPN to reach “TRIFECTA” at robot-assisted partial nephrectomy (RAPN). Patients and Methods: This is a retrospective study, with prospective data collection of 101 patients submitted to RAPN by a single surgeon. In order to analyze the learning curve, sample was chronologically divided in two phases: first phase: P1: 50 first patients, second phase: P2: 51 subsequent patients. TRIFECTA was defined as: ischemia time lower than 25 minutes, negative surgical margin and absence of severe complications (Clavien >2). Results: Mean age of patients was 54 years (SD=11.85), median tumor size was 32mm (SD=17) and surgery was performed with zero ischemia time in 33.6% of patients (29.8% at P1 and 40.9% at P2). Demographic data of patients were similar between both groups, except tumor size (P1=27.5mm vs. P2=35.3mm; p=0.02) and body mass index (BMI) (P1=26.6kg/m2 vs. P2=29kg/m2; p=0.03). Rate of bleeding, surgical time, presence of positive margin and peri-operatory surgical complications were similar in both phases. TRIFECTA was higher in P2 in relation to P1 (P1: 58% vs. P2: 87.8%; p=0.002) and median time of hot ischemia was significantly lower at P2 (P1: 17.3 vs. P2: 11.7; p=0.02). At multivariate analysis independent factors related to TRIFECTA included: chronological phase (OR 10.74; 95% IC: 1.63-70.53; p=0.013) and tumor size (OR 0.95; 95% IC: 0.91-0.99; p=0.024). Conclusion: RAPN seems to be safe and efficient with good functional and oncological results (TRIFECTA) since the beginning. Experience improvement was related to treatment of larger tumors, higher proportion of patients with zero ischemia and higher rate of TRIFECTA.

RESUMEN. En una sociedad que se integra a la era de la economía del conocimiento, el aprendizaje en defensa digital para adolescentes es fundamental, en especial para los técnicos de redes informáticas. Este artículo presenta una propuesta formativa desarrollada en el Instituto Federal de São Paulo - Campus São Paulo Pirituba, estructurada en cinco ejes de estudio para la gestión y seguridad de la información, así como los proyectos integradores surgidos en este curso. Participaron 42 estudiantes de educación técnica integrados a la escuela secundaria, quienes presentaron, desde sus intereses personales de indagación, cuatro trabajos sobre temas relacionados con la defensa digital: malware, prevención y capacitación, secuestro de datos y ciberacoso. Estos proyectos ponen en práctica los conocimientos aprendidos y su aplicación en investigaciones que forman parte de la educación profesional.

ABSTRACT. In a society entering the era of the knowledge economy, digital defense learning for adolescents is essential, especially for computer network technicians. This article presents a training proposal conducted at the Pirituba Campus of the Federal Institute of São Paulo and the integrating projects that emerged from this course. The proposal was structured in five information management and security study axes. Forty-two high school students in technical education participated. They presented, from their personal research interests, four works on topics related to digital defense, such as malware, prevention and training, data kidnapping, and cyber-bullying. These projects applied the knowledge obtained and implemented it in the research, which is part of professional education.