Abstract Primary anal cancer accounts for 1% to 3% of gastrointestinal cancers. The most common histology is squamous cell carcinoma, with an incidence of 0.5 to 2 per 100,000 people. The main risk factor is infection with the human papillomavirus, particularly subtypes 16 and 18, which represent 85% to 93% of cases. Treatment and prognosis depend on the stage of the tumor. Localized tumors can be treated with curative surgery, but locally advanced stages require a combination of chemotherapy and radiation. Advanced-stage tumors (IIIC and IV) have a poor prognosis even with chemotherapy. In recent years, immunotherapy and targeted therapies have shown promise in improving survival for patients with advanced, recurrent, or difficult-to-treat disease. We present the case of a 69-year-old woman with moderately differentiated squamous cell carcinoma (T2N1M0, stage IIIA) of the anal canal who, after treatment with chemoradiotherapy and checkpoint inhibitors and subsequent disease progression, received targeted therapy (cetuximab) and achieved complete remission with a sustained response for over 18 months. This case highlights the challenges of treating advanced anal cancer and the potential benefits of targeted therapy, particularly cetuximab, in achieving long-term responses. Further research and large-scale studies are needed to determine the role of targeted therapy and immunotherapy in the treatment of anal canal cancer.

Resumen El cáncer anal primario representa del 1% al 3% de los cánceres gastrointestinales. La histología más común es el carcinoma escamocelular, con una incidencia de 0,5 a 2 por cada 100.000 personas. El principal factor de riesgo es la infección por el virus del papiloma humano, especialmente los subtipos 16 y 18, que representan del 85% al 93% de los casos. El tratamiento y el pronóstico dependen del estadio del tumor. Los tumores localizados se pueden tratar con cirugía curativa, pero las etapas localmente avanzadas requieren una combinación de quimioterapia y radiación. Los tumores en estadio avanzado (IIIC y IV) tienen un mal pronóstico incluso con quimioterapia. En los últimos años, la inmunoterapia y las terapias dirigidas son prometedoras para mejorar la supervivencia de los pacientes con enfermedad avanzada, recurrente o difícil de tratar. Se presenta el caso de una mujer de 69 años con carcinoma escamocelular moderadamente diferenciado (T2N1M0, estadio IIIA) del canal anal que, después del tratamiento con quimiorradioterapia e inhibidores de punto de chequeo y luego de la progresión de la enfermedad, recibió tratamiento con terapia blanco (cetuximab) y logró la remisión completa de la enfermedad y una respuesta mantenida por más de 18 meses. Este caso destaca los desafíos del tratamiento del cáncer anal avanzado y los beneficios potenciales de la terapia dirigida, especialmente cetuximab, para lograr respuestas a largo plazo. Se necesitan más investigaciones y estudios a gran escala para determinar el papel de la terapia blanco y la inmunoterapia en el tratamiento del cáncer del canal anal.

Abstract The quality of potatoes for processing depends on varietal, environmental and crop management factors, and the consumption of potato products has increased. The objective of the research was to determine the effect of calcareous amendments on the production and frying quality of potatoes potato cv. Bicentenaria under high Andean conditions. The research was carried out in the rural community of Canín at Checras district (Lima) altitude of 3880 masl. The climate of the locality is humid and cold, with an annual rainfall of 800 mm and acid soils (pH 5.0) of sandy-clay texture. Five liming treatments and a control without liming were applied to the soil (agricultural lime 500 kg ha-1 and carbonatite 500, 1000, 1500 and 2000 kg ha-1). Agronomic and biochemical characteristics of the tuber were evaluated and sensory analysis was performed for potato frying. Data were analyzed statistically and the Scott-Knott test was used to compare treatment means. Liming with carbonatite 1500 kg ha-1 statistically outperformed the other treatments in tuber weight and was similar to the control; treatment with carbonatite 1000 kg ha-1 had a greater effect on mean tuber weight. The treatments with agricultural lime or carbonatite significantly reduced (p <0.05) the glucose content in the tuber with respect to the control. Sensory tests were significant for liming treatments for chip color. Soil liming influenced some agronomic characteristics and biochemical parameters of the tuber, as well as the sensory evaluation of potato chips.

Resumen La calidad de la papa para procesamiento depende de factores varietales, ambientales y de manejo del cultivo y el consumo de sus productos derivados, se ha incrementado. El objetivo de la investigación fue determinar el efecto de enmiendas calcáreas sobre la producción y calidad para fritura de la papa cv. Bicentenaria bajo condiciones altoandinas. La investigación se realizó en la comunidad campesina de Canín, distrito de Checras, Huaura (Lima), a una altitud de 3880 m. snm. El clima de la localidad es húmedo y frío, con una precipitación anual de 800 mm y suelos ácidos, de textura franco-arcillosa. Se aplicaron cinco tratamientos de encalado al suelo (cal agrícola 500 kg ha-1 y carbonatita 500, 1000, 1500 y 2000 kg ha-1) y un control. Se evaluaron características agronómicas y bioquímicas del tubérculo y se realizó análisis sensorial para frituras de papa. Los datos se analizaron estadísticamente y se usó la prueba de Scott-Knott para comparar las medias de tratamiento. El encalado con carbonatita 1500 kg ha-1 superó estadísticamente en peso de tubérculos al resto de tratamientos y fue similar al control; el tratamiento con carbonatita 1000 kg ha-1 tuvo mayor efecto sobre el peso medio del tubérculo. Los tratamientos con cal agrícola o carbonatita, redujeron significativamente (p <0,05) el contenido de glucosa en el tubérculo respecto al control. Las pruebas sensoriales fueron significativas para los tratamientos de encalado para color de las hojuelas. El encalado del suelo influyó en algunas características agronómicas y parámetros bioquímicos del tubérculo, así como en la evaluación sensorial de las hojuelas de papa.

Abstract The objective is to determine the relationship between the performance of the Mexican banking system and the use of digital technology. The methodology is through the use of the fixed effects panel data model, profit per share was used and related to the increase in technological infrastructure. The result shows that the performance of the Mexican banking system is significantly determined by the increase in technological investment, the diversity of technologies used and the Internet connectivity facilities available to the population. It is recommended to identify the new disruptive technologies that will be the basis for the future growth of the banking system. The limitation of the study is that it has focused on the analysis of the impact of technological channels and not traditional channels. The originality is the use of an econometric model to validate the theoretical assertion that digital technologies have been fundamental for the performance of the banking system, in the conclusions it is established that the greater the investment in technologies, the more favorable the growth of the banking system of a country.

Resumen El objetivo es determinar la relación entre el desempeño del sistema bancario mexicano y el uso de la tecnología digital. La metodología es a través del uso del modelo de datos de panel de efectos fijos, se utilizó la utilidad por acción y la relaciona con el incremento de la infraestructura tecnológica. El resultado muestra que el desempeño del sistema bancario mexicano se encuentra significativamente determinada por el incremento de la inversión tecnológica, la diversidad de tecnologías usadas y las facilidades de conectividad de internet disponibles para la población. Se recomienda identificar las nuevas tecnologías disruptivas que serán base del futuro crecimiento del sistema bancario. La limitación del estudio establece que se ha enfocado en el análisis del impacto de los canales tecnológicos y no los canales tradicionales. La originalidad es el uso un modelo econométrico para validar la aseveración teórica de que las tecnologías digitales han sido fundamentales para el desempeño del sistema bancario, en las conclusiones se establecen que entre mayor es la inversión en tecnologías es más favorable el crecimiento del sistema bancario de un país.

Abstract The physical and virtual infrastructure are important aspects to evaluate in organizations, since, if not, there could be deficiencies in operations, non-functional equipment and furniture, poor control of data and electronic resources, poor technological adaptability, to mention a few. Even more so, in an era of increasing remote work, technological dependence and demand for adequate conditions in the work area. The objective is to design and validate an instrument that collects information related to the perception of infrastructure in an organization, under a quantitative, cross-sectional, correlational, non-exploratory and descriptive approach. The methodology was: panel of experts validated the content; second, factor analysis validated the construct, using the KMO test (Kaiser Meyer Olkin) and Bartlett's sphericity; third, the reliability of the instrument was obtained with Cronbach's Alpha coefficient. The result, after applying the pilot test to 58 individuals was: KMO 0.738; Bartlett's sphericity 0.000; Cronbach's Alpha coefficient of 0.942 for the complete instrument. Finally, the findings and conclusions are the increase of four dimensions proposed by ISO to six, with their respective Cronbach's Alpha coefficient, called: information processors (0.882); cybersecurity and telecommunications (0.887); electronic devices, internet service and transportation (0.865); physical and virtual space (0.809); information exchange and storage (0.724); ergonomics and ventilation in the workspace (0.861). The main contribution is an instrument with scientific rigor, relevant for general use in the academic community and any productive sector.

Resumen La infraestructura física y virtual son aspectos importantes por evaluar en las organizaciones, ya que, en caso de no hacerlo, pueden surgir deficiencias en las operaciones, el equipo y el mobiliario no funcional, así como escaso control de datos y recursos electrónicos y poca adaptabilidad tecnológica, entre otros. Por eso, el objetivo de este trabajo es diseñar y validar un instrumento que recolecte información relacionada con la percepción sobre infraestructura en una organización. Para ello, se empleó un enfoque cuantitativo, transversal, correlacional, no exploratorio y descriptivo. La metodológica consistió en un panel de expertos que validó el contenido, así como en un análisis factorial que validó el constructo usando la prueba KMO (Kaiser Meyer Olkin) y la esfericidad de Bartlett. Además, con el coeficiente alfa de Cronbach se obtuvo la confiabilidad del instrumento. Después de aplicar la prueba piloto a 58 individuos, el resultado fue el siguiente: KMO 0.738, esfericidad de Bartlett 0.000 y coeficiente alfa de Cronbach de 0.942 para el instrumento completo. Finalmente, los hallazgos permitieron determinar el incremento de cuatro a seis dimensiones propuestas por ISO con su respectivo coeficiente alfa de Cronbach, denominadas procesadores de información (0.882); ciberseguridad y telecomunicaciones (0.887); dispositivos electrónicos, servicio de internet y transporte (0.865); espacio físico y virtual (0.809); intercambio y almacenamiento de información (0.724); ergonomía y ventilación en el espacio de trabajo (0.861). En síntesis, la principal contribución es un instrumento pertinente y con rigor científico para el uso general en la comunidad académica y cualquier sector productivo.

Resumo As infra-estruturas físicas e virtuais são aspectos importantes a avaliar nas organizações, pois, caso não o façam, podem surgir deficiências nas operações, nos equipamentos e no mobiliário não funcional, bem como um mau controlo dos dados e dos recursos electrónicos e uma fraca adaptabilidade tecnológica, entre outros. . Portanto, o objetivo deste trabalho é projetar e validar um instrumento que colete informações relacionadas à percepção de infraestrutura em uma organização. Para isso, utilizou-se uma abordagem quantitativa, transversal, correlacional, não exploratória e descritiva. A metodologia consistiu em um painel de especialistas que validou o conteúdo, bem como uma análise fatorial que validou o construto por meio do teste KMO (Kaiser Meyer Olkin) e esfericidade de Bartlett. Além disso, a confiabilidade do instrumento foi obtida por meio do coeficiente alfa de Cronbach. Após aplicação do teste piloto em 58 indivíduos, o resultado foi o seguinte: KMO 0,738, esfericidade de Bartlett 0,000 e coeficiente alfa de Cronbach de 0,942 para o instrumento completo. Por fim, os resultados permitiram determinar o aumento de quatro para seis dimensões propostas pela ISO com seus respectivos coeficientes alfa de Cronbach, denominados processadores de informação (0,882); cibersegurança e telecomunicações (0,887); aparelhos eletrônicos, serviço de internet e transporte (0,865); espaço físico e virtual (0,809); troca e armazenamento de informações (0,724); ergonomia e ventilação no ambiente de trabalho (0,861). Em resumo, a principal contribuição é um instrumento relevante e com rigor científico para uso geral na comunidade acadêmica e em qualquer setor produtivo.

Abstract Background: Long COVID is defined as the persistence of COVID-19 symptoms four weeks after having undergone acute infection, according to the most recent CDC definition. It is estimated that there are 65 million people affected by this entity, although other figures speak of 200 million. Objective: To characterize the population affected by long COVID in Mexico. Material and methods: Patients older than 18 years who agreed to answer an online survey and who met the criteria for long COVID were included. Results: Data from 203 subjects were included, with 138 (68.0%) being found to be females, and average age to be 41.8 years; 29.6% had severe disease, and 70.4%, mild to moderate disease; 89.7% had received prior COVID-19 vaccination: 6.9% had received one dose; 31.5%, two doses; and 51.2%, three or more doses. The main risk factors were diabetes, overweight or obesity, and hypertension. The most commonly reported symptom was fatigue, followed by other neuropsychiatric manifestations. Conclusion: It is important for the population affected by long COVID to be characterized in order to generate diagnostic and treatment protocols.

Resumen Antecedentes: El COVID persistente se define como la persistencia de síntomas de COVID-19 después de cuatro semanas de cursar con un cuadro agudo, según la definición más reciente de los Centers for Disease Control and Prevention. Se estima que existen 65 millones de personas afectadas por esta entidad, aunque algunos reportes indican 200 millones. Objetivo: Caracterizar a la población afectada por COVID persistente en México. Material y métodos: Se incluyeron pacientes mayores de 18 años que consintieron responder a una encuesta en línea y que cumplían los criterios de COVID persistente. Resultados: Se incluyeron los datos de 203 sujetos. Se identificó que 138 (68.0 %) contestaron ser del sexo femenino, con una media de edad de 41.8 años; 29.6 % presentó enfermedad grave y 70.4 %, enfermedad leve a moderada; 89.7 % había recibido vacunas previas para COVID-19: 6.9 %, una dosis; 31.5 %, dos dosis; y 51.2 %, tres o más dosis. Los principales factores de riesgo fueron diabetes, sobrepeso u obesidad e hipertensión arterial sistémica. El principal síntoma reportado fue fatiga, seguido de otras manifestaciones neuropsiquiátricas. Conclusión: Es importante caracterizar a la población para generar protocolos de diagnóstico y tratamiento.

RESUMO A aplicação do índice de área foliar (IAF) na gestão da cultura do cafeeiro depende da disponibilidade de metodologias para sua estimativa correta. É proposta aqui uma metodologia para a avaliação visual do IAF em plantas de café, por tanto se estabelece um protocolo para o treinamento dos avaliadores. Foram feitas quatro rodadas de medições do IAF utilizando estimativas visuais, dois instrumentos (LAI 2200-C e AccuPAR LP-80), e desfolhações de sebes de café na Costa Rica. A cada rodada, cinco trabalhadores estimaram visualmente os valores do IAF em duas ocasiões e separados por 15 dias. Ao final de cada rodada, foi dada uma retroalimentação a cada trabalhador. A avaliação visual mostrou alta repetibilidade e reprodutibilidade, e as estimativas foram ajustadas para o modelo de regressão linear na maioria dos casos. Os avaliadores melhoraram sua capacidade de avaliar visualmente o IAF ao longo das rodadas, e o valor de R2 aumentou consistentemente para a maioria dos trabalhadores, com valores tão altos quanto 0,87. A avaliação do IAF por instrumentos produziu valores de R2 de 0,5-0,6, com significativa tendência de subestimação, e não se ajustou ao modelo de regressão linear. O desempenho dos diferentes métodos é discutido no contexto de coberturas com amplo espaço. A metodologia visual proposta constitui uma determinação sólida, rápida, simples e confiável do IAF na lavoura do café e considera-se uma ajuda na tomada de decisões para a gestão da safra. (IAF correta visuais LAI 2200C C 2200 LP80, LP80 LP 80 , LP-80) Rica rodada 1 dias trabalhador reprodutibilidade casos R 087 0 87 0,87 0,50,6, 0506 0,5 0,6, 5 6 0,5-0,6 subestimação espaço sólida rápida considerase considera safra 220 LP8 8 LP-80 08 0,8 50 0,50,6 050 05 0, 06 0,6 0,5-0, 22 LP-8 0,50, 0,5-0 2 LP- 0,50 0,5-

ABSTRACT The application of leaf area index (LAI) in coffee crop management depends on the availability of methodologies for proper estimation. The objective of this study was to develop a methodology for the visual assessment of LAI in coffee fields and to establish a protocol for training, evaluation, and feedback for evaluators. Four rounds of LAI measurements were conducted using visual estimates, two instruments (LAI 2200-C and AccuPAR LP-80), and defoliation of coffee hedgerows in Poás, Costa Rica. In each round, five workers visually estimated the LAI values on two occasions separated by 15 days, and feedback reinforcement was provided to each worker at the end of each round. Visual assessments showed high repeatability and reproducibility and the estimates were adjusted to the linear regression model in most cases. Evaluators improved their capacity to visually assess the LAI throughout the rounds, as the value of R2increased consistently for most workers, with values as high as 0.87. Instrumentation evaluation of LAI produced R2values of 0.5-0.6, with significant underestimation bias. The performance of the different methods is discussed in the context of widely spaced hedgerows. The proposed visual methodology constitutes a statistically sound, rapid, simple, and reliable method for determining the LAI of coffee fields to aid in decision-making for crop management. estimation training evaluators 2200C C 2200 LP80, LP80 LP 80 , LP-80) Poás Rica round 1 days cases Rincreased R increased 087 0 87 0.87 Rvalues 0.50.6, 0506 0.5 0.6, 5 6 0.5-0.6 bias sound rapid simple decisionmaking decision making 220 LP8 8 LP-80 08 0.8 50 0.50.6 050 05 0. 06 0.6 0.5-0. 22 LP-8 0.50. 0.5-0 2 LP- 0.50 0.5-

El consenso chileno sobre el uso de inhibidores de SGLT-2 (iSGLT-2) en la práctica clínica, elaborado conjuntamente por las sociedades Chilenas de Cardiología, Diabetes, Medicina Familiar y Nefrología, recomienda fuertemente el uso de estos fármacos en personas con insuficiencia cardíaca y fracción de eyección reducida, diabetes mellitus tipo 2 para prevención de eventos cardiovasculares y evitar la progresión de enfermedad renal crónica. En insuficiencia cardíaca con fracción de eyección conservada o levemente reducida, y enfermedad renal crónica sin diabetes, el consenso sugiere el uso de iSGLT-2. Se destaca la importancia de combinar iSGLT-2 con IECAs o ARA-II en enfermedad renal crónica, y se recomienda su uso en reemplazo de sulfonilureas como segunda línea para control glicémico en diabetes tipo 2. El consenso enfatiza la necesidad de estrategias para optimizar el diagnóstico, mejorar la adherencia y educar sobre los beneficios más allá del control glicémico. Se discuten consideraciones de seguridad y costo-efectividad para una implementación priorizada según la evidencia. El documento resalta la importancia de la colaboración multidisciplinaria y la generación de evidencia local para aprovechar al máximo el potencial de estos fármacos en el manejo de condiciones cardiometabólicas complejas en Chile.

The Chilean consensus on the use of SGLT-2 inhibitors (iSGLT-2) in clinical practice, jointly developed by the societies of Cardiology, Diabetes, Family Medicine, and Nephrology, strongly recommends the use of these drugs in people with heart failure with reduced ejection fraction, type 2 diabetes mellitus for prevention of cardiovascular events, and chronic kidney disease. In heart failure with preserved or mildly reduced ejection fraction, and chronic kidney disease without diabetes, the consensus suggests the use of iSGLT-2. The importance of combining iSGLT-2 with ACE inhibitors or ARBs in chronic kidney disease is highlighted, and their use is recommended to replace sulfonylureas as a second-line treatment for glycemic control in type 2 diabetes. The consensus emphasizes the need for strategies to optimize diagnosis, improve adherence, and educate about benefits beyond glycemic control. Safety and cost-effectiveness considerations for prioritized implementation according to evidence are discussed. The document highlights the importance of multidisciplinary collaboration and the generation of local evidence to maximize the potential of these drugs in the management of complex cardiometabolic conditions in Chile.

RESUMO: Protocolos que induzem à lactação artificial em vacas e novilhas são eficazes e estão comercialmente disponíveis no Brasil. No entanto, esses protocolos demandam longos tratamentos hormonais, o que é discutível visto que poucas pesquisas foram feitas sobre o assunto. Para entender melhor os protocolos de indução artificial à lactação (IAL), realizamos dois experimentos. Foi testada a hipótese de que um protocolo curto (oito dias) de IAL é tão eficiente quanto o protocolo padrão de 15 dias. No experimento 1 objetivou-se caracterizar o perfil esteroidal durante um protocolo de IAL e avaliou-se os perfis séricos de estradiol (E2) e progesterona (P4) de vacas Jersey (n=6) submetidas a um protocolo convencional. No experimento 2 foram comparadas a produção de leite e as concentrações séricas de E2 de novilhas holandesas induzidas à lactação pelo protocolo padrão de IAL (15 injeções de E2 e 8 injeções de P4) e por um protocolo curto, no qual o número de injeções de E2 e, consequentemente, a dosagem geral de E2 foram reduzidas (oito injeções de E2 e oito injeções de P4). A hipótese foi confirmada, demonstrado que um protocolo mais curto induziu a lactação em novilhas holandesas sem prejudicar a produção de leite. RESUMO Brasil entanto hormonais assunto IAL, , (IAL) experimentos dias objetivouse objetivou se avaliouse avaliou E (E2 P4 P (P4 n=6 n6 n 6 (n=6 convencional (1 consequentemente P4. . confirmada (IAL (E (P n= (n= ( (n

ABSTRACT: Protocols to artificially induce cows and heifers into lactation are effective and commercially available in Brazil. However, these protocols demand long hormonal treatments, which is debatable since little research has been done in the subject. To further understand artificial induction to lactation (AIL) protocols, we conducted two experiments. In experiment 1, our objective was to better characterize steroidal profile during an AIL protocol and assess the estradiol (E2) and progesterone (P4) serum profiles of Jersey cows (n=6) subjected to a conventional protocol. In experiment 2, we aimed to compare milk production and serum E2 concentrations of Holstein heifers induced into lactation by the standard AIL protocol (15 injections of E2 and 8 P4 injections) and by a short protocol in which the number of E2 injections and, consequently, the overall dosage of E2, were reduced (8 injections of E2 and 8 P4 injections). We hypothesized that a short AIL protocol (8 days) would be as efficient as the long standard protocol of 15 days. Our hypothesis was confirmed, since we demonstrated that a shorter protocol was able to induce lactation in Holstein heifers without hindering milk production. ABSTRACT Brazil However treatments subject (AIL experiments 1 E (E2 P (P4 n=6 n6 n 6 (n=6 2 (1 consequently ( injections. . days confirmed (E (P n= (n= (n

Abstract Background: Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation. Methods: Randomized, double-blinded, placebo-controlled trial. Setting: Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. Sample: 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I-III aged 18–80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels. Results: Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51–0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08–0.43, p < 0.001). Conclusion: Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo. Background complications Betablockers, Betablockers Beta blockers, blockers Beta-blockers pathway However unclear Methods Randomized doubleblinded, doubleblinded double blinded, blinded double-blinded placebocontrolled controlled trial Setting Brasília Brazil Recruitment 202 Sample 22 ASA (ASA IIII I III 1880 18 80 18–8 years surgery bronchospasm laryngospasm MAP, MAP , (MAP) HR (HR levels Results analysis 10 43.1% 431 43 1 (43.1 vs 648 64 8 64.8% RR 0.66, 066 0.66 0 66 0.66] 95 [95 0.51–0.87, 051087 0.51–0.87 51 87 0.51–0.87] 0.003. 0003 0.003 . 003 0.003) 5.9% 59 9 (5.9% moderatesevere moderate severe 3 31.4% 314 31 4 (31.4% 0.19 019 19 008043 08 0.08–0.43 0.001. 0001 0.001 001 0.001) Conclusion 20 2 188 18– (MAP 43.1 (43. 64.8 06 0.6 [9 05108 0.51–0.8 000 0.00 00 5.9 (5.9 31.4 (31.4 0.1 01 00804 0.08–0.4 43. (43 64. 0. [ 0510 0.51–0. 0.0 5. (5. 31. (31. 0080 0.08–0. (4 051 0.51–0 (5 (31 008 0.08–0 ( 05 0.51– (3 0.08– 0.51 0.08 0.5

ABSTRACT Purpose: To evaluate exogenous hyaluronic acid (HA) derived from bacterial fermentation through enteral and parenteral routes in ischemic skin flaps induced in rats, using clinical and histological exams; and interleukins (IL) as tissue inflammatory biomarkers. Methods: Sixty-four male adults Wistar rats with ischemic skin flaps on the dorsum were randomized into four groups, based on the treatment protocol: subcutaneous administration of saline solution (0.9%) (GI); oral administration of distilled water (GII); subcutaneous administration of HA (0.3%) (GIII); and oral administration of HA (1%) (GIV). Flaps of all groups were comparable regarding clinical and macroscopic evaluation, histological examination, pro-inflammatory cytokines (IL-1β, IL-6, and tumor necrosis factor-α) and anti-inflammatory cytokine IL-10. Results: A lower percentage of necrosis was identified in flaps treated with subcutaneous administration of HA (0.3%). The pro- and anti-inflammatory cytokines, epidermis thickness, blood vessels, and inflammatory cells showed statistically significant inter-group and intra-group differences (p < 0.05). Conclusions: High molecular HA (1,400 ~ 2,000 kDa) administrated by subcutaneous or oral route exhibited beneficial effects in ischemic skin flaps of rats. However, subcutaneous administration of HA (0.3%) showed better results in terms of the percentage of necrosis and epithelialization. Purpose (HA exams IL (IL biomarkers Methods Sixtyfour Sixty protocol 0.9% 09 0 9 (0.9% GI (GI) GII (GII) 0.3% 03 3 (0.3% GIII (GIII) 1% 1 (1% GIV. GIV . (GIV) evaluation examination proinflammatory pro IL1β, IL1β ILβ 1β, 1β β (IL-1β IL6, IL6 6, 6 IL-6 factorα factor α factor-α antiinflammatory anti IL10. IL10 10. 10 IL-10 Results 0.3%. thickness vessels intergroup inter group intragroup intra p 0.05. 005 0.05 05 0.05) Conclusions 1,400 1400 400 (1,40 2000 2 000 2,00 kDa However epithelialization 0.9 (0.9 (GI (GII 0.3 (0.3 (GIII (1 (GIV IL- IL1 IL-1 00 0.0 1,40 140 40 (1,4 200 2,0 0. (0. ( 1,4 14 4 (1, 20 2, (0 1,

Abstract: Respiratory syncytial virus (RSV) infection is a frequent cause of morbidity and mortality in children. Recently, great advances have been made in the development of new monoclonal antibodies and vaccines thanks to the recognition of the structural conformation of virus proteins. The objective of this study was to review the advances related to the prevention of RSV infection in the first 6 months of life. Advances in structural biology have shown that the RSV fusion protein (F-Protein) in its prefusion state (Pre-F) is an excellent antigen for developing monoclonal antibodies and vaccines to prevent respiratory syncytial virus (RSV) infections. A new single-dose monoclonal antibody, Nirsevimab, has greater neutralizing power than currently available Palivizumab, and prolonged protection for 5 to 6 months. Nirsevimab has demonstrated an efficacy of 76.8% (95% CI, 49.4 to 89.4) in preventing lower respiratory infection 150 days after vaccination, decreasing the risk of ICU admission by 90.1% (95% CI: 16.4-98.8). Clesrovimab is another single-dose monoclonal antibody that has also shown promising results in phase 1b-2a trials. More recently, a bivalent vaccine against RSV A and B (Bivalent Prefusion F) has also been developed by replicating the F-protein stabilized in its Pre-F state as an antigen, using genetic engineering. This antigen, when administered to pregnant women between 24-36 weeks of gestation, induces high levels of antibodies in the mother with high transplacental transfer to the fetus. This vaccine has demonstrated an efficacy of 81.8% (95% CI: 40.6-96.3) at 90 days and 69.4% (95% CI: 44.3-84.1) at 180 days to prevent severe RSV disease (primary endpoint) without safety events detected so far. Nirsevimab and the Pre-F vaccine for pregnant women confer effective protection through passive immunity against RSV that lasts for the first 5 to 6 months of life and have already been approved for use in Europe by the EMA and in Canada and the United States by the FDA.

Resumen: La infección por virus respiratorio sincicial (VRS) es causa frecuente de morbimortalidad en niños. Recientemente se han logrado grandes avances en el desarrollo de nuevos anticuerpos monoclonales y vacunas gracias al reconocimiento de la conformación estructural de proteínas del virus. El objetivo de este estudio es revisar los avances relacionados con la prevención de VRS en los primeros 6 meses de vida. Avances en biología estructural han demostrado que la proteína de fusión del VRS (Proteína F) en su conformación prefusión (Pre-F) constituye un excelente antígeno para desarrollar anticuerpos monoclonales y vacunas para prevenir infecciones por virus respiratorio sincicial (VRS). Un nuevo anticuerpo monoclonal de dosis única, nirsevimab, tiene mayor poder neutralizante que palivizumab actualmente disponible, y una protección prolongada por 5-6 meses. Nirsevimab tiene eficacia demostrada de 76,8 % (IC 95%: 49,4-89,4) para prevenir infección respiratoria baja a 150 días después de la inyección, disminuyendo el riesgo de hospitalizarse en UCI en un 90,1% (IC 95%: 16,498,8). Clesrovimab es otro anticuerpo monoclonal, de dosis única, que también ha presentado promisorios resultados en los ensayos fase 1b-2a. Mas recientemente se ha desarrollado, replicando con ingeniería genética, la proteína F estabilizada en su estado Pre-F como antígeno, una vacuna bivalente contra VRS A y B (Bivalent Prefusion F) la que, administrada a embarazadas, entre las 24-36 semanas de gestación, induce altos niveles de anticuerpos maternos con elevado traspaso transplacentario al feto. Esta vacuna ha demostrado una eficacia de 81,8% (IC 95%: 40,6-96,3) a 90 días y de 69,4% (IC 95%: 44,3-84,1) a 180 días para prevenir enfermedad grave por VRS sin eventos de seguridad detectados hasta el momento. Estos desarrollos confieren protección efectiva mediante inmunidad pasiva contra VRS que dura los primeros 5-6 meses de vida, y tanto en el caso de nirsevimab como la vacuna PreF para embarazadas ya ha sido aprobado para su uso en Europa por EMA, Canadá y en Estados Unidos por la FDA.

ABSTRACT Objective: To determine the digital skills among students of the master’s program in Palliative Care and Pain Management at Universidad Nacional Mayor de San Marcos School of Medicine in 2022. Materials and methods: A non-experimental, descriptive and cross-sectional research. The study population was comprised of students of the master’s program in Palliative Care and Pain Management enrolled in the year 2022. A non-probability sample was used. Data were collected through the survey "Digital Skills in Higher Education Questionnaire" (CDES), consisting of 46 indicators distributed in five factors with a reliability of 0.96 according to Cronbach’s alpha. Data confidentiality and participants’ autonomy were respected. Results: The final sample was made up of 59 students, the average age was 38.03 years and 76.3 % were women. All students had a personal computer and Internet access. The descriptive analysis showed that the "very important" rating prevailed: 49.2 % for the "digital citizenship" factor, 47.5 % for the "communication and collaboration" factor, 45.8 % for the "creativity and innovation" and the "access and use of information" factors, and 44.1 % for the "digital literacy" factor. According to the digital skills global analysis, 49.2 % and 42.4 % chose the "very important" and "important" ratings, respectively. There were no results for the "not at all important" rating. Conclusions: All students had a personal computer and Internet access, which confirms the growing interest in including aspects related to digital skills in university education. The "digital literacy" and the "digital citizenship" factors had a lower and higher rating, respectively, compared to the other factors. A total of 91.6 % of the students considered that digital skills are important and very important, which could be considered as highly favorable.

RESUMEN Objetivo: Determinar las competencias digitales de los estudiantes de la maestría en Cuidados Paliativos y Manejo del Dolor de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos en el año 2022. Materiales y métodos: Investigación de diseño no experimental, descriptivo y de corte transversal. La población de estudio estuvo conformada por los alumnos de la maestría en Cuidados Paliativos y Manejo de Dolor matriculados en el año 2022. Se empleó una muestra no probabilística. Los datos se recolectaron a través de la encuesta Cuestionario de competencias digitales en educación superior (CDES), compuesta por 46 indicadores distribuidos en cinco factores, que tiene una fiabilidad de 0,96 según alfa de Cronbach. Se respetó la confidencialidad de los datos y la autonomía en las decisiones de los participantes. Resultados: Se trabajó con una muestra final de 59 alumnos. La edad promedio fue 38,03 años y el 76,3 % fueron mujeres. Todos los estudiantes contaban con una computadora personal y acceso a internet. El análisis descriptivo determinó un predominio de la valoración "muy importante": 49,2 % para el factor "ciudadanía digital"; 47,5 % para el factor "comunicación y colaboración"; 45,8 % para "creatividad e innovación" y "acceso y uso de la información"; y 44,1 % para el factor "alfabetización digital". Según el análisis global de competencias digitales, 49,2 % manifestó una valoración "muy importante" y 42,4 %, "importante"; no hubo resultados para la denominación "nada importante". Conclusiones: Todos los estudiantes disponen de una computadora personal y cuentan con acceso a internet, lo que ratifica el creciente interés por incluir los aspectos relacionados con la competencia digital en la educación universitaria. El factor "alfabetización tecnológica" presentó menor valoración, mientras que el factor "ciudadanía digital" tuvo mayor valoración. El 91,6 % de estudiantes valora la competencia digital entre importante y muy importante, lo que podría considerarse como muy favorable.

Abstract The objective of the research is relate the economic growth and financial inclusion in Mexico. The methodology is fixed effects data panel, incorporating in the analysis temporality and spatiality, used the Quarterly Index of State Economic Activity (ITAEE) as a dependent variable and related it to the increase in available technological infrastructure as independent variables. The result found shows that the increase in financial inclusion is significantly related to the increase in technological access points, so it is recommended to boost its growth. The limitation of this research is that is focused on analyzing and impacting digital technology channels and does not consider traditional channels. Originality is established by validating through an econometric study the theoretical assertion that digital technologies represent the best way to increase financial inclusion and economic growth. In the conclusions, it is observed that digital devices have been established as a significantly relevant factor in the growth of financial inclusion and economic growth.

Resumen El objetivo de la investigación es relacionar el crecimiento económico y la inclusión financiera en México. La metodología empleada es datos de panel de efectos fijos, incorporando el análisis de temporalidad y espacialidad, se utilizó el Índice Trimestral de Actividad Económica Estatal (ITAEE) como variable dependiente y la relaciona con el incremento de la infraestructura tecnológica disponible como variables independientes. El resultado muestra que el aumento de la inclusión financiera se encuentra significativamente relacionada con el incremento de los puntos de acceso tecnológicos, por lo que se recomienda impulsar su crecimiento. La limitación del estudio es que se enfocado a analizar e impacto en los canales tecnológicos digitales y no considera los canales tradicionales. La originalidad es que se valida mediante un modelo econométrico la aseveración teórica de que las tecnologías digitales representan la mejor manera de aumentar la inclusión financiera y el crecimiento económico. En las conclusiones, se observa que los dispositivos digitales se han establecido como un factor significativamente relevante en el crecimiento de la inclusión financiera y el crecimiento económico.

ABSTRACT This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant-primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding ow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on buid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para el manejo de la pancreatitis aguda en el Seguro Social del Perú (EsSalud). Su objetivo es proveer recomendaciones clínicas basadas en evidencia para el manejo de la pancreatitis aguda en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed durante el 2022. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y flujogramas correspondientes. Finalmente, la GPC fue aprobada con Resolución N° 105-IETSI-ESSALUD-2022. La presente GPC abordó 7 preguntas clínicas sobre fluidoterapia, momento de inicio de nutrición enteral, analgesia, tipo de nutrición, tratamiento antibiótico y quirúrgico. En base a dichas preguntas se formularon 8 recomendaciones (1 fuerte y 7 condicionales), 13 BPC, y 1 flujograma. El presente artículo resume la metodología y las conclusiones basadas en evidencia de la GPC para el manejo de la pancreatitis aguda en EsSalud.