Experiencia en el manejo de cancer colorrectal en el hospital universitario mayor - Mederi

Introducción: El cáncer colorrectal es el tercer cáncer más diagnosticado en los hombres y el segundo en las mujeres a nivel mundial. Hasta 1.000 casos nuevos se diagnostican en Colombia cada año, por lo que es importante conocer la experiencia con esta patología en un centro de experiencia recientemente creado en el “Méderi, Hospital Universitario Mayor”. Materiales y métodos: Se realizó un estudio de corte transversal de la población con diagnóstico de cáncer colorrectal atendida entre agosto 2012 y diciembre 2014 que corresponde al tiempo de funcionamiento del servicio de Coloproctología. Resultados: Se atendieron un total de 152 pacientes con cáncer colorrectal en la institución. Se operó el 91% de los pacientes. El estadío más frecuente fue el IV. Solo el 4.9% presentó dehiscencia de anastomosis, datos concordantes con la literatura cuando el manejo es a cargo de expertos. El subtipo histológico más frecuente fue adenocarcinoma moderadamente diferenciado y la mortalidad perioperatoria de 2.63%. Discusión: El cáncer colorrectal es una entidad con alta morbimortalidad lo cual puede cambiar si se realizan pruebas de tamizaje, para realizar un manejo temprano y oportuno. Además juega un papel importante la experiencia del cirujano y la discusión de los pacientes en juntas multidisciplinarias. Palabras clave: cáncer de colon, cáncer de recto, epidemiología, estadificación

Efectividad del tratamiento inmunomodulador con leucocitos alogénicos, en aborto involuntario recurrente. Revisión sistemática y metaanálisis

Dentro del marco del aborto involuntario recurrente (AIR), se han propuesto causas autoinmunes y alogénicas, e implementación de terapias como la inmunización activa con leucocitos alogénicos de la pareja o de donantes. La evidencia disponible en cuanto a la efectividad de estos tratamientos es contradictoria, por lo que se desea realizar una revisión sistemática para evaluar la efectividad de la inmunización activa con leucocitos alogénicos de la pareja o de donantes para esta condición. Se realizó un estudio tipo revisión sistemática de la literatura, usando las siguientes bases de datos: Medline, Embase, Cochrane Library y Scielo. Se realizó una búsqueda a través del registro de ensayos clínicos del Instituto Nacional de Salud de los Estados Unidos (www.clinicaltrials.gov) y, una búsqueda manual a través de las referencias de los estudios seleccionados siguiendo la estrategia de bola de nieve. Se seleccionaron ensayos clínicos y estudios de cohorte analítica, en idioma inglés y español. Se realizó un análisis cuantitativo de la información por medio de un metaanálisis. El tratamiento inmunomodulador con linfocitos puede considerarse como una terapia efectiva para mantener la gestación y lograr recién nacido vivo según resultados estadísticos; sin embargo la calidad de los estudios incluidos es baja, por lo que no se aconseja para la práctica rutinaria. Se sugiere la realización de estudios con metodologías robustas y que apoyen los resultados presentados en esta investigación.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Allocation of GHG emissions in a paper mill, an application tool to reduce emissions

El sector de pasta i paper és considerat un dels set sectors industrials més intensius en consum energètic. La producció i consum d'electricitat i de vapor esdevenen les fonts majoritàries d'emissions de gasos d'efecte hivernacle en aquest sector industrial. Les fàbriques papereres poden assolir objectius de reducció d'emissions mitjançant reducció en origen (substitució de combustibles, introducció d'energies renovables) o bé a partir de mesures d'eficiència energètica en el propi procés. En aquest context, s'ha desenvolupat un mètode de distribució d'emissions que permet assignar a cada unitat d'operació del procés paperer, el seu grau de responsabilitat en emissions. També s'han avaluat diferents mètodes de càlcul de factors d'emissió de vapor i electricitat, tant per plantes de cogeneració com per sistemes individuals. A partir d'aquesta avaluació s'han proposat nous mètodes alternatius als analitzats. Aquests mètodes i els factors d'emissions s'han aplicat a dues fàbriques papereres catalanes.

Cost Cutting for Success: Factors Influencing Costs

Irrespective of whether an airline has high or low operating costs, a thorough knowledge and breakdown of them is vital in order for management to: • monitor performance (to check if targets / budgets are being met. If not, remedial action can be taken) • set appropriate fares and tariffs • evaluate new routes, aircraft acquisition and outsourcing opportunities

Identification of resilience factors in rail engineering work

This paper discusses an ongoing project that aims at improving the potential for resilience of a system responsible for the planning of rail engineering work delivery. It focuses on the use of a human factors based approach as a way to achieve this end. In particular, the paper discusses the initial data collected by means of interviews and how this process gave way to a two fold goal: Understanding how the planning process works in reality and identifying any critical aspects of the system from a Resilience Engineering perspective. Given the nature of the process under study, information flows and communication issues have been given particular attention throughout the data collection and analysis stages. Initial data confirms that the planning process is greatly reliant on the capability of people using their knowledge and skills to communicate in a dynamic informational environment. Finally, the added value of the interviews is discussed from a human factors perspective and as a mean towards the aim of better understanding resilience in rail engineering planning.

Stand and within-stand factors influencing Golden-winged Warbler use of regenerating stands in the central Appalachian Mountains

The Golden-winged Warbler (Vermivora chrysoptera) is currently being considered for protected status under the U.S. Endangered Species Act. The creation of breeding habitat in the Appalachian Mountains is considered a conservation priority for this songbird, which is dependent on extensively forested landscapes with adequate availability of young forest. We modeled abundance of Golden-winged Warbler males in regenerating harvested forest stands that were 0-17 years postharvest at both mid-Appalachian and northeast Pennsylvania regional scales using stand and within-stand characteristics of 222 regenerating stands, 2010-2011. Variables that were most influential at the mid-Appalachian scale were different than those in the northeast region. Across the mid-Appalachian ecoregion, the proportion of young forest cover, i.e., shrub/scrub cover, within 1 km of regenerating stands best explained abundance of Golden-winged Warblers. Golden-winged Warbler response was best explained by a concave quadratic relationship in which abundance was highest with 5-15% land in young forest cover. We also found evidence that the amount of herbaceous cover, i.e., the amount of grasses and forbs, within a regenerating stand positively influenced abundance of Golden-winged Warblers. In northeastern Pennsylvania, where young forest cover is found in high proportions, the distance to the nearest regenerating stand best explained variation in abundance of Golden-winged Warblers. Abundance of Golden-winged Warblers was <1 male per survey when another regenerating stand was >1500 m away. When modeling within-stand features in the northeast region, many of the models were closely ranked, indicating that multiple variables likely explained Golden-winged Warbler response to within-stand conditions. Based on our findings, we have proposed several management guidelines for land managers interested in creating breeding habitat for Golden-winged Warblers using commercial timber operations. For example, we recommend when managing for Golden-winged Warblers in the central Appalachian Mountains that managers should strive for 15% young forest in a heavily forested landscape (>70% forest cover) and cluster stands within 1-2 km of other young forest habitats.

Adaptive project planning and management based on best practices - COBRA system

Planning a project with proper considerations of all necessary factors and managing a project to ensure its successful implementation will face a lot of challenges. Initial stage in planning a project for bidding a project is costly, time consuming and usually with poor accuracy on cost and effort predictions. On the other hand, detailed information for previous projects may be buried in piles of archived documents which can be increasingly difficult to learn from the previous experiences. Project portfolio has been brought into this field aiming to improve the information sharing and management among different projects. However, the amount of information that could be shared is still limited to generic information. This paper, we report a recently developed software system COBRA to automatically generate a project plan with effort estimation of time and cost based on data collected from previous completed projects. To maximise the data sharing and management among different projects, we proposed a method of using product based planning from PRINCE2 methodology. (Automated Project Information Sharing and Management System -�COBRA) Keywords: project management, product based planning, best practice, PRINCE2

Factors affecting potassium leaching in different soils

A set of lysimeter based experiments was carried out during 2000/01 to evaluate the impact of soil type and grassland management on potassium (K) leaching. The effects of (1) four soil textures (sand, loam, loam over chalk and clay), (2) grazing and cutting (with farmyard manure application), and (3) K applied as inorganic fertilizer, dairy slurry or a mixture of both sources were tested. Total K losses in the clay soil were more than twice those in the sand soil (13 and 6 kg K ha(-1), respectively) because of the development of preferential flow in the clay soil. They were also greater in the cut treatment than in the grazed treatment (82 and 51 kg K ha(-1), respectively; P less than or equal to0.01), associated with a 63% increase of K concentration in the leachates from the former (6.7 +/- 0.28 and 4.1 +/- 0.22 mg K L-1 for cut and grazed, respectively; P less than or equal to0.01) because of the K input from the farmyard manure. The source of fertilizer did not affect total K losses or the average K concentration in the leachates (P >0.05), but it changed the pattern of these over time.

Genotype x environment interaction in the uptake of Cs and Sr from soils by plants

The soil-plant transfer factors for Cs and Sr were analyzed in relationship to soil properties, crops, and varieties of crops. Two crops and two varieties of each crop: lettuce (Lactuca sativa L.), cv. Salad Bowl Green and cv. Lobjoits Green Cos, and radish (Raphanus sativus L.), cv. French Breakfast 3 and cv. Scarlet Globe, were grown on five different soils amended with Cs and Sr to give concentrations of 1 mg kg(-1) and 50 mg kg(-1) of each element. Soil-plant transfer coefficients ranged between 0.12-19.10 (Cs) and 1.48-146.10 (Sr) for lettuce and 0.09-13.24 (Cs) and 2.99-93.00 (Sr) for radish. Uptake of Cs and Sr by plants depended on both plant and soil properties. There were significant (P less than or equal to 0.05) differences between soil-plant transfer factors for each plant type at the two soil concentrations. At each soil concentration about 60% of the variance in the uptake of the Cs and Sr was due to soil properties. For a given concentration of Cs or Sr in soil, the most important factor effecting soil-plant transfer of these elements was the soil properties rather than the crops or varieties of crops. Therefore, for the varieties considered here, soil-plant transfer of Cs and Sr would be best regulated through the management of soil properties. At each concentration of Cs and Sr, the main soil properties effecting the uptake of Cs and Sr by lettuce and radish were the concentrations of K and Ca, pH and CEC. Together with the concentrations of contaminants in soils, they explained about 80% of total data variance, and were the best predictors for soil-plant transfer. The different varieties of lettuce and radish gave different responses in soil-plant transfer of Cs and Sr in different soil conditions, i.e. genotype x environment interaction caused about 30% of the variability in the uptake of Cs and Sr by plants. This means that a plant variety with a low soil-plant transfer of Cs and Sr in one soil could have an increased soil-plant transfer factor in other soils. The broad implications of this work are that in contaminated agricultural lands still used for plant growing, contaminant-excluding crop varieties may not be a reliable method for decreasing contaminant transfer to foodstuffs. Modification of soil properties would be a more reliable technique. This is particularly relevant to agricultural soils in the former USSR still affected by fallout from the Chernobyl disaster.

Soil fertility management in the mid-hills of Nepal: Practices and perceptions

Sustaining soil fertility is essential to the prosperity of many households in the mid-hills of Nepal, but there are concerns that the breakdown of the traditional linkages between forest, livestock, and cropping systems is adversely affecting fertility. This study used triangulated data from surveys of households, discussion groups, and key informants in 16 wards in eastern and western Nepal to determine the existing practices for soil fertility management, the extent of such practices, and the perception of the direction of changes in soil fertility. The two principal practices for maintaining soil fertility were the application of farmyard manure (FYM) and of chemical fertilizer (mainly urea and diammonium phosphate). Green manuring, in-situ manuring, slicing terrace risers, and burning plant residues are rarely practiced. FYM usage was variable with more generally applied to khet land (average 6053 kg fresh weight manure ha(-1)) than to bari land (average 4185 kg fresh weight manure ha-1) with manure from goats and poultry preferred above that from cows and buffaloes. Almost all households (98%) apply urea to khet land and 87% to bari land, with 45% applying diammonium phosphate to both types of land. Application rates and timings of applications varied considerably both within and between wards suggesting poor knowledge transfer between the research and farming communities. The benefits of chemical fertilizers in terms of ease of application and transportation in comparison with FYM, were perceived to outweigh the widely reported detrimental hardening of soil associated with their continued usage. Among key informants, FYM applied in conjunction with chemical fertilizer was the most popular amendment, with FYM alone preferred more than chemical fertilizer alone - probably because of the latter's long-term detrimental effects. Key informant and householder surveys differed in their perception of fertility changes in the last decade probably because of differences in age and site-specific knowledge. All key informants felt that fertility had declined but among households, only about 40% perceived a decline with the remainder about evenly divided between no change and an increase. Householders with small landholdings (< 0.5 ha) were more likely to perceive increasing soil fertility while those with larger landholdings (> 2 ha) were more likely to perceive declining fertility. Perceived changes in soil fertility were not related to food self-sufficiency. The reasons for the slow spread of new technologies within wards and the poor understanding of optimal use of chemical fertilizers in conjunction with improved quality FYM may repay further investigation in terms of sustaining soil fertility in this region.

Fragmentation or creative diversity? Options in the provision of land management advisory services

Rural land managers need access to sound advice and information to respond to pressures from environmental regulations, declining farm incomes, changing patterns in international trade and new institutional arrangements within the domestic food chain. Governments have cut back their provision of advisory services but need more than ever to influence land managers' decisions to achieve a growing array of policy objectives: The paper develops a conceptual framework for analysing advisory services and concludes, through a review of sixteen case studies, that the needs of both governments and land managers can be met by a diverse mixture of private and public sector provision. (C) 2003 Elsevier Ltd. All rights reserved.

Risk factors for tick attachment to smallholder dairy cattle in Tanzania

A cross-sectional study was conducted in Tanga and Iringa regions of Tanzania, and a longitudinal study in Tanga, to investigate tick-control methods and other factors influencing tick attachment to the cattle of smallholder dairy farms. Most farmers reported applying acaricides at intervals of 1-2 weeks, most used acaricides that require on-farm dilution and most farmers incorrectly diluted the acaricides. Rhipicephalus appendiculatus and Boophilus spp. ticks were those most-frequently encountered on the cattle, but few cattle carried ticks of any species (only 13 and 4.6% of tick counts of the cattle yielded adult R. appendiculatus and Boophilus spp., respectively). Animals were more likely to carry one or more adult Boophilus spp. ticks if they also carried one or more R. appendiculatus adults (OR = 14.4, CI = 9.2, 22.5). The use of pour-on acaricides was associated with lower odds that animals carried a R. appendiculatus tick (OR = 0.29, CI = 0. 18, 0.49) but higher odds that they carried a Boophilus spp. tick (OR = 2.48, CI = 1.55, 3.97). Animals > 4 months old and those with a recent history of grazing had higher odds of carrying either a R. appendiculatus (ORs = 3.41 and 2.58, CIs = 2.34, 4.98 and 1.80, 3.71), or a Boophilus spp. tick (ORs = 5.70 and 2.18, CIs = 2.34, 4.98 and 1.49. 3.25), but zero-grazing management did not prevent ticks attaching to cattle even when combined with high-frequency acaricide treatments. The odds that animals carried ticks varied amongst the agro-ecological zones (AEZs) and administrative districts where the farms were situated-but there was still considerable residual variation in tick infestation at the farm level. (c) 2004 Elsevier B.V. All rights reserved.