Este trabajo examina la influencia de los financiamientos en el desempeño de las microempresas artesanales de San Bartolo Coyotepec, Oaxaca, México. Para ello, se aplicaron encuestas y entrevistas ...semiestructuradas a actores clave del desarrollo local y empresarios artesanales entre enero y febrero de 2017. Los resultados evidencian que, si bien los créditos contribuyen en el desempeño de las empresas, coexisten otros factores que influyen en su desempeño como la voluntad del líder y los problemas sociales y del contexto de las localidades donde se encuentran.
Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because ...the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico's prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.
Urinothorax is an unusual cause of pleural effusion. To describe a case with urinothorax secondary to urinary system trauma. 41-year-old male readmitted to our hospital 16 days after a right ...percutaneous nephrolithotomy with fever, shortness of breath, chest pain and multiloculated pleural effusion confirmed by CT scan, resolved with surgical treatment. Readmitted twenty-one days later with recurrent empyema and diagnosis of reno-pleural fistula, treated with new thoracotomy and double J and urinary catheter placement. The suspected diagnosis and the multidisciplinary approach allowed to solve this rare complication.
We diagnosed 11 Guillain–Barré syndrome (GBS) cases among 71,904 COVID patients attended at 61 Spanish emergency departments (EDs) during the 2‐month pandemic peak. The relative frequency of GBS ...among ED patients was higher in COVID (0.15‰) than non‐COVID (0.02‰) patients (odds ratio OR = 6.30, 95% confidence interval CI = 3.18–12.5), as was the standardized incidence (9.44 and 0.69 cases/100,000 inhabitant‐years, respectively, OR = 13.5, 95% CI = 9.87–18.4). Regarding clinical characteristics, olfactory–gustatory disorders were more frequent in COVID‐GBS than non‐COVID–GBS (OR = 27.59, 95% CI = 1.296–587) and COVID–non‐GBS (OR = 7.875, 95% CI = 1.587–39.09) patients. Although COVID‐GBS patients were more frequently admitted to intensive care, mortality was not increased versus control groups. Our results suggest SARS‐CoV‐2 could be another viral infection causing GBS. ANN NEUROL 2021;89:598–603
ABSTRACT Introduction and objectives: Chronic total coronary occlusion (CTO) of coronary arteries is frequent in heart transplant recipients (HTR). It is usually managed with medical therapy due to ...the suboptimal results shown by the percutaneous coronary intervention (PCI). Although the PCI of native CTOs is performed in experienced centres, in HTR we do not know PCI results or clinical efficacy. This is the first study ever to actually analyse the PCI-Target Lesion Procedure Success of CTO PCI and its angiographic and clinical follow-up in HTR. In addition, we compared the clinical follow-up of CTO vs non-CTO PCI in HTR. Methods: We retrospectively analysed the baseline characteristics, procedural outcomes and clinical events during the follow-up of HTR with CTO undergoing PCI between January 1, 2006 and December 31, 2016 in 2 centres with an ongoing CTO program. Over the same period, we also compared clinical events during the follow-up of these patients vs PCI on non-CTO stenosis in HTR at one of the centres. Results: PCI was successful in 13 out of 14 patients. A systematic follow-up angiography was conducted at centre 1 (n = 10). Two patients showed in-stent restenosis (20%), and a new PCI was performed successfully in both cases. Mortality rate was 28.5%, after a median follow-up of 33.5 months interquartile range, 20-50. We found no statistical differences in the clinical events after the PCI of CTO lesions vs non-CTO lesions in HTR. Conclusions: The PCI of CTO in HTR is feasible in experienced centres and selected patients, with a high success rate and low rate of intraprocedural complications.
There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses.
We investigated the incidence, ...clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department.
We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non–COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes.
We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% 95% confidence interval {CI} 1.21–1.78%). This incidence was lower than that observed in non–COVID-19 patients (3.64% 95% CI 3.54–3.74%; odds ratio OR 0.40 95% CI 0.33–0.49). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR aOR 6.36 95% CI 1.84–22.1, aOR 4.63 95% CI 1.88–11.4, and aOR 2.46 95% CI 1.15–5.25). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21–0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84–12.4).
The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.
A nivel mundial el uso de combustibles fósiles ha crecido conforme pasa el tiempo. Sin embargo, estos tipos de energía se están agotando, lo que conlleva a que sus costos aumenten, resultado de la ...oferta y demanda global, por lo que es necesario utilizar otro tipo de energías que no afecten al medio ambiente y tampoco recurran a grandes costos. Una de las maneras de generar energía renovable es a través del uso de biodigestores que permiten la producción de biogás, el cual está compuesto por una mezcla de gases, principalmente dióxido de carbono y metano. Este subproducto puede ser empleado como generador de energía eléctrica o como reemplazo de ciertos combustibles fósiles usados en las actividades diarias. El objetivo del estudio fue calcular el impacto económico generado por la producción y uso de biogás en una empresa productora de quesos en el municipio de Saucillo, Chihuahua, México. Esta empresa cuenta con una instalación de biodigestores, cuya producción de biogás es suficiente para reemplazar el uso del gas LP. En el presente estudio se analizó el impacto económico resultante del uso del proceso de biodigestión en la empresa, a través de diversos indicadores económicos aplicados conforme la información recolectada y de acuerdo a la metodología de Baca Urbina. Obteniendo como resultados una TIR de 46.72%, VPN de $4, 937, 745. 64 y una relación beneficio-costo de 1.80. Como conclusión, el uso de los biodigestores proporciona un impacto aceptable y favorable mostrando que la inversión del proyecto es rentable para la empresa.
Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), ...a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES.
pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy. Vessel healing was assessed by OCT at 90 days.
Fifty-three patients were randomized (26 DES vs. 27 DCB). At 90 days, both strategies showed a low rate of uncovered struts (3.2 vs. 3.2%, P = 0.64) and a very high and similar rate of covered and apposed struts (96.6 vs. 96.1%, respectively; P = 0.58). However, DCB group had a significantly lower rate of major coronary evaginations (68 vs. 37%, P = 0.026), and more frequently developed a thin homogeneous neointimal layer (20 vs. 70.4%, P = 0.001) suggesting distinct superior healing at 3 months compared to DES.
In pPCI both, sirolimus-DES and DCB-strategy, provide excellent strut coverage at 3 months. However, DCB ensures more advanced and optimal stent healing compared to sirolimus-DES. Further research is needed to determine whether, in patients undergoing pPCI, DCB offers superior long-term clinical and angiographic outcomes than new-generation DES (NCT03610347).
One of the most critical devices in an electrical system is the transformer. It is continuously under different electrical and mechanical stresses that can produce failures in its components and ...other electrical network devices. The short-circuited turns (SCTs) are a common winding failure. This type of fault has been widely studied in literature employing the vibration signals produced in the transformer. Although promising results have been obtained, it is not a trivial task if different severity levels and a common high-level noise are considered. This paper presents a methodology based on statistical time features (STFs) and support vector machines (SVM) to diagnose a transformer under several SCTs conditions. As STFs, 19 indicators from the transformer vibration signals are computed; then, the most discriminant features are selected using the Fisher score analysis, and the linear discriminant analysis is used for dimension reduction. Finally, a support vector machine classifier is employed to carry out the diagnosis in an automatic way. Once the methodology has been developed, it is implemented on a field-programmable gate array (FPGA) to provide a system-on-a-chip solution. A modified transformer capable of emulating different SCTs severities is employed to validate and test the methodology and its FPGA implementation. Results demonstrate the effectiveness of the proposal for diagnosing the transformer condition as an accuracy of 96.82% is obtained.
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