La Casa de las arenas : estudio sobre la obra de Reinaldo Arenas "El mundo alucinante"

Profesional en Estudios LiterariosPregrad

Alternativas de ahorro e inversión para personas naturales en los tres principales bancos de Colombia: Bancolombia, Banco de Bogotá y banco Davivienda para el año 2010

El Sistema Bancario Colombiano, ha tomado gran importancia en la vida cotidiana de un gran número de habitantes de la población, quienes directa o indirectamente se ven en la necesidad de acudir a las entidades bancarias con la finalidad de solucionar sus requerimientos de ahorro, inversión, financiación o transaccionalidad. En este sentido se decidió centrar la investigación en brindar una guía completa sobre las diferentes alternativas de ahorro e inversión que ofrece el sector bancario colombiano para personas naturales en el año 2010, para lo cual fueron seleccionados los bancos: Bancolombia, Banco de Bogotá y Banco Davivienda, por ser los más grandes de Colombia, según su nivel de activos y de este modo, proporcionar la información detallada de los diferentes productos de ahorro e inversión que ofrecen están entidades con sus características, rentabilidades y costo. El objetivo principal de este trabajo fue orientar a cualquier tipo de lector, desde una ama de casa que desconoce, en buena medida, asuntos relacionados con las alternativas de ahorro e inversión en sector bancario, hasta un alto ejecutivo que por falta de tiempo, le resultaría dispendioso hacer este tipo de análisis para tomar la mejor decisión en cuanto al banco que manejará sus ingresos, sus ahorros o inversiones, si así fuese su elección; dejando siempre a criterio del lector, la alternativa que más se ajuste a sus necesidades individuales. La metodología utilizada para este trabajo se fundamentó en las consultas a las páginas oficiales de las entidades financieras y los principales diarios especializados en finanzas del país obteniendo como resultado una síntesis de las diferentes alternativas de ahorro e inversión ofrecidas por los principales bancos del país.The Colombian banking system has been taking such an importance to population in the everyday life. Those inhabitants directly or indirectly have seen the necessity to turn to bank premises in order to solve their saving, investments, finances and transactionality issues. In this regard it has been decided to focus the investigation on offering a complete guide about the diverse saving and investment choices that the Colombian banking sector offers to natural persons in 2010. The following banks were selected: Bancolombia, Banco de Bogotá and Banco Davivienda. This selection was made since they are the biggest in Colombia and according to their asset level. Therefore, it is possible to provide detailed information about the different investment and saving products with their own characteristics, profits and costs. The main goal of this work is to guide any kind of reader in suitable alternatives. For these reason is directed to a housewife who ignores issues concerning saving and investments alternatives or even busy executive person who could find difficult to make the best decision on which bank could manage his incomes and investments. The methodology used for this work is based on consultations with the official websites of financial institutions and major newspapers in the country specialized in finance resulting in a synthesis of different savings and investment alternatives offered by major banks

Estrategias de evaluación basadas en competencias en estudiantes de medicina de internado de dos Universidades de la ciudad de Bogotá, Colombia, 2020 – 2021

La evaluación del  rendimiento académico en el último año de estudio de medicina se ha convertido en un reto, pues implica la conjunción de elementos de desempeño clínico y componente teórico; con esto nos referimos a las capacidades que debe ostentar un interno en tres áreas grandes del quehacer médico que son:  enfoque teórico de las patologías médicas y quirúrgicas,  interacción holística  con el paciente y la realización de procedimientos médicos básicos; si imaginamos al profesional médico como un sistema compuesto por  tres ruedas dentadas,  para su adecuado  funcionamiento se requiere un engranaje perfecto del sistema. Como el internado es el año previo para dar inicio al ejercicio profesional, es la última oportunidad para desarrollar capacidades y reforzar conocimientos; se hace por tanto indispensable identificar los instrumentos que permitan conocer el momento de aprendizaje en el cual se encuentra el estudiante, y es acá donde ingresa el concepto de competencia. Se plantea un estudio cualitativo con enfoque fenomenológico que nos permita describir cuales son las estrategias empleadas para evaluar de manera global las competencias adquiridas por los estudiantes de medicina de último año (internos) de dos universidades de la ciudad, en los servicios de medicina interna y urgencias de dos instituciones de tercer nivel de la ciudad de Bogotá. Con esta investigación se pretende indagar con los estudiantes y los docentes acerca de las experiencias que han tenido en el proceso de evaluación para posteriormente establecer estrategias de evaluación por competencias realizando un proceso inductivo, que va de lo particular de cada estudiante a lo general

Adjudicación y derecho a la cultura en Colombia. el papel de la corte constitucional: Adjudication and right to culture in Colombia. the role of the constitutional court

Three decades ago, to talk about a right to culture in Colombia was absurd and unthinkable, especially of ethnic communities, that is, indigenous, black and Afro Colombian, Raizal and Palenqueras. This panorama changes with the issuance of the 1991 Charter that would establish effective mechanisms to achieve material justice and imposes a greater burden on the State to formalize, execute and monitor the plans in relation to the different communities, especially the indigenous ones. This is how the right to culture, within the framework of the 1991 Constitution, has acquired objective and subjective, individual and community dimensions and, in this sense, has served as a reference for the protection of the collective rights of ethnic communities to the guarantee of their right to recognition, and a form of protection for the individuals who belong to it.Based on the above, it was found the need to study the process of adjudication of the right to culture in accordance with the mandates of the Colombian Constitutional Court for historical and social phenomena through orders issued to state institutions and, especially, based on records in which it seeks to effectively comply with the orders issued by the guardian of the Constitution, that is, in order to achieve the materialization of the 1991 text. This article is an analysis of the orders issued by the CourtHace apenas tres décadas, hablar en Colombia de un derecho a la cultura, especialmente de comunidades étnicas, esto es indígenas, negras y afrocolombianas, raizales y palenqueras era un asunto complejo desde el punto de vista jurídico y socio- jurídico. El panorama cambia con la expedición de la Carta de 1991 que consagraría mecanismos efectivos para lograr la justicia material e impone al Estado una carga superior para formalizar, ejecutar y vigilar los planes en relación con las distintas comunidades, especialmente las indígenas. Es así como el derecho a la cultura, en el marco de la Constitución de 1991, ha adquirido dimensiones objetiva y subjetiva, individual y comunitaria y, en tal sentido, ha servido como referente para la protección de los derechos colectivos de las comunidades étnicas para la garantía de su derecho al reconocimiento, y una forma de protección de los individuos que pertenecen a ella. A partir de lo anterior, se presenta como objetivo del presente artículo estudiar el proceso de adjudicación del derecho a la cultura de conformidad con los mandatos de la Corte Constitucional Colombiana por los fenómenos histórico y social a través de órdenes impartidas a las instituciones estatales y, especialmente, a partir de autos en que propende por el cumplimiento efectivo de las órdenes emanadas del guardia de la Constitución, esto es, con el fin de lograr la materialización del texto de 1991. Este artículo es un análisis de las órdenes emitidas por la Corte utilizando el enfoque metodológico con método descriptivoanalítico y objetivo específic

Confirmación del método de ayuda diagnóstica de la dinámica cardiaca de aplicación clínica desarrollado con base en la teoría de la probabilidad

A partir de la teoría de probabilidad y los sistemas dinámicos se desarrolló previamente una nueva metodología de ayuda diagnóstica para el Holter con base en la teoría de la probabilidad. El propósito de este trabajo es evaluar su concordancia diagnóstica en casos normales y con enfermedad aguda. Se tomaron 15 Holters normales y 100 con diferentes patologías cardiacas de pacientes mayores a 20 años. Se establecieron rangos de frecuencias cardiacas y de número de latidos por hora y se calculó la probabilidad de estos rangos. Los valores obtenidos se analizaron de acuerdo con los parámetros diagnósticos establecidos en la metodología previamente desarrollada para diferenciar normalidad de enfermedad. Finalmente se evaluó sensibilidad, especificidad y coeficiente Kappa de la evaluación física matemática respecto al diagnóstico convencional para los casos normales y con enfermedad aguda.Los Holter con enfermedad aguda presentaron entre 6 y 13 rangos de frecuencias y los normales entre 13 y 21 rangos. La probabilidad máxima de latidos por hora en normalidad presentó cuatro casos con probabilidad menor o igual a 0,217 o mayor o igual a 0,304, mientras que para enfermedad aguda todos tuvieron valores mayores o iguales a 0,304. De los Holter, 5 con enfermedad aguda, y 2 normales presentaron un número de latidos menor a 3.000. La suma de las probabilidades de las dos frecuencias más probables se encontró entre 0,203 y 0,379 para los normales y entre 0,333 y 0,652 para los Holters con patologías agudas. Los valores de sensibilidad y especificidad fueron de 100% Y 73,3% y el coeficiente Kappa de 0,86. Se confirmó que la metodología desarrollada con base en la teoría de la probabilidad revela una autoorganización del sistema cardiaco que permite diferenciar normalidad de enfermedad aguda y evidenciar la evolución entre ambos a nivel clínico

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border

BackgroundMigrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico.MethodsWe conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors.ResultsAbout 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded.ConclusionThese findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

In Colombia, the epidemiology and circulating genotypes of Clostridium difficile have not yet been described. Therefore, we molecularly characterized clinical isolates of C.difficile from patients with suspicion of C.difficile infection (CDI) in three tertiary care hospitals. C.difficile was isolated from stool samples by culture, the presence of A/B toxins were detected by enzyme immunoassay, cytotoxicity was tested by cell culture and the antimicrobial susceptibility determined. After DNA extraction, tcdA, tcdB and binary toxin (CDTa/CDTb) genes were detected by PCR, and PCR-ribotyping performed. From a total of 913 stool samples collected during 2013–2014, 775 were included in the study. The frequency of A/B toxins-positive samples was 9.7% (75/775). A total of 143 isolates of C.difficile were recovered from culture, 110 (76.9%) produced cytotoxic effect in cell culture, 100 (69.9%) were tcdA+/tcdB+, 11 (7.7%) tcdA-/tcdB+, 32 (22.4%) tcdA-/tcdB- and 25 (17.5%) CDTa+/CDTb+. From 37 ribotypes identified, ribotypes 591 (20%), 106 (9%) and 002 (7.9%) were the most prevalent; only one isolate corresponded to ribotype 027, four to ribotype 078 and four were new ribotypes (794,795, 804,805). All isolates were susceptible to vancomycin and metronidazole, while 85% and 7.7% were resistant to clindamycin and moxifloxacin, respectively. By multivariate analysis, significant risk factors associated to CDI were, staying in orthopedic service, exposure to third-generation cephalosporins and staying in an ICU before CDI symptoms; moreover, steroids showed to be a protector factor. These results revealed new C. difficile ribotypes and a high diversity profile circulating in Colombia different from those reported in America and European countries

Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

En Colombia, actualmente no existen parámetros claros para el diagnóstico de pacientes con talla baja, ni sobre el tratamiento de esta población con hormona de crecimiento recombinante humana (somatropina), lo cual se ve favorecido por la diversidad de programas de formación de profesionales en endocrinología pediátrica. En respuesta a esta problemática se realizó el primer acuerdo colombiano de expertos en talla baja liderado por la Asociación Colegio Colombiana de Endocrinología Pediátrica (ACCEP); este trabajo contó con la participación y el aval de expertos clínicos de importantes instituciones de salud públicas y privadas del país, además de expertos metodológicos del instituto Keralty, quienes garantizaron la estandarización del uso de la somatropina. Después de realizar una minuciosa revisión de la literatura, se propone la unificación de definiciones, un algoritmo diagnóstico, los parámetros de referencia de las pruebas bioquímicas y dinámicas, una descripción de las consideraciones de uso de la somatropina para el tratamiento de las patologías con aprobación por la entidad regulatoria de medicamentos y alimentos en Colombia y, por último, un formato de consentimiento informado y de ficha técnica del medicamento.In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinanthuman growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation,the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order tostandardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium ofclinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada deServicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private healthinstitutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia ClínicaKeralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm,biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use amongthe indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consentand a medication fact sheet available for parents and patients.https://orcid.org/0000-0002-7856-7213https://orcid.org/0000-0003-2241-7854Revista Nacional - Indexad

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

La salud está de luto - estigma institucional y barreras de acceso a servicios de salud para mujeres que ejercen el trabajo sexual en Bogotá

Magíster en PsicologíaMaestrí