Diseño del sistema de agua potable, con captación Coanda de Pencapampa, Chachapoyas

Pencapampa, anexo del distrito de Chachapoyas, presenta una población pequeña de 42 viviendas que consumen agua de fuentes no confiables como pozos y quebradas, hecho que presenta implicaciones negativas en su salud por la presencia de padecimientos diarreicos y parasitarios. En consecuencia, en este estudio de tipo descriptivo – aplicada, propongo el diseño de un sistema de agua potable con captación Coanda (aún no realizada en nuestro país), para entregar este recurso natural en provecho de los pobladores, en cantidades y condiciones adecuadas. Para ello, realicé el estudio de análisis químico de la fuente de abastecimiento, levantamiento topográfico, cálculo de caudales y población futura; también diseñé estructuras como son: Captación Coanda, prefiltros de grava, filtro lento de arena, reservorio de almacenamiento, línea de conducción, línea de aducción, redes de distribución y conexión predial. Pude determinar, mediante el software COANDA, que el paso a través de la pantalla Coanda es de 1.2 l/s de agua, cantidad suficiente para abastecer a la población de Pencapampa. Esto confirma que el diseño planteado servirá para abastecer a Pencapampa con el líquido elemento en mejores condiciones para que mejoren la situación de salubridad actual

Factores que provocan variaciones del tiempo de curación e incapacidad, en individuos que han sufrido hechos de tránsito con implicaciones médico legales

Según datos oficiales del gobierno, hasta el cierre del año 2019, se habían reportado 20107 accidentes viales, dentro de los cuales se presentaron 1406 fallecidos, siendo la zona metropolitana la que mayormente se vio afectada, con un total de 7508 siniestros viales (Viceministerio de Transporte, 2019), lo que representa un porcentaje del 37.34% a nivel nacional. Una considerable cantidad de las víctimas de estos hechos de tránsito son enviados por parte de Fiscalía, para ser evaluados en el Instituto de Medicina Legal “Dr. Roberto Masferrer” de San Salvador, donde se les practican reconocimientos de lesiones, mejor llamado valoración médico legal del daño corporal. Dicha valoración se hace tomando en cuenta todos los factores que pueden influir de forma directa o indirecta en el tiempo de curación. El tiempo estimado en la evaluación es lo que ayuda al sistema judicial para poder tipificar el delito; por lo tanto, la identificación de factores que influyen en una variación entre el tiempo de curación e incapacidad realizadas en el Instituto de Medicina Legal es de suma importancia tanto científica como jurídica. Es por ello que se considera pertinente realizar la presente investigación, ya que los hechos de transito no solamente se catalogan un problema de salud pública, debido a los altos costos que le genera al Estado por el manejo de los pacientes con traumas y secuelas por dichas eventualidades, sino también como un problema médico legal, de especial interés por el aumento en su casuística y la necesidad de auxiliar a los juristas determinar las responsabilidades civiles y/o penales sobrevinientes de la ocurrencia de aquellos

Unidentified dengue serotypes in DENV positive samples and detection of other pathogens responsible for an acute febrile illness outbreak 2016 in Cajamarca, Peru

Objective: To describe the prevalence of dengue virus serotypes, as well as other viral and bacterial pathogens that cause acute febrile illness during an outbreak in Cajamarca in 2016. Results: Dengue virus (DENV) was the most frequent etiologic agent detected in 25.8% of samples (32/124), followed by Rickettsia spp. in 8.1% (10/124), Zika virus in 4.8% (6/124), Chikungunya virus 2.4% (3/124) and Bartonella bacilliformis 1.6% (2/124) cases. No positive cases were detected of Oropouche virus and Leptospira spp. DENV serotypes identification was only achieved in 23% of the total positive for DENV, two samples for DENV-2 and four samples for DENV-4. During the 2016 outbreak in Cajamarca-Peru, it was observed that in a large percentage of positive samples for DENV, the infecting serotype could not be determined by conventional detection assays. This represents a problem for the national surveillance system and for public health due to its epidemiological and clinical implications. Other viral and bacterial pathogens responsible for acute febrile syndrome were less frequently identified.Revisión por pare

Clinical characteristics and molecular detection of bordetella pertussis in hospitalized children with a clinical diagnosis of whooping cough in Peru

Background and Objectives: Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, be-sides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru. Materials and Methods: The population of this cross-sectional study were children under 5 years old hospitalized as presumptive cases of pertussis during December 2017 to December 2018. The nasopharyngeal samples were analyzed by real-time PCR for the detection of B. pertussis. Results: B. pertussis was identified as PCR + in 42.3% of our sample (33/78). The clinical presentation that was observed most frequently includes paroxysmal coughing (97%), difficulty breathing (69.7%), cyanosis (72.7%) and post-tussive em-esis (60.6%). Additionally, pneumonia was the most observed complication (33.3%). Four of the patients with PCR+ for B. pertussis presented only lymphocytosis, five only leukocytosis, two patients with decreased leukocytosis and lymphocytes and only one patient with leukopenia and relative lymphocytosis. There was a percentage of 84.8% of unvaccinated children in the PCR+ group. Finally, the mother was the most frequent symptom carrier (18.2%). Conclusion: In conclusion, in the studied population there is a high rate of PCR+ cases for B. pertussis. Laboratory values may show leukopenia or lymphopenia in patients with pertussis. It is necessary to use appropriate laboratory diagnostic tests in all infants with respiratory symptoms for B. pertussis. Since, the clinical diagnosis overestimates the diagnosis of pertussis.Revisión por pare

Planeamiento estratégico de la macro región V

La Macro Región V constituida por Lima Metropolitana, el Callao y Lima Provincias se encuentra ubicado en la costa oeste del Perú y posee una ubicación estratégica para acceder a los mercados internacionales mediante los principales puertos y aeropuerto del país, además de su diversa producción agrícola y minera cuenta además con un sector turístico. La Macro Región V tiene establecido un presupuesto participativo para Callao y para Lima que se viene utilizando anualmente y como se observó en el estudio, este presupuesto no se llega a utilizar en su totalidad lo que nos muestra un desaprovechamiento de los mismos, la propuesta es mejorar las condiciones de los principales sectores económicos que pueden impulsar la generación de producción y empleo en diferentes áreas de la región aprovechando estos recursos no utilizados. Se desarrolló un programa de objetivos de corto y largo plazo en un marco de plan estratégico para los sectores Agrícola, Pesquero, Minero y Turístico con los cuales se promoverá mayor generación de empleo directos e indirectos. En el sector pesquero se impulsará la producción de enlatados y conservas de mayor valor agregado, en el sector agrícola se impulsara la producción de productos a través de la implementación de nuevas tecnologías de captación de agua, se impulsará la inversión privada en el sector minero para incrementar la producción de zinc y plomo aumentando la exportación de minerales, en el sector turístico se impulsará el turismo gastronómico. Se buscará la reducción de la delincuencia con la construcción de comisarías y colocación de mayor número de personal policial en toda la región. Estos objetivo tiene como propósito principal integrar a la región para dar mayor beneficio y participación a la ciudadanía buscando su desarrollo y bienestar como fin primordial, cabe indicar que tales estrategias proceden del empleo de la metodología del modelo secuencial, propuesto por D’Alessio (2015), que contempla un análisis interno y externo para un mayor conocimiento de la situación actual, con lo cual se asegura que implementando este plan se podría alcanzar estos objetivos al 2027The Macro Region V constituted by Metropolitan Lima, Callao and Lima Provinces is located on the west coast of Peru and has a strategic location to access international markets through the main ports and airport of the country, in addition to its diverse agricultural production and mining also has a tourism sector. Macro Region V has established a participatory budget for Callao and for Lima that has been used annually and as noted in the study, this budget does not get to use in its entirety what shows us a wastage of them, the proposal is Improve the conditions of the main economic sectors that can boost the generation of production and employment in different areas of the region taking advantage of these unused resources. A program of short and long term objectives was developed within a strategic plan framework for the agricultural, fishing, mining and tourism sectors with which to promote greater direct and indirect employment generation. In the fishing sector, the production of canned and preserved products with higher added value will be promoted, in the agricultural sector the production of products will be promoted through the implementation of new water collection technologies, private investment in the mining sector will be promoted to Increase the production of zinc and lead increasing the export of minerals, tourism will boost gastronomic tourism. Reduction of delinquency will be sought through the construction of police stations and placement of more police personnel throughout the region. The main purpose of these objectives is to integrate the region in order to give greater benefit and participation to the public, seeking its development and well-being as a primary goal. It is worth mentioning that such strategies come from the use of the methodology of the sequential model, proposed by D'Alessio (2015), which includes an internal and external analysis for a better understanding of the current situation, which ensures that implementing this plan could achieve these objectives by 2027Tesi

Proposal for a surety risk monitoring guide using the framework of the PMI® Standard for Portfolio Management to strengthen the management of technical reserves of sureties in force in public projects in Peru

Actualmente, la ejecución de obras públicas en el país requiere de cartas fianzas para garantizar el cumplimiento de las obligaciones contraídas por el contratista en el contrato de obra. En ese sentido, una compañía de seguros suscribe con el contratista una póliza de caución, el cual es un tipo de contrato seguro para avalarlo frente a una entidad. Sin embargo, la ejecución contractual está expuesta a modificaciones del alcance que generan controversias, como el reconocimiento de adicionales, deductivos, ampliaciones de plazo, etc. Además, la compañía recibe solicitudes de liberación de contragarantías cuando la suma asegurada es reducida; por lo que, es importante tener una visión integral de los proyectos asegurados. En ese contexto, se propone una guía de seguimiento de riesgos de caución, que utiliza el marco de trabajo del Standard for Portfolio Management del PMI®, para fortalecer la gestión de las reservas técnicas de fianzas en vigor, mediante una buena cobertura porcentual de la suma asegurada. Esta guía es evaluada mediante un Juicio de Expertos, obteniendo un coeficiente alfa de Cronbach de 0.90; para así, catalogarla con consistencia “buena” y validar la confiabilidad de los resultados. En la implementación, para los riesgos de siniestros, se obtuvo como resultado un recupero por S/ 56,872.03 en el proyecto del PNSU. Por otro lado, para los riesgos en curso, se determinó aprobar la liberación parcial por S/ 71,977.97 del proyecto en Jaén, rechazar la liberación del proyecto en Islay y aprobar la liberación parcial por S/ 49,020.95 del proyecto en Jacobo Hunter.Currently, the execution of public works in the country requires letters of guarantee to guarantee compliance with the obligations contracted by the contractor in the work contract. In that sense, an insurance company signs a surety policy with the contractor, which is a type of insurance contract to guarantee it against a entity. However, contractual execution is exposed to modifications of the scope that generate controversy, such as the recognition of additional, deductive, term extensions, etc. In addition, the company receives requests for the release of counterguarantees when the insured sum is reduced; Therefore, it is important to have a comprehensive vision of the insured projects. In this context, a surety risk monitoring guide is proposed, which uses the framework of the PMI® Standard for Portfolio Management, to strengthen the management of current surety technical reserves, through good percentage coverage of the guarantee. sum assured. This guide is evaluated through an Expert Judgment, obtaining a Cronbach's alpha coefficient of 0.90; in order to classify it with “good” consistency and validate the reliability of the results. In the implementation, for the risks of claim’s, a recovery of S/ 56,872.03 was obtained in the PNSU project. On the other hand, for ongoing risks, it was determined to approve the partial release for S/ 71,977.97 of the project in Jaén, reject the release of the project in Islay and approve the partial release for S/ 49,020.95 of the project in Jacobo Hunter.Tesi

The Chikungunya virus: A reemerging cause of acute febrile illness in the high jungle of northern Peru

Background The Chikungunya virus (CHIKV) is an emerging arthropod-borne virus (arbovirus) that causes undifferentiated acute febrile illness. Cases of CHIKV may be under-reported in Peru, given the various difficulties in diagnosing it, such as lack of diagnostic tests in remote areas, the passive nature of epidemiological surveillance, and co-circulation of other arthro-pod-borne pathogens. Therefore, a study was conducted in the high jungle of northern Peru to determine the prevalence of CHIKV among febrile patients and describe their clinical characteristics. Methods A cross-sectional study was conducted in the province of Jaen, Cajamarca, located in the high jungle of northern Peru. Patients attending primary healthcare centers within Cajamar-ca’s Regional Health Directorate were enrolled. The study took place from June 2020 through June 2021. Patients were eligible if they sought outpatient healthcare for a clinical diagnosis of acute febrile illness (AFI). Serum samples were collected from all patients, and the diagnosis of CHIKV was determined using real-time RT-PCR, as well as the detection of IgM antibodies by ELISA. A logistic regression model was employed to identify the risk factors for CHIKV, and the odds ratios (ORs) were calculated, along with their corresponding 95% confidence intervals (95% CI). Results A total of 1 047 patients with AFI were included during the study period. CHIKV was identified in 130 patients of 1 047 (12.4%). Among the CHIKV positive cases, 84 of 130 (64.6%) were diagnosed by RT-PCR, 42 of 130 (32.3%) by IgM ELISA detection, and 4 of 130 (3.1%) by both assays. The majority of patients with CHIKV infection fell within the 18–39 years age group (50.0%), followed by the 40–59 years age group (23.9%) and those with 60 years or older (10.8%). The most common clinical symptoms observed in patients with CHIKV infection were headache (85.4%), myalgias (72.3%), and arthralgias (64.6%). The highest number of positive CHIKV cases occurred in May (23.1%), followed by March (20.0%) and February (13.8%) of 2021. Conclusion The study reports a considerable frequency of CHIKV infections among patients with AFI from the high jungle of northern Peru. These findings highlight the importance of recognizing CHIKV as an ongoing pathogen with continuous transmission in various areas of Peru. It is crucial to enhance epidemiological surveillance by implementing reliable diagnostic tech-niques, as the clinical symptoms of CHIKV infection can be nonspecific.Revisión por pare

Nivel socioeconómico bajo se asocia con tiempos prolongados de evaluación y tratamiento, sepsis y muerte infecciosa en fiebre pediátrica en El Salvador

Background. Infection remains the most common cause of death from toxicity in children with cancer in low- and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1) Longer times from fever onset to hospital presentation/antibiotic treatment and (2) Sepsis and infection-related mortality. Method. This prospective cohort study included children aged 0–16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection related mortality were documented. Findings. Of 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%). Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0–20.0), and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0–3.0). Forty-seven (17.5%) patients developed sepsis and 7 (2.6%) died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029) and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09–8.63; P = 0.034). More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03– 1.81; P = 0.031) and in families with an annual household income, US$2,000 (OR 13.90, 95$2000 (OR 13,90, IC del 95 % 1,62–119,10; P = 0,016). Interpretación. El analfabetismo, la pobreza y los tiempos de viaje más largos se asocian con retrasos en la evaluación y el tratamiento de la fiebre y con la sepsis y la mortalidad infecciosa en la leucemia pediátrica. Brindar educación adicional a las familias de alto riesgo y permanecer en una casa de huéspedes cercana durante los períodos de neutropenia puede disminuir la sepsis y la mortalidad infecciosa

Detection of dengue virus serotype 3 in Cajamarca, Peru: Molecular diagnosis and clinical characteristics

Objective: To describe and molecularly characterize an outbreak of dengue virus (DENV) infection in Cajamarca, an Andean region in Peru. Methods: A total of 359 serum samples from patients with acute febrile illness were assessed for the presence of DENV via RT-PCR, ELISA NS1, IgM and IgG in Cajamarca, Peru from January 2017 to June 2017. The evaluation of the different diagnostic tests and their applicability was performed. Results: Dengue virus was detected in 24.7% of samples by RTPCR. Meanwhile, serological analysis detected 30.3% positive cases via ELISA NS1 antigen, 16.7% via ELISA IgG and 9.7% via ELISA IgM. Most of the cases corresponded to DENV-3 (77.5%). The use of RT-PCR performed better in primary infections (P<0.01), while detection of ELISA IgM performed better in secondary infections (P<0.01). The combination of NS1 and IgM performed better than the other assays in detecting primary (92.5%) and secondary infections (96.6%). The most frequent symptoms associated with fever were headaches, myalgias, and arthralgias across all groups. Conclusions: We report an important outbreak of dengue infection caused by DENV-3 in Cajamarca, Peru. Our findings encourage the use of NS1 antigen and IgM co-detection. These findings demonstrate an increasing expansion of DENV-3 in Peru and highlight the importance of molecular diagnosis and serotype characterization among the clinically defined dengue cases to strengthen the Peruvian epidemiological surveillance.Ministry of Health and WelfareRevisión por pare