Determinación de la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua superficiales de la margen derecha del río Mayo, 2015

La presente investigación “Determinación de la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua de la margen derecha del río Mayo, 2015”, permitió determinar la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua superficiales de la margen derecha del río Mayo- 2015.Se ha logrado realizar las mediciones del caudal de los cuerpos de agua superficial de la margen derecha del río Mayo en dos eventos: la época seca y época humedad. Encontrándose que el río Tónchima presenta mayor caudal en los dos eventos de muestreo reportando 15.7 m3/s en la época seca y 36.96 m3/s en la época húmeda. El río que presenta menor caudal está determinado por el río Yuracyacu el cual reporta 0.8 m3/s en la época seca y 2.69 en la época húmeda.En general, las fuentes de agua superficial que se encuentran en la margen derecha del río Mayo presentan una condición de cuerpo receptor que no representa riesgo significativo para la Conservación del Ambiente Acuático de acuerdo a lo establecido en el D.S. N° 015-2015 (Estándares de Calidad Ambiental para Agua- ECA).TesisAp

Exportación de servicio y empleabilidad en una empresa de centros de llamadas del sector de telecomunicaciones, Ate 2022

La realización del presente estudio estuvo orientado a identificar la relación entre el Exportación de servicio y empleabilidad en una empresa de centros de llamadas del sector de Telecomunicaciones, Ate 2022, por lo cual se ha considerado empresas donde contribuirán favorablemente a las empresas que ponen la teoría en práctica. La investigación que se ha empleado fue de tipo aplicada, con un diseño no experimental, transversal y correlacional, constituida por una muestra de 25 colaboradores. Usando como técnica principal la encuesta y por instrumento, se empleó dos cuestionarios validados por juicios de expertos, asimismo cuya confiabilidad de Alfa de Cronbach fue de 0. 926 para exportación de servicio y 0. 928 para empleabilidad. Por ser una muestra menor a 50, se empleó el coeficiente de correlación de Pearson. Los resultados obtenidos en las variables fue que existe correlación positiva alta con un coeficiente de Pearson 0.849) y el nivel de significancia fue de p.00, lo cual es menor p.05 (0.000<0.05). Se concluye, que existe relación positiva alta entre la exportación de servicios con la empleabilidad en una empresa de centros de llamadas del sector de Telecomunicaciones. Lo cual quiere decir, que la práctica de exportación de servicios fideliza al cliente interno (colaboradores)

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options

Determinación de la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua superficiales de la margen derecha del río Mayo, 2015

TesisApaLa presente investigación “Determinación de la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua de la margen derecha del río Mayo, 2015”, permitió determinar la concentración de contaminantes físico químicos y bacteriológicos en los cuerpos de agua superficiales de la margen derecha del río Mayo- 2015.Se ha logrado realizar las mediciones del caudal de los cuerpos de agua superficial de la margen derecha del río Mayo en dos eventos: la época seca y época humedad. Encontrándose que el río Tónchima presenta mayor caudal en los dos eventos de muestreo reportando 15.7 m3/s en la época seca y 36.96 m3/s en la época húmeda. El río que presenta menor caudal está determinado por el río Yuracyacu el cual reporta 0.8 m3/s en la época seca y 2.69 en la época húmeda.En general, las fuentes de agua superficial que se encuentran en la margen derecha del río Mayo presentan una condición de cuerpo receptor que no representa riesgo significativo para la Conservación del Ambiente Acuático de acuerdo a lo establecido en el D.S. N° 015-2015 (Estándares de Calidad Ambiental para Agua- ECA)

Nonfunctioning Pituitary Adenoma That Changed to a Functional Gonadotropinoma

Objective. Pituitary adenomas can be classified as clinically functional or silent. Depending on the reviewed literature, these are the first or second place in frequency of the total pituitary adenomas. Even rarer is the presence of a functional gonadotropinoma since only very few case reports exist to date. The conversion of a clinically silent to functional pituitary adenoma is extraordinarily rare; the mechanisms that explain these phenomena are unknown or not fully understood. Methods. We report the case of a woman who initially had a nonfunctional gonadotropinoma and in the course of her medical condition showed biochemical changes in her hormonal pituitary profile compatible with a functional gonadotropinoma. Results. We considered that the patient had a functional gonadotropinoma due to the hyperestrogenemia in the context of secondary amenorrhea, resolving the hyperestrogenemia after almost complete resection of the tumor. Conclusion. It is necessary to point out from a clinical and/or biochemical point of view the change in functionality that a nonfunctional pituitary adenoma may have. In the case of our patient, the suspicion of this change in functionality became evident when we found an increase in the FSH/LH ratio and a progressive increase in serum estradiol concentrations when the patient had amenorrhea

Current Approach of Functioning Head and Neck Paragangliomas: Case Report of a Young Patient with Multiple Asynchronous Tumors

Introduction. Pheochromocytomas (Pheo) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla and from the extra-adrenal autonomic paraganglia, respectively. Only 1–3% of head and neck PGL (HNPGL) show elevated catecholamines, and at least 30% of Pheo and PGL (PCPG) are associated with genetic syndromes caused by germline mutations in tumor suppressor genes and proto-oncogenes. Clinical Case. A 33-year-old man with a past medical history of resection of an abdominal PGL at the age of eleven underwent a CT scan after a mild traumatic brain injury revealing an incidental brain tumor. The diagnosis of a functioning PGL was made, and further testing was undertaken with a PET-CT with 68Ga-DOTATATE, SPECT-CT 131-MIBG, and genetic testing. Discussion and Conclusion. The usual clinical presentation of functioning PCPG includes paroxistic hypertension, headache, and diaphoresis, sometimes with a suggestive family history in 30–40% of cases. Only 20% of PGL are located in head and neck, of which only 1–3% will show elevated catecholamines. Metastatic disease is present in up to 50% of cases, usually associated with a hereditary germline mutation. However, different phenotypes can be observed depending on such germline mutations. Genetic testing is important in patients with PCPG since 31% will present a germline mutation. In this particular patient, an SDHB gene mutation was revealed, which can drastically influence the follow-up plan and the genetic counsel offered. A multidisciplinary approach is mandatory for every patient presenting with PCPG

The Genomic Landscape of Corticotroph Tumors: From Silent Adenomas to ACTH-Secreting Carcinomas

Corticotroph cells give rise to aggressive and rare pituitary neoplasms comprising ACTH-producing adenomas resulting in Cushing disease (CD), clinically silent ACTH adenomas (SCA), Crooke cell adenomas (CCA) and ACTH-producing carcinomas (CA). The molecular pathogenesis of these tumors is still poorly understood. To better understand the genomic landscape of all the lesions of the corticotroph lineage, we sequenced the whole exome of three SCA, one CCA, four ACTH-secreting PA causing CD, one corticotrophinoma occurring in a CD patient who developed Nelson syndrome after adrenalectomy and one patient with an ACTH-producing CA. The ACTH-producing CA was the lesion with the highest number of single nucleotide variants (SNV) in genes such as USP8, TP53, AURKA, EGFR, HSD3B1 and CDKN1A. The USP8 variant was found only in the ACTH-CA and in the corticotrophinoma occurring in a patient with Nelson syndrome. In CCA, SNV in TP53, EGFR, HSD3B1 and CDKN1A SNV were present. HSD3B1 and CDKN1A SNVs were present in all three SCA, whereas in two of these tumors SNV in TP53, AURKA and EGFR were found. None of the analyzed tumors showed SNV in USP48, BRAF, BRG1 or CABLES1. The amplification of 17q12 was found in all tumors, except for the ACTH-producing carcinoma. The four clinically functioning ACTH adenomas and the ACTH-CA shared the amplification of 10q11.22 and showed more copy-number variation (CNV) gains and single-nucleotide variations than the nonfunctioning tumors