Plan comunitario de gestión del riesgo de desastres, barrio la rivera baja municipio de Dosquebradas, Risaralda

Anteriormente la Gestión del Riesgo de Desastres se enfocaba principalmente en el proceso de Atención de Emergencias, es decir que no se fomentaba el conocimiento y la reducción del riesgo; debido a esto los desastres se volvieron cada vez más recurrentes y aumentaron el número de pérdidas y daños en las personas y sus medios de vida, entre otros recursos de vital importancia. Esta situación encendió las alarmas a nivel mundial, dado que enfrentar estos eventos inesperados puso a los países en aprietos, especialmente en los aspectos financiero y económico, dado que, al no contar con un plan de contingencia o con la suficiente preparación para atender la magnitud de los daños ocasionados, se requiere desviar los recursos destinados a otros proyectos de desarrollo e incluso solicitar recursos internacionales para la recuperación y rehabilitación después del desastre. Así mismo, la fuerza de trabajo que impulsa la economía del país se ve afectada por el número de personas heridas o fallecidas, así como por los daños en sus medios de vida e infraestructura. Por tal motivo, lo que hoy llamamos Gestión del Riesgo de Desastres, incorpora los procesos de conocimiento, prevención y reducción del riesgo los cuales permiten realizar una gestión prospectiva, es decir con un enfoque preventivo, que sirva de preparación antes de los desastres, con el ánimo de disminuir sustancialmente el riesgo, haciendo énfasis en la reducción de la vulnerabilidad, para que en la ocurrencia de un evento desastroso los impactos generados sean cada vez menores. Adicional a esto, se conservan los procesos de preparación, respuesta, rehabilitación y reconstrucción. Todos los procesos mencionados para la gestión del riesgo de desastres, la Ley 1523 de 2012 los agrupa en tres grandes procesos de: conocimiento del riesgo, reducción del riesgo y manejo del desastre. En este sentido el presente trabajo es el resultado

Propuesta de mejora para cumplimiento de requisitos de sostenibilidad en los establecimientos turísticos que prestan servicio de alojamiento en el municipio de Marsella, Risaralda

Desde el año 2017 Marsella está adelantando procesos para certificarse como destino turístico sostenible NTS-TS001-1. Gracias a esta iniciativa que tiene la alcaldía de Marsella, algunos establecimientos turísticos que prestan servicio de alojamiento en el municipio desean implementar la NTS-TS002 que hace referencia al cumplimiento de requisitos de sostenibilidad en establecimientos de alojamiento y hospedaje (EAH). En este sentido, el presente trabajo de grado tiene como objetivo principal diseñar una propuesta de mejora para los establecimientos turísticos que prestan servicio de alojamiento en el municipio de Marsella

Plan de auditoría interna ISO 22000:2018 para la empresa Productos Alimenticios Estrella Gourmet.

Apéndice 1 Programa de auditoria interna al sistema de gestión de la calidad a los Productos Alimenticios Estrella Gourmet.En el presente plan de auditoría interna se describe las actividades y estándares acordados, donde se evidencian resultados y logran metas en sus acciones y las observaciones sobre cada hallazgo o proceso comprobable y análisis de los resultados. Se demuestra la implementación frente a las acciones correctivas registradas, se evalúa el cumplimiento de los requisitos de la norma ISO 22000 del año 2018 a través de pruebas documentadas del sistema y la evaluación práctica. Se lleva a cabo entrevista al personal e inspección de documentos elaborados para el control de riesgos, peligros en los procesos, se realiza la evaluación del grado de efectividad de las normas a tener en cuenta y el cumplimiento de aspectos que interfieren en la calidad e inocuidad de los alimentos. Para determinar el cumplimiento de políticas y procedimientos, los sistemas de gestión de calidad y seguridad se utilizan como estrategia de mejora del desempeño que implica “alimentos seguros” y “de alta calidad”, que trabajen juntos para confirmar estos aspectos entre ellos, los resultados se logran de acuerdo con las disposiciones reglamentarias y los requisitos de las normas involucradas. Palabras Claves: Auditoría Interna, ISO 22000:2018, calidad, inocuidad alimentaria, Sistema de gestión, alimentos seguros.This internal audit plan describes the agreed activities and standards, where results are evidenced and achieve goals in their actions and observations on each finding or verifiable process and analysis of the results. The implementation is demonstrated against the corrective actions recorded, compliance with the requirements of ISO 22000 of 2018 is evaluated through documented system tests and practical evaluation. Interviews with personnel and inspection of documents prepared for the control of risks, hazards in the processes are carried out, the evaluation of the degree of effectiveness of the standards to be considered and compliance with aspects that interfere with the quality and safety of food is performed. To determine compliance with policies and procedures, quality and safety management systems are used as a performance improvement strategy that involves "safe food" and "high quality", working together to confirm these aspects between them, the results are achieved in accordance with regulatory provisions and the requirements of the standards involved. Keywords: internal audit, ISO 22000:2018, quality, food safety, management system, safe food

Regulatory role of vitamin D in T-cell reactivity against myelin peptides in relapsing-remitting multiple sclerosis patients

Background: Low levels of plasma 25-hydroxyvitaminD (25(OH)D) are associated with a higher incidence of multiple sclerosis (MS) due to the immune suppressive properties of vitamin D. The aim of this study was to determine the correlation between plasma 25(OH)D concentrations and clinical and immunological variables in a cohort of multiple sclerosis patients. Methods: Plasma 25(OH)D concentrations were evaluated in summer and winter in 15 primary progressive MS (PPMS) patients, 40 relapsing- remitting MS (RRMS) patients and 40 controls (HC). Protocol variables included demographic and clinical data, radiological findings and immunological variables (oligoclonal bands, HLADR15 and T-lymphocyte proliferation to a definite mix of 7 myelin peptides). Results: During the winter, plasma concentrations were significantly lower in RRMS patients compared to HC, whereas no differences were found in summer. No relationships were found between plasma 25(OH)D concentrations and clinical or radiological variables. RRMS patients with a positive T-cell proliferation to a mix of myelin peptides (n = 31) had lower 25(OH)D concentrations. Conclusions: 25(OH)D is an immunomodulatory molecule that might have a regulatory role in T-cell proliferation to myelin peptides in RRMS patients

Subclinical hypothyroidism in childhood, treatment or only follow-up?

Subclinical hypothyroidism (SH) is defined as serum levels of thyroid-stimulating hormone (TSH) above the upper limit with normal concentrations of free T4 (fT4). Its management remains challenging. The aim of the study was to evaluate clinical and laboratory findings as well as the clinical course of children with SH followed in a third level hospital. Sixty-five patients aged between 2 and 18 years old were retrospectively studied. The patients were followed for a median period of 9 months (range 6 months to 24 months). Those who normalized TSH levels were discharged (Group 1). If TSH persisted mildly elevated (5-10μUI/mL) with normal fT4 and negative TPOAb/TgAb, they were classified as Group 2 and followed semi-annually without treatment. Those patients whose TSH raised ≥10μUI/mL or who maintained TSH 5-10μUI/mL and positive TPOAb/TgAb were considered suitable for thyroxin therapy (Group 3, G3). In 89% of our patients, TSH concentrations spontaneously reverted to normality or remained stable without treatment (Groups 1 and 2), whereas less than 11% progressed to clinical hypothyroidism (Group 3). Baseline TSH was significantly lower in group 1 than in group 3. In group 3 the prevalence of female sex (71%) was higher and TPO antibodies were present in 85% of patients. The risk of developing overt hypothyroidism in patients with positive anti-thyroid antibodies respect to those who normalized TSH was 45 (95%CI 6.5-312.5). Baseline TSH, female sex and the presence of thyroid autoimmunity were the best predictors of the evolution to SH over time

Relationship of YKL-40 and adiponectin and subclinical atherosclerosis in asymptomatic patients with type 1 diabetes mellitus from a European Mediterranean population

Background: The glycoprotein YKL-40 is a new marker of early inflammation and endothelial dysfunction. Adiponectin is a collagen-like protein with anti-atherogenic and anti-inflammatory effects. Increased concentrations of both markers have been reported in patients with type 1 diabetes (T1D). Aim: To assess the possible role of YKL-40 and adiponectin as a marker of subclinical cardiovascular disease in asymptomatic patients with type 1 diabetes with no history of ischemic or macrovascular heart disease and its relationship with other classic inflammatory biomarkers.Methods: Concentrations of YKL-40, adiponectin, IL-6, IL-1β, TNF- α, hsCRP and homocysteine were determined in 150 T1D patients (58 % men, age: 38.6 ± 8.1 years, 20.4 ± 8.1 years of evolution, BMI: 25.1 ± 3.6 kg/m2; HbA1c 8.1 ± 2.3 %, 48 % smokers; 26 % retinopathy, microalbuminuria 9 %) and 50 controls age, sex and smoke condition matched. Subclinical atherosclerosis was assessed by a carotid ultrasonography and a computed tomography for evaluation of calcium artery calcification score (CACS). Results: 82 % of T1D patients and 92 % of controls had a calcium score of 0. T1D patients showed a significantly higher mean common carotid artery intima media thickness (CIMT) compared to controls (0.55 ± 0.14 vs 0.48 ± 0.14 mm, p = 0.01). Concentrations of YKL-40 and adiponectin were significantly higher in T1D [42.6 (10.4-195.0) vs ±28.7 (11.0-51.2) ng/ml, p = 0.001 and 15.8 ± 9.1 vs. 12.4 ± 5.3 mg/ml, p = 0.008], with no differences when compared to other inflammatory parameters. In T1D patients no association was found between YKL-40 and adiponectin and screening test for subclinical arterial disease (neither CACS nor CIMT). A positive correlation was found between levels of YKL-40 and age and duration of disease (r = 0.28, p = 0.003; r = 0.35, p = 0.001). There were no differences in the YKL-40 in relation to the presence or absence of retinopathy or nephropathy. Levels of adiponectin were higher in patients with nephropathy (21.84 ± 8.15 vs. 14.88 ± 8.27 mg/ml, p = 0.008). Conclusions: Type 1 diabetes patients from a Mediterranean area with a longer disease evolution, although a lower degree of subclinical disease, showed significatively higher concentrations of YKL-40 and adiponectin compared with the controls. Therefore, we conclude that YKL-40 and adiponectin are early inflammatory markers in diabetic subjects even in the presence of a low atherosclerotic background

Reference Intervals of Thyroid Function Tests Assessed by Immunoassay and Mass Spectrometry in Healthy Pregnant Women Living in Catalonia

Background: Recent guidelines recommend establishing a local reference interval (RI) for thyroid function. We aimed to establish trimester-specific RIs for thyrotropin (TSH) and free thyroxine (FT4) in a cohort of healthy pregnant women in Catalonia (Spain). Methods: A prospective observational study was conducted with 332 healthy pregnant women, from the first trimester (1T) to delivery. TSH was measured using an Architect ® immunoassay (Abbott) and FT4 by two immunoassays, Architect ® (Abbott) and Cobas ® (Roche), in the three trimesters. FT4 was also measured by liquid chromatography mass spectrometry (LC/MS/MS) in the 1T. Results: TSH (µUI/mL) increased throughout pregnancy (1T: 0.03-3.78; 2T: 0.51-3.53; 3T: 0.50-4.32; p < 0.0001) and FT4 (pmol/L) progressively decreased (Architect ® 1T: 10.42-15.96; 2T: 8.37-12.74; 3T: 8.24-12.49; p < 0.0001; and Cobas ® : 1T: 11.46-19.05; 2T: 9.65-14.67; 3T: 8.88-14.54; p < 0.0067). The FT4 RI during 1T determined LC/MS/MS was 8.75-18.27. Despite the 1T FT4 results measured by LC/MS/MS and with the two immunoassays being significantly correlated, the results obtained by the three methods were found to be non-interchangeable. Conclusions: We established trimester-specific RIs for TSH and for FT4 with immunoassays in our population. We also validated the 1T FT4 using LC/MS/MS to confirm the results of FT4 lower than the 2.5th percentile or higher than the 97.5th percentile

Patógenos de importancia clínica

PublishedEl presente libro Patógenos de importancia clínica: Inves­tigaciones Recientes en el Valle del Cauca nace como una iniciativa para socializar los resultados obtenidos en los tra­bajos de investigación más recientes de los miembros del Grupo de Investigación en genética, fisiología y metabolis­mo –GEFIME– de la Universidad Santiago de Cali. Estas investigaciones involucran patógenos que son importantes agentes causales de infecciones y de alto impacto en la salud pública en la ciudad de Cali y en el Valle del Cauca. Este libro consta de cinco capítulos con trabajos de investiga­ción en bacterias resistentes a los antibióticos como Staphylo­coccus aureus y Mycobacterium tuberculosis y su comporta­miento epidemiológico en ambientes intrahospitalarios y en poblaciones, respectivamente. En el Capítulo 3 se presenta un estudio epidemiológico que establece la presencia del virus del papiloma humano (VPH) en mucosa oral y su relación con el desarrollando cáncer oral y en el Capítulo 4 se presenta una investigación realizada con moléculas efectoras (alarmona pp­Gpp y la proteína DksA) de Salmonella enterica serovar Typhi­murium y su influencia en la patogenicidad y la formación de biopelículas in-vitro

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

The effects of adiponectin and leptin on human endothelial cell proliferation: A live-cell study

et al.The effect of adiponectin and leptin on the proliferation of the human microvascular endothelial cell line (HMEC-1) was studied in the absence or presence of fetal bovine serum (FBS). The participation of extracellular signal-regulated kinase (ERK) and phosphatidylinositol 3-kinase/Akt (PI-3K/Akt) pathways in this effect were evaluated. We studied the effect of both adipokines on the motility, mitosis, proliferation and cell death processes of HMEC-1 cells using live-cell imaging techniques. Adiponectin but not leptin further increased the proliferative effect induced by FBS on HMEC-1. This effect seems to be the consequence of an increase in the mitotic index in adiponectin-treated cells when compared to untreated ones. The presence of either the mitogen-activated protein kinase (MAPK) inhibitor (PD98059), or PI-3K inhibitor (LY294002), reduced the effect of adiponectin in a dose-dependent manner. Neither adipokine was able to affect HMEC-1 proliferation in FBS-free conditions. Duration of mitosis, cell motility and the cell death process were similar in all conditions. These data suggest that adiponectin and leptin exert different effects on endothelial cell function. Adiponectin was able to potentiate proliferation of HMEC-1. This effect involves the activation of both PI3-K/Akt and ERK/MAPK pathways. However, it seems to exert minimal effects on HMEC-1 function in the case of leptin. Copyright © 2012 S. Karger AG.This work was supported by grants from Fondo de Investigaciones Sanitarias (PI09/0871) and Mutua Madrileña (6012-2009). M.M. and R.J. were paid with a grant from Red Cardiovascular del FIS (RD06/0014/0007). L.A.A.-S., J.M., M.V.B., R.M., M.L.N., V.L. and V.C. are members of the Red Cardiovascular del FIS (RD06/0014/000, RD06/0014/0007 and RD06/0014/0010).Peer Reviewe