Propuesta de mejoramiento de la eficiencia administrativa del área de metrología de la empresa Ángel Diagnóstica S.A.S. ubicada en la ciudad de Cali, Valle del Cauca.

En la actualidad se puede evidenciar que en la mayorías de las empresas exitosas utilizan procesos administrativos correctamente definidos para manejar sus operaciones ya que este proceso está compuesto por: (planeación, organización, dirección y control). Son estos procesos los necesarios para así logar los objetivos propuestos de cada mes o año. Los procesos administrativos son sumamente importantes en cada organización ya que estos ayudan a evitar una improvisación en algún momento de crisis y así poder superar los retos más difíciles teniendo estos como ayuda en la toma de decisiones más importante. El área de la salud no es ajena a esta problemática, ya que seguir con los procesos administrativos es una parte fundamental, debido a que si se trata de un laboratorio donde se toman muestras y/o exámenes que determinan una enfermedad o la misma vida de un ser humano, cumplir estos procesos correctamente es de vital importancia para así garantizar la entrega de resultados exactos de su estado de salud, así mismo es de igual importancia que cada área que comprende una organización que esté en el área de salud cumpla con procesos del área de metrología de la manera correcta, ya que en el área de la salud se ven casos donde sus colaboradores no le prestan la suficiente atención a estos procesos, los cuales pueden generar sanciones en el caso de auditorías y así mismo generar resultados que no van a ser bien vistos por parte de la organización y la comunidad.PregradoADMINISTRADOR(A) DE EMPRESA

Carcinoma epidermoide de pene. A propósito de un caso

It is presented a report on a patient who was operated years ago from a squamous cell carcinoma of the penis and who apparently had a delayed relapse. It raised doubts as to its origin, because it could be a new primary tumor or a relapse. A new tumor of the same histological type was finally diagnosed, but on another location far from the first location. The importance of monitoring this type of tumor after conservative surgery is summarized because of the potential long-term relapse.Presentamos el caso de un paciente operado hace años de un carcinoma epidermoide de pene que, de forma tardía y aparentemente, presentó una recidiva que generó dudas en cuanto a su origen, pues podía ser también un nuevo tumor primario o una recidiva; finalmente se diagnosticó un nuevo tumor del mismo tipo histológico, pero en otro sitio distante de la primera localización. Reseñamos la importancia de un seguimiento de este tipo de tumores tras la operación conservadora dada la posibilidad de recidiva a largo plazo

Nefrolitotomía percutánea. Presentación de un paciente

A patient operated on at the Department of Urology of the Arnaldo Milian Castro Provincial University Hospital in Santa Clara is presented. The patient had a diagnosis of right renal pelvic calculi and was operated on using a minimally invasive technique implemented for the first time in our province.Se presenta un paciente operado en el Servicio de Urología del Hospital Provincial Universitario “Arnaldo Milián Castro” de Santa Clara con el diagnóstico de litiasis de pelvis renal derecha mediante una técnica mínimamente invasiva utilizada por primera vez en la provincia de Villa Clara

High prevalence of Salmonella spp. in wastewater reused for irrigation assessed by molecular methods

[EN] Salmonella spp. is one of the most important causal agents of food-borne illness in developed countries and its presence in irrigation water poses a risk to public health. Its detection in environmental samples is not easy when culture methods are used, and molecular techniques such as PCR or ribosomal rRNA probe hybridization (Fluorescent zn situ Hybridization, FISH) are outstanding alternatives. The aim of this work was to determine the environmental risk due to the presence of Salmonella spp. in wastewater by culture, PCR and FISH. A new specific rDNA probe for Salmonella was designed and its efficiency was compared with the rest of methods Serotype and antibiotic resistance of isolated strains were determined. Forty-five wastewater samples (collected from two secondary wastewater treatment plants) were analysed. Salmonella strains were isolated in 24 wastewater samples (53%), two of them after disinfection treatment. Twenty-three Salmonella strains exhibited resistance to one or more antimicrobial agent. Analysis of wastewater samples yielded PCR positive results for Salmonella in 28 out of the 45 wastewater samples (62%). FISH analysis allowed for the detection of Salmonella in 27 (60%) samples. By using molecular methods, Salmonella was detected in four samples after disinfection treatment. These results show the prevalence of Salmonella in reclaimed wastewater even after U.V. disinfection, what is a matter of public health concern, the high rates of resistance to antibiotics and the adequacy of molecular methods for its rapid detection. FISH method, with SA23 probe developed and assayed in this work provides a tool for detecting Salmonella in water within few hours, with a high rate of effectiveness.Authors gratefully acknowledge the financial support from the Ministerio de Ciencia e Innovacion (Project: AGL2008-05275-C03-02).Santiago Cuellar, P.; Jiménez Belenguer, AI.; García Hernández, J.; Montes Estellés, RM.; Hernández Pérez, M.; Castillo López, MÁ.; Ferrús Pérez, MA.... (2018). High prevalence of Salmonella spp. in wastewater reused for irrigation assessed by molecular methods. International Journal of Hygiene and Environmental Health. 221(1):95-101. https://doi.org/10.1016/j.ijheh.2017.10.007S95101221

Cirugía percutánea de la litiasis renal. Experiencia inicial

Percutaneous surgery of kidney stones was introduced in urology more than 20 years ago. Extracorporeal lithotripsy appeared shortly after. The objective of this article is to show the experience in this type of surgery after its introduction in the Urology Department. For this, the results of 50 patients undergoing percutaneous surgery for kidney stones were analyzed retrospectively. The two positions, known worldwide, were used. There was a minimum of complications, short surgical time and high effectiveness, reducing the post operative stay with a high problem-solving capacity and patient satisfaction.La intervención quirúrgica percutánea de la litiasis renal fue introducida en la Urología hace más de 20 años; poco después lo fue la litotricia extracorpórea. El objetivo de este trabajo es mostrar la experiencia en este tipo de intervención luego de su introducción en el Servicio de Urología, para lo que se analizaron, en forma retrospectiva, los resultados de 50 pacientes operados de litiasis renal por intervención quirúrgica percutánea. Se utilizaron las dos posiciones reconocidas mundialmente, con un mínimo de complicaciones bajo tiempo quirúrgico y una elevada efectividad, disminuyó la estadía post operatoria y hubo un alto poder de resolutividad y satisfacción de los pacientes

Is Routine Prophylaxis Against Pneumocystis jirovecii Needed in Liver Transplantation? A Retrospective Single-Centre Experience and Current Prophylaxis Strategies in Spain

In liver transplant (LT) recipients, Pneumocystis jirovecii pneumonia (PJP) is most frequently reported before 1992 when immunosuppressive regimens were more intense. It is uncertain whether universal PJP prophylaxis is still applicable in the contemporary LT setting. We aimed to examine the incidence of PJP in LT recipients followed at our institution where routine prophylaxis has never been practiced and to define the prophylaxis strategies currently employed among LT units in Spain. All LT performed from 1990 to October 2019 were retrospectively reviewed and Spanish LT units were queried via email to specify their current prophylaxis strategy. During the study period, 662 LT procedures were carried out on 610 patients. Five cases of PJP were identified, with only one occurring within the first 6 months. The cumulative incidence and incidence rate were 0.82% and 0.99 cases per 1000 person transplant years. All LT units responded, the majority of which provide prophylaxis (80%). Duration of prophylaxis, however, varied significantly. The low incidence of PJP in our unprophylaxed cohort, with most cases occurring beyond the usual recommended period of prophylaxis, questions a one-size-fits-all approach to PJP prophylaxis. A significant heterogeneity in prophylaxis strategies exists among Spanish LT centres.Funding: This study was supported by the Health Research Institute Marqués de Valdecilla. IDIVAL. Santander. NEXT VAL17/07 grant to José Ignacio Fortea Ormaechea

POEMS Syndrome: Real World Experience in Diagnosis and Systemic Therapy - 108 Patients Multicenter Analysis

POEMS syndrome, a rare plasma cell disorder, is challenging both in the diagnostic and therapeutic management. We present real word retrospective analysis of 108 cases analyzing clinical features and therapeutic modes. We compare our results with the available literature. This is the first description with such wide use of proteasome inhibitors in first line treatment. POEMS (Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) syndrome is a rare and challenging plasma cell disorder, both in the diagnostic and therapeutic management of the disease. Currently, the literature on POEMS is sparse with most evidence being case reports and small case studies. We present a retrospective real world experience of 108 patients with POEMS. We analyzed the clinical features and therapeutic interventions. Regarding clinical features, our findings demonstrated that skin lesions, thrombocythemia and polycythemia were present less frequently than reported previously. Regarding clinical interventions, this is one of the largest analyses of front line treatment in POEMS and the first one to include frequent utilization of proteasome inhibitors (37%). Bortezomib monotherapy was the most effective therapy achieving complete remission/very good partial remissions (CR/VGPR) in 69% of patients. Thirty percent of patients proceeded to planned autologous stem cell transplant (ASCT) as part of the front-line treatment resulting in statistically superior progression-free (PFS) and overall survival (OS) compared to non-ASCT treated patients (P= .003). In multivariate analysis, anemia, thrombocytopenia, and as age over 60 were associated with a negative impact on patient outcomes

Cancer genomics paves the way to targeted therapy.

RESUMEN: La lucha contra el cáncer es aún un desafío mayor, con cerca de 14 millones de nuevos casos de cáncer al año y más de 8 millones de muertes anuales atribuidas al cáncer. Con la ayuda de múltiples servicios clínicos del HUMV y otras Instituciones, trabajamos para demostrar la hipótesis de que análisis integrados de genómica y secuenciación dirigida de alta profundidad en especímenes quirúrgicos de rutina puede generar datos firmes y relevantes sobre la complejidad molecular, composición subclonal, índice mutacional, firmas mutacionales y mutaciones precisas en genes con implicaciones terapéuticas; así generando una herramienta diagnóstica robusta que permita predecir sensibilidad a terapias específicas. In este proyecto, hemos podido demostrar que los estudios genómicos del cáncer demuestran dianas útiles para la intervención terapéutica y que la combinación de múltiples terapias inactivando rutas oncogénicas convergentes representa una opción plausible para pacientes con cáncer avanzado.ABSTRACT: Cancer is still a mayor challenge with something more than 14M new cases per year in the world and more of 8M patients dying yearly because of cancer. With the collaboration of multiple clinical services at the HUMV and other clinical institutions, we are working to demonstrate the hypothesis that genomics integrative analysis and high-depth targeted mutational analysis in routine cancer specimens may generate consistent, relevant data informing about molecular complexity, subclonal composition, mutational rate, mutational signatures and precise mutations in genes with therapeutic implications; thus generating a robust, solid, diagnostic tool that may allow to predict the sensitivity to specific therapies. In this project we have been able to demonstrate that cancer genome studies do demonstrate actionable targets, and that the combination of multiple therapies targeting convergent pathways represent a plausible option for advanced cancer patients

Traditional Excluding Forces: A Review of the Quantitative Literature on the Economic Situation of Indigenous Peoples, Afro-Descendants, and People Living with Disability

Unequal income distribution in Latin America and the Caribbean is linked to unequal distributions of (human and physical) assets and differential access to markets and services. These circumstances, and the accompanying social tensions, need to be understood in terms of traditional fragmenting forces; the sectors of the population who experience unfavorable outcomes are also recognized by characteristics such as ethnicity, race, gender and physical disability. In addition to reviewing the general literature on social exclusion, this paper surveys several more specific topics: i) relative deprivation (in land and housing, physical infrastructure, health and income); ii) labor market issues, including access to labor markets in general, as well as informality, segregation and discrimination; iii) the transaction points of political representation, social protection and violence; and iv) areas where analysis remains weak and avenues for further research in the region

Marejadas rurales y luchas por la vida, vol. iv: permanencias, resistencias y luchas por la vida

Volumen 4. Permanencias, resistencias y luchas por la vida, coordinado por: Elisabeth A. Mager Hois, Miguel Ángel Paz Frayre y Carla Zamora Lomelí, integra 15 capítulos y está dividido en tres secciones, la primera denominada Permanencia, contiene 5 capítulos que intentan establecer como eje común la lucha continua en las comunidades campesinas para continuar con la vida rural. La segunda, Identidad y resistencia, está compuesta por 4 capítulos que reflexionan sobre varios procesos de resistencia de la vida rural ante los cambios globales e internos en su propio proceso de vida, otros trabajos intentan encontrar aquellos elementos que generan y mantienen alguna forma de identidad, y la tercera sección, Lucha por la vida, contiene 6 trabajos que demuestran todas aquellas posibilidades que existen en el medio rural para sostenerse y mantenerse, generando diferentes formas y estrategias que los une en la continua lucha por vivir con pocas pretensiones y con difíciles perspectivas pero siempre encontrando alternativas.ASOCIACIÓN MEXICANA DE ESTUDIOS RURALES, INSTITUTO DE CIENCIAS AGROPECUARIAS Y RURALES (ICAR), UNIVERSIDAD DE GUADALAJARA, FACULTAD DE ESTUDIOS SUPERIORES ACATLÁN-UNAM, ECOSUR, CUCOSTA SUR GRANA, EL COLEGIO DE MICHOACÁN A.C., UNIVERSIDAD MICHOACANA DE SAN NICOLAS HIDALG