Strategic plan for Creamás

The purpose of this research is to develop a 2015-2020 Strategic plan for Creamás, a Peruvian NGO that fosters the dreams and ambition of children through education and diverse workshops. The company began operating in the country in 2009 and throughout the years has managed to become a referent in the NGO national industry. In order to do that the model proposed by Fernando D’Alessio was followed throughout the nine chapters of the document. After thorough research, meetings with the directorates and volunteers, and on-site visitation, data was analyzed in an attempt to decipher the current holistic situation of the organization; its strengths, weaknesses and which opportunities and threats the external situation posed the organization. By complementing such information with a newly proposed vision and mission, and the identified organization’s interests; six long term objectives were defined with their correspondent short-term objectives. Besides that, five strategies were chosen in order for the Creamás to achieve its objectives and as a consequence, its desired vision. Furthermore, in order for Creamás to assess the implementation of this Plan, the document includes the proposed Balanced Scorecard; with the short-term objectives and their correspondent indicators. The fallouts of this work indicate that currently Creamás lacks operational efficiency due to the poor training of its volunteers, is still unable to measure its actual impact on the students, and does not possess a solid funding structure; all of them a must if the firm is to remain relevant in the industryEl objetivo de este trabajo es desarrollar un Plan Estratégico de Creamás para el periodo 2015-2020. Creamás es una ONG peruana que promueve que más niños tengan sueños y ambiciones por medio de clases de matemática y talleres complementarios. La empresa empezó a operar en el país en 2009 y a través de los años ha logrado convertirse en una reconocida organización. Para el desarrollo del trabajo se siguieron los nueve pasos del planeamiento estratégico definidos por Fernando D’Alessio (D’Alessio, 2013). Luego de una detallada investigación, reuniones con Directores y voluntarios, y visitas en campo, se analizó la data recogida a fin de descifrar la situación actual de la organización; sus fortalezas, debilidades y las oportunidades y amenazas que el entorno le presenta. Al complementar esta información con una nueva propuesta de visión y misión, además de los intereses de la empresa; se definieron seis objetivos a largo plazo. Asimismo, se eligieron cinco estrategias para alcanzarlos y que Creamás consiga lograr su situación futura deseada. Para la implementación del presente Plan, el documento incluye un Tablero de Control Balanceado con objetivos a corto plazo y sus indicadores de medición correspondientes. Los resultados de la investigación indican que Creamás presenta problemas en cuanto a eficiencia operacional debido al pobre entrenamiento que reciben sus voluntarios, no es capáz de medir el impacto que causa en los estudiantes y no cuenta aún con una sólida estructura de donaciones; situaciones que deben ser resueltas para mantenerse relevante en la industria.Tesi

Importance of differentiating Mycobaterium bovis in tuberculous meningitis

The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortunately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30%) had a neurological infection. Positive cultures were found in 54 (84%) cases, 18 (33%) in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA) enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001) and the presence of M. bovis (P=0.020) were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032) when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis

TÉCNICAS PARA CONTRARRESTAR LA PÉRDIDA DE VARIABILIDAD EN UN UMDA

Debido a la naturaleza de su proceso de aprendizaje, los algoritmos de estimación de la distribución (conocidos como EDA) han padecido, desde sus primeras implementaciones, de problemas de variabilidad (respecto a las soluciones utilizadas en su proceso de optimización); lo que conlleva a estancamientos en óptimos locales o lentitud para encontrar la solución óptima. Diversos métodos y técnicas han sido implementados en estos algoritmos que reducen, y en algunos casos anulan, dicho problema. El UMDA (Univariate Marginal Distribution Algorithm), es la implementación más simple de un EDA; al asumir independencia entre sus variables, simplifica la estimación de la distribución de las soluciones en el producto de las probabilidades marginales. La aleatoriedad de la primera población y el número de individuos utilizados para estimar la distribución son factores que influyen en la variabilidad del algoritmo. Este artículo presenta un análisis comparativo entre los métodos que tratan este problema, involucrando cuatro de los más utilizados en la literatura y dos más propuestos por los autores. También se presenta un análisis de la influencia en la variabilidad de un UMDA de los parámetros utilizados en los operadores de selección y remplazamiento.

IS200 and multilocus sequence typing for the identification of Salmonella enterica serovar Typhi strains from Indonesia

In this work, IS200 and multi-locus sequence typing (MLST) were used to analyze 19 strains previously serotyped as Salmonella enterica serovar Typhi and isolated in Indonesia (16 strains), Mexico (2 strains), and Switzerland (1 strain). Most of the strains showed the most common Typhi sequence types, ST1 and ST2, and a new Typhi genotype (ST1856) was described. However, one isolate from Mexico and another from Indonesia were of the ST365 and ST426 sequence types, indicating that they belonged to serovars Weltevreden and Aberdeen, respectively. These results were supported by the amplification of IS200 fragments, which rapidly distinguish Typhi from other serovars. Our results demonstrate the utility of IS200 and MLST in the classification of Salmonella strains into serovars. These methods provide information on the clonal relatedness of strains isolated worldwide. [Int Microbiol 2015; 18(2):99-104]Keywords: Salmonella Typhi · bacterial molecular typing · multilocus sequence typing (MLST) · clonal complex · insertion sequence IS20

PROSE: survey on requirements for hosting open source software projects

Widespread use of free/libre/open source software (FLOSS) in European funded projects is vital to innovation transfer, but often, such software doesn’t enter general use. Legal issues, lack of business drivers, incomplete documentation and lack of knowledge about FLOSS are some of the most common reasons for this. PROSE, an EU-funded project tasked with promoting FLOSS, aims to provide a common cloud platform on which open source projects can be hosted and information shared. But how would such a platform work? And what would be its main requirements and features? PROSE turned to ICT FP7 participants for answers

Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

Introduction: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI).Objective: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City.Design: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010.Methods: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis.Results: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score >= 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed.Conclusions: the cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.Pfizer Inc.Salvador Zubiran Natl Inst Med Sci & Nutr, Dept Med, Mexico City, DF, MexicoHosp Escuela Tegucigalpa, Tegucigalpa, HondurasUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilNatl Canc Inst, Div Infect Dis, Mexico City, DF, MexicoUniv Nacl Colombia, Dept Internal Med, Bogota, ColombiaUniv Peruana Cayetano Heredia, Dept Med, Lima, PeruHosp Vargas Caracas, Caracas, VenezuelaCtr Med Caracas, Caracas, VenezuelaUniv Fed Rio de Janeiro, Univ Hosp, Rio de Janeiro, BrazilUniv Texas Med Sch Houston, Mem Hermann Texas Med Ctr, Dept Med, Houston, TX USAUniv Fed Parana, Hosp Clin, BR-80060000 Curitiba, Parana, BrazilUniv Chile, Fac Med, Hosp Luis Calvo Mackenna, Dept Pediat, Santiago 7, ChileUniv Desarrollo, Clin Alemana, Dept Med, Santiago, ChileHosp Clin Jose San Martin, Infect Dis Unit, Buenos Aires, DF, ArgentinaPontificia Univ Catolica Ecuador, Fac Med, Hosp Vozandes, Quito, EcuadorUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilPfizer Inc.: INF-168Web of Scienc

Cisto mesentérico gigante, um achado incidental. Relatório de caso

Myrka Daniela Almeida Cabrera: Médico residente de medicina interna en Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Ciudad de México, México. Correo electrónico: [email protected], ORCID: 0000-0002-0373-9949 -- Louis Fernando Robles Fernandes: Médico residente de medicina interna en Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, Ciudad de México, México. Correo electrónico: [email protected] ORCID: 0000-0002-0387-8797 -- Roberto Alfredo Ibarra Ponce de León: Médico residente de medicina interna en Centro Médico Nacional La Raza del Instituto Mexicano del Seguro Social, Ciudad de México, México. Correo electrónico: [email protected] ORCID: 0000-0002-6510-0470Se presenta el caso de un hombre de 58 años de edad, sin antecedentes de importancia para la presencia de hepatopatía, quien presentó distensión abdominal progresiva que no respondió al manejo a base de diuréticos, diagnosticado incidentalmente a través de estudios de imagen con un quiste mesentérico gigante, el cual constituye un tumor raro, con pocos reportes de caso en la literatura, según lo referido es más frecuente en el sexo femenino, su etiología aun es desconocida, su diagnóstico generalmente se realiza a través de estudios de imagen y el tratamiento consiste en la escisión quirúrgica completa ya que su drenaje constituye un medio ineficaz por el alto riesgo de recurrencia.We present the case of a 58-year-old man, with no history of significant hepatopathy, who presented progressive abdominal distension that did not respond to diuretics, diagnosed incidentally through imaging studies with a giant mesenteric cyst, which is a rare tumor, Its etiology is still unknown, its diagnosis is generally made through imaging studies and the treatment consists of complete surgical excision since its drainage is an ineffective means due to the high risk of recurrence.Apresentamos o caso de um homem de 58 anos, sem historial de hepatopatia significativa, que apresentava uma distensão abdominal progressiva que não respondia a uma gestão baseada em diuréticos, diagnosticada incidentalmente através de estudos de imagem com um cisto mesentérico gigante, que é um tumor raro, A sua etiologia é ainda desconhecida, o seu diagnóstico é geralmente feito através de estudos de imagem e o tratamento consiste na excisão cirúrgica completa, uma vez que a drenagem é um meio ineficaz devido ao elevado risco de recidiva

Fitcare Perú

El proyecto de compresas calientes son productos para rehabilitación en caliente que propone una forma de negocio innovadora, que se basa en un producto reutilizable que complementa el tratamiento para lesiones, problemas musculares y alivio de dolor para deportistas y personas que sufran alguna lesión muscular. En este negocio se propone aliviar, combatir las lesiones causadas por diferentes funciones y acciones durante el día a día, lo cual ocasiona que todos tengan cansancio, dolores y contracciones en el cuerpo, tomando esto como un factor de reducción de movimientos. Ante estos problemas se presenta el producto de compresas calientes, que tienen la ventaja de no detener las actividades de las personas y sean adaptables a la zona afectada, generando una satisfacción de alivio y mantenimiento muscular positivo. El producto está elaborado en PCV Termo plástico material que se ablanda mediante el calor y se endurece a la hora de enfriarse, siendo un producto reutilizable de fácil uso para el cliente. Este producto está dirigido a las personas de 18 a 50 años, de los sectores A, B y C1 que realizan deporte y actividades físicas de Lima metropolitana, por ser la zona de operación de la empresa. Respecto a la evaluación financiera, se proyectaron los flujos de caja para cinco años y se concluyó que el negocio será viable y rentable para sus inversionistas por sus resultados VAN de S/27,259 y TIR de 79%. Así mismo, se determinó la inversión inicial de S/69,733 para poner en marcha a la empresa.The project of hot compresses are products for hot rehabilitation that proposes an innovative form of business, which is based on a reusable product that complements the treatment for injuries, muscle problems and pain relief for athletes and people suffering from any muscle injury. In this business it is proposed to alleviate, fight injuries caused by different functions and actions during the day to day, which causes everyone to have fatigue, pains and contractions in the body, taking this as a factor of movement reduction. Faced with these problems, the product of hot compresses is presented, which has the advantage of not stopping the activities of the people and being adaptable to the affected area, generating a satisfaction of relief and positive muscular maintenance. The product is made of PCV Termo plastic material that is softened by heat and hardens when it cools, being a user-friendly reusable product. This product is aimed at people from 18 to 50 years of age, sectors A, B and C1 that carry out sport and physical activities in metropolitan Lima, as it is the area of operation of the company. Regarding the financial evaluation, cash flows were projected for five years and it was concluded that the business will be viable and profitable for its investors due to its NPV results of S / 27,259 and TIR of 79%. Likewise, the initial investment of S / 69,733 was determined to start up the company.Trabajo de investigació

Tuberculosis-Related Deaths within a Well-Functioning DOTS Control Program

To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates

Tuberculosis risk in patients with rheumatoid arthritis

Antecedentes: Los estudios sobre riesgo de enfermedad tuberculosa (ET) en artritis reumatoide (AR) en pacientes no usuarios de terapia biológica son controversiales. Objetivo: Evaluar AR como factor de riesgo independiente para ET. Diseño: Estudio de cohortes no concurrente. Lugar: Red asistencial Hospital Guillermo Almenara Irigoyen, Lima-Perú, hospital docente. Participantes: Pacientes con AR no usuarios de terapia biológica. Intervenciones: Una cohorte de pacientes con AR no usuarios de terapia biológica (cumplimiento de criterios 1987 del ACR) fue pareada por edad y género con una cohorte control (pacientes con trastornos no inmunológicos). Se realizó una entrevista personal. El seguimiento para la cohorte AR se inició en el diagnostico de AR y culminó en el momento de la entrevista o en el diagnóstico de ET (los controles fueron seguidos el mismo periodo de tiempo). Se calculó la densidad de incidencia (DI) para ET en cada cohorte y el riesgo relativo (RR). La probabilidad de ET de acuerdo al tiempo de enfermedad fue comparada mediante curvas de Kaplan Meier. Se aplicó un modelo de Cox para ajustar drogas y patologías predisponentes (hazard ratio - HR). Principales medidas de resultados: Enfermedad tuberculosa en pacientes con artritis reumatoide. Resultados: La cohorte AR y los controles (667 y 664 pacientes, respectivamente) tuvieron 6 940,75 y 6 666,53 personas-año de seguimiento. La edad al diagnóstico de AR fue 46,65 años. Un 29,7% de 195 pacientes AR fueron PPD positivos. Quince pacientes AR y ocho controles desarrollaron ET (DI de 216,1/100 000 y 122,1/100 000 personas/año). El RR para TBC fue 1,8 (IC 95% = 0,8-4,2) y luego del ajuste para drogas y comorbilidades predisponentes de ET, el HR fue 1,69 (IC 95%=0,26-10,93). No hubo diferencia al comparar las curvas de Kaplan Meier (p=0,19). Conclusiones: La incidencia de ET entre los pacientes con AR fue mayor que en los pacientes sin dicha condición; sin embargo, esta diferencia no fue significativa luego de ajustar variables confusoras.Background: Studies on tuberculosis (TB) risk in patients with rheumatoid arthritis (RA) non-users of biological therapy show contradictory results. Objetives: To determine RA as independent risk factor for TB. Design: Non concurrent cohort study. Setting: Guillermo Almenara Asistential Net, Lima-Peru, a teaching hospital. Participants: Biological therapy non-users RA patients. Interventions: RA patients fulfilled the ARA 1987 diagnosis criteria and were biological therapy non-users. Control group was paired by age and sex to RA patients. Patients in control groups had non immunological disorders. Clinical information was completed by interviews. RA patients follow-up was started at the time of diagnosis and ended at the time of interview and/or TB diagnosis. Density incidence (DI) was found for each cohort and TB relative risk (RR) was calculated. To evaluate time length to TB evolution a Kaplan Meier curve was graphed and compared both groups with log-rank test. Drugs and predisposing TB pathologies were analyzed. Main outcome measures: Tuberculosis in patients with rheumatoid arthritis. Results: Six hundred and seventy six out of 808 RA patients and 664 controls qualified for inclusion criteria’s. RA and control groups reached 6 940,75 and 6 666,53 follow-up patients-year, respectively. RA cohort mean age was 46,65 at RA diagnosis. Only 29,7% of RA patients had a positive tuberculin reaction. Fifteen TB cases were identified in the RA cohort and 8 at the control group, yielding a mean DI of 216,1/100 000 and 122,1/ 100 000 patients-year respectively. TB RR was 1,8 (IC 95%=0,8- 4,2), and after adjusting drugs and co-morbidity the HR was 1,69 (IC 95%=0,26-10,93). Statistically significant difference was not found with Kaplan Meier curves comparison (p=0,19). Conclusions: We did not find a higher risk of rheumatoid arthritis patients to develop tuberculosis