Etiología del síndrome febril agudo en la provincia de Jaén, Perú 2004-2005

Objetivo: Conocer la etiología del síndrome febril agudo en pacientes que acudieron a tres establecimientos de salud de la provincia de Jaén entre mayo de 2004 y abril de 2005. Materiales y métodos: Estudio descriptivo prospectivo realizado en tres establecimientos de salud: Hospital General de Jaén, Hospital de Apoyo Bellavista y Centro de Salud Morro Solar. Se incluyeron pacientes entre 5 y 65 años con fiebre de menos de ocho días de evolución y sin foco infeccioso aparente. Inicialmente se les realizó gota gruesa para malaria y frotis sanguíneo para Bartonelosis; de los casos negativos se obtuvo una segunda muestra de sangre para la búsqueda de ELISA IgM y microaglutinación para el diagnóstico de leptospirosis, ELISA IgM para dengue, Mayaro, Oropuche y encefalitis equina venezolana, e inmunofluorescencia indirecta para Rickettsiosis. Resultados: De 1039 febriles incluidos, se determinó la etiología en 680 (65,4%) casos, malaria por P. falciparum 312 (30,0%), leptospirosis 115 (11,1%), dengue 105 (10,1%), malaria por P. vivax 76 (7,3%), leptospirosis más dengue 30 (2,9%), Rickettsiosis 15 (1,4%), Bartonelosis 17 (1,6%), leptospirosis más Rickettsiosis 7 (0,7%), y leptospirosis, dengue más Rickettsiosis 3 (0,3%). Los serovares de Leptospira más frecuentes fueron varilla (35,7%) y bratislava (32,5%). Conclusión: La malaria es la principal causa de síndrome febril agudo en Jaén, se destaca la presencia de la leptospirosis como segunda causa, por delante del dengue; es necesario considerar dentro del diagnóstico diferencial Rickettsiosis y Bartonelosis

Multiobjective Capacitated Arc Routing Problem

Abstract. The Capacitated Arc Routing Problem (CARP) is a very hard vehicle routing problem raised for instance by urban waste collection. In addition to the total route length (the only criterion minimized in the academic problem), waste management companies seek to minimize also the length of the longest trip. In this paper, a bi-objective genetic algorithm is presented for this more realistic CARP, never studied before in literature. Based on the NSGA-II template, it includes two-key features: use of good constructive heuristics to seed the initial population and hybridization with a powerful local search procedure. This genetic algorithm is appraised on 23 classical CARP instances, with excellent results. For instance, for a majority of instances, its efficient solutions include an optimal solution to the academic CARP (minimization of the total route length). 1 Introduction: the CARP and its Applications The Capacitated Arc Routing Problem (CARP) is defined in the literature o

Télécom/Télécom Ecole de Management

(This page is intentionally left blank) 2 A mes enfants, Je vous aime plus que tout

The Good Manager: An Archetypical Quest for Morally Sustainable Leadership

This paper explores the potential for morally sustainable leadership, i.e., leadership with an awareness of both light and dark sides contained in the role of the leader, as symbolized by the archetype of the king. A narrative enquiry aiming at the study of fictive stories authored by management theorists and practitioners from different contexts, interweaving collective individual elements, brings to light how issues of leadership goodness are related to each other and to other themes. The stories are presented as archetypical tales, that is, stories that touch profound aspects of culture and the psyche. They reveal what happens when people are asked to imagine a good manager, and how this results in tragic ironic representations, rather than tales of straightforward goodness. </jats:p