Diseño de propuestas de mejoramiento del área de ensamble y empaquetado de la Empresa Ideas Metálicas Ltda mediante la metodología de las 5’s y la gestión visual /

Actualmente las empresas para ser más competitivas a nivel nacional e internacional se enfrentan al reto de buscar e implantar nuevas técnicas organizativas y de producción que les permitan lograr eficiencia en sus procesos en la medida que sean organizados, controlados y posean condiciones seguras para los operarios. El modelo de Lean Manufacturing constituye una alternativa para lograr lo anteriormente enunciado debido a que además de incrementar la productividad, elimina los desperdicios establecidos por Taichí Ohno, creador del Toyota Production System, tales como sobreproducción, esperas, desplazamientos innecesarios, transporte, sobreprocesamientos, inventario, personal y recursos que no agregan valor. Uno de los pilares básicos del lean Manufacturing es la metodología de las 5S, la cual determina los pasos a seguir para conseguir puestos de trabajo organizados, ordenados, limpios y que además se mantengan a lo largo del tiempo. La implementación de las 5s constituye el primer paso para la consecución de mejoras, un aumento en la productividad y un entorno agradable y seguro. Para el caso en estudio, Ideas Metálicas es una empresa perteneciente a la industria metalmecánica encargada de la fabricación de productos de acero para el sector de electrónica y electrodomésticos; con sede en la ciudad de Cartagena, la cual inició sus operaciones en el año 1990 y se dedica al diseño, producción y comercialización de soportes para televisores, DVD, microondas y racks de audio.Incluye referencias bibliográficas (página 127) y anexo

Spontaneous splenic rupture in a teenager as first manifestation of acute myeloid leukemia: Case report and literature review

Spontaneous splenic rupture is a well-known, but rare life-threatening complication of hematological malignancies. We describe the case of a 12-year-old boy with a 5-day history of fever and successively left upper quadrant abdominal pain and sudden clinical deterioration necessitating emergency splenectomy. On arrival, a blood dyscrasia was postoperatively confirmed as acute myeloid leukemia. Cases of atraumatic rupture in diseased spleens are widely reported and pathological rupture of the spleen is a rare, but well recognized complication in hematological malignancies. This case report represents a rare and fatal initial presentation of acute myeloid leukemia in an adolescent. Because of the rarity of atraumatic splenic rupture, a high index of clinical suspicion must be maintained in patients with left upper quadrant pain and abnormal differential count on peripheral blood smear

Interpretation of electrocardiogram in an ultra-marathon athlete: a case report

The electrocardiogram (ECG) of athletes, especially in those that are endurance-trained, frequently shows some alterations; however, abnormalities of athlete’s ECG may be an expression of an underlying heart disease, which carries a risk of sudden death during sport. It is important that ECG abnormalities are correctly distinguished. We report a case of an ultramarathon athlete who arrived in Emergency Department, after a 100 kilometres race, showing ECG alterations that required further investigations to rule out a cardiac disease. ECG trace showed anterior repolarization abnormalities with ST-segment elevation in V1 to V3 leads. He was admitted in the Cardiology Department and underwent a coronary study that was normal. A cardiac magnetic resonance was also performed. The final diagnosis was athlete’s heart

Functional evaluation of ultra-octogenarian patients undergoing Cardiac Rehabilitation: correlation between Six minute Walking Test and Rivermead Mobility Index

Background. There is an increasing need for admission of octogenarians to cardiac rehabilitation programs. The aim of this study was to evaluate if the Rivermead Mobility Index (RMI) (scale of mobility) is related to the functional capacity assessed by the 6 Minute Walking Test (6MWT). Methods. We selected 108 consecutive patients ≥ 80 years (M = 53, mean age 82.5 ± 2.7 years, after cardiac surgery n = 72, heart failure n = 36) enrolled to our cardiac rehabilitation unit. All patients were evaluated with the RMI and underwent 6MWT both at admission (RMI1 and 6MWT1) and after a period of daily physical training (RMI2 and 6MWT2). The RMI2/RMI1 and 6MWT2/6MWT1 ratios were calculated as indexes of functional improvement (IM). Results. The average in hospital stay was 20 ± 11 days with an average of 11.9 training sessions per patient. The average distance walked at 6MWT1 and 6MWT2 was 193 ± 116 and 278 ± 122 m, respectively (p <0.001). The average score of RMI1 and RMI2 was 8.5 ± 3.4 and 13.1 ± 2.9, respectively (p <0.001). The values of 6MWT1 and RMI1 results were significantly correlated (r = 0.56, p <0.001). The RMI IM was significantly correlated to 6MWT IM (r = 0.309, p = 0.002). At multivariate analysis, RMI IM was found to be predictive of 6MWT IM even after correction for age, gender, length of hospitalization and number of sessions of training. Conclusions. In octogenarians, cardiac rehabilitation results in a significant improvement of both RMI and 6MWT. RMI IM is independently correlated to 6MWT IM. Therefore, RMI could be a useful tool for evaluating the improvement of functional capacity even in patients who cannot undergo 6MWT

Enhanced p53 Levels Are Involved in the Reduced Mineralization Capacity of Osteoblasts Derived from Shwachman–Diamond Syndrome Subjects

14noopenShwachman–Diamond syndrome (SDS) is a rare autosomal recessive disorder characterized by bone marrow failure, exocrine pancreatic insufficiency, and skeletal abnormalities, caused by loss-of-function mutations in the SBDS gene, a factor involved in ribosome biogenesis. By analyzing osteoblasts from SDS patients (SDS-OBs), we show that SDS-OBs displayed reduced SBDS gene expression and reduced/undetectable SBDS protein compared to osteoblasts from healthy subjects (H-OBs). SDS-OBs cultured in an osteogenic medium displayed a lower mineralization capacity compared to H-OBs. Whole transcriptome analysis showed significant differences in the gene expression of SDS-OBs vs. H-OBs, particularly in the ossification pathway. SDS OBs expressed lower levels of the main genes responsible for osteoblastogenesis. Of all downregulated genes, Western blot analyses confirmed lower levels of alkaline phosphatase and collagen type I in SDS-OBs than in H-OBs. Interestingly, SDS-OBs showed higher protein levels of p53, an inhibitor of osteogenesis, compared to H-OBs. Silencing of Tp53 was associated with higher collagen type I and alkaline phosphatase protein levels and an increase in SDS-OB mineralization capacity. In conclusion, our results show that the reduced capacity of SDS-OBs to mineralize is mediated, at least in part, by the high levels of p53 and highlight an important role of SBDS in osteoblast functions.openFrattini, Annalisa; Bolamperti, Simona; Valli, Roberto; Cipolli, Marco; Pinto, Rita Maria; Bergami, Elena; Frau, Maria Rita; Cesaro, Simone; Signo, Michela; Bezzerri, Valentino; Porta, Giovanni; Khan, Abdul Waheed; Rubinacci, Alessandro; Villa, IsabellaFrattini, Annalisa; Bolamperti, Simona; Valli, Roberto; Cipolli, Marco; Pinto, Rita Maria; Bergami, Elena; Frau, Maria Rita; Cesaro, Simone; Signo, Michela; Bezzerri, Valentino; Porta, Giovanni; Khan, Abdul Waheed; Rubinacci, Alessandro; Villa, Isabell

Banderas rojas en pacientes que consultan por cefalea :conceptos básicos y revisión narrativa de la literatura

La cefalea es un motivo de consulta frecuente en el servicio de urgencias, así mismo, puede tener gran variedad de cuadros etiológicos y diferentes grados de severidad, adquiriendo una alta relevancia su estudio y abordaje. Las “banderas rojas” son una estrategia diseñada para evaluar las características del cuadro, ayudando a clasificar su causa en primaria o secundaria. Los objetivos de este estudio son la revisión de conceptos básicos respecto a la cefalea y las banderas rojas y la recopilación de estudios relacionados, con el fin de demostrar la necesidad de implementar dicha estrategia en los servicios de urgencias. El capítulo I presenta los conceptos básicos, tratando los tipos de cefalea, abordaje, examen físico, imágenes, la descripción de cada una de las banderas rojas y su significado clínico. Respecto al capítulo II, se presentan investigaciones relevantes acerca del uso y eficacia de la estrategia de banderas rojas en el abordaje de pacientes con cefalea en instituciones médicas, sus resultados y sus conclusiones. Finalmente, se puede concluir que los resultados de los estudios revisados son diversos, encontrando en algunos de ellos correlación entre la presencia de banderas rojas y la existencia de causas secundarias de cefalea, evidenciadas con neuroimágenes. Pese a ello, presentan un bajo porcentaje de hallazgos clínicamente significativos, por lo tanto, se recomienda la realización de más estudios acerca de la utilidad de las banderas rojas para el abordaje de pacientes con cefalea, tanto en la población general como en grupos poblacionales especiales.PregradoMedic

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Evaluación del efecto de la fermentación del maracuyá en sus semillas como tratamiento pre germinativo in vitro

The passion fruit (Passiflora edulis) is a widely distributed and exported fruit in the country, with Huila being one of the departments that contributes the most to its production. The food deficit and the adoption of the concept of Food Security, has led the urban population to use reduced spaces for crops, which favors the production of passion fruit. The seed of thisplant tends, due to its morphology, to have a low germination percentage, so it is necessary to implement pre-germination treatments that increase the germination percentage. This study aims to implement fermentation as a pre-germination treatment in passion fruit seeds, where it was evidenced that this process for 3 days and washing after the treatment, makesthe seed have a softening of the testa and allows the embryo to germinate (46.6 %). . On the contrary, by not using this methodology or subjecting the seed to 24 hours of fermentation, it had a germination percentage of only 26%. According to the above, it is recommended to know the germination percentage of the seed if it is from certified suppliers and to implement theproposed methodologies for greater success in obtaining seedlings&nbsp;El maracuyá (Passiflora edulis), es una fruta altamente distribuida y exportada en el país, siendo el Huila uno de los departamentos que más aporta en su producción. El déficit de alimentos y adoptando el concepto de Seguridad Alimentaria, ha llevado a la población urbana al uso de espacios reducidos para cultivos, lo que impulsa la producción de maracuyá. La semilla de esta planta tiende, por su morfología, a tener un bajo porcentaje de germinación, por lo que se hace necesario la implementación de tratamientos pregerminativos que incrementen el porcentaje de germinación. Este estudio tiene como objetivo implementar la fermentación como un tratamiento pregerminativo en semillas de maracuyá, donde se evidenció que este proceso por 3 días y lavada postratamiento, hace que la semilla tenga un ablandamiento de la testa y permita el brote del embrión (46.6%). Por el contrario, el no uso de esta metodología o someter la semilla a 24horas de fermentación, tuvo un porcentaje de germinación apenas del 26%. Según lo anterior, se recomienda conocer el porcentaje de germinación de la semilla si es de proveedores certificados e implementar las metodologías propuestas para un mayor éxito en la obtención de plántula