ABSTRACT The main objective of this research is to determine the impact of the dimensions of the Competitive Strategies of Service Marketing on the level of language teaching offered by the SENATI Language Center, in order to improve the brand of that institution. The sample consisted of a total of 40 students. For the analysis of these data, a questionnaire was conducted in two sections, from which the answers were operationalized by applying the Likert scale. As a result it has been found that the level of competitive strategies in the Language Center has not been well implemented, as well as the competitive advantages in service costs, differentiation and focus are considered low. These dimensions had a moderate impact on English language teaching in that institution, which in turn was considered low.

RESUMEN Esta investigación tiene como objetivo principal determinar el impacto que hay entre las dimensiones de las Estrategias Competitivas del Marketing de Servicios en el nivel de enseñanza de idiomas que ofrece el Centro de Idiomas de la SENATI, para mejorar la marca de esa institución. La muestra ha estado conformada por un total de 40 estudiantes. Para el análisis de estos datos se ha realizado un cuestionario en dos secciones, del cual se operacionalizan las respuestas aplicando la escala de Likert. Como resultado se ha encontrado que el nivel de estrategias competitivas en el Centro de Idiomas no se ha implementado bien, así como las ventajas competitivas en costos del servicio, diferenciación y enfoque se considera bajos. Estas dimensiones impactaron en un nivel moderado sobre la enseñanza del idioma inglés en esa institución, que a su vez fue considerada con nivel bajo.

There is no consensus on the diagnostic algorithms for many scenarios of Trypanosoma cruzi infection, which hinders the establishment of governmental guidelines in endemic and non-endemic countries. In the acute phase, parasitological methods are currently employed, and standardised surrogate molecular tests are being introduced to provide higher sensitivity and less operator-dependence. In the chronic phase, IgG-based serological assays are currently used, but if a single assay does not reach the required accuracy, PAHO/WHO recommends at least two immunological tests with different technical principles. Specific algorithms are applied to diagnose congenital infection, screen blood and organ donors or conduct epidemiological surveys. Detecting Chagas disease reactivation in immunosuppressed individuals is an area of increasing interest. Due to its neglect, enhancing access to diagnosis of patients at risk of suffering T. cruzi infection should be a priority at national and regional levels. nonendemic non countries phase employed operatordependence. operatordependence operator dependence. dependence operator-dependence IgGbased IgG based used accuracy PAHOWHO PAHO WHO principles surveys interest neglect T levels

Abstract: Objective: We describe two adolescent patients with multiple sclerosis, which is a demyelinating disease of the central nervous system. Presentation of the cases: The first case was a 14-year-old female patient with overweight; her condition was characterized by dizziness, headache, paresthesia in the lower limbs, diplopia and bradylalia. On physical examination, compatible data of cerebellar involvement were identified. A magnetic resonance imaging (MRI) of the skull showed areas of demyelination in the posterior fossa. Multiple sclerosis, the relapsing-remitting variety, is diagnosed. After the administration of steroids and beta interferon, there was improvement in symptoms. Second case: 13-year-old female, who presented fall from her own height, bladder incontinence, loss of strength in the left arm and leg. On physical examination, left hemiparesis was detected. MRI: demyelination data in lateral ventricle, cerebellum and spinal cord. The patient improved after starting steroids and interferon. Conclusions: The clinical presentation of multiple sclerosis in pediatric patients is a challenge, since it is a condition with unspecific manifestations. Establishing the diagnosis requires multiple studies. The earlier treatment is started, the more favorable the prognosis.

Resumen: Objetivo: Describir dos pacientes adolescentes con esclerosis múltiple, la cual es una enfermedad desmielinizante del sistema nervioso central. Presentación de los casos: El primer caso se trató de una paciente de 14 años con sobrepeso, con un padecimiento caracterizado por mareo, cefalea, parestesias en miembros inferiores, diplopía y bradilalia. A la exploración, datos compatibles de afectación a nivel cerebeloso. En estudio de imagen de resonancia magnética (IRM) de cráneo se evidencia áreas de desmielinización en fosa posterior. Se diagnostica esclerosis múltiple de variedad remitente recurrente. Con la administración de esteroides e interferón beta hubo mejoría de sintomatología. Segundo caso: femenino de 13 años de edad, quien presenta caída de propia altura, incontinencia de esfínter vesical, pérdida de fuerza en brazo y pierna izquierdas. En la exploración física, hemiparesia izquierda. IRM: datos de desmielinización en ventrículo lateral, cerebelo y médula espinal. La paciente mejoró al iniciar esteroides e interferón. Conclusiones: La presentación clínica de la esclerosis múltiple en pacientes pediátricos es un reto, ya que es un padecimiento que tienen manifestaciones poco específicas. Para establecer el diagnóstico se requiere realizar múltiples estudios. El pronóstico puede ser más favorable entre más temprano se inicie el tratamiento.

RESUMEN I: Para mantener la reducción de la malaria, se promueven iniciativas que aceleren la eliminación. En años recientes con la reducción sostenida de la malaria, Colombia hacia el 2021 propone su eliminación en áreas urbanas por lo cual se requieren investigaciones para este desafío O: Establecer la situación epidemiológica de la transmisión de malaria urbana/peri en Guapi 2011-2015 y describir los desafíos en capacidad vectorial, receptividad, infectividad y vulnerabilidad. M: Se realizó un estudio descriptivo, se obtuvieron datos epidemiológicos, entomológicos, parasitológicos, de servicios de salud y socio económicos mediante entrevistas y fuentes secundarias. Con la información se realizaron análisis uni y bivariados, se aplicaron formatos de eliminación de malaria propuestos por la Organización Mundial de la Salud y se analizaron brechas. R: Se notificaron 1097 casos, 39,5% se registraron en el área urbana/peri, y a su vez, el 68% de éstos se concentraron en tres barrios. En capacidad vectorial se identificó como vector primario a anopheles albimanus, con susceptibilidad a los insecticidas, múltiples criaderos y estrategias de instalación de mosquiteros con altas coberturas; en infectividad se encontró predominio de infecciones por p, falciparum, oportunidad de consulta en las primeras 48 horas del 48,1% y automedicación; en vulnerabilidad los casos no urbanos representaron 60,5 % del total. C: La malaria se caracterizó por ser de baja intensidad, focalizada y con picos. Hay significativa receptividad, en infectividad hay retrasos de oportunidad de consulta y existe alta vulnerabilidad por población migrante.

ABSTRACT I: To maintain the reduction of malaria, initiatives that accelerate the elimination are promoted. In recent years with the sustained reduction of malaria, Colombia by 2021 proposes its elimination in urban areas, which requires research for this challenge O: Establish the epidemiological situation of transmission of urban / peri malaria in Guapi 2011-2015 and describe the challenges in vector capacity, receptivity, infectivity and vulnerability. M: A descriptive study was conducted, epidemiological, entomological, parasitological, health and socioeconomic services were obtained through interviews and secondary sources. With the information, univariate and bivariate analyzes were carried out, malaria elimination formats proposed by the World Health Organization were applied and gaps were analyzed. A: 1097 cases were notified, 39.5% were registered in the urban / peri area, and in turn, 68% of these were concentrated in three neighborhoods. In vectorial capacity anopheles albimanus was identified as the primary vector with susceptibility to insecticides, multiple hatcheries and strategies for installing mosquito nets with high coverage; In infectivity, predominance of p. falciparum, 48.1% consultation opportunity in the first 48 hours and self-medication; in vulnerability, non-urban cases represented 60.5% of the total. C: Malaria was characterized by being of low intensity, focused and with spikes. There is significant receptivity, in infectiousness there are delays in the opportunity of consultation and there is high vulnerability due to migrant population.

RESUMO I: Para manter a redução da malária, são promovidas iniciativas que aceleram a eliminação. Nos últimos anos, com a redução sustentada da malária, a Colômbia propõe, até 2021, sua eliminação nas áreas urbanas, o que requer pesquisa para esse desafio O: Estabelecer a situação epidemiológica da transmissão da malária urbana / peri-Guapi 2011-2015 e descrever os desafios em capacidade de vetores, receptividade, infecciosidade e vulnerabilidade. M: Estudo descritivo, epidemiológico, entomológico, parasitológico, de saúde e socioeconómico, obtido por meio de entrevistas e fontes secundárias. Com as informações, foram realizadas análises univariadas e bivariadas, os formatos de eliminação de malária propostos pela Organização Mundial da Saúde foram aplicados e as lacunas foram analisadas. R: 1097 casos foram notificados, 39,5% foram registrados na área urbana / peri e, por sua vez, 68% destes foram concentrados em três bairros. Em capacidade vetorial, anopheles albimanus foi identificado como vetor primário, com suscetibilidade a inseticidas, múltiplos incubatórios e estratégias para a instalação de redes mosquiteiras com alta cobertura; Na infectividade, predomínio de p. falciparum, 48,1% de oportunidade de consulta nas primeiras 48 horas e automedicação; em vulnerabilidade, os casos não urbanos representaram 60,5% do total. C: A malária foi caracterizada por ser de baixa intensidade, focada e com picos. Há uma receptividade significativa, na infecciosidade há atrasos na oportunidade de consulta e há alta vulnerabilidade devido à população migrante.

BACKGROUND Rapid urbanisation in difficult socio-economic conditions such as inadequate housing infrastructure, lack of public services, improper sanitation, and poor water drainage systems in vegetation-rich areas lead to ecological conditions that are conducive to the breeding of mosquitoes and transmission of malaria, in semi-urban and urban settings. OBJECTIVES This study aimed to describe the cases of malaria that were reported in the peri-urban areas of Pereira (Colombia), between 2008 and 2015. METHODS A retrospective study was conducted using data from the Malaria Surveillance System 2009-2015 and an outbreak study (between December 2008 and March 2009). Frequency distributions and summary measures, as well as univariate analysis were performed for all the variables in consideration. The annual parasite index (API) was calculated. FINDINGS Data on 214 cases were obtained from the surveillance system. A majority of the cases were reported in men (63.1%), followed by in children < 15 years (23.8%), and were caused predominantly by Plasmodium vivax (86.0%), with most of the infection occurring in the urban areas (52.8%) of Pereira. The API, by sex and age group, was higher among men ≥ 80 years. The outbreak study reported 14 cases of malaria in rural/peri-urban neighborhoods, and it was observed that the anopheline breeding sites were in close proximity to the houses in these areas. This population did not use protective measures against mosquitoes and chemical control was conducted through residual and spatial insecticide spraying. MAIN CONCLUSIONS This study suggested the presence of autochthonous malaria transmission, in Pereira, between 2008 and 2015, most of which were cases of P. vivax. A greater intensity was observed between 2008 and 2009 when malaria was possibly reintroduced to the region. During the years of the study, a gradual decrease in the number of reported cases of malaria was observed in Pereira, except for the time period between 2008 and 2009 when a spike was noted (estimated using the API); this was most likely caused by an outbreak. Interventions that are more aggressive in nature are required to prevent further malarial transmission and dissemination.

Resumen Introducción. Las enfermedades transmitidas por vectores representan más de 17 % de todas las enfermedades infecciosas y causan anualmente un millón de defunciones a nivel mundial. En Colombia, la malaria, el dengue, la enfermedad de Chagas y las leishmaniasis son condiciones endemoepidémicas persistentes. Objetivo. Determinar el comportamiento epidemiológico de las enfermedades transmitidas por vectores en zonas urbanas y rurales de Colombia entre 1990 y 2016. Materiales y métodos. Se hizo un estudio descriptivo del comportamiento epidemiológico de las principales enfermedades transmitidas por vectores en zonas urbanas y rurales de Colombia entre 1990 y 2016, con la información proveniente de fuentes oficiales secundarias. Resultados. En el periodo estudiado se registraron 5’360.134 casos de enfermedades transmitidas por vectores, de los cuales 54,7 % fueron de malaria y 24,9 % de dengue. Estos casos concentraron el 80 % de la carga acumulada de casos de enfermedades transmitidas por vectores. Las medianas de las tasas de incidencia fueron 1.371 y 188 por 100.00 habitantes para malaria y dengue, respectivamente. Además, los casos de chikungunya fueron 774.831 desde su introducción en el 2014 y, los de Zika, 117.674 desde su aparición en 2015. En las zonas rurales predominaron las enfermedades parasitarias transmitidas por vectores como la malaria, las leishmaniasis y la enfermedad de Chagas. A nivel urbano, predominaron el dengue, el chikungunya y el Zika. Conclusiones. La transmisión en Colombia de estas enfermedades es persistente en las zonas urbanas y en las rurales, y de tipo endemoepidémico en los casos de malaria, dengue, leishmaniasis y enfermedad de Chagas. Dicha transmisión se ha dado de manera focalizada y con patrones variables de intensidad. Asimismo, se mantienen las condiciones que han favorecido la transmisión emergente de nuevas arbovirosis.

Abstract Introduction: Vector-borne diseases account for more than 17% of all infectious diseases and annually they cause one million deaths worldwide. In Colombia, malaria, dengue, Chagas disease, and leishmaniasis are persistent endemo-epidemic events. Objective: To determine the behavior and transmission scenarios of vector-borne diseases in Colombia between 1990 and 2016. Materials and methods: We conducted a descriptive study on the epidemiological behavior of the main vector-borne diseases in Colombia between 1990 and 2016 based on information from official secondary sources. Results: During the study period, there were 5,360,144 cases of vector-borne diseases, 54.7% of which were due to malaria and 24.9% to dengue, accounting for 80% of the cumulative disease burden of vector-borne disease cases. The median incidence rates were 1,371 and 188 per 100,000 inhabitants for malaria and dengue, respectively. In addition, emerging events such as Chikungunya registered 774,831 cases since its introduction in 2014, while 117,674 Zika fever cases were reported since its emergence in 2015. In rural settings, parasitic vector-borne diseases such as malaria, leishmaniasis and Chagas disease predominated, while in urban scenarios dengue, chikungunya and Zika were predominant. Conclusions: Persistent epidemic and endemic transmission of vector-borne diseases in urban and rural settings in Colombia was observed mainly in the case of malaria, dengue, leishmaniasis and Chagas disease. Such transmission was focused and had variable intensity patterns. On the other hand, the conditions that have favored the emergence of new arboviruses persist.

Gold-mining may play an important role in the maintenance of malaria worldwide. Gold-mining, mostly illegal, has significantly expanded in Colombia during the last decade in areas with limited health care and disease prevention. We report a descriptive study that was carried out to determine the malaria prevalence in gold-mining areas of Colombia, using data from the public health surveillance system (National Health Institute) during the period 2010-2013. Gold-mining was more prevalent in the departments of Antioquia, Córdoba, Bolívar, Chocó, Nariño, Cauca, and Valle, which contributed 89.3% (270,753 cases) of the national malaria incidence from 2010-2013 and 31.6% of malaria cases were from mining areas. Mining regions, such as El Bagre, Zaragoza, and Segovia, in Antioquia, Puerto Libertador and Montelíbano, in Córdoba, and Buenaventura, in Valle del Cauca, were the most endemic areas. The annual parasite index (API) correlated with gold production (R2 0.82, p < 0.0001); for every 100 kg of gold produced, the API increased by 0.54 cases per 1,000 inhabitants. Lack of malaria control activities, together with high migration and proliferation of mosquito breeding sites, contribute to malaria in gold-mining regions. Specific control activities must be introduced to control this significant source of malaria in Colombia.

Introducción. La recolección de información completa y efectiva de los casos de paludismo es fundamental para elaborar planes operativos, así como para el desarrollo y la aplicación de las políticas de prevención y control. Sin embargo, no todos los casos identificados son notificados y no todos son incorporados en el sistema de información. El subregistro representa un problema para quienes toman las decisiones. Objetivo. Estimar el tipo y la cantidad de errores cometidos al llenar la ficha de notificación de los casos de paludismo y su nivel de digitación, mediante el uso y seguimiento de la ficha de notificación en diez municipios nariñenses durante 2009. Materiales y métodos. Se trata de un estudio descriptivo, transversal en muestra no probabilística, de conveniencia, de los puestos de diagnóstico y tratamiento. Se obtuvieron copias de la fichas y de la base de datos de la notificación del sistema de vigilancia y se compararon caso a caso. Se calcularon las proporciones. Resultados. De 2.816 fichas de notificación de casos positivos, se evidenció que en más de 60 % de los casos no se reportó la información de las variables municipio de residencia, municipio de origen y código de ocupación. En la comparación caso a caso se encontró que 845 (30,0 %) fichas no habían sido digitadas. La información de variables como el nombre del municipio de residencia y la fecha del inicio de síntomas, no fue completa ni exacta en más de 50 % de los casos. Conclusiones. El empleo de las fichas de notificación con copia permite conocer el subregistro de la notificación debida a la falta de digitación. Una tercera parte de los casos pueden ser recuperados.

Introduction. The complete and effective collection of data of malaria cases is essential to formulate operative plans, as well as to develop and apply policies for its prevention and control. However, in Colombia, not all of the identified cases are notified nor incorporated into the surveillance system. This underreport represents a serious problem for decision makers. Objective. To estimate the type and quantity of errors made during the completion of the malaria individual case reporting form and its digitization level, through the use and monitoring of the reporting form in ten municipalities of Nariño in 2009. Materials and methods. A descriptive cross-sectional study with a non-probabilistic and convenience sample of diagnosis and treatment sites was carried out. Copies of the reporting forms from these sites and of the Public Health Surveillance System database were taken to compare them case-by-case. Proportions were calculated. Results. In more than 60% of the 2,816 reporting forms of positive cases the information about municipality of residence, municipality of origin and occupation was not reported. The case-by-case comparison revealed that 845 (30.0%) notification forms were not digitized at all. Information of variables such as residence, name of the municipality, and date of onset of symptoms were neither complete nor exact in more than 50% of the cases. Conclusions. The use of copies of the reporting forms allows knowing the underreporting due to lack of digitization. One third of the cases can be recovered.

Introducción. En Colombia, el paludismo representa un grave problema de salud pública. Se estima que, aproximadamente, 60 % de la población se encuentra en riesgo de enfermar o de morir por esta causa. Objetivo. Describir la tendencia de la mortalidad por paludismo en Colombia desde 1979 hasta 2008. Materiales y métodos. Se llevó a cabo un estudio descriptivo para determinar la tendencia de las tasas de mortalidad. Las fuentes de información fueron las bases de datos de las defunciones registradas y de las proyecciones de población de 1979 a 2008 del Departamento Nacional de Estadística (DANE). El indicador empleado fue la tasa de mortalidad. La tendencia se analizó mediante el software de análisis de regresión de puntos de inflexión (joinpoint). Resultados. Se certificaron 6.965 muertes por paludismo para una tasa ajustada por edad de 0,74 muertes por 100.000 habitantes para el periodo estudiado. En 74,3 % de las muertes, no se especificó la especie parasitaria. Las tasas de mortalidad por paludismo presentaron una tendencia decreciente estadísticamente significativa, que fue menor a partir de la segunda mitad de la década de los 90 en comparación con la presentada en la década de los 80. Conclusiones. La magnitud de la mortalidad por paludismo en Colombia no es grande, a pesar del evidente subregistro; se observó una tendencia descendente entre 1979 y 2008. La información derivada de los certificados de defunción, junto con la del sistema de vigilancia en salud pública, permitirá modificar las recomendaciones y mejorar la toma de medidas preventivas y de control pertinentes para continuar reduciendo la mortalidad causada por el paludismo.

Introduction. In Colombia, malaria represents a serious public health problem. It is estimated that approximately 60% of the population is at risk of the disease. Objective. To describe the mortality trends for malaria in Colombia, from 1979 to 2008. Materials and methods. A descriptive study to determine the trends of the malaria mortality was carried out. The information sources used were databases of registered deaths and population projections from 1979 to 2008 of the National Statistics Department. The indicator used was the mortality rate. The trend was analyzed by join point regression. Results. Six thousands nine hundred and sixty five deaths caused by malaria were certified for an age-adjusted rate of 0.74 deaths/100.000 inhabitants for the study period. In 74.3% of the deaths, the parasite species was not mentioned. The trend in the mortality rate showed a statistically significant decreasing behavior, which was lower from the second half of the nineties as compared with that presented in the eighties. Conclusions. The magnitude of mortality by malaria in Colombia is not high, in spite of the evident underreporting. A marked downward trend was observed between 1979 and 2008. The information obtained from death certificates, along with that of the public health surveillance system will allow to modify the recommendations and improve the implementation of preventive and control measures to further reduce the mortality caused by malaria.

La cirugía mínimamente invasiva ha tomado un papel preponderante en el abordaje inicial del paciente con trauma torácico. Se presenta el primer caso nacional de un paciente pediátrico con neumotórax persistente, resuelto satisfactoriamente mediante cirugía torácica video-asistida.

The minimally invasive surgery has been successfully used in patients with thoracic trauma. We present the first case of a pediatric patient with persistent pneumothorax secondary to gunshot treated satisfactorily with video-assisted thoracic surgery.