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Background The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. Materials and methods This was a retrospective cross-sectional study (2014–2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results 172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6–10.3, P = 0.002), 46 IU/L (OR 3.2, 95% CI 1.3–8, P = 0.010). Conclusions Histoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.

Resumen Objetivo La mortalidad relacionada con el shock septico sigue siendo alta y puede llegar incluso al 50%. El objetivo de este estudio es comparar el riesgo de muerte entre dos grupos de pacientes con shock septico, uno de los cuales recibio tratamiento estandar solo vs. tratamiento estandar mas vitamina C, tiamina e hidrocortisona (protocolo VITHA) por via intravenosa. Materiales y metodos Estudio observacional analitico de cohorte no concurrente, en donde se comparo el curso clinico de una cohorte de pacientes con shock septico que recibio tratamiento estandar mas vitamina C, tiamina e hidrocortisona durante seis meses consecutivos (protocolo VITHA), con una cohorte de pacientes que recibio solo tratamiento estandar. El desenlace primario que se midio fue mortalidad. Resultados Se reclutaron 74 pacientes (37 para cada grupo), sin diferencias significativas en sus caracteristicas basales. La mortalidad fue menor en el grupo que recibio tratamiento, en comparacion con el grupo control, 10 vs. 40%, respectivamente (p = 0,003). El aclaramiento de lactato entre el ingreso y las 48 h fue mayor en el grupo de tratamiento, 50 vs. 11% (p = 0,0001), al igual que la disminucion en la puntuacion SOFA entre el ingreso y las 72 h, 55 vs. 44% (p = 0,001). El riesgo relativo de mortalidad es 0,26. Conclusiones Segun nuestros resultados, la administracion de vitamina C, tiamina e hidrocortisona en pacientes con shock septico, ademas del tratamiento estandar, parece disminuir la mortalidad, mejora el aclaramiento de lactato y la puntuacion SOFA. Se necesitan estudios adicionales.

Resumen: Introducción: la fragilidad es una condición del paciente anciano, caracterizada por un estado de vulnerabilidad para desenlaces adversos en salud, incluidos los causados por la cirugía cardíaca. Objetivo: establecer la prevalencia de fragilidad en el contexto prequirúrgico del anciano sometido a cirugía cardiaca y establecer el riesgo de desenlaces adversos otorgado por esta condición. Metodología: estudio analítico de cohorte que valoró la fragilidad en 66 pacientes ancianos sometidos a cirugía cardiaca mediante el fenotipo físico de fragilidad de Fried. Se realizó un seguimiento a 30 días, durante el cual se estableció la prevalencia de fragilidad y el riesgo otorgado por esta condición a los desenlaces adversos de la cirugía cardiaca. Resultados: la edad de los pacientes osciló entre los 60 y los 83 años; la mediana fue de 70,5 años. La prevalencia de la fragilidad fue del 31,8%. La fragilidad incrementó los siguientes desenlaces adversos postoperatorios: muerte (p 0,001), ventilación prolongada (p 0,001), uso prolongado de vasoactivos (p 0,001) e infección del sitio operatorio (p 0,004). El riesgo de mortalidad otorgado por la fragilidad fue más alto que el de los puntajes usuales de valoración como el EuroSCORE II (HR 5,49; IC95% 1,0-28,5 vs. HR 1,17 IC95% 1,0-1,29). Conclusión: la fragilidad es una condición frecuente en el paciente anciano sometido a cirugía cardiaca e incrementa el riesgo de eventos adversos, en especial el de mortalidad. Se recomienda incluir la medición de la fragilidad en el protocolo prequirúgico del paciente anciano. Abstract: Introduction: Frailty is a common condition in the elderly patient, and is noted for its vulnerability for adverse outcomes in health, including those caused by cardiac surgery. Objective: To establish the prevalence of frailty in the pre-surgical context of the elderly subjected to cardiac surgery, as well as to establish the risk of adverse outcomes due to this condition. Method: An analytical cohort study was performed in order to evaluate frailty in 66 elderly patients subjected to cardiac surgery, using the physical phenotype of frailty described by Fried. A follow-up was made at 30 days, during which the frailty prevalence was established, as well the risk of adverse outcomes of the cardiac surgery due to this condition. Results: The age of the patients varied between 60 and 83 years, with a median of 70.5 years. The prevalence of frailty was 31.8%. Frailty increased the following post-surgical adverse outcomes: death (P = .001), longer ventilation time (P = .001), prolonged use of vasoactive drugs (P = .001), and infection of the surgical site (P = .004). The mortality risk due to frailty was higher than that of the usual evaluation scores such as Euro SCORE II (HR 5.49; 95% CI; 1.0-28.5 vs. HR 1.17: 95% CI; 1.0-1.29). Conclusion: Frailty is a common condition in the elderly patient subjected to cardiac surgery, and increases the risk of adverse events, particularly, mortality. It is recommended to use measurements of frailty in the pre-surgical protocol of the elderly patient.

Resumen Una mujer de 74 anos, portadora de protesis valvular mecanica mitral, con corazon estructuralmente aceptable y fraccion de eyeccion ventricular izquierda preservada del 68%, se encontraba anticoagulada con warfarina por su reemplazo valvular mecanico. Consulta a urgencias de la clinica por presencia de hematemesis y melenas progresando a choque hipovolemico, anemia, coagulopatia con valores de hemoglobina de 5 g/dl e INR 7,8. Ingresa en la UCI con puntaje de APACHE II de 26 y SOFA 12 puntos. Se maneja con liquidos intravenosos, cristaloides y trasfusion de hemoderivados (5 unidades de concentrado globular, 4 unidades de plasma fresco congelado), con respuesta satisfactoria clinica y estabilidad hemodinamica. Tres dias despues de su hospitalizacion presenta compromiso de la mecanica respiratoria (frecuencia respiratoria 28 x minuto), disfuncion pulmonar (PaO2/FIO2 140), hiperdinamia (frecuencia cardiaca 140 x minuto), mayor respuesta inflamatoria sistemica (leucocitos 14900, neutrofilos 88%), acidosis metabolica (Ph 7.14, HCO3- 15) e hiperlactatemia (2,5 mmol/L). La radiografia de torax mostro infiltrados intersticiales retrocardiacos lo que se considero como un foco neumonico. La paciente progresa a estado de choque distributivo septico y se decide iniciar manejo con esteroide venoso, antimicrobianos de amplio espectro (meropenem+ vancomicina), liquidos cristaloides y vasopresores en dosis altas (norepinefrina de 0,5 mcg/kg/min + vasopresina 2,5 U/hora) sin respuesta adecuada despues de 12 horas. Se decide iniciar monitorizacion hemodinamica minimamente invasiva (EV 1000 Volumen View - Flotrac ®) que reporto: bajo gasto cardiaco 3,3 L/min, indice cardiaco limite inferior 2,5 L/min/m2, indice de poder cardiaco disminuido de 0,23 w/m2 y resistencias vasculares sistemicas bajas 1172 dinas. Los marcadores de perfusion alterados con SvcO2 baja 60%, Delta de CO2 de 9 mm/Hg, tasa de extraccion de oxigeno del 35%; los biomarcadores cardiacos tambien reportaron troponina I positiva en 1,8 ng/dl (0,005 ng/dl), niveles de pro-BNP elevados (> 35000). El ecocardiograma TT reporto disfuncion sistolica severa con fraccion de expulsion del 32% e hipocinesia del ventriculo izquierdo. Se sospecho disfuncion miocardica inducida por sepsis. Se inicia manejo con dobutamina en dosis de 2,5 hasta 5 mcg/kg/min. Diez dias despues del manejo integral, se evidencia mejoria clinica, con resolucion de la vasoplejia, mejor gasto cardiaco, reversion de la disfuncion organica multiple y retiro de los vasopresores. Se realizo un ecocardiograma transesofagico y se confirmo una funcion ventricular izquierda normal, con una fraccion de eyeccion ventricular izquierda calculada en 76% sin trastornos de la contractilidad. Despues de 16 dias de manejo en la unidad de cuidados intensivos egresa a hospitalizacion en condiciones generales adecuadas, y puntajes APACHE II de 6 y SOFA 4 al egreso. Los examenes complementarios de colonoscopia y gastroduodenoscopia revelaron gastropatia atrofica corporoantral y polipo del ciego no resecado sin sangrado activo.

Introduction. The characterization of students in a Medical Program and its impact on academic performance and successful completion is a relatively unstudied process in medical education. Material and Methods: This observational, descriptive, and cross-sectional study characterized students in the Medical Program at the Universidad Tecnológica de Pereira from 1977-2018. Results: Participants were grouped into applicants (23738), enrolled (3714), graduates (1984), and non-graduates (1730). In the enrolled student subgroup, the male:female ratio varied with a trend favoring females in terms of age when starting the program, age at graduation, graduation percentage, and periods enrolled. Application and enrollment were predominantly composed of students from lower socioeconomic strata, and who had graduated from public schools. There was a progressive participation of women in all groups, completing the program in less time and graduating at a younger age. The applicant/enrollment ratio was 25:1, unmet demand was 96% and the adjusted percentage of non-graduates was 27.4%. Conclusion: This information opens the discussion on the development of educational policies that seek to increase coverage and strengthen student follow-up programs, allowing for a timely and successful graduation.

The academic community of the department of Risaralda, in its permanent interest in evidencing the results of the research processes that are carried out from the Higher Education Institutions and as a product of the VI meeting of researchers of the department of Risaralda held in November 2021 presents its work: “The journey of research as a challenge towards new trends”, which reflects the result of the latest research and advances in different lines of knowledge in Agricultural Sciences, Health Sciences, Social Sciences and Technology and Information Sciences, which seek to solve and meet the demands of the different sectors. This work would not have been possible without the help of each of the teachers, researchers and authors who presented their articles that make up each of the chapters of the book, to them our gratitude for their commitment, dedication and commitment, since their sole purpose is to contribute from the academy and science to scientific and technological development in the search for the solution of problems and thus contribute to transform the reality of our society and communities. We also wish to extend our gratitude to the institutions of the Network that made this publication possible: UTP, UCP, UNAD, UNIREMINGTON; UNISARC, CIAF, Universidad Libre, Uniclaretiana, Fundación Universitaria Comfamiliar and UNIMINUTO, institutions that in one way or another allowed this work to become a reality, which we hope will be of interest to you. Preface............................................................................................................................7 Chapter 1. Technologies and Engineering Towards a humanization in Engineering using soft skills in training in Engineers.............................................................................................................11 Omar Iván Trejos Buriticá1, Luis Eduardo Muñoz Guerrero Innovative materials in construction: review from a bibliometric analysis....................................................................................................................27 Cristian Osorio Gómez, Daniel Aristizábal Torres, Alejandro Alzate Buitrago, Cristhian Camilo Amariles López Bibliometric review of disaster risk management: progress, trends, and challenges.........................................................................................................51 Alejandro Alzate Buitrago, Gloria Milena Molina Vinasco. Incidence of land coverage and geology, in the unstability of lands of the micro-basin of the Combia creek, Pereira, Risaralda....................................73 Alejandro Alzate Buitrago, Daniel Aristizábal Torres. Chapter 2. Arts, Humanities, and Social Sciences Training experience with teachers teaching mathematics using the inquiry methodology ...............................................................................................95 Vivian Libeth Uzuriaga López, Héctor Gerardo Sánchez Bedoya. Interpretation of the multiple representations of the fears associated to the boarding of limited visual patients in the elective I students’ written productions and low vision ...................................................................................113 Eliana Bermúdez Cardona, Ana María Agudelo Guevara, Caterine Villamarín Acosta. The relevance of local knowledge in social sciences............................................131 Alberto Antonio Berón Ospina, Isabel Cristina Castillo Quintero. Basic education students’ conceptions of conflict a view from the peace for the education....................................................................................................143 Astrid Milena Calderón Cárdenas,Carolina Aguirre Arias, Carolina Franco Ossa, Martha Cecilia Gutiérrez Giraldo, Orfa Buitrago. Comprehensive risk prevention in educational settings: an interdisciplinary and socio-educational approach ............................................................................163 Olga María Henao Trujillo, Claudia María López Ortiz. Chapter 3. Natural and Agricultural Sciences Physicochemical characterization of three substrates used in the deep bedding system in swine .......................................................................................175 Juan Manuel Sánchez Rubio, Andrés Felipe Arias Roldan, Jesús Arturo Rincón Sanz, Jaime Andrés Betancourt Vásquez. Periodic solutions in AFM models........................................................................187 Daniel Cortés Zapata, Alexander Gutiérrez Gutiérrez. Phenology in flower and fruit of Rubus glaucus benth. Cv. Thornless in Risaralda: elements for phytosanitary management .........................................199 Shirley Palacios Castro, Andrés Alfonso Patiño Martínez, James Montoya Lerma, Ricardo Flórez, Harry Josué Pérez. Socio-economic and technical characterization of the cultivation of avocado (Persea americana) in Risaralda..............................................................217 Andrés Alfonso Patiño Martínez, Kelly Saudith Castañez Poveda, Eliana Gómez Correa. Biosecurity management in backyard systems in Santa Rosa de Cabal, Risaralda................................................................................................................227 Julia Victoria Arredondo Botero, Jaiver Estiben Ocampo Jaramillo, Juan Sebastián Mera Vallejo, Álvaro de Jesús Aranzazu Hernández. CONTENTS Physical-chemical diagnosis of soils in hillside areas with predominance of Lulo CV. La Selva production system in the department of Risaralda.............241 Adriana Patricia Restrepo Gallón, María Paula Landinez Montes, Jimena Tobón López. Digestibility of three concentrates used in canine feeding....................................271 María Fernanda Mejía Silva, Valentina Noreña Sánchez, Gastón Adolfo Castaño Jiménez. Chapter 4. Economic, Administrative, and Accounting Sciences Financial inclusion in households from socioeconomic strata 1 and 2 in the city of Pereira ..................................................................................................285 Lindy Neth Perea Mosquera, Marlen Isabel Redondo Ramírez, Angélica Viviana Morales. Internal marketing strategies as a competitive advantage for the company Mobilautos SAS de Dosquebradas........................................................................303 Inés Montoya Sánchez, Sandra Patricia Viana Bolaños, Ana María Barrera Rodríguez. Uses of tourist marketing in the tourist sector of the municipality of Belén de Umbría, Risaralda.............................................................................................319 Ana María Barrera Rodríguez, Paola Andrea Echeverri Gutiérrez, María Camila Parra Buitrago, Paola Andrea Martín Muñoz, Angy Paola Ángel Vélez, Luisa Natalia Trejos Ospina. Territorial prospective of Risaralda department (Colombia), based on the SDGS...............................................................................................................333 Juan Guillermo Gil García, Samanta Londoño Velásquez. Chapter 5. Health and Sports Sciences Performance evaluation in times of pandemic. What do medical students think?.......................................................................................................353 Samuel Eduardo Trujillo Henao, Rodolfo A. Cabrales Vega, Germán Alberto Moreno Gómez. The relevance of the therapist’s self and self-reference in the training of psychologists.....................................................................................................371 Maria Paula Marmolejo Lozano, Mireya Ospina Botero. Habits related to oral health which influence lifestyle of elder people in a wellness center for the elderly in Pereira 2020. .............................................387 Isadora Blanco Pérez, Olga Patricia Ramírez Rodríguez, Ángela María Rincón Hurtado. Analysis of the suicide trend in the Coffee Region in Colombia during the years 2012-2018 ..............................................................................................405 Germán Alberto Moreno Gómez, Jennifer Nessim Salazar, Jairo Franco Londoño, Juan Carlos Medina Osorio. Hind limb long bone fractures in canines and felines...........................................419 María Camila Cruz Vélez, Valentina Herrera Morales, Alba Nydia Restrepo Jiménez, Lina Marcela Palomino, Gabriel Rodolfo Izquierdo Bravo. Prevalence of overweight and obesity in children in the rural and urban area of Risaralda....................................................................................................439 Angela María Álvarez López, Angela Liceth Pérez Rendón, Alejandro Gómez Rodas, Luis Enrique Isaza Velásquez. Chapter 6. Architecture, Design and Advertising The artisan crafts of Risaralda, characteristics, importance, and risks within the Colombian Coffee Cultural Landscape, CCCL....................................457 Yaffa Nahir Ivette Gómez Barrera, Javier Alfonso López Morales.

Annually, the Technological University of Pereira has been carrying out some events in the line of Social Appropriation of Knowledge. This has been done through the research, innovation, and extension Vice Rectory, moreover, these sessions are framed within the institutional objective: “Define and direct the guidelines for the institutional research that strengthen the research groups and the Seedbeds, through the formation of researchers, the development of science, technology, and innovation projects or programs, as well as the generation of networks and strategic partnerships that contribute to the creation and appropriation of knowledge for the society”. Therefore, the 6th Social Appropriation of Knowledge event took place under the title of “The research, Innovation, and Extension at the service of society” which was constituted as an academic and institutional opportunity where the results of the research projects from the last 5 years were published. The results of this event revealed, once again, the high academic level in investigation development at the university. There were 11 articles divided into 6 fields: Health, Engineering, Technology, Education, Industrial Technology, and Art, in which the results obtained by the research projects from the investigation groups were shown, promoting a knowledge exchange from their authors whose intellectual formation is diverse. With this publication, as part of a permanent effort to socialize the knowledge, the university promotes the circulation of its professors, students, and general community voices, having in mind that knowledge must be transferred through different channels, strengthening the academy and society in general, according to the institutional mission that invites us to incentivize a research culture in the university community. Presentation........................................................................................................... 5 Chapter 1. Health Teaching during the pandemic: what changes did professors implement? Results of a survey in a Colombian medical program. ........................................... 9 Germán Alberto Moreno Gómez ,Rodolfo Adrián Cabrales Vega, Jairo Franco Londoño, Samuel Eduardo Trujillo Henao, Víctor Manuel Patiño Suárez Evaluation of the effectiveness of a rat, rabbit and human intestine decellularization protocol...................................................................................... 19 Julio César Sánchez Naranjo, Laura Victoria Muñoz Rincón, Andrés Felipe Quiroz Ma zuera, Andrés Mauricio García Cuevas, Cristhian David Arroyave Durán, Fabián David Giraldo Castaño, Álvaro Guerra Solarte, Juliana Buitrago Jaramillo Exploration of the filtering functions of the intestine through a filtering loop model: an experimental approach towards a feasible renal replacement.............. 31 Julio César Sánchez Naranjo, Laura Victoria Muñoz Rincón, Andrés Mauricio García Cuevas, Álvaro Guerra Solarte y Juliana Buitrago Jaramillo Chapter 2. Engineering Identification of sociodemographic factors using multivariate analysis related to the dropout of Universidad Tecnológica de Pereira undergraduate students.... 47 Nelcy N Atehortua-Sanchez, Paula Marcela Herrera, Julian D Echeverry Correa Design and Construction of an HVDC-MMC Terminal on a Low Scale to Interconnection of Windfarms to the Electrical Grid........................................ 61 Diego Alberto Montoya Acevedo, Andrés Escobar Mejía Chapter 3. Technologies Preliminary study of cytototoxic and bactericidal activities of nonpolar extracts from seeds and peel of Persea americana cv Lorena ............................................ 85 Gloria Edith Guerrero Alvarez, Daniel Steven Fernández, Daniela Londoño Ramirez Cytototoxic and bactericidal activities of nonpolar extracts from seeds and peel of Persea americana cv Hass..................................................................................... 95 Gloria Edith Guerrero Alvarez, Gustavo Alfonso Cifuentes Colorado, Paula Daniela Sandoval Mossos Chapter 4. Education Pedro Henríquez Ureña traveler and Cosmopolitan ........................................... 107 William Marín Osorio Reading and writing in the training of our teachers: a commitment of all ......... 133 María Gladis Agudelo Gil, Gloria Inés Correa Aristizábal Chapter 5. Industrial engineering Tasks design to promote metacognitive regulation in discrete event simulation ......................................................................................................... 151 María Elena Bernal Loaiza, Manuela Gómez Suta, Rosario Iodice CONTENIDO Chapter 6. Arts The media feuilleton, between fiction and reality............................................... 169 Teresita Vásquez Ramírez

Resumen Objetivo: Cuantificar el cumplimiento de notificacion de casos probables de dengue en el area Metropolitana Centro Occidente de Colombia, en el ano 2014. Metodos: Esta investigacion corresponde a un estudio observacional, descriptivo de corte transversal a partir de los registros de diagnosticos de dengue y sus diagnosticos diferenciales identificados en los Registros Individuales de Prestacion de Servicios (RIPS) y el Sistema Nacional de Vigilancia en Salud Publica (SIVIGILA) del ano 2014, de las Unidades Primarias Generadoras de Datos (UPGD) del Area Metropolitana Centro Occidente del Departamento de Risaralda. Se seleccionaron todos los registros de dengue (Censo) y se obtuvo una muestra de los diagnosticos diferenciales con un nivel de confianza del 95%, una p de 0.5 y una precision del 5%. Posteriormente se calcularon porcentajes de cumplimiento en la notificacion para dengue y para casos probables. Resultados: El 64% de los pacientes con diagnosticos de dengue fueron notificados al SIVIGILA en el ano 2014. El 10,7% de los diagnosticos diferenciales cumplieron con el criterio de caso probable de dengue y el 12,9% de los casos probables de dengue fueron notificados al SIVIGILA en el ano 2014. Discusion: Los resultados de este estudio son importantes porque brindan informacion sobre el cumplimiento de la notificacion obligatoria de los casos de dengue al Sistema de Vigilancia Epidemiologica del dengue de las UPGD publicas del Area Metropolitana Centro Occidente del Departamento de Risaralda, evidenciando un incumplimiento en la notificacion. Ademas, al comparar los resultados con otros estudios realizados tanto a nivel internacional (Costa Rica, Brasil y Chile) y a nivel nacional (Santander y Valle) se observan problemas similares de notificacion en los Sistemas de Vigilancia Epidemiologica respectivos.

Este artículo presenta los patrones que determinaron el ingreso de las gestantes críticamente enfermas a la Unidad de Cuidados Intensivos (UCI) o de Alta Dependencia Obstétrica (UAD), y las causas de complicaciones y muerte más frecuentes, al igual que los factores que afectan el pronóstico perinatal. Se plantea la implementación de las Unidades de Alta Dependencia Obstétrica para el manejo de las gestantes críticamente enfermas, y el entrenamiento del personal involucrado en el manejo obstétrico de estas pacientes.