Metástasis en hueso maxilar superior de adenocarcinoma de esófago: presentación de un caso clínico

Las metástasis en cavidad oral son lesiones raras que representan aproximadamente el 1% de todas las neoplasias malignas de cavidad oral. Las metástasis orales se localizan en un 80-90% en mandíbula, siendo mas raras en maxilar superior. Las metástasis en tejidos blandos de boca son raras, y es encía donde con mayor frecuencia se localizan las metástasis en tejidos blandos en boca. Los tumores primarios que metastatizan a boca son los más frecuentes pulmón, mama y riñón. Las metástasis en cavidad oral es como consecuencia de una diseminación a distancia de la enfermedad e indica un mal pronóstico, con una supervivencia corta. Aquí presentamos un caso clínico de un paciente diagnosticado de adenocarcinoma de esófago que presentó metastasis en hueso maxilar superior izquierdo.Metastases in the oral cavity are rare lesions which represent approximately 1% of all malignant neoplasms in the oral cavity. Oral metastases are located in the mandible 80-90% on average, the maxilla location being rarer. Metastases in mouth soft tissue are also rare, and within these it is on the gums where they more frequently occur. Primary tumours which metastasize to mouth are most commonly: lung, breast and kidney. Oral cavity metastases appear as a result of distant disease spreading and show wrong prognosis, with short survival. Here we present a clinical case of a patient diagnosed with esophagus adenocarcinoma which presented metastasis in upper-left maxillary bone

Influence of the role defended during a role-playing on pre-service elementary science teachers' scientific knowledge

This work shows a study about the influence of the role defended during the participation in a role-playing game about nuclear energy on the pre-service elementary science teachers’ scientific knowledge. 74 pre-service teachers participated in four role-playing games and a mixed approach was followed for data analysis, through a pre-test/post-test. The results suggest that the pre-service teachers who had to defend a role with a position against their personal point of view could achieve greater scientific knowledge learning. Furthermore, some limitations of this study are discuss.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Pie de Charcot. Cuando menos es más.

Paciente diabética de 71 años de edad, insulino-dependiente, obesa e hipertensa con mal con - trol metabólico que presentó una fractura de tobillo y una luxación subastragalina. Inicialmente fue tratada en su hospital con tracción transesquelética durante varias semanas que resultó infructuosa, evolucionando a una desestructuración completa del retropié y a una úlcera profunda y tórpida, al iniciar la marcha la paciente.Con este escenario acude la paciente a nuestras consultas, tras dos años de evolución, para valorar alternativas a la amputación.A 71-years-old female, diabetic pacient insulin-dependent, obese with high blood pressure and poor metabolic control suffered an ankle fracture and a subtalar dislocation. At the beginning skeletal traction was applied at her Institution but result was unsuccessful, so a complete breakdown of the hindfoot and a deep and torpid ulcer developed. Facing this scenario the patient came to our clinic, after two years of evolution, to assess alternatives to amputation

Pre-service teachers’ ideas about obtaining electricity in nuclear power stations in a role play context

This study examined whether participation in a role play on the socio-scientific issue of the use of nuclear power had an impact on pre-service primary teachers’ ideas regarding the process of obtaining electricity in a nuclear power station. Before and after the role play, 78 pre-service primary teachers were asked to describe this process to analyze the ideas they displayed about the stages involved in it. The results showed, overall, an increased presence of more scientifically informed ideas in some of these stages following the role play, although a number of nonscientifically informed ideas persisted, for example, regarding the way in which heat is obtained or the final transformation of energy into electricity. These results support the potential value of role play for developing more scientifically informed ideas, although some modifications of the role play are recommended for further development of them.This study was supported by the European Social Fund and Spain’s National Research Agency through a researcher training contract (PRE2018-083328) as part of the Excellence in R+D project “Developing the competences of secondary and university students in relation to everyday problems through the scientific practices of argumentation, inquiry and modelling” (EDU2017-82197-P), by the Spanish National Plan R+D+i Project, entitled “Citizens with critical thinking: A challenge for teachers in science education” (PID2019-105765GA-I00), and the support for open publishing by the University of Malaga

The role-playing game as a teaching strategy on environmental awareness development. A Design-Based Research.

Este trabajo muestra el desarrollo de experiencias de juegos de rol sobre la producción de energía nuclear a lo largo de tres cursos académicos, cuya metodología se ha ido modificando teniendo en cuenta los resultados obtenidos en cada una de ellas mediante una investigación basada en el diseño. Los sucesivos cambios metodológicos han mostrado mejoras en cuanto a los resultados obtenidos en cada experiencia respecto a las anteriores, concluyéndose que el juego de rol se muestra como una estrategia que favorece tanto el aprendizaje de conceptos científicos básicos como el tratamiento de aspectos concernientes a la conciencia ambiental, fomentando la práctica de habilidades argumentativas y poniendo en juego opiniones, creencias, actitudes y posiciones de muy diversa índole.This work shows the development of role-playing game experiences on nuclear energy production over three academic years and whose methodology has been modified based on the results obtained in each of them, through a design-based research. The methodological changes have shown improvements in terms of the results obtained in each experience with respect to the previous ones, assuming the role-playing game as a strategy that favours the learning of basic scientific concepts, such as the treatment of aspects concerning environmental awareness, encouraging the practice of argumentative skills and implies opinions, beliefs, attitudes and positions of a very diverse nature

The current role of radiologists in a multidisciplinary team treating breast cancer

In the last decade, advances in the diagnosis and treatment of breast cancer have achieved a significant increase in the general and disease-free survival of affected women but have also increased the complexity of therapeutic decisions. The decision-making process requires agreement between the physicians involved in the management of these patients. Radiologists must understand what other physicians expect and inform them about the usefulness of imaging modalities. This review attempts to provide an update on these subjects

The Short Form of the Fonseca Anamnestic Index for the Screening of Temporomandibular Disorders: Validity and Reliability in a Spanish-Speaking Population

The Short Form of the Fonseca Anamnestic Index (SFAI) is a simple and quick questionnaire used for screening temporomandibular disorders (TMDs). The present study aimed to validate the Spanish version of the SFAI in patients with TMDs. The study sample comprised 112 subjects (50 TMDs and 52 controls). Test–retest reliability, factorial validity, internal consistency, concurrent validity, and the SFAI’s ability to discriminate between TMDs subjects and healthy controls were analyzed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol) as the reference. Factor analysis showed a single factor that explained 63% of the total variance. Cronbach’s alpha was 0.849. The reliability of the items measured with the Kappa index showed values from 0.767 to 0.888. Test–retest reliability was substantial (intraclass correlation coefficient = 0.837). The total SFAI score showed a significant correlation with orofacial pain, vertigo, and neck disability measurements. For a cut-off point of >10 points, the SFAI showed a sensitivity of 78% and specificity of 78.85% at differentiating between TMDs patients and healthy subjects, with an area under the curve (AUC) of 0.852. The Spanish version of the SFAI is a valid and reliable instrument for diagnosing people with TMDs and shows generally good psychometric properties

Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review

Background: It is not clear whether clinical practice guidelines (CPGs) and consensus statements (CSs) are adequately promoting shared decision making (SDM). Objective: To evaluate the recommendations about SDM in CPGs and CSs concerning breast cancer (BC) treatment. Search strategy: Following protocol registration (Prospero no.: CRD42018106643), CPGs and CSs on BC treatment were identified, without language restrictions, through systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2010 to December 2019. Inclusion criteria: CPGs and CSs on BC treatment were selected whether published in a journal or in an online document. Data extraction and synthesis: A 31-item SDM quality assessment tool was developed and used to extract data in duplicate. Main results: There were 167 relevant CPGs (139) and CSs (28); SDM was reported in only 40% of the studies. SDM was reported more often in recent publications after 2015 (42/101 (41.6 %) vs 46/66 (69.7 %), P = .0003) but less often in medical journal publications (44/101 (43.5 %) vs 17/66 (25.7 %), P = .009). In CPGs and CSs with SDM, only 8/66 (12%) met one-fifth (6 of 31) of the quality items; only 14/66 (8%) provided clear and precise SDM recommendations. Discussion and conclusions: SDM descriptions and recommendations in CPGs and CSs concerning BC treatment need improvement. SDM was more frequently reported in CPGs and CSs in recent years, but surprisingly it was less often covered in medical journals, a feature that needs attention

Quality and reporting of clinical guidelines for breast cancer treatment: A systematic review

Background: High-quality, well-reported clinical practice guidelines (CPGs) and consensus statements (CSs) underpinned by systematic reviews are needed. We appraised the quality and reporting of CPGs and CSs for breast cancer (BC) treatment. Methods: Following protocol registration (Prospero no: CRD42020164801), CPGs and CSs on BC treatment were identified, without language restrictions, through a systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2017 to June 2020. Data were extracted in duplicate assessing overall quality using AGREE II (% of maximum score) and reporting compliance using RIGHT (% of total 35 items); reviewer agreement was 98% and 96% respectively. Results: There were 59 relevant guidance documents (43 CPGs, 16 CSs), of which 20 used systematic reviews for evidence synthesis. The median overall quality was 54.0% (IQR 35.9e74.3) and the median overall reporting compliance was 60.9% (IQR 44.5e84.4). The correlation between quality and reporting was 0.9. Compared to CSs, CPGs had better quality (55.4% vs 44.2%; p ¼ 0.032) and reporting (67.18% vs 44.5%; p ¼ 0.005). Compared to subjective methods of evidence analysis, guidance documents that used systematic reviews had better quality (76.3% vs 51.4%; p ¼ 0.001) and reporting (87.1% vs 59.4%; p ¼ 0.001). Conclusion: The quality and reporting of CPGs and CSs in BC treatment were moderately strong. Systematic reviews should be used to improve the quality and reporting of CPGs and CSs.Beatriz Galindo (senor modality) Program by the Ministry of Science, Innovation, and Universities of the Spanish Governmen

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group