Vaginoplastia por técnica de Mayer en síndrome Rokitansky-Hauser-Kuster. A propósito de un caso

The Rokitansky-Hauser-Kuster Syndrome is a serious congenital abnormality of the female reproductive tract. It has an embryologic etiology by a failure of fusion of the mullerian ducts. It may coincide with other kidney and skeletal malformations, mainly of the spine and ribs, and others in the abdominal cavity. The karyotype is 46xx, therefore, the patient may or may not have uterus, fallopian tubes, ovaries, normal hair distribution, or may also present agenesis of the genital organs. There is a familial appearance and an autosomal dominant mutation linked to sex. Its diagnosis is presumptive in childhood and adolescence. The clinical, diagnostic and therapeutic characteristics of a patient with vaginal agenesis are presented, as well as the creation of an artificial vagina.El síndrome de Rokitansky-Hauser-Kuster es una anomalía grave congénita del tracto reproductivo femenino que tiene una etiología embriológica por una alteración de la fusión de los conductos mullerianos. Puede coincidir con otras malformaciones renales y óseas, principalmente de la columna vertebral y las costillas, y otras de la cavidad abdominal. El cariotipo es 46xx, por lo que puede o no tener útero, trompas, ovarios, distribución del vello normal o puede también haber agenesia de órganos genitales. Se plantea su aparición familiar y una mutación dominante autosómica limitada al sexo; su diagnóstico es presumible en la niñez y la adolescencia. Se plantean las características clínicas, diagnósticas y terapéuticas de una paciente con agenesia vaginal y la creación de una vagina artificial

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

100 Cartas para Paulo Freire de quienes pretendemos Enseñar

Realizar un texto colectivo como “100 Cartas para Paule Freire de quienes pretendemos Enseñar”, es un desafío al reunir el aprehender desde el sentido profesional de la educación y con el espíritu de transformación, desde la educación como un espacio endógeno de revolución y exógeno a las comunidades y sociedades, en busca de un sentido de identidad. Hoy desde una crítica decolonial, antirracista, feminista y ecologica en la construcción de un sentido real que busque enfrentar el sistema hegemónico y destructivo que se ha impuesto con explotación, sangre y libertades de nuestro pueblo