Takayasu Arteritis: new trends in surgical approach – case presentation

Takayasu arteritis (TA) is defined as a rare chronic granulomatous panarteritis that classically involves segments of large arteries such as the aortic arch. The aim of this report is to present our recent experience in diagnosis and treatment of TA and to provide aspects of surgical strategy for inflammatory aneurysms caused by TA. We present the case of a 36-year-old Caucasian female admitted to our clinic with low effort dyspnea, fatigability, palpitations, sweats, malaise and light-headedness. The medical history revealed a history of treated tuberculosis, anemia, arterial hypertension, chronic inflammatory syndrome, aortic insufficiency, and anterior mitral valve prolapse. Echocardiography revealed grade III-IV aortic regurgitation, grade I-II mitral regurgitation, a dilated ascending aorta and mild systolic dysfunction. CT angiography revealed an aneurysmal dilatation of the ascending aorta. Surgical treatment was mandatory, and intraoperative, the surgeon noted a diffuse thickening of the aortic wall and suspected TA, further confirmed by histopathological examination. The tricuspid aortic valve was excised and a composite graft with a biological valve and an aortic conduit were implanted on patient’s request. Postoperative course was uneventful and the patient was discharged from the hospital on the 10th postoperative day, and directed towards Rheumatology Clinic for medical treatment. A multidisciplinary approach to the diagnosis and management of TA patients is essential to a satisfactory outcome

Women’s image and role in art: from Medieval virtuous mystics to today’s Advertising perverse figures

For various historically documented reasons, women have always been considered a paradigm of either virtue or perversion. In this article, we focus firstly on the image of women as reflected in medieval illuminated manuscripts, where portrayals raged from mainly mystics in convents, saints, mothers, damsels in distress, labourers in the fields and even women of ill character. Apart from that, we mention the role of women as writers and illustrators of Manuscripts. Secondly, we have a brief look at modern western art, based on the heritage of medieval art, that carries on even further the stereotyped image of women, systematically objectifying them. Thirdly and finally, we examine how this has influenced today's advertising depictions of women, outlined with distinctive characteristics. The visual discourse emphasizes certain physical and moral traits based again on clichés, stressing mostly decadent passive attitudes and poses or submissive roles. The present research is quantitative and qualitative, based on case studies and referred in articles on Medieval Illuminated Art and Today's Advertising and Mass Media

Miradas que migran: proyecto de sensibilización para fomentar una cultura de acogida, igualdad e inclusión para las personas desplazadas forzosamente, migrantes y refugiadas

Proyecto de concienciación social en el que, aplicando la metodología ApS y en colaboración con la ONG Entreculturas, el alumnado del Grado en Diseño crea proyectos de sensibilización para la inclusión de las personas en situación de vulnerabilidad, desplazadas forzosamente, migrantes y refugiadas

Mental Illness and Patricide. A Case Report of Patricide

According to world-wide statistics, schizophrenia is the most common mental illness identified in people who commit this type of murder. Also, there are slight associations between matricide which is often committed by the sons and patricide which is often committed by daughters. Most of the perpetrators in cases of parricide are under the age of 30, with adolescents covering a big part of the chart. The age of schizophrenic debut, the psychiatric and social attendance of the patients, the active psychotic symptoms, with hallucinations and paranoid persecution ideas but also, the affective inversion towards close friends and family members are frequently found in people who commit parricide. Also, psychotic symptoms and schizophrenia-like clinical aspects can appear in other mental disorders such as mental retardation, dementia or bipolar disorder. The subject is extremely complex as it has to be understood through the characteristics of the mental illness, the basic family relations, the personality of the victims, and last, but not least, the discernment issue that gives more heaviness to the juridic and social involvements of these cases.We hereby present the case of a 17-year-old girl, from the forensic psychiatric board, diagnosed with mental retardation and psychotic symptoms that murdered her father by multiple strikes in vital areas with blunt and sharp objects. We will assess the familial, social and psychological aspects of the case, revealing the implications of mental illness and forensic psychiatry in law enforcement and social services.</p

International multicenter survey on screening and confirmatory testing in primary aldosteronism

Objective: Primary aldosteronism (PA) is one of the most frequent causes of secondary hypertension. Although clinical practice guidelines recommend a diagnostic process, details of the steps remain incompletely standardized. Design: In the present SCOT-PA survey, we have investigated the diversity of approaches utilized for each diagnostic step in different expert centers through a survey using Google questionnaires. A total of 33 centers from 3 continents participated. Results: We demonstrated a prominent diversity in the conditions of blood sampling, assay methods for aldosterone and renin, and the methods and diagnostic cutoff for screening and confirmatory tests. The most standard measures were modification of antihypertensive medication and sitting posture for blood sampling, measurement of plasma aldosterone concentration (PAC) and active renin concentration by chemiluminescence enzyme immunoassay, a combination of aldosterone-to-renin ratio with PAC as an index for screening, and saline infusion test in a seated position for confirmatory testing. The cutoff values for screening and confirmatory testing showed significant variation among centers. Conclusions: Diversity of the diagnostic steps may lead to an inconsistent diagnosis of PA among centers and limit comparison of evidence for PA between different centers. We expect the impact of this diversity to be most prominent in patients with mild PA. The survey raises 2 issues: the need for standardization of the diagnostic process and revisiting the concept of mild PA. Further standardization of the diagnostic process/criteria will improve the quality of evidence and management of patients with PA.Metabolic health: pathophysiological trajectories and therap

Preconception management of thyroid dysfunction

Uncorrected thyroid dysfunction in pregnancy has well‐recognized deleterious effects on foetal and maternal health. The early gestation period is one of the critical foetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre‐empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves’ disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnanc

La interfaz como contexto de comunicación en el diseño de los teléfonos móviles inteligentes desde 1998 hasta 2009

Esta tesis doctoral centra su estudio en la interfaz como objeto de diseño y espacio de comunicación útil y estética, en el caso de los teléfonos móviles inteligentes desde 1998 hasta 2009. La interfaz representa la identidad del objeto, el contexto que da lugar al entendimiento entre el este y el sujeto, el aspecto comunicante del objeto con el mundo a través de un lenguaje propio. Así como las personas tenemos nuestro idioma para comunicarnos, cada objeto tiene una interfaz propia según la función para la que fue diseñado. Se distingue entre dos tipos de interfaces: la tangible y concreta, el aspecto externo del objeto, a la que se llamará interficie; y la interna o virtual, la parte que no se puede tocar, la interfaz. En la interficie se articula la interacción entre el cuerpo humano y el objeto; es el lugar de encuentro entre dos o más entidades donde se reflejarán las cualidades físicas de las partes que interactúan y donde se desarrollará la acción interactiva. La tesis se pretende monográfico-teórica, y consta de dos partes: una teórica y otra práctica. Se parte, en el capítulo 2I, de una breve definición y análisis del mundo de los objetos, ya que ese mundo es el que constituye la razón de existir de la interfaz. A partir de ahí se procede a definir cada tipo de interfaz en el capítulo 3I. A continuación, en el capítulo 4I, se amplía y se apoya su estudio con una exploración de las teorías de la percepción visual. Para finalizar la investigación teórica, se dedica el último capítulo, capítulo 5I, al campo del diseño, estudiando la interficie y la interfaz a través de los siguientes temas: proceso comunicacional del diseño, estética y lenguaje visual, las Leyes de la Gestalt, diseño emocional e interfaz humana. La segunda parte se abre con un breve repaso histórico, en el capítulo 2II, de la telefonía móvil que analiza las fases de desarrollo tecnológico y de diseño de la interficie y de la interfaz; se define después su diseño en el contexto móvil, en el capítulo 3II, y se detallan los elementos gráficos y formales que la componen. Se dedica un capítulo, el 4II, a las funciones de las interfaces, a las aplicaciones y los usos convencionales y no convencionales del móvil, y a la relación que se crea con el usuario; se trata también el carácter accesorio del móvil, en el capítulo 5II, como si de un complemento de moda se tratase, mencionando el impacto en la sociedad y su papel como símbolo de identidad; se concluye en el capítulo 6II con un planteamiento sobre la posible trayectoria futura de la interficie y de la interfaz móvil: la interfaz será dinámica y anticipativa, capaz de prever la siguiente acción del usuario y adaptarse a sus necesidades según el contexto y la localización, y tomará sus propias iniciativas comunicativas dependiendo de la información recabada sobre su usuario y gracias a una continua actualización de sus preferencias. La conclusión final es que la comunicación entre objeto y sujeto está condicionada por sus interfaces. Estas son espacio y contexto de comunicación, e ilustran la capacidad comunicativa de un objeto con el ser humano, y de los seres humanos entre sí a través de ellos. La tecnología móvil hace más evidente esta interacción, por eso hemos elegido estudiarla. La interficie del móvil, la forma externa, es portavoz de la identidad del usuario, según la elección de su aspecto y la manera de llevarla; y la interfaz, el contenido interno, las aplicaciones, el software también, además de ser el lugar de encuentro entre diferentes usuarios conectados a través de una red. La importancia de las interfaces reside, al fin y al cabo, en constituir el canal a través del cual se hace posible la comunicación constante con nuestro entorno, cercano o lejano, en ser el vehículo que facilita su entendimiento, apoyando e incrementando el nivel de interacción con los objetos contenidos en el entorno inmediato, real, físico o virtual, dondequiera que estemos y en el momento que lo necesitemos

A severe but reversible reduction in insulin sensitivity is observed in patients with insulinoma.

Background: Hypoglycemic manifestations are highly variable in patients with an insulinoma and largely independent of tumour size and severity of insulin hypersecretion. Objectives: We investigated the clinical, biological and tumoral characteristics of insulinomas in a large monocentric series of patients and we evaluated their insulin sensitivity before and after successful pancreatic surgery. Patients and methods: This was a retrospective analysis of 40 patients treated for an insulinoma between 1982 and 2012 in our academic hospital. Insulin sensitivity and beta cell function were evaluated by a HOMA test outside hypoglycaemic episodes in a large subset of these patients. Results: The mean age at onset of symptoms was 48.8. ±. 20.1 years and the mean age at diagnosis was 50.7. ±. 19.9 years. Neuroglycopenic symptoms were observed in 90% of patients. The most effective preoperative imaging technique to localize the tumour was endoscopic ultrasound. Insulin sensitivity was greatly reduced in patients with insulinoma (38.9%. ±. 22.3%), while beta cells function was increased (359.0. ±. 171.5%), but to a variable extent (range: 110.6-678.6%). After complete resection of the tumour and remission of hypoglycemic episodes, insulin sensitivity increased in all evaluated subjects (72.8. ±. 36.7%) and normalized in the majority. Conclusion: Although neuroglycopenic symptoms are present in most patients, diagnosis of insulinoma is often delayed. Endoscopic ultrasound remains the most sensitive preoperative technique to localize the tumour. We also show that in response to chronic hyperinsulinemia, patients with insulinoma develop protective mechanisms responsible for a marked insulin resistance, which is reversible after complete resection of the tumour