Guillain-Barré syndrome, tuberculosis and inflammatory bowel disease: a multiple association

Guillain-Barré syndrome (GBS) has been associated with both infective or non-infective aetiologies. GBS is usually preceded by acute respiratory or gastrointestinal infection but its association with tuberculosis has been exceptionally reported. Inflammatory bowel disease (IBD) is associated with clinical manifestations involving the neurological system, peripheral neuropathy is known to be related to IBD and, either demyelinating or axonal involvement of peripheral nerves have been described. We report an unusual case of GBS associated with lymph node tuberculosis and ulcerative colitis

Clinical characterization and outcomes of 85 patients with neurosarcoidosis

To analyze the frequency and clinical phenotype of neurosarcoidosis (NS) in one of the largest nationwide cohorts of patients with sarcoidosis reported from southern Europe. NS was evaluated according to the Diagnostic Criteria for Central Nervous System and Peripheral Nervous System Sarcoidosis recently proposed by Stern et al. Pathologic confrmation of granulomatous disease was used to subclassify NS into defnite (confrmation in neurological tissue), probable (confrmation in extraneurological tissue) and possible (no histopathological confrmation of the disease). Of the 1532 patients included in the cohort, 85 (5.5%) fulflled the Stern criteria for NS (49 women, mean age at diagnosis of NS of 47.6 years, 91% White). These patients developed 103 neurological conditions involving the brain (38%), cranial nerves (36%), the meninges (3%), the spinal cord (10%) and the peripheral nerves (14%); no patient had concomitant central and peripheral nerve involvements. In 59 (69%) patients, neurological involvement preceded or was present at the time of diagnosis of the disease. According to the classifcation proposed by Stern et al., 11 (13%) were classifed as a defnite NS, 61 (72%) as a probable NS and the remaining 13 (15%) as a possible NS. In comparison with the systemic phenotype of patients without NS, patients with CNS involvement presented a lower frequency of thoracic involvement (82% vs 93%, q= 0.018), a higher frequency of ocular (27% vs 10%, q< 0.001) and salivary gland (15% vs 4%, q= 0.002) WASOG involvements. In contrast, patients with PNS involvement showed a higher frequency of liver involvement (36% vs 12%, p= 0.02) in comparison with patients without NS. Neurosarcoidosis was identifed in 5.5% of patients. CNS involvement prevails signifcantly over PNS involvement, and both conditions do not overlap in any patient. The systemic phenotype associated to each involvement was clearly diferentiated, and can be helpful not only in the early identifcation of neurological involvement, but also in the systemic evaluation of patients diagnosed with neurosarcoidosis

Sarcoidosis sistémica con afectación gastrointestinal y hepática

Sarcoidosis is a systemic granulomatous disease of uncertain aetiology. It is diagnosed when non-necrotising granulomas are found in the absence of other autoimmune or infectious processes or external agents. The incidence of gastrointestinal involvement is estimated at 0.1-1.6%, while liver involvement occurs in 50-65% of cases, and may be subclinical or discovered in the study of liver enzyme abnormalities. We present the case of a 51-year-old man with postprandial satiety, epigastric pain and refractory ascites in the context of sarcoidosis with gastrointestinal, and hepatic involvement. He was treated with prednisone and azathioprine with subsequent clinical stabilisation.La sarcoidosis es una afectación granulomatosa sistémica de etiología incierta. Se diagnostica ante el hallazgo de granulomas no necrotizantes en ausencia de otros procesos autoinmunes, infecciosos o agentes externos. La incidencia de la afectación gastrointestinal se estima en un 0,1-1,6% mientras que la afectación hepática ocurre en el 50-65% de los casos, pudiendo ser subclínica o descubierta en el estudio de una alteración de las enzimas hepáticas. Presentamos el caso de un varón de 51 años con un cuadro de saciedad posprandial, dolor epigástrico y ascitis refractaria en contexto de una sarcoidosis con afectación gastrointestinal y hepática. Se inició tratamiento con prednisona y azatioprina con estabilización clínica posterior

Planeamiento estratégico de Ransa Comercial S.A.

El presente documento desarrolla el Planeamiento Estratégico de Ransa Comercial. Este plan es producto del análisis del entorno externo, en el que se consideran la estabilidad y competitividad del sector e industria; y el entorno interno, en el que se identifican las principales características y potencialidades de la empresa. Basado en esto, se plantea una visión que describe la situación futura esperada y una misión que permita entender la naturaleza de sus operaciones. La empresa brinda servicios logísticos, principalmente en transporte y almacenes; también ofrece soluciones especializadas como agenciamiento de aduanas, construcciones modulares, entre otros servicios. Consolidada como líder en la industria, ha incrementado sus ventas e infraestructura a nivel latinoamericano; sin embargo, ha sido afectada fuertemente afectada por la reducción de la demanda, incremento de la informalidad en el mercado y competidores con precios reducidos. Además, la empresa no tiene un plan estratégico acorde, que permita hacerle frente a este entorno, ni defina la estructura interna de la empresa para ello. Desde una perspectiva metodológica, el presente estudio cumple con el modelo de proceso estratégico recomendado por el Dr. Fernando D´Alessio, con lo que se incrementa el valor que pueda aportar en la toma de decisiones de la dirección estratégica de Ransa Comercial, logrando la visión propuesta de ser una empresa reconocida a nivel mundial por sus altos estándares de calidad y posicionada entre los primeros operadores logísticos en Latinoamérica con ventas superiores a los US$500 millones al 2021. Esto se logrará a través de cinco objetivos de largo plazo y 11 estrategias, el control se realizará por medio del Tablero de Control Balanceado.The following document develops Ransa Comercial’s Strategic Plan. This document is the result of the analysis of the external environment, in which the stability and competitiveness of the industry are considered; and the internal environment, where the most important characteristics of the business are identified. Based on this, a vision is proposed, which describes what the company is expected to become in the future; and a mission that allows understanding the nature of its operations. Ransa Comercial provides logistics solutions, with is core in transport and storage; the company also offers customer brokerage, modular buildings, among others. As a leader in the industry, Ransa has increased its sales and infrastructure in Latin America; however, the company has been affected due to a decrease in the demand, informality in the industry, and competitors offering reduced prices. Furthermore, Ransa Comercial does not have a strategic plan that allows face the environment, nor the company’s structure. From a methodological view, the current study fits the strategic process model recommended by Dr. Fernando D’Alessio, which increases the value to take decisions within the strategic direction of Ransa Comercial, achieving the proposed mission for a worldwide company for its high quality standards and positioned among the first logistic operators in Latin America, with sales above$500 million by 2021. This is achieved through five longterm goals and 11 strategies, the control will be performed through the Balanced Scorecard.Tesi

Clima escolar, inteligencia emocional y psicología educativa en los espacios de aprendizaje

Desde hace un tiempo se vienen detectando niveles de estrés, fracaso escolar, en niveles más elevados y en etapas educativas ansiedades más tempranas. Este suceso viene derivado de factores como el aumento de responsabilidad y autonomía, carga de trabajo académico, así como falta de habilidades para gestionar las emociones. De ahí que, en las últimas décadas, la Inteligencia Emocional haya adquirido una mayor importancia en el ámbito educativo, puesto que actúa como medio para promover el bienestar psicológico del alumnado, facilitándoles la comprensión del entorno que los rodea, así como dotándolos de las competencias. necesarios para hacer frente a las diversas situaciones que se presentan. De esta manera, este constructo se constituye como un proceso educativo que ha de ser permanente y continúo favoreciendo el desarrollo integral de los estudiantes

Association of Functional Polymorphisms of KIR3DL1/DS1 With Behçet's Disease

Behçet's disease (BD) is an immune-mediated vasculitis related to imbalances between the innate and adaptive immune response. Infectious agents or environmental factors may trigger the disease in genetically predisposed individuals. HLA-B51 is the genetic factor stronger associated with the disease, although the bases of this association remain elusive. NK cells have also been implicated in the etiopathogenesis of BD. A family of NK receptors, Killer-cell Immunoglobulin-like Receptor (KIR), with a very complex organization, is very important in the education and control of the NK cells by the union to their ligands, most of them, HLA class I molecules. This study aimed to investigate the contribution of certain KIR functional polymorphisms to the susceptibility to BD. A total of 466 BD patients and 444 healthy individuals were genotyped in HLA class I (A, B, and C). The set of KIR genes and the functional variants of KIR3DL1/DS1 and KIR2DS4 were also determined. Frequency of KIR3DL1004 was lower in patients than in controls (0.15 vs. 0.20, P = 0.005, Pc = 0.015; OR = 0.70; 95% CI 0.54-0.90) in both B51 positive and negative individuals. KIR3DL1004, which encodes a misfolded protein, is included in a common telomeric haplotype with only one functional KIR gene, KIR3DL2. Both, KIR3DL1 and KIR3DL2 sense pathogen-associated molecular patterns but they have different capacities to eliminate them. The education of the NK cells depending on the HLA, the balance of KIR3DL1/KIR3DL2 licensed NK cells and the different capacities of these receptors to eliminate pathogens could be involved in the etiopathogenesis of BD

The complex HLA-E-nonapeptide in Behçet disease

Introduction: The knowledge of the aetiology of Behçet disease (BD), an immune-mediated vasculitis, is limited. HLA-B, mainly HLA-B51, and HLA-A molecules are associated with disease, but the ultimate cause of this association remains obscure. There is evidence that NK cells participate in the etiopathology of BD. NK cells have activator and inhibitor surface receptors, like the KIR and the NKG2 families. Classical HLA-class I molecules (A, B and C) are keys in the activity control of the NK because they are KIR ligands. Most NKG2 receptors bind HLA-E, which presents only nonapeptides derived from the signal peptide of other class-I molecules. Objective: This study investigates the contribution of the pair HLA-E and ligand, nonapeptide derived from the 3-11 sequence of the signal peptides of class I classical molecules, to the susceptibility to BD. Methods: We analyzed the frequency of the HLA-derivated nonapeptide forms in 466 BD patients and 444 controls and an HLA-E functional dimorphism in a subgroup of patients and controls. Results: In B51 negative patients, the frequency of VMAPRTLLL was lower (70.4% versus 80.0% in controls; P=0.006, Pc=0.04, OR=0.60, 95%CI 0.41-0.86), and the frequency of VMAPRTLVL was higher (81.6% versus 71.4% in controls; P=0.004, Pc=0.03, OR=1.78, 95%CI 1.20-2.63). In homozygosity, VMAPRTLLL is protective, and VMAPRTLVL confers risk. The heterozygous condition is neutral. There were no significant differences in the distribution of the HLA-E dimorphism. Discussion: Our results explain the association of BD with diverse HLA-A molecules, reinforce the hypothesis of the involvement of the NK cells in the disease and do not suggest a significant contribution of the HLA-E polymorphism to disease susceptibility

Innovación y desarrollo de nuevos recursos y metodologías docentes para la mejora en la adaptación virtual de la formación de posgrado del Máster en Psicosalud Laboral de la Universidad de Salamanca en el marco de la EEES

Memoria ID-016 Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Winds at the Mars 2020 Landing Site. 2. Wind Variability and Turbulence

Wind speeds measured by the Mars 2020 Perseverance rover in Jezero crater were fitted as a Weibull distribution. InSight wind data acquired in Elysium Planitia were also used to contextualize observations. Jezero winds were found to be much calmer on average than in previous landing sites, despite the intense aeolian activity observed. However, a great influence of turbulence and wave activity was observed in the wind speed variations, thus driving the probability of reaching the highest wind speeds at Jezero, instead of sustained winds driven by local, regional, or large-scale circulation. The power spectral density of wind speed fluctuations follows a power-law, whose slope deviates depending on the time of day from that predicted considering homogeneous and isotropic turbulence. Daytime wave activity is related to convection cells and smaller eddies in the boundary layer, advected over the crater. The signature of convection cells was also found during dust storm conditions, when prevailing winds were consistent with a tidal drive. Nighttime fluctuations were also intense, suggesting strong mechanical turbulence. Convective vortices were usually involved in rapid wind fluctuations and extreme winds, with variations peaking at 9.2 times the background winds. Transient high wind events by vortex-passages, turbulence, and wave activity could be driving aeolian activity at Jezero. We report the detection of a strong dust cloud of 0.75–1.5 km in length passing over the rover. The observed aeolian activity had major implications for instrumentation, with the wind sensor suffering damage throughout the mission, probably due to flying debris advected by winds.The authors acknowledge and thank the Mars 2020 team. The authors would like to thank Editors and two anonymous reviewers for their constructive reviews, which greatly improved this manuscript. This work is supported by the Spanish Ministry of Science and Innovation, under project RTI2018-098728-B-C31. The derived data presented in this work were processed in the DPS24PA system, which is supported by project no. DV2020-ATM-A01. Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). The UPV/EHU team is supported by Grant PID2019-109467GB-I00 funded by 1042 MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22