Lipo-lymphoedema and idiopathic cyclic oedema

The case of a 56-year-old patient suffering from morbid obesity associated with lymphoedema of the lower limbs is reported. A clinical diagnosis of idiopathic cyclic oedema and stage II lipo-lymphoedema was made, characterized by hardened oedema which was irreversible during resting, and the presence of varicosities in the lower medial third of the limbs. The limb circumferences were measured. Lymphatic drainage was chosen as treatment for 15 days, which led to a reduction in the circumference of the limb. After this, the patient missed treatment for about 15 days and again presented with an increase of the oedema, but this increase improved with rest. An Unna boot was chosen due to the difficulty of using contention stockings or bandages. The association of the Unna boot accelerated the reduction of the oedema. In conclusion, the differentiation between lipoedema and lipo-lymphoedema is difficult, so a successful treatment was achieved with the association of several therapies, including the use of a multidisciplinary healthcare team.The case of a 56-year-old patient suffering from morbid obesity associated with lymphoedema of the lower limbs is reported. A clinical diagnosis of idiopathic cyclic oedema and stage II lipo-lymphoedema was made, characterized by hardened oedema which was irreversible during resting, and the presence of varicosities in the lower medial third of the limbs. The limb circumferences were measured. Lymphatic drainage was chosen as treatment for 15 days, which led to a reduction in the circumference of the limb. After this, the patient missed treatment for about 15 days and again presented with an increase of the oedema, but this increase improved with rest. An Unna boot was chosen due to the difficulty of using contention stockings or bandages. The association of the Unna boot accelerated the reduction of the oedema. In conclusion, the differentiation between lipoedema and lipo-lymphoedema is difficult, so a successful treatment was achieved with the association of several therapies, including the use of a multidisciplinary healthcare team

El efecto del ejercicio sobre los niveles de ansiedad, depresión y autoconcepto de pacientes con dolencia pulmonar obstructiva crónica

La rehabilitación pulmonar ha sido la mejor alternativa de tratamiento para los pacientes con Dolencia Pulmonar Obstructiva Crónica (DPOC). Este ensayo clínico estudió el efecto del ejercicio sobre los niveles de ansiedad, depresión y auto concepto de 30 pacientes con DPOC (media de edad 63,66+-11,62, 80% sexo masculino) evaluados en las formas de pre y post test. Los pacientes participaron en el estudio durante 12 semanas y se dividieron aleatoriamente en dos grupos: el grupo experimental (G1) y el grupo control (G2). Los pacientes de G1 (n=14) tuvieron 24 sesiones de fisioterapia respiratoria, 12 de acompanamiento psicológico, 3 de educación y 24 de ejercicio. Los pacientes de G2 (n=16) tuvieron las mismas actividades que los pacientes de G1, pero no realizaron ejercicio. Ambos grupos mostraron diferencias estadísticamente significativas (p0,05), incluyendo disminución de la ansiedad y depresión, aumento del auto concepto y mejora en el test de 6 minutos de caminata. No se observaron diferencias significativas entre ambos grupos.Multidisciplinary pulmonary rehabilitation has been the most suitable treatment for chronic obstructive pulmonary disease, COPD. This clinical trial studied the effect of exercise on anxiety, depression and self-concept of 30 COPD patients. (mean age 63,66 +11,62; 80% male). All patients were evaluated at baseline and at completion of rehabilitation program. The participants of the trial were randomized in two groups: experimental group (G1) and control group (G2). Both groups underwent to a 12-weeks programs of treatment. G1 group (n = 14) recived: 24 sessions of physiotherapy; 12 psychological sessions; 3 educational sessions and 24 sessions of physical exercise. G2 group (n =16) recived de same treatment except the sessions of physical exercise. Both groups demostraded significantly satistical improvementes (p< 0.05=, including reduced anxiety and depression, improved self-concept and endurance. There were nonsignificant differences between treatment groups

Functional Analysis of Recurrent Non-Coding Variants in Human Melanoma

Worldwide incidence rates of cutaneous melanoma are increasing, and while survival rates for early stages of melanoma are high, rates drop precipitously for metastatic melanomas or those that are unable to be targeted by currently available treatments. As melanomas have a propensity to quickly metastasize, understanding the contributions of melanoma initiation remains critical for early intervention. Onset of melanoma is characterized most by mutations that stimulate mitogen-activated protein kinase (MAPK) signaling, disrupt DNA damage checkpoints, and trigger mechanisms to bypass senescence through elongation of telomeres. Additionally, in zebrafish melanoma models, the earliest cluster of melanoma-initiating cells activate expression of a neural crest reporter which remains on during the melanoma lifespan. Neural crest cells are highly multipotent and migratory stem cells that arise in early development. Bulk and single-cell RNA-sequencing have confirmed the prevalence of cells that are transcriptionally similar to neural crest cells in human and mouse melanomas and established the importance of this lineage in initiation, metastasis, immune response, and drug evasion. Cutaneous melanomas have one of the highest mutational loads of any cancer types. The most common protein-coding mutations occur in BRAF or NRAS, which activate MAPK signaling, and CDKN2A, PTEN, or TP53, which inactivate tumor suppressors. Even more common are non-coding mutations in the promoter of TERT. These non-coding variants, present in 80% of melanomas, create a novel GABPA binding site leading elevated TERT transcription. Emerging evidence suggests that up-regulation of TERT elongates telomeres and assists in bypassing senescence brought on by excessive MAPK signaling. Since the discovery of the TERT promoter mutation, several other functional non-coding variants have been identified in not only in melanoma but across other cancer types and diseases. As cutaneous melanomas have some of the highest mutation rates, the number of functional non-coding variants in melanoma likely remains largely uncharacterized. Non-coding variants typically occur in or create cell-type specific enhancers. Under this assumption, we created a pipeline to identify recurrent variants in putative melanoma regulatory regions. Within these regions, we identified 140 statistically significant recurrently mutated regions, i.e. hotspots, that harbored ~2000 putative cis-regulatory variants. As we started with almost 21 million variants, the almost 10,000-fold reduction in the number of variants led to a pool of high-confidence variants for which to validate. Statistically significant variants were almost exclusively identified in promoters and more specifically at ETS transcription factor binding sites. Our pipeline identified the TERT promoter mutations as the 13th highest scoring hotspot. Through several rounds of validation by luciferase assays and massively parallel reporter assays, we narrowed in on mutations in the promoter of CDC20 which is mutated in 39 out of 140 cutaneous melanoma samples, spanning different stages of the melanoma lifespan. Almost all the promoter mutations in CDC20 reduced reporter activity significantly across seven melanoma cell lines, one primary melanocyte cell line, and a human embryonic kidney cell line, likely though the disruption of an ETS motif. As high CDC20 is prognostic for worse overall survival, we hypothesized that low levels of CDC20 were important for early stages of melanoma but disadvantageous at later stages. Inspecting variant allele frequencies across different stages of melanoma supported this hypothesis, demonstrating variant allele frequencies like that of BRAF and TERT, known early events, in primary melanomas. However, many of the CDC20 promoter variants were not detected in distant metastases, supporting the notion that CDC20 promoter variants are selected against in metastatic populations as high levels of CDC20 appear to be beneficial for migration. Furthermore, in samples with low levels of CDC20, we identified high levels of key neural crest transcription factors and known melanoma oncogenes including SOX10, an important neural crest and melanocyte lineage specifier. Previous studies have shown that increased expression of SOX10 is observed in melanoma and leads to faster melanoma formation while knock-down of SOX10 slows down melanoma onset. We engineered a small indel in the promoter of CDC20 in a human melanoma cell line and observed decreased migration capabilities and increased expression of SOX10, among other key neural crest genes. Ongoing and future work will establish the mechanisms by which high and low CDC20 expression leads to metastasis and neural crest identity re-emergence, respectively. One promising hypothesis is that changes in the length of the specific cell cycle stages could lead to changes in gene expression specific to differentiation pathways. For example, prolonging of the G2 phase in human embryonic stem cells upregulated pluripotency maintenance factors. Overall, we identify a non-coding variant that abolishes an ETS motif, leads to down-regulation of CDC20, and establishes a transcriptional program more reminiscent of early stages of melanoma as opposed to the metastatic stage. Therefore, we propose that CDC20 has a dosage-dependent effect on melanoma and that throughout the melanoma lifespan, CDC20 promoter variants confer different advantages at different stages of cancer progression

Women in Guatemala’s Metropolitan Area: Violence, Law, and Social Justice

The article examines the legal framework for addressing violence against women in post war Guatemala. New laws constitute a response to, and have occurred concurrent to, an increase in violent crime against women, particularly in the form of mass rapes and murders. The paper juxtaposes the laws for addressing violence against women with Guatemalan women's complex, multilayered and multi-dimensional life experiences. The latter expose the limitations of strictly legal understandings of the phenomenon of gender-based violence and highlight the need for broad social justice approaches that take into account the different structures of violence, inequality, and injustice present in women’s lives

Estudo em túnel de vento das dunas barcanas da região dos lençóis maranhenses, MA

Dunas costeiras são elevações de areia formadas pela interação entre o mar, o vento, a areia e a vegetação. Elas fazem parte do contexto de erodibilidade da faixa litorânea, e estão diretamente relacionadas a fatores ecológicos e socioeconômicos. Dunas possuem um grande papel ambiental ligado à biodiversidade e à paisagem, uma influência grande na geração de atividades turísticas, mas também podem causar desastres ambientais devido a sua migração. A migração de dunas é capaz de soterrar vilas, vias de acesso e corpos d’água. Portanto, é de suma importância o estudo desses corpos sedimentares ativos, para poder compreender e contornar questões relacionadas aos campos de dunas. Para esse trabalho, foi investigada uma amostra de material arenoso provenientes de campos dunas da região dos Pequenos Lençóis, no Parque Nacional dos Lençóis Maranhenses (PNLM)/MA. Visando contribuir com os estudos brasileiros sobre migração dunas, este trabalho consistiu na tentativa de geração de um modelo em escala reduzida de duna, a partir de um cone de areia. O cone de areia é uma curva realística próxima à curva Gaussiana descrita no trabalho de Herrmann e Sauermann (2000), como forma inicial na simulação computacional feita pelos mesmos e usada como referência neste estudo. Os ensaios com areia de duna foram realizados dentro de um túnel de vento subsônico de pequenas dimensões. Realizou-se preliminarmente um estudo sedimentar das areias originais do PNLM, através de ensaios de granulometria, sedimentação, condutividade elétrica e salinidade, e descrição sedimentar com microscópio. Foram feitas análises completas de dados meteorológicos de direção e intensidade do vento nos Lençóis Maranhenses, análises detalhadas do campo de ventos dentro da área de testes do túnel de vento e estudos matemáticos de adimensionalização para o modelo em escala. A Plataforma Móvel foi construída para auxiliar no melhor aproveitamento das condições de ensaio; diversos testes com areia foram realizados dentro do túnel de vento, e importantes adaptações foram feitas para que fosse gerado o melhor modelo em escala de duna barcana possível nas condições atuais. Concluiu-se que não foi possível gerar, até o final deste trabalho, um modelo próximo à duna barcana a partir da observação de divergências entre as áreas de erosão e sedimentação no corpo de ensaio e nas dunas reais

Adaptations in the Treatment of Congenital Lymphedema Centered on the Quality of Life

Case Description. This report describes the evolution, necessary adaptations, and complications in the treatment of a 9-year-old child with primary congenital lymphedema. Description of Intervention. The clinical treatment of lymphedema was started in the first year of the patient’s life and for five years she was only treated using the Godoy & Godoy technique of cervical stimulation. Three years ago the patient was prescribed a compression stocking made from a cotton-polyester fabric (grosgrain) because of a sudden increase in the lymphedema after she started to take growth hormones. Outcome and Conclusion. The combination of cervical stimulation and a compression stocking was effective to keep the child’s life relatively normal, performing all day-to-day and recreational activities

Ultrasonographic measurement of cervical length at 16 to 24 weeks gestation as a predictor of spontaneous preterm delivery in a population of asymptomatic Latina women.

Objetivo: Evaluar en una población de gestantes latinoamericanas asintomáticas que cursen con un embarazo único el valor de una sola cervicometría realizada entre semana 16 a 24 de gestación para predecir parto pre término espontáneo Materiales Y Métodos: En un estudio de Cohorte prospectiva, se invitaron a participar todas aquellas gestantes que se realizaron una ecografía obstétrica en las instalaciones adscritas al Instituto de Salud de Bucaramanga (ISABU), cuando al momento de realizar la ecografía cursaban con embarazos de entre 16 y 24 semanas + 0 días de gestación durante el período de tiempo comprendido entre el 1 de noviembre del 2020 y el 30 de noviembre del 2022. A las pacientes que cumplían con los criterios de inclusión y firmaban los consentimientos, se procedía a realizar la cervicometría con una técnica que se ciñó estrictamente a la descrita por la Sociedad Internacional de Ultrasonido en Ginecología y Obstetricia (ISUOG), la cual es la avalada por FECOPEN (Federación Colombiana de Perinatología), pero se le adicionaron un par de datos más: a) la evaluación con el modo Doppler color de la presencia flujos vasculares relacionados con el orificio cervical interno (OCI) y b) la distancia en mm del borde más bajo de la inserción placentaria respecto de este. El resultado de la cervicometría se expresó en milímetros y en los casos en los cuales el resultado de la medición fue menor a 25 mm o se realizaron hallazgos relacionados con anomalías de la inserción placentaria el dato se incluyó en el informe ecográfico y las pacientes fueron referidas de inmediato a valoración en el servicio de sala de partos. Resultados: Observamos que el orden de frecuencia de la presentación de las tres principales variables clínicas asociadas con PP fue: antecedente de aborto (68.88%), antecedente de legrados (27.77%) y antecedente de parto prematuro (20%), de las cuales la única variable que mostró significancia estadística fue el antecedente de aborto (p de 0.03). La mediana de la edad gestacional en el momento de la evaluación del cuello uterino fue de 19.4 Semanas (RIQ 17-21). Respecto de la cervicometría se hicieron los siguientes hallazgos: la mediana de la longitud cervical fue de 40 mm. Mediante el análisis de la curva ROC, se evaluó la realización de una única medición de la longitud del cuello uterino para la predicción de PP espontaneo < 37 semanas: encontrando un área bajo la curva (AUC) de 0,54 (IC 95 %: 0,45–0,64, p = 0,054). Lo que adicionalmente permitió concluir que un valor de cervicometría de 25 mm, presenta una especificidad (98.92%) y Valor predictivo negativo (90.20. La mediana de la edad gestacional en el momento del parto fue de 39 (RIQ,38–39) semanas, en donde de las 285 pacientes analizadas, 31 mujeres (10.88%) tuvieron un parto antes de las 37 semanas de gestación y de esos PP, 17 (54,84%) fueron espontáneos y 14 (45,16%) fueron inducidos por causas obstétricas. Conclusión: En mujeres latinas con embarazo único, asintomáticas para PP, la medición de la longitud cervical en el segundo trimestre es una herramienta de cribado útil para identificar pacientes sanas dado su alta especificidad y VPN, lo cual permite identificar la población que muy probablemente no desarrollará un PP e identifica un grupo de pacientes con alto riesgo de presentarlo, en quienes se debe considerar altamente la pertinencia de realizar un control prenatal diferencial y de recibir tratamiento con la intención de disminuir la carga de la morbimortalidad asociada a la patología en cuestión.1. Título 4 2. Resumen 4 3. Descripción del problema 7 3.1. Planteamiento del problema de investigación y su justificación 7 4. Marco teórico 14 4.1. Definición de trabajo de parto pretérmino 14 4.2. Epidemiología 14 4.3. Factores de Riesgo 16 4.4. Fisiopatología 18 a) Activación de la interacción placentaria materno-fetal con el eje hipotálamo-hipófisis-adrenal: 18 b) Inflamación en el tejido amniocoriónico-decidual: 19 c) Hemorragia decidual: 19 d) Distensión patológica del miometrio: 19 4.5. Predicción del parto prematuro espontáneo 20 1) Medición de la Longitud Cervical 21 2) Aplicación clínica 25 4.6. Prevención 26 5. Estado del arte 27 Estado del arte. 30 6. Objetivo general y objetivos específicos 36 7. Metodología Propuesta 36 7.1. Tipo de estudio 36 7.2. Población 36 7.3. Muestra 37 7.4. Estimación de tamaño de muestra 37 7.5. Muestreo 38 7.6. Criterios de selección 38 7.7. Variables del estudio 39 7.8. Procedimientos del estudio 40 7.9. Plan de análisis 43 8. Resultados 44 9. Discusión 54 10. Fortalezas y limitaciones 59 11. Conclusiones 59 12. Consideraciones éticas 60 13. Anexos: 62EspecializaciónObjective: To evaluate in a population of asymptomatic Latin American pregnant women with a singleton pregnancy the value of a single cervicometry performed between 16 to 24 weeks of gestation to predict spontaneous preterm delivery. Materials And Methods: In a prospective Cohort study, all those pregnant women who underwent an obstetric ultrasound at the facilities attached to the Health Institute of Bucaramanga (ISABU) were invited to participate, when at the time of performing the ultrasound they had pregnancies between 16 and 24 weeks + 0 days of gestation during the period of time between November 1, 2020 and November 30, 2022. The patients who met the inclusion criteria and signed the consents, proceeded to perform cervicometry with a technique that strictly adhered to that described by the International Society of Ultrasound in Gynecology and Obstetrics (ISUOG), which is endorsed by FECOPEN (Colombian Federation of Perinatology), but a couple of additional data were added: a) the evaluation with color Doppler mode of the presence of vascular flows related to the internal cervical orifice (ICO) and b) the distance in mm of the lowest edge of the placental insertion with respect to it. The cervicometry result was expressed in millimeters and in cases in which the result of the measurement was less than 25 mm or there were findings related to abnormalities of the placental insertion, the data were included in the ultrasound report and the patients were immediately referred for evaluation in the delivery room service. Results: We observed that the order of frequency of presentation of the three main clinical variables associated with PP was: history of abortion (68.88%), history of curettage (27.77%) and history of preterm delivery (20%), of which the only variable that showed statistical significance was history of abortion (p of 0.03). The median gestational age at the time of cervical assessment was 19.4 weeks (RIQ 17-21). Regarding cervicometry the following findings were made: the median cervical length was 40 mm. By means of ROC curve analysis, the performance of a single measurement of cervical length was evaluated for the prediction of spontaneous PP < 37 weeks: finding an area under the curve (AUC) of 0.54 (95 % CI: 0.45-0.64, p = 0.054). This additionally allowed us to conclude that a cervicometry value of 25 mm presents a specificity (98.92%) and a negative predictive value (90.20). The median gestational age at delivery was 39 (RIQ,38-39) weeks, where of the 285 patients analyzed, 31 women (10.88%) had a delivery before 37 weeks of gestation and of these PP, 17 (54.84%) were spontaneous and 14 (45.16%) were induced by obstetric causes. Conclusion: In Latina women with a singleton pregnancy, asymptomatic for PP, the measurement of cervical length in the second trimester is a useful screening tool to identify healthy patients given its high specificity and NPV, which allows identifying the population that most likely will not develop PP and identifies a group of patients at high risk of presenting it, in whom the relevance of performing a differential prenatal control and receiving treatment with the intention of reducing the burden of morbidity and mortality associated with the pathology in question should be highly considered.Modalidad Presencia

‘’Senda’’, sistema que brinda información vial a las personas con discapacidad visual para cruzar avenidas de forma segura y autónoma en Lima Metropolitana

En el Perú un 10.4% de la población presenta al menos una discapacidad, y de ello el 48.3% de los casos son visuales. Pese a ello no se han implementado diseños inclusivos en los entornos viales del contexto peruano, limitando así el acceso a la información en las calles para personas con discapacidad visual, haciendo su desplazamiento en exteriores urbanos sea frustrante e inseguro. La base teórica de esta investigación aborda los conceptos teóricos sobre la discapacidad visual, el tránsito en Lima, bajo un enfoque de movilidad, la accesibilidad vial; así como, los conceptos de diseño como: el Diseño Centrado en el Humano, Diseño Expositivo y Diseño Universal. Actualmente en el Perú, existen aproximadamente 10% de sistemas acústicos para invidentes en todo Lima Metropolitana, como los semáforos inteligentes ubicados en algunos cruces peatonales, los cuales avisan a los usuarios cuando es seguro transitar por medio de un sonido, sin embargo, debido a la falta de cultura vial adecuada, contaminación sonora por parte de los vehículos, así como un Estado no involucrado que no brinda el mantenimiento y cuidado necesario, estas soluciones no logran ayudar en su totalidad a las personas con discapacidad visual, de modo que, dependen de usuarios videntes para cruzar las avenidas. En consecuencia, Senda propone el diseño de un sistema de información vial que permita cruzar calles de forma segura y autónoma a las personas con discapacidad visual de grave a ceguera en las calles de Lima Metropolitana. Se realizaron los siguientes estudios de investigación para comprender mejor las necesidades de este grupo social: Estudio etnográfico, mapas de empatía, shadowing, journey maps, diseño empático; así como, entrevistas a usuarios invidentes y validaciones con especialistas de diferentes rubros. Senda le aporta al usuario una mayor información vial al invidente al transitar en las calles, le da seguridad y confianza para poder realizar estas actividades de manera autónomaIn Peru, 10.4% of the population has at least one disability, 48.3% of which are visual. Despite this, inclusive designs have not been implemented in road environments in the Peruvian context, thus limiting access to information on the streets for people with visual impairment, making their movement in urban exteriors frustrating and unsafe. The theoretical basis of this research addresses theoretical concepts on visual impairment, traffic in Lima, under a mobility approach, road accessibility; as well as, design concepts such as: Human Centered Design, Expository Design and Universal Design. Currently in Peru, there are approximately 10% of acoustic systems for the blind throughout Metropolitan Lima, such as intelligent traffic lights located at some crosswalks, which warn users when it is safe to transit through a sound, however, due to the lack of adequate road culture, noise pollution from vehicles, as well as a State not involved that does not provide the necessary maintenance and care, these solutions fail to fully help visually impaired people, so that they depend on sighted users to cross the avenues. Consequently, Senda proposes the design of a road information system that allows people with severe to blindness visual impairment to cross streets safely and autonomously in the streets of Metropolitan Lima. The following research studies were conducted to better understand the needs of this social group: ethnographic study, empathy maps, shadowing, journey maps, empathic design; as well as interviews with blind users and validations with specialists in different fields. Senda provides the user with more road information when walking on the streets, giving them security and confidence to be able to perform these activities autonomousl

Desmascarando os eus : a utilização de mascaras em grupos de terapia expressiva

Orientador : Lucia Helena ReilyDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de ArtesMestrad

Are We Closing the Gap? Reforms to Legal Capacity in Latin America in Light of the Convention on the Rights of Persons with Disabilities

This Article examines the the reforms developed in Latin America over the last decade that have adapted domestic legislation regarding legal capacity toward the support model of the Convention on the Rights of Persons with Disabilities (CRPD). Our examination of the reforms in Costa Rica, Argentina, Peru, and Colombia focuses on the adoption process of the reforms, the main characteristics of the implemented support model, some transitional and implementation aspects of the reforms, and a critical examination of their relationship to the CRPD. Finally, this Article explores some weaknesses related to the reforms\u27 implementation processes