Unusual Course of an Aggressive Pituitary Prolactinoma: Case Report and Review of the Literature

Pituitary carcinomas are rare tumors with heterogeneous behaviors. Their carcinogenesis is still unknown. Consequently, treatment is multimodal and not standardized. Dopamine (DA) agonists are used as first-line treatments, while radiotherapy and surgery may be used for local control of invasive tumors. We describe the case of a 35-year-old male who presented with an invasive prolactinoma, managed initially with a transsphenoidal resection, postsurgical radiotherapy and DA agonists. The patient posteriorly presented a sole metastatic lesion to the lumbar spine that was later managed with local radiotherapy. Due to pituitary recurrence of the lesion, multiple surgical resections were needed until further treatment was declined. The clinical course in this patient was unusual. He lived for 13 years after initial diagnosis, with a very invasive tumor without systemic chemotherapy. Radiotherapy is used in pituitary tumors in which surgery fails; we hypothesize that it contributed to the malignant transformation and the late resistance to DA agonists in our patient. Several biomarkers in tumoral tissue have been evaluated regarding their association with malignancy and aggressive behaviors, although more studies are still needed. Therapeutic strategies are limited, without evidence on the impact on overall survival and prognosis. Risk factors associated with early malignancy in pituitary prolactinomas include recurrent behavior, increase in prolactin levels with a stable sellar mass, and secondary development of DA agonist resistance. However, there are still no conclusive answers as to whether physicians should rigorously follow up these patients or provide direct therapy with aggressive approaches

The Caldera. No. 17

Además de recoger, a través de imágenes y de palabras, las experiencias y vivencias que logramos a raíz del homenaje que se rindió a nuestro idioma, a partir de las distintas actividades realizadas por el área de Lengua Castellana, en el mes de Abril, esta edición de “La Caldera”, se centra, en especial, en la mujer y en el amor, vistos, abordados desde la literatura. De esta manera, nuestros jóvenes de undécimo grado se aproximan, desde la modalidad del ensayo, a hacer un análisis serio y riguroso de temas intemporales como el amor y el rol de la mujer, llegando a sus propias conclusiones; aquí, lo más importante es el acercamiento que se logra a la lectura, al análisis de obras consideradas como clásicos de la literatura universal y a la construcción de una serie de argumentos en torno a un trabajo de sustentación, de de nuestros jóvenes educandos.Es tiempo para la paz, el lenguaje es un buen comienzo. Abril: Mes del Idioma. “Celebremos la palabra”; Por: Gisela Afanador Díaz…04 Expresiones caldistas: El amor y la mujer (Desde la literatura) …08 #PazSinCaracteres. Encuentro de líderes estudiantiles; Por: María Paula Gómez Silvestre y Paula…24 Proyecto Ambiental OIKOS…26 Galería de Imágenes…28In addition to collecting, through images and words, the experiences that we achieved as a result of the tribute that was paid to our language, from the different activities carried out by the Spanish Language area, in the month of April, this edition of "La Caldera", focuses, especially, on women and love, seen, approached from literature. In this way, our eleventh grade youths approach, from the essay modality, to make a serious and rigorous analysis of timeless themes such as love and the role of women, reaching their own conclusions; Here, the most important thing is the approach that is achieved to reading, to the analysis of works considered as classics of universal literature and to the construction of a series of arguments around a support work, of our young students

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamento de Casanare

En el presente documento se expone la propuesta de acción psicosocial realizada por medio de la reflexión y análisis psicosocial, desde el enfoque narrativo y la foto voz, así mismo se hace una reflexión de dos historias colombianas que muestran las causas de la violencia del conflicto armado interno, el primer testimonio es expuesto por la Comisión de la verdad (2022) “Historias que retornan, capítulo 5 – Shimaia”, es la historia de una mujer de una comunidad indígena que tuvo que salir forzadamente del país con decenas de familias de su comunidad, el segundo testimonio es expuesto en El Tiempo Casa Editorial (2020) “Masacre en El Salado”, es la historia de una familia del pueblo, las mujeres de los Velazco Garrido las cuales afrontaron, violaciones, desplazamiento y el asesinato de sus familiares. En el planteamiento del proceso de intervención, se evaluaron los sucesos psicosociales traumáticos narrados, los cuales dieron lugar a la proyección de tres estrategias, que proporcionan métodos de afrontamiento a las víctimas, reflexión ante las pérdidas materiales y no materiales que han afectado y generado, estancamiento de sus proyectos de vida, creencias distorsionadas, sentimientos de culpa, desbordamiento de las emociones, autoestima baja, temores e inseguridades, así mismo han generado restablecimiento de las redes de apoyo familiar y social. (Echeburúa y del corral, 2007). Finalmente se realizó un análisis reflexivo de las experiencias de la foto voz, aplicados en contextos afectados por la violencia, en tres municipios del departamento Casanare.In this document the proposal for psychosocial action carried out through reflection and psychosocial analysis is exposed, from the narrative approach and the photo voice, likewise a reflection is made of two Colombian stories that show the causes of the violence of the armed conflict Internally, the first testimony is exposed by the Truth Commission (2022) “Histories that return, chapter 5 – Shimaia”, is the story of a woman from an indigenous community who had to leave the country forcibly with dozens of families from her community, the second testimony is exposed in El Tiempo Casa Editorial (2020) “Massacre in El Salado”, is the story of a family from the town, the women of the Velazco Garrido who faced rape, displacement and the murder of their relatives. In the approach of the intervention process, the narrated traumatic psychosocial events were evaluated, which led to the projection of three strategies, which provide coping methods for the victims, reflection on the material and non-material losses that have affected and generated, stagnation of their life projects, distorted beliefs, feelings of guilt, overflow of emotions, low self-esteem, fears and insecurities, likewise have generated reestablishment of family and social support networks. (Echeburúa and del corral, 2007). Finally, a reflective analysis of the experiences of the photovoice was carried out, applied in contexts affected by violence, in three municipalities of the Casanare department

University Issues Year 5. Number 5. Magazine of the Center for Research in Social Sciences and Arts

La revista Cuestiones Universitarias del Centro de Investigación en Ciencias Sociales y Artes de la Universidad Autónoma de Bucaramanga presenta a la comunidad académica nacional e internacional su quinta edición, en la que se destacan artículos y trabajos derivados de investigación en sus áreas disciplinares y reseñas y reflexiones no derivadas de investigación, a propósito de diferentes saberes que convergen en las ciencias sociales.Investigación Científica y Tecnológica. - Reflexión Derivada de Investigación. - Revisión no derivada de investigación. - Anaquel.The University Questions magazine of the Center for Research in Social Sciences and Arts of the Autonomous University de Bucaramanga presents its fifth edition to the national and international academic community, which highlights articles and works derived from research in its disciplinary areas and reviews and reflections not derived from research, about different knowledge that converge in the social sciences

The Caldera. No. 16

Cuando hablamos de paz, generalmente asociamos el vocablo con adjetivos, momentos, experiencias que nos produzcan un estado de relajación, de calma, de quietud; es decir, la zozobra, la inquietud e incluso, el debate, serían antónimos de paz: Este año nuestra querida Institución Educativa se ha propuesto marcar la pauta en este tema; por tal razón, se ha implementado, dentro de los diferentes espacios pedagógicos que disfrutan nuestros educandos, la “CÁTEDRA DE LA PAZ”, como una alternativa viable, que les permita a nuestros estudiantes, desde los primeros años de preescolar, hasta los últimos de bachillerato, lograr acercamientos a distintas situaciones cotidianas, que hacen parte de nuestra condición humana y permanente de seres comunicativos y sociales; por tanto, las aulas de clase, los distintos escenarios en los que nos movemos deben convertirse en espacios en los que se deben llegar a establecer acuerdos que nos permitan ambientes, de estudio, de trabajo, de recreación, aún más agradables y cordiales.Biografías: Steve Jobs, John Lennon; Por: Javier Felipe Molina Salazar e Isabella Polo García…04 II Concurso Intercolegiado de Oratoria “Literatura y paz” “El arte de leer”; Por: Mariana Alejandra Galvis M. …08 Deporte en el Instituto Caldas Instituto Caldas: Subcampeón Departamental de Baloncesto…10 El pequeño gran ajedrecista; Por: Sebastián Felipe Blanco…11 Escritores memorables, Kafka; Por: Daniel José Galvis Jaimes…12 Proyectos Pedagógicos (Preescolar); Por: Slendy Pinzón González…15 Talentos caldistas…16 Reloj Solar 2014…20 Expresiones caldistas…22 Galería de Imágenes…29When we speak of peace, we generally associate the word with adjectives, moments, experiences that produce us a state of relaxation, calm, and stillness; that is to say, anxiety, concern and even debate, would be antonyms for peace: This year our beloved Educational Institution has proposed to set the standard on this issue; For this reason, the "CHAIR OF PEACE" has been implemented within the different pedagogical spaces that our students enjoy, as a viable alternative that allows our students, from the first years of preschool, to the last years of high school, achieve approaches to different daily situations, which are part of our human and permanent condition of communicative and social beings; therefore, the classrooms, the different settings in which we move, must become spaces in which agreements must be reached that allow us environments, study, work, recreation, even more pleasant and cordial

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Bullying en Medicina, una visión desde la relación Docente - Alumno

En las últimas décadas el “Bullying” se ha convertido en un tema de suma importancia en el ámbito académico. La palabra “Bullying” hace referencia al acoso, maltrato o agresión sistemática y repetitiva entre Pares y ha sido ampliamente estudiado y descrito entre Niños y Adolescentes en etapa Escolar; lo preocupante es que también se ha documentado a nivel Universitario. La Enseñanza y el Aprendizaje de la Medicina se lleva a cabo en diferentes escenarios donde se integra la teoría y la práctica, siempre bajo la supervisión de un Tutor y donde se manifiestan relaciones jerárquicas de poder, observándose frecuentemente casos de “bullying” derivados de la relación Docente - Alumno. En un mundo donde cada vez se exige más un trato y una Medicina humanizada nos preguntamos ¿Cuál es la prevalencia con la que se presenta el “bullying” durante las Prácticas Clínicas, y cuál es la percepción de Docentes y Estudiantes frente a esta problemática en un Hospital Universitario? Materiales y Métodos: El trabajo que presentamos a continuación se llevó a cabo en la Facultad de Medicina de una Universidad Pública y un Hospital Universitario, con Estudiantes de tercer y sexto año de Medicina. Es una Investigación con enfoque Mixto, donde mediante Encuestas se busca encontrar la Prevalencia de dicho fenómeno, así como también explorar las Percepciones de Estudiantes y Docentes frente al “bullying”. Resultados: Se ha encontrado una prevalencia elevada de este fenómeno en Facultades de Medicina, pudiéndose identificar factores de riesgo, patrones, severidad y consecuencias e impacto negativo a corto, mediano y largo plazo, no solo entre las Víctimas sino también en los Victimarios. Implicaciones: Su relevancia recae en la importancia de identificar el “bullying” como problema real y frecuente al interior de las Facultades de Medicina desde la relación Docente - Alumno y además surge la necesidad de generar Estrategias que permitan mitigarlo.In recent decades "Bullying" has become a very important issue in the Academic field. The word “Bullying” refers to systematic and repetitive harassment, mistreatment or aggression among peers and has been widely studied and described among Children and Adolescents at school; the worrying thing is that it has also been documented at the University level. The Teaching and Learning of Medicine is carried out in different settings where theory and practice are integrated, always under the supervision of a Tutor and where hierarchical power relationships are manifested, frequently observing cases of Bullying derived from the relationship Teacher - Student. In a world where humanized Medicine is increasingly demanded, we ask ourselves, what is the Prevalence of bullying during Clinical Practices, and what is the Perception of Teachers and Students regarding this problem in a University Hospital? Materials and Methods: The work that we present below was carried out in the Faculty of Medicine of a Public University and a University Hospital, with third and sixth year Medical Students. It is an Investigation with a Mixed approach, where through Surveys we seek to find the Prevalence of this phenomenon, as well as to explore the Perceptions of Students and Teachers regarding Bullying. Results: A high prevalence of this phenomenon has been found in Medical Schools, being able to identify risk factors, patterns, severity and consequences and negative impact in the short, medium and long term; not only among the Victims but also in the Perpetrators. Implications: Its relevance lies in the importance of identifying Bullying as a real and frequent problem within the Faculties of Medicine, from the Teacher - Student relationship; and also the need to generate Strategies to prevent this fenomena