Portuguese consensus on the best practice for the management of inflammatory bowel disease: IBD ahead 2010 meeting results

AbstractIntroductionThe treatment of inflammatory bowel disease (IBD) has focussed on the management of symptoms but is becoming more resolute on changing the course of the disease and its complications in the long-term. In order to minimize the development of complications and to improve outcomes for these patients it is important to develop other strategies to manage IBD and to optimize current clinical practice.ObjectiveThis article reports the main consensus statements reached during the Portuguese National Meeting on improvement of disease control in IBD, on optimization of corticosteroid and immunosuppressive use in Crohn's disease and on best practice in topics of current interest in Crohn's disease.MethodsAn International Steering Committee selected the top 10 most important unanswered practical questions on the use of conventional therapy in Crohn's disease, to be debated and analysed in several National Meetings of different countries. In each country a National Steering Committee (NSC) was created to moderate a National Meeting during which several expert groups answered the selected questions in light of their clinical practice. Answers were classified according to the Oxford levels of evidence.ConsensusA general consensus was obtained, some of the conclusions were as follows. It is important to introduce conventional corticosteroids in moderate to severely active Crohn's disease of any localization with initial duration of treatment varying according to patient's response; the best option to prevent steroid-induced side effects is to avoid its prolonged or repetitive use and switching appropriate patients to immunosuppressive therapy. Initiation of immunomodulators early in the disease course should be considered for patients with a poor prognosis and optimal safety monitoring was discussed, with the need to reassess patients at appropriate timepoints, make corticosteroid-free remission a goal and treat beyond symptoms

Mediación escolar en la resolución de conflictos, una mirada desde la noción de zona de desarrollo próximo

Los conflictos son situaciones inherentes a todo sistema de conviviencia. Las instituciones escolares deben tomar conciencia de ellos en forma colectiva y transformarlos en un problema común a resolver. Se propone la mediación como una respuesta constructiva para tal fin. La mediación es una negociación asistida, en el que una tercera parte neutral ayuda a las partes en conflicto a alcanzar un acuerdo mutuamente aceptable y consensuado. El aprendizaje engendra un área de desarrollo potencial: existe una distancia óptima entre lo que se sabe y lo que se puede saber. Recorrer esta distancia necesita de la acción de un tercero y constituye aprendizaje. El propósito de este trabajo es crear una vinculación a nivel teórico entre los conceptos de mediación y la noción de zona de desarrollo próximo de Vygotsky desde una concepción constructivista del aprendizaje considerando los social y la contribución de los mediadores como fundamentales para la transformación de la realidad y del propio sujeto.Fil: Lago, Paula Andrea. Facultad de Psicología. Universidad Nacional de Mar del Plata; ArgentinaFil: Monteagudo, Silvia. Facultad de Psicología. Universidad Nacional de Mar del Plata; Argentin

Relationship between serum lithium concentration and kidney damage in a preclinical model

Objectives: The aim of the present study was to assess whether there is a relationship between serum lithium concentrations and the magnitude of kidney damage in a preclinical model. Methods: Thirty Wistar male rats were randomized into three groups: control group fed ad libitum powered standard diet for 3 months; and experimental groups fed ad libitum the same diet supplemented with 30 or 60 mmol/kg diet for 3 months (LowLi and HighLi groups respectively). Laboratory parameters were assessed at months 1 and 3 and histopathological changes were evaluated after 3 months. Results: Serum lithium levels in experimental rats were within therapeutic range used in humans throughout the entire experiment. After 3 months of treatment, lithium levels were statistically higher in HighLi group. Rats of the LowLi group showed dilation of cortical tubules although with similar clearance of creatinine. Rats from the HighLi group had greater histopathological damage in addition to lower creatinine clearance than the other two groups. Conclusions: Our study suggests that during long-term treatments, even with serum lithium levels within the therapeutic range used in humans, the risk of kidney damage could increase proportionally to the serum lithium concentration.Fil: Ossani, Georgina Paula. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología. Centro de Patología Experimental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Alemán. Laboratorio de Medicina Experimental; ArgentinaFil: Uceda, Ana Margarita. Hospital Alemán. Laboratorio de Medicina Experimental; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología. Centro de Patología Experimental; ArgentinaFil: Lago, Néstor R.. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología. Centro de Patología Experimental; ArgentinaFil: Martino, Diego Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; Argentin