Trismus as the first manifestation of cholangiocarcinoma

The initial presentation of a cholangiocarcinoma (CC) as trismus due to metastasis to the parotid gland is extremely rare and no previous reports have been found in the literature. A 29-year-old woman presented trismus that initiated 2 months before admission, just after superior left third molar extraction. Physical examination revealed severe trismus and a mass in the parotid gland. Computed tomography (CT) showed a heterogeneous mass in the left parotid gland. The next day she presented jaundice, bilirubinuria, and fever, followed by massive bleeding, intravascular disseminated coagulation, and respiratory insufficiency. Two days later she died. At autopsy, the parotid tumor was identified as a metastasis from a CC of the extrabiliary tract. To our knowledge, this is the first reported case of a metastatic CC that initially presented as trismus due to a mass in the parotid gland. This case represents a rare but important diagnosis that otolaryngologists and oral surgeons should add to the catalog of uncommon causes of trismus

El régimen jurídico de la relación laboral de los estibadores: pasado, presente, futuro

La regulación del trabajo portuario de manipulación de mercancías ha sufrido un proceso de pro-gresiva liberalización en nuestro ordenamiento jurídico, a veces en sintonía, a veces por imperati-vo, de las directrices de la Unión Europea cuya última fase viene representada por el RD-L 8/2017. La singular fuerza de los representantes de los trabajadores portuarios, sindicatos corporativos con gran poder de negociación y movilización, ha sido siempre un elemento esencial e influyente en la labor de fijación de las condiciones de trabajo del sector, especialmente en lo que al acceso al empleo y prioridad de prestación de servicios concierne. La ausencia de una regulación europea global y común, abandona en manos del Convenio núm. 137 de la OIT la única vía de regulación general de las condiciones de trabajo portuario. Una norma cuya escasa ratificación, relativa efica-cia y falta de actualización no responde ya en plenitud a los nuevos tiempos del discurrir del traba-jo en los puertos en particular, y de la evolución económica, tecnológica y del empleo, en generalThe regulation of port work for the handling of goods has undergone a process of progressive liberalization in our legal system, sometimes in tune, sometimes as a matter of urgency, with the guidelines of the European Union whose last phase is represented by RD-L 8/2017 The singular strength of the representatives of port workers, corporate unions with great negotiation and mobi-lization power, has always been an essential and influential element in the work of setting the wor-king conditions of the sector, especially as regards access to employment and priority of service provision concerns. The absence of a global and common European regulation, leaves in the hands of Convention no. 137 of the ILO the only way of general regulation of port work conditions. A norm whose scant ratification, relative efficiency and lack of updating does not fully respond to the new times of work in ports in particular, and of economic, technological and employment developments, in general

Contemporary Preaching to a Non-contemporary Society: Nineteenth-Century Reformed Theology Comes to Non-nineteenth-Century Brazil

Patrocinio, Jorge Luiz. “Contemporary Preaching to a Non-Contemporary Society: Nineteenth-Century Reformed Theology Comes to Non-Nineteenth-Century Brazil.” Ph.D. diss., Concordia Seminary, 2009. 241 pp. When Presbyterian missionaries came from America to nineteenth-century Brazil, they encountered a society strongly marked by a Roman Catholicism that was both tugged in several directions and also marked by a spirit more attuned to the later Middle Ages. In planting and then cultivating the Presbyterian Church, first the missionaries and then indigenous Brazilian pastors responded by spreading a message strongly rooted in Reformation theology, approaching their task almost as if the Reformation were unfolding again in Brazil. Under that “Reformation” label, the rhetoric would shift over time from a relatively mild, straightforward presentation to a more aggressive tone in that Catholic-dominated culture. This mission effort also imported elements of the past, reaching back as far as Puritan England with a strict approach to faith and blending this with other elements drawn from the American sending church, all combined to produce a Reformation-based theology that still colors the Presbyterian Church of Brazil today. This all is reflected in the pages of one of the most important tools used to spread this theological message. Over the course of several years, O Púlpito Evangélico, a periodical supported by the Presbyterians in Brazil, published sermons by the American missionaries, Brazilian pastors, and selected outside preachers. These sermons, first available in the journal issues and then collected, were a way to multiply the influence of a relatively small number of preachers, broadcasting a theology that reflected the context and need, and that would hopefully shape the hearts and minds of readers and hearers in a direction the Reformation had set. Judging from the longevity of the sermon collection, there must have been a receptive audience. An analysis of these sermons both generally confirms the nature of the religious culture in which the missionaries and pastors worked and gives a clear picture of the theological themes and accents they first introduced and then recast over several decades of working in nineteenth-century Brazil

Importancia del Trabajo Social como forma de intervención municipal

Trascurridos 30 años de la puesta en marcha del Sistema Público de Servicios Sociales, procede destacar el protagonismo desarrollado por los ayuntamientos que han sido el referente más significativo de la implantación del Sistema por su compromiso institucional en el desarrollo de los Servicios Sociales Generales Básicos, potenciando las Unidades de Trabajo Social en todos los municipios, lo que ha hecho visible para la ciudadanía, tanto las potencialidades de los Servicios Sociales, como sus déficits. Hoy se puede afirmar que las/los ciudadanas/os reclaman de los Servicios Sociales el mismo enfoque que perciben la Sanidad o la Educación, como pilares del Estado de Bienestar y se exige que avancen hacia la universalidad, desarrollando el derecho subjetivo de sus prestaciones básicas, priorizando precisamente en estos momentos de situación de crisis el derecho a las prestaciones más demandadas socialmente. En esta línea destaca la trayectoria de compromiso de los Trabajadores Sociales y su contribución como valor añadido de una praxis social eficiente para afrontar el reto de la cohesión social ante a la crisis.Thirty years after the Public Social Service System was got under way, the major role played by Councils should be stressed. These bodies have been the most significant referent in the implementation of the System through their institutional commitment in the development of Basic General Social Services, by promoting Social Work Units in all municipalities. This has allowed townspeople to recognise both the potential and the shortcomings of Social Services. People nowadays can be said to seek the same approach from the Social Services as they perceive in the Health Service or Education, as pillars of the Welfare State. They are demanding that progress should be made towards universality, developing the subjective right of their basic assistance, giving priority to the right to the most socially demanded services precisely at this time of crisis. In this respect we should stress Social Workers' tradition of commitment and their contribution of the added value of an efficient social praxis to face up to the challenge of social cohesion against the crisis

Older adults’ activity on a geriatric hospital unit: A behavioral mapping study

Systematic reviews highlight a preponderance of prolonged sedentary behavior in the hospital setting, with possible consequences for patients’ health and mobility. To date, most of the published literature in this field focus on the hospital experience for older adults with dementia or stroke. Few data describe hospital activity patterns in specialized geriatric units for frail older adults, who are already at risk of spending prolonged periods of time sitting. Yet, promoting older adults’ activity throughout hospitalization, when possible, is an avenue for exploration to identify opportunities to encourage more daily functional activities, and minimize the risk of post-hospital syndrome. These exploratory findings are an opportunity to, generate hypotheses for future testing, and act as a starting point to collaborate with front line clinicians to highlight the indoor environment’s role in promoting activity, and develop future strategies to safely introduce more activity into the acute care setting for older adult