Case Report: Glioblastoma Tumor Presenting with Mild Changes in Memory

We report a case of a 66-year-old female who presented to the ED with generalized headache and mild confusion, who was diagnosed with high-grade glial neoplasm. The differential diagnosis of headache is vast, but without red flags or symptoms is generally from a benign cause and easily treatable. However, even in the context of a normal neurologic physical exam, symptoms such as confusion, forgetfulness, and behavioral changes should merit imaging in the workup. Glioblastoma is the most common brain tumor, accounting for 47.7% of all cases, with an incidence of 3.21 per 100,000 population. Median age of diagnosis is 64 years, more commonly in men. Treatments include radiation, chemotherapy, and surgical resection

Case Report: The Challenge of Balancing Stewardship and Advocacy

We report a case of a 62-year-old female who presented with chief complaint of generalized weakness and was ultimately diagnosed with hypereosinophilia. This chief complaint is challenging for many EM physicians, and the differential diagnosis of generalized weakness is vast. Etiologies of generalized weakness in the adult population ranges from infection, dehydration, cardiovascular disease, to neurologic compromise. It is crucial for the Emergency Physician to put emphasis on proper history collection, detailed physical exam, and appropriate ancillary testing. In this case report we showcase the significance of the optimal evaluation of life-threatening disorders that presents as generalized weakness, as well as the importance of balancing stewardship and advocacy for patients

Estudio coyuntural: caso Brexit

La decisión de los votantes de Reino Unido, Gran Bretaña e Irlanda del Norte se expresó en el sufragio que tuvo lugar el 23 de junio del 2016, en el marco de un referéndum que se planteaba el destino del Reino Unido a partir del interrogante ¿debería el Reino Unido seguir siendo miembro de la Unión Europea o abandonar la Unión Europea? (de la cual es miembro desde el 1 de enero de 1973). Esta unión se crea en 1958 bajo el nombre de Comunidad Económica Europea (CEE), con el fin de aumentar las relaciones multilaterales de los Estados miembros, asumiendo que entre mayor fuese la interdependencia económica menor seria la posibilidad de conflicto. Teniendo en cuenta que es en el periodo post Segunda Guerra Mundial cuando se origina la unión, es en 1993 cuando se consolida como una organización política, económica y social a través de la modificación del nombre a Unión Europea (Unión Europea, 2016)

Cluster analysis as a methodology within phylogenetic systematics to construct phylogenetic trees

All evolutionary studies of groups of species are based on the choice of appropriate characteristics for rebuilding their phylogenies (a phylogeny is the relationship or kinship among species in general and tries to reconstruct evolutionary relationships). A phylogenetic analysis reconstructs the evolutionary relationships between species, which descend from common ancestors and, furthermore, which are the genetic distances or separation times between these species [1]. To generate a phylogenetic analysis characters must have two requirements: independent of each other and be homologous, they have the same origin and the same function in all organisms Study The nature of those characters can be varied. Any source of validated and proved phylogenetic information can provide characters for an evolutionary study. Among the main evolutionary studies that have been developed stand two methods: The methods that have been taken as morphological characters base in which the presence of physical characteristics that describe the species is identified, and methods that have been based on molecular characteristics as the sequence DNA [2]. These characters are recorded in a data matrix within which, the state in which the character has been observed is represented with zero if it is absent or one if present respectively, and whether it is a character that may be present in the species with different values (multi-state) within the data matrix can be represented by the value corresponding to that character [2]. For this reason, homologous characters, once they have been validated and proven, may be taken as the basis for an evolutionary study because they provide enough information for the reconstruction of a phylogenetic tree

Eventos adversos en pacientes bajo régimen de ventilación mecánica

Objective To identify adverse events in patients ongoing mechanical ventilation in the intensive care unit polyvalent Cienfuegos-Cuba. Methodology Descriptive, prospective study was conducted during the months of august 2015 to february 2016. The universe was composed of 155 patients admitted to the regime under mechanical ventilation during the study period. The international form of the Spanish Society of lntensive Care Medicine and Coronary Units (SEMlCYUC) taking items related to mechanical ventilation was used. One form for each patient on admission, completed by nurses and medical assistance, for reporting voluntary and anonymous of adverse events occurred surrendered. Results 41 from 158 patients had some type of adverse event (25,9 %): 14 of them (8,9%) developed pneumonia, 10 (6,3%) atelectasis, 9 (5,7%), accidental disconnection and 8 (5,0%) unplanned extubation . As for pneumonia associated with mechanical ventilation, the most common germs in cultures of secretions traqueobronqueales were: Acinetobacter baumannii (57,1% ), Pseudomona aeruginosa ( 21,4 %) and Staphylococcus aureus (7,1%).ldentificar los eventos adversos en pacientes bajo régimen de ventilación mecánica en la unidad de cuidados intensivos polivalentes de Cienfuegos-Cuba. Metodología Estudio descriptivo, prospectivo realizado durante los meses de agosto de 2015 a febrero de 2016. El universo estuvo constituido por 155 pacientes ingresados en el servicio bajo régimen de ventilación mecánica durante el período de estudio. Se utilizó el formulario internacional de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMlCYUC) tomando los ítems relacionados con la ventilación mecánica. Se entregó un formulario para cada paciente a su ingreso, diligenciado por personal de enfermería y médicos de asistencia, para la notificación de forma voluntaria y anónima de los eventos adversos sucedidos. Resultados De los 158 pacientes 41 presentaron algún tipo de evento adverso (25,9%): 14 de ellos (8,9%) desarrollaron neumonía, 10 (6,3%) atelectasia, 9 (5,7%) desconexión accidental y 8 (5,0%) extubación no programada. En cuanto a la neumonía asociada a la ventilación mecánica, los gérmenes más frecuentes en los cultivos de las secreciones traqueobronqueales fueron: Acinetobacter baumannii (57,1%), Pseudomona aeroginosa (21,4%) y Estafilococus aureus (7,1%). Conclusiones El conocimiento de los eventos adversos y sus causas permite llegar a su análisis y en cuencia, a la elaboración de indicadores de calidad en la atención de este tipo de pacientes

Gallbladder agenesis in a patient with choledochoduodenal fistula, report of an exceptional case

Vesicular agenesis refers to the congenital absence of the gallbladder, however, vesicular agenesia is a very scarce condition worldwide, so there is little information available on its clinical presentation and surgical data. This is a 79-year-old male patient, with a history of diabetes mellitus of long evolution, without a surgical history, who comes for colic pain of 15 days of evolution in right hypochondrium, as well as unquantified fever and jaundice, during its initial evaluation in the emergency room para clinics were requested observing leukocytosis, hyperbilirubinemia and elevation of liver enzymes, ultrasound of liver and bile ducts reported common anatomical situation gallbladder, occupied entirely by multiple hyperechogenic images, configuring sign of W.E.S. and common bile duct of 7.2 mm, concluding gallbladder scleroatrophic and vesicular agenesia during trans-surgery. Vesicular agenesis is an extremely rare condition that is mostly diagnosed during surgery, which can lead to erroneous diagnosis and unnecessary surgery in patients with symptoms including biliary colic, choledocholithiasis with or without cholangitis, and an ultrasound showing a scleroatrophic gallbladder. Surgeons In situations where there is clinical evidence consistent with biliary colic in a context of gallbladder agenesis, and the symptoms persist without finding any other cause, a surgical approach to release adhesions could be considered; since, as observed, this may result in improved symptoms, although the explanation is not yet completely clear

Evaluation of comparative advantages in the profitability and competitiveness of the small-scale dairy system of Tulancingo Valley, Mexico

This article combines a Policy Analysis Matrix with a sensitivity and poverty line analysis with the objective of evaluating the economic contribution of comparative advantages to the private profitability and competitiveness of small-scale dairy systems. For 1 year, socioeconomic data were collected from 82 farms selected from four strata via statistical sampling. Two scenarios were established to determine the quantitative contribution of comparative advantages: (1) a simulated scenario, which accounted for the cost of purchasing the total food and the opportunity cost of the family labour force (FLF), and (2) an actual production scenario, which accounted for the cost of producing food and eliminating the payment of the FLF and included other incom

Aprendizaje por proyectos para fortalecer la competencia indagación en la enseñanza del concepto de la energía y sus transformaciones

Esta propuesta tiene como objetivo fortalecer la competencia indagación en los estudiantes de quinto grado a través del Aprendizaje Basado en Proyectos mediante la enseñanza del concepto de la energía y sus transformaciones. Fue aplicada una secuencia didáctica con actividades estructuradas, complementarias entre sí, que favorecen un proceso de aprendizaje progresivo y consecuente en tres instituciones educativas de carácter oficial de la ciudad de Santa Marta. Dichas actividades fueron planeadas siguiendo las estrategias y la metodología del Aprendizaje Basado en Proyectos (ABPr) considerando los principios teóricos del Aprendizaje en Equipos Cooperativos, evidenciando avances significativos en lo referente al concepto trabajado y a las habilidades científicas de la competencia. Éstas se ven reflejadas en: i) la producción oral y escrita que mostraron los estudiantes durante las actividades propuestas; ii) la capacidad de observar de forma objetiva y analítica escenarios o fenómenos; iii) la formulación de preguntas a partir de la identificación de situaciones problemas presentes en su contexto-; iv) realizar procesos de búsqueda de información en diversas fuentes y al registrar en la bitácora la información; v) aplicación de encuestas a sus familiares; vi) al organizar los datos escritos en prosa y en gráficas, e interpretarlos; y vii) a la capacidad para estar abierto a nuevas experiencias

Liberdade religiosa, ensino religioso e a interpretação conforme a Constituição na Ação Direta de Inconstitucionalidade n. 4439

O presente artigo tem como tema a discussão em torno da liberdade religiosa. De forma sucinta, faz isso sob a ótica do direito previsto na Constituição Federal de 1988, cujo texto assegura a liberdade de crença e de culto, em especial, no que tange ao ensino religioso nas escolas públicas e a existência de um espaço para tratar sobre religião em sala de aula. Trata-se de uma revisão de literatura por meio de pesquisa bibliográfica, sendo que a busca restringiu-se a palavra-chave “Ação Direta de Inconstitucionalidade n. 4439” no banco de teses e dissertações da CAPES e portal de periódicos da CAPES. Para discussão e análise recorreu-se ao método dedutivo, partindo do princípio que a liberdade religiosa é um direito humano fundamental. A discussão permeia a necessidade de um constante diálogo entre a liberdade religiosa e o direito à educação e, para isso, traz-se à baila o pensamento de Boaventura de Sousa Santos sobre o trabalho de tradução e a possibilidade de aplicá-lo ao ambiente escolar por meio da disciplina de ensino religioso. Ao final, ocupa-se com a orientação do Supremo no julgamento da Ação Direta de Inconstitucionalidade n. 4439 e a interpretação conforme a Constituição. Como resultado este estudo contribui para a compreensão do movediço território que envolve a liberdade religiosa, suas possibilidades e práticas