Pubertad normal y variantes de la normalidad

La pubertad es un periodo de transición entre la infancia y la vida adulta, regulada por complejos mecanismos biológicos que, a su vez, están controlados por la interacción entre redes nodales de genes y el ambiente. Aunque ha existido una notable tendencia secular en el inicio de la pubertad, desde el siglo XIX hasta mediados del siglo XX, esta se ha estabilizado en las últimas décadas. De esta forma, se define como pubertad normal aquella que acontece entre los ocho y los trece años en las niñas y entre los nueve y catorce en los niños. El principal signo físico a tener en cuenta para la valoración del desarrollo puberal, es la aparición de telarquia progresiva en las niñas y el incremento del tamaño testicular en los niños. Seguidamente, se desarrollarán otros caracteres sexuales secundarios y se objetivará un incremento de la velocidad del crecimiento. En el diagnóstico diferencial de trastornos de la pubertad, aparte de conocer los límites normales de la pubertad, deberemos tener en cuenta una serie de variantes de la normalidad, como son: la adrenarquia prematura idiopática, la telarquia prematura aislada, la pubertad adelantada y el retraso constitucional del crecimiento y pubertadPuberty is a transition period between childhood and adulthood regulated by complex biological mechanisms, which in turn are controlled by the interaction between gene networks and environment. Although there has been a significant secular trend in onset of puberty from the XIX century to the mid XX century, it has been stabilized in recent decades. Thus, it is defined normal puberty as that occurs between eight and thirteen years old in girls and between nine and fourteen years old in boys. The main physical sign to be considered for assessment of pubertal development is the emergence of progressive thelarche in girls and increased testicular size in boys. Then, other secondary sexual characteristics will develop and increased growth velocity will be observed. In the differential diagnosis of puberty disorders, apart from knowing the normal limits of puberty, we must consider a number of variants of normality such as idiopathic premature adrenarche, premature thelarche, early puberty and constitutional delay of growth and pubert

The Journalistic Ethics In The American Cinema. Analysis Of Four Mythical Titles

“Para ejercer el periodismo, ante todo, hay que ser buenos seres humanos. Las malas personas no pueden ser buenos periodistas. Si se es una buena persona se puede intentar comprender a los demás, sus intenciones, su fe, sus intereses, sus dificultades, sus tragedias”, Ryszard Kapuscinski. Esta cita es un ejemplo claro de la importancia y necesidad de la existencia de buenos periodistas, y de intentar suprimir a todos los que no se interesen por la búsqueda de lo verdaderamente importante y de la mejor manera de expresarlo para los ciudadanos. El periodismo posee un poder muy importante en la humanidad y es por esto que la información que transmite ha de ser veraz y no corrompida por ningún tipo de interés. Esta profesión siempre ha estado muy cuestionada por la sociedad, y uno de los motivos principales de esto ha sido la ética, o más bien poca ética, de algunos periodistas a la hora de realizar su trabajo. No es raro escuchar frases como “qué poco profesionales son”, “el periodismo está comprado por los políticos” o “los periodistas son capaces de cualquier cosa por conseguir una exclusiva”. ¿Tendrán razón? ¿La ética y moral periodística está dejando de existir? ¿Los códigos deontológicos están de decoración? De esto trata este Trabajo de Fin de Grado, pero desde una perspectiva mucho más cinematográfica. La selección de cuatro títulos míticos del cine americano (El gran Carnaval, Network, El precio de la verdad y Nightcrawler) y varios casos reales de las mismas épocas que estos filmes, darán las claves para ver si realmente es necesaria la ética y moral periodística y si se está dando uso de ella en estos diferentes períodos de tiempo, desde los años 50 hasta la actualidad. Y, por tanto, observar si existe algún tipo de evolución en la visión que se da del periodista y si tiene relación con la vida real."To exercise journalism, first of all, you have to be good human beings. Bad people can not be good journalists. If you are a good person you can try to understand others, their intentions, their faith, their interests, their difficulties, their tragedies", Ryszard Kapuscinski. This quote is a clear example of the importance and necessity of the existence of good journalists, and of trying to suppress all those who are not interested in the search for the truly important and the best way to express it for citizens.Journalism has a very important power in humanity and that is why the information it transmits must be truthful and not corrupted by any kind of interest. This profession has always been very questioned by society, and one of the main reasons for this has been the ethics, or rather unethical, of some journalists at the time of carrying out their work. It is not uncommon to hear phrases like "how unprofessional they are", "journalism is bought by politicians" or "journalists are capable of anything to get an exclusive". Are they right? Is journalistic ethics and morals ceasing to exist? Are deontological codes decoration? This is what this Final Degree Project is about, but from a much more cinematographic perspective. The selection of four mythical titles of the American cinema (The great Carnival, Network, The price of the truth and Nightcrawler) and several real cases of the same times that these films, will give the keys to see if journalistic ethics and morals are really necessary and if it is being used in these different periods of time, from the 50s to the present. And, therefore, to observe if there is some kind of evolution in the vision given by the journalist and if it is related to real lif

Exploring digital competencies: validation and reliability of an instrument for the educational community and for all educational stages

Digital competencies are very significant in terms of integrating digital resources into educational processes. This study presents the validity and reliability of an instrument cre- ated by Carrera et al. (2011), in order to evaluate the basic digital competence of the three main educational agents of the educational community (teachers, students, and parents) for all educational stages (Early Childhood Education, Primary Education, Secondary Educa- tion and Higher Education), making use of digital resources to (1) Skills in management and transfer of technological data, (2) Software and hardware skills, (3) Web navigation skills, (4) Skills in using word processors, (5) Data processing and management skills, y (6) Multimedia presentation design skills. The application of the instrument was carried out with a sample of 1,149 participants from all educational stages, coming from the entire territory of the Dominican Republic. Reliability was assessed using various mea- sures, including Cronbach’s Alpha, Spearman-Brown Coefficient, Guttman’s Two Halves, McDonald’s Omega, and composite reliability. To validate the instrument, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out with the purpose of understanding the validity and dimensionality of the scale (comprehension validity, construct validity, convergent, discriminant and invariance validity). The results demonstrated highly satisfactory reliability, and in terms of construct validity, a good fit of the model was observed, valid for any educational agent and for any educational stage. The final version of the instrument consists of 20 items classified into six latent factorsFunding for open access charge: Universidad de Málaga / CBU

EFECTIVIDAD DE LA RADIOFRECUENCIA DEL NERVIO SUPRAESCAPULAR EN EL HOMBRO DOLOROSO

El hombro doloroso es el tercer motivo de consulta por patología musculoesquelética en atención primaria, siendo la lesión del manguito rotador una de las principales etiologías del mismo. La radiofrecuencia (RF) del nervio supraescapular (NSE) es el tratamiento de elección cuando han fracasado todas las opciones de tratamiento conservador.En este estudio descriptivo prospectivo, se realiza una valoración clínica del dolor, de la funcionalidad del hombro, y de la respuesta al tratamiento de aquellos pacientes a los que se le realizó la RF del NSE durante el mes de Mayo de 2021 en el Servicio de Medicina Física y Rehabilitación del Hospital Universitario Miguel Servet de Zaragoza, y durante los 3 meses posteriores a la realización de la RF.De los 35 pacientes que forman la muestra a estudio, 10 son hombres y 25 son mujeres, oscilando la edad entre los 44 y 98 años. Existe una disminución estadísticamente significativa de la puntuación obtenida en la Escala Verbal Numérica (EVN) y cuestionario Shoulder Pain And Disability Index (SPADI) al mes de realizar la RF (EVN -2.48; SPADI -20.7%) y a los 3 meses tras el procedimiento intervencionista (EVN -3.6; SPADI -29.4%). Además, existe un aumento estadísticamente significativo de la puntuación obtenida en la escala Constant al mes de realizar la RF (CONSTANT +18.5) y a los 3 meses de la misma (CONSTANT +22.8).El tratamiento del síndrome de hombro doloroso mediante RF pulsada del NSE es considerado como un tratamiento efectivo cuando todo el abanico de tratamiento conservador ha fracasado, de forma que reduce el dolor y existe una mejoría de la capacidad funcional del hombro.<br /

Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases

Gestational diabetes mellitus (GDM) is defined as the presence of high blood glucose levels with the onset, or detected for the first time during pregnancy, as a result of increased insulin resistance. GDM may be induced by dysregulation of pancreatic β-cell function and/or by alteration of secreted gestational hormones and peptides related with glucose homeostasis. It may affect one out of five pregnancies, leading to perinatal morbidity and adverse neonatal outcomes, and high risk of chronic metabolic and cardiovascular injuries in both mother and offspring. Currently, GDM diagnosis is based on evaluation of glucose homeostasis at late stages of pregnancy, but increased age and body-weight, and familiar or previous occurrence of GDM, may conditionate this criteria. In addition, an earlier and more specific detection of GDM with associated metabolic and cardiovascular risk could improve GDM development and outcomes. In this sense, 1st–2nd trimester-released biomarkers found in maternal plasma including adipose tissue-derived factors such as adiponectin, visfatin, omentin-1, fatty acid-binding protein-4 and retinol binding-protein-4 have shown correlations with GDM development. Moreover, placenta-related factors such as sex hormone-binding globulin, afamin, fetuin-A, fibroblast growth factors-21/23, ficolin-3 and follistatin, or specific micro- RNAs may participate in GDM progression and be useful for its recognition. Finally, urine-excreted metabolites such as those related with serotonin system, non-polar amino-acids and ketone bodies, may complete a predictive or earlydiagnostic panel of biomarkers for GDMThis work was supported by the grant PI17/01495, from the Fondo de Investigación Sanitaria (ISC-III) and Fondo Europeo de Desarrollo Regional (FEDER) (for EJ), and grant SAF2017-84776-R, from Ministerio de Educación y Ciencia (for PC)

Sex-dependent relationship of C-reactive protein levels with HDL-cholesterol and HDL-phospholipid concentrations in children

Obesity has been consistently associated with inflammation but the influence of HDL on this association remains under study. Our study analyzes the influence of obesity-related parameters in the relationship of high-sensitivity C-reactive protein (hs-CRP) with HDL-cholesterol and HDL-phospholipid in male and female adolescents. The study sample population comprised 350 males and 401 females aged 12 to 16 years. Information regarding anthropometric parameters, HDL-cholesterol, HDL-phospholipid, adiponectin, leptin, insulin, and hs-CRP concentrations was available. hs-CRP levels were inversely related to HDL-cholesterol and HDL-phospholipid in males but not in females, and were positively related to leptin concentrations in both sexes but were not related to adiponectin levels. In regression analyses, HDL-phospholipid and leptin appeared significantly associated to hs-CRP in males in a model explaining 14.3% of hs-CRP variation. In females, only leptin appeared related to hs-CRP concentrations. After adjusting by leptin and adiponectin, males in the highest hs-CRP tertile showed significantly lower levels of HDL-cholesterol and HDL-phospholipid than those in tertiles 1 and 2, while no significant differences in HDL-cholesterol and HDL-phospholipid concentrations by hs-CRP tertile were observed in females. In summary, high hs-CRP levels were associated with lower plasma HDL-cholesterol and HDL-phospholipid concentrations in male adolescents irrespective of adipokines, while in females, HDL-related parameters are not associated with hs-CRP concentrationsTis research was funded by the Fondo de Investigación Sanitaria, Grant Number PI 18/01016, and by Biobank Grant Number FEDERRD09/0076/00101. Claudia Vales-Villamarín is recipient of a research contract from Carlos III Institute of Health (pFIS).Te article is dedicated to the late Prof. Manuel de Oya as the warmest homage to his memor

Self Care system for Heart Failure out of hospital patients

CUORE is a Heart Failure (HF) Disease Assessment System that makes use of innovative approaches, based on Information Technologies (IT) and portable monitoring devices, for the continuous assessment of HF progression and cardiovascular risk stratification. The system valuates the cardiac condition integrating patient data from different sources with special emphasis in the information obtained for ECG processing. Rather than just evaluate the cardiovascular status, the system also aims to motivate patients to have an active role in their health management and to improve their cardiac condition by promotion of an active lifestyle. In order to make the system usable the methodology adopted to create the final solution is iterative and it involves users in all stages. This paper presents the conceptualization of CUORE as a solution to self care for heart failure out of hospital patients

Differential effects of ethanol ingestion on somatostatin content,somatostatin receptors and adenylyl cyclase activity in thefrontoparietal cortex of virgin and parturient rats

Chronic ethanol ingestion decreases the number of somatostatin (SRIF) receptors in the rat frontoparietal cortex and female sex hormones modulate the effects of ethanol in the brain. Therefore, we investigated the differential effects of ethanol consumption on the SRIFergic system in the frontoparietal cortex of virgin and parturient rats given ethanol in their drinking water before and during gestation. In parturient rats, ethanol consumption decreased the density of SRIF receptors (25%, p < 0.01 vs control parturient group) whereas the SRIF-like immunoreactivity (SRIF-LI) content was increased (140%, p < 0.01). In virgin rats, ethanol ingestion decreased the density of SRIF receptors (42%, p < 0.01) more than in alcoholic parturient rats. SRIF-LI levels were unaffected. The inhibitory effect of SRIF on basal and forskolin-stimulated adenylyl cyclase was significantly lower in alcoholic virgin rats as compared to alcoholic parturient rats. No differences in the levels of the G inhibitory (Gi) ¿1 and Gi¿2 proteins were observed among the experimental groups. These results suggest that gestation may confer partial resistance to the ethanol-induced effect on the SRIFergic system

Monitoring coastal storms’ effects on the Trabucador barrier beach (Ebro Delta) through Sentinel-2 derived shorelines

The vulnerable Trabucador barrier beach has recently suffered significant storm-induced geomorphological changes. This study presents the monitoring of its shoreline during storm events for assessing their effects on beach dynamics. After fine-tuning the CoastSat tool (i.e. optimal NDWI threshold) for shoreline extraction from Sentinel-2 imagery (S2), results were validated with GNSS-RTK reference shorelines (RMSE = 6.8 m). Shorelines were extracted from Dec-2019 to Feb-2021, encompassing 11 storms (Hs > 2m; duration = 24h), including Gloria (Jan-2020). Results showed that S2 imagery provides enough temporal and spatial resolution to capture the storm effects on the site. The shoreline timeseries gave relevant information about the geomorphological processes occurring during storm events (barrier breaching, erosion, washover), allowing the assessment of their cumulative effects. These results might be important for coastal management, in a site suffering from chronic flooding.Peer ReviewedPostprint (author's final draft

The influence of puberty on vitamin D status in obese children and the possible relation between vitamin D deficiency and insulin resistance

Background: Puberty can affect vitamin D levels. Objectives: The goal of this study was to analyze the relation between vitamin D deficiency and puberty in obese Spanish children, along with the possible interrelation between vitamin D status and degree of insulin resistance. Methods: A cross-sectional study was carried out, in which clinical and biochemical data were gathered from 120 obese and 50 normal weight children between January 2011 and January 2013. Results: Mean vitamin D levels were 19.5 and 31.6 ng/mL in obese pubertal and obese prepubertal children, respectively. About 75% of the obese pubertal subjects and 46% of the obese prepubertal subjects had vitamin D deficiency. Vitamin D levels were significantly lower in pubescent subjects compared with pre-pubescent subjects in summer, fall, and winter. There was no apparent relation between vitamin D levels and homeostasis model assessment index for insulin resistence (expressed in standard deviation score for sex and Tanner stage) in either puberty or pre-puberty. Conclusion: Puberty may be a risk factor for the vitamin D deficiency commonly found in the obese child population. This deficiency is not associated with higher insulin resistance in obese pubertal children compared with obese prepubertal childre