Hombre de 31 años con dolor abdominal, diarrea y síndrome constitucional

A 31-year-old male with paroxysmal abdominal pain of 2 months of evolution and diarrhea. The complementary tests revealed the presence of multiple lymphadenopathy, splenomegaly, hypodense focal lesions in the liver and spleen, as well as an intra-ileum mass in the terminal ileum. Finally the diagnosis of Sarcoidosis with mainly digestive affectation is established. There are few cases described in the scientific literature of gastrointestinal Sarcoidosis. A high clinical suspicion is necessary for the diagnosis, and this is established within a clinical-radiological and anatomopathological context, excluding other causes of granulomatosis.Varón de 31 años con dolor abdominal paroxístico de 2 meses de evolución y cuadro diarreico. Las pruebas complementarias realizadas pusieron de manifiesto la presencia de múltiples adenopatías, esplenomegalia, lesiones focales hipodensas en hígado y bazo, así como una masa intraasa en íleon terminal. Finalmente se establece el diagnóstico de sarcoidosis con afectación principalmente digestiva. Existen pocos casos descritos en la literatura científica de sarcoidosis gastrointestinal. Para el diagnóstico es necesario una sospecha clínica alta, y este se establece dentro de un contexto clinicorradiológico y anatomopatológico, excluyendo otras causas de granulomatosis

Lectura, escritura y medio ambiente

El presente proyecto surge de la necesidad de dar continuidad a un trabajo que ya se había iniciado en el año de 1992, el cual ha tenido como objetivos centrales: - Contribuir al cambio social construyendo con el nuevo maestro su papel frente al saber pedagógico. - Reflexionar sobre la educación ambiental como planteamiento integrante e integrador. - Cualificar los procesos de lectura y escritura de los niños del Colegio Fe y Alegría El Limonar. - Establecer relaciones entre la lectura, la escritura y la educación ambiental Este proyecto se desarrolló básicamente en tres niveles; primero se desarrolló el diagnóstico pedagógico de la institución, luego se construyeron y se ejecutaron los proyectos de aula; por último se elaboraron las memorias del trabajo. El trabajo expuesto a continuación se convierte en herramienta de apoyo y en derrotero para futuros proyectos pedagógicos, donde a partir de la lectura y la escritura y la educación ambiental se generen nuevos procesos educativos que contribuyan a mejorar la calidad de la educación

Geomorphology of the Avilés Canyon System, Cantabrian Sea (BayofBiscay)

The Avilés Canyon System (ACS) is a complex, structurally-controlled canyon and valley system constituted by three main canyons of different morphostructural character. They are, from east to west: La Gaviera Canyon, El Corbiro Canyon and Avilés Canyon. In addition to this ACS, a new canyon has been surveyed: Navia Canyon. We present for the first time a high resolution multibeam map showing with great detail the morphological and structural complexity of this segment of the Cantabrian margin. ACS presents a tectonic imprint marked by NW-SE, NNE-SSW and E-W structures. The morphology of their reaches as well as their single mouth, in addition to some rock dredges in their major valleys, demonstrates active down-slope flushing. The continental shelf shows a flat, uniform slope with local and well defined rock outcrops south of Aviles Canyon head. Sedimentary zones are limited, showing thin unconsolidated sedimentary cover. Strong continental margin water dynamics avoid thicker sediment deposition, being littoral sedimentary dynamics responsible for transport to the canyons heads and conduit to the Biscay Abyssal plain. Biscay Abyssal Plain shows evidence of a strong westward current affecting the surveyed strip of this more than 10 km wide plain. Presence of two parallel deep sea channels, erosive scarps, and erosion of gully divides on the lower slope, may indicate that this is part of the distal fan at the termination of the large turbiditic system fed by Cap Ferret, Capbreton and other large canyons (Santander, Torrelavega, Lastres and Llanes) to the west of ACS.Instituto Español de OceanografíaVersión del edito

Faculty of Social Communication. Number 1

La primer apublicación de una Facultad que comienza, asís ea de comunicación social, tiene todas las ventajas de lo que apenas inicia. También sus defectos y problemas.¿Habra demanda para los comunicadores de la UNAB?. - 7 Ideas para formar un comunicador. - 13 Matemáticas y comunicación. - 19 Los cronistas de tierra firma. - 25 Dice Alvaro Chavez. "Los colombianos todos queremos ser blancos. El indio es el otro". - 29 Tres visiones de Feyerabend. - 33 Reseñas. - 45 Material bibliográfico. - 53The first publication in a Faculty that is just beginning, even if it is Social Communication, has all the advantages of what is just beginning. Also all defects and problems

Drug-refractory myasthenia gravis : Clinical characteristics, treatments, and outcome

Altres ajuts: R. Alvarez-Velasco was supported by grant SLT008/18/00207 from the Health Research and Innovation Strategic Plan (PERIS). The NMD-ES Project and F. PlaJunca (data curator) are partially funded by the Centro de Investigacion Biomédica en Red de Enfermedades Raras (CIBERER).To describe the clinical characteristics and outcomes in patients with refractory myasthenia gravis (MG) and to determine the effectiveness and side effects of the drugs used for their treatment. This observational retrospective cross-sectional multicenter study was based on data from the Spanish MG Registry (NMD-ES). Patients were considered refractory when their MG Foundation of America post-interventional status (MGFA-PIS) was unchanged or worse after corticosteroids and two or more other immunosuppressive agents. Clinical and immunologic characteristics of drug-refractory patients, efficiency and toxicity of drugs used, and outcome (MGFA-PIS) at end of follow-up were studied. We included 990 patients from 15 hospitals. Eighty-four patients (68 of 842 anti-acetylcholine receptor [AChR], 5 of 26 anti-muscle-specific tyrosine kinase [MusK], 10 of 120 seronegative, and 1 of 2 double-seropositive patients) were drug refractory. Drug-refractory patients were more frequently women (p < 0.0001), younger at onset (p < 0.0001), and anti-MuSK positive (p = 0.037). Moreover, they more frequently presented a generalized form of the disease, bulbar symptoms, and life-threatening events (p < 0.0001; p = 0.018; and p = 0.002, respectively) than non-drug-refractory patients. Mean follow-up was 9.8 years (SD 4.5). Twenty-four (50%) refractory patients had side effects to one or more of the drugs. At the end of follow-up, 42.9% of drug-refractory patients (42.6% of anti-AChR, 100% of anti-MuSK, and 10% of seronegative patients) and 79.8% of non-drug-refractory patients (p < 0.0001) achieved remission or had minimal manifestations. Eighty percent of drug-refractory-seronegative patients did not respond to any drug tested. In this study, 8.5% of MG patients were drug-refractory. New more specific drugs are needed to treat drug-refractory MG patients

miR-146a rs2431697 identifies myeloproliferative neoplasm patients with higher secondary myelofibrosis progression risk

Myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PV) and essential thrombocythemia (ET), and remarkably shortens survival. Although JAK2V617F and CALR allele burden are the main transformation risk factors, inflammation plays a critical role by driving clonal expansion toward end-stage disease. NF-κB is a key mediator of inflammation-induced carcinogenesis. Here, we explored the involvement of miR-146a, a brake in NF-κB signaling, in MPN susceptibility and progression. rs2910164 and rs2431697, that affect miR-146a expression, were analyzed in 967 MPN (320 PV/333 ET/314 MF) patients and 600 controls. We found that rs2431697 TT genotype was associated with MF, particularly with post-PV/ET MF (HR = 1.5; p < 0.05). Among 232 PV/ET patients (follow-up time=8.5 years), 18 (7.8%) progressed to MF, being MF-free-survival shorter for rs2431697 TT than CC + CT patients (p = 0.01). Multivariate analysis identified TT genotype as independent predictor of MF progression. In addition, TT (vs. CC + CT) patients showed increased plasma inflammatory cytokines. Finally, miR-146a−/− mice showed significantly higher Stat3 activity with aging, parallel to the development of the MF-like phenotype. In conclusion, we demonstrated that rs2431697 TT genotype is an early predictor of MF progression independent of the JAK2V617F allele burden. Low levels of miR-146a contribute to the MF phenotype by increasing Stat3 signaling

Clinical characteristics and outcomes of thymoma-associated myasthenia gravis

[Background and purpose] Prognosis of myasthenia gravis (MG) in patients with thymoma is not well established. Moreover, it is not clear whether thymoma recurrence or unresectable lesions entail a worse prognosis of MG.[Methods] This multicenter study was based on data from a Spanish neurologist-driven MG registry. All patients were aged >18 years at onset and had anti-acetylcholine receptor antibodies. We compared the clinical data of thymomatous and nonthymomatous patients. Prognosis of patients with recurrent or nonresectable thymomas was assessed.[Results] We included 964 patients from 15 hospitals; 148 (15.4%) had thymoma-associated MG. Median follow-up time was 4.6 years. At onset, thymoma-associated MG patients were younger (52.0 vs. 60.4 years, p < 0.001), had more generalized symptoms (odds ratio [OR]: 3.02, 95% confidence interval [CI]: 1.95–4.68, p < 0.001) and more severe clinical forms according to the Myasthenia Gravis Foundation of America (MGFA) scale (OR: 1.6, 95% CI: 1.15–2.21, p = 0.005). Disease severity based on MGFA postintervention status (MGFA-PIS) was higher in thymomatous patients at 1 year, 5 years, and the end of follow-up. Treatment refractoriness and mortality were also higher (OR: 2.28, 95% CI: 1.43–3.63, p = 0.001; hazard ratio: 2.46, 95% CI: 1.47–4.14, p = 0.001). Myasthenic symptoms worsened in 13 of 27 patients with recurrences, but differences in long-term severity were not significant. Fifteen thymomatous patients had nonresectable thymomas with worse MGFA-PIS and higher mortality at the end of follow-up.[Conclusions] Thymoma-associated MG patients had more severe myasthenic symptoms and worse prognosis. Thymoma recurrence was frequently associated with transient worsening of MG, but long-term prognosis did not differ from nonrecurrent thymoma. Patients with nonresectable thymoma tended to present severe forms of MG.This work is supported by Fondo de Investigaciones Sanitarias (FIS) grant FIS19/01774, Instituto de Salud Carlos III and cofunded by the European Union (ERDF/ESF, A Way to Make Europe/Investing in Your Future). Rodrigo Álvarez-Velasco was supported by a PhD for Medical Doctors grant from the Pla Estratègic de Recerca i Innovació en Salut (PERIS), Generalitat de Catalunya (SLT008/18/00207). Elena Cortés-Vicente was supported by a Juan Rodés grant (JR19/00037) from the Fondo de Investigación en Salud, Instituto de Salud Carlos III, Ministry of Health (Spain).Peer reviewe

Cognitive vulnerability in mental disorders

ABSTRACT: Introduction: Modes of cognitive vulnerability were evaluated in outpatients of psychological services centers with diagnoses of mental disorders. Objective: To establish components of cognitive vulnerability in different mental disorders. Method: The participants were 490 users of psychological services centers from twelve universities in Colombia. To identify the presence or absence of mental disorders, they completed the MINI International Neuropsychiatric Interview.The Young Schemes Questionnaire, the Core Beliefs Questionnaire for Personality Disorders, the Inventory of Automatic Thoughts, and the Coping Strategies Questionnaire were also applied. To establish distinctive characteristics among actual major depression, generalized anxiety disorder, panic disorder, social anxiety, and non-alcoholic substance abuse, a logistic regression analysis was conducted. Results: The results showed cognitive distinctive vulnerability profiles, according to the disorder. Conclusion: The hypothesis of cognitive specificity for the different mental disorders is confirmed.RESUMEN: Introducción: Se evaluaron los modos de vulnerabilidad cognitiva en usuarios de consulta externa en psicología, diagnosticados con trastornos mentales. Objetivo: Establecer componentes de vulnerabilidad cognitiva en diferentes trastornos mentales. Método: Participaron 490 usuarios de servicios psicológicos de doce universidades de Colombia. Se aplicó la Entrevista Neuropsiquiátrica Internacional para identificar la presencia o no de trastornos mentales; igualmente, se aplicaron el Cuestionario de Esquemas de Young, el Cuestionario de Creencias Centrales de Trastornos de la Personalidad, el Inventario de Pensamientos Automáticos y el Cuestionario de Estrategias de Afrontamiento. Se realizaron análisis de regresión logística para establecer características distintivas en los trastornos de depresión mayor actual, ansiedad generalizada, angustia, ansiedad social y abuso de sustancias no alcohólicas. Resultados: Se reportaron perfiles cognitivos de vulnerabilidad diferenciados de acuerdo con el trastorno. Conclusión: Se confirma la hipótesis de especificidad cognitiva para los diferentes trastornos mentales