The Great Mimicker. A Case of Gastrointestinal Tuberculosis.

Background: Gastrointestinal (GI) tuberculosis (TB) is rare, accounting for 1-3 % of all TB cases worldwide. Mycobacteria enter the GI tract via hematogenous spread from active pulmonary TB, swallowing infected sputum, or ingesting contaminated food. The ileocecal area is most affected; however, tuberculous enteritis can involve any part of the GI tract. The vague clinical presentation makes the diagnosis challenging and often delayed requiring a high index of suspicion. Case Presentation: A 28-year-old female who emigrated to the US from Mexico presented to the ED with a 4-month history of abdominal pain, vomiting, diarrhea, anorexia, 40-pound weight loss, intermittent fever, night sweats, and dry cough. Medical history included untreated rheumatoid arthritis, SLE, and pulmonary tuberculosis, diagnosed three weeks before presentation. The patient reported worsening abdominal pain and inability to tolerate oral intake following initiation of RIPE therapy, which led to the discontinuation of anti-TB drugs four days before admission. Physical exam revealed diffuse abdominal tenderness. Labs showed a WBC of 4.4, hemoglobin 10.9, CRP 13.8, negative HIV, and albumin 2.7. CT chest revealed bilateral opacities and left axillary lymphadenopathy. Abdominal CT showed nonspecific thickening of the distal small bowel. RIPE was restarted on admission; however, not tolerated due to persistent vomiting. Colonoscopy revealed a mass-like ulcerated lesion with scarring of the ileocecal valve. Small bowel biopsy showed non-necrotizing granulomas, crypt distortion, and villous blunting. Mycobacteria species were detected via acid-fast stain compatible with mycobacterial enteritis. Due to small bowel obstruction, the patient underwent a robotic right colectomy and small bowel resection. Pathology showed granulomatous enterocolitis with 24 lymph nodes with varying degrees of granulomatous inflammation. The patient’s medical condition deteriorated, resulting in septic shock and death. Conclusions: The diagnosis of GI TB is difficult to establish due to its nonspecific features, many of which overlap with GI infections, malignancy, and inflammatory bowel disease. Anti-TB therapy is the mainstay of treatment, with surgery only required in a minority of cases. In our patient, delayed recognition and treatment led to disease progression, complications, and death. This case highlights the importance of maintaining a high index of suspicion, particularly in patients who have migrated from an endemic region or have other risk factors

Satisfacción laboral y compromiso organizacional del personal de contratación administrativa de servicios de las facultades de la Universidad Nacional José Faustino Sánchez Carrión, Huacho, 2023

Objetivo: Conocer la relación entre la satisfacción laboral y el compromiso organizacional del personal de Contratación Administrativa de Servicios de las facultades de la Universidad Nacional José Faustino Sánchez Carrión, Huacho, 2023. Métodos: La presente investigación es de tipo básica, nivel correlacional, diseño no experimental, enfoque cuantitativo. La población fue de 87 miembros del personal, muestra de 71 miembros del personal. Resultados: Según los datos, el 47.9% considera su satisfacción laboral como buena, solo el 11.3% la percibe como deficiente y el 40.8% la ve como regular; por otro lado, el 36,6% considera su compromiso organizacional como bueno, el 54.9% lo ve como regular y solo el 8.5% lo percibe como deficiente. Conclusión: el coeficiente de correlación entre la satisfacción laboral y el compromiso organizacional es de 0.646, lo que indica una correlación positiva moderada a fuerte entre ambas variables. El valor de significancia (Sig. bilateral) es 0.000, lo que significa que esta correlación es estadísticamente significativa en el nivel 0.05

Principio de culpabilidad en las rupturas matrimoniales : Divorcio y separacion judicial

72 p.La siguiente tesis no es autorizada por el autor para su difusion en formato digital.Este trabajo aborda las instituciones de separación judicial y divorcio actualmente establecidas por la Ley de Matrimonio Civil Nº 19.947, comprendiendo el análisis de sus causales y el estudio específico del principio de culpabilidad presente en las causales subjetivas para descubrir la conveniencia o no del mantenimiento de ellas en nuestra legislación. Para ello, esta memoria abarca inicialmente la descripción de la realidad existente durante la vigencia de la antigua Ley de Matrimonio Civil de 1884, luego se realiza un estudio comparativo con la legislación española y finalmente se esboza la orientación del nuevo Derecho de Familia, expresados en los principios rectores establecidos en la Ley Nº 19.968. Finalmente, es posible concluir que no se pueden excluir las causales culposas en la medida en que solucionan la situación grave existente entre los cónyuges, pero sí eliminar el carácter sancionatorio que persigue, protegiéndose las relaciones familiares establecidas

Position control of a shape memory alloy actuator using a four-term bilinear PID controller

Shape memory alloy (SMA) actuators have a number of appealing features, such as their low weight or their high force-to-weight ratio, that make them a potential alternative to traditional actuation technologies in fields such as space applications, surgical devices or wearable robotics. In this paper, a type of bilinear controller consisting of a conventional PID controller cascaded with a bilinear compensator, known as BPID, is proposed. Bilinear controllers are a subset of nonlinear controllers, which is why the BPID may be a promising alternative to control the position of a SMA actuator. Nonlinear control techniques are commonly applied to control SMA actuators, because of their nonlinear behavior caused by thermal hysteresis. The BPID controller is simpler and easier to implement than other nonlinear control strategies, which makes it a very appealing candidate to control SMA actuators. The performance of the BPID controller has been compared with other two controllers, a conventional PID and a commuted feed-forward PIPD, controlling a real SMA actuator. To this end, a set of five tests has been defined, in which the controlled actuator must follow a series of position references. From these tests, the position and error of the actuator have been plotted, and a series of metrics has been computed to have quantitative measurements of the performance of the three controllers. It is shown that, in most of the experiments, the BPID has a better performance than the other two tested controllers, especially tracking step references. However, the power consumption is slightly higher when the actuator is controlled with this strategy, although-the difference is minimal. Also, the BPID imposes greater energy variations to the SMA actuator, which might affect its service life. Overall, the BPID controller has proved to be a viable alternative to control SMA actuators.The research leading to these results has received funding from the STAMAS (Smart technology for artificial muscle applications in space) project, funded by the European Union’s Seventh Framework Programme for Research (FP7) (grant number 312815), and from the RoboHealth (DPI2013-47944-C4-3-R) Spanish research project

Estimating the Non-Monetary Burden of Neurocysticercosis in Mexico

Neurocysticercosis (NCC) is a major public health problem caused by the larvae of the parasite Taenia solium. The condition occurs when humans ingest eggs of the pork tapeworm Taenia solium, which then develop into larvae in the central nervous system. The disease is predominantly found and considered important in Latin American, Asian, and African countries and is associated with a large social and economic burden. Very few studies have been conducted to evaluate the burden of NCC and there are no estimates from Mexico. We estimated the disability adjusted life years (DALYs) lost due to NCC in Mexico incorporating morbidity and mortality due to NCC-associated epilepsy, and morbidity due to NCC-associated severe chronic headaches. NCC-associated epilepsy and severe chronic headaches were estimated to cause a loss of approximately 0.25 healthy year of life per 1,000 persons annually in Mexico. This is the first estimate of DALYs associated with NCC in Mexico. However, this value is likely to be underestimated since only the clinical manifestations of epilepsy and severe chronic headaches were included

Thyroid hormones according to gestational age in pregnant Spanish women

<p>Abstract</p> <p>Background</p> <p>Thyroid function changes during pregnancy and maternal thyroid dysfunction have been associated with adverse outcomes. Our aim was to evaluate thyroid hormones levels in pregnant women resident in Aragon, Spain.</p> <p>Findings</p> <p>Samples for 1198 pregnant women with no apparent thyroid disorders were analyzed, using paramagnetic microparticle and chemiluminescent detection technologies, in order to determine levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab). Of the women in our sample, 85.22% had normal values for TPO-Ab and Tg-Ab and 14.77% had results revealing the presence of autoimmune diseases of the thyroid. The thyroid hormone reference values obtained according to gestational age (in brackets) were as follows: for free T3, values were 3.38 ± 0.52 pg/mL (<11 weeks), 3.45 ± 0.54 pg/mL (11-20 weeks), 3.32 ± 0.43 pg/mL (21-30 weeks), 3.21 ± 0.53 pg/mL (31-36 weeks), and 3.23 ± 0.41 pg/mL (>36 weeks); for free T4, values were 1.10 ± 0.14 ng/dL (<10 weeks), 1.04 ± 0.14 ng/dL (11-20 weeks), 0.93 ± 0.12 ng/dL (21-30 weeks), 0.90 ± 0.13 ng/dL (31-36 weeks), and 0.80 ± 0.21 ng/dL (>36 weeks); and for TSH, values were (μIU/mL): 1.12 ± 0.69 (<10 weeks), 1.05 ± 0.67 (11-20 weeks), 1.19 ± 0.60 (21-30 weeks), 1.38 ± 0.76 (31-36 weeks), and 1.46 ± 0.72 (>36 weeks).</p> <p>Conclusion</p> <p>Pregnant women with normal antibody values according to gestational age had values for FT4 and TSH, but not for FT3, that differed to a statistically significant degree. The values we describe can be used as reference values for the Aragon region of Spain.</p

Prognostic significance of pathological response after neoadjuvant chemotherapy or chemoradiation for locally advanced cervical carcinoma

BACKGROUND: Cisplatin-based chemoradiation is the standard of care for locally advanced cervical cancer patients; however, neoadjuvant modalities are currently being tested. Neoadjuvant studies in several tumor types have underscored the prognostic significance of pathological response for survival; however there is a paucity of studies in cervical cancer investigating this issue. METHODS: Four cohorts of patients with locally advanced cervical carcinoma (stages IB2-IIIB); included prospectively in phase II protocols of either neoadjuvant chemotherapy with 1) cisplatin-gemcitabine, 2) oxaliplatin-gemcitabine, 3) carboplatin-paclitaxel or 4) chemoradiation with cisplatin or cisplatin-gemcitabine followed by radical hysterectomy were analyzed for pathological response and survival. RESULTS: One-hundred and fifty three (86%) of the 178 patients treated within these trials, underwent radical hysterectomy and were analyzed. Overall, the mean age was 44.7 and almost two-thirds were FIGO stage IIB. Pathological response rates were as follows: Complete (pCR) in 60 cases (39.2%), Near-complete (p-Near-CR) in 24 (15.6 %) and partial (pPR) in 69 cases (45.1%). A higher proportion rate of pCR was observed in patients treated with chemoradiotherapy (with cisplatin [19/40, 47.5%]; or with cisplatin-gemcitabine [24/41, 58.5%] compared with patients receiving only chemotherapy, 6/23 (26%), 3/8 (37.5%) and 8/41 (19.5%) for cisplatin-gemcitabine, oxaliplatin-gemcitabine and carboplatin-paclitaxel respectively [p = 0.0001]). A total of 29 relapses (18.9%) were documented. The pathological response was the only factor influencing on relapse, since only 4/60 (6.6%) patients with pCR relapsed, compared with 25/93 (26.8%) patients with viable tumor, either pNear-CR or pPR (p = 0.001). Overall survival was 98.3% in patients with pCR versus 83% for patients with either pNear-CR or pPR (p = 0.009). CONCLUSION: Complete pathological response but no Near-complete and partial responses is associated with longer survival in cervical cancer patients treated with neoadjuvant chemotherapy or chemoradiotherapy

Launching of the Anaemia Research Peruvian Cohort (ARPEC): a multicentre birth cohort project to explore the iron adaptive homeostasis, infant growth and development in three Peruvian regions.

BACKGROUND: Preventing infantile anaemia and ensuring optimal growth and development during early childhood, particularly in resource-constrained settings, represent an ongoing public health challenge. Current responses are aligned to treatment-based solutions, instead of determining the roles of its inter-related causes. This project aims to assess and understand the complex interplay of eco-bio-social-political factors that determine infantile anaemia to inform policy, research design and prevention practices. METHODS: This is a longitudinal birth cohort study including four components: (1) biological, will assess known blood markers of iron homeostasis and anaemia and stool microbiota to identify and genetically analyse the participants' flora; (2) ecological, will assess and map pollutants in air, water and soil and evaluate features of nutrition and perceived food security; (3) social, which will use different qualitative research methodologies to explore key stakeholders and informants' perceptions related to nutritional, environmental and anaemia topics, participant observations and a participatory approach and (4) a political analysis, to identify and assess the impact of policies, guidelines and programmes at all levels for infantile anaemia in the three regions. Finally, we will also explore the role of social determinants and demographic variables longitudinally for all study participants. This project aims to contribute to the evidence of the inter-related causal factors of infantile anaemia, addressing the complexity of influencing factors from diverse methodological angles. We will assess infantile anaemia in three regions of Peru, including newborns and their mothers as participants, from childbirth until their first year of age. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Research Ethics Committee of the Instituto Nacional de Salud del Niño (Lima, Peru), CIEI-043-2019. An additional opinion has been granted by the Ethical Committee of Queen Mary University of London (London, UK). Dissemination across stakeholders is taking part as a continues part of the research process

Compartiendo saberes de educación y humanidades

Los capítulos referentes a este libro tratan diversos temas tales como: 1) la construcción de los estudiantes de la licenciatura en químico farmacéutico biólogo el juicio valorativo y personaI deI significado en su desarroIIo profesionaI desde eI punto de vista axiológico, 2) se realiza un estudio en el Plantel Cuauhtémoc con Ia finaIidad de orientar a Ia comunidad estudiantiI aI tratamiento deI probIema de los residuos sólidos desde su etapa de diagnóstico hasta una propuesta de solución de la problemática, 3) se analiza como a nivel básico se construye el conocimiento y la participación del género en los estudiantes, en donde se observa que el papel del docente es un promotor importante, 4) es un tema que actualmente está causando mucho interés tanto en la educación como el la población en general, las redes sociales que actuaImente ese consideran un medio de comunicación con mucha influencia dentro de la sociedad, 5) se adentra al campo de la psicología y la tanatología ante los recursos resilientes que presentan las familias ante la muerte de un hijo, 6) es una investigación dedicada a identificar Ias diferentes percepciones que tienen las mujeres y los hombres en relación a la felicidad y la desdicha dentro del matrimonio, 7) es un análisis Transgeneracional para aportar las referencias familiares que permiten la permanencia del abuso sexual infantil en tres generaciones, de las cuales en la última generación se rompe ese secreto avallazador al romper el silencio, 8) es un ensayo acerca del juego terapéutico desde el punto de vista psicoanalítico, en el que se advierte ese juego en el que entra el paciente con el psicoanalista, 9) la metodología de la observación para la integración de la pericial en psicología, en donde se denotan desde la parte jurídica como se fundamente esta pericial y fortalece el logro del dictamen para tener un buen dictamen, 10) es una propuesta de construcción y validez del instrumento BP-22 Bienestar Psicológico en el ámbito de la educación superior, 11) se identifica a Ios procesos eIectoraIes como complicados, de tal manera que abre un panorama al marketing de los partidos políticos para conducir la voluntad ciudadana, y además ayuda al posicionamiento de los partidos, 12) aporta una base sobre Ios procesos identificatorios en eI movimiento estudiantiI de Ia UNAM deI año de I999, pIanteándoIo desde dos ejes de análisis: las identidades universitarias y el apartado del texto, que permiten configurar eI movimiento estudiantiI como un acontecimiento capaz de generar articulaciones nuevas de solidaridad. AI finaI deI Iibro se encuentran Ias síntesis curricuIares de cada uno de los autores, que aportaron sus investigaciones para la integración y generación de nuevos aportes científicos.Como su nombre lo indica COMPARTIENDO SABERES DE EDUCACIÓN Y HUMANIDADES, es un Iibro que denota eI deseo de integrar conocimiento para la comunidad estudiantil, llevarlos al interés de la investigación a través de la participación de los investigadores de diferentes áreas como: la educación, las ciencias sociales y las humanidades. Que les permite tener no solo un espacio en la difusión de los avances de sus estudios, sino que además permite el generar el interés de quién lo lee en diferentes formas de investigación, se encuentran estudios tanto cualitativos como cuantitativos, desde descriptivos hasta un nivel de intervención en la práctica de estas áreas.Universidad Autónoma del Estado de méxic