Tunneled Island Flaps for the Reconstruction of Nasal Defects: A 21-Case Series.

(1) Background: The reconstruction of cutaneous defects following surgical procedures in the nasal pyramid presents a challenge due to the limited amount of available tissue. In cases of larger defects, skin from adjacent units is used. Traditionally, two-stage surgical flaps have been employed for reconstructing these defects. Tunnelized island flaps allow for the one-stage surgical reconstruction of nasal pyramid defects, using tissue from the forehead or cheek for the flap. (2) Methods: Descriptive retrospective study of 21 consecutive patients who underwent surgery for defects on the nasal pyramid using tunnelized island flaps. (3) Results: Surgical reconstruction was performed in 21 patients with basal cell carcinomas, 14 of them using the melolabial island flap and 7 using the paramedian forehead island flap. In all cases except one, clear histological margins were obtained. Immediate complications were mild and minor. It is worth noting the trapdoor effect complication, which improved over time in most cases, resulting in a satisfactory cosmetic outcome. No tumor recurrences were observed during an average follow-up period of 17.7 months. (4) Conclusions: Tunnelized island flaps allow for single-stage reconstruction of nasal pyramid defects, yielding excellent cosmetic results by utilizing adjacent skin. This procedure demands a certain level of skill but is associated with minimal complications, making it a valuable alternative in reconstructive dermatological surgery.

Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases.

(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

Jóvenes, multitud y estallido social en Chile / Youth, multitudes and social upheaval in Chile / Jovens, multidões e explosão social no Chile

Resumen (analítico) El 18 de octubre de 2019, miles de jóvenes chilenos salieron a las calles para exigir una sociedad más justa, iniciando un proceso de cambio constitucional y de ciudadanía. Este artículo analiza ese proceso centrándose en las estrategias disruptivas de los y las jóvenes para impugnar los espacios públicos en los primeros meses de protesta. Con esta finalidad, se realizó una etnografía durante diez semanas -octubre a diciembre del 2019--, en las ciudades de Santiago y Valparaíso. Los resultados muestran que estos jóvenes se identifican como parte de una multitud que ha experimentado un despertar ciudadano, exigiendo mayor participación social. Se concluye que este despertar refleja las tendencias sociales de las juventudes de otras partes del mundo, que igualmente disputan y exigen transformaciones sociales en las democracias liberales.

Abstract (analytical) On October 18, 2019 in Chile, thousands of young people flooded the streets to demand a fairer life, representing the start of the construction of a new citizenship. This article analyzes how these young people disputed the control of public spaces in the first months of this social upheaval. An ethnography was carried out for ten weeks between October and December 2019 in the cities of Santiago and Valparaíso, observing and interviewing mobilized young people. The results show that the young people protesting in in the street identify themselves as being part of a social awakening. The Chilean case is discussed as part of a synergy of youth revolts at a global level. The authors conclude that the young people who protest belong to a generation that questions liberal democracies as the dominant form of participation and political action.

Resumo (analítico) Em 18 de outubro de 2019 no Chile, milhares de jovens sitiaram as ruas para exigir uma vida mais justa, começando a construir uma nova cidadania. Este artigo analisa como esses jovens disputaram os espaços públicos nos primeiros meses da 'revolta social'. Foi realizada uma etnografia durante dez semanas - outubro e dezembro de 2019 - nas cidades de Santiago e Valparaíso, observando e entrevistando jovens mobilizados. Os resultados mostram que esses jovens constituem uma multidão nas ruas que os identifica com um despertar social. O caso chileno é discutido como parte de uma sinergia de revoltas juvenis em nível global, e conclui-se que os jovens que protestam pertencem a uma geração que questiona as democracias liberais como forma de participação e ação política.

Land-use intensity affects the potential for apparent competition within and between habitats.

Arthropod communities dwelling in adjacent habitats are able to impact one another via shared natural enemies. In agricultural landscapes, drastic differences in resource availability between crop and non-crop habitats cause variation in insect herbivore densities over short distances, potentially driving inter-habitat effects. Moreover, the composition of the landscape in which the habitats are embedded likely affects realised attack rates from natural enemies via impacts on local arthropod community structure. Here, we examine indirect effects between herbivore species within and between habitat types by calculating the potential for apparent competition between multiple populations. Firstly, we aim to determine how disparities in resource availability impact the strength of the potential for apparent competition occurring between habitats, secondly to examine the impact of landscape composition upon these effects, and finally to couch these observations in reality by investigating the link between the potential for apparent competition and realised attack rates. We used DNA metabarcoding to characterise host-parasitoid interactions within two habitat types (with divergent nutrient inputs) at 11 locations with variable landscape composition within an agroecosystem context. We then used these interaction networks to estimate the potential for apparent competition between each host pair and to compare expected versus realised attack rates across the system. Shared natural enemies were found to structure host herbivore communities within and across habitat boundaries. The size of this effect was related to the resource availability of habitats, such that the habitat with high nutrient input exerted a stronger effect. The overall potential for apparent competition declined with increasing land-use intensity in the surrounding landscape and exhibited a discernible impact on realised attack rates upon herbivore species. Thus, our results suggest that increasing the proportion of perennial habitat in agroecosystems could increase the prevalence of indirect effects such as apparent competition among insect herbivore communities, potentially leading to enhanced population regulation via increased attack rates from natural enemies like parasitoid wasps.

Entre managerialismo y nostalgia. El debate por el futuro de la Universidad y el Trabajo Académico / Between managerialism and nostalgia: the dispute for the future of the University and AcademicWork

La universidad y el trabajo académico han sido interpeladas a hacerse más eficientes bajo los criterios del Nuevo Management Público, promoviendo privatización y modelos de gestión y fi-nanciamiento por desempeño. Chile, considerado caso emblemático, ha realizado nuevas re-formas respondiendo a las movilizaciones estudiantiles que han cuestionado dicho modelo des-de 2011. Este artículo aborda el debate en torno a estas reformas, desplegado en columnas de opinión, editoriales y cartas al director en los principales medios. Los resultados evidencian la disputa entre dos versiones de universidad y trabajo académico: la managerialista, orientada a competencia, estándares e indicadores, y la humboldtiana basada en constantes apelaciones a un “pasado mejor” que fue truncado. Entre estas, emergen otras híbridas que dan cuenta de la variabilidad en el uso de estos repertorios. Las versiones desplegadas muestran los límites del debate, y de la posibilidad de imaginar un futuro de la universidad más allá del managerialis-mo.(AU)

The university and academic work have been challenged to become more efficient under the criteria of the New Public Management, promoting privatization and performance manage-ment and financing models. Chile, considered an emblematic case, has carried out new re-forms in response to student mobilizations that have questioned this model since 2011. This article addresses the debate around these reforms, displayed in opinion columns, editorials and letters to the editor in the main media. The results show the dispute between two ver-sions of university and academic work: the managerialist, oriented to competence, standards and indicators, and the Humboldtian based on constant appeals to a “better past” that was truncated. These versions show the limits of the debate and of the possibility of imagining a future of the university beyond managerialism.(AU)

Metastatic Melanoma Negative for 5 Melanocytic Markers, Complete Regressed Primary Cutaneous Melanoma, and Melanoma-Associated Leukoderma in the Same Patient.

Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black-bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.

Signo ecográfico de las capas de cebolla en el testículo / Onion Ring Sign in the Testicle

Resumen Los quistes epidermoides del testículo son tumores benignos que representarían aproximadamente el 1% de todas las masas testiculares. Clínicamente es una patología poco sintomática, que se presenta como un aumento de volumen testicular o es detectado en exámenes de rutina. La ecografía demuestra una lesión focal del testículo, ovalada, heterogénea, con múltiples capas lineales hiperecogénicas concéntricas que da el signo clásico de "capas de cebolla" o con morfología de "anillo", y que no presenta flujo al Doppler color (Figuras1,2y3). Cabe señalar también que se ha descrito la presencia de calcificaciones murales o una imagen hiperecogenica central como forma de presentación. Es necesario tener en cuenta que existen algunas publicaciones que describen casos aislados en que esta apariencia ecográfica característica podría también estar presente en teratomas, el cual sería su principal diagnóstico diferencial. La importancia del conocimiento de esa lesión radica en la alta probabilidad de ser una lesión benigna, que puede ser tratada con enucleación y no necesariamente requerir orquiectomia extendida, ya que hasta ahora, no existen reportes de malignización, diseminación ni recurrencia.

¿Qué papel juega la actividad de la enfermedad en el riesgo cardiovascular de la artritis reumatoide? / What role does rheumatoid arthritis disease activity have in cardiovascular risk?

La artritis reumatoide (AR) presenta una mortalidad de 1,3 a 3 veces superior a la población general; la principal causa de muerte son las complicaciones cardiovasculares (40-50%). En el abordaje inicial se debe incluir la valoración del riesgo cardiovascular (RCV) mediante algoritmos adaptados para esta población. Si bien el SCOREm constituye un avance importante, hay datos que indican que podría infradiagnosticar la ateroesclerosis subclínica. Objetivo: Estimar la fuerza de asociación entre la ecografia carotídea y el SCOREm en esta población, así como la implicancia de la actividad de la enfermedad. Metodología: Estudio observacional, transversal y analítico, realizado en el Hospital General de Ciudad Real durante el periodo junio de 2013-mayo de 2014. Se realizó la valoración del RCV y según el SCOREm se dividió a la población en riesgo bajo y alto (medio, alto y muy alto). Se estudió la presencia de ateroesclerosis subclínica en los pacientes de riesgo bajo. Resultados: Del total de 119 pacientes con AR, el 73,1% presentaba factores de riesgo tradicionales. Se excluyeron 38 pacientes por evento cardiovascular previo, diabetes mellitus y nefropatía. Se objetivó placa ateromatosa en el 14,63% de la población de riesgo bajo. El factor con mayor asociación con la presencia de aterosclerosis subclínica fue el grado de actividad moderada/alta de la AR medida mediante el SDAI, con un OR de 4,95 (IC 95%: 1,53-16,01). Conclusiones: Aunque existe una aceptable asociación entre la presencia de aterosclerosis subclínica y el SCOREm, hay una proporción no despreciable de pacientes clasificados de riesgo bajo con placas ateromatosas. La actividad de la enfermedad fue el factor de riesgo más asociado al incremento del RCV

Rheumatoid arthritis (RA) is associated with a 1.3 to 3-fold increase in mortality, being the major cause of death from cardiovascular complications (40%-50%). Therefore, the initial approach should include cardiovascular risk (CVR) assessment using algorithms adapted for this population. Although, SCOREM is an important advance, there are data indicating that subclinical atherosclerosis may be underdiagnosed. Objective: To estimate the strength of association between carotid ultrasound and SCOREM in this population, as well as the implication of disease activity. Methodology: Cross-sectional, observational, analytical study performed at the General Hospital of Ciudad Real, Spain, between June 2013 and May 2014. The evaluation of CVR was performed and, according to SCOREM, the population was divided into low and high (medium, high and very high) risk. We studied the presence of subclinical atherosclerosis in low-risk patients. Results: Of the total of 119 RA patients, 73.1% had traditional risk factors. Thirty-eight patients were excluded because of a previous cardiovascular event, diabetes mellitus and/or nephropathy. Atheromatous plaque was observed in 14.63% of the low-risk population. The factor with the strongest association to the presence of subclinical atherosclerosis was a moderate or high activity of RA measured by the simplified disease activity index with an odds ratio of 4.95 (95% CI: 1.53-16.01). Conclusions: Although there was an acceptable correlation between the presence of subclinical atherosclerosis and SCOREM, there was a considerable proportion of atheromatous plaques in low-risk patients. Disease activity was the risk factor most closely associated with increased CVR

Artritis reumatoide, una enfermedad sistémica con un riesgo cardiovascular subestimado / Rheumatoid arthritis; a systemic disease with an under-estimated cardiovascular risk

RESUMEN Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascular (RCV) en los pacientes con artritis reumatoide. Materiales y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital General de Ciudad Real, entre junio de 2013 y mayo de 2014. Se realizó una analítica completa, se elaboró un perfil clínico, se calculó el SCOREm y se estratificó el RCV. Finalmente, se determinó la presencia de aterosclerosis subclínica mediante la realización de una ecografía carotídea. Resultados: 119 pacientes aceptaron participar en el estudio. Hubo una prevalencia del 73,1% de los factores de riesgo tradicionales, 6,72% había presentado un evento cardiovascular al momento del estudio, 22,68% poseía un infradiagnóstico de diabetes mellitus o nefropatía. La distribución final del RCV fue: riesgo bajo 46 (38,7%), riesgo intermedio 33 (27,7%), riesgo alto 2 (1,7%), riesgo muy alto 38 (31,9%). Conclusiones: Existe una alta prevalencia de factores de RCV y riesgo elevado infradiagnosticado en esta población. Por lo que si bien la artritis reumatoide se manifiesta de forma más aparente a nivel articular, ha de considerarse una enfermedad sistémica asociada a una mayor incidencia de eventos cardiovasculares.

ABSTRACT Objective: To determine the cardiovascular risk and the prevalence of cardiovascular risk (CVR) factors in patients with rheumatoid arthritis. Material and methods: Observational, descriptive and cross-sectional study performed in the General Hospital of Ciudad Real from June 2013 to May 2014. A complete laboratory analysis was performed, a clinical profile was prepared, the Systematic Coronary Risk Evaluation (SCOREm) was calculated, and the CVR was stratified. Finally, the presence of sub-clinical atherosclerosis was determined by performing a carotid ultrasound. Results: 119 patients accepted to participate in the study. There was a prevalence of 73.1% of traditional risk factors; 6.72% having had a cardiovascular event at the time of the study, and 22.68% had an underdiagnosis of diabetes mellitus and/or nephropathy. The final distribution of the CVR was: Low risk 46 (38.7%), intermediate risk 33 (27.7%), high risk 2 (1.7%), very high risk 38 (31.9%). Conclusions: There is a high prevalence of CVR factors and an elevated risk of underdiagnosis in the rheumatoid arthritis population. Therefore, although rheumatoid arthritis manifests itself more in the joints, it should be considered a systemic disease associated with a higher incidence of cardiovascular events.

La construcción discursiva del joven trabajador: Un análisis crítico a los informes Tendencias Mundiales de Empleo / The Discursive Construction of the Youth as Workers: A Critical Analysis of Global Employment Trends for Youth

Resumen El presente artículo se propone como objetivo describir las formas en que la Organización Internacional del Trabajo (OIT) construye discursivamente al joven trabajador. Para esto, se realiza un análisis de discurso de los informes Tendencias Mundiales de Empleo (TEM), publicados por la OIT entre 2004-2014. Los resultados obtenidos dan cuenta que en los informes TEM aparecen seis figuras de la subjetividad que construyen al joven trabajador: a) el joven pobre, b) el joven ocioso, c) la generación perdida, d) el joven feliz, e) los desafortunados jóvenes, y f) los jóvenes desconfiados. De acuerdo al análisis basado en el enfoque de la Gubernamentalidad, se puede constatar que estas formas de conceptualizar a la juventud se fundamentan desde una lógica economicista, basada en valores neoliberales. Se discute en torno a cómo estas figuras de la subjetividad corresponden a Tecnologías del Yo, que permiten prescribir formas de conducir la conducta de los jóvenes para su inclusión al mercado del trabajo.

Abstract This article aims to describe the ways in which the International Labour Organization (ILO) discursively constructs the youth as workers. To do this, a discourse analysis of the Global Empoyment Trends for Youth (GET) reports, published by the ILO from 2004 to 2014, was conducted. The results show six figures of subjectivity that construct the young workers in the TEM reports: a) the poor youth, b) the idle youth, c) the lost generation, d) the happy youth, e) the unfortunate youth, f) the distrust youth. According to the Governmentality approach, it can be seen how these ways of conceptualizing young workers correspond to neoliberal values. Its discussed how these figures of subjectivity correspond to Technologies of the Self, that allow conduct the conduct of youth in order to prescribe way of including young people into the labor market.

What role does rheumatoid arthritis disease activity have in cardiovascular risk? / ¿Qué papel juega la actividad de la enfermedad en el riesgo cardiovascular de la artritis reumatoide?

Rheumatoid arthritis (RA) is associated with a 1.3 to 3-fold increase in mortality, being the major cause of death from cardiovascular complications (40%-50%). Therefore, the initial approach should include cardiovascular risk (CVR) assessment using algorithms adapted for this population. Although, SCOREM is an important advance, there are data indicating that subclinical atherosclerosis may be underdiagnosed. OBJECTIVE: To estimate the strength of association between carotid ultrasound and SCOREM in this population, as well as the implication of disease activity. METHODOLOGY: Cross-sectional, observational, analytical study performed at the General Hospital of Ciudad Real, Spain, between June 2013 and May 2014. The evaluation of CVR was performed and, according to SCOREM, the population was divided into low and high (medium, high and very high) risk. We studied the presence of subclinical atherosclerosis in low-risk patients. RESULTS: Of the total of 119 RA patients, 73.1% had traditional risk factors. Thirty-eight patients were excluded because of a previous cardiovascular event, diabetes mellitus and/or nephropathy. Atheromatous plaque was observed in 14.63% of the low-risk population. The factor with the strongest association to the presence of subclinical atherosclerosis was a moderate or high activity of RA measured by the simplified disease activity index with an odds ratio of 4.95 (95% CI: 1.53-16.01). CONCLUSIONS: Although there was an acceptable correlation between the presence of subclinical atherosclerosis and SCOREM, there was a considerable proportion of atheromatous plaques in low-risk patients. Disease activity was the risk factor most closely associated with increased CVR.

Neoplasia de celulas dendriticasblastica plasmocitoide.

Plasmacytoid blast dendritic cell neoplasia (NCDBP) is an uncommon malignant neoplasm, presenting clinically with cutaneous involvement and subsequent lymph node and bone marrow extension. It characteristically expresses the markers: CD56, CD4, and CD123. There is no optimal treatment, relapses are frequent, and the survival time is short. We present the case of an elderly patient with NCDBP who initially presented with cutaneous lesions, but experienced rapid systemic progression and did not, respond to treatment.

Amiloidosis cutánea primaria del oído externo: una entidad peculiar, inusual y benigna / Primary cutaneous amyloidosis of the external ear: A peculiar, unusual and benign entity

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[Hyper-immunoglobulin E syndrome: report of one case]. / Síndrome de hiper IgE, una enfermedad poco frecuente en edad adulta: reporte de un caso.

The Hyperimmunoglobulin E syndrome (HIES) is a rare sporadic or autosomal dominant immune and connective tissue disorder characterized by chronic eczema, cutaneous abscesses, pneumonias, invasive infections, high levels of Immunoglobulin E, primary teeth retention and bone abnormalities. We report a 24-year-old male with a history of cutaneous abscesses and esophageal candidiasis. He was admitted due to a left gluteal cellulitis. During the fifth day of hospitalization he presented a distal necrosis of the fourth finger of the right hand. Laboratory results showed high levels of IgE and positive cryoglobulins. The patient was discharged and was admitted again five days later with a new gluteal abscess. IgE levels were even higher. Applying Grimbacher scale, the diagnosis of Hyperimmunoglobulin E syndrome was reached.

Postoperative abdominal collections drainage: Percutaneous versus guided by endoscopic ultrasound.

BACKGROUND AND AIM: Postoperative fluid collections (POFC) have high mortality. Percutaneous drainage (PD) is the preferred treatment modality. Drainage guided by endoscopic ultrasound (EUS-GD) represents a good alternative. The aim of the present study was to compare clinical success and complication rates of EUS-GD versus PD. METHODS: Data collected prospectively were analyzed in a retrospective manner. Patients with POFC from October 2008 to November 2013 were included. All collections were drained percutaneously or by EUS-GD. RESULTS: Sixty-three procedures in 43 patients with POFC were analyzed; 13 patients were drained using EUS-GD and 32 patients with PD. Two patients assigned initially to the PD group were reassigned to EUS-GD. Surgery procedures most often related to the collections were intestinal reconnection, distal pancreatectomy, biliary-digestive bypass, and exploratory laparotomy. Technical success (100% vs 91%; P = 0.25), clinical success (100% vs 84%; P = 0.13), recurrence (31% vs 25%; P = 0.69), hospital stay days (median 22 vs 27; P = 0.35), total costs (8328 ± 1600 USD vs 11 047 ± 1206 USD; P = 0.21), complications (0% vs 6%; P = 0.3), and mortality (8% vs 6%; P = 0.9) were each evaluated in the EUS-GD and PD groups, respectively. In the PD group one death was related to the procedure. CONCLUSIONS: EUS-GD is as effective and safe as PD in patients with POFC. The advantage of not requiring external drainage and a trend to higher clinical success and lower total costs must be considered.

Carcinoma basocelular umbilical / Umbilical basal cell carcinoma

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