Este ensayo reflexiona sobre un uso crítico de los medios electrónicos y de la movilidad de información que producen, junto con los desafíos educativos que abren en los primeros años de la ...escolaridad, haciendo especial hincapié en las tecnologías de la información y la comunicación (TIC). Se partirá de la discusión de resultados y conclusiones surgidas a raíz de trabajos de investigación cualitativos realizados por la autora al respecto, durante varios años, entre el 2012 y 2018 en Galicia (España). Se apoyará, también, en el análisis explicativo del papel que juegan estos medios en el mundo social, así como en las necesidades infantiles, del profesorado y, en general, de los entornos escolares, inmersos en un mundo en el cual la movilidad electrónica, azuzada por la celeridad, rompe fronteras temporales y espaciales. La búsqueda de la simultaneidad y la construcción de caminos planetarios han hecho que la información salga y entre y se proyecte fuera y dentro del planeta. Nuevas realidades e identidades emergen capaces de originar no pocas dificultades, pero también nuevos senderos y soluciones a problemas hasta entonces irresolubles. El uso comprometido con la justicia y contra la exclusión de las TIC debiera formar parte de las intervenciones de la escuela, representando recursos y no fines en sí mismas, de manera que su uso ético resulta condición imprescindible para que sean verdaderamente educativas. Han dado lugar a realidades complejas y niños y niñas de cortas edades construyen conocimiento al respecto, por lo cual representan una fuente de prácticas docentes que deben ser analizadas para alejarse de la exclusión y empeñarse en la búsqueda de la equidad, entendida desde el punto de vista infantil.
Objectives
To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT
®
) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of ...disease activity according to both ACRODAT
®
and the physicians’ clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients.
Design
Multicenter, observational, descriptive and cross-sectional study.
Methods
Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT
®
.
Results
According to ACRODAT
®
, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT
®
classification of disease activity significantly correlated with physicians’ opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV = 86.21%). No correlation was found between IGF-I levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectively
Conclusions
ACRODAT
®
detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT
®
is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating “patient-centred” parameters like symptoms and QoL to the clinical evaluation of acromegaly.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal ...deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain.
Methods
We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3–6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study.
Results
Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3–6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism.
Conclusions
Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Acromegaly is a rare disease with nonspecific symptoms with acral enlargement being almost universally present at diagnosis. The estimated prevalence is 40-125 cases/million but targeted universal ...screening studies have found a higher prevalence (about 10 fold). The aim of the ACROSAHS study was to investigate the prevalence of acromegaly and acromegaly comorbidities in patients with sleep apnea symptoms and acral enlargement. ACROSAHS was a Spanish prospective non-interventional epidemiological study in 13 Hospital sleep referral units. Facial and acral enlargement symptoms including: ring size and shoe size increase, tongue, lips and jaws enlargement, paresthesia or carpal tunnel syndrome and widening of tooth spaces, as well as other typical acromegaly comorbidities were recorded with a self-administered questionnaire of patients who attended a first visit for sleep apnea symptoms between 09/2013 and 07/2014. Serum insulin-like growth factor type 1 (IGF1) was measured in patients with ≥1 acral symptom to determine the prevalence of acromegaly. Of the 1557 patients enrolled, 1477 with complete data (72% male) were analyzed. 530 patients (36%) reported at least 1 acral enlargement symptom and were tested for IGF-1, 41 were above range, persisted in 7, and among those, 2 cases of acromegaly were diagnosed (prevalence of at least 1.35 cases/1000). Overall, 1019 patients (69%) had ≥2 acromegaly symptoms and should have been screened according to guidelines; moreover 373 patients (25%) had ≥1 symptom of acral enlargement plus ≥3 other acromegaly symptoms. In conclusion, in patients with sleep apnea symptoms and acral enlargement, we found an acromegaly prevalence of at least 1.35 cases per 1000 and a high prevalence of typical acromegaly symptoms. It is important that sleep specialists are aware of acromegaly symptoms to aid with acromegaly diagnosis.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper discusses the phenomenon of teacher awards with particular reference to one bestowed in Spain. This phenomenon is analysed in line with the consequences of free market ideology in ...education and the ideology of influencers and followers. Drawing on qualitative research based in participant and non-participant observation, in-depth interviews and document analysis, the results show that education practice was determined by the award requirements, and complying with its criteria became the overriding objective. The need for recognition was highlighted but critical views were also brought to light in relation to the notions of microcelebrities, performativity, individualism and competitiveness. The paper contributes to critical reflections on the already existing controversies regarding awards in education and specifically those presented to individuals. School teachers' perceptions of and reasons for participating in these initiatives and the repercussions in their classrooms are examined.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Abstract Context Few data exist about the clinical course of acromegaly, surgical and medical outcomes in patients with GH- and prolactin cosecreting pituitary adenomas (GH&PRL-PAs). Nevertheless, ...some series described a more aggressive clinic-radiological behavior than in growth hormone–secreting pituitary adenomas (GH-PAs). Objective This work aims to evaluate differences in clinical presentation and in surgical outcomes between GH-PAs and GH&PRL-PAs. Methods A multicenter retrospective study was conducted of 604 patients with acromegaly who underwent pituitary surgery. Patients were classified into 2 groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal (ULN) and IHC for GH and PRL was positive or PRL levels were greater than 100 ng/dL and PRL IHC was not available (n = 130) and b) GH-PA patients who did not meet the previously mentioned criteria (n = 474). Results GH&PRL-PAs represented 21.5% (n = 130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P < .001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs 77.4%; P = .001) and tended to be more invasive (33.6% vs 24.7%; P = .057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (odds ratio 2.8; 95% CI, 1.83-4.38). Insulin-like growth factor ULN levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 interquartile range (IQR) 1.73-3.29 vs 2.7 IQR 1.91-3.67; P = .023). There were no differences in the immediate (41.1% vs 43.3%; P = .659) or long-term postsurgical acromegaly biochemical cure rate (53.5% vs 53.1%; P = .936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs 2.4%; P = .011) in GH&PRL-PA patients. Conclusion GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger, and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
Purpose
In 2017, the WHO established that pituicytoma, granular cell tumour (GCT) and spindle cell oncocytoma (SCO) are posterior pituitary tumours (PPT). Recent data suggests that these tumours ...probably arise from the pituicytes and may constitute a spectrum of a unique histopathological entity. Our aim is to report the clinical findings and surgical outcomes of 16 patients with PPT. We also evaluated the tissue specimens available in light of current knowledge.
Method
Cross-sectional study with retrospective data.
Results
PPT were 7 pituicytomas, 3 GCT and 6 SCO. Patients mean age was 55 years old and 75% were female. Basal hormonal study showed hyperprolactinemia (43.7%) and hypopituitarism (37.5%). There was no case of diabetes insipidus (DI). MRI showed sellar/suprasellar masses with mean size of 19.7mm. PPT was not suspected in any patient. Fifteen patients underwent surgery and complications were common: 20% had perioperative bleeding (one patient died because of a massive haemorrhage), 57.1% hypopituitarism, 35.7% permanent DI and 21.4% underwent a second surgery. Pathological findings shown positivity for thyroid transcription factor 1, vimentin and negativity for cytokeratin and chromogranin A in all specimens evaluated. S100 protein was positive in 88.8% of tumours. Ki67 was ≥ 3% in 66.6% and ranged from 4-7% in SCO.
Conclusion
PPT have similar histology, clinical features and are frequently misdiagnosed as nonfunctioning pituitary tumours. However, post-surgical complications including haemorrhage are common. A high clinical suspicion is needed to presume the diagnosis prior surgery and diminish the high morbidity of these tumours.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population.
To evaluate the clinicopathological features and therapeutic ...outcomes of CP diagnosed in the elderly.
This was a retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated.
From a total of 384 adult CP patients, we selected 53 (13.8%) patients (27 women 50.9%, mean age 72.3 ± 5.1 years range 65-83 years) diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). The maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%), and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP and papillary CP were present in 51 and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9 to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs. 53.6%, p = 0.008). Patients were followed for 46.7 ± 40.8 months. The mortality rate was 39.6% with a median survival time of 88 (95% CI: 57-118) months. DI at last visit was associated with a lower survival.
CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation, visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.
This article examines part of an action research project carried out in a Spanish public school. We explain the complex reality of an early childhood education classroom. Focusing on early childhood ...education, the project was developed in collaboration with a teacher from one of the classrooms of four year olds. Several of the children in the class have serious behaviour problems. The teacher (Lucía) is very concerned because they take their anger and frustration out on objects, classmates and adults by hitting them. She has a lot of difficulty working with these problem children. This research work deals with transforming the practices of the researcher, the pupils and the teacher. One of the first critical challenges was to turn classroom discussions into opportunities for addressing the injustices that the children experience daily. Teaching should serve to empower children. Programmed classroom discussions can be a place where pupils are given the chance to speak out about conflicts, and where important decisions are made to address them.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
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