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Mali is one of the poorest countries in sub-Saharan Africa. Limited infrastructure renders access to health care difficult. There is a need to establish functional ways to improve Malian people’s health and treat disability. From this point of view, our project aims to implement a remote occupational therapy service for the beneficiaries of the Kalana clinic in Mali through international cooperation. Using a spiral iterative model, a proposal for a remote occupational therapy service was developed and refined for a multidisciplinary context. The International Classification of Functioning, Disability, and Health (ICF) was used as a means to work from a multidisciplinary approach to treat all needs. The results are exemplified with a case report and qualitative impressions of the services.

The different sets of criteria for diagnosis or classification of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) lead to numerous overlapping and reclassified diagnoses in clinical practice. We designed this study to assess the difficulties in classifying patients with AAV. As a secondary objective, different variables were tested to predict prognosis. We conducted a retrospective chart review in a Western Spain multicentre survey. A total of 115 adult patients diagnosed with AAV from 2002 to 2013 and followed for at least 3 years were included. They were classified according to (1) Chapel Hill Consensus Conference (CHCC), (2) European Medicines Agency algorithm and (3) French Vasculitis Study Group/European Vasculitis Society phenotypes. Fifty-three patients (46%) had neither distinctive histopathological data of a single AAV definition nor any surrogate markers for granulomatous inflammation and thus did not fulfill any diagnostic criteria. Ocular, ear, nose, throat, skin, and lung involvement were more frequent with proteinase 3 (PR3) antibodies, whereas peripheral neuropathy was more frequent with myeloperoxidase (MPO) antibodies. When the disease was severe at diagnosis, the HR for mortality was 10.44. When induction treatment was not given in accordance with the guidelines, the HR for mortality was 4.00. For maintenance treatment, the HR was 5.49 for mortality and 2.48 for relapse. AAV classification is difficult because many patients had neither specific clinical data nor distinctive histological features of a single CHCC definition. A structured clinical assessment of patient severity is the best tool to guide the management of AAV.

Background Professional reasoning provides a firm basis for the development of teaching and assessment strategies to support the acquisition of skills by healthcare students. Nevertheless, occupational therapy educators should use diverse methods of learning assessment to examine student learning outcomes more fully with an evaluation that supports the overall complexity of the process, particularly learners’ subjective experience. The aim of this article is to identify the range of perspectives among occupational therapy undergraduates regarding terms or concepts that are key for improving their professional reasoning. Methods Q-methodology was used to address the aim of the study. A concourse relating to a series of ideas, phrases, terminology, and concepts associated with various studies on professional reasoning in occupational therapy, specifically on students in this field, was generated. The terms that had the clearest evidence, the most relevance or the greatest number of citations in the literature were collected (n = 37). The P-set was assembled by non-probabilistic sampling for convenience. It comprised undergraduate university students in occupational therapy. Factor analysis was conducted using Ken-Q Analysis v.1.0.6, reducing the number of Q-sets to smaller groups of factors representing a common perspective. Results Through statistical analysis of the Q-sorts of 37 occupational therapy students, 8 default factors were identified. The four factors in accordance with the selection criteria were rotated by varimax rotation to identify variables that could be grouped together. Each viewpoint was interpreted, discussed and liked to different aspects of professional reasoning in occupational therapy. Conclusions The observed perceptions were linked to the various aspects of professional reasoning that have been widely discussed in the occupational therapy literature. For most of the students, there was a strong correspondence between the narrative, interactive and conditional aspects of the various components.

Background: This review aims to evaluate the level of scientific evidence for the effectiveness of Community Occupational Therapy interventions. Methods: A systematic review was used to analyze and synthesize the studies collected. The databases of Cochrane, OTseeker, OTCATS, Web of Science, Scielo and Scopus were used in order to collect articles published between 2007 and 2020. PRISMA recommendations were followed. Results: A total of 12 articles comprised part of the study (7 randomized controlled studies, 4 systematic reviews and 1 meta-analysis). The main areas of practice were geriatric gerontology (22.1%) and mental health (19.7%), which were statistically significant (χ2; p < 0.005) compared to the rest. Regarding the studies analyzed, all of them had scores of >7 on the PEDro and AMSTAR scales. Conclusions: Research on Community Occupational Therapy constitutes a consolidated line of research but the objectives and areas of research were limited. Descriptive qualitative methodology predominated and studies on the effectiveness of Community Occupational Therapy interventions showed a medium–low level of evidence.

The objective of the present study was to describe macroscopic and microscopic lesion in the rumen of bovine slaughtered in the Municipal Meat Processor of Colima, Mexico. The lesions found during the slaughter were macroscopically and subsequently fixed in 10% buffered formalin with pH 7.2 described. It was with the routine histological technique, and stained with hematoxylin-eosin (H-E) processed. 100 rumen were collected, as well as data on the origin, age, sex, and species of the animals. Data were, with the Chi-square independence test and logistic regression analysis analyzed. The 98% of the bovines presented at least one of the following lesions: hemorrhages, erosions, ulcers, scars, hyperkeratosis, hydropic degeneration, rumenitis, lymphangiectasia, a sample had a papilloma and the presence of the protozoan Balantidium coli was in 30% of the samples found. Dependence was found between B. coli to the origin (P= 0.046) and the sex (P= 0.041) of the animals. The variables that were significant (P=

Background/Aim. One way to facilitate occupational therapy undergraduate students transferring their academic skills of data gathering and analysis to professional settings is to ensure they can competently use diagnostic reasoning. Nevertheless, there are several obvious gaps in empirical evidence related to the learning and development of this style of reasoning in occupational therapy undergraduates. The most important are related to promoting higher-order thinking and the use of information to solve problems in the context of professional practice. This study analyses undergraduates’ diagnostic reasoning and its changes during their education. Materials and Methods. This multicentre study was conducted with a descriptive observational design. The study took place at the University of Coruña (Spain), University of Castilla-La Mancha (Spain), and University of el Valle (Colombia). The sample was n=247. For data collection, a clinical case was specifically designed. IBM SPSS Statistics (v19) and EPIDAT 3.1 were used for the data analysis. Results. Participants identified and categorized occupational performance problems. However, they had difficulties when identifying and categorizing the occupational performance components (specifically, the symptoms and signs of the disease presented in the study case). They presented limitations to analyse and synthesize the information collected to develop an explanation of the occupational problems and their causes. Conclusions. Undergraduate students’ ability to analyse and synthesize information during data collection is poorly organized, so it makes the problem formulation difficult. This study contributes to the knowledge of undergraduates’ diagnostic reasoning features, specifically the undergraduate students’ capacities and limits to process information during the occupational assessment.

Background/Aim. Professional reasoning in occupational therapy is the process used by practitioners to plan, direct, perform, and reflect on client care. The professional’s ability to manage the process of the intervention is structured around it, thereby influencing the effectiveness of the work carried out. The objectives of this research were to identify and describe (a) the historical development of this area of research from 1982 to 2017 and (b) the nature and volume of the scientific literature on professional reasoning in occupational therapy and the evidence that exists today. Methods. A scoping review method was used to carry out an historical mapping of research on professional reasoning and to summarise the lines of research explored to date. The review was conducted in five stages following the PRISMA guidelines. After applying the selection criteria, the search identified 303 references. Results. The results are presented under three headings: (a) nature and volume of publications on professional reasoning in occupational therapy according to number and year of publications, journal, country, author, and line of research; (b) historical trends in the scientific literature on professional reasoning in occupational therapy since 1982; and (c) methodological aspects of the research. Each of them is discussed through statistical analysis. Conclusions. The research about professional reasoning in occupational therapy is a field of empirical nature, in which qualitative studies predominate. Principal lines of research are focused on specific fields of practice, undergraduates, and theoretical aspects of professional reasoning. There were identified three historical phases with common features in terms of objectives and research methods.

The reproductive cycle of the gastropod Hexaplex princeps (Broderip, 1833) from Puerto Angel was studied through gonadal histology during two annual periods. The sex proportion for the total collected individuals was not statistically different from parity although most of the time the number of males was slightly larger than that of females, which only outnumbered males during the spawning season. The histological analysis of gonad sections permitted to establish six maturity stages for females: 1 Initial oogenesis, 2 Previtellogenic maturity, 3 Vitellogenic maturity, 4 Maturity, 5 Spawning, 6 Resting, and five for males: 1 Initial spermatogenesis, 2 Maturity, 3 Spawning, 4 Onset of the rest, 5 Resting). Monthly variations in the gonad maturation stages showed that H. princeps has an annual reproductive cycle with a long period of gonadal activity. The spawning season comprised from November to March (females) and from December to March (males) with peaks of activity for both sexes in January. Resting periods of females comprised from March to October and for males May and June. Thus the reproductive events were related to high Chlorophyll concentrations which in turn are due to the upwelling processes resulting from the winds during winter months (November to March). This study provides baseline information that may serve to establish measures for adequate exploitation and for aquaculture implementation of this species in the future. Normal 0 21 false false false ES-MX JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

Aspects of the reproductive biology of Octopus hubbsorum Berry, 1953 from the Coast of Oaxaca, Mexico, were analyzed. A total of 998 specimens of mantle length (ML) ranging from 40–220 mm were obtained from catches of artisanal fisheries from January 2011 to December 2012. The reproductive activity was assessed using gonad histology, oocyte development, maximum oocyte size, maturity, and gonadosomatic index. A good correspondence between main macroscopic characteristics and histological structure was observed, as emphasized in females where oviductal gland morphology correlates very well in the macroscopic evaluation of maturity. The fecundity range was estimated between 22,447–545,444 oocytes. Maturing oocyte size—frequency distribution was polymodal, and the spawning season is extended with two reproductive peaks. These results indicate that O. hubbsorum has asynchronic ovulation and, is an intermittent terminal spawner. The estimated size at sexual maturity (L50) for females was 90.5 mm ML an...

In this study, the growth of Oreochromis niloticus both mixed sex and males sexually reversed were analyzed in concrete ponds in the FES Zaragoza, UNAM, under the environmental conditions of the Mexico City. The experiment was carried from May to November 2013, in two concrete ponds of 50 m2. Similar feeding regime and stocking density of fish were maintained for the culture systems. Different growth parameters like body weight, length, daily weight gain (DWG), specific growth rate (SGR), feed conversion rate (FCR), Fulton’s condition index (K) and survival were analyzed during six months culture period. It was found that culture with monosex males tilapias yielded the highest weight, length, DWG and SGR compared to mixed sex populations tilapias. Water quality was monitored along the experiment. Based on the results, there were statistically significant differences in size (W = 20942.5, p 5 mg/L), warm water (>20°C), productive ( 8). Acceptable growth of fish and a yield of 3 ton/ha/6 months were obtained in both two ponds; therefore, the culture of tilapia under conditions of Mexico City was recommended.

RELAP/SCDAPSIM Mod 3.4 has been used to simulate a station blackout occurring at a BWR/5 power station. Further, a simplified model of a wet well and dry well has been added to the NSSS model to study the response of the primary containment during the evolution of this accident. The initial event leading to severe accident was considered to be a LOOP with simultaneous scram. The results show that RCIC alone can keep the core fully covered, but even in this case about 30% of the original liquid water inventory in the PSP is vaporized. During the SBO, without RCIC, this inventory is reduced about 5% more within six hours. Further, a significant pressure rise occurs in containment at about the time when a sharp increase of heat generation occurs in RPV due to cladding oxidation. Failure temperature of fuel clad is also reached at this point. As the accident progresses, conditions for containment venting can be reached in about nine hours, although there still exists considerable margin before reaching containment design pressure. Detailed information of accident progress in reactor vessel and containment is presented and discussed.

Introduction: The introduction of imatinib mesylate as first-line treatment has led to great improvements in the prognosis of patients with chronic myeloid leukemia (CML). The most used prognostic scores are Sokal, EUTOS and Hasford. Also, the time from diagnosis to imatinib and cytogenetic response influence the prognosis of patients with CML. However, there is no information about CML patients in chronic phase treated with imatinib in developing countries. Objectives: The aim of this study was to determine the prognostic factors in Peruvian patients with CML in chronic phase treated with imatinib (Glivec). Methods: Retrospective cohort of peruvian patients with chronic phase CML that received Imatinib (Glivec-Novartis) through the Glivec International Patient Assistance Program (GIPAP) in a national cancer center. The patients were classified according to prognostic scores of Sokal, EUTOS and Hasford at the beginning of imatinib therapy. The overall survival (OS) was calculated from the date of initiation of imatinib until the date of death or last contact. Event-free survival (EFS) was calculated from the date of start of treatment to date of occurrence of death from any cause during treatment, progression to accelerated phase or blast crisis CML or loss of major cytogenetic response. Transformation-free survival (TFS) was calculated from the date of start of treatment to date of occurrence of accelerated progression to blastic phase. Survival curves were estimated by Kaplan-Meier and comparison was done by log-rank test. Multivariate analysis for OS was performed with the Cox proportional hazard regression model. Results: 99 patients met the eligibility criteria and had a median observation time of 71.3 months. The average time from diagnosis to start imatinib was 11.4 months (CI 7.58-15.31). 14% of the patients had an age>55 years. The complete cytogenetic response at 12+3 months was 36%; the partial response was 16.67% and the lower response was 13.89%. According to the criteria of Sokal, EUTOS and Hasford, 59.58%, 49.49% and 27.27% were classified as higher risk, respectively. The 5-yrs-OS was 66.67% (CI 0.04-0.18%); 5-yrs-EFS, 68.63% (CI 0.13-0.38%) and 5-yrs-TFS, 60.82% (CI 0.21-0.41%). The patients with an age>55 years had significantly lower OS compared with the younger patients (p=0.039). The patients with a time higher than 12 months from diagnosis to imatinib had significantly lower OS than the patients that started it earlier (p=0.0076). The OS was significantly different according to the risk groups of Sokal score (p=0.0221). Also, significant difference was found in the EFS according to cytogenetic response (p=0.042). In the multivariate analysis, the factors that influence OS were high risk according toSokal score (HR=9.42 CI1.09-81.29) and a time greater than 12 months from diagnosis Imatinib (HC=3.53 CI1.12-11.18). Conclusion: In this Peruvian population, the majority of patients are at high risk groups of Sokal, EUTOS and Hasford scores. High risk according to Sokal score and a time higher than 12 months from diagnosis to imatinib were the main prognostic factors. Disclosures No relevant conflicts of interest to declare.

Objective. There are limited data on the long-term prognosis of microscopic polyangiitis (MPA). A systematic review was performed to estimate the survival, renal survival and relapse rates in patients with MPA. Methods. Articles included in MEDLINE and EMBASE databases were reviewed. Randomized or nonrandomized trials, cohort, casecontrol and cases-series studies of patients with MPA diagnosed according to Chapel Hill Consensus Conference definitions, a high rate of biopsy-confirmed diagnosis, follow-up >1 year and follow-up losses

Long-term prognoses of Wegener granulomatosis (WG) and Churg-Strauss syndrome (CSS) are known; however, few data exist on long-term prognoses for microscopic polyangiitis (MPA). Our aim was to analyse the prognoses of MPA.Cohort study with retrospective selection of patients. Twenty-two patients admitted to our Hospital (1990-2006) with biopsy-proven MPA were studied. The start date for entry into the study was the date of diagnosis. Statistical analysis was performed to look for prognostic factors for survival.MPA patients were followed-up for a median of 78 (5-131) months. MPA patients were treated with cyclophosphamide (Cy) plus corticosteroid (Cs) (59%) or Cs alone (41%). Seven MPA patients died. Cumulative MPA patient survival at 1, 5, and 10 years were 85% (75-95%), 85% (75-95%), and 74% (60-88%) in those treated with Cy plus Cs and 50% (32-68%), 36% (14-58%), and 0% (0-30%) in those treated with Cs alone, respectively (P=0.04). Disease extent index5 (P=0.02) and age65 years (P=0.02) were associated with improved survival rates in MPA patients treated with Cy. Five MPA (23%) patients relapsed after a median of 54 months (35-93). No variables were related to relapses. Despite treatment, 11MPA (50%) patients developed end-stage renal disease after a median of 9 months (0-53).Most MPA patients had life-threatening renal or lung involvement at diagnosis. Patients not treated with immunosuppressants had a poorer prognosis. The long-term prognosis of MPA patients who survived 6 months post diagnosis was good, although renal survival rates are low.

Objetivo: Aportar un nuevo caso de leiomioma capsular asintomático. Método: Paciente de 68 años asintomático que tras estudio radiológico (ECO y TAC ) es diagnosticada de masa sólida. Resultado: El tratamiento de este proceso neoformativo renal , fue nefrectomía radical, con curso postoperatorio sin incidencias y anatomía patológica, leiomioma renal. Conclusión: El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que debe tenerse en cuenta ante el diagnóstico de masa renal , dado que sería subsidiario de una cirugía renal conservadora, no obstante ante la dificultad para diferenciarlo del carcinoma renal, no es infrecuente que el diagnóstico se produzca tras el análisis histológico de la pieza de nefrectomía.

OBJETIVO: Presentar un caso de rabdomiosarcoma paratesticular derecho en un adulto joven de 21 años de edad. MÉTODOS: Tras realizar tratamiento con orquiectomía radical derecha vía inguinal, que se clasifica dentro del grupo clínico IA según el IRS - III (enfermedad localizada completamente resecada), se complementa con vincristina y actinomicina- D. RESULTADOS/CONCLUSIONES: Encontrándose libre de enfermedad a los 18 meses de la intervención quirúrgica. Destacando la importancia del tratamiento adyuvante en la evolución posterior de la enfermedad tumoral.

Bartter syndrome can manifest in three different forms and is rarely concomitant with glomerular nephropathies. However, this association is more frequently observed in children. We report the case of a 50-year-old woman with Gitelman syndrome for the past 30 years who also had a nephrotic syndrome of recent appearance. Her renal biopsy revealed hyperplasia of the juxtaglomerular apparatus and mesangial deposits of C1q, with no clinical or serological evidence of systemic erythematous lupus. We have not found any reports of instances of association of Gitelman syndrome and nephrotic syndrome arising from C1q nephropathy in adult patients. Our case suggests the possible existence of an association between hypokalaemic tubular nephropathies and glomerular nephropathies that may cause nephrotic syndrome.

Objective: To estimate the prevalence and characteristics of urinary incontinence (UI) in the noninstitutionalized elderly population of Madrid. Spain. Methods: We carried out a cross-sectional study in a representative sample of all community-dwelling people aged 65 or over. Subjects were interviewed in their homes. The question: Do you currently experience any difficulty in controlling your urine?... In other words, does your urine escape involuntarily? Was used to identify UI. Type of UI, use of absorbents and specific drugs were also assessed, as well as consultation behaviour. Results: 589 persons were interviewed (response rate: 71,2 %). The prevalence of UI was 15,5%. No significant difference was observed between men and women. Urge UI was the main type for men and mixed UI for women. Use of pads was referred by 20,2% of men. A total of 34,4% of subjects never went to the doctor for their problem (25,2% of men and 39,4% of women). Conclusion: Compared to other populations the overall prevalence of UI in Spanish elders living at home is relatively high. A very small difference by gender was found, although a lower response rate in women could in part explain this unexpected finding. Publicado

To the Editor: The small-vessel vasculitides associated with antineutrophil cytoplasmic antibodies (AASV) are a group of rare conditions characterized by inflammation and necrosis of blood vessel walls. The etiology of these conditions is largely unknown, but genetic and environmental factors have been related with the pathogenesis of AASV. Clues to the role of the environmental factors have been obtained by comparison of the incidence of the various entities of the AASV in different regions of the world1,2. Although evidence suggests that the overall incidence of AASV is similar throughout Europe3,4, reports support the idea of a north-south gradient of the granulomatosis with polyangiitis (Wegener’s) (GPA)/microscopic polyangiitis (MPA) ratio. GPA would be more common in the northern regions of the continent1,2,4,5, and MPA more common in the southern regions1,2,6 … Address correspondence to Dr. L. Corral-Gudino, Department of Internal Medicine, Hospital el Bierzo, c/o Medicos sin Fronteras, 7, CP: 24411, Fuentesneuvas, Ponferrada, Leon, Spain. E-mail: lcorral{at}saludcastillayleon.es