Metastatic Crohn's disease: a difficult diagnosis from different perspectives

Metastatic Crohn's disease (MCD) is a rare cutaneous manifestation of Crohn's disease (CD). The simultaneous involvement of the vulva and oral region is uncommon in clinical presentations of MCD. We present the case of a middle-aged woman with a family history of autoimmunity who initially presented with oral and vulvoperineal involvement. Initially, Behçet's disease was ruled out, but histopathological studies of the vulva revealed findings compatible with MCD. The patient had no gastrointestinal symptoms, and fecal calprotectin levels were normal. Upper and lower endoscopic examinations and capsule endoscopy of the small intestine (SI) did not reveal any significant findings. Treatment with anti-tumor necrosis factor (anti-TNF) agents was initiated but resulted in paradoxical psoriasis with adalimumab and infliximab. Cyclosporine was also used, but the patient experienced intolerable tachycardia. After 18 months, the patient developed episcleritis and experienced diarrhea accompanied by cramp-like abdominal pain. Repeat upper and lower endoscopic examinations showed normal results, while capsule endoscopy of the SI revealed CD enteritis. The patient was diagnosed with CD of the small intestine, along with extraintestinal manifestations of vulvoperineal MCD, oral involvement, and episcleritis. Management with azathioprine and ustekinumab was initiated, resulting in significant clinical improvement. MCD poses a diagnostic challenge due to its unusual manifestations. It may present without gastrointestinal tract involvement, mimicking other conditions. Therefore, timely diagnosis and the selection of the most appropriate therapeutic strategy are crucial.

La enfermedad de Crohn metastásica (ECM) es una entidad rara, es una manifestación cutánea en enfermedad Crohn (EC), y en su presentación clínica es inusual el compromiso vulvar y oral de modo concomitante. Se describe el caso de una mujer de edad media que tiene historia familiar de autoinmunidad, presenta inicialmente compromiso oral y vulvoperineal. En su abordaje inicial se descartó enfermedad de Behçet, pero los estudios histopatológicos a nivel vulvar tuvieron hallazgos compatibles para ECM. Hubo ausencia de síntomas gastrointestinales y sus niveles de calprotectina fecal eran normales. Los estudios endoscópicos altos y bajos, y la cápsula endoscópica del intestino delgado (ID) no tuvieron hallazgos relevantes. Se inició el tratamiento con antifactor de necrosis tumoral (anti-TNF) y presentó una psoriasis paradójica con adalimumab e infliximab. También se utilizó ciclosporina y presentó una taquicardia intolerable. 18 meses después de estos síntomas tuvo epiescleritis e inició con diarrea asociada a dolor abdominal tipo cólico, por lo que se repitieron los estudios endoscópicos altos y bajos, que resultaron normales, y cápsula endoscópica de ID mostró una enteritis por EC. Se consideró EC de ID con manifestaciones extraintestinales y con ECM vulvoperineal, compromiso oral y epiescleritis. Se requirió manejo con azatioprina y ustekinumab, con una mejoría clínica significativa. La ECM es un reto diagnóstico, pues es una manifestación inusual; en su debut puede haber ausencia de compromiso en el tracto gastrointestinal y también simular otras entidades. Debe buscarse lograr el diagnóstico oportuno y la estrategia terapéutica más segura.

Oral manifestations associated with inflammatory bowel disease and early endoscopic findings in patients with spondyloarthritis.

BACKGROUND AND AIMS: Spondyloarthritis (SpA) is a group of autoinflammatory disorders, of which the primary extra-articular manifestation is inflammatory bowel disease (IBD). The oral cavity being a part of gastrointestinal tract, is significantly compromised in IBD, and in many cases, it is the first site of clinical manifestations of IBD. This study aimed to identify changes in the oral mucosa associated with the onset of IBD and their association with endoscopic/histological findings. MATERIALS AND METHODS: The study assessed 80 patients with SpA and 52 healthy controls. Oral, rheumatological, and gastroenterological assessments were performed. The ileocolonoscopy was performed via digital magnification chromoendoscopy. The statistical analysis consisted of Chi-square, Fisher's exact, and multiple correspondence discriminant analysis tests. RESULTS: From the disease cohort, 63.0% patients showed oral lesions (p = 0.050). These manifestations ranged from gingivitis (55.0%, p = 0.001), aphthous stomatitis (3.8%, p = 0.091), angular cheilitis (2.6%, p = 0.200), and perioral erythema with scaling (1.3%, p = 0.300). All patients who presented with alterations in colonic mucosa also had oral lesions associated with IBD (p = 0.039), specifically gingivitis/aphthous stomatitis (p = 0.029). CONCLUSION: The patients with SpA without IBD present significant oral signs and symptoms. Gingivitis seems to be the most relevant because of its associations with early endoscopic and histological findings. CLINICAL RELEVANCE: An integral approach to the diagnostic tests that includes evaluations of oral, rheumatological and gastroenterological tissues may favor timely attention and improve patients' quality of life.

Predictores del bienestar psicológico en estudiantes universitarios mexicanos físicamente activos / Preditores de bem-estar psicológico em estudantes universitários mexicanos fisicamente ativos / Predictors of psychological well-being in physical activity mexican university students

El objetivo de la presente investigación fue analizar el poder predictivo de la motivación intrínseca y la autoeficacia para mantenerse activo sobre el bienestar psicológico en estudiantes universitarios mexicanos físicamente activos. La muestra de este estudio predictivo transversal estuvo conformada por 539 estudiantes universitarios físicamente activos, de ambos sexos (Hombres = 34%, mujeres = 66%) y con edades comprendidas entre los 17 y 47 años (M = 19.8, DT = 2.88). El 84% de los universitarios reporta hacer ejercicio físico de manera regular y el 36% practicar deporte de manera formal. De acuerdo con los principales resultados del análisis de regresión múltiple por el método de pasos sucesivos, la autoeficacia resultó el mejor predictor de los tres indicadores de bienestar psicológico (Autoestima, satisfacción con la vida y vitalidad subjetiva). La motivación intrínseca predijo la vitalidad subjetiva. A pesar de que los porcentajes de varianza explicada son relativamente bajos, tanto la autoeficacia como la motivación intrínseca resultaron predictores de la vitalidad subjetiva en universitarios que realizan actividad físico-deportiva de manera regular. La autoeficacia para mantenerse físicamente activo resultó ser el mejor predictor de los tres indicadores de bienestar psicológico. Un individuo que confía en sus planes para mantenerse realizando actividad físico-deportiva, con objetivos claros, es probable que se sienta mejor consigo mismo, acepte su vida actual y experimente niveles de energía óptimos. (AU)

Theobjective of the current research is to analyze the predictive power of intrinsic motivation and self-efficacy for physical activity on psychological well-being in Mexican university students. The sample of this transversal predictive studyconsisted of 539 physically active university students of both sexes (men = 34%, women = 66%) and aged between 17 and 47 years (M= 19.8, SD= 2.88). 84% of the university students reported to exercise on a regular basis and 36% practice sports in a formal way. According to the results of the multiple regression analysis using the successive steps method, self-efficacy was the best predictor of the three indicators of psychological well-being (self-esteem, satisfaction with life and subjective vitality). In the same way,intrinsic motivation predicted subjective vitality. Even though the explained variance percentages are relatively low, both self-efficacy and intrinsic motivation were predictors of subjective vitality in university students who regularly have physical-sports activity. Self-efficacy for physical activity is the best predictor of the three indicators of psychological well-being. Therefore, when people trust in their plans to keep doing physical activity, with clear objectives, they are more likely to feel better about themselves, enjoy their life and have optimal energy levels. (AU)

O objetivo desta pesquisa foi analisar o poder preditivo da motivação intrínseca e da autoeficácia para permanecer ativo no bem-estar psicológico em estudantes universitários mexicanos fisicamente ativos. A amostra deste estudo preditivo transversal foi composta por 539 universitários fisicamente ativos, de ambos os sexos (Homens = 34%, mulheres = 66%) e com idade entre 17 e 47 anos (M = 19,8, DP = 2,88). 84% dos universitários relatam praticar exercícios físicos regularmente e 36% praticam esportes formalmente. De acordo com os principais resultados da análise de regressão múltipla pelo método de etapas sucessivas, a autoeficácia foi o melhor preditor dos três indicadores de bem-estar psicológico (autoestima, satisfação com a vida e vitalidade subjetiva). A motivação intrínseca predisse a vitalidade subjetiva. Apesar dos percentuais de variância explicada serem relativamente baixos, tanto a autoeficácia quanto a motivação intrínseca foram preditores de vitalidade subjetiva em universitários que praticam regularmente atividade física e esportes. A autoeficácia para se manter fisicamente ativo foi o melhor preditor dos três indicadores de bem-estar psicológico. Um indivíduo que confia em seus planos de continuar praticando atividade física e esportes, com objetivos claros, provavelmente se sentirá melhor consigo mesmo, aceitará sua vida atual e experimentará níveis ótimos de energia. (AU)

Autoestima y estilos de afrontamiento: predictores de la calidad de vida en personas con hemofilia / Self-esteem and coping skills: predictors of quality of life in patients with hemophilia

Introducción: La hemofilia es un trastorno hemorrágico que causa dolor y daños articulares graves. Las personas con esta condición de salud suelen presentar problemas psicosociales como baja autoestima y dificultad para enfrentar la enfermedad, lo cual puede impactar negativamente en su calidad de vida relacionada a la salud (CVRS). Objetivo: Analizar el efecto predictor de la autoestima y las estrategias de afrontamiento hacia la CVRS en personas con hemofilia. Métodos: Estudio cuantitativo, no experimental, de tipo correlacional, con muestra por conveniencia, realizado en 60 participantes con hemofilia, edades comprendidas entre 15 y 67 años (media = 27,43, desviación estándar = 11,32). Se utilizaron los cuestionarios: Calidad de Vida Específica para Hemofilia, Autoestima y Afrontamiento al Dolor Crónico. Se realizaron análisis descriptivos, correlación de Pearson y análisis de regresión lineal múltiple con el método por pasos. Resultados: Se obtuvo que el nivel de CVRS fue mayormente moderado; sin embargo, se observaron niveles bajos en las dimensiones Deporte y tiempo libre y Futuro. La dimensión Éxito de la escala de autoestima correlacionó positivamente con las dimensiones Deporte y tiempo libre (r(60)= 0,59), Salud física (r(60)=0,54) y Autopercepción (r(60)=0,48) de la escala calidad de vida; además de haber mostrado un nivel alto de predicción de la calidad de vida (R 2 = 0,35, p= 0,00). Conclusiones: Se comprobó que la autoestima resulta ser una variable predictora de la CVRS de los pacientes con hemofilia. Se requiere fortalecer la autoestima y la manera de enfrentarse ante el dolor crónico en personas con este padecimiento en pro de su calidad de vida y bienestar(AU)

Introduction: Hemophilia is a bleeding disorder that causes severe pain and damage to the joints. People with this health condition often present psychosocial problems such as low self-esteem and difficulty facing their disease, which can negatively impact their health-related quality of life (HRQoL). Objective: To analyze the predictive effect of self-esteem and coping strategies towards HRQL in people with hemophilia. Methods: This was a quantitative, non-experimental, correlational study, with a convenience sample, carried out in 60 participants with hemophilia, ages between 15 and 67 years (mean = 27.43, standard deviation = 11.32). The Specific Quality of Life for Hemophilia, Self-esteem and Coping with Chronic Pain questionnaires were used. Descriptive analyzes. Pearson correlation and multiple linear regression analysis were performed with the stepwise method. Results: It was found that the level of HRQL was mostly moderate, however, low levels were observed in the Sports and free time and Future dimensions. The Success dimension of the self-esteem scale positively correlated with the Sports and free time dimensions (r(60) = 0.59). Physical health (r(60) = 0.54) and Self-perception (r(60) = 0.48) of the quality of life scale, in addition to having shown a high level of prediction of quality of life (R2 = 0.35, p = 0.00). Conclusions: It was found that self-esteem turns out to be a predictor variable of HRQL in patients with hemophilia. It is necessary to strengthen self-esteem and the way of coping with chronic pain in people with this condition in favor of their quality of life and well-being(AU)

Psychometric Validation of the Internet Gaming Disorder-20 Test among Ecuadorian Teenagers and Young People.

Excessive internet gaming in high prevalence is a very common problem that has been increasing in recent years, especially in teenagers and university students. However, there is a lack of psychometric evaluation for Internet Gaming Disorder in the Latin American context, particularly in Ecuador. This paper aims to examine the psychometric properties of the Spanish version of the Internet Gaming Disorder test (IGD-20 test) in university and high school students (n=2931, Mage=15.99, 57.22% male and 42.51% female). The validation process was performed using one, two, five and six factors taking into account the Spanish, Chinese, Korean, Arabic and Turkish contexts. After checking the models proposed to date, the best fit model was the one with a single factor. Using two samples according to gender (male, female), the invariance has been confirmed with an excellent internal consistency. All, α=0.94; Male, α=0.93; Female, α=0.93). Furthermore, we performed correlation analyses between the IGD-20 Test and socio-demographic variables, and finally, the IGD-20 Test applied to Ecuadorian teenagers and young people demonstrated good psychometric properties.

Reduced ecosystem resilience quantifies fine-scale heterogeneity in tropical forest mortality responses to drought.

Sensitivity of forest mortality to drought in carbon-dense tropical forests remains fraught with uncertainty, while extreme droughts are predicted to be more frequent and intense. Here, the potential of temporal autocorrelation of high-frequency variability in Landsat Enhanced Vegetation Index (EVI), an indicator of ecosystem resilience, to predict spatial and temporal variations of forest biomass mortality is evaluated against in situ census observations for 64 site-year combinations in Costa Rican tropical dry forests during the 2015 ENSO drought. Temporal autocorrelation, within the optimal moving window of 24 months, demonstrated robust predictive power for in situ mortality (leave-one-out cross-validation R2  = 0.54), which allows for estimates of annual biomass mortality patterns at 30 m resolution. Subsequent spatial analysis showed substantial fine-scale heterogeneity of forest mortality patterns, largely driven by drought intensity and ecosystem properties related to plant water use such as forest deciduousness and topography. Highly deciduous forest patches demonstrated much lower mortality sensitivity to drought stress than less deciduous forest patches after elevation was controlled. Our results highlight the potential of high-resolution remote sensing to "fingerprint" forest mortality and the significant role of ecosystem heterogeneity in forest biomass resistance to drought.

[Kidney transplant future developments.] / Futuro del trasplante renal.

OBJECTIVE: Kidney transplantation process involves a series of challenges such as the shortage of organs worldwide for a population waiting for a first and subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizing the ischemia time as much as possible, minimizing the impact of surgery and subsequent immunosuppressive therapy. METHODS: We carry out a review of the different advances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enabling the expansion of living donor programs as well as orga preservation strategies previous to transplantation surgery.The arrival of robotic surgery in the field of kidney transplantation has been an important milestone in the last decade, showing improvements compared to traditional open surgery, maintaining satisfactory functional results, although its implementation is currently reduced with technical limitations in the extension to any type of recipient. New immunosuppressive agents that minimize potential side effects or reduce anticalcineurinic drugsdoses are also important lines of research. CONCLUSIONS: The future of kidney transplantation involves the search for increasingly global strategies to improve the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the different areas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools in the field of tissue generation or targeted immunosuppressive therapies.

OBJETIVO: El proceso del trasplante renal conlleva una serie de retos como son la escasez de órganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injertomás apropiado para cada receptor optimizando al máximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora.MÉTODOS: Realizamos una revisión de los diferentes avances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes,posibilitar la expansión de programas de donante vivo así como las estrategias de preservación del órgano previamente a la cirugía del implante.El desembarco de la cirugía robótica en el campo del trasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en la actualidad con limitaciones técnicas en la extensión a cualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicos son también líneas importantes de investigación. CONCLUSIONES: El futuro del trasplante renal pasa por la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en el acondicionamiento y preservación de los injertos o el desarrollo a escala global de la cirugía mínimamente invasiva en los diferentes ámbitos del trasplante renal. El peso de las biotecnologías y terapias génicas suponen herramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.

Futuro del trasplante renal / Future of kidney transplantation

Objetivo: El proceso del trasplante renalconlleva una serie de retos como son la escasez deórganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injerto más apropiado para cada receptor optimizando almáximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora. Métodos: Realizamos una revisión de los diferentesavances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes, posibilitar la expansión de programas de donante vivo así como las estrategias de preservación delórgano previamente a la cirugía del implante. El desembarco de la cirugía robótica en el campo deltrasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en laactualidad con limitaciones técnicas en la extensión acualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicosson también líneas importantes de investigación.Conclusiones: El futuro del trasplante renal pasapor la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en elacondicionamiento y preservación de los injertos o eldesarrollo a escala global de la cirugía mínimamenteinvasiva en los diferentes ámbitos del trasplante renal. Elpeso de las biotecnologías y terapias génicas suponenherramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.(AU)

Objetive: Kidney transplantation process involves a series of challenges such as the shortageof organs worldwide for a population waiting for a firstand subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizingthe ischemia time as much as possible, minimizing theimpact of surgery and subsequent immunosuppressivetherapy.Methods: We carry out a review of the differentadvances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enablingthe expansion of living donor programs as well as organpreservation strategies previous to transplantation surgery. The arrival of robotic surgery in the field of kidneytransplantation has been an important milestone in thelast decade, showing improvements compared to traditional open surgery, maintaining satisfactory functionalresults, although its implementation is currently reducedwith technical limitations in the extension to any type ofrecipient. New immunosuppressive agents that minimizepotential side effects or reduce anticalcineurinic drugsdoses are also important lines of research.Conclusions: The future of kidney transplantationinvolves the search for increasingly global strategies toimprove the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the differentareas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools inthe field of tissue generation or targeted immunosuppressive therapies.(AU)

Burnout, Positivity and Passion in Young Mexican Athletes: The Mediating Effect of Social Support.

The burnout syndrome is a negative experience for athlete development and it has been demonstrated that it gets worse when a sport is practiced in an obsessive way. Interventions with a positive view towards sports could be a protective factor to boost the athlete's wellbeing. The aim of the present study was to analyse the mediator effect from social support, the relationship between the burnout, positivity and passion in young Mexican athletes. The sample was composed by 452 Mexican athletes, males and females (women 45%), from 12 to 18 years of age (M = 16.29, SD = 1.66). Participants answered the Athlete Burnout Questionnaire, The Scale of the Social Support Perceived by Athletes, the Passion Scale and the Positivity Scale. The results of structural equation modeling showed a good adjustment model (χ2 = 889.213; df = 274; χ2/df = 3.245; p ˂ 0.01; CFI = 0.93; TLI = 0.91; IFI = 0.94; NFI = 0.91; RMSEA = 0.07). The harmonious passion presented direct and indirect effects on the burnout, being the perceived social support the mediator variable of the indirect effect. The positivity resulted positive predictor from the social support (ß = 0.714, p ˂ 0.001) and social support predicted the burnout (ß = -0.270, p ˂ 0.005). The obsessive passion had a direct effect over burnout (ß = 0.627, p ˂ 0.001). Developing negative commitments to sports could be an indicator of a greater risk of experiencing individual conflicts that lead to sports burnout.

P048 Metastatic Crohn's Disease Debuting with Severe Oral Manifestation and Vulvar Involvement - A Diagnostic Challenge.

CASE: Background: Metastatic Crohn's disease (MCD) is an unusual cutaneous manifestation in Crohn's disease (CD), and concomitant oral and vulvar involvement is even more unusual. It can debut with cavity lesions oral such as canker sores, ulcers, lip edema, granulomatosis, dry mouth, abscesses in the salivary ducts, erythema, gingivitis, glossitis, among others, however, simultaneous compromise with several oral lesions and so severe with loss of multiple pieces dental is very rare. CASE PRESENTATION: Patient in the fourth decade of life with a family history of autoimmunity who debuts with severe oral manifestations with a requirement for extraction of 14 teeth, severe gingivitis, smooth tongue and glossitis, aphthous stomatitis, ulcers, lip edema and angular cheilitis, without clear cause, and in management by the oral pathology group. Associated with this, there was vulvo-perineal compromise with ulcerated, inflammatory, erythematous and infiltrated lesions. It was initially suspected of Behçet's disease, HLA B51 was performed, it was negative, also, negative pathergy test, and no other suggestive systemic findings. A vulvar biopsy was performed with marked edema of the dermis, dilated lymphatics with perivascular and interstitial lymphoplasmacytic infiltrate and noncaseating granulomas, negative for microorganisms. At this level, it was compatible with MCD, without presence of gastrointestinal symptoms and calprotectin levels in stool in normal range. High and low endoscopic studies and capsule endoscopy were performed in small intestine, without alterations, it was managed by dermatology with topical steroids and by dentistry with dental implants. It was considered patient with inflammatory bowel disease (IBD) type CD with severe extraintestinal manifestations (EIM), although it did not present compromise intestinal treatment, it was decided to start treatment with anti-TNF initially with adalimumab developing paradoxical psoriasis, later treatment with infliximab, again with presentation of severe paradoxical psoriasis, for which it was suspended. Cyclosporine was also used as an immunomodulator, presenting intolerable tachycardia. 18 months after these symptoms, she presented episcleritis of the left eye and begins with colicky abdominal pain and average diarrheal stools 5-a-day, it was performed high and low endoscopic studies without alterations and new capsule endoscopic of small intestine documenting Crohn's enteritis involving the duodenum, jejunum and ileum, considering a patient with IBD type CD, with EIM with vulvo-perineal compromise, severe oral involvement and episcleritis. Currently is under management with azathioprine and Ustekinumab, with clinical improvement significant. CONCLUSIONS: MCD represents a diagnostic challenge, it can debut without gastrointestinal involvement, and its clinical and histopathological findings simulate other entities. A timely diagnosis is required to seek early benefit in the patient.

P050 Oral Inflammatory Changes Associated With Inflammatory Bowel Disease in Spondyloarthritis Associated With Early Endoscopic Findings.

BACKGROUND: Spondyloarthritis (SpA) is a heterogeneous group of chronic autoinflammatory disorders that can present extra-articular gastrointestinal manifestations. Among them is mainly inflammatory bowel disease (IBD). Although IBD mainly affects the intestinal tract, it can include early manifestations evident in the oral cavity. No comparative data on these oral manifestations in patients with SpA were found in the literature. OBJECTIVE: To identify oral clinical manifestations due to changes in the oral mucosa associated with IBD in patients with SpA without a diagnosis of IBD and associate them with endoscopic and histological findings. METHODS: 80 patients with SpA and 52 healthy controls were evaluated. They were assessed intra- and extra-orally, following the modified World Health Organization guideline. In addition, by clinical parameters of rheumatological, gastrointestinal and laboratory activity. Ileocolonoscopy was performed with digital chromoendoscopy with magnification and histological analysis. Comparative analyzes were performed by Chi square tests, Fisher's exact tests, confirmed by univariate regression and discriminant analysis of multiple correspondences. Institutional ethics committee approval cod-2017-023. RESULTS: The patients with SpA had 56% male gender, mean age of 42.8 years (SD ± 10.4) and a BMI in the range of 23.9 - 28.4. The healthy controls, 54% of the male gender with an average age of 41 years (SD ± 13.6) and a body mass index-BMI in the range of 22.9 - 27.6. The patients reported smoking only in 6.2%, however as a smoking history in 31% and passive smokers (15%), the majority employed (41%), married (56%) and professionals (49%). Of the healthy controls, they smoked (15%), with a history of smoking (31%), passive smokers (21%), the majority employed (77%), with their own home (67%), and professionals (54%). The patients with SpA reported a greater presence of some signs and symptoms of gastrointestinal origin 69%, while in the controls it was 7.7% (p = 0.001). Forty one of them were referred to colonoscopy with magnification being in 17.1 % changes in the mucosa of the rectum and in the same frequency changes in the mucosa of the sigmoid colon. Regarding the ileum, changes in the mucosa were evidenced in 41.5% of the cases. The presence of oral lesions was evident and predominated in them (63%) compared to controls p = 0.050. The main oral lesions associated with IBD were gingivitis (55%) (p = 0.001), followed by aphthous stomatitis (3.8%), angular cheilitis (2.6%) and perioral erythema with scaling (1.3%). 100% of the patients who presented alteration of the colonic mucosa presented oral lesions associated with IBD (p = 0039), which was also significantly associated with the presence of gingivitis/aphthous stomatitis (p = 0.029). CONCLUSION: Patients with SpA without a diagnosis of IBD have more oral signs and symptoms compared to healthy controls. Gingivitis is important given its association with early endoscopic and histological findings. Manifestations in the oral cavity can precede intestinal manifestations, therefore the clinical assessment by the oral pathologist in conjunction with gastroenterology and rheumatology allows a timely referral to gastroenterology and an endoscopic and histological evaluation, impacting the quality of life of patients.

A catastrophic tropical drought kills hydraulically vulnerable tree species.

Drought-related tree mortality is now a widespread phenomenon predicted to increase in magnitude with climate change. However, the patterns of which species and trees are most vulnerable to drought, and the underlying mechanisms have remained elusive, in part due to the lack of relevant data and difficulty of predicting the location of catastrophic drought years in advance. We used long-term demographic records and extensive databases of functional traits and distribution patterns to understand the responses of 20-53 species to an extreme drought in a seasonally dry tropical forest in Costa Rica, which occurred during the 2015 El Niño Southern Oscillation event. Overall, species-specific mortality rates during the drought ranged from 0% to 34%, and varied little as a function of tree size. By contrast, hydraulic safety margins correlated well with probability of mortality among species, while morphological or leaf economics spectrum traits did not. This firmly suggests hydraulic traits as targets for future research.

Análisis de las propiedades psicométricas de la versión mexicana de la Dieting Self-Efficacy Scale (DIET-SE) / Analysis of the psychometric properties of the Mexican version of the Dieting Self-Efficacy Scale (DIET-SE)

Introducción: investigaciones recientes demuestran que las personas con altos niveles en autoeficacia para llevar una dieta saludable pueden controlar su peso. La escala Dieting Self-Efficacy Scale (DIET-SE) es un instrumento completo que mide la autoeficacia para llevar una dieta saludable, sin embargo, no existen versiones en español para población mexicana. Objetivo: el propósito del presente estudio es analizar las propiedades psicométricas de la versión mexicana del DIET-SE. Método: la muestra estuvo conformada por 807 estudiantes universitarios mexicanos, de ambos sexos y con edades comprendidas entre los 17 y los 48 años (M = 20,65, DT = 3,16). Para la traducción al castellano de la escala DIET-SE, se siguió la metodología parallel back- translation. Además del análisis descriptivo y la correlación de Pearson, se utilizó el coeficiente alfa de Cronbach para el estudio de la consistencia interna y para el ajuste del modelo se utilizaron varios índices. Resultados: los resultados del AFC por el método de máxima verosimilitud encontraron suficiente evidencia para la validez de constructo (χ2 = 175,68;gl = 35 [77-42]; χ2/gl = 5,02, p < 0,01; TLI = 0,92, IFI = 0,96, CFI = 0,95 y RMSEA = 0,07). Las cargas factoriales de los once ítems mostraron valores aceptables. Los resultados en el análisis de correlación entre la DIET-SE y los indicadores de bienestar psicológico pueden considerarse como prueba favorable de la validez discriminante. En cuanto a la fiabilidad, se encontraron resultados aceptables en consistencia interna. Conclusión: la DIET-SE es una escala válida y fiable para evaluar la autoeficacia para mantener una dieta en estudiantes universitarios mexicanos

Introduction: recent research shows that people with high levels of self-efficacy for a healthy diet can control their weight. The Dieting Self-Efficacy Scale (DIET-SE) scale is a complete instrument that measures self-efficacy for a healthy diet, however, there are no Spanish versions for the Mexican population. Objective: the purpose of this study is to analyze the psychometric properties of the Mexican version of DIET-SE. Method: the sample consisted of 807 Mexican university students, of both sexes and aged between 17 and 48 years (M = 20.65, SD = 3.16). The parallel back-translation methodology was used to translate the DIET-SE scale into Spanish. In addition to the descriptive analysis and the Pearson correlation, the Cronbach alpha coefficient was used to measure the internal consistency and other indices were used for the factorial model. Results: the results of the CFA using the maximum likelihood estimation found good evidence for the construct validity (χ2 = 175.68; gl = 35 [77-42]; χ2/gl = 5.02, p < 0.01; TLI = 0.92, IFI = 0.96, CFI = 0.95 y RMSEA = 0.07). The factorial loads of the eleven items showed acceptable values. The results in the correlation analysis between the DIET-SE and psychological well-being indicators can be considered as a favorable proof of the discriminant validity. In terms of reliability, acceptable results were found in internal consistency. Conclusion: the DIET-SE is a valid and reliable scale to evaluate the self-efficacy to maintain a diet in Mexican university students

[Analysis of the psychometric properties of the Mexican version of the Dieting Self-Efficacy Scale (DIET-SE)]. / Análisis de las propiedades psicométricas de la versión mexicana de la Dieting Self-Efficacy Scale (DIET-SE).

INTRODUCTION: Introduction: recent research shows that people with high levels of self-efficacy for a healthy diet can control their weight. The Dieting Self-Efficacy Scale (DIET-SE) scale is a complete instrument that measures self-efficacy for a healthy diet, however, there are no Spanish versions for the Mexican population. Objective: the purpose of this study is to analyze the psychometric properties of the Mexican version of DIET-SE. Method: the sample consisted of 807 Mexican university students, of both sexes and aged between 17 and 48 years (M = 20.65, SD = 3.16). The parallel back-translation methodology was used to translate the DIET-SE scale into Spanish. In addition to the descriptive analysis and the Pearson correlation, the Cronbach alpha coefficient was used to measure the internal consistency and other indices were used for the factorial model. Results: the results of the CFA using the maximum likelihood estimation found good evidence for the construct validity (χ2 = 175.68; gl = 35 [77-42]; χ2/gl = 5.02, p < 0.01; TLI = 0.92, IFI = 0.96, CFI = 0.95 y RMSEA = 0.07). The factorial loads of the eleven items showed acceptable values. The results in the correlation analysis between the DIET-SE and psychological well-being indicators can be considered as a favorable proof of the discriminant validity. In terms of reliability, acceptable results were found in internal consistency. Conclusion: the DIET-SE is a valid and reliable scale to evaluate the self-efficacy to maintain a diet in Mexican university students.

INTRODUCCIÓN: Introducción: investigaciones recientes demuestran que las personas con altos niveles en autoeficacia para llevar una dieta saludable pueden controlar su peso. La escala Dieting Self-Efficacy Scale (DIET-SE) es un instrumento completo que mide la autoeficacia para llevar una dieta saludable, sin embargo, no existen versiones en español para población mexicana. Objetivo: el propósito del presente estudio es analizar las propiedades psicométricas de la versión mexicana del DIET-SE. Método: la muestra estuvo conformada por 807 estudiantes universitarios mexicanos, de ambos sexos y con edades comprendidas entre los 17 y los 48 años (M = 20,65, DT = 3,16). Para la traducción al castellano de la escala DIET-SE, se siguió la metodología parallel back- translation. Además del análisis descriptivo y la correlación de Pearson, se utilizó el coeficiente alfa de Cronbach para el estudio de la consistencia interna y para el ajuste del modelo se utilizaron varios índices. Resultados: los resultados del AFC por el método de máxima verosimilitud encontraron suficiente evidencia para la validez de constructo (χ2 = 175,68;gl = 35 [77-42]; χ2/gl = 5,02, p < 0,01; TLI = 0,92, IFI = 0,96, CFI = 0,95 y RMSEA = 0,07). Las cargas factoriales de los once ítems mostraron valores aceptables. Los resultados en el análisis de correlación entre la DIET-SE y los indicadores de bienestar psicológico pueden considerarse como prueba favorable de la validez discriminante. En cuanto a la fiabilidad, se encontraron resultados aceptables en consistencia interna. Conclusión: la DIET-SE es una escala válida y fiable para evaluar la autoeficacia para mantener una dieta en estudiantes universitarios mexicanos.

Análisis de las propiedades psicométricas del Athlete Burnout Questionnaire (ABQ) en deportistas mexicanos / Analysis of the psychometric properties of the athlete Burnout Questionnaire (ABQ) in Mexican athletes

El Athlete Burnout Questionnaire (ABQ) se ha convertido en el instrumento más utilizado para evaluar el burnout en el contexto deportivo, lo que ha permitido un incremento significativo en las investigaciones. A pesar de ello, una revisión en la literatura revela que no existen trabajos que proporcionen datos psicométricos del ABQ con muestra mexicana, por lo que el objetivo de la presente investigación fue analizar las propiedades psicométricas del Athlete Burnout Questionnaire en deportistas mexicanos. El análisis de los datos se desarrolló a través de 2 estudios, aplicando el cuestionario en el primero de ellos a una muestra de 464 jóvenes deportistas entre 13 y 18 años de edad (M = 14.85, DT = 1.45). Los resultados del Análisis Factorial Confirmatorio (AFC) indicaron índices de ajuste aceptables (c2 = 176.7; c2 /gl = 2.18; p < .01; TLI = .93, IFI = .95, CFI = .95 y RMSEA = .05) así como pesos de regresión aceptables para la estructura trifactorial del cuestionario original. Para el segundo estudio se utilizó una muestra de 1009 deportistas mexicanos entre 12 y 39 años de edad (M = 17.28, DT = 2.98). Los resultados del AFC encontraron suficiente evidencia para la validez de constructo (c2 = 419.5; c2 /gl = 5.59; p < .01; TLI = .94, IFI = .96, CFI = .96 y RMSEA = .07). Los resultados en el análisis de correlación entre el Athlete Burnout Questionnaire (ABQ) y el Athlete Engagement Questionnaire (AEQ) pueden considerarse como prueba favorable de la validez discriminante. En cuanto a la fiabilidad, se encontraron resultados aceptables en consistencia interna en ambas fases del estudio, concluyendo que el ABQ es una herramienta útil para evaluar el burnout en depotistas mexicanos

The Athlete Burnout Questionnaire (ABQ) has become one of the most used tools to assess burnout in sport contexts. Despite a significant increase in research in this field, the literature has shown that there are no papers which provide psychometric data of the ABQ using a Mexican sample. Hence the objective of the present study was to analyze the psychometric properties of the Athlete Burnout Questionnaire of Mexican athletes. Data analysis was obtained using two studies. The first study consisted of 464 young athletes between 13 and 18 years old (M = 14.85, DT = 1.45). The results of the Confirmatory Factor Analysis (CFA) showed acceptable fit indices (c2 = 176.7; c2 /gl = 2.18; p < .01; TLI = .93, IFI = .95, CFI = .95 y RMSEA = .05) Acceptable results of load regression were also found for the original three factor questionnaire. A sample of 1009 Mexican athletes between 12 and 39 years of age (M = 17.28, SD = 2.98) were used for the second study. The results of the CFA found sufficient evidence for the construct validity (c2 = 419.5; 2cc2 /gl = 5.59; p < .01; TLI = .94, IFIS = .96, CFI = .96 and RMSEA = .07). The results in the analysis of correlation between the Athlete Burnout Questionnaire (ABQ) and the Athlete Engagement questionnaire (AEQ) can be considered as evidence of the discriminant validity. In regard to reliability, acceptable results were observed in internal consistency in both phases of the study, concluding that the ABQ is a useful tool to evaluate the burnout in Mexican athletes

[Psychometric properties of the weight control perceived self-efficacy inventory in university students from the health area]. / Propiedades psicométricas del inventario autoeficacia percibida para el control de peso en estudiantes universitarios del área de la salud.

INTRODUCTION: empirical research shows that perceived self-efficacy is an important variable in maintaining and reducing weight. There are available instruments to measure perceived self-efficacy and its relation to obesity, but in Mexico it is still insufficient. OBJECTIVE: the purpose of the current research is to analyze the psychometric properties of the Mexican version of the self-efficacy inventory for weight control (SEI-WC) in university students in the health area. METHODS: participants in this study were 872 university students from the School of Health Sciences, aged between 17 and 47 (20.07 ± 2.61) years. Bartlett's sphericity test was performed to evaluate the relevance of the factor analysis. The principal component analysis with Varimax rotation was used to evaluate the adjustment of the scores on each factor. RESULTS: internal consistency (Cronbach's alpha) shows adequate psychometric properties for the three final factors: 0.856 for the factor "feeding style and externality", 0.85 for "programmed physical activity" and 0.671 for "daily physical activity". CONCLUSION: the findings of this study show that the SEI-WC is a reliable and valid instrument to measure the level of self-efficacy for weight control in Mexican university students in the health area.

Introducción: las investigaciones empíricas demuestran que la autoeficacia percibida es una variable importante en el mantenimiento y la reducción del peso. Existen instrumentos que evalúan la autoeficacia percibida y su relación con la obesidad, pero en México aún son insuficientes.Objetivo: el propósito de la presente investigación es analizar las propiedades psicométricas de la versión mexicana del inventario de autoeficacia para el control de peso (AP-CP) en estudiantes universitarios del área de la salud.Métodos: en el estudio participaron 872 estudiantes universitarios de la Escuela de Ciencias de la Salud con edades comprendidas entre 17 y 47 (20,07 ± 2,61) años. Para evaluar la pertinencia del análisis factorial se realizó la prueba de esfericidad de Bartlett. Para evaluar el ajuste de los puntajes en factores específicos se llevó a cabo el método de componentes principales con rotación Varimax.Resultados: el análisis del índice de consistencia interna (coeficiente alfa de Cronbach) muestra adecuadas propiedades psicométricas para los tres factores resultantes: 0,856 para el factor "estilo de alimentación y externalidad", 0,85 para el factor "actividad física programada" y 0,671 para el factor "actividad física cotidiana".Conclusión: los hallazgos de este estudio muestran que el AP-CP es un instrumento confiable y válido para medir el nivel de autoeficacia para el control de peso en estudiantes universitarios mexicanos del área de la salud.

Propiedades psicométricas del inventario autoeficacia percibida para el control de peso en estudiantes universitarios del área de la salud / Psychometric properties of the weight control perceived self-effi cacy inventory in university students from the health area

Introducción: las investigaciones empíricas demuestran que la autoeficacia percibida es una variable importante en el mantenimiento y la reducción del peso. Existen instrumentos que evalúan la autoeficacia percibida y su relación con la obesidad, pero en México aún son insuficientes. Objetivo: el propósito de la presente investigación es analizar las propiedades psicométricas de la versión mexicana del inventario de autoeficacia para el control de peso (AP-CP) en estudiantes universitarios del área de la salud. Métodos: en el estudio participaron 872 estudiantes universitarios de la Escuela de Ciencias de la Salud con edades comprendidas entre 17 y 47 (20,07 ± 2,61) años. Para evaluar la pertinencia del análisis factorial se realizó la prueba de esfericidad de Bartlett. Para evaluar el ajuste de los puntajes en factores específicos se llevó a cabo el método de componentes principales con rotación Varimax. Resultados: el análisis del índice de consistencia interna (coeficiente alfa de Cronbach) muestra adecuadas propiedades psicométricas para los tres factores resultantes: 0,856 para el factor "estilo de alimentación y externalidad", 0,85 para el factor "actividad física programada" y 0,671 para el factor "actividad física cotidiana". Conclusión: los hallazgos de este estudio muestran que el AP-CP es un instrumento confiable y válido para medir el nivel de autoeficacia para el control de peso en estudiantes universitarios mexicanos del área de la salud

Introduction: empirical research shows that perceived self-efficacy is an important variable in maintaining and reducing weight. There are available instruments to measure perceived self-efficacy and its relation to obesity, but in Mexico, it is still insufficient. Objective: the purpose of the current research is to analyze the psychometric properties of the Mexican version of the self-efficacy inventory for weight control (SEI-WC) in university students in the health area. Methods: participants in this study were 872 university students from the School of Health Sciences, aged between 17 and 47 (20.07 ± 2.61) years. Bartlett's sphericity test was performed to evaluate the relevance of the factor analysis. The principal component analysis with Varimax rotation was used to evaluate the adjustment of the scores on each factor. Results: internal consistency (Cronbach's alpha) shows adequate psychometric properties for the three final factors: 0.856 for the factor "feeding style and externality", 0.85 for "programmed physical activity" and 0.671 for "daily physical activity". Conclusion: the findings of this study show that the SEI-WC is a reliable and valid instrument to measure the level of self-efficacy for weight control in Mexican university students in the health area

Natural re-establishment of a population of a critically endangered primate in a secondary forest: the San Martin titi monkey (Plecturocebus oenanthe) at the Pucunucho Private Conservation Area, Peru.

The San Martin titi monkey (Plecturocebus oenanthe) is endemic to a small area of northern Peru and is considered Critically Endangered on the IUCN due to massive habitat loss. Between 1994 and 2005 small scale reforestation efforts in the 23.5 ha area of Pucunucho have led to the recuperation of habitat from an area of pasture and crop lands. The first record of P. oenanthe re-establishment in the area is from 2010, although re-establishment probably began earlier. We carried out short population surveys using triangulation to monitor densities of P. oenanthe in Pucunucho in 2011, 2012 and 2016. We estimate the current population of P. oenanthe in this area at 27 individuals, giving population densities of 35 groups/km2 and 124 individuals/km2. The successful regeneration of habitat and natural re-population of the area by this Critically Endangered species provides evidence of successful reforestation based conservation activities for this and potentially other primate species. Although now protected as a Private Conservation Area, Pucunucho remains threatened.

Athletes' motivational needs regarding burnout and engagement / Necessidades motivacionais dos atletas a respeito do burnoute do compromisso / Necesidades motivacionales de los atletas respecto al burnout y el compromiso

This study analyzed the relationships between the basic motivational needs, burnout and engagement in soccer players with the aim of finding an explanation for why these athletes stay engaged or burnout. Participants were 227 male Spanish third division soccer players between the ages of 18 and 32 (M = 23.36; SD = 3.63), who completed questionnaires measuring perceived autonomy, perceived competence and the need for relatedness in order to examine basic motivational needs. Athletes also completed questionnaires to analyze burnout and engagement. Soccer players reported moderate satisfaction of psychological needs for competence, autonomy and relatedness, and low to moderate levels of athlete burnout symptoms of emotional exhaustion, reduced personal accomplishment and depersonalization as well as moderate to low burnout factors in the global assessment. In regards to engagement factors, moderate to high levels were reported for vigor, dedication and absorption. The results of the structural equation model showed positive and negative predictions of the basic psychological needs about engagement and burnout respectively. The need for autonomy is the variable that predicts best the symptoms of the athlete burnout and engagement in Spanish third division soccer players. Finally, the reduced personal fulfillment symptom was the psychological need that best predicted the burnout symptoms

Este estudio analizó la relación entre las necesidades motivacionales básicas, burnout y compromiso en futbolistas con el propósito de encontrar una explicación de por qué los deportistas permanecen comprometidos o se queman. Los participantes fueron 227 futbolistas de la tercera división española, entre 18 y 32 años (M = 23.36; DE = 3.63), los cuales completaron cuestionarios para medir la Autonomía percibida, Competencia percibida y la Necesidad de relacionarse con el fin de examinar las necesidades motivacionales básicas. Los deportistas también completaron cuestionarios para analizar el burnout y el compromiso. Los futbolistas informaron de una moderada satisfacción de las necesidades psicológicas para la competencia, la autonomía y la relación y niveles de bajos a moderados en síntomas de burnout como agotamiento emocional, baja realización personal y despersonalización, así como de moderados a bajos en la apreciación global de los factores de burnout. En lo que respecta a los factores de compromiso se informó de niveles de moderados a altos en vigor, dedicación y absorción. Los resultados del modelo de ecuaciones estructurales mostraron predicciones positivas y negativas de las necesidades psicológicas básicas acerca del compromiso y el burnout, respectivamente. La necesidad de autonomía es la variable que predice mejor el síntoma de burnout deportivo y compromiso en futbolistas españoles de tercera división. Por último, los síntomas de reducida realización personal fue la necesidad psicológica que mejor predijo los síntomas de burnout

Este estudo analisou a relação entre as necessidades motivacionais básicas, burnout e compromisso em futebolistas, com o propósito deidentificar uma explicação sobre o porquê dos atletas permanecerem comprometidos ou padecerem de burnout. Os participantes foram 227 futebolistasda terceira divisão espanhola, com idades compreendidas entre os 18 e os 32 anos (M= 23.36; DP= 3.63), os quais completaram os questionários paramedir a Autonomia percebida, Competência percebida e a Necessidade de se relacionar, visando examinar as necessidades motivacionais básicas. Osatletas completaram também questionários para analisar o burnout e o compromisso. Os futebolistas revelaram uma moderada satisfação das necessidadespsicológicas para a competência, autonomia e relação, bem como níveis baixos e moderados na apreciação global dos factores de burnout. No queconcerne aos factores de compromisso, verificaram-se níveis moderados e altos relativamente ao vigor, dedicação e envolvimento. Os resultados domodelo de equações estruturais revelaram predições positivas e negativas das necessidades psicológicas básicas acerca do compromisso e do burnout,respectivamente. A necessidade de autonomia é a variável que prediz melhor o sintoma de burnout desportivo e o compromisso em futebolistas espanhóisda terceira divisão. Por último, a reduzida realização pessoal foi a necessidade psicológica que melhor predizeu os sintomas de burnout

Tendencia de la incidencia de cáncer de pulmón en un Área de Salud / Trends in Lung Cancer Incidence in a Healthcare Area

El presente estudio tiene por objetivo conocer la tendencia de la incidencia del cáncer de pulmón en el Área de Salud de León. Fueron incluidos los casos de cáncer de pulmón del Registro Hospitalario de Tumores del Centro Asistencial Universitario de León (CAULE), entre 1996-2010, con residencia en el Área de Salud de León. Se calcularon las incidencias trienales brutas y ajustadas a población mundial y europea. Se incluyeron 2.491 casos. Las tasas estandarizadas a población europea en varones ascendieron de 40,1 (trienio 1996-1998) a 61,8 (trienio 2005-2007), descendiendo a 54,6 casos nuevos por 100.000 (trienio 2008-2010). En el caso de las mujeres las tasas se triplicaron de 3,0 (trienio 1996-1998) a 9,2 casos nuevos por 100.000 (trienio 2008-2010). El cáncer de pulmón, a pesar de ser evitable, es un problema grave en el área de salud de León, siendo preocupante el incremento de la incidencia en mujeres

The aim of this study was to identify trends in the incidence of lung cancer in the Leon Healthcare Area. All cases of cancer among residents of the Leon healthcare catchment area listed in the hospital-based tumor registry of the Centro Asistencial Universitario de Leon (CAULE) between 1996 and 2010 were included. Gross incidence rates over 3-year intervals were calculated and adjusted for the worldwide and European populations. A total of 2,491 cases were included. In men, incidence adjusted for the European population rose from 40.1 new cases per 100,000 population (1996-1998) to 61.8 (2005-2007), and then fell to 54.6 (2008-2010). In women, incidence tripled from 3.0 (1996-1998) to 9.2 new cases per 100,000 (2008-2010). Although lung cancer is an avoidable disease, it is a serious problem in the Leon Healthcare Area. Of particular concern is the rising incidence among women