Metastatic pheochromocytoma and paraganglioma: a retrospective multicentre analysis on prognostic and predictive factors to chemotherapy.

Background: Prognostic and predictive markers in metastatic pheochromocytoma and paraganglioma (mPPGL) are unknown. We aimed to evaluate epidemiology of mPPGL, and prognostic factors of overall survival (OS) and predictive markers of treatment duration with first-line chemotherapy (TD1L). Patients and methods: Retrospective multicentre study of adult patients with mPPGL treated in Latin American centres between 1982 and 2021. Results: Fifty-eight patients were included: 53.4% were female, median age at diagnosis of mPPGL was 36 years and 12.1% had a family history of PPGL. The primary site was adrenal, non-adrenal infradiaphragmatic and supradiaphragmatic in 37.9%, 34.5% and 27.6%, respectively. 65.5% had a functioning tumour and 62.1% had metachronous metastases. Positive uptakes were found in 32 (55.2%) 68Gallium positron emission tomography (PET/CT), 27 (46.6%) 2-deoxy-2-[fluorine-18]fluoro-D-glucose PET/CT and 37 (63.8%) of 131Iodine-metaiodobenzylguanidine (MIBG) tests. Twenty-three (40%) patients received first-line chemotherapy, with cyclophosphamide, vincristine and dacarbazine used in 12 (52%) of patients. At a median follow-up of 62.8 months, median TD1L was 12.8 months. Either functional exams, tumour functionality, pathological characteristics or primary tumour location were significantly associated with response or survival. Yet, negative MIBG, Ki67 ≥ 10%, infradiaphragmatic location and functional tumours were associated with numerically inferior OS. Conclusions: In patients with mPPGL, prognostic and predictive factors to chemotherapy are still unknown, but negative MIBG uptake, Ki67 ≥ 10%, infradiaphragmatic location and functional tumours were numerically linked to worse OS. Our results should be further validated in larger and independent cohorts.

Detection of Giardia duodenalis and Toxoplasma gondii in soil and water samples in the Quindío River basin, Colombia.

Two zoonotic protozoan pathogens, Giardia duodenalis and Toxoplasma gondii, are important causes of waterborne infections in the Quindío region in Colombia. No previous data exist on how contamination occurs at the source for drinking water consumed by the human population in this region. Our aim was to describe the frequency of G. duodenalis and T. gondii DNA in 11 sampling points during a five-month period in water and adjacent soil at the Quindío River basin (Andean region in the central western part of Colombia). The study employed nested PCR for T. gondii, using the B1 gene as the amplification target, and single-round PCR for G. duodenalis assemblage A and assemblage B, amplifying the gdh gene, followed by DNA sequencing. In 50 soil samples, 28% (14/50) were positive for T. gondii. For G. duodenalis, distribution was in equal parts for assemblage A (8%; 4/50) and assemblage B (8%, 4/50). Genotyping of T. gondii sequences showed two soil samples with type I strain, another two samples of soil with type III strain, but most samples were of unidentified strains. In water samples, T. gondii was detected in 9.1% (5/55), G. duodenalis assemblage A in 34.5% (19/55), and G. duodenalis assemblage B in 12.7% (7/55). T. gondii DNA positivity was associated with lower soil temperature (p = 0.0239). Presence of G. duodenalis and T. gondii was evidenced in soil and water samples in the Quindío River basin, indicating soil as the potential source of contamination for the river that it is destined for human consumption. Monitoring these protozoa in drinking water is necessary to prevent public health risks in human populations.

Targeting BRAF V600E in metastatic colorectal cancer: where are we today?

Colorectal cancer (CRC) is the second most frequent cause of direct cancer death worldwide. The study of the molecular state of oncogenes has predictive and prognostic value in metastatic CRC (mCRC). The B-raf proto-oncogene (BRAF) gene mutation represents the 8%-12% of all mutations in mCRC. The BRAF V600E mutation, considered the most common alteration of BRAF, corresponds to a constitutive kinase with a high activating capacity of the RAS/RAF/MEK/ERK pathway after a cascade of successive phosphorylations in the transcription of genes. BRAF V600E mutation is more prevalent in women, elderly, right-sided colon cancer and Caucasian population. Unfortunately, it is considered a poor predictive and prognosis biomarker. Patients with mCRC BRAF V600E mutated (BRAFm) are generally associated with poor response to chemotherapy and short progression-free survival and overall survival. Recently, randomised clinical trials have studied the combination of different chemotherapy regimens with angiogenic inhibitors in mCRC BRAFm. In addition, new anti-BRAF and immunotherapy agents have also been studied in this population, with positive results. The objective of this review is to acknowledge the biology and molecular pathway of BRAF, critically analyse the clinical trials and the therapy options published until today and evaluate the options of treatment according to the patient's clinical presentation.

Study design of Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS).

AIMS: The role of non-invasive telemedicine (TM) combining telemonitoring and teleintervention by videoconference (VC) in patients recently admitted due to heart failure (HF) ('vulnerable phase' HF patients) is not well established. The aim of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial is to assess the impact on clinical outcomes of implementing a TM service based on mobile health (mHealth), which includes remote daily monitoring of biometric data and symptom reporting (telemonitoring) combined with VC structured, nurse-based follow-up (teleintervention). The results will be compared with those of the comprehensive HF usual care (UC) strategy based on face-to-face on-site visits at the vulnerable post-discharge phase. METHODS AND RESULTS: We designed a 24 week nationwide, multicentre, randomized, controlled, open-label, blinded endpoint adjudication trial to assess the effect on cardiovascular (CV) mortality and non-fatal HF events of a TM-based comprehensive management programme, based on mHealth, for patients with chronic HF. Approximately 508 patients with a recent hospital admission due to HF decompensation will be randomized (1:1) to either structured follow-up based on face-to-face appointments (UC group) or the delivery of health care using TM. The primary outcome will be a composite of death from CV causes or non-fatal HF events (first and recurrent) at the end of a 6 month follow-up period. Key secondary endpoints will include components of the primary event analysis, recurrent event analysis, and patient-reported outcomes. CONCLUSIONS: The HERMeS trial will assess the efficacy of a TM-based follow-up strategy for real-world 'vulnerable phase' HF patients combining telemonitoring and teleintervention.

Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria / Expert consensus on multidisciplinary management and integrated approaches in heart failure. Continuity of care from hospital discharge to primary care

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

Perspectiva de género en el estudio OFRECE: diferencias en la atención entre pacientes que consultan por dolor torácico o por palpitaciones / The gender perspective within the OFRECE study: differences in health care among patients consulting for chest pain and/or palpitations

Introducción y objetivos: En un estudio de base poblacional, se analizaron las posibles diferencias en función del sexo en la atención al dolor torácico o las palpitaciones como motivo de consulta. Métodos: El estudio OFRECE incluyó una muestra aleatoria de la población española de 8.400 participantes de edad ≥ 40 años, de los que 1.132 (13,5%) tenían antecedentes de consulta por dolor en el pecho y 1.267 (15,1%), por palpitaciones y se incluyen en este estudio. Se calculó la odds ratio (OR) de que se practicaran determinadas pruebas y se comunicaran los resultados de las consultas en relación con el hecho de ser mujer, tanto brutas como ajustadas por los factores de riesgo cardiovascular clásicos, antecedentes de enfermedad cardiovascular y diagnóstico de angina estable o fibrilación auricular confirmado en este estudio en cada caso. Resultados: No se observaron diferencias en los antecedentes de consulta por dolor torácico entre mujeres y varones (el 13 y el 14,1%; p=0,159) y sí en las consultas por palpitaciones (el 19,0 y el 10,4% respectivamente; p <0,001). A las mujeres con antecedentes de consulta por dolor torácico, en comparación con los varones, se les realizaron menos ecocardiogramas (el 32,5 y el 45,3%; p <0,001), se las remitió con menor frecuencia al cardiólogo (el 49,1 y el 60,1%; p <0,001), ingresaron menos (el 20,1 y el 39,4%; p <0,001) y se alcanzó un diagnóstico en menor proporción de casos (el 60,9 y el 71,9%; p <0,001). Al ajustar, disminuyen las diferencias y dejan de ser significativas en todos los casos: para ecocardiogramas, OR ajustada=0,81 (IC95%, 0,60-1,09); para remisión al cardiólogo, OR ajustada=0,86 (IC95%, 0,63-1,16), y para ingreso, OR ajustada=0,76 (IC95%, 0,54-1,09). En el caso de las palpitaciones, las diferencias no ajustadas son menores y todas desaparecen al ajustar. Conclusiones: Este trabajo no confirma un sesgo en razón del sexo en la atención a estos síntomas, aunque no es descartable completamente un sesgo de género en el diagnóstico confirmado en el estudio que limite su capacidad para identificar diferencias en la atención a las pacientes

Introduction and objectives: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. Methods: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. Results: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. Conclusions: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care

The Gender Perspective Within the OFRECE Study: Differences in Health Care Among Patients Consulting for Chest Pain and/or Palpitations.

INTRODUCTION AND OBJECTIVES: To analyze differences between sexes in the clinical management of patients presenting with symptoms of chest pain and/or palpitations within a population-based study. METHODS: The OFRECE study included a random sample of 8400 individuals from the Spanish population aged 40 years and older; 1132 (13.5%) had previously consulted for chest pain and 1267 (15.1%) had consulted for palpitations and were included in the present study. We calculated both the crude and adjusted odds ratios (OR) of undergoing certain tests and the results of consultations by sex. Adjustment was performed by classic cardiovascular risk factors, a personal history of cardiovascular disease, and a diagnosis of stable angina or atrial fibrillation confirmed in the OFRECE study in each case. RESULTS: No differences were observed in history of consultation for chest pain between women and men (13% vs 14.1%; P=.159) but differences were found in palpitations (19% vs 10.4%, respectively; P <.001). Women who had previously consulted for chest pain underwent fewer echocardiograms (32.5% vs 45.3%, respectively; P <.001), were less frequently referred to a cardiologist (49.1% vs 60.1%; P <.001), were less often admitted to hospital (20.1% vs 39.4%; P <.001), and less frequently received a confirmed diagnosis (60.9 vs 71, 9; P <.001). After full adjustment, all differences decreased and become nonsignificant echocardiograms: adjusted OR, 0.81; 95%CI, 0.60-1.09; referral to a cardiologist: adjusted OR, 0.86; 95%CI, 0.63-1.16; hospital admission: adjusted OR, 0.76; 95%CI, 0.54-1.09). For palpitations, crude differences were smaller and all became nonsignificant after adjustment. CONCLUSIONS: This study does not confirm the existence of sex-related bias in the management of chest pain and palpitations. However, such bias cannot be completely ruled out in diagnoses confirmed within the OFRECE study, which might limit its ability to detect sex-related differences in health care.

Diferencias de género en la carrera profesional de los cardiólogos en 70 hospitales españoles / Gender differences in the professional lives of cardiologists in 70 Spanish hospitals

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Identificación de bacterias y parásitos asociados a la materia fecal de diferentes ejemplares de Equus ferus caballus de Salento, departamento del Quindío / Identification of bacteria and parasites associated with fecal matter from different specimens of Equus ferus caballus from Salento, department of Quindío

Las enfermedades de origen zoonótico han sido gravemente descuidadas en países en vía de desarrollo, sin tener en cuenta que esto puede tener graves implicaciones a nivel de salud pública, particularmente para Colombia, en las últimas décadas se han dado fuertes cambios sociales que han implicado, entre otras cosas, el aumento de la tendencia a la posesión de animales de compañía incluyendo a Equus ferus caballus, para el cual, la microbiota asociada ha sido mal estudiada en comparación con otros animales. Por lo anterior, se planteó como objetivo identificar la microbiota bacteriana y parasitaria asociada a la materia fecal de Equus ferus caballus, para cumplir dicho objetivo, se tomaron muestras independientes para cada uno de los fines, realizando la concentración de parásitos mediante la técnica de Ritchie y cultivo de bacterias para su posterior identificación mediante el Kit BD BBL CRYSTAL E/NF y GP. Para el análisis de los datos se realizó regresión logística mediante Statgraphics. Se lograron aislar 19 bacterias de las cuales seis fueron explicadas por al menos uno de las variables tenidas en cuenta. Nueve de las bacterias aisladas no se habían reportado con anterioridad para equinos. Se reportan tres géneros de parásitos nuevos para la especie (Balantidium sp, Cyclospora sp. y Taenia sp.) y cuatro nuevos para el país (Allantosoma sp, Blepharocorys sp, Cycloposthium sp. y Bundleia sp.) Se concluye que las variables tenidas en cuenta si tienen influencia en la incidencia de algunos microorganismos aislados, de igual manera se reportan nuevas especies de bacterias para Equus ferus caballus así como de parásitos.

Diseases of zoonotic origin have been seriously neglected in developing countries, without taking into account that this may have serious public health implications, particularly for Colombia, in recent decades there have been strong social changes that have involved, among other things, the increase of the tendency to the possession of companion animals including Equus ferus caballus, for which, the associated microbiota has been poorly studied in comparison with other animals. Therefore, we set ourselves the objective of identifying the bacterial and parasitic diversity associated with fecal matter of Equus ferus caballus. For this, independent samples were taken for each of the purposes, making the concentration of parasites using the Ritchie technique; Samples for bacterial isolation were processed and identified with the BD BBL CRYSTAL E / NF and GP Kit. For the analysis of the data, logistic regression was performed using Statgraphics. We were able to isolate 19 bacteria, of which six were explained by at least one of the variables taken into account. Nine of the isolated bacteria had not been previously reported for equines. Three genera of new parasites are reported for the species (Balantidium sp, Cyclospora sp and Taenia sp.) And four new for the country (Allantosoma sp, Blepharocorys sp, Cycloposthium sp. and Bundleia sp.) It is concluded that the variables taken into if they have influence on the incidence of some isolated microorganisms, in the same way new species of bacteria for Equus ferus caballus as well as parasites are reported.

Sacubitril/valsartan and short-term changes in the 6-minute walk test: A pilot study.

BACKGROUND: Impaired exercise capacity is the most disabling symptom in patients with heart failure with reduced ejection fraction (HFrEF). Despite sacubitril/valsartan showing reduced long-term morbidity and mortality over enalapril in HFrEF, its effects on short-term functional capacity remain uncertain. We sought to evaluate the effects of sacubitril/valsartan on a 30-day six-minute walk test in eligible patients with HFrEF. METHODS AND RESULTS: From November 1, 2016 to February 1, 2017, a total of 58 stable symptomatic patients with HFrEF were eligible for sacubitril/valsartan and underwent 6-MWT before and 30days after initiation of sacubitril/valsartan therapy. A mixed-effects model for repeated-measures was used to analyze the changes. Mean age was 70±11years. 72.4% males, 46.6% with ischemic heart disease, and 51.7% on NYHA functional class III were included. The mean (SD) values of baseline LVEF and 6MWT were 30±7%, and 300±89m, respectively. The median (IQR) of NT-proBNP at baseline was 2701pg/ml (1087-4200). Compared with baseline, the 6-MWT distance increased significantly at 30days by 13.9% (+∆=41.8m (33.4-50.2); p<0.001). CONCLUSIONS: In this pilot study, sacubitril/valsartan was associated with an improvement in exercise tolerance in symptomatic patients with HFrEF.

Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy.

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminal-prohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.

Allosteric Interactions by p53 mRNA Govern HDM2 E3 Ubiquitin Ligase Specificity under Different Conditions.

HDM2 and HDMX are key negative regulatory factors of the p53 tumor suppressor under normal conditions by promoting its degradation or preventing its trans activity, respectively. It has more recently been shown that both proteins can also act as positive regulators of p53 after DNA damage. This involves phosphorylation by ATM on serine residues HDM2(S395) and HDMX(S403), promoting their respective interaction with the p53 mRNA. However, the underlying molecular mechanisms of how these phosphorylation events switch HDM2 and HDMX from negative to positive regulators of p53 is not known. Our results show that these phosphorylation events reside within intrinsically disordered domains and change the conformation of the proteins. The modifications promote the exposition of N-terminal interfaces that support the formation of a new HDMX-HDM2 heterodimer independent of the C-terminal RING-RING interaction. The E3 ubiquitin ligase activity of this complex toward p53 is prevented by the p53 mRNA ligand but, interestingly, does not affect the capacity to ubiquitinate HDMX and HDM2. These results show how ATM-mediated modifications of HDMX and HDM2 switch HDM2 E3 ubiquitin ligase activity away from p53 but toward HDMX and itself and illustrate how the substrate specificity of HDM2 E3 ligase activity is regulated.

Carcinoma neurendocrino de células grandes primario del esófago / Large cell neuroendocrine carcinoma primary of oesophagus

Los tumores neuroendocrinos primarios del esófago son raros y difícilmente considerados dentro del diagnóstico diferencial de los tumores esofágicos. En este artículo describimos el caso de un paciente de 76 años portador de un tumor neuroendocrino de células grandes primario del esófago, el cual constituiría el segundo caso reportado a nivel mundial, así como una revisión de la literatura.

Primary neuroendocrine tumors of the esophagus are rare and hardly included in differential diagnoses of esophageal tumors. In this article we describe the case of a 76 years old man with a large cell neuroendocrine carcinoma primary of the oesophagus; this is the second case reported worldwide. A literature review is presented.

Carcinoma neuroendocrino de células grandes primario del esófago / Large cell neuroendocrine carcinoma of the esophagus primary

Los tumores neuroendocrinos primaros del esófago son raros y difícilmente considerados dentro del diagnóstico diferencial de los tumores primarios del esófago. En este artículo describimos el caso de un paciente de 76 años portador de un tumor neuroendocrino de células grandes primario del esófago, el cual constituiría el segundo caso reportado a nivel mundial, así como una revisión de la literatura.

Primary neuroendocrine tumors of esophagus are rare and hardly included in the differential diagnoses to esophageal tumors. In this article we describe a 76-year-old man with a large cell neuroendocrine carcinoma primary of the esophagus; this would be the second case reported worldwide. A literature review is presented.

Sarcoma primario de hígado: reporte de un caso en el Instituto Nacional de Enfermedades Neoplásicas (INEN) / Primary liver sarcoma: a case report in the National Institute of Neoplastic Diseases (NIND)

Caso de una paciente de 34 años diagnosticada de una entidad rara, Sarcoma Primario Hepático, que recibió tratamiento preoperatorio con quimioterapia en base a antraciclínicos, luego de la cual pudo tener una resección quirúrgica completa.

Case report about a 34 year old woman with a rare disease, primary sarcoma of the liver, who received preoperative treatment with anthracyclines, after which the patient had a complete surgical resection.

Los grupos extracurriculares en agronomía de la Universidad de Caldas (Colombia): 1970-2006: de la efervescencia política a la formación científica / Os grupos extracurriculares no programa de Agronomia da Universidade de Caldas (Colômbia): 1970-2006; da efervescência política ao treinamento científico / The extracurricular groups in Agricultural Engineering at the University of Caldas (Colombia): 1970-2006; from political effervescence to scientific training

En vista de que la formación de profesionales es un asunto complejo que supera los propósitos expresados en los planes de estudio, los estudiantes han complementado su formación mediante Grupos Extracurriculares (GE). Con el fin de dar cuenta de esta dinámica, se realizó una caracterización de éstos grupos en el programa de Agronomía de la Universidad de Caldas, desde el año 1970 hasta el 2006. Se trató de indagar cómo contribuyeron a la formación de los estudiantes y a la realimentación de los planes de estudio. El texto, en la primera parte analiza los GE como "comunidades de aprendizaje", en segundo lugar, se elabora una caracterización de los grupos en el programa Agronomía, en tres períodos: la efervescencia política de los años 70, el reflujo de los 80 y la emergencia de los semilleros de investigación, después de los 90. Por último, se presentan las lecciones aprendidas en este ejercicio de investigación, en donde se destaca y reafirma la importancia que tiene la formación en investigación.

Visto que o treinamento de profissionais é um assunto complexo que supera os propósitos expressados nos programas de estudos, os estudantes complementam seu treinamento mediante Grupos Extracurriculares (GE). Para dar conta desta dinâmica, fez-se uma caracterização destes grupos no programa de Agronomia da Universidade de Caldas, desde o ano 1976 até o ano 2006. Tratou-se de indagar como estes grupos contribuíram ao treinamento dos estudantes e à re-alimentação dos programas de estudos. Este texto analisa, na primeira parte, os GEs como "comunidades de aprendizagem"; em segundo lugar, faz-se uma caracterização dos grupos no programa de Agronomia em três períodos: na efervescência política dos anos 70, o refluxo dos anos 80 e a emergência dos viveiros de pesquisa depois dos anos 90. Por último, apresentam-se as lições apreendidas neste exercício, onde se destaca e reafirma a importância do treinamento em pesquisa.

Taking into consideration that training professionals is a complex matter that overcomes the goals consigned in the syllabus, the students have complemented their training by means of Extracurricular Groups (EG). To comply with this dynamics, a characterization of these groups in the program of Agricultural Engineering at the University of Caldas from 1970 to 2006 was carried out. It aimed at finding out how these groups contributed to the students' training and how they provided the syllabi with positive feedback. The first part of this paper examines the EG's as "learning communities"; the second part, characterizes the groups in the program of Agricultural Engineering in three periods: the political effervescence in the1970's, the reflux of the 80's and the emergence of research seedbeds after the 90's. Finally, some lessons that had been learned during this research exercise and that highlight and reaffirm the importance of research training are presented.

Criterios financieros que deben ser considerados a objeto de determinar la suspensión del acto administrativo por grave perjuicio al solicitante

Para el desarrollo de la propuesta se tomaron en cuenta aspectos financieros propios que hacen a una empresa. Los cuales reflejan el funcionamiento de la misma. Y que son de utilidad para el solicitante y para la autoridad competente, para la suspensión del acto administrativo

Linfoma NK Blastico / Blastic NK lymphoma

Linfoma de células NK blásticos (LNKB) es una neoplásia hematológica poco frecuente que fue recientemente propuesta por Nakamura en 1995 y Suzuki en 1997 que se caracteriza por tener características celulares blásticas con expresión de CD56 y negatividad para CD3 de superficie. Compromete ganglios linfáticos aunque tiene predilección por compromiso estramodal, especialmente la piel, tejidos blandos sangre periférica o médula ósea; raros casos se presentan en la cavidad nasal. No esta clara su predilección racial ni su etiología. En este artículo, presentamos un caso de LNKB en una paciente joven con compromiso dérmico masivo. ies