[Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society]. / Valoración de la densidad mineral ósea en personas transgénero. Posicionamiento de la Sociedad Argentina de Osteoporosis.

The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

La Sociedad Argentina de Osteoporosis convocó a especialistas reconocidos en la atención de personas transgénero para la elaboración del primer posicionamiento local sobre la evaluación de la salud ósea en esta población. La ley 26.743 de "Identidad de género" reconoce todas las identidades y garantiza su atención de manera gratuita en el sistema de salud. El impacto de los diferentes tratamientos de afirmación de género sobre la masa ósea ha sido tópico de debate internacional. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo, creemos relevante mencionar nuestra experiencia plasmando mediante este documento una serie de sugerencias para ser utilizadas en la atención médica.

Classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) in adult males: Clinical presentation, hormone function and the detection of adrenal and testicular adrenal rest tumors (TARTs).

INTRODUCTION: 21-hydroxylase deficiency (21-OHD) is the most common form of congenital adrenal hyperplasia (CAH). In adulthood, most studies are reported in females. By contrast, data on adult males are scarce. OBJECTIVE: To describe a series of adult males with classic 21-OHD and to assess the presence of adrenal masses and testicular adrenal rest tumors (TARTs). MATERIAL AND METHODS: Eight males (21-42 years) were included. We evaluated clinical presentation, 17-Hydroxyprogesterone (17-OHP), Testosterone (T), Δ4Androstenedione (Δ4A) ACTH, LH, FSH and plasma renin activitiy (PRA) levels at consultation. Molecular studies of the CYP21A2 gene, testicular ultrasound (US), semen analysis and adrenal computed tomography (CT) scan were performed. Treatment and compliance were assessed. RESULTS: Basal 17-OHP levels were >20ng/ml in all patients. At consultation, median 17OH-P was 11.5 (2.3-81) ng/ml, FSH: 3 (0.3-4) mUI/ml, LH: 1.1 (0.1-6) mUI/ml, T: 4.3 (1.7-8) ng/ml, Δ4A: 5.7 (1.4-16) ng/ml, ACTH: 86.4 (76-334) pg/ml, PRA: 9.5 (1.3-23.6) ng/ml/h. Semen analysis was performed in 5/8 patients, showing azoospermia in two. Molecular genetic analysis was performed in 4/8 patients. TARTs were found in 5/6, being bilateral in four. Adrenal masses were found in 4/6. In the 7 patients diagnosed in childhood, their follow-up was referred to as irregular, both in their attendance at consultations and in compliance with the indicated treatment. CONCLUSIONS: To our knowledge, this is the first series on adult males with classic 21-OHD which concomitantly assesses clinical presentation, molecular biology, adrenal and testicular imaging studies, semen analysis and compliance to treatment. A high prevalence of adrenal masses and TARTs was observed, possibly associated with poor treatment compliance leading to elevated ACTH and increased proliferation. Our findings on TARTs agree with reports in international publications of CAH in males, with adrenal imaging being added in our group. Although we are aware that further studies with a larger sample size and more data are needed, we consider that our findings contribute to the clinical management of classical 21-OHD in the male population.

La "Accesibilidad-DHD" en el caso Memoria y Experiencia Cossettini": hacia una co-construcción multimodal para un equitativo acceso a contenidos web / The "DHD-Accessibility" in the case "Memoria y Experiencia Cossettini: towards a multimodal co-construction for equitable access to web content

Resumen El artículo presenta un estudio de caso cuya objetivo es mejorar las condiciones de accesibilidad web de un dispositivo de comunicación pública de ciencia y tecnología titulado Dispositivo Hipermedial Dinámico Memoria y experiencia Cossettini. El mismo, publica en Acceso Abierto documentos digitalizados del Archivo pedagógico Cossettini conteniendo una gran cantidad de elementos estéticos visuales. Desde el marco teórico se sostiene que la elaboración colaborativa de objetos digitales multimodales contextualizados podría posibilitar a quienes participan del DHD MyECossettini una experiencia sensible/accesible de exploración, interpretación y recreación no excluyente de los archivos patrimoniales digitalizados, sin desmedro de lo singular y significativo de la fuente original. En este sentido, se ha propuesto la Accesibilidad-DHD basada en los principios de Percepción, Comprensión, Acción y Flexibilidad. En lo metodológico, se abordó el análisis y desarrollo de objetos digitales accesibles con un enfoque socio-técnico e interdisciplinar en atención al principio de percepción. Los resultados alcanzados constatan que las alternativas accesibles elaboradas habilitan nuevos canales perceptivos y proporcionan información contextual que constituye un valor agregado para todas las personas. Finalmente, se concluye que participar de la Accesibilidad-DHD no requiere necesariamente de experticia en informática, habilitando a que cada persona, desde su lugar, colabore en garantizar el acceso equitativo a la información. No obstante se advierte que, el desafío más complejo se presenta en la construcción de una toma de conciencia colectiva activa que asuma con responsabilidad de garantizar el Derecho Humano a habitar sin exclusiones el ciberespacio.

Abstract This article presents a case study with the aim to improve the conditions of web accessibility of a science and technology public communication device, "Dynamic Hypermedia Device, Memoria y Experiencia Cossettini". It publishes in Open Access digitized documents from the "Cossettini pedagogical archive" containing a large number of visual aesthetic elements. From the theoretical framework, the collaborative elaboration of contextualized multimodal digital objects could allow those who participate in the DHD MyECossettini a sensitive/accessible experience of exploration, interpretation and non-exclusive recreation of digitized heritage archives, without detriment to the singular and significant of the original source. Therefore, it is proposed DHD-Accessibility based on the principles of Perception, Comprehension, Action and Flexibility. Methodologically, the analysis and development of accessible digital objects are developed with a socio-technical and interdisciplinary approaches, focused on the principle of perception. The results achieved confirm that the accessible alternatives developed enable new perceptual channels and provide contextual information that constitutes added value for all people. Finally, it is highlighted that participating in "DHD-Accessibility" does not necessarily require IT expertise, enabling each person, from their place, to collaborate in guaranteeing equitable access to information. However, it is noted that the most complex challenge is presented in the construction of an active collective awareness that assumes with responsibility to guarantee the Human Right to inhabit cyberspace without exclusions.

Classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) in adult males: Clinical presentation, hormone function and the detection of adrenal and testicular adrenal rest tumors (TARTs).

INTRODUCTION: 21-hydroxylase deficiency (21-OHD) is the most common form of congenital adrenal hyperplasia (CAH). In adulthood, most studies are reported in females. By contrast, data on adult males are scarce. OBJECTIVE: To describe a series of adult males with classic 21-OHD and to assess the presence of adrenal masses and testicular adrenal rest tumors (TARTs). MATERIAL AND METHODS: Eight males (21-42 years) were included. We evaluated clinical presentation, 17-Hydroxyprogesterone (17-OHP), Testosterone (T), Δ4Androstenedione (Δ4A) ACTH, LH, FSH and plasma renin activitiy (PRA) levels at consultation. Molecular studies of the CYP21A2 gene, testicular ultrasound (US), semen analysis and adrenal computed tomography (CT) scan were performed. Treatment and compliance were assessed. RESULTS: Basal 17-OHP levels were >20ng/ml in all patients. At consultation, median 17OH-P was 11.5 (2.3-81) ng/ml, FSH: 3 (0.3-4) mUI/ml, LH: 1.1 (0.1-6) mUI/ml, T: 4.3 (1.7-8) ng/ml, Δ4A: 5.7 (1.4-16) ng/ml, ACTH: 86.4 (76-334) pg/ml, PRA: 9.5 (1.3-23.6) ng/ml/h. Semen analysis was performed in 5/8 patients, showing azoospermia in two. Molecular genetic analysis was performed in 4/8 patients. TARTs were found in 5/6, being bilateral in four. Adrenal masses were found in 4/6. In the 7 patients diagnosed in childhood, their follow-up was referred to as irregular, both in their attendance at consultations and in compliance with the indicated treatment. CONCLUSIONS: To our knowledge, this is the first series on adult males with classic 21-OHD which concomitantly assesses clinical presentation, molecular biology, adrenal and testicular imaging studies, semen analysis and compliance to treatment. A high prevalence of adrenal masses and TARTs was observed, possibly associated with poor treatment compliance leading to elevated ACTH and increased proliferation. Our findings on TARTs agree with reports in international publications of CAH in males, with adrenal imaging being added in our group. Although we are aware that further studies with a larger sample size and more data are needed, we consider that our findings contribute to the clinical management of classical 21-OHD in the male population.

The Use of Antidotes for Calcium Gluconate Extravasation: An Experimental Study in Mice.

BACKGROUND: Calcium gluconate extravasation is a process that can cause serious lesions, such as necrosis and calcification of the soft tissues. The aim of the present study was to analyze the beneficial effects of four possible local antidotes for calcium gluconate extravasation: hyaluronidase, sodium thiosulfate, triamcinolone acetonide, and physiologic saline solution. METHODS: Seventy-four BALB/c mice were used in the study. The substances selected for use in this study were calcium gluconate (4.6 mEq/ml), hyaluronidase (1500 IU/ml), sodium thiosulfate (25%), triamcinolone acetonide (40 mg/ml 0.5 mg/kg), and saline solution 0.9%. Five minutes were allowed to lapse after the calcium gluconate infiltration, and then an antidote was infiltrated. After 3 weeks, a skin biopsy was performed and a radiographic and histologic study was carried out. RESULTS: Only in the group infiltrated with sodium thiosulfate did all skin lesions disappear after the 3-week period after infiltration. In the radiographic study, calcium deposits larger than 0.5 mm were observed in 40 percent of cases without an antidote, in 33 percent with triamcinolone acetonide, in 13 percent with a saline solution, and in none with thiosulfate and hyaluronidase. In the histologic study, calcium deposits were found in 53 percent of cases without antidote, 100 percent of cases with triamcinolone acetonide, 33 percent of cases with saline solution, and 13 percent of cases with sodium thiosulfate or hyaluronidase. CONCLUSION: Sodium thiosulfate and hyaluronidase prevent the development of calcium deposits after calcium gluconate extravasation.

Alteraciones endocrinometabólicas en pacientes ambulatorios con infección por virus de la inmunodeficiencia humana / Endocrine and metabolic changes in outpatients with human immunodeficiency virus infection

La infección por el virus de inmunodeficiencia humana produce una enfermedad sistémica crónica. El tratamiento con fármacos antirretrovirales altamente activos ha modificado la evolución de estos pacientes incrementando la sobrevida. En contraposición, asociadas a su enfermedad y/o a la medicación antirretroviral, se describen múltiples enfermedades crónicas que comprometen aún más la calidad de vida de estos pacientes. Nuestro objetivo es describir las alteraciones endocrinometabólicas en nuestros pacientes ambulatorios con infección por el virus de inmunodeficiencia humana y realizar una actualización del tema.

The human immunodeficiency virus causes a chronic systemic disease. Treatment with highly active antiretroviral drugs has changed the evolution of the disease, and increasing the rate of survival. However, due to the disease and/or the antiretroviral drugs, there are other multiple chronic diseases that compromise the quality of life of the patients even more. The aim of this study is to present endocrine and metabolic changes in outpatients with human immunodeficiency virus, and present an update of the related literature.

Navegar a través de las fisuras del dispositivo hipermedial / Sailing though hypermedia device´s fisures

El estudio sobre la especificidad del dispositivo hipermedial centrado en el modo interactivo y su gramática, en ambientes de investigación y aprendizaje -modalidad de taller presencial-virtual- es una de las problemáticas que aborda actualmente el proyecto de investigación y desarrollo Obra abierta: hacia la construcción de un sistema para investigar y aprender en entornos virtuales organizacionales (Conicet)Interrogamos sobre cómo construir una perspectiva que posibilite un verdadero diálogo intercultural a través de un vínculo intersubjetivo fundamentado en el acto responsable, en una comunicación superadora del instrumentalismo, en una comunicación (comunidad) para la convivencia.Exploramos un novedoso ciberjuego de guerra y los supuestos de dicho desarrollo.Observamos que el modo interactivo del dispositivo hipermedial puede llegar a disolver completamente (construir-destruir) lo que se ha dado como objeto, y que este nuevo dispositivo multiplica las posibilidades de lo que ha sido llamado efecto blow up. Finalmente, atendiendo a las posibilidades comunicativas que brinda el contexto tecnológico virtual,, consideramos absolutamente necesario elaborar teoría sobre categorías propias del lenguaje hipermedial, vinculadas a procesos de pensamiento, acción y lenguaje, y a la complejidad de los actuales dispositivos hipermediales

Navegar a través de las fisuras del dispositivo hipermedial / Sailing though hypermedia device s fisures

El estudio sobre la especificidad del dispositivo hipermedial centrado en el modo interactivo y su gramática, en ambientes de investigación y aprendizaje -modalidad de taller presencial-virtual- es una de las problemáticas que aborda actualmente el proyecto de investigación y desarrollo Obra abierta: hacia la construcción de un sistema para investigar y aprender en entornos virtuales organizacionales (Conicet)Interrogamos sobre cómo construir una perspectiva que posibilite un verdadero diálogo intercultural a través de un vínculo intersubjetivo fundamentado en el acto responsable, en una comunicación superadora del instrumentalismo, en una comunicación (comunidad) para la convivencia.Exploramos un novedoso ciberjuego de guerra y los supuestos de dicho desarrollo.Observamos que el modo interactivo del dispositivo hipermedial puede llegar a disolver completamente (construir-destruir) lo que se ha dado como objeto, y que este nuevo dispositivo multiplica las posibilidades de lo que ha sido llamado efecto blow up. Finalmente, atendiendo a las posibilidades comunicativas que brinda el contexto tecnológico virtual,, consideramos absolutamente necesario elaborar teoría sobre categorías propias del lenguaje hipermedial, vinculadas a procesos de pensamiento, acción y lenguaje, y a la complejidad de los actuales dispositivos hipermediales(AU)