ABSTRACT Langerhans cell histiocytosis comprises a heterogeneous range of clinical manifestations secondary to clonal proliferation of histiocytes, characterized by the accumulation of these cells in various organs and tissues. The ophthalmological component commonly involved is the orbit. Herein, we report a rare case of Langerhans cell histiocytosis with eyelid involvement, which resulted in severe ocular surface complications, which subsequently significantly impacted the patient’s quality of life. This case report highlights the fact that despite being rare, Langerhans cell histiocytosis should be included in the differential diagnosis of eyelid lesions. Furthermore, a multidisciplinary approach with a systemic overview is crucial for managing the ocular complications. histiocytes tissues orbit Herein involvement complications patients patient s life lesions Furthermore

ABSTRACT Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases. Purpose simple subjective isotretinoininduced induced changes Methods score. margins groups (A (B (C radiologists reliability Results 064 0 64 0.64 078 78 0.78 059 59 0.59 090 90 0.90 respectively 0.62, 062 62 (0.62 035 35 0.35 082 82 0.8 (0.78 1. . Furthermore Conclusion cases 06 6 0.6 07 7 0.7 05 5 0.5 09 9 0.9 0.62 (0.6 03 0.3 08 8 0. (0.7 (0. (0 (

Abstract This review article emphasizes the importance of specific evaluation and management for adenocarcinoma-type colorectal cancer (CRC), a disease prone to local recurrence and systemic metastasis. It highlights the need for a distinctive approach compared to colon cancer. Improved local staging, facilitated by the use of magnetic resonance imaging (MRI), as well as more precise and effective treatments, have achieved a significant reduction in the mortality rate in adults over 50 years of age over the last few decades. MRI plays a vital role in the evaluation before and after treatment, being essential for the multidisciplinary team to personalize the most appropriate treatment option, thus highlighting the central importance of the radiologist. In primary staging, MRI allows evaluating tumor height in the rectum, T and N categories, detecting prognostic elements such as extramural vascular invasion and mucinous differentiation, and evaluating the involvement of the sphincter apparatus and other local organs and structures. During restaging, MRI evaluation has demonstrated significant prognostic value and is effective in selecting patients for an active follow-up strategy (watch and wait).

Resumen Este artículo de revisión resalta la importancia de realizar una evaluación y manejo específicos para el cáncer de recto de tipo adenocarcinoma (CRC), una enfermedad que tiende a la recurrencia local y la metástasis sistémica. Se destaca la necesidad de un enfoque distintivo en comparación con el cáncer de colon. Una mejor estadificación local, facilitada por el uso de resonancia magnética (RM), así como tratamientos más precisos y eficaces, han logrado una disminución significativa en la tasa de mortalidad en adultos mayores de 50 años a lo largo de las últimas décadas. La RM desempeña un papel esencial en la evaluación antes y después del tratamiento, siendo fundamental para que el equipo multidisciplinario pueda personalizar la opción de tratamiento más adecuada, resaltando así la importancia central del radiólogo. En la etapificación primaria, la RM permite evaluar la altura tumoral en el recto, categoría T y N, detectar elementos pronósticos como invasión vascular extramural y diferenciación mucinosa, y evaluar el compromiso del aparato esfinteriano y de otros órganos y estructuras locales. Durante la reetapificación, la evaluación mediante RM ha demostrado gran valor pronóstico y ser eficaz en la selección de pacientes para estrategia de seguimiento activo (watch and wait).

ABSTRACT Blastic plasmacytoid dendritic cell neoplasia (BCDPN) is a rare and generally aggressive hematological malignancy, which requires early recognition. Below, the clinical course of a 72-year-old patient with NCDPB is described, whose most relevant findings included the presence of skin lesions, organomegaly, and bone marrow infiltration. After the diagnosis, systemic chemotherapy was indicated, with a good response; however, after 2 months the lesions recurred and the patient died. In this disease it is necessary to establish the differential diagnosis with lymphoproliferative disorders, lymphoid and acute myeloid leukemias, with the morphological analysis of the neoplastic cells being an important aspect for adequate diagnostic guidance.

RESUMEN La neoplasia de células dendríticas plasmocitoides blásticas (NCDPB) es una malignidad hematológica poco frecuente y generalmente agresiva, por lo cual se requiere su reconocimiento precoz. A continuación, se describe el curso clínico de una paciente de 72 años con NCDPB, en cuyos hallazgos más relevantes destacó la presencia de lesiones cutáneas, organomegalias, infiltración de la médula ósea. Posterior al diagnóstico se indicó quimioterapia sistémica, con buena respuesta, no obstante, a los 2 meses presentó recidiva de lesiones y la paciente falleció. En esta enfermedad es necesario establecer el diagnóstico diferencial con trastornos linfoproliferativos, leucemias linfoides y mieloides agudas, constituyendo el análisis morfológico de las células neoplásicas un aspecto importante para una adecuada orientación diagnóstica.

ABSTRACT Sarcoidosis is a chronic inflammatory disease characterized by the prevalence of noncaseating granulomas that can affect multiple organs. We present the case of a 35-year-old male, with no previously known pathologies, a bricklayer, from an urban area. The patient presents a 4-month history that begins with dyspnea and dry cough, as well as a feverish feeling and weight loss. The simple chest tomography showed parahilar condensations and multiple solid nodular and micronodular lesions with a clear predominance in the upper lobes. Histopathology reports non-caseating granulomas in the lung tissue sample. Treatment with systemic corticosteroids was instituted with notable improvement in respiratory symptoms.

RESUMEN La sarcoidosis es una enfermedad inflamatoria crónica caracterizada por la prevalencia de granulomas no caseosos que puede afectar múltiples órganos. Presentamos el caso de un varón de 35 años de edad, sin patologías conocidas previamente, albañil, procedente de zona urbana. Presenta un cuadro de 4 meses de evolución que inicia con disnea y tos seca, además de sensación febril y pérdida de peso. En la tomografía de tórax simple se visual condensaciones parahiliares y múltiples lesiones nodulares y micronodulares sólidas con claro predominio en lóbulos superiores. La histopatología informa granulomas no caseosos en la muestra de tejido pulmonar. Se instaura tratamiento con corticoides sistémicos con notable mejoría de los síntomas respiratorios.

ABSTRACT Paracoccidioidomycosis is a deep systemic mycosis, endemic in some Latin American countries, with an acute/subacute clinical presentation. In our country, it is the main differential diagnosis of pulmonary tuberculosis. We describe the clinical case of a 48-year-old man from a rural area, immunocompetent, who presented clinically with respiratory distress, progressive weight loss and lesions in the oral mucosa; as radiological findings, he presented bilateral reticular infiltrates. From a mycological point of view, the presence of the microorganism was evidenced in various biological samples: biopsies of oropharyngeal lesions and mycological study of sputum. Targeted treatment with intravenous antifungals was performed, presenting a good response to it with clinical improvement.

RESUMEN La paracoccidioidomicosis es una micosis profunda sistémica, endémica en algunos países de Latinoamérica, de presentación clínica es de evolución aguda/subaguda, en nuestro país es el principal diagnostico diferencial de la tuberculosis pulmonar. Se describe el caso clínico de un hombre de 48 años, procedente de zona rural, inmunocompetente, que se presentó clínicamente por dificultad respiratoria, pérdida de peso de forma progresiva y lesiones en mucosas oral; como hallazgos radiológicos presentó infiltrados reticulares bilaterales. Desde el punto de vista micológico se evidenció la presencia del microorganismo en diversas muestras biológicas: biopsias de lesiones orofaríngeas y estudio micológico del esputo. Se realizó tratamiento dirigido con antimicótico intravenoso presentando buena respuesta al mismo con mejoría clínica.

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic disease endemic to Latin American countries, with a high impact in terms of morbidity, mortality and costs for the health system if patients progress to advanced stages. This work aimed to collect data published in publications on autochthonous cases of PCM, from the first cases diagnosed in Paraguay, with a description of the historical context and identifying the pioneers in the diagnosis in Paraguay, following a chronological order, to the most recently reported cases. Methodology: search in national libraries and online databases of PCM cases in Paraguay, published in national historical scientific journals and other sources available in print format, and more recent scientific articles available in electronic format, respectively. Results: 479 cases of PCM were identified in publications between the years 1935 and 2023, corresponding to autochthonous cases and whose diagnoses were made in Paraguayan territory. Dr. Juan Boggino and collaborators were responsible for the first diagnoses in the country. The predominant clinical form was chronic. The average age was 45.78 years. The vast majority of patients diagnosed were from the Eastern Region of the country, predominantly male farmers. Conclusion: PCM is an endemic disease in Paraguay. Since the first cases were diagnosed and until today, patients with a severe and disabling course of the disease have been detected, which demonstrates the need to disseminate its knowledge and expand the early diagnostic capacity at the national level. Due to its clinical pleomorphism and its ability to simulate other diseases, it is important to include PCM as a differential diagnosis for patients who present risk factors for the development of the disease.

RESUMEN La Paracoccidioidomicosis (PCM), es una enfermedad sistémica endémica de países de América Latina, con alto impacto en términos de morbilidad, mortalidad y costos para el sistema de salud si los enfermos progresan a sus estadios avanzados. Este trabajo tuvo como objetivo recopilar datos divulgados en publicaciones sobre casos autóctonos de PCM, desde los primeros casos diagnosticados en Paraguay, con una descripción del contexto histórico e identificando a los pioneros en el diagnóstico en Paraguay, siguiendo un orden cronológico, hasta los casos más recientemente informados. Metodología: búsqueda en bibliotecas nacionales y bases de datos online de casos de PCM en Paraguay, publicados en revistas científicas históricas nacionales y otras fuentes disponibles en formato impreso, y artículos científicos más recientes disponibles en formato electrónico, respectivamente. Resultados: Se identificaron 479 casos de PCM en publicaciones entre los años 1935 y 2023, correspondientes a casos autóctonos y cuyos diagnósticos fueron realizados en territorio paraguayo. El Dr. Juan Boggino y colaboradores fueron los responsables de los primeros diagnósticos en el país. La forma clínica predominante fue la crónica. La media de edad de 45,78 años. La gran mayoría de los pacientes diagnosticados fueron oriundos de la Región Oriental del país, predominantemente hombres agricultores. Conclusión: La PCM es una enfermedad endémica del Paraguay, desde los primeros casos diagnosticados y hasta hoy en día, son detectados pacientes con una evolución grave y discapacitante de la enfermedad, lo que demuestra la necesidad de la difusión de su conocimiento y ampliación de la capacidad diagnóstica precoz a nivel nacional. Debido a su pleomorfismo clínico y su capacidad de simular otras enfermedades, es importante incluir a la PCM como diagnóstico diferencial de pacientes que presenten factores de riesgo para el desarrollo de la enfermedad.

Resumen: Se trata de estudiar, en una primera aproximación, el impacto del cambio en el modo de producción como consecuencia de la telemática y el uso del aprendizaje de las máquinas y la inteligencia artificial en muchas de las aplicaciones y procesos repetitivos en los sistemas sociales de producción y distribución de bienes. Se utilizó el método del construccionismo sistémico, que, en definitiva, parte de la base de que los datos no son datos, sino construcciones con supuestos teóricos inevitables, y de que la lengua es el sistema en el que se construyen los lenguajes que son un límite general para obtener y comunicar información en la sociedad. Esto conduce a una teoría de las acciones algo diferente de las de Parsons y Luhmann, que lleva al concepto de praxemas, y a todo un nuevo análisis de la sociedad y su derecho. Resumen estudiar aproximación bienes sistémico definitiva inevitables Luhmann praxemas derecho

Abstract: The aim is to study, in a first approximation, the impact of the change in the production mode as a result of telematics and the use of machine learning and artificial intelligence in many of the applications and repetitive processes in social systems of production and distribution of goods. The method of systemic constructionism was used, which, in short, assumes that data are not data - they are constructions with unassailable theoretical assumptions and that language is the system in which the general limit languages are constructed to obtain and communicate information in society. This leads to a theory of actions somewhat different from those of Parsons and Luhmann - leading to the concept of praxemas, and to a whole new analysis of society and its law. Abstract study approximation goods used short praxemas law

Resumo: Objetiva-se estudar, em primeira aproximação, o impacto da mudança do modo de produção por efeito da telemática e do emprego do machine learning e inteligência artificial em grande parte das aplicações e processos repetitivos nos sistemas sociais de produção e distribuição de mercadorias. Utilizou-se o método do construcionismo-sistêmico que, em síntese, assume que os dados não são dados – são construções com pressupostos teóricos inafastáveis em que a língua é o sistema no qual se constroem as linguagens, limite geral da obtenção e da comunicação de informações na sociedade. Disso advém uma teoria das ações diferente daquelas de Parsons e Luhmann – conduzindo ao conceito de praxemas e, a toda uma nova analítica da sociedade e de seu direito. Resumo Objetivase Objetiva estudar aproximação mercadorias Utilizouse Utilizou construcionismosistêmico construcionismo sistêmico síntese linguagens direito

Resumen: La vasculitis reumatoidea es una complicación sistémica y poco frecuente de la Artritis Reumatoidea. Si bien su incidencia ha descendido en los últimos años con el advenimiento de las nuevas terapias inmunosupresoras y biológicas, continua teniendo una alta morbimortalidad. Predomina en el sexo masculino, en pacientes seropositivos y con un largo período de la enfermedad establecida. Requiere de alta presunción diagnostica, siendo el compromiso cutáneo y nervioso periférico el más frecuente. La biopsia de nervio o piel es requerida habitualmente para su diagnóstico. El tratamiento se basa en corticoides e inmunosupresores. Presentamos tres casos clínicos y realizamos una revisión de la literatura.

Abstract: Rheumatoid vasculitis is a rare systemic complication of rheumatoid arthritis. Although its incidence has decreased in recent years with the advent of new immunosuppressive and biological therapies, it continues to have a high morbidity and mortality. It predominates in males, in seropositive patients and with a long period of established disease. It requires high diagnostic presumption, with skin and peripheral nervous involvement being the most affected. Nerve or skin biopsy is usually required for diagnosis. Treatment is based on corticosteroids and immunosuppressants. We present three clinical cases and carry out a review of the literature.

Resumo: A vasculite reumatóide é uma complicação sistêmica rara da artrite reumatóide. Embora sua incidência tenha diminuído nos últimos anos com o advento de novas terapias imunossupressoras e biológicas, continua apresentando elevada morbidade e mortalidade. Predomina no sexo masculino, em pacientes soropositivos e com longo período de doença estabelecida. Exige alta presunção diagnóstica, sendo o envolvimento cutâneo e nervoso periférico os mais afetados. A biópsia de nervo ou pele geralmente é necessária para o diagnóstico. O tratamento é baseado em corticosteroides e imunossupressores. Apresentamos três casos clínicos e realizamos uma revisão da literatura.

Abstract The competitiveness of SMEs is relevant to analyze their development in the market, which increasingly requires better performance to remain relevant. Competitiveness must be analyzed comprehensively to have a better overview of these companies and know how they interact with their competitors. The objective of this article is to present an analysis of the level of competitiveness of SMEs in the municipality of Umán, Yucatán. The present work is with a quantitative and cross-sectional approach. In this research, the systemic competitiveness model was used, the study population was 95 companies with a sample of 77. The main findings of the work indicate that the companies studied have a high competitiveness index, where the quality assurance factor is one of the best evaluated, while the environmental management factor is one of those that obtained the lowest score.

Resumen La competitividad de las PyMEs resulta relevante para analizar su desarrollo en el mercado, el cual cada vez exige un mejor desempeño para que se mantengan vigentes. La competitividad debe ser analizada de forma integral para tener un mejor panorama de estas empresas y conocer cómo interactúan con sus competidores. El objetivo del presente artículo es presentar un análisis del nivel de competitividad de las PyMEs del municipio de Umán, Yucatán. El presente trabajo es con enfoque cuantitativo y de corte transversal. En esta investigación se empleó el modelo de la competitividad sistémica, la población de estudio fueron 95 empresas con una muestra de 77. Los principales hallazgos del trabajo indican que las empresas estudiadas presentan un alto índice de competitividad, donde el factor de aseguramiento de la calidad es uno de los mejores evaluados, mientras que el factor de la gestión ambiental es uno de los que obtuvieron menor puntaje

Abstract: The shape of cities has historically been the expression of complex processes of material and energy differentiation. Like any open and self-regulating system, it needs to evolve by exchanging flows of information and matter with its environment based on non-linear interactions made up of hierarchies and complementarities necessary for its adaptation. In order to establish causality with the phenomenon of socio-spatial fragmentation, structural inequality has been analyzed as a stratifying factor of spatialities in urban space. The dialectical hermeneutic method has allowed the modeling of concepts from information theory and thermodynamics to explain the interaction logic of the operating subsystems and their consequences in the hybrid structuring of urban space. The identification of cycles and morphogenetic causality in the production of spatialities forms a theoretical-conceptual contribution to the study of urban dynamics when spatial proximity coexists with social distance as a norm.

Resumen: La forma de las ciudades ha sido históricamente la expresión de complejos procesos de diferenciación material y energética. Como todo sistema abierto y autorregulador, necesita evolucionar intercambiando flujos de información y materia con su entorno a partir de interacciones no lineales conformadas por jerarquías y complementariedades necesarias para su adaptación. Con el fin de establecer una causalidad con el fenómeno de la fragmentación socio- espacial, se ha analizado la desigualdad estructural como factor estratificador de las espacialidades en el espacio urbano. El método hermenéutico dialéctico ha permitido modelar conceptos de la teoría de la información y la termodinámica para explicar las lógicas de interacción de los (sub)sistemas operantes y sus consecuencias en la estructuración híbrida del espacio urbano. La identificación de ciclos y patrones morfogenéticos repetidos de manera sistémica en la producción de espacialidades conforma un aporte teórico- conceptual para el estudio de las dinámicas urbanas cuando conviven como una norma, la proximidad espacial con la distancia social.

ABSTRACT This article examines the transformative potential of adopting a non-binary approach to international law, particularly focusing on international economic law. Traditional binary categories of sex and gender within legal frameworks not only restrict a comprehensive understanding of human diversity but also perpetuate systemic inequalities. By challenging these binaries, the article discusses how international law can evolve to represent global diversity more holistically. The article addresses the resistance faced when integrating non-binary perspectives due to prevailing cultural, social, and political norms. On these grounds, future research should delve deeper into how gender norms could be incorporated into international trade policies, and the intersections of gender, race, and class in our understanding of international law. Ultimately, the article advocates for an international law framework that not only acknowledges but celebrates and systematically incorporates a spectrum of gender identities, thus fulfilling its promise of universality.

RESUMEN Este artículo examina el potencial transformador de adoptar un enfoque no binario en el derecho internacional, enfocándose particularmente en el derecho internacional económico. Las categorías binarias tradicionales de sexo y género dentro de los marcos legales no solo restringen una comprensión integral de la diversidad humana, sino que también perpetúan desigualdades sistémicas. Al desafiar estos binarios, el artículo discute cómo el derecho internacional puede evolucionar para representar de manera holística la diversidad global. El artículo aborda la resistencia enfrentada al integrar perspectivas no binarias debido a las normas culturales, sociales y políticas predominantes. Sobre esta base, las investigaciones futuras podrían profundizar cómo los conceptos no binarios podrían incorporarse en las perspectivas del comercio internacional y explorar las intersecciones de género, raza y clase en nuestra compresión del derecho internacional. En última instancia, el artículo aboga por un marco de derecho internacional que no solo reconozca sino que celebre e incorpore sistemáticamente un espectro de identidades de género, cumpliendo así su promesa de universalidad.

Abstract Introduction: In December 2016, an outbreak of sylvatic yellow fever (YF) occurred in the non-endemic areas of the south-eastern region of Brazil. The immune response to the yellow fever vaccine and its safety in individuals with chronic kidney disease (CKD) living in YF-endemic regions are not thoroughly understood. The objective of this study is to assess the incidence of adverse events and the serological response after primary vaccination with the 17DD-YF vaccine in CKD patients undergoing dialysis. Methods: This was a multicenter, retrospective cohort study involving 223 individuals with CKD who were on dialysis after primary vaccination against YF. Clinical and epidemiologic characteristics were collected and the vaccine adverse event (VAE) were assessed. Around 35 months after vaccination, the serological response was evaluated in 71 (32%) patients using neutralization tests. Results: No serious VAE occurred in any patient. Local reactions were reported in 13 individuals (5.8%), while 6 (2.7%) reported generalized systemic reactions and 205 (91.9%) did not display any VAE. No clinical or epidemiologic characteristic predicted the occurrence of VAE. Adequate serological response was found in 38% of participants and none of the clinical or epidemiological characteristics were associated with immunogenicity. Conclusion: The outcomes of our study suggest that the yellow YF vaccine is well-tolerated in CKD patients undergoing dialysis, but it does not induce adequate immune response. Future research should focus on evaluating both cellular and humoral immune responses following administration of various doses of the YF vaccine. Introduction 2016 (YF nonendemic non endemic southeastern south eastern Brazil (CKD YFendemic understood 17DDYF DDYF 17DD DD Methods multicenter 22 (VAE assessed 3 7 32% 32 (32% tests Results patient 1 5.8%, 58 5.8% , 5 8 (5.8%) 2.7% 27 2 (2.7% 20 91.9% 919 91 9 (91.9% 38 immunogenicity Conclusion welltolerated well tolerated 201 (32 5.8 (5.8% 2.7 (2.7 91.9 (91.9 (3 5. (5.8 2. (2. 91. (91. ( (5. (2 (91 (5 (9

Resumo Introdução: Em dezembro de 2016, houve um surto de febre amarela (FA) silvestre em áreas não endêmicas da região sudeste do Brasil. A resposta imunológica à vacina contra FA e sua segurança em indivíduos com doença renal crônica (DRC) que vivem em regiões endêmicas de febre amarela não são totalmente compreendidas. O objetivo deste estudo foi avaliar a incidência de eventos adversos e a resposta sorológica após vacinação primária com a vacina 17DD-YF em pacientes com DRC submetidos à diálise. Métodos: Este foi um estudo de coorte retrospectivo e multicêntrico envolvendo 223 indivíduos com DRC que estavam em diálise após vacinação primária contra FA. Foram coletadas características clínicas, epidemiológicas e avaliados os eventos adversos da vacina (EAV). Cerca de 35 meses após a vacinação, a resposta sorológica foi avaliada em 71 (32%) pacientes usando testes de neutralização. Resultados: Não houve EAV grave em nenhum paciente. Reações locais foram relatadas em 13 indivíduos (5,8%), enquanto 6 (2,7%) relataram reações sistêmicas generalizadas e 205 (91,9%) não apresentaram nenhum EAV. Nenhuma característica clínica ou epidemiológica predisse a ocorrência de EAV. Uma resposta sorológica adequada foi encontrada em 38% dos participantes e nenhuma das características clínicas ou epidemiológicas foi associada à imunogenicidade. Conclusão: Os desfechos de nosso estudo sugerem que a vacina contra FA é bem tolerada em pacientes com DRC em diálise, mas não induz uma resposta imunológica adequada. Pesquisas futuras devem se concentrar na avaliação das respostas imunes tanto celulares quanto humorais após a administração de várias doses da vacina contra FA. Introdução 2016 (FA Brasil (DRC compreendidas 17DDYF DDYF 17DD YF DD Métodos 22 . (EAV) 3 7 32% 32 (32% neutralização Resultados paciente 1 5,8%, 58 5,8% , 5 8 (5,8%) 2,7% 27 2 (2,7% 20 91,9% 919 91 9 (91,9% 38 imunogenicidade Conclusão 201 (EAV (32 5,8 (5,8% 2,7 (2,7 91,9 (91,9 (3 5, (5,8 2, (2, 91, (91, ( (5, (2 (91 (5 (9

Resumen: Este artículo ahonda – desde una perspectiva sistémica y constructivista- en las prácticas y discursos de ocho líderes de iglesias evangélicas de diversas denominaciones, presentes en tres regiones de Chile, con posturas orientadas a la apertura e inclusión de lesbianas y homosexuales en estas iglesias. La recolección de información se realizó con el método bola de nieve y gracias a contactos de las autoras. Las categorías analizadas tienen relación con la experiencia de líderes con lesbianas y homosexuales al interior de sus iglesias, las problemáticas que surgen en la comunidad cristiana, los desafíos teológicos que representa esta experiencia y la identificación de pasos hacia una teología inclusiva en Chile. Resumen constructivista denominaciones Chile autoras cristiana

Resumo: Este artigo se aprofunda – de uma perspectiva sistêmica e construtivista – nas práticas e discursos de oito líderes de igrejas evangélicas de diferentes denominações, presentes em três regiões do Chile, com posições orientadas para a abertura e a inclusão de lésbicas e homossexuais nas igrejas que elas representam. A coleta de informações foi realizada pelo método bola de neve e graças aos contatos das autoras. As categorias analisadas estão relacionadas com a experiência de líderes com lésbicas e gays dentro de suas igrejas, os problemas que surgem na comunidade cristã, os desafios teológicos que esta experiência representa e, finalmente, a identificação de passos para uma teologia inclusiva no Chile. Resumo denominações Chile representam autoras cristã finalmente

Abstract: This article delves – from a systemic and constructivist perspective – into the practices and discourses of eight leaders of Evangelical churches of different denominations, present in three regions of Chile, with positions oriented to the openness and inclusion of lesbians and gay people in the churches they represent. The collection of information was carried out using the snowball method and thanks to the authors’ contacts. The categories analyzed are related to the experience of leaders with lesbian and gay people within their churches, the problems that arise in the Christian community, the theological challenges that this experience represents and finally the identification of steps towards an inclusive theology of sexual diversity. Abstract denominations Chile represent authors contacts community diversity

Abstract Introduction: Hereditary transthyretin amyloidosis (ATTRv) is a severe autosomal dominant systemic disease. It affects the peripheral and autonomic nervous systems, heart, kidneys, and eyes. Amyloid deposition has been demonstrated in the glomerular and tubulointerstitial compartments of the kidney. Therefore, urinary acidification disorders such as renal tubular acidosis (RTA) may be early manifestations of renal involvement in this population. Objective: To evaluate the prevalence of RTA in individuals with ATTRv. Methods: We included symptomatic and asymptomatic individuals with TTR mutation, older than 18 years, GFR >45 mL/min/1.73m2, without systemic metabolic acidosis. Urinary acidification protocol was performed with furosemide and fludrocortisone after 12 h of water deprivation (water deprivation test - WDT) and measurements of urine ammonium ( UNH 4 +) and titratable acidity (UTA). Proximal RTA (pRTA) was diagnosed when FEHCO3>10%. Incomplete form distal RTA (dRTA) was diagnosed if UpH>5.3. Results: We selected 49 individuals with a mean age of 40 (35.5–56.5) years, 63% of which were female, 84% were Caucasian, and mean GFR was 85.5 ± 20.5 mL/min/1.73m2. 94% had the genetic variant Val50Met and 57% were symptomatic. The prevalence of pRTA was 2% and of dRTA was 16.3%. In the subgroup with dRTA, there was no significant increase in excretion of UNH 4 + and UTA. We observed a good correlation between UpH by potentiometry and UpH dipstick. A UpH<5.5 on the dipstick had 100% sensitivity and negative predictive value to exclude dRTA. Conclusion: A high prevalence of RTA was found in individuals with TTR mutations. The UpH dipstick after WDT had good accuracy for screening for dRTA. Further studies are needed to evaluate the impact of early diagnosis and treatment of RTA in this population. Introduction ATTRv (ATTRv disease systems heart kidneys eyes kidney Therefore (RTA population Objective Methods mutation 1 years 45 >4 mLmin173m2 mLminm mL min 73m2 m mL/min/1.73m2 UTA . (UTA) (pRTA FEHCO310 FEHCO FEHCO3 10 FEHCO3>10% (dRTA UpH53 5 3 UpH>5.3 Results 35.5–56.5 355565 35 56 (35.5–56.5 63 female 84 Caucasian 855 85 85. 205 20 20. 94 ValMet Val Met 57 2 163 16 16.3% UpH55 UpH<5. 100 Conclusion mutations > mLmin mLmin173m 73m mL/min/1.73m (UTA FEHCO31 FEHCO3>10 UpH5 UpH>5. 35.5–56. 35556 (35.5–56. 6 8 9 16.3 UpH<5 FEHCO3>1 UpH>5 35.5–56 3555 (35.5–56 16. UpH< FEHCO3> UpH> 35.5–5 355 (35.5–5 35.5– (35.5– 35.5 (35.5 35. (35. (35 (3

Resumo Introdução: A amiloidose hereditária por transtirretina (ATTRv) é uma doença sistêmica autossômica dominante grave. Afeta os sistemas nervoso periférico e autônomo, coração, rins e olhos. A deposição de amiloide foi demonstrada nos compartimentos glomerular e tubulointersticial do rim. Portanto, distúrbios de acidificação urinária, como acidose tubular renal (ATR), podem ser manifestações precoces de envolvimento renal nessa população. Objetivo: Avaliar a prevalência de ATR em indivíduos com ATTRv. Métodos: Incluímos indivíduos sintomáticos e assintomáticos com mutação na TTR, maiores de 18 anos, TFG >45 mL/min/1,73m2, sem acidose metabólica sistêmica. Realizou-se protocolo de acidificação urinária com furosemida e fludrocortisona após 12 horas de privação hídrica (teste de restrição hídrica - TRH) e medições de amônia urinária ( uNH 4 +) e acidez titulável (uTA) na urina. ATR proximal (ATRp) foi diagnosticada quando FEHCO3>10%. ATR distal (ATRd) de forma incompleta foi diagnosticada se pHu>5,3. Resultados: Selecionamos 49 indivíduos com idade média de 40 (35,5–56,5) anos, 63% mulheres, 84% caucasianos e TFG média de 85,5 ± 20,5 mL/min/1,73m2. 94% apresentaram a variante genética Val50Met; 57% eram sintomáticos. A prevalência de ATRp foi 2% e a de ATRd foi 16,3%. No subgrupo com ATRd, não houve aumento significativo na excreção de uNH 4 + e uTA. Observamos uma boa correlação entre pHU por potenciometria e pHU por fita reagente. Um pHU<5,5 na fita reagente apresentou 100% de sensibilidade e valor preditivo negativo para excluir a ATRd. ConclusÃO: Uma alta prevalência de ATR foi encontrada em indivíduos com mutações na TTR. O pHU por fita reagente após TRH teve boa precisão para triagem de ATRd. São necessários mais estudos para avaliar o impacto do diagnóstico e tratamento precoces da ATR nessa população. Introdução ATTRv (ATTRv grave autônomo coração olhos rim Portanto ATR, , (ATR) população Objetivo Métodos TTR 1 anos 45 >4 mLmin173m2 mLminm mL min 73m2 m mL/min/1,73m2 Realizouse Realizou teste uTA (uTA urina (ATRp FEHCO310 FEHCO FEHCO3 10 FEHCO3>10% (ATRd pHu53 pHu 5 3 pHu>5,3 Resultados 35,5–56,5 355565 35 56 (35,5–56,5 63 mulheres 84 855 85 85, 205 20 20, 94 Val50Met ValMet Val Met 57 2 163 16 16,3% pHU55 pHU<5, 100 ConclusÃO (ATR > mLmin mLmin173m 73m mL/min/1,73m FEHCO31 FEHCO3>10 pHu5 pHu>5, 35,5–56, 35556 (35,5–56, 6 8 9 16,3 pHU5 pHU<5 FEHCO3>1 pHu>5 35,5–56 3555 (35,5–56 16, pHU< FEHCO3> pHu> 35,5–5 355 (35,5–5 35,5– (35,5– 35,5 (35,5 35, (35, (35 (3