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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.

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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.

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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)

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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