Características neuro-psicopedagógicas de las dificultades de aprendizaje escolar: un estudio de caso / Neuro-psychopedagogical characteristics of school learning difficulties: a case study

Este artículo tiene como objetivo presentar las características neuropsicopedagógicas de un niño con dificultades escolares y de comportamiento. Se llevó a cabo un estudio de caso con un participante de 11 años de edad, quien durante la investigación cursaba el grado quinto de básica primaria en una institución educativa de carácter privado del municipio de Itagüí, Antioquia. Los instrumentos aplicados para la evaluación fueron: el Test Breve de Inteligencia de KAUFMAN (K-BIT), la Batería Psicopedagógica EVALÚA - 5, el Cuestionario de Depresión para Niños (CDS) y una entrevista semiestructurada para padres y docentes, relacionada con los aspectos del desarrollo, el aprendizaje y la conducta del estudiante. Los resultados demostraron que el niño presentaba un coeficiente intelectual dentro de los parámetros normales y las principales dificultades se encontraron en el contexto familiar-social, lo que permitió evidenciar que el rendimiento escolar es el resultado de la interacción de diferentes factores que abarcan componentes cognitivos, del neurodesarrollo, emocionales, familiares y contextuales. Así mismo, se evidenció que las dificultades en el comportamiento asociadas al contexto escolar no siempre están relacionadas con trastornos del aprendizaje o de la conducta. Se hace necesaria la obtención de este tipo de perfiles neuropsicopedagógicos con el fin de establecer rutas de intervención pertinentes y eficaces que incorporen las características cognitivas individuales, los vínculos socio afectivos, el entorno social, escolar, y la dinámica familiar del estudiante.

This article aims to present the neuropsychopedagogical characteristics of a child with school and behavior difficulties. A case study was carried out with an 11-year- old participant, who during the research was studying the fifth grade of elementary school in a private educational institution in the municipality of Itagüí, Antioquia. The instruments applied for the evaluation were: the KAUFMAN Brief Intelligence Test (K-BIT), the EVALÚA Psychopedagogical Battery­5, the Depression Questionnaire for Children (CDS) and a semi-structured interview for parents and teachers, related to aspects of development, learning and behavior of the student. The results showed that the child had an IQ within normal parameters and the main difficulties were found in the social family context, which allowed to show that school performance is the result of the interaction of different factors, which include cognitive, neurodevelopmental, emotional, family and contextual components. It was also evidenced that behavioral difficulties associated with the school context are not always related to learning or conduct disorders. Obtaining this type of neuropsychopedagogical profiles is necessary in order to establish relevant and effective intervention routes, which incorporate individual cognitive characteristics, socio-affective ties, the social and school environment and the student's family dynamics.

Prevalence of Hospital Functional Impairment in a Colombian Elderly Population at the San Ignacio University Hospital / Prevalencia de deterioro funcional hospitalario en una población colombiana de ancianos en el Hospital Universitario San Ignacio / Prevalência de deterioro funcional hospitalar em uma população colombiana de idosos no Hospital Universitário San Ignacio

Abstract Introduction: Functional decline following hospitalization (FDH) is defined as the loss of the functional capacity to perform at least one basic activity of daily life (BADL) when being discharged from hospital; a situation compared to functional capacity performed in the last couple of weeks, prior the acute disease. This impairment is precipitated in the elderly by factors such as aging, architectural conditions, malnutrition, hospital routines and physical restraints. The objective of this study is determining the prevalence of functional impairment in adults over 65 years of age hospitalized in the San Ignacio University Hospital (SIUH) and its associated factors. Materials and Methods: A descriptive cross-sectional study of a hospital cohort was carried out from December 1st 2015 to December 31st 2017. Univariate and multivariate analyses were performed to identify associated variables. Results: 1055 people were included, with FDH prevalence of 41.14%. The three main factors associated with the development of FDH in the elderly population that consulted the SIUH were time of hospital stay [OR 1.88, CI95% (1.41-2.49), p = <0.0001], malnutrition [OR 1.59, CI95% (1.16-2.19), p = 0.004] and delirium [OR 2.38, CI95% (1.83-3.10), p = <0.001]. Conclusion: FDH is a highly prevalent condition in the geriatric population hospitalized in the San Ignacio University Hospital, where length of stay, malnutrition and delirium are the factors associated with its disease onset.

Resumen Introducción: El deterioro funcional hospitalario (DFH) se define como la pérdida de la capacidad para realizar al menos una actividad básica de la vida diaria (ABVD) en el momento del alta respecto a la situación funcional dos semanas previas al inicio de la enfermedad aguda; dicha situación es precipitada en los ancianos por factores como el envejecimiento, las condiciones arquitectónicas, la desnutrición, las rutinas hospitalarias y las restricciones físicas. El presente estudio busca determinar la prevalencia de deterioro funcional en adultos mayores de 65 años hospitalizados en el Hospital Universitario San Ignacio (HUSI) y sus factores asociados. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal de una cohorte hospitalaria de diciembre de 2015 al 31 de diciembre de 2017; se llevó a cabo un análisis univariado y multivariado para identificar variables asociadas. Resultados: Se incluyeron 1055 personas, con una prevalencia de DFH del 41,14%. Los tres principales factores asociados al desarrollo de DFH en la población anciana que consulta al HUSI fueron tiempo de estancia hospitalaria [OR 1,88, CI95% (1,41-2,49), p = <0,0001], malnutrición [OR 1,59, CI95% (1,16-2,19), p = 0,004] y delirium [OR 2,38, CI95% (1,83-3,10), p = <0,001]. Conclusión: El DFH es una condición altamente prevalente en la población geriátrica hospitalizada en el Hospital Universitario San Ignacio, siendo el tiempo de estancia intrahospitalaria, la malnutrición y el delirium factores asociados a su aparición.

Resumo Introdução: O deterioro funcional hospitalar define-se como a perda da capacidade para realizar pelo menos uma atividade básica da vida diária (ABVD) no momento da alta médica respeito à situação funcional duas semanas prévias ao início da doença aguda. Dita situação e precipitada nos idosos por fatores como o envelhecimento, as condições arquitetônicas, a subnutrição, rutinas hospitalares e restrições físicas. O presente estudo busca determinar a prevalência de deterioro funcional em idosos de 65 anos hospitalizados no Hospital Universitário San Ignacio (HUSI) e seus fatores associados. Materiais e métodos: Se realizou um estudo descritivo de corte transversal de uma coorte hospitalar de dezembro de 2015 ao 31 de dezembro de 2017; se realizou uma análise univariada e multivariada para identificar variáveis associadas. Resultados: Se incluíram 1055 pessoas, com uma prevalência de DFH do 41,14%. Os três principais fatores associados ao desenvolvimento de DFH na população idosa que consulta ao HUSI foram tempo de permanência hospitalar [OR 1,88, CI95% (1,41-2,49), p = <0,0001], a subnutrição [OR 1,59, CI95% (1,16-2,19), p = 0,004] e o delirium [OR 2,38, CI95% (1,83-3,10), p = <0,001]. Conclusão: O DFH é uma condição altamente prevalente na população geriátrica hospitalizada no Hospital Universitário San Ignacio sendo o tempo de permanência intra-hospitalar, a subnutrição e o delirium fatores associados à sua aparição.

Otomyiasis: Systematic Review

Abstract Introduction Myiasis is a disease causedby fly larvae that growinthetissues of animals and humans. It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever andmalaise.Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues. Its management varies depending on the location, and on the preferences of the doctor that faces this challenge. Myiasis usually occurs in tropical countries, and, in many places, it is not a rare condition. The cases are rarely reported, and there are no publishedmanagement protocols. Objective To review the literature regarding the most common agents, the predisposing factors and the treatment alternatives for otic myiasis, a rare form of human myiasis caused by the infestation of fly larvae in the ear cavities. Data synthesis We present a systematic review of the literature. The search in five databases (Medline, Embase, Cochrane Database of Systematic Reviews, LILACS and RedALyC) led to 63 published cases from 24 countries, in the 5 continents. The ages of the patients ranged fromnewborn to 65 years old. Themost common agents belong to the Sarcophagidae or Calliphoridae families. Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors. The treatment alternatives are herein discussed. Conclusion The results highlight the need for monitoring, follow-up and standardization of medical approaches. (AU)

Prevalence of hypothyroidism in major psychiatric disorders in hospitalised patients in Montserrat Hospital during the period March to October 2010 / Prevalencia de hipotiroidismo en trastorno psiquiátrico mayor de pacientes hospitalizados en la Clínica Montserrat en el periodo de marzo a octubre de 2010

Abstract Introduction: Hypothyroidism results from inadequate production of thyroid hormone. It is known that there is a relationship between the major psychiatric disorders and hypothyroidism. Objective: To determine the prevalence of hypothyroidism in patients admitted due to major psychiatric disorders in Montserrat Hospital during the period from March to October 2010. Material and methods: A descriptive cross-sectional study was conducted on 105 patients admitted to Montserrat Hospital with a primary diagnosis of major psychiatric disorder (major depression, bipolar affective disorder, generalised panic disorder, panic disorder, mixed anxiety-depressive disorder, and schizophrenia) in the aforementioned period. Thyroid stimulating hormone (TSH) was performed to assess the evidence of hypothyroidism. Results: The overall prevalence of hypothyroidism was found to be 10.5% (95%CI, 5-16%). It was 12.5% in anxiety disorder, 11.1% in depressive disorder, with a lower prevalence of 10.3% for bipolar disorder, and 9.9% for schizophrenia. Conclusions: The overall prevalence of hypothyroidism was found to be less than in the general population, which is between 4.64% and 18.5%, and hypothyroidism was found in disorders other than depression.

Resumen Introducción: El hipotiroidismo resulta de una inadecuada producción de hormonas tiroideas. Es conocido que existe una relación entre los trastornos psiquiátricos mayores y el hipotiroidismo. Objetivo: Determinar la prevalencia de hipotiroidismo en los pacientes hospitalizados por trastorno psiquiátrico mayor en la Clínica Montserrat en el periodo de marzo a octubre de 2010. Material y métodos: Se realizó un estudio descriptivo transversal, para el que se seleccionó una muestra de 105 pacientes que ingresaron a la Clínica Montserrat con diagnóstico de trastorno psiquiátrico mayor (depresión mayor, trastorno afectivo bipolar, trastorno de ansiedad generalizada, trastornos de ansiedad, trastorno mixto ansioso-depresivo y esquizofrenia) en el periodo mencionado. Para evaluar el hipotiroidismo se realizó una prueba de Hormona Estimulante del Tiroides (TSH). Resultados: La prevalencia general del hipotiroidismo fue del 10,5% (intervalo de confianza del 95%, 5%-16%). Al determinar el hipotiroidismo por diagnóstico, se encontró que había mayor prevalencia en los trastorno de pánico (12,5%) y depresivo (11,1%) y menor en el trastorno bipolar (10,3%) y la esquizofrenia (9,9%). Conclusiones: La prevalencia general del hipotiroidismo fue menor que en la población general (18,5-4,6%) y se encontró hipotiroidismo en otros trastornos diferentes de la depresión.

Niveles de impulsividad y riesgo de alcoholismo en personas pertenecientes a barras bravas en la ciudad de Ibagué - Colombia / Levels of impulsivity and risk of alcoholism in adults Belonging to "barras bravas" in the city of ibagué - Colombia

El objetivo de este trabajo es determinar la relación entre niveles de impulsividad y riesgo de alcoholismo en adultos pertenecientes a "barras bravas" en la ciudad de Ibagué (Tolima) a partir de la aplicación del test de CAGE, la Escala de Impulsividad de Plutchik (EI) y una ficha de caracterización sociodemográfica. Se utilizó un modelo correlacional de corte transversal. Los hallazgos evidencian niveles bajos (78%) y promedios de impulsividad (20%). El 28% no presenta problemas relacionados con el alcohol, mientras que el 36% tiene indicios de consumo y el restante 36% dependencia alcohólica. Se hallaron correlaciones bajas entre las puntuaciones, la correlación significativa fue de tipo directamente proporcional entre edad y riesgo de alcoholismo (r= 0,287; p= 0.43), lo que indica que a mayor edad mayor es el riesgo de alcoholismo. © Revista Colombiana de Ciencias Sociales.

The objective of this study was to determine the relationship between levels of impulsivity and risk of alcoholism in adults belonging to "barras bravas" in the city of Ibagué (Tolima) from the application of the CAGE test, the scale of impulsiveness of Plutchik (EI) and a socio-demographic characterization data sheet. A correlational cross-sectional model was used. The findings show low levels (78%) and averages of impulsivity (20%). The 28% do not show problems related with alcohol, while 36% have signs of consumption and 36% alcoholic dependence. There were found low correlations between such scores, the significant correlation was directly proportional between age and risk of alcoholism (r = 0,287, p = 0.43) indicating that a greater age, greater is the risk of alcoholism.

Vulnerabilidad de los implantes dentales y ortopédicos / Vulnerability of dental and orthopedic implant

La colocación de implantes en diferentes partes del cuerpo ha sido realizada desde hace muchotiempo atrás. Se ha identificado diferentes factores de riesgo y complicaciones que pueden alterarlos tejidos perimplantares posterior a la colocación de estos. No existe evidencia científica que realice la comparación entre diferentes implantes colocados en diferentes partes del cuerpo.

The placement of implants on different body parts has been practiced since long ago. Variousrisk factors and complications that can alter perimplant tissue after placement of these have beenidentified. There is no scientific evidence to make the comparison among different implants placed indifferent parts of the body.

Automatización en el laboratorio clínico / Automation in the clinical laboratory

La automatización de los laboratorios clínicos es un fenómeno que va en aumento, un proceso aplicable a todas las etapas del proceso analítico; el uso de la computación, la incorporación de autoanalizadores y otros elementos automáticos proporciona una serie de ventajas mejorando la eficiencia y la capacidad productiva en beneficio de los pacientes, de los profesionales y del propio laboratorio, reconocer el momento adecuado en que debe aplicarse la automatización así como el grado y etapas en las que se puede intervenir reporta una serie de beneficios, este cambio debe hacerse en forma planificada considerando elementos tales como los costos, la capacitación del personal y las tecnologías disponibles.

The automation of the clinical laboratories is a phenomenon that increases, a process applicable to all the stages of the analytical process, the use of the computation, the incorporation of autoanalyzers and other automatic elements provide a series of advantages improving the efficiency and the productive capacity to the benefit of the patients, of the professionals and the own laboratory, to recognize the suitable moment in which it must be applied to the automation as well as the degree and stages in which it is possible to be taken part reports a series of benefits, this change must be made in planned form considering elements such as the costs, the qualification of the personnel and the technologies available.

Estudio crítico del HOMA como método de pesquisa de resistencia insulínica en clínica / A critical study of the HOMA test as a screening for insulin resistance

Background: The hyperinsulinemic euglycemic clamp is the gold standard to measure directly insulin resistance.Unfortunately, the procedure is technically demanding, expensive and, unsuitable for clinical work. Cliniciansare used to request an HOMA test (Homeostasis Model Assessment) to indirectly assess the presence of insulinresistance given that it is an inexpensive and readily performed test but it has several shortcomings. Aim: To studythe diagnostic performance of the HOMA test as it is done in our country. Material and methods: We selected 32 women aged 32 +/- 2 years and 18 men aged 42 +/- 3 years. Half of them were categorized as insulin resistant by the pancreatic suppression test with octreotide, that is highly correlated with the euglycemic clamp but simpler to perform. Insulin was measured in two different laboratories in Santiago (Barnafi-Krause and Laboratorio deNutrición, Universidad Católica) and HOMA results were calculated using serum fasting insulin and glucose levels.Results: The correlation coefficients between HOMA, calculated using insulin values of both laboratories, and the results of the pancreatic suppression test were 0.45 and 0.55 (p< 0.01). Only six of 25 subjects defined as insulin resistant by the pancreatic suppression test were detected with HOMA. Therefore, the sensitivity of the latter for insulin resistance was 24 percent. However all subjects defined as insulin resistant by HOMA (BK) hadan abnormal pancreatic suppression test. Conclusions: Even though HOMA test was positively correlated with insulin resistance, it had a poor diagnostic sensitivity. Clinicians should be aware that the HOMA test is proneto under-diagnose the presence of insulin resistance.

Association between proinsulin, insulin, proinsulin/insulin ratio, and insulin resistance status with the metabolic syndrome

The Metabolic Syndrome (MS) constitutes an independent risk factor of cardiovascular disease. There is evidence that proinsulin blood levels and the proinsulin/insulin ratio are associated to the MS. The purpose of this study was to compare proinsulin and insulin, insulin resistance index, and the proinsulin/insulin ratio as predictors of MS. This is a cross-sectional study involving 440 men and 556 women with a mean age of 24 years. Diagnosis of MS was made according to the National Cholesterol Education Program Adult Treatment Panel III. Blood levels of insulin and proinsulin were measured, and the insulin resistance status was estimated using the homeostatic model assessment (HOMA-IR). The prevalence of MS was 10.1 percent. HOMA-IR was the best MS risk factor for both women and men (OR = 2.04; 95 percent CI: 1.68-2.48 and 1.09; 95 percent CI: 1.05-1.13, respectively). HOMA-IR presented the best positive predictive value for MS: 22 percent and 36 percent for men and women, respectively, and was the best MS indicator. The proinsulin/insulin ratio did not show significant association with MS. HOMA-IR, proinsulin, and insulin presented good negative predictive values for both genders that could be used to identify an at-risk population.

A síndrome metabólica (SM) constitui um fator de risco independente para doenças cardiovasculares. Existem evidências de que níveis sangüíneos de proinsulina e o índice proinsulina/insulina estão associados com a presença da SM. O objetivo deste trabalho foi comparar proinsulina e insulina, índice de resistência insulínica e o fator proinsulina/insulina para predizer a presença da SM. Este é um estudo transversal envolvendo 440 homens e 556 mulheres com média de 24 anos de idade. O diagnóstico da SM foi feito de acordo com o Painel III do programa de tratamento nacional educacional de colesterol para adultos. Níveis sangüíneos de insulina e proinsulina foram medidos, o índice de resistência insulínica foi estimado através do modelo de avaliação hemostático (HOMA-IR). A prevalência da SM foi de 10 por cento. HOMA-IR demonstrou ser o melhor fator de risco da SM em homens e mulheres (OR = 2,04; 95 por cento CI: 1,68-2,48 e 1,09; 95 por cento CI: 1,05-1,13, respectivamente). HOMA-IR apresentou o melhor valor preditivo positivo para SM: 22 por cento e 36 por cento para homens e mulheres, respectivamente, e foi o melhor indicador da SM. O índice proinsulina/insulina não apresentou associação significativa com SM. HOMA-IR, proinsulina e insulina apresentaram bons valores preditivos negativos para ambos sexos, o que poderia ser usado para identificar uma população de risco.

Lupus eritematoso neonatal: comunicación del caso de una madre con síndrome de Sjögren / Neonatal erythematosus lupus: report of the case of a mother with Sjögren's syndrome

Se comunica el caso de un lactante de cuatro meses de edad, del sexo masculino, con lesiones cutáneas eritematoescamosas, anulares, diseminadas que se iniciaron en el segundo mes de vida y que corresponden a lupus eritematoso neonatal. El diagnóstico se hizo con base en el estudio histopatológico y en los anticuerpos Ro-SSA de 54.6 UE/ml. Se detectó un síndrome de Sjögren en la madre del paciente con base en anti-Ro-SSA de 88.2 UE/ml. El lupus eritematoso neonatal se relaciona con lupus eritematoso sistémico materno y otras colagenopatías, como el síndrome de Sjögren. Este caso desarrolló lesiones cutáneas a partir del segundo mes, las que generalmente aparecen en los primeros días de vida.

Rizotomía selectiva posterior limitada a tres dorsales: una variable para el tratamiento neuroquirúrgico de la espasticidad / Neurosurgical treatment of spasticity, selective posterior rhizotomy. A new procedure

Introducción. La rizotomía selectiva posterior (RSP) es efectiva para reducir la espasticidad asociada con la parálisis cerebral infantil (PCL). Para evitar una hipotonía postoperatoria se presentó una variante a la técnica quirúrgica clásica. Material y métodos. Diceséis niños con espasticidad secundaria a PCI fueron evaluados antes y después de la rizotomía. Se comparó el grado de espasticidad de miembros superiores y de miembros inferiores. Se disecaron las raíces dorslaes de L4, L5 y S1. Resultados. En todos los grupos musculares analizados se observó una disminución de la espasticidad sin hipotonía asociada. Conclusiones. La técnica quirúrgica propuesta en este estudio es efectiva para reducir la espasticidad tanto en los miembros superiores com en los inferiores. Espasticidad; rizotomía selectiva posterior; parálisis cerebral