The impact of SARS-CoV-2 on emotional state among older adults in Latin America

In Latin America, the volume of care of infected patients, higher presence of comorbidities among older adults, and restricted access to clinical controls have become this age group into one with the highest risk (Dubey etal., 2020). Under confinement circumstances, older people can experience feelings of helplessness and uncertainty about the future, difficulties to stay focused, anxiety, stress, agitation, withdrawal, and depression (Armitage and Nellums, 2020; Wang etal., 2020). Accordingly, a Consortium of universities, research centers, and clinical centers have joined forces to carry out research which seeks to know the emotional state of Latin American older adults during confinement by Coronavirus disease (COVID-19). The study included the following countries: Argentina, Bolivia, Chile, Colombia, Costa Rica, Ecuador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Puerto Rico, Dominican Republic, and Venezuela. Between April and May, we carry out the piloting of the evaluation protocol, making cultural and linguistic adaptations. Later, between June and October, more than 7000 older adults were evaluated by telephone by an expert professional through filling out an online form. The protocol we used includes a sociodemographic and clinical questionnaire, information on confinement, lifestyles, and the abbreviated version of the Yesavage Geriatric Depression Scale (Martínez de la Iglesia etal., 2020). Sociodemographic characteristics of the final sample (n = 5245) show that 34% are men and 66% are women, with an average age of 69.61 years (SD = 7.28). Average schooling was 10.99 years (SD = 5.85) depending on the country, and 16.7% were illiterate. The major racial pattern of the population is Latin American mestizo (55.1%) followed by white (39.4%), South American indigenous (1.5%), and African American subjects (1.2%). Seventy-seven percentage of the participants have a monthly income, from retirement (45.9%) or independent work (26.4%), and 85% live with their spouses or relatives. Regarding quarantine, 86.7% of the respondents stated that they complied with the confinement measures, with an average of 123.15 days (SD = 42.43) of quarantine, which varies by country. Our data analysis has revealed that 30.27% of the older adults exhibit emotional disturbances. In Mexico and Peru, we have observed the highest levels of geriatric depression (38.9% and 38.1%, respectively) and in Venezuela the lowest (21.35%). Regression analysis shows that more years of schooling (OR = 0.943; IC95%: 0.93–0.95), having an economic income (OR = 0.764; IC95%: 0.64–0.90) and being a Latin American mestizo (OR = 0.832, IC95%: 0.71–0.98) are associated with reduced risk of geriatric depression. On the other hand, being widowed (OR = 1.428; IC95%: 1.10–1.85) or separated (OR = 1.352; IC95%: 1.01–1.82), lived in Bolivia (OR = 1.805; IC95%: 1.31–2.48), Mexico (OR = 2.320; IC95%: 1.70–3.16), and Peru (OR = 2.008; IC95%: 1.45–2.78) are associated with highest risk. This first multicenter study found that emotional status of older adults during the SARS-CoV-2 pandemic in Latin America varies depending on the country where they live and sociodemographic and socioeconomic factors. It is necessary for follow-up studies to validate diagnosis and analyze the greater risk of deterioration in the coming months

Presentation of bilateral facial paralysis in Melkersson–Rosenthal syndrome

Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. +is was an overall 20- day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. +e patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. +e etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. +ere are no curative treatments. +erapy is focused on modulating the patient’s immune response, and relapses are frequent

Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation

Introduction Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). Discussion Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation

Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation

Introduction: Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. Objective: To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. Materials and methodology: One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). Results: Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). Discussion: Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation

Factores que Influyen en el Conocimiento y Aplicación del Proceso de Enfermería Bucaramanga 1997

RESUMEN  Objetivo: El Proceso de Enfermería es un método sistemático y organizado para administrar cuidados individualizados de Enfermería, se centra en la identificación y tratamiento de las respuestas únicas de la persona y fue adoptado como marco de referencia del perfil académico del profesional colombiano desde 1986; a pesar de esto son pocas las evidencias prácticas de su aplicación en el ejercicio profesional. Este trabajo tuvo como objetivo identificar los factores que influyen en el conocimiento y aplicación del Proceso de Enfermería en la academia y el ejercicio profesional. Método: Se realizó un estudio de corte transversal, en una muestra aleatoria de 200 personas, entre enfermeras de Bucaramanga y su área metropolitana y estudiantes de la Universidad Industrial de Santander, a las cuales se les aplicó una encuesta auto administrada. Se obtuvo respuesta en el 77% de la muestra, Resultados: Los resultados pueden resumirse de la siguiente manera: el 70.1 % dice utilizar el Proceso de Enfermería y el 75.3% lo definió correctamente. Sin embargo sólo el 25.3% enunció correctamente las etapas. Dentro de las dificultades percibidas durante la formación y aplicación del Proceso de Enfermería se destacan: el tiempo que exige su aplicación y registro, la falta de unificación de criterios en la elaboración del diagnóstico, la falta de compromiso institucional para asumir el Proceso de Enfermería como método de trabajo y el desconocimiento del mismo en la mayoría del personal. En relación con las alternativas de solución es notable que no hubo coherencia entre estas y las dificultades expresadas. Conclusiones: El conocimiento sobre el Proceso de Enfermería dista de ser perfecto. Su enseñanza y aplicación deben ser mejoradas y aumentadas. Salud UIS 2002: 34; 104-109 Palabras clave: Proceso de Enfermería, Enfermería.  ABSTRACT  Objective: Nursing Process is a systematic method to administer nursing care. It centers in the identification and treatment of the unique responses of people and was adopted as a framework for the academic formation in Colombian nursing schools since 1986; nevertheless there is not empiric evidence of the use in real practice. Methods: a descriptive cross sectional design was used. The sample consisted of 200 persons that included nurses from the metropolitan area of Bucaramanga and nursing students of the Universidad Industrial de Santander. A self-administered questionnaire was used to obtain the Information, to which 77% of the sample answered, Results: the summary of the results are: 70.1% say that they use Nursing Process and 75.3% defined it correctly, nevertheless only 25.3% described correctly its steps. In relation to the difficulties during the learning and use of the Nursing Process, nurses and students, points to excessive time which is needed for the application and register, inexistence of unified criteria, and the institution's poor interest in adopting it as a framework for nursing care. The solutions proposed to surmount the difficulties for its use, do not agree with the problems. Conclusion: the knowledge of the Nursing Process is far from perfect and its teaching and use should be improved and increased. Salud UIS 2002: 34; 104-109 Key words: Nursing Process, Nursing.

Factors associated with cognitive impairment in Latin American older adults: A cross‐sectional observational study of COVID‐19 confinement

INTRODUCTION: The effects of COVID-19 confinement have been severe, especially in older adults. Therefore, we analyzed the factors associated with cognitive impairment (CI) in Latin America (LA). METHODS: We conducted a cross-sectional observational study with a total of 5245 older adults from 10 countries in LA. Measurement: We used the Telephone Montreal Cognitive Assessment (T-MoCA) and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) scale. RESULTS: We found that age, depressive symptomatology, bone fractures, being widowed, having a family member with dementia, and unemployment were associated with an increased risk of CI. In contrast, higher education, hypertension with continuous treatment, quarantine, and keeping stimulating cognitive and physical activities were associated with a lower probability of CI. No significant association was found between suffering from diabetes or being retired and CI. DISCUSSION: It is essential to conduct follow-up studies on these factors, considering their relationship with CI and the duration of confinement

Efecto de la capacidad visoespacial en el rendimiento académico de estudiantes de anatomía médica

Visuospatial ability is associated with clinical skills in medical education, as it predicts the academic performance of anatomy students. Objective: To determine whether visuospatial processing generates changes in the teaching of medical anatomy and predicts academic performance in that subject. Methods: 140 students were evaluated at the beginning of the semester and before final exams with the Rey Complex Figure Test (CRFT).&nbsp; Student's t-tests were performed to contrast pre- and post-test differences, Cohen's d to measure effect size, and linear regression to evaluate prediction with final grades. Results: Mean age 20.22 years (SD=1.12), mean grade point average 4.96 (SD=1.20). Seventy percent of the students passed the course. The t-test reports significant differences of TFCR (Memory recall: t=-17.383; p&lt;0.001; Delayed recall: t=-16.547, p&lt;0.001) with a medium effect size (d=0.59 and d=0.56), respectively. The scores obtained in the post-test on the TFCR deferred recall task explained up to 90% of the students' academic performance. Conclusions: The instrument's deferred memory predicted academic performance and anatomy learning improved students' visuospatial function performance.La capacidad visoespacial se asocia con habilidades clínicas en la educación médica, ya que predice el desempeño académico de los estudiantes de anatomía. Objetivo: Determinar si el procesamiento visoespacial genera cambios en la enseñanza de la anatomía médica y predice el desempeño académico en esa asignatura. Método: 140 estudiantes evaluados al inicio de semestre y antes de exámenes finales con el Test de la Figura Compleja de Rey.  Se realizaron análisis t de Student para contrastar las diferencias pre y pos-test, d de Cohen para medir el tamaño de efecto y regresión lineal para evaluar la predicción con las notas finales. Resultados: Edad promedio 20.22 años (DE=1.12), media de calificaciones 4.96 (DE=1.20). El 70% de los estudiantes aprobó la asignatura. La prueba t reporta diferencias significativas del TFCR (Evocación de Memoria: t=-17.383; p&lt;0.001; Evocación diferida: t=-16.547, p&lt;0.001) con un tamaño del efecto mediano (d=0.59 y d=0.56), respectivamente. Las puntuaciones obtenidas en el post-test en la tarea de memoria diferida del TFCR, explicaron hasta en un 90% el desempeño académico de los estudiantes. Conclusiones: La memoria diferida del instrumento predijo el rendimiento académico y el aprendizaje de anatomía mejoró el desempeño en la función visoespacial de los estudiantes

MoCA-T as a remote assessment tool to determine cognitive impairment in patients with moderate to severe OSA

La pandemia de COVID-19 ha dado lugar al surgimiento de herramientas tecnológicas que permiten la valoración de pacientes de forma remota. La prueba de evaluación cognitiva de Montreal, versión telefónica (MoCA-T), es una de ellas. Se considera como un recurso de la telemedicina que permite la tamización cognitiva a distancia en épocas de pandemia y en la población con dificultades en el acceso a los centros de salud. El deterioro cognitivo leve (DCL) es un hallazgo usual en pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS); sin embargo, no se ha estudiado la aplicación de pruebas telefónicas para su tamización cognitiva. El objetivo principal de este trabajo es determinar la frecuencia de deterioro cognoscitivo mediante la aplicación de MoCA-T como prueba de tamización remota en pacientes con SAHOS moderado y severo. Para ello, se aplicó la prueba de MoCA-T en 104 pacientes entre 18 y 65 años con diagnóstico polisomnográfico de SAHOS moderado y severo, excluyéndose a pacientes con comorbilidades que afectasen las capacidades cognoscitivas. Se obtuvieron resultados anormales de MoCA-T en el 43% de los pacientes, siendo los dominios cognitivos de la memoria y la atención los más comúnmente afectados. Finalmente, los resultados anormales de MoCA-T se correlacionaron con la autopercepción de las dificultades en la memoria, estando más frecuentemente alterada en quienes manifestaron quejas cognitivas. La prueba MoCA-T podría ser una herramienta tecnológica breve, validada y factible para realizar el tamizaje cognitivo de pacientes con SAHOS en épocas de pandemia y en pacientes con barreras asistenciales.The COVID-19 pandemic has led to the emergence of technological tools that allow remote assessment on patients. The Montreal Cognitive Assessment Test Telephone Version (MoCA-T) is one of them. Considered as a telemedicine resource that allows remote cognitive screening in pandemic era and in the population with difficulties in accessing health centers. Mild cognitive impairment (MCI) is a common finding in patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). However, the application of telephone tests for cognitive screening has not been studied. To determine the frequency of cognitive deterioration through the application of MoCA-T as a remote screening test in patients with moderate and severe OSAHS is the main objective of this work. To do this, the MoCA-T test was applied to 104 patients with polysomnographic diagnostic capabilities for moderate and severe OSAHS between ages 18 and 65, excluding patients with comorbidities that affect cognitive ones. Abnormal MoCA-T results were obtained in 43% of patients, with the cognitive domains of memory and attention being the most affected. Finally, abnormal MoCA-T results correlated with self-perception of memory difficulties, being more frequently altered in those who manifest cognitive complaints. The MoCA-T test could be a brief, validated and feasible technological tool for cognitive screening of patients with OSAHS in times of pandemic and in patients with care barriers

Effectiveness of deep brain stimulation in refractory and drug-resistant aggressiveness in autism spectrum disorder

Background. Aggressive behavior, resistant to pharmacological and psychological treatment, is observed in some cases of autism. The main objective of this study is to analyze the efficacy of deep brain stimulation (DBS) for aggressive behavior in severe autism. Method. The effectiveness of DBS was analyzed in a clinical follow-up of 5 autistic patients, with impaired functional activity and refractoriness to psychopharmacological and behavioral treatment. The patients were examined in medical meetings and evaluated by experienced professionals using the Overt Aggressiveness Scale (OAS), before surgical implantation and after 6, 12 and, 18 months of follow-up. Student's t-test analyses were performed to assess changes in aggressiveness scores. The effect size of surgical intervention on patients' OAS performance was estimated. Results. Before the intervention, patients scored very high on the aggressiveness scale. In the subsequent medical controls, a clinically and psychometrically significant decrease in aggressiveness and self-injury symptoms was observed. These data were confirmed by the parents up to 18 months of follow-up. Very large effect sizes were obtained in favor of DBS. Conclusions. In this case series, DBS significantly reduced aggressiveness and self-injury, favoring functionality, social adaptation of the patients, and improving the quality of life of the family. We believe that DBS may be a viable treatment option

Deep Brain Stimulation in the Posteromedial Hypothalamic Nuclei in Refractory Aggressiveness: Post-Surgical Results of 19 Cases

Aggression is a clinical manifestation that usually occurs in neurodevelopmental disorders. In intellectual disability, dysfunctional behavior and aggressive and maladaptive responses are common. These facts put at risk the patient's safety and cause discomfort in family members and caregivers (Gouveia et al., 2019). In general, drug prescription and behavioral therapy have favorable results in these individuals. However, there is a subset of patients who do not respond adequately to pharmacological and psychological treatment due to the severity of clinical symptoms and associated brain dysfunction (Torres et al., 2013) responsible for aggressive behavior...Fil: Benedetti Isaac, Juan Carlos. Medihelp Clínic; ColombiaFil: Camargo, Loida. Universidad del Sinú. Medical School; ColombiaFil: Gargiulo, Pascual Angel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Departamento de Patología; ArgentinaFil: Lopez, Norman Dario. Universidad de la Costa; Colombi