What about adolescents' mental health after the pandemics? An analyses of a grade II hospital.

OBJECTIVES: Suicidal ideation and suicide are serious situations that affect children and adolescents. The restrictions imposed by the SARS-CoV-2 pandemic have had a significant negative impact, due to social isolation, prolonged screen exposure and reduced outdoor activities. This study aims to compare the access to the Pediatric Emergency Department due to suicidal ideation and suicide attempts before and during the pandemic. METHODS: This descriptive and retrospective study analyzed clinical records of children/adolescents who attended a Level II Pediatric Emergency Department of a hospital due to suicidal ideation and/or suicide attempts, between March 2018 and March 2020 (pre-pandemic period) and April 2020 to March 2022 (pandemic period). Demographic (age and sex) and clinical (psychopharmacological therapy, discharge destination and follow-up psychiatric/psychological consultations) variables were collected. Statistical analysis was performed using Microsoft Excel 2022® and SPSS v20.0®, considering statistical significance at p<0.05. RESULTS: A total of 71 children/adolescents were admitted for suicidal ideation, with a median age of 15 years (minimum: 10 years, maximum: 17 years), 27 in pre-pandemic period and 44 in pandemic period (p<0.001). The majority were girls, with a significant increase in pandemic period (pre-pandemic: 55.6 %, pandemic: 79.6 %; p<0.05). The age group with the highest increase in admissions was 15 years. There was a significant increase in suicidal attempts among girls (p<0.05) as well as self-harm behaviors (p<0.01). There was also a significant increase in the number of psychology/child psychiatry follow-up consultations in pandemic period (p<0.05). Most patients were referred to another hospital in both periods (pre-pandemic: 55.6 %, pandemic: 68.2 %) at discharge. CONCLUSIONS: During the pandemic period, there was an increase in the number of suicidal ideation cases, particularly among females, as well as in suicide attempts cases, which appears to be correlated with the pandemic restrictions. Larger-scale studies are needed to draw more accurate conclusions.

Multisensory effects of mask wearing on speech intelligibility and the benefit of multilingualism / Efeitos multissensoriais do uso de máscara na inteligibilidade da fala e o benefício do multilinguismo

ABSTRACT Purpose Due to the pandemic of the Covid-19 disease, it became common to wear masks on some public spaces. By covering mouth and nose, visual-related speech cues are greatly reduced, while the auditory signal is both distorted and attenuated. The present study aimed to analyze the multisensory effects of mask wearing on speech intelligibility and the differences in these effects between participants who spoke 1, 2 and 3 languages. Methods The study consisted of the presentation of sentences from the SPIN test to 40 participants. Participants were asked to report the perceived sentences. There were four conditions: auditory with mask; audiovisual with mask; auditory without mask; audiovisual without mask. Two sessions were conducted, one week apart, each with the same stimuli but with a different signal-to-noise ratio. Results Results demonstrated that the use of the mask decreased speech intelligibility, both due to a decrease in the quality of auditory stimuli and due to the loss of visual information. Signal-to-noise ratio largely affects speech intelligibility and higher ratios are needed in mask-wearing conditions to obtain any degree of intelligibility. Those who speak more than one language are less affected by mask wearing, as are younger listeners. Conclusion Wearing a facial mask reduces speech intelligibility, both due to visual and auditory factors. Older people and people who only speak one language are affected the most.

RESUMO Objetivo Devido à pandemia da doença Covid-19, o uso de máscaras em espaços públicos tornou-se comum. Ao cobrir a boca e o nariz, reduzem-se amplamente as pistas visuais associadas à fala, assim como se distorce e atenua o sinal auditivo. Este estudo teve como objetivo analisar os efeitos multissensoriais do uso da máscara na percepção da fala e a diferença entre participantes falantes de uma, duas ou três línguas. Método Este estudo consistiu na apresentação de frases do SPIN teste a 40 participantes. Os participantes tinham como tarefa reportar as frases percebidas em quatro condições: Auditiva com máscara, audiovisual com máscara, auditiva sem máscara, audiovisual sem máscara. Conduziram-se duas sessões, com uma semana de intervalo, cada uma com os mesmos estímulos mas com diferente relação sinal-ruído. Resultados Os resultados demonstraram que o uso de máscara reduz a inteligibilidade da fala, tanto devido à diminuição da qualidade do estímulo auditivo, como devido à perda de informação visual. A relação sinal-ruído afeta a inteligibilidade e com o uso de máscara são necessárias relações mais altas para obter qualquer identificação correta. Aqueles que falam mais do que uma língua, assim como os mais novos, são menos afetados na percepção de fala com uso de máscara. Conclusão O uso de máscara facial reduz a inteligibilidade da fala, tanto devido a fatores visuais como auditivos. Indivíduos monolíngues, assim como os mais velhos, são os mais afetados nesta tarefa.

Importance of Genetic Diagnosis in Global Developmental Delay: A Case of Cabezas Syndrome Caused by CUL4B Gene Deletion and Not Identified by Array-CHG.

Global developmental delay (GDD) and intellectual disability (ID) are common reasons for referral to neurodevelopmental assessment. The etiology of GDD and ID can be genetic, acquired, or multifactorial. We report a case of a 10-year-old boy with ID and GDD who was diagnosed with Cabezas syndrome, a rare genetic disorder caused by a deletion of the CUL4B gene. Despite normal results from previous testing, exome sequencing with copy number variation analysis led to the identification of the deletion. Early diagnosis of GDD and ID is crucial for effective patient management, including planning interventions and providing support, therapy, and genetic counseling for families.

Multisensory effects of mask wearing on speech intelligibility and the benefit of multilingualism.

PURPOSE: Due to the pandemic of the Covid-19 disease, it became common to wear masks on some public spaces. By covering mouth and nose, visual-related speech cues are greatly reduced, while the auditory signal is both distorted and attenuated. The present study aimed to analyze the multisensory effects of mask wearing on speech intelligibility and the differences in these effects between participants who spoke 1, 2 and 3 languages. METHODS: The study consisted of the presentation of sentences from the SPIN test to 40 participants. Participants were asked to report the perceived sentences. There were four conditions: auditory with mask; audiovisual with mask; auditory without mask; audiovisual without mask. Two sessions were conducted, one week apart, each with the same stimuli but with a different signal-to-noise ratio. RESULTS: Results demonstrated that the use of the mask decreased speech intelligibility, both due to a decrease in the quality of auditory stimuli and due to the loss of visual information. Signal-to-noise ratio largely affects speech intelligibility and higher ratios are needed in mask-wearing conditions to obtain any degree of intelligibility. Those who speak more than one language are less affected by mask wearing, as are younger listeners. CONCLUSION: Wearing a facial mask reduces speech intelligibility, both due to visual and auditory factors. Older people and people who only speak one language are affected the most.

Malignant Syphilis: A Rare Case of Early Secondary Syphilis in an Immunocompetent Patient.

Early malignant syphilis is an uncommon form of secondary syphilis and characterized by pleomorphic multiple round-to-oval papules, some with necrosis, and associated with systemic signs and symptoms. Usually seen in immunosuppressed patients, mainly those infected with HIV, it can also be observed in immunocompetent patients. We report a case in a young healthy woman with the characteristic features of the disease and with favourable skin lesion evolution after appropriate treatment with penicillin. LEARNING POINTS: Skin lesions can be caused by numerous systemic diseases.Syphilis is the 'great mimicker' and should always be considered as a diagnosis in those with skin lesions.

Dogs Barking and Babies Crying: The Effect of Environmental Noise on Physiological State and Cognitive Performance.

Objective: The exposure to some environmental sounds has detrimental effects on health and might affect the performance in cognitive tasks. In this study, we analyze the effect of the neighborhood noises of a baby crying and dogs barking on the autonomic response and cognitive function. Materials and methods: Twenty participants were exposed, in separate sessions, to white noise, a baby crying, a small dog barking, and a large dog barking. During each session, heart rate, skin conductance, reaction times, spatial memory, and mathematical processing measures were taken throughout time. Results: The sounds of a baby crying and dogs barking led to significantly higher heart rates and skin conductance levels as opposed to exposure to white noise. Results were not as consistent with exposure to barking as they were to the baby. Exposure to the baby crying and dogs barking led to faster reaction times, possibly due to a facilitation by the autonomic system activation. No significant effects on spatial memory were found. Conversely, participants performed worse and slower in a mathematical task when exposed to the dog and baby sounds, than when exposed to control noise. Conclusion: Exposure to the sound of crying babies and dogs barking leads to increased sympathetic response and decreased cognitive ability, as compared to exposure to control sounds. Special attention should be paid to the mitigation of exposure to these types of noises.

A Rare Case of Unilateral Tongue Edema with Angiotensin Converting Enzyme Inhibitors.

Angiotensin converting enzyme inhibitors (ACEi) are widely used for the treatment of multiple conditions such as hypertension, heart failure and chronic kidney disease. Angioedema is a rare but potentially fatal complication of ACEi use and unilateral tongue edema is a very rare presentation. We report a case of a 55-year-old man, with a history of hypertension, on enalapril for three years, who presented to the hospital with unilateral tongue swelling, without airway compromise. Other causes were excluded and the diagnosis of angioedema due to enalapril was established. The patient was discharged with discontinuation of ACEi with total resolution of symptoms and without relapse after several months. Although very rare, unilateral tongue swelling should be considered in the presentation of angioedema associated with ACEi. Tight surveillance is important to prevent fatal complications such as airway obstruction. ACEi discontinuation is crucial to avoid clinical relapse.

Os inibidores da enzima de conversão da angiotensina (iECAs) são amplamente usados no tratamento de várias patologias como a hipertensão arterial, insuficiência cardíaca e doença renal crónica. O angioedema é uma complicação rara mas potencialmente fatal desta medicação e o edema unilateral da língua é uma apresentação rara desta condição. Reportamos o caso de um homem de 55 anos com hipertensão, medicado há três anos com enalapril, que à admissão hospitalar apresentava edema unilateral da língua sem compromisso da via aérea. Outras etiologias foram excluídas, tendo-se assumido o diagnóstico de angioedema associado ao enalapril. Após suspensão do iECA os sintomas diminuíram progressivamente, sem recorrência do quadro após vários meses. Ainda que raro, o edema unilateral da língua deve ser considerado na apresentação do angioedema associado a iECA. É importante uma vigilância apertada para prevenir complicações fatais, tais como a obstrução da via aérea. A descontinuação do iECA é fundamental para evitar recidiva.

Relationship Between the Self-Concept of Children and Their Ability to Recognize Emotions in Others.

The aim of this study was to assess the relationship between the self-concept of children and their ability to recognize emotions in others from facial expressions. It is hypothesized that children use their self-representations to interpret depictions of emotion in others and that higher self-concepts might be associated with earlier development of emotion recognition skills. A total of 54 children aged between 5 and 11 years participated in this study. Self-concept was assessed in all children using the Piers-Harris Self-Concept Scale for Children (Piers-Harris 2). To assess emotion recognition, a computerized instrument, the Penn Emotion Recognition Task (PERT), was applied. Despite the small sample of children, results show clear statistical effects. It is shown that emotion recognition ability is directly correlated with self-concept for intellectual/school status. The ability to correctly identify emotions from facial expressions is affected by general self-concept, intellectual/school status, and stimulus features of gender, intensity, and emotion. Further analysis shows that the general self-concept of children particularly affects the ability to identify happy faces. Children with a higher intellectual status score recognize happiness and neutral faces more easily. We concluded that the self-concept in children relates to the ability to recognize emotions in others, particularly positive emotions. These findings provide some support to the simulation theory of social cognition, where children use their own self-representations to interpret mental states in others. The effect of the self-concept for intellectual status on emotion recognition might also indicate that intellectual abilities act as a mediator between self-concept and emotion recognition, but further studies are needed.

Association of Multiple Myeloma and Giant Cell Arteritis - A Case Report.

Autoimmune diseases (AID) have been associated with a variety of lymphoproliferative disorders. Multiple myeloma (MM), one of the most common haematologic malignancies characterized by clonal proliferation of bone marrow plasma cells, has been associated with a range of autoimmune disorders. In this report, we described a case study of a patient admitted to our Internal Medicine Department for a bone marrow biopsy and myelogram due to a monoclonal peak observed by his general practitioner. However, at admission he presented typical giant cell arteritis (GCA) complaints, suggesting the coexistence of both diseases. The possible pathogenesis, as found in the literature, explaining the association will be discussed. LEARNING POINTS: A relationship between AID and lymphoproliferative diseases, although rare, may occur and some studies suggest that the diagnosis of autoimmune disease has a negative impact on survival in MM patients.Bone marrow plasmacytosis can present a diagnostic dilemma, since it may be due to neoplastic or non-neoplastic conditions (that is, reactive plasmacytosis associated with AID, chronic infection, metastatic carcinoma, liver diseases and acquired immunodeficiency).Immunophenotyping in a myelogram or immunohistochemistry in bone marrow studies are useful in confirming a monoclonal plasma cell proliferation.

Modeling the Perception of Audiovisual Distance: Bayesian Causal Inference and Other Models.

Studies of audiovisual perception of distance are rare. Here, visual and auditory cue interactions in distance are tested against several multisensory models, including a modified causal inference model. In this causal inference model predictions of estimate distributions are included. In our study, the audiovisual perception of distance was overall better explained by Bayesian causal inference than by other traditional models, such as sensory dominance and mandatory integration, and no interaction. Causal inference resolved with probability matching yielded the best fit to the data. Finally, we propose that sensory weights can also be estimated from causal inference. The analysis of the sensory weights allows us to obtain windows within which there is an interaction between the audiovisual stimuli. We find that the visual stimulus always contributes by more than 80% to the perception of visual distance. The visual stimulus also contributes by more than 50% to the perception of auditory distance, but only within a mobile window of interaction, which ranges from 1 to 4 m.

Auditory localization by subjects with unilateral tinnitus.

Tinnitus is associated with changes in neural activity. How such alterations impact the localization ability of subjects with tinnitus remains largely unexplored. In this study, subjects with self-reported unilateral tinnitus were compared to subjects with matching hearing loss at high frequencies and to normal-hearing subjects in horizontal and vertical plane localization tasks. Subjects were asked to localize a pink noise source either alone or over background noise. Results showed some degree of difference between subjects with tinnitus and subjects with normal hearing in horizontal plane localization, which was exacerbated by background noise. However, this difference could be explained by different hearing sensitivities between groups. In vertical plane localization there was no difference between groups in the binaural listening condition, but in monaural listening the tinnitus group localized significantly worse with the tinnitus ear. This effect remained when accounting for differences in hearing sensitivity. It is concluded that tinnitus may degrade auditory localization ability, but this effect is for the most part due to the associated levels of hearing loss. More detailed studies are needed to fully disentangle the effects of hearing loss and tinnitus.

Predicting auditory space calibration from recent multisensory experience.

Multisensory experience can lead to auditory space recalibration. After exposure to discrepant audiovisual stimulation, sound percepts are displaced in space, in the direction of the previous visual stimulation. This study focuses on identifying the factors in recent sensory experience leading to such auditory space shifts. Sequences of five audiovisual pairs were presented, each randomly congruent or discrepant in space. Each sequence was followed by a single auditory trial and two visual trials. In each trial, participants had to identify the perceived stimuli positions. We found that auditory localization is shifted during audiovisual discrepant trials and during subsequent auditory trials, suggesting a recalibration effect. Time did not lead to greater recalibration effects. The last audiovisual trial affects the subsequent auditory shift the most. The number of discrepant trials in a sequence, and the number of consecutive trials in sequence, also correlated with the subsequent auditory shift. To estimate the individual contribution of previously presented trials to the recalibration effect, a best-fitting model was developed to predict the shift in a linear weighted combination of stimulus features: (1) whether matching or discrepant trials occurred in the sequence, (2) total number of discrepant trials, and (3) maximum number of consecutive discrepant trials, (4) whether the last trial was discrepant or not. The selected model consists of a function including as properties the type of stimulus of the last audiovisual sequence trial and the overall probability of mismatching trials in sequence.

Formação do eu professor na abordagem Walloniana* / Formación del yo profesor en el abordaje Walloniano / The I Professor Formation in the Wallonian approach

RESUMO Objetivos Analisar como o professor percebe a construção de seu Eu Professor na perspectiva de Wallon e conhecer como vivencia seu cotidiano na escola na condição de ser o si mesmo e o outro. Método Estudo qualitativo que contou com 13 participantes atuantes no Curso Bacharelado em Enfermagem. A coleta de dados foi realizada em 2013, por meio de entrevistas submetidas à análise temática. Resultados Emergiram três categorias: Construção do Eu Professor; Viver o cotidiano apoiado em si mesmo e no outro; e Componentes da construção do Eu Professor, com destaque para a conscientização e valorização de si mesmo e do outro, edificando a construção do Eu Professor. Conclusão Os professores percorreram uma trajetória na qual permitiu reconhecer o si mesmo em diferentes movimentos da internalização do Eu.

RESUMEN Objetivos Analizar como el profesor percibe la construcción del Yo Profesor en la perspectiva de Wallon y conocer como vivencia su cotidiano en la escuela en la condición de ser a sí mismo y el otro. Método estudio cualitativo, que contó con 13 participantes actuantes del Curso de Bachiller en Enfermería. La recolección de los datos fue realizada en 2013, por medio de entrevistas, las cuales fueron sometidas al análisis temático. Resultados surgieron tres categorías: Construcción del Yo Profesor; Vivir el cotidiano apoyado en sí mismo y del otro; y Componentes de la construcción del Yo Profesor, destacándose la concientización y valorización de sí mismo y del otro, edificando la construcción del Yo Profesor. Conclusión Los profesores siguieron una trayectoria tal que les permitió reconocerse a sí mismo y en los distintos movimientos de la internalización del Yo.

ABSTRACT Objectives Analyze how teachers perceive the construction of their I Professor from the perspective of Wallon and learn about their everyday experiences in school in the condition of being self and other. Method Qualitative, with 13 participants from the Bachelor of Nursing Program. Data collection was carried out in 2013 using interviews that were subjected to thematic analysis. Results Three categories emerged: Construction of the I Professor; living daily life supported by oneself and the other; and the components for constructing the I Professor, highlighting consciousness and valuing of oneself and the other. Conclusion The teachers traveled a path that allowed them to recognize themselves in different movements of the internalization of the I.

The I Professor Formation in the Wallonian approach. / Formação do eu professor na abordagem Walloniana.

Objectives Analyze how teachers perceive the construction of their I Professor from the perspective of Wallon and learn about their everyday experiences in school in the condition of being self and other. Method Qualitative, with 13 participants from the Bachelor of Nursing Program. Data collection was carried out in 2013 using interviews that were subjected to thematic analysis. Results Three categories emerged: Construction of the I Professor; living daily life supported by oneself and the other; and the components for constructing the I Professor, highlighting consciousness and valuing of oneself and the other. Conclusion The teachers traveled a path that allowed them to recognize themselves in different movements of the internalization of the I.

A review on auditory space adaptations to altered head-related cues.

In this article we present a review of current literature on adaptations to altered head-related auditory localization cues. Localization cues can be altered through ear blocks, ear molds, electronic hearing devices, and altered head-related transfer functions (HRTFs). Three main methods have been used to induce auditory space adaptation: sound exposure, training with feedback, and explicit training. Adaptations induced by training, rather than exposure, are consistently faster. Studies on localization with altered head-related cues have reported poor initial localization, but improved accuracy and discriminability with training. Also, studies that displaced the auditory space by altering cue values reported adaptations in perceived source position to compensate for such displacements. Auditory space adaptations can last for a few months even without further contact with the learned cues. In most studies, localization with the subject's own unaltered cues remained intact despite the adaptation to a second set of cues. Generalization is observed from trained to untrained sound source positions, but there is mixed evidence regarding cross-frequency generalization. Multiple brain areas might be involved in auditory space adaptation processes, but the auditory cortex (AC) may play a critical role. Auditory space plasticity may involve context-dependent cue reweighting.

The effect of instruction to synchronize over step frequency while walking with auditory cues on a treadmill.

Walking to a pacing stimulus has proven useful in motor rehabilitation, and it has been suggested that spontaneous synchronization could be preferable to intentional synchronization. But it is still unclear if the paced walking effect can occur spontaneously, or if intentionality plays a role. The aim of this work is to analyze the effect of sound pacing on gait with and without instruction to synchronize, and with different rhythmic auditory cues, while walking on a treadmill. Firstly, the baseline step frequency while walking on a treadmill was determined for all participants, followed by experimental sessions with both music and footstep sound cues. Participants were split into two groups, with one being instructed to synchronize their gait to the auditory stimuli, and the other being simply told to walk. Individual auditory cues were generated for each participant: for each trial, cues were provided at the participant's baseline walking frequency, at 5% and 10% above baseline, and at 5% and 10% below baseline. This study's major finding was the role of intention on synchronization, given that only the instructed group synchronized their gait with the auditory cues. No differences were found between the effects of step or music stimuli on step frequency. In conclusion, without intention or cues that direct the individual's attention, spontaneous gait synchronization does not occur during treadmill walking.