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Background: Cardiac diseases are among the leading causes of death worldwide, including sudden cardiac arrest in particular. Nursing professionals are often the first to encounter these scenarios in various settings. Adequate preparation and competent knowledge among nurses significantly impact survival rates positively. Aim: To describe the state of knowledge about Basic and Advanced Life Support guidelines among Ecuadorian nursing professionals. Methodology: A nationwide, descriptive, cross-sectional study was conducted from February to April 2023 among Ecuadorian nursing professionals. Participants were invited through official social media groups such as WhatsApp and Facebook. The study utilized a self-administered online questionnaire to evaluate theoretical knowledge of Basic Life Support (BLS) and Advanced Life Support (ALS). Knowledge scores were assigned based on the number of correct answers on the tests. T-tests and one-way ANOVA were used to examine relationships between knowledge scores and demographic and academic training variables. Results: A total of 217 nursing professionals participated in the study. The majority of the participants were female (77.4%) and held a university degree (79.9%). Among them, only 44.7% claimed to have obtained a BLS training certificate at least once, and 19.4% had ALS certification. The overall BLS knowledge score (4.8/10 ± 1.8 points) was higher than the ALS score (4.3/10 ± 1.8 points). Participants who had obtained BLS certification and those who used evidence-based summaries as a source of extracurricular training achieved higher BLS and ALS knowledge scores. Conclusion: Ecuadorian nursing professionals in this study exhibited a significant deficiency in theoretical knowledge of BLS and ALS. Formal training and preparation positively impact life support knowledge. Support and inclusion of Ecuadorian nurses in training and academic preparation programs beginning at the undergraduate level are essential for promoting life support knowledge and improving outcomes.
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Purine-rich element-binding protein A (PURα) regulates multiple cellular processes. Rare de novo mutations can lead to PURA syndrome, which manifests as a range of multisystem disturbances, including hypotonia, global developmental delay, swallowing disorders, apnea, seizures, visual impairments, and congenital heart defects. We report the case of a Colombian girl with no relevant medical history who was diagnosed with PURA syndrome at the age of 7, due to a heterozygous mutation located at 5q31.2, specifically the variant c.697_699del (p.Phe233del), in exon 1 of the PURA gene. This represents the first documented case of PURA syndrome in South America and the first association of the syndrome with vitiligo, thereby expanding the known phenotypic spectrum. In addition to enriching the literature concerning the phenotypic diversity of PURA syndrome, this report highlights, for the first time, the diagnostic challenges faced by developing countries like Colombia in diagnosing high-burden rare diseases such as PURA syndrome.
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BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a complex disorder that includes various phenotypes, leading to different manifestations. It also shares different disadvantages typical of rare diseases, including limited recognition, lack of prospective studies assessing treatment, and little or delayed access to advanced treatment options. Reliable data about the prevalence and natural history of cardiomyopathies in South America are lacking. This study summarizes the features and management of patients with HCM in a university hospital in Colombia. METHODS: This was an observational retrospective cohort study of patients with HCM between January 2010 and December 2021. Patient data were analyzed from an institutional cardiomyopathy registry. Demographic, paraclinical, and outcome data were collected. RESULTS: A total of 82 patients during the study period were enrolled. Of these, 67.1% were male, and the mean age at diagnosis was 49 years. Approximately 83% were in NYHA functional class I and II, and the most reported symptoms were dyspnea (38%), angina (20%), syncope (15%), and palpitations (11%). In addition, 89% had preserved left ventricular ejection fraction (LVEF) with an asymmetric septal pattern in 65%. Five patients (6%) had alcohol septal ablation and four (5%) had septal myectomy. One patient required heart transplantation during follow-up. Sudden cardiovascular death was observed in 2.6%. The overall mortality during follow-up was 7.3%. CONCLUSIONS: HCM is a complex and heterogeneous disorder that presents with significant morbidity and mortality. Our registry provides comprehensive data on disease courses and management in a developing country.
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Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified.A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.
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Tronco Encefálico/fisiología , Encéfalo/fisiología , Síndrome de Leucoencefalopatía Posterior , Convulsiones/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Pronóstico , Convulsiones/fisiopatologíaRESUMEN
Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto de desarrollo del esmalte de origen multifactorial que afecta de uno a cuatro primeros molares permanentes y frecuentemente está asociada con incisivos permanentes. Clínicamente se caracteriza por presentar opacidades demarcadas de color blanco-crema y/o amarillo-café. En casos severos puede haber dolor, fracturas posteruptivas, lesiones de caries dental y/o restauraciones atípicas. Entre las opciones de tratamiento se encuentran restauraciones temporales con cemento de ionómero de vidrio, restauraciones en resina compuesta, coronas, restauraciones indirectas y exodoncia. El objetivo de este caso es analizar las consideraciones diagnósticas de la exodoncia de primeros molares permanentes severamente afectados por la HMI. Paciente de sexo femenino, 9 años de edad, patrón esquelético Clase I, maloclusión Clase I bilateral e HMI severa. Para el tratamiento se optó por realizar la exodoncia de los cuatro primeros molares permanentes bajo anestesia general. Luego de 10 meses, se observa que los segundos molares permanentes están clínicamente sanos y presentan inclinaciones y posiciones favorables para el cierre espontáneo del espacio. Se concluye que la exodoncia de primeros molares permanentes severamente afectados por la HMI es una estrategia que mejora el pronóstico del paciente y para realizarla, se requiere trabajar en conjunto con el ortodoncista para diagnosticar y planear individualmente cada caso.
Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito de desenvolvimento do esmalte, de origem multifatorial que afecta de um a quatro primeiros molares permanentes e frequentemente está associada aos incisivos permanentes. Clinicamente se caracteriza como opacidades demarcadas de coloração branco-creme e/ou amarelo-café. Em casos severos pode haver dor, fraturas pós-irruptivas, lesões de cárie dentária e restaurações atípicas. Dentre as opções de tratamento estão as restaurações temporárias com cimento de ionômero de vidro, restaurações em resina composta, coroas, restaurações indiretas e a exodontia. Esta última opção permite que o segundo molar permanente se reposicione espontaneamente desde que realizada a tempo, portanto, é considerada uma alternativa viável e custo-efetiva. O objetivo deste caso foi analisar as considerações diagnósticas de exodontia de primeiros molares permanentes severamente afetados pela HMI. Paciente do sexo feminino, 9 anos de idade, padrão esquelético Classe I, maloclusão Classe I bilateral e HMI severa. Para o tratamento, optou-se por realizar a exodontia dos quatro primeiros molares permanentes sob anestesia geral. Após 10 meses, se observa que os segundos molares permanentes estão clinicamente saudáveis e apresentam inclinações e posicionamentos favoráveis para o fechamento espontâneo do espaço. Conclui-se que a exodontia de primeiros molares permanentes melhora o prognóstico do paciente e para realizá-la requer um trabalho em conjunto com o ortodontista para diagnosticas e planejar individualmente cada caso.
Abstract Molar and Incisor Hypomineralization (MIH) is an enamel development defect of multifactorial origin that affects one-to-four permanent first molars and is frequently associated with permanent incisors. Clinically it is characterized by demarcated white-cream and/ or yellow-brown opacities. In severe cases, there may be tooth pain, posteruptive fractures, dental caries lesions, and/ or atypical restorations. Treatment options include temporary restorations with glass ionomer cement, restorations with composite resin, crowns, indirect restorations, and tooth extraction. When extractions are performed at the right time, it allows the spontaneous replacement of the second permanent molar, therefore, it is considered a viable and cost/effective treatment. The objective of this case report is to analyze the diagnostic considerations for the extraction of first permanent molars severely affected by MIH. Female patient, 9 years old, Class I skeletal pattern, Class I malocclusion, and severe MIH. For the treatment, it was decided to perform the extraction of the first four permanent molars under general anesthesia. After 10 months, it is observed that the second permanent molars are clinically healthy and have favorable inclinations and positions for spontaneous closure of the space. It is concluded that the extraction of first permanent molars severely affected by MIH is a strategy that improves the patient's prognosis and to carry out, it is necessary to work together with the orthodontist to diagnose and plan each case individually.
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La Gliomatosis Cerebri (GC) se define como un compromiso infiltrativo difuso de un tumor glial generalmente astrocítico que compromete al menos 3 lóbulos cerebrales de manera bilateral y usualmente la afección se extiende al tallo cerebral. Su incidencia representa aproximadamente el 1% de la totalidad de los tumores encefálicos y se presenta con mayor frecuencia en adultos jóvenes. El diagnóstico se establece por medio de la clínica, la imagenología y confrimación histológica. Las posibilidades terapéuticas son limitadas y la sobrevida cercana a los 2 años mostrando una alta mortalidad. Reportamos el caso de un paciente masculino de 11 años de edad quien fue atendido en el Hospital Militar Central de Bogotá Colombia donde se realizó el diagnóstico y se instauró el tratamiento
Gliomatosis Cerebri (GC) is defined as a diffuse infiltration of a glial tumor generally astrocytic that involves at least 3 cerebral lobes bilaterally and usually the condition extends to the brainstem. Its incidence represents approximately 1% of all brain tumors and occurs more frequently in young adults. The diagnosis is established for the clinic environment, imaging and histological confirmation. The therapeutic possibilities are limited and the survival close to 2 years showing a high mortality. We report the case of an 11-year-old male patient who was treated at the Central Military Hospital of Bogotá Colombia where the diagnosis was made and treatment was instituted
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Humanos , Masculino , Niño , Neoplasias Encefálicas/diagnóstico por imagen , Enfermedades del Nervio Oculomotor/diagnóstico por imagen , Neoplasias Neuroepiteliales/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Neoplasias del Sistema Nervioso CentralRESUMEN
La lepra puede presentar dificultades diagnósticas, especialmente en la forma neural primaria. Un hombre de 38 años, exsoldado y trabajador rural, presentó durante más de 10 años hiperestesia supraclavicular y supraescapular izquierdas y anestesia progresiva escapular y en guante de la mano y brazo izquierdos, con reabsorción ósea de las falanges distales del primero y segundo dedos de la misma mano, cambios que le dificultaban realizar sus labores; no tenía lesiones cutáneas de lepra. El nervio cubital izquierdo presentaba engrosamiento epitroclear, por lo que se sospechó lepra neural pura. Las baciloscopias de moco, pabellones auriculares y codos fueron negativas, al igual que los anticuerpos IgM contra el glicolípido fenólico 1; dos biopsias de piel de zonas anestésicas fueron normales también. La electromiografía evidenció disminución notoria de los potenciales sensitivos de los nervios cubital, radial y mediano izquierdos, lo cual favoreció el diagnóstico de lepra neural primaria. Se inició tratamiento para lepra multibacilar por tener afección de más de un tronco nervioso, dos meses después comenzó a presentar mejoría notoria de los síntomas y logró reanudar sus actividades comunes y laborales. La lepra neural primaria cursa con zonas de hipoestesia y anestesia cutánea y engrosamiento neural troncular, puede permanecer sin diagnóstico durante años. La electromiografía, que demuestra disminución de los potenciales sensitivos, es una ayuda diagnóstica considerable, mientras la biopsia de piel anestésica ayuda al diagnóstico solo en la tercera parte de los casos. La sospecha clínica razonable es suficiente para iniciar tratamiento antileproso, cuando no se dispone de otros medios diagnósticos.
Leprosy can be difficult to diagnose, in particular the pure neuritic leprosy type. A 38-year-old male, former soldier and rural worker, presented with a 10-year history of supraclavicular and suprascapular hyperesthesia of the left side and progressive scapular left arm anesthesia, including the hand, associated with bone resorption in distal phalanges of the first and second finger. No typical leprosy skin changes were present. An examination of the skin revealed epitrochlear thickening of the left side cubital nerve, therefore primary neural leprosy was suspected. Skin smears from the routine sites were normal, as were two skin biopsies and the serologic assay specific for M leprae to detect phenolic glycolipid-1. Electromyography revealed an important reduction in the sensory action potential of the ulnar, radial and medial nerves, which favored the primary neural leprosy diagnosis. After two months of multibacillar leprosy treatment, the symptoms started to disappear and the patient could recommence his old job. Pure neuritic leprosy presents with skin areas of hypesthesia and anesthaesia associated with nerve thickening. It is a disease that is commonly misdiagnosed for several years before the correct diagnosis is made and effective treatment is started. Electromyography can be a helpful tool in the diagnosis, typically showing reduced sensory action potential, while a biopsy of anesthetic skin is only helpful in one-third of cases. Reasonable clinical suspicion is sufficient to initiate antileprosy treatment when no other diagnostic methods are available.
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Humanos , Masculino , Adulto , Lepra Tuberculoide , Mycobacterium leprae , Anomalías Cutáneas , Electromiografía , Hipoestesia , Anestesia , Lepra/diagnósticoRESUMEN
El síndrome de encefalopatía posterior reversible es una condición que responde a múltiples causas y presenta características clínicas o radiológicas distintivas; los intensivistas y los médicos de urgencias deben conocerlo con el fin de hacer el diagnóstico y ordenar el tratamiento oportuno. Se presenta un caso fatal de síndrome de encefalopatía posterior reversible, en el cual se determinaron los factores de riesgo relacionados con el resultado final. Un hombre de 60 años sin antecedentes médicos ingresó por urgencias con depresión de la conciencia, convulsiones y tensión arterial elevada. Las imágenes de la tomografía revelaron un hematoma cerebeloso posterior, y las de resonancia magnética mostraron zonas isquémicas, edema vasogénico que se extendía desde los tálamos hacia el tallo cerebral, los pedúnculos cerebelosos medios y la sustancia blanca profunda de los hemisferios cerebelosos, así como zonas de transformación hemorrágica. A pesar del tratamiento médico y quirúrgico recibido, el paciente falleció. Se determinaron los factores de riesgo que se han descrito como causa de muerte en este síndrome. Este caso demuestra que dicho síndrome puede ocurrir sin que se hayan detectado factores de riesgo desencadenantes y pone en evidencia la necesidad de su reconocimiento temprano para establecer una intervención adecuada y evitar daños o un desenlace fatal. Además, abre el camino a nuevos estudios sobre la propensión a desarrollarlo y las medidas preventivas que pueden adoptarse.
Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified. A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.
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Síndrome de Leucoencefalopatía Posterior , Edema Encefálico , Imagen por Resonancia Magnética , Hemorragia Cerebral , Síndromes de Neurotoxicidad , Sustancia BlancaRESUMEN
Objetivo: analizar las historias clínicas de los pacientes intervenidos quirúrgicamente por reflujo vesicoureteral en el Hospital Infantil Universitario Rafael Henao Toro de Manizales-Caldas (Colombia) durante los años 2008-2015. Materiales y métodos:estudio descriptivo en el cual se revisaron 50 historias clínicas. Resultados: el género masculino tiene una proporción de 52%, en un 70% la procedencia es de Manizales,54,3% de estrato social 3, la edad promedio es de 3,22±2,81 años. En cuanto a las variables pondoestaturales, los niños tienen un peso promedio de 16,59±10,49 kg,63,3% con peso adecuado para la edad, en promedio la talla es de 98,92±24, 47 cm, 80,6% con talla adecuada para la edad. Referente a las variables clínicas el 70% consulta por fiebre la primera vez, el 77,6% tenían ecografía prenatal, el 16% presentan anomalías extrarrenales, siendo vejiga neurogénica la más frecuente 37,5%, el 32% muestra complicaciones, siendo la infección de las vía urinarias la más frecuente con un 25%, respecto a la lateralidad la afectación del riñón izquierdo fue del 40,8% y se encuentra el parcial de orina alterado en el 85,4%. El método diagnóstico más frecuente fue la ecografía post-natal con un 72%. Conclusiones: en este estudio selogra dilucidar características tanto clínicas y sociodemográficas del reflujo vesicoureteral pero no se logra confirma el perfil epidemiológico de los pacientes encontrado en otros estudios, también se obtiene información sobre los métodos diagnósticos y el manejo más utilizado en esta zona del país.
Objective: to analize medical histories of treated patients by vesicoureteral reflux atHospital Infantil Universitario Rafael Henao Toro from Manizales-Colombia duringyears 2008-2015. Materials and methods: descriptive studies in which 50 medicalhistories were reviewed. Results: male gender has a 52% proportion, in a 70% theorigin from Manizales, 54,3% are in a social stratum number 3, the average age is3.22±2,81 years old. Regarding the pondostaturals variables, kids weight is on average16.59±10,49 kg, 63.3% of them have a porportional weight according to the age, meanwhile the average height is 98,92±24,47 cm, 80,6% have a proportional heightaccording to the age. Relating to medical variables, 70% of consults are due to firsttime fever, 77.6% had a prenatal ecography, 16% have extrarenal abnormalities, beingneurogenic bladder the most frequent with a 37,5%, 32% show complications, beingurinary tract infection the most frequent with a 25%, regarding the laterality left kidney affectation was 40,8% and urine test is altered in the 85,4%. The most frequent method to diagnose was post-natal ecography with a 72%. Conclusions: in this study is possible to elucidate both medicals and sociodemographic characteristics of vesicoureteralreflux nevertheless is not possible to confirm the epidemiologyc profile of the patients found in other studies, also information is obtained about diagnose methods and the most used management in this part of the country.
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Anomalías Congénitas , Riñón , Reflujo VesicoureteralRESUMEN
Resumen El presente estudio tuvo como objetivo identificar la frecuencia del acoso y ciberacoso escolar y los factores asociados en una muestra representativa de 475 estudiantes de secundaria en tres instituciones públicas del municipio de Chinchiná, en el departamento de Caldas, Colombia, en el año 2014. La población fue seleccionada mediante un muestreo probabilístico estratificado por grado y género. Aplicamos las escalas: APGAR familiar, CAGE (Cut, Annoyed, Guilty, Eye), Escala Hospitalaria de Ansiedad y Depresión (HAD), la SCOFF (Scik Control On Fast Food), el acoso escolar por medio de la encuesta sobre convivencia escolar para alumnos, y el ciberacoso por medio de Escala de Patchin. De acuerdo al cuestionario empleado se encontró una proporción del más alto nivel de acoso del 1.9%, 0.4% acosadores, 1.3% ciberacoso, 1.9% ciberacosadores, en rango medio, 14% acoso, 8.5% acosador, 5.5% ciberacoso, 4.9% ciberagresores. Se encontraron relaciones significativas entre nivel de acoso y funcionalidad familiar, consumo de alcohol, ansiedad, depresión, consumo de sustancias, nivel de ciberacoso también con trastornos de la conducta alimentaria. Los factores asociados con acoso y ciberacoso afectan por igual a acosados y acosadores, resultado también encontrado en otros estudios. En esta población se presentan principalmente niveles de acoso medio y bajo.
Abstract This study aimed to identify the frequency of bullying and cyberbullying and associated factors in a representative sample of 475 high school students in three public institutions of Chinchiná (Colombia) in 2014. This is a cross sectional study. Demographic variables were taken; family functioning was assessed by the family APGAR scale instrument, taken with the CAGE (Cut, Annoyed, Guilty, Eye) scale, anxiety and depression, with hospital scale of anxiety and depression (HAD), eating disorders SCOFF (Scik Control On Fast Food), scale bullying staff through the survey about coexistence school for students and cyberbullying through Patchin scale. According to the questionnaire employed a high ranking proportion of 1.9% was found, 4% bullies, cyber bullying 1.3%, 1.9% cyberbulliesin the middle bullying 14%, 8.5% stalker 5.5% cibera-sew, 4.9% cyber attackers. Significant relationships between the level of harassment and family functioning, alcohol consumption, anxiety, depression, substance abuse levels were found, level of cyberbullying also disordered eating behavior. We found that factors associated Aphek-as both bullies and bullied, result similar to that found in other studies. In this population, high levels of harassment have low proportions, not harassment levels low and medium.
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Los potenciales evocados cognitivos son mediciones electrofisiológicas relacionadas con procesos que tienen que ver con ciertas funciones cognitivas. El potencial cognitivo P300 está específicamente relacionado con procesos de atención. Objetivo: identificar valores para la latencia y amplitud de onda P300 en una muestra de individuos colombianos y describir su comportamiento con respecto a edad, género y escolaridad de los sujetos. Método: se estudiaron 122 sujetos sanos entre los 6 y 80 años, se practicó medición del potencial según la metodología odd-ball, en las derivaciones Cz y Pz. Resultados: se identificaron valores medianos, mínimos y máximos para diferentes grupos etarios y se estableció que la latencia de la onda P300 aumenta con la edad de los individuos y que, por el contrario, la amplitud de la misma tiende a disminuir. De igual forma, al correlacionar latencia y amplitud, se evidenció una relación inversa. Conclusiones: no se encontraron diferencias para latencia y amplitud de onda relacionadas con el género ni la escolaridad de los sujetos, así como tampoco se halló diferencia al realizar la medición en la derivación Pz comparada con la onda obtenida en la derivación Cz.
Cognitive evoked potentials are electrophysiological measurements of cognitive functions. Cognitive potential P300 is specifically related to attention processes. Objetive: the aim of this study was to establish reference values for latency and amplitude of P300 wave in the Colombian population and determine their variability with age, gender and education of the subjects. Methods: we studied 122 healthy subjects between 6 and 80 years, are practical potential measurement methodology as odd-ball, in leads Cz and Pz. Results: we were able to establish reference values for different age groups, and statistical significance was found with which the latency of P300 wave increases with the age of individuals, and instead thereof the amplitude tends to decrease. Similarly to correlate latency and amplitude was shown an inverse relationship between them. Conclusions: no differences were found for latency and wave amplitude, gender-related or school subjects as well as no difference was found when measuring the Pz derivation obtained compared with the wave in lead Cz.
Os potenciais evocados cognitivos são medições eletrofisiológicas das funções cognitivas. O Potencial Cognitivo P300 está relacionado com processos de atenção. Objetivo: estabelecer valores de referência para a latência e a amplitude de onda P300 na população colombiana e determinar sua variabilidade na presença de variáveis como a idade, o gênero e a escolaridade dos indivíduos. Método: em uma amostra de 122 indivíduos sãos, com idades entre os 6 e os 80 anos, mensurou-se o potencial segundo a metodologia odd-ball nas derivações Cz e Pz. Resultados: estabeleceram-se valores de referência para diferentes grupos de idade e verificou-se que a latência da onda P300 aumenta com a idade dos indivíduos, enquanto que a amplitude da onda tende a diminuir. Conclusões: um estudo de correlação entre a latência e a amplitude permitiu evidenciar que existe uma relação inversa entre as duas características. Quanto ao gênero e a escolaridade, não foram observadas diferenças para a latência e a amplitude da onda, tanto na derivação Pz quanto na derivação Cz.