Trastorno por Déficit de Atención/Hiperactividad (TDAH) y Trastorno de Tourette (TT): entre la comorbilidad y el diagnóstico diferencial / Attention deficit/hyperactivity disorder (ADHD) and To urette disorder (TD): between comorbidity and differential diagnosis

Resumen El Trastorno de Tourette (TT) y el Trastorno por déficit de atención / hiperactividad (TDAH) son entidades neu ropsiquiátricas que usualmente inician en la infancia. Esta revisión busca colaborar con los clínicos, quienes suelen confrontarse al dilema de saber si existe una comorbilidad o un diagnóstico diferencial, ya que esta pregunta cobra vital importancia en el momento de decidir el tratamiento. Invitamos al colega a revisar nuestros hallazgos, soportados por bases moleculares, fisiológicas y neuroanatómicas, además de los datos epidemiológicos. Al final, brindamos una propuesta de algoritmo diag nóstico que podrá utilizar cuando se encuentre ante síntomas compartidos entre los dos diagnósticos. El TDAH y el TT deben ser intervenidos tempranamente, para mejorar la calidad de vida y funcionalidad del paciente y prevenir secuelas, no solo en niños, niñas y adolescentes (NNA), también a lo largo de la vida.

Abstract Tourette Disorder (TD) and attention deficit hyperac tivity disorder (ADHD) are both major neuropsychiatric conditions that usually begin during infancy. This revision aims to collaborate with pediatricians, who are often confronted with the question of co-mor bidity or differential diagnosis between ADHD and TD. The question becomes urgent when the clinician must decide if he/she can start ADHD or TD treatment. We encourage our colleagues to revise our findings, based in bimolecular and neuroanatomic shared issues in ad dition to updated epidemiological findings. The clinician will find an original proposed algorithm that they can use when the shared symptoms are pres ent in a little patient. TD and ADHD must be intervened early, so we can get better outcomes. The consequences of letting the symptoms increase can generate sequels and handicaps, that can interfere with the quality of life and functionality not only during infancy and adoles cence but also in adult life.

Estilos de aprendizaje y Tecnologías de la Información y la Comunicación en la Educación Superior / Learning Styles and Information and Communication Technologies in Higher Education

Introducción: el desarrollo de preferencias con respecto a los estilos de aprendizaje de un estudiante universitario sufre variaciones porque la nueva era tecnológica provoca un cambio en la manera en que se aprende, dado por un punto convergente: las Tecnologías de la Información y la Comunicación y el uso del teléfono inteligente, entre otros dispositivos digitales. Objetivo: explicar aspectos conceptuales y metodológicos que establecen la necesidad de un adecuado binomio estilos de aprendizaje-TIC en el proceso de enseñanza aprendizaje (PEA) de la educación superior actual. Métodos: mediante el análisis documental se revisó la bibliografía en español e inglés entre 2012 y 2022, se emplearon las bases de datos: Redalyc, Dialnet, SciELO, y Google Scholar. Las palabras clave fueron: estilos de aprendizaje, tecnologías de la información y la comunicación y proceso de enseñanza aprendizaje. Los criterios de selección se aplicaron a 145 fuentes bibliográficas identificadas inicialmente y fueron seleccionados 25 artículos. Desarrollo: se confrontaron criterios y se emitieron juicios relacionados con la necesidad de preparación de los docentes universitarios para utilizar las Tecnologías de la Información y la Comunicación en el proceso de enseñanza aprendizaje, teniendo en cuenta los estilos de aprendizaje de los estudiantes. Conclusiones: los estudiantes universitarios han desarrollado los estilos de aprendizaje en función de las Tecnologías de la Información y la Comunicación, lo cual exige la preparación docente en función de aplicar estrategias metodológicas contextualizadas para el logro de un adecuado binomio estilos de aprendizaje-Tecnologías de la Información y la Comunicación, que garantice un mejor ejercicio de su profesión.

Introduction: the development of preferences with respect to the learning styles of a university student, it undergoes variations because the new technological era causes a change in the way in which one learns, given by a converging point: Information and Communication Technologies and the use of the smartphone, among other e- devices. Objective: explain conceptual and methodological aspects that establish the need for an adequate binomial of learning styles-ICT in the teaching-learning process (TLP) of current higher education. Methods: through documentary analysis, the bibliography was reviewed in Spanish and English from 2012 to 2022, the databases were used: Redalyc, Dialnet, SciELO, and Google Scholar. The keywords were: learning styles, information and communication technologies and teaching-learning process. The selection criteria were applied to 145 bibliographic sources initially identified and 25 articles were selected. Development: criteria were compared, and judgments were made related to the need to prepare university teachers to use Information and Communication Technologies in the teaching-learning process, considering the learning styles of the students. Conclusions: university students have developed learning styles based on Information and Communication Technologies, which requires teacher preparation based on applying contextualized methodological strategies to achieve an adequate binomial of learning styles-Information and Communication Technologies, which guarantees a better exercise of their profession.

Clinical correlates, characteristics and comorbidities of paediatric tic disorders

Background: Tic disorders are complex neuropsychiatric disorders of childhood onset. The associated comorbidities in paediatric tic disorders are of vast importance as they account for the major functional impairment in these children, data of which is lacking in our Indian context.Methods: Descriptive Cross-sectional study conducted among children of 3-15 years of age in child psychiatry department of Institute of Child health, Egmore, ChennaiResults: In this study 60 patients were studied of whom 47 were male and 13 were females. Comorbid psychiatric disorders were present in 38 (63.3%) children. They were ADHD (48.3%), OCD (6.6%), ASD (6.6%), SLD (20%), Behavioural problems in 16.6%. Motor tics were the most common type of tics. Significant correlation between tic severity and presence of comorbid psychiatric disorders was seen.Conclusions: Tic disorders are not completely benign and simple as it is thought. Tic disorders usually present with associated comorbidities, which cause more impairment than tics themselves. ADHD is the most common comorbidity associated with paediatric tic disorders.

Inclusão Digital de idosos: as (TICs) e o uso do celular / Digital inclusion of seniors: the (ICTs) and the use of the smartphone

O envelhecimento humano é um fenômeno que vem crescendo em escala global e se constitui como um acontecimento que chama a atenção de alguns anos para cá. Outro fator de muita relevância na contemporaneidade são as Tecnologias da Informação e Comunicação (TICs) que nos possibilitam questionar quais são os significados atribuídos pelos idosos a essas tecnologias, levando em consideração o uso do smartphone. O presente estudo tem como objetivo conhecer de que forma os idosos utilizam e como se relacionam com este aparelho. Trata-se de um estudo quantitativo, em que a coleta de dados foi realizada por meio da aplicação de questionários a 100 pessoas com mais de sessenta anos, participantes de grupos de convivência em uma cidade do interior do Rio Grande do Sul. Os dados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS) versão 25, possibilitando a análise por meio de uma estatística descritiva. A pesquisa possibilitou a compreensão de como os idosos se relacionam com esta tecnologia, as dificuldades de inserção em um mundo conectado e as limitações que estes apresentam ao manusear seu smartphone. Também foram listados os aplicativos mais utilizados pela categoria pesquisada, contemplando durante a discussão os benefícios de utilizarem as TICs e os sentimentos que acometem esses idosos.(AU)

Human aging is a phenomenon that has been growing on a global scale and constitutes an event that has drawn attention in recent years. Another very relevant factor in contemporaneity are the Information and Communication Technologies (ICTs) that allow us to question what are the meanings attributed by the elderly to these technologies, considering the use of smartphones. The present study aims to understand how the elderly use and relate to this device. This is a quantitative study, in which data collection was carried out by applying questionnaires to 100 people over sixty years old, participants of socialization groups in a city in the countryside of Rio Grande do Sul. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25, enabling analysis by using descriptive statistics. The research made it possible to understand how the elderly relate to this technology, the difficulties of insertion in a connected world, and the limitations they present when handling their smartphone. The applications most used by this researched category were also listed, contemplating during the discussion the benefits of using ICTs and the feelings that affect these elderly people.(AU)

Clinical characteristics and risk factors of cerebral infarction in 45 newborns / 中华围产医学杂志

Objective:To summarize the clinical characteristics of neonatal cerebral infarction and its risk factors, so as to provide a reference for clinical diagnosis and early prevention of the disease.Methods:This study retrospectively analyzed the demographic data, clinical manifestations and brain imaging features of neonates with cerebral infarction ( n=45) admitted to the Department of Neonatal Critical Care Medicine of the Affiliated Children's Hospital of Xi'an Jiaotong University from June 2012 to July 2020. Ninety newborns without cerebrovascular disease matched for date of birth and gestational age were selected as the control. Two independent sample t-test, rank-sum test, Chi-square or corrected Chi-square test were used for univariate analysis and binary logistic regression were applied for analyzing the risk factors for neonatal cerebral infarction. Results:A total of 45 infants with clinically diagnosed neonatal cerebral infarction were enrolled, including eight small for gestational age and three macrosomia infants. The median age at disease onset was 1 d (1-2 d). There were 71% (32/45) presenting with convulsions as the first symptom, 4% (2/45) admitted with apnea and respiratory distress as the chief complaints, respectively,11% (5/45) having poor response and 9% (4/45) showing no obvious clinical manifestations. Cranial MRI and magnetic resonance angiography identified left hemisphere lesion in 25 cases (56%), right hemisphere lesion in 16 (36%) and both in four (9%). Thalamus and basal ganglia were involved in 11 cases. The lesions were supplied by middle cerebral artery [38% (17/45)], anterior cerebral artery ( n=1), posterior cerebral artery ( n=4), anterior and middle cerebral arteries ( n=4), middle and posterior cerebral arteries ( n=16), or anterior, middle and posterior cerebral arteries ( n=3). Univariate analysis showed that the proportions of small for gestational age [18% (8/45) vs 6% (5/90), χ 2=5.15], cesarean section after failure of trial of labor [18% (8/45) vs 1% (1/90), χ 2=10.85], meconium stained amniotic fluid [33% (15/45) vs 9% (8/90), χ 2=12.68], fetal distress [20% (9/45) vs 3% (3/90), χ 2=8.34] and neonatal asphyxia [16% (7/45) vs 2% (2/90), χ 2=6.56] were all higher in the infarcted infants than those in the control (all P<0.05). Binary logistic regression analysis revealed that small for gestational age ( OR=3.981, 95% CI: 1.075-14.742, P=0.039), cesarean section after failure of trial of labor ( OR=17.959, 95% CI: 2.032-158.698, P=0.009) and fetal distress ( OR=5.756, 95% CI: 1.129-29.331, P=0.035) were independent risk factors for neonatal cerebral infarction. Conclusions:Most neonates with cerebral infarction would have convulsions initially, while some are asymptomatic. Middle cerebral arteries are often involved in the lesion. The risk of this disease may be increased in small for gestational age infants, cesarean section after failure of trial of labor and fetal distressed cases.

Estrategias de autorregulación del aprendizaje en contextos virtuales en estudiantes de odontología / Strategies for the self-regulation of learning in virtual contexts in dental students

Objetivo: Comparar estrategias de autorregulación del aprendizaje en contextos virtuales de estudiantes de la carrera de odontología. Métodos: Participantes: estudiantes de 5 asignaturas de la carrera de odon-tología (N=1514). Instrumento: escala de auto-re-porte validada con 25 reactivos agrupados en 5 dimensiones: D1) Estrategias de planeación y control; D2) Atribuciones motivacionales; D3) Trabajo colabo-rativo con compañeros; D4) Apoyo del asesor en las tareas. La muestra se agrupó en 3: (G3) cursantes del último año de la carrera; (G2) de asignaturas in-termedias; (G1) de primer año. Se utilizaron: ANOVA de medidas repetidas y test de Tukey como post-hoc; tests de X2 y comparación de proporciones con post-hoc de Bonferroni. Resultados: Puntajes por grupo (media±DS-%): D1) G3=39,2±5,6-78,5%; G2=38,8±6,1-77,6%; G1=36,7±5,7-73,1%. D2) G3=14,4±5,2-57,4%; G2=15,5±5,1-61,9%; G1=14,8±5,6-59,3%. D3) G3=22,8±3,1-91,2%; G2=21,2±4,3-84,7%; G1=18,9±6,5­76,3%. D4) G3=15,5±4,5­61,9%; G2=15,8±4,6-63,1%; G1=16,4±4,0-65,8%. Diferencias significativas: entre G1 y G3 en D1 (p=0,014) y entre los tres grupos en D3 (p<0,001). G1 y G3 se diferenciaron (p<0,05) en cin-co de los 10 reactivos de D1 y en todos los reactivos de D3. Conclusiones: Los estudiantes de primer año reportaron menos estrategias de planeación y con-trol. El trabajo colaborativo mostró un incremento a lo largo de la carrera (AU)

Objective: To compare self-regulated learning strat-egies in virtual contexts (VC) among dental students. Methods: Participants: Undergraduate dental students attending five subjects. (N=1514). We used a validat-ed self-report scale with 25 items grouped into five dimensions: D1) planning and control strategies, D2) motivational attributes, D3) collaborative work with colleagues, and D4) support from the advisor Statistical analysis: The relative percentage of the max-imum score was calculated. Students were grouped into 3: those in the last year of their degree (G3), an intermediate group (G2), and freshmen (G1). We used repeated measures ANOVA and Tukey's post-hoc test to compare the relative weights of the dimensions; X2 test, proportion comparisons, and Bonferroni post-hoc test were used for comparisons. Results: Scores by group (mean±SD-%): D1) G3=39.2±5.6-78.5%; G2=38.8±6.1-77.6%; G1=36.7±5.7-73.1%. D2) G3=14.4±5.2-57.4%; G2=15.5±5.1-61.9%; G1=14.8±5.6-59.3%. D3) G3=22.8±3.1-91.2%; G2=21.2±4.3-84.7%; G1=18.9±6.5­76.3%. D4) G3=15.5±4.5­61.9%; G2=15.8±4.6-63.1%; G1=16.4±4.0­65.8%. Significant differences were observed between G1 and G3 on D1 (p=0.014), and between the three groups on D3 (p<0.001). G1 and G3 differed (p<0.05) in five of the 10 D1 items and in all D3 items. Conclusions: Freshmen reported the lowest number of planning and control strategies. Collaborative work increased throughout the career (AU)

Treatments for Tourette syndrome in children and young adults: a systematic review / Tratamento da síndrome de Tourette em crianças e jovens adultos: uma revisão sistemática

INTRODUCTION: Tourette's Syndrome (TS) is a neurodevelopmental disorder characterized by motor and / or vocal tics for more than 12 months. TS affects about 0.8% of pediatric patients and is associated with great functional impairment and psychological distress. The present study aims to list and compare the effectiveness of therapies used in children and young people with TS. METHODS: PubMed / MEDLINE, Cochrane Library, ScienceDirect, SciELO and Lilacs were used from September 2020 to April 2021 to search for randomized clinical trials with pharmacological, behavioral, physical or alternative interventions for tics in children and young people with ST. RESULTS: 13 clinical trials were included, of which six pharmacological, six behavioral and one of other conformation. The global score on the Yale Global Tic Severity Scale showed evidence in favor of Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT). Evidence from two studies suggests that antipsychotic medications improve tic scores. Evidence from other interventions has shown no conclusive benefit. CONCLUSIONS: The present study identified benefits with the use of antipsychotics. The study also found that HRT and CBIT showed improvement in reducing the severity of tics, in addition to not having any adverse effects. These therapies showed significant clinical improvement, but there is no comparison between the use of these isolated approaches in relation to their use associated with medications. In view of the different forms of therapy, further studies are needed to identify the effectiveness and the profile of adverse effects of these interventions.

INTRODUÇÃO: A Síndrome de Tourette (ST) é um distúrbio do neurodesenvolvimento caracterizado por tiques motores e/ou vocais por mais de 12 meses. A ST afeta cerca de 0,8% dos pacientes pediátricos e associa-se a grande comprometimento funcional e sofrimento psíquico. O presente estudo tem como objetivo listar e comparar a eficácia das terapias utilizadas em crianças e jovens com ST. MÉTODOS: PubMed/MEDLINE, Cochrane Library, ScienceDirect, SciELO e Lilacs foram usados desde setembro de 2020 até abril de 2021 para a busca de ensaios clínicos randomizados com intervenções farmacológicas, comportamentais, físicas ou alternativas para tiques em crianças e jovens com ST. RESULTADOS: 13 ensaios clínicos foram incluídos, dos quais seis farmacológicos, seis comportamentais e um de outra conformação. A pontuação global na Yale Global Tic Severity Scale, apresentou evidências a favor do Treinamento de Reversão de Hábito (TRH) e Intervenção Comportamental Abrangente para Tiques (ICAT). As evidências de dois estudos sugerem que medicamentos antipsicóticos melhoram os escores de tiques. Evidências de outras intervenções não mostraram nenhum benefício conclusivo. CONCLUSÕES: O presente estudo identificou benefícios com o uso do antipsicóticos. O estudo também identificou que a TRH e a ICAT apresentaram melhora na redução da gravidade dos tiques, além de não apresentarem efeitos adversos. Essas terapias mostraram importante melhora clínica, mas não há comparação entre o uso dessas abordagens isoladas em relação ao seu uso associado com medicamentos. Diante das diferentes formas de terapia, mais estudos são necessários para identificar a eficácia e o perfil de efeitos adversos dessas intervenções.

Objetos de aprendizaje para el estudio de la Ontogenia Humana. Argumentación teórica

RESUMEN Introducción: con la apertura a las Tecnologías de la Informática y las Comunicaciones en el país y principalmente en el sistema educacional se han desarrollado estrategias para mejorar la calidad de las clases en las aulas cubanas. Los objetos de aprendizaje constituyen actualmente una poderosa herramienta de apoyo a la docencia por lo que es necesario profundizar en su estudio desde la perspectiva pedagógica. Con el objetivo de argumentar sobre los referentes teóricos de los objetos de aprendizaje para el estudio de la Ontogenia Humana se realizó esta revisión bibliográfica. Desarrollo: la asignatura Ontogenia Humana y SOMA es nueva dentro del plan de estudio, por ello está en pleno desarrollo la creación de medios para el aprendizaje, que se sustenten en la didáctica especial como elemento de la creatividad pedagógica de los profesores, siendo necesario argumentar los referentes teóricos de los objetos de aprendizaje, su evolución en el proceso enseñanza - aprendizaje en las Ciencias Médicas. Caracterización, ventajas y desventajas. Conclusiones: los objetos de aprendizaje brindan la posibilidad a los estudiantes de interactuar y dinamizar los procesos, potenciando las actividades educativas, lo que resulta de gran utilidad para fortalecer los contenidos de Ontogenia Humana.

ABSTRACT Introduction: with the opening to Information Technology and Communications in the country and mainly in the educational system, strategies have been developed to improve the quality of classes in Cuban classrooms. Learning objects are currently a powerful tool to support teaching, so it is necessary to deepen their study from a pedagogical perspective. With the aim of arguing about the theoretical references of learning objects for the study of Human Ontogeny, this bibliographic review was carried out. Development: the subject Human Ontogeny and SOMA is new within the study plan, for this reason the creation of means for learning is in full development, which are based on special didactics as an element of the pedagogical creativity of teachers, being necessary to argue the theoretical references of learning objects, their evolution in the teaching-learning process in Medical Sciences. Characterization, advantages and disadvantages. Conclusions: the learning objects provided the possibility for students to interact and streamline the processes, enhancing educational activities, which is very useful to strengthen the contents of Human Ontogeny.

RESUMO Introdução: com a abertura à Tecnologia da Informação e Comunicações no país e principalmente no sistema educacional, foram desenvolvidas estratégias para melhorar a qualidade das aulas nas salas de aula cubanas. Os objetos de aprendizagem são atualmente uma poderosa ferramenta de apoio ao ensino, pelo que é necessário aprofundar o seu estudo numa perspetiva pedagógica. Como objetivo de discutir os referenciais teóricos dos objetos de aprendizagem para o estudo da Ontogenia Humana, foi realizada esta revisão bibliográfica. Desenvolvimento: a disciplina Ontogenia Humana e SOMA é nova dentro do plano de estudos, por isso a criação de meios de aprendizagem está em pleno desenvolvimento, os quais se baseiam na didática especial como elemento da criatividade pedagógica dos professores, sendo necessário discutir a referenciais teóricos dos objetos de aprendizagem, suaevolução no processo de ensino-aprendizagem em Ciências Médicas. Caracterização, vantagens e desvantagens. Conclusões: os objetos de aprendizagem possibilitaram aos alunos interagir e agilizar os processos, potencializando as atividades educativas, o que é muito útil para fortalecer os conteúdos de Ontogenia Humana.

Conocimientos, prácticas y habilidades estudiantiles sobre la búsqueda bibliográfica e investigación en salud ambiental / Knowledge, practices and student skills on bibliographic search and research in environmental health

Durante el ejercicio profesional, los enfermeros les corresponden brindar educación a la comunidad para prevenir la exposición a los riesgos medioambientales e, integrarse y proponer profilaxis en pro del bienestar de la comunidad, en este sentido, les incumben consolidar destrezas que les permitan desarrollar historia ambiental valorando riesgos, diagnosticando problemas, proponiendo intervenciones, evaluando resultados, e incluso identificando los factores peligrosos de acuerdo a vulnerabilidades particulares. Para los estudiantes de enfermería de UNIANDES, el reto, en esta área de formación es doble (investigativa y académica), y lo deben asumir, de manera autodidáctica. Este trabajo pretendió explorar conocimientos, prácticas y habilidades estudiantiles sobre la búsqueda bibliográfica e investigación en salud ambiental. La muestra estuvo conformada por 120 estudiantes. Se precisó que 17,5% poseen conocimiento para realizar búsqueda básica de información, utilizando principalmente el motor web Google 40,8%. El nivel de destreza fue bajo 73,3%; percepción de los estudiantes, mala 49,2%: prácticas para realizar búsqueda, no sabe 54,2%, sin asociación estadísticamente significativa con sexo. Para la percepción del nivel de competencia en investigación y búsqueda de información en salud ambiental: lectura crítica obtuvo 3,08 puntos, seguida de búsqueda de información 2,98 puntos, lo que las clasifican como regular; mientras que, redacción de artículos y el proceso de publicación, ambas con 2,70 puntos; se catalogan deficientes. Estos resultados permiten afirmar que es necesario un acompañamiento permanente en la instrucción sobre el uso de información digital a lo largo de la carrera y con especial atención en el área de salud ambiental(AU)

During professional practice, nurses are responsible for providing education to the community to prevent exposure to environmental risks and integrate and propose prophylaxis for the well-being of the community, in this sense, they are responsible for consolidating skills that allow them to develop environmental history assessing risks, diagnosing problems, proposing interventions, evaluating results, and even identifying dangerous factors according to particular vulnerabilities. For UNIANDES nursing students, the challenge in this training area is twofold (investigative and academic), and they must assume it in a self-taught manner. This work aimed to explore student knowledge, practices and skills on bibliographic search and research in environmental health. The sample consisted of 120 students. It was specified that 17.5% have knowledge to perform basic information searches, mainly using Google web engine 40.8%. The skill level was low 73.3%; perception of the students, poor 49.2%: practices to carry out searches, do not know 54.2%, without statistically significant association with gender. For the perception of the level of competence in research and information search in environmental health: critical reading obtained 3.08 points, followed by information search 2.98 points, which classifies them as regular; while, writing articles and the publication process, both with 2.70 points; are classified as deficient. These results allow us to affirm that permanent accompaniment is necessary in the instruction on the use of digital information throughout the career and with special attention in the area of environmental health(AU)

Entorno virtual de aprendizaje de Genética Médica en tiempos de la COVID-19 en la Facultad de medicina Finlay-Albarrán / Environment of Medical Genetics Learning during the Time of COVID-19 at the Finlay-Albarrán Faculty of Medicine

Introducción: el entorno virtual de aprendizaje como modalidad de educación a distancia, se ha convertido en una necesidad para las universidades pues aprovecha los avances de las tecnologías de la informática y las comunicaciones para garantizar un aprendizaje dinámico, en el cual el estudiante es un ente activo. Ante la contingencia epidemiológica de la COVID-19, cobra gran importancia para garantizar la continuidad del proceso docente. Objetivo: relatar la experiencia del entorno virtual de aprendizaje en la asignatura Genética médica, para estudiantes del cuarto semestre de la carrera de Medicina de la Facultad Finlay-Albarrán, durante el período de enfrentamiento a la pandemia de la COVID-19. Material y Métodos: se aplicó un diseño de paradigma cualitativo, del nivel investigativo exploratorio, en el que se realiza un estudio de caso. Resultados: en la primera etapa se utilizó la modalidad del aprendizaje mixto, previa creación del entorno virtual de aprendizaje en la plataforma Moodle. En ella se aplicaron la mayoría de sus herramientas informáticas como el foro de discusión, el chat, el examen tipo test, entre otros. En la segunda etapa, se aplicó la modalidad e-learning y se creó un grupo WhatsApp para darle continuidad al proceso. En la tercera etapa se re-estableció la modalidad presencial, haciendo énfasis en la integración de los conocimientos desde la perspectiva del tema 8. Conclusión: la educación a distancia virtual, garantizó la continuidad del proceso docente de la asignatura Genética médica durante el periodo de emergencia epidemiológica por la COVID-19(AU)

Introduction: the virtual learning environment as a distance education modality has become a necessity for universities, which takes advantage of advances in information technology and communications to guarantee dynamic learning, in which the student is an active entity. Given the epidemiological contingency of the COVID-19 pandemic, it is of great importance to guarantee the continuity of the teaching process. Objective: to report the experience of the virtual learning environment in the subject of Medical Genetics for the fourth semester students of the Medicine career at the Finlay-Albarrán Faculty that was developed during the period of confrontation with the COVID-19 pandemic. Material and Methods: a qualitative paradigm design of the exploratory research level was applied, in which a case study is carried out. Results: in the first stage, the blended learning modality was used, after creating the virtual learning environment on the Moodle platform; most of its computer tools were applied, such as the discussion forum, the chat, multiple choice exam, among others. In the second stage, the e-learning modality was applied and a WhatsApp group was created to give continuity to the process. In the third stage, the face-to-face modality was re-established, emphasizing the integration of knowledge from the perspective of topic 8. Conclusion: virtual distance education guaranteed the continuity of the teaching process of the subject of medical genetics during the period epidemiological emergency of COVID-19(AU)

Calidad de vida del adulto mayor del Valle del Mezquital post apoyo educativo mediante las Tic´s / Quality of life od the elderly in the Valley of the Mezquital post educational support by Ict´s

Introducción: según estudios previos en México señalan que la esperanza de vida era de 75.5 años y de acuerdo con nuevos datos, se estima que esta aumentara a 77.8 años para 2030¹, por lo cual es necesario fortalecer y fomentar el autocuidado en el adulto mayor, mediante el apoyo educativo, debido a la pandemia a través del uso de las tecnologías de la información y la comunicación (TICs) con la finalidad de aumentar su nivel de calidad de vida. Objetivo: evaluar el nivel de calidad de vida de los adultos mayores del Valle del Mezquital antes y después del apoyo educativo para fomentar el autocuidado mediante el uso de las TICs. Material y métodos: investigación cuantitativa, nivel de alcance exploratorio, con un diseño metodológico experimental, prolectivo longitudinal prospectivo. Se ocupó la prueba estadística paramétrica t de student. Resultados: de acuerdo al instrumento WHOQOL-BREF preintervención se obtuvo que el 80% de la población reflejo una calidad de vida media, posterior a un mes de intervención 67 % de la población reflejo calidad de vida alta, de acuerdo con la prueba estadística t se obtuvo una significan la bilateral de .041 posterior a la intervención. Conclusiones: la calidad de vida de los adultos mayores mejoró gracias a las intervenciones educativas ofrecidas médiate las TICs logrando así una nueva estrategia de acercamiento en tiempos de pandemia demostrando que estas herramientas ayudan a mejorar el autocuidado.

Introduction: according to previous studies in Mexico indicate that life expectancy was 75.5 years and according to new data, it is estimated that this will increase to 77.8 years by 2030, so it is necessary to strengthen and encourage self-care in the elderly, through educational support, due to the pandemic through the use of Information and communication technologies (ICTs) to increase their quality of life. Objective: to assess the quality of life of older adults in the Mezquital Valley before and after educational support to promote self-care through the use of ICTs. Material and methods: basic research with a quantitative approach, exploratory scope level, with an experimental methodological design, prospective longitudinal prolective. The parametric statistical test of the student was taken. Results: according to the instrument WHOQOL-BREF pre intervention was obtained that 80 % of the population reflected an average quality of life, and after a month of intervention was obtained 67 % of the population reflected high quality of life, according to the statistical test was obtained a bilateral mean of .041 after the intervention. Conclusions: the quality of life of older adults improved thanks to the educational interventions offered by ICTs, thus achieving a new approach strategy in times of pandemic, demonstrating that these tools help to improve self-care

Propuesta terapéutica de las manifestaciones orales del síndrome de tourette. A propósito de un caso / Therapeutic Proposal of the Oral Manifestations of the Tourette Syndrome. A Case Report

RESUMEN El síndrome de Tourette (ST) es un trastorno neurológico-conductual crónico que comienza en la infancia y la adolescencia. Su característica principal es la emisión de múltiples tics motores y fónicos de distinto tipo y complejidad. Se asocian a vocalizaciones involuntarias (ecolalia, coprolalia). A menudo empeoran cuando la persona está excitada o padece de ansiedad y se atenúan durante la realización de actividades calmadas o que requieren de concentración. Su tratamiento consiste en el uso de medicamentos que pueden causar efectos adversos o la intervención global de comportamiento para tics (Comprehensive Behavioral Intervention for Tics, CBIT), que es un tratamiento conductual no farmacológico diseñado para enseñar a los pacientes y sus familias un conjunto específico de habilidades para reducir la frecuencia, la intensidad y el impacto general de los tics motores y vocales. Se reporta caso clínico de paciente de 13 años de edad que asistió a la Facultad de Odontología de la Universidad de Cartagena por presentar úlcera dolorosa en cavidad bucal. Como terapéutica se decidió utilizar la placa de protección mucosa (PPM) en el maxilar, y se observó una disminución del tamaño de la úlcera y en el control a los 45 días se observó la cicatrización completa de la lesión. Se complementó el tratamiento bucal con la remisión a tratamiento psicológico de soporte.

ABSTRACT Tourette Syndrome (TS) is a chronic neurological-behavioral disorder that begins in childhood and adolescence. Its main characteristic is the emission of multiple motor and phonic tics of different types and complexity. They are associated with involuntary vocalizations (echolalia, coprolalia). They often worsen when the person is excited or has anxiety and becomes less alert during calm or concentration-intensive activities. Its treatment consists in the use of drugs that can cause adverse effects or the global behavioral intervention for tics (Comprehensive Behavioral Intervention for Tics, CBIT) which is a non-pharmacological behavioral treatment designed to teach patients and their families a specific set of skills to reduce the frequency, intensity and overall impact of motor and vocal tics. We report a case of a 13-year-old patient who attended the University of Cartagena School of Dentistry due to a painful ulcer in the oral cavity. As a therapy, it was decided to use the mucosal protective plate (PPM) in the maxilla, observing a decrease in the size of the ulcer, and in the control at 45 days the complete healing of the lesion was observed. The oral treatment was complemented with the referral to psychological support treatment.

Rendimiento académico de estudiantes universitarios en asignaturas de las ciencias morfológicas: uso de aprendizajes activos basados en problemas (ABP) / Academic performance in university students in morphological science courses: use of active problem-based learning (PBL)

RESUMEN: La educación universitaria busca desarrollar competencias profesionales y capacidades para el aprendizaje autónomo. Las metodologías de aprendizajes activos, centrado en los alumnos, como el aprendizaje basado en problemas (ABP), podría ser de gran utilidad en mejorar el rendimiento académico en asignaturas de las Ciencias Básicas en estudiantes de carreras de salud y medicina. El objetivo de este estudio fue determinar el impacto del uso de la metodología activa de aprendizaje basado en problemas, sobre el rendimiento académico de estudiantes universitarios que cursan asignaturas morfo-biológicas en las carreras de Kinesiología y de Obstetricia. De un universo de 500 alumnos que ingresaron a los primeros años de carreras de la salud de la Universidad de Tarapacá (año lectivo 2018), se seleccionaron 100 estudiantes (mayores de 18 años), separando como grupo control o no intervenido (n=50) a estudiantes de Obstetricia y grupo intervenido, con aplicación de ABP (n=50), estudiantes de la carrera de Kinesiología. El estudio tuvo una duración de 24 semanas lectivas. Los resultados muestran que el grupo intervenido mejoró significativamente el rendimiento académico, con un 98% de aprobación y una evaluación final de 5,9. El grupo control alcanzó un 84 % de aprobación y evaluación final de 4,8. Se concluye que el uso de metodología activa de ABP, mejora significativamente el rendimiento académico de los estudiantes de ciencias de la salud que cursan asignaturas morfo-biológicas y que las actividades con participación directa a través de cuestionarios y exposiciones científicas grupales e individuales permiten que el estudiante sea su propio agente de cambio en los procesos de evaluación formativa. Se sugiere implementar este tipo de metodologías activas en los cursos regulares considerando además, los factores psicológicos del aprendizaje.

SUMMARY: University education seeks to develop professional skills and capacities for autonomous learning. Active learning methodologies, centered on students, such as problem- based learning (PBL), could be very useful in improving academic performance in Basic Sciences courses in health and medical students. The objective of this study was to determine the impact of the use of the active problem-based learning methodology on the academic performance of university students who take morpho-biological courses in the Kinesiology and Obstetrics degree programs. From a total of 500 students who entered the first years of health degrees at the University of Tarapacá (academic year 2018), 100 students (over 18 years of age) were selected, separating as a control or non-intervened group (n = 50) to Obstetrics students and intervened group, with application of ABP (n = 50), students of the Kinesiology degree program. The study lasted 24 school weeks. The results show that the intervened group significantly improved academic performance, with 98 % approval and a final evaluation of 5.9. The control group achieved 84 % approval and a final evaluation of 4.8. It is concluded that the use of the active PBL methodology significantly improves the academic performance of health sciences students who take morpho-biological subjects and that activities with direct participation through questionnaires and group and individual scientific presentations, allow the student be their own agent of change in the educational assessment processes. It is suggested to implement this type of active methodologies in regular courses, also considering the psychological factors of learning.

Domestic status and systematic review of the use of probiotic in premature infants / 中华实用儿科临床杂志

A recent systematic evaluation analysis identified probiotic strains with efficacy on clinical outcomes related to premature infants, and found only a small number of single or hybrid strains of probiotics could reduce the mortality and complication rates.In this paper, the objective is to provide recommendations for a systematic evaluation of the literature on which strains can be used and which strains should not be used, and provide the status of corresponding preparations and applications in China.If the quality and safety of all product preparations can be satisfied and monitored, in order to reduce the incidence of such complications as infection in premature infants, the single strain of Lactobacillus rhamnosus or hybrid strains of Bifidobacterium infantis, Bifidobacterium lactis and Streptococcus thermophilus could be recommended.

Interview and treatment of idiopathic hypersomnia comorbidity tics disorder / 四川精神卫生

The purpose of this paper is to present the diagnosis and treatment of idiopathic hypersomnia comorbidity tics disorder. The client is 15 years old， female， a senior student， with frequent blinking and a crooked mouth since childhood， diagnosed with tics disorder. She previously had consistently good academic performance. Since the COVID-19 epidemic in 2020， the client has been sleeping more， averaging 12 hours per day， accompanied by increased daytime sleep with fatigue after waking up， and a significant decline in her studies. She was diagnosed with idiopathic hypersomnia comorbidity persistent （chronic） movement or tic disorder. It was suggested that she adopt a method of comprehensive biopsychosocial intervention. Biotherapy with methylphenidate can improve her arousal， enhance attention and improve drowsiness， meanwhile， changes to tic symptoms must be monitored. Cognitive behavioral therapy was used to help the client correct cognitive biases， reshape cognitive structure， and establish confidence in rehabilitation. Mindfulness therapy was adopted to help the client adjust her emotions. In terms of social resources， the client was encouraged to explore resources actively， seek social support， and build therapeutic alliances. Through coordinating multiple resources， the client reduced symptoms of sleepiness and enhanced her adaptability to continue with her studies.

Impacto de las TIC's en la subjetividad del adolescente y en los vínculos intersubjetivos familiares / Impact of ICTs on adolescent subjectivity and intersubjective family bonds

En este artículo se analiza el impacto de las Tecnologías de la Información y la Comunicación (TICs) en la subjetividad del adolescente y en los vínculos intersubjetivos familiares, específicamente en el vínculo parento-filial. Se analizó una muestra de adolescentes (n=112) y una muestra de madres/padres de adolescentes (n=101) para evaluar la accesibilidad y uso de las TICs, la percepción del uso de las mismas en adolescentes y madres/padres y la incidencia que tienen en los vínculos intersubjetivos familiares. En el análisis se comprobó que las TICs aportan aspectos negativos en las relaciones familiares, ya que provocan conflictos familiares, no promueven la comunicación entre padres e hijos y generan una reducción de las actividades familiares, generando así que el vínculo intersubjetivo familiar se debilite. Las TICs constituyen una herramienta que favorece el proceso de crecimiento adolescente en la medida en que la familia actué como mediadora(AU)

This article analyzes the impact of Information and Communication Technologies (ICTs) on the adolescent subjectivity and on intersubjective family bonds, specifically on the parental-filial bond. A sample of adolescents (n = 112) and a sample of mothers / fathers of adolescents (n = 101) were analyzed to evaluate the accessibility and use of ICTs, the perception of their use in adolescents and mothers / fathers and the impact they have on family intersubjective bonds. In the analysis it was found that ICTs bring negative aspects in family relationships, since they cause family conflicts, do not promote communication between parents and children and generate a reduction in family activities, thus generating a weakening of the intersubjective family bond. ICTs constitute a tool that favors the adolescent growth process if the family acts as a mediator(AU)

Síndrome de Tourette: Tratamiento farmacológico en pacientes pediátricos, una puesta al día / Tourette's Syndrome: An Update on Pharmacological Treatment in Paediatric Patients

El síndrome de Tourette (ST) se caracteriza por tics motores y fónicos, destacando las dificultades de su manejo farmacológico. El objetivo de este artículo es describir los resultados de una revisión bibliográfica de las alternativas de tratamiento farmacológico existentes en la actualidad para el ST pediátrico. Metodología: Se realizó una búsqueda bibliográfica en base de datos PubMed utilizando los términos meSH "Tourette syndrome", "Tics", "Therapeutics" y "Children" entre los años 1950 y 2020, tras priorización y exclusión se obtuvo un total de 64 artículos. Resultados: Los artículos muestran 21 alternativas terapéuticas, que se detallan en dos niveles según eficacia y efectos adversos. Conclusiones: Existen múltiples alternativas farmacológicas, algunas con efectos adversos que pueden llegar a determinar la imposibilidad de continuar el tratamiento. Esta sigue siendo un área abierta de investigación en la búsqueda de alternativas que disminuyan estos efectos.

Abstract. Introduction: Tourette syndrome (TS) is characterized by motor and phonic tics, and the difficulties of its pharmacological management. The objective of this article is to describe the results of a bibliographic review of the pharmacological treatment alternatives that currently exist for pediatric TS. Methods: A bibliographic search was carried out in the PubMed database using the meSH terms "Tourette syndrome", "Tics", "Therapeutics" and "Children" between 1950 and 2020, after prioritization and exclusion, a total of 64 articles were selected. Results: The articles show 21 therapeutic alternatives, which are categorized into two levels according to efficacy and adverse effects. Conclusions: There are multiple pharmacological alternatives, some with adverse effects that may make it impossible to continue treatment. This continues to be an open area of investigation in the search for alternatives that minimize these side effects.

Evaluación y seguimiento de tele - cuidados en pacientes pediátricos del servicio de oncología / Evaluation and monitoring of tele - care in pediatric patients of the oncology service

El cáncer infantil se considera mayoritariamente una enfermedad crónica. La información acerca de la enfermedad y los tratamientos es una necesidad presente en todos los miembros de la familia, en los primeros momentos puede ser difícil de entender y recordar por lo cual una información clara y sencilla permitirá una mejor comprensión. Las nuevas tecnologías de la información hacen posible establecer conexiones infinitas y el campo de la salud no ha escapado a este fenómeno, han aparecido términos como "Tele cuidados" o "Tele-Enfermería", refiere al uso de las tecnologías de la información y las comunicaciones. Objetivo: evaluar los beneficios que brinda la implementación del Tele cuidado en la continuidad de los cuidados en pacientes pediátricos oncológicos y su familia. Material y Método: estudio descriptivo - evaluativo, la población fué de 9 pacientes incorporados al Proyecto de Telecuidado. Se utilizaron entrevistas, telefonía celular, fichas y listas de cotejo. El programa lleva implementado 6 meses en la institución, esta evaluación corresponde a una primera etapa de desarrollo del mismo. Resultados: según las dimensiones de Evaluación de necesidades, Evaluación de conceptualización y lógica del programa, Evaluación de proceso y Evaluación de resultados. Conclusión: El presente estudio nos ha permitido determinar al Tele Cuidado como una herramienta que nos ayuda a mejorar la atención de enfermería, además incrementa los procesos de comunicación y apoya la continuidad de los cuidados en el hogar[AU]

Childhood cancer is mostly considered a chronic disease. Information about the disease and treatments is a necessity present in all family members, in the first moments it can be difficult to understand and remember why clear information and simple it will allow a better understanding. The new information technologies make it possible to establish infinite connections and the field of Health, has not escaped this phenomenon, they have jumped into the health arena terms such as "Tele care" or "Tele-Nursing" , which refers to the use of information and communications technologies. Objective: to evaluate the benefits of implementing Tics in the continuity of care in pediatric cancer patients and their family. Material and Method: descriptive - evaluative study, the population was of 9 patients who joined the Telecare Project. Interviews, records and checklist were used. The program has been implemented for 6 months in the institution, this evaluation corresponds to a first stage of its development. Results: these are analyzed according to the dimensions of Needs Assessment, Evaluation of conceptualization and logic of the program, Process evaluation and Evaluation of results. Conclusion: This study has allowed us to determine Tele Care as a tool that helps us improve nursing care, also increases communication processes and allows continuity of care[AU]

O câncer infantil é considerado principalmente uma doença crônica. Informações sobre a doença e tratamentos são uma necessidade presente em todos os membros da família; nos primeiros momentos, pode ser difícil entender e lembrar, razão pela qual informações claras e simples permitirão uma melhor compreensão. As informações possibilitam o estabelecimento de conexões infinitas e o campo da Saúde, não escapou a esse fenômeno, foram destacados termos como "Telecare" ou "Tele- Nursing", que se referem ao uso das tecnologias da informação. e comunicações. Objetivo: avaliar os benefícios proporcionados pela implementação das TICs na continuidade do atendimento em pacientes com câncer pediátrico e sua família. Material e Método: estudo descritivo-avaliativo, a população foi de 9 pacientes que ingressaram no Projeto Telecare. Foram utilizadas entrevistas, arquivos e uma lista de verificação. O programa foi implementado por 6 meses na instituição, esta avaliação corresponde a um primeiro estágio de desenvolvimento. Resultados: são analisados de acordo com as dimensões Avaliação de Necessidades, Conceitualização de Programas e Avaliação Lógica, Avaliação de Processos e Avaliação de Resultados. Conclusão: Este estudo nos permitiu determinar o TeleCare como uma ferramenta que nos ajuda a melhorar os cuidados de enfermagem, também aumenta os processos de comunicação e permite a continuidade dos cuidados[AU]

Trastornos por tics en niños: un caso con retraso diagnóstico / Tics disorders in children: a case with diagnostic delay

Resumen Un tic es un movimiento (tics motores) o sonido (tics vocal o fónico) breve, repentino y no rítmico. El DSM 5 define tres trastornos por tics: transitorios, vocales o motores persistentes y, el trastorno de la Tourette. Su diagnóstico es eminentemente clínico, siendo cruciales la historia clínica y la observación para realizar un adecuado diagnóstico diferencial con otros trastornos hipercinéticos del movimiento, tales como distonías, corea o atetosis, entre otros. Se presenta el caso de un niño de nueve años diagnosticado luego de dos meses de síntomas y de tratamientos inadecuados, quien mejoró luego de establecerse un diagnóstico correcto y ofrecerse terapia farmacológica dirigida.

Abstract A tic is a movement (motor tics) or sound (vocal or phonic tics) that is brief, sudden and not rhythmic. The DSM 5 defines three tics disorders: transient tics disorder, persistent (chronic) vocal or motor tics disorder, and Tourette's syndrome. Their diagnosis is mainly made through clinical history and observation. It is crucial to make an adequate differential diagnosis with other hyperkinetic disorders as dystonias, choreas or athetosis. We present the case of a 9-year-old boy diagnosed after 2 months of symptoms and inadequate treatments, who improved after establishing a correct diagnosis and offering targeted pharmacological therapy.

Oficina de comunicación a distancia del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ­ más de 20 años construyendo telemedicina / Outreach Communication Office of Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ­ more than 20 years building telemedicine

Introducción: El Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ha sido pionero en la atención de la salud de la población infantil del país y de Latinoamérica. El 53% de los pacientes que concurren al hospital viven más allá del área metropolitana de Buenos Aires. En agosto de 1997, se creó la Oficina de Comunicación a Distancia como una herramienta para sostener la continuidad asistencial de los pacientes de áreas remotas; su apertura significó el embrión del primer programa de telemedicina del país. Objetivos: Promover la construcción de redes integradas de servicios de salud. Impulsar nuevos procesos que mejoren el acceso a la salud. Metodología: Basados en la lógica de redes integradas de servicios de salud con la incorporación de las tecnologías de la información y la comunicación. Resultados: Desde 1997 hasta el primer semestre de 218 se crearon 283 OCD. Se asistieron más de 70.000 consultas asincrónicas y se realizaron más de 5000 videoconferencias. Conclusiones: La modalidad de comunicación a distancia y telemedicina estimula el trabajo colaborativo interinstitucional favoreciendo la atención de los pacientes en origen

Introduction: Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" has been a Pioneer in health care for children in Argentina and Latin America. Overall, 53% of the patients that are covered by the hospital live outside the metropolitan area of Buenos Aires. In August 1997, the Outreach Communication Office (OCO) was created as a tool to sustain continuous care for patients living in remote areas; its inauguration was the seed for the first telemedicine program in the country. Objectives: To promote the development of networks of health-care services. To initiate processes to improve Access to health care. Methods: Development of comprehensive health-care networks with the incorporation of information and communication technologies. Results: Between 1997 and the first semester of 218, 283 OCO's were created. Overall, 70,000 asynchronous consultations were conducted and more than 5000 videoconferences were held. Conclusions: The modality of outreach communication and telemedicine encourages interinstitutional collaboration favoring patient care at their site of origin