A Genetic Lab-on-Phone Test for Point-of-Care Diagnostic of Lactose Intolerance near Patient and in less than 90 Minutes.

BACKGROUND: The -13910 C/T single nucleotide polymorphism located within the MCM6 gene, an enhancer region located upstream of the lactase-phlorizin hydrolase gene, is associated with lactase persistence/non-persistence traits among the Caucasian population. The performance of a new point-of-care CE-IVD (In Vitro Diagnostic) marked isothermal lab-on-phone lactose intolerance assay, using crude samples, was assessed in comparison with Sanger sequencing using purified DNA, as reference method. METHODS: The study was conducted following a non-probability sampling using direct buccal swab (n = 63) and capillary blood (n = 43) clinical samples from a total of 63 volunteers. A 3 × 3 confusion matrix/contingency table was used to evaluate the performance of the isothermal lab-on-phone lactose intolerance assay. RESULTS: The isothermal lab-on-phone lactose intolerance assay successfully detected the -13910 C/T variant with a limit of detection of 5 cells/assay and demonstrated an overall accuracy of 98.41% (95% CI, 91.47%-99.96%) for buccal swab samples and 100% (95% CI, 91.19%-100%) for capillary blood, taking just 90 min from sample to result, with only 2 min hands-on. CONCLUSIONS: The lab-on-phone pocket-sized assay displayed good performance when using direct buccal swab and capillary blood samples, enabling a low-cost, real-time, and accurate genotyping of the -13910 C/T region for the rapid diagnosis of primary lactose intolerance at point-of-care, which enables a prompt implementation of appropriate diet habits and/or intolerance therapies. To our knowledge, this is the first point-of-care genetic test for lactose intolerance to be made available on the market.

AELI® KINETEST, complemento para el diagnóstico clínico / AELI® KINETEST: A Complement for Clinical Diagnosis

Introducción: Con la meta permanente de mejorar la relación médico-paciente y favorecer que este último asuma una posición proactiva en la búsqueda de su salud, se implementa la metodología AELI® KINETEST, aceptada desde 2017 por la Oficina Cubana de la Propiedad Industrial, órgano estatal subordinado al Ministerio de Ciencia, Tecnología y Medio Ambiente. Esta emplea una forma diferente de realizar diagnóstico y tratamiento, con una marcada intención de lograr visión integral del paciente, que abarca contexto personal, familiar, laboral, y complementa así el método clínico. Objetivo: Describir los resultados de la atención a pacientes con AELI®KINETEST. Métodos: Estudio retrospectivo, descriptivo y de corte transversal. La población estuvo conformada por 582 pacientes del Hospital Universitario Clínico Quirúrgico Dr. Miguel Enríquez, entre marzo de 2016 y marzo de 2019. Se confeccionó una ficha personal que incluía los resultados de la aplicación del protocolo del test muscular de los miembros superiores para identificar las disarmonías energéticas. Resultados: Se halló una evolución positiva, predominante a partir de la segunda consulta, en la que se encontraba asintomático el 84,4 por ciento y en la tercera, el 91 por ciento. Conclusiones: AELI® KINETEST resulta una metodología que promueve salud desde una visión integral del ser humano; y permite crecimiento personal, control de los síntomas a corto plazo y rápida reincorporación laboral y familiar. Los resultados muestran la aceptación social y apuntan a una inmediata inclusión en el aprendizaje de las ciencias de la salud(AU)

Introduction: With the permanent goal of improving the doctor-patient relationship and encouraging the latter to assume a proactive position in the pursuit of her or his health, the AELI®KINETEST methodology is implemented. It has been accepted since 2017 by the Cuban Office of Industrial Property, a state body subordinated to the Ministry of Science, Technology and the Environment. This methodology uses a different way of making a diagnosis and carrying out treatment, with a marked intention to achieve an comprehensive vision of the patient, covering the individual, family, work, and other contexts. Objective: To describe the results of patient care with AELI®KINETEST. Methods: A retrospective, descriptive and cross-sectional study was conducted. The population consisted of 582 patients from Hospital Universitario Clínico Quirúrgico Dr. Miguel Enríquez, during March 2016 and March 2019. An individual file was prepared, including the results of the application of the upper limb muscle test protocol for identifying energetic disharmonies. Results: A positive evolution was observed, predominantly from the second consultation, at which moment 84.4 percent were asymptomatic; while at the moment of the third consultation, 91 percent were asymptomatic. Conclusions: AELI® KINETEST is a methodology that promotes health with an approach towards a comprehensive vision of the human being, as well as it allows individual growth, short-term symptom control and a rapid reincorporation to work and family. The results show social acceptance and point to an immediate inclusion in the learning of health sciences(AU)

Herramienta de Detección de Maltrato Infantil para la Clínica Odontológica

RESUMEN: El maltrato infantil es una grave vulneración a los derechos humanos de los niños, que afecta su salud física, mental y emocional, y que puede provocar además graves consecuencias en su vida adulta. El odontólogo tiene la responsabilidad de detectar los posibles casos de maltrato infantil y tomar acciones para detenerlo en una etapa temprana. Sin embargo, muchas veces la decisión de intervenir y/o denunciar un caso se hace difícil, pues no se posee las herramientas para objetivar la sospecha. Aplicando el método Delphi, con el apoyo de destacados expertos nacionales, se desarrolló un breve formulario de auto-aplicación para el odontólogo, en el que se definieron siete puntos clave que se deben examinar al enfrentarse a un niño lesionado que llega a la clínica odontológica. Este formulario guía al cirujano dentista en el reconocimiento de las señales y signos clínicos de abuso, y le permite determinar cuándo un caso presenta suficientes elementos que apuntan a posible maltrato infantil y se hace recomendable su denuncia, tal como indica la ley. La aplicación del formulario mejorará la pesquisa de los casos, que es el primer paso para asegurar el bienestar de las niñas y los niños maltratados.

ABSTRACT: Child abuse is a serious violation of children's human rights, that affects their physical, mental and emotional health, and can, furthermore, have serious consequences in their adult life. Dentists have the responsibility to detect possible cases of child abuse and take actions to put a stop to it at an early stage. However, often the decision to report a case is made difficult due to a lack of tools to express an objective suspicion. Applying the Delphi method with the support of prominent national experts, a short self-application questionnaire was developed to be applied by odontologists in the dental clinic, defining seven key points that should be examined when handling the case of an injured child. The questionnaire guides dentists in recognizing the signs of abuse and deciding when a case has enough elements suggesting possible child abuse that it is advisable to report it, as required by law. Applying this questionnaire will improve the detections of cases, which is the first step to ensure the wellbeing of abused children.

Multimedia como herramienta educativa e instructiva para mejorar la calidad de vida del adulto medio / Multimedia as an educational and instructive tool to improve the quality of life in middle-aged adults

RESUMEN Introducción: Villa Clara es la provincia más envejecida del país, pues el adulto medio ocupa un alto porciento dentro de su población. Durante esta etapa de la vida, si bien algunos cambios fisiológicos se deben a factores genéticos y biológicos personales, también es importante considerar la influencia del modo de vida, experimentado en la actual calidad de vida del adulto medio, que puede ser mejorada con la actividad física. Objetivos: Diseñar una multimedia como herramienta educativa e instructiva para mejorar la calidad de vida del adulto medio, en la Facultad de Tecnología de la Salud-Enfermería, de la Universidad de Ciencias Médicas de Villa Clara. Métodos: Se realizó un estudio de tipo innovación tecnológica en el período de septiembre de 2018 a septiembre de 2019. El universo de estudio estuvo constituido por 397 profesores, que constituyen el total de docentes a tiempo completo; la muestra fue de 40 profesores. Como criterio de exclusión se consideró a los que no estaban ubicados en el rango de edad correspondiente con el adulto medio. Las variables fueron: edad, peso, talla, sexo, ejercicios físicos, enfermedades crónicas no transmisibles y tipo de alimentación. Se utilizaron métodos teóricos, empíricos y de nivel matemático-estadístico. Resultados: El producto final proporcionó beneficios, pues con él se motivó al adulto medio hacia el desarrollo de habilidades y capacidades que le permitan tomar decisiones correctas para elevar la calidad de vida. Conclusiones: La multimedia educativa constituye una vía novedosa y motivadora para influir en la calidad de vida del adulto medio.

ABSTRACT Introduction: Villa Clara is the oldest province in the country, since middle-aged adults occupy a high percentage of its population. During this stage of life, although some physiological changes are due to individuals' genetic and biological factors, it is also important to consider the influence of lifestyle, experienced in the current quality of life in middle-aged adults, which can be improved with physical activity. Objective: to design a multimedia, at the Faculty of Health Technology and Nursing in the University of Medical Sciences of Villa Clara, as an educational and instructive tool to improve the quality of life in middle-aged adults. Methods: a technological innovation study was carried out from September 2018 to September 2019. The universe of study consisted of 397 teachers, who constituted the total number of full-time teachers; the sample was 40 teachers. Those who were not in the age range corresponding to middle-aged adults were considered as an exclusion criterion. Age, weight, height, gender, physical exercises, non-communicable chronic diseases and type of diet were among the variables studied. Theoretical, empirical and mathematical-statistical methods were used. Results: the final product provided benefits, since middle-aged adults were motivated towards the development of skills and abilities, allowing them to make correct decisions in order to improve their quality of life. Conclusions: educational multimedia is a novel and motivating way to influence the quality of life in middle-aged adults.

Determinants of the risk of intraoperative complications in phacoemulsification among patients with pseudoexfoliation.

PURPOSE: The purpose of the study was to study the relationship between pseudoexfoliation (PES) and other predictors in the development of complications in cataract surgery by phacoemulsification in patients with PES. METHODS: A retrospective cohort study of patients undergoing cataract surgery by phacoemulsification in the health area of Cee in northwestern Spain during the 2-year period from 2009 to 2010. Capsule rupture, choroidal hemorrhage, and vitreous loss were included as complications and intraoperative nucleus or lens dislocation as the independent variable. PES, age, hardness, type of cataract, myopia, preoperative visual acuity, antiplatelet use, anticoagulant uses, alpha agonist use, mydriasis prior to surgery, anterior chamber depth, and axial length were included as predictor variables. All predictive hierarchical models were tested using as a selection criterion the one minimizing the Akaike index. RESULTS: A total of 551 patients were initially identified from hospital register, of which 48 were excluded due to the presence of an exclusion factor. After the initial selection, the final sample was 681 eyes of 503 patients. Of the 8192 possible models, a model with the following seven variables was selected: PES, steroid use, alpha agonist use, nuclear hardness, mydriasis, anterior chamber depth, and axial length. The selected model had an Akaike index of 435.4 and an area under the curve of 0.7895 corresponding to a sensitivity of 6.2% and a specificity of 98.5%. CONCLUSION: PES, nuclear hardness, and alpha agonist use are risk factors strongly predictive of complications.

Portafolio de evaluación: una experiencia novedosa en la asignatura Introducción a la Medicina General Integral / Assessment portfolio: a novel experience in the Introduction to Comprehensive General Medicine course

RESUMEN Se hace referencia a la novedosa aplicación del portafolio en la asignatura Introducción a la Medicina General Integral en primer año de la carrera de Medicina para la evaluación de las actividades de educación en el trabajo. El portafolio representa un nuevo escenario para la evaluación, es una técnica que informa sobre las competencias que el estudiante puede demostrar, así como la naturaleza y el aprovechamiento del proceso de aprendizaje, permite acumular evidencias e incluye la evaluación de los aspectos educativos en vínculo indisoluble a lo instructivo. Por su pertinencia y novedad, los autores consideran oportuno compartir sus experiencias sobre esta modalidad de evaluación a través de la presente comunicación.

ABSTRACT Reference is made to the novel application of the portfolio in the Introduction to Comprehensive General Medicine subject in the first year of the Medicine degree for the evaluation of the in-service training activities. The portfolio represents a new scenario for evaluation, it is a technique that informs about the competences that the student can demonstrate, as well as the nature and use of the learning process, allows the accumulation of evidence and includes the evaluation of educational aspects in an indissoluble link to the instructive. Due to its relevance and novelty, the authors consider it appropriate to share their experiences on this type of evaluation through this research paper.

Competencias profesionales para el trabajo con población multilingüe y multicultural en España: creencias, prácticas y necesidades de los/las logopedas / Professional competencies for working with multilingual and multicultural populations in Spain: speech-language therapists' beliefs, practices and needs

ANTECEDENTES Y OBJETIVOS: El aumento del número de personas que precisan intervención logopédica bilingüe y multilingüe justifica que las actuales prácticas logopédicas sean revisadas. Los/as logopedas son éticamente responsables de proporcionar la mejor intervención posible, basada en la evidencia, a las familias con las que trabajan. Existe, por tanto, una clara demanda de logopedas competentes para atender a población de origen lingüístico y culturalmente diverso. El objetivo de este trabajo es documentar las creencias, necesidades y prácticas desarrolladas en España y profundizar en las competencias lingüísticas, culturales y profesionales desde la perspectiva de los/as logopedas. MÉTODO: A partir de trabajos previos en otros países, se diseña un cuestionario adaptado a la cultura y lengua española para estudiar la situación de la intervención logopédica multilingüe y multicultural. La muestra está conformada por 208 logopedas de todas las comunidades autónomas que trabajan con población diversa. RESULTADOS: El 84% de los encuestados/as declara hablar más de una lengua, pero solo el 56% se considera bilingüe. El 77% ha trabajado con personas multilingües. El 86% declara no haber recibido formación inicial con este enfoque. El 92% declara carecer de recursos para la evaluación logopédica en diferentes lenguas. Sin embargo, aparecen diferencias significativas en las prácticas y las creencias cuando se compara a los profesionales que se consideran bilingües con los monolingües. CONCLUSIONES: Este trabajo presenta resultados similares a estudios previos y sería un primer paso para el diseño de prácticas, políticas y recursos que mejoren las competencias profesionales y las prácticas

BACKGROUND AND AIMS: The increase in the number of people who require bilingual and multilingual speech-language intervention justifies reviewing the current practices of Speech-Language Therapists (SLTs), who are ethically responsible for providing the best possible evidence-based intervention to the families with whom they work. There is, therefore, a clear need to competently serve populations with linguistically and culturally diverse backgrounds. The goal of this work was to document the beliefs, needs and practices of SLTs in Spain, as well as to obtain a deeper understanding of linguistic, cultural and professional competencies from the perspective of SLTs. METHOD: Based on previous work in other countries, a questionnaire was designed to study multilingual and multicultural speech-language intervention in Spain. The sample consisted of 208 SLTs working with a diverse population across regions of Spain. RESULTS: Eighty-four percent of the survey respondents reported that they speak more than one language, but only 56% considered themselves bilingual; 77% reported having faced the challenge of working with multilingual people; 86% reported that they had not received training focused on this diversity and 92% reported that they lacked resources for conducting bilingual speech and language evaluations. Nevertheless, there were significant differences in the beliefs and practices when bilingual and monolingual SLTs were compared. CONCLUSIONS: This work, with results similar to those of previous studies, provides a first step for designing methods, policies and resources to improve professional competencies and multilingual practices. Several challenges for SLTs facing this new social reality are discussed

Prácticas en logopedia infantil en entornos bilingües y multilingües. Recomendaciones basadas en la evidencia / Speech & Language therapy practices with children growing up in bilingual and multilingual environments. Evidence-based recommendations

Algunos niños y niñas que crecen en entornos con oportunidades de comunicación en varias lenguas pueden necesitar en algún momento de su desarrollo apoyo de profesionales de la logopedia/fonoaudiología. El Comité de Expertos en Multilingüismo y Multiculturalidad de la Asociación Española de Logopedia, Foniatría y Fonoaudiología, e Iberoamericana de Fonoaudiología ha consensuado una propuesta de recomendaciones basadas en la evidencia para las prácticas en logopedia con el fin de facilitar que los/as niños/as puedan ejercer el derecho a su identidad cultural y a emplear su propio idioma. Se parte de una concepción dinámica del bi/multilingüismo centrado en la persona y su entorno, considerando un enfoque transcultural, transdisciplinar y funcional, dirigido a fomentar las oportunidades de aprendizaje. Considerando los resultados de investigaciones actuales sobre el desarrollo lingüístico-comunicativo de los/las niños/as bi/multilingües con y sin trastornos del lenguaje, habla y comunicación, se plantean herramientas para el desarrollo de la evaluación y la intervención logopédica/fonoaudiológica desde una perspectiva lingüístico-funcional. Así, se incluyen propuestas para realizar la entrevista e instrumentos para la evaluación directa y/o indirecta. Todo ello mediante la valoración del entorno bilingüe y la evaluación translingüística y funcional, en estrecha colaboración con las familias, las escuelas y otros profesionales de apoyo, como intérpretes. Finalmente se plantea la necesidad de formación continua en competencias profesionales, como las de gestión emocional para el trabajo con personas en entornos de origen lingüístico y cultural diverso

Some children who grow up in environments in which there is the opportunity to learn more than one language may, at some point in their development, need the support of speech and language professionals. The present paper by the Expert Committee on Multilingualism and Multiculturalism of the Spanish and Ibero-American Association of Speech and Language Therapy (AELFA-IF) provides evidence-based recommendations for speech and language therapy practices that facilitate children's ability to exercise their right to their cultural identity and the use of their language(s) (United Nations, 1989). These recommendations are based on a dynamic conceptualization of bilingualism/multilingualism that is centred on the person and his or her environment, and use a cross-cultural, transdisciplinary and functional approach to providing learning opportunities for speech and language professionals. Based on the results of research on the linguistic-communicative development of bilingual/multilingual children with and without speech/language and communication disorders, tools for developing speech/language assessment methods and intervention from a functional-linguistic perspective are proposed. These include suggestions for conducting interviews and using direct and indirect evaluation instruments to assess the bilingual environment, as well as the use of cross-linguistic and functional evaluation methods, in close collaboration with families, schools and other support professionals, such as interpreters. Finally, the paper outlines the need for continuous training in professional competencies, such as interpersonal skills, needed for working with people from diverse linguistic and cultural backgrounds

Factores de riesgo que influyen en la enfermedad renal crónica en San Juan y Martínez / Risk factors influencing in chronic kidney disease in San Juan y Martinez municipality

RESUMEN Introducción: en la actualidad existe en el mundo una verdadera epidemia de las llamadas "enfermedades crónicas no comunicables": diabetes mellitus, hipertensión arterial, enfermedad cardiovascular y enfermedad renal crónica. Objetivo: caracterizar los factores de riesgo que influyen en la enfermedad renal crónica en el municipio San Juan y Martínez en el 2017. Métodos: se realizó un estudio observacional, descriptiva y transversal. El universo estuvo constituido por 51 pacientes que fueron diagnosticados con esta enfermedad en el período estudiado; el universo coincide con la muestra de estudio. Resultados: predominó el sexo masculino con edades entre 50 y 59 años, los hábitos tóxicos que favorecieron la progresión de la enfermedad renal crónica a su estadio terminal fueron el alcohol y el tabaco, entre las enfermedades asociadas estuvo la hipertensión arterial, la diabetes mellitus y las dislipidemias, la mayoría de los pacientes padecen esta enfermedad desde hace más de cinco años y reciben tratamiento farmacológico. Conclusiones: la prevención primaria está orientada en un principio a evitar la aparición de enfermedades renales, por lo que debe promoverse y divulgarse en la población la necesidad de cambios de estilos de vida saludables.

ABSTRACT Introduction: in current times there is a true epidemic of the known "chronic non-communicable diseases" worldwide: diabetes mellitus, high blood pressure, cardiovascular diseases and chronic kidney disease. Objective: to characterize the risk factors influencing in chronic kidney disease in San Juan y Martinez municipality during 2017. Methods: an observational, descriptive and cross-sectional study was conducted; the target group comprised 51 patients diagnosed with this disease in the period studied, coinciding this with the sample of study, patients meeting the inclusion criteria established for this research were included. Results: male gender predominated with ages between 50-59 years old, the toxic habits favoring the progression of chronic kidney disease up to its end-stages were alcohol addiction and smoking; high blood pressure, diabetes mellitus and dyslipidemias were among the associated diseases; the majority of the patients suffer from this disease for more than five years and undergoing pharmacological treatment. Conclusions: primary prevention is basically oriented to avoid the onset of kidney diseases therefore the need for practicing healthy lifestyles should be promoted and spread.

Genetic diversity of HLA system in three populations from Guanajuato, Mexico: Guanajuato City, León and rural Guanajuato.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 262 Mexicans from the state of Guanajuato living in the cities of Guanajuato (N = 78), León (N = 22) and rural communities (N = 162), to obtain information regarding allelic and haplotypic frequencies. We find that the most frequent haplotypes found in the state of Guanajuato include 12 Native American and three European haplotypes. Admixture estimates revealed that the main genetic components in the state of Guanajuato are Native American (50.64 ±â€¯2.11% by ML, 43.35% of Native American haplotypes) and European (44.14 ±â€¯1.14% by ML; 39.35% of European haplotypes), while African genetic component is less apparent (5.22 ±â€¯2.08% by ML; 8.36% of African haplotypes).

Importancia de la enfermera escolar según la percepción de funcionarios de colegios básicos de una provincia de chile / Importance of the school nurse according to the perception of officials of basic schools of a province of chile / Importância da enfermagem escolar de acordo com a percepção de funcionários de escolas básicas de uma província do chile

RESUMEN Objetivo: Describir la importancia de la enfermera escolar según la percepción de los funcionarios de colegios básicos de una provincia al sur de Chile. Material y Método: Estudio cuantitativo, descriptivo, transversal que, a partir de un universo de 169 funcionarios de 5 colegios públicos y privados, obtuvo una muestra de 126 (75%) personas quienes, posterior a dar su consentimiento informado, respondieron el instrumento "Percepción de la importancia de la enfermera escolar", desde la perspectiva de sus funciones asistenciales, educativas, investigativas, administrativas y de gestión. La investigación fue aprobada por el Comité de ética de la Universidad Adventista de Chile. Resultados: El 94% de los funcionarios refieren que es importante la enfermera escolar para actuar en emergencias ocurridas durante el horario escolar; un 93,5% percibe que la enfermera es indispensable para atender en primeros auxilios; un 92,25% cree que los padres estarán tranquilos al saber que hay un profesional de salud en la escuela y un 91,75% dice que el profesional de enfermería puede educar al alumnado sobre infecciones de transmisión sexual. Conclusión: Según los funcionarios de los colegios, la presencia de una enfermera escolar es importante y debiera estar presente para mantener la salud de los estudiantes.

ABSTRACT Objective: To describe the importance of the school nurse as perceived by school staff members of elementary schools from a province south Chile. Materials and Methods: Quantitative, descriptive, cross-sectional study, using a sample of 126 (75%) participants from a population of 169 school staff members of 5 public and private schools. After giving informed consent, the participants answered the instrument "Perception of the importance of the school nurse", from the perspective of their caregiving, educational, research and management functions. The research was approved by the Ethics Committee of the Chilean Adventist University. Results: 94% of school staff members indicate that the school nurse is important when acting in emergencies during school hours; 93.5% consider that the school nurse is vital when it comes to providing first aid; 92.25% believe that parents feel reassured when there is a health professional in the school, and 91.75% say that nurses can educate students on sexually transmitted infections. Conclusion: According to school staff members, the presence of a school nurse is important and should be promoted for maintaining student's health.

RESUMO Objetivo: Descrever a importância da enfermeira escolar de acordo com a percepção dos funcionários da escola básica de uma província sul do Chile. Material e Método: Estudo quantitativo, descritivo, transversal que, de um universo de 169 funcionários de 5 escolas públicas e privadas, obteve uma amostra de 126 (75%) pessoas que, depois de dar o consentimento informado, responderam ao instrumento "Percepção da importância da enfermeira escolar", na perspectiva de suas funções assistenciais, educacionais, de pesquisa, administrativas e gerenciais. A pesquisa foi aprovada pelo Comité de Ética da Universidade Adventista do Chile. Resultados: 94% dos funcionários relata que a enfermeira escolar é importante para atuar em emergências durante o horário escolar; 93,5% percebe que a enfermeira é indispensável para o atendimento de primeiros socorros; 92,25% acredita que os pais ficam calmos sabendo que existe um profissional de saúde na escola e 91,75% diz que o profissional de enfermagem pode educar os alunos sobre infecções sexualmente transmissíveis. Conclusão: Segundo os funcionários da escola, a presença de uma enfermeira escolar é importante e deve estar presente para manter a saúde dos alunos.

Logopedia en entornos bilingües desde un enfoque naturalista / Speech and language therapy in bilingual environments from a naturalistic approach

En los últimos años, en los que la logopedia ha evolucionado desde paradigmas más tradicionales a enfoques socioconstructivistas, se hace especialmente necesaria una revisión de la intervención logopédica con niños bilingües. El principal reto para la intervención logopédica en población bilingüe consiste en ofrecer una respuesta situada y significativa, tanto para el niño como para su familia en los diferentes entornos en los que se produce la interacción. Una primera cuestión que se plantea es cómo realizar la evaluación logopédica de una población bilingüe para determinar las competencias generales en las dos lenguas que utiliza. La literatura muestra que las pruebas estandarizadas diseñadas para niños monolingües no son totalmente válidas para poblaciones bilingües. Se recomienda, por tanto, una evaluación holística de las competencias de cada lengua realizada en un entorno natural de uso comunicativo. Otra cuestión importante es la elección adecuada de la lengua en la que se interviene. La tendencia actual en la intervención es recomendar un enfoque bilingüe, a pesar de que algunos profesionales siguen proponiendo y realizando abordajes monolingües, bien por no dominar la otra lengua, bien por no conocer en profundidad la evidencia actualizada. Este trabajo pretende, precisamente, facilitar al logopeda un acercamiento a los últimos estudios sobre intervención naturalista con entornos bilingües y la intervención centrada en la persona y su familia. Los resultados sugieren que la intervención centrada en la familia es un enfoque que permite empoderar a las familias para apoyar de manera significativa el desarrollo comunicativo de sus hijos

Speech and Language Therapy (SLT) has evolved from a traditional to a socio-constructivist approach over the last years. Consequently, it is now necessary to review the intervention with bilingual children. The main challenge for the SLT working with bilingual population is to offer a situated and meaningful response for both the children and their families in the different environments where interaction takes place. The first question to be solved is how to develop an evaluation of a bilingual population in order to determine the general competences in both languages. Literature shows that standardised tests designed for monolingual children are not valid for bilingual population. Therefore, it is recommended to use a holistic evaluation of each languagés competence carried out in a natural environment of communicative use. Another important issue is the choice of the language in which intervention is going to be developed. The current trend in SLT intervention is to recommend a bilingual approach; however, some professionals are still using monolingual approaches. There are several reasons for this approach: professionals may not have sufficient abilities in the other language or may not have read the latest publications in the field. This work tries, precisely, to facilitate the access to the latest works about naturalistic intervention in bilingual settings and to offer a framework in personal and family-centred intervention. Results suggest that family-centred intervention is an approach that allows to empowering families to significantly support their children's communicative development

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain / A prevalência de complicações de catarata em pacientes com síndrome pseudoesfoliativa no noroeste da Espanha

ABSTRACT Purpose: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. Methods: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. Results: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. Conclusion: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

RESUMO Objetivo: Avaliar a relação entre a síndrome de pseudoexfoliação e a prevalência de complicações e fatores clínicos relacionados em pacientes submetidos à cirurgia de catarata. Métodos: Foi realizado um estudo retrospectivo de coorte de 503 de 551 pacientes que se submeteram à cirurgia de facoemulsificação durante 2 anos em um distrito de saúde no noroeste da Espanha. No total, 120 dos 681 olhos submetidos ao procedimento apresentavam síndrome de pseudoexfoliação. Dados sobre o procedimento cirúrgico e complicações associadas foram obtidos dos prontuários médicos. As complicações incluíram qualquer combinação de ruptura da cápsula posterior, perda de humor vítreo, diálise zonular e luxação do núcleo ou do cristalino. Resultados: Encontramos uma associação significativa entre síndrome de pseudoexfoliação e diálise zonular (razão de probabilidade [RP]: 6,89; IC 95%, 2,27-20,93), a miose perioperatória (RP: 2,15; IC 95%, 1,10-4,22) e luxação do cristalino >1,5 mm (RP: 9,49; IC 95%, 0,85-105,54). Porém, ao ajustar para o risco global de complicações em pacientes com síndrome de pseudoexfolição em consideração à miopia, uso de anticoagulantes ou α-agonistas, midríase prévia e comprimento da câmara anterior, a RP diminuiu para 1,02 (IC 95%, 0,47-2,21) e não foi, portanto, significativo. Conclusão: A diálise zonular e a miose intraoperatória foram complicações intraoperatórias em pacientes submetidos à cirurgia de catarata com síndrome de pseudoexfoliação quando comparados aos controles.

Prevalence of cataract complications in patients with pseudoexfoliation syndrome in Northwestern Spain.

PURPOSE: To assess the relationship between pseudoexfoliation syndrome and incidence of complications and related clinical factors in patients undergoing cataract surgery. METHODS: We conducted a retrospective cohort study of 503 of 551 patients who underwent phacoemulsification surgery over 2 years in a health care district in Northwest Spain. In total, 120 of 681 eyes undergoing the procedure had pseudoexfoliation syndrome. Data on the surgical procedure and associated complications were extracted from the medical record. Complications included any combination of posterior capsular rupture, vitreous loss, zonular dialysis, and nuclear or lens luxation. RESULTS: We found a significant association between pseudoexfoliation syndrome and zonular dialysis (odds ratio [OR], 6.89; 95% CI, 2.27-20.93), intraoperative miosis (OR, 2.15; 95% CI, 1.10-4.22), and lens luxation >1.5 mm (OR, 9.49; 95% CI, 0.85-105.54). However, when adjusting for the overall risk of complications in pseudoexfoliation syndrome patients in consideration of myopia, use of anticoagulants or α-agonists, previous mydriasis, and anterior chamber length, the OR decreased to 1.02 (95% CI, 0.47-2.21) and was therefore not significant. CONCLUSION: Zonular dialysis and intraoperative miosis were intraoperative complications in cataract surgery patients with pseudoexfoliation syndrome when compared to controls.

Análisis de los fallos de la Corte Suprema de Justicia de Chile en casos de responsabilidad médica, años 2014 y 2015 / Analysis of Chilean Supreme Court rulings in medical malpractice cases, 2014-2015

Objetivo: Analizar los datos epidemiológicos y jurídicos de los casos por responsabilidad médica fallados por la Corte Suprema de Justicia chilena los años 2014 y 2015. Material y método: Se realizó un estudio retrospectivo, revisando los fallos de la Corte Suprema de Justicia en la base de datos electrónica del Poder Judicial chileno. Se seleccionaron y analizaron los fallos por responsabilidad médica. Resultados: Se detectó un total de 110 casos por responsabilidad médica. Todos correspondieron a causas civiles. La duración promedio de los procedimientos fue de 39 meses. La especialidad más demandada fue ginecología. La mayoría de las demandas afectó al Sistema Público de Salud. Los casos que dan origen a las demandas son, en su mayoría, de atención programada frente a los de urgencias, y de tratamiento frente a procedimientos quirúrgicos. El 39% de los casos resultaron en muerte del paciente. La mayoría de las demandas resultó desfavorable para los demandantes. Conclusiones: Se requiere un urgente análisis de los factores de riesgo, no solo de la ocurrencia de mala praxis, sino de la judicialización de los conflictos médico-paciente, especialmente en el área ginecoobstétrica. Además, dado que los juicios conllevan un alto coste no solo económico, sino también psicológico y emocional para todos los involucrados, un análisis de los mecanismos judiciales propios de este tipo de casos podría contribuir a que estos se resolvieran, en la medida de lo posible, en instancias prejudiciales o en procesos judiciales más cortos, beneficiando a todos los involucrados

Objective: The objective of the present study is to characterise the epidemiological and legal data on medical malpractice ruled by the Chilean Supreme Court (CSC) in the years 2014 and 2015. Material and method: A search of the CSC electronic database was conducted to identify and analyse CSC rulings for criminal and civil medical malpractice cases. Results: A total of 110 malpractice cases were identified. The CSC received only civil cases of medical malpractices during the studied period. The average duration of the trial was 39 months. Gynaecologists faced suits more frequently than any other type of specialist. The majority of cases were associated with the public health system. More claims were associated with scheduled than with emergency care. Likewise, more claims. Were associated with non-surgical treatment than with surgical procedures. More than a third (39%) of the cases resulted in the patient's death. The majority of CSC rulings were in favour of the defendants. Conclusions: An urgent analysis of the risk factors is necessary, not only of the occurrence of malpractice, but also of doctor-patient conflicts by judicial means, especially in the gynaecological-obstetrics area. In addition, considering that the trials not only involve a high economic cost, but also psychological and emotional one, for all involved, an analysis of the judicial mechanisms of these types of cases could help resolve them, and when possible, in preliminary courts or in shorter judicial processes, benefiting all parties

Conservative Management of Scrotal Hematoma Secondary to Adrenal Hemorrhage in Newborns.

A 24-hour-old male presented with bruising and swelling of the right hemiscrotum and groin. Testicular torsion was ruled out in a Doppler sonography, signs of an evolving right adrenal hemorrhage was demonstrated in the abdominal ultrasound. The imaging follow-up proved the disappearance of both scrotal and adrenal hematomas. Including the adrenal hemorrhage of the newborn in the differential diagnosis of an acute scrotum can prevent unnecessary surgical explorations.

Lesiones orales en víctimas del síndrome de munchausen por poder / Oral lesions in victims of munchausen syndrome by proxy

Resumen La presente es una revisión bibliográfica de casos publicados de niños con manifestaciones orales de maltrato físico, específicamente del Síndrome de Munchausen por poder. Tiene como objetivo resumir y presentar las características de las lesiones de víctimas del Síndrome, utilizando las principales bases de datos de publicaciones científicas. Se encontraron 9 casos, en todos ellos la victimaria fue la madre. Las lesiones se localizaron en la mucosa orofaríngea, las encías, la lengua, el paladar y los labios; fueron causadas por sustancias tóxicas administradas por vía oral o por compresión manual de la boca. En dos casos la víctima falleció. Se registró la muerte previa de 6 hermanos de las víctimas. Finalmente, se propone un esquema de evaluación odontológica forense para establecer o descartar que las lesiones de la cavidad oral sean parte del Síndrome.

Abstract This is a literature review of published cases of children with oral manifestations of physical abuse, specifically of Munchausen Syndrome by proxy. It is intended to summarize and present the characteristics of injuries of victims of the Syndrome, using the main databases of scientific publications. 9 cases were found, all of them the perpetrator was the mother. The lesions were found in the oropharyngeal mucosa, gums, tongue, palate and lips; they were caused by toxic substances administered orally or by manual compression of the mouth. In two cases the victim died. The previous death of 6 brothers of the victims was recorded. Finally, a forensic dental evaluation scheme intends to establish or rule out that lesions of the oral cavity are part of the syndrome.

Solid-phase microextraction of heavy metals in natural water with a polypyrrole/carbon nanotube/1, 10-phenanthroline composite sorbent material.

A simple and sensitive method for simultaneous microextraction and determination of heavy metals using a new direct immersion solid-phase microextraction (DI-SPME) sorbent material combined with inductively coupled plasma mass spectrometry (ICP-MS) was investigated. In this method, sorbent coating composites were prepared by simultaneous electropolymerization of pyrrole on pencil lead in the presence of carbon nanotubes (CNTs) and different metal chelating ligands. Among the coatings evaluated, a polypyrrole coating with entrapped CNTs and the chelator 1, 10 phenanthroline allowed the determination of silver, cadmium, cobalt, iron, nickel, lead, and zinc. Parameters influencing microextraction efficiency including pH, extraction time, and desorption time were optimized. The linear dynamic ranges were 1-1000 µg L-1 for Ag, 1-750 µg L-1 for Cd, Pb, and Zn, and 1-500 µg L-1 for Co, Fe, and Ni with limits of detection of 0.012-0.163 µg L-1 and limits of quantification of 0.039-0.542 µg L-1. The relative standard deviations (RSDs, n = 5) ranged from 1.85% to 5.01%. The effect of inorganic interferences on the determination of the heavy metals also was examined and finally, the method was successfully applied for the determination of heavy metals in real water samples.

Enfermedad de Castleman multicéntrica en una paciente postrasplantada de médula ósea / Multicentric Castleman's disease in a patient post-transplanted of bone marrow

Resumen La enfermedad de Castleman es un grupo heterogéneo de trastornos linfoproliferativos con dos formas de manifestación: variedad unicéntrica y multicéntrica. En términos histológicos se caracteriza por ganglios linfáticos con hiperplasia del centro germinal y aumento en la vascularidad. Se comunica el caso de una paciente de 70 años de edad con antecedente de trasplante autólogo de células troncales y progenitoras hematopoyéticas, que acudió a consulta por padecer astenia, pérdida de peso, dolor abdominal y disnea de evolución progresiva; a la que se le encontró un tumor retroperitoneal y derrame pleural derecho. Se plantea el abordaje del caso y se revisa la bibliografía, ya que se estima la incidencia en 21-25 casos por un millón de habitantes, sólo 14% de los casos reportados con manifestación retroperitoneal.

Abstract Castleman's disease is a heterogeneous group of lymphoproliferative disorders (LPD'S), which has two types of presentation, unicentric (UCD) and multicentric (MCD) variety. Histologically it is characterized by lymph nodes with hyperplasia of germinal centers and increased vascularity. This article reports the clinical case of a 70-year-old female with previous autologous haematopoietic stem cell transplant. She arrived with asthenia, weight loss, abdominal pain and progressive dyspnea. A retroperitoneal tumor and right pleural effusion were found. Clinical approach and bibliographic review are reported, the incidence estimation for this disorder is 21-25 cases per million population, and only 14% of reported cases had a retroperitoneal presentation.

Conocimiento y utilización de la visita preconcepcional en atención primaria de salud / Knowledge and attitudes towards preconception visits within primary health care

OBJETIVO: Averiguar si las mujeres embarazadas conocen la visita preconcepcional y determinar la prevalencia de mujeres que solicitaron atención preconcepcional durante el año previo a la gestación. Sujetos/material y método: Se realizó un estudio observacional, descriptivo y transversal, con muestreo de conveniencia, en mujeres que iniciaron el control gestacional en los centros salud de las unidades de atención a la salud sexual y reproductiva (ASSIR) pertenecientes al Área Metropolitana Norte de Cataluña en 2015. RESULTADOS: Se estudió a 235 gestantes. Conocían la posibilidad de solicitar asistencia previa a la concepción el 50,2% de las mujeres (n= 118), y finalmente solicitaron asistencia el 38,7% (n= 91). Únicamente el 4,3% (n= 4) realizó una demanda activa con finalidad preventiva. El profesional al que acudieron con mayor frecuencia fue la matrona 41,5% (n= 48) seguido del ginecólogo 34,74% (n= 41). El 65,5% (n= 59) de las mujeres que recibieron atención preconcepcional iniciaron la toma de ácido fólico en el periodo pregestacional, frente al 17,7% (n= 27) que no solicitaron atención preconcepcional (p= 0,03). CONCLUSIONES: Las gestantes desconocen la importancia de los cuidados de la visita preconcepcional con finalidad preventiva. Ante la poca demanda, es necesario hacer promoción y difusión activa de esta visita para recibir una atención previa a la gestación, con el objetivo de que las parejas estén informadas y tengan un estado de salud óptimo previo a la gestación

OBJECTIVES: Determine if pregnant women know the preconception visit and the prevalence of women who requested preconception care during the year prior to pregnancy. Subjects/material and method: A transversal descriptive observational study was carried out, with convenience sampling, in women who initiated gestational control in the health centers of the sexual and reproductive health care units (ASSIR) belonging to the Northern Metropolitan Area of Catalonia (Spain) to the year 2015. RESULTS: 235 pregnant women were studied. They knew the possibility of requesting pre-conception assistance 50.2% of women (n= 118), requesting assistance at 38.7% (n= 91). Only 4.3% (n= 4) made an active demand for preventive purposes. The professional who attended most frequently was midwife 41.5% (n= 48) followed by gynaecologist 34.74% (n= 41). We observed a direct impact of preconception care in the prevention of neural tube defects, observing statistically significant differences (p= 0.03) among women who did receive preventive advice. 65.5% (n= 59) of the women who received preconception care started taking folic acid in the pre-pregnancy period compared to 17.7% (n= 27) in those who did not request preconception care. CONCLUSIONS: Pregnant women are unaware of the importance of the care of the preconception visit for preventive purposes. Given the low demand, it is necessary to promote the preconception visit to receive pre-pregnancy with the aim of ensuring that couples are informed and has an optimal health status prior to pregnancy