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Background: The growth of the prison population and the high recidivism rates of inmates represent a major public safety problem. Objective: This systematic review explored executive functions in inmates convicted of violent behavior compared with inmates convicted of non-violent behavior and healthy controls (HCs). Methods: Systematic searches were carried out using five databases (PubMed, Scopus, Web of Science, EBSCO, and Embase) until March 6th, 2023. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, two reviewers independently performed the screening, data extraction, and risk of bias assessment of the 8 studies included. The protocol of this study was registered in Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42021252043. Results: Consistently, inmates convicted of violent behavior exhibited a greater alteration in inhibition than inmates convicted of non-violent behavior (four out of four studies) and HCs (two out of two studies). In addition, inmates convicted of violent behavior showed greater impairments in cognitive flexibility (two out of three studies) and working memory (two out of three studies) than HCs. Although with limited evidence (only one study), they also showed worse performance in set shifting and planning than HCs. Conclusion: This study provides evidence of alterations in inhibition in inmates convicted of violent behavior compared to inmates convicted of non-violent behavior and HCs. Even though inmates convicted of violent behavior showed greater impairments in planning and set shifting than HCs, these findings were supported in only one study. In general, more robust evidence is needed to confirm alterations in inmates convicted due to violent behavior. These findings highlight the importance of designing and promoting specific cognitive interventions that contribute to the reintegration of inmates into society. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252043, identifier CRD42021252043.
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La evaluación del estado ácido base y de la oxigenación de un paciente es fundamental en cualquier escenario clínico, sea en consulta externa, en un servicio de urgencias, hospitalización, en cirugía o en la unidad de cuidado intensivo. El conocimiento de las bases fisiopatológicas es de suma importancia para el entendimiento y adecuada interpretación de estas condiciones. El objetivo de esta revisión es proveer las bases de conocimiento necesarias para el abordaje adecuado de los gases arteriovenosos y proponer un modelo para la compresión e interpretación de estos. Este artículo aborda las bases fisiopatológicas de las alteraciones ácido base, los modelos existentes en su compresión, el modelo propuesto para su abordaje diagnóstico, sus diagnósticos diferenciales, el enfoque de la hipoxemia, la interpretación de los gases arteriovenosos y las variables que se pueden obtener de estos, el enfoque de la acidosis láctica y unos ejemplos del modelo propuesto.
The evaluation of the acid-base status and the oxygenation of a patient is fundamental in any clinical setting, be it in an outpatient clinic, in an emergency service, hospitalization, in surgery or in the intensive care unit. Knowledge of the pathophysiological bases is of the utmost importance for the understanding and adequate interpretation of these conditions. The objective of this review is to provide the necessary knowledge for the adequate understanding of arteriovenous gases and to propose a model for their comprehension and interpretation. This article addresses the pathophysiological bases of acid-base disorders, the existing models in their comprehension, the model proposed for their diagnostic approach, their differential diagnoses, the diagnostic approach to hypoxemia, the interpretation of arteriovenous gases and the variables that can be obtained from them, the diagnostic approach of lactic acidosis and some examples of the proposed model.
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Humanos , Oxigenação , GasometriaRESUMO
Introduction: Actinomycosis is an unusual chronic granulomatous infectious disease. They are commensals in various sites of the human body but with little pathogenicity. Actinomyces israelii is the most prevalent species but more than 30 species have been described. Infection of the lower respiratory tract is unusual, the involvement of mediastinum being even rarer. Case report: A 63-year-old man, previously healthy and living in a rural area, presented with a 5-month history of hemoptysis, pleuritic pain, weight loss, and night sweats. Community-acquired pneumonia with a mediastinal mass was documented, for which he received antibiotic management. Thoracoscopy was carried out for diagnosis and resection of the mediastinal mass due to inconclusive findings in the percutaneous biopsy. Pathology reported the presence of filamentous Gram-positive bacteria visible in Grocott staining. Due to the pathology findings, and the fact that no other infectious agents were identified, a diagnosis of actinomycosis was established. Treatment with oral amoxicillin 1g TID for 6 months was initiated. Conclusions: As far as we are aware, we present the sixth case of mediastinal actinomycosis. We present this case to bring attention to this rare but clinically relevant presentation to be considered as a differential diagnosis of mediastinal masses and to emphasize the need for specific anaerobic cultures to improve the diagnostic yield.
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INTRODUCTION: Hafnia alvei is an enterobacteria that is a common inhabitant of the gastrointestinal flora of bees, birds, fish, and mammals. In humans this enterobacteria has been recovered from the oropharynx and the gastrointestinal tract but it has been rarely reported as a pathogen and usually identified as hospital-acquired enterobacteria. CASE REPORT: We describe a case of a 57-year-old woman, previously healthy, with a 7-day history of cough with brown sputum, sudden onset of chills, subjective fever, malaise, and pleuritic pain in the right hemithorax. A diagnosis of community-acquired pneumonia (CAP) was suspected and empiric antibiotic treatment was started. However, the patient showed no response and developed hemoptysis. A diagnosis of CAP by Hafnia alvei was confirmed with bronchoalveolar lavage and the patient was treated with i.v. cefepime 2 g TID with a good response. CONCLUSIONS: We presented a case of community-acquired pneumonia by Hafnia alvei in a previously healthy patient that, as far as our knowledge reaches, is the third reported case of CAP secondary to this pathogen.
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INTRODUCTION: Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is Fusobacterium necrophorum. CASE REPORT: A 27-year-old male, previously healthy, presented with a 7-day history of sore throat and fever. He was diagnosed with Lemierre's syndrome, coinfection by Bacillus circulans, F. nucleatum and Staphylococcus aureus with an atypical presentation due to the involvement of the external jugular vein and the internal jugular vein. CONCLUSIONS: As far as we are aware, we present the first case of Lemierre's syndrome with these characteristics.
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Taenia solium is the most common parasitic infection of the central nervous system and it can cause parenchymal or extra-parenchymal lesions. Subarachnoid cysticercosis is a type of extra-parenchymal infection in which the prevalence is not known and racemose NC with cerebellar involvement has been rarely reported. The diagnosis is challenging because of its similarity to other infectious diseases or to subarachnoid involvement of systemic malignancies. Treatment usually requires cysticide drugs, however, there are no randomized studies concerning the anti-parasitic treatment in subarachnoid NC. We present a case of racemose NC in the cerebellar hemisphere to draw attention to this pathology, endemic in many parts of the world; and highlight all the current gaps in our understanding of this entity.
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Cisticercose , Neurocisticercose , Amigos , Humanos , Neurocisticercose/diagnóstico , Neurocisticercose/tratamento farmacológico , PraziquantelRESUMO
Resumen La enfermedad de Behçet es una enfermedad poco frecuente con un compromiso sistémico cuyas principales manifestaciones abarcan el sistema gastrointestinal, neurológico, vascular y articular, además de la piel y los ojos. Por su compromiso multisistémico, es frecuente confundirlo con otras entidades como la enfermedad inflamatoria intestinal, con la cual comparte gran parte de su presentación clínica, por lo que se describe un caso clínico y se aborda una revision narrativa desde el punto de vista epidemiológico de las manifestaciones clínicas con el fin de tener un mayor conocimiento para identificarla a tiempo.
Abstract Behçet's disease is a rare disease with systemic involvement whose main manifestations include the gastrointestinal, neurological, vascular, and articular systems, as well as the skin and eyes. Due to its multisystemic nature, it is often mistaken for other entities such as inflammatory bowel disease since they share multiple characteristics in their clinical presentation. A clinical case is described, and an epidemiological review of clinical manifestations is discussed to have better knowledge that allow identifying it on time.
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Humanos , Masculino , Pessoa de Meia-Idade , Sinais e Sintomas , Doenças Inflamatórias Intestinais , Síndrome de Behçet , Doenças RarasRESUMO
OBJECTIVE: To examine the effect of self-generation on learning and memory in Spanish-speaking individuals with traumatic brain injury (TBI). METHOD: Thirty Spanish-speaking individuals with moderate-to-severe TBI and 31 healthy controls were recruited to read 32 individual sentences and required to remember the last word in each sentence. Target words were presented both in a self-generated and provided condition for each participant. Recall and recognition of the words were examined immediately, after 30 minutes and after 1 week. RESULTS: Findings indicated that both healthy controls and individuals with TBI showed significantly better recall and recognition for words in the generated condition than words that had been provided to them at immediate, 30-minute and 1-week time intervals. CONCLUSION: The self-generation technique effectively improves learning and memory in Spanish-speaking individuals with TBI. Results should encourage researchers and clinicians to use the principles of cognitive psychology to adapt (as opposed to simply translate) cognitive rehabilitation protocols for use in Spanish-speaking populations with neurological conditions.
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Aprendizagem por Associação , Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/reabilitação , Rememoração Mental , Retenção Psicológica , Adolescente , Adulto , Idoso , Lesões Encefálicas/complicações , Lesões Encefálicas/epidemiologia , Estudos de Casos e Controles , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Colômbia/epidemiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Idioma , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fatores de Tempo , Adulto JovemRESUMO
Objetivo: realizar un análisis comparativo entre un grupo control y pacientes con trauma craneoencefálico (TCE) para determinar si existen diferencias neuropsicológicas a los seis meses de evolución y así orientar programas de intervención acordes con las necesidades de esta población. Materiales y métodos: se evaluó un total de setenta y nueve pacientes con antecedente de TCE con mínimo de seis meses de evolución y setenta y nueve sujetos en grupo control, el cual presentó una escolaridad promedio de once años frente a nueve años del grupo de TCE; ambos grupos con una media de treinta y cuatro años de edad, sin antecedentes neurológicos y/o psiquiátricos. La media del Glasgow en el grupo de TCE se ubicó en un rango moderado con una puntuación de once. Se aplicó la evaluación neuropsicológica breve en español Neuropsi a los dos grupos. Resultados: los grupos muestran diferencias significativas (p ≤ 0,05) en las tareas de orientación, atención, memoria, lenguaje, lectura y escritura. Conclusiones: el TCE deja secuelas neuropsicológicas significativas, aun seis meses después de ocurrido el evento traumático. Estos hallazgos sugieren que los pacientes con TCE requieren de tratamiento después de superar la etapa inicial.
Objetive: comparative analysis between control group and patients with TBI to determine whether there neuropsychological differences at 6 months of evolution, to guide timely intervention commensurate with the needs of this population. Materials and methods: a total of 79 patients with a history of TBI with a minimum of 6 months of evolution and 79 control subjects were evaluated. Both groups with a mean age of 34 and without previous neurological or psychiatric disorders and an average schooling of 11 years for the control group and 9 years for the TBI group. The Glasgow Coma Scale in the TBI group was classified as moderate with 11 points. The Brief Neuropsychological Evaluation in Spanish Neuropsi was applied to both groups. Results: significant differences (p≤0.05) in the tasks of orientation, attention, memory, language, reading and writing were found. Conclusions: TBI generates significant neuropsychological changes, even six months after discharge from the health service. It suggests that patients with head injury require treatment after overcoming the initial stage.
Objetivo: realizar uma análise comparativa entre um grupo controle e pacientes com traumatismo cranioencefálico, TCE, para determinar se existem diferenças neuropsicológicas aos seis meses de evolução e assim orientar programas de intervenção conforme com as necessidades desta população. Materiais e métodos: avaliou-se um total de setenta e nove pacientes com antecedente de TCE com um mínimo de seis meses de evolução e setenta e nove pessoas em grupo controles, que apresentou uma escolaridade média de onze anos frente a nove anos do grupo de TCE; ambos os grupos com uma média de trinta e quatro anos de idade, sem antecedentes neurológicos ou psiquiátricos. A média de Glasgow no grupo de TCE localizou-se em uma distância moderada com uma pontuação de onze. Aplicou-se a avaliação neuropsicológica breve em espanhol Neuropsi aos dois grupos. Resultados: os grupos mostram diferenças significativas (p≤0,05) nas tarefas de orientação, atenção, memória, linguagem, leitura e escrita. Conclusões: o TCE deixa sequelas neuropsicológicas significativas, ainda seis meses depois de acontecido o evento traumático. Estas descobertas sugerem que os pacientes com TCE requerem de tratamento depois de superar a etapa inicial.
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Humanos , Neuropsicologia , Terapêutica , Ferimentos e Lesões , Escala de Coma de Glasgow , Colômbia , Disfunção Cognitiva , Lesões Encefálicas TraumáticasRESUMO
Introducción: El trauma craneoencefálico (TCE) es una de las principales causas de muerte y discapacidad en personas jóvenes en Colombia. Aquellos que logran sobrevivir a un TCE suelen quedar con secuelas de problemas cognitivos, emocionales y comportamentales que interfieren con su vida familiar, social y laboral. Pese a la importancia de estos problemas, no existen investigaciones en Colombia en esta área. Objetivo: Determinar a largo plazo las alteraciones cognoscitivas, emocionales y neurocomportamentales de un grupo de pacientes con TCE de la ciudad de Cali, Colombia. Método: A cada uno de los 60 participantes (30 sujetos con trauma de cráneo moderado y severo del Hospital Universitario del Valle y del Centro de Rehabilitación Neurológica Teravida y 30 controles) se le administró la batería neuropsicológica breve (Neuropsi) y el Inventario de Funcionamiento Neurocomportamental (IFN). Resultados: Comparado con el grupo control, los pacientes con TCE presentaron puntuaciones significativamente más bajas en las pruebas de atención y concentración, memoria a corto y largo plazo, lenguaje y funciones ejecutivas, y más altas en depresión, síntomas somáticos y problemas de comunicación. Conclusión: Los pacientes con TCE a largo plazo tienen no sólo dificultades cognitivas, sino síntomas depresivos, somáticos y problemas de comunicación, que señalan la necesidad de que reciban atención desde los servicios de salud en estas dos áreas (cognitivo y emocional-comportamental), involucrándolos en programas de rehabilitación cognoscitiva, psicoterapéuticos y psicoeducativos, que permitan mejorar la calidad de vida tanto de los pacientes como de sus familias...
Introduction: Traumatic Brain Injury (TBI) is one of the primary causes of death and disability in Colombia. The objective of the present study was to determine the cognitive, emotional, and neurobehavioral functioning of a group of individuals with TBI in Cali, Colombia. Method: A neuropsychologist administered a comprehensive neuropsychological evaluation (Neuropsi) and the Spanishlanguage version of the Neurobehavioral Functional Inventory (NFI) to 30 individuals with TBI from Teravida Neurological Rehabilitation Center and del Valle University Hospital in Cali, Colombia and 30 healthy controls. Results: Compared to controls, the patients scored significantly worse on attention, memory, executive functioning, and language tests. The patients scored significantly higher than controls on three sub-scales of the NFI: Depression, somatic symptoms, and communication problems. Conclusion: Patients with long-term TBI not only have cognitive difficulties, but also depressive symptoms, somatic, and communication problems, which underlines the need for these patients to receive care from health services in these two areas (cognitive and emotionalbehavioral), involving them in programs of cognitive rehabilitation, psychotherapy, and psychoeducation to improve the quality of life of the patients and their families...
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Traumatismos Craniocerebrais , Avaliação da DeficiênciaRESUMO
OBJECTIVE: The aim of the present study was to determine the most and least important family needs in a group of family caregivers of individuals with TBI from Cali, Colombia, and to examine which of those needs were more likely to be met and unmet. DESIGN: Cross-sectional descriptive study. SETTING: Valle University Hospital in Cali, Colombia. PARTICIPANTS: Twenty-nine family caregivers of individuals with traumatic brain injury. OUTCOME MEASURE: The Family Needs Questionnaire, a 40-item questionnaire divided into six sub-scales. RESULTS: Health Information, Community Support Network and Professional Support Network sub-scales were the most important needs reported by this group of Colombian TBI family caregivers. The most frequently met needs in the present study fell within Health Information, Involvement with Care and Instrumental Support sub-scales and the most frequently unmet needs fell within the Emotional Support, Instrumental Support and Professional Support sub-scales. CONCLUSIONS: Family needs in caregivers of individuals with TBI from Colombia are similar, but more likely to be unmet, than those reported in previous studies. Interventions designed to meet family caregivers' needs in these areas should be implemented in Colombia.
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Lesões Encefálicas/enfermagem , Cuidadores/psicologia , Família/psicologia , Avaliação das Necessidades , Adulto , Lesões Encefálicas/reabilitação , Colômbia , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Apoio Social , Inquéritos e QuestionáriosRESUMO
El déficit de la atención es uno de los problemas más comunes después de una lesión cerebral, incidiendo a su vez en el funcionamiento de otros procesos cognitivos importantes como la memoria, funciones ejecutivas, orientación, concentración, entre otros. Este artículo tiene como objetivo describir la atención y las alteraciones que se producen como consecuencia del trauma craneoencefálico y revisar los aportes de la rehabilitación neuropsicológica para el manejo de estos pacientes. Para lograrlo, se realizó una búsqueda de información siete años atrás y algunos pioneros en el tema. Se encontró que la atención es un mecanismo esencial en la actividad humana, que no depende de un área especializada exclusiva, sino que es el resultado de la interacción entre los componentes de una red, por tanto, las alteraciones que se presentan después de un trauma craneoencefálico producen profundos déficit en la atención afectando la autonomía del paciente. La rehabilitación neuropsicológica se constituye en una forma de intervención ideal para estos casos, teniendo en cuenta que debe hacerse de manera integral y continua en el tiempo; ésta influye sobre otras esferas, como conductual, emocional y social, que le permiten al paciente reinsertarse en mejores condiciones a las actividades de la vida diaria.
Attention deficit is one of the most common problems after a brain injury, affecting also the proper functioning of other important cognitive processes like memory, executive functions, orientation, concentration, amongst others. This article has for objective, to describe the attention and the alterations that are produced as a consequence of craneoencephalic trauma and to review the contributions of the neuropsychological rehabilitation in the management of these patients. To achieve this, a search for information was performed seven years back and some pioneers on the subject. It was found that the attention is an essential mechanism in human activity that does not depend on an exclusive specialized area, but is the result of the interaction between the components of a net, therefore, the alterations that are present after a craneoencephalic trauma produce profound deficits in the attention and affecting the autonomy of the patient. The neuropsychological rehabilitation constitutes itself in an ideal intervention for this cases, considering that it should be done in an integral and continuous way in time, this influences other spheres, like conductual, emotional and social, that allow the patient to reinsert himself in better conditions to the daily life activities.
O déficit da atenção é um dos problemas mais comuns depois que uma lesão cerebral, incidindo, no funcionamento de outros processos cognitivos importantes como a memória, funções executivas, orientação, concentração, entre outros. Este artigo tem como objetivo descrever a atenção e as alterações que se produzem como conseqüência do trauma craneoencefálico e revisar os aportes da reabilitação neuropsicológica para o uso destes pacientes. Se realizou uma busca de informação sete anos atrás e alguns pioneiros no tema. Se encontrou, que a atenção é um mecanismo essencial na atividade humana, que não depende de uma área especializada exclusiva, mas é o resultado da interação entre os componentes de uma rede, portanto, as alterações que se apresentam depois que um Trauma craneoencefálico, produzem profundos déficit na atenção afetando a autonomia do paciente. A reabilitação neuropsicológica se constitui em uma forma de intervenção ideal para estes casos, levando em conta, que deve fazer-se de maneira integral e contínua no tempo, esta influi sobre outras esferas, como na conduta, emocional e social, que lhe permitem ao paciente reinsertarse em melhores condições nas atividades da vida diária.