The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus. The new coronavirus disease (COVID-19) was initially described in December 2019 in Wuhan , rapidly spread worldwide and was classified as pandemic by the World Health Organization (WHO), on March 11, 2020.   So far, the primordial measures against this new agent are early detection and isolation of suspected patients. The most common initial symptoms described for the COVID-19 infection include constitutional and respiratory symptoms, such as fever, malaise, cough, coryza, and dyspnea.   , 4  This mechanism may explain the occurrence of gastrointestinal symptoms in patients with COVID-19, such as diarrhea, nausea, vomits, and lack of appetite, who may or may not be present with respiratory symptoms. However, it was observed that some patients are asymptomatic from the respiratory point of view, and have only abdominal complaints as their initial clinical findings. This phenomenon can be a diagnostic challenge and a potential risk of COVID-19 transmission, not only to other patients but also to the health professionals involved in healthcare.Recent studies showed that the new coronavirus, an RNA virus, uses the angiotensin-converting enzyme 2 (ACE2) to enter the cells, yielding potential to infect different organs and systems of the human body. Therefore, it is important for the abdominal radiologists, radiologists on-call, and other physicians that are on the frontline against the COVID-19, to be aware of the importance of evaluating the lung bases on abdominal computed tomography (CT) in this present pandemic, even in the absence of respiratory complaints.We retrospectively analyzed all emergency abdominal CT of our institution performed between March 15, 2020 and April 21, 2020, looking for changes caused by COVID-19 on the pulmonary basis included on abdominal images, which could lead to further investigation for this viral pneumonia.Ten patients met these inclusion criteria, and we further reviewed their past medical history.Of the patients assessed, five were male (50%). The mean age was 62 years, ranging from 41 to 84 years. All ten patients tested positive for COVID-19 in real-time polymerase chain reaction (RT-PCR), obtained from an nasopharyngeal swab sample.  , 6  All patients analyzed had gastrointestinal symptoms that preceded the respiratory symptoms.The most frequent gastrointestinal symptoms were abdominal pain, diarrhea, nausea, vomiting, and lack of appetite   , in agrAbdominal pain was the most prevalent complaint in the patients assessed; - two presented with diffuse abdominal pain and four with epigastric pain. One patient had pain in the left flank, and another had pain in the right iliac fossa.Eight patients presented with diarrhea, with a mean duration of 7 days, range of 3 to 20 days. The patient with history of diarrhea for 20 days stayed longer at the hospital, took several antibiotics, which may have contributed to longer duration of this symptom.   such as peripheral and basal predominant ground-glass opacities, with septal thickening and thin reticulation, sparse consolidations and subpleural curvilinear lines  of the exams had no significant abdominal changes. Two CT had positive findings. Nine out of ten of the subsequent chest CT, all of which were motivated by the initial abdominal CT findings had typical COVID-19 alterations, r lines   . One chr lines   .A 74-year-old female patient, presented to the emergency department on March 18, 2020, with a history of abdominal pain, on the right iliac fossa, for 15 days. She referred fever for 4 days, and denied having diarrhea, nausea, vomiting, or respiratory symptoms. She presented diffuse abdominal pain upon palpation, more intense on the right iliac fossa. Her chest auscultation was unremarkable. The patient was submitted to a contrast-enhanced CT of the abdomen, with findings consistent with non-complicated acute diverticulitis in the sigmoid colon   . She reAfter 4 days of antibiotics, the patient returned to the emergency department complaining of weakness, abdominal cramps, and lack of appetite, still with no respiratory symptoms. She was admitted to the hospital, and presented diarrhea, cough, and desaturation. A RT-PCR was requested from the oropharyngeal swab, and it was positive for COVID-19. A chest CT was performed on March 23, 2020, and showed typical findings for COVID-19   . A retrA 75-year-old female patient came to the emergency department on March 18, 2020, presenting with malaise, fever, diarrhea, and dyspnea. The hypothesis of an abdominal sepsis was raised, and the patient was admitted to an intensive care unit. An abdominal CT with no contrast enhancement was requested, which revealed a thickened ascending colon and distal ileum, associated with adjacent fat stranding, findings that suggested enterocolitis   . In the   reported a 61% prevalence of gastrointestinal symptoms upon admission or in the course of the disease.As the COVID-19 spreads and new studies are finalized, its gastrointestinal effects become more evident: some symptoms, such as abdominal pain, diarrhea, nausea, and vomiting are not rare, as deemed in the beginning of the pandemic. A study by Lin et al., We illustrated one case of acute diverticulitis that preceded a new coronavirus infection, and another presenting with diarrhea and signs of enterocolitis during de course of the disease. We questioned if the findings of enterocolitis could be a manifestation of COVID-19 infecting enterocytes, or if there was an intestinal coinfection.  , 8  acting as an inflammatory mediator. Besides, new studies found the virus in feces of infected patients, supporting not only the possibility of direct intestinal infection but also the possibility of a fecal-oral transmission route.   , 9 New evidence in the literature suggests that there is ACE2 expression in the enterocytes,   , 11  Therefore, in the actual pandemic, it is of paramount importance that radiologists keep a high grade of suspicion even when analyzing an exam not directed to the chest, and even when there is no suspicion by the clinical staff, assuring a prompt COVID-19 diagnosis. Since there is no specific treatment for COVID-19, the early diagnosis has an impact on the medical care concerning isolation, reducing transmissibility of the disease not only at home but also at hospitals.Abdominal complaints are frequently assessed with imaging studies, and some protocols include images of the pulmonary bases, which are frequent sites of involvement by COVID-19. We believe that some COVID-19 patients will not show respiratory symptoms, leading to a challenging diagnosis, delaying adequate isolation measurements. In addition, some studies have demonstrated that abdominal symptoms are not rare in this group of patients and can appear earlier in the course of the disease. COVID-19 has a broad spectrum of gastrointestinal symptoms, which are much common than we originally considered. In this pandemic context, we believe radiologists, especially abdominal radiologists, should be aware of the typical and atypical pulmonary changes of coronavirus disease when assessing the lung bases.   A doença do novo coronavírus (COVID-19) foi inicialmente descrita em dezembro de 2019 em Wuhan, Hubei, na China. Ela se disseminou rapidamente pelo mundo e foi classificada como pandemia pela Organização Mundial de Saúde (OMS) em 11 de março de 2020.   Até o momento, as medidas primordiais contra esse novo agente são detecção precoce e isolamento de casos suspeitos. Os sintomas iniciais mais comuns descritos para a COVID-19 incluem sintomas constitucionais e respiratórios, como febre, mal-estar, tosse, coriza e dispneia.   , 4  Esse mecanismo pode explicar a ocorrência de sintomas gastrointestinais em pacientes com infecção pela COVID-19, como diarreia, náusea, vômitos e inapetência, que podem ou não se manifestar juntamente de sintomas respiratórios. Porém, observou-se que alguns pacientes são assintomáticos do ponto de vista respiratório e apresentam apenas queixas abdominais como achado clínico inicial. Esse fenômeno pode representar um desafio diagnóstico e um risco potencial de transmissão da COVID-19, não apenas a outros pacientes, mas também aos profissionais de saúde envolvidos no atendimento.Estudos recentes mostraram que o COVID-19, um vírus de RNA, utiliza a enzima conversora de angiotensina 2 (ECA2) para entrar nas células, o que lhe confere o potencial de infectar diferentes órgãos e sistemas do corpo humano. Assim, é importante alertar os radiologistas abdominais, radiologistas de plantão e outros médicos que atuam na linha de frente contra a COVID-19 sobre a importância de se avaliar a base dos pulmões em tomografia computadorizada (TC) de abdome durante a presente pandemia, mesmo na ausência de queixas respiratórias.Analisamos retrospectivamente todas as TC abdominais de emergência da nossa instituição, realizadas entre 15 de março de 2020 e 21 de abril de 2020, em busca de alterações causadas pela COVID-19 nas bases pulmonares contempladas em imagens abdominais, que poderiam motivar uma investigação mais aprofundada para esse tipo de pneumonia viral.Dez pacientes atenderam aos critérios de inclusão, e analisamos mais a fundo a história pregressa deles.swab nasofaríngeo.Dos pacientes avaliados, cinco eram do sexo masculino (50%). A média de idade foi de 62 anos, variando de 41 a 84 anos. Todos os dez pacientes tiveram resultado positivo no teste de reação em cadeia da polimerase em tempo real (RT-PCR) usando amostra de   , 6  Todos os pacientes analisados apresentaram sintomas gastrointestinais antes dos respiratórios.Os sintomas gastrointestinais mais frequentes foram dor abdominal, diarreia, náusea, vômitos e inapetência   , em conDor abdominal foi a queixa mais prevalente nos pacientes avaliados – dois apresentaram dor abdominal difusa e quatro, epigástrica. Um paciente tinha dor no flanco esquerdo e outro apresentou dor na fossa ilíaca direita.Oito pacientes apresentaram diarreia, com duração média de 7 dias, variando de 3 a 20 dias. O paciente com história de 20 dias de diarreia permaneceu no hospital por um período mais longo e precisou tomar diversos antibióticos, o que pode ter contribuído para a longa duração desse sintoma.   como opacidades em vidro fosco predominantemente periféricas e basais associadas a espessamento septal e reticulação fina, além de consolidações esparsas e linhas curvilíneas subpleurais  dos exames não mostraram alterações abdominais significativas. Duas TC apresentaram achados positivos. Nove das dez TC de tórax subsequentes, todas elas motivadas pelos achados das TC de abdome inicial, revelaram alterações típicas da COVID-19, leurais   . Uma TCleurais   .Paciente do sexo feminino, 74 anos de idade, compareceu ao pronto-socorro em 18 de março de 2020, com história de dor abdominal na fossa ilíaca direita há 15 dias. Relatou febre por 4 dias e negou outros sintomas. Ao exame físico, apresentou dor abdominal difusa à palpação, mais intensa na fossa ilíaca direita. A ausculta torácica foi normal. A paciente foi submetida à TC abdominal com contraste, com achados condizentes com diverticulite aguda não complicada do cólon sigmoide   . Ela foswab orofaríngeo, com resultado positivo para COVID-19. Foi realizada TC do tórax em 23 de março de 2020, que revelou achados típicos de COVID-19 ( Após 4 dias de antibióticos, a paciente retornou ao pronto-socorro com queixa de fraqueza, cólicas abdominais e inapetência, ainda sem sintomas respiratórios. Foi hospitalizada, após apresentar diarreia, tosse e dessaturação. Foi solicitado o RT-PCR do OVID-19   . A análOVID-19   . A paciPaciente do sexo feminino, 75 anos de idade, compareceu ao pronto-socorro em 18 de março de 2020, com mal-estar, febre, diarreia e dispneia. Foi levantada a hipótese de sepse abdominal, e a paciente foi internada em unidade de terapia intensiva. Foi solicitada TC abdominal sem contraste, que revelou espessamento do cólon ascendente e do íleo distal, associado a estriações da gordura adjacente, achados sugestivos de enterocolite   . No mes   relatou prevalência de 61% de sintomas gastrointestinais na admissão ou no curso da doença.À medida que a COVID-19 se propaga, e novos estudos são finalizados, os efeitos gastrointestinais da doença tornam-se mais evidentes: alguns sintomas, como dor abdominal, diarreia, náusea e vômitos, não são tão incomuns quanto se pensava no início da pandemia. Um estudo de Lin et al., Ilustramos um caso de diverticulite aguda precedendo infecção por COVID-19, e outro que apresentou diarreia e sinais de enterocolite durante o curso da doença. Questionamos se os achados de enterocolite poderiam ser uma manifestação de infecção dos enterócitos pela COVID-19, ou se haveria uma coinfecção intestinal.  , 8  atuando como mediadora inflamatória. Além disso, novos estudos encontraram o vírus nas fezes de pacientes infectados, o que corrobora não apenas a possibilidade de infecção intestinal direta, mas também uma possível via de transmissão fecal-oral.   , 9 Novas evidências na literatura sugerem que há expressão de ECA2 nos enterócitos   , 11  Assim, na presente pandemia, é primordial que os radiologistas mantenham um alto nível de suspeição, mesmo para exames que não sejam dirigidos ao tórax e quando não houver uma suspeita clara da equipe clínica, para garantir um diagnóstico rápido da COVID-19. Como ainda não há tratamento específico para a COVID-19, o diagnóstico precoce tem impacto no atendimento médico, particularmente em relação ao isolamento, reduzindo a transmissibilidade da doença não apenas no ambiente domiciliar, mas também nos hospitais.Queixas abdominais são frequentemente avaliadas com estudos de imagem, e alguns protocolos incluem imagens das bases do pulmão, um local frequentemente acometido pela COVID-19. Acreditamos que alguns pacientes com COVID-19 não apresentam sintomas respiratórios, o que dificulta o diagnóstico, atrasando a implementação de medidas de isolamento adequadas. Além disso, estudos demonstraram que sintomas abdominais não são incomuns nesse grupo de pacientes e podem aparecer precocemente no curso da doença. A COVID-19 apresenta um amplo espectro de sintomas gastrointestinais, que são muito mais comuns do que se pensava originalmente. No contexto da presente pandemia, acreditamos que os radiologistas, principalmente os radiologistas abdominais, devem ficar alertas a alterações pulmonares típicas e atípicas da doença do novo coronavírus ao avaliarem a base dos pulmões.


In the published article, there was an error in affiliation 3. Instead of “Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain”, it should be “Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain”.In the published article, there was an error regarding the affiliations for Elisabet Dominguez-Clavé. As well as having affiliation 1, they should also have “Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain” and “Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain”. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


There are errors in the Funding statement. The correct Funding statement is as follows: This work was supported by Centro de Investigação Interdisciplinar em Sanidade Animal (CIISA), Faculdade de Medicina Veterinária, Universidade de Lisboa, through Grant UIDB/00276/2020, from the Portuguese Foundation for Science and Technology (FCT) to LMC.


To describe the implementation status of the Community-Based Rehabilitation in Chile. Quantitative, transversal and descriptive study. The scope was constituted by the 66 community-based rehabilitation centers in the Chilean Metropolitan Region that implemented Community-Based Rehabilitation until December 2016. The sampling was based on a census method, so all the community centers were contacted. A self-administered questionnaire designed based on the Community-Based Rehabilitation matrix defined by the World Health Organization was applied. The questionnaire was answered on-line by the coordinators of the strategy in their respective centers. The data analysis was performed using descriptive statistics. A heterogeneous level of implementation of Community-Based Rehabilitation was identified, specifically in terms of the components of the matrix described by the World Health Organization. The most implemented component was Health; the Social, Livelihood and Empowerment components were moderately implemented; and the Education component was the least implemented. The implementation of Community-Based Rehabilitation is mainly based on the Health component. The level implementation of the other components of the matrix needs to be increased, as well as interdisciplinary and intersectoral strategies to achieve greater social inclusion of people with disabilities. This change in CBR has been associated with the paradigm change about disability and the ratification of the rights of disabled persons with the enactment of the Convention on the Rights of Persons with Disabilities1.The disability is associated with different factors of inequity that will lead to a situation of social, individual and familial exclusion. The main strategy defined by the World Health Organization (WHO) to achieve the reduction of these inequalities is the Community-Based Rehabilitation (CBR). This is a community development strategy for rehabilitation, equal opportunities and social inclusion, providing rehabilitation services in communities, and providing education and training opportunities to people with disabilities, their families and community members. To this end, the strategy is composed of objectives and actions in five components: health, education, work, social and community strengthening . Initial3. Thus, CBR activities are designed to meet the basic needs of people with disabilities and to enable access to health, education, livelihood and social opportunities3.CBR is proposed as a strategy that seeks to ensure the maximum degree of social inclusion of people with disabilities and the full exercise of their rights. The reformulations converge with the principles of the Convention and are established as a multisectoral strategy that can ensure principles that make the difference in the community. While the Convention provides philosophy and policy, CBR is a practical strategy for implementation4.Chile began implementing CBR in 2003, incorporating it into the public health system, specifically in primary care. The purpose was to provide quality rehabilitation services in a timely and accessible way to people with permanent or transitory disabilities, improving resolution at the primary health care level7. International studies about CBR in low-income countries have developed different focuses of analysis and methods. These conclude that this strategy has a positive impact on the self-esteem, empowerment, social inclusion and self-sufficiency of people with disabilities8. A longitudinal study of seven years of monitoring in India reports that people with disabilities who participated in CBR had more support in accessing pensions, paid work and technical aids9. Of the different forms of implementation, those with a bottom-up strategy, those that go from the community to the levels of local government, are best able to address the local needs of the community. However, the sustainability and solvency of the programs are vulnerable because of their dependence on volunteers and lack of stable resources10.The multidisciplinary and systemic nature of CBR makes it a heterogeneous strategy, complex to implement and evaluate12show conceptual differences about international guidelines and methodological orientations of the health sector implemented in the country. The concept of community is shaped by the WHO based on belonging, interrelation and culture, forming an active and involved community. However, for the Chilean Ministry of Health, it is conceived only as a territorial unit with symbolic participation11. Furthermore, in Chile, CBR is mostly developed in the context of primary care centers. Funding is almost exclusively linked to the achievement of targets according to pathology care, thus diminishing the importance of other areas of the strategy. Despite these and other limitations, there is a positive evaluation in the clinical context of the functioning of the strategy12. Despite the change in the approach to CBR to encourage community-oriented work, the state of implementation is heterogeneous and the differences and tensions between the principles and objectives of the CBR conceptual model and the implementation process in Chile are unknown.There are few studies evaluating the implementation of CBR in Chile. Some of themThe objective of this study was to describe the status of CBR implementation in community rehabilitation centers in the Metropolitan Region of Chile.The census sampling method was used. The scope was defined as all community rehabilitation centers in the Chilean Metropolitan Region that implemented CBR until December 2016, and that were recognized by the National Disability Service (NDS) or by the Chilean Ministry of Health. Although there is no single official register, 66 centers were identified in the Metropolitan Region. Forty-six responses were obtained from the total number of community rehabilitation centers in the Metropolitan Region. Three centers were discarded due to inconsistencies in the information provided, resulting in a response rate of 63.6%.3  and Spearman correlation coefficient (parametric association) were used for implementation indices.The internal consistency of the questionnaire was established using the Cronbach alpha value overall and by dimension. A value of 0.95 was obtained on the global Cronbach alpha, which showed good internal consistencyAn informed consent process was conducted with each coordinator. Necessary safeguards were taken to ensure the anonymity of participants and community rehabilitation centers through coding of information sources.The Human Research Ethics Committee of the Facultad de Medicina of Universidad de Chile approved this research on December 22, 2015 (169-2015).The implementation of CBR started between 2004 and 2015. The starting point was between 2011 and 2012 (34.9%); 2.3% of the centers had more than 10 years of implementation.Physical therapists and occupational therapists were in 100% of the teams in a proportion of 2:1 respectively. Other health professionals, such as speech speech therapists, nurses and nursing technicians, were present in less than half of the centers.All the community rehabilitation centers conducted group rehabilitation activities, while 86.0% made home visits and individual rehabilitation activities. This was followed by participatory diagnosis activities (74.4%) and the creation of support for organizations (62.8%). The lesser activities performed were those linked to labor inclusion (41.9%) and educational integration (16.3%).The level of implementation was estimated based on the frequency of development of activities under each of the five components of the CBR matrix described in the WHO guidelines. The most developed activities of the Health component were “Assistance Devices” (97.7%) and “Rehabilitation” (95.3%), while the less developed were “Primary Prevention” (55.8%) and “Secondary Prevention” (41.9%) .The level of implementation of all activities in the Education component was low, with the activity “Lifelong Learning” standing out at 7%, in contrast to the absence of implementation of “Non-formal Education” for children and young people .The activities “Social protection, support networks” were the most implemented in the Education component with 72.1%, while “Basic skills development,” “Entrepreneurship skills development” and “Paid work” were implemented with 18.6% each one .On the other hand, most of the activities of the Social and Strengthening components had high levels of implementation .The “Social Relations” activity had the highest percentage of implementation (79.1%) of the Social component versus the “Maternity and Paternity” activity with 18.6%.The most developed activity of the Strengthening component was “Community empowerment” (60.5%) in contrast to the activity “Skills for political participation” (20.9%).An implementation index was developed based on the results of the activities of each component . A 100% When comparing the level of global implementation and by component of the activities performed in the centers, those that declare to perform “Training of organizations of people with disabilities” presented a higher level of implementation of the CBR matrix than those that do not declare to perform them (p < 0.001 between each of the components).The teams had different levels of training in the components of the CBR matrix. 65.1% of the centers reported a “very high” and “high” level of training in the Health component, while 62.8% of the responses in the Education component were distributed between “low” and “very low” levels of training .The main sources of funding for CBR were the Ministry of Health (86.0%) and local governments (65.1%). Other sources of funding were also reported, such as self-managed funds (16.3%) and funds provided by the National Disability Service (7.0%). Only one center reported receiving funding from private sources.The community rehabilitation centers were linked to community organizations and institutions in the local level territory. The community and local level organizations with the greatest links were the municipal local government (51.2%), the neighborhood organizations (37.2%), the Municipal Office for Disability and Health Centers (both with 34.9%). On the other hand, central government (14.0%), educational centers (14.0%), health user organizations (14.0%), foundations, corporations and non-governmental organizations (11.6%), Municipal Office of Labor Mediation (11.6%), organizations of persons with disabilities (7.0%) and the private sector (4.7%), were the bodies with less involvement reported.This study is one of the first approaches to evaluate the implementation of CBR in Latin America after the ratification of CRPD.14.A heterogeneous state of the implementation of CBR was identified in community-based rehabilitation centers in the Metropolitan Region of Chile, specifically with regard to the components of the matrix defined by WHO. The implementation of the strategy focuses on the “Health” component. This component is the most present in the usual practices of medical care, rehabilitation and support in the use of assistive devices and where a higher level of training of professionals is reported. In contrast, the “Education” component reports the lowest level of implementation and training of professionals. This is consistent with the fact that the activities and indicators of the Chilean Ministry of Health’s community-based rehabilitation programme focus on physical rehabilitation and on adults as the target population3. In Chile, the goal of the CBR program is that 10% of the people served in community rehabilitation centers achieve social inclusion 4. However, most centers report few activities in the Education and Livelihood components, such as educational leveling and job skills development activities. This represents a barrier to the achievement of the proposed objectives in the area of social inclusion and the rights exercise. This finding coincides with other studies that show the incorporation of socio-economic supports, such as labor intermediation or vocational training, in addition to physical rehabilitation; contribute to inclusion, to improving people’s self-esteem and to changing society’s attitude towards them15.The main objective of the CBR strategy is to ensure the maximum degree of social inclusion and exercise of rights by people with disabilities16.All centers have physical therapists and occupational therapists, and less than half have professionals from other disciplines, such as speech therapists, nurses, psychologists and nursing technicians. Although the existence of the dual physical-occupational therapist is an advance in the implementation of a comprehensive rehabilitation model, it is still insufficient for the adequate implementation of the CBR strategy. In addition, there is little intersectoral work. 51.2% of the centers report having links with local government in the context of the Metropolitan Region. In addition, there is little involvement of other partners, such as monitors and community agents, to promote the implementation of primary and secondary prevention activities and other activities related to mental health, education and community strengthening. This finding coincides with evaluation studies on CBR programmes in other countries  which indicate that the limited human resources and training is a major constraint to their implementationIf we hope to achieve “no one left behind, through the full implementation of the Convention on the Rights of Persons with Disabilities,” as established by the CRPD monitoring committee in June 2018, we must position CBR as a trans-sectoral strategy that achieves social inclusion. Continuing to focus only on reducing the gap in access to rehabilitation will not provide either the tools or the results required for sustainable development to be achieved at 2030.It is recognized as limitations of this study that the information was obtained from CBR coordinators. This creates the possibility of overestimating the state of implementation by reporting on their own performance as managers. However, the perspective of the agents responsible for the community rehabilitation centers is required, since in their coordinating role, they have great importance in the implementation of the programme. Future research should include the professional team and people with disabilities and their families in the evaluation processes of the community centers in order to deepen and capture the complexity of the implementation. This would allow for compliance with the principles of CRPD and a comprehensive evaluation of the activities implemented.Furthermore, it is only possible to refer to the state of implementation of CBR in the Metropolitan Region and not to the entire national territory, given the geographical and socio-demographic characteristics of the region as the capital of the country. On the other hand, there was no instrument to evaluate the activities conducted in the context of CBR implementation in Chile. From this study, an instrument is available allowing the collection of complete information about the implementation of CBR in all the national territory.The implementation of CBR in Chile is focused on the health component of the matrix proposed by the WHO. This fact must be considered in the processes of evaluation and formulation of plans to improve the strategy. Not only is it important to continue with the implementation of the other components of the matrix, but also to complete the implementation of the Health component. This should be done through the incorporation of promotion, prevention, support for the use of technical aids and comprehensive care that includes attention in the field of mental health to accompany the processes of acceptance and adaptation, both for persons with disabilities and their families.The strategy should enhance intersectoral work and recognize institutional and community members, with whom they should generate alliances to join efforts to build a more inclusive society. CBR, even in health-focused programmes, can promote positive coexistence between models of understanding about disability . This is provided that rehabilitation services respond to the needs and interests of people with disabilities and that there are opportunities for training and reflection concerning society’s role in establishing barriers to inclusion. It is necessary to have a greater diversity of professionals in order to expand the activities implemented in CBR centers. On the other hand, it is essential to support the development of organizations of people with disabilities to defend their rights and thus advance in the construction of a more fair and inclusive society. 1.La Convención sobre los Derechos de las Personas con Discapacidad (CDPD) define que “dentro del grupo de las personas con discapacidad se incluyen a todas aquellas que tengan deficiencias físicas, mentales, intelectuales o sensoriales a largo plazo que, al interactuar con diversas barreras, puedan impedir su participación plena y efectiva en la sociedad, en igualdad de condiciones con las demás”2.Más de mil millones de personas viven con algún tipo de discapacidad, lo que significa, de acuerdo a las estadísticas poblacionales de 2010, un 15% de la población mundial3. Este giro en la RBC se ha asociado al cambio de paradigma sobre la discapacidad y a la ratificación de los derechos de las personas con discapacidad con la promulgación de la Convención sobre los Derechos de las Personas con Discapacidad1.La discapacidad se asocia a diferentes factores de inequidad que conducirán a una situación de exclusión social individual y familiar. La principal estrategia definida por la Organización Mundial de la Salud (OMS) para lograr la reducción de estas inequidades es la Rehabilitación Basada en la Comunidad (RBC). Esta es una estrategia de desarrollo comunitario para la rehabilitación, la igualdad de oportunidades y la inclusión social, prestando servicios de rehabilitación en las comunidades, y proveyendo de educación y oportunidades de entrenamiento y capacitación a las personas con discapacidad, sus familiares y miembros de la comunidad. Para esto, la estrategia se compone de objetivos y acciones en cinco componentes: salud, educación, trabajo, social y fortalecimiento comunitario . En un c3. En ese sentido, las actividades de la RBC se diseñaron para satisfacer las necesidades básicas de las personas con discapacidad y permitir el acceso a salud, educación, subsistencia y oportunidades sociales3.La RBC es propuesta como una estrategia que busca asegurar el máximo grado de inclusión social de las personas con discapacidad y el pleno ejercicio de sus derechos. Las reformulaciones confluyen con los principios de la Convención y se establece como una estrategia multisectorial que puede asegurar que estos principios hagan una diferencia en la comunidad. Mientras la Convención brinda filosofía y política, la RBC es una estrategia práctica para su implementación4.Chile inició la implementación de la RBC en el 2003, incorporándose en el sistema público de salud, específicamente en la atención primaria. El propósito fue entregar prestaciones de rehabilitación de calidad de forma oportuna y accesible a las personas en situación de discapacidad, permanente o transitoria, mejorando la resolutividad a nivel de atención primaria de salud7. Estudios internacionales sobre RBC realizados en países de bajos ingresos han desarrollado distintos focos de análisis y métodos. Concluyen que esta estrategia impacta positivamente en la autoestima, el empoderamiento, la inclusión social y autosuficiencia de las personas con discapacidad8. Un estudio longitudinal de siete años de seguimiento en India da cuenta de que las personas con discapacidad que participaron de la RBC tuvieron más apoyos para el acceso a pensiones, trabajo remunerado y ayudas técnicas9. De las diferentes formas de implementación, aquellas en las cuales la estrategia es ascendente, es decir, desde la comunidad a los niveles de gobierno local, logra abordar de mejor forma las necesidades locales de la comunidad. Sin embargo, se ven amenazadas la sostenibilidad y la solvencia de los programas por depender de voluntarios y no tener recursos estables10.El carácter multidisciplinario y sistémico de la RBC hace de ella una estrategia heterogénea, compleja de implementar y evaluar12 muestran diferencias conceptuales sobre los lineamientos internacionales y las orientaciones metodológicas del sector salud implementadas en el país. La OMS configura el concepto de comunidad desde la pertenencia, interrelación y cultura, configurándose una comunidad activa e involucrada. Sin embargo, para el Ministerio de Salud chileno, se concibe solo como una unidad territorial con participación simbólica11. Además, en Chile, la RBC se desarrolla mayoritariamente en el contexto de los centros de atención primaria. El financiamiento está vinculado casi exclusivamente al logro de metas según atenciones por patologías, restándole así importancia a otras áreas de la estrategia. A pesar de estas y otras limitaciones, existe una positiva evaluación en el ámbito clínico respecto al funcionamiento de la estrategia12. A pesar del giro planteado en la RBC con el propósito de incentivar su trabajo con orientación comunal, el estado de implementación es heterogéneo y se desconocen las diferencias y tensiones existentes entre los principios y objetivos declarados en el modelo conceptual de la RBC y el proceso de implementación en Chile.Se han realizado escasos estudios que evalúen la implementación de la RBC en Chile. Algunos de ellosEl objetivo de este estudio fue describir el estado de implementación de la RBC en centros comunitarios de rehabilitación de la Región Metropolitana de Chile.Se utilizó un muestreo con intención censal. Se definió como universo a todos los centros comunitarios de rehabilitación de la Región Metropolitana de Chile que implementaron la RBC hasta diciembre de 2016 y que tuvieran el reconocimiento del Servicio Nacional de la Discapacidad (SENADIS) o del Ministerio de Salud chileno. Si bien no existe un registro oficial único, se han reconocido 66 centros en la Región Metropolitana. Se obtuvieron 46 respuestas del total de centros de rehabilitación comunitaria de la Región Metropolitana. Se descartaron tres por inconsistencia de la información entregada, consiguiendo un nivel de respuesta del 63,6%.3  respondió de acuerdo a su percepción sobre el desarrollo de cada dimensión durante el año 2016.La recolección de datos se realizó mediante un cuestionario autoadministrado diseñado con base en los componentes y elementos de la matriz de RBC definida por la OMS3 . El cues13. Se utilizaron promedios y desviaciones estándar para los índices que distribuyeron normal para resumir la información de las variables cuantitativas. Se utilizaron mediana y rangos intercuartílicos para variables que no distribuyeron normal. Se utilizó el test de Shapiro y Wilks para pruebas de normalidad y el coeficiente de correlación de Pearson (asociación paramétrica) y coeficiente de correlación de Spearman (asociación no paramétrica) para los índices de implementación.Se estableció la consistencia interna del cuestionario mediante el valor alfa de Cronbach global y por dimensión. Se obtuvo un valor de 0,95 en el alfa de Cronbach global, lo que mostró una buena consistencia internaSe realizó un proceso de consentimiento informado con cada coordinador(a). Se tomaron los resguardos necesarios para garantizar el anonimato de los participantes y de los centros comunitarios de rehabilitación a través de la codificación de las fuentes de información.Esta investigación fue aprobada por el Comité de Ética de Investigación en Seres Humanos de la Facultad de Medicina de la Universidad de Chile el 22 de diciembre de 2015 (169-2015).La implementación de la RBC se inició entre los años 2004 y 2015. La moda de inicio se encontró entre los años 2011 y 2012 . Un 2,3% de los centros tenían más de 10 años de implementación.En el 100% de los equipos había kinesiólogos/fisioterapeutas y terapeutas ocupacionales en una proporción 2:1 respectivamente. Otros profesionales sanitarios, tales como fonoaudiólogos/logopedas, enfermeras(os) y técnicos de nivel superior, estuvieron presentes en menos de la mitad de los centros.El 100% de los centros de rehabilitación comunitaria realizaba actividades de rehabilitación grupales, mientras que un 86,0% realizaba visitas domiciliarias y actividades de rehabilitación individual. Le siguen las actividades de diagnóstico participativo  y de creación de apoyo a organizaciones . Las actividades menos realizadas fueron las vinculadas a inclusión laboral  e integración educacional .Se estimó el nivel de implementación basado en la frecuencia de desarrollo de las actividades propias de cada uno de los cinco componentes de la matriz de la RBC descrita en las guías de la OMS. Las actividades del componente Salud más desarrolladas fueron “Dispositivos de Asistencia”  y “Rehabilitación” , mientras que las menos desarrolladas fueron “Prevención primaria”  y “Prevención secundaria”  .El nivel de implementación de todas las actividades del componente Educación fue bajo, destacando con un 7% la actividad de “Aprendizaje de toda la vida”, en contraste con la ausencia de implementación de “Educación no formal” para niños(as) y jóvenes .Las actividades “Protección social, redes de apoyo” fueron las más realizadas en el componente Educación, con un 72,1%, mientras que “Desarrollo de destrezas básicas”, “Desarrollo de destrezas para el emprendimiento” y “Trabajo remunerado” se implementaron en un 18,6% cada una .Por otro lado, la mayoría de las actividades de los componentes Social y Fortalecimiento tuvo altos niveles de implementación .La actividad “Relaciones sociales” tuvo el mayor porcentaje de realización  del componente Social versus la actividad de “Maternidad y Paternidad” con un 18,6%.Lo más desarrollado del componente Fortalecimiento fue la “Movilización comunal”  en contraste con la actividad “Destrezas para la participación política” .Se elaboró un índice de implementación basado en los resultados de las actividades por cada uno de los componentes . Se asumAl comparar el nivel de implementación global y por componente de las actividades realizadas en los centros, aquellos que declaran realizar “Formación de organizaciones de personas con discapacidad” presentaron mayor nivel de implementación de la matriz de RBC que aquellos que no declaran realizarlas .Los equipos de trabajo contaron con distintos niveles de capacitación en los componentes de la matriz de RBC. Un 65,1% de los centros reportó un nivel “muy alto” y “alto” de capacitación en el componente Salud, mientras que un 62,8% de las respuestas en el componente Educación se distribuyeron en los niveles de capacitación “bajo” y “muy bajo” .Las principales fuentes de financiamiento de la RBC correspondieron al Ministerio de Salud  y a los gobiernos locales . También se reportaron otras fuentes de financiamiento, tales como fondos autogestionados  y fondos aportados por el Servicio Nacional de Discapacidad . Solo un centro reportó recibir financiamiento de fondos privados.Los centros de rehabilitación comunitaria se vincularon con organizaciones comunitarias e instituciones del territorio comunal. Los organismos comunitarios y comunales con los que existía mayor vinculación fueron el gobierno local municipal , las juntas de vecinos , la Oficina Municipal de Discapacidad y Centros de Salud . Por otro lado, el gobierno central , centros educacionales , organizaciones de usuarios de salud , fundaciones, corporaciones y organizaciones no gubernamentales , Oficina Municipal de Intermediación Laboral , organizaciones de personas con discapacidad  y sector privado , fueron los organismos con los que se reportó menor vinculación.Este estudio es una de las primeras aproximaciones a la evaluación de la implementación de la RBC en Latinoamérica tras la ratificación de la CDPD.14.Se identificó un estado heterogéneo de implementación de la RBC en los centros comunitarios de rehabilitación de la Región Metropolitana de Chile, específicamente en lo relativo a los componentes de la matriz definida por la OMS. La implementación de la estrategia se centra en el componente “Salud”. Este componente es el más presente en las prácticas habituales de atención médica, rehabilitación y apoyo en el uso de dispositivos de asistencia y donde se reporta un mayor nivel de capacitación de los profesionales. Por el contrario, el componente “Educación” es el que reporta un menor nivel de implementación y de capacitación de los profesionales. Esto es consistente con el hecho de que las actividades e indicadores del programa de rehabilitación comunitaria del Ministerio de Salud chileno se centran en la rehabilitación física y en personas adultas como población objetivo3. En Chile, se estableció como meta del programa RBC que un 10% de las personas atendidas en los centros de rehabilitación comunitaria logren la inclusión social 4. Sin embargo, la mayoría de los centros reporta la realización de escasas actividades de los componentes de Educación y Subsistencia, como actividades de nivelación de estudios y desarrollo de destrezas laborales. Esto representa una barrera para el logro de los objetivos propuestos en el ámbito de la inclusión social y el ejercicio de los derechos. Este hallazgo es coincidente con otros estudios que evidencian que la incorporación de apoyos socio-económicos, tales como intermediación laboral o entrenamiento vocacional, adicionales a la rehabilitación física, contribuyen a la inclusión, a mejorar la autoestima de las personas y al cambio de actitud de la sociedad frente a ellas15.El principal objetivo de la estrategia de RBC es asegurar el máximo grado de inclusión social y ejercicio de derechos de las personas con discapacidad16.Todos los centros cuentan con kinesiólogos/fisioterapeutas y terapeutas ocupacionales, y menos de la mitad cuenta con profesionales de otras disciplinas, tales como fonoaudiólogos/logopedas, enfermeras(os), psicólogos y técnicos de nivel superior. Si bien la existencia de la dupla kinesiólogo/fisioterapeuta - terapeuta ocupacional es un avance en la implementación de un modelo de rehabilitación integral, sigue siendo insuficiente para una adecuada implementación de la estrategia RBC. A esto se suma la poca presencia de trabajo intersectorial. El 51,2% de los centros reporta vincularse con el gobierno local en el contexto de la Región Metropolitana. Además, es escasa la participación de otros actores, tales como monitores y agentes comunitarios, que promuevan la realización de actividades de prevención primaria y secundaria y otras actividades relacionadas con la salud mental, la educación y el fortalecimiento comunitario. Este hallazgo coincide con estudios de evaluación de programas de RBC realizados en otros países  que indican que la escasez de recursos humanos y de capacitación es una limitación importante para su implementaciónSi esperamos cumplir con “no dejar a nadie atrás, a través de la completa implementación de la Convención sobre los Derechos de las Personas con Discapacidad”, como estableció el comité de seguimiento de la CDPD en junio de 2018, debemos posicionar la RBC como una estrategia intersectorial que logre la inclusión social. Seguir enfocados en solo reducir la brecha de acceso a rehabilitación no dará ni las herramientas ni los resultados requeridos para el desarrollo sostenible a alcanzar al 2030.Se reconoce como limitaciones de este estudio que la información fue obtenida desde los coordinadores(as) de la RBC. Esto genera la posibilidad de sobreestimar el estado de implementación al dar cuenta de su propia gestión como responsables. No obstante, se requiere la perspectiva de los actores responsables de los centros de rehabilitación comunitaria, ya que en su rol de coordinación, tienen gran importancia en la implementación del programa. Futuras investigaciones deben incluir al equipo profesional y a las personas con discapacidad y sus familias en los procesos de evaluación de los centros comunitarios para profundizar y captar la complejidad de la implementación. Esto permitiría dar cumplimiento a los principios de la CDPD y a una evaluación integral de las actividades realizadas.Además de eso, solo es posible referirse al estado de implementación de la RBC en la Región Metropolitana y no a todo el territorio nacional, dadas las características geográficas y sociodemográficas propias de la región en cuanto capital del país. Por otro lado, no existía un instrumento para evaluar las actividades realizadas en el contexto de la implementación de la RBC en Chile. A partir de este estudio, se puede disponer de un instrumento que permite el levantamiento de información completa sobre la implementación de la RBC en todo el territorio nacional.La implementación de la RBC en Chile está centrada en el componente Salud de la matriz propuesta por la OMS. Este hecho debe ser tomado en cuenta en los procesos de evaluación y formulación de planes de mejora de la estrategia. No solo se debe continuar con la implementación de los demás componentes de la matriz, sino que completar la implementación del componente Salud. Esto a través de la incorporación de actividades de promoción, prevención, apoyo al uso de ayudas técnicas y atención integral que incluya atención en el ámbito de la salud mental para acompañar los procesos de aceptación y adaptación, tanto de las personas con discapacidad como de su familia.La estrategia debe potenciar el trabajo intersectorial y reconocer a los actores institucionales y comunitarios, con quienes deben generar alianzas para sumar esfuerzos que busquen construir una sociedad más inclusiva. La RBC, incluso en aquellos programas centrados en salud, puede potenciar una positiva convivencia entre los modelos de comprensión de la discapacidad . Esto, siempre y cuando las prestaciones de rehabilitación respondan a las necesidades e intereses de las personas con discapacidad y existan instancias de formación y reflexión en torno al rol de la sociedad en el establecimiento de barreras para la inclusión. Es necesario contar con mayor diversidad de profesionales que permitan ampliar las actividades que se realizan en los centros de RBC. Por otro lado, es esencial apoyar el desarrollo de organizaciones de personas con discapacidad para la defensa de sus derechos y así avanzar en la construcción de una sociedad más justa e inclusiva.


A 34-year-old woman with a personal history of ulcerative rectocolitis for 5 years who were using sulphasalazine and mesalazine. The patient was admitted to the emergency unit presenting asthenia, dyspnea, fever, cough with hemoptoic sputum for 8 days, and oxygen saturating by 97% in room air. The computed tomography (CT)  showed sMagnetic resonance imaging cuts  showed b The signal of reversed halo can appear more lately in time.A viral infection when presenting lung manifestations often can be similar and indistinguishable pattern among them. In case of COVID-19, we know the typical pattern is peripheral and bilateral ground-glass, or round and multifocal, associated with or not to consolidation and septal lines, often predominant in the posterior aspect of the lower lobes. in a tomography study with similar aspects and distributions. In cases that similar findings of the present report are detected in patients without diagnostic and who would be conducting MR for other reasons, i.e., to investigate abdomen and dorsal spine, there is a need to inform the physician assistant about patterns in the lungs as markers of COVID-19 infection, especially in times of pandemic. This would help to establish rapid therapeutic approach, immediate isolation of the infected individual, and consequently, reduction in person-to-person transmission and organization of close monitoring.Although chest magnetic resonance (MR) is seldom-used method and often not indicated for lung pulmonary assessment in suspected cases of COVID-19, this method can be adopted to analyze radiological signs in the lung parenchyma that indicate the presence of this disease in patients who conducted a study for other reasons. The radiologist needs to understand these findings and be alert to recognize them in cases with confusing respiratory picture. In our case, we observed ground-glass opacities with intermediate signal in T2 in lung bases, such as the one already reported Paciente do sexo feminino, 34 anos, com antecedente pessoal de retocolite ulcerativa há 5 anos, em uso de sulfassalazina e mesalazina, deu entrada no pronto-socorro apresentando quadro de astenia, dispneia, febre e tosse associada a escarro hemoptoico há 8 dias, saturando 97% ao ar ambiente. Realizou tomografia computadorizada (TC)  que demoOs cortes da RM  evidenci O sinal do halo invertido pode aparecer mais tardiamente.As infecções virais, quando apresentam manifestação pulmonar, geralmente podem se mostrar com padrão semelhante e indistinguível entre si. No caso da COVID-19, sabe-se que o padrão típico é o de vidro fosco periférico e bilateral, ou arredondado e multifocal, associado ou não a consolidações e linhas septais de permeio, frequentemente predominando no aspecto posterior dos lobos inferiores. já demonstradas no estudo tomográfico e com aspecto e distribuição superponíveis. Em casos em que achados como esse sejam detectados em pacientes sem o diagnóstico e que estejam realizando RM por outros motivos, como, por exemplo, estudos do abdome ou da coluna dorsal, faz-se necessário informar o médico assistente do padrão de imagem suspeita para acometimento pulmonar para a COVID-19, sobretudo em tempos de pandemia, para que uma abordagem terapêutica integrada seja prontamente formulada, e o adequado isolamento do doente seja realizado, minimizando a infecção de terceiros e realizando o acompanhamento próximo.Apesar de a RM de tórax ser um método pouco utilizado e não ser indicada para avaliação pulmonar em casos suspeitos de COVID-19, é possível analisar sinais radiológicos no parênquima que indiquem a presença da doença em pacientes que realizam o estudo por outros motivos, devendo o médico radiologista conhecer esses achados e estar atento para seu reconhecimento em casos sem nítido quadro respiratório. No caso demonstrado, vemos as opacidades com sinal intermediário em T2 nas bases pulmonares, tal qual relatado,


We describe a student-run, near-peer information panel at the University of Toronto on the residency application process. Similar panels currently exist at multiple medical schools across Canada. Previous papers indicate that students find peer-to-peer and near-peer advising to be particularly useful for CaRMS, electives, and clerkship-related topics. This event aimed to provide pre-clerkship students with information on strategies for CaRMS applications, elective selection, excelling during clerkship, and maintaining wellness. Topics were selected based on interests expressed in a pre-event student survey; therefore, this panel could be easily modified to suit the specific needs of students at other schools.Nous décrivons un panel d’information de quasi-pairs dirigé par des étudiants à l’Université de Toronto sur le processus de demande de résidence. Des panels similaires existent actuellement dans de nombreuses facultés de médecine au Canada. Des articles antérieurs indiquent que les étudiants trouvent que les conseils entre des pairs ou des quasi-pairs sont particulièrement utiles pour les thèmes relatifs au CaRMS, aux stages à option et à des sujets reliés à l’externat. Cet évènement visait à fournir aux étudiants des renseignements sur les stratégies en lien avec les demandes au CaRMS, le choix des stages à option, la performance durant l’externat et le maintien du bien-être. Les thèmes ont été sélectionnés selon les intérêts exprimés dans un sondage pré-évènement auprès des étudiants ; par conséquent, ce panel pourrait être facilement modifié pour convenir aux besoins particuliers des étudiants d’autres facultés.1 While most applications are successful, a growing percentage of medical graduates do not match to a residency program, necessitating a year-long wait until the next application cycle.2 Given these implications, students across the country are becoming increasingly eager to understand the CaRMS process earlier in training. A prior study showed that advice from peers was highly influential in helping students prepare CaRMS applications and make electives decisions.3 Another study indicated that 77% of medical students felt near-peer information sessions on succeeding in clerkship were helpful.4 As such, medical students at the University of Toronto implemented an annual ‘CaRMS panel’ to provide pre-clerkship students with relevant and well-informed advice on this issue. Other medical schools, including Saskatchewan, Western, McMaster, Queen’s, McGill, and Memorial, hold similar events.Completing a residency program is a necessary step on the path to becoming a practicing clinician, taking a minimum of two years and as long as seven years. Regretfully, the process by which students ‘match’ to a residency – better known as CaRMS (Canadian Resident Matching Service) – is a common source of anxiety.The CaRMS panel was organized annually in April from 2016-2018. It was held on campus in the evening. The study was exempt from ethical review by the University of Toronto Human Research Ethics Program. The panel consisted of 10 graduating students who recently matched to various residency programs. Panelists were selected based on matched specialty to represent a wide variety of common specialties. The panel always included at least one representative from family medicine, internal medicine, surgery, psychiatry, pediatrics, and OB/GYN. Most often, panelists who matched to emergency medicine, anesthesiology, and radiology were also included. In 2018, this event was expanded to include 2 ‘unmatched’ panelists. Topics were informed by themes that emerged from a pre-event student survey (n = 70) and were iteratively adjusted based on particular interests each year. They included strategies for CaRMS applications, elective selection, how to be a ‘good clerk’, and maintaining wellness. After a 50-minute discussion and a 10-minute Question & Answer (Q&A) period, students had the opportunity to speak with panelists individually.Following the 2016 event, students (n = 35) completed an optional online survey rating the event’s impact on their preparedness for and understanding of CaRMS, electives, and clerkship on a 5-point Likert scale . Eighty-Survey results indicate that a majority of students felt the panel discussion and Q&A were valuable and informative. As the survey was distributed immediately after the event, it is possible that the panel had long-term implications that were not reflected in the results. Next steps include a follow-up survey prior to CaRMS examining the relationship between CaRMS panel attendance and preparedness for the CaRMS process, as well as further integration of the event with UGME-directed career counseling initiatives. Furthermore, in future iterations of the event, we will explicitly identify and include panelists who matched to their second-choice specialty to further expand panel diversity.


To analyze the latency and the amplitude values of Mismatch Negativity and P300 cognitive potential in children with stuttering, with no auditory complaints, with auditory thresholds within the normality range, comparing them to the findings of a Control Group. A cross-sectional study involving 50 children of both sexes, 15 with stuttering and 35 without stuttering, aged 6 to 11 years, with no diagnosis of ear pathology or other diseases. All children were submitted to peripheral audiological evaluation  and a central audiological evaluation . For the evaluation of fluency, all children with stuttering had a specific history taken and were video recorded in a spontaneous speech. Afterwards, the transcription was done, followed by speech analysis to classify children according the severity of stuttering. There was a significant difference in the latencies of Mismatch Negativity and P300 cognitive potential, as well as in the amplitude of Mismatch Negativity. There was a significant delay in the latencies of Mismatch Negativity and P300 cognitive potential, as well as increase in the amplitude of the Mismatch Negativity in children with stuttering when compared to children in the Control Group. Changes in the morphology of the waves were found in the Stuttering Group. Mismatch Negativity is a potential that detects changes in discernible auditory stimulus, and it is generated in the frontal cortex, thalamus and hippocampus.,4,5Long-latency auditory evoked potentials (LLAEP) are used in cognitive investigation, especially the P300 cognitive potential, which is endogenous and shows bioelectrical responses that run through the thalamus and cortex.The P300 potential is generated voluntarily and actively in the resolution of a specific task: it evaluates perception, attention and auditory memory skills. It is generated in the hippocampus, the mesencephalic reticular formation, the medial thallus, the pre-frontal cortex and parietotemporal association areas.The main characteristic of MMN is that it registers without the influence of the individual’s attention or demands from tasks, which makes it efficient for clinical studies in different populations.,7,8 in populations with autistic spectrum disorder, auditory processing disorders, cleft lip and palate, prematurity, and language development disorder. Most articles are about dyslexia, and MMN is underexplored in individuals with stuttering. In the Brazilian population, only one published study was found that investigated P300 in children who stutter. Up till now, there are no studies with children using both techniques, MMN and P300, concomitantly.Regarding children, there are studies with MMN,11 Stuttering that develops during childhood is called persistent developmental stuttering (PDS) and affects 5% of children,13Stuttering is a fluency disorder, which involves alterations in speech flow. They are atypical and involuntary interruptions, hinder smooth and fluid speech, and are characterized by repetitions, prolongation and blocks. It has a 1% prevalence in the global adult population and affect up to 5% of children. Neuroimaging shows that children who stutter present neuroanatomical and functional differences.Current theories use a combination of genetic, neurological, motor, linguistic and environmental factors to explain the etiology of PDS. Therefore, investigating LLAEP in relation to stuttering is very important because, through an objective evaluation, it might result in a better understanding of the factors that interfere in speech fluency and help with therapeutic rehabilitation techniques.Auditory aspects may be impaired and could interfere in speech fluency.To analyze the latency and amplitude values of long-latency auditory evoked potentials in children with stuttering and without auditory complaints, with auditory thresholds within normality and compare the results to a Control Group.Instituto de Psicologia da Universidade Federal do Rio Grande do Sul (UFRGS), protocol number 2011039. The convenience sample included children of both sexes, aged between 6 and 11 years, divided into two groups: Study Group with Developmental Stuttering (SG) with children with mild to severe stuttering, and Control Group (CG) with children with normal development.This is an observational, cross-sectional, comparative study, contemporary and individual, carried out in 2017. The study was approved by the Research Ethics Committee of the Information about age; sex; manual preference; level of education; language, social, neural and hearing impairment; and about patients undergoing speech therapy or not were obtained through general patient’s history. Exclusion criteria included hearing, language and learning complaints; inability to count from 1 to 50; any type of hearing loss; otorhinolaryngological evaluation showing alterations; psychiatric syndromes or alterations; having undergone speech therapy for stuttering; and not having done the procedures or concluded exams for any reason. All the children underwent peripheral auditory assessment and central electrophysiological assessment.The SG was previously triaged by two speech therapists. The diagnosis of stuttering was verified and confirmed by speech therapists with experience in the area. The Kappa measurement was used for diagnosis agreement analysis.®, with inspection earphones 3A and silver electrodes. Electrical impedance was under 5Ω in each derivation, and the difference between the three electrodes was more than 2Ω. After verifying the impedance, the electroencephalogram scan was performed.For the audiological evaluation, patient history was taken, external acoustic meatuses were inspected, and pure tone audiometry threshold, speech audiometry, and immittance test were performed. The research about MMN and P300 was done using the equipment Masbe ATC Plus by ContronicThe parameters used for the MMN study were auditory stimuli presented in monoaural mode, with a frequency of 1,000Hz (50 cycles), for the frequent stimulus, and 2,000Hz (50 cycles), for the rare stimulus, with an intensity of 70 dBNA for both. The presentation rate was of 1.8 pulses per second (pps). The average was 2,000 stimuli and the paradigm was 90/10, with alternated polarity. For the acquisition, the full scale was 200µV; a 1Hz high-pass filter; 20Hz low-pass filter; Notch:YES; 500ms temporal window; and tracing amplitude up to 7.5µV. During this process, the individuals were conditioned to watch an interesting silent video on a tablet to distract them from the auditory stimuli presented. Before the exam, the children were instructed to pay attention to the video.For the P300 study, binaural stimuli with 80 dBNA intensity were used for both ears. The frequency was 1,000Hz with 50 cycles of duration and 20% rise and decay time, with trapezoidal envelope. The frequency for the rare stimuli was of 2,000Hz tone burst, with 100 cycles of duration with 20% rise and decay time with trapezoidal envelope, presented in oddball paradigm, with an occurrence probability of 80% and 20%, respectively. The stimuli were presented at a rate of 0.8pps. In the acquisition, the full scale was of 200µV; 01Hz high-pass filter; 20Hz low-pass filter; Notch: YES; and a 1,000ms temporal window was used. During this process, the children had to pay attention to the frequent and rare auditory stimuli presented, but only had to count the rare ones. The latency of P300 was marked at the point of maximum amplitude of the wave, and the analysis was done through the resulting wave.t test was used. Significance level was set at 5% (p<0.05), and the analyses were done through the software (SPSS) for Windows, version 17.0.The exams were performed twice. In order to verify the agreement of the analyses of MMN and P300, Kappa statistics were used. The results were organized in descriptive statistical form. The Kolmogorov-Smirnov test was used to evaluate data normality. To compare the ears in relation to latency and amplitude results, the Student Fifteen children with different stuttering severity levels were selected: mild to moderate (n=4); moderate (n=6); moderate to severe (n=2); severe (n=1); and severe to extremely severe (n=2). In total, 50 children participated effectively in the study. There was excellent agreement among the raters in the severity analysis of stuttering (Kappa 0.82) and in the analysis of the components of the LLAEP MMN and P300 (Kappa 0.89). According to the interclass correlation coefficient, 0.76 was found for MMN and 0.85 for P300, with a nearly perfect correlation.All children responded to the MMN evaluation. Means and standard deviations of the latency and amplitude for the right ear (RE) and left ear (LE) are shown in In the P300 study, there was a response from 14 of the children with stuttering – only one child did not respond. The differences in performance observed between the groups are shown in  and another with 12 children. Regarding studies about P300, there was one Brazilian study that included 13 children who stuttered. It is known that an elevated number of individuals can ensure more statistical power to a study; however, studies developed with groups of stuttering patients and Control Groups present a reduced number of children in their sample – less than 20.,9,14The analyzed sample is compatible to the number of children with stuttering investigated in other international studies. Regarding investigations about MMN, there were only two international studies with a number higher than ours – one with 18 children,In the CG, there was equivalence between the number of boys and girls, but, in the SG, the percentage of boys was much higher than of girls, which was expected. The fact that girls develop language earlier than boys may contribute to this difference In this study with MMN, through a tone burst stimulus, with electrodes placed at Fpz, delayed latency was found in relation to the CG. This delay suggests that the SG required more time to differentiate the standard from the rare stimuli. Delayed latency suggests an altered central auditory processing.In the area of auditory electrophysiology, the magnitude (amplitude) and the speed (latency) of the processing reflect the efficacy of neural functions. In addition to PDS, latency delays were shown in children with specific language impairment (SLI) and dyslexia.Neuroimaging has shown that a deficit in auditory processing may stem from a deficit in the temporal processing of information. The explanation offered by the researchers was of an inefficient neural processing of the differences between speech sounds. The stimulus used was linguist and not pure tone. These results suggest generalized central difficulties in sound differentiation, and imprecision in auditory discrimination skills.Contrary to our findings, there are reports in the literature of lower amplitude values of MMN in children with stuttering in comparison to the Control Group. results similar to ours were reported in the literature about studies on stuttering, but with different protocols from ours and with speech stimuli – in this case, phoneme variation. Such results were attributed to a difficulty to synchronize the neural activities of auditory areas, leading to an exacerbated response. The visible increase in response, which generates a greater amplitude of the wave, may be related to the also exacerbated quantity of neurons recruited for the resolution of the task. Functional neuroimaging shows that brain areas that are more activated indicate greater difficulty and cognitive demand to complete a task. However, this finding is not a marker for a specific type of disorder, but it may suggest an altered cognitive standard and be helpful as a risk indicator.Still on the amplitude of MMN, our results showed significant differences between the investigated groups, with increased amplitude in the SG. Although a great part of clinical studies present reduced or even absent MMN amplitude, showing reduced auditory attention. In one of the studies, in addition to P300, there was a behavioral evaluation of temporal processing using the Random Gap Detection Test (RGDT). It was found that the latency delay of P300 and the low performance on the RGDT affect the speed of auditory processing of sound.Regarding the P300, the SG obtained latencies that were significantly more delayed than the CG. Findings of young adults with stuttering also corroborate our data on the latency of P300, Based on that, it seems well documented that latency delays of the P300 wave can suggest alterations in the processing of auditory information. The amplitude of P300 in the SG was reduced in comparison to the CG. It is possible that some individuals in the SG presented a deficit in non-linguistic auditory processing, which may be related to an alteration in cortical processing. Similar results in the amplitude of P300 were found in young adults who stutter.In addition to stuttering, other populations presented delayed latencies in P300, such as children with Down syndrome. In this study, there were a few children in the SG who were 6 years old, which could explain this finding. However, this hypothesis may be controversial, because the CG also included 6-year-old children and the group presented a more defined morphology. Therefore, there seems to be a relation between stuttering and the alterations in the morphology of the waves of the investigated LLAEP. Children with no auditory complaints, but with complaints regarding learning difficulties, also presented alterations in the morphology of the P300 wave.The morphology of the waves of the children in the SG was altered in MMN and P300. In individuals with auditory thresholds within normality, a more defined morphology of the waves is expected starting at the age of 8 years. The left hemisphere is responsible for the linguistic analysis of sound, and the right hemisphere is responsible for the encoding of non-linguistic sounds, such as musical rhythms. Therefore, it was expected that left-handed and right-handed children would present differences in their performances on the same test. Our results corroborate this hypothesis, partly because in MMN and P300 left-handed children showed more latency delay than right-handed children, even though there was no significant difference between the groups. The amplitude of the left-handed children in relation to the right-handed children were greater in MMN and equal in P300. The low number of children in each group may have affected our statistical results and a higher number of children may yield different results. However, similar results were found in the literature.Regarding manual preference, the SG presented a higher rate of left-handed children than the CG. In typical development, even with some controversies, right-handed children have performed better at tests that include speech motor skills and cognitive language tests. This advantage suggests left hemispheric laterality for motor and speech processing.There is a significant latency delay of the long latency auditory evoked potentials Mismatch Negativity and P300 cognitive potential of the children with stuttering in comparison to children who do not stutter. ,2 O Mismatch Negativity (MMN), outro potencial endógeno, é um PEALL que reflete a resposta cerebral elétrica das habilidades de processamento, discriminação e memória auditiva. Ele é um potencial que detecta a mudança de estímulo auditivo discriminável, tendo por sítios geradores o córtex frontal, o tálamo e o hipocampo.,4,5Os potenciais evocados auditivos de longa latência (PEALL) são utilizados na investigação cognitiva, com destaque para o potencial cognitivo P300, um potencial endógeno, o qual mostra respostas bioelétricas que percorrem o tálamo e o córtex.Já o P300 é gerado voluntariamente, de forma ativa na resolução de uma tarefa específica; avalia as habilidades de percepção, atenção e memória auditiva. Seus sítios geradores são o hipocampo, a formação reticular mesencefálica, o tálamo medial, o córtex pré-frontal e as áreas de associação parietotemporal.A principal característica do MMN é seu registro sem a influência da atenção do sujeito e nem exigências de tarefas, tornando-o eficaz para estudos clínicos em diferentes populações.,7,8 em populações com transtorno do espectro autista, transtornos do processamento auditivo, fissura labiopalatina, prematuridade e transtorno do desenvolvimento da linguagem. A maioria dos artigos são sobre dislexia, sendo o MMN pouco explorado em indivíduos com gagueira.Na população brasileira, foi encontrado apenas um estudo publicado com P300 em crianças com gagueira. Até o presente momento, são desconhecidos estudos nessa população com ambas as técnicas, MMN e P300, utilizadas concomitantemente.Na população infantil, há estudos com MMN,11 A gagueira iniciada na infância é chamada de gagueira desenvolvimental persistente (GDP) e tem incidência de 5 para cada 100 crianças.,13A gagueira é um distúrbio da fluência, que envolve alterações no fluxo da fala. São interrupções involuntárias e atípicas, dificultando uma fala fluída e suave, caracterizada por repetições, prolongamentos e bloqueios. Sua prevalência é de 1% da população mundial adulta e de até 5% na população infantil. A pesquisa com neuroimagem evidencia que crianças que gaguejam possuem diferenças neuroanatômicas e funcionais.Teorias atuais incorporam a união de fatores genéticos, neurológicos, motores, linguísticos e ambientais para explicar a etiologia da GDP. Assim, a pesquisa dos PEALL para a área de gagueira é de grande relevância, pois pode auxiliar em uma melhor compreensão dos fatores que interferem no desempenho da fluência de fala, por meio de avaliação objetiva, bem como auxiliar em técnicas terapêuticas de reabilitação.Aspectos auditivos podem estar prejudicados e interferir na fluência da fala.Analisar os valores de latência e amplitude dos potenciais evocados auditivos de longa latência, em crianças com gagueira, sem queixas auditivas, com limiares auditivos dentro dos padrões de normalidade, comparando aos achados aos de um Grupo Controle.Estudo realizado ao longo do ano de 2017, observacional, transversal e comparativo, contemporâneo e individual, aprovado pelo Comitê de Ética em Pesquisa do Instituto de Psicologia da Universidade Federal do Rio Grande do Sul (UFRGS), sob o número 2011039. A amostra por conveniência consistiu de crianças de ambos os sexos, entre 6 e 11 anos de idade, divididas em dois grupos: Grupo Estudo com Gagueira Desenvolvimental (GE), composto por crianças com severidade de leve a muito grave, e Grupo Controle (GC), composto por crianças com desenvolvimento normal.As informações sobre idade, sexo, preferência manual, escolaridade, comprometimento linguístico, social, neural e otológico, assim como ter ou não frequentado terapia fonoaudiológica, foram obtidas por anamnese geral. Como critério de exclusão, foram consideradas queixas auditivas, de linguagem ou de aprendizagem, não saber contar de 1 a 50, qualquer tipo de perda auditiva, avaliação otorrinolaringológica alterada, apresentação de síndromes ou alterações psiquiátricas, ter participação em terapia fonoaudiológica para gagueira e, por algum motivo, não ter realizado os procedimentos e nem concluído os exames. Todas as crianças realizaram avaliação auditiva periférica e avaliação eletrofisiológica central.O GE foi previamente triado por duas fonoaudiólogas. O diagnóstico de gagueira foi verificado e confirmado por profissionais fonoaudiólogos com experiência na área. Referente à análise de concordância sobre o diagnóstico, foi utilizada a medida de Kappa.®, com uso de fone de inspeção earfone 3A e eletrodos de prata. A impedância elétrica foi inferior a 5Ω em cada derivação, e a diferença entre os três eletrodos não excedeu a 2Ω. Após a verificação da impedância, foi realizada a varredura do eletroencefalograma.Para avaliação audiológica, foram realizadas anamnese, inspeção dos meatos auditivos externos, audiometria tonal limiar, logoaudiometria e imitanciometria. A pesquisa do MMN e P300 foi realizada por equipamento Masbe ATC Plus, da marca Contronictablet, com a intenção de desviar a atenção sobre os estímulos auditivos apresentados. Antes de iniciar o exame, a criança foi orientada sobre a execução do teste, no sentido de prestar atenção no vídeo.Os parâmetros utilizados para a pesquisa do MMN foram estímulos auditivos apresentados de modo monoaural, com frequência de 1.000Hz (50 ciclos), para o estímulo frequente, e 2.000Hz (50 ciclos), para o estímulo raro, em uma intensidade de 70 dBNA para ambos. A taxa de apresentação foi de 1,8 pulso por segundo (pps). As promediações foram de 2.000 estímulos e o paradigma de 90/10, com polaridade alternada. Na aquisição, o fundo de escala foi de 200µV, filtro passa-alta de 1Hz, filtro passa-baixa de 20Hz, Notch – SIM, janela temporal 500ms e amplitude do traçado até 7,5µV. Durante esse processo, os indivíduos foram condicionados a assistirem um vídeo interessante e silencioso no rise e decay time, com envelope trapezoidal, e a do estímulo raro foi tone burst de 2.000Hz, com 100 ciclos de duração com 20% de rise e decay time com envelope trapezoidal, apresentados em paradigma do tipo raro-frequente , com probabilidade de 80% e 20% de aparecimento, respectivamente. Os estímulos foram apresentados na taxa de 0,8pps. Na aquisição, o fundo de escala foi de 200 µV, filtro passa-alta de 01Hz, filtro passa-baixa de 20Hz, Notch – SIM, e janela de leitura utilizada foi de 1.000ms. Durante este processo, as crianças tiveram que prestar atenção nos estímulos auditivos frequentes e raros apresentados, contando apenas os raros. A latência do P300 foi marcada no ponto de máxima amplitude da onda, e sua análise foi realizada por meio da onda resultante.Na pesquisa do P300, foram utilizados estímulos binaurais com intensidade de 80 dBNA para ambas as orelhas. A frequência foi de 1.000Hz com 50 ciclos de duração e 20% de t Student foi aplicado. O nível de significância adotado foi de 5% , e as análises foram realizadas pelo software (SPSS) para Windows, versão 17.0.Os exames foram realizados duas vezes. Com objetivo de verificar a concordância da análise do MMN e P300, foram utilizados os métodos estatísticos de Kappa. Os resultados foram organizados sob forma de estatística descritiva. O teste Kolmogorov-Smirnov foi utilizado para avaliar a normalidade dos dados. Para comparar as orelhas em relação aos resultados de latência e amplitude, o teste Foram selecionadas 15 crianças com gagueira, as quais tinham diferentes graus de severidade: 4 de leve para moderada, 6 moderada, 2 moderada para grave, 1 grave e 2 grave para muito grave. Ao total, 50 crianças participaram efetivamente do estudo. A Houve excelente concordância entre juízes na análise da severidade da gagueira , bem como na análise dos componentes dos PEALL MMN e P300 . De acordo com o coeficiente de correlação interclasse, obtiveram-se 0,76 para o MMN e 0,85 para o P300, com correlação quase perfeita.Todas as crianças apresentaram resposta na avaliação do MMN. As médias e os desvio padrão da latência e amplitude, tanto da orelha direita (OD) como da orelha esquerda (OE), estão apresentadas na Na pesquisa de P300, foi observada resposta em 14 das crianças com gagueira, com exceção de 1. As diferenças de desempenho observadas entre os grupos estão ilustradas na Na  outro contou com 12 crianças. Na pesquisa com P300, um estudo nacional investigou 13 crianças com gagueira. Sabe-se que um número elevado de sujeitos pode garantir maior força estatística ao estudo, entretanto estudos desenvolvidos com gagueira e Grupos Controles apresentam número reduzido de crianças em sua amostra − este número é inferior a 20.,9,14A amostra analisada é compatível com o número de crianças com gagueira investigadas em outros estudos internacionais. Na pesquisa com MMN, superior ao nosso número, foi encontrado apenas um estudo internacional, com 18 crianças;No GC, houve equivalência entre os números de meninos e meninas, porém, no GE, o percentual de meninos foi bem maior do que o de meninas, o que já era esperado. O fato de as meninas desenvolverem a linguagem mais cedo pode contribuir para esta diferença. Na presente pesquisa com MMN, por meio do estímulo tone burst, com eletrodos em posição Fpz, foram evidenciadas latências tardias no GE, em relação ao GC. Este atraso indica que o GE necessitou de mais tempo para diferenciar o estímulo padrão do estímulo raro. A latência tardia sugere processamento auditivo central alterado.Na área da eletrofisiologia auditiva, a magnitude (amplitude) e a velocidade (latência) do processamento refletem a eficácia das funções neurais.deficit no processamento auditivo podem ser decorrentes de deficit no processamento temporal da informação. Além da GDP, atrasos na latência foram evidenciados em crianças com deficit específico de linguagem (DEL) e dislexia.A neuroimagem tem mostrado que  A explicação dos pesquisadores foi de um processamento neural ineficaz das diferenças entre os sons de fala. O estímulo utilizado foi linguístico e não tom puro. Estes resultados sugerem dificuldades centrais generalizadas na diferenciação do som, bem como uma imprecisão na habilidade de discriminação auditiva.Contrário aos nossos achados, há relato na literatura de valores de amplitude do MMN menores em crianças com gagueira comparadas a um Grupo Controle. resultados semelhantes aos nossos foram reportados na literatura com gagueira, mas com protocolos diferentes aos do atual estudo e com estímulos de fala − no caso, variação de fonemas. Tais resultados foram atribuídos a uma dificuldade de sincronização da atividade neural das áreas auditivas, ocasionando resposta exacerbada. O aumento visível na resposta, o qual gera amplitude maior da onda, pode estar relacionado à quantidade também exagerada de neurônios recrutados para resolução da tarefa. A neuroimagem funcional mostra que áreas cerebrais mais ativadas indicam maior dificuldade e demanda cognitiva para dar conta de uma tarefa. No entanto, este achado não é um marcador de um tipo específico de desordem, mas pode indicar um padrão cognitivo alterado e ser útil como indicador de risco.Ainda sobre a amplitude do MMN, nossos resultados mostraram diferenças significativas entre os grupos investigados, em favor de uma amplitude aumentada no GE. Embora grande parte dos estudos clínicos apresente amplitudes do MMN reduzidas ou mesmo ausentes, sendo evidenciada atenção auditiva reduzida. Em um dos estudos, além do P300, foi realizada avaliação comportamental do processamento temporal, por meio do Teste de Detecção de Intervalos Aleatórios (RGDT - Random Gap Detection Test). Foi verificado que o atraso na latência do P300, bem como o baixo desempenho no RGDT, impactam na velocidade de processamento auditivo do som.Atinente ao P300, o GE obteve latências significativamente mais atrasadas do que o GC. Achados de adultos jovens com gagueira igualmente corroboram nossos dados de latência do P300,Com base no exposto, parece bem documentado que o atraso na latência da onda P300 pode fornecer indícios de alterações no processamento da informação auditiva.Além da gagueira, outras populações apresentaram latências atrasadas no P300 como, por exemplo, crianças com síndrome de Down.deficit no processamento auditivo não linguístico, e estes estarem relacionados a uma alteração do processamento cortical. Resultados semelhantes na amplitude do P300 foram encontrados em adultos jovens com gagueira.A amplitude do P300 no GE foi reduzida, na comparação com o GC. Há a possibilidade de uma parcela do GE exibir  No presente estudo, havia algumas crianças no GE com 6 anos, o que poderia justificar este achado. Contudo, esta hipótese pode ser questionada, uma vez que, no GC, também tinha crianças com 6 anos, e o grupo apresentou morfologia mais definida. Assim, parece haver relação entre a gagueira e as alterações na morfologia da onda dos PEALL investigados. Crianças sem queixas auditivas, mas com queixas de dificuldade de aprendizagem, também apresentaram alterações na morfologia da onda P300.Tanto no MMN como no P300, a morfologia das ondas das crianças do GE mostrou-se alterada. Em indivíduos com audição dentro dos padrões de normalidade, espera-se morfologia das ondas mais definida a partir dos 8 anos de idade. O hemisfério esquerdo seria responsável pela análise linguística do som, ao passo que o hemisfério direito seria responsável pela codificação de sons não linguísticos, como ritmo musical. Desse modo, esperava-se que crianças canhotas e destras apresentassem diferenças de desempenho em um mesmo teste. Nossos resultados corroboram esta hipótese, em parte, pois, no MMN e P300, embora não tenha ocorrido diferença significativa entre os grupos, as crianças canhotas obtiveram latências mais atrasadas do que as destras. As amplitudes dos canhotos em relação aos destros foram maiores no MMN e iguais no P300. O número pequeno de crianças em cada um dos grupos pode ter interferido nos resultados estatísticos e um número maior de crianças poderia alterar os resultados. Entretanto, resultados semelhantes foram evidenciados na literatura.Referente à preferência manual, o GE apresentou percentual de canhotos maior do que o GC. No desenvolvimento típico, mesmo com algumas controvérsias, crianças com preferência manual direita têm apresentado melhor desempenho em testes que incluem habilidade motora da fala e em testes cognitivos de linguagem. Esta vantagem sugere lateralidade hemisférica esquerda para o processamento motor e de fala.Mismatch Negativity e potencial cognitivo P300 das crianças com gagueira, ao serem comparados com crianças sem este tipo de acometimento.Existe atraso significativo nas latências dos potenciais evocados auditivos de longa latência