Abstract Background Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by "direct oral anticoagulants", as factor X inhibitor. Objectives This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture. Methods We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant. Results An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose. Conclusion We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0
ABSTRACT Objective: To analyze the composition of macronutrients present in the milk of mothers of preterm newborn infants (PTNB) - protein, fat, carbohydrate, and calories - by gestational age (GA), chronological age (CA) and maternal variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from May/2013-January/2014. Milk collection was performed by pickup pump, on a fixed day of each week until discharge. The spectrophotometric technique with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative analysis. A sample of 7 mL of human milk was taken from the total volume of milk extracted by the mother. The data was grouped by GA (25-27, 28-31, 32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change, with no difference among groups of GA. When the macronutrients were analyzed by groups of CA, protein decreased, with significant difference between the first two groups of CA. Carbohydrates, fat and calories presented increasing values in all groups, without significant differences. Weight gain during pregnancy, maternal hypertension and maternal age were associated with changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first eight weeks after birth. CA may be an important factor in the composition of human milk.
RESUMO Objetivo: Analisar a composição dos macronutrientes presentes no leite de mães de recém-nascidos pré-termo (RNPT) - gorduras, carboidratos e calorias - por idade gestacional (IG), idade cronológica (IC) e variáveis maternos. Métodos: Estudo longitudinal para analisar 215 amostras de leite de 51 mães de RNPT admitidos em três unidades neonatais do Rio de Janeiro de maio/2013 a janeiro/2014. A coleta de leite foi realizada por bomba coletora, em dia fixo a cada semana até a alta. Utilizou-se a técnica espectrofotométrica com análise de infravermelho (MilkoScan Minor 104) para a análise quantitativa. Uma amostra de 7 mL de leite humano foi retirada do volume total de leite extraído pela mãe. Os dados foram agrupados por IG (25-27, 28-31, 32-36 e 37-40 semanas) e por IC (0-4, 5-8, 9-12 e 13-16 semanas). Resultados: Proteínas, carboidratos, gorduras e calorias não apresentaram nenhum padrão de mudança, não havendo diferença entre os grupos de IG. Quando os macronutrientes foram analisados por grupos de IC, a proteína diminuiu, com diferença significante entre os dois primeiros grupos de IC. Carboidratos, gorduras e calorias apresentaram valores crescentes em todos os grupos, sem diferença estatística. O ganho de peso durante a gestação, a presença de hipertensão arterial e a idade materna foram associados a alterações de gordura e calorias no primeiro momento da análise do leite. Conclusões: Observou-se redução estatisticamente significante nos níveis de proteína durante as primeiras oito semanas após o nascimento. A IC pode ser um fator importante na composição do leite humano.
ABSTRACT: Spiders are part of the soil biodiversity, considered fundamental to the food chain hierarchy, directly and indirectly influencing several services in agricultural and forest ecosystems. The present study aimed to evaluate the biodiversity of soil spider families and identify which soil properties influence their presence, as well as proposing families as potential bioindicators. Native forest (NF) and reforested sites (RF) with Araucaria angustifolia (Bertol.) Kuntze were evaluated in three regions of the state São Paulo, both in the winter and summer. Fifteen soil samples were collected from each forest to evaluate the biological (spiders and microbiological), chemical and physical soil properties, in addition to properties of the litter (dry matter and C, N and S contents). For soil spiders, two sampling methods were used: pitfall traps and soil monoliths. In total, 591 individuals were collected, and distributed in 30 families, of which 306 individuals (22 families) came from pitfall traps and 285 individuals (26 families) from monoliths. Only samples obtained by the monolith method revealed seasonal differences in the mean density and richness of spiders between NF and RF. Canonical discriminant analysis showed the separation of these forests of Araucaria. Principal Component Analysis demonstrated the correlation of a number of spider families with certain soil properties (organic carbon, basal respiration, metabolic quotient, litter carbon, total porosity, bulk density and soil moisture). We identified 10 families (Anapidae, Corinnidae, Dipluridae, Hahniidae, Linyphiidae, Lycosidae, Nemesiidae, Palpimanidae, Salticidae, Scytodidae) that contributed most to separating native forest from the replanted forest, indicating the possibility of the spiders being used as bioindicators.
ABSTRACT: This study aimed to evaluate the relationship of edaphic fauna under a no-tillage system with different levels of soybean productivity [High (NTH), Medium (NTM) and Low (NTL)] in the west of Santa Catarina (Brazil), identifying which chemical and physical variables most affect them, and the best indicators that can be used. Native forest (NF) areas were used as a reference. A total of 207 samples of soil fauna were collected by soil monolith and pitfall trap methods over two years of evaluation in four municipalities. Based on edaphic fauna data, Shannon-Wiener (H’), Pielou (J), Dominance (D), Margalef and Fisher Alpha (α) indices were generated, in addition to the average richness and abundance. Data from NTs were submitted to analysis of variance and compared by Tukey's test (p > 0.05). The NF was used as a reference and compared with the agriculture system by Dunnett test (p > 0.05), and regressions between soybean productivity and diversity indices. The H’, Margalef, α indices, and average richness for soil fauna sampled by soil monoliths followed the productivity gradient NTH > NTM > NTL, showing a positive correlation with the increase of soybean productivity. NTH has a diversity index similar to that of NF. Soybean productivity is affected by the richness and diversity of edaphic fauna, but abundance was not sensitive in predicting treatments under no-tillage; Fisher's alpha index was more sensitive in treatment separation with soil monoliths. The environmental variables aluminum, organic matter, phosphorus, potassium and penetration resistance affect the fauna edaphic.
Molecular-typing can help in unraveling epidemiological scenarios and improvement for disease control strategies. A literature review of Mycobacterium tuberculosis transmission in Brazil through genotyping on 56 studies published from 1996-2019 was performed. The clustering rate for mycobacterial interspersed repetitive units - variable tandem repeats (MIRU-VNTR) of 1,613 isolates were: 73%, 33% and 28% based on 12, 15 and 24-loci, respectively; while for RFLP-IS6110 were: 84% among prison population in Rio de Janeiro, 69% among multidrug-resistant isolates in Rio Grande do Sul, and 56.2% in general population in São Paulo. These findings could improve tuberculosis (TB) surveillance and set up a solid basis to build a database of Mycobacterium genomes.
ABSTRACT Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients’ clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.
RESUMO A opacidade em vidro fosco é uma alteração muito frequente e pouco específica na tomografia computadorizada de tórax. Ela admite grande leque de diagnósticos diferenciais no contexto agudo, desde pneumonias virais, como as causadas pelo vírus influenza, pela doença do coronavírus 2019 e pelo citomegalovírus, até mesmo lesões de origem não infecciosa, como vaping , infarto pulmonar, hemorragia alveolar e edema pulmonar. Para essa diferenciação diagnóstica, deve-se correlacionar o vidro fosco com os demais achados nos exames de imagem, exames laboratoriais e quadro clínico do paciente. É de suma importância, no contexto de pandemia, recordar as demais patologias com os achados semelhantes aos da doença do coronavírus 2019 nos exames de imagem.
Abstract Due to the small number of records of Streblidae on bats, despite extensive study on these mammals in the state of Rio de Janeiro, a survey was carried out in an area of the Atlantic Forest. The present study was carried out at Bom Retiro Farm Natural Heritage Private Reserve. We captured 401 bats of 17 species, 13 genera, and four families; bat flies infested 221 bats of only four species. Carollia perspicillata (Linnaeus, 1758) has the highest fly diversity, with seven fly species: Trichobius joblingi (Wenzel, 1966) (n = 23), Megistopoda proxima (Séguy, 1926) (n = 15), Strebla guajiro (García & Casal, 1965) (n = 15), Aspidoptera falcata (Wenzel, 1976) (n = 6) Paratrichobius longicrus (Miranda Ribeiro, 1907) (n = 8), Paraeuctenodes similis (Wenzel 1976) (n = 3), and Trichobius anducei (Guerrero, 1998) (n = 1). Two species infested Platyrrhinus lineatus (É. Geoffroy, 1810): Aspidoptera falcata (n = 1) and Anastrebla caudiferae (Wenzel, 1996) (n = 1). Paradyschiria parvula (Falcoz, 1931) (n = 11) infested Noctilio leporinus (Linnaeus, 1758) and M. proxima (n = 12) and Trichobius uniformis (Curran, 1935) (n = 1) infested Sturnira lilium (É. Geoffroy, 1842). Sturnira lilium has the highest infestation rate, with ten out of 46 captured individuals parasitized, followed by Carollia perspicillata, with 33 out of 164 captured parasitized, and by P. lineatus with only two parasitized individuals out of ten. Among 97 streblid flies captured, M. proxima was the most abundant (27.83%), followed by T. joblingi (23.71%), and S. guajiro (15.46%). All remaining bat fly species represented 33%. Paradichyria parvula has the first record for Rio de Janeiro State.
Resumen Objetivo: Comparar los resultados obtenidos de diferentes sistemas de identificación de C. auris. Métodos: Análisis descriptivo con datos recopilados durante 2016-19 mediante la vigilancia nacional. Se evaluaron los resultados generados por los sistemas MicroScan, Phoenix BD, VITEK 2 y MALDI-TOF MS de instituciones hospitalarias de 843 aislamientos clínicos sospechosos de C. auris remitidos al INS y se compararon con los resultados generados de confirmación a través de MALDI- TOF MS (Bruker Daltonics) o PCR. Resultados: De los 843 aislamientos clínicos remitidos al INS, el 81,7% fueron confirmados como C. auris mediante MALDI- TOF MS o PCR en el INS y el resto, 18,3%, fueron identificados como otras especies de Candida spp. Las identificaciones correctas enviadas por los laboratorios representaron el 42,4%. MicroScan identificó C. auris principalmente como C. haemulonii, C. guilliermondii, C. albicans y C. famata; Phoenix BD, VITEK 2 y MALDI-TOF MS identificó C. auris como C. haemulonii. Discusión: Estudios señalan que C. auris exhibe una estrecha relación filogenética con C. haemulonii. Las identificaciones discrepantes pueden darse debido a que las bases de datos de los sistemas de diagnóstico son limitadas para este patógeno. Las deficiencias de los sistemas comerciales para la identificación de C. auris deben ser complementados con otros sistemas como MALDI-TOF MS o pruebas moleculares.
Abstract Objective: To compare the identification results obtained by different identification systems of C. auris isolates. Methods: A descriptive study with data collected during the years 2016-19 through surveillance. The results generated by the MicroScan, Phoenix BD, VITEK 2 and MALDI-TOF MS systems of 843 clinical isolates of C. auris submitted to the INS were evaluated and compared with the results generated from confirmation through MALDI-TOF MS (Bruker Daltonics) or PCR. Results: Out of 843 clinical isolates submitted to the INS, 81.7% were confirmed as C. auris by MALDITOF MS or PCR in the INS and the rest, 18.3%, were identified as other species of Candida spp. The correct identifications sent by the laboratories was 42.4%. MicroScan identified C. auris as C. haemulonii, C. guilliermondii, C. albicans and C. famata; Phoenix BD, VITEK 2 and MALDI-TOF MS identified C. auris as C. haemulonii. Discussion: Studies indicate that C. auris exhibits a close phylogenetic relationship with C. haemulonii. In addition, discrepant identifications may occur because the databases of diagnostic systems are limited with reference to this pathogen. The deficiencies of commercial systems for the identification of C. auris must be complemented with other systems such as MALDI-TOF MS or molecular tests.
RESUMEN La explotación de yacimientos de crudos pesados utilizando procesos de inyección de vapor cada vez presenta mayores retos dada la volatilidad de los precios del petróleo, eficiencias energéticas y nuevas y más estrictas regulaciones ambientales. En este sentido, el presente trabajo resume los avances de programa de Investigación y Desarrollo (I y D) establecido desde el 2018 para identificar oportunidades para mejorar la eficiencia de recobro de campos de crudos pesados en el Valle Medio del Magdalena (VMM), Colombia. Este trabajo resume la metodología de simulación numérica empleada para evaluar tecnologías de generación de calor de fondo y de métodos híbridos de inyección de vapor basados en indicadores económicos básicos e indicadores ambientales y energéticos. Específicamente, en este trabajo la metodología se describe en la identificación de posibles escenarios óptimos para el desarrollo de pozos de crudos pesados. Este estudio también resume los avances recientes de estudios de laboratorio de tecnologías híbridas (de inyección de vapor p.e. gases de combustión y solventes), así como una actualización de los resultados del piloto de inyección cíclica de vapor con espumas en dos pozos del VMM. La metodología propuesta representa una valiosa herramienta para apoyar decisiones a nivel gerencial, lo cual servirá de soporte al asignar y distribuir recursos para desarrollar estudios de laboratorio e ingeniería con el fin de evaluar las tecnologías de recobro mejorado térmico con mayor potencial para poder contribuir las necesidades energéticas de Colombia. Adicionalmente, esta metodología también contribuyó a reducir el ciclo de implementación de este tipo de tecnologías basados en la descripción del concepto de analogía de yacimientos de análisis de reservas. Lo anterior se valida con la implementación exitosa del piloto de inyección cíclica de vapor con espumas en Julio del 2019.
ABSTRACT The development of heavy oil reservoirs under steam injection methods is facing multiple challenges due to the volatility of oil markets, energy efficiency, and new and stricter environmental regulations. This study aims to summarize the advances of a Research and Development (R&D) program established by Ecopetrol in 2018 to identify potential opportunities to improve the recovery performance of steam injection projects in heavy oil reservoirs in the Middle Valley Magdalena Basin (VMM) of Colombia. This paper summarizes an approach used to evaluate downhole heating and hybrid steam injection technologies assisted by basic benefit-cost ratios and energy and environmental indexes. Specifically, the methodology is described for the identification of optimum development plan scenarios for heavy oil wells. This study also summarizes recent advances in laboratory studies for the evaluation of hybrid steam flooding technologies (steam plus flue gas and solvents), and provides updates on the hybrid cyclic steam-foam pilot carried out in two VMM wells. The proposed approach represents a fast screening method that has proven to be valuable in supporting management decision-making to allocate resources for laboratory and engineering studies to evaluate thermal enhanced oil recovery (tEOR) technologies in Colombia. The proposed methodology has also contributed to reducing the implementation cycle of tEOR technologies following the reservoir analog description of reserve analysis. The latter was validated with the successful pilot results of the hybrid steam injection with foams implemented in July 2019.
Abstract Willing to increase the shelf life of the food matrix, studies regarding new preservations methods are developed to preserve fish deterioration. The application of natural additives as preservatives is increasingly common, with a current emphasis on the growing use of protein hydrolysates, in substitution to artificial ones. These compounds have been the subject of recent studies, focusing on determining their functional properties and the best form of applying peptide chains. The present study aimed to evaluate the effects of the protein hydrolysate obtained by the enzymatic hydrolysis of commercial fish gelatin added to rainbow trout fillets (Oncorhynchus mykiss) packed under vacuum and maintained under refrigeration. The fillets were distributed into three sample groups (controls and hydrolysate addition at 1:10 and 1:1 ratios). Microbiological and physico-chemical assessments were carried out. The results were compared and correlations observed regarding fish preservation assessments. A relationship between pH, redox potential and N-TVB was verified when compared to microbial development, especially with regard to psychrotrophic aerobic heterotrophic bacteria count. It was concluded that the application of protein hydrolysate as an additive is promising and can be effective in the control of food quality and maintenance of freshness for a longer period.
Abstract Pandemics such as that of COVID-19 affect a relatively large number of people and impose new rules and social habits on the world population. Information about the pandemic is constant in the media. Moreover, social distancing has been adopted in Brazil to prevent the spread of COVID-19, which may have economic and psychosocial consequences. This study aimed to verify the factors associated with indicators of mental disorders symptoms in residents of Rio Grande do Sul during the initial period of the social distancing policy. The study was approved by CONEP. There were 799 participants, aged between 18 and 75 years (M = 36.56; SD = 12.88); 82.7% were women, who answered a sociodemographic questionnaire of social distancing and the Self-Report Questionnaire (SRQ-20). The results indicated that having decreased income in the period, being part of the risk group and being more exposed to information about deaths and infected, are factors that can significantly harm mental health in this pandemic period. Investigating social determinants that contribute to greater vulnerability to the mental illness of the population is vital in the field of collective health for the planning of public actions and policies.
Resumo As pandemias, como a da COVID-19, afetam uma quantidade relativamente grande de pessoas e impõem novas regras e hábitos sociais para a população mundial. As informações sobre a pandemia são constantes na mídia. Além disso, o distanciamento social foi adotado no Brasil como medida de prevenção da disseminação da COVID-19, o que pode ter consequências econômicas e psicossociais. Nesse contexto, o objetivo deste estudo foi verificar os fatores associados a indicadores de sintomas de transtornos mentais em residentes do Rio Grande do Sul, durante o período inicial da política de distanciamento social decorrente da pandemia da COVID-19. O estudo foi aprovado pelo CONEP. Participaram 799 pessoas, com idades entre 18 e 75 anos (M = 36,56; DP = 12,88), 82,7% mulheres, que responderam um questionário sociodemográfico, de distanciamento social e ao Self-Report Questionnaire (SRQ-20). Os resultados indicaram que ter renda diminuída no período, fazer parte do grupo de risco e estar mais exposto a informações sobre mortos e infectados, são fatores que podem provocar maior prejuízo na saúde mental nesse período pandemia. Investigar determinantes sociais que contribuem para maior vulnerabilidade ao adoecimento mental da população é importante no campo da saúde coletiva para o planejamento de ações e políticas públicas.
The inhibition effect of limonene on the organisms involved in anaerobic reactors may affect obtaining H2 in this process. Rapid and precise limonene quantification is desirable to characterize wastewaters. The objective of this research was to develop a Gas Chromatography Coupled to Mass Spectrometry (GC-MS) method to determine limonene concentration in liquid samples from batch reactors applied to H2 production at 30 ºC. Method validation was carried out through calibration curves (3 to 20 mg L-1of limonene), in addition to evaluating its precision (CV =0.1%), linearity (R2=0.979), limits of detection (1.7 mg L-1) and quantification (4.2 mg L-1). Its inhibitory effect was evaluated with increasing concentrations of limonene (without addition to 2000 mg L-1). Limonene affected the starting time of H2 production (λ), since λ was 8.7 h in control assays and 15 h with 2000 mg L-1 of limonene. The same was observed for obtaining H2, since 19.5 mmol H2 L-1 was obtained in control assays and 8.7 mmol H2 L-1 was obtained in assays with 2000 mg L-1 of limonene. This method was effective for limonene determination in liquid samples from batch reactors and could be used for characterization and control of anaerobic reactors.
Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.
The present work studied aqueous extracts of castor beans as a natural inhibitor of the corrosion of mild steel in 1 M HCl using gravimetric tests, potentiodynamic polarization curves, linear polarization method, electrochemical impedance measurements, surface analysis by scanning electron microscopy (SEM) and chemical characterization by Fourier transform infrared spectroscopy (FTIR). Gravimetric tests showed that inhibition efficiency (IE) increased with immersion time and concentration of the extract, reaching 97.8% in the presence of 800 mg L−1 inhibitor after 24 h immersion time. For the gravimetric tests varying the temperature, a decrease of the activation energy (Ea) was observed, suggesting chemical adsorption of extract components on the metal surface. The extracts from the castor beans acted as a good corrosion inhibitor, and the macromolecules present in the high molecular weight fraction (HMWF) have a fundamental participation in this process since it presented 93.7% of IE for 200 mg L−1.
Resumen El síndrome de Morquio B es una enfermedad rara y de baja prevalencia, por lo cual poco se ha estudiado sobre el funcionamiento neuropsicológico y estado cognitivo de quienes lo padecen. Este estudio de caso presenta los resultados del funcionamiento en atención, memoria, lenguaje, gnosias, praxias y funciones ejecutivas de un adulto colombiano diagnosticado con este síndrome. Se encontró que el paciente puede adquirir nuevo conocimiento; muestra memoria visoespacial y de trabajo verbal conservadas; repite, lee y escribe información sencilla que es conocida para él; sigue órdenes simples a partir de comandos verbales; muestra habilidades viso perceptuales y grafomotoras; tiene un desarrollo normal de pensamiento abstracto y asociativo, y es capaz de planear y solucionar problemas. Sin embargo, presenta dificultades en atención visual sostenida, atención audio-verbal, velocidad de procesamiento, lenguaje comprensivo, repetición y escritura al dictado de frases completas, flexibilidad cognitiva, y fluidez verbal semántica y fonológica. Se discute como factores más relevantes del funcionamiento cognitivo del paciente la relación entre el síndrome de Morquio B y la gangliosidosis GM1, y la falta de entrenamiento en el manejo de información de alta complejidad, dada su condición de desescolarización.
Abstract Since Morquio B syndrome is a low-prevalence rare disease, scarce evidence about neuropsychological functioning and cognitive status in diagnosed people is known. This case study shows the results of functioning in attention, memory, language, gnosias, praxias, and executive functions in a Colombian man diagnosed with this syndrome. It was found that the patient is capable of acquiring new information and exhibits preserved visuospatial and verbal working memory; he is also able to repeat, read and write simple information as long as it is familiar to him, and is capable of following simple verbal instructions with no difficulty; moreover, he displays preserved visuospatial and graphomotor abilities, has a normal development of abstract and associative thinking, and is able to plan and solve problems. Nonetheless, he exhibits difficulties in audio-verbal and sustained visual attention, as well as in processing speed, comprehensive language, repetition and writing of complete phrases, cognitive flexibility, and semantic and phonological verbal fluency. It is discussed the association between Morquio B syndrome and gangliosidosis GM1 as well as the lack of training in the management of highly complex information due to unschooling of this patient as the two most relevant factors of his cognitive functioning.