There are different teaching strategies for ensuring significant learning, including research seminars, workshops, directed independent reading, the clinical case, the problem-based learning methods, in-depth lines of study, etc. In many departments of the clinical area, such as the Department of Pediatrics, a clinical case taken from real life is used as an effective learning method. It consists of providing the case to all participants (students, professors, pediatricians) for study and analysis. This study is discussed in small groups and the solution or possible responses are presented in a meeting scheduled for this purpose.

Case reports rose to popularity around the same time as the creation of periodical journals, and are the greatest source of evidence to support the majority of clinical practices in speech-language pathology. There has been an overwhelming increase in publications of case reports in the last decade at the international level. Even when their contributions to evidence-based practices are called into question, case reports continue to be an essential part of science and contribute in a significant way to the formulation of hypotheses that can lead to more complex studies.

Symptomatic cholelithiasis is a highly prevalent disease in Colombia, though its presentation in patients with situs inversus totalis has rarely been described. This report describes the case of a patient with symptomatic cholelithiasis and situs inversus totalis who underwent a single-port laparoscopic surgery after concomitant gallstones were ruled out. This procedure is a minimally invasive technique of SILS (Single Incision Laparoscopic Surgery). Situs Inversus is a rare genetic disorder which is characterized by the transposition of the abdominal and chest organs through the sagittal plane, having a so-called “mirror image” effect. While the etiology is still unclear, it is often attributed to a genetic predisposition caused by an autosomal recessive gene of incomplete penetrance. The presence of symptomatic vesicular lithiasis in a patient with SIT not only creates diagnostic doubt but also presents a real challenge for treatment as any surgical procedure (especially laparoscopic cholecystectomy) will be more difficult due to the anatomical abnormalities of the patient.

Congenital malaria is a disease that appears in the neonatal period and that, if not treated in a timely manner, may have fatal consequences for the newborn. According to statistics published in The State of the World Children 2009 Report, 3.7 million children under the age of 28 days die annually around the world at present. 8% of cases correspond to children under 5 years of age with malaria (1). Similarly, studies in endemic areas have reported incidences of congenital malaria of between 0.83 and 5.93% (2). Here, we present a case of congenital malaria in a one-month-old nursing infant whose mother received treatment for malaria from Plasmodium vivax (P. vivax) during gestation but suffered a relapse with a consequent compromise of the infant in utero. There is a need to recognize the high prevalence of this disease in our context and to know how to monitor and treat the disease in special cases like those of gestating mothers and newborn infants with congenital infections.

Esophageal lung is a rare broncopulmonary foregut malformation, in which the main stem bronchus arises from the esophagus. Since the description by Keely et al. in 1960, less than 25 cases have been reported. We present a case of a 4-month-old female, who was referred to our institution after 2 months of management for respiratory recurrent infections. Contrast studies were performed during the evaluation and a right broncography was identified in the esophagogram. Bronchoscopy was performed confirming the atresic right bronchus. Complementary imaging and cardiology evaluation confirmed the absence of major vascular anomalies, especially a pulmonary artery sling that has been described in relation with this entity. Due to the hypoplastic lung in the absence of major vascular anomalies, thoracoscopic pneumonectomy was deemed possible. Procedure was performed with four ports and 3 mm equipment was used. Special attention was made identifying and dissecting the vascular structures first, and then the arising esophageal bronchus was dissected. The hypoplastic lung was extracted trough a small incision inferior to the axilla.We consider that due to the hypoplastic lung and vessels, the thoracoscopic approach is safe and feasible for the management of the esophageal lung and even for de esophageal bronchus in the absence of major vascular anomalies.

Although rare, traumatic abdominal wall hernia associated with handlebar injury is a well-described entity in the pediatric population with about 40 cases and only one laparoscopic repair reported in children. We present two cases of male patients, 9 and 13 years old, who were assessed in our emergency room for blunt abdominal trauma associated with handlebar injury. The patients showed signs of handlebar trauma in the abdominal wall: one presented with a painful mass, and the other with intermittent pain in the area of trauma with no palpable mass. Neither of the patients were hemodynamically unstable or showed any peritoneal signs. Ultrasound and CT scans were performed in both patients to identify abdominal wall hernias containing bowel content in the absence of other injuries. Laparoscopic repair was performed uneventfully in both patients with interrupted non-absorbable multifilament suture with 2 and 3 ports respectively. Oral intake was initiated one day after surgery and both patients were discharged the following day. In the follow-up visit, the patients were asymptomatic and no signs of abdominal wall hernias were found. Laparoscopic repair of blunt traumatic abdominal wall hernias is safe and technically possible in children and should be considered as the standard initial approach in the stable patient.

The main objective of the National Institute of Legal Medicine and Forensic Science (Instituto Nacional de Medicina Legal y Ciencias Forenses) is to provide scientific support to the administration of justice in Colombia, through this activity it has forged itself a remarkable reputation and has opened the door to various expressions of knowledge in the forensic field. In over a century of practicing this specialty, the Institute has provided answers to numerous questions that have been asked by legal authorities in the clarification of criminal offenses. Over this period of time, the Institute has acquired experience in the analysis of cases of all forensic disciplines and has shared it with other national and international entities, mainly through personalized training in its laboratories and different branches.

When faced with an element which is the suspected cause of a cut or lesion, dental casting can be made to compare characteristics observed on the surface of the tool mark with those found on the bones. There is a large variety of materials available on national and international markets to record and analyze marks or signs that an element leaves on any given surface (bite marks, tool marks on bones, finger prints, etc.), all of which are useful in forensic investigation (1). However, the unconventional application of odontological techniques and the use of materials such as alginate and silicone have been found useful recovering tool marks on bones, which allows the forensic scientist to clearly establish when an element was used to cause cuts and injuries in an individual. This technique has been applied in five cases of possible homicide with the use of a cutting element and, as a result, has generated highly accurate casts. It also shows that both materials are appropriate for this purpose, and although silicone offers greater detail in the impression, either material can be used depending on the commercial availability.

This is the case of a six-year-old schoolchild —identified as J— who was born with ambiguous external genitalia. Upon medical recommendation, the child was registered as male by the parents; however, further testing (diagnostic imaging and karyotyping) showed that the child was biologically female. Based on this, the parents started the judicial process to change their child’s name, and the judge ordered a forensic psychiatric evaluation to determine the child’s true sex1. When the forensic study concluded that the child’s sex was female, the result was transmitted to government authorities and the name was corrected in the child’s civil registry. 1 Literal request from the court

This is the case of a typical request for a chemical laboratory analysis to conduct a comparison of materials or trace evidence with completely unexpected results from those obtained if established protocols had been followed. This request involved the collation of black gunpowder, a material which is generally associated with firearms. In this case, however, the prosecutor’s request was to compare the powder from two groups of paper used in tejo (a popular Colombian sport) in order to ascertain the identity of a homicide suspect at the scene of the crime.

Background: In 2011, at least 34 million people live with HIV. HIV vertical infected children require close follow-up from all the way through diagnosis to treatment and management of complications. Case summary: This is the case of a 13-year-old male patient with HIV (vertical transmission) diagnosed at 4 months old. His HIV diagnosis was made in the context of opportunistic manifestations of immunodeficiency because his mother did not access prenatal check-ups. He developed AIDS sequelae such as spastic paraparesia derived from HIV myelopathy and CMV retinitis due to immunodeficiency; these diseases presented in first two years of life. After three years from HAART initiation, the patient was exposed to inadequate HAART (ritonavir without another protease inhibitor), and experienced a first change of therapy due to virological failure. Subsequent treatment regimens —a sum of 7— presented failures in their formulation and this, along with delays due to administrative issues, led to the patient developing multiresistance to most of antiretrovirals given. The patient died mainly from multiorganic failure due to HIV and wasting syndrome. Conclusion: Congenital HIV is a fundamental issue in public health. It is a preventable disease, and perinatal management, including diagnosis and treatment, is a must. Treatment has demonstrated effectiveness when it is given with proper schemes and adherence. Administrative barriers led to failures in treatment and this affects the prognosis of any patient with HIV. This case is an example that highlights the relationship between virological and clinical failures with health system barriers, in HIV infected children. Managing gaps in diagnosis, antiretroviral administration, and follow up of HIV infected children translates into the prognosis of future adolescents and adults.