[Update in diagnosis and early intervention of Autistic Spectrum Disorder]. / Actualización en diagnóstico e intervención temprana del Trastorno del Espectro Autista.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects the social commu nication and behavior areas. Its symptomatology display heterogeneity and a wide range of functio nality levels in each child. In the last decade, significant advances have been made in the early detec tion of risk signs, favoring early diagnosis. This has allowed access to interventions that capitalize neuroplasticity of this stage of development, raising the possibility of mitigating the full manifesta tion of the disorder. The objective of this update is to review early diagnostic tools and early inter vention models and to analyze how to implement evidence-based interventions in a health context in a country like Chile.

What Do Your Neighbors Think About You? How Perceived Neighbor Attitudes Toward Latinos Influence Mental Health Among a Pregnant Latina Cohort.

Latina women living in the USA experience disproportionately higher rates of psychological distress compared to their non-Latina White counterparts. Poor maternal mental health during pregnancy can contribute to intergenerational mental health disparities. Through this pathway, mothers' experiences, environments, and exposures (henceforth "exposures") during pregnancy become biologically embodied and can negatively affect the fetus and life-long developmental trajectories of her child. One of the exposures that can affect mother-offspring dyads is the neighborhood. With the goal of integrating anthropological and sociological theories to explain mental health disparities among pregnant Latina women, we explored how perceptions of neighbor attitudes may influence mental health during pregnancy. We analyzed self-reported responses from 239 pregnant Latina women in Southern California (131 foreign-born, 108 US-born) on their mental health and perceived attitudes of their neighbors using multiple linear regression models. Among foreign-born Latina women, living in neighborhoods with more favorable views of Latinos was associated with lower depression scores (pooled ß = - .70, SE = .29, p = .019) and lower pregnancy-related anxiety scores (pooled ß = - .11, SE = .05, p = .021), but greater state anxiety scores (pooled ß = .09, SE = .04, p = .021). Among US-born women, there were no associations between neighbor attitudes and mental health. Overall, results suggest that social environments are correlated with mental health and that foreign-born and US-born Latinas have varied mental health experiences in the USA. Our findings highlight the importance of improving aspects of neighborhood cohesion as part of maternal-fetal care management.

Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews.

OBJECTIVE: To assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children. DESIGN: Overview of systematic reviews (SRs). PARTICIPANTS: Children aged 12 years and under with ASD. SEARCH METHODS: In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication. INTERVENTIONS: 17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study). DATA COLLECTION AND ANALYSIS: We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs. MAIN OUTCOME MEASURES: A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PUBLIC AND PATIENT INVOLVEMENT STATEMENT: Organisations of parents of children with ASD participated in external revision of the final version of the report. RESULTS: We identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing). CONCLUSIONS: Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed. PROSPERO REGISTRATION NUMBER: CRD42020206535.

Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews.

OBJECTIVES: To assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD). DESIGN AND SETTING: Overview of systematic reviews (SRs). SEARCH METHODS: In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication. PARTICIPANTS: Children aged 12 years or less with ASD. INTERVENTIONS: Risperidone and aripiprazole with no dosage restrictions. DATA COLLECTION AND ANALYSIS: We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation certainty of the evidence according to the analysis conducted by the authors of the included SRs. MAIN OUTCOMES MEASURED: A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PATIENT AND PUBLIC INVOLVEMENT: Organisations of parents of children with ASD were involved during part of the process, participating in external revision of the final version of the report for the Chilean Ministry of Health with no additional comments (ID 757-22-L120 DIPRECE, Ministry of Health, Chile). The organisations involved were: Fundación Unión Autismo y Neurodiversidad, Federación Nacional de Autismo, Vocería Autismo del Sur, and Vocería Autismo del Norte. RESULTS: We identified 22 SRs within the scope of this overview, of which 16 were of critically low confidence according to AMSTAR 2 and were excluded from the analysis. Both aripiprazole and risperidone were effective for reducing autism symptoms severity, repetitive behaviours, inappropriate language, social withdrawal and behavioural problems compared with placebo. The certainty of the evidence for most outcomes was moderate. Risperidone and aripiprazole are associated with metabolic and neurological adverse events. Follow-up was short termed. CONCLUSIONS: We found that aripiprazole and risperidone probably reduce symptom severity at short-term follow-up but may also cause adverse events. High-quality and updated SRs and larger randomised controlled trials with longer term follow-up are needed on this topic. OVERVIEW PROTOCOL: PROSPERO CRD42020206535.

Relationship between Neuromuscular Mechanosensitivity and Chronic Neck Pain in Guitarists: A Cross-Sectional Study.

Musicians frequently complain of musculoskeletal pain due to high mechanical demands, with the cervical spine being the most affected. Increased neuromuscular mechanosensitivity due to repetitive mechanical stress over time has been described in neck pain patients. Nevertheless, the association between musculoskeletal pain and neuromuscular mechanosensitivity in musicians is unknown. Therefore, the aim of this study was to analyze the relationship between neuromuscular tissue mechanosensitivity and neck pain in guitarists. Guitarists with chronic neck pain (n = 70) and without pain (n = 70) were enrolled. Pain and disability were measured by the visual analogue scale and the Neck Disability Index, respectively. The pressure pain threshold (PPT) was bilaterally measured for the upper trapezius and median nerve. Finally, the Upper limb neural test one (ULNT1) was bilaterally measured. The analyses included a 2-by-2 mixed analysis of variance, pairwise comparisons with Bonferroni correction, linear regression model, and multiple linear regression. Our data showed that chronic neck pain guitarists have a lower PPT at all locations compared to healthy guitarists. They also showed a bilateral main effect for pain for ULNT1 compared to healthy guitarists. These results were not affected by the mediator variables. Finally, a relationship between upper trapezius PPT and median nerve PPT was found.

Comparación del rendimiento académico basado en metodología TBL y metodología tradicional de enseñanza en estudiantes de odontología en Santiago de Chile / Comparison of academic. Performance based on TBL methodology and traditional teaching methodology in dentistry students in Santiago de Chile

INTRODUCCION Con el pasar de los años han surgido metodologías activas de enseñanza, donde el estudiante pasa a tener un rol protagonista. La metodología activa Team Based Learning (TBL) promueve la participación de los estudiantes tanto de manera individual como grupal permitiendo fomentar el aprendizaje y aplicar contenidos enseñados. El objetivo de este estudio fue comparar el rendimiento académico obtenido por los estudiantes en la asignatura de cariología mediante metodología tradicional en los años 2016, 2017 y 2018; y metodología TBL en el año 2019. MATERIAL Y METODOS Se realizó un diseño analítico transversal donde se compararon los promedios de calificaciones de certámenes 1 y 2 de cariología de los estudiantes de la carrera de Odontología de la Universidad Finis Terrae entre los años 2016 y 2019; dicha población se estratificó en función de año académico y tipo de metodología. RESULTADOS Los resultados muestran que el promedio de las calificaciones de los certámenes 1 y 2 de cariología obtenido por los estudiantes mediante metodología tradicional de aprendizaje fue de 4,79 y mediante metodología TBL es de 5,01, existiendo una diferencia estadísticamente significativa entre ambos grupos de estudio (p = 0,03). CONCLUSION El rendimiento académico en cariología, obtenido por los estudiantes mediante metodología TBL el año 2019 fue significativamente mayor que aquel obtenido por los estudiantes mediante metodología tradicional en los años 2016, 2017 y 2018.

INTRODUCTION Over the years, active teaching methodologies have emerged, where the student play a leading role. The active Team Based Learning (TBL) methodology promotes participation of students both individually and in groups allowing to promote the learning and applying taught content. The aim of this study was to compare the academic performanc he students in the subject of cariology through traditional methodology in the years 2016, 2017 and 2018; and TBL methodology in 2019. MATERIAL AND METHODS A cross-sectional analytical design was conducted where the grade point of test 1 and 2 of cariology of Dentistry students from University Finis Terrae between the years 2016 and 2019, were averaged. The population was stratified according to academic year and type of methodology. RESULTS The results show that the average of the qualifications of test 1 and 2 of cariology obtained by students through traditional learning methodology was 4.79 and through TBL methodology is 5.01, there being a statistically significant difference between both study groups (p = 0.03). CONCLUSION The academic performance in cariology, obtained by the students through the TBL methodology on year 2019 was significantly higher than that obtained by the students through the methodology traditional in the years 2016, 2017 and 2018

Procalcitonin as an early marker in the detection of anastomotic intestinal leak in a Universitary Hospital of Bogotá / Procalcitonina como um marcador precoce na detecção de vazamento anastomótico intestinal em um Hospital Universitário de Bogotá

ABSTRACT Introduction: Anastomotic leakage is a complication of intestinal anastomosis, with an incidence of 2%-7% in centers of experience. To be able to achieve an early detection, serological markers such as Procalcitonin were included. Methods: Descriptive retrospective cohort study of patients taken to colorectal surgery with intestinal anastomosis, the objective is to estimate association between procalcitonin (≥2 ng/dl) as an early inflammatory marker and anastomotic leakage in a Coloproctological Service of a highest level of health care hospital, between September 2017 and January 2019. Results: Cohort of 237 patients, 51% women (18-89 years), with multiple comorbidities in 81% of patients, colon cancer was the most operated pathology (53.1%). Laparoscopic approach was the most applied 60.34%, colorectal anastomosis was the most frequently performed (47.26%). Ileocolic anastomosis presented a higher frequency (43.75%-n:7) of dehiscence. Anastomotic leakage was associated with a serum procalcitonin positive 3 days postoperatively (p-value <0.05). Patients with a positive result had 4.28 times higher risk of presenting an anastomotic leak, compared to this risk in those patients with negative results 3 days postoperatively, this association was statistically significant 95% CI (1.34-14.16); p value <0.05. Conclusion: Anastomotic leakage is a source of morbidity in patients taken to intestinal anastomosis. It's necessary to guarantee an early diagnosis of this complication, prevent abscesses and secondary peritonitis, providing adequate treatment and even reducing the associated mortality. We recommend including the procalcitonin in the assessment protocol on the third day of postoperative follow-up.

RESUMO Introdução: O vazamento anastomótico é uma complicação da anastomose intestinal, com uma incidência de 2% a 7% em centros com experiência. Para conseguir uma detecção precoce, foram incluídos marcadores sorológicos como a Procalcitonina. Métodos: Estudo de coorte descritivo e retrospectivo de pacientes submetidos à cirurgia colorretal com anastomose intestinal, cujo objetivo é estimar a associação entre os níveis de procalcitonina (≥ 2 ng/dL) como marcador inflamatório precoce e vazamento anastomótico em um Serviço de Coloproctologia de alto nível de atenção à saúde hospitalar, entre setembro de 2017 a janeiro de 2019. Resultados: Coorte de 237 pacientes, 51% mulheres (18−9 anos), com múltiplas comorbidades em 81% dos pacientes, sendo o câncer de cólon a patologia mais operada (53,1%). A abordagem laparoscópica foi a mais utilizada, em 60,34%, e a anastomose colorretal foi a mais frequentemente realizada (47,26%). A anastomose ileocólica apresentou a maior frequência (43,75%, n = 7) de deiscências. O vazamento anastomótico foi associado a procalcitonina sérica positiva 3 dias após a cirurgia (p < 0,05). Pacientes com resultado positivo tinham um risco 4,28 vezes maior de apresentar vazamento anastomótico, em comparação com esse mesmo risco nos pacientes com resultado negativo 3 dias após a cirurgia, sendo essa associação estatisticamente significativa, (IC95%:1,34−14,16); p < 0,05. Conclusão: O vazamento anastomótico é fonte de morbidade em pacientes encaminhados para anastomose intestinal. É necessário garantir o diagnóstico precoce desta complicação, prevenir abscessos e peritonites secundárias, proporcionando tratamento adequado e até mesmo reduzindo a mortalidade associada. Recomendamos incluir a procalcitonina no protocolo de avaliação no terceiro dia de seguimento pós-operatório.

Actualización en diagnóstico e intervención temprana del Trastorno del Espectro Autista / Update in diagnosis and early intervention of Autistic Spectrum Disorder

Resumen: El Trastorno del Espectro Autista (TEA) es una alteración del neurodesarollo que afecta las áreas de comunicación social y conducta, las cuales se manifiestan de manera heterogénea en cada niño y con una amplia gama de niveles de funcionalidad. En la última década se han hecho avances significativos en la detección temprana de señales de riesgo, favoreciendo la realización de diagnósticos precoz. Esto ha permitido el acceso a intervenciones que capitalizan la neuroplasticidad de esta etapa del desarrollo, planteando la posibilidad de mitigar la completa manifestación del trastorno. Los objetivos de esta actualización son revisar herramientas de diagnóstico precoz y modelos de intervención temprana, y analizar cómo implementar intervenciones basadas en la evidencia en un contexto sanitario de un país como Chile.

Abstract: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects the social commu nication and behavior areas. Its symptomatology display heterogeneity and a wide range of functio nality levels in each child. In the last decade, significant advances have been made in the early detec tion of risk signs, favoring early diagnosis. This has allowed access to interventions that capitalize neuroplasticity of this stage of development, raising the possibility of mitigating the full manifesta tion of the disorder. The objective of this update is to review early diagnostic tools and early inter vention models and to analyze how to implement evidence-based interventions in a health context in a country like Chile.

Creación de un Currículo de Competencias en Cariología para Estudiantes de Pregrado de Odontología en Chile / Development of a Competency-based Curriculum in Cariology for Undergraduate Dental Students in Chile

RESUMEN: Objetivo: Creación de un currículo de competencias mínimas en Cariología, para la formación de los Cirujano-Dentistas egresados de las escuelas de Odontología de Chile. Metodologías: A partir de una reunión de académicos de las Universidades de Talca y de Chile (año 2011), se elaboró una propuesta de currículo inicial, basado en los dominios propuestos por la Unión Europea (Schulte AG y cols). Durante el año 2016, dicha propuesta fue analizada mediante diálogos digitales y grupos de trabajo, con la participación del 96% de las Escuelas de Odontología existentes en el país, que concluyeron en un documento intermedio. Este documento fue analizado, discutido y perfeccionado durante el Taller para el Desarrollo de un Currículo de Competencias Mínimas en Cariología para las Escuelas de Odontología Chilenas (22/Mayo/2017, Talca, organizado por la Universidad de Talca y la Universidad de Chile) con la asistencia de representantes del 96% de las escuelas dentales chilenas, Ministerio de Salud de Chile, Colegio de Cirujano-Dentistas de Chile y con la asesoría de los profesores de Cariología Dres. Margherita Fontana y Carlos González-Cabezas (Universidad de Michigan, Ann Arbor, EEUU). Cada grupo de trabajo revisó el documento y envió nuevos comentarios, los que fueron incorporados en el documento final por una comisión asesora. Resultados: El documento del Currículo en Cariología se organizó en 5 Dominios: 1. Conocimientos base; 2. Determinación de Riesgo, diagnóstico de caries y detección de lesiones de caries; 3. Toma de decisiones y manejo preventivo no operatorio; 4. Toma de decisiones y manejo operatorio y 5. Cariología basada en la evidencia, en la práctica clínica y de salud pública. Se consensuaron las definiciones operacionales, las competencias principales y las sub-competencias para cada uno de los dominios. Las sub-competencias fueron clasificadas en tres niveles: A: Ser competente en; B: Tener conocimientos sobre y C: Estar familiarizado con. El documento final fue enviado a todos los participantes del taller para su aprobación y difusión en cada una de las instituciones involucradas. Conclusiones: Se logró, por medio de consenso, la construcción del Currículo de Competencias mínimas en Cariología para estudiantes de pregrado de Odontología en las universidades chilenas.

ABSTRACT: Objective: Development of a minimum set of competencies in Cariology that every dentist graduated from a Dental School in Chile must have. Methodology: Starting from a meeting of scholars from the Universities of Talca and Chile (year 2011), an initial proposal for a curriculum was developed, based on the domains proposed by the European Cariology Curriculum (Schulte, et al, 2011). During 2016, this proposal was discussed through online dialogues and working groups, with the participation of 95.2% of the Chilean dental schools, which resulted in an intermediate document. This document was analyzed, discussed and refined during the Workshop for the Development of a Curriculum of Minimum Competencies in Cariology for Chilean Dental Schools (May 22, 2017, Talca, organized by the Universities of Talca and Chile) with the attendance of representatives from 95.2% of the Chilean dental schools, the Chilean Ministry of Health, Chilean College od Dentists and with the assistance of the professors of Cariology Margherita Fontana and Carlos González-Cabezas (University of Michigan, Ann Arbor, USA). Each working group revised the document and provided feedback, which was incorporated in the final document by an advisory committee, elected on the day of the workshop, including the authors of the present article. Results: The Cariology Curriculum was organized in 5 Domains: 1. Basic knowledge; 2. Risk assessment, caries diagnosis and caries lesion detection; 3. Decision-making and non-operative preventive treatment; 4. Decision making and operative treatment; and 5. Evidence-based, clinical and public health practice. Operational definitions, main competencies and sub-competencies for each domain were agreed. Sub-competencies were classified into three levels: A: Be competent in; B: Have knowledge about, and C: Be familiar with. The final document was sent to all the participants of the workshop for dissemination in each of the institutions involved. Conclusions: The development of the Competency-based Curriculum in Cariology for undergraduate dental students at Chilean universities was achieved through consensus.

Síndrome de Moebius: descripción de una serie de 6 casos / Moebius syndrome: description of a 6 cases series

La parálisis facial y del nervio abducens congénita fue descrita como entidad clínica en 1888. Esta definición se amplió a parálisis facial unilateral o bilateral completa o incompleta, limitación de abducción ocular, disfunción de otros pares craneales, defectos oro-faciales, músculoesqueléticos y del desarrollo. Los criterios de diagnóstico varían y la entidad sigue siendo subdiagnosticada. El objetivo de este trabajo es caracterizar el cuadro clínico de pacientes con diagnóstico de Síndrome de Moebius, a través de la revisión de seis casos en control en dos Policlínicos de Neurología Infantil. En este grupo, fueron motivo de consulta: falta de esfuerzo respiratorio, hipomimiafacial, trastorno de alimentación. En dos casos hubo uso de misoprostrol durante el embarazo. Los hallazgos del examen incluyeron parálisis facial bilateral (5), unilateral (1), alteración bilateral de abducción ocular (6). Otras malformaciones asociadas fueron: paladar alto, microretrognatia, fisurapalatina, criptorquidia, polidactilia bilateral y pie bot. El conocimiento extendido de las características mínimas para el diagnóstico y de la variedad de manifestaciones de el Síndrome de Moebius, facilitan su reconocimiento y tratamiento oportuno.

Congenital facial and abducens nerves palsy were first described as a clinical entity in 1888. Later the definition was expanded to unilateral or bilateral facial palsy, limitation of ocular abduction, other cranial nerves involvement, orofacial, musculoskeletal or developmental defects. Diagnostic criteria vary among authors and the condition remains probably underdiagnosed. The aim of this study is to characterize the clinical features of Moebius Syndrome in a group of six patients diagnosed and controlled at two Child Neurology Outpatients Clinics. In this group, the main complaint at first consultation was: lack of respiratory effort, facial hypomimia, eating disorder. The use of misoprostol during pregnancy was identified in two cases. Findings on physical examination included bilateral (5) and unilateral (1) facial palsy, bilaterally impaired conjugate gaze (6).Other associated findings were: high palate, microretrognathia, cleft palate, polydactyly, bilateral cryptorchidism and clubfoot. The extended knowledge of minimal criteria required for Moebius Syndrome diagnosis, as well as other associated features, will facilitate recognition and timely treatment.