Señales de alarma precoces del trastorno del espectro autista en personas con síndrome de Down / Early warning signs of autism spectrum disorder in people with Down syndrome

Introducción. En la población general, el diagnóstico de trastornos del espectro autista (TEA) se realiza generalmente en una etapa temprana, mejorándose así el pronóstico. En las personas con síndrome de Down (SD), la falta de instrumentos específicos y adaptados para el diagnóstico, y la falta de experiencia de los profesionales, hace que el diagnóstico de TEA suela pasar desapercibido. Objetivo. Identificar señales de alarma «tempranas» de un posible diagnóstico de TEA en niños con SD en los primeros años de vida (de 0 a 4 años). Métodos. Estudio retrospectivo de cohortes: niños con SD y TEA (SD-TEA) y niños con SD y sin TEA (SD-noTEA) emparejados por sexo y edad. Se identificaron las siguientes señales de alarma tempranas: 1) ausencia de sonrisa social; 2) falta atención compartida; 3) falta de búsqueda de consuelo/protección; 4) ausencia de queja; 5) poco interés por el otro; 6) no señala; 7) no imita; 8) ausencia de balbuceo, vocalización; 9) expresión facial inapropiada; 10) rituales verbales o acciones repetitivas; 11) manierismos manos/dedos; 12) estereotipias; 13) interés sensorial, y 14) no integración de la mirada y la conducta. Seis investigadores, quienes no participaron en la identificación de las señales de alarma tempranas, seleccionaron aquellas que orientarían a un diagnóstico de TEA (análisis cualitativo). Se solicitó a los padres videos de las personas con SD en «actividad» entre los 0 y 4 años. Los mismos investigadores, cegados al diagnóstico de TEA y tras visualizar los videos, puntuaron las señales de alarma tempranas en 3 categorías: presencia/ausencia/no evaluable (análisis cuantitativo). Resultados. Durante el año 2013, se obtuvieron 12 videos de 12 personas con SD: 6 del grupo SD-TEA y 6 del grupo SD-noTEA. El análisis cualitativo identificó como señales de alarma temprana relacionadas con el diagnóstico de TEA: «no integración de la mirada», «no imita», «rituales verbales o acciones repetitivas» y «estereotipias»; y el análisis cuantitativo identificó: «falta de atención compartida» y «falta de interés por el otro». Conclusión. Ciertas «señales de alarma» pueden orientar hacia un diagnóstico de TEA en los primeros años de vida en niños con SD (AU)

Introduction. In general population, the current trend is to make the diagnosis of Autism Spectrum Disorders (ASD) at an early stage, which it is crucial to improve the prognosis. In contrast, in Down syndrome (DS) population, the ASD diagnosis is frequently delayed, having negative consequences on the overall development of the children who suffer. Objective. To identify «early warning signals» for the detection of the ASD in DS in the first years of life (0 to 4 years). Methods. Retrospective cohort study: SD with an ASD diagnosis (SD-ASD) and healthy-DS (SD-noASD) matched by sex and age. Early warning signals were identified and selected from different questionnaires for ASD of general population: 1. Lack of social smile; 2. Shared care foul; 3. Lack of finding comfort/protection; 4. Lack of complaint; 5. Little interest for the others; 6. No pointing; 7. Non-imitation; 8. Lack of babbling/vocalization; 9. Inappropriate facial expression; 10. Presence of rituals as repetitive actions or repetitive sentences; 11. Mannerisms hands/fingers; 12. Stereotypes; 13. Lack of interest sensory; and 14. Non-integration of the look. Six investigators, who did not participate in the identification of the «early warning signals», selected those that would guide a diagnosis of ASD (qualitative analysis). Parents were asked for videos of people with DS in «activity» between 0 and 4 years. The same investigators, blinded to the diagnosis of ASD and after watching the videos, scored the «early warning signals» in three categories: presence / absence / non-evaluable (quantitative analysis). Results. During the year 2013, 12 videos of 12 people with SD were obtained: 6 from SD-ASD group and 6 from the SD-noASD group. The qualitative analysis identified as early warning signals related to the diagnosis of ASD: «non-integration of the look», «non-imitation», «presence of rituals as repetitive actions or repetitive sentences» and «stereotypies», and the quantitative analysis: «shared care foul» and «little interest for the others». Conclusion. Certain «warning signals» may lead to a diagnosis of ASD in the first years of life in children with DS (AU)

Lack of activity of 15-epi-lipoxin A4 on FPR2/ALX and CysLT1 receptors in interleukin-8-driven human neutrophil function.

Neutrophil recruitment and survival are important control points in the development and resolution of inflammatory processes. 15-epi-lipoxin (LX)A interaction with formyl peptide receptor 2 (FPR2)/ALX receptor is suggested to enhance anti-inflammatory neutrophil functions and mediate resolution of airway inflammation. However, it has been reported that 15-epi-LXA4 analogues can also bind to cysteinyl leukotriene receptor 1 (CysLT1) and that the CysLT1 antagonist MK-571 binds to FPR2/ALX, so cross-reactivity between FPR2/ALX and CysLT1 ligands cannot be discarded. It is not well established whether the resolution properties reported for 15-epi-LXA4 are mediated through FPR2/ALX, or if other receptors such as CysLT1 may also be involved. Evaluation of specific FPR2/ALX ligands and CysLT1 antagonists in functional biochemical and cellular assays were performed to establish a role for both receptors in 15-epi-LXA4-mediated signalling and function. In our study, a FPR2/ALX synthetic peptide (WKYMVm) and a small molecule FPR2/ALX agonist (compound 43) induced FPR2/ALX-mediated signalling, enhancing guanosine triphosphate-gamma (GTPγ) binding and decreasing cyclic adenosine monophosphate (cAMP) levels, whereas 15-epi-LXA4 was inactive. Furthermore, 15-epi-LXA4 showed neither binding affinity nor signalling towards CysLT1. In neutrophils, 15-epi-LXA4 showed a moderate reduction of interleukin (IL)-8-mediated neutrophil chemotaxis but no effect on neutrophil survival was observed. In addition, CysLT1 antagonists were inactive in FPR2/ALX signalling or neutrophil assays. In conclusion, 15-epi-LXA4 is not a functional agonist or an antagonist of FPR2/ALX or CysLT1, shows no effect on IL-8-induced neutrophil survival and produces only moderate inhibition in IL-8-mediated neutrophil migration. Our data do not support an anti-inflammatory role of 15-epi-LXA4- FPR2/ALX interaction in IL-8-induced neutrophil inflammation.

El surgimiento de la vida psíquica del bebé con síndrome de Down: consideraciones desde la atención temprana / The emergence of the psychological life of the child with Down syndrome: reflections regarding early intervention

La franja de edad a partir de la cual interviene elprofesional de atención temprana le permite ser testigoy acompañante a la vez del proceso de construcciónsubjetiva del niño con síndrome de Down (SD).Considerando el desarrollo como un proceso dinámico,se analiza cuáles deberían ser las condicionesnecesarias para favorecer el crecimiento delbebé/niño hacia la vida adulta y se revisa cómo surgela vida psíquica del niño a partir del encuentro relacionalque establece con sus progenitores. Finalmente,se reflexiona sobre algunos aspectos que,desde la experiencia de la atención temprana, se consideranrelevantes para el desarrollo emocional delniño con síndrome de Down (SD) (AU)

The age range with which early interventionspecialists work enables them both to witness andsupport the construction of the subjective selfprocess in children with Down syndrome (SD).Viewing development as a dynamic process, thisarticle looks at what conditions are necessary to helpthe baby/child grow into adult life and reviews theway in which the child’s psychological life emergesfrom the parent-child relationship. Lastly, itconsiders aspects believed to be important in theemotional development of the child with Downsyndrome (DS) on the basis of experiences in earlyintervention (AU)

¿Por qué lo llamamos autocontrol cuando deberíamos llamarlo autoanálisis? / Why do we say self-management when we should say self-analysis?

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Evaluation, by a statistically designed experiment, of an experimental grade of microcrystalline cellulose, Avicel 955, as a technology to aid the production of pellets with high drug loading.

A statistically designed experiment has been undertaken to evaluate an experimental grade of microcrystalline cellulose (Avicel 955) as a technology to aid the production of pellets by extrusion spheronization of formulations with high drug load. An attempt has been made to relate the properties of the drugs to the ability to produce spherical pellets which have a narrow size distribution and are round, as assessed by a 2-dimensional shape factor by the process of extrusion/spheronization. Twenty drugs were tested at a level of 80%, and in all cases pellets could be produced. In some cases in terms of either size distribution or shape they were not of the highest quality. Nevertheless, a best level of water was identified for each drug. Principal component analysis did allow structuring of the data characterizing the process and the pellets, identifying a relationship between the water content and the steady state extrusion force as one component with the median pellet size and its interquartile range as the other. When multivariate analysis was used with the whole data set, it was not possible to relate the drug properties of pKa, freezing point depression, or solubility to the water content, steady state extrusion force, median pellet diameter, its interquartile range, and its shape satisfactorily. Thus other properties of the drug must be involved in the extrusion/spheronization process. Prediction of the best water content to use in a formulation was possible for 50% of the formulations by using a nonlinear model to relate the above drug properties to the water content.

[Children's accidents treated at health centers]. / Accidentes infantiles atendidos en los centros de salud.

OBJECTIVES: To find the characteristics of accidents to children treated at our Health Centres. DESIGN: A descriptive crossover study. SETTING: Almanjayar and Cartuja Health Centres, Granada. PATIENTS: The 0 to 14 age-group treated at our centres because of an accident. MEASUREMENTS AND MAIN RESULTS: The number of accidents to children treated at our health centres during 1994 was 217. The most common accidents were, in descending order: falls, 27%; burns, 20.7%; traffic accidents, 17%; poisoning, 15%; inhalation of foreign bodies, 10.5%; bites and aggressions, 9.2%. 48.3% of the accidents occurred at home, 37.7% in the street and 13.8% at school. In the relation of type of accident to age group, we found that burns affected children under 5 to a greater extent. Poisoning was more common between 5 and 9. Traffic accidents and falls affected children between 10 and 14 more. The relationship between age and type of accident is significant (p < 0.005). There is no significant connection between gender and type of accident. CONCLUSIONS: Age and some types of accident are directly related. The majority of accidents tend to occur at home and in the street. We consider that prevention is the best way of decreasing accidents to children. Programmes involving children, parents and teachers should be set up.

[Preoperative psychoprophylaxis in childhood. Results of a hospital program]. / Psicoprofilaxis quirúrgica en la infancia. Resultados de un programa hospitalario.

Results of a surgical psychoprophylaxis program, theoretically and technically framed within psychoanalytic theory is presented. It also comprises a description of the method used, as well as criteria by which authors have determined whether or not a child is ready for surgery. Results obtained with 134 children and a description of those who showed post-surgical disturbances are presented. Analysis is carried out of the percentage of disorders according to age group, showing that highest risk is among children up to five years of age, coinciding with the finding put forth by other authors. Finally some conclusions in relation to prevention of psychologic iatrogenic disorders in pediatric surgery are drawn.