Experiencia de entrenadores deportivos y padres en el proceso de inclusión de niños y jóvenes con síndrome de Down en Puerto Rico / Experience of sports coaches and parents in the inclusion process of children and youth with Down syndrome in Puerto Rico

Introducción Los jóvenes con discapacidad suelen ser menos activos físicamente que los jóvenes sin discapacidad y existen barreras que limitan el nivel de actividad física en su diario vivir. El propósito de esta investigación cualitativa con diseño fenomenológico fue explorar y describir la experiencia de los padres y entrenadores de equipos deportivos en Puerto Rico, en el proceso de inclusión de niños y jóvenes con síndrome de Down. Método Los participantes fueron 3 entrenadores deportivos y 3 padres de niños y/o jóvenes con síndrome de Down, cuyos hijos fueran estudiantes de los entrenadores. Se llevaron a cabo entrevistas semiestructuradas en las que se encontró que la experiencia para los padres fue positiva en términos de los beneficios físicos y sociales que brinda el realizar actividad física junto con niños o jóvenes típicos. Resultados Pudieron ser identificados diferentes barreras y facilitadores para el proceso de inclusión y los entrenadores se consideran una herramienta clave en este proceso. Los fisioterapeutas fueron identificados como facilitadores de la inclusión, por su rol como promotores de salud, desarrollo y actividad física. Conclusiones Existe un espacio de oportunidad para la creación y promoción de más programas de deporte inclusivo, y se resaltó la importancia de que profesionales de la salud como los fisioterapeutas estén involucrados en la promoción de la inclusión y educación a los padres de niños o jóvenes con síndrome de Down sobre alternativas disponibles para que sus hijos estén físicamente activos (AU)

Introduction Children and young people with disabilities are usually less physically active than young people without disabilities with barriers that limit the levels of physical activity in their daily lives. The purpose of this qualitative research with phenomenological design was to explore and describe the experience of parents and coaches of sports teams in Puerto Rico, in the inclusion process of children and young people with Down syndrome. Method The participants were 3 sports coaches and 3 parents of children and/or young people with Down syndrome, whose children were students of the coaches. Semi-structured interviews were carried out in which it was found that the experience for the parents was positive in terms of the physical and social benefits provided by performing physical activity together with typical children or young people. Results Different barriers and facilitators were identified for the inclusion process and the sports coaches are considered a key tool in this process. Physiotherapists were identified as facilitators of inclusion, due to their role as promoters of health, development, and physical activity. Conclusions There is a window of opportunity for the creation and promotion of more inclusive sports programmes, and the importance is highlighted of health professionals such as physiotherapists being involved in promoting the inclusion and education of parents of children or young people with Down syndrome on available alternatives for their children to be physically active (AU)

Parsonage-Turner posterior a vacunación antirrábica por mordedura de murciélago: comunicación de un caso / Parsonage-Turner after rabies vaccination due to bat bite: case report

Introducción:Paciente adulto masculino que consulta por mordedura de murciélago. Se realiza aplicación de vacuna antirrábica y toxoide tetánico, tras lo cual presenta alteraciones motoras, sensitivas y dolor de difícil manejo en el miembro superior derecho. Siendo un reto diagnóstico de manera inicial, posterior a estudios electrofisiológicos se consideró un síndrome de Parsonage-Turner. Este caso es relevante por la asociación de vacuna antirrábica no descrita en antecedentes de inmunización en revisiones previas.Caso clínico:Se le realizaron varias pruebas diagnósticas e imágenes como ecografías, resonancia magnética y estudios electrofisiológicos los cuales confirmaron el diagnóstico de neuritis braquial (síndrome de Parsonage-Turner). El paciente recibió intervenciones quirúrgicas con fascitomías y neurólisis, además de múltiples manejos farmacológicos para dolor, incluyendo opioides fuertes, neuromoduladores, antidepresivos y medicamentos por bomba intratecal, con disminución solo del 50 % de los síntomas de dolor y afectación a su calidad de vida.Conclusión:El caso nos muestra cómo el síndrome de Parsonage-Turner, una enfermedad neurológica con etiología desconocida, se puede cronificar en un síndrome doloroso al no tener un diagnóstico temprano o someter al paciente procedimientos no indicados. Este síndrome debe considerarse en la atención de urgencias y consulta externa por sus consecuencias a largo plazo y el difícil manejo de los síntomas crónicos. Hay una relación causal reportada en la literatura con el toxoide tetánico, pero este se aplicó previo a los síntomas; no hay referencias de inicio de síntomas posterior a la vacuna antirrábica, lo cual puede generar a futuro, una relación causal si se encontraran nuevos casos.(AU)

Introduction:Adult male patient who suffers a bat bite, after which rabies vaccine and tetanus toxoid are administered; later, he presents on the right upper limb severe motor, sensory and pain disorders. Initially a diagnostic challenge, after electrophysiological studies, Parsonage-Turner syndrome was considered. This case is relevant since the association between rabies vaccine and this syndrome has not been described.Clinical case:Several diagnostic tests and images were performed, including ultrasound, magnetic resonance and electrophysiological studies, which confirmed the diagnosis of brachial neuritis (Parsonage-Turner syndrome). Even though the patient received surgical interventions with fasciotomies and neurolysis as well as multiple pharmacological pain management with strong opioids, neuromodulators, antidepressants and intrathecal pump medications, there was a 50 % decrease in pain symptoms and an impairment of their quality of life.Conclusion:The case shows a Parsonage-Turner syndrome, a neurological disease with unknown etiology, with difficult diagnosis which can lead to chronic pain syndrome or unnecessary surgical procedures. This syndrome should be considered in emergency care and outpatient care due to its long-term consequences and the difficult management of chronic symptoms. There is a causal relationship reported in the literature with tetanus toxoid, but it was applied prior to symptoms; there are no reports of onset of symptoms after the rabies vaccine, which may generate a causal relationship in the future if new cases are found.(AU)

Early ovarian follicular development in prepubertal Wistar rats acutely exposed to androgens.

Androgens may directly modulate early ovarian follicular development in preantral stages and androgen excess before puberty may disrupt this physiological process. Therefore, the aim of this study was to investigate the dynamics of follicular morphology and circulating androgen and estradiol levels in prepubertal Wistar rats acutely exposed to androgens. Prepubertal female Wistar rats were distributed into three groups: control, equine chorionic gonadotropin (eCG) intervention and eCG plus dehydroepiandrosterone (DHEA) intervention (eCG+DHEA). Serum DHEA, testosterone and estradiol levels were determined, and ovarian morphology and morphometry were assessed. The eCG+DHEA group presented increased serum estradiol and testosterone levels as compared with the control group (P<0.01), and higher serum DHEA concentration v. the eCG-only and control groups (P<0.01). In addition, the eCG+DHEA group had a higher number of, and larger-sized, primary and secondary follicles as compared with the control group (P<0.05). The eCG group presented intermediate values for number and size of primary and secondary follicles, without significant differences as compared with the other two groups. The number of antral follicles was higher in the eCG+DHEA and eCG groups v. controls (P<0.05). The number of primordial, atretic and cystic follicles were similar in all groups. In conclusion, the present experimental model using an acute eCG+DHEA intervention was useful to investigate events involved in initial follicular development under hyperandrogenic conditions, and could provide a reliable tool to study defective follicular development with possible deleterious reproductive consequences later in life.