La determinación social del autismo en población infantil ecuatoriana / The Social Determination of Autism in an Ecuadorian Child Population / A determinação social do autismo na população infantil equatoriana

Resumen Introducción: la determinación social del autismo es un análisis desde la perspectiva de la epidemiología crítica, cuyo objetivo es entender el autismo de forma integral, es decir, desde su realidad individual y colectiva. El propósito del estudio fue identificar las condiciones y las características diferenciales de las familias de niños con y sin autismo. Analizar cómo estas condiciones están presentes con mayor o menor fuerza, tanto en los casos como en los controles, para profundizar en el conocimiento de la situación de la población infantil autista en el país. Evaluar los procesos protectores y destructivos que los rodean, y levantar hipótesis para confrontarlas en futuros estudios. Desarrollo: se trata de comprender cómo estas lógicas de poder se expresan en procesos destructores o protectores del metabolismo sociedad-naturaleza en sus modos de vida, y analizar cómo estos pueden intervenir en el genotipo y en el fenotipo. Un estudio transversal fue realizado en 2016 con 69 niños diagnosticados con autismo y 91 niños neurotípicos, en una edad comprendida de 2 a 12 años, provenientes de Quito y Guayaquil. La investigación reveló que un 56.5 % de la población autista se ubicó en la capa media (Quito) y pobre (Guayaquil), condición que limitó el acceso al diagnóstico temprano: el 73.4 % de padres detectó los signos de alarma antes de los 3 años, y acudió al pediatra sin poder obtener un diagnóstico acertado. La población de la capa pobre presentó un mayor porcentaje de comorbilidades que las registradas en la capa media. El gasto requerido fluctuó entre 100 y 25 mil dólares, según la inserción social. Conclusión: estos resultados muestran una clara diferenciación entre los modos de vida, de acuerdo con la condición socioterritorial de la muestra.

Abstract Introduction: The social determination of autism is an analysis from the perspective of the critical epidemiology and the neurodiversity paradigm, which objective is to understand autism holistically, therefore insertion from a personal reality to a group. The purpose of the study was to identify differential conditions and characteristics of families with children diagnosed with autism and families with children not diagnosed with autism and to analyze how these conditions are present with more or less strength in cases or in controls, to get to know the situation of autism disorder diagnosed children in the country. The investigation also evaluated the protective and destructive processes that surround them, with the purpose of raising hypothesis to confront in future studies. Development: The research focused on understanding how these logics are expressed in destructive or protective processes of the society-nature metabolism in their ways of life and analyzing how these intervene in the genotype and phenotype. A cross-sectional study conducted in 2016 in the cities of Quito and Guayaquil, with 69 autism disorder diagnosed children and 91 neurotypical children, aged 2 to 12, revealed that 56.5 % of the population with autism appears to be in the middle social and economic class in Quito and the poor social and economic one in Guayaquil. Their social and economic conditions limit the access to early diagnosis: 73.4 % of parents detected the signs of alarm before the children were three years old and took them to be evaluated by the pediatrician, without being able to obtain an accurate diagnosis. The population of a poor social and economic class presented a higher percentage of comorbidities than the one located in the middle class. The required expenditure fluctuated between 100 to 25 thousand dollars, according to the social insertion. Conclusion: These results show a clear differentiation between lifestyles, according to the socio-territorial condition of the sample.

Resumo Introdução: a determinação social do autismo (DSA), é uma análise desde a perspectiva da epidemiologia crítica, cujo objetivo é entender o autismo em forma integral, portanto, desde sua realidade individual e coletiva. O propósito do estudo foi identificar as condições e características diferenciais da família de crianças com e sem autismo. Analisar como estas condições estão presentes com maior ou menor força tanto nos casos quanto nos controles, para aprofundar no conhecimento da situação das crianças com autismo no país. Avaliar os processos protetores e destrutivos que os rodeiam, e levantar hipóteses a ser confrontadas em futuros estudos. Desenvolvimento: tenta-se compreender como estas lógicas de poder, se expressam em processos destrutores ou protetores do metabolismo sociedade-natureza em seus modos de vida, e analisar como estes podem intervir no genótipo e fenótipo. Um estudo transversal realizado no 2016, com 69 crianças diagnosticadas com autismo e 91 crianças neurotypical, em uma idade compreendida de 2 a 12 anos e provenientes de Quito e Guayaquil. O estudo revelou que um 56.5 % da população com autismo localizou-se na capa meia (Quito) e pobre (Guayaquil), condição que limitou o acesso ao diagnóstico temporão: o 73.4 % dos pais, detectara os signos de alarma antes dos 3 anos, e foi ao pediatra sem conseguir obter um diagnóstico acertado. A população da capa pobre apresentou uma maior percentagem de co-morbidades que as registradas na capa meia. O gasto requerido flutuou entre 100 até 25 mil dólares, segundo a inserção social. Conclusão: estes resultados mostram uma clara diferenciação entre os modos de vida, de acordo à condição sócio territorial da amostra.

Optimization of rhein-loaded polymeric nanoparticles using a factorial design and evaluation of the cytotoxic and anti-inflammatory effects.

The aim of the work was to develop rhein loaded polymeric nanoparticles (R-PNPs). Nanoparticles were prepared by three methods, solvent emulsion-evaporation, double emulsion, and nanoprecipitation, by means of experimental design. Additionally, the effects of the best formulation on in vitro cytotoxicity and inflammation were evaluated. The solvent emulsion-evaporation method presented the highest encapsulation efficiency of the three techniques (38.41%), as well as had a mean diameter of 189.33 nm and a polydispersity index of less than 0.1. Despite efforts to optimize the encapsulation of rhein, the drug release from nanoparticles was close to 50% during the first 5 min, followed by a continuous release within 60 min. It was observed that macrophages exposed to the highest concentration of R-PNPs showed cell viability about 80% and at the lowest nanoparticle concentrations was closed to 100%. IL-1ß in cell culture supernatants was decreased in the presence of R-PNPs and TNFα concentrations were lower than the sensitivity of the assay. ROS production was only inhibited with R-PNPs at concentrations of 2.5 and 5 µM. In conclusion, the solvent emulsion-evaporation was the best method evaluated to obtain nanoparticles with the desired specifications. It was possible to assess R-PNPs with low cytotoxicity and anti-inflammatory properties showed by the inhibition of IL-1ß production and a low decrease in ROS production.

Autismo en Ecuador: Un grupo social en espera de atención / Autism in Ecuador: A social group waiting for attention

Resumen Aunque se han dado vigorosos avances históricos en torno a definir las características de las personas que tienen una conducta que puede estar dentro del Espectro Autista, aún queda por atender, y de manera urgente, a los procesos, la exactitud y la rigurosidad que se debe emplear en el diagnóstico. Ecuador no escapa a esta realidad. El presente estudio pionero en el campo del autismo a nivel nacional, hecho con 160 niños y niñas de la costa y de la sierra, 80 diagnosticados con autismo junto con otros 80 neurotípicos, destaca la necesidad de atender estos tópicos. Se concluyó por medio de encuestas y confirmación de casos, que incluyó de forma innovadora el análisis de inserción social, que los procesos diagnósticos demandan ingentes gastos económicos, y varían según la inserción social y la ubicación socio espacial; el 26% de los niños del grupo de estudio recibió entre 1 a 5 diferentes diagnósticos previos, el 13,75% fue diagnosticado erróneamente, el 46,2% en Guayaquil y el 23,7% en Quito, gastaron más de 1000 dólares en búsqueda de ese ansiado diagnóstico. La presente investigación de tipo caso-control con niños/as de entre 2 a 12 años, provenientes de Quito y Guayaquil, permitió conocer la situación real del autismo en el Ecuador, objetivo que reveló grandes problemáticas en lo que respecta a la forma de obtener el diagnóstico, y los procesos terapéuticos; datos que se entrelazan con la situación socioeconómica de los padres estudiados.

Summary Although increasing historical progresses have been achieved in defining the characteristics on an unusual behavior among people who could be on the autism spectrum disorder, still remains processes, accuracy and preciseness that must be used in order to get a diagnosis, which requires an urgent attention. Ecuador is also part of this reality. This study is the first research that has been performed in the country, with 160 school-aged boys and girls coming from the mountains and the coast of Ecuador, 80 diagnosed with autism, and 80 neuro-typical kids. The results reveal the necessity to attend this matter. Surveys and confirmation cases including an innovative way of social insertion analysis show that the diagnostic processes demands important economical resources, and these economical resources could vary according to social insertion, and socio-spatial location; 26% of the children that were part of this study, received between 1 to 5 previous different diagnosis, 13,75% were mistakenly diagnosed; 46,2% of them, that were from the city of Guayaquil, and 23,7% from the city of Quito, spent more than one thousand dollars trying to get the diagnosis. This case-control study with children between ages of 2 and 12 years old, from Quito and Guayaquil, allows us to know the real situation of autism in Ecuador. It reveals major problems regarding on how to obtain a diagnosis, a therapeutic process, most of them related to the socio economical situation of the parents that were part of this study.

Development, characterization and in vitro evaluation of biodegradable rhein-loaded microparticles for treatment of osteoarthritis.

Rhein is an active metabolite of the drug diacerein, whose anti-inflammatory properties have been demonstrated in both in vitro and in vivo models. However, the low oral bioavailability of rhein has limited its utility as a potential treatment of osteoarthritis (OA), a chronic inflammatory disease. In order to overcome this limitation, the aim of this work was the development of a drug delivery system intended for intra-articular administration of rhein, based on polymeric biodegradable PLGA microparticles (MPs) loaded with the drug. The MPs, prepared by the emulsion-solvent evaporation technique were characterized in terms of several parameters including morphology, encapsulation efficiency, molecular interactions between components of the formulation and in vitro release profiling. Furthermore, cell-based in vitro studies were performed to evaluate the cytotoxicity of the formulations and their effect on the release of inflammatory markers including pro-inflammatory cytokines and reactive oxygen species (ROS). Scanning electron microscopy demonstrated that the prepared MPs exhibited an almost spherical shape with smooth surface. The size distribution of the prepared MPs ranged between 1.9 and 7.9µm, with mean diameter of 4.23±0.87µm. The optimal encapsulation efficiency of rhein was 63.8±3.0%. The results of powder X-ray diffraction and differential scanning calorimetry studies demonstrated that the active ingredient is partially the crystalline state, dispersed in the polymer matrix. This outcome is somewhat reflected in the release kinetics of rhein from the MPs. The cytotoxicity evaluation, carried out in macrophages derived from THP-1 cells, showed that both rhein-loaded MPs and unloaded MPs did not significantly affect the cell viability at MP concentrations up to 13.8µM. In lipopolysaccharide-activated macrophages, the rhein-loaded MPs significantly decreased the production of interleukin-1ß (IL-1ß) and (ROS), when compared to the unloaded MPs. In conclusion, the results of this preliminary study suggest that an MP-based formulation of rhein could be tested in animal models of inflammation, aiming for an injectable commercial product capable of providing a therapeutic solution to patients suffering from chronic joint diseases.