Una aproximación al análisis bioético del paradigma de las neurociencias en el estudio del autismo / An approach to the bioethical analysis of the paradigm of neurosciences in the study of autistic disorder

Resumen Dada las peculiares características del autismo, la diversidad de sus formas y la gravedad a la que puede arribar este cuadro, profesionales e investigadores posicionados desde distintos paradigmas se ocupan por comprenderlo y detectarlo tempranamente. Cada paradigma define su campo de investigación y las metodologías que va a emplear para abordar el problema de investigación, sostenido y fundado en supuestos teóricos que explican la realidad y que están en consonancia con la comunidad científica a la que reconocen como legítima. Creemos que la forma en la que se comprende el autismo desde el paradigma de la neurociencia es un problema susceptible de ser abordado también desde la perspectiva bioética, en función a las conductas y las prácticas de los individuos que llevan a cabo las investigaciones en este campo. Se hace necesario profundizar sobre las implicancias bioéticas que tiene la aplicación de los avances tecnológicos y la introducción de máquinas e instrumentos en el estudio y experimentación con niños en búsqueda de la medición de sus manifestaciones corporales. Reflexionar desde una perspectiva bioética genera la posibilidad de introducir nuevos enunciados ante el posible riesgo de caer en posturas que objetualizan y reducen la complejidad del sujeto a un mero mecanismo, desestimando así como opera el concepto de niñez y la singularidad en cada caso.

Abstract Considering the peculiar characteristics of autism, the diversity of its shapes and the gravity of its diagnosis, researchers and professionals from different paradigms try to understand and detect the symptoms early. Each paradigm defines the field of research based on theoretical assumptions that explain reality and that are consistent with the scientific community recognised as legitimate. We believe that the understanding of autism according to the paradigm of neurosciences deserves also to be addressed from the bioethics perspective, regarding the behaviors and practices of those researchers working in this field. It is necessary to deepen into the bioethical implications of the application of technological advances and the introduction of machines and tools in the study and experimentation with children, in the attempt to measure body manifestations. Reflecting from the bioethics perspective provides the possibility of introducing new statements in the face of the possible risk of falling into positions that objectify and reduce the complexity of the child to a simple mechanism, thus dismissing how the concept of childhood and singularity operates in each case.

La formación de los médicos y la literatura. Proyecto grupo de investigación: literatura y medicina. / The education of medical doctors and literature. Research group project: literature and medicine

Este artículo fue llevado adelante por docentes y estudiantes de los Departamentos de Ciencias de la Salud, HumanidadesFilosofía y Letras, de la Universidad del Sur. Se inició un proyecto que integre las diferentes perspectivas y que permita reflexionar y proponer distintos debates, cuestiones o problemas, con el objetivo de encontrar un diálogo fecundo entre las "ciencias" de la salud, la literatura y los planteos filosófico-existenciales.

This article was written by professors and students of the Departments of Health Sciences and Humanities -Philosophy and Literature- of the Universidad Nacional del Sur. A research project integrating the different perspectives and allowing for reflection was carried out. Different debates, issues or problems were proposed with the aim of reaching a productive dialogue among health "sciences", literature, and philosophic-existential arguments.

Quantitative sensory testing in trigeminal traumatic neuropathic pain and persistent idiopathic facial pain.

The objective of this article was to investigate, with a systematic protocol of quantitative sensory testing, patients with persistent idiopathic facial pain (PIFP) and others with trigeminal traumatic neuropathic pain (TTN) compared to controls. Thirty patients with PIFP, 19 with TTN, and 30 controls were evaluated on subjective numbness and dysesthesia and with a systematic protocol of quantitative sensory testing for thermal evaluation (cold and warm), mechanical detection (touch and pinpricks for mechanical pain), superficial pain thresholds, and corneal reflex. We found that PIFP and TTN had numbness and dysesthesia higher than controls (p<0.001 and p=0.003), and that in both of them mechanical pain by pinpricks detection was abnormal intra and extra orally at the mandibular branch (p<0.001). Cold, warm, and tactile detections and pain thresholds were similar among the groups. Corneal reflex was abnormal in TTN (p=0.005). This study supports neuropathic mechanisms involving pain processing in PIFP and that the criterion on absence of sensorial variations in PIFP should be revised.

Quantitative sensory testing in trigeminal traumatic neuropathic pain and persistent idiopathic facial pain / Teste sensitivo quantitativo em dor neuropática trigeminal pós-traumática e dor facial idiopática persistente

The objective of this article was to investigate, with a systematic protocol of quantitative sensory testing, patients with persistent idiopathic facial pain (PIFP) and others with trigeminal traumatic neuropathic pain (TTN) compared to controls. Thirty patients with PIFP, 19 with TTN, and 30 controls were evaluated on subjective numbness and dysesthesia and with a systematic protocol of quantitative sensory testing for thermal evaluation (cold and warm), mechanical detection (touch and pinpricks for mechanical pain), superficial pain thresholds, and corneal reflex. We found that PIFP and TTN had numbness and dysesthesia higher than controls (p<0.001 and p=0.003), and that in both of them mechanical pain by pinpricks detection was abnormal intra and extra orally at the mandibular branch (p<0.001). Cold, warm, and tactile detections and pain thresholds were similar among the groups. Corneal reflex was abnormal in TTN (p=0.005). This study supports neuropathic mechanisms involving pain processing in PIFP and that the criterion on absence of sensorial variations in PIFP should be revised.

O objetivo deste artigo foi investigar, com um protocolo sistemático de testes sensitivos quantitativos, pacientes com dor facial idiopática persistente (DFIP) e outros com dor neuropática trigeminal traumática (DNTT) comparado aos controles. Trinta pacientes com DFIP, 19 com DNTT e 30 controles foram avaliados quanto à dormência e à disestesia subjetiva e por meio de um protocolo sistemático de testes sensitivos quantitativos, que incluiu avaliação térmica (frio e quente), detecção mecânica (táctil e alfinetes), limites de dor superficial e reflexo córneo-palpebral. Foi observado que os pacientes apresentaram mais dormência e disestesia do que os controles (p<0,001 e p=0,003), além de mais anormalidades intra e extraorais no ramo mandibular (p<0,001). As alterações de calor, frio, dor e tato foram semelhantes entre os grupos. O reflexo córneo-palpebral foi anormal somente no grupo com DNTT (p=0,005). Este estudo suporta mecanismos de dor neuropática envolvidos no processamento da DFIP, e o critério de ausência de variações sensoriais nesta deve ser revisto.

Facial sensibility of patients with trigeminal neuralgias.

OBJECTIVES: Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. METHODS: 18 patients with PHN and 26 patients with ITN were diagnosed by the IASP criteria. They were evaluated with a systematic approach, which included mechanical, thermal (cold and warm) and painful stimuli. RESULTS: We found statistical significance at the ophthalmic branch of PHN in pain (p=0.001), tactile (p=0.002), cold (p=0.016) and warm (p=0.013); in ITN, the maxillary branch had higher threshold with pinpricks (p=0.016) and the mandibular branch had higher tactile threshold. CONCLUSIONS: The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.

Regeneração óssea guiada em defeitos extensos pós-exodontias utilizando membrana exposta ao meio bucal / Guided bone regeneration after tooth extraction using membrane exposed to the oral environment. Case reports

Este artigo traz dois casos clínicos de pacientes que apresentaram defeitos ósseos extensos após exodontias. Os defeitos foram protegidos com barreira regenerativa de polipropileno, exposta ao meio bucal, a qual foi removida uma semana após a cirurgia. Nenhum tipo de biomaterial foi usado para preencher o defeito a ser reparado, apenas sangue. A literatura científica enfatiza a importância de manter as dimensões do rebordo alveolar depois de extrações dentárias, principalmente visando a colocação de implantes osseointegráveis. Entretanto, nem sempre se consegue um rebordo que permita a estabilidade do implante, ou boa estética, principalmente em casos quando há defeitos ósseos extensos. Os casos apresentados mostram que no período avaliado foi possível conseguir a preservação de um rebordo alveolar que deu condições de inserção de implantes e que também favoreceu a estética. O uso da técnica de regeneração óssea guiada através de barreira de polipropileno e que fique exposta ao meio bucal é viável e reduz a morbidade de cirurgias mais traumáticas.

This article presents two cases of patients who had advanced bone defects after dental extraction. The defects were covered with a polypropylene membrane, exposed to the oral environment, which was removed one week after surgery. The scientific literature emphasizes the importance of maintaining the dimensions of the alveolar ridge after tooth extraction, mainly targeting the placement of dental implants. However, extensive bone defects oftentimes prevent an alveolar ridge that enables the stability of the implant or good esthetics, particularly in those cases. The cases presented showed that during the period evaluated it was possible to achieve preservation of alveolar ridge providing conditions for implant placement, which also favored the aesthetic result. The use of guided bone regeneration technique with a polypropylene barrier exposed to the oral environment is feasible and reduces the morbidity during traumatic surgeries.

Evaluation of the sensation in patients with trigeminal post-herpetic neuralgia.

BACKGROUND: Post-herpetic neuralgia (PHN) is one complication after herpes zoster infection, which may affect the facial superficial sensitivity. METHODS: Eighteen patients with PHN were interviewed and evaluated according to a systematized sensitivity approach, including mechanical, thermal and pain. RESULTS: The pain location was V1 in 15 patients. All trigeminal branches from both facial sides were evaluated; we compared the affected with the opposite side. There was a significant difference at V1 with cold (P=0.038), vonFrey (P=0.008) and pinpricks (P=0.022); at V2, the statistical difference occurred with cold (P=0.034), heat (P=0.019) and pinpricks (P=0.037); at V3, differences occurred with cold (P=0.042) and heat (P=0.036). Only V1 and oral mucosa (V2-3) presented pain threshold differences between both sides (P=0.001, P=0.021). CONCLUSION: Age, predominance of trigeminal PHN in V1 and continuous burning pain was common and similar to literature. Sensation was hampered with evident deficits of all sensory modalities in the affected trigeminal areas, especially V1.