Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article).

BACKGROUND: The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. PATIENT AND METHODS: The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. RESULTS: A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009-211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). CONCLUSION: The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. CLINICAL RELEVANCE: The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.

Modification of collagen-based sponges can induce an upshift of the early inflammatory response and a chronic inflammatory reaction led by M1 macrophages: an in vivo study.

BACKGROUND: The present study evaluated the cellular tissue reaction of two equine-derived collagen hemostatic sponges (E-CHS), which differed in thickness after pressing, over 30 days in vivo. The inflammatory response during physiological wound healing in sham-operated animals was used as control group. MATERIAL AND METHODS: First, the E-CHS was pressed by applying constant pressure (6.47 ± 0.85 N) for 2 min using a sterile stainless-steel cylinder until the material was uniformly flattened. Consequently, the original (E-CHS), the pressed (P-E-CHS), as well as the control group (CG; sham operation) were studied independently. The 3 groups were evaluated in vivo after subcutaneous implantation in Wistar rats during 3, 15, and 30 days. Histochemical and immunohistochemical methods provided observations of biomaterial degradation rate, cellular inflammatory response, and vascularization pattern. A derivative of human blood known as platelet-rich fibrin (PRF) was used as an ex vivo model to simulate the initial biomaterial-cell interaction. Segments of E-CHS and P-E-CHS were cultivated for 3 and 6 days with PRF, and the release of pro-inflammatory proteins was measured using ELISA. PRF cultivated alone was used as a control group. RESULTS: At day 3, the CG induced a statistically significant higher presence of monocytes/macrophages (CD68+), pro-inflammatory macrophages (M1; CCR7+), and pro-wound healing macrophages (M2; CD206+) compared to E-CHS and P-E-CHS. At the same time point, P-E-CHS induced a statistically significant higher presence of CD68+ cells compared to E-CHS. After 15 days, E-CHS was invaded by cells and vessels and showed a faster disintegration rate compared to P-E-CHS. On the contrary, cells and vessels were located only in the outer region of P-E-CHS and the biomaterial did not lose its structure and accordingly did not undergo disintegration. The experimental groups induced similar inflammatory reaction primarily with positive pro-inflammatory CD68+/CCR7+ macrophages and a low presence of multinucleated giant cells (MNGCs). At this time point, significantly lower CD68+/CCR7+ macrophages and no MNGCs were detected within the CG when compared to the experimental groups (P < 0.05). After 30 days, E-CHS and P-E-CHS were fully degraded. All groups showed similar inflammatory reaction shifted to a higher presence CD206+ macrophages. A low number of CCR7+ MNGCs were still observable in the implantation bed of both experimental groups. In the ex vivo model, the cells and fibrin from PRF penetrated E-CHS. However, in the case of P-E-CHS, the cells and fibrin stayed on the surface and did not penetrate towards materials central regions. The cultivation of P-E-CHS with PRF induced a statically significant higher release of pro-inflammatory proteins compared to the CG and E-CHS after 3 days. CONCLUSION: Altering the original presentation of a hemostatic sponge biomaterial by pressing modified the initial biomaterial-cell interaction, delayed the early biomaterial's degradation rate, and altered the vascularization pattern. A pressed biomaterial seems to induce a higher inflammatory reaction at early time points. However, altering the biomaterial did not modify the polarization pattern of macrophages compared to physiologic wound healing. The ex vivo model using PRF was shown to be an effective model to simulate the initial biomaterial-cell interaction in vivo. CLINICAL RELEVANCE: A pressed hemostatic sponge could be applied for guided tissue regeneration and guided bone regeneration. In that sense, within the limitations of this study, the results show that the same biomaterial may have two specific clinical indications.

Platelet-rich fibrin secretome induces three dimensional angiogenic activation in vitro.

Different tissue engineering techniques are used to support rapid vascularisation. A novel technique is the use of platelet-rich fibrin (PRF), an autologous source of growth factors. This study was the first to investigate the influence of PRF matrices, isolated following different centrifugation protocols, on human dermal vascular endothelial cells (ECs) in mono-culture and co-culture with human primary fibroblasts (HFs) as an in vitro model for tissue regeneration. Focus was placed on vascular structure formation and growth factor release. HFs and ECs were cultivated with PRF prepared using a high (710 ×g) or low (44 ×g) relative centrifugation force (RCF) over 14 d. Immunofluorescence staining and immunohistochemistry were used to evaluate the microvascular formation. Cell culture supernatants were collected for evaluation of growth factor release. The results showed a PRF-mediated effect on the induction of angiogenesis in ECs. Microvessel-like structure formation was promoted when ECs were combined with low-RCF PRF as compared to high-RCF PRF or control group. The percentage of vascular lumen area was significantly higher in low-RCF PRF, especially at day 7, which coincided with statistically significantly higher growth factor [vascular endothelial factor (VEGF), transforming growth factor ß1 (TGF-ß1) and platelet derived growth factor (PDGF)] concentration measured in low-RCF PRF as compared to high-RCF PRF or control group. In conclusion, reducing the RCF according to the low-speed centrifugation concept (LSCC) resulted in increased growth factor release and angiogenic structure formation with EC mono-culture, suggesting that PRF may be a highly beneficial therapeutic tool for tissue engineering applications.

Relación de las reglas con los medios técnico-tácticos en minibasket / Relationship between rules and technical and tactical contents in minibasket

Las reglas condicionan el desarrollo del juego en cualquier deporte ya que delimita lo que se puede hacer. Se pretende conocer el orden de importancia de las reglas en minibasket, así como los medios técnico-tácticos que se derivan éstas. El método utilizado para la toma de datos ha sido el grupo nominal. Los participantes han sido siete expertos que cumplían unas condiciones mínimas. Con relación a la primera pregunta, el orden de importancia de las reglas ha sido: los pasos, dobles, líneas delimitadoras, faltas, árbitro, reglas de tiempo y puntuación. Con relación a los medios técnico-tácticos que se derivan de las reglas más importantes, a modo de ejemplo, a través de los pasos se aprende el bote, las arrancadas, las paradas, entradas, etc. Estos datos permiten organizar una programación basada en las reglas (AU)

The rules determine the development of the game in every sport because they put a limit to what you can do and what not. The aims of the research were to determine the order of importance of the basic basketball rules as well as the technical and tactical contents deriving from these rules. The method used for the data collection was that of the nominal group technique. The nominal group consisted of seven experts who fulfilled the minimum conditions. Regarding the first question, the order of importance of the rules was: steps, double dribble, lines, fouls, referee, rules regarding time limits and score. With regard to the technical and tactical contents deriving from the most important rules, for example, through the steps’ rules, players can learn starts, stops, lay-up, etc. These data allow organizing a program based on the rules (AU)

Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

Influencia de enseñar minibasket desde las reglas en la disminución de las infracciones reglamentarias / Influência do ensino Minibasket das regras para disminuir violações regulatórias / How infractions to the rules are influenced by the teaching of minibasket from teaching its rules

La enseñanza de las reglas ha sido poco estudiada en la iniciación al baloncesto a pesar de su incidencia en el juego. Así, se diseñó y aplicó un programa de intervención con un equipo de minibasket que se basaba en la enseñanza de las reglas. El objetivo principal fue conocer la evolución de las infracciones cometidas por el equipo objeto de estudio (grupo experimental, GE) a lo largo de las competiciones. Como hipótesis de la investigación se plantea que el GE infringe en menos ocasiones el reglamento comparado con los grupos control (GC). Para el estudio se usó un diseño cuasi-experimental de mediciones sucesivas a través de la observación descriptiva. El GE estaba compuesto por 14 jugadores masculino, con edades comprendidas entre 6 y 7 años. Los GC fueron los equipos contra los que se enfrentó el GE en competición. Se observaron diez partidos entre el GE y los cinco GC. Los resultados indican que el GE cometió menos infracciones de forma significativa en cuanto a las faltas personales, dobles y pasos que los GC. Sin embargo, el GE realizó más faltas de saque que los GC, de forma significativa. A modo de conclusión, el programa de iniciación al minibasket, basado en la enseñanza de las reglas, ha sido eficaz con relación a la disminución de infracciones como faltas, dobles y pasos tanto en la mejora a lo largo de la temporada como con relación a los equipos rivales (AU)

O ensino das regras tem sido pouco estudada no mini-basquetebol apesar de seu impacto no jogo. Então, nós projetamos e executamos um programa de intervenção com uma equipe de mini-basquete que foi baseado no ensino das regras. O principal objetivo foi determinar a evolução das violação das regras cometidas pela equipe em estudo (grupo experimental, a GE) em toda a competição. A hipótese é proposto que a GE faz violação das regras menos frequentemente em comparação com os grupos de controle (GC). Para o estudo utilizou um desenho quasi-experimental de medições repetidas através da observação descritiva. A GE consistiu de 14 jogadores do sexo masculino, com idades entre 6 e 7 anos. O GC foram as equipes que jogaram contra GE durante a competição. Foram observados dez partidas. Os resultados indicam que a GE mostraram significativamente menos violações das regras relativas faltas pessoais, duplos e as etapas que o GC. Em conclusão, o programa de intervenção para ensinar mini-basquetebol, com base nos ensinamentos das regras, tem sido eficaz no que respeita à diminuição no infracções das regras ao longo da estação, em comparação com as equipas rivais (AU)

The teaching of the rules has been little studied in mini-basketball despite their impact on the game. So, we designed and implemented an intervention program with a team of mini-basketball which was based on the teaching of the rules. The main objective was to determine the evolution of the infractions committed by the team under study (experimental group, GE) throughout the competition. As hypothesis is proposed that the GE makes infractions less frequently compared to the control groups (GC). For the study used a quasi-experimental design of repeated measurements through descriptive observation. The GE consisted of 14 male players, aged between 6 and 7 years. The GC were the teams which played against GE during the competition. Ten matches were observed. The results indicate that GE showed significantly fewer violations regarding personal fouls, double and steps that the GC. In conclusion, the intervention program to teach mini-basketball, based on the teaching of the rules, has been effective in relation to the decrease in infractions throughout the season as compared to rival teams (AU)

[Spirometry quality in preschool children]. / Calidad de la espirometría en preescolares.

BACKGROUND: Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). METHOD: A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. RESULTS: A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. CONCLUSIONS: Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care.

Calidad de la espirometría en preeescolares / Spirometry quality in preschool children

Fundamento: La realización de maniobras espirométricas de calidad en niños preescolares tanto en el diagnóstico como en el seguimiento de enfermedades respiratorias sigue siendo muy escaso, por diversas razones entre las que se encuentran la falta de un consenso en los criterios de calidad y aceptabilidad de la prueba. Por ello, se inició este estudio con el fin de obtener ecuaciones de referencia provenientes de una población de niños preescolares sanos de la Comunidad Foral de Navarra (España). Métodos: Se incluyeron un total de 114 niños preescolares sanos con edades comprendidas entre los 3 y los 7 años y sin experiencia previa en la realización de estudios de función pulmonar. Resultados: Un total de 76 fueron capaces de realizar al menos dos maniobras espirométricas de aceptables y de ellos 60 aceptables y reproducibles, de acuerdo a los criterios ATS/ERS, lo cual representa un porcentaje global de éxito de 59%. El fallo más habitual fue la terminación prematura y brusca de la maniobra espirométrica, seguido de un pico espiratorio inadecuado. Conclusiones: Más de la mitad de los preescolares fueron capaces de realizar espirometrías de calidad. Nuestros datos permiten recomendar los criterios de calidad propuestos, como adecuados para su uso rutinario, y fomentar el uso de la espirometría en la práctica clínica habitual, dentro del entorno de la atención especializada (AU)

Background: Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). Method: A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. Results: A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. Conclusions: Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care (AU)

Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult.

INTRODUCTION: Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intra-abdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE: A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION: Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION: Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach.

[Experiences and changes in parents of children with infant cerebral palsy: a qualitative study]. / Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo.

BACKGROUND: The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. METHODS: A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. RESULTS: The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. CONCLUSIONS: In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program.

PURPOSE: The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile. METHODS: Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development. RESULTS: Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly. CONCLUSION: The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.

Experiencias y cambios en los padres de niños con parálisis cerebral infantil: estudio cualitativo / Experiences and changes in parents of children with infant cerebral palsy: a qualitative study

Fundamento. El diagnóstico de parálisis cerebral infantil (PCI) supone un evento de carácter traumático que puede provocar una multitud de efectos y cambios en el entorno familiar. Se pretende conocer cuáles son las principales dificultades que encuentran los padres en el proceso de parentalidad, especialmente en los primeros momentos tras el diagnóstico. Método. Se realizó un estudio fenomenológico de carácter cualitativo a través de entrevistas semi-estructuradas. Participaron 16 padres y madres cuyos hijos estaban diagnosticados de PCI. El análisis de los datos se llevó a cabo con el software Atlas.ti6.2 a través de una codificación abierta. Resultados. La recepción de la noticia es percibida como un acontecimiento inesperado que obliga a restructurar las expectativas con respecto a su hijo. La forma de relacionarse con el hijo con PCI es diferente a la que se establece con otros niños, centrándose sobre todo en las posibilidades de mejora y en la evolución de su hijo en el futuro. Se observan cambios en diferentes aspectos de la vida de estos padres como el tiempo, la situación económica y laboral, así como las relaciones de pareja. Conclusiones. En la atención a niños con PCI es necesario incorporar y tomar en cuenta la problemática de los padres, especialmente en los primeros momentos del diagnóstico. El proceso de crianza de un hijo con PCI conlleva un gran número de cambios en la dinámica familiar por lo que se necesita abordarlos mediante una perspectiva global (AU)

Background. The diagnosis of infant cerebral palsy (ICP) is a traumatic event that can provoke multiple effects and changes in the family. The aim of the study is to discover the difficulties that parents face in the process of parenting, especially in the initial period following diagnosis. Methods. A qualitative study was carried out through semi-structured interviews. Sixteen mothers and fathers whose children were diagnosed with cerebral palsy participated in the study. Data analysis was performed with Atlas.ti 6.2 software following a strategy of open coding. Results. The reception of the diagnosis is perceived as an unexpected event that makes parents change expectations and hopes related to their children. The mode of relation with the child with ICP is different from that with other children as parents are more focused on the possibility of improvement and the future evolution of their child. Changes in different aspects of the lives of these parents are shown, such as demands on time, their economic and labour situation, as well as the relationship of the couple. Conclusions. In providing care for children with cerebral palsy it is necessary to take the problems of the parents into account, especially in the initial period after diagnosis. The process of parenting a child with cerebral palsy entails many changes in the family so a global perspective is needed to organize interventions (AU)

[Program of sanitary education for people with autistic spectrum disorder]. / Programa de educación sanitaria para personas con trastornos del espectro autista.

INTRODUCTION: Autism is a developmental disorder that it is characterized by a qualitative alteration of social interaction, communication and repetitive and stereotyped behaviours, interests and activities. Recent studies about health are showing that people with autism have lower hope of life. Among other causes, difficulty to identify and to communicate uneasiness and resistance to allow medical explorations are important factors to consider. AIMS: To design and to implant a specific program for people with Autistic Spectrum Disorder (ASD) with the objective of habituating them to the medical explorations so that they admit it and collaborate, facilitating the sanitary personnel's work. Our aim was to evaluate the effectiveness of the program and the maintenance of the potentials improvements. METHOD: Our sample was formed by twenty-two children with ASD (mean chronological age, 9;10 years). A quasi-experimental design of interrupted temporary series was carried out. VARIABLES: two grouping variables (clinical characteristics of the groups about QI and about linguistic abilities) as dependent variable a measure of percentage of success has been used through an observation protocol designed for this program. RESULTS: Improvements in all the groups. Results are not conditioned neither for the level of intellectual abilities (IQ) neither for the existence or not of linguistic abilities. Likewise, it is found that carrying out maintenance sessions in period of seven weeks allows to maintain long term achievements reached by the program. However, we found that those children which were severely impaired could obtain more benefit from more frequent maintenance sessions.

Programa de educación sanitaria para personas con trastornos del espectro autista / Program of sanitary education for people with autistic spectrum disorder

Introducción: El autismo es un trastorno del desarrollo que se caracteriza por la presencia de una alteración cualitativa de la interacción social, de la comunicación y por patrones de comportamiento, intereses y actividades restringidos, repetitivos y estereotipados. Los escasos estudios sobre salud apuntan que estos pacientes pueden tener una esperanza de vida inferior a la población normal. Entre otras causas, la dificultad para identificar y comunicar malestar y la resistencia a permitir exploraciones médicas son factores que hay que considerar. Objetivo: Diseñar e implantar un programa específico para personas con trastorno del espectro autista (TEA) con el objetivo de habituarles a las exploraciones médicas para que las permitan y colaboren, facilitando el trabajo del personal sanitario. El objetivo es evaluar la eficacia del programa y el mantenimiento de las potenciales mejoras. Método: La muestra está compuesta por 22 niños con TEA (edad media, 9; 10 años). Se ha realizado un diseño cuasi-experimental de series temporales interrumpidas. Las variables utilizadas son: dos variables agrupadoras (características clínicas de los grupos en función del cociente intelectual y de las habilidades lingüísticas), y como variable dependiente se ha utilizado una medida de porcentaje de éxito a través de un protocolo de observación diseñado para este programa. Resultados: Mejoras en todos los grupos. Los resultados no se ven condicionados ni por el nivel de competencia intelectual ni por la existencia o no de habilidades lingüísticas. Asimismo, se indica que realizar sesiones de mantenimiento con una periodicidad de 7 semanas de media permite mantener a largo plazo los logros alcanzados por el programa. No obstante, se detecta que aquellos niños afectados de mayor gravedad podrían necesitar sesiones de recuerdo más frecuentes (AU)

Introduction: Autism is a developmental disorder that it is characterized by a qualitative alteration of social interaction, communication and repetitive and stereotyped behaviours, interests and activities. Recent studies about health are showing that people with autism have lower hope of life. Among other causes, difficulty to identify and to communicate uneasiness and resistance to allow medical explorations are important factors to consider. Aims: To design and to implant a specific program for people with Autistic Spectrum Disorder (ASD) with the objective of habituating them to the medical explorations so that they admit it and collaborate, facilitating the sanitary personnel's work. Our aim was to evaluate the effectiveness of the program and the maintenance of the potentials improvements. Method: Our sample was formed by twenty-two children with ASD (mean chronological age, 9; 10 years). A quasi-experimental design of interrupted temporary series was carried out. Variables: two grouping variables (clinical characteristics of the groups about QI and about linguistic abilities) as dependent variable a measure of percentage of success has been used through an observation protocol designed for this program. Results: Improvements in all the groups. Results are not conditioned neither for the level of intellectual abilities (IQ) neither for the existence or not of linguistic abilities. Likewise, it is found that carrying out maintenance sessions in period of seven weeks allows to maintain long term achievements reached by the program. However, we found that those children which were severely impaired could obtain more benefit from more frequent maintenance sessions (AU)

Utilidad del antígeno de Streptococcus pneumoniae en orina para el diagnóstico de la neumonía en niños / Usefulness of Streptococcus pneumoniae antigen in urine in the diagnosis of pneumonia in children

Pretendemos evaluar la utilidad de la detección de antígenode Streptococcus pneumoniae en orina en el diagnóstico de laneumonía extrahospitalaria en niños que necesitaron ingresohospitalarioMATERIAL Y MÉTODOSEstudio prospectivo durante 15 meses de 61 niños ingresadospor neumonía extrahospitalaria y 21 niños sanos como control.La detección del antígeno se realizó mediante el sistemaBinax Now previa concentración de la orinaRESULTADOSLa técnica mostró una sensibilidad del 100%, una especificidaddel 21.4% El 78.8% de los niños con neumonía presentanantígeno en orina, aunque también se encontraba en el 47%de niños sanos (p=0.005). CONCLUSIONESEstá técnica no es útil en el diagnóstico de este proceso por suescasa especificidad. Sin embargo, la dificultad de establecer unpatrón diagnóstico de la neumonía neumocócica no bacteriémicadificulta la correcta evaluación de esta técnica y otros datossugieren que los datos de especificidad pueden ser superiores

Our aim is to assess the usefulness of the detection ofStreptococcus pneumoniae antigen in urine in the diagnosis ofextrahospital pneumonia in children who require admission tohospitalMATERIAL AND METHODSProspective study over a period of 15 months of 61 childrenadmitted to hospital with extrahospital pneumonia and 21healthy children as controls. The antigen was detected usingthe Binax Now system after concentrating the urineRESULTSThe technique was seen to have a sensitivity of 100%, aspecificity of 21.4%. The antigen in urine was present in 78.8%of the children with pneumonia, and also in 47% of the healthychildren (p=0.005). This technique is not useful because it has a low specificity,but the difficulty in establishing diagnostic guidelines for nonbacteraemiapneumococcus pneumonia makes it difficult toassess this technique properly, although other data indicatethat it may have greater specificity

[Social functioning and psychopathologic risk factors in hemophilic children]. / Funcionamiento social en niños hemofílicos. Análisis de encuesta para determinar factores psicopatológicos de riesgo.

BACKGROUND: Children with hemophilia can experience problems with their mental health status and social functioning. AIM: To assess the mental health status of hemophilic children. MATERIAL AND METHODS: Thirty four hemophilic children aged 5 to 13 years were studied. A translation of the special survey to assess mental health in children, denominated "Domingo" Mental Health Survey was applied. It consisted in animated cartoon questions related to the family, social and school life. According to the score obtained, children were classified as normal, doubtful or pathologic. The social functioning areas studied were family, school, relationship and emotional. Aggressiveness, depression/anxiety and rejection were the psychopathologic factors analyzed. RESULTS: Forty four percent of hemophilic children were considered normal, 20% doubtful and 35% pathologic. According to the severity of the disease, 67% of children with severe, 57% with moderate and 45% with mild hemophilia, were considered abnormal. Aggressiveness was the main risk factor in the emotional and family area, depression/anxiety in the family and emotional area and rejection in the family area. Fifty six percent of children had abnormalities in their social functioning and the severity of the disease was a predisposing factor. CONCLUSIONS: Psychopathologic factors in children with hemophilia appear mainly in the family environment.

Funcionamiento social en niños hemofílicos: Análisis de encuesta para determinar factores psicopatológicos de riesgo / Social functioning and psychopathologic risk factors in hemophilic children

Background: Children with hemophilia can experience problems with their mental health status and social functioning. Aim: To assess the mental health status of hemophilic children. Material and methods: Thirty four hemophilic children aged 5 to 13 years were studied. A translation of the special survey to assess mental health in children, denominated "Domingo" Mental Health Survey was applied. It consisted in animated cartoon questions related to the family, social and school life. According to the score obtained, children were classified as normal, doubtful or pathologic. The social functioning areas studied were family, school, relationship and emotional. Aggressiveness, depression/anxiety and rejection were the psychopathologic factors analyzed. Results: Forty four percent of hemophilic children were considered normal, 20% doubtful and 35% pathologic. According to the severity of the disease, 67% of children with severe, 57% with moderate and 45% with mild hemophilia, were considered abnormal. Aggressiveness was the main risk factor in the emotional and family area, depression/anxiety in the family and emotional area and rejection in the family area. Fifty six percent of children had abnormalities in their social functioning and the severity of the disease was a predisposing factor. Conclusions: Psychopathologic factors in children with hemophilia appear mainly in the family environment.

Neurodevelopment of neonates in neonatal intensive care units and growth of surviving infants at age 2 years.

SUMMARY: The presence of development disorders in neonates attended in a Neonatal Intensive Care Unit (NICU) is highly variable; the aim of this study, therefore, was to determine the evolution of somatic and neurosensory development in a group of neonates requiring treatment in the NICU and to analyse the perinatal and developmental aspects of children presenting abnormalities. PATIENTS AND METHODS: A total of 492 neonates (275 premature, 106 with birthweight < or =1500 g), who were treated in the NICU between January 1994 and December 1997, were followed-up until the age of 2 years. Data were obtained concerning birthweight, body length, head circumference, gestational age, normality of weight for gestational age, single/multiple birth, duration of stay in the NICU and the hospital, duration of mechanically assisted respiration and evolutive somatometry, neurological examination and the Brunet-Lezine development test, adjusted for the gestational age of the neonates, at 6, 12, 18 and 24 months. When abnormal results were detected, Early Attention (EA) programmes were applied. RESULTS: Somatometry at birth in relation to gestational age revealed a weekly weight gain of 8.6%, an increase in body length of 1% and in head circumference of 1% (p<0.001). The evolution of somatic development to the age of 2 years showed that neonates with a birthweight < or =1500 g did not reach the values of neonates with a greater birthweight. The prevalence of cerebral palsy among all neonates was 6.8%, 14.6% among those weighing < or =1500 g, 4% among those weighing 1501-2500 g and 5% among those weighing >2500 g. The overall rate of neurosensory injury was 10.5%. These neonates presented less somatic development than those did with no neurologic disorder. To sum up, most of the neonates attended in the NICU during the 1990s presented a normal pattern of development. Nevertheless, they should be the object of special attention during the first years of life, particularly those neonates with a birthweight < or =1500 g and those presenting neurosensory risk.