Child Welfare Reform in Bulgaria - from Institutional to Family-Based Community Care: Engaging with Families, Children and Colleagues?

The authors present the child welfare policy reform and the process of deinstitutionalization of children's services in Bulgaria. These developments are examined in the context of the country's transition from a post-totalitarian to a liberal democratic state and from collectivistic to individual-centred practices. Therefore, the implementation of social policy promoting and regulating individualised community-based services faces challenges related to attitudes that support group-oriented and institutional-based care. There are three key contextual barriers to the provision of quality services for children with disability: engaging with the individual client, involving parents, and working in multidisciplinary teams. Clinical social work vignettes are presented to illustrate the above challenges

Assessment of Children with Autism Spectrum Disorder and Post-Assessment Meeting with Parents: Some Issues of Planning and Professional Attitude

The authors, child psychiatrists and clinical psychologists, conducting team assessment of children with developmental disabilities (including autism spectrum disorder) for more than two decades, present some important in their view issues and recommendations concerning planning and proceeding of assessment and post-assessment meetings with parents. It is essential to ensure not only an accurate assessment protocol and diagnosis, but also to "attune" to parents in order to facilitate their understanding and more positive use of assessment outcome results. Parents need further support to "survive" psychically the post - assessment period and to provide for adequate interventions for their child

DIAGNOSTIC POSSIBILITIES OF ELECTROROENTGENOGRAPHY IN POSTPHLEBITIC SYNDROME

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Amniotic membrane transplantation algorithms - outcomes within a period of 7 years

Трансплантацията на амниотична мембрана (АМТ) през последните години се превърна в една от най-често извършваните оперативни процедури при тежки, неподаващи се на медикаментозното лечение заболявания на предния очен сегмент. Познаването на оперативните техники е изключително важно с оглед постигането на добър постоперативен резултат.Цел: Целта на настоящото проучване е да се направи обзор на трансплантациите на амниотична мембрана за периода от 2001 до 2016г. и да се създадат алгоритми за оперативно лечение с цел трайно възстановяване увредената предна очна повърхност.Материали и методи: В проучването са включени 420 пациента, преминали и оперирани в СБОБАЛ за 7 годишен период. На всички пациенти е извършена трансплантация на криосъхранена АМ. Пациентите са разделени в седем групи по диагнози. В зависимост от тежестта на обективната симптоматика (големина и дълбочина на дефекта) и вида на заболяването е извършена трансплантация тип покритие и/ или пълнител в един, два или повече слоя. Оценка на големината и дълбочината на дефекта е извършена по тристепенна скала (големина- 1- до 4mm, 2- 4-7mm, 3- >7mm от диаметъра на роговицата; дълбочина: 1 - 50% от дебелината).Резултати: При 74% от болните е извършена трансплантация тип покритие, a при 26% - техника тип пълнител. Доказана е сигнификантна разлика във вида на трансплантацията при отделните групи диагнози. Повлияване на големината на язвата се наблюдава при всички видове трансплантации, като значително намаляване на размера има при трансплантациите тип- покритие, тип-пълнител (едно слоен) и тип-пълнител (двуслоен) (р 7mm diameter of the cornea, depth (1 - 50% of the thickness of the cornea).Results: 74% of patients received an onlay technique transplantation, and 26% - an inlay one. The result analyses show that there is a significant difference in the type of transplantation in the different groups of diagnoses. With all types of transplantations the size of the ulcer was influenced; a significant reduction in its size was observed in onlay type of transplantations, inlay ones (single layer) and inlay type (dual layer) (p <0.001). On the 25th postoperative day in 98% of the patients who have received an onlay type of transplantation a recovery of corneal defects below 2mm was observed. The same effect (92%) was observed in patients with single-layer combined transplantation. With multi-type inlay transplantation positive influence was observed in 71%. The outcomes that show how much the depth of the ulcer was influenced are similar to the ones associated with size.Conclusion: The amniotic membrane proved to be the tool of choice for refractory, recurrent and severe pathological conditions affecting the anterior segment. The use of appropriate surgical technique according to the type and severity of the objective symptomatology leads to a significant improvement in the post-operative result

Early Assessment of Mental Development in Children with Autism Spectrum Disorder (ASD) and other Neurodevelopmental Disorders - Sharing of Clinical Experience

The authors present a synthesised review of the methods for assessing mental development and autism, with an emphasis on the general tendency to reduce the age of diagnosis. Based on clinical experience, a number of particularities are described in terms of: testing, working with parents, observing and reflecting on the nature and meaning of autistic behaviours. On focus is a toolkit for detailed assessment of mental development that was elaborated within the inter-university cooperation between Sofia Medical University and Universite catholique de Louvain (UCL) - Belgium. Illustrated and discussed are typical profiles of cognitive and socio-communicative functioning of children with ASD and other neurodevelopmental disorders, which help a differential diagnosis to be made by the multidisciplinary clinical team. Further described are the advantages of early assessment of mental development as a basis for future educational and therapeutic programs

Asperger’s Syndrome in a Clinical Sample: Reasons for Referral and Comorbidity

Asperger’s Syndrome (AS) is an autism spectrum disorder without mental retardation and language delay. AS often remains unrecognized until these children fail to adapt to school or kindergarten. The comorbid psychiatric disorders, achieving clinical significance, were considered as another pathway to diagnosis. This study is aimed to elucidate the reasons for referral, the frequency and the kinds of comorbidities in a clinical sample of consecutive cases of children and adolescents with AS. To this objective, clinical records of children and adolescents, who have received a DSM-IV diagnosis of AS after multidisciplinary assessment in a given time period were reviewed. After excluding 3 cases due to insufficient information, 24 cases of children and adolescents with Asperger’s Syndrome (23 boys and one girl) were identified. The mean age at the time of assessment and receiving diagnosis was 9.6 yrs. (age range 4 to 17 years). In twenty-one (87%) of the cases the reason for referral was an episode of disorganized behavior following an attempt to enrollthe child at school or kindergarten, and more rare referral occurred within the significant school transition period. In the remaining 3 cases, the reason for referral was a comorbid condition. Comorbid conditions identified at the moment of assessment include: ADHD documented in 4 cases, tics in 3 cases, obsessive-compulsive behaviors in 4 cases, Stereotypic Movement Disorder or Trichotilomania in 4 of the cases. Within the clinical sample, a priori expected to include relatively severe cases, a higher frequency of comorbidity was found as compared to the rates in the general population. Adjustment reactions and comorbidities occasioned the refer

Incunabular Immunological Events in Prion Trafficking

While prions probably interact with the innate immune system immediately following infection, little is known about this initial confrontation. Here we investigated incunabular events in lymphotropic and intranodal prion trafficking by following highly enriched, fluorescent prions from infection sites to draining lymph nodes. We detected biphasic lymphotropic transport of prions from the initial entry site upon peripheral prion inoculation. Prions arrived in draining lymph nodes cell autonomously within two hours of intraperitoneal administration. Monocytes and dendritic cells (DCs) required Complement for optimal prion delivery to lymph nodes hours later in a second wave of prion trafficking. B cells constituted the majority of prion-bearing cells in the mediastinal lymph node by six hours, indicating intranodal prion reception from resident DCs or subcapsulary sinus macrophages or directly from follicular conduits. These data reveal novel, cell autonomous prion lymphotropism, and a prominent role for B cells in intranodal prion movement

4-Hydroxy-1-naphthaldehydes: proton transfer or deprotonation

A series of naphthaldehydes, including a Mannich base, have been investigated by UV-Vis spectroscopy, NMR and theoretical methods to explore their potential tautomerism. In the case of 4-hydroxy-1-naphthaldehyde concentration dependent deprotonation has been detected in methanol and acetonitrile. For 4-hydroxy-3-(piperidin-1-ylmethyl)-1-naphthaldehyde (a Mannich base) an intramolecular proton transfer involving the OH group and the piperidine nitrogen occurs. In acetonitrile the equilibrium is predominantly at the OH-form, whereas in methanol the proton transferred tautomer is the preferred form. In chloroform and toluene, the OH form is completely dominant. Both 4-hydroxy-1-naphthaldehyde and 4-methoxy-1-naphthaldehyde (fixed enol form) show dimerization in the investigated solvents and the crystallographic data, obtained for the latter, confirm the existence of a cyclic dimer

Quantum Dots for Tracking Dendritic Cells and Priming an Immune Response In Vitro and In Vivo

Dendritic cells (DCs) play a key role in initiating adaptive immune response by presenting antigen to T cells in lymphoid organs. Here, we investigate the potential of quantum dots (QDs) as fluorescent nanoparticles for in vitro and in vivo imaging of DCs, and as a particle-based antigen-delivery system to enhance DC-mediated immune responses. We used confocal, two-photon, and electron microscopies to visualize QD uptake into DCs and compared CD69 expression, T cell proliferation, and IFN-γ production by DO11.10 and OT-II T cells in vivo in response to free antigen or antigen-conjugated to QDs. CD11c+ DCs avidly and preferentially endocytosed QDs, initially into small vesicles near the plasma membrane by an actin-dependent mechanism. Within 10 min DCs contained vesicles of varying size, motion, and brightness distributed throughout the cytoplasm. At later times, endocytosed QDs were compartmentalized inside lysosomes. LPS-induced maturation of DCs reduced the rate of endocytosis and the proportion of cells taking up QDs. Following subcutaneous injection of QDs in an adjuvant depot, DCs that had endocytosed QDs were visualized up to 400 µm deep within draining lymph nodes. When antigen-conjugated QDs were used, T cells formed stable clusters in contact with DCs. Antigen-conjugated QDs induced CD69 expression, T cell proliferation, and IFN-γ production in vivo with greater efficiency than equivalent amounts of free antigen. These results establish QDs as a versatile platform for immunoimaging of dendritic cells and as an efficient nanoparticle-based antigen delivery system for priming an immune response

Self-adjuvanting polymer-peptide conjugates as therapeutic vaccine candidates against cervical cancer

Dendrimers are structurally well-defined, synthetic polymers with sizes and physicochemical properties often resembling those of biomacromolecules (e.g. proteins). As a result they are promising candidates for peptide-based vaccine delivery platforms. Herein, we established a synthetic pathway to conjugate a human papillomavirus (HPV) E7 protein-derived peptide antigen to a star-polymer to create a macromolecular vaccine candidate to treat HPV-related cancers. These conjugates were able to reduce tumor growth and eradicate E7-expressing TC-1 tumors in mice after a single immunization, without the help of any external adjuvant