Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017 / Diagnóstico, tratamento e notificação da sífilis durante a gestação em Goiás, de 2007 a 2017

ABSTRACT OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments' percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms' data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.

RESUMO OBJETIVO Analisar a evolução das notificações da sífilis durante a gestação em relação à classificação clínica, ao diagnóstico e ao tratamento no estado de Goiás, entre 2007 e 2017. MÉTODOS Estudo de série temporal com análise de dados fornecidos pela Secretaria Estadual de Saúde de Goiás. Foram analisadas as variáveis relacionadas ao diagnóstico e tratamento das gestantes e seus parceiros, e sua tendência evolutiva ao longo dos anos. Utilizou-se estatística descritiva, cálculo de porcentagens e verificação das tendências de aumento e diminuição por meio do teste de Cochran-Armitage com nível de significância α = 0,05. RESULTADOS Ao todo, 7.774 casos foram notificados no período. A maior porcentagem das notificações ocorreu no segundo trimestre de gestação (39,8%) e correspondeu à sífilis primária (34,1%). O tratamento prescrito com maior frequência foi a penicilina benzatina em dose de 7,2 milhões (43,8%). Entre 2007 e 2017, observou-se tendência crescente nas porcentagens de notificações de sífilis latente (14,1% para 30,7%), secundária (5,2% para 19%) e terciária (4,4% para 11,4%), assim como no tratamento com penicilina benzatina em dose de 7,2 milhões (19,3% para 59,6%). Tendência decrescente foi observada nas porcentagens de notificação de sífilis primária (43,4% para 22,1%) e nos demais esquemas de tratamento. CONCLUSÕES Houve aumento no número de notificações de sífilis latente em gestantes e no tratamento com penicilina na dose de 7.200.000 UI. Também foi observado aumento na completitude dos dados da ficha de notificação nas variáveis de classificação clínica e tratamento, sugerindo melhora no processo de notificação.

Notalgia paresthetica and neuropathic itch. Case report / Notalgia parestésica e prurido neuropático. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Notalgia paresthetica is a neuropathic sensory syndrome located in the dorsal region between T2-T6 dermatomes and is characterized by a chronic evolution with periods of remission and exacerbation. The objective of this study was to demonstrate a case of notalgia paresthetica, from its clinical and laboratory investigation to the treatment adopted. CASE REPORT: A 77-year-old female patient, retired, attended the Outpatient Pain Service of the University Hospital of the Federal University of Maranhão. The main complaint was severe pruritus in the right dorsal region with extension to the breasts, associated with intermittent pain, burning, shock and tingling, worsening with physical effort and movement. Her sleep quality worsened because of the pain. At the physical examination, no pain was reported on palpation of the site, with mild hypoesthesia in T5 and T6 dermatomes, without altering the thermal sensitivity. She denied a history of skin lesions. The patient received conservative pharmacological treatment, with significant improvement in pain and sleep quality after six months. CONCLUSION: Notalgia paresthetica is a syndrome of unknown etiology, and the lack of studies makes it difficult to optimize the indications and recommendations to direct the treatment. This report illustrates the handling of a case of paresthetica notalgia where gabapentin was used as therapeutic management for pain control, for which it proved to be efficient.

RESUMO JUSTIFICATIVA E OBJETIVOS: A notalgia parestésica é um distúrbio neuropático sensitivo que acomete a região dorsal entre os dermátomos de T2 a T6, caracterizando-se por uma evolução crônica com períodos de remissão e exacerbação. O objetivo deste relato foi descrever um caso de notalgia parestésica, desde a sua investigação clínica e laboratorial até a conduta adotada. RELATO DO CASO: Paciente do sexo feminino, 77 anos, aposentada, compareceu para atendimento no Serviço Ambulatorial de Dor do Hospital Universitário da Universidade Federal do Maranhão, tendo como queixa principal prurido intenso em região dorsal direita com extensão para as mamas, associada a dor intermitente, em queimação, choque e pontadas, piorando com esforço físico e movimento. Seu sono não era reparador. Ao exame físico, não referiu dor à palpação do local, com discreta hipoestesia em dermátomos T5 e T6, não havendo alteração de sensibilidade térmica. Negava histórico de lesões de pele. A paciente recebeu tratamento conservador farmacológico, havendo melhora importante do prurido, da dor e da qualidade do sono após seis meses. CONCLUSÃO: A notalgia parestésica é uma síndrome de etiologia ainda desconhecida, em que a escassez de estudos dificulta uma otimização das recomendações para direcionar o tratamento. Este relato ilustrou o manuseio de um caso de notalgia parestésica onde o tratamento com gabapentina foi empregado para o controle de dor, para o qual se mostrou eficiente.

Adherence to fibromyalgia treatment: challenges and impact on the quality of life / Adesão ao tratamento da fibromialgia: desafios e impactos na qualidade de vida

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic and idiopathic syndrome, characterized by a general distributed pain, more prevalent in women. Its pathophysiology remains unclear. Its chronicity implies an exclusively symptomatic treatment, often unsatisfactory. The lack of adherence to the established treatment is quite common. The objective of this study is to present a review of the adherence to the fibromyalgia syndrome treatment. CONTENTS: The concept of adherence to the fibromyalgia syndrome treatment, its classification, the identification of its measurement options, and the detection of its causes are detailed, revised and updated. CONCLUSION: The review of the literature regarding the adherence to the fibromyalgia syndrome treatment points to a large number of nonconformity of prescription, in general with the prevalence of the adoption of the reduction of the recommended dose and the interruption of the treatment, over possible overdoses and self-medication. The study of the causes that led to the non-adherence to the treatment elects the characteristics of the syndrome as the great villain for its occurrence. However, other associated factors such as the age of the subject with fibromyalgia, the intensity of the pain, the established polypharmacy, the quality of the doctor-patient relationship and the socioeconomic variables were also listed. The patient's quality of life was always higher in patients with higher adherence to treatment and persistence. Patients' quality of life indices may indicate the level of commitment to treatment adherence, and vice versa.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome crônica e idiopática, caracterizada por queixa dolorosa de distribuição generalizada, mais prevalente em mulheres. A sua fisiopatologia continua não totalmente esclarecida. Sua cronicidade implica em tratamento exclusivamente sintomático e muitas vezes insatisfatório. A falta de adesão ao tratamento instituído é bastante comum. O objetivo deste estudo foi apresentar uma revisão sobre a adesão do tratamento da síndrome fibromiálgica. CONTEÚDO: O conceito de adesão ao tratamento da síndrome fibromiálgica, sua classificação, a identificação das opções de sua mensuração, e a detecção de suas causas são detalhados, revisados e atualizados. CONCLUSÃO: A revisão da literatura referente à adesão ao tratamento da síndrome fibromiálgica mostra um grande contingente de inconformidade de prescrição, em geral predominando a adoção da redução da dose orientada e a interrupção do próprio tratamento, sobre possíveis sobredoses e automedicações. O estudo das causas que levaram à falta de adesão ao tratamento elege as características da própria síndrome como a grande vilã para sua ocorrência; embora, tenham sido também elencados outros fatores associados como a idade do portador da síndrome fibromiálgica, a intensidade da dor, a polifarmácia instituída, a qualidade da relação médico-paciente, e as variáveis socioeconômicas. A qualidade de vida dos pacientes sempre foi maior naqueles cuja adesão e persistência ao tratamento foram maiores. Os índices de qualidade vida dos pacientes podem indicar o nível de comprometimento com a adesão ao tratamento, e vice-versa.

Current Management of Childhood Amblyopia

Amblyopia is defined as the reduction of best-corrected visual acuity of one or both eyes caused by conditions that affect normal visual development. The basic strategy to treat amblyopia is to obtain a clear retinal image in each eye and correct ocular dominance through forced use of the amblyopic eye. Treatment modalities include correcting any underlying organic disease, prescribing appropriate optical correction, and providing occlusion/penalization therapy for the non-amblyopic eye. Given the success of amblyopia treatment declines with increasing age, the detection and management of amblyopia should begin as early as possible during the sensitive period for visual development. Proper management of amblyopia during childhood can reduce the overall prevalence and severity of visual loss. This study aims to provide an update for the management of childhood amblyopia to provide better visual outcomes.

Pharmacologic Treatment Using Non-Hypoglycemic Agents for Nonalcoholic Fatty Liver Disease / 임상당뇨병

Nonalcoholic fatty liver disease (NAFLD) is a common condition that may progress to end-stage liver disease. Recently, NAFLD has been recognized as a hepatic manifestation of metabolic syndrome and an independent risk factor for cardiovascular disease. Therefore, appropriate management of this common disorder is an important public health issue. The management of NAFLD is based on gradual weight loss through lifestyle modification. Reducing total calorie intake and carbohydrates in the diet is beneficial for NAFLD patients. Regular exercise reduces hepatic fat content independent of weight loss. However, such lifestyle changes are difficult to maintain long term for most patients. Despite the growing need for pharmacologic therapy, there is currently no effective agent for the treatment of NAFLD. Several large clinical trials have shown promising but inconsistent effects of pioglitazone and vitamin E for improving NAFLD. However, larger clinical trials are required before definitive conclusions can be drawn.

El delirium: una actualización para Internistas y Psiquiatras

RESUMEN A lo largo del tiempo, al delirium se lo ha conocido por diversos nombres: falla cerebral aguda, síndrome cerebral orgánico agudo, síndrome confusional o psicosis postquirúrgica. No obstante, el término preferido en la actualidad es delirium (de latín delirare, que significa "arar fuera del surco"). El delirium, como síndrome, es un conjunto de signos y síntomas de inicio agudo caracterizado por deterioro cognitivo fluctuante, con enturbiamiento de la conciencia y capacidad disminuida de mantener y cambiar la atención de un punto a otro. Numerosos estudios han demostrado que los pacientes que desarrollan delirium tienen un riesgo aumentado de resultados adversos tanto durante la hospitalización como tras el alta. Este riesgo es independiente de cualquier comorbilidad existente, de la severidad de la enfermedad, la edad u otras variables asociadas. Asimismo, el delirium está asociado a un incremento en la mortalidad, aumento del tiempo de hospitalización y desarrollo de disfunciones cognitivas posteriores al alta. Este artículo de revisión presenta una actualización acerca de la fisiopatología del delirium, de las herramientas de reconocimiento del cuadro y de su tratamiento. Todas estas informaciones resultan útiles en el manejo diario de este tipo de pacientes, tanto por médicos internistas como por médicos psiquiatras.

ABSTRACT Over time, delirium has been known by several names: acute brain failure, acute organic brain syndrome, confusional syndrome, or post-surgical psychosis. However, the currently preferred term is delirium (from the Latin term delirare, which means "to go out of the furrow"). Delirium, as a syndrome, is a set of signs and symptoms of acute onset characterized by fluctuating cognitive impairment, clouding of consciousness and diminished ability to maintain and shift attention from one point to another. Numerous studies have shown that patients who develop delirium have an increased risk of adverse outcomes both during hospitalization and after discharge. This risk is independent of any existing comorbidity, severity of disease, age or other associated variables. Likewise, delirium is associated with an increase in mortality, increase in hospitalization time and the development of cognitive dysfunctions after discharge. This review article presents an update on the pathophysiology of delirium, the tools for recognizing the condition and its treatment. All this information is useful in the daily management of this type of patients, by both internists and psychiatrists.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (IV): Non-Pharmacologic Treatment

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in early childhood and can persist throughout adulthood. ADHD causes difficulties in various area of life, such as academic achievement, peer relationships, family functioning, employment and marriage. Although ADHD is known to respond well to medication, such treatment is more effective when combined with psychosocial (non-pharmacologic) therapy in terms of alleviating the core symptoms and improving appropriate functions. Psychosocial treatment interventions are divided into psychoeducation, behavioral parent training, school intervention, cognitive behavior therapy, social skill training, parent-child interaction therapy, play therapy, other treatments (coaching, complementary and alternative medicine), neurofeedback and Cogmed. Adult ADHD cognitive behavioral therapy is described separately. These practice parameters summarize the evidence for psychosocial treatment. Based on this evidence, specific recommendations are provided for psychosocial interventions.

Exercício físico controla pressão arterial e melhora qualidade de vida / Exercise control blood pressure and improvement quality of life

INTRODUÇÃO: Para o tratamento correto da hipertensão arterial, é plausível a hipótese de que diante da prática regular de exercícios físicos estes pacientes não necessitariam de fármacos anti-hipertensivos. OBJETIVO: Avaliar o efeito do tratamento exclusivo com exercício físico na pressão arterial (PA) e qualidade de vida (QV) de hipertensos. MÉTODO: Ensaio clínico com 32 hipertensos sedentários, 55±9 anos, que estavam sob tratamento farmacológico (TF) aleatoriamente alocados em Grupo Exercício (GE) e Grupo Controle (GC). No GE, 18 indivíduos (50% mulheres) após pelo menos dez dias de interrupção do TF iniciaram programa de exercício de dez semanas, 3x/semana, 30 minutos de exercício aeróbio seguidos por exercícios resistidos, enquanto 14 do GC (57% mulheres) se mantiveram sob TF. Foi verificada PA sistólica (PAS) e diastólica (PAD) no início e final do estudo pelo método auscultatório clássico e QV pelo questionário MINICHAL. Os dados foram expressos por M±DP, usou-se teste t de Student, U de Mann-Whitney e Wilcoxon, considerando-se p < 0,05 significativo. RESULTADOS: No início e final da pesquisa, não foram observadas diferenças na PA entre os grupos. Intragrupos, a PA no GE manteve-se semelhante aos valores antes da retirada dos fármacos (PAS 132,2 ± 13,3 x 134,4 ± 10 mmHg; PAD 85,0 ± 9 x 85,3 ± 10 mmHg p = ns), assim como no GC (PAS 127,2 ± 19 x 130,2 ± 16 mmHg; PAD 82,1 ± 16 x 85,3 ± 12 mmHg p = ns). Para a QV, entregrupos não foi observada diferença dos escores no início e final, intragrupos melhora significativa no aspecto emocional do GE (p = 0,02). CONCLUSÃO: A terapêutica anti-hipertensiva, exclusivamente por meio do exercício físico na comparação com tratamento farmacológico convencional, possibilitou idêntico controle da PA e melhor percepção de QV.

BACKGROUND: Hypertension can be correctly treated when exercise is regularly practiced and hence, patients would not need anti-hypertensive drugs. PURPOSE: To evaluate the effect of treatment exclusively with exercise on blood pressure (BP) and quality of life (QL) of hypertensive subjects. METHODS: Clinical trial with 32 sedentary hypertensive subjects, aged 55 ± 9 years, under pharmacological treatment (PT) randomly allocated to Exercise Group (EG) and Control Group (CG). At EG, 18 subjects (50% women) at least 10 days after the cessation of PT started the exercise program of 10 weeks, 3x/week, 30 minutes of aerobic exercise followed by resistance exercises, while 14 CG (57% women) remained under PT. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated by auscultation at the beginning and end and QL was evaluated using the questionnaire MINICHAL. Data were expressed as mean ± SD and statistical analysis was performed using t test, Mann Whitney U and Wilcoxon tests. RESULTS: At the beginning and end of the study, no significant differences in were observed in BP between groups. Within groups, BP in EG remained similar to the values before drugs were removed (SBP 132.2 ± 13.3 x 134.4 ± 10 mmHg, DBP 85.0 ± 9 x 85.3 ± 10 mmHg p = ns) and the CG (SBP 127.2 ± 19 x 130.2 ± 16 mmHg, DBP 82.1 ± 16 x 85.3 ± 12 mmHg p = ns).For QL, no inter-group difference was observed in scores at the beginning and end; intra-group significant improvement in the emotional aspect of the EG (p = 0.02). CONCLUSION: The anti-hypertensive therapy with exercise only in comparison to conventional pharmacological treatment allowed the same BP control and better QL perception.

Pharmacologic treatment of osteoarthritis

A variety of pharmacologic agents have been developed for the treatment of osteoarthritis. At present, however, none of them has been proven to prevent disease progression, and the medications are used only for symptomatic relief. Thus, non-pharmacologic conservative treatment such as education, weight reduction in the obese, and consistent exercise should be recommended first to maintain fitness and tolerance to physical activity. Medication is then indicated to better control symptoms provided non-pharmacologic measures prove inadequate, and a successful strategy most likely would entail a combination of these non-pharmacologic and pharmacologic approaches. Acetaminophen can be tried first because of its efficacy and relatively safe profile, especially in those with mild osteoarthritis. Nonselective non-steroidal anti-inflammatory drugs may be used in patients with moderate to severe pain, but long-term medication requires caution due to the increased risk of gastrointestinal and renal complications. Selective cyclooxygenase-2 inhibitors can be better tolerated, especially in patients with risk factors for gastrointestinal adverse events, but potential cardiac and cerebrovascular thrombotic events should be considered in those with preexisting cardiovascular disease. Tramadol and opioids are more potent analgesics. However, they are not recommended for routine use due to a high incidence of nausea, constipation, and drowsiness. These agents require close monitoring for those adverse effects, especially in a geriatric population. Lastly, the pharmacologic plan should be individualized according to the severity and duration of pain, age and gender of the patient, and concurrent comorbidities to maximize the benefit as well as to minimize the risk of adverse effects from medication.

Parmacologic treatment of depression in patients with myocardial infarction / 老年心脏病学杂志（英文版）

Depression is a common medical problem and is more prevalent among patients with coronary artery disease.Whether early detection and treatment of depression will enhance cardiovascular outcome is uncertain.Obviously,the safety and efficacy of the anti-depression drugs is an important link.This article reviews the pathophysiologic and behavioural links between depression and cardiovascular disease progression,the treatment of depression,and the potential benefits of anti-depressants in patients with coronary disease.

Encuesta chilena acerca de terapia farmacológica en epilepsias del niño y el adolescente / Chilean survey on epilepsy drug therapy in child and adolescent

La Liga Chilena contra la Epilepsia, Chilean Bureau (LICHE), la Sociedad de Psiquiatra y Neurología de la Infancia y Adolescencia (SOP-NIA) y la Sociedad de EpileptologIa de Chile, Chilean ILAE Chapter, (SOCEPCHI), deciden unir sus esfuerzos para realizar un consenso de uso de fármacos antiepilépticos (FAE) en 14 síndromes electro-clínicos específicos, 3 tipos de Status epilepticus (parcial, de ausencias y tónico clónico generalizado) y epilepsia parcial de origen no precisado. Previo al consenso, los organizadores se plantean realizar una encuesta que aporte a responder algunas preguntas: ¿Qué grado de uniformidad existe entre los neuropediatras chilenos en cuanto a la elección de tratamiento farmacológico en cada uno de los síndromes epilépticos y otras epilepsias planteadas? El contexto público o privado donde se realiza la práctica profesional (que determina menores o mayores recursos económicos) influye en la elección de los FAEs? ¿Sería útil esta información, para las conclusiones de un futuro consenso de uso de FAEs?. Material y método: Se proyecta un estudio descriptivo a través de la elaboración de una encuesta que incluye: Un caso clínico para cada uno de los síndromes electro-clínicos y otras epilepsias elegidas, una lista de FAEs con su sigla correspondiente. Se envía la encuesta por correo electrónico, a 46 neuropediatras del servicio público y privado simultáneamente. Después de tres semanas de plazo, se reciben 37 encuestas que se analizan en forma anónima y manteniendo la privacidad del encuestado. Resultados: Se describe el tratamiento propuesto por 37 neurólogos para cada uno de los 14 cuadros presentados. No existe coincidencia clara entre los 37 neuropediatras chilenos en cuanto a la elección de tratamiento farmacológico en la mayoría de los casos planteados. En algunos síndromes, como Epilepsia de Ausencias de la Niñez se observa más de un 90 por ciento de acuerdo en el uso del mismo FAE, en cambio en otros, especialmente en síndrome y...

The Liga Chilena contra la Epilepsia (LICHE), !LAE Chilean Bureau, the Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA) and the Sociedad de Epileptologia de Chile (SOCEPCHI), ILAE Chilean Chapter, decided to join efforts in developing a Consensus on antiepileptic drugs (AED5) treatment options in 14 specific electro-clinical syndromes, three types of status epilepticus (partial, absence and generalized tonic clonic). Attending to routine clinical management, partial epilepsy of unknown origin was added. Prior to the implementation of this consensus, the organizers decide to carry on a survey intending to answer the following questions: What degree of consensus exists between the chilean child neurologists as to the choice of drug therapy in epilepsies and epileptic syndromes? Does the public or private context in which the professional practice takes place influence the choice of AEDs? Will this information be a useful tool in the development of a consensus for the use of AEDs?. Methods: A descriptive study based on a survey including a typical clinical case for each of the 14 electra clinical syndromes and other epilepsies selected and a list of AEDs drugs with standard abbreviation was sent by electronic mail to 46 child neurologists living from Arica to Punta Arenas, six of them work exclusively in private hospitals, six work exclusively in public service and 24 in both simultaneously. After three weeks, 37 surveys were answered and analyzed anonymously, maintaining the privacy of the respondent. Results: We describe for each of the 14 cases the proposed drug treatment by 37 neurologists. There is no clear coincidence between the chilean child neurologists as to the choice of drug therapy in most of the epilepsies and epileptic syndromes raised. In some syndromes, as childhood absence epilepsy the agreement was over 90 percent, whereas in other less common and more difficult to manage syndromes, a wide dispersion was...

Psychosocial treatment of psychiatric disorders of the elderly

Interest in psychosocial treatment as non-pharmacologic treatment in the elderly has been increasing, and this treatment has became an important therapeutic approach for the following common psychiatric disorders: depressive disorder, anxiety disorder, some psychological conditions, and some cognitive disorders. Some examples of the psychosocial treatments frequently used with older people with psychiatric disorders are cognitive behavior therapy, interpersonal therapy, individual psychotherapy, reality orientation, validation therapy, reminiscence therapy, and cognitive training. Those treatment options should be used carefully in light of individual needs and optimal objectives for the elderly and their caregivers. It is crucial for the clinician to understand the characteristics and clinical applications of each psychosocial treatment for the elderly in particular. Further studies are needed to demonstrate the feasibility and effectiveness of old and new psychosocial treatment modalities for older people with psychiatric disorders. Psychosocial treatments are very important with or without pharmacological treatment in the elderly with psychiatric problems. Clinician should become familiar with various psychosocial treatments.

The Effectiveness of School Based Short-Term Social Skills Training in Children with Attention-Deficit/Hyperactivity Disorder(ADHD)

OBJECTIVES: Children with attention-deficit hyperactivity disorder (ADHD) often have difficulties in social behavior. The aim of this study was to evaluate the effectiveness of a short-term training program for improving social skills, selfperception and attention deficits. METHODS: The subjects were nine children diagnosed with ADHD with (or without) other mental disorders using the Diagnostic Interview Schedule for Children (DISC-ADHD) module. Children were given eight sessions of a social skills training program. Parents of children simultaneously participated in their own training which was designed to support their children's generalization of skills. Assessments included child, parent and teacher ratings of social skills, self-perception and attention deficit at baseline and post-treatment. RESULTS: Social skills training led to significant improvements in child-reported measures of self-esteem, in teacherreported measures of social skills, and in parent-reported measures of attention deficit. CONCLUSION: This study suggests that short-term social skills training programs for children with ADHD may improve their social skills, self-perception and attention deficits.

A Case Report of Traumatic neuropathic Pain Patient

A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system. None of these mechanisms is disease-specific, and several different pain mechanisms may be present simultaneously in any one patient. Diagnosis of neuropathic pain is often easily made from the information gathered on neurologic examination and from patient history. Evidence of sensory disturbances elicited by examination combined with laboratory tests confirming injury to peripheral nerve establishes the diagnosis of neuropathic pain. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if dentist has a complete understanding of the therapeutic options. Pharmacologic therapy has been the mainstay of treatment. Selection of an appropriate pharmacologic agent is by trial and error since individual response to different agents, doses, and serum level are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuripathic pain. If pharmacologic treatment is not effective, nerve block using lidocaine, steroid and alcohol and neurectomy must be considered for treatment option.

A Case Report of Traumatic neuropathic Pain Patient

A variety of mechanisms may generate pain resulting from injury to the peripheral nervous system. None of these mechanisms is disease-specific, and several different pain mechanisms may be present simultaneously in any one patient. Diagnosis of neuropathic pain is often easily made from the information gathered on neurologic examination and from patient history. Evidence of sensory disturbances elicited by examination combined with laboratory tests confirming injury to peripheral nerve establishes the diagnosis of neuropathic pain. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if dentist has a complete understanding of the therapeutic options. Pharmacologic therapy has been the mainstay of treatment. Selection of an appropriate pharmacologic agent is by trial and error since individual response to different agents, doses, and serum level are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuripathic pain. If pharmacologic treatment is not effective, nerve block using lidocaine, steroid and alcohol and neurectomy must be considered for treatment option.

Update Treatment of Dementia: Focus on Pharmacologic Treatment

Dementia is an increasingly common diagnosis in our population, and the numbers are expected to rise exponentially in coming years. Within the past decades research has progressed rapidly on multiple fronts, including epidemiology, etiology, pathology, diagnosis, and treatment. This article reviews the evidence for the effecacy of various pharmacologic treatments on dementia. Acetylcholinesterase inhibitors and NMDA antagonist are effective in patients with Alzheimer's disease. Benefit for vitamine E, anti-inflammatory drugs and ginko biloba have been suggested, but supporting evidence is not strong. And although antipsychotics have efficacy and safety in the treatment of aggression, agitation, and psychosis in patients with Alzheimer's disease, adverse effects limit their overall effectiveness. SSRI and atypical antipsychotic agents are frequently used to manage behavioral abnormalities associated with frontotemporal dementia. Cholinesterase inhibitors and levodopa have been reported to improve hallucination, cognition, apathy in dementia with Lewy bodies. And pharmacological intervention was largely ineffective in the management of corticobasal degeneration. Phenothiazine, quinacrine are being evaluated as treatment for CJD patients in trials. Cholinergic deficits in vascular dementia are due to ischemia of basal forebrain nuclei and of cholinergic pathways and can be treated with the use of the cholinesterase inhibitors. Future studies, directed to distinct causal and pathological factors, will be needed to enable therapeutic advances in dementia. Larger, well-controlled treatment studies are required to reach more definitive conclusions about treatment efficacy.

The Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder(IV): Non-Pharmacologic Treatment

This practice parameter for non-pharmacological treatment for attention-deficit hyperactivity disorder(ADHD) review the domestic and international literature on the psychosocial treatment of children and adolescents with ADHD. This parameter include the parental training & education, cognitive behavior therapy(group or individual), social skill training, family therapy, play therapy(individual psychotherapy) and non-traditional therapy(art therapy, herbal therapy et al). Among them, there is some proven evidence only in parental training & education and cognitive behavior therapy. So, this parameter describes some details only in the field of parental training & education and cognitive behavior therapy. The efficacy or effectiveness, especially, cost-effectiveness of specific psychosocial treatment method for ADHD cannot be fairly assessed due to the scarcity of controlled clinical data. Based on the clinical expert consensus and limited evidence, we cautiously suggest the practice recommendations about the non-pharmacological psychosocial treatment for children and adolescents with ADHD.

Tratamento farmacológico da gagueira: evidências e controvérsias / Pharmacologic treatment of stuttering: evidences and controversies

OBJETIVO: Este artigo tem por objetivo analisar a situação do tratamento farmacológico da gagueira, mostrando a eficácia de diferentes abordagens baseadas em drogas psiquiátricas, além de evidenciar a utilização de outros fármacos no tratamento dessa enfermidade. MÉTODOS: Revisão de literatura em base de dados Medline, utilizando os termos stuttering treatment, disfluency, disfluency treatments, botulinum toxin and stuttering treatment, botulinum toxin and disfluency treatment. RESULTADOS: Foram encontrados estudos envolvendo as seguintes drogas: citalopram + clomipramina, paroxetina, olanzapina, citalopram + alprazolam, pimozida, risperidona, tiaprida, clomipramina e desipramina, levetiracetam, divalproato de sódio, clonidina e betanecol, além de ensaios clínicos com a utilização de toxina botulínica tipo A e anestésicos. Os estudos envolvendo citalopram + clomipramina, paroxetina, olanzapina, citalopram + alprazolam, risperidona, clomipramina e desipramina, levetiracetam, divalproato de sódio, lidocaína e toxina botulínica tipo A demonstraram resultados positivos. A maioria das pesquisas relativas ao tratamento farmacológico da gagueira se restringe a estudos de caso e ensaios clínicos com pequenas amostras. CONCLUSÃO: Não existem evidências suficientes que justifiquem a utilização de um tratamento específico para a gagueira. Os estudos apresentados indicam a necessidade da realização de mais ensaios clínicos duplo-cegos e controlados com placebo envolvendo amostras maiores.

OBJECTIVE: This article analyzes the pharmacologic treatment of stuttering, assessing the effectiveness of different treatments using psychiatric drugs and further evidences of other drugs in the treatment of this disorder. METHODS: Search in Medline database, using the terms stuttering treatment, disfluency, disfluency treatments, botulinum toxin and stuttering treatment, botulinum toxin and disfluency treatment. RESULTS: Studies involving the following drugs were found: citalopram + clomipramine, desipramine, paroxetine, olanzapine, pimozide, risperidone, tiapride, levetiracetam, divalproex sodium, citalopram + alprazolam, clonidine and bethanecol, as well as clinical trials with the botulinum toxin A and anesthetics. Studies with citalopram + clomipramine, paroxetine, olanzapine, citalopram + alprazolam, risperidone, clomipramine and desipramine, levetiracetam, divalproex sodium, lidocaine and botulinum toxin A showed positive results. However, the great majority of pharmacological studies in this area are case series or clinical trials with small samples. CONCLUSION: Enough evidences do not exist that justify the use of a specific treatment for stuttering. The presented studies indicate the necessity of accomplishment of more double-blind placebo-controlled trials involving larger samples.

Guidelines for Clinical Management of Premenstrual Syndrome

Premenstrual syndrome(PMS) refers to a group of menstruation-related symptoms that impair daily activity and interpersonal relationship. The therapeutic modality for PMS consists of non-pharmacologic and pharmacologic treatment. Generally, after confirmation of PMS, a set of non-pharmacologic treatments is recommended before pharmacologic treatment. Patients can be benefited from non-pharmacological treatments such as patient education, cognitive therapy, behavioral therapy, and dietary supplementation. Pharmacologic therapy including psychotropic agents, diuretics, and prostaglandin inhibitors may be used, when PMS symptoms are not sufficiently improved after non-pharmacologic treatments, or when symptoms fit the diagnostic criteria of premenstrual dysphoric disorder(PMDD). When treatment fails, hormonal therapy to manipulate menstrual cycle may be considered, and several trials showed improvement of physical and mood symptoms.

Pharmacologic Treatment of Peripheral Neuropathy

Peripheral neuropathy is a common neurological disorder and has a variety of identifiable causes such as diabetes, metabolic derangements, neurotoxic substances, and even genetic abnormalities. Even with a thorough evaluation, however, the underlying cause cannot be identified in a large portion of peripheral neuropathy. In addition to the diagnostic dilemma, the wide spectrum of clinical manifestations with a variety of combinations of altered sensation, muscle weakness, and autonomic symptoms in peripheral neuropathy also makes it difficult to introduce an appropriate management. Treatments for peripheral neuropathy are categorized according to the underlying conditions and the strategies designed to relieve peripheral nerve pain irrespective of the cause. This article summarizes the mechanisms of peripheral neuropathic pain and current pharmacologic treatments including tricyclic antidepressants and anticonvulsants.