Progresión de los síntomas en niños con trastorno por déficit de atención e hiperactividad en tratamiento con metilfenidato / Progression of symptoms in children with attention deficit and hyperactivity disorder in treatment with methylphenidate

El trastorno por déficit de atención e hiperactividad (TDAH) es un trastorno neurobiológico frecuente en la infancia. Sus síntomas cardinales involucran a la atención y/o la impulsividad y/o la hiperactividad. Hay diferentes subtipos de TDAH según la expresividad clínica de esos tres síntomas. Hay distintas estrategias terapéuticas de alta efectividad. El metilfenidato, un estimulante que actúa en las vías dopaminérgicas y adrenérgicas, se utiliza con frecuencia en su tratamiento. El Cuestionario de Cualidades y Dificultades (SDQ) es un cuestionario de despistaje breve utilizado para la detección de problemas de salud mental en niños y adolescentes. Consta de 25 preguntas que se distribuyen en 5 escalas: sintomatología emocional, problemas de conducta, hiperactividad/inatención, problemas con los compañeros y conducta prosocial. Se recogió la puntuación del SDQ en una muestra de pacientes con TDAH con una edad situada entre los 7 y 12 años. Se comparó la puntuación obtenida antes de comenzar el tratamiento con metilfenidato y después de comenzar tratamiento, cada 3-6 meses y hasta un periodo de 2 años. Se realizó el procesamiento estadístico mediante R, que es un programa gratuito para análisis estadísticos y gráficos, y permite análisis temporales. Los resultados indican que la hiperactividad mejora a lo largo del primer año de tratamiento, la sintomatología emocional y los problemas de comportamiento mejoran durante los primeros 6 meses de tratamiento, la sintomatología prosocial mejora lentamente a lo largo de los 2 años y los problemas con compañeros no mejoran en el tiempo analizado.

Attention deficit and hyperactivity disorder (ADHD) is a neurobiological disorder frequent in childhood. The main symptoms are attention disorder and/or impulsivity and/or hyperactivity. There are different subtypes of ADHD according to the degree of presence of these three symptoms. There are different therapeutic approaches with high proved effectiveness. Methylphenidate, a stimulant that acts through the dopaminergic and adrenergic pathways, is commonly used for the treatment of ADHD. The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening instrument internationally used for the screening of mental health problems in children and adolescents. It consists in a 25 items questionnaire with 5 different scales: emotional symptoms, conduct problems, hyperactivity / inattention, peer relationship problems and prosocial behaviours. The SDQ score was collected in a sample of ADHD patients with an age between 7 and 12 years. The score obtained before starting treatment with methylphenidate was compared before and after starting treatment, every 3-6 months and up to a period of 2 years. Statistical processing was performed using R, which is a free program for statistical and graphical analysis, that allows temporary analysis. The results indicate that hyperactivity improves throughout the first year of treatment, emotional symptoms and behavioral problems improve during the first 6 months of treatment, pro-social symptoms slowly improve over 2 years. Problems with partners do not improve in the analyzed time.

Can the success of structured therapy for giggle incontinence be predicted?

ABSTRACT Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Tabagismo, abandono do fumo e os otorrinolaringologistas do estado de São Paulo / Smoking, smoking cessation and otorhinolaryngologists in the state of Sao Paulo, Brazil

Os otorrinolaringologistas estão diretamente envolvidos no diagnóstico e tratamento de doenças provocadas pelo cigarro, incluindo o câncer das vias aéreas superiores. É importante que os especialistas estejam capacitados a tratar o tabagismo e a dependência da nicotina. Também se sabe que há fumantes entre os próprios médicos. OBJETIVO: Pesquisar as opiniões e condutas de otorrinolaringologistas do Estado de São Paulo frente ao tabagismo e à dependência química da nicotina, e avaliar o hábito tabagístico dos especialistas. FORMA DE ESTUDO: Corte transversal. MATERIAL E MÉTODOS: Foram selecionados aleatoriamente 600 otorrinolaringologistas do Estado de São Paulo. A esses especialistas foi enviado, em março de 2005, por correio, um questionário padrão. Foram analisadas as respostas recebidas no período de março a maio de 2005. RESULTADOS: Foram recebidas 209 respostas. Nestas, 97 profissionais (46,4 por cento) avaliaram sua familiaridade com os meios de tratamento da dependência de nicotina como regular e 60 (28,7 por cento) como insatisfatória. Dos participantes do estudo, 144 (68,9 por cento) nunca fumaram, 50 (23,9 por cento) são ex-fumantes, nove (4,3 por cento) são fumantes ocasionais e seis (2,9 por cento) são fumantes. CONCLUSÃO: A prevalência de tabagistas na amostra de 209 otorrinolaringologistas do Estado de São Paulo foi de 7,1 por cento.

Otorhinolaryngologists are directly involved in the diagnosis and management of smoking related diseases, including upper airway malignancy. It is important that the specialists have skills to treat smoking and nicotine dependence. It is also known that there are smokers amongst doctors. AIM: To assess the opinions and practices of the otorhinolaryngologists of the state of Sao Paulo, Brazil, concerning smoking and nicotine dependence, and evaluation of smoking habits of the specialists. STUDY DESIGN: Cross-sectional. MATERIAL AND METHODS: We randomly selected 600 otorhinolaryngologists of Sao Paulo State, Brazil. A survey was mailed to the specialists in March 2005. We gathered data received from March to May 2005. RESULTS: There were 209 respondents. Forty-seven specialists (46.4 percent) rated themselves as moderately familiar with the methods for treatment of nicotine dependence, and 60 (28.7 percent) as unsatisfactorily familiar. One hundred and forty-four respondents (68.9 percent) have never smoked, 50 (23.9 percent) were former-smokers, nine (4.3 percent) were occasional smokers and six (2.9 percent) were regular smokers. CONCLUSION: The prevalence of smoking in the sample of 209 otorhinolaryngologists of Sao Paulo State, Brazil, was 7.1 percent.

El Síndrome de interrupción de los inhibidores selectivos de la recaptación de serotonina / The discontinuation syndrome of selective serotonin reuptake inhibitors

Los pacientes que suspenden las medicaciones (antidepresivos, estabilizadores del afecto o antipsicóticos) presentam con frecuencia síntomas y cognoscitivos que pueden, en algunos casos, como sucede con los IMAOS clásicos, requerir tratamiento intrahospitalario. La sintomatología es inespecífica y difiere de los síntomas secundarios indeseables del fármaco o del síndrome de abstinencia que se apresenta con hipnóticos, barbitúricos, benzodiacepinas, alcohol o sub tancias adictivas. En el presente trabajo se hace una revisión de la literarura sobre los aspectos clínicos, epidemiológicos y terapéuticos del Síndrome de Interrupción del tratamiento con los inhibidores selectivos de la recaptación de serotonina (SRS)

Amineptine in the treatment of amphetamine withdrawal: a placebo-controlled, randomised, double-blind study.

Temporary inability to function without amphetamine and the experience of withdrawal syndrome enhance the tendency for repetitive use. The investigators proposed to examine the therapeutic effects of amineptine, an antidepressant with dopamine reuptake inhibition effect, for the treatment of amphetamine withdrawal. The 14-day study was carried out on a randomised, double-blind, placebo-controlled design. The authors assessed the severity of amphetamine withdrawal syndrome by using two measures and performed both end-point and intent-to-treat analyses. The results showed that amineptine helped relieve a depressed mood within one week and improved the general condition within 2 weeks. In conclusion, amineptine is effective in rapid relief of depressed mood and improves the general condition of patients with amphetamine withdrawal. Since the amphetamine withdrawal may last for several weeks, studies with longer duration should be conducted before incorporating amineptine into the clinical practice a of amphetamine withdrawal treatment.