Presencia e influencia de sintomatología sugestiva de trastorno por déficit de atención e hiperactividad en adultos con un trastorno de la conducta alimentaria(AU) / Presence and influence of attention deficit hyperactivity disorder symptoms in adults with an eating disorder

Fundamento. La coexistencia de trastornos de la conducta alimentaria (TCA) y del trastorno por déficit de atención e hiperactividad (TDAH) es frecuente. El objetivo del estudio fue cuantificar la presencia de sintomatología TDAH en pacientes adultos con TCA y evaluar posibles correlaciones entre ambas sintomatologías. Material y métodos. Estudio transversal en pacientes con TCA. Se cumplimentaron los cuestionarios Eating Attitudes Test de 40 ítems (EAT-40), Eating Disorder Inventory 3ª edición (EDI-3) y la versión abreviada del Adult ADHD Self-Report Scale (ASRS v1.1). Aquellos pacientes con ≥12 puntos en ASRS v1.1 completaron el cuestionario Attention Déficit Hyperactivity Disorder Rating Scale 4ª edición (ADHD-RS IV). Resultados. El 42,6% de los 108 pacientes incluidos puntuaron ≥12 en el ASRS v1.1. Estos sujetos puntuaron más en bulimia y en algunas escalas de desajuste psicológico del EDI-3, y aquellos con conductas de atracón y/o purga puntuaron más en Trastornos psicobiológicos del EAT-40 y en Insatisfacción corporal y Riesgo de TCA del EDI-3. No hubo diferencias en ADHD-RS IV según fueran cuadros restrictivos puros (n=13) o compulsivo-purgativos (n=33). La sintomatología TDAH correlacionó más con la clínica alimentaria y con el desajuste psicológico general en los casos compulsivopurgativos. Conclusiones. En población clínica con TCA son frecuentes los síntomas sugestivos de TDAH, más en cuadros con clínica compulsivo-purgativa pero no necesariamente más intensos. La correlación entre TDAH y TCA es mayor en cuadros compulsivo-purgativos. Los síntomas de TDAH conllevan mayor desajuste psicológico y mayor gravedad a nivel alimentario en los cuadros con sintomatología compulsivo-purgativa.(AU)

Background. The coexistence of eating disorders (ED) and attention deficit hyperactivity disorder (ADHD) is common. The aim of the study was to quantify the presence of ADHD symptoms in adult patients with ED and evaluate any possible correlation between both symptomatologies. Methods. Cross-sectional study of patients with ED. The following questionnaires were completed: the Eating Attitudes Test - 40 items (EAT-40), the Eating Disorder Inventory 3rd edition (EDI-3) and the abbreviated version of the Adult ADHD Self-Report Scale (ASRS v1.1). The patients who scored ≥12 points in ASRS v1.1 completed the Attention Deficit Hyperactivity Disorder Rating Scale (4th edition, ADHD-RS IV). Results. 42.6% of the 108 patients scored ≥12 in the ASRS v1.1. These subjects scored higher in bulimia and in some scales of psychological maladjustment of the EDI-3, and those with binging and/or purging behaviours scored higher in Psychobiological disorders of the EAT-40 and in Body dissatisfaction and Eating disorder risk composite scales of the EDI-3. There were no differences in ADHD-RS IV between pure restrictive syndromes (n=13) and those with binging and/or purging behaviours (n=33). We found that, in cases with binge/purge symptoms, ADHD symptoms correlated higher with ED symptoms and with general psychological maladjustment. Conclusion. ADHD symptoms are common in the clinical population with ED, and more in groups with binge/purge symptoms, although they are not necessarily more intense. The correlation between ADHD symptoms and ED is higher in cases with binging and/or purging behaviours. ADHD symptoms involve more psychological maladjustment and more serious ED symptomatology in cases with binge/purge symptoms.(AU)

[Presence and influence of attention deficit hyperactivity disorder symptoms in adults with an eating disorder].

BACKGROUND: The coexistence of eating disorders (ED) and attention deficit hyperactivity disorder (ADHD) is common. The aim of the study was to quantify the presence of ADHD symptoms in adult patients with ED and evaluate any possible correlation between both symptomatologies. METHODS: Cross-sectional study of patients with ED. The following questionnaires were completed: the Eating Attitudes Test - 40 items (EAT-40), the Eating Disorder Inventory 3rd edition (EDI-3) and the abbreviated version of the Adult ADHD Self-Report Scale (ASRS v1.1). The patients who scored =12 points in ASRS v1.1 completed the Attention Deficit Hyperac-tivity Disorder Rating Scale (4th edition, ADHD-RS IV). RESULTS: 42.6% of the 108 patients scored =12 in the ASRS v1.1. These subjects scored higher in bulimia and in some scales of psychological maladjustment of the EDI-3, and those with binging and/or purging behaviours scored higher in Psychobi-ological disorders of the EAT-40 and in Body dissatisfaction and Eating disorder risk composite scales of the EDI-3. There were no differences in ADHD-RS IV between pure restrictive syndromes (n=13) and those with binging and/or purging behaviours (n=33). We found that, in cases with binge/purge symptoms, ADHD symptoms correlated higher with ED symptoms and with general psychological maladjustment. CONCLUSION: ADHD symptoms are common in the clinical population with ED, and more in groups with binge/purge symptoms, although they are not necessarily more intense. The correlation between ADHD symptoms and ED is higher in cases with binging and/or purging behaviours. ADHD symptoms involve more psychological maladjustment and more serious ED symptomatology in cases with binge/purge symptoms.

HDL-c levels predict the presence of pleural effusion and the clinical outcome of community-acquired pneumonia.

OBJECTIVES: To investigate if HDL cholesterol (HDL-c) could be a biomarker of the degree of severity according to prognostic prediction scores in community-acquired pneumonia (CAP) or the development of clinical complications such as pleural effusion. METHODS: We included in a retrospective study 107 patients admitted to the hospital that fulfilled diagnostic criteria for CAP between the 30th October 2011 and 1st September 2012. HDL-c levels at admission, CAP prognosis scores (PSI and CURB65) and clinical outcomes were recorded for the study. RESULTS: Basal HDL-c levels were not statistically different according to prognostics scores neither PSI nor CURB-65. Significantly lower levels of HDL-c were also associated to the development of septic shock and admission to the intensive care unit. HDL-c were inversely correlated with acute phase reactants CRP (r = -0.585, P < 0.001), ESR (r = -0.477, P < 0.001), and leukocytes cell count (r = -0.254, P < 0.009). Patients with pleural effusion showed significant lower levels of HDL-c [28.9 (15.5) mg/dl vs. 44.6 (21.1) mg/dl]; P = 0.007. HDL-c is a good predictor of the presence of pleural effusion in multivariate analyses and using ROC analyses [AUC = 0.712 (0.591-0.834), P = 0.006]. HDL-c levels of 10 mg/dl showed a sensitivity of 97.6 % and a specificity of 82.4 % for the presence of pleural effusion. CONCLUSION: Monitoring HDL-c in CAP is an useful serum marker of acute phase response, clinical outcome and the presence of pleural effusion.

Nutritional Status and Lipid Profile in HIV-Infected Adults.

In the last decades, there have been many reports of HIV infection and abnormalities in lipid metabolism and cardiovascular disease (CVD). This study aims at describing the nutritional status of HIV-infected adults and its relation to lipid profile through traditional [total cholesterol (TC), HDL cholesterol (HDL), triglycerides (TG), non-HDL cholesterol and LDL cholesterol (LDL)] and other parameters [Apolipoprotein B (ApoB), fibrinogen, and high sensitive-C-reactive protein (hs-CRP)]. A cross-sectional descriptive study was performed. Body mass index (BMI) was calculated and references were taken from WHO. TC, HDL, TG and glucose were determined and non-HDL cholesterol and LDL were calculated. ApoB and fibrinogen were determined by quantitative radial immunodiffusion on agar plates (Diffuplate,Biocientífica SA,Argentina) and hs-CRP by immunoturbidimetric test. Qualitative variables were compared with the Chi-square test or Fisher's exact test. Quantitative variables were compared applying parametrics or nonparametric tests. Pearson test for correlations. Software SPSS 17.0. 97 patients were analyzed: 69.1% were men. 80% were on antiretroviral treatment. Average (SD) BMI was 24.3 (4.1) kg/m(2). 29.4% were overweight and 5.9% obese. Patients with a BMI ≥25.0 kg/m(2) presented significantly higher levels of TG, ApoB and glycemia than well-nourished people [246.1(169.0) vs. 142.9(78.4) mg/dL;p=0.029, 198.6(69.3) vs. 126.4(50.6) mg/dL;p=0.01 and 100 (3.2) vs. 90.2 (6.9) mg/dL;p=0.008 resp.] and a significantly decreased HDL [37.2(1.5) vs. 49.8(10.4) mg/dL;p<0.01]. No statistically significant correlation was found between ApoB and non-HDL (p=0,063). There was no evidence that there is a direct relation between Apo B and the other lipid parameters. The potential increase in CVD in this group of patients, would be related to the higher levels of TG, ApoB and overweight/obesity. Nutritional education is needed to promote a healthy weight to warn against the risk of cardiovascular disease.

Spontaneous EEG theta/beta ratio and delta-beta coupling in relation to attentional network functioning and self-reported attentional control.

Relationships between electroencephalographic (EEG) slow- and fast-wave frequency bands are considered to be of interest in the study of dispositional affective traits, emotion regulation, and attentional phenomena. However, to date, no previous studies had explored whether both state performance-based and self-reported attentional control (AC) measures potentially relate to different patterns of spontaneous EEG measures, in the absence of emotional stimuli. In the present study, individual differences in spontaneous EEG theta/beta ratio and delta-beta coupling at frontal and parietal sites were explored in a sample of 110 healthy volunteers as potential correlates of individual differences in performance-based attentional network functioning, as measured through the Attentional Network Test for Interactions (ANT-I) and self-reported AC. We found that stronger delta-beta coupling at parietal sites was associated with higher self-reported AC. However, no significant associations were found between executive control network functioning and the EEG ratio or coupling measures. Furthermore, a lower spontaneous fronto-parietal theta/beta ratio was found to be associated with better orienting network functioning. These results are discussed with a focus on the potential utility of spontaneous EEG measures in several cortical regions for capturing trait-like individual differences in temperament-related factors.

Spontaneous EEG activity and spontaneous emotion regulation.

Variability in both frontal and parietal spontaneous EEG activity, using α and ß band power and θ/ß and δ/ß ratios, was explored in a sample of 96 healthy volunteers as a potential correlate of individual differences in spontaneous emotion regulation (SER). Following a baseline EEG recording, participants were asked to continuously rate their discomfort while looking at affective pictures, as well as for a period of time after exposure. Greater spontaneous ß band power in parietal locations, lower frontal and parietal δ/ß ratios, and lower parietal θ/ß ratio were associated with lower ratings of discomfort after the offset of unpleasant pictures. Moreover, lower parietal δ/ß ratio was also related to less time needed to recover from discomfort after exposure to aversive pictures, while only a greater frontal and parietal α band power appeared to be associated with faster recovery from discomfort induced by normative-neutral pictures. However, parietal δ/ß ratio was the only predictor of both minimum discomfort ratings and time needed to downregulate following exposure to unpleasant pictures, and frontal α band power the only spontaneous EEG index that predicted variability in spontaneous down-regulation after the exposure to normative-neutral pictures. Results are discussed focusing on the utility of diverse spontaneous EEG measures in several cortical regions when capturing trait-like individual differences in emotion regulation capabilities and processes.

Inflammatory biomarker profile in children with cystic fibrosis: preliminary study.

The aim of this preliminary study was to determine specific proteins, related to inflammation process and nutritional status as well as to total antioxidant capacity, in children suffering from cystic fibrosis (CF). The study was performed on 17 nonhospitalized children (12 boys and 5 girls) with CF aged 3 months to 10 years, who were assisted at the Nutrition Service from Pedro de Elizalde Hospital. Transferrin, transthyretin, ceruloplasmin (Cp), haptoglobin, C-reactive protein (CRP) and fibrinogen were measured by single radial immunodiffusion techniques. Total antioxidant capacity (TAC) was determined by a decolorization assay. Statistical analyses were performed by the Student's t test. Transferrin and transthyretin values were lower in CF patients in comparison with data obtained from healthy children (reference group, RG). The decreased transferrin concentration and the tendency towards low plasma transthyretin values suggested an abnormal nutritional status. However, higher Cp and haptoglobin levels were shown in patients than in RG. The fact that 23 and 50% of patients exceeded the desirable values for fibrinogen (<285.0 mg/dl) and CRP (<0.2 mg/dl), respectively, should be highlighted. The TAC (mM; Trolox equivalents) was shown to be lower in the CF group than in RG. The diminished TAC concomitant with an increased plasma Cp concentration would exacerbate the inflammatory status and could explain the depression of the immune system. These preliminary results could explain the need to include biochemical and functional parameters in the early nutritional status evaluation in CF patients in order to use appropriate nutritional and pharmacological therapies and consequently to improve their survival and quality of life.

Evaluación nutricional de pacientes pediátricos críticos: estudio preliminar / Nutritional evaluation of critical pediatric patients: Preliminary study

El objetivo del trabajo es evaluar el estado nutricional con respecto a hierro en un grupo de niños con diferentes patologías, al ingreso en terapia intensiva, a través de la determinación de hematocrito, concentración de hemoglobina, protoporfirinas eritrocitarias libres y analizar los niveles de fracciones séricas específicas: transferrina, proteína C reactiva y ceruloplasmina. En treinta y un pacientes (entre tres y cuarenta y ocho meses de edad) internados en la Unidad de Cuidados Intensivos Pediátricos con diferentes patologías, se determina hematocrito (Hto), la concentración de hemoglobina (g/dL) (Hb) por colorimetría, FEP por método Piomelli expresándose los resultados como FEP/Hto y FEP/Hb y transferrina, ceruloplasmina y preoteína C reactiva sérica (mg/dL) por inmunodifusión radial cuantitativa sobre placas...

Evaluación nutricional de pacientes pediátricos críticos: estudio preliminar / Nutritional evaluation of critical pediatric patients: Preliminary study

El objetivo del trabajo es evaluar el estado nutricional con respecto a hierro en un grupo de niños con diferentes patologías, al ingreso en terapia intensiva, a través de la determinación de hematocrito, concentración de hemoglobina, protoporfirinas eritrocitarias libres y analizar los niveles de fracciones séricas específicas: transferrina, proteína C reactiva y ceruloplasmina. En treinta y un pacientes (entre tres y cuarenta y ocho meses de edad) internados en la Unidad de Cuidados Intensivos Pediátricos con diferentes patologías, se determina hematocrito (Hto), la concentración de hemoglobina (g/dL) (Hb) por colorimetría, FEP por método Piomelli expresándose los resultados como FEP/Hto y FEP/Hb y transferrina, ceruloplasmina y preoteína C reactiva sérica (mg/dL) por inmunodifusión radial cuantitativa sobre placas...(AU)

[Attitudes of primary care health staff to the mentally ill patient, psychiatry and the mental health team]. / Actitudes del personal sanitario de atención primaria hacia el enfermo mental, la psiquiatría y el equipo de salud mental.

OBJECTIVES: To measure the reliability of a questionnaire on attitudes and knowledge of mental health and the mental health team (MHT). To find out what these attitudes are and their associations with demographic and work variables. DESIGN: Observational, transversal. SETTING: Primary care (PC) centres in an urban environment. PARTICIPANTS: Health staff (n=141) of PC centres whose mental health centres (MHC) for referral are in an area of Guipuzcoa. MAIN MEASUREMENTS: Self-administered, anonymous questionnaire including a section with social, demographic and work data. Survey including items on attitudes towards the mentally ill, psychiatry, the MHCs, staff's perception of their own knowledge and their attitude towards attending courses on the subject. RESULTS: The reply rate was 70%. The factorial analysis had 5 factors whose measurements and scores were: "attendance at courses", 30.8 (8-40); "knowledge", 17.5 (7-35); "more treatment", 12.2 (6-30); "less treatment", 14.4 (5-25); "care through the MHC", 11.5 (4-20). The internal consistency of the 5 scales was 0.95, 0.92, 0.85, 0.83, and 0.65, respectively. 13% did not think you had to be on the look out for the mentally ill. CONCLUSIONS: No negative attitude towards the mentally ill was perceived. PC health staff perceived their lack of psychiatric knowledge and that they did not have sufficient dealings with the MHC, and showed good predisposition towards improving both questions.

Qualitative method for determination of aflatoxin B1 in nuts.

The proper characterization of a commercial qualitative method for determining aflatoxin B1 in some nuts is described. A qualitative method that provides binary responses of the yes/no type means that the performance parameters have been properly adapted and defined. Performance characteristics such as the cut-off limit, the detection limit, sensitivity, specificity, false-positive and negative rates, and the unreliability or uncertainty region are defined and then estimated by means of the performance characteristic curves. The commercial test kit showed the cut-off limit at 1.6 ng/g, with a sensitivity rate of 95% and a false-negative rate of zero. A modification can be performed to shift the cut-off to 2.0 ng/g, keeping the same values for the sensitivity and false-negative rate.

Cue exposure in the treatment of resistant bulimia nervosa.

OBJECTIVE: It was hypothesized that binge eating (bulimia nervosa [BN]) may be caused by the anticipatory and immediate anxiety associated with certain types of food. Consequently, an extinction schedule should reduce binge eating. METHODS: Cue exposure was carried out with 6 bulimic women who had responded poorly or not at all to the usual pharmacologic or cognitive-behavioral treatments. RESULTS: Binge eating and vomiting were almost totally suppressed in the 6 patients. Symptom suppression was maintained at two follow-ups, one at 4-20 months and another at 2.5-3 years. DISCUSSION: Cue exposure may be effective with BN that is resistant to conventional treatments. The anxiety associated with food plays an important role in provoking and/or maintaining binge eating. Motivation to change is likely to be an important mediator.

Spectroscopic analysis of roman wall paintings from Casa del Mitreo in Emerita Augusta, Mérida, Spain.

The use of visible spectroscopy, applied to chromatic characterization of Roman wall paintings, allows an easy and trustworthy grouping of the samples studied. The use of other spectroscopic techniques such as Fourier transform infrared spectroscopy (FTIR) and energy-dispersive X-ray spectroscopy (EDS) in conjunction with X-ray diffraction (XRD) allows a good identification of the substances present in the pictorial layers that define and differentiate each chromatic group. In this paper, a study of 40 Roman wall painting samples, from Pinturas Báquicas of Casa del Mitreo in Emerita Augusta (Mérida, Spain), is described. In these samples, some pigments of high quality and cost, as well as some unusual mixtures, not described in the bibliography, have been found.

Activities of adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) on undernourished and renourished rats' thymus.

We studied the effect of administration of a low quality dietary protein, from weaning onwards, on the thymus of undernourished rats and the posterior effect of refeeding with a high quality dietary protein. Changes in thymus weight and the activity of Adenosine Deaminase (ADA) and Purine Nucleoside Phosphorylase (PNP) on thymus, were determined. Wistar rats were suckled in groups of 14-16 per dam since birth to weaning (23 days) to obtain undernutrition. At weaning, a group of 14-16 rats received pre-cooked maize flour (Protein content: 6.5%) for 18 days. One group was sacrificed (M) and the other rats were refed with the casein diet (Protein content: 20%) during 20 days (R). The age-matched control groups were fed stock diet since 40 (C40) and 60 (C60) days of age, respectively. At the end of the experimental period, body (Bw) and thymus weight were determined. ADA and PNP activities were determined in thymocyte suspensions. Highly significant differences in thymus weight-expressed as mg or mg/Bw(0.75)-and the activity of ADA and PNP were observed in rats fed the experimental diet containing maize flour, when compared to the respective age-matched control. No statistical differences were observed between R and C60.The administration of a high quality dietary protein to undernourished weanling rats is capable to reverse the damage produced by the low quality dietary protein on thymus weight and ADA and PNP thymus activities.

Potential markers of the nutritional status in an experimental model.

The activity of adenine deaminase (ADA) and purine nucleoside phosphorylase (PNP) as potential nutritional markers was analyzed in an experimental model. Weanling Wistar rats were fed a protein-free diet ad libitum to obtain a severe degree of wasting. An age-matched control group received a stock diet. At the end of the experiment, body weight (BW) and thymus weight (TW) were determined. Activity of ADA and PNP was determined on thymocytes of protein-deprived and control rats; the results, expressed as micromoles of uric acid x 10(-1)/W (W = TW/BW(0.75)), were 17.0 +/- 2.6 versus 9.1 +/- 3.0 for ADA and 11.5 +/- 4.2 versus 3.9 +/- 1.0 for PNP (P < 0.01). These results suggest that the nutritional stress provoked by the administration of a protein-free diet from weaning onward affects the development of thymocytes. Moreover, the increase in the activity of ADA and PNP would be an alternative mechanism to avoid the accumulation of high levels of deoxynucleotides, which would be toxic for T lymphocytes. However, some investigators have observed an increase of ADA activity in human serum under some adverse conditions; for this reason and taking into account the present findings, it would be interesting to determine the relation between the activity of ADA and PNP in thymocytes and serum in experimental models to analyze and propose these biochemical parameters as potential and useful markers of nutritional status; it also would be interesting to test this relation in human studies.

[Alternatives to population screening for breast cancer. Is the chance detection useful?]. / Alternatives al cribado poblacional de cáncer de mama. Es útil la detección oportunística?

OBJECTIVES: 1. To evaluate the characteristics of the demand, coverage and acceptability of random detection of breast cancer at a health centre (HC) between January 1995 and December 1996. 2. To describe the cases of breast cancer diagnosed since the setting up in 1988 of random demands for screening mammographies. DESIGN: Crossover study. SETTING: La Mina Primary Care Centre, Barcelona. PATIENTS: A sample of 340 women of a population of 2796 women between 45 and 75 with a clinical history at the HC were studied. MEASUREMENTS AND MAIN RESULTS: The profile of women with neoplasms was: aged 59 +/- 8.5; 279 women attended, 273 medicine, 132 medicine and gynaecology, and 6 gynaecology. Mammographies requested were: 143 (118 through gynaecology, 12 medicine and 13 outside the centre), which was 51% of women who attended and 42% of the sample. The reason for mammography was screening (129) and symptoms (14). Screening mammographies actually done (acceptance) were 116 out of 129 (90%). Sample coverage was 34% (116/340); and 42% of the women who attended (116/279). Most studied age-group was 50-64 (coverage 45%, n = 176). 11 cases of breast cancer were diagnosed: age 54.3 +/- 9.1; 1 in situ, 3 < 10 mm, 2 between 10 and 20 mm, 4 > 20 mm, 1 without data. Diagnosis to treatment delay: 33.7 +/- 0 days. At time of writing 8 women were free of illness. CONCLUSIONS: Through random detection 34% coverage was achieved with good acceptance. Most neoplasms are diagnosed in their early stages. The general practitioner should be more attentive to periodic requests for mammographies.

[Effect of n-3 PUFA polyunsaturated fatty acids on the thymus of rats with severe protein depletion]. / Efecto de los ácidos grasos poliinsaturados n-3 PUFA sobre el timo de ratas con depleción proteica severa.

Severe protein deprivation at weaning provokes an arrest of cellular proliferation and maturation, and an increase of ADA and PNP activities in the thymus of growing rats. A 20% casein diet fed during 9 days was enough to reverse the effect on ADA and PNP. The supplementation with 24 mg/d of n-3 PUFA, was able to recover thymus' cellular proliferation and maturation.

A fast method for the confirmation of fecal streptococci from M-enterococcus medium.

M-Enterococcus medium, used for the detection and enumeration of fecal streptococci from different types of water, demonstrated a very low specificity. We propose the transfer of membrane filters to bile-esculin medium as a confirmation technique. It has proved to be more reliable, faster to perform, and more effective than the random selection of colonies, which is recommended for confirmation in Standard Methods for the Examination of Water and Wastewater (A.E. Greenberg, L.S. Clesceri, and A.D. Eaton, ed., 1992).