Long-term efficacy of a new 6-session cognitive behavioral therapy for adults with attention-deficit/hyperactivity disorder: A randomized, controlled clinical trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 2.8 % of the adult population. Cognitive behavioral therapy (CBT) has been demonstrated to be the most effective psychological intervention for ADHD. The aim of this study was to explore the efficacy of a new 6-session CBT program in comparison with a 12-session CBT program for adults with ADHD at short- and long-term. METHODS: 81 adults with ADHD (58 % males; mean age = 41.27±9.26 years old) were randomly assigned to each treatment condition (6- or 12-session CBT). Validated instruments were used to assess ADHD symptoms, comorbidities (anxiety and depression), and functional impairments at post treatment, and at 3- and 6-month follow-up. RESULTS: A significant improvement in ADHD severity, comorbidities (anxiety and depression) and functional impairments were found in both CBT programs after treatment. Furthermore, this improvement was also reported at 3- and 6-month follow-up. CONCLUSION: The current study highlights that a 6-session CBT program is as effective as a 12-session CBT program for ADHD improvement at post treatment and follow-up. The newly developed 6-session CBT program can be used to treat a larger number of patients, reducing the financial cost.

Presentación infrecuente de síndrome de Frey bilateral, tratado con toxina botulínica / An unusual presentation of bilateral Frey syndrome treated with botulinum toxin

El síndrome de Frey o síndrome auriculotemporal, incluye sudoración facial al estímulo gustatorio, más frecuentemente después de cirugía de la glándula parótida. Describimos el caso de un síndrome de Frey bilateral, después de una cirugía unilateral de la glándula parótida, y su tratamiento exitoso con toxina botulínica tipo A. Se trata de una mujer de 54 años de edad, remitida para tratamiento a nuestro servicio de rehabilitación por referir sudoración en la mejilla durante la masticación, 2 años después de cirugía de la glándula parótida. En la valoración con el test de iodo/almidón, se observó un área de sudoración en ambas mejillas, mayor en la homolateral a la cirugía. Ambas áreas fueron tratadas con toxina botulínica, 50 unidades en cada una con un total de 100 unidades reconstituidas en 2 ml de solución salina estéril. A los 6 meses y al año de seguimiento, la paciente sigue asintomática. Nuestra paciente presentaba una forma inusual de síndrome de Frey y fue tratada con éxito con toxina botulínica. No hemos encontrado casos similares en la literatura de aparición en la edad adulta. La patofisiología del síndrome queda todavía por esclarecer (AU)

Frey syndrome, also known as auriculotemporal syndrome, includes facial gustatory sweating, mainly after surgery of the parotid gland. We describe a case of bilateral Frey syndrome after unilateral surgery and its subsequent successful treatment with type A botulinum toxin. A 54-year-old woman was referred for treatment to our physical medicine and rehabilitation department 2 years after parotid gland surgery complaining of sweating while eating in her ipsilateral cheek. When the affected area was assessed with the iodine and starch test, a hyperhydrotic area was revealed in both cheeks, which was greater in the ipsilateral cheek to surgery. Both areas were treated with botulinum toxin, 50 units in each, with a total of 100 units reconstituted with 2 ml sterile saline solution. Injections were performed following recommended protocols every 1 cm2. At 6 months and 1 year of follow up, the patient was asymptomatic. Our patient had an unusual form of Frey syndrome and was successfully treated with botulinum toxin. To the best of our knowledge, this is the first reported case of bilateral Frey syndrome beginning in adulthood. Further research is warranted to clarify the pathophysiology of this syndrome (AU)

Trypan blue exclusion assay by flow cytometry

Dye exclusion tests are used to determine the number of live and dead cells. These assays are based on the principle that intact plasma membranes in live cells exclude specific dyes, whereas dead cells do not. Although widely used, the trypan blue (TB) exclusion assay has limitations. The dye can be incorporated by live cells after a short exposure time, and personal reliability, related to the expertise of the analyst, can affect the results. We propose an alternative assay for evaluating cell viability that combines the TB exclusion test and the high sensitivity of the flow cytometry technique. Previous studies have demonstrated the ability of TB to emit fluorescence when complexed with proteins. According to our results, TB/bovine serum albumin and TB/cytoplasmic protein complexes emit fluorescence at 660 nm, which is detectable by flow cytometry using a 650-nm low-pass band filter. TB at 0.002% (w/v) was defined as the optimum concentration for distinguishing unstained living cells from fluorescent dead cells, and fluorescence emission was stable for 30 min after cell treatment. Although previous studies have shown that TB promotes green fluorescence quenching, TB at 0.002% did not interfere with green fluorescence in human live T-cells stained with anti-CD3/fluorescein isothiocyanate (FITC) monoclonal antibody. We observed a high correlation between the percentage of propidium iodide+CD3/FITC+ and TB+CD3/FITC+ cells, as well as similar double-stained cell profiles in flow cytometry dot-plot graphs. Taken together, the results indicate that a TB exclusion assay by flow cytometry can be employed as an alternative tool for quick and reliable cell viability analysis.

Whole-body vibration decreases the proliferativeb response of TCD4+ cells in elderly individuals with knee osteoarthritis

The aim of this study was to investigate the effect of adding whole-body vibration (WBV; frequency = 35 to 40 Hz; amplitude = 4 mm) to squat training on the T-cell proliferative response of elderly patients with osteoarthritis (OA) of the knee. This study was a randomized controlled trial in which the selected variables were assessed before and after 12 weeks of training. Twenty-six subjects (72 ± 5 years of age) were divided into three groups: 1) squat training with WBV (WBV, N = 8); 2) squat training without WBV (N = 10), and 3) a control group (N = 8). Women who were ≥60 years of age and had been diagnosed with OA in at least one knee were eligible. The intervention consisted of 12 uninterrupted weeks of squatting exercise training performed 3 times/week. Peripheral blood mononuclear cells were obtained from peripheral blood collected before and after training. The proliferation of TCD4+ and TCD8+ cells was evaluated by flow cytometry measuring the carboxyfluorescein succinimidyl ester fluorescence decay before and after the intervention (∆). The proliferative response of TCD4+ cells (P = 0.02, effect size = 1.0) showed a significant decrease (23%) in the WBV group compared to the control group, while there was no difference between groups regarding the proliferative response of TCD8+ cells (P = 0.12, effect size = 2.23). The data suggest that the addition of WBV to squat exercise training might modulate T-cell-mediated immunity, minimizing or slowing disease progression in elderly patients with OA of the knee.

13--Antibiotic therapy of community-acquired pneumonia (CAP) caused by atypical agents.

Macrolides, fluoroquinolones, doxycycline, and ketolides show a good intrinsic activity against intracellular pathogens which are responsible for a variable percentage of community-acquired pneumonia (CAP). These therapeutic agents all seem effective in treating most cases of CAP caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella spp. Among quinolones, the more recent fluoroquinolones, such as gemifloxacin or moxifloxacin, generally show a better intrinsic activity than the older ones. Among macrolides, azithromycin, and clarithromycin show a better pharmacokinetic profile. Both of them are available in intravenous form. It is quite common for M. pneumoniae and C. pneumoniae to continue to be shed in respiratory secretions, weeks after an effective therapy. The clinical relevance of this finding is not clear since most of these patients have a good outcome. Azithromycin, due to its advantageous pharmacokinetic profile, seems the best option when antibiotic prophylaxis is considered in some epidemiological settings. It has been proved effective in closed M. pneumoniae outbreaks.

Manejo conservador de una grave complicación esofágica con pegamento de fibrina (Tissucol) / Conservative management of a severe esophageal complication of fibrin sealant (Tissucol)

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