Effectiveness of Duloxetine versus Other Therapeutic Modalities in Patients with Diabetic Neuropathic Pain: A Systematic Review and Meta-Analysis.

Objectives: Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus (DM) with symptoms like intense pain and impaired quality of life. This condition has no treatment; instead, the pain is managed with various antidepressants, including duloxetine. The aim of this study is to analyze the evidence on the efficacy of duloxetine in the management of DPN. Methods: A systematic search in different databases was conducted using the keywords "diabetic neuropathy", "duloxetine therapy", "neuropathic pain", and "Diabetes Mellitus". Finally, eight studies were included in this meta-analysis. Results: All articles comparing duloxetine at different doses vs. a placebo reported significant differences in favor of duloxetine on pain scales like 24 h Average Pain Severity (standardized mean difference [SMD] = -1.06, confidence interval [CI] = -1.09 to -1.03, and p < 0.00001) and BPI Severity (SMD = -0.70, CI = -0.72 to -0.68, and p < 0.00001), among others. A total of 75% of the meta-analyses of studies comparing duloxetine at different doses showed a tendency in favor of the 120 mg/d dose. There were significant differences in favor of duloxetine when compared to routine care on the Euro Quality of Life (SMD = -0.04, CI = -0.04 to -0.03, and p < 0.00001) and SF-36 Survey (SMD = -5.86, CI = -6.28 to -5.44, and p < 0.00001) scales. There were no significant differences on the visual analog scale (VAS) when comparing duloxetine and gabapentin. Conclusions: Duloxetine appears to be effective in the management of DPN in different pain, symptom improvement, and quality of life scales.

The multiple meanings of ADHD: between deficit, disruption and hidden potential / Os diversos significados de TDAH: entre déficit, distúrbio e potencial oculto

Abstract The purpose of this article is to describe the subjective experience of the diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) and the cultural meanings that shape this experience. Based on interviews and discussion groups with diagnosed people and their families in Chile and France, this article show that ADHD can acquire multiple meanings. From a thematic analysis, we identified three registers or ways of living and thinking about ADHD. In the deficit register, the disorder is experienced primarily as a failure of certain abilities. In the disruption register, the disorder is experienced as disrupting the person's life, personality and interactions, which must then be normalized. In the register of hidden potential, on which this article focuses, ADHD is simultaneously thought of as a difficult and valuable condition, a source of exceptional capacities that are often hidden in the ordinary functioning of social life. We therefore invite reflection that identifies the factors of mobilization or non-mobilization of the hidden potential register, with particular emphasis not only on relational configurations, socio-economic variables, and the gender variable, but also on the institutional and political context of each country.

Resumo O objetivo deste artigo é descrever a experiência subjetiva do diagnóstico de Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e os significados culturais que moldam essa experiência. Com base em entrevistas e grupos de discussão com pessoas diagnosticadas e suas famílias no Chile e na França, este artigo demonstra que diversos significados podem ser atribuídos ao TDAH. A partir de análise temática, foram identificados três registros ou modos de viver e pensar TDAH. No registro déficit, o transtorno é vivenciado primariamente como falha de certas habilidades. No registro distúrbio, o transtorno é vivenciado como uma perturbação da vida pessoal, personalidade e interações que necessita ser normalizada. No registro de potencial oculto, foco deste artigo, TDAH é considerado simultaneamente condição difícil e valiosa, fonte de capacidades excepcionais que estão habitualmente ocultas no andamento comum da vida social. Portanto, propõe-se refletir e identificar os fatores de mobilização e não mobilização do registro de potencial oculto, com particular ênfase não só nas configurações relacionais, variáveis socioeconômicas e de gênero, mas também no contexto institucional e político de cada país.

Validation of a BMI cut-off point to predict an adverse cardiometabolic profile with adiposity measurements by dual-energy X-ray absorptiometry in Guatemalan children.

OBJECTIVE: To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point. DESIGN: Cross-sectional study. SETTING: Two public schools in poor urban areas on the outskirts of Guatemala City. SUBJECTS: A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years). RESULTS: Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)). CONCLUSIONS: Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.

Spatio-temporal variation in the prevalence of trematodes in the bivalve Perumytilus purpuratus.

Perumytilus purpuratus is an abundant bivalve located in the intertidal rocky zone of South America that has been considered as a key species of the ecosystem. There are few studies of the host-parasite relationship of this bivalve; thus, this research aims to analyse the spatial and temporal variation in the prevalence of trematodes in P. purpuratus. Bivalves were collected from three localities (El Tabo, Las Cruces and Montemar) of central Chile (33°S, 71°W) during different seasons of 2010. The bivalves were also collected every metre, from the lowest to the highest level of the intertidal rocky zone, to determine the parasite distribution within the localities. Three species of trematodes as sporocyst stages were found: Prosorhynchoides carvajali, Proctoeces sp. and an undetermined fellodistomid species. Of the 37,692 bivalve specimens collected, 2.68% were parasitised. The undetermined fellodistomid species was the most prevalent parasite observed (1.69%). There were little detected differences in the prevalence of some trematode species between seasons. The prevalence of P. carvajali varied between localities, being most prevalent at Montemar. The distribution of trematodes along the rocky zone within the localities was variable, with P. carvajali being more prevalent in the mid-lowest level of the intertidal zone and the undetermined fellodistomid species being more prevalent in the mid-highest level. Both the abundance of definitive hosts and the environmental conditions likely result in different levels of infection by trematodes in P. purpuratus between and within the localities.

Secular trends in energy intake and diet quality in a Mediterranean population.

BACKGROUND/AIMS: Assessing secular trends of diet quality at the population scale is an important tool for health policymakers. The aim of this study was to describe secular trends in energy intake and diet quality in a representative Mediterranean population, accounting for energy underreporting. METHODS: We analyzed the dietary data from 4,061 men and 4,409 women who were included in 2 population-based cross-sectional studies conducted in northeast Spain in 2000 and 2005. The surveys included randomly selected free-living men and women between 35 to 74 years of age. RESULTS: No significant differences in reported energy intake between 2000 and 2005 were observed. Protein (p = 0.014) and carbohydrate (p = 0.02) consumption (expressed as percent of total energy intake) decreased in men and women, respectively. Energy density and intake of total, saturated and monounsaturated fat were significantly higher (p < 0.001) in 2005 than in 2000 in both genders. In contrast, lower consumption of fibre, fruit and meat (p < 0.001) was observed for both genders in 2005 compared to 2000. A significantly lower proportion of men and women met the recommended intake for carbohydrates, total fat, saturated fat, cholesterol and fruits in 2005 when compared to 2000. When energy underreporters were excluded from the analysis, a decline in energy intake (p < 0.001) and an increase in fish consumption (p < 0.001) between 2000 and 2005 was observed in men; no other significant differences were found in diet quality and food consumption trends among non-underreporters. CONCLUSIONS: Whereas energy intake remained stable from 2000 to 2005, overall diet quality showed an unfavourable trend during this timeframe. Secular dietary trends did not change their magnitude or direction, with the exception of energy and fish consumption in men, after excluding energy underreporters from the analysis.