COVID-19 pandemic, substance use disorders and body image issues, a worrisome correlation.

The SARS-CoV-2 pandemic has profoundly affected the social fabric and the economic and health care viability and functioning of most countries. Aside from its deeply destructive impact on health care systems and national economies, the pandemic has jeopardized people's emotional and psychological well-being as well. The authors aimed to shed a light on how the pandemic has been affecting patients with addiction issues and body dysmorphic disorder (BDD), which is characterized by negative thoughts about appearance and body misperceptions. People with body dysmorphic disorder are in fact at increased risk of developing substance use disorders, and such a destructive association has only been made more severe by pandemic-related restrictions, emotional distress and anxiety, as well as longer exposure to social media and online interactions. This is a major cause for concern, because substance use worsens symptoms of BDD and contributes to unfavorable treatment outcomes.

Postnatal nutritional treatment of neurocognitive deficits in fetal alcohol spectrum disorder.

Ethanol is the most important teratogen agent in humans. Prenatal alcohol exposure can lead to a wide range of adverse effects, which are broadly termed as fetal alcohol spectrum disorder (FASD). The most severe consequence of maternal alcohol abuse is the development of fetal alcohol syndrome, defined by growth retardation, facial malformations, and central nervous system impairment expressed as microcephaly and neurodevelopment abnormalities. These alterations generate a broad range of cognitive abnormalities such as learning disabilities and hyperactivity and behavioural problems. Socioeconomic status, ethnicity, differences in genetic susceptibility related to ethanol metabolism, alcohol consumption patterns, obstetric problems, and environmental influences like maternal nutrition, stress, and other co-administered drugs are all factors that may influence FASD manifestations. Recently, much attention has been paid to the role of nutrition as a protective factor against alcohol teratogenicity. There are a great number of papers related to nutritional treatment of nutritional deficits due to several factors associated with maternal consumption of alcohol and with eating and social disorders in FASD children. Although research showed the clinical benefits of nutritional interventions, most of work was in animal models, in a preclinical phase, or in the prenatal period. However, a minimum number of studies refer to postnatal nutrition treatment of neurodevelopmental deficits. Nutritional supplementation in children with FASD has a dual objective: to overcome nutritional deficiencies and to reverse or improve the cognitive deleterious effects of prenatal alcohol exposure. Further research is necessary to confirm positive results, to determine optimal amounts of nutrients needed in supplementation, and to investigate the collective effects of simultaneous multiple-nutrient supplementation.

Maltrato prenatal / Prenatal maltreatment

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Arsenic levels in immigrant children from countries at risk of consuming arsenic polluted water compared to children from Barcelona.

Arsenic is a highly toxic element that pollutes groundwater, being a major environmental problem worldwide, especially in the Bengal Basin. About 40% of patients in our outpatient clinics come from those countries, and there is no published data about their arsenic exposure. This study compares arsenic exposure between immigrant and native children. A total of 114 children (57 natives, 57 immigrants), aged 2 months to 16 years, were recruited and sociodemographic and environmental exposure data were recorded. Total arsenic in urine, hair, and nails and arsenic-speciated compounds in urine were determined. We did not find significant differences in total and inorganic arsenic levels in urine and hair, but in organic arsenic monomethylarsenic acid (MMA) and dimethylarsinous acid (DMA) in urine and in total arsenic in nails. However, these values were not in the toxic range. There were significant differences between longer than 5 years exposure and less than 5 years exposure (consumption of water from tube wells), with respect to inorganic and organic MMA arsenic in urine and total arsenic in nails. There was partial correlation between the duration of exposure and inorganic arsenic levels in urine. Immigrant children have higher arsenic levels than native children, but they are not toxic. At present, there is no need for specific arsenic screening or follow-up in immigrant children recently arrived in Spain from exposure high-risk countries.

Prenatal ethanol exposure and placental hCG and IGF2 expression.

INTRODUCTION: Fetal alcohol spectrum disorder (FASD) is the main cause of preventable non-genetic mental retardation. Diagnosis of prenatal exposure to ethanol (PEE) is based on questionnaires and biomarkers in perinatal matrices. Early diagnosis of FASD is important to mitigate secondary disabilities that will arise later in life. It is important to identify biomarkers related to cellular damage caused by PEE. The main objective was to identify novel candidate biomarkers from placental tissue using an in vitro model of exposure to ethanol and to support it in placental tissue obtained from pregnancies with PEE assessed by fatty acid esters in meconium samples. METHODS: First, hormone production was examined using two different human trophoblast cell lines, JEG3 and BeWo. Viable cell count by exclusion method was analyzed and human chorionic gonadotrophin (hCG) and insulin-like growth factor 2 (IGF2) were quantified by Western blot and ELISA. Second, these techniques were used in protein lysates from human placentas from pregnancies with and without exposure to ethanol. RESULTS: Both trophoblast cell lines showed a decrease in cell viability accompanied with apoptosis activation after a chronic ethanol treatment. Moreover, we showed an increase in the secretion of hCG and IGF2 in a dose-dependent manner. Interestingly, this increase was also observed in a set of human placenta tissue from fetuses exposed prenatally to ethanol. DISCUSSION: Ethanol exposure during pregnancy causes placenta cell damage, so altering its normal function. The specific hCG and IGF2 release pattern is a candidate surrogated biomarker of the damage due to PEE.

Hallazgo inesperado en el consejo genético / Unexpected finding in genetic advice

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Ethanol cytotoxic effect on trophoblast cells.

Prenatal ethanol exposure may cause both, altered fetal neurodevelopment and impaired placental function. These disturbances can lead to growth retardation, which is one of the most prevalent features in Fetal Alcohol Syndrome (FAS). It is not known whether there is a specific pattern of cytotoxicity caused by ethanol that can be extrapolated to other cell types. The aim of this study was to determine the cytotoxic effects caused by sustained exposure of trophoblast cells to ethanol. The cytotoxic effect of sustained exposure to standard doses of ethanol on an in vitro human trophoblast cell line, JEG3, was examined. Viable cell count by exclusion method, total protein concentration, lactate dehydrogenase (LDH) activity and activation of apoptotic markers (P-H2AX, caspase-3 and PARP-1) were determined. Sustained exposure to ethanol decreased viable cell count and total protein concentration. LDH activity did not increased in exposed cells but apoptotic markers were detected. In addition, there was a dose-dependent relationship between ethanol concentration and apoptotic pathways activation. Sustained ethanol exposure causes cellular cytotoxicity by apoptotic pathways induction as a result of DNA damage. This apoptotic induction may partially explain the altered function of placental cells and the damage previously detected in other tissues.

Anales de Pediatría: ayer, hoy y mañana / Anales de Pediatría: The past, the present and the future

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Exposición a drogas de abuso en pediatría / Exposure to drugs of abuse in paediatrics

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Dispensación de medicamentos sin prescripción médica en oficinas de farmacia / Dispensing of over-the-counter drugs in pharmacies

Introducción: En España, la legislación actual no permite la dispensación sin receta de los medicamentos de prescripción médica. Ningún fármaco está totalmente exento del riesgo de producir efectos secundarios y el uso no adecuado de antibióticos puede generar la aparición de resistencias y suponer un gasto injustificado. Objetivos: Conocer si se dispensan sin receta fármacos de prescripción médica para uso pediátrico en oficinas de farmacia de Barcelona y comparar los resultados con los datos recogidos en 2006. Material y métodos: Estudio observacional prospectivo en el que una actriz representa un caso clínico estándar (madre de lactante con cuadro respiratorio de vías altas y fiebre) y solicita algún medicamento sin aportar una prescripción médica, en 50 farmacias de Barcelona. Se registra la dispensación sin receta y la adecuación de los consejos de salud ofrecidos. Resultados: Existe dispensación de antibióticos sin receta en el 8% de las farmacias, sin diferencias significativas entre 2006 y 2012. Se dispensaron medicamentos que no requieren prescripción en el 26% de los casos. El personal farmacéutico no estaba correctamente identificado en el 42% de las oficinas de farmacia y la derivación al pediatra solo se realizó en el 67% de los casos. No se preguntó acerca de alergias medicamentosas en ninguna de las farmacias visitadas. Discusión: La dispensación sin receta de fármacos de prescripción médicas persiste en las farmacias de Barcelona a pesar de las campañas y cambios en la legislación actual. Estas no cumplen plenamente su papel como agentes de salud ni indican correctamente las medidas a seguir ante un problema médico. Se debe evitar la dispensación sin prescripción pues supone un riesgo sanitario poco controlado, pervierte el circuito de atención clínica, trivializa el uso de medicamentos y no contribuye a la educación sanitaria de la población (AU)

Introduction: In Spain, current legislation does not allow to dispense drugs without medical prescription. There are no drugs totally exempt of producing secondary effects, the inappropriate use of antibiotics may lead to emergent resistances and it causes an unjustified expenditure. Objectives: To determine whether drugs for pediatric use are being dispensed without prescription in Barcelona's pharmacy offices and to compare the results with data collected in 2006. Material and methods: Prospective observational study in which an actress represents a standardized clinical case (mother of a 9 months old baby with upper respiratory tract symptoms and fever). Medication without providing a medical prescription is requested in 50 pharmacies of Barcelona. Dispensation without prescription and the adequacy of health advice offered are recorded. Results: Antibiotics were dispensed without prescription in 8% of the pharmacy offices. No significant differences were founded between 2006 and 2012. Over the counter drugs were dispensed in 26% of cases. The pharmacy staff was not correctly identified in 42% of the pharmacies and derivation to a pediatrician was performed only in 67% of cases. Drug allergies were not interrogated in any of the pharmacies visited. Discussion: Dispensation without prescription persists in Barcelona's pharmacies despite current campaigns and legislation changes. Pharmacy offices do not fully perform their role as health agents and they wrongly indicate the steps to be followed towards a medical problem. Dispensing without prescription must be avoided since it supposes a poorly controlled health risk, it perverts clinical care track, it trivializes drug use and it does not contribute to the population's health education (AU)

Talidomida: una historia inacabada / Thalidomide: an unfinished history

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Metilfenidato en el tratamiento del trastorno de déficit de atención con hiperactividad en pediatría: monitorización en matrices biológicas / Methylphenidate in the treatment of children with attention-deficit hyperactivity disorder: Monitoring in biological matrices

En los últimos años, el trastorno por déficit de atención e hiperactividad (TDAH) se ha convertido en el trastorno psiquiátrico más frecuentemente diagnosticado y tratado en población pediátrica. En los años 80 fue aprobado en España el metilfenidato (MFD), un fármaco psicoestimulante, para el tratamiento sintomático del TDAH. Desde entonces, se ha convertido en uno de los medicamentos más ampliamente estudiado y prescrito tanto en niños como en adultos. En este artículo se revisan los principios farmacológicos del MFD especialmente su farmacocinética en matrices biológicas convencionales (sangre, orina) y no convencionales (cabello, saliva y sudor), preparados farmacéuticos, concentraciones terapéuticas y efectos indeseables(AU)

Attention-deficit hyperactivity disorder (ADHD) has emerged in the last few years as the most commonly diagnosed and treated psychiatric disorder in the paediatric population. In 1980's, methylphenidate (MFD) a psychomotor stimulant drug, was approved in Spain for the symptomatic therapy of ADHD. Since then, MFD has become one of the most extensively prescribed and studied treatment for ADHD both in children and adults. In this paper, the main pharmacological issues of MFD are reviewed, focusing on its pharmacokinetics in conventional (blood and urine) and non-conventional (hair, oral fluid and sweat) biological matrices, its pharmaceutical preparations, therapeutic levels and side effects(AU)

[Methylphenidate in the treatment of children with attention-deficit hyperactivity disorder: monitoring in biological matrices]. / Metilfenidato en el tratamiento del trastorno de déficit de atención con hiperactividad en pediatría: monitorización en matrices biológicas.

Attention-deficit hyperactivity disorder (ADHD) has emerged in the last few years as the most commonly diagnosed and treated psychiatric disorder in the paediatric population. In 1980's, methylphenidate (MFD) a psychomotor stimulant drug, was approved in Spain for the symptomatic therapy of ADHD. Since then, MFD has become one of the most extensively prescribed and studied treatment for ADHD both in children and adults. In this paper, the main pharmacological issues of MFD are reviewed, focusing on its pharmacokinetics in conventional (blood and urine) and non-conventional (hair, oral fluid and sweat) biological matrices, its pharmaceutical preparations, therapeutic levels and side effects.