TDAH y memoria de trabajo en niños / ADHD and working memory in children

El Trastorno por Déficit de Atención/Hiperactividad (TDAH) es uno de los trastornos con mayor prevalencia en Colombia. Las Funciones Ejecutivas (FE) cumplen un papel fundamental en el aprendizaje y en especial la Memoria de Trabajo (MT). El ojetivo de este estudio es identificar la relación entre TDAH y MT en niños y niñas a través de la búsqueda en bases de datos con artículos publicados del 2015 al 2023, artículos de investigación sobre la MT con niños entre los 6 y 14 años diagnosticados con TDAH. Los autores reconocen que el índice de MT está afectado en las FE en los niños con TDAH por lo cual es necesario profundizar más en los subtipos de TDAH y usar el índice de MT como método de diagnóstico del TDAH.

ADHD (Attention Deficit/Hyperactivity Disorder) is one of the most prevalent disorders in Colombia. Executive Func-tions (EF) play a fundamental role in learning and especially Working Memory (WM). The objective of this study is to identify the relationship between ADHD and WM in boys and girls by searching databases with articles published from 2015 to 2023, research articles on WM with children between the ages of 6 and 14 years diagnosed with ADHD. The authors acknowledge that the WM index is affected in EFs in children with ADHD so it is necessary to further investigate the subtypes of ADHD and to use the MT index as a method of diagnosing ADHD.

Septic shock patients admitted to the intensive care unit with higher SOFA score tend to have higher incidence of abdominal compartment syndrome - a preliminary analysis.

BACKGROUND: Intra-abdominal hypertension (IAH) is relatively frequent in critical patients. According to the most recent consensus of the World Society of Abdominal Compartment Society (WSACS), there are no predictive factors for IAH diagnosis. Risk factors are the only motivators to date for early IAH diagnosis. Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) maintained above 20 mm Hg (> 3 kPa), with or without abdominal perfusion pressure below 60 mm Hg (< 8 kPa), associated with a new organ dysfunction. Sepsis is a recognized cause of secondary ACS, but to date there is no correlation with admission SOFA (sequential organ failure assessment) score and ACS onset incidence. The objective of the present study is to determine the profile of extra-abdominal septic shock patients with IAH/ACS admitted to the intensive care unit (ICU) and correlating with admission SOFA score. Better understanding of this population may bring to light clinical predictive factors for IAH/ACS early diagnosis. METHODS: In this observational study IAH/ACS incidence was correlated with SOFA score calculated at ICU admission. The study enrolled all critically ill patients more than 18 years old admitted to the Medical Intensive Care Unit (MICU) of a university teaching hospital between April and October 2016, who had been diagnosed with extra-abdominal septic shock, according to the Surviving Sepsis Campaign and SEPSIS-3. RESULTS: Twenty-five patients were evaluated during 10 hospitalization days. The average age was 51.13 ± 16.52 years, and 64% of the patients were male. Most patients (76%) had pneumonia. On admission, the SOFA score was 6.54 ± 2.71. Mortality rate in the population studied was 52%. The incidence of IAH was 43.5%, while the incidence of ACS in the IAH population was 28%. SOFA admission score in patients with the diagnosis of ACS was of 8.42 ± 1.27. In this study SOFA score higher than 7 is correlated with IAH, with an accuracy of 68.8% (P < 0.03). CONCLUSIONS: The incidence of ACS in patients with extra-abdominal septic shock admitted to a university teaching hospital MICU was higher than those found in the literature. Higher admission and consecutive SOFA score of more than 7 was associated with higher ACS incidence and higher mortality rate.

Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes com fratura de osso longo / The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture

A reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) realizou uma revisão crítica da literatura e selecionou três artigos recentes sobre o uso de corticoide para a profilaxia da síndrome de embolia gordurosa. O foco desta revisão foi a indicação ou não do uso de corticoide nos pacientes admitidos na unidade de terapia intensiva (UTI) com risco de desenvolverem embolia gordurosa pós traumática. O primeiro artigo foi um estudo prospectivo com o objetivo de estabelecer fatores preditivos confiáveis, precoces e úteis associados ao aparecimento da síndrome da embolia gordurosa (SEG) em pacientes traumatizados. O segundo artigo foi uma revisão de literatura sobre o papel do corticoide como medida profilática à síndrome de embolia gordurosa. O último artigo foi uma meta-análise sobre a capacidade do corticoide em reduzir o risco de síndrome da embolia gordurosa nos pacientes com fraturas de ossos longos. As principais conclusões e recomendações foram que pacientes traumatizados devem ser monitorizados na UTI com oximetria de pulso e medida do lactato já que estes fatores podem predizer o aparecimento de SEG e que não existe evidência suficiente para recomendar o uso de corticoide para a profilaxia desta síndrome.

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome. The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which occurred early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review of the role of corticosteroids as a prophylactic measure for fat embolism syndrome (FES). The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these factors may predict the development of FES, and that there is not enough evidence to recommend the use of steroids for the prophylaxis of this syndrome.

The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture.

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome. The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which occurred early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review of the role of corticosteroids as a prophylactic measure for fat embolism syndrome (FES). The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these factors may predict the development of FES, and that there is not enough evidence to recommend the use of steroids for the prophylaxis of this syndrome.

GABA receptor agonists in the medial preoptic area and maternal behavior in lactating rats.

We studied the effects of injecting agonists of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) muscimol (GABA-A receptor agonist) and baclofen (GABA-B receptor agonist) in the medial preoptic area (MPOA) and neighboring brain regions, the bed nucleus of the stria terminalis (BNST), and lateral preoptic area (LPO) on maternal behavior. Lactating female rats were implanted with bilateral cannulae in the MPOA/BNST on day 1 postpartum. On day 5, a maternal behavior test was conducted in the home cage after females received injections of muscimol or baclofen (0, 12.5, 50 or 200 ng per side). On day 7, after MPOA/BNST injections, a second maternal behavior test was conducted with pups placed at the end of a T-runway projecting from the home cage. Finally, after injections on day 9 maternal aggression, olfaction, and locomotor behavior were tested. The GABA receptor agonists injected in the MPOA/BNST produced dose-dependent deficits in all components of maternal behavior, including maternal aggression, except licking. Muscimol produced deficits in the active component, nest building at lower doses than baclofen, both agonists produced deficits in retrieving, while baclofen produced deficits in passive components (hovering and crouching over pups) at lower doses than muscimol. Both GABA receptor agonists increased locomotor activity and reduced olfactory responsiveness but these were only correlated with deficits in retrieving and crouching in baclofen-treated females.