Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder.

OBJECTIVE: A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. METHOD: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. RESULTS: The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8). CONCLUSION: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.

Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate.

OBJECTIVE: Although attention-deficit hyperactivity disorder (ADHD) is a well-known risk factor for cigarette smoking, prospective studies aimed at reducing smoking risk in this population are critically needed. STUDY DESIGN: This was a 2-year, prospective, open-label clinical trial of extended-release methylphenidate for smoking prevention in adolescents with ADHD (n = 154). Smoking outcomes were assessed with the Fagerstrom Tolerance Questionnaire. Comparisons were made using data from a historical, naturalistic sample of ADHD (n = 103) and non-ADHD comparators (n = 188) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial. RESULTS: The smoking rate at endpoint (mean, 10 months of methylphenidate treatment) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically (7.1% vs 8.0% vs 10.9%; P > .20). In contrast, the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment (7.1% vs 19.6%; P = .009 [not significant], adjusting for comorbid conduct disorder and alcohol and drug abuse). CONCLUSION: Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD. If confirmed, this finding would have significant clinical and public health impacts.

Validation of the University of São Paulo Sensory Phenomena Scale: initial psychometric properties.

INTRODUCTION: Although obsessions and compulsions comprise the main features of obsessive-compulsive disorder (OCD), many patients report that their compulsions are preceded by a sense of "incompleteness" or other unpleasant feelings such as premonitory urges or a need perform actions until feeling "just right." These manifestations have been characterized as Sensory Phenomena (SP). The current study presents initial psychometric data for a new scale designed to measure SP. METHODS: Seventy-six adult OCD subjects were probed twice. Patients were assessed with an open clinical interview (considered as the "gold standard") and with the following standardized instruments: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Yale-Brown Obsessive-Compulsive Scale, Dimensional Yale-Brown Obsessive-Compulsive Scale, Yale Global Tic Severity Scale, Beck Anxiety Inventory, and Beck Depression Inventory. RESULTS: SP were present in 51 OCD patients (67.1%). Tics were present in 16 (21.1%) of the overall sample. The presence of SP was significantly higher in early-onset OCD patients. There were no significant differences in the presence of SP according to comorbidity with tics or gender. The comparison between the results from the open clinical interviews and the University of São Paulo Sensory Phenomena Scale (USP-SPS) showed an excellent concordance between them, with no significant differences between interviewers. The inter-rater reliability between the expert raters for the USP-SPS was high, with K=.92. The Pearson correlation coefficient between the SP severity scores given by the two raters was .89. CONCLUSION: Preliminary results suggest that the USP-SPS is a valid and reliable instrument for assessing the presence and severity of SP in OCD subjects.

Tratamiento laparoscópico de pancreatitis aguda grave. Reporte de un caso / Laparoscopic treatment of severe acute pancreatitis. A case report

Objetivo. Reportar el tratamiento laparoscópico de un paciente con pancreatitis aguda grave. Antecedentes. La eficacia y ventajas de la cirugía laparoscópica en el tratamiento de enfermedades intraabdominales agudas ha sido demostrado previamente. La vía laparoscópica ya ha sido reportada para el diagnóstico y tratamiento de diversas enfermedades pancreáticas, incluyendo formas severas de pancreatitis y sus complicaciones. Material y métodos. Paciente masculino de 70 años de edad con cuadro de abdomen agudo al que se le realizó laparoscopia diagnóstica encontrándose colecistitis aguda y pancreatitis grave. Siete días después debido a curso tórpido requirió de reintervención para realizar necrosectomía por vía laparoscópica. Conclusión. El tratamiento laparoscópico de la pancreatitis grave es factible en casos seleccionados y brinda grandes ventajas sobre el procedimiento tradicional. Son necesarios estudios y protocolos prospectivos para validar el abordaje laparoscópico en el diagnóstico y tratamiento de la pancreatitis grave

Alimentación en el niño con padecimientos renales / Feeding children with renal diseases

La alimentación en el niño con padecimientos renales, al igual que en un niño sano, tiene por objeto mantener un crecimiento adecuado y bienestar general, de acuerdo con las características propias de cada enfermedad renal. Para esto hay que conocer la fisiopatología de cada una de las enfermedades, y adecuar la alimentación al estado metabólico presente. Al hacer la prescripción dietética, hay que calcular siempre las calorías, proteínas, agua y electrolitos, de acuerdo con las pérdidas sufridas. Durante la insuficiencia renal, el paciente no puede excretar los productos finales del metabolismo, por lo cual las proteínas se deben restringir pensando siempre en su valor biológico. En el síndrome nefrótico, cuando las proteínas se pierden en exceso, su ingesta debe aumentar para compensar la pérdida. Otros elementos, se debe manejar de una manera similar; por ejemplo, el sodio se debe restringir en pacientes con edema o hipertensión arterial, y se debe aumentar en pacientes con tubulopatías que pierden este elemento de manera exagerada por la orina. Se hace énfasis en las diferentes metabólicas de las diferentes edades y la repercusión que tienen al prescribir la dieta.