Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial.

Recent guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) have claimed the possible benefits of psychoeducational techniques in the comprehensive management of ADHD. To evaluate the efficacy of a psychoeducation programme for parents of children and adolescents with ADHD in a clinical setting using a blind randomized trial. 81 children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation programme (intervention group, n = 44), or a parent counselling and support intervention (control group, n = 37). Measures of child ADHD symptoms, psychopathology, quality of life and family stress were taken before and after intervention and after a year follow-up. Parents and evaluators were unaware of the condition received. Compared to the support control group, the psychoeducation group showed ADHD Index and cognitive/inattention levels significantly reduced after the intervention ended (Mann-Whitney U = 3.34; p = 0.001; Mann-Whitney U = 3.47; p = 0.001). An improvement in the pro-social domain was also observed after 1 year follow-up (Mann-Whitney U = -2.37; p = 0.018), and clinical global impression found a statistically significant effect for severity over the time. Differences were initially found for the impact of the disorder in the family in different domains, including emotional and social functioning; these differences were no longer significant after alpha correction. No significant differences in quality of life or family stress were found in comparison with the control group. This psychoeducation programme is a valuable treatment for parents/carers of children/adolescents with ADHD, which needs to be considered when evaluating different non-pharmacological treatment options. Psychoeducation and other kind of non-pharmacological approaches need to be regarded not as a substitute, but as a complementary treatment to medications; these approaches might help other very crucial aspects of ADHD including social and familiar outcomes.

Síndrome de abstinencia en Cuidados Intensivos Pediátricos. Incidencia y factores de riesgo / Withdrawal syndrome in the pediatric intensive care unit. incidence and risk factors

Objetivo Conocer la incidencia de síndrome de abstinencia tras perfusión prolongada de fentanilo y midazolam en niños, y los factores de riesgo asociados. Diseño Estudio de cohorte histórica o retrospectiva. Ámbito UCI pediátrica de seis camas de un hospital universitario. Pacientes Se incluyen 48 pacientes pediátricos que recibieron sedoanalgesia en perfusión continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Intervenciones Ninguna. Variables de interés principales Se recogen datos clínicos y demográficos, dosis y duración de sedoanalgesia recibida, aparición de síndrome de abstinencia, gravedad y tratamiento del mismo. Resultados El 50% desarrolló síndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duración del tratamiento previo y dosis acumulada de ambos fármacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duración de la perfusión de ambos de 5,75 días fueron factores de riesgo para el desarrollo de abstinencia. La mayoría presentó un cuadro leve o moderado, que comenzó a las 12-36 horas de suspender la perfusión. El fármaco más utilizado en el tratamiento fue la metadona. Conclusiones La incidencia de síndrome de abstinencia en niños tras perfusión prolongada de midazolam y fentanilo es elevada. El desarrollo del síndrome se relaciona con tiempos de perfusión prolongados y con dosis acumuladas elevadas de ambos fármacos (AU)

Objective To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Design Historic or retrospective cohort study. Setting Pediatric Intensive Care Unit in an academic center. Patients Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours.InterventionsNone.Main variables of interest Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. Results Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48mg/kg, a cumulative midazolam dose of 40mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36hours after weaning from infusion. Methadone was used in most cases for treating with drawal. Conclusions There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome (AU)

Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal women.

UNLABELLED: Postmenopausal women who were vitamin D deficient and had high serum levels of retinol had an eight times higher risk of having osteoporosis. A high retinol level together with vitamin D deficiency/insufficiency is an additional risk factor for osteoporosis. PURPOSE: The aim of this study was to evaluate the association between vitamin D deficiency/insufficiency and excess of vitamin A intake as an osteoporosis risk factor in healthy postmenopausal women DESIGN: The design is a cross-sectional study of 232 healthy postmenopausal women. METHODS: Bone mass was evaluated by dual energy X-ray absorptiometry. Serum calcium, albumin phosphorus, creatinine, total high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and triglycerides analyzed by standard methods and retinol and 25-hydroxyvitamin D [25(OH)D] measured by an online solid-phase extraction coupled with high-pressure liquid chromatography-ultraviolet detection. RESULTS: Prevalence of vitamin D deficiency [25(OH)D < 20 ng/mL] was 70.1 %; 14.3 % had a 25(OH)D < 10 ng/mL, and 23.6 % had insufficiency [25(OH)D 21-29 ng/mL]. Prevalence of high serum levels of retinol (>80 µg/dL) was 36.4 %. Among subjects with 25(OH)D <20 ng/mL (n = 152), 60.4 % (n = 92) had serum levels of retinol > 80 µg/dL. Bone density measurements revealed that the risk of osteoporosis was ~8 times higher in women with the highest retinol levels, as compared with women with the lowest retinol levels. In women with 25(OH)D < 20 ng/mL, the risk for osteoporosis increased substantially in women who had the highest blood levels of retinol compared to the women with lowest retinol levels. CONCLUSIONS: Higher retinol levels together with vitamin D deficiency could be a significant additional risk factor for osteoporosis, underscoring the need for improved physician and public education regarding optimization of vitamin D status in postmenopausal women and developing policies to avoid high serum levels of vitamin A.

Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors.

OBJECTIVE: To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. DESIGN: Historic or retrospective cohort study. SETTING: Pediatric Intensive Care Unit in an academic center. PATIENTS: Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. RESULTS: Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal. CONCLUSIONS: There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.

Evaluation of planning dysfunction in attention deficit hyperactivity disorder and autistic spectrum disorders using the zoo map task.

Attention-Deficit-Hyperactivity-Disorders (ADHD) and Autistic-Spectrum-Disorders (ASD) share overlapping clinical and cognitive features that may confuse the diagnosis. Evaluation of executive problems and planning dysfunction may aid the clinical diagnostic process and help disentangle the neurobiological process underlying these conditions. This study evaluates the planning function problems in 80 male children and adolescents diagnosed with ADHD and 23 male children and adolescents with ASD using the Zoo Map Task; both groups were comparable in terms of age and IQ. The relationship between planning function and other executive functions is also assessed. In comparison to the ADHD groups, ASD children presented more errors in the open-ended tasks; these planning function problems seem to be mediated by processing speed and motor coordination, however it does not seem to be mediated by other executive function problems, including attention, working memory or response inhibition. In the time for planning, an interaction between the specific subgroups and working memory components was observed. ADHD and ASD present with different patterns of planning function, even when other components of executive function are taken into account; clinical and educational implications are discussed.

On-line coupling of automatic solid-phase extraction and HPLC for determination of carotenoids in serum.

The automated method developed for the determination of carotenoids uses 200 µL of serum, which was mixed with 400 µL of tetrahydrofuran, vortexed for 1 min, settled for 10 min, centrifuged for 6 min and the supernatant injected into an automatic solid-phase extraction (SPE) system for cleanup-preconcentration. A 10% water-acetonitrile mobile phase at 1.5 mL min(-1) eluted the retained compounds and transferred them on-line to a reversed-phase analytical column for individual separation of the target analytes. Visible detection was performed at 450 and 460 nm. The detection limits for the target analytes were between 3 and 30 ng mL(-1); the precision (expressed as relative standard deviation) ranged between 2.83 and 5.06% for repeatability and between 3.80 and 7.40% for within laboratory reproducibility. The total analysis time was 18 min. The proposed method is reliable, robust, and has an excellent potential for high-throughput use in both clinical and research laboratories.

Standard operation protocol for analysis of lipid hydroperoxides in human serum using a fully automated method based on solid-phase extraction and liquid chromatography-mass spectrometry in selected reaction monitoring.

Standard operating procedures (SOPs) are of paramount importance in the analytical field to ensure the reproducibility of the results obtained among laboratories. SOPs gain special interest when the aim is the analysis of potentially unstable compounds. An SOP for analysis of lipid hydroperoxides (HpETEs) is here reported after optimization of the critical steps to be considered in their analysis in human serum from sampling to final analysis. The method is based on automated hyphenation between solid-phase extraction (SPE) and liquid chromatography-mass spectrometry (LC-MS). The developed research involves: (i) optimization of the SPE and LC-MS steps with a proper synchronization; (ii) validation of the method-viz. accuracy study (estimated as 86.4% as minimum value), evaluation of sensitivity and precision, which ranged from 2.5 to 7.0 ng/mL (0.25-0.70 ng on column) as quantification limit and precision below 13.2%), and robustness study (reusability of the cartridge for 5 times without affecting the accuracy and precision of the method); (iii) stability study, involving freeze-thaw stability, short-term and long-term stability and stock solution stability tests. The results thus obtained allow minimizing both random and systematic variation of the metabolic profiles of the target compounds by correct application of the established protocol.

Automated method for targeting analysis of prostanoids in human serum by on-line solid-phase extraction and liquid chromatography-mass spectrometry in selected reaction monitoring.

Prostanoids are potent biologically active lipid molecules demanding for analysis methods combining precision, sensitivity and high-throughput for pharmacological and clinical applications. The present research describes the development and validation of an on-line automated method based on solid-phase extraction liquid chromatography-tandem mass spectrometry (SPE-LC-MS/MS) for the quantification of prostanoids in human serum. This approach overcomes the main limitation of previous methods involving manual protocols, such as analyte losses, metabolites degradation and time-consuming protocols, are minimized. Human serum (100 µL) was directly injected into an automatic solid-phase extraction workstation for cleanup and preconcentration of the target metabolites. The eluate was on-line transferred to a reversed-phase analytical column for chromatographic separation prior to mass spectrometry detection in selected reaction monitoring mode. The detection limits for the target analytes ranged from 2.3 to 63.3 pg on column. The precision (expressed as relative standard deviation) was within 3.30 and 6.15% for repeatability and from 4.16 to 11.11% for within-laboratory reproducibility. Accuracy was evaluated with spiked and non-spiked serum samples to estimate concentration differences that could be affected by matrix effects or inefficient SPE performance. Accuracy, estimated as recovery factor, was from 87.7 to 100% for the target compounds. The proposed method is reliable and has an excellent potential for high-throughput use in both clinical and research laboratories by minimizing analyst intervention.

Influence of vegetable oils fatty-acid composition on biodiesel optimization.

Biodiesel is an alternative fuel for diesel engines produced through transesterification of oleaginous feedstocks. To analyze the influence of the fatty-acid composition on biodiesel optimization, transesterification of several vegetable oils has been studied. Reactions were carried out in flasks filled with vegetable oils, heated to the reaction temperature and stirred at 1100 rpm. The reactions started when the methanol and potassium hydroxide solutions were added to the flasks. Concentration of catalyst, amount of methanol, reaction temperature and time were optimized using a factorial design and a surface response design. Also, a kinetics study was carried out to optimize the reaction time. Results showed that reaction parameters optimal values depend on the oil chemical and physical properties. It can be concluded from this field trial that the effect of both catalyst concentration and reaction time over the transesterification yield is greatly influenced by the saturation degree and fatty-acid chain length.

Vitamin D deficiency and high serum levels of vitamin A increase the risk of osteoporosis evaluated by Quantitative Ultrasound Measurements (QUS) in postmenopausal Spanish women.

OBJECTIVES: Association between vitamin D deficiency and excess of vitamin A as a potential risk factor of osteoporosis and fracture has been evaluated. DESIGN AND METHODS: 232 healthy postmenopausal women were studied. Serum parameters were analyzed by standard methods and fat-soluble vitamins by an own HPLC method. QUS measurement of the calcaneal bone was carried out by Sahara. RESULTS: 124 patients were considered non-osteoporotic and 101 (44.9%) were osteoporotic. The prevalence of high serum levels of retinol was 36.4% and vitamin D deficiency was 70.1%. 60.4% of women with vitamin D deficiency have high serum levels of retinol. In the whole population, the increased risk of osteoporosis was up to three times higher for the highest retinol quintile, as compared with the lowest retinol quintile. Whereas in women with vitamin D deficiency the risk of osteoporosis increased was up 5 times higher than women in the lowest quintile of retinol. CONCLUSIONS: Our results show that high retinol levels together with vitamin D deficiency are hitherto an overlooked risk factor for osteoporosis.

Automated determination of folate catabolites in human biofluids (urine, breast milk and serum) by on-line SPE­HILIC­MS/MS.

A rapid, precise and fully-automated method for analysis of folate (vitamin B9) and its catabolites (viz. p-aminobenzoylglutamate and its acetamide derivative) in biofluids is here presented. The method is based on on-line hyphenation of solid-phase extraction (SPE) by a Prospekt 2 system with hydrophilic interaction liquid chromatography­tandem mass spectrometry (HILIC­MS/MS). The method was analytically characterized by estimation of repeatability (RSD, n = 5, between 0.5 and 4.1%), accuracy (between 96 and 105%), and sensitivity (limits of quantificantion between 0.3 and 8.3 ng/mL (1.1 and 18.8 pmol/mL) or 0.03 and 0.83 ng (0.11 and 1.88 pmol)). The proposed method is suited for routine analysis of folate catabolites as biomarkers to monitor deficiency of vitamin B9.

Evaluation of vitamin D endocrine system (VDES) status and response to treatment of patients in intensive care units (ICUs) using an on-line SPE-LC-MS/MS method.

Vitamin D deficiency is recognized as one of the most common chronic medical conditions in the world. Vitamin deficiency has been associated with increased mortality. The aim of the study here presented was to evaluate the vitamin D endocrine system (VDES) status in healthy blood donors and critically ill patients baseline and in response to treatment during a week with two doses of 1.5 mg of 25-hydroxyvitamin D3 and 2 microg calcitriol (1,25(OH)2D3) IV on alternate days, by monitoring levels in serum of major vitamin D metabolites in critically ill patients. Group 1: healthy blood donors (control group) (n=92), and group 2: critically ill subjects from an intensive care unit (ICU) (n=33). Critically ill patients were divided into three groups: group A (n=12) is the control group; group B (n=11), administration PO 1,5 mg of 25(OH)D3, in days 0 and 4 of treatment; and group C (n=11), administration IV of 2 microg 1,25(OH)2D3 on alternate days. Baseline serum levels of vitamin D2 and 25(OH)D2 were not detected. Vitamin D3 (9.8 vs 26.0 nM) (p<0.05), 25(OH)D3 (13.3 vs 52.3 nM) (p<0.001), and 1,25(OH)2D3 (53.8 vs 120.5 pM) (p<0.01) serum levels were significantly lower in critically ill subjects than in healthy donors. After treatment in group B: 25OHD3 increased to 46.0+/-16.5 ng/ml (p<0.0001) (22.2%<75 nM, 11.1% <50 nM). 1,25(OH)2D3 increased to 121.8+/-61.8 pM<0.01 whereas were slightly decreased in the other groups during the study. 24,25(OH)2D3 serum levels were increased in patients treated with calcitriol 8.5+/-5.3 vs 24.8+/-16.3 nM (p<0.05) while the levels kept stable in group A patients. In summary, critically ill patients have a severe vitamin D deficiency, which can be easily corrected by administration of high doses of 25OHD (PO). The VDES functional deficiency could be probably also corrected through administration of calcitriol (IV). Both treatments could produce an improvement in the general health and probably a reduction in overall mortality risk of the critically ill patients.

Validación de la medición transcutánea de la presión parcial de dióxido de carbono en el paciente crítico pediátrico / Validation of the transcutaneous carbon dioxide tension measurements in critical paediatric patients

Objetivo: Valorar la fiabilidad de la medición de la presión transcutánea de dióxido de carbono (PtCO2) respecto a la medición de la presión arterial de dióxido de carbono (PaCO2). Material y métodos: Estudio analítico, observacional, longitudinal y prospectivo. Cohorte de pacientes ingresados en unidad de cuidados intensivos pediátricos. La PtCO2 se midió con el monitor digital SenTec, aplicando el sensor con un anillo específico (sensor V-sign, versión MDB 04.04.02). Se recogieron al mismo tiempo la PtCO2 y PaCO2. La significación estadística de la asociación se calculó mediante el test F de Snedecor, el coeficiente de correlación r2 de Pearson y el coeficiente de correlación intraclase. El grado de acuerdo se estimó con el método de Bland y Altman. La consistencia de los resultados se estudió con el ANOVA. Resultados: Se compararon 106 mediciones pareadas de PtCO2 y PaCO2, de 12 pacientes. Las PaCO2 y PtCO2 medias fueron 51,0±13mmHg y 50,1±14mmHg; r2=0,87 (p<0,001), CCI=0,96 (IC: 0,94–0,97). El análisis de Bland-Altman mostró una media de las diferencias de−0,9mmHg (IC:−2,0 a 0,2mmHg). La correlación fue mejor en ausencia de patología respiratoria, con asistencia respiratoria baja, con PaCO2>50mmHg y con aplicación frontal del sensor. Hubo consistencia de los resultados. No se observaron efectos secundarios derivados de la utilización del anillo. Conclusiones: La correlación obtenida entre la PtCO2 y PaCO2 fue muy buena. El monitor digital SenTec y el sensor de anillo específico constituyen una herramienta fiable, segura y fácil de utiliza (AU)

Objective: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO2) compared to the measurement of the arterial carbon dioxide tension (PaCO2). Material and methods: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO2 was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO2 and PaCO2 were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r2 correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). Results: One hundred and six paired measurements, PtCO2 and PaCO2, from twelve patients, were compared. The means of the PaCO2 and PtCO2 were 51.0±13mmHg and 50.1±14mmHg, respectively; r2=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94–0.97). The Bland-Altman analysis showed a mean difference of−0.9mmHg (95% CI:−2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO2>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. Conclusion: The correlation between PtCO2 and PaCO2 is excellent and stable. The ring sensor was safe and easy to us (AU)

[Validation of the transcutaneous carbon dioxide tension measurements in critical paediatric patients]. / Validación de la medición transcutánea de la presión parcial de dióxido de carbono en el paciente crítico pediátrico.

OBJECTIVE: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO(2)) compared to the measurement of the arterial carbon dioxide tension (PaCO(2)). MATERIAL AND METHODS: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO(2) was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO(2) and PaCO(2) were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r(2) correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). RESULTS: One hundred and six paired measurements, PtCO(2) and PaCO(2), from twelve patients, were compared. The means of the PaCO(2) and PtCO(2) were 51.0+/-13mmHg and 50.1+/-14mmHg, respectively; r(2)=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94-0.97). The Bland-Altman analysis showed a mean difference of-0.9mmHg (95% CI:-2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO(2)>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. CONCLUSION: The correlation between PtCO(2) and PaCO(2) is excellent and stable. The ring sensor was safe and easy to use.

Larva migratoria cutánea: diagnóstico y tratamiento de un caso en Atención Primaria / No disponible

Larva migratoria cutánea es un término que designa una erupción dérmica de carácter lineal y serpingoso, producida por larvas de helmintos. Algunos autores lo denominan también erupción serpingosa. La etiología más frecuente es el Ancylostoma braziliense, que se encuentra en zonas de clima cálido. Dado el aumento de viajes a estas zonas cálidas, es una patología a tener encuentra en nuestras consultas ante lesiones características (AU)

Cutaneous larva migrans is a clinical term that design atesa skin eruption of linear and serpinginous character, produced by larvas of helminthes. Some authors also call it serpinginous eruption. The Ancylostoma braziliense is the most frequent etiology, found in zones of warm climate. Given the increase of trips to these warm zones, this disease should be taken into consideration when there are characteristic injuries (AU)

Fast, sensitive and highly discriminant gas chromatography-mass spectrometry method for profiling analysis of fatty acids in serum.

A method for the determination of fatty acids in serum based on GC-MS (micro-SIS detection mode) has been developed and the separation and cis/trans isomers have been identified. A prior two-step extraction/derivatization procedure accelerated by ultrasound allows individual determination of esterified (EFAs) and non-esterified fatty acids (NEFAs), and shortening of the derivatization steps to 5 min for EFAs and 15 min for NEFAs. The total analysis time for 39 fatty acids was 61 min. The minimum LOD and LOQ values were 0.002 and 0.006 microg/ml, respectively. The proposed method was validated for EFAs and NEFAs using two different methods and the results show no statistical differences between the proposed method and those used as reference. The proposed derivatization-extraction methodology is suitable for fatty-acid analysis of human serum, and can be applied to nutritional and epidemiological studies.