Future of ADHD Care: Evaluating the Efficacy of ChatGPT in Therapy Enhancement.

This study explores the integration of large language models (LLMs), like ChatGPT, to improve attention deficit hyperactivity disorder (ADHD) treatments. Utilizing the Delphi method for its systematic forecasting capabilities, we gathered a panel of child ADHD therapy experts. These experts interacted with our custom ChatGPT through a specialized interface, thus engaging in simulated therapy scenarios with behavioral prompts and commands. Using empirical tests and expert feedback, we aimed to rigorously evaluate ChatGPT's effectiveness in therapy settings to integrate AI into healthcare responsibly. We sought to ensure that AI contributes positively and ethically to therapy and patient care, thus filling a gap in ADHD treatment methods. Findings show ChatGPT's empathy, adaptability, and communication strengths, thereby highlighting its potential to significantly improve ADHD care. The study points to ChatGPT's capacity to transform therapy practices through personalized and responsive patient care. However, it also notes the need for enhancements in privacy, cultural sensitivity, and interpreting nonverbal cues for ChatGPT's effective healthcare integration. Our research advocates for merging technological innovation with a comprehensive understanding of patient needs and ethical considerations, thereby aiming to pioneer a new era of AI-assisted therapy. We emphasize the ongoing refinement of AI tools like ChatGPT to meet ADHD therapy and patient care requirements more effectively.

Identification of key functionalization species in the Cp*Ir(III)-catalyzed-ortho halogenation of benzamides.

Cp*Ir(iii) complexes have been shown to be effective for the halogenation of N,N-diisopropylbenzamides with N-halosuccinimide as a suitable halogen source. The optimized conditions for the iodination reaction consist of 0.5 mol% [Cp*IrCl2]2 in 1,2-dichloroethane at 60 °C for 1 h to form a variety of iodinated benzamides in high yields. Increasing the catalyst loading to 6 mol% and the time to 4 h enabled the bromination reaction of the same substrates. Reactivity was not observed for the chlorination of these substrates. A variety of functional groups on the para-position of the benzamide were well tolerated. Kinetic studies showed the reaction dependence is first order in iridium, positive order in benzamide, and zero order in N-iodosuccinimide. A KIE of 2.5 was obtained from an independent H/D kinetic isotope effect study. Computational studies (DFT-BP3PW91) indicate that a CMD mechanism is more likely than an oxidative addition pathway for the C-H bond activation step. The calculated functionalization step involves an Ir(v) species that is the result of oxidative addition of acetate hypoiodite that is generated in situ from N-iodosuccinimide and acetic acid.

Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019 / Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019

Este documento sobre EPOC de la Asociación Latinoamericana de Tórax (ALAT) 2019 analiza las nuevas evidencias de medicación inhalada utilizando la metodología de preguntas clínicas en formato PICO. Surgen de este análisis los siguientes puntos claves: 1) no hay evidencia que compare el uso de broncodilatadores de acción corta vs. larga en pacientes con EPOC leve; en aquellos con EPOC moderada-grave existe mayor beneficio de los broncodilatadores de acción larga, 2) beneficios similares de la monoterapia con antimuscarínicos de acción prolongada (LAMA) y la terapia combinada β2-agonistas de acción larga/corticosteroides inhalados (LABA/CIS), asociada esta última a mayor riesgo de neumonía, 3) mayores beneficios del LABA/LAMA en función pulmonar y riesgo de exacerbación vs. LABA/CIS (esta última con mayor riesgo de neumonía) y 4) mayores beneficios de la terapia LAMA/LABA/CIS comparada con LABA/LAMA sobre el riesgo de exacerbaciones moderadas-severas. En relación al rol de los eosinófilos para guiar el uso de los CIS: debe considerarse su retiro cuando la indicación inicial fue errada o sin respuesta, en pacientes con efectos secundarios como neumonía, y en aquellos con bajo riesgo de exacerbación con recuento de eosinófilos en sangre < 300 cél/μl. Incorporando estas evidencias según la gravedad de la obstrucción, síntomas y riesgo de exacerbaciones se genera un algoritmo para el uso de medicación inhalada en la EPOC

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD

Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019. / Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019.

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting ß2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/µl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD.

Glomerulonefritis rápidamente progresiva asociada con vasculitis por ANCA / Rapidly progressive glomerulonephritis associated with ANCA-vasculitis

Resumen El glomérulo renal, estructura altamente vascularizada, se ve afectado por un grupo de vasculitis de pequeño vaso asociadas con anticuerpos anticitoplasma de neutrófilo (ANCA), descritas por su relativa escasez de depósitos inmunes como pauciinmunes. Estas vasculitis se clasifican según el consenso internacional de Chapel-Hill en poliangeítis microscópica, granulomatosis con poliangeítis, granulomatosis eosinofílica y la llamada vasculitis limitada al riñón. Desde el punto de vista anatomopatológico, la glomerulonefritis rápidamente progresiva puede dividirse en pauciinmune, antimembrana basal glomerular (GBM GN) y mediada por inmunocomplejos. El tratamiento, en general, es con inmunosupresor y terapia renal de soporte desde medidas conservadoras hasta tratamiento de sustitución renal. Se comunica un caso de glomerulonefritis rápidamente progresiva asociada con ANCA por confirmación anatomopatológica.

Abstract The renal glomerulus highly vascularized structure is affected by a small vessel vasculitis group associated with neutrophil cytoplasmic antibodies (ANCA) described by its relative scarcity of pauci-immune deposits as immune. This vasculitis is classified according to international consensus in Chapel-Hill microscopic poliangetitis, granulomatosis with polyangiitis, eosinophilic granulomatosis and the called vasculitis limited to the kidney. From the anatomopathological point of view, the rapidly progressive glomerulonephritis can be divided into pauci-immune, anti glomerular basement membrane and mediated by immune complexes. The treatment is generally based on immunosuppressive therapy and renal therapy support from conservative measures to renal replacement therapy. This paper reports a case of rapidly progressive glomerulonephritis associated with ANCA pathological confirmation.

Reproductive biology of Poecilia sphenops Valenciennes, 1846 (Cyprinidontiformes: Poeciliidae) at the Emiliano Zapata Reservoir in Morelos, Mexico

Poecilia sphenops es una especie nativa registrada recientemente en la cuenca del Balsas y el río Amacuzac en Morelos (México), en el cual es abundante y ampliamente distribuida. En este estudio se analizaron algunos aspectos de la biología reproductiva de Poecilia sphenops de la presa Emiliano Zapata, ubicada en el centro de México. Los especímenes fueron recolectados de Enero a diciembre de 2006, utilizando una red de 20 m de largo con una luz de malla de 5 mm. Se recolectaron un total de 581 especímenes: 407 hembras (70.0%), 83 machos (14.3%) y 91 individuos indiferenciados (15.7%). El tamaño de los peces osciló de 2 a 96 mm de longitud total y de 0.01 a 13.07 g de peso corporal. La proporción sexual de las hembras con respecto a los machos (4.9:1) se desvió significativamente de la unidad (2= 214.2, p 0.05). La variación mensual de los índices gonadosomático, hepatosomático y del desarrollo de los estadios de los ovarios, mostraron que la época de desove de P. sphenops se llevó a cabo entre julio y octubre, durante la época de lluvias. Otro pico de reproducción fue registrado en Febrero. La talla más grande registrada para los machos y para las hembras fue de 96 mm y 83 mm, respectivamente.

Poecilia sphenops is a native species recently recorded in the Balsas basin and the Amacuzac River in Morelos (Mexico), in which it is abundant and widely distributed. This study analyzed some aspects of the reproductive biology of Poecilia sphenops from the Emiliano Zapata Reservoir, in Central Mexico. Specimens were collected using a 20 m-long seine with a 5 mm mesh size, from January to December 2006. A total of 581 specimens were collected: 407 females (70.0%), 83 males (14.3%) and 91 individuals with no differentiated sex (15.7%). Fish ranged from 20 to 96 mm in total length and 0.01 to 13.07 g in body weight. The female to male sex ratio (4.9:1) deviated significantly from the unity (2= 214.2, p 0.05). Monthly variations in gonadosomatic (GSI) and hepatosomatic (HSI) indexes and ovarian development stages showed that P. sphenops spawning season occurred between July and October, concurring with the rainy season. Another reproduction peak was registered in February. The largest length registered for males and females was 96 mm and 83 mm, respectively.

Guía de práctica clínica de la enfermedad pulmonar obstructiva crónica (EPOC) ALAT-2014: preguntas y respuestas / ALAT-2014 chronic obstructive pulmonary disease (COPD) clinical practice guidelines: questions and answers

La guía de práctica clínica de enfermedad pulmonar obstructiva crónica (EPOC) ALAT 2014 fue elaborada contestando preguntas clínicas en formato PICO a través del análisis de evidencias sobre factores de riesgo, búsqueda de casos, evaluación pronóstica, tratamiento y exacerbaciones. La evidencia indica que existen factores de riesgo diferentes al tabaco, diferencias según el género, soporta la búsqueda activa de casos en población de riesgo y el valor predictivo de los índices multidimensionales. En la EPOC estable se encuentran similares beneficios de la monoterapia broncodilatadora (LAMA o LABA) sobre la disnea, función pulmonar o calidad de vida, y mayor efectividad del LAMA para prevenir exacerbaciones. La doble terapia broncodilatadora tiene mayores beneficios comparada con la monoterapia. La eficacia de la terapia con LAMA y la combinación LABA/CI es similar, con mayor riesgo de neumonía con la combinación LABA/CI. Existe limitada información sobre la eficacia y la seguridad de la triple terapia. La evidencia soporta el uso de vacunación contra la influenza en todos los pacientes y contra neumococo en < 65 años y/o con obstrucción grave. Los antibióticos profilácticos pueden disminuir la frecuencia de exacerbaciones en pacientes de riesgo. Está justificado el uso de corticosteroides sistémicos y antibióticos en exacerbaciones que requieren tratamiento intrahospitalario y en algunas de tratamiento ambulatorio

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting

ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.

Revisión contemporánea: hipertensión pulmonar / Contemporary review: pulmonary hypertension

El término hipertensión pulmonar comprende un grupo heterogéneo de condiciones con la capacidad común de generar incremento progresivo de la presión arterial pulmonar y cuyo resultado final puede derivar en dilatación ventricular derecha, falla cardíaca derecha y muerte. La hipertensión arterial pulmonar es una de sus formas y en las últimas décadas se ha producido un creciente interés sobre esta patología. En parte, mucho es debido al desarrollo y diponibilidad de tratamiento farmacológico e intervensiones específicas para una situación en la que, anteriormente, se contaba con limitados recursos terapéuticos y pronóstico invariablemente sombrío.

The term pulmonary hypertension encompasses a group of heterogeneous conditions with the common capacity to generate progressive increase in pulmonary arterial pressure for wicg the final result may derive in right heart dilatation, failure and death. Pulmonary arterial hypertension is one of its forms and in the last decadens a growing interest for this pathology has been encountered. This is largely due to the development and disposal of pharmacological treatment and specific interventions for a situation for which, in the past, limited resources were available and prognosis was invariably poor.