The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder.

OBJECTIVE: The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. METHODS: Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. RESULTS: The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/. CONCLUSIONS: The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD.

First Pediatric Case of Autoimmune Encephalitis Associated With COVID-19 in Costa Rica.

Very few COVID-19-associated autoimmune encephalitis cases have been documented in children. This case report focuses on a previously healthy four-year-old girl who presented to the emergency room of the National Children's Hospital in Costa Rica in a postictal state due to a tonic-clonic seizure that progressed to status epilepticus. She had no previous history of fever or associated trauma. She was considered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive by epidemiological linkage four weeks prior to the event, and her immunoglobulin G (IgG) levels for SARS-CoV-2 were positive. She presented with generalized decrease in muscle strength, she couldn't even walk, also dyskinetic movements in upper extremities, language impairment, frequent seizures, retrograde amnesia, and orolingual dyskinesias. An extensive diagnostic workup was performed, including bacterial and viral panel in cerebrospinal fluid, however the only positive result was the IgG for SARS-CoV-2. Electroencephalogram (EEG) and magnetic resonance imaging (MRI) findings were compatible with autoimmune encephalitis.  An antibody panel was performed, which was negative in cerebrospinal fluid and positive for anti-gamma-aminobutyric acid (GABA)/b1 in serum. She received three antiseizure drugs, plasmapheresis, intravenous gamma-globulin, methylprednisolone, and rituximab, which partially improved her condition. She currently has refractory epilepsy, memory problems, loss of language skills, and neuropsychiatric dysfunction. To our knowledge, this is the first case of autoimmune encephalitis secondary to SARS-COV-2 infection in a pediatric patient in Costa Rica.

Intimate partner violence identified through routine antenatal screening and maternal and perinatal health outcomes.

BACKGROUND: This study investigated the association between intimate partner violence (IPV) identified on routine prenatal screening and perinatal outcomes for mother and infant. METHODS: Routinely collected perinatal data for a cohort of all women and their infants born in public health facilities in Sydney (Australia) over the period 2014-2016 (N = 52,509) were analysed to investigate the risk of adverse maternal and perinatal outcomes associated with a history of IPV. The association between an affirmative response on prenatal IPV screening and low birth weight (LBW) < 2.5 kg, preterm birth < 37 weeks, breastfeeding indicators and postnatal depressive symptoms (PND) was investigated in a series of logistic regression models. RESULTS: IPV was associated with an increased risk of PND (OR = 2.53, 95% CI 1.76-3.63), not breastfeeding at birth (OR = 1.65, 95% CI 1.30-2.09), non-exclusive breastfeeding at discharge (OR = 1.66, 95% CI 1.33-2.07) and first post-natal visit (OR = 1.54, 95% CI 1.24-1.91). Self-reported fear of a partner was strongly associated with an increased risk of PND (OR = 3.53, 95% CI 2.50-5.00), and also LBW (OR = 1.58, 95% CI 1.12-2.22), preterm birth (OR = 1.38, 95% CI 1.08-1.76), lack of early initiation of breastfeeding (OR = 1.67, 95% CI 1.28-2.17), non-exclusive breastfeeding at discharge from hospital (OR = 1.60, 95% CI 1.24-2.06) and at the first post-natal visit (OR = 1.27, 95% CI 0.99-3.04). CONCLUSIONS: IPV reported at the time of pregnancy was associated with adverse infant and maternal health outcomes. Although women may be disinclined to report IPV during pregnancy, universal, routine antenatal assessment for IPV is essential for early identification and appropriate management to improve maternal and newborn health.

Viabilidade de bactérias láticas presentes em leites fermentados comercializados em Barra do Garças-MT / Viability of lactic bacteria present on fermented milk marketed in Barra do Garças-MT

O presente trabalho teve como objetivo avaliar as características físico-químicas e microbiológicas de leites fermentados adquiridos em supermercados da cidade de Barra do Garças-MT. Para tanto foram realizados análises físico-químicas de pH e acidez titulável, e análises microbiológicas para coliformes a 30ºC e coliformes termotolerantes (NMP) e contagem total de fungos e leveduras e bactérias láticas e detecção de Salmonella sp. Todas as marcas apresentaram valores de acidez dentro do preconizado pela legislação vigente. Quanto à contagem de bactérias láticas totais, somente umas das amostras não atendeu ao padrão recomendado durante o período de estocagem avaliado. Os leites fermentados atenderam os requisitos estabelecidos pela legislação, nos parâmetros físico-químicos e microbiológicos do ponto de vista de segurança dos alimentos. Na enumeração de bactérias láticas, o número de células viáveis apresentou-se dentro dos requisitos estabelecidos ao final da vida de prateleira do produto, exceto para uma das marcas.

Características físico-químicas e sensoriais de iogurte firme e sobremesa láctea fermentada com doce de caju / Physical-chemical and sensory characteristics of firm yogurt and fermented dairy dessert with cashew nuts

O objetivo deste estudo foi desenvolver e avaliar iogurte e sobremesa láctea fermentada adicionados de doce de caju. O doce foi elaborado com proporção para atingir 40ºBrix. O iogurte e a sobremesa láctea fermentada foram elaborados e avaliados quanto ao pH, acidez, proteína total, gordura, EST e cinzas após um dia de fabricação. A pós-acidificação foi avaliada durante 35 dias de armazenamento refrigerado. O teste de aceitação e intenção de compra foi realizado após 14 dias de armazenamento refrigerado. Os dados das características físico-químicas, pós-acidificação e avaliação sensorial foram analisados por Análise de Variância e teste de Tukey (p<0,05) ou análise de regressão. Os produtos atenderam os parâmetros físico-químicos e microbiológicos exigidos pela legislação. Na pós-acidificação, o pH dos produtos reduziu ao longo do tempo e a acidez do iogurte foi superior da sobremesa láctea fermentada sendo em média 0,12% de ácido lático durante os 35 dias de armazenamento. O iogurte apresentou maior aceitação e intenção de compra que a sobremesa láctea fermentada. A fabricação dos produtos torna-se viável do ponto econômico, físico-químico e sensorial, além de agregar valor ao soro de leite e o caju.

The aim study was develop and evaluate yogurt and fermented dairy dessert added with cashew sweet. The sweet was prepared in proportion to 40ºBrix. The yogurt and fermented dairy dessert were evaluated for pH, acidity, total protein, fat, total solid and ash content after one day of manufacture. Post-acidification was evaluated during 35 days of refrigerated storage. The acceptance and purchase intention test was performed after 14 days of refrigerated storage. The results of physico-chemical characteristics, post-acidification and sensory evaluation were analyzed by Analysis of Variance and Tukey test (p<0.05) or regression analysis. The products is according the physico-chemical parameters required by the brazilian legislation. In post-acidification, the pH of the products decreased over time and acidity of yogurt was higher than fermented dairy dessert and the acidity on average 0.12% of lactic acid during the 35 days of storage. The yogurt presented a greater acceptance and intention to purchase than the fermented dairy dessert. The manufacture of the products showed viable from the economic point of view, physicochemical and sensorial, besides adding value to the whey and cashew.

Desenvolvimento e caracterização de filme biodegradável inteligente à base de amido de banana verde e extrato de brassica oleraceae (repolho roxo) / Development and characterization of green biodegradable film based on green banana starch and brassica oleraceae extract (purple cabbage)

O objetivo deste estudo foi desenvolver e caracterizar filme indicador de qualidade de alimentos utilizando amido de banana verde incorporado com extrato de repolho roxo. Os filmes foram desenvolvidos a partir de duas formulações: i) amido de banana sem extrato; ii) amido de banana com extrato. Os filmes foram caracterizados através de análise térmica (TG/DT), ensaio mecânico, espectroscopia por infravermelho (FT-IR), índice de intumescimento e ativação em diferentes pH. Os filmes apresentaram um perfil similar de perda de massa, indicando pouco efeito da incorporação do extrato à sua estabilidade térmica. A incorporação do extrato vegetal promoveu maior resistência mecânica e menor taxa de intumescimento. FT-IR mostrou que não houve interação do extrato com o biopolímero. O filme de amido apresentou sensibilidade à variação do pH. O uso do amido de banana verde combinado com gelatina e extrato de repolho roxo apresenta potencial aplicação como indicador visual de qualidade de alimentos duranteo armazenamento.

The aim of the study was to develop and characterize food quality indicator film using green banana starch incorporated with purple cabbage extract. The films were developed from two formulations: i) banana starch without extract; ii) banana starch with extract. The films were characterized by thermal analysis (TG/DTA), mechanical assay, infrared spectroscopy (FT-IR), swelling index and activation at different pH. The films presented a similar profile of mass loss, indicating that extract did not affect thermal stability. The incorporation of the vegetal extract promoted greater mechanical resistance and a lower rate of swelling. FT-IR showed that there was no interaction of the extract with the biopolymer. The starch film showed sensitivity to pH variation. The use of green banana starch combined with gelatin and purple cabbage extract has potential application as a visual indicator of food quality during storage.

Coalho Cheese Made with Protease from Thermomucor indicae-seudaticae N31: Technological Potential of the New Coagulant for the Production of High-Cooked Cheese.

The aim of this study was to explore the use of a new coagulant from Thermomucor indicae-seudaticae N31 for the manufacture of a high-cooked starter-free cheese variety, by evaluating its physicochemical and functional characteristics in comparison to cheeses made with a traditional commercial coagulant. Coalho cheese was successfully produced with the new protease as it exhibited comparable characteristics to the one produced using the commercial enzyme: pH behavior during manufacture; cheese composition; protein and fat recovery; and cheese yield. In addition, during storage, melting was low and not affected by storage time; the increase of TCA 12% soluble nitrogen (% of total nitrogen) was lower than half of that of pH 4.6 soluble nitrogen (% of total nitrogen); concentration of ß-CN significantly decreased, whereas αs1 -CN concentration was not affected by storage time.

Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia.

BACKGROUND: Optimal breastfeeding has benefits for the mother-infant dyads. This study investigated the prevalence and determinants of cessation of exclusive breastfeeding (EBF) in the early postnatal period in a culturally and linguistically diverse population in Sydney, New South Wales, Australia. METHODS: The study used routinely collected perinatal data on all live births in 2014 (N = 17,564) in public health facilities in two Local Health Districts in Sydney, Australia. The prevalence of mother's breastfeeding intention, skin-to-skin contact, EBF at birth, discharge and early postnatal period (1-4 weeks postnatal) were estimated. Multivariate logistic regression models that adjusted for confounders were conducted to determine association between cessation of EBF in the early postnatal period and socio-demographic, psychosocial and health service factors. RESULTS: Most mothers intended to breastfeed (92%), practiced skin-to-skin contact (81%), exclusively breastfed  at delivery (90%) and discharge (89%). However, the prevalence of EBF declined (by 27%) at the early postnatal period (62%). Younger mothers (<20 years) and mothers who smoked cigarettes in pregnancy were more likely to cease EBF in the early postnatal period compared to older mothers (20-39 years) and those who reported not smoking cigarettes, respectively [Adjusted Odds Ratio (AOR) =2.7, 95%CI 1.9-3.8, P <0.001 and AOR = 2.5, 95%CI 2.1-3.0, P <0.001, respectively]. Intimate partner violence, assisted delivery, low socio-economic status, pre-existing maternal health problems and a lack of partner support were also associated with early cessation of EBF in the postnatal period. CONCLUSIONS: Our findings suggest that while most mothers intend to breastfeed, and commence EBF at delivery and at discharge, the maintenance of EBF in the early postnatal period is sub-optimal. This highlights the need for efforts to promote breastfeeding in the wider community along with targeted actions for disadvantaged groups and those identified to be at risk of early cessation of EBF to maximise impact.

Adsorção de índigo carmim em biomassas mortas de aspergillus niger / Adsorption of indigo carmine on dead biomass of aspergillus niger

As indústrias têxteis geram efluentes ricos em corantes durante toda a sua cadeia produtiva. Neste estudo, ensaios cinéticos foram realizados utilizando biomassas mortas de Aspergillus niger, diferentemente tratadas, como adsorvente para a remoção de índigo carmim a partir de soluções aquosas. Ensaio cinético com carvão ativado comercial também foi realizado para comparação. Os resultados obtidos indicam que a biomassa fúngica sem tratamento algum foi capaz de remover 95% do índigo carmim da solução aquosa, remoção equivalente àquela obtida pelo carvão ativado comercial. Os experimentos mostraram que os tratamentos ácidos melhoraram consideravelmente a cinética da remoção do corante, não influenciando, contudo, a capacidade adsortiva máxima do material. Os tratamentos salinos e alcalinos diminuíram tanto a capacidade máxima quanto a cinética de adsorção.

Textile industries produce effluents rich in dyes throughout its production chain. In this study, kinetic experiments were carried using the dead and treated biomass of Aspergillus niger for indigo carmine removal from the synthetic aqueous solutions of this dye. A kinetic run with activated carbon was also carried for comparison. The obtained results suggest that non-treated fungal biomass has been capable of remove 95% of carmine indigo from the aqueous solutions. This removal was similar to that obtained with activated carbon. The results also indicate that acid treatments considerably improve the kinetic of the dye removal, but they are not influenced the maximum adsorptive capacity of the adsorbent. Moreover, saline and alkaline treatments decreased both the maximum capacity and the kinetic of adsorption.

Immune responses induced by the Leishmania (Leishmania) donovani A2 antigen, but not by the LACK antigen, are protective against experimental Leishmania (Leishmania) amazonensis infection.

Leishmania amazonensis is one of the major etiologic agents of a broad spectrum of clinical forms of leishmaniasis and has a wide geographical distribution in the Americas, which overlaps with the areas of transmission of many other Leishmania species. The LACK and A2 antigens are shared by various Leishmania species. A2 was previously shown to induce a potent Th1 immune response and protection against L. donovani infection in BALB/c mice. LACK is effective against L. major infection, but no significant protection against L. donovani infection was observed, in spite of the induction of a potent Th1 immune response. In an attempt to select candidate antigens for an American leishmaniasis vaccine, we investigated the protective effect of these recombinant antigens (rLACK and rA2) and recombinant interleukin-12 (rIL-12) against L. amazonensis infection in BALB/c mice. As expected, immunization with either rA2-rIL-12 or rLACK-rIL-12 induced a robust Th1 response prior to infection. However, only the BALB/c mice immunized with rA2-rIL-12 were protected against infection. Sustained gamma interferon (IFN-gamma) production, high levels of anti-A2 antibodies, and low levels of parasite-specific antibodies were detected in these mice after infection. In contrast, mice immunized with rLACK-rIL-12 displayed decreased levels of IFN-gamma and high levels of both anti-LACK and parasite-specific antibodies. Curiously, the association between rA2 and rLACK antigens in the same vaccine completely inhibited the rA2-specific IFN-gamma and humoral responses and, consequently, the protective effect of the rA2 antigen against L. amazonensis infection. We concluded that A2, but not LACK, fits the requirements for a safe vaccine against American leishmaniasis.