Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic.

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.

Niño de 5 años con macrohematuria ¿Sabríamos ante qué glomerulopatía estamos? / Five-year-old with macrohematuria... Would we know what glomerulopathy we’re dealing with?

Presentamos el caso de un escolar de 5 años que consulta en nuestro servicio por macrohematuria. Tras confirmarse el origen glomerular de la misma se sospecha glomerulonefritis aguda postestreptocócica debido al antecedente de infección faringoamigdalar, sin embargo el complemento es normal. Presenta deterioro rápido y progresivo de función renal, por lo que es diagnosticado de glomerulonefritis aguda rápidamente progresiva. Se realiza biopsia renal, donde se evidencia semilunas en un 81% de los glomérulos y depósitos de C3, compatible con glomerulonefritis aguda postinfecciosa. Inmediatamente después, se inicia tratamiento corticoideo presentando una evolución excelente y con recuperación completa de la función renal. Solo el 10-20% de la glomerulonefritis aguda postinfecciosas cursan con niveles de complemento normal, y solo el 0,5% de los casos se manifiesta como una glomerulonefritis rápidamente progresiva. La macrohematuria en niños puede suponer un reto diagnóstico. En ocasiones las manifestaciones son muy variable y superponibles a diferentes causa y hasta la biopsia no podemos llegar a un diagnóstico fiable.(AU)

We present the case of a 5-year-old school boy who consulted our department for asymptomatic macrohematuria. After confirming the glomerular origin, poststreptococcal acute glomerulonephritis was suspected due to a history of pharyngotonsillar infection, however the complement is normal. He presents rapid and progressive deterioration of kidney function, which is why he is diagnosed with rapidly progressive acute glomerulonephritis. A renal biopsy was performed, showing crescents in 81% of the glomeruli and C3 deposits, compatible with acute post-infectious glomerulonephritis. Immediately afterwards, corticosteroid treatment was started, with excellent progress and complete recovery of kidney function. Only 10-20% of acute post-infectious glomerulonephritis present with normal complement levels, and only 0.5% of cases manifest as rapidly progressive glomerulonephritis. Macrohematuria in children can be a diagnostic challenge. Sometimes the manifestations are very variable and can be attributed to different causes and until the biopsy we cannot reach a reliable diagnosis.(AU)

Enteropatía similar a enfermedad celíaca asociada a olmesartán / Spruelike enteropathy related to olmesartán treatment

No disponible

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.

Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review.

OBJECTIVE: To identify evidence from comparative studies on the effects of psychoeducation programs on clinical outcomes in children and adolescents with ADHD. METHOD: Articles published between January 1980 and July 2010 were searched through electronic databases and hand search. A qualitative systematic review of comparative studies of psychoeducation in ADHD was performed. Psychoeducation was considered if studies use a specific therapeutic program focusing on the didactically communication of information and provide patients and families with coping skills. RESULTS: Seven studies were identified (four randomized-controlled trials, three uncontrolled pre-post treatment designs). Studies differed on whether psychoeducation approaches were applied to parents of ADHD children (three studies), to ADHD children/adolescents and their families (three studies) or to their teachers (one study). Positive outcomes measured as improvement on a number of different variables, including patient's behavior, parent and child satisfaction, child's knowledge of ADHD, children's opinion of the use of medication and adherence to medical recommendations were found. CONCLUSIONS: Although available evidence is limited and some findings may be difficult to be interpreted, the positive role of psychoeducation and other educational interventions in children and adolescents with ADHD in regard to several outcome measures is supported by most of the literature referenced in this review.

Neurobiología de la depresión / Neurobiology of depression

El modelo neurobiológico en el que durante muchos años se han basado la etiología, y por lo tanto el tratamiento de la depresión, comprendía básicamente alteraciones en el funcionamiento de los neurotransmisores, o en los receptores de los mismos. Sin embargo, investigaciones recientes han transformado el escenario de la patofisiología de la depresión, implicándose distintos niveles y sistemas, tanto nerviosos como endocrinos e inmunes, e incluso celulares, moleculares y genéticas. Desde esta nueva perspectiva se pueden entender mejor los síntomas de la depresión y muchas de sus alteraciones neurobiológicas. El presente trabajo pretende integrar de una manera global los distintos mecanismos biológicos que se han relacionado con la etiología de la depresión, para permitir un nuevo abordaje conceptual de los trastornos depresivos y abrir nuevas posibilidades terapeúticas en el futuro (AU)

[Neurobiology of depression]. / Neurobiología de la depresión.

During decades, both aetiology and treatment in Depressive Disorders relied on neurotransmitters' physiopathology or on abnormalities in their receptors function. However, recently evidences from research on neurobiological grounds suggest that there are multiple and complex systems involved in the pathophysiology of Depressive Disorders. Several neurobiological structures, such as the neural, immune and endocrine systems seems to interact among themselves and to influence on clinical manifestations of illness. Moreover, dysregulations on lower levels, such as intracellular and genetic systems might cause anomalies in protein expression, and in consequence might modulate receptors' disfunction and disturbances at the intramolecular level of signal transmission. The above disturbances at different levels of complexity are finally integrated within the frame of most recent theoretical approaches to Depressive Disorders. Specifically, recent theories implicating neuronal plasticity and survival-death cell mechanisms are described. The aim of this review is to integrate recent evidence on pathophysiological mechanisms of Depressive Disorders. New lines of treatment based upon these 'new pathophysiology' of depression will be wellcome.

A survey of endotracheal suctioning with instillation of normal saline.

BACKGROUND: Instillation of normal saline before suctioning is a common nursing intervention although little research supports the practice. OBJECTIVES: To determine when and how often saline is used during suctioning and to assess the knowledge of nurses and respiratory therapists of the advantages and dangers of using saline during endotracheal suctioning. METHODS: A survey of nurses and respiratory therapists working in adult ICUs was conducted in a large university teaching hospital. RESULTS: Of the 187 respondents, 96 (51%) rarely instill saline before suctioning, whereas 61 (33%) frequently use saline. Fifty-five percent use saline to enhance retrieval of secretions, and 45% use it to stimulate a cough. Nurses and respiratory therapists differ in their use and understanding of saline instillation. Most nurses (64%) rarely use saline before suctioning, whereas most respiratory therapists (71%) frequently use saline. Respiratory therapists (57%) were more aware than were nurses (37%) of the benefit of using normal saline to stimulate a cough. Nurses indicated more adverse effects of instillation of normal saline, specifically oxygen desaturation and increased risk of pulmonary infections, than did respiratory therapists. CONCLUSION: The results of the survey helped determine target areas for educational programs for nurses and respiratory therapists. A protocol is being developed for use by all who do suctioning.

Acute dyspnea.

Acute dyspnea is a common symptom in the adult patient in the hospital and often requires rapid assessment and intervention. This sensation accompanies a variety of disorders, including an exacerbation of underlying chronic pulmonary disease, acute pulmonary disease, abnormalities in gas exchange, cardiac disease, neuromuscular dysfunction, and anxiety disorders.

[The evolution of commercial enteral formulas in Spain in 1988-1991]. / Evolución de las fórmulas enterales comercializadas en España en el período 1988-1991.

Enteral nutrition is an artificial form of nutrition which is expanding an there are thus a great many commercial preparations on the market which are rapidly being developed. This study is a presentation of the quantitative and qualitative changes in these preparations from 1988-1991, classified depending upon their main nutrient: proteins. In global terms, there has been an increase of 18 formulae, distributed among different types, but with the most spectacular increase in special diets. Discussion of the trends observed, which respond to further knowledge on the absorption or tolerance of nutrients and nutritional needs in different pathologies.

[Treatment of traumatic arthritis of the temporomandibular joint (TMJ)]. / Tratamiento de la artiritis traumática de la articulación temporomandibular (ATM).

A study of cases of patients with diagnosis of traumatic arthritis of the temporomandibular joint, assisted at the Department of Maxillo-facial Surgery, was carried out in order to value benefits obtained with a multidisciplinary attention in such cases.