A randomised clinical pilot trial to test the effectiveness of parent training with video modelling to improve functioning and symptoms in children with autism spectrum disorders and intellectual disability.

BACKGROUND: Poor eye contact and joint attention are early signs of autism spectrum disorder (ASD) and important prerequisites for developing other socio-communicative skills. Teaching parents evidence-based techniques to improve these skills can impact the overall functioning of children with ASD. We aimed to analyse the impact of conducting a group parent-training intervention with video modelling to improve the intelligent quotient (IQ), social and communication functioning and to minimise symptoms in children with ASD and intellectual disability (ID). METHODS: Study design: A multicentre, single-blinded, randomised clinical pilot trial of parent training using video modelling was conducted. SAMPLE: Sixty-seven parents of children with ASD, aged between 3 and 6 years and with IQs between 50 and 70, were randomised: 34 to the intervention group and 33 to the control group. Intervention program: The intervention group received parent training over 22 sessions, and the control group received the standard community treatment. INSTRUMENTS: Pre-evaluation and post-evaluation (week 28), the following were used: Autism Diagnostic Interview, Vineland Adaptive Behaviour Scale I, Snijders-Oomen Nonverbal Intelligence Test, Autism Behaviour Checklist and Hamilton Depression Rating Scale. DATA ANALYSIS: Intention to treat and complier-average causal effect (CACE) were used to estimate the effects of the intervention. RESULTS: There was a statistically significant improvement in the Vineland standardized communication scores in CACE (Cohen's d = 0.260). There was a non-statistically significant decrease in autism symptomatology (Autism Behaviour Checklist total scores) and a significant increase in the non-verbal IQ in the intervention group. After the false discovery rate correction was applied, IQ remained statistically significant under both paradigms. The effect size for this adjusted outcome under the intention-to-treat paradigm was close to 0.4, and when considering adherence (CACE), the effect sizes were more robust (IQ's Cohen's d = 0.433). CONCLUSIONS: Parent training delivered by video modelling can be a useful technique for improving the care given to children with ASD and ID, particularly in countries that lack specialists.

Effects of Type 1 Insulin-Like Growth Factor Receptor Silencing in a Human Adrenocortical Cell Line.

Type 1 insulin-like growth factor receptor (IGF-1R) is overexpressed in a variety of human cancers, including adrenocortical tumors. The aim of the work was to investigate the effects of IGF-1R downregulation in a human adrenocortical cell line by small interfering RNA (siRNA). The human adrenocortical tumor cell line NCI H295R was transfected with 2 specific IGF1R siRNAs (# 1 and # 2) and compared with untreated cells and a negative control siRNA. IGF1R expression was determined by quantitative reverse-transcription PCR (qRTPCR) and Western blot. The effects of IGF-1R downregulation on cell proliferation and apoptosis were assessed. IGF-1R levels were significantly decreased in cells treated with IGF-1R siRNA # 1 or # 2. Relative expression of IGF1R mRNA decreased approximately 50% and Western blot analysis revealed a 30% of reduction in IGF-1R protein. Downregulation of this gene resulted in 40% reduction in cell growth in vitro and 45% increase in apoptosis using siRNA # 2. These findings demonstrate that decreasing IGF-1R mRNA and protein expression in NCI H295R cells can partially inhibit adrenal tumor cell growth in vitro. Targeting IGF1R is a promising therapy for pediatric malignant adrenocortical tumor and can still be an option for adult adrenocortical cancer based on personalized genomic tumor profiling.

Cow's milk-based beverage consumption in 1- to 4-year-olds and allergic manifestations: an RCT.

BACKGROUND: Nutrients such as docosahexaenoic acid (DHA), prebiotics and ß-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations (AM). Our objective was to assess if consumption of a cow's milk-based beverage with these and other nutrients supports respiratory, gastrointestinal, and skin health in otherwise well-nourished, healthy children. METHODS: In this double-blind, randomized, controlled trial, healthy children (1-4 years of age) from two daycare centers in Brazil were fed three servings/day of a cow's milk-based beverage (CMBB; n = 125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), ß-glucan, and other key nutrients, or a control cow's milk-based beverage (control; n = 131) for up to 28 weeks. Occurrence of respiratory infections, diarrheal disease and AM was assessed by study pediatricians and the number of episodes were analyzed with the Cochran-Mantel-Haenszel test and the Andersen-Gill model. RESULTS: The CMBB group had fewer episodes of AM, which included allergic rhinitis or conjunctivitis, wheezing, allergic cough, eczema and urticaria, compared to the control group (p = 0.021). The hazard ratio for increased number of episodes of AM was lower in the CMBB group compared to control (HR, 0.64; 95 % CI 0.47-0.89; p = 0.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. CONCLUSION: A cow's milk-based beverage containing DHA, PDX/GOS, and yeast ß-glucan, and supplemented with micronutrients, including zinc, vitamin A and iron, when consumed 3 times/day for 28 weeks by healthy 1- to 4-year-old children was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract. TRIAL REGISTRATION: registration number: NCT01431469.

The UV-vis absorption spectrum of the flavonol quercetin in methanolic solution: A theoretical investigation.

The UV-vis absorption spectrum of the solvated quercetin molecule in methanol was investigated theoretically by means of an elegant type of QM/MM scheme better known as sequential Monte Carlo/quantum mechanics (S-MC/QM) methodology. A set of 125 uncorrelated Monte Carlo molecular liquid structures were properly selected through the autocorrelation function of the energy in order to be used in the quantum mechanical calculations. These molecular liquid structures were obtained by means of the radial and minimum distance distribution functions. A detailed account of the pattern of hydrogen bond structures obtained in this study is also available. The computed results obtained here were directly compared with the available experimental data in order to validate our theoretical model and through this comparison a very good conformity between theoretical and available experimental results was found.

Incomplete carbohydrate absorption from fruit juice consumption after acute diarrhea.

We carried out a double-blind, randomized study in 60 children with acute diarrhea to determine their capacity to tolerate commonly consumed fruit juices. Feedings of juice with high fructose/glucose ratios and sorbitol resulted in incomplete carbohydrate absorption and recurrence of diarrhea during the phase immediately after improvement of the illness.

[Hyperlipemic pancreatitis: clinical course]. / Pancreatite hiperlipêmica: aspectos clínico-evolutivos.

Acute pancreatitis is one of the complications associated with severe primary and secondary hypertriglyceridemia. The frequency of hypertriglyceridemia in patients with pancreatitis ranges from 4 to 53%. The elevation in serum triglycerides probably induces the release of free fatty acids, responsible for the pancreatic damage. During a three year study, nine patients with acute pancreatitis due to hypertriglyceridemia were followed up at the University Hospital of Federal University and at the "Hospital Monte Sinai" (Juiz de Fora, MG, Brazil). Suggestive clinical manifestations, especially superior abdominal pain, nausea, vomiting and ileus, were found in all the patients; however, only three showed elevated serum amylase levels. All had triglyceride levels above 1000 mg/dl (11.3 mmol/L). The evolution after clinical treatment was good in eight patients (two needed parenteral nutrition). The only death observed was due to shock and acute respiratory distress, refractory to clinical management. The maintenance treatment aimed at withdrawing the predisposing conditions and reduction of the triglyceride levels prevented recurrence of acute pancreatitis episodes during the 23 months of follow-up.

[Kabuki make-up syndrome]. / A síndrome da máscara do Cabúqui.

The authors present an original case, the first in Brazil and Latin America, of the Kabuki make-up syndrome. To diagnose KMS, the authors point out the importance of the "Pentad of Niikawa", a term created by them to indicate the five basic features of the syndrome. Also new symptoms and signs which might be part of the phenotype of KMS are described. The authors emphasize that studies concerning KMS be widely spread, in order to identify new cases.

Relationship between Sakita endoscopic stage and duration of treatment for duodenal ulcer healing.

1. Endoscopic staging of peptic ulcer lesions according to Sakita will be a methodological improvement in therapeutic trials provided that the correlation between stages and the time spent in treatment is proved valid. 2. We describe a double-blind controlled randomized trial carried out to determine the efficacy of cimetidine in patients with duodenal ulcer in the H stage of Sakita endoscopic staging. Fifty-two patients with duodenal ulcer (H stage) were randomly allocated to receive either 400 mg cimetidine twice daily (N = 26), or placebo (N = 26) for two weeks; patients with unhealed ulcers continued the same treatment for an additional week. 3. Of the cimetidine-treated patients, 19 (73%) were healed after two weeks and 23 (88.5%) after three weeks of treatment, and of the placebo-treated patients, 8 (31%) were healed after two and 13 (50%) after three weeks. 4. These differences indicate a natural tendency of the H stage lesions to heal faster than reported for the active (stage A) lesions and still faster if treated with cimetidine. These findings, by establishing a relationship between the ulcer stage and the time spent in treatment, may help the physician to treat duodenal ulcer patients and will enable the adoption of an important, uniform criterion for selection of duodenal ulcer patients for therapeutic trials, especially in multicenter trials.

Relationship between Sakita endoscopic stage and duration of treatment for duodenal ulcer healing

Endoscopic staging of peptic ulcer lesions according to Sakita will be a methodological improvement in therapeutic trials provided that the correlation between stages and the time spent in treatments is proved valid. We describe a double-blind controlled randomized trial carried out to determine the efficacy of cimentidine in patients with duodenal ulcer in the H stage of Sakita endoscopic staging. Fifty-two patients with duodenal ulcer (H stage) were randomly allocated to receive either 400 mg cimetidine twice daily (N = 26), or placebo (N = 26) for two weeks; patients with unhealed ulcers continued the same treatment for an additional week. Of the cimetidine-treated patients, 19 (73%) were healed after two weeks and 23 (88.5%) after three weeks of treatment, and of the placebo-treated patients, 8 (31%) were healed after two and 13 (50%) after three weeks. These differences indicate a natural tendency of the H stage lesions to heal faster than reported for the active (stage A) lesions and still faster if treated with cimetidine. These findings, by establishing a relationship between the ulcer stage and the time spent in treatment, may help the physician to treat duodenal ulcer patients and will enable the adoption of an important, uniform criterion for selection of duodenal ulcer patients for therapeutic trials, especially in multicenter trials

Pancreatic steatorrhea: action of a total lyophilized pancreas preparation: an "in vitro" and "in vivo" study.

A total lyophilized pig pancreas (TLP) preparation was assayed "in vitro" and "in vivo". Lipase activity of the four lots studied was 6.180 +/- 1.122 IU by gram of the commercial product. There was no free trypsin detectable in the preparation. Fifteen pancreatic exocrine insufficiency patients were studied in a period of four weeks. Adult patients received from 35.500 to 35.776 IU of lipase contained in TLP preparation by meal. All patients had their steatorrhea reduced, or normalized, stool weight reduced and body weight increased. There is not an obligatory relation between stool fat loss and stool weight. Steatorrhea decreased at least during the 14 first days of treatment before reaching a stable level. This long delay before reaching a maximum effect deserves to be known: to test the efficiency of a pancreatic extract, the treatment must be given at least two weeks before estimating its results on fecal fat excretion.

Aspectos endoscopicos, histopatologicos e secretorios no pos-operatorio tardio da vagotomia troncular, antrectomia parcial e gastroduodenostomia na pequena curvatura. / Endoscopic histopathologic and secretory aspects in the late postoperative period of truncal vagotomy, partial anthrectomy and gastroduodenostomy at the lesser curvature

Vinte e cinco pacientes em pos-operatorio tardio de vagotomia troncular, antrectomia parcial e gastroduodenostomia na pequena curvatura foram estudados atraves de esofagogastroduodenoscopia, gastroacidrograma e biopsia de mucosa gastrica. A nova modalidadde cirurgica e empregada no sentido de manter um reservatorio gastrico adequado, prevenir o esvaziamento rapido do estomago, aproveitar melhor a capacidade absortiva e hormonal do duodeno e buscar um nivel de acidez imcompativel com recidiva ulcerosa. Evitar-se-iam, assim, a sindrome de dumping, o emagrecimento ou a incapacidade de ganhar peso, a desnutricao, a anemia ferropriva ou por deficiencia de vitamina B12, a ma absorcao e a ulcera anastomotica. O controle tardio pode ser considerado satisfatorio. Foi observada esofagite de refluxo em um paciente. Em outro, o remanescente gastrico foi considerado pequeno. Em 5 pacientes (20%) observou-se gastrite endoscopicamente intensa, sem correspondencia clinica. Em 6 casos (24%) o nivel secretorio nao baixou a niveis ideais e em 6 pacientes (24%) a boca anastomotica era pequena, o que pode ser atribuido a defeitos tecnicos, ligados ao cirurgiao em aprendizado

Efeitos da pirenzepina sobre o pH do conteudo gastrico e sobre a secrecao acida basal e a estimulada pelo betazol, em pacientes com ulcera duodenal. / Effects of pirenzepin on pH of the gastric content and on the basal acid secretion and the stimulated by betazole, in patients with duodenal ulcer

O efeito da pirenzepina sobre o pH do conteudo gastrico e sobre a secrecao basal de acido e a estimulada pelo betazol foi estudado em pacientes com ulcera duodenal.Os resultados demonstraram que a pirenzepina, duas horas apos uma dose de 50 mg, por via oral, reduziu significativamente a acidez gastrica basal, mas nao modificou a secrecao estimulada pelo betazol. Verificou-se, tambem, que a pirenzepina, na dose de 150 mg, em tres tomadas diarias de 50mg nao alterou significativamente o pH do conteudo gastrico, durante as 24 horas do dia

Efeito de diferentes esquemas terapeuticos de antiacido sobre a acidez do conteudo gastrico, variando a dose e o horario de administracao, em pacientes com ulcera duodenal. / Effect of different therapeutic schedules of antacids on the pH of gastric content, varying dosage and time of administration, in patients with duodenal ulcer

Foram comparados os efeitos de tres diferentes esquemas terapeuticas de antiacido sobre o pH do conteudo gastrico, em 10 pacientes portadores de ulcera peptica duodenal: esquema I (periodo/controle), sem antiacido; esquema II, com 6 doses de antiacido com uma potencia antiacida de 49mEq por dose, ministradas 1 e 3 horas apos as tres principais refeicoes; esquema III, com 3 doses de antiacido de 98mEq, 2 horas apos as refeicoes e, finalmente, esquema IV, com 3 doses com potencia antiacida de 147mEq de antiacido, tambem, ministradas 2 horas apos as refeicoes. A cada hora, de 8 as 22 horas, colhia-se uma aliquota do conteudo gastrico para determinacao potenciometrica do pH. Considerouse sucesso terapeutico a ocorrencia de pH igual ou superior a 3,0. Os tres esquemas com antiacido (II, III e IV) foram superiores ao esquema I (controle), do qual diferiram de forma altamente significativa. Os esquemas II e IV foram iguais entre si e superiores ao esquema III

Efeito de antiacido contendo calcio sobre a secrecao gastrica de acido em pacientes com ulcera duodenal. / Effect of antacid containing calcium of gastric acid secretion, in patients with duodenal ulcer

O efeito de um antiacido contendo calcio, sobre a secrecao gastrica de acido, foi estudado em oito pacientes com ulcera duodenal. Os resultados demonstram que o antiacido contendo calcio na dose de 15 ml, correspondente a uma potencia antiacida de 49,5 mEq, nao provoca a estimulacao da secrecao gastrica acida, nas condicoes do teste, quando comparado com a dose equivalente de bicarbonato de sodio

Antiacidos: estudo da potencia, da cinetica de neutralizacao e do custo financeiro. / Antacids: study of potentiation, neutralization kinetics and financial cost

Foram estudados 45 preparados antiacidos comercializados em farmacias de Belo Horizonte, Minas Gerais, com o objetivo de obter dados para escolha racional destes medicamentos no tratamento de doencas acido-pepticas. Utilizou-se, para a determinacao da potencia antiacida total e da cinetica de neutralizacao, o metodo proposto por Fordtran e cols. (1973), ligeiramente modificado por Ribeiro (1980), que consiste na titulacao, pelo acido cloridrico 0,1 N, de solucao-teste do antiacido ate pH 3,0. Constatou-se: 1) variacao de ate 17 vezes da potencia antiacida total dos antiacidos liquidos; 2) variacao de ate 19,5 vezes da potencia antiacida total dos antiacidos solidos; 3) que os antiacidos liquidos, geralmente, foram mais potentes que seus correspondentes solidos, proporcionando uma posologia unitaria mais adequada ao uso clinico; 4) variacao de zero a 230 min no tempo final para liberacao da potencia antiacida total; e, 5) variacao de ate 84 vezes do custo financeiro de uma dose padrao, convencionada em 100mEq

Alteracoes da mucosa gastrica provocadas pelo teste aumentado do Histalog: estudo endoscopico e histopatologico. / Gastric mucosal changes induced by augmented Histalog test: endoscopic and histopathological study

Avaliou-se endoscopica e histologicamente, em 11 voluntarios, os efeitos sobre a mucosa gastrica, de doses maximas do cloridrato de betazol (Histalog).Gastroscopicamente, nao foram constatadas alteracoes em tres pacientes, enquanto seis mostraram congestao de ligeira a moderada da mucosa gastrica e em dois foram vistos sangramentos petequiais esparsos. No estudo das alteracoes histologicas verificadas na mucosa do corpo e antro gastricos, antes e apos a administracao do Histalog, nao se constatou diferenca estatisticamente significante na ocorrencia de erosoes, hemorragia e adenoma. Concluiu-se que doses maximas de Histalog nao causam hemorragia significante na mucosa gastrica e que a cor amarronzada do suco gastrico, aspirado nas ultimas porcoes de um teste aumentado de Histalog deve-se mais ao traumatismo da succao pela sonda nasogastrica, numa mucosa gastrica congesta pela acao do Histalo