Attention deficit hyperactivity disorder, self-esteem and the impact of treatments.

OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) experience repetitive failures in their school and social life and often receive negative feedback from their environment, endangering the development of their self-esteem. Self-esteem is a forecasting factor for social, psychological, professional and familial well-being. Poor self-esteem is a risk factor for the development of depression, anxiety disorder, and personality disorder. The aim of this article is to evaluate the child's self-esteem at the initial time of ADHD diagnosis, describe self-esteem evolution after diagnosis and identify clinical and therapeutic factors associated with improved self-esteem. METHODS: In a longitudinal descriptive study, 6-12-year-old patients with ADHD underwent a multidisciplinary evaluation including a diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia Present/Lifetime version: K-SADS), a symptoms severity assessment with parent questionnaires (Attention Deficit Hyperactivity Disorder Rating Scale: ADHD-RS), a neurocognitive testing of attention and IQ, and a self-esteem interview (Self-Esteem Inventory of Coopersmith: SEI). The follow-up assessment included a K-SADS-PL, ADHD-RS and SEI assessments and recorded treatment history. We compared the score of self-esteem between these two assessments. RESULTS: Among the 108 screened patients, we obtained complete data from 55 patients at the second assessment. At first evaluation, two-thirds of children with ADHD had low self-esteem scores. At the second evaluation, our results indicate a significant improvement of global, personal, and social self-esteem score (SEI) and symptoms severity score (K-SADS-PL and ADHD-RS). CONCLUSIONS: Self-esteem improved in patients with ADHD after specific treatments.

Bryophytes of rotten logs from El Zafire biological station, Amazonas - Colombia / Briófitos de troncos en descomposición de la estación biológica el zafire, amazonas-colombia

RESUMEN En el presente trabajo se caracterizó la flora briofítica en troncos en descomposición en la estación meteorológica El Zafire, Amazonas-Colombia. Para ello se realizó un muestreo de 100 unidades muestrales en 20 troncos en diferente estado de descomposición y en dos tipos de bosque (tierra firme y varillal inundable). Se reportan 120 especies, 81 hepáticas y 39 musgos, pertenecientes a 55 géneros (33 hepáticas y 22 musgos) y 21 familias (nueve hepáticas y 12 musgos). Se registran cuatro especies nuevas para el país, 25 para la amazonia colombiana y 41 para el departamento del Amazonas. En términos de riqueza total, el bosque de varillal presentó un valor mayor al de tierra firme. Sin embargo, esta diferencia no es significativa (Kruskal Wallis X 2=0,199; p = 0,05); así mismo la diversidad fue mayor en el bosque de varillal inundable (Shanon = 3,93) en comparación con la del bosque de tierra firme (Shanon = 3,67). La composición de las comunidades de briófitos fue diferente entre los dos tipos de bosques (similitud igual a 40 %). En el estudio florístico de los dos tipos de bosques de la estación biológica, se evidenció una marcada dominancia de la familia Lejeunaceae, que representó el 55,5 % de las hepáticas y el 37,5 % del total de las especies de briófitos.

ABSTRACT The present study aims to characterize the bryophyte community on rotten logs in El Zafire biological station, Amazonas-Colombia. We sampled 100 plots on 20 trunks with different states of decomposition in two types of forest (terra firme and floodplain). 120 species are reported, 81 liverworts and 39 mosses, belonging to 55 genera (33 liverworts and 22 mosses) and 21 families (nine liverworts and 12 mosses). Four new species are registered for Colombia, 25 for the Colombia Amazon, and 41 for the department of Amazonas. In terms of richness, the floodplain presented a higher value than the terra firme forest. However, no significant difference was found between the two types of forests (Kruskal Wallis X 2c= 0.199, X 2t= 3.81). Diversity was higher in the floodplain (Shanon = 3.93) compared to the terra firme forest (Shanon = 3.67). The composition of the bryophyte communities shows differences between the two types of forests (similarity equal to 40 %). In the floristic study of the two types of forests of the biological station, the most common family was Lejeuneaceae, it represented 55.5 % of the liverworts sampled and 37.5 % of the total of the bryophyte species.

Assessing treatment response after intravesical bacillus Calmette-Guerin induction cycle: are routine bladder biopsies necessary?

PURPOSE: To determine the need for routine bladder biopsies (BBs) in assessing response to the induction cycle of intravesical bacillus Calmette-Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (NMIBC). METHODS: Our prospectively maintained NMIBC database was queried to identify patients with high-risk disease (carcinoma in situ, high-grade Ta/T1) who underwent BBs after BCG induction cycle. Urine cytology, cystoscopy, and BBs findings were evaluated. RESULTS: A total of 219 patients met the inclusion criteria. Urine cytology was positive in 20 patients and negative in 199; cystoscopy was positive in 35 patients, suspicious in 32 and normal in 152 patients. BBs yielded bladder cancer (BCa) in 43 (19.6%) patients, with a BCa rate of 9.3% in patients with negative cytology and cystoscopy as opposed to 38.0% in patients whereby one or both exams were suspicious/positive. The diagnostic accuracy of urine cytology, cystoscopy, and combined tests was 0.56, 0.70, and 0.71, respectively. The negative predictive value of combined tests was 90.7%. Performing BBs only in patients with positive cytology and/or positive/suspicious cystoscopy would have spared 140 (64%) patients to undergo this procedure while missing BCa in 13 (9.3%) of them, representing 30% of all BCa cases. CONCLUSION: Performing BBs only in patients with positive cytology and suspicious/positive cystoscopy would spare 64% of un-necessary BBs but miss a non-negligible number of BCas. While no data are available regarding the potential consequences of missing such BCas, such information should be taken into account in patient's counselling.

Impact of time to second transurethral resection on oncological outcomes of patients with high-grade T1 bladder cancer treated with intravesical Bacillus Calmette-Guerin.

PURPOSE: To determine the impact of time to restaging transurethral resection (Re-TUR) on recurrence-free survival (RFS), progression-free survival (PFS), and cancer specific survival (CSS) of patients with high-grade T1 bladder cancer (BC) treated with intravesical Bacillus Calmette-Guerin (BCG). MATERIALS AND PATIENTS: Our prospectively maintained NMIBC databases were queried to identify patients with high-grade T1 BC who underwent Re-TUR before receiving intravesical BCG treatment (induction + 1-year maintenance). Patients were divided into three groups based on time to Re-TUR (group A: ≤ 6 weeks; group B: > 6-12 weeks; group C: > 12-18 weeks). Kaplan-Meier plots were used to estimate differences in RFS, PFS, and CSS. Multivariate Cox regression analysis was used to assess the impact of time to Re-TUR on oncological outcomes. RESULTS: Overall, 269 high-grade T1 BC patients were eligible for the analysis. Nineteen (7.1%) had concomitant CIS. Median follow-up was 49.3 (IQR 25-65) months. Kaplan-Meier plots showed no differences in RFS, PFS, and CSS between the three groups. Multivariate Cox regression analysis showed that Group B had a slightly better RFS, while the other outcomes were not affected by time to Re-TUR. CONCLUSIONS: This is the first study testing the role of time to Re-TUR in a homogeneous population of patients with high-grade T1 BC who received complete BCG treatment. The study challenged the concept the sooner the Re-TUR the better, since time to Re-TUR did not significantly affect oncological outcomes.