Relationship between hair cortisol concentrations and cognitive functioning in adolescents with ADHD.

Background: Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.Methods: In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.Results: Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.Conclusions: Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).

We studied the relationship between cortisol and cognition in adolescents with ADHD.Hair cortisol concentrations (HCCs) were determined.We explored the moderating effects of sex and childhood trauma.Sex moderated the relationship between HCCs and attention and memory.Childhood trauma did not moderate the relationship between HCCs and cognition.

Stress-related biomarkers and cognitive functioning in adolescents with ADHD: Effect of childhood maltreatment.

Our study aimed to explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment. Seventy-six adolescents with ADHD were studied. The ADHD rating scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory as well as executive functioning) were identified by confirmatory factor analysis. Stress-related hormone levels were assessed at the clinic (plasma prolactin and cortisol levels and salivary cortisol levels) before cognitive testing and at home for two consecutive days (cortisol awakening response [CAR] and diurnal cortisol slope). Multiple linear regression analyses were used to explore the association between hormone levels and ADHD severity or cognitive functioning while adjusting for sex and childhood maltreatment. Regarding hormonal measurements obtained at the clinic, female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. Prolactin levels were not associated with cognitive functioning or the severity of ADHD. Regarding HPA axis measurements performed at home, lower cortisol levels at awakening were associated with poorer executive functioning. Neither CAR nor the cortisol diurnal slope were associated with cognitive functioning or ADHD severity. Our study suggests that HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending on the symptom type.

Is the COVID-19 pandemic a risk factor for suicide attempts in adolescent girls?

BACKGROUND: The COVID-19 pandemic might increase suicide behaviors. However, results are still limited and inconclusive, especially in adolescents. METHODS: To provide a preliminary evidence of the effects of the COVID-19 pandemic on suicide attempts (SA), we compared data from the Catalonia Suicide Risk Code (CRSC), during the first 12 months of Spain COVID-19 pandemic (March 2020 to March 2021) with data of the previous 12 months (March 2019 to March 2020). The CRSC is a well-established population-based registry of suicide attempts (SA) which allows monitoring of the dynamic changes that COVID-19 may produce in a Spanish region. RESULTS: SA among adolescents increased 25% during the COVID-year, whatever, SA among adults decreased 16,5% in the same period. The increase of SA in girls was especially prominent in the starting school period in the COVID-year (September 2020-March 2021), where the increase reached 195%. LIMITATIONS: This study did not evaluate other individual risk factors of SA in the context of the COVID-19 pandemic, so is unable to make concrete causal inferences. CONCLUSIONS: These finding suggest that SA increased in adolescent girls during the last period of the COVID-19 pandemic, underscoring the need to implement effective preventive measures by public health systems and stakeholders into response during this public health crisis.

Mental Health Emergencies in Paediatric Services: Characteristics, Diagnostic Stability and Gender differences.

INTRODUCTION: Child and adolescent psychiatric emergencies have increased in recent years. The main objective of our study is to analyze sociodemographic and clinical characteristics of psychiatric emergencies under 18 years old that came to our hospital. Secondary objectives were to study diagnostic stability made in the emergency department and undertake a gender analysis. METHODS: Descriptive cross-sectional study of patients attending the pediatric emergency department who required consultation to psychiatry service during 2010 and 2011, comparing data with two previous cross-sectional cuts (2002-2003 and 2006-2007). Then we track the diagnoses assigned during a year. Statistical analysis was descriptive. We also include a gender analysis. RESULTS: We analyzed 328 episodes corresponding to 179 different patients (average age 14.48). We detected a progressive increase of prevalence of psychiatric emergencies from 2002 to 2011. Diagnostic distribution showed a significant association of Behavioral Disorders with males and an association of Self-injured Behaviors and Eating Disorders with females. The admission rate was 18.5%. One-year diagnostic outcomes showed differences comparing to emergency diagnosis. CONCLUSIONS: Increase and complexity of psychiatric consultations in Pediatric Emergency Department requires a greater coordination and training of these services to enhance patients care. Emergency visit could mean the entrance of complex and severe patients to a specialized care. Our results detect gender differences: more Behavioral Disorders, Psychosis and Substance Use Disorders in males and Self-Injury and Eating Behavior Disorders in females.

Urgencias Psiquiátricas en Pediatría: características, estabilidad diagnóstica y diferencias de género / Mental Health Emergencies in Paediatric Services: Characteristics, Diagnostic Stability and Gender differences

Introducción. Existe una tendencia en los últimos años al aumento de las urgencias infanto-juveniles por motivos psiquiátricos. El objetivo principal del estudio fue analizar las características sociodemográficas y clínicas en las urgencias psiquiátricas de los menores de 18 años. Como objetivos secundarios, estudiamos la estabilidad diagnóstica y realizamos un análisis de género. Metodología. Estudio transversal descriptivo de pacientes que consultaron entre 2010 y 2011 al servicio de urgencias pediátricas por motivos psiquiátricos. Comparamos con dos cortes previos (2002-2003 y 2006-2007) y realizamos un seguimiento al año de los diagnósticos asignados. Estadística descriptiva, incluyendo un análisis comparativo de género. Resultados. Se analizaron 328 episodios (179 pacientes, edad media 14,48 años). Se detecta un incremento de prevalencia de 2002 a 2011. La distribución de diagnósticos por género muestra una asociación significativa de la alteración conductual con el masculino y de las conductas autolesivas y los trastornos alimentarios con el femenino. La tasa de ingreso fue del 18,5%. Tras revisar el diagnóstico al año de seguimiento, muestra diferencias con respecto a la orientación diagnóstica en urgencias. Conclusiones. El incremento de las consultas psiquiátricas urgentes en pediatría requiere una mayor coordinación y formación de los servicios para mejorar y adaptarse a esta emergencia. La consulta urgente supone la puerta de entrada a la atención psiquiátrica especializada de pacientes complejos y graves. Existen diferencias de género relevantes: se observan más trastornos conductuales, psicosis y trastornos por uso de substancias en el género masculino y más conductas autolesivas y trastornos alimentarios en el femenino

Introduction. Child and adolescent psychiatric emergencies have increased in recent years. The main objective of our study is to analyze sociodemographic and clinical characteristics of psychiatric emergencies under 18 years old that came to our hospital. Secondary objectives were to study diagnostic stability made in the emergency department and undertake a gender analysis. Methods. Descriptive cross-sectional study of patients attending the pediatric emergency department who required consultation to psychiatry service during 2010 and 2011, comparing data with two previous cross-sectional cuts (2002-2003 and 2006-2007). Then we track the diagnoses assigned during a year. Statistical analysis was descriptive. We also include a gender analysis. Results. We analyzed 328 episodes corresponding to 179 different patients (average age 14.48). We detected a progressive increase of prevalence of psychiatric emergencies from 2002 to 2011. Diagnostic distribution showed a significant association of Behavioral Disorders with males and an association of Self-injured Behaviors and Eating Disorders with females. The admission rate was 18.5%. One-year diagnostic outcomes showed differences comparing to emergency diagnosis. Conclusions. Increase and complexity of psychiatric consultations in Pediatric Emergency Department requires a psiquiágreater coordination and training of these services to enhance patients care. Emergency visit could mean the entrance of complex and severe patients to a specialized care. Our results detect gender differences: more Behavioral Disorders, Psychosis and Substance Use Disorders in males and Self-Injury and Eating Behavior Disorders in females

Kinetics of fomepizole in pregnant rats.

CONTEXT/OBJECTIVES: Fomepizole has been utilized with remarkable success for ethylene glycol and methanol poisonings in children and adults. However, very little information is available regarding the safe and effective use of fomepizole in pregnancy. The goal of this research was to utilize an animal model to investigate the kinetics of fomepizole in pregnancy. MATERIALS/METHODS: Male and pregnant Sprague-Dawley rats, which were obtained at 19 days gestation, were administered fomepizole 15 mg/kg intraperitoneally. The animals were anesthetized and blood, liver, kidney, and fetus samples were collected at 1-24 hours post administration. Tissue samples were homogenized, deproteinized and prepared by solid phase extraction. Fomepizole concentrations from tissue and serum samples were analyzed using high pressure liquid chromatography. RESULTS: Between males and pregnant females, tissue and serum fomepizole levels were similar. Fomepizole concentrations in whole fetal tissue were similar to those in the maternal liver and kidney tissue. Fetal fomepizole concentrations were fivefold higher than maternal serum concentrations. The zero order elimination rate of fomepizole from maternal serum was 7.6 mol/L/h, which was slightly slower than the elimination rate in male rats (12.9 mol/L/h). Elimination of fomepizole from the fetus followed a similar time course to that in the maternal tissues. DISCUSSION/CONCLUSION: Elevated concentrations of fomepizole were detected in the fetus following maternal administration. Although the levels of fomepizole in the fetal tissue would imply significant protection against fetal formation of toxic alcohol metabolites, further research is needed to explore the long-term effects of fomepizole on the fetus.

Lead toxicity and chelation therapy.

PURPOSE: Common sources of lead exposure, the primary clinical effects of lead toxicity, and current recommendations for managing lead toxicity, including chelation therapy, are reviewed. SUMMARY: Common sources of lead exposure in children and adults include industrial and mining activities, paint, dust, soil, water, air, the workplace, food, trinkets, ethnic folk remedies, and cosmetics. The absorption and biological fate of lead are affected by a variety of factors, including an individual's nutritional status, health, and age. Children with a blood lead concentration of >10 microg/dL and adults with a blood lead concentration of > or = 45 mug/dL should undergo further evaluation. Symptoms and time to onset of symptoms postexposure may vary, and it can be difficult to identify the early, subtle neurologic effects of lead toxicity. The classic symptoms of lead toxicity generally correlate with blood lead concentrations of 25-50 microg/dL in children and 40-60 microg/dL in adults. Management of lead toxicity requires extensive risk assessment and caregiver education. Chelation is generally not indicated for adults with blood lead concentrations of < 45 microg/dL because of the potential risk of adverse drug events and concerns about remobilized lead, and chelation for children with blood lead concentrations of < 45 microg/dL remains controversial. Dimercaprol, edetate calcium disodium, and succimer are the three agents primarily used for chelation. CONCLUSION: Lead toxicity remains a significant public health concern. Elimination of elevated blood lead levels in children can be accomplished by educating appropriate health care providers and caregivers, recognizing potential lead sources, and adopting aggressive prevention and case management measures.

Iron bezoar retained in colon despite 3 days of whole bowel irrigation.

Concretion formation is a documented complication of large iron ingestions. The generally accepted treatment is supportive care, whole bowel irrigation, and intravenous deferoxamine for systemic toxicity. Laparotomy and gastrotomy have also been used in patients with a high iron burden and bezoar formation. Though experiments suggest that iron is poorly absorbed in the colon, there are no case reports of iron overdose without systemic toxicity, despite a retained colonic bezoar. We report the case of a 16-month-old who presented to an Emergency Department 19 h after an iron ingestion. Initial laboratory studies revealed an anion gap of 14 mEq/L, and a 20 h serum iron concentration of 429 mcg/dL. An abdominal radiograph revealed multiple pills throughout the stomach and small bowel; whole bowel irrigation was initiated. Deferoxamine was administered at 10 mg/kg/h and then stopped when the serum iron level reached 27 mcg/dL, 36 h later. At this time, the abdominal radiograph showed an iron bezoar remaining in the ascending colon despite a clear rectal effluent from whole bowel irrigation. Despite whole bowel irrigation over the next 36 h, the iron bezoar was not removed and actually migrated proximally in the colon. Treatment was stopped on the third day and a normal diet was instituted with prompt passage of the bezoar.

Cyanide poisoning and its treatment.

Cyanide is both widely available and easily accessible throughout the world. Although the compound is not frequently encountered, it has been used as a poison and contaminant in the past and is a potential terrorist agent. Cyanide has the ability to cause significant social disruption and demands special attention to public health preparedness. It can be obtained from a variety of sources, including industrial, medical, and even common household products. Another frequently encountered source of cyanide exposure is residential fires. Exposure to high concentrations of the chemical can result in death within seconds to minutes. Long-term effects from cyanide exposure can cause significant morbidity. The only treatment for cyanide toxicity approved for use in the United States is a kit consisting of amyl nitrite, sodium nitrite, and sodium thiosulfate. Future research aims to find a faster-acting, more effective, and better tolerated treatment for cyanide toxicity.