Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder.

PURPOSE: The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake. METHODS: A cohort of 100 participants, including 50 individuals with ADHD and 50 age- and sex-matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non-cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings. RESULTS: We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2 (2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non-cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049). CONCLUSIONS: Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.

Factibilidad y efectos de la prehabilitación en cirugía cardiaca. Estudio preliminar / Feasibility and effects of prehabilitation in cardiac surgery. Preliminary study

Objetivo: Evaluación de la factibilidad de un programa de prehabilitación multimodal y su efecto sobre la capacidad funcional en pacientes candidatos a cirugía cardiaca electiva. Métodos: Estudio piloto realizado desde julio de 2017 hasta junio de 2018 en pacientes candidatos a revascularización miocárdica y/o recambio valvular. El programa consistió en: 1) programa de entrenamiento físico supervisado, 2) incentivación respiratoria, 3) soporte nutricional y 4) entrenamiento en mindfulness. Se realizó una evaluación previa al inicio del programa y al finalizar el mismo (preoperatoriamente). Resultados: Todos los pacientes, excepto uno que rechazó la cirugía, completaron el programa, que tuvo una duración media de 45 días. Ningún paciente presentó complicaciones relacionadas con el programa. El programa indujo un aumento significativo de la capacidad funcional medido por el test de la marcha de seis minutos (510,7+62m vs. 534,3+71m; p=0,007) y el test de la silla (13,2+4,7 vs. 16,4+7 repeticiones; p=0,02), así como un aumento del nivel de actividad física medido mediante el cuestionario de actividad física de Yale (37,6+20 vs. 54,2+27; p=00029). Conclusiones: La prehabilitación multimodal en pacientes candidatos a cirugía cardiaca electiva es factible y aumenta la capacidad funcional preoperatoriamente sin asociarse a complicaciones. El presumible impacto beneficioso de esta mejora sobre la incidencia de complicaciones postoperatorias y estancia hospitalaria requiere ser investigado.(AU)

Objective: Evaluation of the feasibility of a multimodal prehabilitation program and its effect on functional capacity in patients candidates for elective cardiac surgery. Methods: Pilot study conducted from July 2017 to June 2018 in patients candidates to myocardial revascularization and/or valve replacement. The program consisted of: 1) supervised exercise training program, 2) breathing incentive exercises, 3) nutritional support, and 4) mindfulness training. An evaluation was carried out prior to the start of the program and at the end of it (preoperatively). Results: All patients except one who refused surgery, completed the program, which lasted an average of 45 days. No patients presented complications related to the program. The program induced a significantly increase in functional capacity measured by the six-minute walking test (510.7+62m vs 534.3+71m, P=.007) and the chair test (13.2+4, 7 vs 16.4+7 repetitions, P=.02), as well as an increase in the level of physical activity measured by the Yale physical activity questionnaire (37.6+20 vs 54.2+27; P=00029). Conclusions: Multimodal prehabilitation in patients candidates for elective cardiac surgery is feasible and it increases functional capacity preoperatively without being associated with complications. The presumed beneficial impact of this improvement on the incidence of postoperative complications and hospital stay, requires further investigation.(AU)

Feasibility and effects of prehabilitation in cardiac surgery. Preliminary study.

Prehabilitation programs that combine exercise training, nutritional support, and emotional reinforcement have demonstrated efficacy as a strategy for preoperative optimization in abdominal surgery. The experience in cardiac surgery, one of those associated with greater morbidity and mortality, is anecdotal. OBJECTIVE: evaluation of the feasibility of a multimodal prehabilitation program and its effect on functional capacity in patients candidates for elective cardiac surgery. METHODS: Pilot study conducted from July 2017 to June 2018 in patients candidates to myocardial revascularization and/or valve replacement. The program consisted of: 1) supervised exercise training program, 2) breathing incentive exercises, 3) nutritional support, and 4) mindfulness training. An evaluation was carried out prior to the start of the program and at the end of it (preoperatively). RESULTS: All patients except one who refused surgery, completed the program, which lasted an average of 45 days. No patients presented complications related to the program. The program induced a significantly increase in functional capacity measured by the six-minute walking test (510.7 + 62 m vs 534.3 + 71 m, p = 0.007) and the chair test (13.2 + 4, 7 vs 16.4 + 7 repetitions, p = 0.02), as well as an increase in the level of physical activity measured by the Yale physical activity questionnaire (37.6 + 20 vs 54.2 + 27; p = 00029). CONCLUSIONS: Multimodal prehabilitation in patients candidates for elective cardiac surgery is feasible and it increases functional capacity preoperatively without being associated with complications. The presumed beneficial impact of this improvement on the incidence of postoperative complications and hospital stay, requires further investigation.

Maniobras de reclutamiento pulmonar: abriendo la puerta a un enemigo oculto / Lung recruitment maneuvers: opening the door to a hidden enemy

Las maniobras de reclutamiento (MR) son una práctica habitual en anestesiología; sin embargo, pueden tener efectos adversos. Presentamos un caso de una complicación inesperada tras las MR. Se trata de una paciente intervenida de cirugía de resección bronquial tumoral. Inmediatamente después de la MR, presentó una parada circulatoria por disociación electromecánica. Después de las maniobras de reanimación y recuperación de la circulación espontánea, una ecocardiografía transesofágica mostró un foramen oval permeable (FOP), disfunción ventricular con alteraciones segmentarias y aire en cavidades izquierdas. Se interpretó como posible embolia aérea paradójica coronaria. La paciente presentó buena evolución inmediata, reversión de las alteraciones segmentarias y un curso postoperatorio sin incidencias. Durante las MR se producen cambios de presiones intracavitarias que pueden favorecer la apertura de FOP (presente hasta en un 30% de la población), e inversión del shunt fisiológico izquierda-derecha. La disponibilidad de ecocardiografía transesofágica permitió el diagnóstico diferencial y el seguimiento inmediato

Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoing surgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electrical activity immediately after RMs. A transoesophageal echocardiogram performed after return of spontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunction with segmental changes, and air in the left ventricle, leading to suspicion of paradoxical air embolism. The contractility changes normalised spontaneously, and postoperative evolution was uneventful. RMs cause changes in intracavitary pressures that can lead to opening of a PFO (present in up to 30% of the population) and reversal of the physiological left-right shunt. Transoesophageal echocardiography facilitated immediate diagnosis and follow-up

Lung recruitment maneuvers: opening the door to a hidden enemy. / Maniobras de reclutamiento pulmonar: abriendo la puerta a un enemigo oculto.

Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoing surgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electrical activity immediately after RMs. A transoesophageal echocardiogram performed after return of spontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunction with segmental changes, and air in the left ventricle, leading to suspicion of paradoxical air embolism. The contractility changes normalised spontaneously, and postoperative evolution was uneventful. RMs cause changes in intracavitary pressures that can lead to opening of a PFO (present in up to 30% of the population) and reversal of the physiological left-right shunt. Transoesophageal echocardiography facilitated immediate diagnosis and follow-up.

Neumomediastino espontáneo de repetición secundario al síndrome de hiperémesis por cannabis / Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome

El síndrome de hiperémesis por cannabis (SHC) es poco conocido entre los clínicos y se caracteriza por dolor abdominal y vómitos cíclicos, tras un consumo intensivo de cannabis durante años, que no responde al tratamiento con antieméticos pero sí a las duchas de agua muy caliente. Presentamos el caso de un paciente de 24 años, con antecedentes de consumo de cannabis desde los 14 años y un episodio de neumomediastino (NMD), etiquetado como idiopático, el mes anterior, que presentó asociación entre SHC y neumomediastino secundario a los intensos vómitos repetidos del SHC. Se le administró capsaicina tópica y 5 mg de haloperidol endovenoso, permaneciendo 48 h en la Unidad de Corta Estancia de Urgencias. Esta observación clínica aislada podría indicar la necesidad de descartar el SHC como causa de NMD en sujetos jóvenes y, de la misma manera, considerar la presencia de NMD en la exploración clínica de pacientes jóvenes con SHC o en pacientes con patologías en cuya etiología pueda influir el aumento de presión intratorácica

Cannabinoid hyperemesis syndrome (CHS) is little known amongst clinicians and is characterised by abdominal pain and cyclical vomiting, after intense consumption of cannabis over several years. It does not respond to treatment with antiemetics, but does respond to showers in very hot water. We present the case of a 24-year-old patient whose antecedents included cannabis consumption since the age of 14 and an episode of spontaneous idiopathic pneumomediastinum (PM) the previous month, which presented an association of CHS and secondary pneumomediastinum with the intense, repeated vomiting of the CHS. He was given topical capsaicin and 5 mg of intravenous haloperidol, and was kept for 48 hours in the Emergency Short Stay Unit. This isolated clinical observation appears to indicate the need to rule out CHS as the cause of PM in young patients and, similarly, to consider the presence of PM in the clinical exploration of young people with CHS and in patients with pathologies whose aetiology might be influenced by an increase in intrathoracic pressure

[Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome]. / Neumomediastino espontáneo de repetición secundario al síndrome.

Cannabinoid hyperemesis syndrome (CHS) is little known amongst clinicians and is characterised by abdominal pain and cyclical vomiting, after intense consumption of cannabis over several years. It does not respond to treatment with antiemetics, but does respond to showers in very hot water. We present the case of a 24-year-old patient whose antecedents included cannabis consumption since the age of 14 and an episode of spontaneous idiopathic pneumomediastinum (PM) the previous month, which presented an association of CHS and secondary pneumomediastinum with the intense, repeated vomiting of the CHS. He was given topical capsaicin and 5 mg of intravenous haloperidol, and was kept for 48 hours in the in A and E Short Stay Unit. This isolated clinical observation appears to indicate the need to rule out CHS as the cause of PM in young patients and, similarly, to consider the presence of PM in the clinical exploration of young people with CHS and in patients with pathologies whose aetiology might be influenced by an increase in intrathoracic pressure.

Recurrent DNA copy number alterations in intestinal-type sinonasal adenocarcinoma.

BACKGROUND: Intestinal-type sinonasal adenocarcinoma (ITAC) is a rare tumour related to occupational wood dust exposure. Few studies have described recurrent genetic changes on a genome-wide scale. The aim of this study was to obtain a high resolution map of recurrent genetic alterations in ITAC. MATERIAL AND METHODS: Copy number alterations were evaluated by microarray CGH and MLPA in 37 primary tumours. The results were correlated with pathological characteristics and clinical outcome. RESULTS: Microarray CGH identified the following recurrent aberrations, in descending order: gains at 5p15 (22 cases, 60%), 8q24 (21 cases, 57%), 20q13 (20 cases, 54%), 20q11, and 8q21 (19 cases, 51%), 20p13, and 7p11 (16 cases, 43%), and losses at 5q11-qter, 8p12-pter, and 18q12-23 (15 cases, 40%), and 17p13, and 19p13 (13 cases, 35%). MLPA analysis confirmed this global pattern of gains and losses. Chromosomal loss at 4q32-ter and gains at 1q22, 6p22 and 3q29, as well as deletion of TIMP2 and CRK correlated with unfavourable clinical outcome. CONCLUSION: ITACs have a unique pattern of chromosomal abnormalities. The four different histological subtypes of ITAC appeared genetically similar. Four chromosomal gains and losses and two specific genes showed prognostic value and may be involved in tumour progression.

A comparison of fresh, pasta filata, and aged Hispanic cheeses using sensory, chemical, functional, and microbiological assessments.

Anecdotal information suggests that some Hispanic consumers may consider US-made Hispanic cheeses as having a general lack of authenticity compared with those made in their countries of origin. To characterize the potential differences, samples of fresh, pasta filata, and aged Hispanic cheeses were acquired from both the United States (total n=39) and countries of origin (total n=30) purchased from Mexico, Central America (Costa Rica and El Salvador), and the Caribbean (Puerto Rico). The proximate composition, microbial counts, melt profile, and sensory characteristics were evaluated and compared in country-of-origin cheeses and the US-made counterparts. The presence of Listeria spp. was confirmed for 1 Mexican aged cheese sample and 6 cheese samples from Central America (3 fresh, 2 pasta filata, and 1 aged). The chemical composition, melt profile, and sensory characteristics of fresh and pasta filata US Hispanic cheeses were not significantly different from their Mexican counterparts. Likewise, the chemical composition and melt profile of US aged Hispanic cheeses was not significantly different from the aged Mexican cheeses, but sensory characteristics varied among all aged cheeses. These results demonstrate the similarities and differences among US fresh, pasta filata, and aged Hispanic cheeses relative to their counterparts made in the countries of origin.

Short communication: Reactivity of diacetyl with cleaning and sanitizing agents.

Diacetyl is used to impart a buttery flavor to numerous food products such as sour cream, cottage cheese, vegetable oil-based spreads, baked goods, and beverages. Recent studies have linked exposure to high concentrations of diacetyl and the onset of bronchiolitis obliterans. Due to the reported risks that diacetyl may pose, many food companies have altered practices to reduce worker exposure to diacetyl, including the use of personal respirators, improved air handling systems, and adequate cleaning practices. Commonly used cleaning and sanitizing agents may be reactive with diacetyl; however, the efficacy of these chemicals has not been studied in detail and remains unclear. The objective of this work was to study the reaction chemistry of diacetyl with common industrial cleaning and sanitizing chemicals. The reactions were assessed at equimolar concentrations and analyzed by gas chromatography-mass spectrometry. Peroxyacetic acid was most reactive with diacetyl (95% reduction in diacetyl), followed by sodium hypochlorite (76% reduction), and hydrogen peroxide (26% reduction). Benzalkonium chloride (BAC) did not react with diacetyl. Acetic acid was detected as the main product of reactions of diacetyl with peroxyacetic acid, sodium hypochlorite, and hydrogen peroxide. 1,1-Dichloro-2-propanone and 1,1,1-trichloropropanone were also identified as volatile reaction products in the sodium hypochlorite reactions.

Short communication: Evidence for methylglyoxal-mediated browning of Parmesan cheese during low temperature storage.

Brown pigmentation can occasionally form in Parmesan cheese during the ripening process, creating an unappealing appearance and associated off-flavors. The browning reactions proceed at refrigerated temperatures and in the relative absence of reducing sugar, contrary to typical Maillard browning. Residual sugars, lipid oxidation products, byproducts of fermentation, and (or) enzymes may react with primary amines in cheese to form brown pigmentation and concomitantly generate volatile compounds unique to each of these reactions. Determining the volatile profiles provides a means of understanding the potential substrates involved and causative reaction pathways. This work is divided into 2 segments. The first portion characterized the pigmentation and the browning index of Parmesan cheeses with and without extensive browning. The second phase examined the volatile character of the cheeses using gas chromatography-mass spectrometry. Various pyrazines, such as 2,3,5-trimethylpyrazine and 3,5-diethyl-2-methylpyrazine, were found in the brown cheeses but were not present in the white samples. The formation of pyrazines is proposed to result from the spontaneous condensation of aminoacetone. Aminoacetone can be formed by the Strecker degradation of amino acids with methylglyoxal, the latter a byproduct of sugar fermentation. Evidence is provided to support a browning pathway mediated by the production of methylglyoxal in Parmesan cheese.

Diacetyl levels and volatile profiles of commercial starter distillates and selected dairy foods.

Starter distillates (SDL) are used as ingredients in the formulation of many food products such as cottage cheese, margarine, vegetable oil spreads, processed cheese, and sour cream to increase the levels of naturally occurring buttery aroma associated with fermentation. This buttery aroma results, in part, from the presence of the vicinal dicarbonyl, diacetyl, which imparts a high level of buttery flavor notes and is a key component of SDL. Diacetyl (2,3-butanedione) is a volatile product of citrate metabolism produced by certain bacteria, including Lactococcus lactis ssp. diacetylactis and Leuconostoc citrovorum. In the United States, SDL are regarded as generally recognized as safe ingredients, whereby usage in food products is limited by good manufacturing practices. Recently, diacetyl has been implicated as a causative agent in certain lung ailments in plant workers; however, little is published about the volatile composition of SDL and the levels of diacetyl or other flavoring components in finished dairy products. The objective of this work was to characterize the volatile compounds of commercial SDL and to quantitate levels of diacetyl and other Flavor and Extract Manufacturers Association-designated high-priority flavoring components found in 18 SDL samples and 24 selected dairy products. Headspace volatiles were assessed using a solid-phase microextraction and analyzed by gas chromatography-mass spectrometry. In addition to diacetyl (ranging from 1.2 to 22,000 µg/g), 40 compounds including 8 organic acids, 4 alcohols, 3 aldehydes, 7 esters, 3 furans, 10 ketones, 2 lactones, 2 sulfur-containing compounds, and 1 terpene were detected in the SDL. A total of 22 food samples were found to contain diacetyl ranging from 4.5 to 2,700 µg/100g. Other volatile compounds, including acetaldehyde, acetic acid, acetoin, benzaldehyde, butyric acid, formic acid, furfural, 2,3-heptanedione, 2,3-pentanedione, and propanoic acid, were also identified and quantified in SDL or food samples, or both. The results obtained in this work summarize the volatile composition of commercial SDL and the approximate levels of diacetyl and other Flavor and Extract Manufacturers Association-designated high-priority flavoring components found in SDL and selected dairy foods.

Invited review: The application of alkaline phosphatase assays for the validation of milk product pasteurization.

Standard practices for indirectly assessing the pasteurization status of milk products are primarily based on the thermal inactivation kinetics of the endogenous milk enzyme, alkaline phosphatase (ALP). This assessment provides an invaluable, if not required, tool for both regulatory and in-house process control and validation. Endogenous milk ALP manifests a slightly higher heat resistance than the pathogenic microflora upon which pasteurization time and temperature requirements are based. Hence, ALP activity is recognized and accepted as the method of choice for the rapid validation of milk product pasteurization. However, ALP assays have notable limitations that must be understood if they are to be administered and interpreted correctly and the results are to be applied judiciously. Issues such as the reactivation of heat-denatured ALP and the presence of both heat-stable and -labile microbial ALP are addressed. A discussion of ALP in the milk of nonbovine species is presented based on the limited literature available. Some discussion of research involving alternative pasteurization indicators also is presented. This article is intended to summarize the pertinent details of the ALP assay for dairy products (noting the basis and limitations of various methods) and the processing, handling, and known compositional factors that influence the assay results.

Clinical manifestations and sequential computed tomography scans of cerebral cysticercosis in childhood.

Cerebral cysticercosis was studied in 131 children. The patients were divided into two groups, confirmed and probable cysticercosis. The clinical picture may be divided into two stages: initial stage of acute invasion and chronic encephalitic stage. Symptoms in the initial stage are headache, vomiting, fever, myalgia, abdominal pain, seizures and psychotic reactions. In the initial stage only cerebral edema can be seen in the computed tomography (CT) scan. In the chronic stage, variability of symptomatology is great, and it is in this phase that cysticerci can be seen in the CT scan. Only 66 out of the 131 patients studied had CT performed. The computed tomographic sequence of parenchymatous brain cysticercosis is described. A feature not previously reported was the presence of transient arterial hypertension due to cerebral cysticercosis found in four cases.