The role of circadian rhythms in individuals with attention deficit hyperactivity disorder and obesity: A narrative review / El papel de los ritmos circadianos en personas con trastorno por déficit de atención con hiperactividad y obesidad: Una revisión narrativa

Abstract Background A relationship between attention deficit hyperactivity disorder (ADHD) and obesity has been consistently documented. Obesity and metabolic syndrome have been associated with misalignment between daily activities and circadian rhythm. ADHD patients have a high prevalence of delayed sleep phase syndrome, which is a circadian rhythm disorder. Understanding this relationship is important for the evaluation of obese population at risk. Objective The aim of this narrative review was to summarize the information updated until 2019 about the role of circadian rhythms in obese ADHD individuals. Method A search was performed in MEDLINE, EMBASE, and Google Scholar database. The terms ADHD, obesity, circadian rhythm, sleep disorders, adolescent, adult, Adolesc, circadian, attention deficit hyperactivity disorder, and child were combined with logical functions. Results A total of 132 articles were reviewed. Evidence showed that ADHD subjects have an increased risk to present obesity and circadian rhythms disorders. Some possible pathways for this relationship have been hypothesized including obesity as a risk factor, an underpinned common biological dysfunction, and behavioral and cognitive features of individuals with ADHD. As most of the articles are methodologically cross-sectional, it is not possible to establish causative associations. Discussion and conclusion This review points out the importance of early recognizing and treating circadian rhythms disorders and obesity in ADHD patients. Future studies must be carried out with a longitudinal design to establish the effect of each comorbidity in the treatment of individuals with ADHD.

Resumen Antecedentes La relación entre el trastorno por déficit de atención con hiperactividad (TDAH) y la obesidad se ha documentado consistentemente. Por otro lado, el síndrome metabólico y la obesidad se han asociado con un desfase del ritmo circadiano. En poblaciones clínicas con TDAH se han encontrado una alta prevalencia del trastorno de fase de sueño retrasada, el cual es un trastorno del ritmo circadiano. Entender la relación entre estos padecimientos es importante para evaluar la población en riesgo de obesidad. Objetivo Resumir la información actualizada hasta 2019 sobre el rol del ritmo circadiano en individuos obesos con TDAH. Método Se realizó una búsqueda de artículos en las bases de datos MEDLINE, EMBASE y Google Scholar. Los términos TDAH, obesidad, ritmos circadianos, trastornos del sueño, adolescentes, adultos y niños se combinaron con operadores lógicos. Resultados Se revisaron un total de 132 artículos. La evidencia demostró que los sujetos con TDAH tienen un alto riesgo de sufrir obesidad y ritmos circadianos alterados. Existen algunas hipótesis para establecer esta relación, incluyendo la obesidad como factor de riesgo para TDAH, la disfunción biológica común entre estos trastornos y las características conductuales y cognitivas de los individuos con TDAH. Sin embargo, como la mayoría de los artículos son transversales, no es posible establecer una asociación causal. Discusión y conclusión Esta revisión señala la importancia del reconocimiento temprano y tratamiento de los trastornos del ritmo circadiano y obesidad en pacientes con TDAH. Estudios futuros deben realizarse de manera longitudinal para establecer el efecto de estas comorbilidades en el tratamiento de los individuos con TDAH.

Chemical and statistical analyses of blotter paper matrix drugs seized in the State of Rio de Janeiro.

Drugs of abuse are psychoactive substances illicitly distributed and used worldwide. In Rio de Janeiro, Brazil, they represent a public health issue and are directly related to several social problems. The recent increase in appearances of new psychoactive substances (NPS), derived from structural modifications of existing psychoactive substances, poses a threat to public health and forensic laboratories worldwide, as little is known about these substances. This study aimed to chemically and geographically map drugs of abuse from blotter papers seized by the Civil Police of Rio de Janeiro State (PCERJ) between 2006 and 2019. High-performance analytical techniques, such as gas chromatography-mass spectrometry (GC-MS) and Orbitrap mass spectrometry (Orbitrap-MS), combined with statistical analyses, were employed to characterize the seized samples. The most common chemical compounds in NPS found in this study were synthetic phenethylamines, i.e., molecules from the 25I-NBOH (2-(((4-iodo-2,5-dimethoxyphenethyl)amino)methyl)phenol) and 25I-NBOMe (2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine) families. Prior to 2014, the majority of seized blotter papers contained lysergic acid diethylamide (LSD) and were concentrated in the Metropolitan region. An upsurge in blotter paper seizures was observed from 2014 to 2017; the most common substances during this time were from the NBOMe family. NBOH compounds emerged in 2016 in coastal regions with high tourism, reaching over 1300 items only in 2017. Only one synthetic cannabinoid was found among the blotter papers seized in Rio de Janeiro between 2006 and 2019. The assembled chemical data and statistical analyses allowed the mapping and monitoring of the chemical profiles of the seized blotter papers, providing a strong foundation for the understanding of the origins and movement of these drugs around the RJ State.

Asymmetric bioreduction of ketoesters derivatives by Kluyveromyces marxianus: influence of molecular structure on the conversion and enantiomeric excess

ABSTRACT This study presents the bioreduction of six β-ketoesters by whole cells of Kluyveromyces marxianus and molecular investigation of a series of 13 β-ketoesters by hologram quantitative structure-activity relationship (HQSAR) in order to relate with conversion and enantiomeric excess of β-stereogenic-hydroxyesters obtained by the same methodology. Four of these were obtained as (R)-configuration and two (S)-configuration, among them four compounds exhibited >99% enantiomeric excess. The β-ketoesters series LUMO maps showed that the β-carbon of the ketoester scaffold are exposed to undergo nucleophilic attack, suggesting a more favorable β-carbon side to enzymatic reduction based on adopted molecular conformation at the reaction moment. The HQSAR method was performed on the β-ketoesters derivatives separating them into those provided predominantly (R)- or (S)-β-hydroxyesters. The HQSAR models for both (R)- and (S)-configuration showed high predictive capacity. The HQSAR contribution maps suggest the importance of β-ketoesters scaffold as well as the substituents attached therein to asymmetric reduction, showing a possible influence of the ester group carbonyl position on the molecular conformation in the enzyme catalytic site, exposing a β-carbon side to the bioconversion to (S)- and (R)-enantiomers.

Asymmetric bioreduction of ß-ketoesters derivatives by Kluyveromyces marxianus: influence of molecular structure on the conversion and enantiomeric excess.

This study presents the bioreduction of six ß-ketoesters by whole cells of Kluyveromyces marxianus and molecular investigation of a series of 13 ß-ketoesters by hologram quantitative structure-activity relationship (HQSAR) in order to relate with conversion and enantiomeric excess of ß-stereogenic-hydroxyesters obtained by the same methodology. Four of these were obtained as (R)-configuration and two (S)-configuration, among them four compounds exhibited >99% enantiomeric excess. The ß-ketoesters series LUMO maps showed that the ß-carbon of the ketoester scaffold are exposed to undergo nucleophilic attack, suggesting a more favorable ß-carbon side to enzymatic reduction based on adopted molecular conformation at the reaction moment. The HQSAR method was performed on the ß-ketoesters derivatives separating them into those provided predominantly (R)- or (S)-ß-hydroxyesters. The HQSAR models for both (R)- and (S)-configuration showed high predictive capacity. The HQSAR contribution maps suggest the importance of ß-ketoesters scaffold as well as the substituents attached therein to asymmetric reduction, showing a possible influence of the ester group carbonyl position on the molecular conformation in the enzyme catalytic site, exposing a ß-carbon side to the bioconversion to (S)- and (R)-enantiomers.

Pancreatitis aguda recidivante con enteropatía por gluten asociada. Características clínico-analíticas y evolutivas en 34 pacientes / No disponible

Objetivos: describir la frecuencia y características clínico-analíticasde la pancreatitis aguda (PA) recidivante con enteropatíapor gluten (EG) asociada.Pacientes y métodos: estudiamos de forma prospectiva loscasos de pancreatitis agudas ingresados en nuestro Servicio duranteel año 2006. Registramos un total de 185 pacientes. A lasformas recurrentes que fueron 40 en total (22%), les aplicamos unprotocolo clínico-analítico consistente en la determinación demarcadores serológicos, genéticos y biopsias duodenales, paradescartar una EG asociada.Resultados: un total de 34 pacientes (18%) cumplían criteriosclínico-biológicos de EG asociada (grupo 1) y se compararon conel resto de las PA no-EG (n = 161) (grupo 2). La edad media en laEG fue de 54 ± 25 años, ligeramente inferior al grupo 2, (61 ±14) (NS). Existía un ligero predominio de mujeres (50%) en el grupo1, respecto al grupo 2 (38,5%) (NS). Siete pacientes del grupo1 (20%) presentaron una PA grave, frente a 27 (17%) en el grupo2 (NS). La presencia de colelitiasis en el grupo 1, fue de 6 casos(18%), significativamente inferior a la del grupo 2, de 72 casos(45%) (p < 0,05). Cuatro pacientes con EG desarrollaron seudoquistes(12%) frente a 13 (8%) en el grupo 2 (NS).La transglutaminasa tisular (TGt) estaba elevada únicamente en3 casos (9%). Nueve pacientes (34%) fueron DQ2 (+) y 4 (12%)DQ8 (+), siendo el resto (54%), negativos para ambos marcadores.Existía una duodenitis difusa desde el punto de vista endoscópicoen 32 pacientes (95%). Las biopsias duodenales, mostraronatrofia vellositaria (Marsh 3) en 2 casos (6%); infiltración inflamatoriade la submucosa (Marsh 2) en 10 casos (29,4%); aumento delos linfocitos intraepiteliales (Marsh 1) en 8 casos (23,5%) y mucosanormal (Marsh 0) en 14 casos (41,2%). La respuesta a la DSGal año, fue excelente en 30 pacientes (88%).Conclusiones: la PA recidivante con EG, constituye una asociaciónrelativamente frecuente, indistinguible desde el punto devista clínico y evolutivo del resto de PA, excepto por una menorpresencia de colelitiasis (p < 0,05)

Objectives: to describe the frequency and the clinical and laboratorycharacteristics of relapsing acute pancreatitis (AP) associatedwith gluten enteropathy (GE).Patients and methods: we prospectively examined all acutepancreatitis cases admitted to our Department in 2006. Werecorded a total of 185 patients. With recurring forms, 40 (22%)in all, we used a clinical-lab protocol including serologic and geneticmarkers, and duodenal biopsy to rule out GE.Results: a total of 34 patients (18%) met clinical-biological criteriafor GE (group 1), and were compared to the remaining non-GE AP cases (n = 161) (group 2). Mean age in the GE group was54 ± 25 years, slightly younger than group 2 (61 ± 14) (NS).There was a mild predominance of women (50%) in group 1 versusgroup 2 (38.5%) (NS). Seven patients in group 1 (20%) hadsevere AP, as compared to 27 (17%) in group 2 (NS). The presenceof cholelithiasis in group 1 involved 6 cases (18%), whichwas significantly lower than in group 2 – 72 cases (45%) (p <0.05). Four patients with GE developed pseudocysts (12%) versus13 (8%) in group 2 (NS).Tissue transglutaminase (tTG) was elevated only in 3 patients(9%). Nine patients (34%) were DQ2 (+) and 4 (12%) DQ8 (+); therest (54%) were all negative for both markers. From an endoscopicperspective there was diffuse duodenitis in 32 patients (95%).Duodenal biopsies revealed villous atrophy (Marsh 3) in 2 patients(6%); submucosal inflammatory infiltration (Marsh 2) in 10(29.4%); increased intraepithelial lymphocytes (Marsh 1) in 8 cases(23.5%), and normal mucosa (Marsh 0) in 14 patients (41.2%).Response to GFD after 1 year was excellent in 30 patients (88%).Conclusions: relapsing AP with GE represents a relativelycommon association that is indistinguishable from other APs froma clinical-evolutive stand point, except for a lower presence ofcholelithiasis (p < 0.05) (AU)

Hemorragia digestiva baja secundaria a tumor estromal rectal (GIST rectal) / Lower GI bleeding secondary to a stromal rectal tumor (rectal GIST)

No disponible

Enfermedad celiaca (EC), colitis ulcerosa (CU) y colangitis esclerosante primaria (CEP) asociadas en el mismo paciente: estudio familiar / Celiac disease (CD), ulcerative colitis (UC), and primary sclerosing cholangitis (PSC) in one patient: a family study

Presentamos el caso de un varón de 17 años, que a la edad de 7 años fue diagnosticado de enfermedad celiaca (EC) junto con una colitis ulcerosa (CU) y una colangitis esclerosante primaria (CEP) asociadas. Fue tratado con DSG e inmuno-supresores tipo azatioprina y se encuentra asintomático en la actualidad. Su hermana menor de 12 años, fue diagnosticada de EC cuando tenía 1,5 años y a los 7 años desarrolló una DM tipo 1 de difícil control.Se realizó un estudio familiar y ambos padres están afectos de una EC silente. Todos ellos son DQ2 (+). A propósito del caso y estudio familiar, se hacen una serie de consideraciones sobre la enfermedad celiaca y el desarrollo de complicaciones

We discuss the case of a 17-year-old male who at the age of 7 was diagnosed with celiac disease (CD) together with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). The patient was treated with gluten-free diet and immunosuppressive drugs (azathioprine), and currently remains asymptomatic. The patient’s younger, 12-year-old sister was diagnosed with CD when she was 1.5 years old, and at 7 years she developed type-I diabetes mellitus, which was difficult to control. A family study was made, and both parents were found to be affected with silent CD. All were DQ2 (+). In relation to the case ;;and family study, we provide a series of comments related to CD and its complications

[Prevailing right ventricular myocardiopathy for previous myocarditis or arrhythmogenic dysplasia?]. / Miocardiopatia preponderante de ventrículo direito por miocardite prévia ou por displasia arritmogênica?

A clinical case of a 10-year-old male patient is reported. His dilated and prevailing right ventricular myocardiopathy shows diagnostic difficulties between previous myocarditis etiology and arrhythmogenic dysplasia. As the elements are not pathognomonic of one or other cause, the increase of cardiac enzymes in subacute stage maybe tends to the supposition of previous myocarditis. Hence, the questioning that many cases labeled as arrhythmogenic dysplasia can truly correspond to the possibility of evolutional myocarditis. The controversial clinic management is disputable.

Miocardiopatia preponderante de ventrículo direito por miocardite prévia ou por displasia arritmogênica? / Prevailing right ventricular myocardiopathy for previous myocarditis or arrhythmogenic dysplasia?

É relatado o caso clínico de um paciente do sexo masculino com 10 anos de idade, cuja miocardiopatia dilatada e preponderante de ventrículo direito apresenta dificuldades diagnósticas entre a etiologia de miocardite prévia e a displasia arritmogênica. Como os elementos não são patognomônicos de uma ou de outra causa, a elevacão de enzimas cardíacas na fase subaguda talvez incline para a suposicão de miocardite prévia. Daí, o questionamento de que muitos casos rotulados como displasia arritmogênica poderem, verdadeiramente, corresponder à possibilidade de miocardite evolutiva. A controvertida conduta clínica é discutida.

Hepatitis aguda por ticlopidina. Presentación de 12 casos y revisión de la literatura / Acute hepatitis due to ticloidine. A report of 12 cases and review of the literature

Objetivo. Analizar las características de la hepatotoxicidad por ticlopidina. Pacientes y métodos. Describimos todos los casos de hepatotoxicidad atribuidos a ticlopidina y remitidos al Registro de Hepatopatías asociadas a medicamentos e identificamos por MEDLINE e Índice Médico Español los casos publicados durante el período 1982-2001. Resultados. Se remitieron 12 casos de alteración hepática relacionada con ticlopidina, que constituyeron un 5 por ciento del total de casos de hepatotoxicidad notificados al Registro. El 83 por ciento de los pacientes eran varones con una edad media de 68 años. El 66 por ciento de éstos precisó ingreso hospitalario. El período de latencia varió de 2 a 13 semanas. El patrón de lesión hepática fue de tipo colestásico en el 75 por ciento de los casos, hepatocelular en el 16,6 por ciento y mixto en el 8,3 por ciento. El 25 por ciento de los pacientes recibió una dosis subterapéutica. Conclusiones. Ticlopidina se relaciona frecuentemente con hepatotoxicidad, que parece obedecer a un mecanismo idiosincrásico y es predominantemente de carácter colestásico. La utilización de dosis menores a la recomendadas, además de carecer del efecto terapéutico esperado, no protege del desarrollo de hepatotoxicidad. Los médicos que prescriben este medicamento deben estar informados de este potencial para establecer una correcta relación beneficio-riesgo (AU)

Do olhar à escuta dois paradgimas clinicos

A psicanálise surgiu devido a uma dupla subversão. Em princípio, Freud estava ciente da necessidade de fazer um corte preciso com a medicina e também com a psicologia, marcando desse modo um lugar específico para esta nova disciplina. Além disso,empenhou-se inicialmente numa espécie de tarefa delicada, que consistiu em confrontar o sujeito que, movido pelos seus sintomas, apresenta-se na condição de ser-em-sofrimento, com a responsabilidade de assumir um saber inconsciente sobre o desejo sexual.É por essa via que nos remontamos à experiência originária de talking-cure e também nos reportamos à passagem da clínica da observação (onde se tem como instrumento o olhar, momento fecundo do ensinamento de Charcot) para uma clínica sustentada na escuta, a qual diz respeito a inovação metodológica freudiana, cujo suporte é a palavra na qual o sujeito se encontra irremediavelmente implicado.(AU)