The Development and Content Validation of a Clinical Screening Scale to Identify Attention-Deficit Hyperactivity Disorder Cases Based on the Gender Perspective: An e-Delphi Study.

BACKGROUND: Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD. OBJECTIVE: The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD. METHODS: The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content. RESULTS: A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls. CONCLUSIONS: To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.

[Co-infection with Neisseria gonorrhoeae and Actinomyces naeslundii]. / Coinfección por Neisseria gonorrhoeae y Actinomyces naeslundii.

OBJECTIVE: To report a case of co-infection with Neisseria gonorrhoeae and Actinomyces naeslundii in a woman with an intrauterine device. CASE REPORT: A 36-year-old woman with IUD, who entered to the hospital because of suprapubic abdominal pain, fever and foul-smelling vaginal discharge. RESULTS: We identified Neisseria gonorrhoeae and Actinomyces naeslundii and despite antibiotic treatment, ultrasound allowed objectify pelvic inflammatory disease and appendiceal involvement, which led to its surgical removal and bilateral salpingectomy. CONCLUSIONS: The surgical approach allowed to solve the box co.

Evolution of antibody profiles against SARS-CoV-2 in experienced and naïve vaccinated elderly people.

Introduction: The third dose of the COVID-19 vaccine is especially necessary in people over 65 years of age due to their lower immune response. Methods: We designed a multicentre, prospective observational study including 98 people ≤65 years old who lived in two nursing homes in Valladolid, Spain. One of the groups had previous experience with SARS-CoV-2 (n=68;69.4%) and the other was naïve (n=30;30.6%). We evaluated the response to the three doses of the Comirnaty vaccine and the dynamics of antibodies during 5 consecutive serum samplings: 2 after the first two doses of vaccination, one three months after the first dose, another at 6 months and the last one month after the third dose. IgG antibodies against SARS-CoV-2 S1, RBD and N antigens were analysed. Results: Both groups increased the level of Abs against S1 and RBD, but the experienced group showed a 130-fold higher humoral response due to hybrid immunisation (infection+vaccination). The response to vaccination with Comirnaty against COVID-19 was higher in those ≤65 years with previous experience than those who were naïve. However, the amount of antibodies against S1 and RBD equalised at 6 months. After the third dose, both groups raised the amount of antibodies to a similar level. The reinfections suggested by the analysis of antibodies against N were frequent in both groups. Discussion: The third dose showed a clear benefit for elderly people, with the reinforcement of the antibody levels after the decline suffered after six months of the first two doses.

Snijders Blok-Campeau Syndrome: Description of 20 Additional Individuals with Variants in CHD3 and Literature Review.

Snijders Blok-Campeau syndrome (SNIBCPS, OMIM# 618205) is an extremely infrequent disease with only approximately 60 cases reported so far. SNIBCPS belongs to the group of neurodevelopmental disorders (NDDs). Clinical features of patients with SNIBCPS include global developmental delay, intellectual disability, speech and language difficulties and behavioral disorders like autism spectrum disorder. In addition, patients with SNIBCPS exhibit typical dysmorphic features including macrocephaly, hypertelorism, sparse eyebrows, broad forehead, prominent nose and pointed chin. The severity of the neurological effects as well as the presence of other features is variable among subjects. SNIBCPS is caused likely by pathogenic and pathogenic variants in CHD3 (Chromodomain Helicase DNA Binding Protein 3), which seems to be involved in chromatin remodeling by deacetylating histones. Here, we report 20 additional patients with clinical features compatible with SNIBCPS from 17 unrelated families with confirmed likely pathogenic/pathogenic variants in CHD3. Patients were analyzed by whole exome sequencing and segregation studies were performed by Sanger sequencing. Patients in this study showed different pathogenic variants affecting several functional domains of the protein. Additionally, none of the variants described here were reported in control population databases, and most computational predictors suggest that they are deleterious. The most common clinical features of the whole cohort of patients are global developmental delay (98%) and speech disorder/delay (92%). Other frequent features (51-74%) include intellectual disability, hypotonia, hypertelorism, abnormality of vision, macrocephaly and prominent forehead, among others. This study expands the number of individuals with confirmed SNIBCPS due to pathogenic or likely pathogenic variants in CHD3. Furthermore, we add evidence of the importance of the application of massive parallel sequencing for NDD patients for whom the clinical diagnosis might be challenging and where deep phenotyping is extremely useful to accurately manage and follow up the patients.

Early efficacy evaluation of mesenchymal stromal cells (MSC) combined to biomaterials to treat long bone non-unions.

BACKGROUND AND STUDY AIM: Advanced therapy medicinal products (ATMP) frequently lack of clinical data on efficacy to substantiate a future clinical use. This study aims to evaluate the efficacy to heal long bone delayed unions and non-unions, as secondary objective of the EudraCT 2011-005441-13 clinical trial, through clinical and radiological bone consolidation at 3, 6 and 12 months of follow-up, with subgroup analysis of affected bone, gender, tobacco use, and time since the original fracture. PATIENTS AND METHODS: Twenty-eight patients were recruited and surgically treated with autologous bone marrow derived mesenchymal stromal cells expanded under Good Manufacturing Practices, combined to bioceramics in the surgical room before implantation. Mean age was 39 ± 13 years, 57% were males, and mean Body Mass Index 27 ± 7. Thirteen (46%) were active smokers. There were 11 femoral, 4 humeral, and 13 tibial non-unions. Initial fracture occurred at a mean ± SD of 27.9 ± 31.2 months before recruitment. Efficacy results were expressed by clinical consolidation (no or mild pain if values under 30 in VAS scale), and by radiological consolidation with a REBORNE score over 11/16 points (value of or above 0.6875). Means were statistically compared and mixed models for repeated measurements estimated the mean and confidence intervals (95%) of the REBORNE Bone Healing scale. Clinical and radiological consolidation were analyzed in the subgroups with Spearman correlation tests (adjusted by Bonferroni). RESULTS: Clinical consolidation was earlier confirmed, while radiological consolidation at 3 months was 25.0% (7/28 cases), at 6 months 67.8% (19/28 cases), and at 12 months, 92.8% (26/28 cases including the drop-out extrapolation of two failures). Bone biopsies confirmed bone formation surrounding the bioceramic granules. All locations showed similar consolidation, although this was delayed in tibial non-unions. No significant gender difference was found in 12-month consolidation (95% confidence). Higher consolidation scale values were seen in non-smoking patients at 6 (p = 0.012, t-test) and 12 months (p = 0.011, t-test). Longer time elapsed after the initial fracture did not preclude the occurrence of consolidation. CONCLUSION: Bone consolidation was efficaciously obtained with the studied expanded hBM-MSCs combined to biomaterials, by clinical and radiological evaluation, and confirmed by bone biopsies, with lower consolidation scores in smokers.

Implementation of a Tool for the Assessment of the Frail Elderly in a Robotic Agent.

The concern for aging, chronic illness, and dependence is relevant in today's society. The Nursing discipline is responsible for its approach to care. Furthermore, this profession must develop technologies to assist. The main objective is the development of a robotic system for assessment of fall risk and adherence to pharmacological treatment. The magnitude of this prototype design and its validation by experts warrant the attention to support care for the vulnerable and fragile with technology.

The influence of sex on right ventricular dysfunction in patients with severely depressed left ventricular ejection fraction.

AIM: To assess the influence of sex on right ventricular dysfunction (RVD) in patients with severe left ventricular systolic dysfunction. METHODS AND RESULTS: We studied 385 consecutive patients with left ventricular ejection fraction (LVEF) <0.35. All patients underwent invasive measurement of right ventricular and pulmonary artery pressures and evaluation of RVD by standard transthoracic echocardiography. Female patients (n=84, 21.8%) were significantly older than male patients (62.0+/-11.4 vs. 58.2+/-10.7 years), p=0.005. The prevalence of RVD was lower in women (26.5%) than in men (38.9%), p=0.03; both in patients with and without coronary artery disease (19.4% vs. 34.5% and 31.9% vs. 44.4%, respectively). Haemodynamic parameters and LVEF were similar in men and women. Low LVEF, pulmonary systolic pressure, degree of mitral regurgitation, male sex, and absence of significant coronary artery disease were independently correlated with RVD. CONCLUSION: Women with severe left ventricular systolic dysfunction have less RVD than men, despite similar haemodynamic parameters and LVEF.

Adipose tissue-derived stem cells: the friendly side of a classic cardiovascular foe.

Recently, the existence of a population of stem cells located in the adipose tissue has been observed. Adipose-derived stem cells are able to differentiate into multiple cell lineages including cardiac myocytes. Hence, adipose-derived cells are emerging as a new source of adult stem cells for cardiovascular repair. In this review, we discuss the basic principles of adipose-derived stem cells (types and characteristics, obtention processes, immunophenotypic characterization, and cell potency), the initial experimental studies, and the currently ongoing clinical trials.

Pronóstico de una población inicialmente candidata a trasplante cardíaco controlada con tratamiento médico / Prognosis of heart transplant candidates stabilized on medical therapy

Introducción y objetivos. Un porcentaje importante de los pacientes evaluados como posibles candidatos a trasplante cardíaco logra, con tratamiento médico, una estabilización que permite posponer indefinidamente su entrada en lista. El objetivo de este estudio es determinar el pronóstico de estos pacientes. Pacientes y método. Estudio retrospectivo de 118 pacientes con disfunción sistólica severa de ventrículo izquierdo (fracción de eyección ≤ 35%), consecutivamente enviados para valoración de trasplante cardíaco, no trasplantados por estabilización clínica con tratamiento médico. El seguimiento medio fue de 2,14 ± 2,19 años. Se elaboraron las curvas de supervivencia de Kaplan-Meier, se realizó un análisis univariable y se ajustó un modelo de riesgos proporcionales de Cox para analizar los factores predictivos de supervivencia. Resultados. Murieron 18 pacientes (15,2%), 12 (66,7%) por muerte súbita, 5 (27,8%) por insuficiencia cardíaca y 1 (5,5%) por causa no cardíaca. La probabilidad de supervivencia el primer año fue de 0,88, y la de los 2 siguientes de 0,82. En el análisis univariable, las variables asociadas con la mortalidad (p ≤ 0,05) fueron el valor de las presiones arterial pulmonar y capilar pulmonar, el tratamiento diurético y la ausencia de tratamiento con bloqueadores beta; esta última fue la única variable que mantuvo la significación en el análisis multivariable (p = 0,003; riesgo relativo, 0,13; intervalo de confianza del 95%, 0,03-0,50). Conclusiones. En una población de pacientes con disfunción sistólica severa del ventrículo izquierdo, candidatos a trasplante cardíaco pero estabilizados con tratamiento médico, la mortalidad el primer año de seguimiento fue del 12%. El tratamiento con bloqueadores beta fue la única variable asociada con una mayor supervivencia

Introduction and objectives. A significant percentage of patients selected as candidates for heart transplantation can be stabilized by medical treatment, thereby enabling indefinite postponement of inclusion on the operation list. The aim of this study was to investigate the prognosis of these patients. Patients and method. We studied retrospectively 118 patients with severe left ventricular systolic dysfunction (ejection fraction ≤35%) who were consecutively evaluated for cardiac transplantation but who did not undergo transplantation because they became clinically stable on medical treatment. The mean follow-up period was 2.14 (2.19) years. Kaplan-Meier survival analysis, and univariate and multivariate Cox proportional risk analyses of factors predicting survival were performed. Results. There were 18 deaths (15.2%): 12 were sudden (66.7%), 5 were due to heart failure (27.8%), and 1, to a non-cardiac cause (5.5%). The survival rate was 88% in the first year and 82% in the following 2 years. Univariate analysis showed that the parameters associated with mortality (P≤.05) were pulmonary artery and capillary wedge pressures, diuretic treatment, and the absence of beta-blocker therapy. In the multivariate analysis, only the absence of beta-blocker therapy remained statistically significant (P=.003; RR = 0.13; 95%CI, 0.03-0.50).Conclusions. In a population of patients with severe left ventricular systolic dysfunction who were candidates for heart transplantation but who were stabilized by medical therapy, mortality during the first year of follow-up was 12%. Beta-blocker therapy was the only variable associated with better survival

Carta ao mestre: vivência em psicologia médica / Letter to teacher: experience in medical psychology

Dando-se seqüência a trabalho anterior, apresenta-se experiência de ensino em Psicologia Médica, onde incentivou-se a vivência como instrumento de aprendizado. Os estudantes säo convidados a expressarem sentimentos, opiniöes e críticas em torno de temas sobre desenvolvimento da personalidade e relaçöes interpessoais. Os dados necessários foram obtidos de uma prova na qual os estudantes escreveram uma carta ao mestre. Os resultados mais uma vez mostraram que as relaçöes professor-aluno estäo em crise, com alto grau de insatisfaçäo dos estudantes. Considera-se que a ambivalência e as contradiçöes próprias do adolescente e do adulto jovem por si só näo explicam as expressöes abertas de ódio e as expectativas pueris de paternalismo. Por isso, levantam-se algumas hipóteses para posteriores investigaçöes