Is neurodevelopment impaired in Brazilian children with intestinal failure on prolonged parenteral nutrition? A single center study.

PURPOSE: To assess the neurodevelopment outcomes of children younger than 42 months of age with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by a Pediatric Multidisciplinary Intestinal Rehabilitation Program from a public tertiary hospital in Brazil. METHODS: Bayley III scale was administered in children aged 2 to 42 months with IF and receiving PN for more than 60 days. Composite scores in cognitive, motor, and language domains were analyzed. Developmental delay was defined as a performance 2 standard deviations (SD) below the average at the 3 domains. Association between Bayley III composite scores and clinical variables related to IF were tested. RESULTS: Twenty-four children with median (IQR) age of 17.5 months (9-28.5) were studied, 58.3% were male. Developmental delay was found in 34%, 33% and 27% of the patients in cognitive, motor, and language domains, respectively. There was no significant association between the Bayley-III composite scores and length of hospitalization, prematurity, and number of surgical procedures with anesthesia. CONCLUSION: The study demonstrated impairments in the cognitive, motor and language domains in approximately one-third of young patients with IF on prolonged PN.

Searching for the best approach to assess teachers' perception of inattention and hyperactivity problems at school.

Although major guidelines in the field and current diagnostic criteria clearly demand an assessment of children's attention deficit/hyperactivity disorder (ADHD) symptoms at school, few studies address the fundamental question of which is the best approach for clinicians to get this information from teachers. Three screening strategies for ADHD were applied to teachers of 247 third grade students. They were asked (1) an overt question about potential cases of ADHD in their classroom; (2) to complete a broad-band questionnaire assessing common child mental health problems; (3) to rate ADHD-specific symptoms in a narrow-band questionnaire. Based on the overt question, teachers identified one in five students (21.1 %) as having ADHD; 28 cases (11.3 %) were identified using standard cut-offs for the narrow-band, and 13 (5.3 %) using a standard threshold for the sub-scale of hyperactivity from the broad-band questionnaire. Agreement among strategies was low (k = 0.28). A subsample of students, clinically assessed to confirm screenings, showed modest agreement with final diagnosis. The narrow-band questionnaire had the best diagnostic performance. Multivariate analysis indicated that the presence of a comorbid externalizing disorder was the only variable associated with teachers' ascertainment of ADHD caseness or non-caseness. Choice of screening strategy significantly affects how teachers report on ADHD symptoms at school. The halo effect of externalizing behaviors impacts the correct identification of true cases of ADHD in the school setting. Clinicians can rely on narrow-band instruments like the SNAP-IV to get information on ADHD symptoms at school from teachers.

Bilateral perisylvian ulegyria: an under-recognized, surgically remediable epileptic syndrome.

PURPOSE: Interest in the association of epilepsy and pseudobulbar palsy was rekindled since the identification through magnetic resonance imaging (MRI) of bilateral perisylvian polymicrogyria (PMG). Seizures are often intractable, but resective epilepsy surgery has not been recommended. However, a similar clinical picture can be encountered in patients with bilateral perisylvian destructive lesions, which fit the description of ulegyria (ULG). We report a series of patients with epilepsy and pseudobulbar palsy due to bilateral perisylvian ULG (BP-ULG), show that hippocampal sclerosis (HS) is often associated and highlight the fact that in this entity, unlike in malformative bilateral perisylvian PMG, seizures may be surgically treated. METHODS: The motor, cognitive, epileptologic, and imaging features of 12 patients with perisylvian ULG followed at three institutions are described. For patients with refractory seizures, we detail extracranial and intracranial electrographic recordings, surgical strategies, histopathologic analyses of the resected tissue, and outcome of surgical treatment. Descriptive statistics were used for quantitative and categorical variables. Student's t-test was used to compare means, and a p < 0.05 was considered significant. KEY FINDINGS: Pseudobulbar palsy and mental retardation were present in all patients with symmetrical BP-ULG. Five had refractory seizures. There was no relationship between the severity of the pseudobulbar palsy or of the mental retardation and the degree of seizure control with medication. The five patients in whom seizures were refractory to medication had significantly earlier age of onset and longer duration of epilepsy (p < 0.05). Dual pathology with associated unilateral HS was present in four. One patient with dual pathology had a temporolimbic electroclinical picture and had an anterior temporal lobectomy (ATL) based upon noninvasive evaluation. The other four had ictal semiology suggesting involvement of both temporolimbic and perisylvian cortex. Intracranial electroencephalography (EEG) showed concomitant seizure onset in the anterior temporal region and in the ipsilateral ULG in three of the four with dual pathology and in the ulegyric cortex in the one without HS. Resection guided by a combination of semiology, MRI, and extra and intracranial EEG led to complete seizure control in two and almost complete seizure control (Engel class II) in two other patients. The only surgical failure was an isolated ATL in a patient with dual pathology, and concomitant seizure onset in both lesions according to semiology and intracranial EEG. SIGNIFICANCE: Our findings suggest that BP-ULG mimics the clinical features of bilateral perisylvian PMG. In patients with refractory seizures, recognition of this entity should lead to consideration of resective surgery despite the bilateral ULG.

Self-Reported Social Media Use by Adolescents in Brazil: A School-Based Survey.

INTRODUCTION: Although there is a general perception that adolescent social media use is a global phenomenon, there is a scarcity of data on patterns and preferences of social media use among youth in low- and middle-income countries. We here describe self-reported prevalences and perceived effects of social media use in a school-based sample of Brazilian adolescents. METHODS: We analyzed cross-sectional data on 7,113 adolescents aged 14 to 16 years-old enrolled in 101 public state schools between 2018 and 2019 in Porto Alegre, Brazil. RESULTS: Among the 7,113 with complete data for analyses, 54.9% were female, and 60.6% reported their skin color as white. At least one social media platform was used by 97.7% of adolescents everyday, and 64.7% reported being online "almost constantly". YouTube and WhatsApp were the most popular platforms. Most participants perceived the effect of social media use on their lives as neutral. DISCUSSION: The pattern of social media use by adolescents in Porto Alegre, Brazil, is similar to that reported for samples from high income countries. Also, we found that those who reported being constantly online were also more likely to report socializing with their friends offline.

Intrinsic Brain Connectivity Following Long-Term Treatment with Methylphenidate in Children with Attention-Deficit/Hyperactivity Disorder.

INTRODUCTION: Although widely used for the treatment of attention-deficit/hyperactivity disorder (ADHD) across the life span, the effects of methylphenidate (MPH) on the brain are not completely understood. Functional neuroimaging techniques may help increase knowledge about the mechanisms of MPH action. OBJECTIVE: To evaluate changes in functional connectivity patterns of the default mode network (DMN) in children with ADHD following long-term treatment with MPH. METHODS: Twenty-three right-handed treatment-naïve boys with ADHD underwent a protocol of intrinsic functional connectivity before and after 6 months of treatment with MPH. Functional connectivity was analyzed using a region of interest (ROI) approach and independent component analysis (ICA). RESULTS: ROI analyses showed no significant changes in connectivity between regions of the DMN following treatment, with a relatively small increase in the anterior-posterior connectivity of the network. ICA revealed a significant increase in connectivity between the left putamen and the DMN (p < 0.001, corrected). There was a correlation between the reduction of symptoms and the increased connectivity between the putamen and the DMN after treatment (rho = -0.65, p = 0.017). CONCLUSION: Dysfunctions in cortical-subcortical circuits have often been associated with the pathophysiology of ADHD. Our findings suggest that effective treatment with MPH in children with ADHD may affect brain functioning by increasing connectivity between the DMN and subcortical nuclei.

Increasing teachers' knowledge about ADHD and learning disorders: an investigation on the role of a psychoeducational intervention.

OBJECTIVE: To investigate elementary school teachers' baseline knowledge about ADHD and learning disorders (LD) and the impact of a strategy to increase awareness of these disorders. METHOD: A total of 37 teachers were selected from four elementary schools in the catchment area of the University Hospital, in Porto Alegre, Brazil. To evaluate teachers' knowledge, two self-report questionnaires about ADHD and LD were applied before and after an awareness program on these disorders. RESULTS: The intervention significantly increased teachers' knowledge of both disorders, even after adjustment for confounding factors (p < .001). In the repeated measures ANCOVA, only teachers' previous knowledge of ADHD/LD (p < .001) was significant in predicting score change in knowledge before and after the intervention. CONCLUSION: Results suggest the efficacy of a brief psychoeducational intervention program for increasing teacher awareness and knowledge about ADHD and LD. Future studies are warranted to confirm the efficacy and evaluate the long-term impact of this intervention.