Identifying potentially marker symptoms of attention-deficit/hyperactivity disorder

Background. For the diagnosis of attention-deficit/hyperactivity disorder (ADHD), the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes that adherence to six symptoms in either group (inattention and hyperactivity/impulsivity) will lead to the diagnosis of one of three presentations of the disorder. Underlying this diagnostic algorithm is the assumption that the 18 symptoms have equal relevance for the diagnosis of ADHD, all are equally severe, and all have the same power to detect the presence of the disorder in all its degrees of severity, without considering the possibility of using marker symptoms. However, several studies have suggested that ADHD symptoms differ in both their power to discriminate the presence of the disorder and the degree of severity they represent. The aim of the present study was to replicate the results of previous research by evaluating the discriminative capacity and relative severity of ADHD symptoms, as well as to extend the investigation of this topic to Spanish-speaking Latin American samples. Methods. The properties of ADHD symptoms rated by the parents of 474 Chilean children were analyzed. Symptom parameters were estimated using the graded response model. Results. The results suggest that symptoms of ADHD differ substantially in both the accuracy with which they reflect the presence of the disorder, and their relative severity. Symptoms "easily distracted by extraneous stimuli'' and "have difficulty sustaining attention in tasks'' (inattention) and "is on the go, acting as if driven by motor'' (hyperactivity/impulsivity) were the most informative, and those with relatively lower severity thresholds. Discussion. The fact that symptoms differ substantially in the probability of being observed conditionally to the trait level suggests the need to refine the diagnostic process by weighting the severity of the symptom, and even to assess the possibility of defining ADHD marker symptoms, as has been done in other disorders.Support was provided by Fondo Nacional de Desarrollo Cientifico y Tecnologico (Fondecyt) de Iniciacion No. 11140524 (http://www.conicyt.cl/fondecyt/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

O poder da lei ou a lei do poder? Uma crítica à abordagem liberal do Mecanismo de Solução de Controvérsia

This article criticizes the approach liberal scholars in International Relations and Law have provided to the Dispute Settlement Understanding of the World Trade Organization. Liberal theorists erroneously believe the enhanced legalization of the system, as compared to dispute resolution under the GATT 1947, will reduce the bias towards powerful countries.Este artigo prove crítica da abordagem liberal em Relações Internacionais e Direito Internacional para o Entendimento para Solução de Controvérsias da Organização Mundial do Comércio. Os teóricos liberais erroneamente sustentam que a maior legalização do DSU, quando comparado ao GATT 1947, reduzirá a tendência de beneficiar países poderosos

Vinte Anos de Crise para a África? Poder, Assimetrias e a Abordagem Liberal da OMC

O objetivo deste artigo é investigar a Organização Mundial do Comércio com base no conceito de poder institucional. Em contraposição à visão liberal de soma positiva das instituições criada desde os anos 1980 em referência ao GATT 1947, desdobra-se o poder institucional nas dimensões da mudança de fórum, poder de mercado e rolo compressor para argumentar-se que a OMC traz perdas absolutas para a África. Os acadêmicos liberais deixam de analisar as assimetrias da OMC e afirmam erroneamente que a natureza mais juridicizada do mecanismo de solução de controvérsias reduz o viés em favor dos países poderosos. As estimativas apontam que os países africanos sofrem perdas associadas a royalties e monopolização advindos da proteção à propriedade intelectual, decréscimos em termos de PIB, exportações e medidas de bem-estar econômico, bem como vultosos custos de ajuste e implementação. Os Estados Unidos e as Comunidades Europeias valeram-se do seu poder de mercado para prover liberalização seletiva, mudar o fórum da propriedade intelectual e impor aos países africanos a escolha entre aderir ou arcar com custos proibitivos de exclusão da OMC, que mantém fechadas áreas de interesse dos países em desenvolvimento, como agricultura. O artigo parodia o título da conhecida obra de Edward Carr, que critica o tratamento liberal da Liga das Nações vinte anos após sua a criação, para desafiar a abordagem liberal da OMC duas décadas após o nascimento do atual regime de comércio

Effects of the structure of vegetation on macrofungi richness and distribution in Isla Palma, colombian pacific region

El objetivo de este trabajo fue estudiar la riqueza de hongos macromicetos y relacionar su variación con las variables ambientales y la estructura vegetal en Isla Palma, Pacífico colombiano. Para esto, se establecieron nueve parcelas fijas de 10x10 m, distribuidas en tres trayectos de 90 m de largo, perpendiculares a la costa oriental de la isla, con inicio a 20 m de la línea de marea, y separados entre sí por 60 m. Se colectaron los macrohongos en cada parcela en visitas mensuales durante seis meses. También se midieron parámetros de la vegetación y la intensidad de luz. Se encontraron 107 morfoespecies de macromicetos, siendo los géneros Marasmius y Mycena los dominantes. La riqueza de macromicetos no estuvo relacionada con los parámetros de vegetación ni con la intensidad de luz; sin embargo, estos parámetros sí estuvieron relacionados con la composición de macromicetos en el bosque.The aim of this work was to study the macrofungal richness and relate its variation with environmental variables and vegetation structure in Isla Palma, Colombian Pacific region. For this, nine fixed 10x10 m plots were established, distributed in three 90 m long paths, perpendicular to the Eastern coast of the island, starting 20 m away from the tide line, and separated 60 m from each other. Macrofungi were collected in each plot monthly for six months. Vegetation parameters and light intensity were also measured. One hundred-seven (107) macrofungal morphospecies were found, being Marasmius and Mycena the dominant genera. Macrofungi richness was not related to vegetation parameters or with the light intensity; however, these parameters were related to the composition of macrofungi in the forest

A Novel View on the Role of Intracellular Tails in Surface Delivery of the Potassium-Chloride Cotransporter KCC2

A plethora of neurological disorders are associated with alterations in the expression and localization of potassium-chloride cotransporter type 2 (KCC2), making KCC2 a critical player in neuronal function and an attractive target for therapeutic treatment. The activity of KCC2 is determined primarily by the rates of its surface insertion and internalization. Currently the domains of KCC2 dictating its trafficking and endocytosis are unknown. Here, using live-cell immunolabeling and biotinylation of KCC2 proteins expressed in murine neuroblastoma N2a cells, human embryonic kidney 293 cells, or primary cultures of rat hippocampal neurons, we identified a novel role for the intracellular N and C termini in differentially regulating KCC2 surface expression. We report that the N terminus is required for KCC2 insertion into the plasma membrane, whereas the C terminus is critical for the membrane stability of KCC2. Our results provide novel insights into the structure–function role of specific KCC2 domains and open perspectives in exploring structural organization of this protein.Peer reviewe

Olanzapine compared to quetiapine in adolescents with a first psychotic episode

Objective: To compare the efficacy, safety, and tolerability of olanzapine and quetiapine in adolescents with first episode psychosis. Method: Fifty adolescents (age 16 ± 1.25) with a first episode of psychosis were randomized to quetiapine or olanzapine in a 6-month open label study. Efficacy and side effect scales, as well as vital signs and laboratory data were recorded at baseline, 7, 15, 30, 90, and 180 days (end of study). Results: Out of the total sample included in the study, 32 patients completed the trial (quetiapine n = 16, olanzapine n = 16). Patients in both treatment groups had a significant reduction in all clinical scales with the exception of the negative scale of the Positive and Negative Symptom Scale (PANSS) for olanzapine and the general psychopathology scale of the PANSS for quetiapine. The only difference between treatment arms on the clinical scales was observed on the patients' strength and difficulties questionnaire (SDQ) scale, with greater improvement for olanzapine. Patients on olanzapine gained 15.5 kg and patients on quetiapine gained 5.5 kg. Conclusion: Olanzapine and quetiapine reduced psychotic symptoms in this adolescent sample. Patients on olanzapine gained significantly more weight. Side effects with both drugs seemed to be more prevalent than those reported in adult studies

Hospitalizations and deaths of children and adolescents with Severe Acute Respiratory Infection due to COVID-19 during the epidemiological year of 2020

This study aimed to analyze the profile of hospitalizations and factors associated with the deaths of children and adolescents with severe acute respiratory infection (SARI) caused by SARS-CoV-2 nationwide. The study comprised 6,843 children and adolescents hospitalized in 2020 who tested positive for COVID-19, based on data from the Influenza Epidemiological Surveillance Information System. Sociodemographic and clinical profiles, hospitalization frequency, lethality and recovery rates were analyzed. The outcome was recovery or death. The 6,843 children and adolescents comprised 1.9% of SARI hospitalized cases (n = 563,051). Of these, 57.7% developed critical SARI and 90% survived. Comorbidities were present in 40.8%, especially asthma, immunodepression, and neurological and cardiovascular diseases. The main symptoms were fever, cough, dyspnea, respiratory distress, and low oxygen saturation. Among those with critical SARI, 91.4% died. There was a higher frequency of children, especially those under five years of age and of mixed ethnicity. The highest hospitalization frequency occurred in the Southeastern and Northeastern regions, the highest recovery rates in the Southeastern and Southern regions, and the highest lethality rates in the Northern and Northeastern regions. Deaths were associated with ages ranging from 12 to 19 and being under one year of age, living in the Northern and Northeastern regions, progression to critical SARI, and having immunosuppression and cardiovascular disease. In contrast, asthma was associated with lower death rates. The frequency of complications and mortality rates caused by SARS-Cov-2 in the pediatric population are relevant, as well as the severity of the epidemic in the social inequality context and the health services’ frailty

Survival of patients with diabetes mellitus hospitalized for acute respiratory syndrome due to COVID-19

Given the magnitude of COVID-19 and the increase in hospitalization cases for severe acute respiratory syndrome (SARS), especially among patients with diabetes mellitus, it is essential to understand the epidemiological aspects inherent to the disease and the worsening of cases. Thus, this study aimed to analyze the survival of patients with diabetes mellitus hospitalized for SARS due to COVID-19 in different regions of Brazil. This is a longitudinal study, carried out based on data reported in the Influenza Epidemiological Surveillance Information System during the year 2020. The number of patients with diabetes mellitus among the hospitalized cases of SARS due to COVID-19 in the different regions of Brazil and the lethality rate among them were identified. A comparison of patient profiles of those who survived or did not survive and the Cox regression analysis were performed to evaluate the factors associated with shorter survival of patients. It was found that 51.4% of patients hospitalized with SARS due to COVID-19 had diabetes, and the case lethality rate among them was 45.0%. The Northeastern and Northern regions presented a higher proportion of patients with diabetes mellitus (56.5% and 54.3%, respectively) and a higher lethality rate (53.8% and 59.9%, respectively). The mean survival time of cases with diabetes mellitus hospitalized for SARS due to COVID-19 was estimated to be 35.7 days (0.5 days). A lower survival rate was observed among residents of the Northeastern and Northern regions with skin color reported as non-white, who required admission to Intensive Care Units and invasive mechanical ventilation, and presented respiratory symptoms such as dyspnea, respiratory distress and an oxygen saturation lower than 95%. It is concluded that diabetes mellitus was responsible for the high occurrence and lethality, mainly in the Northeastern and Northern regions, among non-white patients and those with greater clinical severity, which reinforces the importance of taking measures aimed at supporting this population