RESUMO
Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults.
Assuntos
Dor Abdominal/epidemiologia , Gastroenteropatias/epidemiologia , Adolescente , Doença Celíaca/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Doenças Inflamatórias Intestinais/epidemiologia , Síndrome do Intestino Irritável/complicações , PrevalênciaRESUMO
AIMS: The objective was to assess the consistency of effect of switching to ezetimibe/simvastatin 10/20 mg versus doubling the baseline statin dose (to simvastatin 40 mg or atorvastatin 20 mg) or switching to rosuvastatin 10 mg across subgroups of subjects with (n = 617) and without (n = 191) metabolic syndrome (MetS). METHODS: This was a post hoc analysis of a randomized, double-blind, 6-week study of adults 18-79 years with cardiovascular disease and diabetes mellitus with low-density lipoprotein cholesterol (LDL-C) ≥70 and ≤160 mg/dl. The percent change in LDL-C and other lipids was estimated within each subgroup separately. Safety and tolerability were assessed. RESULTS: In subjects with MetS, percent changes in LDL-C and other lipids were greater with ezetimibe/simvastatin versus doubling baseline statin or numerically greater versus switching to rosuvastatin, except high-density lipoprotein cholesterol and apolipoprotein (Apo) AI (mean percent changes in LDL-C were: -22.49% ezetimibe/simvastatin, -9.64% doubled baseline statin and -19.20% rosuvastatin). In subjects without MetS, percent changes in LDL-C, total cholesterol and Apo B were greater with ezetimibe/simvastatin versus doubling baseline statin or numerically greater versus switching to rosuvastatin (mean percent changes in LDL-C were: -25.14% ezetimibe/simvastatin, -4.75% doubled baseline statin and -19.75% rosuvastatin). Safety profiles were generally similar. CONCLUSION: These results showed that switching to ezetimibe/simvastatin 10/20 mg was more effective at reducing LDL-C, total cholesterol and Apo B versus doubling the baseline statin dose to simvastatin 40 mg or atorvastatin 20 mg or switching to rosuvastatin 10 mg regardless of MetS status. These results were generally similar to those of the full cohort.
Assuntos
Azetidinas/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , LDL-Colesterol/efeitos dos fármacos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Síndrome Metabólica/tratamento farmacológico , Sinvastatina/uso terapêutico , Adolescente , Adulto , Idoso , Anticolesterolemiantes/uso terapêutico , Apolipoproteínas B/sangue , Apolipoproteínas B/efeitos dos fármacos , Atorvastatina , Glicemia/efeitos dos fármacos , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/prevenção & controle , Método Duplo-Cego , Esquema de Medicação , Combinação de Medicamentos , Quimioterapia Combinada , Combinação Ezetimiba e Simvastatina , Jejum , Feminino , Fluorbenzenos/uso terapêutico , Ácidos Heptanoicos/uso terapêutico , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Pirimidinas/uso terapêutico , Pirróis/uso terapêutico , Rosuvastatina Cálcica , Sulfonamidas/uso terapêutico , Resultado do TratamentoRESUMO
This article is a transcription of an electronic symposium in which active researchers were invited by the Brazilian Society of Neuroscience and Behavior (SBNeC) to discuss the advances of the last decade in the neurobiology of emotion. Four basic questions were debated: 1) What are the most critical issues/questions in the neurobiology of emotion? 2) What do we know for certain about brain processes involved in emotion and what is controversial? 3) What kinds of research are needed to resolve these controversial issues? 4) What is the relationship between learning, memory and emotion? The focus was on the existence of different neural systems for different emotions and the nature of the neural coding for the emotional states. Is emotion the result of the interaction of different brain regions such as the amygdala, the nucleus accumbens, or the periaqueductal gray matter or is it an emergent property of the whole brain neural network? The relationship between unlearned and learned emotions was also discussed. Are the circuits of the former the underpinnings of the latter? It was pointed out that much of what we know about emotions refers to aversively motivated behaviors, like fear and anxiety. Appetitive emotions should attract much interest in the future. The learning and memory relationship with emotions was also discussed in terms of conditioned and unconditioned stimuli, innate and learned fear, contextual cues inducing emotional states, implicit memory and the property of using this term for animal memories. In a general way it could be said that learning modifies the neural circuits through which emotional responses are expressed.
Assuntos
Encéfalo/fisiologia , Emoções/fisiologia , Aprendizagem/fisiologia , Neurobiologia , Tonsila do Cerebelo/fisiologia , Animais , Ansiedade , Medo/fisiologia , Humanos , Memória/fisiologia , Substância Cinzenta Periaquedutal/fisiologiaRESUMO
This article is a transcription of an electronic symposium in which active researchers were invited by the Brazilian Society of Neuroscience and Behavior (SBNeC) to discuss the advances of the last decade in the neurobiology of emotion. Four basic questions were debated: 1) What are the most critical issues/questions in the neurobiology of emotion? 2) What do we know for certain about brain processes involved in emotion and what is controversial? 3) What kinds of research are needed to resolve these controversial issues? 4) What is the relationship between learning, memory and emotion? The focus was on the existence of different neural systems for different emotions and the nature of the neural coding for the emotional states. Is emotion the result of the interaction of different brain regions such as the amygdala, the nucleus accumbens, or the periaqueductal gray matter or is it an emergent property of the whole brain neural network? The relationship between unlearned and learned emotions was also discussed. Are the circuits of the former the underpinnings of the latter? It was pointed out that much of what we know about emotions refers to aversively motivated behaviors, like fear and anxiety. Appetitive emotions should attract much interest in the future. The learning and memory relationship with emotions was also discussed in terms of conditioned and unconditioned stimuli, innate and learned fear, contextual cues inducing emotional states, implicit memory and the property of using this term for animal memories. In a general way it could be said that learning modifies the neural circuits through which emotional responses are expressed
Assuntos
Humanos , História do Século XX , Animais , Encéfalo/fisiologia , Emoções/fisiologia , Aprendizagem/fisiologia , Neurobiologia , Tonsila do Cerebelo/fisiologia , Ansiedade , Medo/fisiologia , Memória/fisiologia , Neurobiologia/história , Substância Cinzenta Periaquedutal/fisiologiaRESUMO
We evaluated the reliability of clinical diagnoses using the recently standardized criteria for the diagnosis of vascular dementia (VaD) developed by the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN). Two neurologists and two psychiatrists independently reviewed clinical data abstracted from those of 42 demented subjects participating in a longitudinal study of dementia at the University of Pittsburgh. For each patient we abstracted the clinical data on a standardized form. Each physician diagnosed each case according to the NINDS-AIREN criteria, using both clinical information and MRIs. We calculated the interrater agreement for all two-way combinations of clinicians with kappa statistics, which ranged from 0.46 (moderate agreement) to 0.72 (substantial agreement). The moderate reliability observed in this study may be attributable to patient-, clinician-, or criteria-centered sources of variance.
Assuntos
Demência Vascular/diagnóstico , National Institutes of Health (U.S.) , Idoso , Associação , Demência Vascular/epidemiologia , Feminino , Humanos , Cooperação Internacional , Masculino , Neurociências , Variações Dependentes do Observador , Estados UnidosRESUMO
Neuropsychological and psychiatric evaluations were made of 39 subjects with possible Alzheimer's disease and a history of excessive alcohol consumption (AD + ETOH), who had been abstinent or had drunk minimally for at least three months before evaluation, and 225 patients with probable Alzheimer's disease (PAD) of comparable age, years of education, and baseline global impairment. At baseline, there were no significant differences between the groups in terms of age of onset of dementia, neuropsychological test scores, or current behavioural or psychiatric symptoms. One year later, no differences in rates of decline between 20 abstinent AD + ETOH patients and 88 PAD subjects could be shown. Thus, past heavy alcohol consumption does not appear to modify the presentation of dementia of the Alzheimer's type, nor does it modify progression over a one-year interval.
Assuntos
Alcoolismo/complicações , Doença de Alzheimer/diagnóstico , Testes Neuropsicológicos , Idoso , Alcoolismo/psicologia , Alcoolismo/reabilitação , Doença de Alzheimer/psicologia , Etanol/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/psicologiaRESUMO
OBJECTIVE: The authors conducted a prospective study of the clinical utility of the four DSM-III-R subtypes of primary degenerative dementia of the Alzheimer type (with delirium, with delusions, with depression, or uncomplicated) and acute psychiatric hospitalization for treatment of these subtypes. METHOD: The subjects were 120 consecutive inpatients with Alzheimer's disease, most of whom had behavioral abnormalities. Each subject received detailed physical, neurological, psychiatric, and mental status examinations. The presence or absence of specific behavioral problems was also documented. Patients were treated with medication, psychotherapy, and behavioral techniques. RESULTS: While all patients could be assigned to one of the four DSM-III-R behavioral subtypes, the uncomplicated subtype did not accurately reflect the burden of behavioral symptoms in the patients who did not have delirium, delusions, or depression. Each behavioral subtype responded in a characteristic way to inpatient treatment, as reflected by changes in scores on four psychometric scales used to assess cognitive impairment, psychiatric symptoms severity, and level of functioning at admission and at discharge, as well as by changes in residential setting following hospitalization. Half of all patients admitted from their homes and two-thirds of those with depression were able to go home following discharge. CONCLUSIONS: Behavioral syndromes in Alzheimer's disease should not be overlooked, because they have both clinical and prognostic significance. Short-term psychiatric hospitalization is effective and efficient for achieving the goal of returning patients to their homes and for safely implementing specific treatments in this frail population, and it may reduce the need for institutionalization.
Assuntos
Doença de Alzheimer/diagnóstico , Hospitalização , Transtornos Mentais/diagnóstico , Idoso , Doença de Alzheimer/classificação , Doença de Alzheimer/terapia , Antipsicóticos/uso terapêutico , Terapia Comportamental , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/terapia , Delírio/diagnóstico , Delírio/terapia , Delusões/diagnóstico , Delusões/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Feminino , Idoso Fragilizado/psicologia , Humanos , Institucionalização , Masculino , Transtornos Mentais/terapia , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicoterapia , Índice de Gravidade de DoençaRESUMO
Lithium-induced delirium occurring in geriatric patients with serum lithium levels that are within the "therapeutic" range (less than 1.5 mEq/L) has been described in the literature. We present a case that illustrates three major issues regarding this syndrome: (1) differentiating lithium-induced delirium from a recurrence of a chronic psychiatric disorder; (2) the use of the electroencephalogram in supporting this diagnosis; and (3) factors that may increase a patient's vulnerability to delirium while on lithium. A brief review of the most relevant literature is then presented. We conclude that lithium-induced neurotoxicity should be suspected in any patient receiving lithium who develops delirium, regardless of the serum level, and that immediate discontinuation of the medication be considered.
Assuntos
Delírio/induzido quimicamente , Carbonato de Lítio/efeitos adversos , Transtornos Psicóticos/tratamento farmacológico , Delírio/sangue , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Carbonato de Lítio/farmacocinética , Carbonato de Lítio/uso terapêutico , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtornos Psicóticos/sangue , Transtornos Psicóticos/psicologiaRESUMO
We evaluated the recommendation of the Centers for Disease Control, that children with moderate lead poisoning undergo the lead mobilization test (LMT) to determine the need for a full course of chelation treatment. Current criteria for selection for this test include a blood Pb concentration (bPb) between 25 and 55 micrograms/dl and an erythrocyte protoporphyrin level greater than 35 micrograms/dl. To determine whether the eligibility criteria could be refined to a smaller group of patients, we compared bPb determinations obtained on the day of the LMT in 198 children with moderate Pb poisoning to the results of the LMT. We found that children with bPb less than 25 micrograms/dl were unlikely to respond to the test dose of calcium disodium ethylenediamine tetraacetate with a Pb diuresis (24/25 patients had low urinary Pb excretion on the LMT). In contrast, 88% of children with bPb greater than or equal to 40 micrograms/dl were likely to excrete sufficient Pb to indicate the need for a full course of chelation. We conclude that the LMT is indicated for children with bPbs between 25 and 40 micrograms/dl. Children with bPb between 40 and 55 micrograms/dl may receive chelation therapy without having an LMT, if the performance of the LMT is not practical. Patients with levels less than 25 micrograms/dl should be followed clinically and removed from further Pb exposure.
Assuntos
Intoxicação por Chumbo/diagnóstico , Chumbo/urina , Quelantes/uso terapêutico , Criança , Pré-Escolar , Ácido Edético , Eritrócitos/química , Estudos de Avaliação como Assunto , Humanos , Lactente , Chumbo/sangue , Intoxicação por Chumbo/tratamento farmacológico , Intoxicação por Chumbo/metabolismo , Protoporfirinas/sangueRESUMO
Neuropathologic and neurochemical correlates of psychosis were determined using brain tissue from 27 autopsy-confirmed cases of Alzheimer's disease. The densities of senile plaques and neurofibrillary tangles were determined in the middle frontal and superior temporal cortex, the prosubiculum, and the entorhinal cortex of the hippocampus. The concentrations of norepinephrine, dopamine, and serotonin, the metabolites of these biogenic amines, and the specific activity of choline acetyltransferase were also determined in these four cortical regions as well as in the substantia nigra, thalamus, amygdala, and caudate nucleus. Psychosis was associated with significantly increased densities of senile plaques and neurofibrillary tangles in the prosubiculum and middle frontal cortex, respectively, with trends toward increased densities of these lesions in the other areas examined. This finding is consistent with the increased rate of cognitive decline that accompanies this behavioral disorder. Psychosis was also associated with the relative preservation of norepinephrine in the substantia nigra, with trends in this direction for five of the remaining seven brain regions examined, and a significant reduction of serotonin in the prosubiculum that was accompanied by trends toward reduced levels of serotonin and 5 hydroxyindoleacetic acid in the remaining regions. The profile of neuropathologic and neurochemical changes associated with psychosis is distinct from that previously reported for major depression in the context of primary dementia.