Influence of methylphenidate on brain development – an update of recent animal experiments

Methylphenidate (MPH) is the most commonly used drug to treat attention deficit/hyperactivity disorder (ADHD) in children effectively and safely. In spite of its widespread application throughout one of the most plastic and sensitive phases of brain development, very little is known to date about its long-term effects on brain structure and function. Hence, this short review updates the influence of MPH on brain development, since recent human and animal studies suggest that MPH alters the dopaminergic system with long-term effects beyond the termination of treatment.     

Abdominoperineal resection for adenocarcinoma of the low rectum

Current understanding of the routes of spread of rectal cancer along with technical innovations such as the circular stapler have allowed surgeons to treat most rectal cancers with an anterior resection and low anastomosis. Appropriate use of local therapy options has further decreased the need for abdominoperineal resection (APR). Nonetheless, APR remains the procedure of choice for many distal rectal adenocarcinomas. Numerous factors influence the decision to perform an APR and are discussed in detail. Although mortality for APR has been reduced significantly, morbidity remains high. Specific complications commonly seen after APR are discussed. Operative technique is outlined since much of the specific morbidity of APR can be reduced by attention to detail in the conduct of this complex procedure.

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Resumen El conocimiente actual de las rutas de extensión del cáncer rectal junto con innovaciones técnicas tales como el suturador circular han permitido a los cirujanos tratar la mayoría de los cánceres rectales mediante la resección anterior con anastomosis baja. El uso apropiado de opciones de tratamiento local ha disminuido aún más la necesidad de practicar la resección abdominoperineal (RAP). Sin embargo, la RAP sigue siendo el procedimiento de escogencia para muchos adenocarcinomas del recto distal. Son numerosos los factores que influyen sobre la decisión de realizar una RAP y éstos son motivo de discusión detallada en el presente artículo. Aunque la mortalidad asociada con la RAP se ha reducido significativamente, la morbilidad se mantiene elevada. Se revisan las complicaciones específicas más comunes después de la RAP. Se detalla la técnica quirúrgica, puesto que mucha de la morbilidad específica de la RAP puede ser disminuida si se presta especial atención al detalle en la ejecución de este complejo procedimiento.

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Résumé La connaissance récente des voies de dissémination lymphatique du cancer du rectum ainsi que les innovations techniques comme la machine à agraphage mécanique ont permis de traiter la plupart des tumeurs rectales par une résection antérieure et une anastomose basse. L'utilisation de la radiothérapie locale a diminué encore les indications d'amputations abdomino-périneales. Néanmoins, l'amputation reste l'indication de choix dans beaucoup de cancers rectaux distaux; les facteurs qui interviennent dans ce choix sont discutés. Bien que la mortalité des amputations abdomino-périneales ait beaucoup diminuée, la morbidité reste élevée. Les complications spécifiques de l'amputation sont exposées. La technique opératoire est exposée parce que la morbidité peut être souvent réduite lorsque le chirurgien fait attention à tous les détails au cours de cette intervention complexe.

     

Partial replication of a DRD4 association in ADHD individuals using a statistically derived quantitative trait for ADHD in a family-based association test.

BACKGROUND: Previous research found an association between single nucleotide polymorphisms (SNPs) in the promoter region of DRD4 and statistically derived phenotypes generated from attention-deficit/hyperactivity disorder (ADHD) symptoms. We sought to replicate this finding by using the same methodology in an independent sample of ADHD individuals. METHODS: Four SNPs were genotyped in and around DRD4 in 2631 individuals in 642 families. We developed a quantitative phenotype at each SNP by weighting nine inattentive and nine hyperactive-impulsive symptoms. The weights were selected to maximize the heritability at each SNP. Once a quantitative phenotype was generated at each SNP, the screening procedure implemented in PBAT was used to select and test the five SNPs/genetic model combinations with the greatest power to detect an association for DRD4. RESULTS: One of the four SNPs was associated with the quantitative phenotypes generated from the ADHD symptoms (corrected p-values = .02). A rank ordering of the correlation between each of the ADHD symptoms and the quantitative phenotype suggested that hyperactive-impulsive symptoms were more strongly correlated with the phenotype; however, including inattentive symptoms was necessary to achieve a significant result. CONCLUSIONS: This study partially replicated a previous finding by identifying an association between rs7124601 and a quantitative trait generated from ADHD symptoms. The rs7124601 is in linkage disequilibrium (LD) with the SNPs identified previously. In contrast to the previous study, this finding suggests that both hyperactive-impulsive and inattentive symptoms are important in the association.     

Puumala Virus Infection in Family,Switzerland

We report 3 cases of Puumala virus infection in a family in Switzerland in January 2019. Clinical manifestations of the infection ranged from mild influenza-like illness to fatal disease. This cluster illustrates the wide range of clinical manifestations of Old World hantavirus infections and the challenge of diagnosing travel-related hemorrhagic fevers.     

Impact of COVID‐19 on wound care in Germany

Recent studies showed that the COVID‐19 pandemic caused collateral damage in health care in terms of reduced hospital submissions or postponed treatment of other acute or chronic ill patients. An anonymous survey was sent out by mail to patients with chronic wounds in order to evaluate the impact of the pandemic on wound care. Sixty‐three patients returned the survey. In 14%, diagnostic workup or hospitalisation was cancelled or postponed. Thirty‐six percent could not seek consultation by their primary care physician as usual. The use of public transport or long travel time was not related to limited access to medical service (P = .583). In ambulatory care, there was neither a significant difference in the frequency of changing wound dressings (P = .67), nor in the person, who performed wound care (P = .39). There were no significant changes in wound‐specific quality of life (P = .505). No patient used telemedicine in order to avoid face‐to‐face contact or anticipate to pandemic‐related restrictions. The COVID‐19 pandemic impaired access to clinical management of chronic wounds in Germany. It had no significant impact on ambulatory care or wound‐related quality of life. Telemedicine still plays a negligible role in wound care.