RESUMEN
Attention deficit hyperactivity disorder (ADHD) is a common disorder, often associated with sleep disorders. Patients with primary sleep disorders often present hyperactivity and/or attention deficit symptoms. Indeed, obstructive sleep disorder breathing (snoring, hypoventilation disorder, and obstructive sleep apnea syndrome) with poor sleep quality can mimic ADHD in children. In this case, inattention and hyperactivity behavior are induced by sleep disorders but do not constitute a clinical diagnosis of ADHD. Therefore, it can sometimes be difficult for the clinician to distinguish between a diagnosis of ADHD with comorbid sleep disorder and a sleep disorder that mimics ADHD symptoms. The objective of this article is to review the relations between ADHD and obstructive sleep disorder breathing and propose a decision tree to help diagnosis.
Asunto(s)
Árboles de Decisión , Apnea Obstructiva del Sueño/diagnóstico , Ronquido/etiología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Niño , Diagnóstico Diferencial , HumanosRESUMEN
BACKGROUND AND PURPOSE: One of the main consequences of chronic pain syndrome is major impairment of the quality of sleep. Chronic pain and insomnia are independently linked to significant reductions in quality of life and psychiatric morbidity. Recent studies have suggested the efficacy of spinal cord stimulation (SCS) for the treatment of the back pain component in failed back surgery syndrome (FBSS) patients using a multicolumn lead. The main aim of this pilot study is to assess the influence and potential benefits of SCS on sleep quality in refractory FBSS patients implanted with multicolumn SCS and enrolled in the French multicentre ESTIMET study. METHODS: This is a single-centre, comparative, exploratory, pilot study. Sixteen FBSS patients enrolled in the ESTIMET study and implanted with multicolumn SCS will be monitored for 6months after implantation. Sleep parameters will be recorded by polysomnography, Psychomotor Vigilance Test and Osler tests, actigraphy, sleepiness scales, and sleep quality testing. Sleep will be evaluated before (at the inclusion visit) and after SCS implantation (at the 6-month visit). Secondary objectives will also assess the impact of SCS lead programming (mono vs. multicolumn SCS) and the influence of position-adaptive stimulation at night on sleep quality. TRIAL STATUS: The first patient of this ancillary study was enrolled on 21 May, 2012 and recruitment has now been achieved. Primary endpoint findings are expected to be available in 2015. CONCLUSION: By providing an analysis of the quality of sleep in chronic pain patients who are candidates for implanted neurostimulation, this new approach focuses on an important aspect of quality of life often overlooked in these poly-medication patients. It could show a real clinical benefit and underestimation of these analgesic innovative expensive techniques, where medico-economic analysis, would or would not promote access.
Asunto(s)
Síndrome de Fracaso de la Cirugía Espinal Lumbar/terapia , Sueño , Estimulación de la Médula Espinal/métodos , Adulto , Anciano , Nivel de Alerta , Electrodos Implantados , Determinación de Punto Final , Síndrome de Fracaso de la Cirugía Espinal Lumbar/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Polisomnografía , Estudios Prospectivos , Desempeño Psicomotor , Proyectos de Investigación , Adulto JovenRESUMEN
PURPOSE: The aim of this study was to characterize the population pharmacokinetics of peginterferon (PEG-IFN) alfa-2b in pediatric patients with chronic hepatitis C and to identify covariates influencing PEG-IFN alfa-2b disposition. METHODS: Pharmacokinetic data from a multicenter open-label study of subcutaneously administered peginterferon alfa-2b (60 µg/m(2)/wk) plus oral ribavirin (15 mg/kg/day) in patients with chronic hepatitis C aged 3-17 years old was used to develop a population pharmacokinetic nonlinear mixed-effects model. RESULTS: The final population pharmacokinetic analysis was conducted with the pooled data from 107 pediatric patients. A one-compartment model with first-order absorption, first-order elimination, exponential inter-individual variability on clearance, and a combination additive and proportional residual error model adequately described the PEG-IFN alfa-2b pharmacokinetic profile. Age (apparent clearance and apparent volume of distribution) and sex (apparent clearance) were significant covariates. The mean body surface area normalized apparent clearance of PEG-IFN alfa-2b was 0.56 L/h/m(2), and was similar when evaluated across the pediatric age groups. CONCLUSION: The final population model suggests age-dependent increases in clearance and volume of distribution of PEG-IFN alfa-2b in pediatric patients with chronic hepatitis C. The apparent clearance normalized to body surface area was similar across pediatric age groups, supporting the use of body size-adjusted dosing in pediatric subjects.
Asunto(s)
Antivirales/farmacocinética , Hepatitis C Crónica/metabolismo , Interferón-alfa/farmacocinética , Modelos Biológicos , Polietilenglicoles/farmacocinética , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Interferón alfa-2 , Masculino , Proteínas Recombinantes/farmacocinética , Reproducibilidad de los ResultadosRESUMEN
The major focus of intrahepatic arterial (IHA) administration of adenoviruses (Ad) has been on safety. Currently, there is little published data on the biological responses to Ad when administered via this route. As part of a Phase I study, we evaluated biological responses to a replication-defective adenovirus encoding the p53 transgene (SCH 58500) when administered by hepatic arterial infusion to patients with primarily colorectal cancer metastatic to the liver. In analyzing biological responses to the Ad vector, we found that both total and neutralizing Ad antibodies increased weeks after SCH 58500 infusion. The fold increase in antibody titers was not dependent on SCH 58500 dosage. The proinflammatory cytokine interleukin-6 (IL-6) transiently peaked within 6 h of dosing. The cytokine sTNF-R2 showed elevation by 24 h post-treatment, and fold increases were directly related to SCH 58500 doses. Cytokines TNF-alpha, IL-1beta, and sTNF-R1 showed no increased levels over 24 h. Predose antibody levels did not appear to predict transduction, nor did serum Ad neutralizing factor (SNF). Delivery of SCH 58500 to tumor tissue occurred, though we found distribution more predominantly in liver tissues, as opposed to tumors. RT-PCR showed significantly higher expression levels (P<0.0001, ANOVA) for adenovirus type 2 and 5 receptor (CAR) in liver tissues, suggesting a correlation with transduction. Evidence of tumor-specific apoptotic activity was provided by laser scanning cytometry, which determined a coincidence of elevated nuclear p53 protein expression with apoptosis in patient tissue. IHA administration of a replication defective adenovirus is a feasible mode of delivery, allowing for exogenous transfer of the p53 gene into target tissues, with evidence of functional p53. Limited and transient inflammatory responses to the drug occurred, but pre-existing immunity to Ad did not preclude SCH 58500 delivery.
Asunto(s)
Adenoviridae/genética , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Genes p53/genética , Terapia Genética/métodos , Vectores Genéticos/administración & dosificación , Neoplasias Hepáticas/secundario , Adulto , Anciano , Análisis de Varianza , Anticuerpos Antivirales/sangre , Apoptosis/efectos de los fármacos , Neoplasias Colorrectales/inmunología , Citocinas/sangre , Cartilla de ADN , Femenino , Arteria Hepática , Humanos , Infusiones Intraarteriales , Citometría de Barrido por Láser , Masculino , Persona de Mediana Edad , Receptores Virales/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
A highly sensitive immunoassay for the quantitative measurement of recombinant interferon alfa-2b (IFN alfa-2b) in serum was developed using the ORIGEN electrochemiluminescence (ECL) detection system. The ECL assay developed uses a ruthenylated mouse monoclonal anti-IFN-alfa antibody and a sheep polyclonal anti-IFN-alfa antibody that has been biotinylated. An immune complex, formed between the antibodies and the IFN in the serum, is captured by streptavidin coated paramagnetic beads. The assay is sensitive and can accurately measure 4 IU/ml in undiluted serum samples. In addition, this assay requires less labor than classical ELISAs and is not significantly affected by individual serum factors. The total assay variance for both intra- and inter-assay precision is < 10%. The assay is specific for the analyte. Mean percent recoveries in pooled and individual donor serum samples range from 84 to 114%. In addition, results of the ECL assay correlate well with a bioassay and were more accurate that an ELISA for the detection of interferon alfa-2b in individual human serum samples. The assay can be modified to measure other forms of the analyte and/or interferon in other matrices.