Hyperactive Type Research Articles

Szisztematikus szakirodalmi áttekintés a figyelemhiányos/hiperaktivitás-zavarral élő gyermekek bántalmazása hátterében álló egyéni és interperszonális rizikófaktorokról

Objective: To provide comprehensive knowledge of the factors behind abuse by parents of children with attention-deficit/hyperactivity disorder (ADHD). Are children with ADHD are really at increased risk of child abuse? Is there a relationship between the onset of ADHD (hyperactive/impulsive-, attention deficit, combined) and the type of abuse? Does parental ADHD predispose to abuse? Finally, what are the long-term effects on a child with ADHD? Method: The study is following the PRISMA guidelines, 32 out of 683 studies were selected in the study sample. Result: The group of children with ADHD can indeed be identified as a risk group. The hyperactive type was associated with physical and emotional abuse and neglect of parental authority, attention deficit was associated with physical and sexual abuse, and custody and physical neglect. Parental ADHD has been identified as a risk factor, too. The long-term consequences were drug-use, in addition to the intensification of ADHD symptoms. Conclusion: We argue for the risk factor-reducing importance of parental education and psychological therapy.

Examine the Effects of Atomoxtine Alone Versus Atomoxtine Combined with Risperidone at Sample of Egyptian Children Suffering from ADHD.

Background: An estimated 7% of elementary school children suffer from Attention Deficit Hyperactivity Disorder (ADHD), a mental neuro-developmental condition marked by impulsivity, hyperactivity, and lack of attention. Atomoxetine is one of the most important medications for ADHD however Risperidone has been used as a label for the treatment of ADHD. Aim: To study the Efficacy of Atomoxetine alone vs. Atomoxtine with Antipsychotic (Risperidone) in ADHD children. Subjects and Methods: 54 Egyptian children with ADHD, ranging in age from 6 to 18. They meet the DSM-IV criteria for ADHD and have been receiving therapy at Al Hussian Hospital's psychiatry clinic. Conner's 2 scale was used to evaluate each patient for ADHD. Between January and June of 2024, a study was carried out on all children receiving therapy for all forms of ADHD using either Atomoxetine alone or in combination with an antipsychotic (Risperidone). Results: When Atomoxetine was administered to 27 children, it demonstrated a moderate level of efficacy in 12 of 27 patients (44.4%) for all children with ADHD, regardless of type, but it significantly improved the inattention type of ADHD in 4 from 4 patients (100%). Given to 27 children, the combination of Atomoxetine and Risperidone demonstrated a greater effect on 24 of 27 patients with (88.9%) for all ADHD children, and it showed a discernible improvement on 9 out of 9 with (100%) for ADHD hyperactivity type. Conclusion: Patients with Attention deficit variant responded well to Atomoxetine., Patients with attentiondeficit/hyperactivity variant responded well to Atomoxetine/Antipsychotic (Risperidone) combination., Patients with Hyperactivity variants show good responses to Antipsychotics (Risperidone)., All types of ADHD are responsive to Atomoxetine or Atomoxetine / Antipsychotic (Risperidone) combination, But the Atomoxetine effect is more on the Attention deficit variant than other variants, while Antipsychotic (Risperidone) is more effective on hyperactivity and aggression.

Influence of maternal attention-deficit hyperactive disorder on child dental neglect - An analytical cross-sectional study.

Attention-deficit hyperactivity disorder (ADHD) is a condition that is characterized by symptoms such as inattentiveness, hyperactivity, and impulsivity. The influence of mothers with ADHD and their attitude towards their wards' oral health has not been explored in the Indian scenario. The aim of this study was to assess the prevalence of ADHD in mother-child dyads in western Tamil Nadu and the mothers' dental neglect toward their children. The prevalence of ADHD in mothers and children was assessed using the Adult ADHD Self-report Scale screener and ADHD Rating Scale, respectively. The Child Dental Neglect Scale (CDNS) was used to assess dental neglect in children. The responses were recorded on a Likert scale and statistical analyses were done. The prevalence of ADHD in mothers and children was 10.65% and 10.57%, respectively. The impulsivity and hyperactivity type of ADHD was commonly seen in both the mothers and their children. Mothers without ADHD felt that their children maintained their oral health well. Mothers with ADHD deferred the needed dental treatment for their children. Mothers with ADHD have four times more risk of having children with ADHD. Maternal ADHD influences their child's oral health. Child dental neglect was more prevalent among mothers with ADHD.

Emerging role of immunogenic cell death in cancer immunotherapy.

Cancer immunotherapy, such as immune checkpoint blockade (ICB), has emerged as a groundbreaking approach for effective cancer treatment. Despite its considerable potential, clinical studies have indicated that the current response rate to cancer immunotherapy is suboptimal, primarily attributed to low immunogenicity in certain types of malignant tumors. Immunogenic cell death (ICD) represents a form of regulated cell death (RCD) capable of enhancing tumor immunogenicity and activating tumor-specific innate and adaptive immune responses in immunocompetent hosts. Therefore, gaining a deeper understanding of ICD and its evolution is crucial for developing more effective cancer therapeutic strategies. This review focuses exclusively on both historical and recent discoveries related to ICD modes and their mechanistic insights, particularly within the context of cancer immunotherapy. Our recent findings are also highlighted, revealing a mode of ICD induction facilitated by atypical interferon (IFN)-stimulated genes (ISGs), including polo-like kinase 2 (PLK2), during hyperactive type I IFN signaling. The review concludes by discussing the therapeutic potential of ICD, with special attention to its relevance in both preclinical and clinical settings within the field of cancer immunotherapy.

The Prevalence of Attention Deficit Hyperactivity Disorder in Children and Adolescents: An Umbrella Review of Global Evidence

IntroductionFrom recent epidemiological studies to emerging epidemiological evidence, it becomes evident that numerous primary studies have investigated the prevalence of ADHD in children and adolescents. Additionally, several systematic reviews and meta-analyses have explored this subject. The objective of this umbrella review is to offer a robust synthesis of evidence derived from these systematic reviews and meta-analysesObjectivesTo conduct a comprehensive umbrella review that synthesizes emerging epidemiological evidence regarding the prevalence of ADHD in children and adolescents, drawing insights from numerous primary studies as well as systematic reviews and meta-analyses.MethodsWe conducted a systematic search across multiple databases, including PubMed, Web of Science, PsychINFO, and Scopus, to identify relevant studies. The study was preregistered with PROSPERO (registration number: CRD42023389704). To assess the quality of these studies, we utilized the Measurement Tool to Assess Systematic Reviews (AMSTAR). We employed an inverse variance-weighted random-effects meta-analysis to combine prevalence estimates from the included studies.ResultsThe final analysis incorporated thirteen meta-analytic systematic reviews, encompassing 588 primary studies and a total of 3,277,590 participants. A random-effects meta-analysis of these studies revealed that the global prevalence of ADHD in children and adolescents stood at 8.0% (95% CI: 6.0%–10%). Notably, the prevalence estimate was twice as high in boys (10%) compared to girls (5%). Among the three subtypes of ADHD, the inattentive type (ADHD-I) emerged as the most prevalent, followed by the hyperactive type (ADHD-HI) and the combined type (ADHD-C).ConclusionsThe comprehensive umbrella review findings emphasize the high prevalence of ADHD in children and adolescents, with a notable gender disparity, wherein boys are twice as likely to be affected compared to girls. These results underscore the urgency of prioritizing prevention, early identification, and treatment strategies for ADHD in children and adolescents.Disclosure of InterestNone Declared

Prevalence of ADHD in Adults: An Umbrella Review of International Studies

IntroductionAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly diagnosed in school-age children. However, it can affect individuals of all age groups. This study aimed to provide a comprehensive analysis of the prevalence of ADHD in adults by conducting an umbrella review of systematic reviews and meta-analyses.Objectives To provide a comprehensive synthesis of published evidence on the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adults through an umbrella review of systematic reviews and meta-analyses, with the aim of highlighting the significance of addressing and managing ADHD in the adult population.Methods To conduct this study, we adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). We systematically searched databases such as PsychINFO, Web of Science, PubMed, and Scopus to identify relevant studies. Our review protocol was registered with PROSPERO (registration number: CRD42023389704). The quality of the studies included in our analysis was assessed using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). For the purpose of conducting a meta-analysis, we employed a random-effects model.ResultsOur umbrella review examined findings from five systematic reviews that encompassed data from 57 unique international primary studies undertaken between 2009 and 2021. These studies involved a total of 21,142,129 adult participants. The meta-analysis, employing an inverse variance-weighted random effect model, yielded a pooled prevalence estimate for ADHD in adults of 3.10% (95% confidence interval: 2.60%–3.60%). Regarding ADHD subtypes, our analysis revealed that ADHD-I (inattentive type) remained the most prevalent among adults, followed by ADHD-HI (hyperactive type) and ADHD-C (combined type).ConclusionsOur results underscore the relatively high prevalence of ADHD among adults, with ADHD-I emerging as the most common subtype. These findings emphasize the need for proactive measures to prevent, mitigate, identify, and effectively manage ADHD in the adult population.Disclosure of InterestNone Declared

Conduct problems, hyperactivity, and screen time among community youth: Can mindfulness help?

IntroductionWhile technology continues to evolve and the prevalence of screen-based activities is rising, limited studies have investigated the effect of various types of screen time on youth behavioural problems. Further, the influence of mindfulness intervention programs on behavioural problems beyond hyperactivity is largely understudied.ObjectivesThis study aims to address a research gap by examining the associations between four types of screen time and hyperactivity and conduct problems among community youth during the pandemic. The current study also aimed to investigate the efficacy of a mindfulness-based intervention in reducing hyperactivity and conduct problems.MethodsCommunity youth aged 12-25 from Ontario, Canada, were recruited between April 2021 and April 2022 (n=117, mean age=16.82, male=22%, non-White=21%). The Mindfulness Ambassador Program, a structured, 12-week, evidence-based intervention program, was offered live, online and led by two MAP-certified facilitators. We conducted linear regression analyses using pre-intervention data to examine the unique association between the four types of screen time and behavioural problems (hyperactivity and conduct problems). The efficacy of the MAP on adolescent hyperactivity and conduct problems was examined considering the three survey time points (pre-, post-, and follow-up) using a series of linear regression models utilizing the Generalized Least Squares (GLS) Maximum Likelihood (ML), unstructured model.ResultsThe average score for conduct problems was classified within the normal range, while the average score for hyperactivity was considered borderline at baseline. More than 5 hours of playing video games were significantly associated with increased conduct problems [β= -1.75, 95% CI=-0.20 – 3.30, p=0.03]. Accounting for age, sex, baseline mental health status, and screen time, the mindfulness intervention program significantly contributed to decreased hyperactivity at post-intervention compared to the baseline [β=-0.49, 95% CI=-0.91 to -0.08, p=0.02]. It was maintained at follow-up [β=-0.64, 95% CI=-1.26 to -0.03, p=0.04].Conclusions Our findings suggest an adverse impact of excessive video gaming on behavioural problems among community youth and confirm that the trend remains the same. Considering the simplicity, brevity, non-invasive nature and other mental health benefits of the mindfulness intervention, we argue that the results are promising and worthy of further study and larger-scale implementation. Clinicians, parents, and educators should work collaboratively to provide developmentally appropriate strategies to moderate screen time spent on video games among youth.Disclosure of InterestNone Declared

The Prevalence of Risk Factors Among Children Diagnosed With Attention-Deficit/Hyperactivity Disorder, Aged 4-17 Years: A Cross-Sectional Study.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly observed in children. Although the etiology of ADHD is still unclear, many risk factors have been shown to increase the prevalence of ADHD, such as genetics, environmental factors, socioeconomic status, maternal smoking, and low birth weight. The current cross-sectionalstudy aimed to assess the prevalence of several risk factors associated with ADHD-diagnosed children aged 4-17 years using parent-reported data. An observational cross-section study was conducted between December 2022 and February 2023 using a self-constructed questionnaire that we sent to parents whose children were diagnosed with ADHD. The questionnaire included socioeconomic information (income, gender, parent education, number of children), child information (age, ADHD type, academic achievement), pregnancy and neonatal period (smoking status, gestation age, mode of delivery, child weight), and if there is a history of ADHD in the family. A total of 306 parents responded to the questionnaire. The majority of our study population was males (77.8%). The combined type, which includes symptoms of both hyperactivity and inattention, represented 70% of the population in our study, which is higher than the inattention type (23%) and the hyperactivity type (6%). The prevalence of several risk factors known to be associated with ADHD, such as family income, parental education, complications during pregnancy, and the low birth weight of the child, were also reported. To the best of our knowledge, this is the first study that examines the frequency of risk factors among children diagnosed with ADHD in Saudi Arabia. The study revealed that males are more likely to be diagnosed with ADHD than females. We also found that the combined type is the most diagnosed ADHD among children. Furthermore, there are no significant differences in the prevalence of the risk factors during the gestational or neonatal period among ADHD-diagnosed children. Therefore, a large-scale prospective study is needed to aid in evaluating the frequency and significance of various risk factors among diagnosed children.

Correlation between burst suppression and postoperative delirium in elderly patients: a prospective study.

To explore the correlation between intraoperative burst suppression (BS) and postoperative delirium (POD) in elderly patients, and provide more ideas for reducing POD in clinical. Ninety patients, aged over 60years, who underwent lumbar internal fixation surgery in our hospital were selected. General information of patients was obtained and informed consent was signed during preoperative visits. Patients were divided into burst suppression (BS) group and non-burst suppression (NBS) group by intraoperative electroencephalogram monitoring. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded, and the variation and minimum value were obtained by calculating. Hemoglobin (HGB), C-reactive protein (CRP), system immune inflammatory index (SII) at 24 and 72h after surgery, the incidence of postoperative adverse reactions, postoperative hospital stay, and total cost were recorded after operation. POD assessment was performed using CAM within 7days after surgery or until discharge. SPSS25.0 was used for statistical analysis. Compared with the NBS group, the number of elderly patients with high frailty level in BS group was more (P = 0.048). There is correlation between BS and POD (OR: 4.954, 95%CI 1.034-23.736, P = 0.045), and most of the POD patients in BS group behave as hyperactive type. The occurrence of intraoperative BS is associated with POD, and elderly patients with frailty are more likely to have intraoperative BS. BS can be used as a predictor of POD.

Functional Brain Network Connectivity Changes in Children and Adolescents with Attention- Deficit Hyperactivity Disorder: A Resting-State Brain Functional Magnetic Resonance Imaging Study

Background: ADHD is one of the most common psychiatric disorders in children and adolescents. Altered functional connectivity has been associated with ADHD symptoms. This study aimed to investigate abnormal changes in the functional connectivity of resting-state brain networks (RSNs) among children and adolescents with different subtypes of ADHD.
 Methods: This study was performed on 50 participants Group A: included 30 children and adolescents with ADHD Group B: included 20 normal typically developing controls. All participants aged between 7 and 16 years. All study patients. All participants underwent a neuropsychological assessment by applying the DSM-5 criteria to them. All study children and adolescents will undergo a R-fMRI examination, including Blood oxygenation level dependent BOLD-MRI and pulsed Arterial spin labeling MRI (PASL-MRI).
 Results: According to Conner’s Rating scale, there was a significant difference between ADHD subtypes and severity. Children with combined subtype were more likely to have severe degree in both teacher and parent editions of Conner’s Rating Scale. On the other hand, children with inattentive subtype had less severe degrees by both teacher and parent edition. There were a statistically significance difference between both genders as regard ADHD severity according to Conner’s Rating scale (Teacher and parent editions) (P value = 0.049, 0.028 respectively). Males were significantly affected by moderate and severe type compared to females whose affection were mostly mild and moderate. According to CBCL, most of ADHD children had low competence parameters. There was a statistically significant difference (P value < 0.001) on the type of ADHD and social competence in the studied children, where the lowest parameters were found in children with hyperactive type.
 Conclusion: There was a statistically significant difference on the type of ADHD and social competence, where the lowest parameters were found in children with hyperactive type.

Delirium: The Next Vital Sign in the PICU?*

Delirium: The Next Vital Sign in the PICU?*

Screening of attention deficit hyperactivity disorder among preschool children Gharbia Governorate, Egypt

BackgroundChildren who experience mental health issues, such as attention deficit hyperactivity disorder (ADHD), experience significant distress and impairment at home, at school, and in the community. Without adequate care or prevention, this frequently results in adulthood-long distress and impairment at large societal costs. Determining the prevalence of ADHD cases among preschoolers as well as some associated maternal and child risk factors was the aim of this study.MethodsAn analytical cross-sectional study including 1048 preschool children aged 3–6 years was carried out in Tanta City, Gharbia Governorate. From March to April 2022, a proportionate stratified cluster random sample of them was picked. Data were gathered using a predesigned instrument that included sociodemographic information, family history, maternal and child risk factors, and the Arabic version of the ADHD Rating Scale IV questionnaire.ResultsThe prevalence of ADHD among preschoolers was 10.5%. The inattention type was the most common (5.3%), followed by the hyperactivity type (3.4%). There were statistically significant associations regarding positive family history of psychological and neurological symptoms (17.9% positive vs. 9.7% negative), family history of ADHD symptoms (24.5% positive vs. 9.4% negative), active smoking by the mother (21.1% positive vs. 5.3% negative), cesarean section delivery (66.4% positive vs. 53.9% negative), elevated blood pressure during pregnancy (19.1% positive vs. 12.4% negative), and history of taking drugs during pregnancy (43.6% positive vs. 31.7% negative). Significant child risk factors were: exposure to any source containing lead that causes slow poisoning (25.5% positive vs. 12.3% negative), children with cardiac health problems (38.2% positive vs. 16.6% negative), and hours spent by a child in front of the TV or mobile phone (any screens) per day (60.0% of those with positive screening spent more than 2 h/day vs. 45.7% negative).ConclusionIn the Gharbia governorate, 10.5% of preschoolers suffer from ADHD. Significant maternal risk factors for ADHD included a positive family history of psychiatric and neurological symptoms, a family history of ADHD symptoms, active maternal smoking, caesarean section delivery, increased blood pressure during pregnancy, and a history of drug use during pregnancy. Youngsters who had cardiac health issues and who spent more time each day watching TV or using a mobile device (screen use) were at substantial risk.

Prevalence and Risk Factors of Delirium and Subsyndromal Delirium in Older Adults

Background and Aim: Delirium is the most prevalent geriatric issue that is independently associated with poor outcomes in terms of discharge, length of hospital stay, and increased mortality. Subsyndromal delirium (SSD) is defined by the presence of delirium symptoms that do not yet meet the definition of full-blown delirium. The present study aimed to determine the incidence and delirium-related risk factors in older adults. Method: This prospective study was conducted on 420 elderly patients (>60 years) in the Department of Medicine of Benazir Bhutto Hospital Rawalpindi and Liaquat University Medical and Health Sciences, Jamshoro Hyderabad, from April 2021 to December 2021. Study protocol was approved from research and ethical committees of the institutions. The purpose of the study was explained to the participants after taking written informed consent. Patients were classified into three categories are as follows: delirium, subsyndromal delirium, and cases without both delirium and subsyndromal delirium. Detailed history taking, comprehensive geriatric assessment, and clinical examination from each individual were recorded. All the collected data were analyzed using SPSS version 26. Results: Of the total 420 elderly patients, the incidence of delirium and subsyndromal delirium was 96 (22.9%) and 72 (17.1%) respectively. There were 264 (62.9%) male and 156 (37.1%) females. The overall mean age was 68.4± 4.8 years. Delirium and subsyndromal delirium cases were distributed based on the patient’s age were as follows: 62 (64.6%) and 42 (58.3%) in 60-70 years, 24 (25%) and 22 (30.6%) in 71-80 years, and 10 (10.4%) and 8 (11.1%) in >81 year. Of the 96 delirium cases, the incidence of hypoactive type, hyperactive type, and mixed type was 54 (56.3%), 18 (18.8%), and 24 (24.9%) respectively. Based on cognitive assessment, about 36 (8.6%) MMSE score <23, 78 (18.6%) had MMSE score <18, and 54 (12.9%) did not respond to MMSE. The incidence of common comorbidities such as hypertension, chronic liver disease, asthma, ischemic heart disease, cerebrovascular disease, diabetes, and malignancy was 144 (34.3%), 82 (19.5%), 26 (6.2%), 120 (28.6%), 24 (5.7%), 184 (43.8%), and 14 (3.3%) respectively. Conclusion: The present study found that the incidence of delirium and subsyndromal delirium was 22.9% and 17.1% respectively. Adverse outcomes such as increase in length of hospital stay, mortality, and discharge are independently associated with delirium. Efforts to prevent disease may identify patients who require clinical attention. Keywords: Delirium, subsyndromal delirium, risk factors

Mechanisms of bodily harm in emergency department youths with ADHD

ObjectivesWe sought to perform a review of emergency department data to illuminate whether there is a difference in the prevalence of severe injuries in patients with ADHD compared to patients without ADHD. We hope to illuminate whether providers should consider inquiring whether their pediatric patients have ADHD to improve long term outcomes.MethodsThis study is a retrospective cohort study of patient records contained in the TriNetX database, specifically of pediatric patients in this database who presented to an emergency department. We specifically looked at the risk difference in patients <25 years of age with ADHD, no ADHD, inattentive type ADHD, hyperactive type ADHD, and combined type ADHD who presented with any fracture, a central fracture, an upper limb fracture, a lower limb fracture, an accidental overdose, a burn injury, a drowning incident, a gunshot wounds, suffocation, and a suicide attempt.ResultsComparison between the no-ADHD cohort and the inattentive, hyperactive/impulsive, combined, and overall ADHD cohorts revealed differences in the majority of outcomes studied. Patients with overall ADHD had significant differences in rates of all outcomes aside from the upper limb fracture. Patients with combined or hyperactive/impulsive ADHD had significant differences in all but drowning, and the inattentive cohort had significance all events.ConclusionThe stark difference between severe injury presentations in the pediatric emergency department between children with ADHD and without ADHD suggests that providers should consider inquiring whether patients have ADHD to educate them on their risk for severe injuries.

Clinical and Epidemiological Approach to Delirium in an Acute Care Unit: A Cross-Sectional Study.

During hospital admissions, the union of various factors, those related to acute pathology, dependency conditions, cognitive impairment, change of habitual environment, and others, can cause delirium. Acute delirium in the elderly (ADE) occurs in around a third of patients over 70 years of age. The syndrome generates serious complications that increase hospital morbidity and mortality and a high cost for the health administration. This study aimed to determine the clinical and epidemiological profile of ADE in an internal medicine unit. A descriptive cross-sectional study was carried out using a convenience test. A total of 356 patients participated between September and November 2021. Sociodemographic variables, predisposing and precipitating factors of ADE, methods of action against ADE, and the impact on functional and cognitive deterioration were analyzed. A total of 35.1% of the patients developed ADE, mostly of the hyperactive type and of nocturnal appearance. ADE was mainly treated with psychoactive drugs and 22% required mechanical restraint, with non-pharmacological preventive strategies, support, and caregiver training being the main tools for controlling ADE during hospital admission.

Point Prevalence of Delirium and Its Subtypes in the Patients Admitted with Acute Coronary Syndrome in Cardiac ICU and Its Impact on Mortality

Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay.
 Study Design: Prospective cohort study.
 Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021.
 Methodology: Consecutive adult patients with age >18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (>-3). The types of delirium were also assessed.
 Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium.
 Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............

Sytematic Review: The Effect of Plumbum and Zinc on Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) is a mental disorder characterized by a lack of attention, and/or hyperactivity-impulsivity and is related to the growth and development of one's functions in carrying out social life at home and school. Attention-Deficit/Hyperactivity Disorder (ADHD) can be diagnosed in patients aged 6-18 years. The cause of ADHD is still not known for certain, but there are several factors that are considered to be the cause of ADHD, namely genetic factors, biological factors such as brain development, active neurotransmitter factors, psychosocial factors, trauma factors, family factors, emotional factors or children's temperament, and environmental factors. Environmental factors can include exposure to chemicals, exposure to heavy metals, exposure to toxins, nutrition, and childbirth complications. Pb is a heavy metal and toxin can cause ADHD symptoms. Zn is a compound that when levels in the body are reduced, it can cause ADHD symptoms. Pb and Zn substances are predisposing factors for ADHD. The aim from this study is to determine the effect of Pb and Zn on Attention-Deficit/Hyperactivity Disorder. Studies was conducted through 4 e-databases, namely PubMed, ScienceDirect, Scopus, and SpringerLink. The literature quality assessment was carried out using the NOS (Newcastle-Ottawa Scale). From 1124 citations, we identified 20 relevant articles consisting of 4 cohort studies, 12 case-control studies, and 4 cross sectional studies. There are 14 studies discussing Pb exposure, 4 studies discussing Zn deficiency, and 2 studies discussing both on ADHD symptoms. Exposure to Lead (Pb) has been shown to have an effect on ADHD symptoms especially the type of hyperactivity and impulsivity and zinc (Zn) deficiency has been shown to affect ADHD symptoms especially the inattention type.

Study of Disturbed Eating Behaviors in Children with Attention Deficit Hyperactivity Disorder

ABSTRACT Background There is emergent evidence that disturbed eating behaviors, including emotional eating and obesity, co-occur with attention deficit hyperactivity disorder (ADHD) in children. The current study aims to examine the link between ADHD symptoms, eating behaviors and obesity in ADHD children. Patients and Methods 50 ADHD children diagnosed by Conners scale were included. They completed the Emotional Eating scale adapted for children (ESS-C) to evaluate eating in response to emotions. Parents completed the Children’s Eating Behavior Questionnaire (CEBQ) to assess children’s eating behavior. Multivariable regression analysis was used to detect the most independent factor for higher Body mass Index (BMI) risk. Results: Higher rates of overweight/obesity were detected among ADHD children than among normal population. Also, higher Conners global index was associated with higher BMI z-scores. Both Inattentive and combined types were linked to higher BMI, while hyperactive type with lower BMI. Regarding eating behaviors, a positive association between food approach and BMI, and a negative association between food avoidant and BMI z-scores was found. Similarly, there was a noteworthy positive relation between emotional overeating and BMI. 68% of ADHD children were high emotional eaters, mainly inattentive and combined types. Others, mainly hyperactive type, were low emotional eaters. Only ESS-C total score was confirmed as independent factor for higher BMI risk. Conclusion Our findings provide evidence that emotional overeating and food approach eating behaviors are common among ADHD children with higher BMI associated with them. Future studies for better understanding of this overlap will enhance potential interventions.

Psychological Assessment of a Sample of Egyptian Children and Adolescents with type 1 diabetes

Abstract Background Type 1 Diabetes Mellitus (T1DM) is the most common type of diabetes in children. Besides the damaging effects of diabetes on various organs, cognitive changes are also very common. Changes in memory, executive function, attention and academic performance are among the most important impairments seen in children with diabetes. Objectives The aim of this work is to do psychological assessment of children and adolescents with type 1 diabetes at Ain Shams University paediatrics hospital including Health Related Quality of life assessment and DSM-5 criteria for diagnosing ADHD. Patients and methods This study is cross sectional case-control study included 140 cases divided into two groups group (A) includes seventy diabetic children recruited from the Paediatric Diabetes Clinic, paediatric hospital, Ain Shams University 35 males (50%) and 35 females(50%) age ranges from 6 to 14 years old with Mean±SD (9.56±2.25), group (B) includes seventy normal children 32 males(45.7%) and 38 females(54.3%) age ranges from 5 to 15.5 years old with Mean±SD (10.32 ± 2.93). Both groups were subjected to full history taking, clinical examination including Anthropometric measures i.e. weight, height, Body Mass Index (BMI), laboratory investigations includes HbA1C, CBC, Metabolic Profile, psychometric assessment includes DSM-5 criteria for attention deficit hyperactivity disorder (ADHD), Conners rating scale, health related quality of life ( HRQL) questionnaire, Pediatric Check List (PCL). Results Cases fulfilling criteria of ADHD (predominantly hyperactive type, predominantly inattentive type, mixed type) more than control group and difference was statistically significant, HRQOL of diabetic children shows lower score than those of the control group and difference was statistically highly significant. Conclusion Diabetes has an important impact on the psychosocial development of the children as they grow up.

“Homoeopathic Perspective of Attention Deficit Hyperactivity Disorder - Hyperactive Type – A Review”

Attention Deficit Hyperactivity Disorder (ADHD) is commonly diagnosed neuropsychiatric condition affecting the children and adolescence. Nearly 8 percent of school - going children were diagnosed as ADHD and mostly as hyperactive type. More than 60 percent of children with ADHD were progressed to grow with the symptoms into adulthood which causes significant impaired academic achievements, poor interpersonal skills, disordered social activities, and various psychiatric disorders like learning disability, substance abuse, mood disorders, disruptive behavior disorder, etc., Homoeopathy a unique system of medicine which provides a beneficial effect on the human body through its ultra-diluted and potentized drug substances adopting holistic approach. There are reliable sources where homoeopathy proves its efficacy in treating ADHD children. This article provides a cluster of remedies derived through repertorisation considering only the symptoms of ADHD hyperactive type which will be helpful in cases where the individualization of the child is difficult to achieve. Considering the symptomatology of ADHD hyperactive type mentioned in DSM V criteria the most indicated remedies among various remedies were Medorrhinum, Nux. Vom, Carcinosinum, Hyoscyamus, Anacardium, Chamomilla, Veratrum. Album, Coffea Cruda, Tarentula etc.