No abstract

Burnout is frequent among pediatric intensivists and characterized by cumulative involvement of emotional exhaustion, depersonalization, and professional accomplishment. Earlier recognition of emotional exhaustion may be important in preventing the development of a complete burnout syndrome. Improvement in workplace characteristics and measures to improve physician resilience are entirely warranted.

96Rev Bras Psiquiatr 2001;23(2):96-9 MemóriaOrigens do uso da coca O envolvimento humano com substâncias psicoativas, em especial a cocaína, retornam a um passado longínquo. O abuso de cocaína tem suas raízes nas grandes civilizações pré-colombianas dos Andes que, há mais de 4500 anos, já conheciam e utilizavam a folha extraída da planta Erythroxylon coca ou coca boliviana, como testemunham as escavações arqueológicas do Peru e da Bolívia. A planta de coca cresce na forma de arbusto ou em árvores ao leste dos Andes e acima da Bacia Amazônica. Cultivada em clima tropical e altitudes que variam entre 450 m e 1.800 m acima do nível do mar, continua sendo usada pelos nativos da região que a mascam. Numerosas lendas se referem a ela em associação aos mistérios sagrados da fertilidade, da sobrevivência e da morte, assim como de práticas curativas.O nome coca deriva de uma palavra aimará, "khoka", cujo o Western civilization is involved with multiple social problems and drug abuse is one of them. Cocaine and its abuse have become over the years a public health problem. This paper intends to provide a historical background to the subject. For more than 4,500 years, South America natives have been using coca leaves. After the industrial revolution in the 19 th century, cocaine clorhydrate, an alkaloid present in the coca leaf, reached the developed countries. Many products, which main ingredient was cocaine, were consumed by famous people at that time, such as Vino Mariani, used by Pope Leo XVIII. In medicine, Freud and other doctors used cocaine with the purpose of healing various diseases. However, in the last 30 years, it became more available and its price dropped, making it accessible to an increasing number of people, resulting in alarming consequences to users' health as well as for the whole society.Cocaine. Drug abuse. History. significado seria "a árvore".1 Para os incas, a planta era sagrada, um presente do Deus Sol (Inti), relacionada à lenda de Manco Capac, o filho do sol, que desceu do céu sobre as águas do lago Titicaca para ensinar aos homens as artes, a agricultura e para presentear-lhes com a coca.2 Até a chegada dos espanhóis à América, seu uso era privilégio da nobreza Inca. No período colonial, porém, o consumo entre os índios se popularizou, apesar da oposição da igreja católica. [3][4][5] No Norte do Brasil, também é chamada de epadu. Muitas tribos da Bacia Amazônica, na região fronteiriça entre Venezuela, Colômbia e Brasil, mantêm o hábito de mascar o "epadu" ou "ipadu" como forma de preparo das folhas torradas de coca misturadas com elementos alcalinos, transformadas em pó e agrupadas em pequenas bolinhas. Os homens e as mulheres mais idosos, principalmente da tribo dos Tucanos, ingerem o pó várias vezes ao dia, utilizando colheres

Despite the implication of fronto-striatal circuits in attention-deficit/hyperactivity disorder (ADHD), there is a lack of information on the role of these regions, especially the thalamus, in the heterogeneity of ADHD. We assessed the (1)H-magnetic resonance spectroscopy profile in ventromedial prefrontal cortex (VMPFC)-thalamic-striatal regions bilaterally in three groups of subjects (age range 18-24 years old): ADHD inattentive type (ADHD-I; n = 9), ADHD combined type (ADHD-C; n = 10) and non-ADHD controls (n = 12). The peaks of N-acetylaspartate, Choline (Cho), myo-inositol (mI), creatine (Cr) and glutamate-glutamine-GABA (Glx) to Cr were calculated. Subjects with ADHD-C showed lower mI/Cr ratio in the right VMPFC than controls, higher Cho/Cr ratio in the left thalamus-pulvinar than the ADHD-I group and higher Glx/Cr ratio in left putamen than individuals with ADHD-I and controls. This metabolic profile suggests a disruption of fronto-striato-thalamic structures in the ADHD-C as a result of lower neuronal energetic metabolism.

White matter (WM) abnormalities in patients with cocaine use disorder (CUD) have been studied; however, the reported effects on the human brain are heterogenous and most results have been obtained from male participants. In addition, biological data supporting the imaging findings and revealing possible mechanisms underlying the neurotoxic effects of chronic cocaine use (CU) on WM are largely restricted to animal studies. To evaluate the neurotoxic effects of CU in the WM, we performed an in vivo diffusion tensor imaging assessment of male and female cocaine users (n = 75) and healthy controls (HC) (n = 58). Moreover, we performed an ex vivo large-scale proteomic analysis using liquid chromatography-tandem mass spectrometry in postmortem brains of patients with CUD (n = 8) and HC (n = 12). Compared with the HC, the CUD group showed significant reductions in global fractional anisotropy (FA) (p < 0.001), and an increase in global mean (MD) and radial diffusion (RD) (both p < 0.001). The results revealed that FA, RD, and MD alterations in the CUD group were widespread along the major WM tracts, after analysis using the tract-based special statistics approach. Global FA was negatively associated with years of CU (p = 0.0421) and female sex (p < 0.001), but not with years of alcohol or nicotine use. Concerning the fibers connecting the left to the right prefrontal cortex, Brodmann area 9 (BA9), the CUD group presented lower FA (p = 0.006) and higher RD (p < 0.001) values compared with the HC group. A negative association between the duration of CU in life and FA values in this tract was also observed (p = 0.019). Proteomics analyses in BA9 found 11 proteins differentially expressed between cocaine users and controls. Among these, were proteins related to myelination and neuroinflammation. In summary, we demonstrate convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomics analysis of WM disruption in CUD.