Childhood attention‐deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association.N = 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth‐year adjustments. Secondary outcomes were BPD‐associated traits  analyzed using logistic‐ and linear regression respectively.In a nation‐wide cohort (ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47  per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions—HR for inattention: 1.15 (95% CI: 0.85–1.55), hyperactivity: 0.94 (95% CI: 0.69–1.26), impulsivity: 1.46 (95% CI: 1.12–1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self‐harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self‐harm.Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD. Results indicate that impulsivity impacts the association between childhood symptoms of ADHD and BPD the most out of the subdimensions of ADHD, that is, inattention, hyperactivity and impulsivity.Clinical implications include the importance in noting individual symptom profiles in children. More specifically it highlights the importance in noting children with impulse control difficulties regardless of ADHD‐diagnosis status with regards to BPD, particularly in girls with other predisposing factors for BPD.In practice, our finding could be helpful for clinicians and policymakers to make informed decisions when prioritizing health care resources, for example, to prioritize girls with impulse control difficulties for follow up.Individuals diagnosed with BPD are predominantly female in our sample, as previously found in clinical populations, whereas more evenly prevalent in the two sexes in population studies. This may limit the generalizability of our findings to male.We were unable to analyze the associations between childhood symptoms of ADHD and later BPD in a subsample of individuals with diagnosed ADHD because of limitation by power. This may limit generalizability to a clinical population of individuals with diagnosed ADHD.1Borderline personality disorder (BPD) is a condition characterized by instability in affect, self‐image, and interpersonal relationships and by extreme sensitivity to perceived interpersonal slights.Attention‐deficit/hyperactivity disorder (ADHD) is a neuropsychiatric condition with childhood‐onset characterized by impairment because of difficulties with sustaining attention, hyperactivity, and impulse control.Etiological studies have shown genetic and environmental causes for BPD.Both the international classification of disorders (ICD)To our knowledge only one previous study has attempted to investigate if the subdimensions of ADHD during childhood are differentially present in individuals with BPD.1.1The primary aim was to investigate if any of the subdimensions of ADHD in childhood  was more prominent in the association between childhood symptoms of ADHD and clinically ascertained BPD. The secondary aim was to investigate if any of those subdimensions was more prominently associated with BPD‐related behaviors, specifically self‐harm, alcohol use, and drug use. Our hypothesis was that impulsivity would consistently be most prominently associated with all outcome measures.22.1We used data from the Child and Adolescent Twin Study in Sweden (CATSS), which invites parents of all twins born in Sweden from July 1, 1992 and onwards.Information about BPD diagnoses were extracted from the National Patient Register (NPR)In the primary outcome analyses investigating associations between childhood symptoms of ADHD and adult BPD, individuals younger than 18 at the last NPR update were excluded as BPD is generally not diagnosed before age 18 in Swedish clinical practice , hyperactivity (5 questions) and impulsivity (4 questions), according to the ICD‐10 definitionAt age 9 or 12, parent rated childhood ADHD symptoms were assessed using the Autism—Tics, AD/HD and other Comorbidities inventory (A‐TAC), evaluating the degree of the 18 symptoms of ADHD as defined in DSM IV2.3BPD, defined as an F60.3 ICD‐10‐code in the NPR. We did not differentiate between primary‐ and secondary diagnoses. The diagnoses registered in the NPR are based on clinical assessments. The national clinical guidelines for assessment and treatment of personality disorder issued by the Swedish Psychiatric Association recommends careful clinical interviews, using validated interview instruments for assessing BPD and SCID‐II is emphasized.We obtained the first recorded date of diagnosed self‐harm variable defined as having or not having self‐harmed up to the age of 18 based on the combination of self‐ratings in the Life History of Aggression questionnaire (LHA), and the Brief Obsessive Compulsive Scale (BOCS), and parental ratings in the Adult Behavior Check List (ABCL). See Table We created a binary alcohol and drug use, were created from self‐ratings in the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT), respectively Ethical approval was obtained from the Swedish Ethical Review Authority, Stockholm (Dnr: 2016 2135–31 and 2020–04962). All participants have given informed consent.2.52.5.1We summarized the total number and percentages of individuals with BPD diagnosis, means and numbers and proportions of the exposure and outcome variables, the numbers and proportions of those who had had medication in childhood and medication before the outcomes, and the means of the ADHD‐symptomatology at age 18. We did this for the total population and by sex. We also estimated the cumulative incidence of BPD, for the total population and stratified by sex, using Kaplan–Meier approach.2.5.2To analyze the association between childhood ADHD‐symptoms and subsequent BPD diagnoses we used Cox regression and estimated hazard ratios (HR) with 95% confidence intervals (CIs). We performed separate analyses for the total ADHD‐symptoms and for each subdimension  to analyze the effect of each exposure. To compare the effects of each subdimension to each other, we also fitted a mutually adjusted model. The estimates were adjusted for sex and birth year. Since most individuals with BPD diagnoses in our sample were female and the NPR BPD diagnoses in females have been found to be of good validity, we additionally performed the same analyses among females only.2.5.3To analyze associations between childhood ADHD symptoms and secondary BPD‐associated outcomes up until age 18, we used logistic regression to estimate odds ratios (ORs) of self‐harm, and linear regression to estimate associations with alcohol‐ and drug use. Analogous to analyses with BPD as outcome, separate, and mutually adjusted models were fitted. All analyses were adjusted for sex and birth year.2.5.4For primary outcome analyses of BPD, analyses with adjustment for medication before BPD and adult ADHD symptoms were performed. For secondary outcomes additional analyses with adjustments for medication in childhood and before outcomes as well as for adult ADHD symptoms were performed.To account for shared, stable confounders  we performed within‐pair analyses, where twins were compared with their co‐twins,p‐value < 0.05 was considered statistically significant.Cluster robust sandwich estimator (for standard errors) was used in all analyses to account for deviations from modeling assumptions and dependence between observations in twin pairs. All analyses were performed in R using the “survival”33.1N = 13,330). The overall sex distribution was even . Childhood mean ADHD‐symptom scores were higher in males than in females. Individuals with BPD diagnoses were predominantly female . Of the entire population, 29.1%  had self‐harmed up until age 18, which was more common among females (35.1%) than males (21.0%). AUDIT and DUDIT mean scores indicated higher alcohol and drug consumption among males than females.Table Figure 3.2Childhood ADHD symptom severity was positively associated with later BPD, see Figure We observed the same pattern in sub‐group analyses of BPD in females Figure . Analyse3.3For the BPD‐associated behaviors we found positive associations between total ADHD‐score and self‐harm, OR: 1.25 (95% CI: 1.17–1.32) , but no statistically significant positive association by any of the subdimensions.3.4Sensitivity analyses with additional adjustment for medication before BPD and ADHD‐symptoms at age 18 did not alter the overall tendencies in models with BPD. The patterns remained also in sensitivity analyses with adjustment for medication for ADHD in childhood and before outcomes and for age 18 symptoms in models with self‐harm, AUDIT and DUDIT. In within twin‐pair analyses with BPD and secondary outcomes, all associations were attenuated with wide confidence intervals and no statistically significant findings. See Figure 4To our knowledge this is the first longitudinal study investigating the association between the childhood ADHD subdimensions of inattention, hyperactivity, and impulsivity and later BPD. The results of the present study confirm results from previous studies of a positive association between the degree of total ADHD‐symptom severity in childhood and later BPD. The subdimension analyses indicate that childhood symptom of impulsivity is the most prominent of the subdimensions, and drives the association with later BPD.Results from the secondary analyses indicate similar positive associations between total ADHD symptom score and self‐harm and drug use but not with alcohol use. Unlike the overall association with BPD, the most prominent subdimensional association was between inattention and self‐harm, but no positive association was found for any of the subdimensions with alcohol‐ or drug use. Lastly a weak negative association was found between inattention and alcohol use in the combined model.In sensitivity analyses with adjustments for medication before BPD and for symptoms of ADHD at age 18, the overall association patterns persisted, indicating that these factors do not influence the associations. Within‐pair analyses indicated that genetic and environmental effects shared between twins may play a role in the associations however, caution is warranted because of limited statistical power.The results of the current study confirm previously raised hypotheses of impulsivity as a common underlying feature in ADHD and BPD.Clinical implications include the importance of noting individual symptom profiles. Specifically, our findings indicate a value in noting the subdimensions of ADHD as separate entities as associations differ between those and BPD and the associated behaviors self‐harm, alcohol‐ and drug use. For instance, for BPD the results indicate that impulsivity is the most prominent and driving of the subdimensions in the association with childhood symptoms of ADHD, whereas for self‐harm, inattention is the most prominent and driving of the subdimensions.Regarding self‐harm, the result deviates from the hypothesis and previous findingsOf specific interest, the only statistically significant associations regarding childhood ADHD symptoms and quantity of alcohol‐ and drug use was a weak positive association between total ADHD‐score and DUDIT score and a negative association between inattention and AUDIT score. These findings are surprising, as they differ from previous studies where total ADHD score and the hyperactive/impulsive subtype has been found to be significantly associated with AUDITN = 13,330 in analyses of BPD and 8995 in secondary analyses) and nation‐wide, enabling outcome estimates of good precision and generalizability. The instrument used for measuring ADHD symptoms, A‐TAC, has a good reliability and validity adding to precision and accuracy respectively. BPD‐diagnoses in the NPR have good validity adding to accuracy. Also, the longitudinal design with prospective assessments reduces recall bias.There are several strengths to our study. The study population is large (Some limitations need to be mentioned. Regarding our study population: A family history of psychiatric illness, lower socioeconomic status and diagnosed ADHD is more common among nonparticipants.In future studies, we suggest investigating if the associations between childhood symptoms and ADHD and particularly impulsivity and later BPD is more pronounced in individuals with clinically ascertained ADHD compared with those without to potentially understand if this group should also be prioritized for neuropsychiatric evaluation. Because of the limited number of individuals with BPD this was not possible in our study. Further studies are needed to elucidate if treatments specifically targeting impulsivity, could reduce risks of later impairments related to BPD. In children having problems sustaining attention, our results indicate that assessing self‐harm may be particularly important but the associations between childhood ADHD symptom subdimensions and self‐harm, alcohol‐ and drug use need to be further studied.Annika Tiger, Anna Ohlis, Johan Bjureberg, Henrik Larsson, Clara Hellner, Ralf Kuja‐Halkola and Nitya Jayaram‐Lindström were involved in the conception, development and designing of the work. Ralf Kuja‐Halkola and Annika Tiger performed the analyses and drafted the work. Annika Tiger, Anna Ohlis, Johan Bjureberg, Sebastian Lundström, Paul Lichtenstein, Henrik Larsson, Clara Hellner, Ralf Kuja‐Halkola and Nitya Jayaram‐Lindström interpreted the results and provided critical revision on the manuscript. All authors take responsibility for the integrity of the data, accuracy of the data analyses and approved the final version of the work.The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. H Larsson has served as a speaker for Medice, Evolan Pharma and Shire/Takeda and has received research grants from Shire/Takeda; all outside the submitted work.https://publons.com/publon/10.1111/acps.13476.The peer review history for this article is available at Appendix S1 Supporting InformationClick here for additional data file.


In this study, there were 2899 children aged 8 years or older in Phase 1 and 2120 children aged 9 years or older in Phase 2 from Korea, and the ADHD scores and dietary intake of 1733 children in Phases 1 and 2 were used in the final analysis. The YN group refers to children whose disease had improved in Phase 2, and the NY group refers to children diagnosed with ADHD in Phase 2. A notable within-group result was the increase in vegetable protein (p = 0.03) in the YN group. A between-group comparison showed that significant changes in nutrient intake could be confirmed most in the NY group, and the YN group tended to have a lower nutrient intake than the NY group. In the correlation of changes in nutrient intake and three subtypes , the total fat (p = 0.048) and animal protein (p = 0.099) showed a positive correlation with the prevalence of AD. Vegetable iron , zinc , vegetable protein (p = 0.074), and calcium (p = 0.057) had inhibitory effects on ADHD and its subtype. In conclusion, management of dietary and nutritional status should be considered to ameliorate ADHD and its subtypes in school-age children, and these relationships require further exploration in other settings.Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in school-age children and adolescents. However, the reported associations between ADHD and single nutrient intake are inconsistent. The aim of the study was to investigate the relationships between dietary intake changes and the prevalence of ADHD over time with repeat measurements using data from the Children Health and Environment Research (CHEER). To assess changes over time, we used data obtained in 2006 and 2008 (Phases  Mental health is an important issue regardless of age, but children’s physical and mental states are particularly important, as they affect education and employment  and persω-3 [The causes of ADHD are multifactorial and involve genetic and environmental factors ,22,23. Aω-3 , vitaminω-3 , iodine ω-3 ,28, foodω-3 , food seω-3 , dietaryω-3 ,32, and ω-3 ,16,33,34ω-3 , and dosω-3 ,37,38. HDiet is a major source of essential nutrient intake, and there is growing evidence linking essential nutrients to ADHD. A recent meta-analysis examining dietary patterns of children and their diagnosis or symptoms of ADHD found that children who scored lower on healthy eating patterns and higher on unhealthy eating patterns had a higher risk of diagnosis or symptoms of ADHD . AlthougResearch on child mental health is being conducted in various fields, but study designs have often been cross-sectional or case–control, and few large-scale, repeated investigations have been performed on ADHD. Although the association between nutritional status in children and ADHD has also been analyzed, diet-associated practices change, especially in children, and may be more variable than those of adults; thus, repeated measurements are required when studying children. Therefore, an examination of the relationships between nutrient changes and the prevalence of ADHD over time might provide a realistic perspective of such relationships. We undertook this study to confirm that dietary intake is associated with ADHD in school-age children.The data used in the present study were obtained from the Children Health and Environment Research (CHEER), a prospective nationwide cohort study conducted to examine the association between environmental agents and children’s health in the Korean Environmental Health Survey . This st1 and 2, respectively). Phase 1 involved 2899 children mostly of grade 1 (approximately 8 years old) at elementary schools, and phase 2 involved 2120 children of grade 3 (approximately 9 years old and older) at elementary schools. The number of children who took part in the 2006 and 2008 studies was 1733. A total of 1733 children with ADHD scores and dietary intake for Phases 1 and 2 were enrolled in the final analysis  living under different environmental conditions and those of children exposed to environmental toxins. To assess changes over time, we used data obtained in 2006 and 2008 in a prospective study , and parents were asked to fill it out. The SFFQ used in this study was developed as a useful method to investigate the dietary intake of preschool children in Korea in previous studies . The FFQ2). Socioeconomic characteristics, including parental marital status ), parental education level , and family income  were also collected.Data on age, sex, height, and weight were collected, and body mass indices (BMIs) were calculated by dividing weight (kg) by height squared . Age, sex, family income, marital status, and calorie intake were included as control variables [Demographic and socioeconomic variables were analyzed using descriptive statistics, and a paired t-test was used to analyze the nutrient intake. In addition, the dietary intake for Phases ariables ,49,50,51ariables . Statist1 (N = 2741) and Phase 2 (N = 2102). The mean participant’s age was 7.4 years (SD 0.6) at Phase 1 and 9.4 years (SD 0.6) at Phase 2. Regarding each socioeconomic variable, the percentages of middle income , living with parents , and parents with high school education  were the highest (p < 0.001). The prevalence of ADHD was significantly higher in Phase 1  and significantly higher in boys than in girls during both phases  (both p < 0.001). The number of children allocated to the NN, YN, YY, and NY groups was 1422 (83.6%), 125 (7.4%), 82 (4.8%), and 72 (4.2%), respectively (p = 0.005). The YN, YY, and NY groups included significantly more boys than girls.1 was approximately 103–105%  of the estimated energy requirements (EER); Phase 2 was 83–89%  (energy intake level/EER*100). In the crude model, every significant difference was higher in boys; however, in the energy-adjusted model, every significant difference was found to be higher in girls. In Phases 1 and 2, in the energy-adjusted model, the intake levels of vegetable calcium, phosphorus, total iron, iron, sodium, potassium, zinc, vitamin A, β-carotene, vitamin C, folate, and vitamin E, including fiber, were higher in girls than in boys.The results of the nutrient analysis are presented in 1 and 2 (second–first intake level) (sex not separated). The total calcium, vegetable calcium, animal calcium, phosphorus, potassium, zinc, vitamin B2, retinol, vitamin C, and folate levels in Phase 1 were significantly higher than those in Phase 2. In contrast, Phase 2 showed higher fiber, vitamin A, carotene, vitamin E, cholesterol, total fatty acids, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), ω-3, and ω-6 levels than Phase 1.1, only folate showed a significant difference between the with- and without-ADHD groups . In Phase 2, all significant nutrient intake levels were higher in the with-ADHD group. In particular, there was a difference in the energy intake of 300 kcal between the with- and without-ADHD groups .2–1) for each of the four groups . In the energy-adjusted model, significant nutrient levels were observed in the NN and YN groups. In the NN group, the levels of total fat (p < 0.001), vegetable fat (p < 0.001), zinc (p = 0.004), and animal protein (p < 0.02) in Phase 1 were higher than those in Phase 2, and vegetable protein (p = 0.002) levels in Phase 2 were higher than those in Phase 1. The level of vegetable protein (p = 0.03) in Phase 2 in the YN group was higher than that in Phase 1 .2–1) of NN, YN, NY, and YY. The most significant change in nutrient intake could be confirmed in the NY group compared to the other groups. The changes in total fat, vegetable fat, calcium, sodium, vitamin B2, vitamin E, total fatty acids, SFA, MUFA, PUFA, ω-3, and ω-6 were higher in the NY group than in the other groups. In contrast, the changes in calcium and vitamin B2 were the smallest in the NN group compared to the other groups.As shown in 2–Phase 1) and ADHD scores. Negative correlations were observed between the combined ADHD and vegetable iron (p = 0.061) and zinc (p = 0.022). A negative correlation appeared between the AD and vegetable protein (p = 0.074) and iron (p = 0.044). In contrast, a positive relationship was observed among the animal protein (p = 0.099), total fat (p = 0.048), and AD. In the case of HD, a negative correlation was observed between calcium (p = 0.057) and zinc (p = 0.007).1) and 9.1% (Phase 2) (p < 0.001) mean children aged 9–11 years and 6–8 years, respectively. As already mentioned, the range of ADHD prevalence was rather wide: 3–10% in school-age children [2 in this study, it is within the acceptable range. However, it is necessary to analyze the association between the change in dietary intake and prevalence after adjusting for all variables that can have an effect, except for nutrients. The prevalence of ADHD is generally higher in men than in women. A clear 3:1 to 4:1 male predominance over females has been observed in a community-based sample of young individuals [1) and 2.6:1 (Phase 2) (p < 0.001).Many studies have examined the association between ADHD, food, and dietary factors. On the other hand, most studies examined the association in a case–control study, one measurement, or a small-scale study. To the best of the authors’ knowledge, few large-scale studies have used repeated measurements with a prospective design. This study focused mainly on observing the changes in nutrient intake and the occurrence of ADHD through repeated measurements for a certain period of time among children aged 7–12. In this study, the prevalence was significantly different according to measurement time; 12.1%  was higher in the high-income class than in the other groups . In contrast, the number of children who continued to be diagnosed with ADHD was the highest in the low-income class ). The results of this study can be interpreted collinearly, as in the study by Wu et al. However, before concluding, there were subtle issues. The YN group showed improved symptoms over time, which was the highest in the middle-income group. The number of children who presented with symptoms in Phase 2  was the highest in the low-income class. Therefore, for a detailed analysis, an adjusted model is necessary to include the variable of family income. With respect to children with divorced parents, the number of without-ADHD over the whole study period (NN group) was the lowest , and those with a diagnosis of ADHD over the whole study period (YY group) were the highest  (p = 0.000). However, an adjusted model will be necessary for detailed analysis to include the variable of parental marital status because the number of children with a single parent was the highest in the NN group .Family income and parental marital status were correlated with ADHD diagnosis. In general, but not necessarily, the food security of low-income households is lower than that of high-income households. Food insecurity related to adequate food intake affects pediatric ADHD symptoms, with possible effects lasting into adulthood . A recen1 and 2), 1584.6 kcal, and 1603.2 kcal (girls in Phases 1 and 2). Phases 1 and 2 showed higher calorie intake in girls than in boys. The age at classification was different in the KDRI in this study. The age of the children who were included in this study ranged from 8 years to over 9 years, and the children’s age of classification of KDRIs consisted of 6–8, 9–11, and 12–14 ages. In addition, age comparisons were unsuitable. Therefore, this study compared the age group that included the most children  with that of the KDRIs.The estimated mean energy intake was 1757.4 kcal, 1753.6 kcal (boys in Phases 2–1) were compared within and between groups to provide a more detailed correlation than comparisons at single time points. The within-group results showed that the NN and YN groups had significant nutrients. In the NN group, children who had never been diagnosed with ADHD during the study period had a higher level of total fat (p < 0.0001) and vegetable fat (p < 0.0001) in Phase 1 than in Phase 2. The YN group, with-ADHD in grade 1 of elementary school and without-ADHD in grade 3 of elementary school, had a higher level of vegetable protein in Phase 2 than in Phase 1. No significant differences were observed between the other groups. A notable result in the within-group comparison was the increase in vegetable protein content in the YN group. In the YN group, children who showed improved symptoms over time were observed to have a higher intake of vegetable protein in the third grade than in the first grade of elementary school. This result supports the alleviative effect of vegetable proteins on ADHD symptoms.In this study, differences in nutrient intake levels in each group , calcium (p = 0.015), sodium (p < 0.001), vitamin B2 (p = 0.007), vitamin E (p < 0.001), total fatty acids (p < 0.001), SFA (p < 0.001), MUFA (p < 0.001), PUFA (p < 0.001), ω-3 (p = 0.029), ω-6 (p < 0.001), and total fat (p < 0.001). These results showed a positive number, which means that the level of Phase 2 was higher than that of Phase 1. In contrast, the difference in the levels of calcium (p = 0.015) and vitamin B2 (p = 0.007) in the NN group was the lowest compared with that in the other groups. Comparing only two groups, the NY and YN groups, with a change in disease presence, the YN group tended to have a lower nutrient intake than the NY group, suggesting the possibility of prevention and treatment of ADHD due to dietary intake. In a number of systematic reviews analyzing the effects of different nutritional interventions on behavioral symptoms, the authors found a relationship between ADHD and an unhealthy diet, where children and adolescents with ADHD preferred more palatable and poorly nutritious foods [A between-group comparison showed that children who were diagnosed with ADHD in Phase us foods ,39,54. Tus foods ,40,55.2–1) and three-subtype ADHD , positive or negative nutrient intake affected the prevalence of ADHD and its subtype. Total fat (p = 0.048) and animal protein (p = 0.099) levels were positively correlated with the prevalence of AD. Vegetable iron, zinc, protein, and calcium had inhibitory effects on the prevalence of ADHD and its subtypes. Vegetable iron was negatively correlated with ADHD (p = 0.061) and AD (p = 0.044). Zinc levels were negatively correlated with ADHD (p = 0.022) and HD (p = 0.007). According to Chou et al., children with ADHD tend to consume less calcium and vitamin B2 than healthy controls [p = 0.003) [In the correlation result of the difference in nutrient intake (Phases controls . In addi= 0.003) . Iron is= 0.003) ,56.1 than in Phase 2 and in boys rather than girls. The nutrients with higher levels in Phase 1 were total calcium, vegetable calcium, animal calcium, phosphorus, potassium, zinc, vitamin B2, retinol, vitamin C, and folate. In contrast, the levels of fiber, vitamin A, carotene, vitamin E, cholesterol, total fatty acids, MUFA, PUFA, ω-3, and ω-6 were higher in Phase 2 than in Phase 1. In Phases 1 and 2, in the energy-adjusted model, the levels of carbohydrates, fiber, vegetable calcium, phosphorus, total iron, iron, sodium, potassium, zinc, vitamin A, retinol, β-carotene, vitamin C, folate, and vitamin E were higher in girls than in boys. Although differences in prevalence according to sex and measurement time were observed, it was difficult to confirm some nutrients’ facilitatory or controlling effects on ADHD prevalence. Interestingly, the number and type of nutrients that were significant in nutrient intake analysis according to the diagnosis of ADHD in each phase were determined. Folate was the only significant nutrient in Phase 1. The level of the without-ADHD group was higher than that of the with-ADHD group . On the other hand, in Phase 2, every significant nutrient level was higher in the with-ADHD group: vegetable protein, animal protein, total fat, animal fat, calcium, iron, zinc, vitamin B1, B2, B6, niacin, cholesterol, fatty acids, SFA, MUFA, PUFA, and energy. That is, if only based on these results, it can be concluded that when participants of this study population were in grade 1 in elementary school, folate had a positive effect on the disease, and when in grade 3, many nutrients, including calories, had a negative effect on the disease. These results were identified because the ADHD risk group had more sweet food intake and more rice than the general group. Abnormally high intake of carbohydrate foods increases insulin secretion, and epinephrine secretion is achieved as a mechanism for reducing the hypersecreted insulin level. Due to the nature of epinephrine, hypersecretion of epinephrine causes hyperactivity and memory loss, which is the same as a study that showed ADHD symptoms [Two measurements over 3 years revealed a significant difference in nutrient intake, but it was difficult to observe the probable association with the higher prevalence in Phase symptoms ,55,57. Gsymptoms .In addition, as a result of analyzing the relationship between ADHD and dietary intake, it was found that the ADHD risk group had poorer eating behavior than the normal group. In other words, they tended to eat less frequently, eat a lot at once, and eat quickly . The resIn a case–control study with children aged 8.1–9.8 in China, patients with ADHD had lower intakes of calcium and vitamin B2 . In addiThis study has several limitations and strengths. The few similar references to analytical methods regarding the four groups of ADHD impeded an accurate analysis of the comparisons and differences, and the blood nutrient levels related to changes in nutrient intake as the children grow old were not considered. To study the correlation between blood nutrient concentrations and ADHD symptoms, blood nutrient concentrations should be analyzed regularly and monitored in future trials. Additionally, people with certain dietary deficiencies may benefit more from nutritional supplementation, but it should be the focus of future research to test this hypothesis. In this regard, future clinical trials should include information on the concomitant status and use of other nutritional supplements that may have a masking effect to identify patient populations more likely to respond to nutritional supplementation. Family income and living with parents were found to play an important role in prevalence. Therefore, nutrient analysis is needed to consider these two variables, but the crude or energy-adjusted model was used instead. In addition, a comparison of the between-group differences of four groups revealed a significant difference in some nutrients of the NY and NN groups, but it is necessary to pay attention not only to the difference and intake level at each phase . Moreover, there may be some recall biases and inaccuracies despite dietary assessments of mothers with a 1-month recall. However, to assess general dietary intake in large studies, SFFQ has been proposed as the easiest and least costly dietary assessment method with low recall bias. The SFFQ used in this study was developed and verified in 2002 in consideration of the dietary intake characteristics of pre-school children in Korea . FinallyThe prospective and large sample size could be a strength of this study, but the strongest point is the repeated measurement for the same sample over a 3-year period. The human dietary life is variable. It is important to identify predisposing factors for early life modification, such as nutritional factors, especially because the treatment options available to infants and young children are limited, and the long-term effectiveness of treatment is relatively low. If nutrients from a dietary change could positively or negatively influence the prevalence, repeated measurements and observations are necessary for a certain follow-up period. Therefore, the repeated measurements in this study are meaningful. In order to determine whether there is an optimal age for nutritional supplementation and to evaluate the optimal treatment period, future studies should focus on the preventive effect of nutritional supplementation.2) recorded higher levels of nutrients, such as total fat, than the without-ADHD group. The same tendency of total fat was positively correlated with ADHD score. Negative correlations were observed between vegetable iron and zinc intake and ADHD scores. Children diagnosed with ADHD later (NY group) showed a larger change in quantity than children whose disease had improved over time (YN group). These results may be the basis for further research into diagnosis and interventions in children with ADHD.The results of a 3-year-study composed of dietary and ADHD assessments with repeated measurements (twice) showed that the with-ADHD group later (at Phase


Attention-deficit/hyperactivity disorder (ADHD) is characterized by evident and persistent inattention, hyperactivity, impulsivity, and social difficulties and is the most common childhood neuropsychiatric disorder, and which may persist into adulthood. Seventy to 80% of children and adults with ADHD are treated with stimulant medication, with positive response rates occurring for both populations. Medicated ADHD individuals generally show sustained and improved attention, inhibition control, cognitive flexibility, on-task behavior, and cognitive performance. The ethics of ADHD medication use in athletics has been a debated topic in sport performance for a long time. Stimulants are banned from competition in accordance with World Anti-Doping Association and National Collegiate Athletic Association regulations, due to their ability to not only enhance cognitive performance but also exercise performance. Limited research has been conducted looking at the differences in exercise performance variables in unmedicated ADHD verses medicated ADHD. Not all ADHD athletes choose stimulant medication in their treatment plan due to personal, financial, or other reasons. Non-stimulant treatment options include non-stimulant medication and behavioral therapy. However, the use of caffeinated compounds and exercise has both independently been shown to be effective in the management of ADHD symptoms in human studies and animal models. This mini review will discuss the effect of exercise and caffeine on neurobehavioral, cognitive, and neurophysiological factors, and exercise performance in ADHD athletes, and whether exercise and caffeine should be considered in the treatment plan for an individual with ADHD. Attention-deficit/hyperactivity disorder (ADHD) is characterized by evident and persistent inattention and hyperactivity-impulsivity and is the most common childhood neuropsychiatric disorder and may persist into adulthood in 30–65% of patients, whereby symptoms of inattentiveness appear to outweigh those of hyperactivity . Within via DOPA-decarboxylase , leading to more DA accumulating within the synapse (Methylphenidate inhibits DA/NE transporters (DAT and NET) from reuptake of DA/NE into the presynaptic cell, thereby increasing extracellular concentrations and increasing possible receptor binding . Additio synapse . MPH can synapse . Similar synapse . The inc synapse . Ampheta synapse .In recent years, misuse of stimulant medications for non-medical use has risen . ResearcThe ethics of stimulant use in athletics has been a debated topic in sports performance since 1959 when a number of athletes admitted to stimulant use . HoweverAthletes with ADHD that are taking stimulants must submit documentation to the World Anti-Doping Agency (WADA) and the National Collegiate Athletic Association (NCAA) to receive a Therapeutic Use Exemption (TUE) . DocumenNot all ADHD patients or athletes choose stimulant medication for treatment due to personal, financial, or other reasons. One option is non-stimulant medication such as atomoxetine and behavioral and specialized therapy. Another option is the implementation of exercise, and the potential effects of caffeine supplementation.max), ADHD participants with the worst cognitive performance showed improvements in executive function, which was associated with increased brain activity in task-related regions.Exercise is a powerful non-pharmacological ADHD treatment since it can increase cerebral blood flow, brain activation, DA/NE concentrations, and elevate arousal to yield beneficial cognitive effects on extraneous stimuli inhibition, ability to move deliberately between different tasks, and sustained attention capability . Gapin e2 partial-pressures, decreased glucose metabolism, and vasoconstriction  is the most available and highly consumed substance within the global population . Once a tokinase . Additiotokinase . Centraleceptors . Extraceeceptors . CAF is tability . For exaeceptors .2A receptors. Additionally, DA uptake was significantly reduced after chronic caffeine ingestion in the ADHD rat model, which reflects the normalization of DAT, leading to an increase in DA within the synapse for a longer period of time.Caffeine has the ability to control the density and activity of DAT, namely in ADHD animal models. 2A receptors in the frontocortical nerve terminals in the ADHD rat, indicating that A2A receptors serve a prominent role in ADHD circuitry and possibly behavioral deficits. In support of this notion, 2A receptor downregulation in the prefrontal cortex (PFC) on different behavioral aspects such as delayed-based cost-benefit decision-making to measure impulsivity. The data indicate an increase in impulsive behavior due to the downregulation of A2A receptors in the PFC, which influenced the control of delayed-based cost-benefit decision-making  interact between A2A and D2, and stimulate the D2 receptor which depresses A2A receptor stimulation, and plays a primary role in motor activation, resulting in downstream positive effects for L-DOPA (n-making , 2019. Wn-making , due to behavior . It has behavior  stimulatr L-DOPA .1 receptors, leading to increases in excitability but results in less neuroprotection (2A receptors, affording neuroprotection by preventing memory and motor deficits (Since a large portion of the general population consumes CAF and has been habituated to CAF-use to some degree, habituated consumers may have to take greater amounts of CAF to induce comparable dopaminergic effect as observed in low to non-habituated users . It is potection . Whereasdeficits .Numerous animal studies have examined the effect of CAF consumption or CAF ingestion combined with and exercises on ADHD-like symptoms. In the non-ADHD human population, many studies have been conducted regarding CAF’s effects on cognitive performance. In many cases, CAF doses of 2.5–9°mg/kg or 100–500°mg have been shown to affect the processing of stimuli, decision making, attention, reaction times, cognitive visual processing, and executive function during exercise, and reduced error rates either during or after exercise after an hour following ingestion . HuertasThe effects of CAF supplementation on children with ADHD have been widely studied. Several studies have shown that  the greaAttention-deficit/hyperactivity disorder diagnosis rates have continued to increase within the recent decade, with many diagnoses continuing well into adulthood. While the efficacy of exercise in managing ADHD symptoms is well known, the use of CAF alone and with exercise is potentially impactful, and therefore should be considered in the treatment plan for an individual with ADHD. However, studies examining the effects of CAF in adult ADHD athletes are lacking. Future research should examine the effects of caffeine on an ADHD athlete’s exercise and cognitive performance with and without medication, and to better understand the effects of ADHD on central fatigue.Both authors contributed to the overall collection of information and writing and final revision of the manuscript and approved the submitted version.


ADHD is a risk factor for impulsive/compulsive eating problems (EP). In, bulimia nervosa and compulsive eating disorder, EP are frequently preceded by negative affect and experienced as loss of control. Clarifying the underlying causes  of EP in ADHD would allow the development of targeted interventions.To a) compare levels of EP between ADHD patients and a community sample, and b) test if ADHD symptoms and psychological distress predict EP, in ADHD patients.Adults with ADHD  from the Neurodevelopmental Outpatient Unit of Coimbra and healthy participants  answered an online survey including the Portuguese versions of the Adult ADHD Self-Report Scale Symptom Checklist, the Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire-Current Short and the Depression, Anxiety and Stress Scale.The ADHD group reported experiencing more EP than healthy individuals . ADHD patients with EP suffered from severer ADHD inattentive, hyperactive, and global symptoms and higher levels of psychological distress (p<.001 to p=.027). Logistic regression model testing if ADHD and psychological distress symptoms predicted EP, in ADHD, explained 38.8% of the variance and showed that the only significant predictor was ADHD symptoms .Our results indicate that EP are associated with severer ADHD clinical pictures. EP arose secondarily to ADHD symptoms, instead of serving as means to alleviate psychological distress. Clinicians should be mindful that, in ADHD patients, EP follow specific motivations, i.e., impulsivity and inattention, and may respond to combined cognitive-behavioural/executive training strategy.No significant relationships.


Attention-deficit/hyperactivity disorder is among the common neuropsychiatric disorders affecting children and adolescents. The disorder affects the life of children, their parents, and the community when left untreated. Although evidence indicated a high prevalence of attention-deficit/hyperactivity disorder in the developed world, there is limited evidence in developing countries, particularly, Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of attention deficit hyperactivity disorder among Ethiopian children aged 6 to 17 years.A community-based cross-sectional study was conducted from August to September 2021 among children aged 6 to 17 years in Jimma town. A multistage sampling technique was applied to select 520 study participants. Data were collected by using the Vanderbilt Attention Deficit Hyperactivity Disorder- Parent Rating scale as a modified, semi-structured, and face-to-face interview. The association between independent variables and the outcome variable was investigated using bi-variable and multivariable logistic regression. The final model level of significance was set at a p-value of < 0.05.A total of 504 participants were involved in the study with a response rate of 96.9%. The overall prevalence of attention deficit hyperactivity disorder in this study was . Maternal complication during pregnancy (Adjusted odds ratio (AOR) = 3.56, 95% CI = 1.44–8.79, mothers illiteracy , attending primary school , history of head trauma , maternal alcohol use during pregnancy , bottle feeding during first six months  and child’s age 6–11 years  were significantly associated with attention deficit hyperactivity disorder.In this study, one in ten children and adolescents in Jimma town had attention deficit hyperactivity disorder. Therefore, the prevalence of attention deficit hyperactivity disorder was high. For this reason, there is a need to pay increased attention to control associated factors of attention deficit hyperactivity disorder and reduce its prevalence.The online version contains supplementary material available at 10.1186/s12888-023-04636-9. Attention-Deficit/Hyperactivity Disorder (ADHD) is a neuropsychiatric disorder affecting pre-school teenagers, children, and adolescents around the world. ADHD is characterized by reduced sustained attention and hyperactivity that interferes with functioning or development . The thrGlobally, ADHD prevalence estimates are 5.9–7.1% in children and adolescents depending on the source of information for the diagnosis . From a Children with ADHD have many challenges that include lack of attention, and poor judgment on the outcome of their actions , poor acThe etiology of ADHD is not known, however, it is a result of a complex interaction between genetic, environmental, developmental traits, and genetic factors. About 80% of ADHD are due to genetic factors . A previThe limited attention given to mental health is reflected by the scarcity of data on ADHD in sub-Saharan Africa, and Ethiopia in particular. Due to increasingly challenging behavioral outcomes, among children with ADHD globally, various studies have been conducted among children and adolescents but there is limited data in Ethiopia. Finally, Although studying ADHD is important to come up with evidence which is important to make an intervention, there was a limited study that investigated this in the study area. Therefore, the findings of this study will help to fill this gap and shows the prevalence and associated factors of ADHD among children aged 6 to 17 years living in Jimma town.The study was conducted in Jimma town from located in Western Oromia regional state, Southwest Ethiopia. The town is found 351 km to the Southwest of Addis Ababa, the capital city of Ethiopia and located at 7º 4‟ north latitude and 36 º 5‟ East longitude and the climatic conditions is “Wayne Dega”. Based on figures from the Central Statistical Agency in 2005, this town has an estimated total population of 159 009, of whom 80 897 were males and 78 112 were females. The town has 17 Kebele and the study was conducted in five kebele .A cross-sectional study design was conducted from one August 2021 to one September 2021.The source population of this study was children aged 6 to 17 years who reside in Jimma town, Southwest Ethiopia. Study population was a sample of children between the age of 6 to 17 years from the source population, who fulfils the eligibility criteria. Children aged 6 to 17 years’ old who can able to speak, and had either parents or caregivers All children aged 6 to 17 year who were resident in Jimma town for at least six months. Children and parents who were critically ill during data the collection period and not able communicate. The sample size was determined by using single proportion formula and factors associated with ADHD among children aged 6–17 year from previous research which was conducted in Ethiopia . CalculaThe presence of ADHD among children aged 6 to 17 years old were assessed by using the Vanderbilt ADHD diagnostic parent rating scale (VADHD) based on the DSM-IV criteria of ADHD on the original scoring. The scale consists of 18 items representing symptoms of ADHD, and the VADHD rating scale is a proxy-administered (parent or teacher) questionnaire that is based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnostic criteria for ADHD. Each symptom were rated on a 4-point likert type scale indicating the occurrence and the severity of symptoms: 0 (never), or (rarely), 1 (sometimes), 2 ( often) and 3 (very often ). The diagnostic criteria for ADHD were met if the informants marked six items or more for any subtype (Inattentive or Hyperactivity/Impulsivity) as “often” or “very often.” Inattention requires six or more counted behaviors from questions 1 to 9 as“often” or “very often.” an indication of the predominantly inattentive subtype. Hyperactivity-impulsive requires six or more counted behaviors from questions 10 to 18 as“often” or “very often.” an indication of the predominantly hyperactive/impulsive subtype. Combined requires six or more counted behaviors each from both the subtype inattention and sub-type hyperactivity/impulsivity dimensions.Vanderbilt ADHD diagnostic parent rating scale has performance sections as impairment criteria in addition to symptoms criteria. The scale consists of 8 items representing impairments. The Performance scale were rated on five point likert scale indicating the imparment criteria: excellent . ChildreThe VADHD rating Scale was pretested for validity in our sample and was found to be easily understood by the participants with internal consistency . Data was collected from parents using face to face interview technique using the VADHD Rating scale items that was translated to the local language Afaan Oromo and Amharic. A structured questionnaire of possible associated factors related to ADHD were attached to the parent’s rating scale which was filled at home. In addition, potential explanatory variables identified by reviewing literature included the following Sociodemographic factors: information regarding both children and their parents’ age, sex, educational level of father/mother, occupation of father/mother, monthly family income, child feeding style during first six months: “Was this child breastfed or bottle feeding during his/her first six months,” yes/no, head injury with loss of consciousness yes/no, mother’s age at time of the pregnancy, family history of mental illness yes/no, complications during labor/delivery Yes/No If yes what complication?, alcohol exposure during pregnancy yes/no, nicotine exposure during pregnancy yes/no, and information regarding parent marital status: married, divorced/separated/widowed. Family size: based on the Ethiopia Demographic and Health Survey (EDHS), those urban households who have family size of ≥ 4 persons was considered as having above average family size and family monthly income: Using the world bank poverty line cut point those family who have average monthly income of less than 2,565 ETB(1.9$/day) was taken as below poverty line.A structured questionnaire was used; it was translated to the local language Afaan Oromo and Amharic by experts in three languages and translated back to English by another person to ensure consistency and accuracy; before data collection training was given for data collectors. Five BSc Psychiatry and five clinical nurse were participated in data collection. After ethical review board approval, the investigator visited Jimma town health office and explained the aims and methods of the study to the office then permission to conduct the study was obtained. A latter of invitation to participate in the study was be given to the children’s parents and the latter explain the aims and methods of the study, name and contact information of the chief researcher, and that participation was voluntary. The questionnaire were prepared first in English and translated into Afaan Oromo/Amharic language then back translated to English to check consistency. Training was given for data collectors, and supervisor. Pre-test was conducted (5% of the sample size) at Agaro town to identify potential problems in data collection tools and modification of the questionnaire. Regular supervision and support were given for data collectors by the supervisors and principal investigator. Data were checked for completeness and consistency by supervisors and principal investigator on daily bases during data collection time. The anonymity and confidentiality of the information was kept at all stages of data processing.Data was entered into Epi Data Version 4.6  and analA total 520 children were invited to participante in the study and 504 completed the interview with a response rate of 96%. Out of the total children, were males. About half of children  were between the ages of 12 and 17 years. About half of the parents,  were Muslim by religion. Likewise, most of the parents  were married, while  were divorced/separated. Out of the total mothers,  attended school until secondary school or above. Regarding family size,  of the families had more than four children in the house.Three fourth  of families had a monthly income above poverty line of greater than 2565ETB. About half of children  were the first child in birth order attending primary school . Almost all  of participants were living with their family  had reported maternal complication during pregnancy such as, bleeding (8.3%), hypertension (5.0%) and others 4.2%). whereas 37(7.3%) had family history mental illness, 116(23%) were preterm birth, 54(10.7%) had some kind of complication during delivery, 37(7.3%) had history of head trauma, and 43(8.5%) had bottle feeding during first six month  used substance during pregnancy. Likewise,  mothers reported they have used khat, while  and  reported cigarrete and alcohol use respectively. Regarding mother’s ever use of substance  mothers reported they have used tobacco,  used khat and  used alcohol  50(9.9%) with 95% CI .Table S 1). After controlling confounders using multivariable binary logistic regression, young age 6–11 years, maternal complication during pregnancy, history of head trauma, child feeding style during first six month, alcohol use during pregnancy, and mother’s educational status were associated with attention deficit hyperactivity disorder. Younger age 6–11 year was about four times more likely to have ADHD than age 12–17 year ). Additionally, the odds of having ADHD was 3.6 fold higher  among children and adolescent who had maternal complication during pregnancy as compared with those who have no maternal complication during pregnancy.This study has revealed that children aged 6–17 year who have head trauma had more than three times more likely to have ADHD  than those who have no history of head trauma. Additionally, children and adolescent who have maternal alcohol use during pregnancy were three times more likely to have ADHD than those who have no maternal alcohol use during pregnancy . Likewise, bottle feeding during first six months increases the likelihood of having ADHD by about three times as compared to children and adolescents who were fed breast, . Children who have low maternal education(unable to read and write) and was about more than three times more likely to have ADHD than secondary school and above . Similarly, children and adolescents whose mother have primary education were about 3-times more likely to have ADHD than secondary school and above    and findThe higher prevalence of ADHD in the current study compared to the previous study from Kenya might be due to the difference in the study setting, difference in age range of study participants and sample size. As study from Kenya was conducted at health institution that was a tertiary care hospital accident and emergency unit and included 240 children aged 6 to 12, whereas the present study is community-based which includes 520 children aged 6 to 17 years. Furthermore, differences between the Nigerian study and our study might be explained by differences in data collection tools employed, as they used DBDRS, just symptoms criterion, and their age ranged from 5 to 12 years. Additionally, the difference between Thailand’s study and ours is that the former was performed in a school setting, and they employed SNAP-IV to collect data and the diagnosis was validated by a pediatric neuropsychiatrist using DSM-5 criteria, however, we used the Vanderbilt ADHD rating scale for this community based study.Furthermore, the lower prevalence of ADHD in the current study compared to study conducted in rural district of Ethiopia might be attributed to the difference in study setting and Data collection tools as they did in a rural districts, and they used DBDRS, just symptoms criterion, to collect data however, our study was conducted in urban population, we used Vanderbilt ADHD rating scale with the requirement of impairment criteria for the diagnosis. Additionally, the difference between Egypt study and ours is that the former was performed in both a school setting and home setting, and they used DSM-5 symptom criteria to collect data. However, we used the Vanderbilt ADHD rating scale with the inclusion of impairment Criterion which has been found to be significantly alter the prevalence of ADHD  and at home setting only. As previous evidence has indicated , diagnosThe current study indicated that children who had head trauma had higher odds to have ADHD compared to those who were not with head trauma, that was consistent with previous study . FurtherBottle feeding also had increased odds of experiencing ADHD, the association between bottle feeding and ADHD was supported by previous studies conducted in Egypt and Saudi arabia , 40 wherLow level of the moternal education also had higher odds to have ADHD in children and adolescents. This was inline with the previous study conducted in Uganda that a child whose primary caretaker had either no education or had primary education were more likely to have ADHD compared highest level of education .This wasThis study also observed that age less than 11 years had higher odds to have ADHD. This was similar to the study conducted among Ugandan children; in which Children less than 10 years were more likely to have ADHD .This finThese results indicate that, maternal complication during pregnancy and alcohol use during pregnancy had higher odds to have ADHD, which was consistent with a study conducted in Uganda, which found that a maternal complication during pregnancy was significantly associated with ADHD . AnotherThe study was community-based and included children and adolescents of various ages, increasing its repressentiveness for all children and adolescents in the study context. The most important variables, such as alcohol consumption throughout pregnancy, pregnancy complications, and childhood health condition, were addressed. Standardized instruments were used, and in addition to the symptoms criteria, the impairment criteria were included, which had not been included in the previous studies. Recall bias may exist for child health status before to the age of six, child feeding style in the first six months of life, mother health status during pregnancy, and birth complications.We tried to mitigate this by training interviewers to explain participants the aim of the study, interviewing them in isolated area to maintain their privacy and informing them as their response was anonymous.The prevalence of ADHD among children and adolescent is high; one in ten children and adolescent have ADHD in Jimma town. It underlines the importance of greater epidemiological research in this area for treatment and policy implications. A number of factors were significantly associated with ADHD. For this reason, there is a need to pay increased attention to control associated factors of ADHD and reduce its prevalence. Further, there is a need to conduct longitudinal study to investigate the cause effect relationship of risk factors of ADHD. Thus, it was also recommended for future researches to assess ADHD including teacher rating scale, academic performance of school age children and burden of ADHD on academic performance.Below is the link to the electronic supplementary material.A bivariable binary logistic regression model of factors associated with ADHD among children aged 6–17 year in Jimma town, Southwest Ethiopia, 2021.


Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement.We present a case of an 80-year-old female with a resolving HZ rash on her left leg and buttocks that presented with left leg weakness for two weeks. The patient’s rash preceded the left leg weakness by two weeks. The exam revealed erythematous macular and crusting lesions in the left L3/L4 distribution. The left thigh was flaccid with 1/5 knee extension strength with an absent patellar reflex. Lumbar spine magnetic resonance imaging (MRI) revealed enhancement of the left L4 roots, suggestive of inflammation or neuropathy. The patient was discharged on gabapentin, amitriptyline, and a two-week prednisone taper. In this case study, we present SZP, a rare complication that occurs in approximately 3% of HZ patients. The majority of SZP cases occur on the face or upper extremity, whereas our patient had SZP of the lower extremity. This case emphasizes the importance of maintaining a comprehensive differential diagnosis and highlights that SZP should be considered in patients who present with acute weakness in an extremity. Primary varicella-zoster virus (VZV) infection, also known as chickenpox, results in a skin rash with small vesicular lesions that are in different stages and eventually scab over. After the initial infection, the virus can persist asymptomatically in the dorsal ganglia for decades. Reactivation of VZV typically occurs when there is a decrease in immunity and more commonly occurs in older adults -3.Herpes zoster (HZ), also known as shingles, occurs when VZV reactivation causes a painful vesicular eruption that is usually restricted to a single unilateral dermatome . The incThe pathogenesis of SZP is unclear, however, it may be due to the spread of the virus from the dorsal root ganglia to the anterior horn . Most caAn 80-year-old female with a past medical history of hypertension, B-cell lymphoma (currently in remission), and brain aneurysm status post clipping presented to the hospital with progressive pain, numbness, and weakness of the left lower extremity for the past two weeks. The weakness was severe enough that the patient now required a walker for ambulation. A few weeks ago, the patient had been diagnosed with HZ of the left lower extremity prior to the onset of her weakness and had completed treatment with valacyclovir as an outpatient. She denied any associated constitutional symptoms at the time of presentation.The patient’s vitals were stable on presentation. A physical exam revealed erythematous macular and crusting lesions in the anterior left L3/L4 distribution. The left thigh was flaccid with 1/5 strength on knee extension strength and an absent patellar reflex.Diagnostic laboratory evaluation, including a complete blood count, complete metabolic panel, and creatine kinase, was unremarkable. Magnetic resonance imaging (MRI) of the spine with and without contrast revealed enhancement of the left L4 nerve roots suggestive of inflammation or neuropathy with no evidence of masses or impingement Figure .The patient was diagnosed with SZP. As she had already completed a course of valacyclovir and did not have any active zoster lesions, she was not retreated with antiviral therapy. Her pain improved with gabapentin, nortriptyline, capsaicin, and a lidocaine patch. A prednisone taper was started at 60 mg every other day to relieve the inflammation and pain. She was discharged to a skilled nursing facility for rehabilitation of her ongoing weakness.Our patient had SZP, a rare complication of HZ that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement -5. SZP oPatients with SZP typically have MRI findings that include nerve enlargement and T2 hyperintensity consistent with the clinical symptoms . ElectroOf note, our patient had not previously received the Zoster vaccine, a two-dose recombinant vaccine that is extremely effective in preventing HZ and its complications . CompletFinally, this case emphasizes the importance of maintaining a comprehensive differential diagnosis. SZP is a rare complication of HZ that can mimic numerous other conditions depending on the location of the initial rash. While most cases of SZP may mimic a stroke, infection, or autoimmune process, SZP can also mimic many other conditions . This caSZP is a rare complication of HZ that causes focal weakness in the myotome that corresponds to the dermatome of the rash. SZP usually occurs on the face or the upper extremity; however, SZP may occur in the lower extremity as well. SZP may mimic stroke, infection, or autoimmune pathology. This case highlights that SZP should be considered in patients who present with acute weakness in the extremities, especially in patients with a recent rash. This case also emphasizes the importance of vaccination in elderly patients since previous vaccination likely would have prevented this patient's HZ outbreak, sequelae, and subsequent hospitalization.


Blank and loaded zein nanoparticles were characterized in terms of size, polydispersity and zeta potential. Furthermore, the antimicrobial activity against bacteria and yeasts and the hemolytic activity were investigated and compared to the surfactants in a solution. Nanoparticles were found to be monodisperse, presenting a size of between 180–341 nm, a pdI of <0.2 and a positive zeta potential of between +13 and +53 mV, remaining stable over 365 days. The nanoencapsulation maintained the antimicrobial activity as unaltered, while the extensive hemolytic activity found for the surfactants in a solution was reduced drastically. Nuclear Magnetic Ressonance (NMR), molecular docking and monolayer findings indicated that zein entraps the surfactants, interfering in the surfactant–membrane interactions. Accordingly, the nanoepcasulation of arginine surfactants improved their selectivity, while the cationic charges were free to attack and destroy bacteria and fungi; the aliphatic chains were not available to disrupt the cellular membranes.Cationic surfactants carry antimicrobial activity, based on their interaction and disruption of cell membranes. Nonetheless, their intrinsic toxicity limits their applicability. To overcome this issue, a feasible strategy consists of using solid nanoparticles to improve their delivery. The zein nanoparticles were loaded with four cationic arginine-based surfactants: one single chain Nα-lauroyl-arginine (LAM) and three Gemini surfactants Nα Nω-Bis (Nα-lauroyl-arginine) α, ω—diamide) (C Amino acid based cationic surfactants are a good alternative to conventional cationic surfactants, as they are biodegradable, prepared from renewable raw materials and also present low-toxic effects .Cationic gemini surfactants offer a different possibility for interacting with the cellular membranes of microorganisms . These sCandida tropicalis, Candida glabrata and more recently the worrisome Candida auris have been spreading over the last years. The number of antibiotic resistant bacteria has also been responsible for a rapid increment in infectious caused mortality. All these factors reinforce the urgent search for new potential treatments.One of the major sanitary concerns is the rise of resistant pathogens. Uncommon species of yeasts such as An effective strategy to meet today’s demand to heal a number of infections like pulmonary, skin or wounds, is to use cationic surfactants with antimicrobial properties. Those surfactants are molecules with an amphiphilic structure, containing hydrophilic and hydrophobic domains. Their structure determines the physicochemical and biological properties, being determinant on their biomedical applicability. Cationic surfactants are extensively used in a number of fields, although they present an intrinsic toxicity which limits their applicability in medical treatments. Arginine-based cationic surfactants have shown great potential as antimicrobials because of their ability to interact with the negatively charged cell membranes , provokiMoreover, their biocide effect was found to be more pronounced against bacteria than yeasts ,6. This Polymeric nanoparticles (PNPs) have shown some unique properties when designed for drug delivery, such as drug protection, controlled release, selective/enhanced activity and targeting. The PNPs´ structure is often designed to enable delivery to target cells or to reach metabolic pathways.Zea mays), presents the ability to entrap and carry therapeutic molecules. This protein can encapsulate both hydrophilic and hydrophobic molecules and is listed in the Generally Recognized as Safe (GRAS) FDA list. Recently, it has been used in the composition of different delivery systems, demonstrating its versatility as a nanocarrier ,1812,18]Blank zein nanoparticles (BNp) were prepared in the same manner, except for the surfactants’ loading, and used as controls.The nanoparticles were characterized in terms of size, polydispersity index (pdI) and zeta potential . In order to access the best storage conditions, the stability of the formulations was assessed over 365 days under two different conditions in controlled temperature chambers: room temperature (25 ± 2 °C) and low temperature (5 ± 3 °C), according to the ICH guidelines ,38. The 1H-19F/13C/15N triple resonance PA-TXI probe with deuterium lock channel and shielded PFG z-gradient. The spectrometer control software was TopSpin 4.0. The chemical shifts reported are referenced to the lock deuterium solvent. Spectra were processed and analyzed with Mestrenova software v14.0 .NMR experiments were conducted at 25 °C on a Bruker NEO 17.6 T spectrometer (proton resonance 750 MHz), equipped with a 3(LA)2, C6(LA)2 and C9(LA)2 and their binary mixtures with zein were dissolved and homogenized in 0.6 mL of CD3OD:D2O 9:1 (v/v). The concentration of zein was fixed at 8 mM, while the mixtures were prepared at a molar ratio surfactant: zein of 50:1. NMR spectra were measured following our previous studies [1H spectra were measured for the individual components and for the mixture surfactant–zein. The 1H-STD-NMR spectrum was measured for the mixture. The saturation time was set to 2 s and the STDoff saturation was applied at 20 ppm. The STDon saturation was applied at 2.0 ppm for surfactant–zein mixture corresponding to a region of the spectrum where proton signals of zein but not surfactant are expected. The STDon and STDoff subspectra were measured in alternate scans and subtracted by phase cycling providing the STDoff-on spectrum.In order to investigate the chemical interactions between the surfactants and zein, the single compounds LAM, C studies ,29. One-3(LA)2, C6(LA)2 and C9(LA)2 and their binary mixtures with zein dissolved and homogenized in 0.6 mL of CD3OD:D2O 9:1 (v/v). The version of the experiment used introduces a T2 relaxation filter prior and after the NOESY mixing time, each one with a duration of 40 ms. The experiment was repeated at the following mixing times: 0.02, 0.04, 0.2, 0.3, 0.5, 0.6, 0.9, 1.5, 2.0 and 3 s. Each spectrum was acquired with 128 scans and a total duration of each scan of 6.0 s.NOE-exchange relayed (NOEexch) experiments  were acq3(LA)2, C6(LA)2 and C9(LA)2) and zein dissolved in H2O:CD3OD 4:5 v/v. The experiments were performed with a selective 180 degrees’ inversion pulse applied over the water signal at 4.7 ppm by means of a gaussian shaped selective pulse of 7.5 ms covering a band width of 118 Hz (0.15 ppm in our spectrometer). The experiment was repeated with a mixing time of 50 and 500 ms for comparison, while the last was used for plotting the results. Each waterLOGSY spectrum was acquired with 64 scans and a total duration of each scan of 5 s.WaterLOGSY experiments  were acqIn order to elucidate the binding modes of the surfactants within zein protein, a molecular docking simulation was carried out using AutodockVina  . The strv/v, 1/5). Isotherms were recorded at 25 °C and the volume of samples deposited at the interface was 12.5 µL for individual samples and 25 µL for binary samples, using a Hamilton syringe. After 15 min of solvent evaporation, the surface pressure (π) as a function of area (A) was recorded. The rate of barrier symmetric compression was 20 mm/min. The subphase was ultrapure water.The surface pressure (π) of monolayer isotherms were measured using a Langmuir film balance , provided with a Wilhelmy paper plate (KSV) an electrobalance and a through and a barrier system of Teflon. Through and barriers were cleaned following the protocol described in Lozano et al. (2008)  Before aBacilus subtilis ATCC 6633, Staphylococcus aureus ATCC 29213, Acinetobacter baumanniii ATCC 19606, Pseudomonas aeruginosa ATCC 27853, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 25922, Listeria monocytogenes ATCC 15313 and Enterococcus faecalis ATCC 29212, Candida albicans ATCC 90028, Candida jadinni ATCC 60459, Candida rugosa ATCC 10571, Candida glabrata ATCC 66032, Candida paropsilosis ATCC 22019, Candida tropicalis ATCC 7349, Candida auris ATCC 21092 and Candida albicans ATCC 10231. Frozen stocks of microorganisms were seeded in culture media plates  and incubated overnight at 35 °C and 30 °C, respectively. Three to four colonies of each strain were dispersed in the appropriate sterile broth  to obtain dispersions equivalent to 0.5 in the McFarland turbidity scale . To obtain the bacteria inoculum, the suspensions were diluted to 10 in MHB to reach 107 colony forming units (CFU)/mL. The yeast inoculums were used without dilution (~1.5 × 107 CFU/mL).The antimicrobial activity of the arginine surfactants based nanoparticles was checked over selected yeasts and bacteria: 6 UFC/mL. The plates containing bacteria and yeasts were incubated at 30 °C and 37 °C for 24 h, respectively. After the incubation period, the turbidity of wells was checked. The MIC was determined as the lowest concentration without apparent turbidity. To confirm this observation, 20 μL of resazurin at 0.015% w/v was added to each well and left to react for approximately 1 h for bacteria and 3 h for yeasts at 35° and 30 °C, respectively. After the incubation period, the indicative of bacterial growth, i.e., changing from blue to pink, confirmed the MIC value observed. To obtain the MBC and the MFC, an aliquot of 10 μL of the MIC well and the 2 concentrations immediately above were seeded over agar MH and SB for bacteria and yeasts and incubated for 24 h at 35 and 30 °C, respectively. The MBC and MFC were determined as the lowest concentration in which no colonies were observed on the agar plates.The minimal inhibitory concentration (MIC), minimal bactericide concentration (MBC) and minimal fungicide concentration (MFC) were determined using the microdilution method according to the CLSI protocol . Each we9 cells/mL. To check the quality of the blood 975 μL of ultrapure water and 25 μL of the erythrocytes´ suspension were mixed and gently homogenized for 10 min and centrifuged at 10,000 rpm for 5 min. Finally, the absorbance of the supernatant was measured at λ = 575 nm , using PBS 7.4 as the blank.Heparinized fresh blood from a white New Zealand rabbit was used to determine the hemolytic activity  of the sBefore the test, the basal hemolytic activity (0%) was checked using PBS 7.4 as control, while the 100% hemolysis was determined using ultrapure water. The last was used to determine comparatively the individual hemolytic activity (in %). After that, blank and surfactant-loaded zein nanoparticles and their solutions were assayed using the adjusted erythrocytes suspension.To quantify the leached hemoglobin, the absorbance of the supernatant was measured at λ = 540 nm using PBS 7.4 as blank and the % of hemolysis was calculated according to the following equation:2O as a co-solvent, there is a binding between the surfactants and the zein mediated by a layer of water molecules that have relative long residence times attached to the hydrophilic surface of the protein (bound water fraction). Qualitatively, the poor transference of saturation from the protein to the surfactants in the STDoff–on spectra could reflect either a relative strong binding or a relevant fraction of bound water molecules in the zein binding site. The stability is affected by the type of surfactant loaded, being more notable in Gemini surfactants with longer spacer chains such as C6(LA)2 and C9(LA)2. LAM enhanced its antimicrobial activity when nanoencapsulated, while the Gemini surfactants experienced a slightly reduced activity against the bacteria and fungi when loaded in the zein nanoparticles. The nanoencapsulation reduced extensively the hemolytic activity of all surfactants, while the highest reduction was observed in the Gemini surfactants, specially C6(LA)2. This improves their selectivity when considering the differentiation between microbial and human cell membranes. Therefore, these nanoparticles can become candidates for antimicrobial therapies as a potent activity together with a reduced toxicity which could be achieved after the nanoencapsulation in zein nanoparticles. Those results are in agreement with the NMR, Langmuir monolayers and docking findings, indicating that zein interacts with the surfactants by the aliphatic chain and as a result interferes in the surfactant–lipid interaction necessary for the microbial and cellular interactions. As a result, the cationic charges are freely available to attack and destroy the bacteria and fungi, while the aliphatic chain are not free to disrupt the cellular membranes.Zein nanoparticles containing arginine-based surfactants have been prepared using two different methods. Both preparation methods are viable for loading the surfactants into zein nanoparticles The antimicrobial properties and the hemolytic activity of these cationic nanoparticles have been studied. Zein is a protein which offers a great versatility for nanoparticle formation, which allows the obtaining of nanoparticles with different characteristics. The NMR results indicate that when using H


Ovarian cancer (OC) is a common clinical gynecological disease, which seriously threatens women's health and life. We investigated the roles of SPOCK2 in OC and its associated molecular mechanism in the current study.  The expressions and prognostic value of SPOCK2 in OC were identified using the clinical data and data from the GEPIA database. Then, SPOCK2 silence was implemented to search functions of SPOCK2 in OC cells. CCK-8 was used to examine cell proliferation. Cell apoptosis was detected by flow cytometry. The OC cell invasion and migration were evaluated by transwell assays. β-catenin.  Overexpressed SPOCK2 was identified in OC, which was correlated with poor prognosis and a shorter survival rate. SPOCK2 downregulation significantly suppressed OC cell proliferation, migration, and invasion, and cell apoptosis was markedly promoted by SPOCK2 silence. Meanwhile, SPOCK2 knockdown could effectively suppress Wnt/ SPOCK2 exerted crucial functions in OC progression and could serve as a promising candidate for OC targeted therapy. Ovarian cancer (OC) is one of the common malignancies of the female reproductive system . A recenSPOCK family proteins are proteoglycans of the vertebrate extracellular matrix (ECM) . SPOCK-e54 OC Patients Who Underwent Tumor Resection from January 2015 to January 2017 at Our Hospital Were Selected. All Specimens Taken from the Adjacent Normal Tissues and the Cancer Tissues Were Stored at -80°C for Further Experiments2.OVCAR3, SKOV3, A2780, OV90, and ES-2 were cultured in DMEM medium  containing 10% FBS (Invitrogen) and stored in a humidified incubator at 37°C with 5% COhttp://gepia.cancer-pku.cn/) was used to analyze the SPOCK2 levels between OC tissues and normal tissues. Additionally, OS and DFS analyses of OC patients in the database were downloaded from the website.The online tool GEPIA (Cell transfection with si-SPOCK2 or control siRNA was performed with Lipofectamine 2000 (Invitrogen). SPOCK2 overexpression was achieved by transfection of SPOCK2 expression plasmids.Total RNA was isolated with Trizol reagent (Invitrogen), and cDNA was synthesized with a reverse transcription Kit . The qRT-PCR assay was performed using SYBR Green (Takara) on an ABI 7500 system. GAPDH was an internal control.450 was estimated using a microplate reader.Cells transfected with corresponding vectors were cultured at densities of 2 × 103 cells/well. CCK-8 was added into the wells at the indicated time  and incubated for 2 h. The ODβ-catenin, c-Myc, cyclin D1, E-cadherin, N-cadherin, Vimentin, and GAPDH . Following 3 washes with TBST, the membranes were incubated with HRP-conjugated secondary antibodies for 1 h at room temperature. GAPDH was an internal control.After measuring protein concentrations using a BCA assay , the samples were separated on SDS-PAGE gels and transferred onto PVDF membranes . The membranes were blocked with 5% skim milk and then incubated with primary antibodies at 4°C overnight. The antibodies included antibodies for SPOCK2, cleaved caspase-3, procaspase-3, Cell apoptosis was detected by Annexin V-FITC kit . The cells were incubated with Annexin V-FITC and PI at room temperature and protected from light for 30 minutes.2 at 37°C, the cells that had adhered to the lower membrane were fixed and stained with 20% methanol and 0.1% crystal violet. The cells were counted under an inverted light microscope . For migration assay, the transwell chamber was not coated with matrigel.For cell invasion assays, cells in serum-free DMEM were added into the upper chamber with matrigel on the filter membrane. After incubation for 24 h in 5% COt-test or by one-way analysis of variance (ANOVA) between two groups or in more than two groups. χ2 analysis was used to analyze the correlation between JARID2 expressions and clinicopathologic features. P < 0.05 was considered statistically significant.The data were analyzed using SPSS 18.0. The difference was analyzed by Student's To confirm the functions of SPOCK2 in OC progression, we examined the expressions of SPOCK2 in OC tissues and cells. The comparison of the expressions of SPOCK2 in OC and normal tissues based on the GEPIA database indicated that SPOCK2 expressions were increased in OC tumors . SimilarTo further evaluate the clinical significance of SPOCK2 in OC, we analyzed the relationship between SPOCK2 expressions and clinicopathological characteristics of OC patients. We found significant correlations between SPOCK2 overexpression and TNM stage, lymphoid metastasis, distant metastasis, and FIGO stage . No evidTo further determine the functions of SPOCK2 in OC progression, SPOCK2 was silenced by si-SPOCK2 in OC cells. The successful knockdown of SPOCK2 in OC cells was confirmed by RT-qPCR and western blot Figures . CCK-8 aApoptosis plays a key role in tumor regression, and cell apoptosis was assessed to confirm whether SPOCK2 was involved in OC cell apoptosis. Results of flow cytometric analysis demonstrated that SPOCK2 silence significantly increased the apoptosis rates of OC cells Figures . FurtherTo verify the functions of SPOCK2 in OC cells, we performed transwell assays to determine whether SPOCK2 could affect OC cell migration and invasion. As shown in To further confirm the functions of SPOCK2 in OC progression, the SPOCK2 was upregulated in A2780 cells. As shown in β-catenin pathway was crucial for OC development. The expressions of activated β-catenin, cyclin D1, and c-Myc in OVCAR3 cells were determined, when SPOCK2 was silenced or overexpressed. As shown in β-catenin, cyclin D1, and c-Myc were significantly upregulated by SPOCK2 overexpression and decreased by SPOCK2 knockdown. Furthermore, we also detected the changes in the biological behaviors of OVCAR3 cells transfected with the SPOCK2 vector in the absence or presence of XAV-939, a specific inhibitor of Wnt/β-catenin signaling. Results showed that SPOCK2 overexpression remarkably promoted OC cell proliferation, invasion, and migration; the above effects of SPOCK2 were partially eliminated by XAV-939 β-catenin pathway, finally regulating OC progression.To elucidate the potential mechanism of SPOCK2 in OC progression, we analyzed whether the Wnt/The incidence of ovarian malignancies has gradually increased in recent years, ranking third among gynecologic tumors, but its mortality rate ranks first among gynecologic tumors . Unless β-catenin, and other pathways, and increase cancer cell resistance to chemotherapeutic drugs [Previous studies showed that SPOCK presented high plasma levels in multiple cancers and could promote tumor growth, metastasis, and invasion through PI3K/Akt, Wnt/ic drugs , 23. In ic drugs . Sambuudic drugs . In addiic drugs .β-catenin, cyclin D1, and c-Myc proteins were reduced after knockdown of SPOCK2, which suggested that SPOCK2 could affect the EMT of OC through Wnt/β-catenin, and thus affect the invasion and metastasis of OC. However, the mechanistic studies in the current study are insufficient, such as the functions of SPOCK2 in vivo, and whether SPOCK2 exerted functions in OC through regulation of certain downstream molecules, which deserves further exploration.Our previous imaging genomics findings suggested that SPOCK2 was aberrantly expressed in OC. In this study, the expressions of SPOCK2 in OC tissues were significantly higher than that of normal controls, suggesting that this gene may be associated with the development of OC. This result was consistent with our imaging genomics findings. Moreover, we also find that the higher the level of SPOCK2 expression, the more malignant the OC was. Furthermore, the prognosis analysis of SPOCK2 in OC patients from the TCGA database also showed that the survival rate of OC patients markedly declined in patients with high SPOCK2 expressions. To further explore the roles and mechanism of SPOCK2 in OC progression, we knocked down SPOCK2 in OC cells and examined the proliferation, migration, and invasion abilities. Results indicated that downregulation of SPOCK2 could promote cell apoptosis, and inhibit cell proliferation, migration and invasion. Moreover, activated β-catenin, which may provide a reference for the clinical diagnosis and treatment of OC.In conclusion, upregulated SPOCK2 in OC tissues was identified, which was related to poor OC prognosis. Silencing SPOCK2 may inhibit OC cell progression by inactivating Wnt/


H-imidazol-3-ium tetraphenylborate (DODI-TPB) surfactant sensor was studied in single and complex mixtures of technical grade QACs—benzalkonium chloride (BAC), N,N-didecyl-N,N-dimethylammonium chloride (DDAC), and N,N-dioctyl-N,N-dimethylammonium chloride (DOAC) usually used in COVID-19 disinfecting agents formulations. The results obtained with the new DODI-TPB sensor were in good agreement with data measured by a 1,3-dihexadecyl−1H-benzo[d]imidazol−3-ium-tetraphenylborate (DMI-TPB) surfactant sensor, as well as two-phase titration used as a reference method. The quantitative titrations of a two-component mixture of the cationic homologs (a) DDAC and DOAC; and (b) BAC and DOAC showed that the new DODI-TPB surfactant sensor can clearly distinguish two separate mixture components in a single potentiometric titration curve with two characteristic inflexion points. The consumption of SDS (used as a titrant) in the end-point 1 (EP 1) corresponded to the content of DDAC (or BAC), whereas the consumption in the end-point 2 (EP 2) corresponded to the total content of both cationic surfactants in the mixture. DOAC content in both mixtures can be calculated from the difference of the titrant used to achieve EP1 and EP2. The addition of nonionic surfactants resulted in the signal change decrease from 333.2 mV  to 243.0 mV . The sensor was successfully tested in ten two-component COVID-19 disinfecting formulations.The behavior of a new 1,3-dioctadecyl-1 Surfactants are key ingredients used as emulsifiers, dispersing, cleaning, wetting, foaming, and anti-foaming agents in many household, and industrial applications and products. Surfactants are most often amphiphilic organic compounds containing a hydrophilic head and a hydrophobic tail. Whereas the nonionic surfactants are characterized by the absence of the charged groups in their head, the ionic surfactants can be divided into cationic, anionic, and amphoteric. Cationic surfactants are mainly used as disinfectants and antiseptics in households as well as industrial cleaning agents. During the COVID-19 pandemic, most disinfectants or antiseptics used for hand and surface disinfection were based on alcohol or cationic surfactants or on various combinations  ,3,4. AlcCommercial product formulations for disinfectants and antiseptics use quaternary ammonium compounds, a type of cationic surfactant, as the active component. QACs are inexpensive agents and are commonly used as disinfectants and antiseptics for home and professional use ,26. QACsN,N-didecyl-N,N-dimethylammonium chloride (DDAC)  and of BAC and DOAC (1:1 w/w) were performed by DODI-TPB as an end-point indicator and an SDS (c = 4 mM) as a titrant.Potentiometric titrations of the two-component model mixtures of DDAC and DOAC [1:1 (w/w) were performed using SDS (c = 4 mM) as a titrant and a DODI-TPB potentiometric sensor as an end-point indicator.Potentiometric titrations of model mixtures of DDAC and non-ionic surfactant Triton X-100 in different proportions 1:0, 1:1,1:2, 1:3, 1:5, 1:10 (c = 4 mM) as a titrant.Potentiometric titrations of the two-component COVID-19 formulations were performed by DODI-TPB as an end-point indicator and an SDS  was used as the titrant.In this investigation, the surfactant sensor DODI-TPB was used as an indicator and endpoint detector in potentiometric titrations of several selected technical cationic surfactants commonly used in detergents and disinfectants for public facilities, hospitals, and industry; then, in titrations of two-component model mixtures; and finally, to determine the cationic surfactants in several COVID-19 formulations of disinfectants. In all the titrations, SDS (−6 to 1.0 × 10−4 M) [The DODI-TPB sensor for surfactants showed an excellent response to cationic surfactants with a nearly Nernstian response and a wide linear concentration range (up to 1.8 × 10 10−4 M) . The tit 10−4 M) . Therefoc = 4 mM) as a titrant, and showed excellent response properties  used as titrant and the DODI–TPB sensor for ionic surfactants as an indicator, in comparison with the results obtained with the DMI-TPB ionic-surfactant sensor and the standard method of two-phase titration and the corresponding statistics, are shown in The results for the potentiometric determination of selected technical cationic surfactants by SDS  corresponds to the content of DDAC, while the consumption of the titrant in EP 2 (mL) corresponds to the content of both cationic surfactants in the mixture. The DOAC content corresponds to the difference in consumption between EP1 and EP2. This is significant since the response of the surfactant sensor DODI-TPB can clearly distinguish two separate mixture components in a single potentiometric titration curve. The quantitative results for the titration of the two-component mixture of the cationic homologs DDAC and DOAC are presented in Although the potential change in the titration of the two-component mixture is the same as in the titration of DDAC (about 272 mV), the endpoint values for the individual cationic surfactants (DDAC and DOAC) correspond to the endpoint values in the two-component mixture, with well-defined inflexions .Titration of BAC and DOAC was performed in the same way. As expected, the titration was very similar, even with two inflections . Consumpw/w) are presented in The potentiometric properties of the titration curves for model solutions of BAC, DOAC, and a separate two-component mixture of BAC and DOAC  was observed in the potentiometric titration with DDAC by anionic surfactant NaDDS (c = 4 × 10−3 M) and the potentiometric sensor DODI-TPB as an indicator (Sometimes nonionic surfactants are included in the formulations of disinfectants and antiseptics with cationic surfactants. The influence of the nonionic surfactant Triton X-100 in different proportions (ndicator .w/w), using NaDDS as the titrant (c = 4 × 10−3 M) and the potentiometric sensor DODI-TPB as an indicator, are presented in Increased amounts of nonionic surfactant Triton X-100 decreased the bending of the titration curve, reduced the signal change, and decreased the value of the first derivative at the endpoint. The quantitative characteristics of the titration curve for the potentiometric titrations of the model mixtures of DDAC and the nonionic surfactant Triton X-100 in different proportions (w/w). The change in the first derivative signal corresponded to the change in the potential signal. The decrease in the change of the first derivative ranged from 71.9  to 43.0 dE/dV . Although the nonionic surfactants have a negative effect on the response of the surfactant sensor to DDAC, the usual concentration range for cationic surfactants in commercial products is up to 1:2 . In this way, the nonionic surfactants could have a negative impact, but still with well-defined endpoints.The addition of nonionic surfactants resulted in a decrease of the signal change from 333.2 mV  to 243.0 mV  and the DODI-TPB potentiometric sensor as the endpoint indicator. The titration results with the corresponding contents of each cationic surfactant are shown in Ten samples of COVID-19 disinfectant formulations with DDAC and DOAC (six samples), and BAC and DOAC (four samples) were titrated using NaDDS as a titrant  DDAC and DOAC; and b) BAC and DOAC showed that the DODI-TPB surfactant sensor can clearly distinguish two individual mixture components in a single potentiometric titration curve. In potentiometric titrations of DDAC, increased amounts of nonionic surfactant Triton X-100 had a negative effect on the inflexion of the titration curve, decreased the signal change, and lowered the value of the first derivative at the endpoint. The quantitative results of the BAC, DDAC, and DOAC in COVID-19 disinfectant formulations showed good agreement with the standard two-phase titration method. The presented study is an interesting tool not only for quantification of the cationic surfactants in raw materials, but also for discrimination and quantification of similar cationic surfactants in their mixtures.