Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Atmospheric pollution effects on childhood health: an environmental study in the Paraíba Valley

OBJETIVOS: estimar as correlações entre os níveis de poluentes atmosféricos e o número de internações por doença respiratória em crianças, em hospital universitário. MÉTODOS: trata-se de um estudo ecológico de série temporal. Os dados sobre poluentes atmosféricos foram obtidos junto à CETESB e os dados sobre internação hospitalar, junto ao SAME do Hospital Universitário de Taubaté, Brasil. O estudo se refere a dados e internação do ano de 2001. Para estudar as correlações dos valores dos poluentes entre si e entre as internações, utilizou-se da técnica de correlação de Pearson. Foram estimados os riscos relativos para internação por doença respiratória comparando os quartis dos agentes poluentes com os valores do primeiro quartil. A significância estatística adotada foi alfa = 5%. RESULTADOS: foram internadas 158 crianças com doença respiratória no ano de 2001 (30% do total de internações no ano). Os poluentes estiveram correlacionados entre si e houve correlação positiva, entre o número de internação e dióxido de enxofre e material particulado; houve aumento de 25% no risco de internação comparando o quarto quartil e o primeiro quartil. CONCLUSÕES: houve correlação positiva entre número de internações por doenças respiratórias e poluentes atmosféricos.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

O objetivo do estudo foi identificar e medir a presença de associação entre cuidado psicossocial e desnutrição. Realizou-se estudo caso-controle incluindo 101 crianças desnutridas (peso/idade < percentil 5 do padrão NCHS/OMS), com idades entre 12 e 23 meses, que foram comparadas a 200 controles eutróficos (peso/ idade > percentil 25) em termos de sua exposição a uma série de comportamentos maternos indicadores da qualidade de seu cuidado psicossocial. Criou-se um escore de cuidado psicossocial, variando de 0 a 14, de acordo com o número de comportamentos maternos desejáveis não observados: quanto maior o escore, pior a qualidade do cuidado psicossocial. Mediante análise de regressão logística verificou-se maior risco de desnutrição para as crianças no 2º e 3º tercis do escore de cuidado psicossocial. Esta associação foi modificada pela renda per capita. Após ajustes para possíveis confundidores, nas crianças dos estratos superiores de renda não houve associação entre cuidado psicossocial e desnutrição. Para as crianças com nível mais baixo de renda, pior cuidado psicossocial dobrou o risco de desnutrição (OR = 7,26; IC95%: 2,42-21,82) em relação àquele associado apenas à baixa renda (OR = 3,08; IC95%: 1,28-7,42).

Whole-body protein turnover in malnourished patients with child class B and C cirrhosis on diets low to high in protein energy

The purpose of this study was to determine the rate of whole-body protein turnover in moderately and severely alcoholic, malnourished, cirrhotic patients fed with different amounts of protein or energy. Six male patients (Child classes B and C) and four age- and sex-matched healthy control subjects were studied for 18 d in fasting and feeding states; a single oral dose of [N-15]glycine was used as a tracer and urinary ammonia was the end product. The kinetic study showed that patients had higher protein catabolism while fasting (patients: 3.14 +/- 1.2 g of lean body mass/9 h; controls: 1.8 +/- 0.3 g of lean body mass/9 h: P<0.02). Although not statistically significant, protein catabolism (grams of lean body mass/9 h) was lower with the hyperproreic/hyperenergetic diet when compared with fasting. Nitrogen retention was consistent with the lower protein-catabolism rate; a statistically significant increase in nitrogen balance was observed when patients were fed with the hyperproteic/hyperenergetic diet compared with fasting 14.3 +/- 3.2 g of nitrogen/d and -2.2 +/- 1.9 g of nitrogen/d, respectively; P < 0.01). These data indicate that Child class B and C cirrhotic patients are hypercatabolic and that Long-term nutritional intervention with a hyperproteic/hyperenergetic diet is likely needed to improve their clinical and nutritional status. Nutrition 2001;17:239-242. (C) Elsevier B.V. 2001.

Visual timing and adaptive behavior in a road-crossing simulation study

In this road-crossing simulation study, we assessed both participant's ability to visually judge whether or not they could cross a road, and their adaptive walking behavior. To this end, participants were presented with a road inside the laboratory on which a bike approached with different velocities from different distances. Eight children aged 5-7, ten children aged 10-12, and ten adults were asked both to verbally judge whether they could cross the road, and to actually walk across the road if possible. The results indicated that the verbal judgments were not similar to judgments to actually cross the road. With respect to safety and accuracy of judgments, groups did not differ from each other, although the youngest group tended to be more cautious. All groups appeared to use a strategy to cross the road based both on the distance and the velocity of the approaching bike. Young children waited longer on the curb before crossing the road than older children and adults. All groups adjusted their crossing time to the time-to-arrival of the bike. These findings are discussed in relation to the ecological psychological approach and the putative dissociation between vision for perception (i.e. verbal judgment) and vision for action (i.e. actual crossing). (c) 2004 Elsevier Ltd. All rights reserved.

A comparative-study between visible-light-activated and autopolymerizing sealants in relation to retention

Two hundred twenty-nine first permanent molar occlusal surfaces were treated with sealants, from a group of sixty-one children. When the three sealants were analyzed at the end of the six-, twelve-, eighteen-, and twenty-four-month periods, it was observed that retentive loss was gradual. Both Concise and Delton showed superior retention when compared with Sealite.

Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: Pediatric rheumatology international trials organization multinational quality of life cohort study

Objective. To investigate the proxy-reported health-related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).Methods. In this multinational, multicenter, cross-sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.Results. A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 +/- 10.6 versus 54.6 +/- 4.0, P < 0.0001; psychosocial: 47.6 +/- 8.7 versus 51.9 +/- 7.59 P < 0.0001), with the physical well-being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score > 1 and a pain intensity rating > 3.4 cm on a 10-cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.Conclusion. We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well-being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.

Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: Study protocol for prospective, randomized, controlled trial

Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.

Urinary bladder washings in autopsies. A cytopathologic study of 63 cases

The sediment from urinary bladder washings from 63 consecutive autopsies was cytologically studied in order to achieve a better understanding of the changes in urothelial cells collected from hospital populations. The observed alterations were correlated with alterations in the urinary system and with therapy preceding death. The specimens obtained were of good quality. In 39.7% of the cases, the sediment contained giant superficial multinucleated cells. Three of nine cases previously subjected to radiation or chemotherapy showed atypical urothelial cells. In three cases with immunosuppression, there was cytologic evidence of subclinical infection by polyomavirus, and virus particles were identified by electron microscopy of the vesical mucosa. The study of the smear background offered additional information: the sediment contained hyaline or hematic or hyaline-cellular casts in 17.4% of the cases, in all of which there were renal tubulopathies when the kidney sections were studied. The method is useful for a good evaluation of the autopsy as well as for training in urinary cytopathology.

Paracoccidioidomycosis: A comparative study of the evolutionary serologic, clinical and radiologic results for patients treated with ketoconazole or amphotericin B plus sulfonamides

A comparative study of two groups of patients with paracoccidioidomycosis was carried out with the objective of comparing the evolutionary serologic, clinical and radiologic results after 6, 12, 15 and 18 months of treatment with ketoconazole (22 patients) or amphotericin B plus sulfonamides (32 patients). The serologic data analyzed as a whole showed a tendency to sharper drops in antibody titers in the patients treated with ketoconazole. Clinically patients treated with ketoconazole fared better but the differences were not statistically significant. No statistical difference was detected between groups in terms of the results of radiologic evolution. © 1985 Martinus Nijhoff/Dr W. Junk Publishers.

Resposta metabólica de pacientes cirróticos (Child A) ao aumento da ingestão protéica e/ou calórica. Estudo do balanço nitrogenado.

The dietary protein assimilation by cirrhotic undernourished patients (lower lean body mass and plasma TBPA and RBP levels) was investigated in five-adult male subjects suffering from histologically diagnosed liver cirrhosis, in its clinically mild stage (Child-Turcotte-Pugh grade A). During the 9 day-dietary study the patients received orally a sequence of complete-regional diets containing different protein-energy compositions identified as (g prot/Cal/kg/day): D0 = 0.42/20.9; D1 = 0.91/37.5; D2 = 0.99/47.9 and D3 = 1.60/40.5. The respective N-balance values (g/day) found were (mean +/- SD): low protein calorie (D0) = -4.24 +/- 2.46; normal protein calorie (D1) = 0.66 +/- 1.99; normal protein-high calorie (D2) = 1.14 +/- 2.54; high protein normal calorie (D3) = 5.12 +/- 2.48. The correspondent urea-N output (g/kg/day) were D0 = 0.22 +/- 0.100; D1 = 0.238 +/- 0.099; D = 0.20 +/- 0.063 and D3 = 0.310 +/- 0.121. The present data thus suggest that protein rather than energy intake would be the limited factor for increasing the N-retention in (mild) cirrhotic patients whom tolerate well dietary protein at either normal or elevated levels.

Genetic susceptibility to bleomycin: A twin study

The frequency of chromatid breaks was analysed in peripheral lymphocytes obtained from sixteen healthy monozygotic (MZ) and sixteen healthy dizygotic (DZ) pairs of twins. In addition, increases in the frequency of chromatid breaks, following in vitro treatment of whole blood with 0.03 unit/ml bleomycin (BLM), were analysed in the same twins. There was a highly significant intrapair difference in the variance of the frequency of chromatid breaks among MZ and DZ twins, before and after BLM treatment. The coefficient of heritability was 85,5% and it was concluded that genetic factors contributed significantly to the individual variation observed in BLM induced chromatid break rates.

Plasma levels of transthyretin and retinol-binding protein in child-a cirrhotic patients in relation to protein-calorie status and plasma amino acids, zinc, vitamin a and plasma thyroid hormones

Transthyretin and retinal-binding protein are sensitive markers of acute protein-calorie malnutrition both for early diagnosis and dietary evaluation. A preliminary study showed that retinal-binding protein is the most sensitive marker of protein-calorie malnutrition in cirrhotic patients, even those with the mild form of the disease (Child A). However, in addition to being affected by protein-calorie malnutrition, the levels of these short half-life-liver-produced proteins are also influenced by other factors of a nutritional (zinc, tryptophan, vitamin A, etc) and non-nutritional (sex, aging, hormones, renal and liver functions and inflammatory activity) nature. These interactions were investigated in 11 adult male patients (49.9 ± 9.2 years of age) with alcoholic cirrhosis (Child-Pugh grade A) and with normal renal function. Both transthyretin and retinol binding protein were reduced below normal levels in 55% of the patients, in close agreement with their plasma levels of retinal. In 67% of the patients (4/6), the reduced levels of transthyretin and retinal-binding protein were caused by altered liver function and in 50% (3/6) they were caused by protein-calorie malnutrition. Thus, the present data, taken as a whole, indicate that reduced transthyretin and retinal-binding protein levels in mild cirrhosis of the liver are mainly due to liver failure and/or vitamin A status rather than representing an isolated protein-calorie malnutrition indicator.

Efficacy, safety and tolerability of terbinafine for Tinea capitis in children: Brazilian multicentric study with daily oral tablets for 1, 2 and 4 weeks

Background: Tinea capitis is a common skin disease seen predominantly in children. The standard therapies for this disease are griseofulvin and ketoconazole. Nevertheless, these drugs have drawbacks in that they are only fungistatic and require treatment for at least 6 weeks. Previous studies with oral terbinafine for the treatment of Tinea capitis have shown that this agent is effective when given for 4 weeks, comparable to an 8-week regimen with griseofulvin. To date there is no data on the use of oral terbinafine in Brazilian children. Objectives: To assess the efficacy, safety and tolerability of oral terbinafine in short-term treatments (1-, 2- and 4-week treatment) of Tinea capitis in children. Patients and methods: One hundred and thirty-two children aged 1-14 years were enrolled in this study, but only 107 were considered for the final efficacy analysis. Diagnosis included clinical assessment and examination by Wood's light. Confirmation was obtained by direct microscopy and culture for fungus. Terbinafine dosage (125 or 250 mg/day) was adjusted according to patient weight. Efficacy was evaluated both by clinical and mycological assessment. Safety and tolerability variables included data on adverse reaction and clinical laboratory evaluations. Results: Mycological evaluation in the follow-up visit at week 12 showed negative direct microscopy and culture results in 48.6, 60.5 and 69.7% patients in groups 1-, 2- and 4-week, respectively (n.s.). At week 12, 84.8% patients in group 4-week achieved clinical cure with a significant difference compared to groups 1- and 2-week, 54.3 and 60.5%, respectively (P < 0.01). Adverse reactions were present in 4.8, 6.8 and 10.9% of patients in groups 1-, 2- and 4-week, respectively. Terbinafine was not associated with clinically relevant increases in liver function tests. Conclusions: Terbinafine is an effective, well tolerated and safe antifungal agent for the treatment of Tinea capitis m children. The shorter duration of treatment resulted in lower cure rates. However, it is important to note that depending on the severity of the disease, a 1-week-only treatment can also be effective in this indication.