Anxiety related to dental care in children and adolescents in a low-income Brazilian community.

AIM: The aims of this study were to determine the prevalence of anxiety related to dental care and analyse associated factors in children and adolescents in a low-income community in Recife, Brazil. STUDY DESIGN: A cross-sectional study was conducted with 101 children and adolescents from both genders, aged from 6 to 16 years. METHODS: The dependent variable, anxiety related to dental care, was obtained by the dental anxiety questionnaire (DAQ). The independent variables were: the previous experience, the pain history and DMFT-dmft. STATISTICS: Chi square test was performed to analyse the associations. In the multivariate analysis, binary logistic regression was performed. RESULTS: The probability of females in the sample experiencing anxiety was 3.1 times higher compared to males (OR 3.1 [1.3-7.2]). Children and adolescents who had never visited a dentist showed a level of anxiety 5.6 times higher than those who did (OR 5.6 [1.3-22.7]). CONCLUSIONS: Anxiety related to the dental care presented a prevalence of 36.6 % in a population aged 6-16 years. Females in this group, as well as subjects who had never been to the dentist were more likely to present anxiety.

Clinical manifestation of selective IgA deficiency evidence after anti-TNF-α treatment in a psoriatic arthritis patient: case report.

It is known that the use of anti-TNF-α drugs is related to an increased incidence of infective diseases. This therapy can not be administered to patients having active infections and it has to be considered with caution in case of acquired or congenital immunodeficiency diseases. We report the case of a 28-years-old man affected by psoriatic arthritis; he developed some infections during treatment with TNF-α blockers. The infections were caused by a selective IgA deficiency, that was not evident before the anti-TNF-α blockers administration and disappeared after withdrawing the biological therapy. This case-report draws our attention to the possibility of cases of subclinical immunodeficiency, unknown by the patients, but important in the prognosis and in the therapeutic approach to these diseases. Therefore, it is important to evaluate carefully the immunologic status of patients during the pre-therapeutic screening for TNF-α blocking therapy.

[Methotrexate in the treatment of peripheral arthritis in ulcerative colitis]. / Il methotrexate nella terapia dell'artrite periferica in corso di rettocolite ulcerosa.

OBJECTIVE: To evaluate efficacy of methotrexate treatment in peripheral arthritis of ulcerative colitis. METHODS: We studied 18 patients (10/8 M/F; mean age: 38.90 yrs; range: 21-65 yrs), with peripheral arthritis (14 with polyarticular, 4 with oligoarticular subset) associate ulcerative colitis. Methotrexate 20 mg/week was administered in our patients, who were already receiving mesalazina for inflammatory bowel disease. At baseline, after 3 (T1), 6 (T2) and 12 months (T3) serological parameters (ESR and CRP), functional status (HAQ) and disease activity (VAS, GH, Ritchie articular index) were evaluated. RESULTS: During the therapy a significant improvement was observed in disease activity, functional status and serological parameters since T1. ESR and CRP did not change at T2 and T3. Instead VAS, GH, Ritchie articular index and HAQ had a significant and gradual improvement from T1 to T3. CONCLUSION: Methotrexate treatment was efficacious in the treatment of peripheral arthritis associate ulcerative colitis. This drug induced improvement in disease activity, functional status and serological parameters after 3 months of therapy.

Relationship between nonalcoholic fatty liver disease prevalence and visceral fat in obese adolescents.

BACKGROUND: Visceral adiposity is the major risk factor for paediatric nonalcoholic fatty liver disease. AIMS: Determine the prevalence of nonalcoholic fatty liver disease according to the visceral fat quartile. SUBJECTS: 181 obese adolescents including 113 girls (16.58+/-1.56 years) and 68 boys (16.87+/-1.62 years) were evaluated. METHODS: The inclusion criteria were obesity and post-pubertal stage of Tanner. Visceral fat of obese adolescents was distributed in quartiles after ultrasound nonalcoholic fatty liver disease diagnosis. RESULTS: Nonalcoholic fatty liver disease prevalence was 45.30%. It was observed that 62.07% and 76.47% of girls and boys with nonalcoholic fatty liver disease were found in the 4th quartile. In a multivariate logistic analysis it was observed that only visceral fat remained statistically significant, every 1cm increase in visceral fat was associated with a 1.97 fold (95% CI 1.06-3.66) in boys and 2.08 fold (95% CI 1.38-3.13) in girls increased risk to develop nonalcoholic fatty liver disease. Indeed it was verified a positive correlation between visceral fat, body mass index, insulin levels, homeostasis model assessment insulin resistance index and steatosis degree. CONCLUSIONS: Our findings suggested that the expansion of visceral fat was a determinant factor to increase nonalcoholic fatty liver disease prevalence and the visceral fat measured by ultrasound might be a good predictor to identify risk for nonalcoholic fatty liver disease in obese adolescents. It was confirmed by a stronger correlation between visceral fat and body mass index.

Macroenzyme investigation and monitoring in children with persistent increase of aspartate aminotransferase of unexplained origin.

Ten children with asymptomatic persistent cryptogenic increased serum levels of aspartate aminotransferase (AST) were screened for detection and monitoring of AST macroenzyme (macroAST). MacroAST was found in 4 patients; their serum AST levels were significantly higher than in those without biochemical evidence of macroAST (mean +/- SD: 515 +/- 433 and 78 +/- 16 IU/L, respectively; P = .0095). MacroAST was a persistent, benign phenomenon and was probably not congenital.

Diagnostic value of various serum antibodies detected by diverse methods in childhood celiac disease.

The diagnostic performances of antiendomysium IgA detected on monkey esophagus and human umbilical cord smooth muscle, of antireticulin IgA, and of antigliadin IgA and IgG were calculated in 74 children with celiac disease (CD) or other gastrointestinal disorders. We also compared four methods for gliadin antibody detection. With a diagnostic specificity of 100%, diagnostic sensitivity was 94% for antireticulin IgA, 93% for antiendomysium IgA when detected on human umbilical cord smooth muscle, and 97% when detected on monkey esophagus. The diagnostic sensitivity for gliadin antibody was highest with an ELISA procedure, followed by fluorogenic detection (94% for IgG, 91% for IgA, 97% with IgA and IgG combined). Because of its high diagnostic sensitivity and ease and speed of use, the combined antigliadin IgG and IgA antibody assay is suitable for screening large groups of patients. In IgG- or IgA-positive cases, the more demanding and more specific antiendomysium IgA evaluation is required to confirm suspected CD.

Differential diagnosis between hepatocellular carcinoma and cirrhosis through a discriminant function based on results for serum analytes.

We applied a multivariate analysis to a large series of serum biochemical tests in an attempt to identify a function that could efficiently discriminate cirrhosis from hepatocellular carcinoma (HC). We analyzed two successive temporal cohorts (1987-90; 1991-94) of HC and cirrhotic patients, all histologically classified (first cohort: 69 cirrhosis and 39 HC; second cohort: 66 cirrhosis and 38 HC). Using data from the first temporal cohort of patients, we obtained a discriminant function based on seven serum analytes: alpha-fetoprotein, the hepatic isoenzyme of alkaline phosphatase, lactate dehydrogenase isoenzyme 5, total gamma-glutamyltransferase (GGT), GGT isoforms complexed with low-density lipoprotein, aspartate aminotransferase, and copper. The same panel of analytes emerged when the second cohort was tested and also when both cohorts were tested together. In the two successive cohorts (total, 212 patients) with a prevalence of cirrhosis vs HC of approximately 2:1, the discriminant function correctly classified 93% of cases, the highest percentage of correct classification of the two diseases obtained so far by laboratory approaches. Validation with the jackknife reallocation statistical algorithm confirmed these results. In addition, of six patients with liver cirrhosis for whom we had the opportunity of following up and observing the evolution to HC, five were classified as HC at diagnosis by the multivariate discriminant analysis; i.e., discriminant analysis provided a diagnostic lead time of 6-12 months over histology. This discriminant function, based on easy-to-perform serum biochemical tests, may help solve a fundamental problem of differential diagnosis in the evolution of chronic liver diseases from cirrhosis to HC.

Detection of Strongyloides stercoralis in the cerebrospinal fluid of a patient with acquired immunodeficiency syndrome.

We report a case of Strongyloides stercoralis hyperinfection syndrome in a patient with acquired immunodeficiency syndrome with CNS involvement who died despite prompt institution of thiabendazole.