Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group.

Preschool wheezing should be considered an umbrella term for distinctive diseases with different observable and measurable phenotypes. Despite many efforts, there is a large gap in knowledge regarding management of preschool wheezing. In order to fill this lack of knowledge, the aim of these guidelines was to define management of wheezing disorders in preschool children (aged up to 5 years). A multidisciplinary panel of experts of the Emilia-Romagna Region, Italy, addressed twelve different key questions regarding the management of preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes) and systematic reviews have been conducted on PubMed to answer these specific questions, with the aim of formulating recommendations. The GRADE approach has been used for each selected paper, to assess the quality of the evidence and the degree of recommendations. These guidelines represent, in our opinion, the most complete and up-to-date collection of recommendations on preschool wheezing to guide pediatricians in the management of their patients, standardizing approaches. Undoubtedly, more research is needed to find objective biomarkers and understand underlying mechanisms to assess phenotype and endotype and to personalize targeted treatment.

Risk Factors Affecting Development and Persistence of Preschool Wheezing: Consensus Document of the Emilia-Romagna Asthma (ERA) Study Group.

Wheezing at preschool age (i.e., before the age of six) is common, occurring in about 30% of children before the age of three. In terms of health care burden, preschool children with wheeze show double the rate of access to the emergency department and five times the rate of hospital admissions compared with school-age asthmatics. The consensus document aims to analyse the underlying mechanisms involved in the pathogenesis of preschool wheezing and define the risk factors (i.e., allergy, atopy, infection, bronchiolitis, genetics, indoor and outdoor pollution, tobacco smoke exposure, obesity, prematurity) and the protective factors (i.e., probiotics, breastfeeding, vitamin D, influenza vaccination, non-specific immunomodulators) associated with the development of the disease in the young child. A multidisciplinary panel of experts from the Emilia-Romagna Region, Italy, addressed twelve key questions regarding managing preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes). Systematic reviews have been conducted on PubMed to answer these specific questions and formulate recommendations. The GRADE approach has been used for each selected paper to assess the quality of the evidence and the degree of recommendations. Based on a panel of experts and extensive updated literature, this consensus document provides insight into the pathogenesis, risk and protective factors associated with the development and persistence of preschool wheezing. Undoubtedly, more research is needed to improve our understanding of the disease and confirm the associations between certain factors and the risk of wheezing in early life. In addition, preventive strategies must be promoted to avoid children's exposure to risk factors that may permanently affect respiratory health.

Experiência inicial da terapia hiperbárica na síndrome de fournier em um hospital de referência no sul catarinense / Initial experience hyperbaric therapy fournier syndrome in a referral hospital in southern Santa Catarina

Introdução: A Gangrena de Fournier é uma fasceítenecrotizante que afeta a região escrotal e a área perineal.Métodos: Foram revisados os prontuários de 8pacientes que tinham o diagnóstico de Gangrena deFournier e que foram submetidos ao tratamento de oxigenioterapiahiperbárica como forma adjuvante entre operíodo de março de 2010 a abril de 2011 no HospitalSão José, Criciúma,SC analisando-se as variáveis: sexo,idade, etiologia, localização da lesão, procedimentoscirúrgicos realizados. Resultados: A maioria foram homenscom idade média de 32,8 anos. O local mais comumde acometimento foi a região urogenital. Agenteetiológico mais frequentemente encontrado foi Enterobacteragglomerans. Todos foram submetidos à desbridamentocirúrgico, sendo que foi realizado colostomiaem três pacientes. A quantidade média de desbridamentoscirúrgicos foi de 2,5. O tempo médio de permanênciahospitalar foi de 45 dias. A média de sessõesem câmera hiperbárica foi de 20,2 sessões. Um pacienteevoluiu para óbito. Discussão: O diagnóstico precocedesta síndrome é fundamental para o sucesso no tratamentoque tem como base a estabilização clínica ecorreção de possíveis distúrbios, além do tratamentocirúrgico que consiste em extenso desbridamento detecidos lesados. A Oxigenioterapia Hiperbárica comométodo adjuvante tem mostrado excelentes resultadose deve ser utilizada como método adicional ao tratamentotradicional com estudos mostrando uma menortaxa de mortalidade. Esta é uma experiência, com númeropequeno de pacientes, porém com excelentes resultadosnos casos realizados.

Introduction: Fournier gangrene is a necrotizing fasciitisaffecting the scrotum and perineal area. Methods:We reviewed the medical records of eight patientswho were diagnosed with Fournier?s gangrene and whounderwent hyperbaric oxygen treatment as adjuvantform between the period march 2010 to april 2011in São José Hospital, Criciúma, SC analyzing variables:gender, age, etiology, lesion location, surgical proceduresperformed. Results: The majority were men with amean age of 32.8 years. The most common site of involvementwas the urogenital region. Etiologic agentwas most frequently found Enterobacter agglomerans.All underwent surgical debridement, and colostomywas performed in three patients. The average numberof debridements was 2.5. The mean hospital stay was45 days. The average number of sessions in the hyperbaricchamber sessions was 20.2. One patient died. Discussion:Early diagnosis of this syndrome is critical tosuccess in treatment is based on clinical stabilizationand correction of potential disturbances, and surgicaltreatment consisting of extensive debridement of injuredtissues. Hyperbaric Therapy as adjunctive methodhas shown excellent results and should be used as an72 additional method to traditional treatment with studiesshowing a lower mortality rate. This is an experience,with small number of patients, but with excellent resultsin cases performed.

Disfunçäo muscular da articulaçäo temporo-mandibular / Muscular disfunction of the temporomandibular articulation

Foram estudados 100 casos de disfunçäo muscular da Articulaçäo Temporomandibular (ATM). Evidenciou-se "a maloclusäo", como fator etiológico principal. Esses casos permitiram observar a freqüência, tanto do desequilíbrio, quanto do desarranjo muscular existente em todo o sistema estomatolgnático