[The management of nephropathic patients during the Covid-19 pandemic: the experience of Ragusa].

The public emergency caused by Covid-19 has forced health services to reorganize in order to separate positive patients from negative ones. In nephrology, this reorganization involves several levels of assistance concerning hospitalizations, ambulatory care and haemodialysis. Within the Complex Unit of Nephrology in Ragusa, the distribution of nephro-dialytic resources has involved four different hospitals, hence ensuring haemodialysis services for asymptomatic and pauci-symptomatic Covid-19 patients as well as for patients in Covid-Unit, Sub-Intensive Therapy and Intensive Care Unit. In this complex context, we had to create a common protocol involving all the professionals who provide assistance in our Unit, across the different structures. We also report some encouraging data that seem to indicate the effectiveness of the protocols put in place.

Chronic kidney disease in children: Assessment of oral health status.

BACKGROUND: Oral disease may be more prevalent in people with chronic kidney disease (CKD) due to the underlying pathology and its treatment. In children, it can elicit a wide spectrum of oral manifestations, including saliva changes, mucosal lesions, oral infection, gingivitis, and dental anomalies (mostly hypoplasia). OBJECTIVES: The aim of the study was to determine the oral health status in a group of children with CKD and to compare with that from healthy controls. MATERIAL AND METHODS: A clinical cross-sectional study was conducted between June 2016 and September 2017 on 126 pediatric patients. Oral findings in a group of 65 children suffering from CKD were compared with a control group consisting of 61 individuals, free of any disease. We obtained an assessment of the oral health status by collecting carious, debris, calculus, gingival conditions, hypoplasia, and salivary flow rate data by using specific indexes. Medical and dental history was obtained for each subject. RESULTS: We found that children with CKD have a lower prevalence of caries for both permanent dentition (p = 0.019) and primary dentition (p = 0.008), while the prevalence of calculus, debris, gingivitis and enamel hypoplasia seems to be higher (all p < 0.005). A significantly reduced salivary flow rate was also noted in the CKD children, both in unstimulated (p = 0.037) and stimulated (p = 0.026) conditions. CONCLUSIONS: CKD pediatric patients are more likely to present oral and dental changes than healthy children, so proper oral care and preventive measures should be taken to avoid potentially severe dental problems.