Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review.

OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.

Structural and intermediary determinants in sexual health care access in migrant populations: a scoping review.

OBJECTIVES: Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. STUDY DESIGN: Scoping review. METHODS: The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. RESULTS: A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identified-structural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints, racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. CONCLUSION: The most relevant dimensions identified as barriers to access to health services were "culture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.

Effects of mesenchymal stem cell culture on radio sterilized human amnion or radio sterilized pig skin in burn wound healing.

Deep second and third degree burns treatment requires fibroblasts, keratinocytes and other skin cells in order to grow new dermis and epidermis. Cells can proliferate, secrete growth factors and extracellular matrix required to repair the damaged tissue. Radiosterilized human amnion and radiosterilized pig skin have been used as natural origin skin dressings for burned patients. Adipose-derived mesenchymal stem cells can differentiate into fibroblasts and keratinocytes and improve wound-healing progress. These cells can stimulate vascular tissue formation, release growth factors, synthetize new extracellular matrix and immunoregulate other cells. In this study, we developed mesenchymal stem cells-cellularized skin substitutes based from radiosterilized human amnion or pig skin. Third-degree burns were induced in mice animal models to evaluate the effect of cellularized skin substitutes on burn wound healing. Mesenchymal phenotype was immunophenotypically confirmed by flow cytometry and cell viability was close to 100%. Skin recovery was evaluated in burned mice after seven and fourteen days post-coverage with cellularized and non-cellularized sustitutes. Histological techniques and immunofluorescence were used to evaluate re-epithelization and type I collagen deposition. We determined that cellularized-human amnion or cellularized-pig skin in combination with mesenchymal stem cells improve extracellular matrix deposition. Both cellularized constructs increase detection of type I collagen in newly formed mouse skin and can be potentially used as skin coverage for further clinical treatment of burned patients.

Preservation of protective capacity of hyperimmune anti-Stx2 bovine colostrum against enterohemorrhagic Escherichia coli O157:H7 pathogenicity after pasteurization and spray-drying processes.

Enterohemorrhagic Escherichia coli (EHEC) O157:H7 is a major etiologic agent that causes bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). Shiga toxin (Stx) is the main virulence factor of EHEC responsible for the progression to HUS. Although many laboratories have made efforts to develop an effective treatment for Stx-mediated HUS, a specific therapy has not been found yet. Human consumption of bovine colostrum is known to have therapeutic effects against several gastrointestinal infections because of the peptide and proteins (including antibodies) with direct antimicrobial and endotoxin-neutralizing effects contained in this fluid. We have previously demonstrated that colostrum from Stx type 2 (Stx2)-immunized pregnant cows effectively prevents Stx2 cytotoxicity and EHEC O157:H7 pathogenicity. In this study we evaluated the preservation of the protective properties of hyperimmune colostrum against Stx2 (HIC-Stx2) after pasteurization and spray-drying processes by performing in vitro and in vivo assays. Our results showed that reconstituted HIC-Stx2 colostrum after pasteurization at 60°C for 60 min and spray-dried under optimized conditions preserved specific IgG that successfully neutralized Stx2 cytotoxicity on Vero cells. Furthermore, this pasteurized/dehydrated and reconstituted HIC-Stx2 preserved the protective capacity against EHEC infection in a weaned mice model. The consumption of hyperimmune HIC-Stx2 bovine colostrum could be effective for HUS prevention in humans as well as in EHEC control in calves. However, further studies need to be done to consider its use for controlling EHEC infections.

Obtención de plasma rico en plaquetas (PRP) en el Laboratorio de Terapia Celular para uso como herramienta terapéutica en medicina regenerativa / Obtaining platelet rich plasma (PRP) in the Cell Therapy Laboratory for use as a therapeutic tool in regenerative medicine

Platelet rich plasma (PRP) is used to speed up tissue repair. Despite its widespread use, the therapeutic application of PRP generates controversies in clinical results due to the variability in methods of obtaining the different preparations and differences between the components of different types of PRP, so it's recommended to mention the type of platelet preparation used. In this article, we describe technical and biologics characteristics of our platelet product, and we compare them to different commercial preparations described in order to validate their clinical use. Our results determine that the preparation can be considered a platelet rich plasma with biological activity in vivo and in vitro, which supports its use as a valid therapeutic tool, alternative to products currently available in Regenerative Medicine. (AU)

Editorial - Child oral health; is there anything more to know?

It seems a strange thing to be writing about child oral health in the middle of a virus pandemic that has, in the UK at least, paused all routine dental care. Perhaps not; as thoughts turn to the return of "normal" opera- tion there are concerns over potential ongoing impacts from COVID-19 on health services including stricter infection-control requirements and economic impacts from the lockdown. It invites ridicule to try and predict what will happen in the coming years, but the economic and social impacts are likely to increase vulnerability among the already vulnerable and the delivery of dental care is likely to be more problematic and more expensive. More than ever we need to reduce the burden of avoidable dental disease.

Deprivation and child dental attendance in England: exploring the shape and moderators.

OBJECTIVE: To describe the shape of the relationship between area deprivation and dental attendance (DA) in children aged 5 years and under in England and the modifying effect of caries prevalence, ethnicity, family profile and dentist-to-population ratio. BASIC RESEARCH DESIGN: DA rates were calculated at lower-tier local authority level (LA, n=326) using NHS data for the year to March 2017. LA deprivation was determined by Index of Multiple Deprivation 2015. Caries prevalence was retrieved from the 2016/17 National Dental Epidemiology Programme; ethnicity and family profile from Census 2011 and dentist-to-population ratio from NHS statistics. Fractional polynomial (FP) models explored the shape of the relationship. Multivariable regression models were adjusted for covariates. The effect of moderators was estimated by adjusted marginal effects. CLINICAL SETTING: English Lower-tier LAs. MAIN OUTCOME MEASURE: Shape of the relationship between DA and deprivation and its moderators. RESULTS: Best-fitting second-order FP model (p=0.582) did not provide a better fit for the relationship than the linear model. Therefore, the linear model was selected for final analysis. Deprivation was associated with decreased DA rates (Coefficient=-0.39, 95%CI=-0.53,-0.24; p=⟨0.001); while White ethnicity (Coefficient=0.35, 95%CI=0.29, 0.41; p=⟨0.001), single parenthood (Coefficient = 2.21, 95%CI=0.91,3.51; p=0.001) and caries prevalence (Coefficient =0.34, 95%CI=0.25,0.44; p=⟨0.001) with increased rates. These moderated the relationship. CONCLUSIONS: We hypothesised that the shape of the relationship between deprivation and DA could be curvilinear with higher rates in the extreme ends of deprivation. However, the analysis showed a linear association, moderated by the effect of ethnicity, single parenthood and disease level.

Greater child dental health inequality in England compared to Wales and Northern Ireland, despite lower average disease levels.

INTRODUCTION: Dental caries and inequalities in dental health are major public health concerns. AIM: To report variation in dental caries experience across deprivation quintiles and the magnitude of inequalities between countries. DESIGN: Secondary analyses of cross-sectional data from the 2013 Child Dental Health Survey (CDHS) in England, Wales, and Northern Ireland. MATERIALS AND METHODS: Distribution of dental caries across deprivation quintiles were estimated using as proportions and means. The magnitude of inequalities was calculated using the Relative Index of Inequality (RII). MAIN OUTCOMES: Dental caries experience as indicated by the prevalence (%dmft/DMFT>0) and severity (dmft/DMFT) of 'obvious' and 'clinical' decay experience in both primary and permanent dentitions. RESULTS: Children from more deprived quintiles showed higher prevalence and severity of dental caries. RIIs for dental caries were greater in England than Wales or Northern Ireland, indicating greater relative inequalities despite lower average dental caries experience. The prevalence and severity of dental caries among the most deprived children in England were 1.7 to 3.7 times greater than those of the least deprived. CONCLUSION: There is a deprivation gradient in child dental caries in all three countries, with England showing the greatest inequalities.

Low rates of dental attendance by the age of one and inequality between local government administrative areas in England.

OBJECTIVE: To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN: Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING: Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE: Attending an NHS primary care dental service. RESULTS: DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS: DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.

Fabrication and in vitro behavior of dual-function chitosan/silver nanocomposites for potential wound dressing applications.

We report the synthesis and in vitro evaluation of dual-function chitosan-silver nanoparticles (CTS-AgNPs) films with potential applications as wound dressings. We attempted to formulate nanocomposite films with appropriate AgNPs concentrations to simultaneously display antibacterial activity and suitability for cell culture. Nanocomposites were obtained by CTS-mediated in situ chemical reduction of AgNO3. Circular-shape AgNPs (sizes ca. 7-50 nm) well distributed within the CTS matrices were obtained in concentrations from 0.018 to 0.573 wt%. Efficacy (bacteriostatic and bactericidal properties) of CTS-AgNPs films to decrease planktonic and biofilm bacterial growth was AgNPs concentration- and bacteria strain-dependent. Films showed significant antibacterial activity against Gram-negative E. coli and P. aeruginosa and Gram-positive S. aureus. Antibacterial activity against S. epidermidis was moderated. Films suitability for cell culture was characterized using primary human fibroblasts (HF). HF displayed cell viability higher than 90% and the characteristic fusiform morphology of adhered fibroblast upon culture on films with AgNPs concentration ≤ 0.036 wt%. HF cultured on these films also showed positive expression of tropoelastin, procollagen type I and Ki-67, characteristic proteins of extracellular matrix and proliferative cells, respectively. In vitro assays demonstrated that cytocompatibility/antibacterial properties decreased/increased as silver concentration increased, suggesting that CTS-AgNPS nanocomposite films with ≈0.04-0.20 wt% might be considered as potential temporary dual-function wound dressings.

Shiga toxin-producing Escherichia coli (STEC) O22:H8 isolated from cattle reduces E. coli O157:H7 adherence in vitro and in vivo.

PROBLEM ADDRESSED: Shiga toxin-producing Escherichia coli (STEC) are a group of bacteria responsible for food-associated diseases. Clinical features include a wide range of symptoms such as diarrhea, hemorrhagic colitis and the hemolytic uremic syndrome (HUS), a life-threatening condition. OBJECTIVE: Our group has observed that animals naturally colonized with STEC strains of unknown serotype were not efficiently colonized with E. coli O157:H7 after experimental infection. In order to assess the basis of the interference, three STEC strains were isolated from STEC persistently-colonized healthy cattle from a dairy farm in Buenos Aires, Argentina. METHODS AND RESULTS: The three isolated strains are E. coli O22:H8 and carry the stx1 and stx2d genes. The activatable activity of Stx2d was demonstrated in vitro. The three strains carry the adhesins iha, ehaA and lpfO113. E. coli O22:H8 formed stronger biofilms in abiotic surface than E. coli O157:H7 (eae+, stx2+) and displayed a more adherent phenotype in vitro towards HeLa cells. Furthermore, when both serotypes were cultured together O22:H8 could reduce O157:H7 adherence in vitro. When calves were intragastrically pre-challenged with 108 CFU of a mixture of the three STEC strains and two days later challenged with the same dose of the strain E. coli O157:H7 438/99, the shedding of the pathogen was significantly reduced. CONCLUSIONS: These results suggest that E. coli O22:H8, a serotype rarely associated with human illness, might compete with O157:H7 at the bovine recto-anal junction, making non-O157 carrying-calves less susceptible to O157:H7 colonization and shedding of the bacteria to the environment.

Characterization of pediatric microtia cartilage: a reservoir of chondrocytes for auricular reconstruction using tissue engineering strategies.

The external ear is composed of elastic cartilage. Microtia is a congenital malformation of the external ear that involves a small reduction in size or a complete absence. The aim of tissue engineering is to regenerate tissues and organs clinically implantable based on the utilization of cells and biomaterials. Remnants from microtia represent a source of cells for auricular reconstruction using tissue engineering. To examine the macromolecular architecture of microtia cartilage and behavior of chondrocytes, in order to enrich the knowledge of this type of cartilage as a cell reservoir. Auricular cartilage remnants were obtained from pediatric patients with microtia undergoing reconstructive procedures. Extracellular matrix composition was characterized using immunofluorescence and histological staining methods. Chondrocytes were isolated and expanded in vitro using a mechanical-enzymatic protocol. Chondrocyte phenotype was analyzed using qualitative PCR. Microtia cartilage preserves structural organization similar to healthy elastic cartilage. Extracellular matrix is composed of typical cartilage proteins such as type II collagen, elastin and proteoglycans. Chondrocytes displayed morphological features similar to chondrocytes derived from healthy cartilage, expressing SOX9, COL2 and ELN, thus preserving chondral phenotype. Cell viability was 94.6 % during in vitro expansion. Elastic cartilage from microtia has similar characteristics, both architectural and biochemical to healthy cartilage. We confirmed the suitability of microtia remnant as a reservoir of chondrocytes with potential to be expanded in vitro, maintaining phenotypical features and viability. Microtia remnants are an accessible source of autologous cells for auricular reconstruction using tissue engineering strategies.

Osteogenic potential of murine periosteum for critical-size cranial defects.

Tissue engineering of bone has combined bespoke scaffolds and osteoinductive factors to maintain functional osteoprogenitor cells, and the periosteum has been confirmed as a satisfactory source of osteoblasts. Suitable matrices have been identified that support cell proliferation and differentiation, including demineralised bone matrix (both compatible and osteoinductive) and acellular human dermis. We have evaluated the osteogenic potential of an osteogenic unit, developed by combining periosteum, demineralised bone matrix, and acellular human dermis, in rodents with critical-size cranial defects. Briefly, remnants from the superior maxillary periosteum were used to harvest cells, which were characterised by flow cytometry and reverse retrotranscriptase-polymerase chain reaction (RT-PCR). Cells were cultured into the osteogenic unit and assessed for viability before being implanted into 3 rodents, These were compared with the control group (n=3) after three months. Histological analyses were made after staining with haematoxylin and eosin and Von Kossa, and immunostaining, and confirmed viable cells that stained for CD90, CD73, CD166, runt-related transcription factor, osteopontin, and collagen type I in the experimental group, while in the control group there was only connective tissue on the edges of the bone in the injury zone. We conclude that osteogenic unit constructs have the osteogenic and regenerative potential for use in engineering bone tissue.

Impact of Infection Dose and Previous Serum Antibodies against the Locus of Enterocyte Effacement Proteins on Escherichia coli O157:H7 Shedding in Calves following Experimental Infection.

Escherichia coli O157:H7 is the main causative agent of haemolytic uremic syndrome. Cattle are the main reservoir of these bacteria, and have been shown to develop immune response to colonization. Our aim was to investigate the faecal shedding pattern of E. coli O157:H7 in calves challenged intragastrically with either 10(8) or 10(10) CFU, as well as the ability of specific preexisting antibodies to reduce shedding of the pathogen. Shedding was analysed by direct counting as well as enrichment of rectoanal mucosal swabs. Statistical analysis was performed using a linear model for repeated measures with and without the inclusion of preexisting antibodies against the carboxy-terminal fraction of intimin-γ (γ-intimin C280) as a covariable. Results suggest that there is a statistical difference in the area under the shedding curves between both doses for 14 as well as 28 days after challenge (p = 0.0069 and 0.0209, resp.). This difference is increased when the prechallenge antibodies are taken into account (p = 0.0056 and 0.0185). We concluded that the bacterial dose influences shedding on calves experimentally challenged and that preexisting antibodies against E. coli O157:H7 γ-intimin C280 could partially reduce faecal excretion.

Chondrocyte differentiation for auricular cartilage reconstruction using a chitosan based hydrogel.

Tissue engineering with the use of biodegradable and biocompatible scaffolds is an interesting option for ear repair. Chitosan-Polyvinyl alcohol-Epichlorohydrine hydrogel (CS-PVA-ECH) is biocompatible and displays appropriate mechanical properties to be used as a scaffold. The present work, studies the potential of CS-PVA-ECH scaffolds seeded with chondrocytes to develop elastic cartilage engineered-neotissues. Chondrocytes isolated from rabbit and swine elastic cartilage were independently cultured onto CS-PVA-ECH scaffolds for 20 days to form the appropriate constructs. Then, in vitro cell viability and morphology were evaluated by calcein AM and EthD-1 assays and Scanning Electron Microscopy (SEM) respectively, and the constructs were implanted in nu/nu mice for four months, in order to evaluate the neotissue formation. Histological analysis of the formed neotissues was performed by Safranin O, Toluidine blue (GAG's), Verhoeff-Van Gieson (elastic fibers), Masson's trichrome (collagen) and Von Kossa (Calcium salts) stains and SEM. Results indicate appropriate cell viability, seeded with rabbit or swine chondrocyte constructs; nevertheless, upon implantation the constructs developed neotissues with different characteristics depending on the animal species from which the seeded chondrocytes came from. Neotissues developed from swine chondrocytes were similar to auricular cartilage, while neotissues from rabbit chondrocytes were similar to hyaline cartilage and eventually they differentiate to bone. This result suggests that neotissue characteristics may be influenced by the animal species source of the chondrocytes isolated.

Involvement of hypoxia and inflammation in early pregnancy loss mediated by Shiga toxin type 2.

INTRODUCTION: Symptomatic or asymptomatic Shiga toxin producing Escherichia coli (STEC) infections during early pregnancy may cause maternal or fetal damage mediated by Shiga toxin type 2 (Stx2). The aim of this study is to elucidate the mechanisms responsible for early pregnancy loss in rats treated with Stx2. METHODS: Sprague Dawley pregnant rats were intraperitoneally injected at day 8 of gestation with a sublethal dose (0.5 ng of Stx2/g of total body weight, 250 µl) of purified Stx2. Control rats were injected with the same volume of PBS. The expression of globotriaosylceramide (Gb3) glycosphingolipid receptor for Stx2 was evaluated by thin-layer chromatography (TLC). Regions of hypoxia in decidual tissue were determined by pimonidazole immunohistochemistry and vascular endothelial growth factor (VEGF) expression by Western blot and immunohistochemistry. Tumor necrosis factor-alpha (TNF-α) levels in serum and decidual tissue were evaluated by ELISA. Serum progesterone levels were determined by RIA. RESULTS: Decidual tissue from both, control and Stx2-treated rats showed similar expression of Gb3 receptor. Intrauterine growth restriction was observed in Stx2-treated rats, associated with hypoxia and an increase of decidual TNF-α levels. Decrease of serum progesterone levels and decidual VEGF expression were also demonstrated. DISCUSSION: Our findings indicate that Stx2 reaches the uteroplacental unit, binds Gb3 and triggers damage in decidual tissue. Poor oxygen supply accompanied with damage in the uteroplacental unit and inflammation could be responsible for the early pregnancy loss. Decrease in the pregnancy protective factors, serum progesterone and local VEGF, may contribute to the pregnancy loss.

Expansores tisulares en reconstrucción de defectos craneofaciales. Estudio multicéntrico retrospectivo / Tissue expansion in reconstruction of craniofacial defects. Multicenter retrospective study

El objetivo del presente estudio es describir y analizar el uso de expansores tisulares para reconstrucción de los defectos craneofaciales en 3 centros de alta complejidad del país (Chile). Corresponde a un estudio descriptivo retrospectivo de pacientes tratados en el Departamento de Cirugía Plástica del Hospital Militar de Santiago, Clínica Alemana e Instituto de Neurocirugía Asenjo entre los años 2004 y 2012 por defectos en el área craneofacial. Recopilamos en un total de 37 pacientes los datos médicos, demográficos, de la operación, tiempo, volumen, número de expansores utilizados, registros fotográficos, complicaciones, volumen de sobrexpansión, y un cuestionario de satisfacción de los pacientes en relación al uso del expansor tisular. Se obtuvo cobertura adecuada del defecto en la totalidad de los casos. En 16 pacientes (43,2 %) mediante el uso de 2 expansores tisulares; en 15 (40,5 %) con 1 expansor; en 4 (10,8 %) con 3 expansores y en 2 pacientes (5,4 %) con 4 expansores. El tiempo total de tratamiento en promedio correspondió a 70 días, con un porcentaje de complicaciones menores en un 35,1 % de los casos, y mayores en un 2,7 % . En relación al cuestionario aplicado, obtuvimos un 94,6 % de respuestas positivas respecto al resultado final de la cirugía; sólo un 54,1 % de los pacientes recomendaría este método de expansión tisular a un tercero. En conclusión, nuestro estudio determina que se logró un buen resultado final, con bajo porcentaje de complicaciones mayores y alto porcentaje de satisfacción en el resultado de la cirugía por parte de los pacientes. La aplicación del cuestionario, resulta útil para la obtención de información más objetiva respecto a la opinión sobre este procedimiento por parte de los pacientes (AU)

Our goal is to describe and analyze the use of tissue expanders for reconstruction of craniofacial defects in 3 highly complex centers in the country (Chile). Corresponds to a retrospective study of patients treated at Hospital Militar de Santiago, Clinica Alemana e Instituto de Neurocirugia Asenjo between 2004 and 2012 by defects in the craniofacial area. We collected in a total of 37 patients medical data, demographic data, operation time, volume, number of expanders used, photographic records, complications, volume overexpansion, and a questionnaire regarding patients' satisfaction with the use of tissue expander. Adequate coverage of the defect was obtained in all cases. In 16 patients (43,2 %) using 2 tissue expanders; in 15 (40,5 %) with 1 expander; in 4 (10,8 %) with 3 expanders and in 2 (5,4 %) with 4 expanders. Total treatment time corresponded on average to 70 days, with a percentage of minor complications in 35,1 % patients and major complications in 2,7 % patients. Regarding the applied questionnaire we obtained 94,6 % of positive responses regarding the final result of the surgery; only 54,1 % of the patients would recommend this method of tissue expansion to a third party. In our study, a good final result was achieved with low rate of major complications and a high rate of satisfaction in the outcome of surgery by patients. The administration of the questionnaire is useful for obtaining more objective information regarding the review of this process by patients undergoing this surgery (AU)

Compromiso neurológico y hematológico por déficit de vitamina B12 en lactante hijo de madre vegetariana: caso clínico / Hematological and neurological compromise due to vitamin B12 deficit in infant of a vegetarian mother: case report

Introducción: La deficiencia de vitamina B12 es una de las complicaciones del vegetarianismo y sus variantes. Los lactantes de madres vegetarianas tienen mayor riesgo de deficiencia y son más lábiles a sus efectos. Objetivo: Relatar un caso para alertar sobre la importancia de la sospecha de deficiencia de vitamina B12 en hijos de madres con hábito vegetariano. Caso clínico: Se presenta una lactante de 12 meses, hija de una mujer vegetariana de larga data, que se presenta con compromiso neurológico y hematológico por déficit de vitamina B12. Luego de un corto período de administración de cianocobalamina parenteral y apoyo enteral nutricional, evoluciona con una notoria mejoría clínica y de laboratorio, aunque aún presenta retraso del desarrollo residual. Conclusiones: La deficiencia de vitamina B12 no es frecuentemente sospechada por el pediatra en lactantes sanos. Sus manifestaciones clínicas pueden ser tan inespecíficas, como la apatía, el rechazo alimentario y el deterioro progresivo del desarrollo psicomotor. Una anamnesis nutricional breve realizada a la madre (con mayor énfasis en aquellas vegetarianas) para estimar sus reservas en el periodo previo, durante y después del parto pueden ser fundamentales para detectar el riesgo déficit de esta vitamina en el niño pequeño.

Introduction: Vitamin B12 deficiency is extremely common in strict vegetarians and their variants. Infants of vegetarian mothers have a higher risk of deficiency and are more prone to its effects. Objective: To report a case in order to warn people about the importance of suspected vitamin B12 deficiency in children of vegetarian mothers. Case report: A 12-month old infant, daughter of a longtime vegetarian woman, who presented neurological and hematological compromise due to vitamin B12 deficiency, is discussed. After a short period of parenteral administration of cyanocobalamin and enteral nutrition, the patient evolved with clinical and laboratory improvement, although she still had residual development delay. Conclusions: Vitamin B12 deficiency is often not suspected by the pediatrician in healthy infants. Clinical manifestations can be nonspecific, such as apathy, food refusal and progressive impairment of psychomotor development. A nutritional anamnesis performed on the mother (with great emphasis on those strict vegetarians) to estimate her reserves in the period prior to, during and after delivery can be critical to detect the risk of this vitamin deficiency in young children.