Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives.

Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

Infecções parasitárias intestinais em crianças e adolescentes na comunidade: aspectos socioeconômicos e higiênico-sanitários / Intestinal parasite infections among children and adolescents in the community: socioeconomic and hygienic-sanitary aspects

Introdução: as parasitoses intestinais estão distribuídas mundialmente e são frequentes entre indivíduos com maior contato interpessoal. A prevalência destas infecções reflete a precariedade das condições sanitárias e socioeconômicas que propiciam sua disseminação na população. Objetivos: determinar a frequência de parasitos intestinais e analisar o perfil socioeconômico e higiênico-sanitário entre crianças e adolescentes em Vitória da Conquista, Bahia, Brasil. Metodologia: estudo transversal conduzido em 116 participantes a partir de entrevista e análise coproparasitológica segundo o método Hoffman, Pons e Janer. O programa EpiInfo Windows versão 3.5.4 foi utilizado para a criação e análise dos bancos de dados. Valor de p<0,05 e IC de 95% foram considerados como significativos. Resultados: foi identificada prevalência de 77,6% de indivíduos parasitados. A média de idade foi de 9,6 anos e 57,8% eram do sexo masculino. Os patógenos mais frequentes foram Giardia duodenalis (35,5%), Entamoeba histolytica/dispar (16,6%), Enterobius vermicularis (3,3%) e Ascaris lumbricoides (1,1%). Organismos comensais foram encontrados em 93,3% dos indivíduos infectados. Verificou-se que 97,8% tinham abastecimento de água tratada; 76,7% possuíam rede de esgoto; 86,7% tinham acesso à coleta de lixo; 72,2% consumiam água filtrada ou fervida em casa e 41,1% declararam higienizar as frutas, verduras e hortaliças antes do consumo. Conclusão: foi identificada alta taxa de parasitismo retratando as condições socioeconômicas e higiênico-sanitárias da população estudada. Destaca-se a necessidade de maiores esforços para a realização de programas de educação em saúde para que a população seja modificadora da sua realidade a partir da conscientização sobre a problemática.

Introduction: intestinal parasites are distributed worldwide and are frequent among individuals with greater interpersonal contact. The prevalence of these infections reflects the precariousness of the sanitary and socioeconomic conditions that promote their dissemination in the population. Objectives: to determine the frequency of intestinal parasites and to analyze the socioeconomic and hygienic-sanitary profile among children and teenagers in Vitória da Conquista, Bahia, Brazil. Methods: cross-sectional study conducted in 116 participants based on interview and parasitological analysis of feces according to the Hoffman, Pons and Janer method. The EpiInfo Windows version 3.5.4 software was used to create and analyze the databases. p-value <0.05 and 95% CI were considered significant. Results: a prevalence of 77.6% of parasitized individuals was identified. The average age was 9.6 years and 57.8% were male. The most frequent pathogens were Giardia duodenalis (35.5%), Entamoeba histolytica/dispar (16.6%), Enterobius vermicularis (3.3%) and Ascaris lumbricoides (1.1%). Commensal organisms were found in 93.3% of infected individuals. It was found that 97.8% had treated water supply; 76.7% had a sewage system; 86.7% had access to garbage collection; 72.2% consumed filtered or boiled water at home and 41.1% declared to clean fruits, vegetables and vegetables before consumption. Conclusion: we identified a high rate of parasitism representing the socioeconomic and hygienic-sanitary conditions of the studied population. We highlight the need for greater efforts in carrying out health education programs so that the population can modify their reality based on awareness of the problem.

Transmission of severe acute respiratory syndrome coronavirus 2 via fecal-oral: Current knowledge.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 93 million cases and 2 million deaths in the world. SARS-CoV-2 respiratory tract infection and its main clinical manifestations such as cough and shortness of breath are well known to the scientific community. However, a growing number of studies have reported SARS-CoV-2-related gastrointestinal involvement based on clinical manifestations, such as diarrhea, nausea, vomiting, and abdominal pain as well as on the pathophysiological mechanisms associated with coronavirus disease 2019. Furthermore, current evidence suggests SARS-CoV-2 transmission via the fecal-oral route and aerosol dissemination. Moreover, studies have shown a high risk of contamination through hospital surfaces and personal fomites. Indeed, viable SARS-CoV-2 specimens can be obtained from aerosols, which raises the possibility of transmission through aerosolized viral particles from feces. Therefore, the infection by SARS-CoV-2 via fecal-oral route or aerosolized particles should be considered. In addition, a possible viral spread to sources of drinking water, sewage, and rivers as well as the possible risk of viral transmission in shared toilets become a major public health concern, especially in the least developed countries. Since authors have emphasized the presence of viral RNA and even viable SARS-CoV-2 in human feces, studies on the possible fecal-oral coronavirus disease 2019 transmission become essential to understand better the dynamics of its transmission and, then, to reinforce preventive measures against this infection, leading to a more satisfactory control of the incidence of the infection.

Soft tissue Rosai-Dorfman disease of the posterior mediastinum.

Rosai-Dorfman disease (RDD) consists of sinus histiocytosis with massive lymphadenopathy. Extranodal involvement occurs in up to 43% of cases. However, isolated soft tissue RDD is rare. Isolated mediastinal RDD is exceedingly rare, and there have been only three previous reports. Involvement of the posterior mediastinum in RDD has been reported only in the context of disseminated RDD. Here, we report the case of a 49-year-old female patient with a two-year history of cervical pain and lymphadenomegaly, which resolved spontaneously. A CT scan revealed a left paravertebral mass with a diameter of 6 cm. The patient was submitted to surgical excision of the mass. Microscopic examination and immunophenotyping of the surgical specimen led to a diagnosis of RDD. During a 12-month follow-up period, the patient complained of mild cough and chest pain. Periodic imaging tests showed no sign of recurrence, and no postoperative cervical lymphadenomegaly was detected.

Soft tissue Rosai-Dorfman disease of the posterior mediastinum / Doença de Rosai-Dorfman de partes moles no mediastino posterior

Rosai-Dorfman disease (RDD) consists of sinus histiocytosis with massive lymphadenopathy. Extranodal involvement occurs in up to 43% of cases. However, isolated soft tissue RDD is rare. Isolated mediastinal RDD is exceedingly rare, and there have been only three previous reports. Involvement of the posterior mediastinum in RDD has been reported only in the context of disseminated RDD. Here, we report the case of a 49-year-old female patient with a two-year history of cervical pain and lymphadenomegaly, which resolved spontaneously. A CT scan revealed a left paravertebral mass with a diameter of 6 cm. The patient was submitted to surgical excision of the mass. Microscopic examination and immunophenotyping of the surgical specimen led to a diagnosis of RDD. During a 12-month follow-up period, the patient complained of mild cough and chest pain. Periodic imaging tests showed no sign of recurrence, and no postoperative cervical lymphadenomegaly was detected.

A doença de Rosai-Dorfman (DRD) consiste em histiocitose sinusal com linfadenopatia maciça. O envolvimento extranodal ocorre em até 43% dos casos. Entretanto, a DRD de partes moles de forma isolada é rara. A forma isolada de DRD mediastinal é muito rara, com apenas três relatos prévios. O envolvimento do mediastino posterior só foi descrito no contexto da DRD disseminada. Relatamos o caso de uma paciente de 49 anos de idade com história de dor e linfadenomegalia cervical há dois anos, com resolução espontânea. A TC revelou uma massa paravertebral à esquerda medindo 6 cm de diâmetro. A paciente foi submetida à ressecção cirúrgica da massa. O exame microscópico e estudo do imunofenótipo da peça cirúrgica definiram o diagnóstico de DRD. A paciente foi acompanhada por 12 meses, queixando-se de tosse discreta e dor torácica. O acompanhamento por imagem não detectou recorrência, e nenhuma linfadenomegalia cervical foi observada após a cirurgia.

Heterotopic intraabdominal ossification: report of a case and review of the literature / Ossificação mesentérica heterotópica: relato de caso e revisão da literatura

There are 28 unequivocal reports of heterotopic mesenteric ossification (HMO) in the medical literature. Most cases are poorly defined lesions in intra-abdominal structures that cause intestinal obstruction. A small well-delineated solid mass was reported in only one patient with no previous history of trauma. We report herein the case of a 67 year-old female patient with calcified mass in the left adnexal region. The awareness of HMO may avoid an erroneous diagnosis of extraskeletal osteosarcoma. This case differs from most cases of HMO as it is the third one reported in females and does not present a diffuse involvement, which leads to obstructive symptoms.

A literatura médica apresenta 28 relatos inequívocos de ossificação mesentérica heterotópica (OMH). A maioria apresenta-se como lesões mal definidas em estruturas intra-abdominais causando obstrução intestinal. Em apenas um caso a lesão apresentava-se como uma pequena massa bem delimitada, num paciente sem histórico de trauma. Apresentamos o caso de uma paciente de 67 anos com massa calcificada em topografia anexial esquerda. O conhecimento da entidade OMH previne eventual diagnóstico errôneo de osteossarcoma extraesquelético. Esse caso difere da maioria dos casos de OMH visto que é apenas o terceiro relatado no sexo feminino, e não apresentava envolvimento difuso levando aos sintomas obstrutivos.