Experiencia en eduación, prevención y control de complicaciones orales de niños con cáncer / Experience in education, prevention and control of oral complications in children with cancer

El tratamiento oncológico actúa no solo en los tejidos enfermos, sino también sobre las células sanas, durante este proceso suelen ocurrir efectos secundarios que pueden aparecer bajo la forma de complicaciones bucales y sistémicas. Son ejemplos mucositis, xerostomía, las infecciones, bacterianas víricas y fúngicas, Objetivo: Evaluar la frecuencia de complicaciones bucales en los niños con cáncer que asistieron a la Facultad de Odontología antes del tratamiento antineoplásico y seis meses después de haber recibido oncoterapia y entrenamiento, para el control de las mismas. Materiales y métodos: La muestra estuvo constituida por 100 niños con diagnóstico de cáncer que procedían de los diferentes hospitales y clínicas privadas de Caracas y sus alrededores. Se realice un cuestionario a los representantes que acompañaban al niño, en el momento de la primera visita para obtener la información inicial, se examinaron los niños, se realizó el tratamiento correspondiente, se entrenaron a los representantes, se controlaron mensualmente por seis meses y se analizaron las complicaciones bucales Resultados: Los representantes no tenían conocimiento inicial sobre las complicaciones bucales. El grupo de edad más afectado fue el comprendido en edades menores a 5 años (48%); el género masculino fue el más afectado (63%); la neoplasia más frecuente fue Linfoma No Hodking (24%); el10% de los niños presento alguna complicación bucal siendo las más frecuentes candidiasis y ulceras. Conclusiones: Enfatizamos la importancia de participación activa del odontopediatra con los representantes del paciente, así como con el oncólogo pediatra, especialmente antes del tratamiento antineoplásico educando sobre los efectos del tratamiento oncológico, ya que son potencialmente nocivos, provocando diversas complicaciones bucales...

Cancer treatment act not only in diseased tissues, but also on healthy cells, during this process often occur side effects that may appear in the form of later oral and systemic. Examples mucositis, xerostomia, infections, bacterial, fungal and viral. Objective: To evaluate the frequency of oral complications in children with cancer who attended the faculty of dentistry before the antineoplastic treatment six months after having received oncoterapia and training, for the control of the same. Materials and methods: The sample consisted of 100 children with diagnosis of cancer that they came from different hospitals and private clinics in Caracas and its surroundings. Was a questionnaire representatives accompanying the child, at the time of the first visit to the initial information, they discussed children, corresponding treatment was carried out, trained representatives, they controlled every month for six months, and oral complications were analyzed Results: Parents had no initial knowledge on oral complications. The age group most affected was understood in ages younger than 5 years (48%); the male gender was the most affected (63%); the most common malignancy was Lymphoma non Hodgkin (24%); 10% of children presented some mouth being the most common candidiasis complication and ulcers. Conclusions: We emphasize the importance of active participation of the dentist with the representatives of the patient, as well as with the oncologist, pediatrician, especially before treatment antineoplastic educating about the effects of cancer treatment, since they are potentially harmful, causing various oral...

Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003).

BACKGROUND: The purpose was to assess in Italy the clinical features at diagnosis of inflammatory bowel disease (IBD) in children. METHODS: In 1996 an IBD register of disease onset was established on a national scale. RESULTS: Up to the end of 2003, 1576 cases of pediatric IBD were recorded: 810 (52%) ulcerative colitis (UC), 635 (40%) Crohn's disease (CD), and 131 (8%) indeterminate colitis (IC). In the period 1996-2003 an increase of IBD incidence from 0.89 to 1.39/10(5) inhabitants aged <18 years was observed. IBD was more frequent among children aged between 6 and 12 years (57%) but 20% of patients had onset of the disease under 6 years of age; 28 patients were <1 year of age. Overall, 11% had 1 or more family members with IBD. The mean interval between onset of symptoms and diagnosis was higher in CD (10.1 months) and IC (9 months) versus UC (5.8 months). Extended colitis was the most frequent form in UC and ileocolic involvement the most frequent in CD. Upper intestinal tract involvement was present in 11% of CD patients. IC locations were similar to those of UC. Bloody diarrhea and abdominal pain were the most frequent symptoms in UC and IC, and abdominal pain and diarrhea in CD. Extraintestinal symptoms were more frequent in CD than in UC. CONCLUSIONS: The IBD incidence in children and adolescents in Italy shows an increasing trend for all 3 pathologies. UC diagnoses exceeded CD.

Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25%, and ropivacaine 0.25% or 0.4%.

BACKGROUND AND OBJECTIVES: To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery. METHODS: Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment. RESULTS: No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups. CONCLUSION: When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Necesidades protésicas de los pacientes que acudieron al Centro de Atención a Pacientes con Enfermedades Infectocontagiosas Dra. Elsa La Corte, CAPEI, de la Universidad Central de Venezuela, entre noviembre del 2003 y noviembre del 2004 / Prosthetic needs of the patients who attended the Center for the Care of Infectio and Contagious Diseases Dra. Elsa La Corte, CAPEI, Central University of Venezuela, between November 2003 and November 2004

Objetivo: El presente estudio fue realizado con la finalidad de conocer las necesidades protésicas de los pacientes que acudieron al Centro de Atención a Pacientes con Enfermedades Infectocontagiosas Dra. Elsa La Corte (CAPEI) de la Universidad Central de Venezuela entre noviembre del 2003 y noviembre del 2004. Materiales y Métodos: Se realizó un estudio descriptivo de tipo transversal con la revisión de 300 historias clínicas. Se analizaron las variables: sexo, nivel de instrucción y necesidades protésicas. Se agruparon los datos y se analizaron con el método de porcentajes y números absolutos. Resultados: El 78,67 por ciento de los pacientes estudiados pertenecían al sexo masculino, el 49 por ciento de estos pacientes cursaron incompletos o terminaron sus estudios de bachillerato. En cuanto a las necesidades protésicas el 73,67 por ciento necesitaban algún tipo de prótesis dental, de estos, el 94,12 por ciento eran edéntulos parciales y el 5, 88 por ciento edéntulos totales. El 74,21 por ciento de los pacientes con necesidades protésicas pertenecían al sexo masculino y el 25,79 por ciento al sexo femenino. Solo el 16,29 por ciento de estos pacientes fueron restaurados protésicamente. Conclusiones: En la población estudiada existe un alto porcentaje de necesidades de prótesis dental, con predominio de prótesis parciales.

Costs associated with outpatient diarrhoea in infants and toddlers: a nationwide study of the Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP).

BACKGROUND: As diarrhoea mortality is negligible in Italy, other costs should be considered when planning health strategies. Little is known about the costs associated with diarrhoea in Italian children. AIMS: To assess the costs associated with outpatient infantile diarrhoea in Italy. METHODS: Primary care paediatricians from five regions filled in a questionnaire for the first 10 children (1-47 months) they visited for acute diarrhoea during a 3-month period. RESULTS: We analysed 473 questionnaires. Mean age (standard deviation) of children was 21 (11) months; mean duration of diarrhoea (standard deviation) was 4.3 (2.6) days. An overall cost of 110 (137) euro per episode was estimated, with significant difference between children younger and older than 36 months (116 euro versus 72 euro). Missed work by relatives accounts for 75% of the cost. The parents of children attending a day-care centre had an increased risk to miss work (relative risk = 2.15). A weak relationship was found between days of diarrhoea and missed work (r = 0.30); it could be estimated that the diarrhoea should be shortened by about 4 days in order to save I day of missed work. CONCLUSIONS: Acute outpatient diarrhoea is associated with a significant financial burden in Italy. Simply shortening the diarrhoea does not seem to be the most expeditious way to reduce the cost of diarrhoea itself.

Manifestaciones bucales e infecciones oportunistas mas frecuentes encontradas en 208 pacientes con infección por VIH/SIDA / Most frequent oral manifestations and oportunistic infections found in 208 patients with HIV/AIDS infection

La historia natural de la infección por VIH/SIDA ha sido descrita como un deterioro insidioso y progresivo del sistema inmune; generalmente esto se acompaña con el reconocimiento de algunas manifestaciones bucales; las mismas son de gran importancia porque podrÝan representar el primer signo de esta enfermedad. El propósito de este estudio fue determinar los tipos y la prevalencia de lesiones bucales asociadas a la infección por VIH/SIDA y la prevalencia de infecciones oportunistas. MÚtodos: este es un estudio descriptivo, transversal, preliminar y exploratorio que incluye un grupo de pacientes con evidencia serológica de infecicón por VIH/SIDA, los cuales fueron examinados durante el perÝodo comprendido entre los meses de noviembre de 1998 y julio del 2000. Resultados: dentro de este grupo de pacientes, 108 (66 por ciento) presentaron lesiones bucales. Las mßs comunes fueron: candidasis (48.7 por ciento), leucoplasia vellosa (12.3 por ciento), herpes labial (11.7 por ciento), otras lesiones bucales fueron: leucoplasia (6.5 por ciento), hiperpigmentación melßnica (4.5 por ciento). Las enfermedades infecciosas oportunistas mßs frecuentes fueron la hepatitis (14.9 por ciento), neumonÝa por pneumocistis carinii (11.5 por ciento), infección por el virus del herpes zoster (8.6 por ciento) y toxoplasmosis (8.6 por ciento). Conclusión: los pacientes con infeccion por VIH/SIDA presentan un amplio espectro de manifestaciones bucales e infecciones oportunistas, por lo tanto el reconocimiento, diagnóstico, manejo y tratamiento adecuado son importantes para el mejoramiento de la calidad de vida de estos individuos

HLA-DP polymorphism in northern Italian celiac patients.

The contribution of HLA-DP genes to celiac disease susceptibility has been investigated in 95 Italian patients, 41 with childhood and 54 with adult disease onset. Polymerase chain reaction amplification, sequence-specific oligonucleotide probe hybridization and restriction fragment length polymorphism analyses have been carried out. All celiac patients and 56 out of 128 random healthy controls were DQw2-positive. The frequency of the DPB1*0101 allele was significantly increased (pc = 0.002, relative risk 5.21) in patients with celiac disease (23.2%) compared to the whole panel of controls (5.5%), but not to the 56 controls bearing DQw2 (10.7%). No significant difference in the frequency of DPB1*0101 was found between celiac patients with pediatric (24.4%) or adult (22.2%) onset. The DPB1*0101 allele was associated with both the DR3-DQw2 and DR7-DQw2 haplotypes. Moreover, our study has not confirmed the association with DPB1*0402 and DPB1*0301 previously reported in celiac children from southern Italy. The linkage of the DPB1*0101 allele with the DQ locus and the observation that the DP but not the DQ association appears to be ethnically dependent strongly support a secondary role of DP molecules in celiac disease susceptibility.

Coeliac disease, epilepsy, and cerebral calcifications. The Italian Working Group on Coeliac Disease and Epilepsy.

There have been anecdotal reports of an association between coeliac disease and epilepsy with cerebral calcifications that resemble those of the Sturge-Weber syndrome. A series of patients who had epilepsy with calcifications, in whom coeliac disease (CD) was incidentally observed, prompted us to study this association. 43 patients (15 male, age range 4.6-30.7 years) were selected from two series. 31 patients with cerebral calcifications of unexplained origin and epilepsy (series A) underwent intestinal biopsy. 12 patients with CD and epilepsy (series B) underwent computed tomography. Antibodies to gluten, folic acid serum concentrations, were measured, and HLA typing was done in most patients. 24 of the series A patients were identified as having CD on the basis of a flat intestinal mucosa (15/22 with a high concentration of serum antigluten), and 5 series B patients showed cerebral calcifications, giving a total of 29 cases with the combination of CD, epilepsy, and cerebral calcifications (CEC). In 27 of these CEC patients, calcifications were located in the parieto-occipital regions. Only 2 of the series A patients had gastrointestinal symptoms at the time of intestinal biopsy; most patients had recurrent diarrhoea, anaemia, and other symptoms suggestive of CD in the first 3 years of life. The epilepsy in CEC patients was poorly responsive to antiepileptic drugs. Gluten-free diet beneficially affected the course of epilepsy only when started soon after epilepsy onset. Cases of "atypical Sturge-Weber syndrome" (characterised by serpiginous cerebral calcifications and epilepsy without facial port-wine naevus) should be reviewed, and CD should be ruled out in all cases of epilepsy and cerebral calcifications of unexplained origin.

Celiac disease, posterior cerebral calcifications and epilepsy.

Ten patients (5 males) affected by epilepsy with cerebral calcifications of unknown etiology mainly located in the posterior regions were subjected to a battery of tests including an intestinal biopsy. Our aim was to establish whether or not the patients also suffered from celiac disease. Celiac diseases was found in 6 patients. This result and the individual cases reported in the literature suggest that this triad of diseases (celiac disease, posterior cerebral calcifications and epilepsy) are casually related. The same HLA phenotype was found in all 10 patients, i.e., including the cases without celiac disease, suggesting an underlying disorder of the immune system. Our results emphasize that particular attention should be paid to a search for celiac disease in all patients with epilepsy and posterior cerebral calcifications.

[Usefulness of the integration between the values of the 1-hour blood xylose test and the hydrogen breath-test after xylose oral load for the indirect evaluation of mucosa damage]. / Utilità dell'integrazione tra i valori del test della xilosemia dopo 1h, e del breath-test dell'H2 dopo carico orale di xilosio per la valutazione indiretta del danno mucosale.

Considering 50 children affected by sub-acute gastrointestinal diseases by severe growth disorders, we have compared the "one-hour blood xylose test" with the "xylose and lactose H2 breath test, looking for a relationship with the duodeno-jejunal mucosal damage. Finally the integration between the "one hour blood xylose test" and the "xylose H2 breath test" may be useful in order to compare more exactly the results of both xylose tests with the mucosal damage. Lactose H2 breath test seems less reliable for our purposes because of the possible presence of children with lactase deficiences, hardly comparable with the mucosal damage.

Rectal diazepam: a clinical and EEG study after a single dose in children.

EEG monitoring was performed on a group of ten children, aged 3 days to 13 years, during admission to the Paediatric Clinic at the University of Bologna for seizures. Diazepam was injected by rectal route as an anticonvulsant, using a dose of 0.5-1 mg/kg in the first nine children, whereas an intravenous bolus was administered to the last child. The main aim of this study was to document the time taken for the drug to reach the brain and to modify the electrical activity. We observed significant EEG changes between 1 and 9.30 min and, in particular, the appearance of fast activity over one or both hemispheres after rectal diazepam. The EEG results confirm the clinical efficacy of rectal diazepam.