Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease

Introduction: Exclusive enteral nutrition (EEN) is recommended as first line therapy for mild to moderate Crohn’s disease (CD) to induce remission in pediatric patients. It involves the use of a whole protein formula given exclusively for six to eight weeks. Aims: To report the preliminary experience of a tertiary care center in Portugal, concerning the efficacy and tolerance of EEN in pediatric patients with CD. Materials and methods: Retrospective descriptive study of pediatric CD patients who received EEN as induction of remission therapy between January/2014 and June/2019. Clinical and laboratory parameters were assessed, including clinical disease activity and nutritional status before and immediately after treatment. Results: In the study period, 37 patients were diagnosed with CD; 19 were included in the study, 17/19 (89.5%) completed the EEN therapy and 16/17 (94%) achieved clinical remission. Ten patients were male, with a median (IQR) age of 14.2 years (11.8; 16.7 years). The majority of the patients had ileocolonic disease (47.4%) or ileocecal disease (42.1%) and an inflammatory behavior (78.9%). None of the patients had growth delay at diagnosis. All patients received EEN orally for six to eight weeks, 18 used polymeric formulas and one used an elemental formula. Comparing data at baseline and after treatment, significant improvements were observed in BMI Z-score (p=0.002), PCDAI score (p<0.001), erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.003), faecal calprotectin concentration (p=0.036), and serum albumin (p=0.020). No side effects were noticed. Discussion/Conclusion: In this series, EEN therapy was associated to significant improvement of disease activity index, nutritional status, weight gain and decreased markers of inflammation in most patients. Our data are in accordance with previous observations that EEN is an effective and well tolerated treatment for the induction of remission in pediatric patients with CD. (AU)

Influence of apical foramen cleaning in the repair of periapical lesions / Influência da Limpeza do Forame Apical no Reparo de Lesões Periapicais

Objetivo: O presente estudo procurou acessar o efeito da limpeza do forame apical no reparo de lesões periapicais detectadas radiograficamente. Materiais e métodos: A amostra constituiu-se de 980 dentes selecionados de 25 de fevereiro de 1997 a 15 de março de 2005 que foram submetidos a tratamento endodôntico e exibiram lesões periapicais radiograficamente visíveis. A amostra foi então divididaem dois grupos: Grupo I, 402 tratamentos de canal em que a limpezado forame apical não foi realizada, e Grupo II, composto pelos 578 dentes restantes onde o procedimento foi realizado. Após um ano, os dentes foram clinica e radiograficamente avaliados.Resultados: No Grupo I, 360 canais (89,55%) não tiveram evidência de lesões periapicais, versus 521 (90,13%) no Grupo II. Presençaparcial dessas lesões foi observada em 23 canais (5,72%) no Grupo I versus 27 (4,67%) no Grupo II. O teste qui-quadrado de Pearson não demonstrou significância estatística entre os Grupos I e II (p=0,732).Conclusões: Estes achados sugerem que a limpeza do forame apical não é um determinante para o reparo de lesão periapical.

Aim: The present study sought to assessthe effect of apical foramen cleaningin the repair of periapical lesionsdetected by radiography. Methods:The sample comprised 980 teeth collected from 25 February 1997 to15 March 2005, which had been subjected to endodontic treatment and exhibited radiographically visibleperiapical lesions. The sample wasthen divided into two groups: Group I,402 root canal treatments in which cleaning of the apical foramen had notbeen performed, and Group II, composed of the remaining 578 rootcanal treatments where the procedure had been performed. After one year, the teeth were clinically and radiographically evaluated. Results: In Group I, 360 canals (89.55%) had no evidence of periapical lesions, versus 521 (90.13%) in Group II. Partial presence of thes e lesions was observedin 23 canals (5.72%) in Group I versus27 (4.67%) in Group II. No changes in images were observed in 19 (4.72%)canals in Group I and 30 in Group II. Pearson’s chi-square test showed nostatistically significant difference between the Groups I and II (p =0.732).Conclusions: These findings suggest thatforamen cleaning is not a determinantof periapical lesion repair.