Inflammatory cytokines and lipid profile in children and adolescents with nephrotic syndrome receiving L. Plantarum: a randomized, controlled feasibility trial.

METHODS: This study aimed to evaluate the efficacy of the action of the Lactobacillus Plantarum probiotic as a immunomodulatory and hypolipidemic agent in dyslipidemic nephrotic children and adolescents. This is a randomized, double-blind, placebo-controlled clinical trial in pediatric, compensated or partially compensated nephrotic syndrome and dyslipidemic subjects undergoing regular outpatient follow-up. Serum lipid and TNF-α (proinflammatory) and IL-10 (anti-inflammatory) cytokine variations were evaluated. Cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the probiotic group there was a tendency to reduce TNF-α levels and increase IL-10 levels when compared to controls. Regarding the lipid profile, there was a decrease in serum triglyceride (6.0 mg / dL) and total cholesterol (41.5 mg / dL) levels in the probiotic group when compared to baseline levels, while in the control group there was an increase in serum triglyceride (49.5 mg / dL) and total cholesterol (8.0 mg / dL) levels, respectively. CONCLUSION: Preliminary results suggest that L. Plantarum showed an immunomodulatory and hypolipidemic effect in nephrotic and dyslipidemic pediatric subjects.

Inflammatory cytokines and lipid profile in children and adolescents with nephrotic syndrome receiving L. Plantarum: a randomized, controlled feasibility trial

SUMMARY This study aimed to evaluate the efficacy of the action of the Lactobacillus Plantarum probiotic as a immunomodulatory and hypolipidemic agent in dyslipidemic nephrotic children and adolescents. METHODS: This is a randomized, double-blind, placebo-controlled clinical trial in pediatric, compensated or partially compensated nephrotic syndrome and dyslipidemic subjects undergoing regular outpatient follow-up. Serum lipid and TNF-α (proinflammatory) and IL-10 (anti-inflammatory) cytokine variations were evaluated. Cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the probiotic group there was a tendency to reduce TNF-α levels and increase IL-10 levels when compared to controls. Regarding the lipid profile, there was a decrease in serum triglyceride (6.0 mg / dL) and total cholesterol (41.5 mg / dL) levels in the probiotic group when compared to baseline levels, while in the control group there was an increase in serum triglyceride (49.5 mg / dL) and total cholesterol (8.0 mg / dL) levels, respectively. CONCLUSION: Preliminary results suggest that L. Plantarum showed an immunomodulatory and hypolipidemic effect in nephrotic and dyslipidemic pediatric subjects.

RESUMO: O objetivo deste estudo foi avaliar a eficácia da ação do probiótico Lactobacillus Plantarum como um agente imunomodulador e hipolipemiante em crianças e adolescentes dislipidêmicos com síndrome nefrótica. MÉTODOS: Este é um estudo randomizado, duplo-cego, controlado com placebo e realizado em pacientes pediátricos com síndrome nefrótica, compensados ou parcialmente compensados e dislipidêmicos passando por acompanhamento ambulatorial. Variações no lipídio sérico e nas citocinas TNF-α (pró-inflamatória) e IL-10 (anti-inflamatória) foram avaliadas. As citocinas foram analisadas por ensaio imunoenzimático (ELISA). RESULTADOS: No grupo probiótico, houve uma tendência de redução dos níveis de TNF-α e de aumento dos níveis de IL-10, quando comparado ao controle. Em relação ao perfil lipídico, houve uma diminuição nos níveis séricos de triglicérides (6,0 mg/dL) e colesterol total (41,5 mg/dL) no grupo probiótico em comparação aos níveis basais, enquanto no grupo de controle houve um aumento nos níveis séricos de triglicérides (49,5 mg/dL) e colesterol total (8,0 mg/dL). CONCLUSÃO: Os resultados preliminares sugerem que o L. Plantarum tem um efeito imunomodulador e hipolipemiante em pacientes pediátricos dislipidêmicos e com síndrome nefrótica.

Rotavirus gastroenteritis in children in 4 regions in Brazil: a hospital-based surveillance study.

BACKGROUND: Rotavirus is a major cause of gastroenteritis in children. Knowledge of rotavirus genotypes is important for vaccination strategies. METHODS: During 2005-2006, rotavirus surveillance studies were conducted in São Paulo, Salvador, Goiânia, and Porto Alegre, Brazil. Stool samples were collected from children <5 years of age who had diarrhea and were screened by the Rotaclone Enzyme Immunoassay for the presence of rotavirus. Confirmed rotavirus-positive samples were characterized for P and G genotypes by reverse-transcriptase polymerase chain reaction. RESULTS: A total of 510 stool samples were collected. Of these, 221 (43.3%) were positive for rotavirus. Overall, G9 was the predominant G type, followed by G2, and G1; P[4] and P[8] were the predominant P types. The most frequent G/P genotype combination detected was G2P[4], followed by G9P[8], G9P[4], and G1P[8]. G2P[4] was the predominant type in Goiânia and Salvador; G9P[8] and G1P[8] were predominant in São Paulo and Porto Alegre, respectively. CONCLUSIONS: The prevalence, seasonality, and genotype distribution of rotavirus infection varied in different regions in Brazil. With immunization programs, continuous monitoring of rotavirus types is important to detect novel and emerging strains.

Molecular characterization of the NSP4 gene of human group A rotavirus samples from the West Central region of Brazil.

Nonstructural protein 4 (NSP4), encoded by group A rotavirus genome segment 10, is a multifunctional protein and the first recognized virus-encoded enterotoxin. The NSP4 gene has been sequenced, and five distinct genetic groups have been described: genotypes A-E. NSP4 genotypes A, B, and C have been detected in humans. In this study, the NSP4-encoding gene of human rotavirus strains of different G and P genotypes collected from children between 1987 and 2003 in three cities of West Central region of Brazil was characterized. NSP4 gene of 153 rotavirus-positive fecal samples was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. For phylogenetic analysis, NSP4 nucleotide sequences of these samples were compared to nucleotide sequences of reference strains available in GenBank. Two distinct NSP4 genotypes could be identified: 141 (92.2%) sequences clustered with NSP4 genotype B, and 12 sequences (7.8%) clustered with NSP4 genotype A. These results reinforce that further investigations are needed to assess the validity of NSP4 as a suitable target for epidemiologic surveillance of rotavirus infections and vaccine development.

Molecular characterization of the NSP4 gene of human group A rotavirus samples from the West Central region of Brazil

Nonstructural protein 4 (NSP4), encoded by group A rotavirus genome segment 10, is a multifunctional protein and the first recognized virus-encoded enterotoxin. The NSP4 gene has been sequenced, and five distinct genetic groups have been described: genotypes A-E. NSP4 genotypes A, B, and C have been detected in humans. In this study, the NSP4-encoding gene of human rotavirus strains of different G and P genotypes collected from children between 1987 and 2003 in three cities of West Central region of Brazil was characterized. NSP4 gene of 153 rotavirus-positive fecal samples was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. For phylogenetic analysis, NSP4 nucleotide sequences of these samples were compared to nucleotide sequences of reference strains available in GenBank. Two distinct NSP4 genotypes could be identified: 141 (92.2 percent) sequences clustered with NSP4 genotype B, and 12 sequences (7.8 percent) clustered with NSP4 genotype A. These results reinforce that further investigations are needed to assess the validity of NSP4 as a suitable target for epidemiologic surveillance of rotavirus infections and vaccine development.

Astrovirus infection in children living in the Central West region of Brazil

This study presents data regarding the circulation of astrovirus in Goiânia-GO and Brasília-DF. These viruses were detected in fecal samples from hospitalized children up to five years old with and without acute gastroenteritis. A total of 1244 fecal samples were collected in two periods, 1994 to 1996 (Brasília) and 1998 to 2002 (Goiânia and Brasília), and were analyzed for viral RNA using the reverse transcription-polymerase chain reaction (RT-PCR). Positivity rates of 4.3 and 0.5 percent for astrovirus were observed in children with acute gastroenteritis and those without gastroenteritis, respectively. Among children with gastroenteritis no statistically significant difference was seen with regards to viral positivity rates in relation to gender and age. However, a higher incidence rate was observed for children from Brasília aged 36 months or more. Overall, astroviruses occurred predominantly from September to March in the two cities, suggesting a seasonal pattern for these viruses which coincides with the highest relative air humidity period. The results of this study highlight the importance of astrovirus as an etiologic agent of acute gastroenteritis in children of the Central West region of Brazil.

A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation

Chloral hydrate and hydroxyzine are a drug combination frequently used by practitioners to sedate pediatric dental patients, but their effectiveness has not been compared to a negative control group in humans. The aim of this crossover, double-blinded study was to evaluate the effect of these drugs compared to a placebo, administered to young children for dental treatment. Thirty-five dental sedation sessions were carried out on 12 uncooperative ASA I children aged less than 5 years old. In each session patients were randomly assigned to groups P (placebo), CH (chloral hydrate 75 mg/kg) and CHH (chloral hydrate 50 mg/kg plus hydroxyzine 2.0 mg/kg). Vital signs and behavioral variables were evaluated every 15 min. Comparisons were statistically analyzed using Friedman and Wilcoxon tests. P, CH and CHH had no differences concerning vital signs, except for breathing rate. All vital signs were in the normal range. CH and CHH promoted more sleep in the first 30 min of treatment. Overall behavior was better in CH and CHH than in P. CH, CHH and P were effective in 62.5 percent, 61.5 percent and 11.1 percent of the cases, respectively. Chloral hydrate was safe and relatively effective, causing more satisfactory behavioral and physiological outcomes than a placebo.

A associação hidrato de cloral- hidroxizina tem sido utilizada na clínica odontológica para sedar crianças, mas sua efetividade ainda não foi comparada a um controle negativo em humanos. O objetivo deste estudo prospectivo foi avaliar o efeito dessas drogas, comparadas a um placebo, em crianças submetidas a tratamento odontológico. Trinta e cinco sessões de sedação foram realizadas em 12 crianças menores de 5 anos, não cooperativas, ASA classe I. Em cada sessão os pacientes foram aleatoriamente alocados para os grupos P (placebo), CH (hidrato de cloral 75 mg/kg) e CHH (hidrato de cloral 50 mg/kg mais hidroxizina 2,0 mg/kg). Sinais vitais e comportamento foram avaliados a cada 15 min, e comparados pelos testes de Friedman e Wilcoxon. Os grupos não apresentaram diferenças quanto às variáveis fisiológicas, exceto a freqüência respiratória. Todos sinais vitais registrados estiveram dentro de faixa aceitável. CH e CHH promoveram mais sono nos primeiros 30 min de tratamento. O comportamento geral foi melhor em CH e CHH do que em P. CH, CHH e P foram efetivos em 62,5 por cento, 61,5 por cento e 11,1 por cento dos casos, respectivamente. O hidrato de cloral foi seguro e relativamente efetivo, levando a resultados fisiológicos e comportamentais melhores que o placebo.

Detection of calicivirus from fecal samples from children with acute gastroenteritis in the West Central region of Brazil.

The objective of this study was to describe the circulation of caliciviruses in the West Central region of Brazil and its correlation with children's gender and age, as well as with the year and months of the sample collection. Reverse transcriptase-polymerase chain reaction was performed to detect the human calicivirus genome in 1006 fecal samples that were collected in Goiânia (n = 696) and Brasília (n = 310). Viral RNA was detected in 8.6% of the samples. No significant difference in viral prevalence was found regarding gender, age or year of the sample. However, it was observed that in Goiânia, there is a higher incidence of caliciviruses from September to March. The analysis employing three primer pairs demonstrated that the Ni/E3 or JV12/13 primer pairs, which detect norovirus (NoV), detected 41 positive samples while the 289/290 primer pair, which detects NoV or sapovirus, detected the remaining 46 samples. Calicivirus circulates in the West Central region of Brazil and for better detection of this virus it is important to use more than one primer pair. Also, we conclude that the seasonality presented by this virus is related to higher humidity in the period.

Detection of calicivirus from fecal samples from children with acute gastroenteritis in the West Central region of Brazil

The objective of this study was to describe the circulation of caliciviruses in the West Central region of Brazil and its correlation with children's gender and age, as well as with the year and months of the sample collection. Reverse transcriptase-polymerase chain reaction was performed to detect the human calicivirus genome in 1006 fecal samples that were collected in Goiânia (n = 696) and Brasília (n = 310). Viral RNA was detected in 8.6 percent of the samples. No significant difference in viral prevalence was found regarding gender, age or year of the sample. However, it was observed that in Goiânia, there is a higher incidence of caliciviruses from September to March. The analysis employing three primer pairs demonstrated that the Ni/E3 or JV12/13 primer pairs, which detect norovirus (NoV), detected 41 positive samples while the 289/290 primer pair, which detects NoV or sapovirus, detected the remaining 46 samples. Calicivirus circulates in the West Central region of Brazil and for better detection of this virus it is important to use more than one primer pair. Also, we conclude that the seasonality presented by this virus is related to higher humidity in the period.

Prescrição de analgésicos não-opiáceos e antiinflamatórios não-esteróides em odontopediatria: consulta rápida / Nonopioid analgesics and nonsteroidal anti-inflammatory drugs in pediatric dentistry: a 5-minute consultation

Para muitos Cirurgiões-dentistas, que praticam a odontopediatria, a prescrição de medicamentos é um tabu, sendo ainda temida ou negligenciada. Este trabalho sugere um modelo de protocolo de prescrição de analgésicos não opiáceos e antiinflamatórios não esteróides (AINEs), considerando diferentes situações da clínica odontológica dirigida a crianças. Após leitura e análise crítica dos artigos e livros selecionados, conclui-se que em caso de dor pós-operatória associada a processo inflamatório (edema, febre), os analgésicos/AINEs mais indicados para crianças são o ibuprofeno e a nimesulida. Quando a dor pós-operatória não estiver associada à inflamação, pode-se fazer uso do paracetamol ou dipirona.

Rotavirus A e sua profilaxia vacinal / Rotavirus A and vaccine prophylaxis

Objetivo: revisar os aspectos microbiológicos, epidemiológicos, clínicos e de prevenção da gastroenterite por rotavírus. Metodologia: foram consultadas as publicações mais relevantes dos últimos 30 anos em periódicos especializados nacionais e internacionais (banco de dados: Medline e Lilacs). Conclusões: os rotavirus constituem a principal causa de diarréia severa na infância,tanto em países desenvolvidos como naqueles em desenvolvimento. O efetivo controle da doença será alcançado com uma vacina eficaz, para uso em larga escala, e que assegure a proteção conra os episódios diarréicos mais severos, particularmente nos dois primeiros anos de vida. Após a suspensão do uso da vacina tetravalente de origem símio-humana, novas candidatas têm surgido como perspectiva profilática. A contínua vigilância das amostras de rotavírus circulantes é fundamental para o desenvolvimento de uma vacina segura e eficaz.

A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77 percent of the cases, and group MH did so in 30.8 percent. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation

Estudo prospectivo da doença diarréica por rotavírus do grupo A em crianças de Goiânia, Goiás: genotipagem e evolução clínico-laboratorial / Prospective study of diarrheoal disease from group A rotavirus in children from Goiânia, Goiás: genotyping and clinical-laboratorial outcome

O objetivo desse estudo foi identificar rotavírus e avaliar a gravidade da doença diarréica em relação aos genotipos identificados. 77 amostras de Rotavirus A foram obtidos a partir de 207 espécimes fecais de crianças com diarréia aguda em Goiânia, Goiás, os quais foram submetidos à genotipagem G e P (RT-PCR and Nested-PCR). As crianças com positividade para Rotavirus A apresentaram quadro clínico mais grave (p<0,001) que as crianças negativas para este agente. Não foi observado diferença em gravidade clínica em relação aos diferentes genótipos G e P identificados. Nenhuma reinfecção por rotavírus ocorreu nas 40 crianças seguidas durante um ano / The aim of this study was to identify rotavirus and to determine G and P genotypes of viral strains related to clinical severity and outcome. 77 Group A rotavirus samples were obtained from fecal samples from 207 children with acute diarrhoea in Goiânia, Goiás, Brazil and analyzed by the polymerase chain reaction (RT-PCR and Nested-PCR) for G and P typing. The children with positivity for Rotavirus A show clinical symptoms more severe (p<0.001) than negative children for this agent. It wasn’t observed diference in relation to severity and genotypes G and P identified. During one year of follow-up wasn’t observed reinfection of rotavirus in 40 children...

Avaliaçäo clinico-laboratorial na doenca de Kawasaki e marcadores da formacao de aneurisma coronariano / Clinical and laboratorial trends in Kawasaki disease and development of coronary artery aneurisms

A Doenca de Kawasaki destaca-se pelas potenciais sequelas cardiovasculares, caracterizadas pela formacao de aneurisma coronariano. O objetivo do presente trabalho e descrever as caracteristicas dos criterios clinicos, das manifestacoes associadas, das alteracoes laboratoriais e das complicacoes cardiovasculares da Doenca de Kawasaki em 36 pacientes, acompanhados no Instituo da Crianca do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. As seguintes caracteristicas clinicas estiveram presentes na...

Avaliaçäo objetiva da terapêutica medicamentosa e aspectos correlatos na prática da odontopediatria / On objetive evaluation of drugs therapy and correlate aspects in pedodontics pratice

O conhecimento da terapêutica medicamentosa aplicada à odontopediatria, ainda que seja imprescindível ao atendimento odontológico infantil, é negligenciado e temido por grande parte dos profissionais que se propöem a atender crianças. O presente trabalho visou avaliar, mediante a distribuiçäo de questionários de perguntas e respostas objetivas a cirurgiöes-dentistas, aspectos gerais referentes à utilizaçäo de medicamentos na prática odontopediátrica. Concluiu-se que há deficiências pertinentes ao assunto, as quais devem ser supridas mediante a reformulaçäo dos currículos odontológicos