Acute gingivostomatitis in children: Epidemiology in the emergency department, pain, and use of codeine before its restriction.

Acute gingivostomatitis is relatively frequent in children; of viral origin, its diagnosis is usually straightforward. Acute gingivostomatitis is very painful and for many years, codeine, whose use was restricted in 2013, was widely employed in this context. The aim of this study was to ascertain the prevalence of acute stomatitis in pediatric emergency care, to evaluate the pain caused by stomatitis, and to determine the analgesic resources deployed both in the emergency department and at discharge, over the 5-year period preceding restriction of the use of codeine. METHODS: This was a retrospective study conducted in a pediatric emergency department (PED) of a university hospital between August 2008 and June 2013. RESULTS: A total of 702 children (372 herpetic gingivostomatitis [HGS], 149 herpangina [H], 181 hand, foot, and mouth disease [HFMD]) were included. Over the 5 years, one case of gingivostomatitis was identified for 303 visits to the PED. A total of 548 (78.1%) children were aged less than 36 months and the median age was 22 months. For 501 of 702 (71.4%) children, parents reported pain and/or feeding difficulties; in the HGS group, 314 of 372 (84.4%) patients had these symptoms. Of the 702 children, 48 (6.8%) were admitted to hospital. Overall, 457 (65.1%) of 702 children were given codeine before the PED visit, during the PED visit, or as a medication to take after discharge. The corresponding figures were 314 of 372 (84.4%) for the HGS group, 67 of 149 (45.0%) for the H group, and 76 of 181 (42.0%) for the HFMD group, P<0.001. CONCLUSIONS: Acute gingivostomatitis is a relative frequent reason for PED visits, and the pain and feeding difficulties that it elicits are a real challenge. Before codeine restriction, this medication played a major role in the analgesic strategy for this disease. It is essential that analgesic regimens at least as effective as codeine replace it. Morphine combined with paracetamol or the association of ibuprofen with paracetamol are options that are recommended by the French National Health Authority (HAS).

Carbon monoxide poisoning from waterpipe (narghile) smoking in a child.

Shisha smoking has spread to many countries since the 1990s and is now a global phenomenon among adolescents. Notwithstanding the connotations of conviviality of shisha smoking, it is in fact highly dangerous since the smoke inhaled contains toxic substances. Carbon monoxide (CO) poisoning carries a high risk of neurological and neuropsychological sequelae such as memory loss, impaired concentration, mood disorders, and various other symptoms. We report a case of severe CO poisoning in a 13-year-old boy after smoking shisha that caused loss of consciousness and seizure. To our knowledge, there have as yet been no reports of cases involving children. We present some epidemiological data on shisha smoking in adolescents as well as on CO intoxication.

Tandem high-dose chemotherapy strategy as first-line treatment of primary disseminated multifocal Ewing sarcomas in children, adolescents and young adults.

The prognosis of primary disseminated multifocal metastatic Ewing's sarcoma (PDMES) is poor even if a slight improvement has been achieved with high-dose alkylating agent-containing chemotherapy. To enhance treatment efficacy, we assessed the feasibility, safety and efficacy of a tandem high-dose chemotherapy (HDC) regimen. In a single institution, patients with PDMES received six courses of vincristine/ifosfamide/doxorubicin/etoposide induction therapy, followed by high-dose thiotepa, and then melphalan-busulfan, 8 weeks apart. Surgical resection of primary tumour was carried out between the two HDC regimens and 70 days after the last HDC regimen for post-operative radiotherapy or irradiation alone. From October 2002 to 2009, 13 of the 18 consecutive patients with PDMES (72%) received the full treatment programme. The other five patients experienced early progression and died. Among the 13 patients, 11 relapsed after the end of the treatment programme within 6 months (2.2-11.9) from end of therapy. Only two patients are still alive in first complete remission after 9 years. The 3-year event-free survival (EFS) and overall survival (OS) rates were 11 and 22%, respectively. The median EFS and OS duration from the diagnosis were 13.4 and 17.3 months, respectively. Neither major complications nor treatment-related death occurred. The tandem-HDC regimen was feasible, with expected side effects, but it did not improve the outcome of patients with PDMES.

Learning impact of education during pulmonary rehabilitation program. An observational short-term cohort study.

BACKGROUND: Among the several components constituting a pulmonary rehabilitation (PR) course, education may contribute to an individual's recognition of symptoms and worsening of the disease. However, the specific benefits of education is far greater than can be clearly documented to the health care providers. The aim of our preliminary study was to assess the learning impact of educational sessions (ES) in Chronic Obstructive Pulmonary Disease (COPD) patients referred to standard PR. METHODS: Six ES on 3 areas (Symptoms-Therapies, Aids, Mood) were applied during PR at our clinic. The learning effect was prospectively evaluated by a specific questionnaire (ESQ) in 285 COPD patients (age 69 +/- 8 years, FEV1 53 +/- 14 % pred), then grouped into those who have completed ES (Completers group, n = 226) or who did not (mean 2 +/- 1 ES) (Control group, n = 59). Total and partial ESQ scores, and PR outcomes (6-minute walking test-6MWD, effort-dyspnoea at Medical Research Council scale-MRC, and health-related quality of life scale-SGRQ) were assessed in a pre (T0) to post (Tend) design. RESULTS: Similar improvement in PR outcomes was recorded in both groups at Tend, whereas ESQ total and partial scores significantly increased in 'Completers' only (p < 0.001). ESQ-Aids score improved to a greater extent in Completers than in Control (+0.60 +/- 1.03 vs +0.27 +/- 1.27 point respectively, p = 0.036). A higher proportion of Completers improved above the median change of both ESQ total and aids scores (p < 0.05). CONCLUSION: Attending educational sessions produces a specific short-term learning effect during rehabilitation of COPD patients.

Dependence, locus of control, parental bonding, and personality disorders: a study in alcoholics and controls.

Personality traits, socio-cultural factors, and dysfunctional family systems are considered to be important in the aetiology and clinical development of alcoholism. Particularly, conflict and issues involving psychological (emotional) dependence have long been associated with alcohol addiction. The present work, part of a more extensive study to validate a new rating scale to measure emotional dependence, the Dependence Self-rating Scale (DSRS), assesses dependence, orientation of locus of control, parental bonding perceptions, and personality disorders (PDs) in alcoholic and non-alcoholic samples. The alcoholics showed a prevalence of PDs of 31.3%. The most frequent is the Schizoid PD (40%) followed by the Dependent PD (20%). Subjects with antisocial PD were not included in our selection criteria. The alcoholics scored higher on the DSRS than the controls, but this difference was not statistically significant. By making a comparison between subjects with and without PDs, the DSRS scores were significantly higher in alcoholics with PDs. No significant differences between alcoholics and non-alcoholics in the parental perceptions and locus of control were seen. These findings are sufficiently coherent to encourage further studies on psychological emotional dependence in alcoholics using the DSRS.