Dynamics of multisystem inflammatory syndrome in children associated to COVID-19 in Chile: Epidemiologic trends during pandemic, before and after children vaccination.

BACKGROUND: Multisystem inflammatory syndrome associated to Covid-19 (MIS-C) is one of the most severe outcomes of SARS-CoV-2 in children. Covid-19 vaccines were successfully implemented in Chile for the pediatric population since 2021, using both mRNA and inactivated platforms. Effectiveness against MIS-C has been reported for mRNA vaccines. The aim of this study was to describe the epidemiologic trend of MIS-C in Chile during Covid-19 pandemic, both before and after the availability of vaccination for children. MATERIALS AND METHODS: Analytic study of MIS-C cases from April 2020 to December 2022. Epidemiological data, SARS-CoV-2 variants and vaccination uptake information were obtained from the Epidemiology Department-Ministry of Health, Institute of Public Health and the National Immunization Program, respectively. RESULTS: 496 cases of MIS-C were reported, 58 % males. Median age was 5 years and most frequent age-cohorts were 6-11 and 0-2 years old with a 33 % each. After the introduction of the Covid-19 vaccine, most cases occurred in children aged 0-2 years. Incidence rates were 3.8, 5.4 and 1.7 per 100,000 inhabitants in 2020, 2021 and 2022, respectively. 97 % of cases (481) occurred in unvaccinated subjects. On those previously vaccinated (15), all but one case occurred in children receiving the inactivated vaccine. No association among circulating variants and incidence was observed. Incidence rate reduction (IRR) comparison between 2020 and 2021-2022 periods was 0.72 (CI 95 % 0.65-0.81, p < 0.05) overall; 0.86 for 0-2 years (CI 95 %:0.71-1; p = 0.12); 0.88 for 3-5 years (CI 95 %:0.69-1.11; p = 0.28); 0.61 for 6-11 years (CI 95 %: 0.50-0.75; p < 0.05); and 0.64 for 12-17 years (CI 95 %:0.47-0.89; p < 0.05), consistent with vaccination uptake during the studied period: 63 % for 3-5 years, 91 % for 6-11 years, and 99 % for 12-17 years. CONCLUSIONS: A decline of MIS-C incidence and a shift to younger, unvaccinated population overtime was observed. IRR decreased in age-cohorts which achieved high vaccination rates.

Randomised clinical trial of Class II ART restoration in primary teeth with and without retentive grooves after 12 months.

AIM: The aim of the study was to evaluate the survival of Class II ART (Atraumatic Restorative Treatment) restorations in primary molars using encapsulated glass ionomer in cavities with and without retentive grooves. A total of 293 Class II restorations were performed on primary molars by three trained operators, using ART hand instruments (SS White/Duflex, Rio de Janeiro, Brazil) and restored with EQUIA Fil (GC Corporation, Tokyo, Japan). One hundred eighty-seven children aged 3 to 7 years (mean age = 5.5) from two public schools located in Lima, Peru, were included in the study. The restorations were performed following the ART protocol, randomising the presence or absence of proximal retentions. Cavity cleaning and restoration times were recorded by the assistant using a digital chronometer. After 6 and 12 months, evaluations occurred following the ART criteria. Data were analysed using the Mann-Whitney, Chisquare and Fisher's exact tests, Kaplan-Meier survival and logarithmic range. The mean dmf-s of the participants was 21.6 (S.D. = 10.2). The mean times to clean the cavity and apply the restorative material were 5.4 and 6.6 minutes, respectively. Success rates after 6 and 12 months for restorations without retentive grooves were 90.3% and 77.2%, respectively; and with retentive grooves 95.9% and 91.8%, respectively. Statistically significant differences were found at the 12-month follow-up (p = 0.001). The proximal retentive grooves increased the survival rate of ART Class II restorations in primary teeth after 12 months of follow-up.

Meningococcal meningitis in Spain in the Horizon 2030: A position paper.

Meningococcal meningitis (MM) and invasive meningococcal disease remain a major public health problem that generates enormous public alarm. It is caused by Neisseria meningitidis, a Gram-negative diplococcus with an enormous capacity for acute and rapidly progressive disease, both episodic and epidemic in nature, with early diagnosis and treatment playing a major role. It occurs at any age, but is most common in children under 5 years of age followed by adolescents. Although most cases occur in healthy people, the incidence is higher in certain risk groups. Despite advances in reducing the incidence, it is estimated that in 2017 there were around 5 million new cases of MM worldwide, causing approximately 290,000 deaths and a cumulative loss of about 20,000,000 years of healthy life. In Spain, in the 2021/22 season, 108 microbiologically confirmed cases of MM were reported, corresponding to an incidence rate of 0.23 cases per 100,000 inhabitants. This is a curable and, above all, vaccine-preventable disease, for which the World Health Organisation has drawn up a roadmap with the aim of reducing mortality and sequelae by 2030. For all these reasons, the Illustrious Official College of Physicians of Madrid (ICOMEM) and the Medical Associations of 8 other provinces of Spain, have prepared this opinion document on the situation of MM in Spain and the resources and preparation for the fight against it in our country. The COVID-19 and Emerging Pathogens Committee of ICOMEM has invited experts in the field to participate in the elaboration of this document.

Invasive meningococcal disease in Chile seven years after ACWY conjugate vaccine introduction.

BACKGROUND: A serogroup W (MenW) outbreak in Chile prompted a meningococcal vaccination campaign using tetravalent meningococcal-conjugate vaccines (MCV-ACWY) in children since 2012, followed by its introduction into the National Immunization Program (NIP) in toddlers from 2014. Direct protection was observed, but no indirect effects in other age-groups were evidenced. The aim of this study was to describe invasive meningococcal disease (IMD) cases in Chile between 2009 and 2019, and its trend after the introduction of MCV-ACWYs. METHODS: IMD cases, cumulative incidence per 100,000 inhabitants, CFR, and vaccination uptake were described. Data were obtained from the Public Health Institute and NIP. RESULTS: Overall-IMD cases increased in 2009-2014 period, followed by a decline in 2015-2019, focused in infants, children <5 years and people ≥60 years. Serogroup B (MenB) and MenW alternate its predominance. Median overall incidence was 0.6/100,000, increasing from 0.6/100,000 in 2009 to 0.8/100,000 in 2014, later decreasing to 0.4/100,000 in 2019. Median incidences for MenB, serogroup C (MenC) and Y (MenY) were 0.25/100,000, <0.01/100,000 and <0.01/100,000, respectively. Median MenW incidence was 0.53/100,000, increasing from 0.01/100,000 in 2009 to 0.56/100,000 in 2014, followed by a constant decline to 0.12 in 2019. Infants, children <5 years and adults ≥60 years were affected the most, with median incidences of 9.7, 0.9 and 0.93, decreasing to 1.3, 0.1 and 0.1/100,000 in 2019, respectively. Median overall-CFR was 19%, 7.5% for MenB and 24.5% for MenW. Median MCV-ACWY uptake was 93% CONCLUSION: Overall-IMD, MenW cases and incidence declined since 2015 after the MCV-ACWY introduction, while MenB, MenC and MenY have been stable. MenW incidence declined in all age groups, including non-immunized infants and people >60 years. Further analysis and a longer period of observation are needed to have a more robust conclusion about this epidemiological trend. By 2019, CFR remains high.

Meningococcal invasive disease by serogroup W and use of ACWY conjugate vaccines as control strategy in Chile.

BACKGROUND: Serogroup causing invasive meningococcal disease (IMD) can change abruptly, as it occurred in Chile when serogroup predominance switched from MenB to MenW in 2012. As a response, a national vaccination strategy was implemented since 2012 using tetravalent meningococcal-conjugate vaccines (MCV-ACWY) in children 9 months through 4 years of age. The aim of this study was to describe IMD cases by MenW in Chile 2009-2016, and to analyse its trend after the introduction of MCV-ACWY. METHODS: Descriptive study of IMD cases in Chile, period 2009-2016. Cumulative incidence and mortality rate per 100,000 inhabitants, and case fatality rate (CRF) were used for descriptive analysis. Linear regression was used for post-intervention trend analysis. RESULTS: In 2012, MenW, mainly ST-11 cc, became predominant. MenW incidence rose from 0.01/100,000 inhabitants in 2009 to a maximum of 0.6/100,000 in 2015. Infants and adults 80 years of age and older were mostly affected, with an incidence peak of 9.7/100,000 and 1.6/100,000, respectively, in 2015. In the group of children from 1 to 4 years of age MenW incidence declined from 1.3/100,000 in 2012 to 0.1/100,000 in 2016, a 92.3% reduction after vaccination implementation. In the same period and age-cohort, CFR decreased from 23% to 0%. High mortality rates concentrated in infants and adults 80 years of age and over. CONCLUSION: MenW became predominant in Chile since 2012. IMD cases increased steadily from 2009 to 2016, with higher incidence, CFR and mortality concentrating in infants and people 80 years of age and older. MCV-ACWY provided direct protection against MenW, reducing its incidence after mass meningococcal vaccine implementation. Indirect effects of vaccination are not yet observed.

Oral health and obesity in the SAYCARE study: reliability and internal validity of diagnostic methods.

OBJECTIVE: The aim of this pilot study was to address the reliability, internal validity and viability of oral health methods used in the South American Youth/Child cARdiovascular and Environmental study. METHODS: South American Youth/Child cARdiovascular and Environmental study was a multicentre feasibility observational study and conducted in seven South American cities. The training sessions were performed in two steps before data collection: the first verified the inter-rater reproducibility between the examiners of the six centres in relation to the gold standard, and the second one verified the inter-rater reproducibility between the examiners at each centre in relation to the main rater. The diagnostic methods used were International Caries Detection and Assessment System II and Pulpal Involvement, Ulceration, Fistula and Abscess for dental caries and Periodontal Screening and Recording and Index Plaque for periodontal disease. Anthropometric variables were measured and used to calculate the body mass index and were classified according to the cut-off points defined by the International Obesity Task Force. Cohen's kappa coefficient and proportions of agreement were calculated to report inter-rater and intra-rater reliability in the calibration process and pilot study. RESULTS: The inter-rater weight kappa ranged from 0.78 to 0.88 and proportion of agreement from 96.07% to 98.10% for the International Caries Detection and Assessment System II and for the Periodontal Screening and Recording, 0.68 to 0.95 and 94.40% to 98.33%, respectively, in the calibration process. At the pilot study, a total of 490 children (40.8% overweight and 12.9% obese) and 364 adolescents (23.4% overweight and 4.3% obese) were examined. The prevalence of dental caries was 66% in children and 78% in adolescents, and gingival bleeding was 49% and 58.20%, respectively. CONCLUSION: The results demonstrated good reliability and internal validity after the examiners were trained, as well as the feasibility of using the methods chosen for this multicentre study.

Evaluación de la salud sexual femenina en la consulta de Ginecología / Evaluation of female sexual health in routine gynaecological practice

Antecedentes: La disfunción sexual en la mujer es un problema multicausal y multidimensional, poco estudiado en la consulta de Ginecología. El objetivo de este trabajo fue estimar la calidad de vida sexual mediante el test de Índice de Función Sexual Femenina en las mujeres que acudieron a la consulta de Ginecología e identificar qué variables se asociaban a esta. Material y métodos: Estudio observacional descriptivo que incluye a las pacientes que acudieron a la consulta de Ginecología entre marzo y agosto 2019. Las pacientes rellenaron anónimamente el test de Índice de Función Sexual Femenina y se recogieron variables sociodemográficas y clínicas. Para establecer las características que pudieron estar asociadas con la calidad de la salud sexual se elaboró un modelo de regresión lineal múltiple. Resultados: Del total de pacientes encuestadas un 39,4% presentaban disfunción sexual con un valor medio del test de 27,2. Si excluimos pacientes que no tenían relaciones en el momento de la encuesta, este porcentaje descendió al 19,2%. La variable que más descendió el valor del Índice de Función Sexual Femenina fue la menopausia. Asimismo la edad y el tener 3 o más hijos también disminuyó el valor del test. Por el contrario, los estudios universitarios mejoraron significativamente el resultado de dicho test. Conclusiones: La disfunción sexual femenina es un problema multifactorial. Dado que afecta de forma significativa la salud global de las mujeres, se hace patente la necesidad de abordar la problemática en las consultas de Ginecología de manera real y eficaz.(AU)

Background and objective: Female sexual dysfunction is a multicausal and multidimensional pathology, often underestimated in gynaecology care. The aim of this study was to estimate the quality of sexual life using the Female Sexual Function Index test in women who attended the gynaecology practice and to identify which variables were associated with sexual dysfunction. Material and methods: Descriptive observational study that includes patients who attended routine gynaecology care between March and August 2019. The patients filled out the Female Sexual Function Index anonymously and sociodemographic and clinical variables were collected. To establish the characteristics that could be associated with the quality of sexual health, a multiple linear regression model was developed. Results: Of the total of patients surveyed, 39.4% presented sexual dysfunction with a mean value of 27.2. After excluding patients without sexual intercourse at the time of the survey, this percentage dropped to 19.2%. Menopause was the variable that most lowered the Female Sexual Function Index value. Likewise, age and having 3 or more children also decreased the test score. Nevertheless, having a university education significantly improved womeńs sexual health. Conclusions: Female sexual dysfunction is a multifactorial problem that greatly affects women's well-being. It is important to assess this problem in routine gynaecology care in order to improve female sexual and global health.(AU)

An investigation of the transverse technique of dentifrice application to reduce the amount of fluoride dentifrice for young children.

PURPOSE: Recent studies have shown an increase in the prevalence of fluorosis. Consequently, recommendations for the use of a small quantity of fluoride dentifrice, 0.25 to 0.5 g or the equivalent of a "pea size" amount for children, have been made. This study evaluated a method of placing dentifrice in a transverse relation to the bristles (TT) and compares it to the standard technique used (ST) and to the "pea size" recommendation (PS). METHODS: The study was conducted in three phases: the first was in a laboratory setting using 22 commercial brands of children's toothbrushes; the second evaluated various recommendations with 240 mothers (Brazilian and Peruvian); and the third evaluated these recommendations in 135 Peruvian children (ages 4 to 6). RESULTS: The results showed that the mean quantity of dentifrice used with ST, PS, and TT was 0.58 g, 0.34 g, and 0.27 g for the mothers and 0.46 g, 0.29 g, and 0.24 g for the children, respectively. The average TT obtained through multiple weighing of 22 children's toothbrushes was 0.22 g. Both recommendations (PS and TT) reduced the amount of dentifrice used. However, TT also yielded a smaller variation range. Mothers and children learn easily and prefer TT. CONCLUSION: This technique could be recommended for young children in order to decrease the amount of fluoride dentifrice used, hence minimizing the potential inadvertent ingestion of fluoride dentifrice.

[Evaluation of fluoride content of bottled drinking waters in Brazil]. / Avaliação da concentração de flúor em águas minerais comercializadas no Brasil.

The utilization of a systemic fluoride method must be controlled in terms of risks and benefits. The reason for this is that while a small dose will not be effective in preventing dental caries, a larger dose may cause dental fluorosis. Therefore the knowledge of the fluoride concentration found in the bottled mineral waters sold throughout the Brazilian market the consumption of which has increased lately, is of great concern. The objective of the study was the analysis of the concentration of fluoride found in the bottled mineral waters. A hundred and four brands coming from different regions of Brazil were analysed using an Orion 96-09 ion specific electrode and an Orion EA 940 ionanalyser. previously calibrated with standard fluoride solutions. Different concentrations of fluoride ranging from 0.0 to 4.4 were found. It was discovered that specific bottled waters contained: 1) Significant concentrations of fluoride not reported by the producer; 2) Fluoride concentrations of no preventive effect, although the producer had advertised the water as a Fluoridated Mineral Water; 3) Fluoride concentrations high enough to cause dental fluorosis, although the producer did not alert the consumer to this fact. It is to be concluded, therefore, that a sanitary regulatory system for the control of the level of fluoride in the bottled mineral waters marketed is necessary. Such reputation should be formulated in terms of benefits as well as in terms of risks.

Biomarkers of fluoride in children exposed to different sources of systemic fluoride.

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

Microtornillos: Una revisión / Miniscrews: A revision

Los microtornillos son un tipo de implante alveolar que proporcionan un método excelente de anclaje. Por su parte, los microtornillos son un elemento económico, fácil de colocar y retirar. Se realiza una revisión del procedimiento quirúrgico y de su utilización clínica y se analizan las ventajas, los inconvenientes y las posibles complicaciones. Se llega a la conclusión de que el procedimiento de inserción de los microtornillos es tan sencillo, que permite su utilización incluso en situaciones clínicas que presentan disminución del soporte dentario. La estabilidad a largo plazo es predecible y fiable y han constituido un impulso para eliminar la cooperación del paciente, además de conseguir resolver problemas relacionados con el control del anclaje dentario. Entre sus principales indicaciones se encuentran los siguientes movimientos dentarios: intrusión de molares, retrusión de incisivos y de la intrusión de incisivos entre otras. En los últimos años, se han diseñado implantes de dimensiones pequeñas para situarlos en cualquier superficie del proceso alveolar, incluso en áreas interdentales. Son relativamente económicos, y las técnicas de colocación y desinserción son simples. Como todo elemento que se inserta en la cavidad bucal, es necesario hacer un estudio radiográfico exhaustivo. No debemos olvidar que estos implantes se colocan entre raíces o en zonas próximas de los dientes. Se han reportado numerosos artículos sobre la lesión periodontal y radicular al insertarlos, éste es el motivo por el cual daremos importancia a este aspecto y detallaremos el procedimiento a seguir en la planificación de la técnica y en las complicaciones que pueden surgir si no se lleva a cabo

The microscrews are a kind of alveolar implant that bring an excellent method of anchorage. Besides, the microscrews are an economic element, easy to place and remove. We carry out the checking of the surgical procedure, and its clinical use; we analize the advantages, disadvantages and draw backs. We finally come to the conclusion that the insertion procedure of the miniscrews is so easy that it allows its use even in clinic situations that show a decrease of the dental support. In the long term, the microimplants bring a predictable and reliable stability and those ones, have reduced the cooperation of the patient; besides solving problems linked to the control of the dental anchorage. Among the main indications, we can find the following dental movements: molar intrusion, incisive retrusion and incisive intrusion among others. In the last years, they have designed miniimplants in order to place them in any surface of the alveolar process even between interdental areas. The miniscrews are quiet cheap, and the techniques of placement and removal are simply. As all the elements are located in the mouth cavity, an exhaustive radiografic study is of far reaching important. We must not forget that those implants are placed between the roots or in areas close to the teeth. Several articles on the periodontal and root damage have been written, reason why we will focus on those damages and we will proceed to detail the planning procedure of this technique and the draw back that can arise, if those procedure is not followed

Dietary fluoride intake by children receiving different sources of systemic fluoride.

There has been no comparison of fluoride (F) intake by pre-school children receiving more traditional sources of systemic F. The aim of this study was to estimate the dietary F intake by children receiving F from artificially fluoridated water (AFW-Brazil, 0.6-0.8 mg F/L), naturally fluoridated water (NFW-Brazil, 0.6-0.9 mg F/L), fluoridated salt (FS-Peru, 180-200 mg F/Kg), and fluoridated milk (FM-Peru, 0.25 mg F). Children (n=21-26) aged 4-6 yrs old participated in each community. A non-fluoridated community (NoF) was evaluated as the control population. Dietary F intake was monitored by the "duplicate plate" method, with different constituents (water, other beverages, and solids). F was analyzed with an ion-selective electrode. Data were tested by Kruskall-Wallis and Dunn's tests (p<0.05). Mean (+/- SD) F intake (mg/Kg b.w./day) was 0.04+/-0.01(b), 0.06+/-0.02(a,b), 0.05+/-0.02(a,b), 0.06+/-0.01(a), and 0.01+/-0.00(c) for AFW/NFW/FS/FM/NoF, respectively. The main dietary contributors for AFW/NFW and FS/FM/NoF were water and solids, respectively. The results indicate that the dietary F intake must be considered before a systemic method of fluoridation is implemented.

Chemical studies on Mexican plants used in traditional medicine, XXI. Ratibinolide II, a new sesquiterpene lactone from Ratibida latipalearis.

Ratibinolide II, a new eudesmanolide, and the known flavanone hispidulin have been isolated from Ratibida latipalearis. The structure elucidation of the new compound was unequivocally established by spectral and X-ray crystallographic analyses.

Oral findings in pediatric AIDS: a case control study in Brazilian children.

A cross-sectional study was performed to verify the oral status in forty-one-children, four months to twelve years old, with antibodies anti-HIV detected by ELISA and Western-blot, in comparison to children with no risk for AIDS. Intraoral and extraoral examinations were performed, and dental and medical history was also obtained. Representative oral findings in AIDS group were cervical lymphadenopathy (53.7 percent), pseudomembranous candidosis (22 percent), angular cheilitis (9.8 percent), parotid enlargement (7.3 percent), erythematous candidosis (4.9 percent), and ulcers (4.9 percent). Control group included only two children with cervical lymphadenopathy. Considering the mean values for dmft and DMFT, there were no statistically significant differences (Student's t test) between the two groups (p < 0.05). While oral soft-tissue lesions were frequently observed in HIV antibodies in seropositive children, dental caries could not be associated primarily with AIDS.