Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Wideband acoustic absorbance in children with Down syndrome / Absorvância acústica de banda larga em crianças com síndrome de Down

Abstract Introduction: Tympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226 Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients. Objective: The aim of this study was to analyze the acoustic absorbance measurements in children with Down syndrome. Methods: Cross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226-8000 Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%. Results: With the 226 Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520 Hz (p = 0.008) for those with normal tympanometry results, and 226-4000 Hz (p < 0.03) for those with a Type B tympanometry curve. Conclusion: The low energy absorption in the presence of normal tympanograms in children with Down syndrome may suggest middle ear abnormalities.

Resumo Introdução: A timpanometria é a ferramenta mais usada para avaliar o status da orelha média, comumente avaliada por meio de uma única frequência com o tom de 226 Hz. No entanto, o uso da medida de imitância acústica com estímulo de banda larga é uma avaliação de alta resolução promissora, especialmente em pacientes conhecidos por frequentemente apresentar alterações da orelha média, como na síndrome de Down. Objetivo: Analisar as medidas de absorvância acústica em crianças com síndrome de Down. Método: Estudo transversal, aprovado pelo comitê de ética da instituição. Foram coletados dados de 30 crianças, com idade média de 8,4 anos, sendo 15 com síndrome de Down (SD-grupo de estudo) e 15 crianças desenvolvimento típico e sem queixas auditivas (grupo controle). A absorvância de energia foi medida nas frequências de 226-8.000 Hz à pressão ambiente e no pico de pressão em função da frequência, usou-se o equipamento Titan. A análise estatística foi feita com o nível de significância estatística adotado de 5%. Resultados: Com o tom de sonda de 226 Hz foram observadas 30 orelhas do grupo controle e 22 do grupo estudo com timpanometria Tipo A e o Tipo B foi observado apenas em oito crianças do grupo estudo. A razão média de absorvância acústica do grupo estudo foi menor do que a do controle nas frequências centradas em 2.520 Hz (p = 0,008) para aqueles com resultados timpanométricos normais e de 226-4.000 Hz (p < 0,03) para aqueles com curva timpanométrica Tipo B. Conclusão: A baixa absorção de energia na presença de timpanogramas normais nas crianças com síndrome de Down pode sugerir anormalidades na orelha média.

Efeitos da eletroestimulação associada ao treino mastigatório em pessoas com síndrome de down / Effects of electrostimulation associated with masticatory training in individuals with down syndrome

RESUMO Objetivo Investigar e mensurar os efeitos da eletroestimulação na musculatura orofacial e nas funções de mastigação, respiração e deglutição dos indivíduos com síndrome de Down. Método Participaram da pesquisa 16 indivíduos com Síndrome de Down, sendo seis do gênero masculino e dez do gênero feminino com idade entre 9 e 25 anos, participantes de um projeto de extensão institucional. Foram realizadas avaliações fonoaudiológicas com uso do protocolo AMIOFE antes e após a intervenção, que consistiu em oito sessões de eletroestimulação semanais. A corrente utilizada foi a Functional Electrical Estimulation (FES), com uma frequência de 10Hz no aquecimento e 30 Hz na aplicação, em um tempo ON de 5s e OFF de 10s comuns nas duas etapas, e com a largura de pulso de 200(µs) no aquecimento e 250(µs) na aplicação. Resultados Observaram-se diferenças significativas após aplicação da eletroestimulação (FES) em relação ao aspecto das bochechas quando comparadas flacidez/arqueamento pré e pós o estímulo elétrico, diferenças na mobilidade de língua (lateralidade direita e esquerda), no comportamento da musculatura na execução das funções estomatognáticas de respiração, melhoria no comportamento dos lábios durante a deglutição e mudanças expressivas no processo de mastigação (mordida e trituração). Conclusão Foi identificado estatisticamente que houve efeito após a eletroestimulação associada ao treino mastigatório nos músculos masseteres, com ganhos funcionais na execução da mastigação, respiração e deglutição, em pessoas com Síndrome de Down.

ABSTRACT Purpose Investigate and measure the effects of electrostimulation on the orofacial musculature and on the chewing, breathing and swallowing functions of individuals with Down syndrome. Methods Study participants were 16 individuals with Down syndrome (six males and 10 females) from an institutional extension project aged nine to 25 years. Speech-language pathology assessment was performed using the protocol of Orofacial Myofunctional Evaluation with Scores (OMES) pre- and post-intervention. This protocol comprised eight weekly electrostimulation sessions. Functional Electrical Stimulation (FES) current was used at a frequency of 10Hz in warm-up and 30Hz in application, intermittent stimulation (cycling pulses) with ON-time of 5s and OFF-time of 10s common to both stages, and pulse width of 200μs in warm-up and 250μs in application. Results Significant differences were observed between pre- and post-application of FES regarding cheek appearance (flaccidity and arching), tongue mobility (right and left laterality), and musculature behavior during performance of functions of the stomatognathic system: respiration, deglutition (lip behavior), and mastication (bite and trituration). Conclusion Effects of electrostimulation associated with masticatory training of the masseter muscles were statistically identified, with functional gains in chewing, breathing and swallowing performance in individuals with Down syndrome.

Salivary density of Streptococcus mutans and Streptococcus sobrinus and dental caries in children and adolescents with Down syndrome

Abstract Streptococcus mutans and Streptococcus sobrinus are strongly associated with dental caries. However, the relationship between oral streptococci and dental caries in children with Down syndrome is not well characterized. Objective To assess and compare dental caries experience and salivary S. mutans, S. sobrinus, and streptococci counts between groups of Down syndrome and non-Down syndrome children and adolescents. Material and Methods This study included a sample of 30 Down syndrome children and adolescents (G-DS) and 30 age- and sex-matched non-Down syndrome subjects (G-ND). Dental caries experience was estimated by the number of decayed, missing, and filled teeth in the primary dentition and the permanent dentition. Unstimulated whole saliva samples were collected from all participants. The fluorescence in situ hybridization technique was used to identify the presence and counts of the bacteria. The statistical analysis included chi-square, Student's t-test and Spearman's correlation. Results The G-DS exhibited a significantly higher caries-free rate (p<0.001) and a lower S. mutans salivary density (p<0.001). No significant differences were found in the salivary densities of S. sobrinus or streptococci between the groups (p=0.09 and p=0.21, respectively). The salivary S. mutans or S. sobrinus densities were not associated with dental caries experience in neither group. Conclusion The reduced dental caries experience observed in this group of Down syndrome children and adolescents cannot be attributed to lower salivary S. mutans densities, as determined with the fluorescence in situ hybridization technique.

El niño con Síndrome de Down en la Unidad de Cuidados Intensivos / Down Syndrome child in the Intensive care unit

El síndrome de Down es la alteración cromosómica más frecuente en los recién nacidos, con una alta incidencia en Chile. Esta condición presenta aspectos fisiológicos únicos, los cuales pueden afectar al niño durante su estadía en una Unidad de Cuidados Intensivos, posterior al período neonatal. En esta revisión abordamos aspectos actuales de la patología respiratoria, cardiovascular, infecciosa y neurológica, así como también consideraciones anestésicas y de analgesia postoperatoria, destete de la ventilación mecánica, inestabilidad columna cervical y pronóstico del niño críticamente enfermo portador de síndrome de Down. La evaluación de todas estas condiciones debe ser realizada cuando el paciente es ingresado a la Unidad de Cuidados Intensivos. El objetivo de la presente actualización es profundizar el conocimiento del diagnóstico y tratamiento de las potenciales complicaciones del niño con síndrome de Down durante su estadía en la unidad de paciente crítico.

Down syndrome is the most common chromosomal abnormality in newborns, with a high incidence in Chile. This condition presents unique physiological aspects that should be known, which can affect the child during their stay in an Intensive Care Unit, beyond the neonatal period This review is focused on the respiratory, cardiovascular, infectious and neurological disorders. Anesthetic management and postoperative analgesia considerations, weaning from mechanical ventilation, cervical spine instability and prognosis of the critically ill child with Down syndrome are also analyzed. The evaluation of these conditions should be performed when the patient is admitted to the intensive care unit. The purpose of this update is to update the knowledge of the diagnosis and treatment of potential complications of children with Down syndrome during their stay in the unit of critical patient.

Caracterização eletrofisiológica da audição em indivíduos com Síndrome de Down / Electrophysiological characterization of hearing in individuals with Down syndrome

RESUMO Introdução Poucos estudos realizaram, concomitantemente, o potencial evocado auditivo de tronco encefálico (PEATE) e o P300 na Síndrome de Down (SD), em indivíduos audiologicamente normais, para a avaliação da via auditiva central, principalmente pela dificuldade de realizar estes procedimentos nesta população. Estudos anteriores sugeriram que indivíduos com SD podem apresentar padrões de respostas diferentes das encontradas em indivíduos com desenvolvimento típico, sendo que a identificação destes seria fundamental para o estabelecimento de um diagnóstico audiológico preciso. Objetivo Caracterizar o PEATE e o P300 em indivíduos com SD audiologicamente normais. Método Foram analisados o PEATE e o P300 de 17 indivíduos com SD e 21 com desenvolvimento típico de sete a 15 anos. A análise foi quantitativa e qualitativa, utilizando medidas descritivas e os testes de hipótese. Resultados Os valores de latência foram menores no PEATE para o grupo SD, com diferença estatisticamente significante para a onda V, interpicos III-V e I-V; não foram encontradas diferenças significantes nos valores de latência do P300. Observou-se maior número de indivíduos com valores precoces para as latências do PEATE e com latências atrasadas para o P300 no grupo SD; ambas as comparações mostraram diferenças significantes. Conclusão Crianças e adolescentes com SD podem apresentar respostas precoces para os componentes do PEATE, sugerindo que a via auditiva destes necessita de menor tempo para a transmissão neural do estímulo acústico até o tronco encefálico. Quanto ao P300, indivíduos com SD podem apresentar latências aumentadas, sugerindo comprometimento na via auditiva central quanto ao processamento cortical da informação auditiva.

ABSTRACT Introduction Few studies have performed Brainstem (BAEP) and P300 Auditory Evoked Potentials simultaneously to assess central auditory pathways in normal hearing individuals with Down syndrome (DS), mainly because of the difficulty in applying these procedures to this population. Previous studies have suggested that individuals with DS might present different patterns of response compared with those of individuals with typical development; nevertheless, the identification of these potentials would be crucial for the establishment of an accurate audiological diagnosis. Purpose To characterize BAEP and P300 in normal-hearing individuals with DS. Methods BAEP and P300 were analyzed in 17 individuals with DS and in 21 individuals with typical development aged 7 to 15 years. The results were quantitatively and qualitatively analyzed using descriptive measures and hypothesis tests. Results In the quantitative analysis, latency values were lower in the BAEP for the DS group, with statistically significant difference for wave V and interpeaks III-V and I-V; there were no significant differences in the P300 latency values. In the qualitative analysis, there were a larger number of individuals with early values for BAEP latencies and late latencies for P300 in the DS group; both comparisons showed statistically significant differences. Conclusion Children and adolescents with DS can present early responses to the components of BAEP, suggesting that their auditory pathway requires less time for the neural transmission of acoustic stimuli to the brainstem. Concerning P300, individuals with DS may present increased latencies, suggesting impairment in the central auditory pathway for the cortical processing of auditory information.

Promoção de saúde bucal e síndrome de Down: inclusão e qualidade de vida por meio da extensão universitária / Oral health promotion and Down's syndrome: inclusion and quality of life through university extension

A prevenção é essencial para o estabelecimento de saúde bucal dos pacientes, principalmente quando relacionada aos indivíduos com deficiência, como os pacientes com Síndrome de Down (SD). O objetivo deste estudo foi identificar as percepções de pais e/ou responsáveis sobre a saúde bucal e em seguida formular um manual sobre escovação dentária, além de encontrar recursos lúdicos de manejo comportamental para o paciente com SD. Com os participantes com SD foram realizadas oficinas de arte e outras atividades lúdicas com caráter de educação em saúde. Participaram do estudo 15 pacientes com SD com idade entre 3 e 16 anos, com seus respectivos pais/cuidadores da Associação de Pais e Amigos das Pessoas com SD de Lençóis Paulista - SP (Brasil). Observou-se que ainda grande parte dos pais desconhece quais doenças acometem a cavidade bucal dos pacientes com SD e como isso afetam sua saúde sistêmica. Constatou-se que os participantes com SD aceitaram e adotaram de maneira mais efetiva as instruções de higiene bucal por meio da música fortalecendo o vínculo paciente-profissional. Portanto, atividades de extensão para essa parcela da população são fundamentais para promoção de saúde bucal, inclusão social e qualidade de vida dos mesmos.(AU)

Prevention in dentistry is essential for oral health promotion, especially when is related to special care patients, including Down´s syndrome patients (DS). The present study aims to identify the parents' perceptions concerning oral health, and then, create a manual about tooth brushing. In addition, this study aims to create behavioral management approaches, performing art workshops and recreational activities about health education for patients with DS. The study included 15 individuals with DS aged 3-16 years with their parents/caregivers of the Association of Parents and Friends of Down's syndrome patients in Lençóis Paulista - SP (Brazil). It was observed that most of the parents still unknown diseases in the oral cavity of patients with DS and how it affects your systemic health. It was verified that participants with DS accepted and adopted more effectively instructions of oral hygiene using music approaches, optimizing patient-professional relationship. Therefore, extra clinical activities to those special needs patients are essential for oral health promotion, social inclusion and quality of life.(AU)

Growth curves in Down syndrome with congenital heart disease / Curvas de crescimento na síndrome de Down com cardiopatia congênita

SUMMARY Introduction: To assess dietary habits, nutritional status and food frequency in children and adolescents with Down syndrome (DS) and congenital heart disease (CHD). Additionally, we attempted to compare body mass index (BMI) classifications according to the World Health Organization (WHO) curves and curves developed for individuals with DS. Method: Cross-sectional study including individuals with DS and CHD treated at a referral center for cardiology, aged 2 to 18 years. Weight, height, BMI, total energy and food frequency were measured. Nutritional status was assessed using BMI for age and gender, using curves for evaluation of patients with DS and those set by the WHO. Results: 68 subjects with DS and CHD were evaluated. Atrioventricular septal defect (AVSD) was the most common heart disease (52.9%). There were differences in BMI classification between the curves proposed for patients with DS and those proposed by the WHO. There was an association between consumption of vitamin E and polyunsaturated fatty acids. Conclusion: Results showed that individuals with DS are mostly considered normal weight for age, when evaluated using specific curves for DS. Reviews on specific curves for DS would be the recommended practice for health professionals so as to avoid precipitated diagnosis of overweight and/or obesity in this population.

RESUMO Objetivo: avaliar hábitos alimentares, estado nutricional e frequência alimentar em crianças e adolescentes com síndrome de Down (SD) portadores de cardiopatia congênita (CC). Adicionalmente, procurou-se comparar classificações de índice de massa corpórea (IMC) de acordo com curvas da Organização Mundial da Saúde (OMS) e curvas desenvolvidas para indivíduos com SD. Método: estudo transversal com indivíduos portadores de SD e CC atendidos em um centro de referência para cardiologia, com idade entre 2 e 18 anos. Foram aferidos peso, altura, IMC, valor energético total (VET) e frequência alimentar. O estado nutricional foi analisado por meio de IMC para gênero e idade, utilizando-se curvas específicas para SD e curvas da OMS. Resultados: foram avaliados 68 indivíduos portadores de SD com CC. O defeito do septo atrioventricular (DSAV) foi a cardiopatia mais frequente (52,9%). Houve diferença de classificação do IMC entre as curvas propostas para portadores de SD e pela OMS. Houve associação entre consumo de vitamina E e ácidos graxos poli-insaturados. Conclusão: resultados mostraram que indivíduos com SD são, em sua maioria, considerados eutróficos para a idade quando avaliados pelas curvas específicas para SD. Avaliá-los de acordo com as curvas específicas para SD seria o recomendado para a prática dos profissionais da saúde, evitando-se diagnósticos precipitados de sobrepeso e/ou obesidade nessa população.

Blood pressure levels and body mass index in Brazilian adults with Down syndrome / Níveis de pressão arterial e índice de massa corporal em adultos brasileiros com síndrome de Down

ABSTRACT CONTEXT AND OBJECTIVE: Increased life expectancy among people with Down syndrome (DS) has introduced new environmental factors that may affect blood pressure (BP) and/or lead to obesity in this population. The aim here was to investigate BP levels and body mass index (BMI) in adults with DS, correlating these data with the patients' sex and age. DESIGN AND SETTING: Analytical cross-sectional observational study conducted in special schools in Curitiba (PR), Brazil. METHODS: 97 adult patients were included. BP was measured in accordance with the established guidelines. BMI was calculated by dividing the weight by the height squared (kg/m2). RESULTS: Sex had no influence on BMI; nor did systolic BP (SBP) or diastolic BP (DBP). The age range was from 18 to 56 years. No correlation was observed between increasing age and greater BMI or BP. Eighty-six individuals (88.7%) presented normal BP, eleven (11.3%) prehypertension and none hypertension. Twenty patients (20.4%) presented BP lower than 90 × 60 mmHg. BMI ranged from 18 to 48 kg/m2 (mean of 28.8 ± 3.92 kg/m2): 21.9% had normal weight; 40.7% were overweight; and 25.3% had obesity class I, 9.9% class II and 2.2% class III. Higher BMI was associated with significantly greater SBP and DBP (P = 0.0175 and P = 0.0015). CONCLUSION: Sex and age did not influence SBP, DBP or BMI in Brazilian adults with DS. Higher BMI was associated with greater BP (both systolic and diastolic).

RESUMO CONTEXTO E OBJETIVO: O aumento da expectativa de vida das pessoas com síndrome de Down (SD) introduziu novos fatores ambientais que podem afetar a pressão sanguínea e/ou levar a obesidade nessa população. O objetivo foi investigar os níveis de pressão arterial (PA) e o índice de massa corporal (IMC) em adultos com SD, correlacionando estes dados com a idade e o gênero dos pacientes. DESENHO E LOCAL: Estudo observacional, transversal e analítico, realizado em escolas especiais em Curitiba (PR), Brasil. MÉTODOS: Foram incluídos 97 pacientes adultos. A aferição da PA foi feita de acordo com as diretrizes estabelecidas. O IMC foi calculado dividindo-se o peso pela altura ao quadrado (kg/m2). RESULTADOS: O gênero não influenciou o IMC, a pressão arterial sistólica (PAS) e diastólica (PAD). A idade variou de 18 a 56 anos. Não foi observada correlação entre aumento da idade e maior IMC ou pressão arterial. 86 indivíduos (88,7%) apresentaram PA normal, 11 (11,3%) pré-hipertensão e nenhum hipertensão. Vinte (20,4%) apresentaram PA inferior a 90 × 60 mmHg. O IMC variou entre 18 e 48 kg/m2 (média de 28,8 ± 3,92), 21,9% tinham peso normal, 40,7% sobrepeso, 25,3% obesidade grau I, 9,9 % grau II e 2,2% obesidade grau III. Aumento significativo da PAS e PAD foi associado com elevação do IMC (P = 0,0175 e P = 0,0015). CONCLUSÃO: Verificou-se que sexo e idade não influenciaram PAS, PAD e IMC em adultos brasileiros com SD. O aumento significativo da PAS e PAD foi associado com o aumento do IMC.

Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect / Fatores associados à insuficiência da valva atrioventricular esquerda nos primeiros 30 dias após correção de defeito de septo atrioventricular total

AbstractIntroduction:Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defects.Objective:To determine factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of surgical repair of complete atrioventricular septal defect.Methods:We assessed the results of 53 consecutive patients 3 years-old and younger presenting with complete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down syndrome. At the time of preoperative evaluation, there were 26 cases with moderate or severe left atrioventricular valve regurgitation (49.1%). Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty was performed in 34% of the patients.Results:At the time of postoperative evaluation, there were 21 cases with moderate or severe left atrioventricular valve regurgitation (39.6%). After performing a multivariate analysis, the only significant factor associated with moderate or severe left atrioventricular valve regurgitation was the absence of Down syndrome (P=0.03).Conclusion:Absence of Down syndrome was associated with moderate or severe postoperative left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect at our practice.

ResumoIntrodução:A insuficiência da valva atrioventricular esquerda é a lesão residual mais preocupante após o tratamento cirúrgico do defeito de septo atrioventricular.Objetivo:Determinar fatores associados à insuficiência da valva atrioventricular esquerda de grau moderado ou importante nos primeiros 30 dias após correção de defeito de defeito de septo atrioventricular total.Métodos:Avaliamos os resultados em 53 pacientes consecutivos menores de 3 anos com defeito de septo atrioventricular total, operados em nosso serviço entre 2002 e 2010. Avaliamos as seguintes variáveis: idade, peso, ausência de síndrome de Down, grau de insuficiência da valva atrioventricular esquerda antes da correção, anormalidades na valva atrioventricular e uso de anuloplastia. A mediana da idade foi de 6,7 meses e a do peso de 5,3 Kg; 86,8% tinham síndrome de Down. Antes da operação, 26 apresentavam insuficiência da valva atrioventricular esquerda pelo menos moderada (49,1%). Anormalidades na valva atroventricular foram encontradas em 11,3% dos casos; anuloplastia foi realizada em 34% dos pacientes.Resultados:Após a correção, houve 21 casos com insuficiência moderada ou grave da valva atrioventricular esquerda (39,6%). Após realização de análise multivariada, o único fator associado com esses graus de insuficiência foi a ausência da síndrome de Down (P=0,03).Conclusão:Ausência de síndrome de Down esteve associada com insuficiência moderada ou grave da valva atrioventricular esquerda após correção cirúrgica de defeito de septo atrioventricular total em nosso serviço.

Motor, linguistic, personal and social aspects of children with Down syndrome

AbstractA global developmental delay is expected from Down syndrome, affecting motor, cognitive, linguistic and personal-social skills. However, not always these delays are proportional; different conditions occur due to several intrinsic and extrinsic variables that must be controlled to form groups of greater homogeneity.Objective To enhance personal-social, fine motor-adaptive, gross motor and linguistic skills among children with Down syndrome and compare them with typically developing children, matched for gender, socioeconomic status and mental age, while controlling some variables that interfere with the global development.Methods The ethical aspects were fulfilled (Case No. 040/2009). The following inclusion criteria were considered: participants without a history of prematurity, very low birth weight, congenital hypothyroidism, significant hearing and vision problems, and signs of Autism Spectrum Disorder. After the inclusion criteria were considered, 40 children participated in the study, of which 20 had Down syndrome (experimental group - EG), these being of both genders and with chronological ages ranging from 38 to 63 months, and the other 20 being typically developing children (control group - CG), matching the EG in terms of gender, socioeconomic status and mental age, with this age ranging from 13 to 50 months. The evaluation consisted in applying the Denver Developmental Screening Test II, a test that assesses areas such as personal-social, fine motor-adaptive, linguistic and gross motor development. The results were subjected to statistical analysis using Student’s t-test.Results A statistically significant difference was verified between the groups for the language and fine motor-adaptive areas.Conclusion Children with Down syndrome showed lower performance in language and fine motor skills when compared with typically developing children. There was no statistically significant difference in gross motor and personal-social areas. It is worth mentioning the importance of controlling the variables to deal with more homogeneous groups.

Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect / Fatores associados à insuficiência moderada ou grave da valva atrioventricular esquerda nos primeiros 30 dias de correção de defeito de septo atrioventricular incompleto

Abstract Introduction: Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect. Objective: To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect. Methods: We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%). Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%. Results: At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%). The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26), unlike patients without such abnormalities (P=0.016). During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02). However, after a multivariate analysis, none of the factors reached significance. Conclusion: None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit ...

Resumo Introdução: A insuficiência da valva atrioventricular esquerda é a lesão residual mais preocupante após o tratamento cirúrgico do defeito de septo atrioventricular. Objetivo: Determinar fatores associados à insuficiência da valva atrioventricular esquerda de grau moderado ou importante nos primeiros 30 dias após correção de defeito de defeito de septo atrioventricular. Métodos: Avaliamos os resultados em 51 pacientes consecutivos menores de 14 anos com defeito de septo atrioventricular incompleto, operados em nosso serviço entre 2002 e 2010. Avaliamos as seguintes variáveis: idade, peso, ausência de síndrome de Down, grau de insuficiência da valva atrioventricular esquerda antes da correção, anormalidades na valva atrioventricular e uso de anuloplastia. A mediana da idade foi de 4,1 anos e a do peso de 13,4 Kg; 37,2% tinham síndrome de Down; antes da operação, 23 apresentavam insuficiência da valva atrioventricular esquerda pelo menos moderada (45,1%); anormalidades na valva atrioventricular foram encontradas em 17,6% dos casos; anuloplastia foi realizada em 21,6% dos pacientes. Resultados: Após a correção cirúrgica, 12 casos apresentaram insuficiência da valva atrioventricular esquerda pelo menos moderada (23,5%). A variância entre os graus de insuficiência da valva atrioventricular esquerda pré e pós-operatória nos pacientes com anormalidades na valva atrioventricular não teve significância estatística (P=0,26), ao contrário daqueles sem tais anormalidades (P=0,016). Pela análise univariada, apenas a ausência de síndrome de Down teve significância estatística (P=0,02). Porém, após análise multivariada, nenhum dos fatores teve significância. Conclusão: Nenhum dos fatores estudados foi determinante de insuficiência da valva atrioventricular esquerda de grau moderado ou importante nos primeiros 30 dias após a correção de defeito de septo atrioventricular incompleto na população avaliada. Pacientes sem anormalidades na valva atrioventricular ...

Down syndrome: a risk factor for malocclusion severity?

The aims of the present study were to compare aspects related to malocclusion between individuals with Down syndrome (DS) and a control group, establish malocclusion severity, and identify determinant factors. A total of 120 individuals (60 with DS and 60 with no physical or mental impairment), were included in the study. Data were collected through interviews, analyses of the medical charts, and oral examinations. The criteria of the Dental Aesthetic Index were used for the diagnosis of malocclusion. Chi-square test (p ≤ 0.05) and multivariate logistic regression were used for comparisons between the two groups and to determine the association between the dependent (malocclusion severity) and independent variables. Statistically significant differences were found between the two groups for the following variables: missing teeth, diastema, overjet, mandibular protrusion, anterior open bite, posterior crossbite, facial type, lip incompetence, and Angle classification. DS, a history of premature birth, and long face pattern were found to be associated with malocclusion severity. Individuals with DS exhibited more occlusal problems than those in the control group.

Skeletal maturation in individuals with Down's syndrome: Comparison between PGS curve, cervical vertebrae and bones of the hand and wrist

INTRODUCTION: This study was conducted with the aim of adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the pubertal growth spurt (PGS) curve. It also aimed to test the reliability and agreement between those methods and the method of hand and wrist radiograph when compared two by two and all together. METHODS: The sample comprised 72 radiographs, with 36 lateral radiographs of the head and 36 hand-wrist radiographs of 36 subjects with Down's syndrome (DS), 13 female and 23 male, aged between 8 years and 6 months and 18 years and 7 months, with an average age of 13 years and 10 months. RESULTS AND CONCLUSIONS: Results revealed that adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the curve of PGS is practical and useful in determining the stage of growth and development of individuals. The stages of maturation evaluated by cervical vertebrae and ossification centers observed in radiographs of the hand and wrist were considered reliable, with excellent level of agreement between the methods by Hassel and Farman as well as Baccetti, Franchi and McNamara Jr and Martins and Sakima. Additionally, results revealed an agreement that ranged between reasonable to good for the three methods used to assess the skeletal maturation, showing statistical significance. .

INTRODUÇÃO: esse estudo foi realizado com o propósito de adaptar os métodos para avaliação da maturação óssea por meio das vértebras cervicais na curva do Surto de Crescimento Puberal (SCP)de Martins e Sakima, assim como testar a confiabilidade e a concordância existente entre eles e o método para a radiografia de mão e punho, quando comparados 2 a 2, e entre todos, conjuntamente. MÉTODOS: a amostra constou de 72 radiografias, sendo 36 telerradiografias em norma lateral da cabeça e 36 radiografias de mão e punho, de 36 indivíduos com Síndrome de Down (SD), sendo 13 do sexo feminino e 23 do masculino, na faixa etária entre oito anos e seis meses até 18 anos e sete meses, com média de 13 anos e dez meses. CONCLUSÃO: de acordo com os resultados obtidos, concluímos que as adaptações dos métodos para a avaliação da maturação óssea por meio das vértebras cervicais na curva de SPC de Martins e Sakima resultaram em uma ferramenta prática e útil na determinação do estágio de crescimento e desenvolvimento dos indivíduos. Os estágios de maturação avaliados por meio das vértebras cervicais e os centros de ossificação observados nas radiografias de mão e punho foram considerados confiáveis, com excelente grau de concordância entre os métodos de diversos outros autores, e uma concordância de razoável a boa entre os três métodos para avaliação da maturação óssea quando comparados conjuntamente, sendo estatisticamente significativa. .

Mean length utterance in Brazilian children: a comparative study between Down syndrome, specific language impairment, and typical language development / Extensão média do enunciado em crianças brasileiras: estudo comparativo entre síndrome de Down, distúrbio específico de linguagem e desenvolvimento típico de linguagem

PURPOSE: To describe the linguistic performance of Brazilian Portuguese-speaking children with Down syndrome by analyzing their Mean Length Utterance; to compare their performance to that of children with Specific Language Impairment and Typical Development; and to verify whether children with Down syndrome present developmental language delay or disorder. METHOD: Participants were 25 children with Down syndrome (Research Group), matched by mental age to a Control Group of typically developing children, and to a Control Group of children with Specific Language Impairment. Participants were divided into subgroups, according to age range (three, four and five years). Speech samples were collected for the Research Group, and the Mean Length Utterance was analyzed for morphemes and words. RESULTS: Differences were observed between the performance of the Research Group and both Control Groups, and the former presented inferior Mean Length Utterance values for all age ranges, characterizing a delay in grammar and general language development. CONCLUSION: The description of the linguistic abilities of Brazilian Portuguese-speaking children with Down syndrome indicated important grammatical deficits, especially regarding the use of functional words. .

OBJETIVO: Descrever o desempenho linguístico de crianças com síndrome de Down falantes do Português Brasileiro por meio da análise da Extensão Média do Enunciado, comparar esse desempenho ao de crianças com Distúrbio Específico de Linguagem e com Desenvolvimento Típico e verificar se as crianças com síndrome de Down apresentam atrasos ou desvios do desenvolvimento linguístico. MÉTODO: Participaram do estudo 25 crianças com síndrome de Down (grupo pesquisa), pareadas pela idade mental ao grupo controle de crianças com desenvolvimento típico e ao grupo controle de crianças com Distúrbio Específico de Linguagem. Os participantes foram divididos em subgrupos de acordo com a faixa etária (três, quatro e cinco anos). Foram colhidas amostras de fala do grupo pesquisa e realizadas análises por meio da Extensão Média do Enunciado medida em morfemas e em palavras. RESULTADOS: Observaram-se diferenças de desempenhos entre o grupo pesquisa e os grupos controle, sendo que o primeiro apresentou valores de Extensão Média do Enunciado inferiores em todas as faixas etárias, o que caracteriza o atraso do desenvolvimento gramatical e linguístico geral. CONCLUSÃO: A descrição das habilidades linguísticas de crianças com síndrome de Down falantes do Português Brasileiro apontou para déficits gramaticais importantes, principalmente no que se refere ao uso de palavras funcionais. .

Influence of additional weight on the frequency of kicks in infants with Down syndrome and infants with typical development

BACKGROUND: Infants with Down syndrome present with organic and neurological changes that may lead to a delay in the acquisition of motor skills such as kicking, a fundamental skill that is a precursor of gait and is influenced by intrinsic and extrinsic factors. Therefore, this movement should be taken into account in early physical therapy interventions in infants. OBJECTIVE: To analyze and to compare the effect of additional weight on the frequency of kicks in infants with Down syndrome and infants with typical development at 3 and 4 months of age. METHOD: Five infants with Down syndrome and five with typical development at 3 and 4 months of age were filmed. The experiment was divided into four experimental conditions lasting 1 minute each: training, baseline, weight (addition of ankle weight with 1/3 the weight of the lower limb), and post-weight. RESULTS: There were significant differences between groups for all variables (p<0.05), with lower frequencies observed for infants with Down syndrome in all variables. There were significant differences between the experimental conditions baseline and post-weight (p<0.001) for both groups in the frequency of contact and success, with a higher frequency in the post-weight condition. CONCLUSIONS: The weight acted as an important stimulus for both groups, directing the kicks toward the target and improving the infants' performance in the task through repetition, however, the infants with Down syndrome had lower frequencies of kicks. .

Análise sialométrica em indivíduos portadores da síndrome de Down / Sialometric assessment of individuals with Down

A síndrome de Down (SD) é a alteração cromossômica mais comum no ser humano e caracteriza-se pelo aparecimento de um cromossomo extra, localizado no par 21. Objetivo: Nesta pesquisa estudou-se a velocidade de fluxo, o pH e a capacidade de tamponamento salivar em pacientes portadores da síndrome de Down. Materiais e Métodos: Foram selecionados 60 indivíduos não aparentados, pareados em idade e sexo, residentes em Curitiba, Paraná, sendo 30 indivíduos diagnosticados com SD (grupo experimental) e 30 indivíduos normorreativos (grupo controle). Para as avaliações bioquímicas salivares coletaram-se as amostras pelo método Spitting preconizado por Navazesh (1992) e posteriormente realizaram-se as análises. O fluxo salivar foi calculado através da fórmula de Banderas-Tarabay (1997). O pH salivar foi mensurado com o auxílio de um medidor digital e a capacidade tampão com o kit Caritest® – SL. Resultados: O valor médio do fluxo salivar foi estatisticamente menor para os indivíduos portadores da SD e os valores médios de pH e capacidade tampão salivar não diferiram entre os grupos. Conclusão: Indivíduos com SD apresentaram alterações uantitativas e não qualitativas do fluido salivar...

Down syndrome (DS) is the most common chromosomal abnormality in humans and is characterizedby the appearance of an extra chromosome, located at par 21. Objective: In this research we studiedthe flow rate, pH and buffering capacity of saliva in patients with Down syndrome. Materials and methods:60 unrelated individuals were selected matched by age and sex, living in Curitiba, Paraná, with 30 patientsdiagnosed with DS (experimental group) and 30 normoreactive individuals (control group). For biochemicalassessment, salivary samples were collected by Spitting method, recommended by Navazesh (1992) and thenthe analyses were carried out. Salivary flow was calculated using the formula of Banderas-Tarabay (1997).Salivary pH was measured with the aid of a digital meter and buffering capacity with the Caritest® – SL kit.Results: The mean salivary flow was statistically lower for patients with SD and the average values of pH andsalivary buffer capacity did not differ between groups. Conclusion: Individuals with SD showed no quantitativeand qualitative changes in salivary fluid...

Efficacy of selected treadmill training programme on oxidative stress in adolescents with Down syndrome

The aim of this study was to assess the efficacy of an electronic treadmill exercise training programme on malondialdehyde [MDA] as a marker for lipid peroxidation and the antioxidant enzyme glutathione peroxidase [GPx] in adolescents with Down syndrome. The study was carried out on 30 adolescent males with Down syndrome, ranging in age from 15 to 18 years, with 30 healthy subjects as a control group. Clinical examination, anthropometric measurements and determination of GPx activity and MDA before and after exercise were done. A treadmill training programme was performed for 12 weeks. Our data showed a significant increase in GPx activity and decrease in serum level of MDA in Down syndrome individuals after treadmill exercise for 3 months. Exercise promotion for adolescents with Down syndrome requires attention to motivators and facilitators of exercise adherence as it may limit risk of increased neurological consequences associated with oxidative stress and improve quality of life