Influencia de la suplementación con vitamina D, omega 3 o el uso de una dieta libre de gluten y caseína en el comportamiento de niños y niñas con trastorno del espectro autista / Influence of the vitamin D, omega 3 supplementation or the use of a gluten and casein free diet in the behavior of boys and girls with autism spectrum disorder

La prevalencia de trastorno del espectro autista ha ido en aumento, sin embargo, en Chile no existen lineamientos nutricionales acerca del posible tratamiento de la condición. Es por ello que el objetivo de esta revisión fue analizar la evidencia actual en relación al uso de una dieta libre de gluten y caseína, suplementación de vitamina D y omega 3 y su impacto en el comportamiento de niños/as con trastorno del espectro autista. Hay evidencia con resultados en torno a los beneficios de la suplementación con vitamina D debido a su carácter neuroprotector y su función neuromuscular. A su vez, la evidencia con omega 3 (DHA) es estadísticamente significativa para irritabilidad, hiperactividad, letargo, comportamiento estereotipado, conciencia social, comunicación y disminución de la severidad del autismo. Respecto a la dieta libre de gluten y caseína lo observado es que no existe evidencia que respalde los beneficios que esta exclusión entregaría. Aún falta evidencia para declarar un manejo nutricional específico para el tratamiento de los síntomas gastrointestinales y de comportamiento, más allá de la suplementación con aquellos micronutrientes en déficit.

The prevalence rate of autism spectrum disorder has been increasing, however, in Chile there are no nutritional guidelines about the possible treatment of the condition. That is the reason why the aim of this review is to analyze the current evidence regarding the use of a gluten and casein free diet, vitamin D and omega 3 supplementation and its impact in the behavior of children's with spectrum disorder autistic. There is evidence based on significant results regarding the benefits of vitamin D supplementation due to its neuroprotective character and neuromuscular function. At the same time the omega 3 evidence is statistically significant in the diminution of irritability hyperactivity, lethargy, stereotypical behavior, severity of autism and increase of social consciousness and communication. Regarding the gluten-free and casein-free diet, what was observed is that there is no evidence to support the benefits that this exclusion would provide. The evidence has not been conclusive to declare a specific nutritional management for the treatment of gastrointestinal and behavioral symptoms, beyond supplementation with those micronutrients in deficit.

Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study

Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children’s behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Neurotoxicity and aggressiveness triggered by low-level lead in children: a review / Neurotoxicidad y agresividad desencadenadas por bajos niveles de plomo en niños: una revisión

Lead-induced neurotoxicity acquired by low-level long-term exposure has special relevance for children. A plethora of recent reports has demonstrated a direct link between low-level lead exposure and deficits in the neurobehavioral-cognitive performance manifested from childhood through adolescence. In many studies, aggressiveness and delinquency have also been suggested as symptoms of lead poisoning. Several environmental, occupational and domestic sources of contaminant lead and consequent health risks are largely identified and understood, but the occurrences of lead poisoning remain numerous. There is an urgent need for public health policies to prevent lead poisoning so as to reduce individual and societal damages and losses. In this paper we describe unsuspected sources of contaminant lead, discuss the economic losses and urban violence possibly associated with lead contamination and review the molecular basis of lead-induced neurotoxicity, emphasizing its effects on the social behavior, delinquency and IQ of children and adolescents.

La neurotoxicidad adquirida inducida por la exposición prolongada a bajos niveles de plomo tiene una importancia especial en los niños. Una plétora de publicaciones recientes ha demostrado el vínculo directo existente entre la exposición a bajos niveles de plomo y el déficit en el desempeño neuroconductual-cognitivo manifestado desde la infancia hasta el final de la adolescencia. En numerosos estudios, la agresividad y la delincuencia juvenil también se han considerado síntomas de la intoxicación por plomo. Se han identificado y explicado ampliamente varias fuentes ambientales, laborales y domésticas de contaminación por plomo y los riesgos resultantes para la salud, pero aún son numerosos los casos de intoxicación por plomo. Se necesitan urgentes políticas de salud pública para prevenir la intoxicación por plomo de manera de reducir los daños y las pérdidas, tanto individuales como para la sociedad. En este artículo se describen algunas fuentes no sospechadas de contaminación por plomo y se discuten las pérdidas económicas y la violencia urbana posiblemente asociada con este tipo de contaminación. Además, se hace una revisión de las bases moleculares de la neurotoxicidad inducida por plomo, con énfasis en sus efectos sobre el comportamiento social, la delincuencia juvenil y el coeficiente intelectual de los niños y los adolescentes.

Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry.

The safe and effective treatment of uncooperative or combative preschool children with extensive dental needs is one of pediatric dentist's ongoing challenges. The traditional methods of behavior management are no longer acceptable to parents as they are not ready to spare more time for dental treatment of their children. Keeping this in mind, the present study was designed and carried out to evaluate the sedative effects of oral ketamine and oral midazolam prior to general anesthesia. Twenty uncooperative children in the age-group of 2-6 years were selected after thorough medical examination and investigations. Informed consent was obtained from the parent. This was a randomized double-blind study. An anesthesiologist administered either 0.5 mg/kg midazolam or 5 mg/kg ketamine orally. The heart rate, respiratory rate, and oxygen saturation were recorded at regular intervals. The sedation and anxiolysis scores were also recorded. The parents were asked to answer a questionnaire at the follow-up session the next day on the surgical experience of the parent and the child and side effects experienced, if any. When the data was subjected to statistical analysis, it was observed that both drugs resulted in adequate sedation at the end of 30 min, with oral midazolam providing significantly better anxiolysis. The heart rate and respiratory rate were marginally higher with oral ketamine. The questionnaire revealed a better response with oral midazolam; side effects were more prominent with oral ketamine.

Conscious sedation--an artist's science! An Indian experience with midazolam.

The present study was undertaken to evaluate Midazolam as a Paediatric conscious sedative agent for a routine Indian dental setup and to compare its efficacy and safety when administered by intranasal and intramuscular routes, at a dosage of 0.2 mg/kg body weight. The present study was accomplished in two phases: Phase 1: Preliminary dose finding pilot study on 10 children. Phase 2: Single dose, randomized parallel clinical trial on 40 children between the ages of 2 and 5 years. These children were randomly assigned to two groups consisting of 20 subjects each. Group M, received Midazolam intramuscularly, while Group N received Midazolam intranasally. Both the intranasal and intramuscular groups showed highly significant decrease in crying levels, motor movements and sensory perception levels, post-sedation (P P < 0.001). Midazolam could be safely and successfully employed by intranasal and intramuscular routes for Paediatric conscious sedation in a routine dental setup with basic facilities at a dosage of 0.2 mg/ kg body weight. Whenever the clinical situation warrants a faster action, peak and recovery, the intranasal route should be the obvious choice.

Comparative evaluation of Midazolam and Propofol as intravenous sedative agents in the management of unco-operative children.

Dental treatment of very young children (toddlers) as well as children with highly negative behaviour is known to be difficult. Management of these children requires special skill and at times the support of pharmacological means. A study was planned and carried out to evaluate and compare the efficacy and safety of Propofol and Midazolam as Intravenous sedative agents in the management of uncooperative children belonging to age group 2-5 years, ASA I Category and Frankl's behaviour rating 1 and 2. The results showed both agents to be effective sedative agents, for short pedodontic procedures with minimal side effects.

Exposição pré-natal á cocaína: revisão dos efeitos neurocomportamentais / Prenatal expoure to cocaine: review of the neurobehavioral effects

Objetivos: Estudar a exposição pré-natal à cocaína com ênfase nos seus efeitos neurocomportamentais. Métodos: Revisão bibliográfica dos últimos 15 anos, abordando o tema por meio do sistema Medline e procura direta. Resultados e conclusões: Conforme os dados da literatura mundial, a exposição pré-natal à cocaína apresenta uma incidência de até 13,5 por cento e os efeitos no recém-nascido são em grande parte sobre o desenvolvimento do sistema nervoso. Os pediatras e as subespecialidades pediátricas devem conhecer as conseqüências da exposição a fim de poder diagnosticar a alterar o prognóstico a alterar o prognóstico dessas criança

Técnicas de manejo del niño durante su atención dental / Techniques of child management during dental care

En este trabajo se efectuó una revisión bibliográfica a nivel mundial (1990-1994) sobre las técnicas de manejo o de adaptación del niño a la atención odontológica. Se encontraron variadas técnicas, desde la más simple y primordial como "decir mostrar-hacer" hasta la anestesia general, las que se explican brevemente en esta revisión. Cabe señalar que en algunos países como EEUU aún se acepta y se usan técnicas restrictivas tales como "mano sobre boca" o "restricción física", previa autorización firmada por los padres. Todos los autores coinciden en darle importancia relevante a la aplicación de técnicas que permitan la adaptación del niño a la atención odontológica. Esta adaptación no puede estar ajena a un proceso continuado y progresivo de las estrategias psicológicas actuales

Use of sedation analgesia for pediatric dentistry.

26 healthy children between the ages of 36 and 60 months (mean 35 months) who satisfied the selection criteria during a screening visit participated in this double blind study. The subjects were assigned randomly to receive either 75 mg/kg Triclofos elixir (Regimen I-21 children) or 50 mg/1kg Trichlofos elixir combined with 1 mg/kg promethazine elixir (Regimen II-22 children). All medications were given orally 45 minutes before treatment. During operative procedures all subjects received nitrous oxide/oxygen at a concentration of 35%. All the patients were restrained in a papoose board (Indigenous). The subjects were monitored for vital signs and evaluated for sedation and sleep, movement, crying and overall behaviour before, during and after the operative procedure. Regimen II was found to be superior to Regimen I with regard to behaviour management of difficult young children. However extremely apprehensive children were not good subjects for this sedation technique.