Oral health status of a sample of Venezuelan patients with spina bifida: a cross-sectional study / Estado de salud bucal de una muestra de pacientes venezolanos con espina bífida: estudio transversal

Abstract: spina bifida (SB) is a congenital malformation of the spinal cord associated with several vertebral abnormalities caused by incomplete neural tube closure. The aim of this study is to report on the oral health status of a sample of Venezuelan patients with SB. Materials and Methods: An observational cross-sectional study was performed in 30 patients with SB to determine their oral health status and other variables of interest. Results: A 46.7 percent of the patients had a history of caries: 22 percent in the 1-4 year group, 71.4 percent in the 5-7 year group, and 100 percent in the 8-16 year group. The dmft and DMFT indices were 1.55 and 3.50, respectively. A 46.7 percent of the patients had gingivitis, 30 percent had dental calculus, with an OHI-S of 2. The 83 percent had Angle Class II and 17 percent, Angle Class I. A 40 percent had parafunctional habits such as digital suction, use of pacifiers and onicophagia. The 70 percent had deep palate. Conclusion: Patients with SB have specific oral characteristics and risk factors that must be taken into account in dental treatments to provide adequate care and improve their quality of life.

Resumen: la espina bífida (EB) es una malformación congénita de la médula espinal con alteraciones vertebrales simultáneas, debido al cierre incompleto del tubo neural. El objetivo de este trabajo es reportar el estado de salud bucal de una muestra de pacientes venezolanos con EB. Materiales y métodos: se realizó un estudio observacional de corte transversal donde se evaluaron 30 pacientes con EB para determinar su estado de salud bucal y otras variables de interés. Resultados: Un 46,7 por ciento de los pacientes presentó historia de caries, con un 22,2 por ciento en el grupo de 1-4 años, 71,4 por ciento en el grupo 5-7 años y del 100 por ciento en los pacientes de 8 a 16 años. El índice ceod fue de 1.55 y el COPD de 3.50. Un 46,7 por ciento presentó gingivitis, el 30 por ciento presentó cálculo dental, siendo el IHOS de 2. El 83 por ciento presentó clase II de Angle y el 17 por ciento clase I de Angle. El 40 por ciento tenía hábitos parafuncionales, siendo éstos, la succión digital, uso de pacificadores y la onicofagia. El 70 por ciento de los pacientes presentó paladar profundo. Conclusiones: Los pacientes con EB presentan características bucales particulares y factores de riesgo que deben ser considerados durante la consulta odontológica para brindarle una atención de adecuada y mejorar su calidad de vida.

Resultados del Programa de Prevención de Defectos de Tubo Neural en Chile mediante la fortificación de la harina con ácido fólico: Período 2001-2010 / Effects of wheat flour fortification with folic acid on the prevalence of neural tube defects in Chile

Background: Congenital malformations (CMF) have an important role in infant mortality. Neural tube defects (NTD) have great relevance from both social and public health points of view. The ECLAMC (Collaborative Latin American Study of Congenital Malformations) maintains in Chile an epidemiological surveillance of CMF prevalence rate at birth since 1969. Aim: To assess the effect of wheat flour folic acid fortification on the prevalence of NTD. Patients and Methods: Only An encephaly, Spina bifida and Cephalocele were considered as NTD. All children born in the maternities incorporated to ECLAMC between 1969 and 1999 were considered as belonging to the pre folic acid fortification period and those who were born from 2001 to 2010 were considered as belonging to the post fortification period. Results: The NTD prevalence rate at birth in the pre fortification period was 17.03/10,000. In the second period, there were 291,996 births and among them, 280 newborns were affected by a form of NTD (9.59 in 10,000 births). This represents a 44% decrease (p < 0.01). Anencephaly rate fell from 7.16/10,000 to 3.67/10,000, representing a 49% lower rate (p < 0.01). Spina bifida rate decreased from 8.61/10,000 to 4.49/10,000, representing a 48% lower rate (p < 0.01). Cephalocele had a 20% non-significant reduction. Conclusions: Wheat flour fortification with folic acid reduced by 44% the prevalence rate of NTD at birth. This means that NTDs were prevented in 185 Chilean newborns each year.

Prevalência e distribuição espacial de defeitos do tubo neural no Estado de São Paulo, Brasil, antes e após a fortificação de farinhas com ácido fólico / Prevalence and spatial distribution of neural tube defects in São Paulo State, Brazil, before and after folic acid flour fortification / Prevalencia y distribución espacial de defectos del tubo neural en el Estado de São Paulo, Brasil, antes y después del enriquecimiento de harinas con ácido fólico

Estudo transversal que analisou prevalência e distribuição espacial de defeitos do tubo neural, antes e após a fortificação das farinhas de trigo e milho com ácido fólico no Estado de São Paulo, Brasil, com uso do Sistema de Informações sobre Nascidos Vivos (SINASC). São apresentadas prevalências segundo características maternas por meio de odds ratio (OR) e intervalos de 95% de confiança (IC95%). Para análise temporal e espacial, foram utilizados, respectivamente, regressão polinomial e mapas com suavização bayesiana empírica. A prevalência diminuiu 35%, de 0,57 para 0,37 por mil nascidos vivos após a fortificação (OR = 0,65; IC95%: 0,59-0,72). Verificou-se redução para mulheres de todas as idades (exceto < 15 anos), com mais de três anos de estudo e sete consultas ou mais de pré-natal. Confirmou-se redução temporal na maior parte do estado, exceto alguns municípios do oeste. Outros aspectos podem ter contribuído para o declínio observado, porém os resultados reiteram a fortificação de farinhas como medida importante para prevenção de defeitos do tubo neural. Outras análises devem ser realizadas para justificar resultado inverso no oeste paulista.

This cross-sectional study analyzed the prevalence and spatial distribution of neural tube defects before and after folic acid flour fortification. The study used the Information System on Live Births (SINASC) and presented prevalence rates according to maternal characteristics with odds ratios (OR) and 95% confidence intervals (95%CI). Polynomial regression was used in time trend analysis and empirical Bayesian smoothed maps for spatial analysis. Total prevalence of neural tube defects decreased by 35%, from 0.57/1,000 to 0.37/1,000 live births after fortification (OR = 0.65; 95%CI: 0.59-0.72). There was a reduction among newborns of mothers with the following characteristics: all age groups (except < 15 years), more than three years of schooling, and seven or more prenatal visits. There was a reduction over time and in most of São Paulo State, except in a few municipalities (counties) located in the western region of the State. Other factors may have contributed to the observed decline, but the results corroborate flour fortification as an important measure to prevent neural tube defects. Further research is needed to elucidate the lack of a decline in neural tube defects in the western part of São Paulo State.

Estudio transversal que analizó la prevalencia y distribución espacial de defectos del tubo neural, antes y después del enriquecimiento de las harinas de trigo y maíz con ácido fólico en el Estado de Sao Paulo, Brasil, con el uso del Sistema de Información sobre Nacidos Vivos (SINASC). Se presentaron prevalencias, según características maternas, mediante odds ratio (OR) e intervalos de un 95% de confianza (IC95%). Para un análisis temporal y espacial, fueron utilizados, respectivamente, regresión polinomial y mapas con suavizamiento bayesiano empírico. La prevalencia disminuyó un 35%, de 0,57 a 0,37 por mil nacidos vivos tras el enriquecimiento (OR = 0,65; IC95%: 0,59-0,72). Se verificó la reducción en mujeres de todas las edades (excepto < 15 años), con más de tres años de estudio y siete consultas o más de carácter prenatal. Se confirmó la reducción temporal en la mayor parte del estado, excepto algunos municipios del oeste. Otros aspectos pueden haber contribuido al declive observado, no obstante, los resultados reiteran el enriquecimiento de harinas como una medida importante para la prevención de defectos en el tubo neural. Otros análisis deben ser realizados para justificar el resultado inverso en el oeste paulista.

Asociación inversa entre asma y defectos del tubo neural: estudio ecológico binacional / Inverse association between asthma and neural tube defects: a binational ecological study

OBJETIVO: Los donadores de metilo como el ácido fólico previenen defectos del tubo neural (DTN), pero estudios recientes sugieren que también favorecen el desarrollo de asma. En este trabajo exploramos una posible asociación ecológica entre DTN y asma. MATERIAL Y MÉTODOS: Se consultaron bases de datos de México y EUA para obtener información sobre distribución geográfica (por estado) y tendencia temporal (por año) de DTN y asma. RESULTADOS: Los estados con menor frecuencia de DTN tuvieron mayor frecuencia de asma, tanto en México (rS=-0.48, p=0.005) como en EUA (rS=-0.39, p=0.005). Las tendencias temporales también mostraron correlación inversa en México (1997-2007, rS=-0.73, p=0.01) y EUA (1979-1998, rS=-0.91, p<0.001). CONCLUSIONES: En ambos países la frecuencia de asma correlacionó de forma inversa con la frecuencia de DTN, tanto en distribución geográfica como en tendencias anuales, apoyando la posibilidad de que la ingestión de donadores de metilo en la dieta o como suplementos esté influyendo sobre la frecuencia de asma.

OBJECTIVE: Dietary intake of methyl donors such as folic acid prevents neural tube defects (NTD), but recent studies showed that it might also favor the development of asthma. In this work a possible ecological association between NTD and asthma was explored. MATERIAL AND METHODS: Data bases from Mexico and the United States (US) were reviewed to obtain information about geographical distribution (by state) and temporal trends (by year) of NTD and asthma. RESULTS: Those states with the lowest frequency of NTD had the highest frequency of asthma, both in Mexico (rS=-0.48, p=0.005) and US (rS=-0.39, p=0.005). Temporal trends also showed an inverse correlation in Mexico (1997-2007, rS=-0.73, p=0.01) and US (1979-1998, rS=-0.91, p<0.001). CONCLUSIONS: In both countries the frequency of asthma inversely correlated with the frequency of NTD, both in geographical distribution and annual trends, giving support to the possibility that methyl donors intake in diet or supplements is influencing the asthma frequency.

Impacto de la fortificación de alimentos con ácido fólico en los defectos del tubo neural en Costa Rica / Impact of the fortification of food with folic acid on neural tube defects in Costa Rica

OBJETIVO: Evaluar el impacto de la fortificación de alimentos con ácido fólico en las tendencias de las prevalencias de los defectos del tubo neural (DTN) y la tasa de mortalidad infantil (TMI) por este trastorno en Costa Rica. MÉTODOS: Se analizaron los datos de vigilancia del Centro de Registro de Enfermedades Congénitas y el Centro Centroamericano de Población. Se consideraron defectos del tubo neural la anencefalia, la espina bífida y el encefalocele. Se examinaron las tendencias durante 1987-2009, así como las diferencias de tasas (intervalo de confianza [IC] 95 por ciento) de prevalencia y mortalidad antes de la fortificación de alimentos con ácido fólico y hasta 12 años después de su implementación. Se determinó el aporte de la fortificación al descenso en la TMI general. RESULTADOS: En 1987-1997, previo al período de fortificación de alimentos con ácido fólico, la prevalencia de DTN fue de 12/10 000 nacidos (IC95 por ciento: 11,1-12,8), mientras que en 2009 fue de 5,1/10 000 nacidos (3,3-6,5). La TMI por DTN en 1997 fue de 0,64/1 000 nacimientos (46-0,82) y en 2009 de 0,19/1 000 (0,09-0,3). La TMI por DTN y su prevalencia disminuyeron en forma significativa, 71 por ciento y 58 por ciento respectivamente (P < 0,05). La TMI general disminuyó de 14,2/1 000 nacidos en 1997 a 8,84/1 000 en 2009 (P < 0,05). El descenso en la TMI por DTN contribuyó a una caída de 8,8 por ciento en la TMI general entre 1997 y 2009. CONCLUSIONES: La fortificación de alimentos con ácido fólico provocó una reducción de DTN al nacimiento y de la TMI por esta malformación durante el período 1997-2009, así como también el descenso de la TMI general. Existe relación de temporalidad entre el inicio de las políticas de fortificación y el descenso de la prevalencia y mortalidad por DTN. Se debe pro-mover esta intervención en los países de América Latina y el Caribe donde todavía no ha sido implementada.

OBJECTIVE: Evaluate the impact of the fortification of food with folic acid on prevalence trends for neural tube defects (NTD) and the infant mortality rate (IMR) associated with this disorder in Costa Rica. METHODS: The surveillance data from the Congenital Disease Registry Center and the Central American Population Center were analyzed. The neural tube defects considered were anencephaly, spina bifida, and encephalocele. The trends from 1987-2009, as well as the differences in prevalence and mortality rates prior to and up to 12 years after food fortification with folic acid, were examined (95 percent confidence interval [CI]). The contribution of fortification to the decrease in the overall IMR was determined. RESULTS: During 1987-1997, prior to the period of food fortification with folic acid, NTD prevalence was 12/10 000 births (95 percent CI: 11.1-12.8), whereas in 2009 prevalence was 5.1/10 000 births (3.3-6.5). The IMR associated with NTD was 0.64/1 000 births (46-0.82) in 1997 and 0.19/1 000 births (0.09-9.3) in 2009. There were significant decreases in the IMR associated with NTD and the prevalence of NTD: 71 percent, and 58 percent, respectively (P < 0.05). The overall IMR decreased from 14.2/1 000 births in 1997 to 8.84/1 000 births in 2009 (P < 0.05). The decrease in the IMR associated with NTD contributed to an 8.8 percent decrease in the overall IMR from 1997 to 2009. CONCLUSIONS: Food fortification with folic acid caused a decrease in NTD at birth and the IMR associated with this malformation during the 1997-2009 period. It also led to a decrease in the overall IMR. There is a temporal relationship between the introduction of fortification policies and the decrease in prevalence and mortality associated with NTD. This intervention should be promoted in Latin American and Caribbean countries where it has not yet been implemented.

Congenital inclusion tumours in spinal dysraphism.

Objective. To review the presentation, diagnosis and management of children with spinal dysraphism and CIT. Methods. It is a retrospective review of 146 children of spina bifida over 9 years (2000-2008) and details the clinical course and outcome of seven with associated congenital inclusion tumors. Results. 7/146 (4.7%) had spina bifida with CIT, 5 dermoid cysts and 2 mature teratoma. The diagnosis was missed by the primary physician even in the presence of a neurocutaneous marker. Spinal imaging with MRI was conclusive. All were managed with multilevel laminectomy, near total/total excision of the CIT and detethering of cord. Intramedullary involvement and established neurological deficits at presentation were associated with persistent deficits. Conclusion. Early detection and comprehensive management of CIT with spinal dysraphism ensures social fecourinary continence, preserves renal function, achieves ambulation and enables patients to lead an acceptable quality of life.

Efecto de la fortificación de la harina con ácido fólico sobre la evolución de las tasas de prevalencia al nacimiento de malformaciones congénitas en los hospitales chilenos del ECLAMC / Effects of folic acid fortification in the rates of malformations at birth in Chile

Background: The effects of folic acid fortification on neural tube defects is well known. Other reports show a beneficial effect of the fortification on orofacial clefts, urinary malformations and defects caused by limb reduction. Aim: To determine the changes in prevalence of congenital malformations after the start of flour folic acid fortification in Chile. Material and methods: The rates of 22 malformations occurring in the maternity of the University of Chile Clinical Hospital and other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were compared before and after the start of flour folic acid fortification. Results: After the start of folic acid fortification a significant reduction in the rates of anencephalia, spina bifida and diaphragmatic hernia, was observed. The rates of all other malformations remained stable or increased. The rates of all malformations at the University of Chile Clinical Hospital had a steady increase until 2005 and were significantly higher than in the rest of hospitals participating in ECLAMC. Conclusions: Folic acid fortification was associated with an expected reduction in rates of spina bifida and anencephalia and an unexpected reduction in the rates of diaphragmatic hernia.

Neural tube defects among infants delivered of mothers with tobacco smoke exposure

To verify the occurrence of congenital neural tube anomalies among the newborns of pregnant women who had experienced exposure to tobacco smoke. A cross sectional study of pregnant women at delivery considering their newborns as a gestational cohort. A systematic random sample of 2300 pregnant women who attended for labour at Maternity and Children hospital in Najaf city were interviewed for history of tobacco smoke exposure during the period 2002-2004. The sample was subdivided into exposed and unexposed women to tobacco smoke. The newborns were clinically examined by a pediatrician for presence of any congenital anomalies especially neural tube defects. The over all newly delivered newborns with congenital anomalies were 3.4% among smoker mothers, and 1.9% among nonsmokers [including small defects]. The most frequent neural tube defects among smoker mothers were anencephaly [1.8%] and spina bifid a [1.2%], versus 0.7% and 0.6% respectively among non smokers or unexposed women [P<0.05]. There was some increase in the risk of such defects among exposed women to tobacco smoke who did not take folic acid in relation to unexposed in spite of no statistically significant difference. Also there was no significant difference in the distribution of neural tube defects between those women who live in urban or rural areas or between different age groups. Smoking is a risk factor for neural tube defects

Prevenção de defeitos de fechamento do tubo neural pela administração de ácido fólico – desafio da saúde pública / Defects prevention of the neural pipe closing for the acid fólico administration - public health challenge

Este trabalho analisou a incidência de Defeitos do Tubo Neural (DTNs) em nascimentos ocorridos em cinco hospitais de Santo André, no período de janeiro a outubro de 2004. Em um total de 6.887 nascimentos foram observados 13 casos de DTN, resultando em uma incidência de 1,9/1000. As mães que tiveram crianças com DTNs foram interrogadas quanto às medidas preventivas atualmente preconizadas como o uso de ácido fólico antes do 28º dia após a concepção. Verificou-se que o não uso do ácido fólico foi devido à gravidez não planejada e desconhecimento da sua importância. Nas que tomaram ácido fólico, a administração foi após o 28º dia de gravidez, portanto fora do período desejado. Paralelamente foram estudadas outras 100 gestantes, aleatoriamente, em relação às medidas preventivas. Verificou-se que 91 parturientes não usaram ácido fólico e 9 tomaram fora do período desejado. Sugere-se com este estudo que a educação de mulheres em idade fértil é fundamental como meio preventivo eficaz, o que representa um desafio de saúde pública.

Malformaciones congénitas y exposición a pesticidas / Congenital malformations and pesticide exposure

Background: Chronic pesticide exposure is a recognized risk for human health. The frequency of congenital malformations in exposed people, can be used for epidemiological studies assessing reproductive risk secondary to toxic exposure. Aim: To study the association between the incidence of congenital malformations and parent's exposure to pesticides. Material and methods: A prospective study of cases and controls. The exposure could be caused by occupational activities or residence around fumigated crops. The records of cases and controls from the surveillance carried out in the Hospital Regional de Rancagua were analyzed. This hospital is active member of a collaborative study of congenital malformations in Latin America. Results: In two years there was a total of 453 newborns (18 stillborn) with congenital malformations, with an incidence of 41.24 ä. Considering only children born alive, the paired analysis of cases and controls showed an association of congenital malformations with a history of maternal exposure, with an attributable fraction of 54.4 percent. Conclusions: These results, showing an association between pesticide exposure and congenital malformations, should be analyzed in the future by a logistic regression test

Perinatal factors associated with neural tube defects (anencephaly [correction of anancephaly], spina bifida and encephalocele)

The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de Säo Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by Estudo Colaborativo Latino-Americano de Malformaçöes Congênitas (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated population of 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop.