The use of abdominal muscle training, breathing exercises and abdominal massage to treat paediatric chronic functional constipation.

AIM: The effect of muscular training, abdominal massage and diaphragmatic breathing was compared with medical treatment in a prospective randomized trial of patients with chronic functional constipation. METHOD: Patients aged 4-18 years old with functional constipation according to the Rome III criteria were randomized to physiotherapy or medical treatment. In the physiotherapy group, exercises (isometric training of the abdominal muscles, diaphragmatic breathing exercises and abdominal massage) were employed during 12 40-min sessions twice a week by a trained physiotherapist, with laxatives. Patients in the medication group were only given laxatives. Primary outcome measures were frequency of defaecation and faecal incontinence. The analysis was performed by intention-to-treat. RESULTS: After 6 weeks of treatment, the frequency of bowel movements was higher in the physiotherapy group [5.1 (2.1) days/week] than in the medication group [3.9 (2.0) days/week] (P = 0.01). The frequency of faecal incontinence was no different between the groups [3.6 (1.9) days/week vs 3.0 (2.1) days/week] (P = 0.31). CONCLUSION: The combined use of isometric training of abdominal muscles, breathing exercises and abdominal massage increased defaecation frequency after 6 weeks but faecal incontinence remained unchanged. Physiotherapy may be a useful treatment for constipation.

Production of interleukin-10 in asthmatic children after Beta-1-3-glucan.

BACKGROUND: Beta-1-3 Glucan is a polysaccharide extracted from Saccharomyces cerevisiae with a possible immunomodulating action that may have a favourable action on asthma symptoms and other allergic diseases. An experimental study carried out using a murine respiratory model detected a decrease in pulmonary tissue eosinophilia, as well as an increase in Interleukin-10 (IL-10) after glucan use. METHODS: This open, exploratory study with blind outcome evaluation included asthmatic children between 6 and 12 years of age with mild to moderate persistent asthma and inadequate disease control (rescue medication needed more than twice a week) in spite of inhaled budesonide 400 microg/day. After a four week run-in period, subcutaneous Beta-1-3-glucan injections were given weekly for the first four weeks and then every two weeks for the last four weeks. IL-10 levels, measured by the immunoenzymatic method (ELISA), were compared before and after glucan administration. RESULTS: Twenty patients (14 male and 6 female) were included. Mean IL-10 levels were 6.4 pg/ml and 11.3 pg/ml before and after glucan, respectively (p = 0.02). There was also a reduction of asthmatic symptoms score at the end of study. CONCLUSIONS: This is the first study which shows that subcutaneous particulate Beta-1-3-glucan increases serum IL-10 levels in asthmatics. The possibility of glucan being able to modulate allergic sensitisation and having a beneficial action in restoring Th2 function should be assessed by means of properly planned controlled clinical trials, as it may represent a new therapeutic strategy.

[Obesity and malnutrition in children: profile of a low-income community] / Desnutrição e obesidade em crianças: delineamento do perfil de uma comunidade de baixa renda.

OBJECTIVE: To establish the nutritional diagnosis of children living in a low-income community through anthropometric evaluation, detecting insufficient nutrition (low weight-for-age, wasting and stunting) and excessive nutrition (overweight and obesity). METHODS: A community-based survey identified children below 11 years living in a low-income community. Their weight and height (or lengths) were measured. The National Center for Health Statistics growth curve was used as reference. The cut-off points used were: low-weight-for-age z score of < -2 (weight-for-age), wasting (weight-for-height) and stunting (height-for-age); respective overweight and obesity z scores of +1 to +2 and of > +2, according to weight-for-height. RESULTS: Prevalence rates were 3.8% for low weight for age, and 24% for low-weight-for-age risk factors; 1.2% for wasting, and 21.6% for wasting risk factors; 5% for stunting, and 14.3% for stunting risk factors; 10.1% for overweight, and 4.6% for obesity. CONCLUSIONS: Main nutritional issues were present in children from that community, with simultaneous occurrence of chronic malnutrition and obesity.

[Signs and symptoms associated with chronic constipation] / Sinais e sintomas associados à constipação crônica.

OBJECTIVE: To check whether signs and symptoms referred to by parents are associated with chronic constipation. METHODS: A comparative survey was carried out in a group of children with constipation and another group without constipation selected from a random sample. Data were collected from mothers using a structured questionnaire. Children with chronic constipation were expected to have undergone painful defecation or defecation with effort during at least thirty days with stools of hard consistency and/or bowel movements frequency below three times per week. RESULTS: An assessment was made of the variables: inappetence, abdominal distension, abdominal pain, fecal bleeding, soiling, urinary problems and vomit. Statistical differences were observed among children with and without constipation for inappetence, abdominal pain and faecal bleeding (p<0.05). CONCLUSIONS: An association was detected between the signs and symptoms analyzed and constipation. This study stresses the need to investigate accurately whether children have constipation and the extent of its relationship with those complications.

[Chronic functional constipation in children: diagnosis and prevalence in a low-income community] / Constipação intestinal crônica funcional na infância: diagnóstico e prevalência em uma comunidade de baixa renda.

OBJECTIVE: To investigate the prevalence of chronic functionalconstipation in children aged under 11 years of a low-incomecommunity in Recife, Northeast Brazil and to assess the validity ofcomplaints of bowel habits for the diagnosis of constipation. METHODS: A community-based survey identified 536 eligiblechildren. Data collection was home-based through a structuredquestionnaire applied to the mothers. The definition of chronicfunctional constipation was based on painful defecation or witheffort, with stools of hard consistency and/or frequency of defecationless than three times per week, during at least the last thirty days. RESULTS: The prevalence of chronic functional constipation was17.5%. Straining was the complaint which obtained the highestsensitivity for the diagnosis of constipation (96.8%) while pain todefecate obtained the highest specificity (99.5%). CONCLUSIONS: Chronic functional constipation was a prevalentsymptom in this community, pointing out to the need of an activesearch in paediatric consultation. Straining was identified as thesingle complaint which better diagnosed constipation.

Potentially malignant epithelial oral lesions: discrepancies between clinical and histological diagnosis.

OBJECTIVE: To evaluate the discrepancy index between the clinical and histological diagnosis and the prevalence of epithelial dysplasia and carcinoma in 45 patients with potentially malignant epithelial oral lesions (PMEL). PATIENTS AND METHODS: We submitted 45 patients with PMEL to clinical examination and obtained a biopsy from each. The results of histological diagnosis were compared to the clinical diagnosis. RESULTS: Clinical diagnosis showed that the most common PMEL was leukoplakia followed by lichen planus and by actinic cheilitis associated with leukoplakia. The most common site was the buccal mucosa. Histological diagnosis revealed that 46.7% of the PMEL were lichen planus. The discrepancy index between clinical and histological diagnosis was 24.4%. The higher discrepancy index occurred among leukoplakias. The prevalence of epithelial dysplasia and carcinoma was 17.8%. CONCLUSIONS: We conclude that all PMEL should be submitted to a microscopic analysis because the discrepancy between clinical and histological diagnosis was present in a quarter of these lesions. Otherwise, the epithelial dysplasia and carcinoma were more frequent in the leukoplakias.