Reprint of "Ethical issues with artificial nutrition of children with degenerative brain diseases".

This report highlights viewpoints of the authors and comments from the auditory at a workshop, held during the 14th international Congress on neuronal ceroid lipofuscinoses (NCL) in Córdoba, Argentina, on ethical aspects of artificial nutrition in children with degenerative brain diseases. The discussion centers on what constitutes the best interest of a patient whose personality was immature before the onset of the disease, who has become demented during its course and is unable to communicate his/her own positions and desires. There is wide consensus that in a child with advanced disease who cannot be fed naturally, decisions to withhold nutrition or to institute or stop artificial nutrition, should only be made by parents (or their representatives) who are adequately prepared on an intellectual and emotional level. We try to show that such decisions are highly individual but can be made in a rationally and emotionally acceptable way after a careful and prolonged dialogue between families and professionals. A checklist summarizes important considerations. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

Ethical issues with artificial nutrition of children with degenerative brain diseases.

This report highlights viewpoints of the authors and comments from the auditory at a workshop, held during the 14th international Congress on neuronal ceroid lipofuscinoses (NCL) in Córdoba, Argentina, on ethical aspects of artificial nutrition in children with degenerative brain diseases. The discussion centers on what constitutes the best interest of a patient whose personality was immature before the onset of the disease, who has become demented during its course and is unable to communicate his/her own positions and desires. There is wide consensus that in a child with advanced disease who cannot be fed naturally, decisions to withhold nutrition or to institute or stop artificial nutrition, should only be made by parents (or their representatives) who are adequately prepared on an intellectual and emotional level. We try to show that such decisions are highly individual but can be made in a rationally and emotionally acceptable way after a careful and prolonged dialogue between families and professionals. A checklist summarizes important considerations. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

Oral ecosystem alterations in celiac children: a follow-up study.

OBJECTIVE: The aims of this work were (1) to assess the oral health status of children with celiac disease (CD) with or without compliance with a gluten-free diet and in non-celiac children in a follow-up study and (2) to identify oral ecosystem changes that could be used as non-invasive monitoring methods for CD patients. STUDY DESIGN: An 18-month follow-up study in children of both genders, who were 4-12 years old during the study period, was performed. Decayed-missing-filled in temporary (dmft) and permanent teeth (DMFT), enamel alterations, oral hygiene, and gingival index were measured. Oral smears were collected by brushing. Flow rate, calcium, phosphate, pH, buffer capacity, fluoride, and Ca/P ratio were measured in saliva. Salivary protein profiles were performed. RESULTS: Most CD patients (80%) presented typical symptoms between 12 and 24 months old. Children with CD had a significantly low frequency of enamel alterations (30%) (p=0.0001). A high percentage of patients (63.15%) reported having had aphthous ulcers at several times. The celiac group showed significantly more polymorphonuclear neutrophils (PMNs) in smears (20% PMNs per area, p=0.0459) than the control group (0% PMNs per area) at baseline. In CD children, 90% of the samples that showed PMNs at baseline did not present them after 18 months. However, 10% of the smears of CD patients presented PMNs at the end of this study. Compliance with the gluten-free diet was controlled to detect the maintenance or worsening of signs and symptoms during the medical controls. CONCLUSIONS: The main differences amongst CD children who did or did not comply with a gluten-free diet and control children are the presence of PMNs in oral mucosa and protein salivary patterns; these findings could be considered as markers for CD, in conjunction with other signs and symptoms.

Evaluation of clinical dental variables to build classifiers to predict celiac disease.

OBJECTIVE: The aim of this study was to evaluate the use of salivary variables to build statistical models for predicting celiac disease in symptomatic children. MATERIALS AND METHODS: The study group consisted of 52 children with celiac disease diagnosed by bowel biopsy, grade III or IV (4 to 12 years old, both sexes) and 23 healthy children as a control group. A logistic regression model was applied to evaluate an individual's belonging to one group or another. The performance of the model was evaluated by the value of area under the ROC curve. The salivary variables included in the model were the concentration of total proteins, calcium, Ca/P molar ratio, buffer capacity and salivary flow. RESULTS: The total proteins (p = 0.0016) and Ca/P molar ratio (p = 0.0237) variables were significantly associated with the celiac condition. The value of the area under the ROC curve, estimated from the probabilities of the logistic model, showed that salivary component values allow the celiac condition of patients to be predicted with 85% accuracy (p <0.0001). CONCLUSION: Logistic discriminant analysis built with salivary variables shows that these are good for predicting this eating pathology with 85% accuracy.

Evaluation of clinical dental variables to build classifiers to predict celiac disease

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Objective: The aim of this study was to evaluate the use of salivary variables to build statistical models for predicting celiac disease in symptomatic children. Materials and Methods: the study group consisted of 52 children with celiac disease diagnosed by bowel biopsy, grade III or IV (4 to 12 years old, both sexes) and 23 healthy children as a control group. A logistic regression model was applied to evaluate an individual’s belonging to one group or another. The performance of the model was evaluated by the value of area under the ROC curve. The salivary variables included in the model were the concentration of total proteins, calcium, Ca / P molar ratio, buffer capacity and salivary flow.Results: The total proteins (p = 0.0016) and Ca / P molar ratio (p = 0.0237) variables were significantly associated with the celiac condition. The value of the area under the ROC curve, estimated from the probabilities of the logistic model, showed that salivary component values allow the celiac condition of patients to be predicted with 85% accuracy(p <0.0001). Conclusion: Logistic discriminant analysis built with salivary variables shows that these are goodfor predicting this eating pathology with 85% accuracy