Evaluation of Gingival Displacement with Aluminum Chloride and Naphazoline Hydrochloride: A Randomized Controlled Trial.

The objective of this study was to evaluate the use of naphazoline hydrochloride in comparison with aluminum chloride for vertical gingival displacement. The inclusion criteria were: patients with a good general systemic condition; periodontal health; and thick gingival biotype. Moreover, the exclusion criteria were: smoking individuals; canine teeth or central incisors with carious lesions, abrasion, erosion, prosthetic abutments or unsatisfactory restorations; patients with periodontal disease; and users of continuous medication. 72 teeth were included and the Square Block Design was used to randomize the samples. Three measures were obtained from each tooth, and mean vertical gingival displacement was calculated. A descriptive analysis of the average displacement was performed. The normality test used was the Lilliefors' Test and for comparison between treatments, the Kruskal-Wallis Test was used. The Bartlett's Test for homogeneity of variances was used and a 5% (p ⟨ 0.05) significant level was considered. Thus, the Aluminum Chloride and Naphazoline Hydrochloride showed no statistically amount of gingival retraction than the control group (p = 0.3822). The average of gingival vertical displacement in all groups were less than 0,5 mm. The technique used did not allow any amount of horizontal displacement on obtained models.

[Recommendations for a gradual and controlled resumption of electroconvulsive therapy in France during the period of lifting of the containment and of the COVID-19 pandemic linked to SARS-CoV-2]. / Recommandations pour une reprise progressive et contrôlée de l'électroconvulsivothérapie en France en période de levée du confinement et de pandémie COVID-19 liée au SARS-CoV-2.

The COVID-19 pandemic has had major consequences for the organization of care. In France and around the world, centers practicing electroconvulsive therapy (ECT) have seen their activity decrease, or even stop for many reasons. In this context, maintaining or resuming this essential therapeutic activity for many patients suffering from psychiatric disorders requires material, human and logistical adaptations that should be supervised. The objective of this collective and national work is to offer simple recommendations that can be applied immediately by any healthcare establishment, public or private, practicing ECT. They are the result of feedback from multiprofessional and inter-establishment experiences. Declined in three stages, these recommendations are accompanied by a practical sheet which describes in detail the necessary conditions and prerequisites for any resumption of ECT activity.

The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants.

INTRODUCTION: The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. OBJECTIVE: The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. STUDY DESIGN: The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-ß1), retinol-binding protein (RBP), and microalbuminuria (µALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro(uretero)nephrosis, 13 cases with grade III bilateral hydro(uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 °C and thereafter analyzed by quantitative enzymatic immunoassay. RESULTS: Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P ≤ 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P ≤ 0.043), NGAL (P ≤ 0.043), KIM-1 (P ≤ 0.03), and TGF-ß1 (P ≤ 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. DISCUSSION: To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-ß1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. CONCLUSIONS: Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention.

[Ethical principles in electronvulsivotherapy]. / Les principes éthiques de l'électroconvulsivotherapie.

ECT or electroconvulsive therapy (ECT) is a therapeutic technique invented in 1935 but which was really developed after World War II and then spreading widely until the mid 1960s. The source of this technique, and some forms of stigma including films, have participated widely to make it suspect from a moral point of view. The ethical principles that support the establishment of a treatment by ECT are those relating to any action in psychiatry and are based on the one hand on the founding principles of bioethics: autonomy, beneficence, non-malfeasance, and justice, and on the other hand on the information on the technical and consent to this type of care.

[Who are patients suffering from bipolar disorders in France? The TEMPPO survey: patients' sociodemographic and clinical characteristics data]. / Caractéristiques sociodémographiques et cliniques de patients souffrant de troubles bipolaires suivis en ambulatoire en France métropolitaine.

AIM: One of the aims of the TEMPPO study was to describe the sociodemographic and clinical characteristics of a cohort of adult outpatients with type I or type II bipolar disorders (as defined by DSM-IV criteria) in France. METHODS: TEMPPO is a multicenter, cross-sectional, non-interventional study conducted in France between November 2008 and May 2009, with a random sample of academic and private practice psychiatrists. Each psychiatrist who agreed to participate in the study had to: complete a register with data on all consecutive patients (up to 20 patients) consulting during a 2-month period and fulfilling inclusion criteria; include in the study the first five patients of the register with an on-going consultation for at least 6 months; for each of which a detailed questionnaire had been assessed, notably their sociodemographic and bipolar clinical characteristics. Adult outpatients diagnosed with bipolar disorders (BD) were enrolled if fulfilling the following inclusion criteria: man or woman, aged 18 and above, diagnosed bipolar type I or II according to DSM-IV criteria, treated (whatever the treatment strategy) or not, and followed-up for at least 6 months by the participating psychiatrist. RESULTS: One hundred and thirty-five psychiatrists included 619 patients with bipolar disorder (197 and 422 followed-up in public and private practice respectively). The estimated prevalence of patients with bipolar disorders consulting psychiatrists was 0.43%. Type I bipolar disorder was the most frequent condition (58% of the patients). As a whole, bipolar disorder was associated with severe handicap (mean global disease Clinical Global Impression [CGI]-Severity score of 4.4 and mean GAF [Global Assessment of Functioning] score of 59), with more depressive episodes than manic episodes (6 vs. 4) or hypomania (6 vs. 3), a high proportion of rapid cycles (11%), psychiatric comorbidities (45% of patients), obesity (16% of patients), libido dysfunction and associated psychotic symptoms. Current manic phase was associated with more pronounced illness severity and lowest functioning. More than half of the patients (57%) had a family history of psychiatric disorders. CONCLUSION: This study could shed some light for a better understanding of demographics and clinical patterns of patients with bipolar disorders consulting psychiatrists in France. The results emphasize the severity of bipolar disorders with mainly depressive episodes, a high proportion of rapid-cycling, comorbidities and associated psychotic symptoms; these characteristics being more marked in patients suffering from BD I. Furthermore, this study confirms the strong negative impact on social and professional life of French bipolar patients, requiring specific management in addition to the symptomatic treatment.

[Treatment practices in the management of patients with bipolar disorder in France. The TEMPPO study]. / Pratiques thérapeutiques dans la prise en charge des patients souffrant de troubles bipolaires en France. Étude TEMPPO.

TEMPPO is an observational, cross-sectional and multicentre study, initiated in the French metropolitan territory in 2009. Set up from a random sample of 135 psychiatrists, it has observed the procedures for therapeutic management of a population (n=619) of their outpatients (respectively 197 and 422 in public and private practice) with bipolar disorder type I or II disorders (DSM-IV). The patients who were followed were mostly very sick. Every patient received a pharmacological treatment. The prescription included at least one mood stabilizer or an antipsychotic (71 % atypical) in 78 % and 56 % of cases respectively. Treatment regimen changes were frequent (61 % of patients had at least one change in treatment during the last 12 months). A single molecule by therapeutic class was generally prescribed. The presence of an antipsychotic in combination therapy was often associated with the severity or difficulty of care of the patient (mixed states, severity of the global functioning impairment, manic states, high number of hospitalizations and history of suicide attempt). The combination of two antipsychotics is found only in the difficult situations of manic states. Patients with severe depressive phase are those who benefit from the combination mood stabilizer+antipsychotic+antidepressant (16 % of the sample). In this study, the prescription of antidepressants significantly differs from recommendations for good prescribing practices. Indeed antidepressants were commonly prescribed in mixed-phase (63 %), particularly as a monotherapy in 5 % of cases. It was also found in patients in euthymic phase (48 %), manic phase (12 %) and hypomanic phase (29 %). The prescription of atypical antipsychotics (monotherapy or combination) is now fully established in the management of all phases of the disease. The importance of non-pharmacological treatment is acknowledged by psychiatrists and proposed whether a psychotherapeutic support, information about the disease and/or lifestyle changes. The data collected in this study allowed to demonstrate that the participant psychiatrists have a pharmacological management of patients with bipolar disorder mostly in line with national and international guidelines.

Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula.

The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82 mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the antilingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.

Abnormalities in body composition and nutritional status in HIV-infected children and adolescents on antiretroviral therapy.

This cross-sectional study aimed to compare growth, nutritional status and body composition outcomes between a group of 94 HIV-infected children and adolescents on antiretroviral therapy (ART) and 364 healthy controls, and to evaluate their association with clinical and lifestyle variables within the HIV-infected group. When compared with the control group, HIV patients had higher risk of stunting (odds ratio [OR] 5.33, 95% confidence interval [CI]: 2.83-10.04) and thinness (OR 4.7, 95% CI: 2.44-9.06), higher waist-to-hip ratios (medians 0.89 versus 0.82 for boys and 0.90 versus 0.77 for girls, P < 0.001), and lower prevalence of overweight or obesity (OR 0.33, 95% CI: 0.14-0.78). Protease inhibitor usage was associated with thinness (OR 3.51, 95% CI 1.07-11.44) and lipoatrophy (OR 3.5, 95% CI 1.37-8.95). HIV-infected children on ART showed significant nutritional status and body composition abnormalities, consistent with the severity of vertical HIV infection and the consequences of prolonged ART.

Unplanned extubation in a paediatric intensive care unit: impact of a quality improvement programme.

Unplanned tracheal extubation is an important quality issue in current medical practice as it is a common occurrence in paediatric intensive care units. We have assessed the effectiveness of a continuous quality improvement programme in reducing the incidence of unplanned extubation over a 5-year period. After a 2-year baseline period, we developed action plans to address the issues identified. Following implementation of the programme, the overall incidence of unplanned extubation decreased from 2.9 unplanned extubations per 100 intubated patient days in the first year to 0.6 in the last year (p = 0.0001). This reduction was the result of a decrease in unplanned extubation in children younger than 2 years of age. Although mortality was similar to that of children who did not experience an unplanned extubation, those with an unplanned extubation had a significantly longer duration of mechanical ventilation, longer stay in the intensive care unit, and longer hospital stay. We found that the implementation of a continuous quality improvement programme is effective in reducing the overall incidence of unplanned extubations.

Antimicrobial resistance of Escherichia coli strains causing community-acquired urinary tract infections among insured and uninsured populations in a large urban center.

We assessed the susceptibility of Escherichia coli strains causing communityacquired urinary tract infection (UTI) in a large urban center in Brazil, comparing two different populations (patients with health insurance vs. uninsured). 581 nonduplicate strains of E. coli were isolated. The prevalence of antimicrobial resistance was greater than 20% for ampicillin (51%), trimethoprim-sulfamethoxazole (43%), tetracycline (41%) and chloramphenicol (22%). Overall, 12% of the E. coli isolates were resistant to ciprofloxacin. Resistance prevalences to most antimicrobials were similar in the two study populations. Our data provide much needed information on the prevalence of antimicrobial resistance among E. coli causing communityacquired UTI in Brazil. Antimicrobial resistance among strains of E. coli causing community-acquired UTIs was relatively high, particularly resistance to ciprofloxacin.

[Microdeletion 22q11: apropos of case of schizophrenia in an adolescent]. / La microdélétion 22q11: à propos d'une observation de schizophrénie chez une adolescente.

Deletion of chromosome 22q11 concerns nearly 1/5.000 births, and is the most frequent interstitial microdeletion. The deletion generates various phenotypes which were initially regarded as distinct syndromes. 1) Di George syndrome was described in 1962 by immunologists, and associates thymic and parathyroid hypoplasia, cardiac malformation, and dysmorphic face; the prognosis is severe, as Di George syndrome is a life-threatening condition. 2) The velocardiofacial syndrome was described in 1978 by stomatologists, and associates palate abnormalities, cardiac malformations, dysmorphic faces, and learning disabilities. 3) The Takao syndrome was described in the late seventies by cardiologists as a clinical condition associating cardiac abnormalities and dysmorphic faces. During the nineties, a common molecular etiology was identified, and a new name proposed: CATCH 22, an acronyme for Cardiac abnormalities, Abnormal face, Thymic hypoplasia, Cleft palate, Hypocalcemia, deleted chromosome 22. Furthermore, new phenotypes have been recently recognized, most of them belonging to the psychiatric spectrum. Descriptive studies of large samples of children with 22q11 deletion, conducted, both in the United States and european countries, have shown the following pattern of associated symptoms:--abnormal face (100%), which expression varies with age, and can be discrete;--cardiac abnormalities (84%), including cardiac malformations of conotroncal types;--mouth abnormalities (49%), including cleft palate (14%), and velar dysfunction (20%);--urinary tract abnormalities (36%), including ureteric reflux, lung dysplasia;--transitory hypocalcemia (60%) mostly during infancy, and due to transitory hypoparathyroid dysfunction;--seizures (21%), which are usually a consequence of hypocalcemia;--immunodeficiency (1%), which worsens the prognosis. Deletion of chromosome 22q11 has been also associated with various psychiatric phenotypes, which can be classified into two groups, developmental abnormalities and psychiatric conditions. The great majority of patients with the deletion exhibit impairment of language and motor development, mild mental retardation, persistent coordination deficits, and poor academic performance. The deletion of chromosome 22q11 is also associated with high frequency of behavioral disorder with attention deficit during childhood, and with high frequency of psychotic disorder (bipolar disorder, and schizophrenia) during adolescence and young adulthood. The link between the 22q11 deletion and schizophrenia has been also supported by recent studies showing that the rate of 22q11 deletion in adults with schizophrenia (2%) is higher than it is in the general population. The rate may even be higher (6%) in subjects with childhood onset schizophrenia. The present work reviews the psychiatric literature associated with 22q11 deletion. We also report a case of 22q11 deletion in a 17-year-old girl that was initially diagnosed as paranoid schizophrenia. We will discuss the diagnostic, prognostic, and therapeutic consequences that such a genetic diagnosis implies. In the case reported here, transitory hypocalcemia induced: 1) dystonic symptoms that was believed to be catatonic symptoms or neuroleptic secondary effects, by clinicians; 2) a poor response to neuroleptic medication.

Assessment of splanchnic perfusion with gastric tonometry in the immediate postoperative period of cardiac surgery in children.

OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19+/- 0.09 (T0), 7.16+/-0.13(T1), and 7.32+/-0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20+/-0.13 (upon admission), 7.27+/-0.16 (after 4 hours), 7.26+/-0.07 (after 8 hours), 7.32+/-0.12 (after 12 hours), and 7.38+/-0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.

Implant-retained removable prosthesis with ball attachments in partially edentulous maxilla.

This clinical report presents a restorative option for the partially edentulous maxilla utilizing an implant-retained removable partial denture without retentive clasps. This approach required (1) fewer patient visits and laboratory procedures; (2) the use of minimal number of implants; (3) lower financial obligations; and (4) no sinus elevation surgery. The use of O-ring attachments provided excellent retention and stability. The detachable prosthesis over implants allows easier oral hygiene by the patient and provides superior esthetics and phonetics in cases involving advanced ridge resorption.

[Airway pressure release in postoperative cardiac surgery in pediatric patients]. / Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca.

OBJECTIVE: Comparison of three modes of MV: intermittent mandatory ventilation with positive end expiratory pressure (IMV + PEEP), APRV and continuous positive airway pressure (CPAP) in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1) in MV with a continuous flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP), oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial-mixed venous CO2 difference. Friedman's test (nonparametric) was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP) showed a significant increasing during APRV compared to IMV + PEEP (p = 0.012). The positive inspiratory pressure (PIP), the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2) didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p = 0.004) and an increase in tidal volume (p = 0.045) when compared to CPAP and IMV + PEEP. In the cardiocirculatory system only CVP showed a significant increased (p = 0.019) during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.

Use of immobilized Candida cells on xylitol production from sugarcane bagasse.

In this study we used the yeast Candida guilliermondii FTI 20037 immobilized by entrapment in Ca-alginate beads (2.5-3 mm diameter) for xylitol production from concentrated sugarcane bagasse hemicellulosic hydrolysate in a repeated batch system. The fermentation runs were carried out in 125- and 250-ml Erlenmeyer flasks placed in an orbital shaker at 30 degrees C and 200 rpm during 72 h, keeping constant the proportion between work volume and flask total volume. According to the results, cell viability was substantially high (98%) in all fermentative cycles. The values of parameters xylitol yield and volumetric productivity increased significantly with the reutilization of the immobilized biocatalysts. The highest values of xylitol final concentration (11.05 g/l), yield factor (0.47 g/g) and volumetric productivity (0.22 g/lh) were obtained in 250-ml Erlenmeyer flasks containing 80 ml of medium plus 20 ml of immobilized biocatalysts. The support used in this study (Ca-alginate) presented stability in the experimental conditions used. The results show that the use of immobilized cells is a promising approach for increasing the xylitol production rates.

Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation.

CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa). RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63% (p = 0.006) and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49). CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.

[Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics]. / Síndrome de abstinência associada à interrupção da infusão de fentanil e midazolam em pediatria.

PURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU) in fentanyl use and midazolam. METHODS: Evaluation of 36 children interned in PICU of the Hospital São Paulo--Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem) who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam. RESULTS: Certain abstinence syndrome in 18 (50%) of the 36 children. Applied Mann Whitney's statistical test to compare the groups with and without abstinence syndrome. Dose accumulated of fentanyl total (5732.7 +/- 5114.91 vs 624.2 +/- 591.2 mcg, p < 0.005), dose daily of fentanyl (98.54 +/- 6.12 vs 36.23 +/- 23.42 mcg/Kg/dia, p < 0.005), velocity of infusion of the fentayl (4.09 +/- 2.75 vs 1.5 +/- 0.95 mcg/Kg/hora, p < 0.005), time of use of the fentanyl (10.2 +/- 5.1 vs 3.16 +/- 1.09 days, p < 0.005), dose accumulated of midazolam total (118.8 +/- 86.97 vs 20.03 +/- 14.79 mg, p < 0.005), dose daily of midazolam (2.32 +/- 0.86 vs 1.21 +/- 0.68 mg/Kg/dia, p < 0.005), velocity of midazolam infusion (0.13 +/- 0.16 vs 0.05 +/- 0.02 mg/Kg/hora, p < 0.005) and time of use of the midazolam (9.20 +/- 4.67 vs 2.55 +/- 1.54 days, p < 0.005) they were considered significant. CONCLUSION: The abstinence syndrome presents an elevated incidence in children interned in PICU owing to the interruption of the fentanyl infusion and midazolam and in these patients it was related with the dose and the time of use.