RESUMO: O objetivo deste estudo foi avaliar a eficácia da ação do probiótico Lactobacillus Plantarum como um agente imunomodulador e hipolipemiante em crianças e adolescentes dislipidêmicos com síndrome nefrótica. MÉTODOS: Este é um estudo randomizado, duplo-cego, controlado com placebo e realizado em pacientes pediátricos com síndrome nefrótica, compensados ou parcialmente compensados e dislipidêmicos passando por acompanhamento ambulatorial. Variações no lipídio sérico e nas citocinas TNF-α (pró-inflamatória) e IL-10 (anti-inflamatória) foram avaliadas. As citocinas foram analisadas por ensaio imunoenzimático (ELISA). RESULTADOS: No grupo probiótico, houve uma tendência de redução dos níveis de TNF-α e de aumento dos níveis de IL-10, quando comparado ao controle. Em relação ao perfil lipídico, houve uma diminuição nos níveis séricos de triglicérides (6,0 mg/dL) e colesterol total (41,5 mg/dL) no grupo probiótico em comparação aos níveis basais, enquanto no grupo de controle houve um aumento nos níveis séricos de triglicérides (49,5 mg/dL) e colesterol total (8,0 mg/dL). CONCLUSÃO: Os resultados preliminares sugerem que o L. Plantarum tem um efeito imunomodulador e hipolipemiante em pacientes pediátricos dislipidêmicos e com síndrome nefrótica.

SUMMARY This study aimed to evaluate the efficacy of the action of the Lactobacillus Plantarum probiotic as a immunomodulatory and hypolipidemic agent in dyslipidemic nephrotic children and adolescents. METHODS: This is a randomized, double-blind, placebo-controlled clinical trial in pediatric, compensated or partially compensated nephrotic syndrome and dyslipidemic subjects undergoing regular outpatient follow-up. Serum lipid and TNF-α (proinflammatory) and IL-10 (anti-inflammatory) cytokine variations were evaluated. Cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the probiotic group there was a tendency to reduce TNF-α levels and increase IL-10 levels when compared to controls. Regarding the lipid profile, there was a decrease in serum triglyceride (6.0 mg / dL) and total cholesterol (41.5 mg / dL) levels in the probiotic group when compared to baseline levels, while in the control group there was an increase in serum triglyceride (49.5 mg / dL) and total cholesterol (8.0 mg / dL) levels, respectively. CONCLUSION: Preliminary results suggest that L. Plantarum showed an immunomodulatory and hypolipidemic effect in nephrotic and dyslipidemic pediatric subjects.

Resumo Pouco se sabe sobre o impacto de um delineamento cruzado nos desfechos de ensaios clínicos randomizados voltados ao comportamento de crianças durante tratamento odontológico. Este estudo objetivou avaliar o efeito da sequência de administração do sedativo, da droga em si e da idade dos participantes no comportamento de crianças que receberam duas consultas odontológicas consecutivas. Dezoito crianças saudáveis não colaboradoras, 2-5 anos de idade, foram randomizadas em dois grupos: G1 - 1,0 mg/kg midazolam oral (primeira sessão) e placebo oral (segunda sessão); G2 - placebo (primeira) e 1,0 mg/kg midazolam oral (segunda). Um observador treinado avaliou o comportamento infantil. Os dados foram analisados por ANOVA de três fatores (alfa=0,05). Midazolam [média(DP); 71,7%(16,5)] e placebo [48,6%(33,1)] resultaram em mais comportamento não cooperativo quando administrados na primeira sessão comparado com a segunda (p=0,001). Com o uso do placebo, crianças de 2-3 anos de idade exibiram mais comportamento não cooperativo [G1 54,9%(36,2); G2 80,5%(8,3)] que as de 4-5 anos de idade (p=0,04). Além disso, a porcentagem de redução do comportamento não cooperativo foi maior em crianças mais velhas em G1 (76,2%) e em crianças mais novas em G2 (32,9%). Considerando a avaliação do comportamento infantil sob sedação, a primeira sessão odontológica influenciou a segunda visita. Os resultados deste estudo confirmam a especulação de que o delineamento cruzado é inadequado para avaliar o comportamento odontológico relacionado à ansiedade/comportamento infantil; os resultados dos ensaios cruzados de sedação odontológica devem ser tratados com extrema cautela.

Abstract Crossover studies continue to be published in spite of warnings about their inherent risks in relation to behavioral outcomes. This study took the opportunity of access to secondary data analysis in order to demonstrate the impact of a crossover design on the outcomes of randomized clinical trials aimed at the behavior of children during dental treatment. We evaluated the effect of the sequence of sedative administration, the sedative and the participant’s age on the behavior of children undergoing two sequential dental visits. Eighteen uncooperative healthy young children were equally randomly assigned to: (G1) 1.0 mg/kg oral midazolam (first session) and oral placebo (second session); (G2) oral placebo (first) and 1.0 mg/kg oral midazolam (second). One trained observer assessed children’s behavior. Data were analyzed by three-way mixed ANOVA. Both midazolam [mean(SD); 71.7%(16.5)] and placebo [48.6%(33.1)] produced more struggling behavior when they were administered in the first session compared to the second one (p=0.001). For the placebo, children aged 2-3 years exhibited more struggling behavior [G1 54.9%(36.2); G2 80.5%(8.3)] than those aged 4-5 years (p=0.04). Also, the reduction of percentage of struggling behavior was higher in G1 for older children (76.2%) and in G2 for younger children (32.9%). There were significant interactions between drug and sequence of administration, and between drug and age. The results of our study confirm the conventional wisdom that crossover study design is inappropriate to evaluate children’s behavior/anxiety related-dental treatment under sedation and the results of crossover studies of dental sedation should be treated with extreme caution.

RESUMO Objetivo: No Brasil, não há escala que avalie a catastrofização dos pais sobre a dor das crianças. O objetivo deste estudo foi traduzir e adaptar transculturalmente o Pain Catastrophizing Scale-Parents para a língua portuguesa do Brasil e avaliar preliminarmente as propriedades psicométricas de pais/outros parentes de crianças com e sem dor de dente. Métodos: Foi realizado um estudo transversal com 237 pais/outros parentes de 237 crianças. A adaptação transcultural da escala para o português brasileiro foi feita conforme a abordagem universalista. Para avaliar a confiabilidade e a validade da escala, os pais/outros parentes fizeram um relato sobre a dor de dente da criança e preencheram as versões brasileiras da Escala de Catastrofização da Dor-Pais e o Questionário de Desconforto Dentário. Resultados: Houve equivalência semântica com a versão original após pequenas modificações. O alfa de Cronbach para os 13 itens da escala foi 0,83 e os respectivos coeficientes de correlação intraclasse do teste-reteste variaram de 0,63 a 0,97. Os escores obtidos na Escala de Catastrofização da Dor-Pais e no Questionário de Desconforto Dentário apresentaram baixa correlação (rho=0,25; p<0,001). O escore total da Escala de Catastrofização da Dor-Pais diferiu significativamente (p<0,001) em crianças com dor de dente à noite (mediana: 30,0; percentil 25-75: 25,0-35,5) quando comparado com o daquelas sem dor de dente (25,5; 20,0-31,0). Conclusões: A versão brasileira da Escala de Catastrofização da Dor-Pais apresentou características aceitáveis nesta avaliação preliminar e pode ser utilizada no Brasil tanto na prática clínica quanto em pesquisas.

ABSTRACT Objective: In Brazil, there is no scale to assess parental catastrophizing about their child’s pain. This study aimed to translate and cross-culturally adapt the Pain Catastrophizing Scale-Parents to the Brazilian Portuguese language, as well as to preliminarily evaluate its psychometric properties among parents/guardians of children with and without a toothache. Methods: A cross-sectional study was conducted with 237 parents/other relatives of 237 children. Across-cultural adaptation of the scale into Brazilian Portuguese was carried out according to the universalistic approach. To assess the reliability and validity of the scale, parents/other relatives reported on the child’s toothache and filled out the Brazilian versions of the Pain Catastrophizing Scale-Parents and the Dental Discomfort Questionnaire. Results: There was semantic equivalence with the original version after minor modifications. TheCronbach’s alpha for the 13 items of the scale was 0.83, and the respective test-retest intraclass correlation coefficients ranged from 0.63 to 0.97. The scores obtained from the Pain Catastrophizing Scale-Parents and the Dental Discomfort Questionnaire had a low correlation (rho=0.25; p<0.001). Thetotal score of the Pain Catastrophizing Scale-Parents differed significantly (p<0.001) in children with a toothache at night (median: 3.0, 25-75 percentile: 25.0-35.5) compared to those who did not have a toothache at night (25.5; 20.0-31.0). Conclusions: The Brazilian version of the Pain Catastrophizing Scale-Parents was acceptable in this preliminary evaluation and can be used in Brazilian clinical and research practice.

Resumo Objetivo: Revisar os riscos e benefícios do uso do corticoide pós-natal para o tratamento da displasia broncopulmonar, uma vez que ainda não há outra terapia mais eficaz. Fontes de dados: A revisão da literatura foi feita pelo banco de dados da Bireme, com os termos bronchopulmonary dysplasia and corticosteroid nos sistemas Lilacs, Ibecs, Medline, Biblioteca Cochrane e SciELO. Foram selecionados os artigos de maior relevância sobre o tema, com ênfase na literatura dos últimos cinco anos. Síntese dos dados: Em recém-nascidos prematuros, a broncodisplasia ainda é um problema frequente e sem terapêutica específica, apesar do conhecimento dos vários fatores de risco. O tratamento, basicamente, é feito por medidas de suporte, mas o corticoide no passado foi largamente usado por se tratar da única medicação com impacto na evolução da doença. Porém, o aparecimento de paralisia cerebral associada ao uso indiscriminado do corticoide inviabilizou a prescrição da droga nos últimos 15 anos. Desde então, nenhuma nova medida foi tomada, a incidência da doença tendeu a um aumento nesse período e criou a necessidade da revisão do uso do corticoide e de possíveis indicações mais restritas. Conclusões: A relação do risco e benefício dos corticoides usados em recém-nascidos prematuros precisa ser ponderada diante de algumas subpopulações de bebês que podem ter mais benefícios do que riscos, como naqueles em ventilação mecânica e com desmame difícil.

Abstract Objective: Review the risks and benefits of postnatal corticosteroid use for the treatment of bronchopulmonary dysplasia, considering that there is not a more effective therapy. Data sources: The literature review was carried out in the BIREME database, using the terms "bronchopulmonary dysplasia and corticosteroid" in the LILACS, IBECS, MEDLINE, Cochrane Library, and SciELO databases, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. Summary of the data: In preterm infants, bronchopulmonary dysplasia is still a common problem and remains without a specific therapy, despite knowledge of the several risk factors. The treatment essentially consists of supportive measures, but in the past, corticosteroids were widely used, as they are the only medications that have an impact on disease progression. However, the emergence of cerebral palsy associated with the indiscriminate use of corticosteroids has prevented the prescription of this drug in the last 15 years. Since then, no new measures have been taken, and the incidence of the disease tended to increase during this period, creating the need for a review of corticosteroid use and, possibly, more restricted indications. Conclusions: The association between risks and benefits of corticosteroid use in preterm infants needs to be considered due to the fact that some infant subpopulations may show more benefits than risks, such as those using mechanical ventilation with difficult weaning.

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.

OBJETIVO: Identificar a ocorrência de anemia entre pacientes pediátricos em hemodiálise e a associação entre os valores de hemoglobina e variáveis relacionadas à anemia na DRC. MÉTODOS: Estudo retrospectivo. Selecionados pacientes até 18 anos com doença renal crônica em hemodiálise no serviço entre janeiro de 2009 e dezembro de 2010. Verificados prontuários para coleta de dados clínicos e laboratoriais. Análise estatística com testes de qui-quadrado, t de Student e General Estimating Equations (GEE) em programa Statistical Package for the Social Sciences 20.0, assumindo-se nível de significância de 5%. RESULTADOS: Analisadas 357 fichas de evolução médica mensal de 29 pacientes. A etiologia mais frequente para a doença renal crônica foram as malformações do trato genito-urinário (28%). Hemoglobina apresentou valor médio (desvio padrão) de 9,20 (1,8) g/dL, com ocorrência de anemia em 65,3% das consultas. Anemia associou-se a internação, uso de antibiótico, transfusão, uso de hidróxido de ferro endovenoso, valores baixos de creatinina, hematócrito e albumina e valores altos de ferritina, alumínio e Kt/V equilibrado (p < 0,05). A odds ratio para anemia com uso de hidróxido de ferro endovenoso foi 0,36 (95% IC 0,25-0,89), ou seja, uma chance 2,78 vezes maior de desenvolver anemia sem o uso dessa medicação. CONCLUSÕES: A anemia predominou em crianças e adolescentes com doença renal crônica, tendo como fator protetor o uso de hidróxido de ferro endovenoso.

OBJECTIVE: To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables. METHODS: This was a retrospective study. Patients aged up to 18 years with chronic kidney disease undergoing hemodialysis at this service between January of 2009 and December of 2010 were selected. Clinical and laboratory data were obtained from medical records. Statistical analysis was performed with chi-squared test, Student's t-test and general estimating equations (GEE) using SPSS 20.0, assuming a significance level of 5%. RESULTS: A total of 357 medical records depicting the monthly evolution of 29 patients were analyzed. The most common etiology for chronic kidney disease was malformations of the genitourinary tract (28%). Hemoglobin showed a mean (standard deviation) value of 9.20 (1.8) g/dL, with the occurrence of anemia in 65.3% of cases. Anemia was associated with hospitalization; antibiotic use; transfusion; use of intravenous iron hydroxide; low values of creatinine, hematocrit, and albumin; and high values of ferritin, aluminum, and equilibrated Kt/V (p < 0.05). The odds ratio for anemia with the use of intravenous iron hydroxide was 0.36 (95% CI: 0.25 to 0.89), i.e., a 2.78-fold higher chance of developing anemia without the use of this medication. CONCLUSIONS: Anemia predominated in children and adolescents with chronic kidney disease; intravenous iron hydroxide use was a protective factor.

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.

OBJETIVO: Rever a literatura disponível sobre a relação entre infecção viral aguda do trato respiratório e o desencadeamento de exacerbações da asma, identificando os vírus mais prevalentes, os métodos de detecção, bem como os aspectos preventivos e terapêuticos. FONTE DOS DADOS : Foi realizada uma busca nas bases de dados PubMed, SciELO e Lilacs utilizando os descritores: asma, exacerbação, vírus, criança e infecção respiratória aguda, entre os anos de 2002 e 2013. SÍNTESE DOS DADOS: Foram selecionados 42 artigos originais que tratavam da identificação de vírus respiratórios durante episódios de exacerbação da asma, em sua maioria estudos transversais. Houve ampla variação na metodologia dos trabalhos avaliados, principalmente em relação à idade das crianças e métodos de coleta e detecção viral. Os resultados apontam que, em até 92,2% das exacerbações, um agente viral foi potencialmente o principal fator desencadeante, sendo o rinovírus humano o mais identificado. O padrão de circulação viral pode ter sido responsável pela sazonalidade das exacerbações. A associação entre infecção viral e inflamação alérgica parece ser determinante para levar ao descontrole clínico-funcional da asma, porém poucos estudos avaliaram outros fatores desencadeantes em associação com a infecção viral. CONCLUSÕES: Os vírus respiratórios estão presentes na maioria das crianças asmáticas durante os episódios de exacerbação. Os mecanismos fisiopatológicos envolvidos ainda não estão totalmente estabelecidos e o sinergismo entre a inflamação alérgica e infecção viral parece determinar o descontrole da doença. O papel dos outros agentes desencadeantes e protetores não estão claramente determinados.

OBJECTIVE: To review the available literature on the association between acute viral respiratory tract infection and the onset of asthma exacerbations, identifying the most prevalent viruses, detection methods, as well as preventive and therapeutic aspects. SOURCES: A search was conducted in PubMed, Lilacs, and SciELO databases, between the years 2002 and 2013, using the following descriptors: asthma exacerbation, virus, child, and acute respiratory infection. SUMMARY OF THE FINDINGS: A total of 42 Original Articless addressing the identification of respiratory viruses during episodes of asthma exacerbation were selected, mostly cross-sectional studies. There was a wide variation in the methodology of the assessed studies, particularly in relation to the children's age and methods of collection and viral detection. The results indicate that, in up to 92.2% of exacerbations, a viral agent was potentially the main triggering factor, and human rhinovirus was the most frequently identified factor. The pattern of viral circulation may have been responsible for the seasonality of exacerbations. The association between viral infections and allergic inflammation appears to be crucial for the clinical and functional uncontrolled asthma, but few studies have evaluated other triggering factors in association with viral infection. CONCLUSIONS: Respiratory viruses are present in the majority of asthmatic children during episodes of exacerbation. The involved physiopathological mechanisms are yet to be fully established, and the synergism between allergic inflammation and viral infection appears to determine uncontrolled disease. The role of other triggering and protective agents is yet to be clearly determined.

To determine the positivity rate of human bocavirus (HBoV) 1 and 3 among children who presented with acute gastroenteritis symptoms during the period of 1994-2004 in the Central-West Region of Brazil, 762 faecal samples were tested using polymerase chain reaction (PCR) for the detection of HBoV DNA. Primers for a segment of the non-structural viral protein 1 (NS1) gene of HBoV-1 and HBoV-3 were used. Twelve HBoV-positive samples were further characterised via genomic sequencing and phylogenetic analysis. Of the samples tested, 5.8% (n = 44) were positive for HBoV-1 or HBoV-3 and co-infection was observed in 14 (31.8%) of the 44 HBoV-positive samples. Nine of the 14 samples were also positive for Rotavirus A and five were positive for Aichi virus. The genomic sequencing of the NS1 partial sequence of 12 HBoV-samples showed that 11 samples were characterised as HBoV-1 and that one was characterised as HBoV-3. The phylogenetic analysis showed that the HBoV-1 samples had a high sequence homology to others previously identified in China, Sweden and Brazil. This is the first study conducted in the Central-West Region of Brazil to detect HBoV-1 and HBoV-3 in faecal samples from children with acute gastroenteritis. Further studies are required to define the role of HBoVs as aetiological agents of gastroenteritis.

Out of 1,588 faecal samples of children taken from three locations of the Central West Region of Brazil, 57 were positive for astroviruses (HAstVs) using reverse transcription-polymerase chain reaction (RT-PCR). They were genotyped by nested RT-PCR and/or genomic sequencing. HAstV-1 (42.8%), HAstV-2 (23.2%), HAstV-3 (3.6%), HAstV-4 (14.3%) and HAstVs -5, -6, -7 and -8 (1.8% each) were detected. In Goiânia and Campo Grande, HAstV-1 was the most frequently detected genotype while in Brasília (DF) it was HAstV-2. Shifts in the circulation of astrovirus genotypes were observed in DF and Campo Grande. All samples collected by rectal swabs were viral negative. The astrovirus genotypes were detected in all age groups and there was no correlation between genotype and age group.

Nonstructural protein 4 (NSP4), encoded by group A rotavirus genome segment 10, is a multifunctional protein and the first recognized virus-encoded enterotoxin. The NSP4 gene has been sequenced, and five distinct genetic groups have been described: genotypes A-E. NSP4 genotypes A, B, and C have been detected in humans. In this study, the NSP4-encoding gene of human rotavirus strains of different G and P genotypes collected from children between 1987 and 2003 in three cities of West Central region of Brazil was characterized. NSP4 gene of 153 rotavirus-positive fecal samples was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. For phylogenetic analysis, NSP4 nucleotide sequences of these samples were compared to nucleotide sequences of reference strains available in GenBank. Two distinct NSP4 genotypes could be identified: 141 (92.2%) sequences clustered with NSP4 genotype B, and 12 sequences (7.8%) clustered with NSP4 genotype A. These results reinforce that further investigations are needed to assess the validity of NSP4 as a suitable target for epidemiologic surveillance of rotavirus infections and vaccine development.

This study presents data regarding the circulation of astrovirus in Goiânia-GO and Brasília-DF. These viruses were detected in fecal samples from hospitalized children up to five years old with and without acute gastroenteritis. A total of 1244 fecal samples were collected in two periods, 1994 to 1996 (Brasília) and 1998 to 2002 (Goiânia and Brasília), and were analyzed for viral RNA using the reverse transcription-polymerase chain reaction (RT-PCR). Positivity rates of 4.3 and 0.5% for astrovirus were observed in children with acute gastroenteritis and those without gastroenteritis, respectively. Among children with gastroenteritis no statistically significant difference was seen with regards to viral positivity rates in relation to gender and age. However, a higher incidence rate was observed for children from Brasília aged 36 months or more. Overall, astroviruses occurred predominantly from September to March in the two cities, suggesting a seasonal pattern for these viruses which coincides with the highest relative air humidity period. The results of this study highlight the importance of astrovirus as an etiologic agent of acute gastroenteritis in children of the Central West region of Brazil.

A associação hidrato de cloral- hidroxizina tem sido utilizada na clínica odontológica para sedar crianças, mas sua efetividade ainda não foi comparada a um controle negativo em humanos. O objetivo deste estudo prospectivo foi avaliar o efeito dessas drogas, comparadas a um placebo, em crianças submetidas a tratamento odontológico. Trinta e cinco sessões de sedação foram realizadas em 12 crianças menores de 5 anos, não cooperativas, ASA classe I. Em cada sessão os pacientes foram aleatoriamente alocados para os grupos P (placebo), CH (hidrato de cloral 75 mg/kg) e CHH (hidrato de cloral 50 mg/kg mais hidroxizina 2,0 mg/kg). Sinais vitais e comportamento foram avaliados a cada 15 min, e comparados pelos testes de Friedman e Wilcoxon. Os grupos não apresentaram diferenças quanto às variáveis fisiológicas, exceto a freqüência respiratória. Todos sinais vitais registrados estiveram dentro de faixa aceitável. CH e CHH promoveram mais sono nos primeiros 30 min de tratamento. O comportamento geral foi melhor em CH e CHH do que em P. CH, CHH e P foram efetivos em 62,5%, 61,5% e 11,1% dos casos, respectivamente. O hidrato de cloral foi seguro e relativamente efetivo, levando a resultados fisiológicos e comportamentais melhores que o placebo.

Chloral hydrate and hydroxyzine are a drug combination frequently used by practitioners to sedate pediatric dental patients, but their effectiveness has not been compared to a negative control group in humans. The aim of this crossover, double-blinded study was to evaluate the effect of these drugs compared to a placebo, administered to young children for dental treatment. Thirty-five dental sedation sessions were carried out on 12 uncooperative ASA I children aged less than 5 years old. In each session patients were randomly assigned to groups P (placebo), CH (chloral hydrate 75 mg/kg) and CHH (chloral hydrate 50 mg/kg plus hydroxyzine 2.0 mg/kg). Vital signs and behavioral variables were evaluated every 15 min. Comparisons were statistically analyzed using Friedman and Wilcoxon tests. P, CH and CHH had no differences concerning vital signs, except for breathing rate. All vital signs were in the normal range. CH and CHH promoted more sleep in the first 30 min of treatment. Overall behavior was better in CH and CHH than in P. CH, CHH and P were effective in 62.5%, 61.5% and 11.1% of the cases, respectively. Chloral hydrate was safe and relatively effective, causing more satisfactory behavioral and physiological outcomes than a placebo.

The objective of this study was to describe the circulation of caliciviruses in the West Central region of Brazil and its correlation with children's gender and age, as well as with the year and months of the sample collection. Reverse transcriptase-polymerase chain reaction was performed to detect the human calicivirus genome in 1006 fecal samples that were collected in Goiânia (n = 696) and Brasília (n = 310). Viral RNA was detected in 8.6% of the samples. No significant difference in viral prevalence was found regarding gender, age or year of the sample. However, it was observed that in Goiânia, there is a higher incidence of caliciviruses from September to March. The analysis employing three primer pairs demonstrated that the Ni/E3 or JV12/13 primer pairs, which detect norovirus (NoV), detected 41 positive samples while the 289/290 primer pair, which detects NoV or sapovirus, detected the remaining 46 samples. Calicivirus circulates in the West Central region of Brazil and for better detection of this virus it is important to use more than one primer pair. Also, we conclude that the seasonality presented by this virus is related to higher humidity in the period.

Há controvérsias quanto aos benefícios do midazolam na sedação de crianças durante a atenção odontológica. Conduziu-se um ensaio clínico controlado, cruzado e duplo-cego para comparar o efeito sedativo em Odontopediatria da administração oral do midazolam, associado ou não à hidroxizina. Trinta e sete sessões foram realizadas em 11 crianças menores de cinco anos, ASA I. Em cada atendimento, os pacientes receberam aleatoriamente o medicamento conforme os grupos: P - placebo, M - midazolam (1,0 mg/kg); MH - midazolam (0,75 mg/kg) associado à hidroxizina (2,0 mg/kg). Os sinais vitais (pressão arterial, freqüência respiratória, pulso e saturação de oxigênio) e os parâmetros comportamentais (consciência, choro, movimento, comportamento geral) foram avaliados a cada 15 minutos. As comparações entre grupos e entre momentos de atendimento num mesmo grupo foram estabelecidas estatisticamente através dos testes Friedman e Wilcoxon. Os grupos P, M e MH não diferiram quanto aos sinais vitais, os quais se mantiveram dentro de valores aceitáveis. A freqüência cardíaca aumentou nos grupos P e M com o transcorrer da sessão. O grupo M esteve associado a menos choro e movimento nos primeiros 15 minutos de tratamento. O grupo MH apresentou mais sonolência no início da sessão. O comportamento geral foi melhor em M do que em P e MH. M produziu sedação efetiva em 77% dos casos, e MH em 30,8%. Concluiu-se que o midazolam foi efetivo e seguro, e que sua associação à hidroxizina não repercutiu em vantagens adicionais na sedação odontopediátrica.

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.