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  • ISSN: 2373-9312
    Current Issue
    Volume 8, Issue 5
    Research Article
    Andrey P. Prodeus*, Olga Vasilievna Shamsheva, Vasiliy F. Uchaykin, Irina Solnyshkina, and Suntje Sander-Struckmeier
    Objectives: This study evaluated the efficacy and safety of racecadotril together with oral rehydration solution (ORS) compared to ORS alone in infants (>3 months), children and adolescents with acute diarrhea. ClinicalTrials.gov Identifier: NCT03463512.
    Methods: A controlled, open-label, parallel-group multicentre study in which a total of 124 children and adolescents aged 3 months to <18 years (n=62 per treatment group), were randomized to treatment with oral racecadotril (1.5 mg/kg), t.i.d. for a maximum of 5 days plus ORS (RACE+ORS) or ORS alone. The primary endpoint was duration of diarrhea from the start of treatment until final diarrheal/watery stool before recovery or end of study treatment.
    Results: The median duration of diarrhea was statistically significantly shorter with RACE+ORS compared to ORS (16.8 h vs 40.6 h; p<0.0001). The overall mean number of stools during the study decreased with RACE+ORS compared with ORS (5.9 vs 8.3), as did the mean number of watery stools (4.2 vs 6.5). All subjects (62/62; 100%) in the RACE+ORS group recovered by Day 6 compared to 58/62 (93.5%) with ORS. The median time to recovery was statistically significantly shorter with RACE+ORS compared with ORS (29.3 h vs 58.2 h; p<0.0001). The median duration of treatment was shorter with RACE+ORS (49.50 h) compared with ORS (67.08 h). No treatment emergent adverse events were reported in either treatment group.
    Conclusions: Racecadotril plus ORS was significantly more effective for the treatment of acute diarrhea than ORS alone in children aged 3 months to <18 years and was well tolerated.
    Review Article
    Maria da Conceicao N. Pinheiro, Saul Rassy Carneiro*, and Carlos Eduardo P. Corbett
    Mercury prenatal exposure can be estimated through mercury concentrations in different maternal/fetal biological matrices. However, questions have been raised regarding the accuracy of umbilical cord matrices as biomarkers of that exposure. The aim of the present study was to verify the potential of umbilical cord matrices as prenatal exposure biomarkers to mercury and their uses in studies of correlation and association with outcome at birth and with neurodevelopment. For such, we have searched different databases for primary scientific articles using the following terms: methylmercury/total mercury and umbilical cord blood, methylmercury/total mercury and umbilical cord tissue; methylmercury/total mercury in umbilical cord and child growth/neurodevelopment. We found 55 articles about that topic, but only 34 articles met the following inclusion criteria. In general, the studies showed that concentrations of total mercury and methylmercury in umbilical cord blood were higher than those found in maternal blood and umbilical cord tissue and that cord tissue concentrations were better correlated with cord blood concentrations than maternal blood concentrations. Methodological differences among the studies were found regarding the collection of umbilical cord blood and the processing of the cord tissue samples for analysis. In the majority studies that used these matrices as mercury, exposure biomarkers have not verified association with anthropometrics or neurodevelopment. Factors inherent to the placenta and differences in the collection and analysis methods among the studies analyzed may explain the uncertainties regarding the definition of the best biomarker of prenatal exposure to mercury.
    Case Report
    Maria da Conceicao N. Pinheiro, Saul Rassy Carneiro*, and Carlos Eduardo P. Corbett
    Purpose: The manifestation of bullous diseases on oral mucoses leadingscarring sequel are widely described in toxic epidermal necrolysis (TEN). These complications cause disfigurement and functional impairment. They are more rarely reported in erythema multiforme (EM). This article aims to describe a case of lip adhesion after EM induced bymycoplasma pneumoniae, where corrective surgery was performed to increase the mouth opening range of a young female patient.
    Methods: Through the 5-flap Z plasty, mucosal flap rotation was performed for better flexibility and better mouth opening.
    Results: The interincisal distance improved by 12 mm and the intercomisural distance increased by 10 mm, with no type of scar that had an aesthetic impairment reestablishing functional improvement.
    Conclusion: Through the microstomy and the choice of using 5-flap Z plasty, there was a significant increase in the patients mouth opening, thus improving the functional and cosmetic condition, with the patients satisfactory evolution over the long term, with no more idea relapse.
    Luke Cielonko*, Dorothee Newbern, and Reeti Chawla
    Noonan syndrome (NS), is a common congenital genetic disorder due to defects in the PTPN11 gene or genes related to Ras/mitogen-activated protein kinase signaling pathway. Common features seen in individuals with NS include characteristic facial features, congenital heart defects, short stature, and developmental delay. Its presentation, however, can be variable with lack of clear genotype-phenotype correlation thus making the diagnosis of a child with NS challenging. In this case report we describe a late diagnosis of NS in a 14 year old male who presented with a normal height, but a predicted adult height discordant with his genetic potential. Furthermore an extensive genetics evaluation as an infant with karyotype and chromosomal microarray returned normal, which likely dismissed the presence of a genetic syndrome. This case highlights the obstacles that resulted in a delay in diagnosis and provides additional considerations for providers who have a clinical suspicion for NS. Early recognition is important for prompt initiation of counseling, monitoring and therapeutic interventions for comorbidities associated with NS.
    Ana Carolina Galvao dos Santos de Araujo*, Thiago Tavares Bernardo, Ana Paula Moura de Almeida, Hudson Dutra Rezende, Andressa de Deus Mateus, and Liana Moura de Almeida
    Munchausens syndrome refers to patients who injure their bodies and repeatedly request medical assistance due to these illnesses or factitious conditions. In the reported case, an 11-year-old girl was referred to the dermatology outpatient clinic, accompanied by her mother, who reported the appearance of red-pink spots on the skin, with a burning sensation, with one month of evolution. The patient has attended a pediatric emergency weekly, where intramuscular promethazine and intravenous corticosteroids were frequently prescribed, with reported improvement of the burning sensation. She was also seen at an allergy outpatient clinic, where she underwent contact examinations and was subjected to various dietary restrictions. On physical examination, red-pink spots were observed on the face, though sparing the mucous membranes. Some lesions were arranged in a linear pattern and pigment of the same color was observed in the hyponychium. Due to the weird clinical presentation, a gauze soaked in saline solution was rubbed in the cervical region and the pigmentation was removed. After 7 days, the patient returned without the stains and was referred to a psychiatrist. Inconsistent aspects of the lesions that were observed on physical examination, pointed to the correct diagnosis. Early identification of Munchausens syndrome helps to avoid iatrogenesis. In this paper we report a case of Munchausen Syndrome in a child, reviewing its main topics, and give awareness about the possible iatrogenesis induced when misdiagnosed.
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