Laterolateral teleradiography of the skull as a screening method for OSA/OSAS, in patients in orthodontic treatment

Aim: Obstructive sleep apnea syndrome (OSAS) is the most common type of sleep apnea and it is caused by complete or partial obstruction of the upper airway. Adenotonsillar hypertrophy, obesity, cranio-facial anomalies and neuromuscular diseases are the main risk factors for the development of OSAS in the pediatric age. Specially several studies identify the relationship between respiratory disorders in sleep and obesity, and, in particular, between OSAS and obesity, designing a prevalence of OSAS among obese subjects between 14 and 78%. The diagnosis of OSAS in the child is of great importance as it can lead to neurocognitive and behavioral complications, growth retardation, systemic arterial hypertension, pulmonary hypertension, cardiovascular disease and metabolism. The WHO (World Health Organization) has established the new criteria for the classification of Obesity on the basis of BMI and the risk of comorbidities, identifying a moderate risk for underweight subjects, a very low risk for normal weights and an increased risk from severe to severe for overweight and obese individuals respectively. According to that the aim of this study is to evaluate the correlation between obstructive sleep apnea syndrome and cephalometric variables in children considering age and BMI. Materials and methods: Children aged 7–10 years and 11-14 years with no genetic syndrome, previous otorhinolaryngologic or orthodontic therapy treatments are being selected from our Departments of Paediatric Dentistry, University of Palermo, and from the Department of Orthodontics, University of Messina (Italy). All patients so far recruited and visited for orthodontic problems were in mixed or early permanent dentition phase, with the first upper molars fully erupted and presented to the history of several symptoms of Osas, such as recurring episodes of shallow or paused breathing during sleep, waking up frequently to urinate, morning headaches, memory or learning problems and not be able to concentrate or feeling irritable. Dental records and lateral cephalometric radiographs were obtained for all of the patients and than they have been subjected to paediatric, otolaryngology and polysomnography visits. Subject with a positive diagnosis of Osas were studied and they were divided in group based on their BMI. In all groups the inter-molar distance in dental records was measured, and the cephalometric traces have been calculated. As reported by the study by Galeotti et al. the cephalometric measurements analysed are S-PNS, ad1-PNS, and ad2-PNS for the nasopharynx; p-pp and pa for oropharynx; H-H’ for the Hyoid bone; SNA for the maxilla; SNB;ANB and Go-Me for the mandible; S-Go, N-Me and P-A for facial Height; SN for cranial base; SN-MP and PP-MP for the typology, and angle ArGoMe for Growth prevision. At the time that children are still in the way of recruitment the results may not yet be defined; however it is necessary to emphasize the importance of the study, because in the child respiratory disturbances in the sleep, and in particular the OSAS, are often underestimated, despite representing the third place between the threats of health after the smoke and the excess of weight

Growth Trajectory and Adult Height in Children with Nonclassical Congenital Adrenal Hyperplasia

Background: Children with nonclassical congenital adrenal hyperplasia (NCCAH) often present increased growth velocity secondary to elevation of adrenal androgens that accelerates bone maturation and might compromise adult height (AH). Objective: The aim of the study was to analyze prognostic factors affecting growth trajectory (GT) and AH in children with NCCAH. Methods: The study was a retrospective, multicentric study. The study population consisted of 192 children with a confirmed molecular diagnosis of NCCAH, followed by pediatric endocrinology centers from diagnosis up to AH. Clinical records were collected and analyzed. AH (standard deviation score; SDS), pubertal growth (PG) (cm), GT from diagnosis to AH (SDS), and AH adjusted to target height (TH) (AH-TH SDS) were evaluated as outcome indicators using stepwise linear regression models. Results: The stepwise linear regression analysis showed that AH and AH-TH were significantly related to chronological age (CA) (p = 0.008 and 0.016), bone age (BA)/CA ratio (p = 0.004 and 0.001), height (H) (p < 0.001 for both parameters) at NCCAH diagnosis, and TH (p = 0.013 and <0.001). PG was higher in males than in females (22.59 ± 5.74 vs. 20.72 ± 17.4 cm, p = 0.002), as physiologically observed, and was positively related to height (p = 0.027), negatively to BMI (p = 0.001) and BA/CA ratio (p = 0.001) at NCCAH diagnosis. Gender, genotype, biochemical data, and hydrocortisone treatment did not significantly impair height outcomes of these NCCAH children. Conclusions: The results of this study suggest that AH and GT of NCCAH patients are mainly affected by the severity of phenotype (CA, BA/CA ratio, and H) at the time of diagnosis. © 2020 S. Karger AG. All rights reserved

Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults

Objective: To analyze the buccal bone thickness, bone depth, and cortical bone depth of the mandibular buccal shelf (MBS) to determine the most suitable sites of the MBS for mini-screw insertion. Materials and Methods: The sample included cone-beam computed tomographic (CBCT) records of 30 adult subjects (mean age 30.9 \ub1 7.0 years) evaluated retrospectively. All CBCT examinations were performed with the i-CAT CBCT scanner. Each exam was converted into DICOM format and processed with OsiriX Medical Imaging software. Proper view sections of the MBS were obtained for quantitative and qualitative evaluation of bone characteristics. Results: Mesial and distal second molar root scan sections showed enough buccal bone for miniscrew insertion. The evaluation of bone depth was performed at 4 and 6 mm buccally to the cementoenamel junction. The mesial root of the mandibular second molar at 4 and 6 mm showed average bone depths of 18.51 mm and 14.14 mm, respectively. The distal root of the mandibular second molar showed average bone depths of 19.91 mm and 16.5 mm, respectively. All sites showed cortical bone depth thickness greater than 2 mm. Conclusions: Specific sites of the MBS offer enough bone quantity and adequate bone quality for mini-screw insertion. The insertion site with the optimal anatomic characteristics is the buccal bone corresponding to the distal root of second molar, with screw insertion 4 mm buccal to the cementoenamel junction. Considering the cortical bone thickness of optimal insertion sites, predrilling is always recommended in order to avoid high insertion torque

Effects of rapid vs slow maxillary expansion on nasal cavity dimensions in growing subjects: A methodological and reproducibility study

Aim To evaluate the methodological feasibility of a RCT comparing skeletal changes of nasal cavity size obtained with RME and SME, assessed via CBCT. Methods Twenty Caucasian children with a mean age of 10.4 years were recruited and allocated to receive RME (10 subjects, mean age 10.4 years) or SME (10 subjects, mean age 10.5 years). Inclusion criteria: constricted maxillary arch, upper and lower first molars erupted, unilateral or bilateral posterior crossbite. Exclusion criteria: age above 15 years, history of previous orthodontic treatment, periodontal disease, systemic disease affecting craniofacial growth, or craniofacial congenital syndrome. CBCT examinations were performed before treatment (T0) and 7 months after expander removal (T1). Changes of nasal width (NW), palatal width (PW) and total nasal volume (TNV) were assessed; palatal and nasal expansion was also calculated as a percentage of the increase of intermolar width IMW (PW% and NW%). Results The correlation between the first and the second readings ranged from 0.991 to 0.995 for linear measurements and was of 0.915 for volumetric measurements. The method error, as described by the value of s, was in general less than 0.3 mm for linear measurements and 0.372 cm3 for volumetric measurements. All linear transverse skeletal and dental measurements and the nasal volume increased with both RME and SME protocols. Conclusions The reported methodology can be reasonably used to investigate the transverse dimension of nasal cavity. The PW% and NW% parameters more accurately described the efficacy of the two expansion protocols as compared to their corresponding absolute measurement (PW and NW)

Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults

Objective: To analyze the buccal bone thickness, bone depth, and cortical bone depth of the mandibular buccal shelf (MBS) to determine the most suitable sites of the MBS for mini-screw insertion. Materials and Methods: The sample included cone-beam computed tomographic (CBCT) records of 30 adult subjects (mean age 30.9 ± 7.0 years) evaluated retrospectively. All CBCT examinations were performed with the i-CAT CBCT scanner. Each exam was converted into DICOM format and processed with OsiriX Medical Imaging software. Proper view sections of the MBS were obtained for quantitative and qualitative evaluation of bone characteristics. Results: Mesial and distal second molar root scan sections showed enough buccal bone for miniscrew insertion. The evaluation of bone depth was performed at 4 and 6 mm buccally to the cementoenamel junction. The mesial root of the mandibular second molar at 4 and 6 mm showed average bone depths of 18.51 mm and 14.14 mm, respectively. The distal root of the mandibular second molar showed average bone depths of 19.91 mm and 16.5 mm, respectively. All sites showed cortical bone depth thickness greater than 2 mm. Conclusions: Specific sites of the MBS offer enough bone quantity and adequate bone quality for mini-screw insertion. The insertion site with the optimal anatomic characteristics is the buccal bone corresponding to the distal root of second molar, with screw insertion 4 mm buccal to the cementoenamel junction. Considering the cortical bone thickness of optimal insertion sites, predrilling is always recommended in order to avoid high insertion torque.Objective: To analyze the buccal bone thickness, bone depth, and cortical bone depth of the mandibular buccal shelf (MBS) to determine the most suitable sites of the MBS for mini-screw insertion. Materials and Methods: The sample included cone-beam computed tomographic (CBCT) records of 30 adult subjects (mean age 30.9 ± 7.0 years) evaluated retrospectively. All CBCT examinations were performed with the i-CAT CBCT scanner. Each exam was converted into DICOM format and processed with OsiriX Medical Imaging software. Proper view sections of the MBS were obtained for quantitative and qualitative evaluation of bone characteristics. Results: Mesial and distal second molar root scan sections showed enough buccal bone for miniscrew insertion. The evaluation of bone depth was performed at 4 and 6 mm buccally to the cementoenamel junction. The mesial root of the mandibular second molar at 4 and 6 mm showed average bone depths of 18.51 mm and 14.14 mm, respectively. The distal root of the mandibular second molar showed average bone depths of 19.91 mm and 16.5 mm, respectively. All sites showed cortical bone depth thickness greater than 2 mm. Conclusions: Specific sites of the MBS offer enough bone quantity and adequate bone quality for mini-screw insertion. The insertion site with the optimal anatomic characteristics is the buccal bone corresponding to the distal root of second molar, with screw insertion 4 mm buccal to the cementoenamel junction. Considering the cortical bone thickness of optimal insertion sites, predrilling is always recommended in order to avoid high insertion torque

Growth in Children With Noonan Syndrome and Effects of Growth Hormone Treatment on Adult Height

Objectives: Growth impairment is a common manifestation in Noonan syndrome (NS). Recombinant human GH (rhGH) treatment has been shown to increase growth and adult height (AH) in a few studies. We aimed to evaluate the growth trajectory towards the AH, and the effects of rhGH treatment in a large cohort of NS children. Methods: Retrospective, multicenter, cohort study including subjects with genetic diagnosis of NS. A total of 228 NS patients, 154 with PTPN11 mutations, 94 who reached AH, were recruited. Auxological data were collected at 2, 5, and 10 years, at pubertal onset, at AH. Sixty-eight NS subjects affected with GH deficiency (GHD) were treated with rhGH at a mean dose of 0.24 mg/kg per week until AH achievement. Results: ANOVA analysis showed a significant difference between birth length and height standard deviation scores (HSDS) at the different key ages (p<0.001), while no significant differences were found between HSDS measurements at 2, 5, and 10 years, at pubertal onset, and at AH. HSDS increased from −3.10 ± 0.84 to −2.31 ± 0.99 during rhGH treatment, with a total height gain of 0.79 ± 0.74, and no significant difference between untreated and treated NS at AH. Conclusions: rhGH treatment at the standard dose used for children with GH idiopathic deficiency is effective in improving growth and AH in NS with GHD. Further studies are needed to assess genotype-specific response to rhGH treatment in the different pathogenic variants of PTPN11 gene and in the less common genotypes

Growth in Children With Noonan Syndrome and Effects of Growth Hormone Treatment on Adult Height

Objectives: Growth impairment is a common manifestation in Noonan syndrome (NS). Recombinant human GH (rhGH) treatment has been shown to increase growth and adult height (AH) in a few studies. We aimed to evaluate the growth trajectory towards the AH, and the effects of rhGH treatment in a large cohort of NS children. Methods: Retrospective, multicenter, cohort study including subjects with genetic diagnosis of NS. A total of 228 NS patients, 154 with PTPN11 mutations, 94 who reached AH, were recruited. Auxological data were collected at 2, 5, and 10 years, at pubertal onset, at AH. Sixty-eight NS subjects affected with GH deficiency (GHD) were treated with rhGH at a mean dose of 0.24 mg/kg per week until AH achievement. Results: ANOVA analysis showed a significant difference between birth length and height standard deviation scores (HSDS) at the different key ages (p<0.001), while no significant differences were found between HSDS measurements at 2, 5, and 10 years, at pubertal onset, and at AH. HSDS increased from 123.10 \ub1 0.84 to 122.31 \ub1 0.99 during rhGH treatment, with a total height gain of 0.79 \ub1 0.74, and no significant difference between untreated and treated NS at AH. Conclusions: rhGH treatment at the standard dose used for children with GH idiopathic deficiency is effective in improving growth and AH in NS with GHD. Further studies are needed to assess genotype-specific response to rhGH treatment in the different pathogenic variants of PTPN11 gene and in the less common genotypes

Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC-WHO clinical characterisation protocol.

BackgroundAcute kidney injury (AKI) is one of the most common and significant problems in patients with Coronavirus Disease 2019 (COVID-19). However, little is known about the incidence and impact of AKI occurring in the community or early in the hospital admission. The traditional Kidney Disease Improving Global Outcomes (KDIGO) definition can fail to identify patients for whom hospitalisation coincides with recovery of AKI as manifested by a decrease in serum creatinine (sCr). We hypothesised that an extended KDIGO (eKDIGO) definition, adapted from the International Society of Nephrology (ISN) 0by25 studies, would identify more cases of AKI in patients with COVID-19 and that these may correspond to community-acquired AKI (CA-AKI) with similarly poor outcomes as previously reported in this population.Methods and findingsAll individuals recruited using the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)-World Health Organization (WHO) Clinical Characterisation Protocol (CCP) and admitted to 1,609 hospitals in 54 countries with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection from February 15, 2020 to February 1, 2021 were included in the study. Data were collected and analysed for the duration of a patient's admission. Incidence, staging, and timing of AKI were evaluated using a traditional and eKDIGO definition, which incorporated a commensurate decrease in sCr. Patients within eKDIGO diagnosed with AKI by a decrease in sCr were labelled as deKDIGO. Clinical characteristics and outcomes-intensive care unit (ICU) admission, invasive mechanical ventilation, and in-hospital death-were compared for all 3 groups of patients. The relationship between eKDIGO AKI and in-hospital death was assessed using survival curves and logistic regression, adjusting for disease severity and AKI susceptibility. A total of 75,670 patients were included in the final analysis cohort. Median length of admission was 12 days (interquartile range [IQR] 7, 20). There were twice as many patients with AKI identified by eKDIGO than KDIGO (31.7% versus 16.8%). Those in the eKDIGO group had a greater proportion of stage 1 AKI (58% versus 36% in KDIGO patients). Peak AKI occurred early in the admission more frequently among eKDIGO than KDIGO patients. Compared to those without AKI, patients in the eKDIGO group had worse renal function on admission, more in-hospital complications, higher rates of ICU admission (54% versus 23%) invasive ventilation (45% versus 15%), and increased mortality (38% versus 19%). Patients in the eKDIGO group had a higher risk of in-hospital death than those without AKI (adjusted odds ratio: 1.78, 95% confidence interval: 1.71 to 1.80, p-value ConclusionsAn extended KDIGO definition of AKI resulted in a significantly higher detection rate in this population. These additional cases of AKI occurred early in the hospital admission and were associated with worse outcomes compared to patients without AKI