17 research outputs found
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
Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries
BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS