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Resumen Las vasculitis, patologias cuyo hallazgo principal es la afectacion de las paredes de los vasos sanguineos, se presentan de forma infrecuente en la poblacion pediatrica. En general, en ninos se clasifican de acuerdo con el consenso de la EULAR/PReS y en adultos, segun la Conferencia de Consenso de Chapel-Hill. Las vasculitis asociadas con ANCA (VAA) hacen parte de las vasculitis de pequenos vasos y estan representadas por la granulomatosis con poliangeitis (GPA), la granulomatosis eosinofilica con poliangeitis (EGPA) y la poliangeitis microscopica (PAM), entre otras. A nivel renal, los hallazgos histopatologicos representativos son la glomerulonefritis focal necrotizante con media luna, inflamacion intersticial variable, ausencia de complejos inmunes o pequenos depositos de inmunoglobulinas. Clinicamente las VAA pueden manifestarse con hematuria, proteinuria, hipertension arterial o glomerulonefritis rapidamente progresiva. La GPA puede afectar de forma severa el rinon en el 75% de los casos, mientras que, en la PAM, el compromiso renal (75-90%) puede ser rapido y severo con posibilidad de requerir terapia de reemplazo renal en mas de la mitad de los pacientes. Ademas, hasta el 25% de los casos puede tener hipertension arterial con una mortalidad a un ano de 85%. En la EGPA, el compromiso renal suele ser leve. Se presentan tres casos pediatricos de VAA con diferentes desenlaces renales, que incluyen necesidad de terapia de reemplazo renal con recuperacion de funcion renal, trasplante renal y muerte, seguidas en una institucion de IV nivel del suroccidente colombiano.

Resumen Introduccion La nefritis lupica (NL) es una consecuencia del lupus eritematoso sistemico (LES). La biopsia renal es un potencial biomarcador de pronostico de funcion renal. Objetivo Correlacionar hallazgos histopatologicos y la funcion renal de los pacientes pediatricos con la NL. Materiales y metodos Estudio observacional retrospectivo. Se incluyeron pacientes pediatricos con diagnostico histopatologico de NL. Se excluyeron pacientes sin seguimiento por la institucion. Se evaluo la biopsia renal al diagnostico con la escala modificada de la International Society of Nephrology and the Renal Pathology Society (ISN/RPS). Se uso el indice kappa para determinar el nivel de acuerdo entre la falla renal (tasa de filtracion glomerular [TFG] Resultados Entre el 2011 y el 2018, 57 pacientes con NL fueron atendidos en la institucion, 40 cumplieron con los criterios de inclusion, 10 (25%) eran de sexo masculino. La mediana de edad de diagnostico de NL fue 12,9 anos (IQR 11,1 a 14,9). El tiempo de seguimiento fue de 2,3 anos (IQR 1,0 a 5,16). Al diagnostico, la cariorexis fue la caracteristica de la escala con mayor nivel de acuerdo con la falla renal (k = 0,1873, EE = 0,0759, p = 0,0068) y al ultimo seguimiento lo fue la esclerosis segmentaria global (k = 0,1481, EE = 0,078, p = 0,0287). No hubo diferencia en la TFG al ultimo seguimiento y presencia de proteinuria al diagnostico (p = 0,3936). Conclusion La biopsia renal puede ser insuficiente para evaluar la prediccion de la funcion renal. El tratamiento de pacientes con NL debe realizarse utilizando otros biomarcadores y signos clinicos. Deben hacerse estudios prospectivos que puedan confirmar esta hipotesis.

Objective In previous studies, smaller renal volumes were reported in prematurely born infants, however, these renal volumes were not corrected for body surface area, the main determinant of renal size. Given the rapid growth of the renal cortex after premature birth, the authors hypothesized that corrected volumes would not differ from healthy controls. Methods Ambispective cohort study with prospective follow-up of prematurely born babies in a large specialized center and retrospectively recruited healthy control group. Children were assessed for renal length and renal volumes at age 5 by three independent ultrasonographers. Detailed anthropometry, blood pressure and renal function were also obtained. Age independent z-scores were calculated for all parameters and compared using descriptive statistics. Results Eighty-nine premature study participants (median 32 weeks gestational age) and 33 healthy controls (median 38 weeks gestational age) were studied. Study participants did not differ in age, sex, Afro-Colombian descent, height, blood pressure, serum creatinine, or new Schwartz eGFR. Premature study participants had a significantly lower weight (17.65 ± 2.93 kg) than controls (19.05 ± 2.81 kg, p = 0.0072) and lower body surface area. The right renal volumes were significantly smaller (39.4 vs 43.4 mL), but after correction for body surface area, the renal volume and renal length z-scores were identical for both kidneys (mean right kidney -0.707 vs -0.507; mean left kidney -0.498 vs -0.524, respectively). Conclusion Renal volumes need to be corrected to body surface area. After correction for body surface area, 5-year-old healthy and prematurely born children have comparable renal volumes.

Made available in DSpace on 2021-06-25T10:55:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: The second permanent molar plays an important role when considering extraction of first permanent molars severely affected by molar-incisor hypomineralization (MIH). Aim: To assess the association between MIH and enamel hypomineralization of the second permanent molars in terms of presence and severity. Design: In this retrospective cross-sectional study, permanent teeth were evaluated in 453 patients between the ages of 13 and 16 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index and dental caries experience using the DMFT and DMFS indices. Statistical analyses were performed using a linear generalized model and ordinal logistic regression. Results: The most commonly affected teeth by enamel hypomineralization were permanent molars, whereas incisors, premolars, and canines were less affected. The presence of severe defects in the first permanent molars was associated with mild defects in the second permanent molars (OR = 4.01; 95% CI: 2.50-7.77). Enamel hypomineralization was associated with increased caries experience (PR = 5.54; 95% CI: 3.81-9.06). Conclusion: Enamel hypomineralization mainly affects the first and second permanent molars. Mild defects in the second permanent molars tend to be more frequent in patients with severe MIH in the first permanent molars. The presence of enamel hypomineralization was associated with higher dental caries experience. Department of Morphology Genetics Orthodontics and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (Unesp) School of Medicine CES University Basic and Clinical Research Group in Dentistry School of Dentistry CES University Department of Morphology Genetics Orthodontics and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (Unesp)

Pediatric nephrologists use kidney length and kidney volume z-scores to longitudinally assess normal nephron endowment. However, most radiologists only report kidney length. Agreement between kidney length and kidney volume z-scores in children has been understudied. This study aims to assess agreement between kidney length and kidney volume z-scores in children. This novel cross-sectional cohort study prospectively followed prematurely born babies from a large specialized prematurity follow-up center. A healthy control group matched the cases by age and sex and was recruited from schools. Children were assessed for kidney length and kidney volumes at age 5 by three independent ultrasonographers. All measurements were performed in triplicate. Detailed anthropometry, blood pressure, and kidney function were also obtained. Age-independent z-scores were calculated for all parameters according to Scholbach and Weitzel and compared using descriptive statistics. We studied 89 premature patients (median 32 weeks gestational age) and 33 healthy controls (median 38 weeks gestational age). There were 732 determinations of kidney length, width, and thickness. The mean z-score of the right kidney length was 0.65 ± 0.08 (SEM) compared with 0.88 ± 0.08 of the left kidney length (p = 0.0003, two-sided paired t test). The squared correlation coefficient for kidney volume to kidney length was 0.32 (p < 0.0001). Bland and Altman analysis revealed considerable bias with − 1.36 ± 0.76 standard deviations and 95% limits of agreement from − 2.83 to − 0.16. Reporting only kidney length results in significant overestimation of age-independent z-scores. Based on our findings, consideration to measuring all kidney dimensions may be more appropriate.

Made available in DSpace on 2022-04-29T08:30:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Background: Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH). Aim: To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months. Design: In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval. Results: The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2). Conclusion: In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months. Department of Morphology Genetics Orthodontics and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (Unesp), São Paulo School of Medicine CES University Basic and Clinical Research Group in Dentistry School of Dentistry CES University Department of Morphology Genetics Orthodontics and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (Unesp), São Paulo

Aim To evaluate whether renal length z-scores predict renal dysfunction in children with a solitary functioning kidney (SFK). Methods In a single-centre retrospective cohort of children with SFK, we correlated body mass index z-scores, extracellular volume and lean body mass to renal length z-scores. We grouped these z-scores to other markers of renal dysfunction (proteinuria, hypertension, extracellular volume and abnormal estimated glomerular function rate [eGFR]) and analysed renal length z-score with multivariate analysis, receiver-operated characteristics (ROC) plots and Youden's index to determine an appropriate cut-off. Results 111 children had a median follow-up 5.08 years, eGFR 80.8 mL/min/1.73 m2 , and age at last follow-up 7.4 (3.8-13.4 years). The median renal length z-scores of those without any renal dysfunction (n = 37, 25.1%) were greater (+3.66, interquartile range 3.02-4.47) than those with renal dysfunction (median 3.11, interquartile range 1.76-4.11, P = .0107, Mann-Whitney test). Using a cut-off of z-score of >+1.911, the odds ratio for having no renal dysfunction was 0.07 (95% CI 0.002-0.459, P = .0010). However, accuracy of the renal length z-score was poor (ROC curve 0.6488). Conclusion In this cohort of children with SKF, using the renal length z-score as a biomarker of renal dysfunction at 7 years of age is not recommended.

Introduction X-linked hypophosphatemic rickets is part of a larger group of hereditary diseases characterized by renal phosphate loss, which causes growth disorders, rickets, and osteomalacia. These conditions are characterized by disorders in phosphate equilibrium, which is essential for bone formation. Case report A female patient presented with bone deformities of the inferior extremities, prominent joints, and loss of teeth. She received initial management with oral calcium and orthotics in inferior extremities, with poor clinical outcome. PHEX gene sequencing revealed a pathogenic variant c.1601C>T (p.Pro534Leu). Discussion XLHR is caused by mutations in the PHEX gene; to date, more than 460 mutations have been associated with the disease. Clinically, it is characterized by bowing of the lower extremities, decreased growth, musculoskeletal complaints, dental abscesses, and other clinical signs and symptoms of rickets.

Resumen Introducción: la nefropatía por inmunoglobulina A (NIgA) es la enfermedad glomerular más común en el mundo. En Colombia, el 11-22 % de las glomerulonefritis primarias en niños corresponden a NIgA y de estos casos, el 30 % progresa a enfermedad renal terminal. Objetivo: describir las características paraclínicas e histopatológicas de la NIgA, así como los resultados clínicos según tres tipos de tratamiento en pacientes pediátricos con esta enfermedad atendidos en un hospital de alta complejidad del suroccidente colombiano. Materiales y métodos: estudio retrospectivo realizado en pacientes pediátricos de entre 1 mes y 18 años de edad con diagnóstico de NIgA. Las variables categóricas se presentaron como proporciones y las continuas con medianas y rango intercuartílico. Se usó la prueba de Fisher para comparar los tres esquemas de tratamiento. Resultados: se incluyeron 58 pacientes pediátricos atendidos entre 1996 y 2013. La media de edad al inicio de síntomas fue 7,5±4,2 años y al momento de la biopsia renal, 10±3,8 años. El 77,6 % de los pacientes presentó hematuria microscópica y el 27,6 %, macroscópica. Además, el 81 % tuvo proteinuria, siendo severa el 29 %. Histológicamente, el 10 % se clasificó como grado I, el 62 % como grado II, el 21 % como grado III y el 7 % como grado IV. Tres pacientes requirieron diálisis y dos, trasplante renal. Los esquemas terapéuticos evaluados fueron: solo prednisona (n=20, 34,5 %), prednisona y mofetil micofenolato (MMF) (n=13, 22,4 %) y sin prednisona ni MMF (n=25, 43,1 %). La diferencia en la presencia de hematuria entre los grupos fue significativa (p>0,001), siendo más frecuente en el grupo sin prednisona ni MMF (68 %). No hubo diferencia entre los grupos de proteinuria, hipertensión arterial y valor de creatinina. La mediana de años entre la biopsia renal y el ultimo control fue de 4 años (RIC 1-7). La supervivencia de la función renal fue del 89,1 % a los 5 años. Conclusión: la NIgA amerita reconocimiento temprano y seguimiento estricto, ya que puede tener desenlaces ominosos como enfermedad renal crónica. Abstract Introduction: IgA nephropathy (IgAN) is the most common glomerular disease in the world, in Colombia belongs to 11-22 % of primary glomerulonephritis in pediatric patients. Of these, 30 % progress to chronic kidney disease. Materials and methods : It is a retrospective descriptive study. We used median and IRQ for continuous variables, and proportions for categorical variables, Fisher test to compare clinical outcomes. Results: Between 1996 to 2013 58 patients were diagnosed. The mean age at symptoms onset was 7.5 years (SD±4.2) and at the time of renal biopsy was 10 years (SD±3.8). At diagnosis, 77.6 % of the patients showed microscopic hematuria, 27.6 % gross hematuria and 81 % proteinuria, classified as severe in 29 %. Three patients required dialysis and two needed kidney transplant. Three groups with different therapeutic regimens were evaluated: first group only prednisone 34.5 % (n = 20), second group prednisone and mycophenolate mofetil (MMF) 22.4 % (n = 13) and third group without prednisone neither MMF 43.1 % (n = 25). The difference in the presence of hematuria among the groups was significant (p> 0.001), being more frequent in the group without prednisone neither MMF (68 %). There were no significant differences in proteinuria, hypertension or creatinine among the groups. The median of years between the renal biopsy and the last control was 4 years RI 1-7. At five years, the renal function survival probability (GFR >90 ml/min/1.73m2) was 89.1 %. Conclusion: IgAN needs early recognition and strict follow-up, since it may have ominous outcomes.

Made available in DSpace on 2022-04-28T19:40:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-07-01 Department of Morphology Genetics Orthodontics and Pediatric Dentistry São Paulo State University (Unesp) Universidad CES Child and Adolescent Oral Health Department Federal University of Minas Gerais Department of Morphology Genetics Orthodontics and Pediatric Dentistry São Paulo State University (Unesp)

Made available in DSpace on 2022-04-29T08:31:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-01 Background: Dental fluorosis (DF) has been one of the most prevalent pediatric dental conditions associated with aesthetic concern and treatment needs. This study aimed to identify the longitudinal clinical change in the severity of DF in 8–12-year-old children and its association with gender, age, severity, and tooth type. Methods: This observational study assessed the dental aspects of the 92 Colombian children in 2015 (mean age at beginning 9.71 years ± 1.23) and 2018 (mean age 13.69 years ± 1.41), from an area with high DF prevalence. DF was recorded in all permanent teeth by two calibrated examiners using the Thylstrup and Fejerskov Index (TFI). DF severity change (maximum-TFI-score) was analyzed with descriptive analysis at the tooth level. Associated factors were evaluated with the generalized linear model, binomial family, and logarithmic link function. Results: TFI scores ranged between 1 (very mild) to 6 (severe), being score 2 (41.7%) the most prevalent. After three years, 29.6% of the teeth presented score reduction, 24.1%, increased and 46.3% did not change; the significant association was related to increasing of the basal TFI = 1 score (44.2%) (RR = 9.7; 95% CI 1.7–56.5; p = 0.01) and with canines, premolars and second-permanent-molars teeth group (RR = 3.3; 95% CI 1.9–5.6; p = 0.005). Conclusion: The present study based on clinical features about DF confirms the dynamic post-eruptive nature of this condition. After three years of follow-up, a considerable proportion of the teeth changed to a higher score. Furthermore, the canines, premolars, and second-permanent-molars showed a higher incidence of an increase in severity of TFI score. Department of Pediatric Dentistry and Orthodontics São Paulo State University (Unesp) Araraquara School of Dentistry, Rua Humaitá, 1680 Research Department School of Dentistry CES University School of Medicine CES University Department of Pediatric Dentistry and Orthodontics São Paulo State University (Unesp) Araraquara School of Dentistry, Rua Humaitá, 1680

Made available in DSpace on 2021-06-25T11:01:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Aim: The aim of this study was to evaluate caries diagnosis and treatment decisions made by undergraduate dental students based on ICDAS or Nyvad criteria. Methods: Twelve students analyzed 90 digital photographs of permanent teeth at different clinical stages of carious lesion development and chose among different treatments in three different assessments: when there was no knowledge of the criteria (described as “No knowledge (N)”; when there was theoretical knowledge of the criteria (described as “Theoretical knowledge (T)” and when there was theoretical knowledge, clinical experience about dental caries and the criteria (described as “Theoretical and clinical knowledge (TC)”. For “T” and “TC” the students were randomized into two experimental groups – ICDAS or Nyvad (experimental units: 6 students/group). The reference standard was established cooperatively by two experienced researchers. Criteria performance was evaluated by sensitivity, specificity, AUC, and Kappa statistics. Treatment decision was described in percentage by contingency tables and Spearman’s correlation with the reference standard. Results: The first assessment demonstrated a high percentage of operative treatment even for initial enamel lesions based on ICDAS criteria and treatment was proposed for both active and inactive lesions, according to the Nyvad criteria. In the second assessment, the students continued recommending treatments for initial or inactive lesions, but less frequently. In the third assessment, treatment decisions presented greater cohesion in relation to the assigned classification criterion. The criteria presented no differences between them in terms of diagnostic in the third assessment. Conclusion: Clinical experience may improve caries detection and treatment decisions with the use of ICDAS and Nyvad criteria. Department of Morphology Genetics Orthodontic and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (UNESP) CES University Faculty of Dentistry Department of Morphology Genetics Orthodontic and Pediatric Dentistry Araraquara School of Dentistry São Paulo State University (UNESP)

Deciduous molar hypomineralization (DMH) is an enamel defect of systemic and multifactorial origin that affects the second deciduous molar. Currently, its treatment is based on guidelines for Molar Incisor Hypomineralization (MIH), a disturbance that affects permanent molars and may or may not be associated with permanent incisors. To date, there are no guidelines for DMH. Therefore, three different therapeutic approaches are presented to treat DMH, emphasizing the relevance of early diagnosis, differential diagnosis and treatment options, and tailored to take into account each patient's and parents' specific needs, as well as the involved tooth, severity of DMH, patients' symptoms and behaviour. CPD/Clinical Relevance: To understand the clinical implications of DMH since the diagnosis and delayed treatment of this enamel alteration could have important complications in both the primary and permanent dentition.

Background:Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage renal disease in children. Diagnosis by genetic testing has proven challenging due to its genetic and phenotypic heterogeneity, as well as incomplete penetrance. We report a case on a 16-months old female with a history of renal cysts and a PAX2 mutation.Case presentation:The patient presented with a prenatal diagnosis of Potter sequence and a postnatal diagnosis of renal cysts. An ultrasound at 20 weeks gestation revealed right renal agenesis and possible left renal dysplasia. Post natal genetic analyses identified a novel mutation in PAX2.Conclusion:Cystic kidney disease is often underdiagnosed due to its variable expressivity and wide range of clinical manifestations; PAX2 genetic screening should be considered for all patients with CAKUT.

The development of good governance practices is necessary for every type of institution. The mitigation of conflicts of interest and an appropriate balance of powers must be sought between governance actors to ensure organizations work toward the common purpose and avoid being held hostage by the interests of a particular individual or group of stakeholders. Higher Education Institutions (HEIs) in Colombia are nonprofit by law. The absence of shareholders, or owners in general, in these organizations imposes specific challenges in terms of mitigating conflicts of interest. Colombia’s Ministry of Education is aware of this, and together with other education sector government agencies, teachers, deans, and rectors of various institutions have in the past decade participated in discussions on the need to encourage good governance at the country’s HEIs. These discussions have led to concrete actions being implemented, but at the same time revealed the need for further work. In this chapter, we propose a course of action that Colombia, and indeed any country in Latin America and beyond, can follow in order to encourage the implementation of good governance practices in HEIs.

Made available in DSpace on 2021-06-25T11:03:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objectives. To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. Methods. Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7-18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. Results. In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89-1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 μg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. Conclusion. In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 μg F/g. It is important to monitor and explore changes in exposure in highly affected population. Graduate Program in Dental Science São Paulo State University (UNESP) School of Dentistry School of Dentistry CES University School of Medicine CES University Department of Biological Sciences University of São Paulo (USP) Bauru School of Dentistry Department of Morphology and Orthodontics and Pediatric Dentistry São Paulo State University (UNESP) School of Dentistry Graduate Program in Dental Science São Paulo State University (UNESP) School of Dentistry Department of Morphology and Orthodontics and Pediatric Dentistry São Paulo State University (UNESP) School of Dentistry

BackgroundAcute kidney injury is frequent in critically ill children; however, it varies in causality and epidemiology according to the level of patient care complexity. A multicenter prospective cohort study was conducted in four medium-complexity pediatric intensive care units from the Colombian southeast aimed to estimate the clinical prognosis of patients with diagnosis of acute kidney injury.MethodsWe included children >28 days and ResultsPrevalence at admission of acute kidney injury was 5.2% (95%CI 4.3% to 6.2%). It was found that 71% of the patients had their maximum KDIGO on day one; an increment in the maximum stage of acute kidney injury increased the pediatric intensive care unit stay. Patients with maximum KDIGO 3 were associated with greater use of mechanical ventilation (47%), compared with maximum KDIGO 2 (37%) and maximum KDIGO 1 (16%). Eight patients with maximum KDIGO 2 and 14 with maximum KDIGO 3 required renal replacement therapy. Mortality was at 11.8% (95%CI 6.4% to 19.4%).ConclusionAcute kidney injury, established and classified according to KDIGO as severe and its maximum stage, was associated with worse clinical outcomes; early therapeutic efforts should focus on preventing the progression to severe stages.

Proporcionar a los profesionales de la salud, conocimientos básicos en la detección, abordaje y seguimiento de las anomalías congénitas del riñón y de la vía urinaria. Materiales y métodos: Revisión no sistemática de la literatura, se accedió a las bases de datos PubMed, LILACS, Science Direct, Tripdatabase, Cochrane Library, Biblioteca Virtual en Salud y revistas de nefrología pediá- trica. Se incluyeron publicaciones de los últimos 25 años. Se utilizaron los términos MeSH “Congenital Anomalies of the Kidney and Urinary Tract, Hydronephrosis, risk factors, prenatal diagnosis, congenital abnormalities”. Resultados: Se han identificado dos importantes factores de riesgo para desarrollar estas patologías, el primero la Diabetes pregestacional, es decir“, aquella diabetes conocida previamente a la gestación, bien diabetes mellitus tipo 1 (DM1), diabetes mellitus tipo 2 (DM2) o intolerancia a los carbohidratos”, en segundo lugar el bajo o tardío consumo de micronutrientes de la gestación. Conclusiones: La diabetes mellitus pregestacional y el bajo consumo de micronutrientes antes o durante la gestación, se ven relacionado con el desarrollo de las anomalías renales y de la vía urinaria en el feto, aunque no las explican en la mayoría de casos.

Made available in DSpace on 2020-12-12T01:14:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Background: The occlusal surface of the first permanent molar is the most frequently affected site by dental caries. Aim: To assess the caries-free survival of first permanent molars in children participating in a community-based oral health preventive program. Design: This was a retrospective study conducted on 426 children under 12 years of age, beneficiaries of a preventive program from 2009 to 2015, in El Cedro, Colombia. The program offered oral health care education, supervised brushing and mouth washing, and application of topical fluoride. By using parametric survival models for interval-censored data, primary and secondary caries-free survival of any first permanent molar was estimated and analyzed. Results: Before program implementation, dental caries lesions presented at an average age, adjusted by age of eruption, of 8.3 years for primary caries lesion and 9.3 years for secondary caries lesion. After 7 years of the program, the estimated average age for presenting primary dental caries lesion was delayed by 4.6 years and by 5.3 years for secondary caries. Conclusion: The implementation of the oral health program led to improved caries-free survival of first permanent molars. Basic Sciences in Dentistry Group (CBO) School of Dentistry CES University School of Dentistry CES University School of Medicine CES University School of Dentistry São Paulo State University (Unesp) School of Dentistry São Paulo State University (Unesp)

Aim: To determine prevalence, severity, and risk factors associated with Molar Incisor Hypomineralization (MIH) in schoolchildren between 6 and 15 years of age in Medellin, Colombia. Study design: We conducted a retrospective observational study including 1.075 children born and residing in Medellin, Colombia. A structured questionnaire addressing gestational period and first three years of child's life was administered to biological mothers. Two calibrated examiners established MIH diagnosis following the European Academy of Paediatric Dentistry criteria. Data were analyzed using descriptive statistics, bivariate analysis, and linear regression with a 5% significance. Results: Study population was predominantly male (70.7%), average age was 9.3±1.9 years. Prevalence of MIH was 11,2%. The majority of defects (85%) were mild. MIH was associated with alterations during last gestational trimester, type of childbirth and respiratory problems. Conclusion. MIH prevalence in schoolchildren between 6 and 15 years of age was 11.2%, being mild defects more frequently found. MIH was associated with different factors during pregnancy and the first three years of life.

La infeccion del tracto urinario (ITU) es una patologia frecuente en la infancia, reconocida como precipitante de enfermedades agudas y cronicas con un gran indice de morbilidad. Es importante el diagnostico apropiado para minimizar la instauracion de cicatrices renales, falla renal e hipertension arterial en la edad adulta. Las indicaciones de profilaxis han cambiado en los ultimos anos. Objetivo: Dar a conocer los conocimientos actuales en patogenesis diagnostico y manejo posterior en ITU. Metodologia: Se realizo una revision bibliografica entre los anos 1995 al 2016, en las bases de datos de Scielo, Elsevier, Pubmed, Redalyc, ScienceDirect, Medwave, Nature Reviews, EBSCO, Naxos, Bases de datos que ofrece la Universidad del Cauca. Se utilizo los terminos MeSH y DeSC -“Urinary Tract Infection, Risk factor, children, diagnostic, treatment”, en ingles y espanol con un total de 276 documentos. Posteriormente fueron evaluados con los respectivos instrumentos de lectura critica de articulos asi: Consort para ensayos clinicos, Strobe, para estudios observacionales, Prisma para meta-analisis y Agree para guia de practica clinica, filtrando un total de 58 documentos. Para la gestion de la informacion se utilizo el programa Mendeley de libre acceso. Resultados: Los conocimientos en ITU en pediatria han avanzado mas hacia la prevencion de cicatrices y prevencion de enfermedades en la etapa adulta. Las indicaciones de profilaxis han cambiado y son mas escuetas. Conclusiones: La ITU es frecuente en pediatria. Han cambiado los manejos, por ahora se necesitan mas estudios en nuestra poblacion.

This chapter utilises the case of an international NGO (INGO) in Hong Kong to explore how institutional embeddedness may facilitate the scaling-up of collaboration and social innovation. Adapting Hess’s (2004) framework, we contend that the scaling-up of collaboration among organisations is affected by the societal, network and territorial embeddedness of the organisational actors. These three forms of embeddedness dynamically affect each other through the agency of the actors. The concept of embeddedness also usefully illustrates how networks and collaboration can scale up beyond the local level, thus providing the conditions for the scaling-up of social innovation.

How should the governance system in a non-membership non-profit organization be designed? This organizational form has no shareholders; instead, donors provide funds. Thus, at the organizational level, the board of directors could have all the power. Under this legal form, who controls the board? If too powerful, boards could misuse resources or distract the organization from its foundational goals. We examine the case of private higher education institutions (HEIs) in Colombia and the balance of power in university governance systems which feature this organizational form. Most HEIs in our sample have a kind of assembly of representatives as the governance body with the highest authority and able to appoint and control the board. We specifically discuss the assemblies’ reason for being, structure, and functions in private HEIs in Colombia. We analyze a total of 204 HEI governance structures and find governance arrangements with the characteristics of an assembly of representatives in 154 (75.9%). Our analysis highlights features in some of these governance bodies that could lead to overly powerful assemblies (e.g., founder donors with tenure for life). Clearly, a proper balance of power is required to avoid rent-seeking behaviors or the pursuit of harmful private non-monetary benefits from assembly members as well as boards. © 2017, The Author(s).

Non-profit higher education institutions (HEIs)’ donors want to insure that their money is used correctly. The agency tensions in non-profit organizations, and specifically in HEIs, can lead to family involvement when families are the donors in the early stage of these organizations. The presence of the founding family can generate benefits like a long-term focus and the avoidance of managerial myopia, the preservation of the foundational goals and mission, and a mitigation of some agency problems depending on the stage of the organization. But family control can also lead to rent-seeking behavior, shifting resources to favor some family members and related parties, and expropriating HEI stakeholders such as students, parents, and faculty, among others. This paper contributes to the corporate governance literature, and specifically to the university governance literature, by highlighting the relevance of good governance provisions, mechanisms and practices in HEIs when the founding-donor family has some level of involvement.

Se presentan 4 casos de derivacion ventriculoperitoneal (DVP) y dialisis peritoneal (DP), combinacion de terapias clinicas poco frecuentes, atendidas en la Unidad Renal RTS Versalles, en Cali, Colombia. De los cuales, 3 corresponden a pacientes con espina bifida en edades de inicio de la DP asi: 6, 10 y 17 anos, y un caso de trauma craneoencefalico en un adulto mayor, con edad de inicio de DP a los 80 anos. Se comentan los casos y se revisa la literatura.

This study aimed to evaluate in vitro performance of near-infrared laser transillumination (NIR-LTI) for detecting early occlusal caries in permanent teeth and compare it with quantitative light-induced fluorescence (QLF), DIAGNOdent Pen (DDPen), and conventional radiography (CR). Ninety-four occlusal surfaces presenting International Caries Detection and Assessment System (ICDAS) scores ranging from 0 to 3 were selected. For the NIR-LTI examination, images were captured using a prototype, which consists of a laser beam (808 nm) and an infrared CCD camera. One occlusal site on each tooth was assessed twice by two examiners. The teeth were prepared histologically and assessed for the presence of early caries. The intraexaminer correlation showed no difference between the NIR-LTI, DDPen, and QLF analytical methods, but all these methods differed from CR. Interexaminer reproducibility was moderate for NIR-LTI, which showed sensitivity (0.68), specificity (0.85), accuracy (0.73), and area under the receiver-operating characteristic (ROC) curve (0.76) similar to those of the fluorescence method and different from those of the CR. In conclusion, the performance of NIR-LTI was comparable to that of DDPen and QLF and may therefore be considered a valid and reliable alternative for the diagnosis of incipient lesions on the occlusal surface of permanent teeth.

BACKGROUND: The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention.AIM: This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria.DESIGN: Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers' consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables.RESULTS: Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non-operative treatments for the same lesions.CONCLUSIONS: IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.

Biodiesel usage as in the environment as an alternative to fossil fuels or in biodiesel/diesel blends requires an understanding of the potential effects of its addition on the integrity of the infrastructure used for fuel storage. Polyethylene is one of the most common materials for the manufacturing of fuel storage tanks. Due to the insoluble nature of polyethylene, biofilm formation on its surface boosted by the presence of biodiesel could potentially contribute to its degradation. In this study, the effect of biodiesel concentration on biofilm development on linear low-density polyethylene (LLDPE), cross-linked polyethylene (XLPE) and a bilayer construction of linear-low density polyethylene and polyamide-11 (LLDPE/PA) was studied. Polymers were exposed to biodeterioration conditions during a 200 days in a simulated fuel storage tank. Excess of water and blends of diesel/biodiesel (0%, 25%, 50%, 75% and 100%) as a carbon source were employed to simulate the conditions found in the bottom of fuel storage tanks, where the presence of water is common as result of condensation. Microorganisms obtained from a diesel storage facility were used as inoculum. Biofilm growth and viability were quantified by a crystal violet assay and hydrolysis of fluorescein diacetate, respectively. Results show that although there is greater accumulation of biofilm material in pure biodiesel samples metabolic activity is higher in pure diesel ones. Microbial community structure and composition were studied by community level physiological profiling (CLPP) and 16s rDNA sequencing. Principal component analysis of CLPP revealed that both biodiesel concentration and polymer type affect the structure and metabolic capabilities of biofilm communities. These results were confirmed by comparison of libraries of 16s rDNA for different polymers growing at different biodiesel concentrations. Genera isolated in the biofilm were characterized either by their ability to degrade hydrocarbons, produce surfactants or degrade polyethylene or polyamide-11. The results of this study may lead to a better understanding of microbial effects on storage materials for diesel/biodiesel blends.

Understanding changes in microbial structure due to biodiesel storage is important both for protecting integrity of storage systems and fuel quality management. In this work a simulated storage system was used to study the effect of biodiesel (0%, 25%, 50%, 75% and 100%) on a microbial population, which was followed by community level physiological profiling (CLPP), 16s rDNA analysis and plating in selective media. Results proved that structure and functionality were affected by biodiesel. CLPP showed at least three populations: one corresponding to diesel, one to biodiesel and one to blends of diesel and biodiesel. Analysis of 16s rDNA revealed that microbial composition was different for populations growing in diesel and biodiesel. Genera identified are known for degradation of hydrocarbons and emulsifier production. Maximum growth was obtained in biodiesel; however, microbial counts in standard media were lower for this samples. Acidification of culture media was observed at high biodiesel concentration.

Objective: To compare the effectiveness of fluoride varnish and 2% chlorhexidine gel for controlling active white spot lesions (WSLs) adjacent to orthodontic brackets. Study design: Thirty-five orthodontic patients (17.2 ± 2.3 years old) presenting 60 WSLs adjacent to orthodontic brackets were enrolled in this randomized, blind, 3-armed and controlled clinical trial. The patients were randomly allocated to 1 of 3 arms: (1) two applications of 5% NaF varnish- F, with one-week interval, (2) two applications of 2% chlorhexidine gel-CHX, with one-week interval and (3) usual home care-control (CO). The WSLs were scored by using a DIAGNOdent pen. An independent examiner scored the surfaces using Nyvad criteria for caries assessment. Results: A total of thirty patients presenting 51 lesions completed the study. All treatments reduced the fluorescence values during the experimental period; however, F induced faster remineralization than CHX. After 3 months, 70.58 % were inactive considering all groups. DIAGNOdent pen and Nyvad presented a significant correlation. Conclusion: After 3 months of treatment, F, CHX and CO were capable of controlling the WSLs adjacent to the orthodontic brackets. However, the treatment with F was capable of controlling the progression of the WSLs in a shorter period of time.

Being able to manipulate mass flow is critically important in a variety of physical processes in chemical and biomolecular science. For example, separation and catalytic systems, which requires precise control of mass diffusion, are crucial in the manufacturing of chemicals, crystal growth of semiconductors, waste recovery of biological solutes or chemicals and production of artificial kidneys. Coordinate transformations and metamaterials are powerful methods to achieve precise manipulation of molecular diffusion. Here, we introduce a novel approach to obtain mass separation based on metamaterials that can sort chemical and biomolecular species by cloaking one compound while concentrating the other. A design strategy to realize such metamaterial using homogeneous isotropic materials is proposed. We present a practical case where a mixture of oxygen and nitrogen is manipulated using a metamaterial that cloaks nitrogen and concentrates oxygen. This work lays the foundation for molecular mass separation in biophysical and chemical systems through metamaterial devices.

Este artículo plantea la hipótesis sobre las razones del cambio de época que justifican un modelo de liderazgo que deben ejercer los rectores de colegios, centrado en la colaboración y la adaptación, para orientar sus instituciones hacia nuevas formas de innovación pedagógica y organizacional que den respuesta a la expectativa familiar y social sobre el resultado del proceso de educación de niños y jóvenes. Mediante la revisión bibliográfica se estructuró el tema en cinco grandes núcleos gerenciales definidos como "desafíos", para aportar una perspectiva que integra, en primer lugar, la consideración de aspectos que parten de la persona en el rol rectoral (el ser) y que en el avance del documento plantean los múltiples frentes de la gestión educativa ante los cuales la dirección debe dar una respuesta oportuna y eficiente (el hacer). Concluye sobre la urgencia de introducir en el rol del rector del colegio una perspectiva de su gestión que incluya, a partir del conocimiento de sí mismo, la habilidad para entender los cambios de época y la competencia técnica para implementar un modelo de dirección competitivo. This article hypothesizes on the reasons of the change of time that justify model of leadership that school headmasters must exercise, with the aim of collaborating and adapting, to guide their institutions to pedagogical and organizational innovation that answer families and societies expectation on the process of education in children and teenagers. Reviewing the literature on the subject, five large management nuclei were structured, defined as "challenges", to contribute with a perspective that integrates, in first place, aspects of the individual in the role of the headmaster, and throughout the document pose the multiple fronts of educational management to which the direction must give proper and efficient answer. It concludes on the urgency of introducing to the role of the headmaster a management perspective that includes, from self understanding, the ability to understand the changes and the technical competence to implement competitive management model. Este artigo propõe uma hipótese sobre as razões da mudança de época que justificam um modelo de liderança que deve exercer os reitores de colégios, centrado na colaboração e na adaptação, para orientar suas instituições a novas formas de inovação pedagógica e organizacional que respondam à expectativa familiar e social sobre o resultado do processo de educação de crianças e jovens. Mediante a revisão bibliográfica, estruturou-se o tema em cinco grandes núcleos gerenciais definidos como "desafíos", para contribuir com uma perspectiva que integra, em primeiro lugar, a consideração de aspectos que partem da pessoa no papel reitoral (o ser) e que no avanço do documento propõem as múltiplas frentes da gestão educativa ante as quais a direção deve dar uma resposta oportuna e eficiente (o fazer). Conclui sobre a urgência de introduzir no papel do reitor do colégio uma perspectiva de sua gestão que inclua, a partir do conhecimento de si mesmo, a habilidade para entender as mudanças de época e a competência técnica para implementar um modelo de direção competitivo.

With the objective of comparing incidence of adverse events of the opioids codeine, hydrocodone, and tramadol in the relief of cancer pain, we conducted a randomized controlled trial in which patients with cancer were randomly assigned according to a computer-generated schedule to receive one of the three opioids. Of the 177 patients who participated, 62 patients received hydrocodone, 59 patients received codeine, and 56 patients received tramadol. The pain experienced by the participants originated most frequently from the stomach, breast, or prostate gland and was classified as either somatic (33%), visceral (52%), mixed (6%), or neuropathic (9%). At the first visit, 60% of the patients described their pain intensity as moderate (4-6/10), with the remaining 40% of the patients describing their pain as severe (7-10/10). The symptoms most associated with pain were weakness, insomnia. and anorexia. In 77% of the total number of cases, the patient was aware of his/her diagnosis prior to admittance to the palliative care unit. Of the total number of cases, 57% fell in the age range of 60-89 years old and 50% of the participants were female. No significant statistical difference in the analgesic efficacy of the three opioids was found (p: 0.69; chi(2): 0.73). Use of tramadol produced higher rates of adverse events than codeine and hydrocodone: vomiting, dizziness, loss of appetite, and weakness (p0.05).

Made available in DSpace on 2015-08-06T16:12:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2015. Added 1 bitstream(s) on 2015-08-06T16:44:04Z : No. of bitstreams: 1 ISSN1537-744X-2015-2015-01-06.pdf: 1667335 bytes, checksum: b8d7a52d576b7900204f3bdac2f19429 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The aims of this study were to compare the effectiveness of fluoride varnish and chlorhexidine gel in controlling white spot lesions (WSLs) adjacent to orthodontic brackets and to compare the ability of Quantitative Light-Induced Fluorescence (QLF) to measure mineral uptake with that of transverse microradiography (TMR). Thirty premolars with artificially induced WSLs were randomly assigned to three groups: (1) two applications of 5% NaF-varnish (F), with one-week interval, (2) two applications of 2% chlorhexidine gel (CHX), with one-week interval, and (3) control (CO), no treatment. QLF was used to measure changes in fluorescence before and after caries induction, 1 week after each application and 1, 2, and 3 months after the last application of F or CHX. TMR was performed to quantify lesion depth and mineral content after caries induction to evaluate the effects of F, CHX, and CO 3 months after the last application of agents. The data were analyzed by repeated measures ANOVA and Tukey’s test. All treatments increased the mineral content during the experimental period; however, F induced faster remineralization than CHX. The correlation between QLF and TMR was significantly moderate. Two applications of fluoride varnish or 2% chlorhexidine gel at one-week intervals were effective in controlling WSLs. Universidade de São Paulo, Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru Universidade Estadual Paulista Júlio de Mesquita Filho, Departamento de Clínica Infantil, Faculdade de Odontologia de Araraquara FAPESP: 2011/21012-1

Recent advances in the design of metamaterials that control diffusive transport processes have enabled efficient devices to manipulate heat conduction. In contrast, control of mass diffusion with metamaterial devices has been largely unexplored. Mass diffusion is critically important in multiple research areas ranging from electronic and energy materials to chemical and biological systems. In this work, we introduce a physical approach to design mass diffusion metamaterial devices that take into account the fundamental physical mechanisms behind mass transport. We demonstrate that mass concentration discontinuities arising from different material solubilities are critical physical factors that need to be incorporated for the accurate design and characterization of mass diffusion metamaterial devices. We employ our approach to devise and analyze cloaking and focusing of molecules and show how the difference in solubilities is critically important for the efficiency of the metamaterials. This work provides ...

Introducción. La Insuficiencia Renal Crónica en pediatría es considerada como enfermedad de alto costo, generando gran impacto emocional, familiar y social en el niño y el cuidador primario. La mayoría de los procesos de atención en este grupo de pacientes son complejos, requiriendo terapias de remplazo renal (TRR) Objetivo. Evaluar la Seguridad de la DPA a niños en casa, a través del entrenamiento a cuidadores primarios por enfermería. Material y Métodos. Estudio descriptivo transversal, utilizando muestreo por conveniencia, incluyó 12 cuidadores primarios de niños en DPA de zona urbana y rural del departamento del Valle del Cauca que pertenecían a una Unidad Renal de Cali-Colombia, se evaluó por medio de visita domiciliaria: perfil socio demográfico, condiciones ambientales, adherencia al tratamiento y factores de riesgo en dos periodos de tiempo. Resultados. Se evaluaron 12 niños entre 5 a 18 años, el 60% con 10 a 15 años; en condiciones ambientales, el 83% habitaban en casas terminadas, 17% en construcción; 50% pertenecían al estrato socioeconómico 2. En relación al nivel educativo del cuidador, el 58% cursaban primaria, 58.3% tenían como cuidador a la madre, 8.3% padre y 25% el mismo paciente. Conclusión. Los niños con DPA son vulnerables a múltiples factores de riesgo, siendo necesario estrategias para su evaluación. El equipo interdisciplinario y en especial el profesional de enfermería direccionan lineamientos al cuidado de la DPA, convirtiéndose en una forma efectiva para minimizar riesgos desencadenantes de complicaciones y poder desarrollar destrezas que orienten la seguridad de la DPA en casa ABSTRACT Introduction: Chronic renal failure in children is considered high-cost disease, causing great emotional impact, family and society on the child and the primary caregiver. Most of the processes of care in this group of patients are complex, requiring renal replacement therapy. Objective: Evaluate the Safety of DPA children at home, through training for nursing primary caregivers. Material and Mhetods: Cross-sectional study using convenience sampling included 12 primary caregivers of children in DPA urban and rural area of Valle del Cauca department belonging to the Renal Unit of Cali-Colombia, was assessed through home visits: socio-demographic profile, environmental conditions, treatment adherence, and risk factors in two time periods. Results: We evaluated 12 children between 5-18 years, 60% with 10-15 years, at ambient conditions, 83% lived in houses completed, 17% in construction, 50% belonged to socioeconomic status 2. In relation to the educational level of the caregiver, 58% attended elementary, 58.3% had a caregiver to mother, father 8.3% and 25% the same patient. Conclusion: Children with APD are vulnerable to multiple risk factors, being strategies necessary for evaluation. The interdisciplinary team and especially addressed nurse care guidelines for DPA, becoming an effective way to minimize risks and complications triggers to develop skills to guide DPA security at home.

Analgesics are an essential component of the treatment of cancer-associated pain. Pharmacologic treatment is usually begun with nonopioid analgesics, most frequently acetaminophen. If pain relief is not achieved, the so-called "weak" opioids, such as codeine and hydrocodone, may be used in combination with acetaminophen. Adverse effects (AEs) of the opioids include constipation, somnolence, nausea, and vomiting. Based on the results of a literature search, data comparing the effects of the opioids are lacking.The purpose of this study was to compare the analgesic efficacy and tolerability of codeine phosphate versus hydrocodone bitartrate in combination with acetaminophen in the relief of cancer-related pain.This 23-day, prospective, double-blind, randomized, parallel-group study was conducted at 3 Colombian centers: University Libre, Social Security Institute, and General Hospital of Medellín, Cali, Colombia. Outpatients with cancer were eligible for the study if they were aged-18 years and had chronic (duration,/= 3 months) moderate to severe cancer-related pain (score on 10-cm visual analog scale [VAS],3 cm [moderate]; score on a 4-point verbal pain-intensity scale,1 [moderate]). Eligible patients were randomly assigned to receive 1 tablet of codeine/acetaminophen (C/A) 30/500 mg or hydrocodone/acetaminophen (H/A) 5/500 mg PO q4h (total daily doses, 150/2500 and 25/2500 mg, respectively) for 23 days. In both groups, if pain intensity was rated as3 on the VAS at week 1 or 2, the dosage was doubled. The primary end point was the proportion of patients who achieved pain relief (defined as a score of1 on a 5-point verbal rating scale [VRS] (0 = none; 1 = a little; 2 = some; 3 = a lot; and 4 = complete) on study days 1 and 2 and weeks 1, 2, and 3. The secondary end point was the proportion of patients in whom pain was decreased (VAS score,- 3 cm). AEs were self-reported on a 4-point VRS (0 = absent; 1 = mild; 2 = moderate; and 3 = severe).Of the 121 patients who participated, 59 received C/A and 62 received H/A. Of the total number of cases, 59% were aged 60 to 89 years, and 55% were men. At baseline, 88% of the patients described their pain intensity as moderate; 12%, severe. Of the patients who received C/A, 58% responded to the initial dosage of 150/2500 mg/d, and 8% of the patients responded to the double dosage; 34% did not experience pain relief. In patients with H/A, pain was reported as absent or mild in 56% of patients at the starting dosage of 25/2500 mg/d; an additional 15% of the patients responded to the double dosage; the remaining 29% of patients did not experience any pain relief. None of the between-group differences in response rates were significant. The most common AEs in the C/A and H/A groups were constipation (36% and 29%, respectively), dizziness (24% and 19%), vomiting (24% and 16%), and dry mouth (15% and 18%), with no significant differences between groups.In this study, efficacy and tolerability were comparable between C/A and H/A over 23 days of treatment in these patients with moderate or severe, chronic, cancer-related pain.