Resumo Antecedentes A epilepsia, uma das doenças neurológicas crônicas mais prevalentes, tem geralmente início na infância. Cerca de 30% das crianças com epilepsia desenvolvem crises de difícil controle medicamentoso. As crises epilépticas recorrentes dificultam a ingestão alimentar, prejudicando o estado nutricional. Intervenções não farmacológicas, como a terapia com dieta cetogênica, podem melhorar a frequência das crises epilépticas, mas existem poucos estudos sobre a repercussão no estado nutricional da criança/adolescente. Objetivo Avaliar o efeito da terapia cetogênica sobre o estado nutricional e a evolução clínica da epilepsia fármaco-resistente. Métodos Estudo tipo corte transversal envolvendo menores de 18 anos acompanhados no Ambulatório de Dieta Cetogênica do Instituto de Medicina Integral Prof. Fernando Figueira entre dezembro de 2015 e dezembro de 2021. Dados socioeconômicos, clínicos, nutricionais e laboratoriais foram coletados nos prontuários dos pacientes em vários momentos da terapia cetogênica. Resultados A amostra foi composta por 49 pacientes com idades entre cinco meses e 17 anos (mediana = 4,4 anos), a maioria do sexo masculino (62,1%) e procedentes de Recife e região metropolitana (51%). Pacientes com baixo peso (de acordo com o IMC para idade) melhoraram seu estado nutricional em seis meses. No entanto, os pacientes com peso adequado e com sobrepeso mantiveram seu estado nutricional. A dislipidemia foi um efeito adverso frequente e de curta duração. Além disso, o tratamento reduziu a frequência de crises epilépticas e a dose de fármacos anticrises. Conclusão A dieta cetogênica preveniu o agravamento da desnutrição e reduziu as crises epilépticas e a dosagem de fármacos anticrises. prevalentes infância 30 medicamentoso alimentar farmacológicas criançaadolescente criança adolescente criança/adolescente fármacoresistente. fármacoresistente fármaco resistente. resistente fármaco-resistente 1 Prof 201 2021 socioeconômicos clínicos 4 mediana 44 4, anos, , anos) 62,1% 621 62 (62,1% 51%. 51 51% . (51%) idade entanto duração disso anticrises 3 20 202 62,1 6 (62,1 5 (51% 2 62, (62, (51 (62 (5 (6 (

Abstract Background Epilepsies are among the most prevalent chronic neurological diseases, usually beginning in childhood. About 30% of children with epilepsies develop seizures that are difficult to control with medication. Recurrent epileptic seizures hinder diet intake, impairing the nutritional status. Although non-pharmacological interventions (e.g., ketogenic diet therapy) can improve epileptic seizure frequency, few studies analyzed their impact on the nutritional status of children and adolescents with epilepsies. Objective The aim was to evaluate the effects of a ketogenic diet on the nutritional status and clinical course of patients with pharmacoresistant epilepsies. Methods This cross-sectional study included patients under 18 years of age followed up at the Ketogenic Diet Ambulatory Clinic of the Instituto de Medicina Integral Prof. Fernando Figueira between December 2015 and December 2021. Socioeconomic, clinical, nutritional, and laboratory data were collected from medical records at different time points during the ketogenic diet. Results The sample comprised 49 patients aged between 5 months and 17 years (median = 4.4 years), mostly male (62.1%), and from Recife and the metropolitan region (51%). Underweight patients (BMI-for-age) improved their nutritional status in six months. However, patients who were normal weight and overweight maintained their nutritional status. Dyslipidemia was a common and short-term adverse effect. Moreover, the treatment decreased epileptic seizure frequency and antiseizure medication intake. Conclusion The ketogenic diet prevented malnutrition from worsening and reduced epileptic seizures and antiseizure medication intake. diseases childhood 30 intake nonpharmacological non pharmacological e.g., eg e g (e.g. therapy crosssectional cross sectional 1 Prof 201 2021 Socioeconomic 4 median 44 4. years, , years) 62.1%, 621 62.1% 62 (62.1%) 51%. 51 51% . (51%) BMIforage BMI for (BMI-for-age However shortterm short term effect Moreover 3 e.g. (e.g 20 202 62.1 6 (62.1% (51% e.g 2 62. (62.1 (51 (62. (5 (62 ( (6

RESUMO Objetivo Avaliar a sobrecarga do cuidador e a qualidade de vida da criança e adolescente com epilepsia fármaco-resistente em tratamento com terapia cetogênica. Métodos Estudo tipo survey envolvendo os cuidadores das crianças e adolescentes em acompanhamento no ambulatório de dieta cetogênica do Instituto de Medicina Integral Prof. Fernando Figueira. Foram coletados dados socioeconômicos a partir da análise dos prontuários e realizadas entrevistas telefônicas, onde foi aplicado ao responsável pela criança/adolescente dois formulários: 1) Qualidade de Vida da Criança com Epilepsia, que aborda pela perspectiva dos pais os domínios físico, psicológico, cognitivo/educacional e sociofamiliar; e 2) Inventário de Sobrecarga de Zarit, que avalia a repercussão dos transtornos crônicos mentais sobre o bem-estar físico e emocional, vida social e aspectos financeiros do cuidador. Resultados A amostra foi constituída por cuidadores de 49 crianças e adolescentes, com mediana de idade de 4,4 anos, sendo 61,2% do sexo masculino. Os resultados obtidos no Qualidade de Vida da Criança com Epilepsia, evidenciaram que após o domínio cognitivo/educacional, o mais prejudicado foi o físico (mediana=52,8, Q1=47,2; Q3=61,1) e o mais preservado foi o psicológico (mediana=77,8; Q1=70,8; Q3=83,3). A sobrecarga foi considerada moderada a grave para a maioria (55,1%) dos cuidadores. Conclusão Foi evidenciado baixa qualidade de vida da criança/adolescente e aumento da sobrecarga do cuidador, interferindo na vida cotidiana e nas relações pessoais dos responsáveis. Assim, a equipe multidisciplinar deve também oferecer amparo e suporte técnico apropriado aos cuidadores. fármacoresistente fármaco resistente Prof Figueira telefônicas criançaadolescente formulários 1 Epilepsia cognitivoeducacional cognitivo educacional sociofamiliar 2 Zarit bemestar bem estar emocional 4 44 4, anos 612 61 61,2 masculino mediana=52,8, mediana528 52 8 (mediana=52,8 Q1=47,2 Q1472 Q Q1 47 Q3=61,1 Q3611 Q3 mediana=77,8 mediana778 77 (mediana=77,8 Q1=70,8 Q1708 70 Q3=83,3. Q3833 Q3=83,3 . 83 3 Q3=83,3) 55,1% 551 55 (55,1% responsáveis Assim 6 61, mediana=52,8 mediana52 5 (mediana=52, Q1=47, Q147 Q3=61, Q361 mediana=77, mediana77 7 (mediana=77, Q1=70, Q170 Q383 Q3=83, 55,1 (55,1 mediana=52, mediana5 (mediana=52 Q1=47 Q14 Q3=61 Q36 mediana=77 mediana7 (mediana=77 Q1=70 Q17 Q38 Q3=83 55, (55, mediana=52 (mediana=5 Q1=4 Q3=6 mediana=7 (mediana=7 Q1=7 Q3=8 (55 mediana=5 (mediana= Q1= Q3= mediana= (5 (mediana (

ABSTRACT Objective To assess caregivers’ burden and quality of life of children and adolescents with drug-resistant epilepsy treated with ketogenic therapy. Methods Survey-type study involving caregivers of children and adolescents being monitored at the ketogenic diet clinic of the Instituto de Medicina Integral Prof. Fernando Figueira. Socioeconomic data were collected from the patients’ medical records. Telephone interviews with the guardians of the child/adolescent were carried out using two instruments: 1) The Quality of Life of Children with Epilepsy, which approaches the physical, psychological, cognitive/educational and socio-familial domains from the parents perspective,; and 2) The Zarit Burden Inventory, which assesses the impact of chronic mental disorders on the physical and emotional well-being, social life and financial aspects of the caregiver. Results The sample consisted of 49 children and adolescents of caregivers with a median age of 44 years, 61;2% of whom were male. The results obtained using the Quality of Life of Children with Epilepsy showed that after the cognitive/educational domain, the domain most impaired was the physical domain (median=52.8, Q1=47.2; Q3=61.1) and the most preserved was the psychological domain (median=77.8; Q1=70.8; Q3=83.3). The burden was considered moderate to severe for the majority (55.1%) of caregivers. Conclusion A poor quality of life for the child/adolescent and an increase in the caregiver’s burden were observed, interfering in the daily life and personal relationships of the guardians. Thus, the multidisciplinary team should also offer support and appropriate technical support to caregivers. drugresistant drug resistant therapy Surveytype Survey type Prof Figueira patients records childadolescent child adolescent instruments 1 cognitiveeducational cognitive educational sociofamilial socio familial perspective, perspective 2 Inventory wellbeing, wellbeing well being, well-being caregiver 4 years 612% 612 61 2% 61;2 male median=52.8, median528 52 8 (median=52.8 Q1=47.2 Q1472 Q Q1 47 Q3=61.1 Q3611 Q3 median=77.8 median778 77 (median=77.8 Q1=70.8 Q1708 70 Q3=83.3. Q3833 Q3=83.3 . 83 3 Q3=83.3) 55.1% 551 55 (55.1% s observed Thus 6 61; median=52.8 median52 5 (median=52. Q1=47. Q147 Q3=61. Q361 median=77. median77 7 (median=77. Q1=70. Q170 Q383 Q3=83. 55.1 (55.1 median=52. median5 (median=52 Q1=47 Q14 Q3=61 Q36 median=77 median7 (median=77 Q1=70 Q17 Q38 Q3=83 55. (55. median=52 (median=5 Q1=4 Q3=6 median=7 (median=7 Q1=7 Q3=8 (55 median=5 (median= Q1= Q3= median= (5 (median (

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl’s behavioral scale was used during toothbrushing to assess the participants’ cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher’s Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 –9 years, p = 0.919; 10–14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.