Oral midazolam as premedication for the apprehensive child before dental treatment

A double-blind study was undertaken to determine the efficacy of an oral dose of midazolam 7.5 mg as compared to placebo in a sample of 32 children who had refused dental care after the conventional psychological approach alone was used to reduce fear and apprehensive behavior. Parameters assessed before and 30 minutes after the oral administration of either midazolam or placebo were mental attitude, hypnotic activity, motor activity, quality of sedation and of dental treatment. A three-point scale was designed in each studied parameter and mean values +/- s.e.m. were compared before and after treatment by using Wilcoxon's rank test. It was shown that an oral dose of midazolam 7.5 mg significantly improved all parameters under evaluation (p < 0.01) as compared to placebo, effects which appeared thirty minutes after administration. It is concluded that oral midazolam provides a fast and adequate sedation in children refusing dental care. Thus, the drug is an alternative to other sedative or hypnotic drugs currently used in the premedication of the apprehensive child.

A case-control study to assess the role of polyomavirus in transplant complications: Where do we stand?

PURPOSE

The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia.

METHODS

Case-control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia.

FINDING

Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato-oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55-46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft-versus-host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV-DNAemia (OR: 13.96, 95% CI: 11.25-15.18, P < .001; OR: 6.14, 95% CI: 3.91-8.80, P < .001; OR: 5.53, 95% CI: 3.37-7.30, P < .001, respectively).

CONCLUSIONS

Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV-DNAemia present poorer outcomes and unfavorable results.