Câncer de boca avançado : o que está acontecendo com os nossos pacientes?

Os tumores de cavidade oral estão cada vez mais prevalentes em nosso meio. Conforme o Instituto Nacional de Câncer (INCA) estima-se que no Brasil, a cada ano, surjam cerca de 15.190 novos casos de câncer de boca, sendo que 6.455 pacientes morrem devido a essa doença. A incidência, antigamente, era muito maior em homens, cerca de quatro vezes mais do que em mulheres. Essa diferença vem diminuindo à medida que a mulher começou a adquirir os hábitos de fumar e ingerir bebidas alcoólicas. Devido à dificuldade de detecção pelo próprio paciente, a falta de suspeição por muitos médicos e/ou a demora em chegar a um serviço especializado, a maioria dos casos de tumor de boca são detectados em estágios avançados. Nesse estudo então, temos o objetivo de identificar os pacientes que chegaram ao Serviço de Otorrinolaringologia e Cabeça e Pescoço do Hospital de Clínicas de Porto Alegre portando lesões malignas de boca em estágios avançados nos anos de 2011 a 2015 para assim, visualizar o cenário do nosso sistema público de saúde, avaliando a localização das lesões na cavidade oral, a idade e o sexo dos pacientes, os fatores de risco, o estágio clínico em que chegaram, tratamentos impostos e a sobrevida no decorrer do seguimento.Oral cavity tumors are increasingly prevalent in our environment. According to the National Cancer Institute (INCA) it is estimated that in Brazil, every year, there are about 15,190 new cases of mouth cancer, and 6,455 patients die from this disease. The incidence, in the past, was much higher in men, about four times higher than in women. This difference has been decreasing as the woman started to acquire the habits of smoking and drinking alcoholic beverages. Due to the difficulty of detection by the patient, the lack of suspicion by many doctors and/or the delay in reaching a specialized service, most cases of oral tumors are detected in advanced stages. In this study, then, we aim to identify patients who arrived at the Otorhinolaryngology and Head and Neck Service of the Hospital de Clinicas de Porto Alegre, carrying malignant lesions of the mouth in advanced stages in the years 2011 to 2015 in order to visualize the scenario of our public health system, evaluating the location of lesions in the oral cavity, the age and gender of patients, risk factors, the clinical stage in which they arrived, imposed treatments and survival during follow-up

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis : a cross-sectional study comparing MASES, SPARCC and LEI

Background: The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA. Methods: A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman’s Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease. Results: Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034). Conclusion: In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA