Alterações citológicas relacionadas à mucosite oral em pacientes oncopediátricos: análise citomorfométrica de quatro casos

Exfoliative cytology allows the analysis of quantitative parameters through the cytomorphometry, contributing to the knowledge of the pathogenesis of many lesions. The aim of this study was to evaluate the cytological alterations in oral mucosa smears from 4 pediatric patients undergoing chemotherapeutic treatment. Smears were collected by exfoliative cytology at the baseline and weekly, with a 7 day interval between the collections, until the development of mucositis. Smears were stained using the Papanicolaou method and analyzed under a light microscope. Fifty epithelial cells were photomicrographed (x400) and the images obtained were submitted to cytomorphometric analysis. Nuclear area (NA), cytoplasmic area (CA) and nucleus-to-cytoplasm area ratio (NA/CA) were evaluated with ImageJ® software. In the reported cases, it was verified that the mean CA as well as the NA decreased from the baseline to the final measurements taken in the time period before the manifestation of the oral mucositis, except in case 2 in which the NA increased. That changed when the NA/CA ratio was compared, for the values decreased for cases 1 and 4, increased for case 2 and was not altered for case 3. Oncopediatric patients undergoing chemotherapeutic treatment revealed cytological alterations in oral mucosal epithelial cells, specially the reduction in CA. These findings highlight the importance of further cohort studies with larger samples to evaluate the potential of these cytological alterations as predictors of the development of oral mucositis and, therefore, allow the execution of early interventions that minimize or prevent its development.Citologia esfoliativa permite a análise de parâmetros quantitativos, por meio da citomorfometria, contribuindo para o conhecimento da patogênese de diversas lesões. O objetivo deste trabalho foi avaliar as alterações citológicas em esfregaços de mucosa oral de 4 pacientes pediátricos sob tratamento quimioterápico. Os esfregaços foram obtidos por meio de citologia esfoliativa nos períodos do baseline e semanalmente, com intervalo de 7 dias entre as coletas, até o desenvolvimento de mucosite. Os esfregaços foram corados com o método de Papanicolaou e analisados sob microscopia de luz. Cinquenta células epiteliais foram fotomicrografadas (x400) e 7 as imagens obtidas foram submetidas à análise citomorfométrica. Área nuclear (AN), área citoplasmática (AC) e proporção núcleo/citoplasma (AN/AC) foram avaliadas usando o programa ImageJ®. Nos casos relatados, constatou-se que a média da AC, bem como da AN diminuíram do baseline para a medição final, no período imediatamente antes do episódio clínico da mucosite oral, exceto na AN do caso 2 que aumentou, sendo diferente quando se compara a AN/AC, pois os valores diminuíram para os casos 1 e 4, aumentou para o caso 2 e não foi alterado para o caso 3. Pacientes oncopediátricos sob tratamento quimioterápico demonstraram alterações nas células epiteliais da mucosa oral, com destaque para a diminuição da AC. Tais achados enaltecem a importância de estudos de coorte com amostras maiores para avaliar o potencial dessas alterações citológicas como preditoras do desenvolvimento de mucosite oral e, assim, permitir a realização de intervenções precoces que minimizem ou impeçam seu desenvolvimento

Impact of Non-Weighting in the Analysis of Data Obtained from Complex Samples

Objective: To compare the estimates obtained, considering or not the weighting data. Material and Methods: Secondary data from the Oral Health Survey of the State of São Paulo (SBSP2015) was used for calculation of mean estimates, standard errors of the mean and confidence intervals (CI) for the DMFT index and components (decayed, lost and filled), in the age group of 35-44 years. Multiple logistic regression models were estimated, considering or not the weighting from the sampling plan (p<0.05). Results: It was observed that the estimates of the DMFT index and the carious component did not vary much when the design was considered or not (1.1% and 2.0%, respectively). However, the data referring to the lost and filled component showed greater differences between the values of the means. The averages fluctuated up and down by up to 6.7% for weighted versus unweighted analyses. The standard error was underestimated in the unweighted analysis and the confidence interval showed variations. Differences between the regression models obtained by the weighted and unweighted analysis of the data were detected. Conclusion: Although weighted and unweighted models presented differences of less than 10% in estimates of the mean, confidence intervals, as well as statistical inferences, were different.  Thus, weighting should be applied in the population base data analysis collected by sampling with complex designs

Biochemical and microbiological analysis of the saliva of institutionalized elderly : with edentulism, use of dentures and presence of biofilm

To analyze biochemical and microbiological parameters of the saliva of institutionalized elders and to investigate the relation of these parameters with edentulism, use of dentures and presence of biofilm. A cross-sectional study carried was out in seven long-term institutions. Samples (n=161) of unstimulated saliva were collected for analysis of salivary flow, quantification of total proteins and identification of microorganisms. Oral examination was carried out to verify the number of missing teeth, the use of dentures and the presence of visible biofilm on the surface of teeth and dentures. Associations were performed using chi-square or Fisher?s exact test (?0.05). Associations were observed between the presence of dentures biofilm and the colonization of Streptococcus sp. (p=0.038) and Candida sp. (p=0.03). The absence of teeth and use of dentures do not influence the amount of total proteins and the microorganisms count in saliva. Denture biofilms are associated with the presence of Streptococcus sp. and Candida sp. in saliva of institutionalized elders

Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer

The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than 100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public system aids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients with oral cancer is associated with socioeconomic factors. A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019. Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementary education; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) were analyzed by multiple logistic regression (p<0.05). Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018 (OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender, men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-white individuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referred by the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796). It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associated with socioeconomic factors

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017

This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (?<0.05). There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p=0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p<0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases. Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil

Acesso em saúde bucal na atenção básica antes e após o início da pandemia de COVID-19 no Brasil

This study compared the access to oral health in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. An observational study with a cross-sectional ecological design was carried out, using data from the Health Information System for Primary Care (SISAB). Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data were collected by state as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable. Data were compared by Wilcoxon test (α&lt;0,05). An increase in the number of OHT was observed in 25 states (MD=45, %V=6.13%, p&lt;0.001), whilst the OHC increased in 17 states (MD=1.01, %V=1.62%, p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42,806, %V=-38.70%, p&lt;0.001), as well as in the number of visits due to dental abscess (MD=-1,032, % V=-29.04%, p=0.002) and due to toothache (MD=-14,445, %V=-32.68%, p&lt;0.001). Although an expansion of OHT and OHC between 2019 and 2020 was verified, access to oral health in primary care has decreased due to the COVID-19 pandemic.Este estudo analisou acesso em saúde bucal na atenção básica, antes e após o início da pandemia do COVID-19 no Brasil. Realizou-se um estudo observacional, com delineamento ecológico transversal, que utilizou dados do Sistema de Informação em Saúde para a Atenção Básica (SISAB). Foram coletados dados referentes ao número de Equipes de Saúde Bucal (ESB), Cobertura de Saúde Bucal na Atenção Básica (CobSB), número de Primeiras Consultas Odontológicas Programadas (PCOP), e número de atendimentos devido abscesso dento-alveolar e dor de dente. Os dados foram coletados por estado como um consolidado do primeiro quadrimestre (Janeiro a Abril) de 2019 e 2020. A mediana da diferença (MD) e o percentual de variação (%V) dos valores foram obtidos para cada variável em estudo. Os dados foram comparados por meio do teste Wilcoxon (α&lt;0,05). Um aumento do número de ESB foi observado em 25 estados (MD=45, %V=6,13%, p&lt;0,001), enquanto a CobSB aumentou em 17 estados (MD=1,01, %V=1,62%, p=0,035), entre 2019 e 2020. Observou-se ainda redução significativa no número de PCOP (MD=-42.806, %V=-38,70%, p&lt;0,001), bem como no número de atendimentos devido abscesso dento-alveolar (MD=-1.032, %V=-29,04%, p=0,002) e a dor de dente (MD=-14.445, %V=-32,68%, p&lt;0,001). Embora tenha sido verificada ampliação de ESB e CobSB entre 2019 e 2020, o acesso à saúde bucal na atenção básica foi reduzido devido a pandemia do COVID-19

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author