Measurement of oral health quality of life among patients who underwent haematopoietic stem-cell transplantation

Abstract Oral mucositis is a painful condition that occurs in patients who have undergone haematopoietic stem-cell transplantation (HSCT) and has a huge impact on their quality of life. The objective of this study was to examine the extent to which interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) are associated with oral health quality of life among patients who underwent HSCT. A. C. Camargo Cancer Center patients were evaluated over 20 months at 4 different time-points: a) at patient admission (M1); b) on the day of infusion of HSC (M2); c) 12 and 20 days after the first day of the conditioning regimen for autologous and allogeneic transplantation, respectively (M3); and d) 30 days after the first day of the conditioning regimen (M4). Mucositis clinical evaluations were performed using World Health Organization (WHO) criteria. Oral health quality of life was measured using the Oral Health Impact Profile short form (OHIP-14), Oral Mucositis Quality of Life (OMQoL) and Patient-Reported Oral Mucositis Symptom (PROMS) scales. Correlations between clinical data and quality of life scores were examined. STATA 11.0 was used to perform the statistical analyses (5% level of significance). Eighty-two patients participated in the study; 62.2% were male, 28.05% had multiple myeloma, and the mean age was 48.49 years (SD 13.76). Higher scores (worse quality of life) were observed as mucositis scores increased, but the results were not significant. The OMQoL had a high correlation with OHIP-14 (0.8377), but the correlation between the PROMS scale and the OHIP-14 was lower (0.6643). Higher concentrations of IL-6 and TNF-α were associated with worse quality of life, according to all indices (p < 0.05). Oral mucositis was associated with quality of life scores (p < 0.01).

Efeitos da irradiação com laser de baixa potência nas glândulas salivares submandibulares de ratas diabéticas induzidas por estreptozotocina / Low-power laser irradiation effects in submandibular glands of streptozotocin-induced diabetic rats

O diabetes mellitus (DM) pode levar à disfunção das glândulas salivares. A ativação do receptor de produtos finais de glicosilação avançada e de seus ligantes tem sido reportado em várias doenças crônicas, entre estas, a diabetes e suas complicações. Este estudo analisou a expressão do RAGE, proteína do grupo de alta mobilidade B1 (HMGB1) e de produtos de glicosilação avançada (AGE), bem como os efeitos da irradiação com laser de baixa potência (ILBP) em glândulas salivares submandibulares (GSMs) de ratas diabéticas. Ratas Wistar com 12 semanas de vida foram divididas em 3 grupos: controle (C), diabético (D) e diabético com laser (DL). A indução de DM nos grupos D e DL foi realizada com injeção intraperitoneal de estreptozotocina 60 mg/kg de peso corporal, no 1° dia experimental. No 29°dia, os animais do grupo DL receberam a ILBP (660 nm, 70 mW, 20 J/cm² e 0,56 J por ponto), aplicado no total de quarenta pontos cobrindo a área correspondente as GSMs, e os seus efeitos foram avaliados 24 h após a irradiação (eutanásia). As análises de parâmetros metabólicos, histológicos e de marcadores de inflamação, apoptose e proliferação foram realizadas. Nossos achados mostram que a ILBP diminuiu a glicemia das ratas diabéticas irradiadas, melhorando a resistência à insulina (HOMA-IR), sensibilidade à insulina (HOMA-IS) e função de células beta (HOMA-?). Em GSM, o DM parece aumentar a expressão do eixo HMGB1/AGE/RAGE, possivelmente associado à ativação do fator de transcrição nuclear kappa B (NF?B). A ILBP reduziu os marcadores de inflamação, HMGB1 e TNF-? em GSM de ratas diabéticas, e parece regular a expressão de proteínas relacionadas à proliferação e à apoptose, pela via do AMP cíclico, parcialmente mediado por proteína kinase regulada por sinais extracelulares. No entanto, mais estudos são necessários para melhor entender os efeitos do laser neste tecido.

Diabetes (DM) can lead to dysfunction of the secretory capacity in salivary glands. Since the activation of the receptor for advanced glycation end-products (RAGE) and its ligands has been suggested to participate in chronic disorders, such as diabetes and its complications. This study analyzed the expression of RAGE, high mobility group box protein B1 (HMGB1) and advanced glycation end-products (AGEs) were evaluated, as well as the effects of low-power laser irradiation (ILBP), in diabetic submandibular glands (GSM). Wistar rats 12 weeks-old were divided in three groups: control (C), diabetic (D) and diabetic with laser (DL). The D and DL rats were intraperitoneally injected with streptozotocin 60 mg/kg, in the 1st experimental day. On the 29° day, the DL rats received the ILBP (660 nm, 70 mW, 20 J/cm² e 0,56J per point), with a total of forty points covering the GSMs area, its effects were evaluated 24h after irradiation (euthanasia). Metabolic parameters, histology and the inflammatory, apoptosis and proliferation markers were evaluated. Our findings show that ILBP reduced the blood glucose levels of the irradiated diabetic rats, improving their insulin resistance (HOMA-IR), insulin sensitivity (HOMA-IS) e beta cell function (HOMA-?). In GSM, DM seems to upregulate the expression of HMGB1/AGE/RAGE axis, possibly associated with the activation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF?B). The ILBP reduced the inflammatory markers HMGB1 and TNF-? in diabetic GSM, and seems to regulate the expression of proteins related to proliferation and apoptosis, by cyclic AMP pathway, partially mediated by extracellular signal-regulated kinase. However, more studies are necessary to better understand the laser effects on this tissue.

Accessibility to dental care for patients with special needs

Introduction and objective: The aim of this study was to verify the professionals' perception about the accessibility to dental care establishments for three types of patients with special needs: Diabetes, AIDS, and Cerebral Paralysis patients, in the city of São Paulo. Material and methods: This was a descriptive, cross-sectional study with a non probabilistic sample. For the analysis, 107 dental care establishments were selected and divided into two categories (private and insurance). Each one of the establishments was randomly selected from a list containing a total of 3,234 private and 2,015 insurance establishments. The information for the study was based on phone conversations, when a semi-structured interview was accomplished to verify the accessibility for AIDS, Diabetes, and Cerebral Paralysis special need patients. The analysis of the interviews' content was executed according to the methodology of Lefèvre and Lefèvre (2000) and in agreement with the central idea. Results: From the total of participants, 55.14% were female and 53.27% worked at a private clinic. In relation to the patients' accessibility, 96.26% had already treated Diabetes patients, 55.14% AIDS patients, and 28.97% Cerebral Paralysis patients. Conclusion: It can be concluded that concerning to Diabetes patients, the main difficulty is the clinical practice, mainly related to problems in blood coagulation. For Cerebral Paralysis patients, the difficulties were related to personnel training, establishment structure, and also clinical practice. For AIDS patients, although difficulties in clinical practice were mentioned, prejudice still seemed to be the major difficulty.