Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study / Relação dos níveis de hemoglobina com desfechos em transplante renal de doador falecido: um estudo de coorte retrospectivo

ABSTRACT Introduction: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. Methods: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. Results: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. Conclusion: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

RESUMO Introdução: A anemia é frequente em pacientes submetidos à terapia substitutiva para insuficiência renal. A anemia nos períodos pré e pós-transplante pode estar relacionada aos desfechos do transplante renal. Portanto, o presente estudo buscou avaliar a relação entre anemia, função retardada do enxerto (FRE), disfunção crônica do enxerto renal (DCE) e óbito por qualquer causa após transplante renal de doador falecido. Métodos: Este foi um estudo retrospectivo com 206 pacientes transplantados renais de doadores falecidos. Analisamos dados demográficos de doadores falecidos e pacientes transplantados renais. Além disso, comparamos parâmetros bioquímicos, status de anemia e medicamentos entre os grupos FRE e não-FRE. Posteriormente, realizamos uma análise multivariada. Também avaliamos desfechos, como DCE em um ano e óbito em dez anos. Resultados: Observamos menor frequência de concentração de hemoglobina (Hb) pré-transplante, mas maior frequência de creatinina sérica do doador e transfusão de hemácias no período de uma semana após o transplante no grupo FRE. Além disso, houve associação independente entre a concentração de Hb antes do transplante e a FRE [OR 0,252; IC 95%: 0,159-0,401; p < 0,001]. Houve também associação entre a concentração de Hb após seis meses de transplante renal e ambos, DCE [OR 0,798; IC95%: 0,687-0,926; p = 0,003] e óbito por qualquer causa. Conclusão: Encontrou-se uma associação entre anemia pré-transplante e FRE e entre anemia seis meses após o transplante e ambos, DCE e óbito por qualquer causa. Assim, a anemia antes ou após o transplante afeta os desfechos de pacientes que foram submetidos a transplante renal de doador falecido.

Incidência de sífilis no estado do Rio de Janeiro e nomunicípio de Seropédica nos anos de 2010 a 2022 / Incidence of syphilis in the state of Rio de Janeiro andmunicipality of Seropédica in the years 2010 to 2022

Sífilis é uma infecção sexualmente transmissível (IST) que sinaliza a necessidade de efetivas políticas públicas devido ao aumento de casos na última década. Dessa forma, o objetivo do trabalho é descrever a incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica. Métodos: foi realizado um estudo descritivo, com abordagem quantitativa. A coleta dos dados foi realizada por meio do Sistema de Informação de Agravos de Notificação (Sinan), referentes ao município de Seropédica e ao estado do Rio de Janeiro, no período de 2010 a 2022. Resultados: foram identificados 105.138, 79.609 e 42.819 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no estado do Rio de Janeiro e 187, 140 e 79 casos de sífilis adquirida, em gestantes e congênita, respectivamente, no município de Seropédica. Foi observado uma incidência maior para sífilis adquirida entre homens em comparação com mulheres tanto no estado do Rio de Janeiro (62.719 versus 42.346) quanto no município de Seropédica (110 versus 77). Houve um aumento nas taxas de incidência de sífilis no estado do Rio de Janeiro e no município de Seropédica ao longo dos anos. Conclusão: a sífilis segue sendo uma doença com alta incidência no território do Rio de Janeiro. Nesse sentido, é importante elaborar estratégias em saúde pública mais efetivas às pessoas acometidas por tal infecção.

Syphilis is a sexually transmitted infection (STI) that signals the need for effective public policies due to the increase in cases in the last decade. Thus, the aim of this study is to describe the incidence of syphilis in the state of Rio de Janeiro and in the municipality of Seropédica. Methods: a descriptive study with a quantitative approach was carried out. Data collection was performed through the Sistema de Informação de Agravos de Notificação (Sinan), referring to the municipality of Seropédica and the state of Rio de Janeiro, from 2010 to 2022. Results: overall, 105.138, 79.609 and 42.819 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the state of Rio de Janeiro, and 187, 140, and 79 cases of acquired syphilis, in pregnant women, and congenital syphilis, respectively, were identified in the municipality of Seropédica. A higher incidence of acquired syphilis was observed among men compared to women both in the state of Rio de Janeiro (62.719 versus 42.346) and in the municipality of Seropédica (110 versus 77). There has been an increase in the incidence rates of syphilis in the state of Rio de Janeiro and the municipality of Seropédica over the years. Conclusion: syphilis continues to be a disease with a high incidence in the territory of Rio de Janeiro. In this sense, it is important to develop more effective public health strategies for people affected by this infection.

Oral Mucositis in Children with Leukemia Undergoing Chemotherapy: A Case Series

ABSTRACT Objective: To report nine cases of pediatric patients with Acute Lymphoid Leukemia (ALL) or Acute Myeloid Leukemia who developed severe oral mucositis (SOM) at the first week of chemotherapy. Material and Methods: The cases were selected from a sample of 105 children followed for 10 consecutive weeks. Hematological and personal data were obtained from the patient's medical records. The oral cavity was examined weekly using the modified Oral Assessment Guide. Results: More of the patients were male (55.6%), had black/brown skin (55.6%), with ALL (66.7%), and the mean age was 5.55. Two patients had values below normal for leukocytes, platelets, and creatinine over the follow-up. However, all patients showed changes in the normality of hematological data in most weeks. The most used chemotherapeutic agents were aracytin, etoposide, and methotrexate, known for their high stomatotoxic potential. Patients had 2 to 6 (mean of 4) episodes of SOM and 4 to 7 (mean of 5.5) episodes of OM. One patient at week 7, one patient at week 5, and one patient at weeks 2 and 10 did not have OM. Saliva (84 times) and lips (44 times) were the most affected items. Conclusion: The patients showed oscillations in the severity of oral mucositis and hematological parameters over the follow-up. All patients were exposed to stomatotoxic drugs during the initial phase of cancer treatment.

Adequacy of school menus and national school food program requirements: a systematic review / Adequação dos cardápios escolares e exigências do programa nacional de alimentação escolar: uma revisão sistemática

Abstract Objectives: this review aimed to evaluate the adequacy of school menus regarding the nutritional requirements of the Programa Nacional de Alimentação Escolar (PNAE) in Brazilian public schools regarding the presence of macronutrients and micronutrients and allocation of resources to purchase products from family farming. Methods: a systematic literature review was carried out using the SciELO, Bireme and Lilacs databases to select the articles. The inclusion criteria were articles that presented data on the adequacy of energy, macronutrients, micronutrients, and purchases of products from family farming during the PNAE regiment, as well as quantitative, cross-sectional, and descriptive studies carried out in the Brazilian territory. Review, editorials, letters, case studies, duplicates and those that did not assess the requirements of the PNAE were excluded. Results: at the end, 12 studies were included that showed overestimation and underestimation of nutritional adequacy in the school environment. In relation to purchases of inputs from family farming, it was observed that most of the Brazilian municipalities evaluated fulfilled the requirements for the allocation of resources. Conclusion: school menus need more supervision so that they meet the adjustments proposed by the PNAE. In addition, it is essential to promote a healthy diet that contains all the nutrients necessary to provide nutritional support for child growth and development.

Resumo Objetivo: avaliar a adequação dos cardápios escolares quanto às exigências nutricionais do Programa Nacional de Alimentação Escolar (PNAE) em escolas públicas brasileiras considerando quanto a adequação de macronutrientes e micronutrientes e destinação de recursos para compras de produtos advindos da agricultura familiar. Métodos: foi realizada uma revisão sistemática da literatura utilizando as bases de dados SciELO, Bireme e Lilacs para seleção dos artigos. Os critérios de inclusão foram: Artigos que apresentaram dados sobre a adequação de energia, macronutrientes, micronutrientes e compras de produtos oriundos da agricultura familiar durante o regimento do PNAE, assim como estudos quantitativos, transversais e descritivos realizados no território brasileiro. Foram excluídos artigos de revisão, editoriais, cartas ao editor, estudos de caso, artigos em duplicatas e que não avaliaram as exigências do PNAE. Resultados: ao final, foram incluídos12 estudos que apontaram superestimação e subestimação nas adequações nutricionais no ambiente escolar. Em relação às compras de insumo provenientes da agricultura familiar, observou-se que a maioria dos municípios brasileiros avaliados cumpriam as exigências de destinação dos recursos. Conclusões: os cardápios escolares necessitam de maior fiscalização para que atendam as adequações propostas pelo PNAE. Além disso, é primordial promover uma alimentação saudável que contenha todos os nutrientes necessários para fornecer um aporte nutricional para o crescimento e desenvolvimento infantil.

Molecular and serological diagnosis of toxoplasmosis: a systematic review and meta-analysis

ABSTRACT Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to serious conditions, such as encephalitis, miscarriage and blindness. Therefore, it is of utmost importance to perform a diagnosis with reproducible techniques in order to obtain a good prognosis. The aim of this review was to analyze the efficiency of toxoplasmosis diagnostic techniques based on sensitivity and specificity results. Five research platforms in English language were used (Eric, Elsevier, Google Scholar, PubMed and SciELO), which contained data on the diagnosis of toxoplasmosis. The search and selection were performed for studies published prior to June 2021. The search resulted in the inclusion of 13 articles published from 2005 to 2020. The data revealed the use of different samples in the standardization of techniques such as serum, total blood, colostrum and amniotic fluid. The flow cytometry, lateral flow immunoassay and qPCR techniques showed 100% sensitivity, whereas the ELISA, western blotting, qPCR and RE-LAMP techniques achieved 100% specificity. Significantly, the qPCR and LAMP techniques were more accurate when the likelihood ratio was assessed. The meta-analysis identified that ISAGA and western blotting have low sensitivity values and LIASON, ELFA and ELISA, using a silica bioconjugate, also have low specificity values. It was noted that a wide range of methods have high values of sensitivity and specificity. Therefore, the choice of the method will be based on the conditions and its financial viability.

Development and validation of a food frequency questionnaire for children aged 7 to 10 years / Desenvolvimento e validação de um questionário de frequência alimentar para crianças de 7 a 10 anos de idade

ABSTRACT Objective Food and nutritional evaluation of children can support public policies to combat early overweight and obesity. This study developed and validated a quantitative food frequency questionnaire for assessing the dietary intake of children. Methods This is a cross-sectional study of the development of a food frequency questionnaire for 130 children of both genders aged 7 to 10 years old. For the food frequency questionnaire list, 81 food items were selected. The validity of the food frequency questionnaire was evaluated by comparison with 24-hour recalls and reproducibility was performed by comparing two food frequency questionnaires. Results Most of the foods with 95% relative contribution were ultra-processed, such as packaged snacks and powdered juice. In validation, correlation coefficients were found between 0.45 (p<0.000) for lipids and 0.37 (p<0.000) for carbohydrates. An adjustment for energy reduced the correlations, but there was an increase in the correlation in calcium (r=0.75) and retinol (r=0.20). In terms of reproducibility, all macronutrients and calcium showed a satisfactory intraclass correlation coefficient (>0.400) and moderate correlations [proteins (0.54; p<0.000) and lipids (0.41; p<0.000)]. Conclusion The food frequency questionnaire developed was valid and able to assess the local food consumption by children from northeastern Brazil.

RESUMO Objetivo A avaliação alimentar e nutricional de crianças pode subsidiar políticas públicas de combate ao sobrepeso e à obesidade precoce. Este estudo desenvolveu e validou um questionário quantitativo de frequência alimentar para avaliação do consumo alimentar de crianças de 7 a 10 anos. Métodos Trata-se de um estudo transversal do desenvolvimento de um questionário de frequência alimentar que avaliou 130 crianças de ambos os sexos com idades entre 7 e 10 anos. Para a lista do questionário, foram selecionados 81 itens alimentares. A validade do instrumento foi avaliada por meio da comparação com recordatórios de 24 horas e a reprodutibilidade foi realizada pela comparação de dois questionários de frequência alimentar. Resultados A maioria dos alimentos com 95% de contribuição relativa foi ultraprocessada, como salgadinhos embalados e suco em pó. Na validação, foram encontrados coeficientes de correlação entre 0,45 (p<0,000) para lipídios e 0,37 (p<0,000) para carboidratos. Um ajuste para energia reduziu as correlações, mas houve um aumento na correlação de cálcio (r=0,75) e retinol (r=0,20). Em termos de reprodutibilidade, todos os macronutrientes e o cálcio apresentaram coeficiente de correlação intraclasse satisfatório (>0,400) e correlações moderadas [proteínas (0,54; p<0,000) e lipídios (0,41; p<0,000)]. Conclusão O questionário de frequência alimentar desenvolvido é válido e foi capaz de avaliar o consumo alimentar local de crianças do Nordeste do Brasil.

DNMT3B (rs2424913) polymorphism is associated with systemic lupus erythematosus alone and with co-existing periodontitis in a Brazilian population

Abstract The association between Periodontitis and Systemic Lupus Erythematosus (SLE) has been primarily based on their similar pathophysiology and both are associated with genetic polymorphisms. Objectives: To investigate an association between the methylation-related gene polymorphisms DNMT3B (rs2424913) and MTHFR (rs1801133) to Systemic Lupus Erythematosus (SLE) and Periodontitis. Methodology: In total, 196 individuals of all genders aged 24 to 60 years old were allocated into four groups based on their systemic and periodontal status, namely: Healthy control (n=60), periodontitis (n=51), SLE (n=47), and SLE + periodontitis (n=38). Individuals with SLE were stratified according to disease activity (SLEDAI) in inactive or active. We performed polymorphism analysis using PCR-RFLP with genomic DNA from mouthwash. We analyzed data using Fisher's Exact, Chi-square test, and regression models. Results: Periodontal status were similar in subjects with periodontitis alone and combined with SLE. SLE patients with periodontitis had a longer SLE diagnosis than SLE only (p=0.001). For DNMT3 B polymorphism, the periodontitis, SLE, and Inactive SLE + periodontitis groups showed a higher frequency of T allele and TT genotypes compared to healthy controls (p<0.05). Regression analyses showed that the TT genotype is a strong risk factor for periodontitis (OR=4.53; CI95%=1.13-18.05) and also for SLE without periodontitis (OR=11.57; CI95%=3.12-42.84) and SLE with periodontitis (OR=5.27; CI95%=1.25-22.11) when compared to control. Conclusion: SLE patients with periodontitis had a longer length of SLE diagnosis. The DNMT3B (rs2424913) polymorphism was associated with periodontitis and SLE alone or combined with periodontitis. Our study contributes to understanding the genetic mechanisms involved in periodontitis and SLE susceptibility.

Validity and accuracy of body fat prediction equations using anthropometric measurements in children 7 - 10 years old / Validade e acurácia de equações de predição de gordura corporal usando medidas antropométricas em crianças de 7 a 10 anos

abstract Children with a deficit of growth because of perinatal malnutrition present specificities in the percentage of body fat (%BF) that could not be detected by previous fat mass-based equations. This study developed and validated predictive equations of the %BF derived from anthropometric variables in children aged 7 to 10 living in Northeast Brazil, using dual-energy x-ray absorptiometry (DXA) as a reference. Body composition data from 58 children were utilized. DXA was used as a reference. A stepwise (forward) multiple regression statistical model was used to develop the new equations. The Bland-Altman analysis (CI: 95%), paired Student's t-test, and the intraclass correlation coefficient (ICC) was used to validate and compare the developed equations. Two new equations were developed for either gender: boys: %BF: 13.642 + (1.527*BMI) + (-0.345*Height) + (0.875*Triceps) + (0.290* Waist Circumference) and girls: %BF: -13.445 + (2.061*Tight). The Bland-Altman analysis showed good agreement, with limits ranging from -1.33 to 1.24% for boys and -3.35 to 4.08% for girls. The paired Student's t-test showed no difference between %BF-DXA and the two new equations (p> 0.05), and the ICC was 0.948 and 0.915, respectively. DXA-based anthropometric equations provide an accurate and noninvasive method to measure changes in the %BF in children.

resumo Crianças com déficit de crescimento por desnutrição perinatal apresentam especificidades na distribuição do percentual de gordura corporal (%GC) que não puderam ser detectadas por equações anteriores baseadas no %GC. Este estudo desenvolveu e validou equações preditivas do %GC derivadas de variáveis ​​antropométricas em crianças de 7 a 10 anos residentes no Nordeste do Brasil, utilizando como referência a absorciometria radiológica de dupla energia (DXA). Foram utilizados dados de composição corporal de 58 crianças. O DXA foi usado como modelo de referência. Um modelo estatístico de regressão múltipla stepwise (forward) foi usado para desenvolver as equações. A análise de Bland-Altman (IC: 95%), teste t de Student pareado e o coeficiente de correlação intraclasse (CCI) foram utilizados para validar e comparar as equações. Duas novas equações foram desenvolvidas para ambos os sexos: meninos: %GC: 13,642 + (1,527*IMC) + (-0,345*Altura) + (0,875*Tríceps) + (0,290* Circunferência da cintura) e meninas: %GC: - 13,445 + (2,061*coxa). A análise de Bland-Altman mostrou boa concordância, com limites variando de -1,33 a 1,24% para meninos e -3,35 a 4,08% para meninas. O teste t de Student pareado não mostrou diferença entre %GC-DXA e as duas novas equações (p>0,05), e o CCI foi de 0,948 e 0,915, respectivamente.

Impact of COVID-19 on Oral Healthcare for Oncopediatric Patients: The Setting in a Reference Hospital in Northeast Brazil

Abstract Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.

ABCG2 polymorphism, age and leukocyte count may contribute to oral mucositis in oncopediatric patients

Abstract The study investigated the relationship between genetic polymorphisms and the development of oral mucositis in pediatric patients undergoing chemotherapy involving methotrexate. A longitudinal study was conducted with 64 patients, and oral mucositis was evaluated by the modified Oral Assessment Guide, which aims to diagnose and classify oral mucositis. Epithelial cells were obtained by mouthwash and DNA was extracted. The polymorphisms MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) and ABCG2 (rs2231142) were analyzed by PCR-RFLP method. Demographic, hematological and biochemical data were collected from medical records. Statistical analysis was performed using the SPSS software adopting a p-value of 0.05. Male sex predominated (56.2%), and the mean age was 10.8 years (± 4.9). Oral mucositis affected 65.6% of the patients, of which 61.9% developed the severe form of the disease. For the ABCG2 gene (rs2231142), the rare A allele and CA genotype were more frequent in individuals with mucositis (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). The severity of the disease was mainly observed in younger patients (median = 9 years; p=0.02). Patients with severe oral mucositis presented lower leukocytes count (median = 2.150 mm3) compared to patients with the mild/moderate form (median = 4.200 mm3; p=0.03). Female patients and each 10,000-platelet increase were protective factors against the onset of oral mucositis (p=0.02). It is concluded that rs2231142 polymorphism increases the likelihood of oral mucositis and younger patients and patients with low leukocytes counts are more likely to develop severe form.

Resumo O presente estudo investigou a relação entre cinco polimorfismos genéticos e o desenvolvimento de mucosite oral em pacientes pediátricos recebendo quimioterapia com metrotexato. O estudo longitudinal foi conduzido com 64 pacientes e a mucosite oral avaliada pelo Oral Assessment Guide modificado, que tem como objetivo diagnosticar e classificar a mucosite oral. Células epiteliais bucais foram obtidas por bochecho e o DNA foi extraído. Os polimorfismos MTHFR (rs1801133), DNMT3B (rs2424913), ABCC2 (rs717620), ABCG2 (rs2231137) e ABCG2 (rs2231142), foram analisados pela técnica de PCR-RFLP. Dados demográficos, hematológicos e bioquímicos foram coletados a partir de registros médicos. Análise estatística foi realizada utilizando o software SPSS adotando um valor de p=0,05. Observou-se que, o sexo masculino foi predominante (56,2%), e a idade média foi de 10,8 anos (± 4.9). A mucosite oral acometeu 65,6% dos pacientes, dos quais, 61,9% desenvolveram a forma grave da doença. Para o gene ABCG2 (rs2231142), o alelo raro A e o genótipo CA foram mais frequentes em indivíduos com mucosite (p= 0.02; RR = 0.60; CI = 0.387 - 0.813). A gravidade da doença foi observada principalmente em pacientes mais jovens (mediana = 9 anos; p=0.02). Além disso, os pacientes com mucosite oral grave apresentaram menor contagem de leucócitos (mediana = 2150 mm3) em comparação aos pacientes com a forma leve/moderada (mediana = 4200 mm3; p=0.03). Pacientes do sexo feminino e aumento a cada 10.000 plaquetas foram fatores de proteção contra o aparecimento de mucosite oral (p=0.02). Concluiu-se que a presença do polimorfismo rs2231142 aumenta o risco de o paciente desenvolver a mucosite oral, bem como pacientes mais jovens e menor contagem de leucócitos contribui com a severidade.

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Abstract This study aimed to evaluate the factors associated with the occurrence of severe oral mucositis (SOM) in pediatric oncology patients during the chemotherapeutic treatment. This is a nested case-control to a prospective cohort that monitored 105 patients for 10 consecutive weeks after the beginning of the chemotherapy treatment. Logistic regression was used to identify the factors associated with SOM, by group of malignancy (hematologic or solid tumors) (Sig.=5%). To patients with hematologic tumors were found factors associated with SOM in two weeks of treatment: in the 6th week (increase in frequency of chemotherapy doses (OR=3.02)) and in the 7th week (female sex (OR=21.28); and increase in frequency of chemotherapy doses (OR=2.51)); and to patients with solid tumors were found factors associated with SOM in five weeks of treatment: in the 1st week (female sex (OR=14.43); age increase (OR=1.24)); in the 2nd week (Miscellany (OR=6.39)); in the 5th week (Antimetabolites (OR=17.44); Miscellany (OR=45.42); and platelets reduction (OR=1.12)); in the 6th week (creatinine increase (OR=1.63)); and in the 7th week (creatinine increase (OR=2.39)). For patients with hematologic tumors, to be female, and the increase in the frequency of chemotherapy doses increased the risk for SOM and for patients with solid tumors, to be female, the increase in age and in level blood concentration of creatinine, the reduction in number of platelets and the use of chemotherapy with miscellany and antimetabolites agents were associated with an increase in risk for occurrence of SOM.

Resumo Este estudo objetivou avaliar os fatores associados com a ocorrência de mucosite oral grave (SOM) em pacientes pediátricos oncológicos durante o tratamento quimioterápico. Trata-se de um estudo de caso-controle aninhado a uma coorte prospectiva que monitorou 105 pacientes por 10 semanas consecutivas após o início do tratamento quimioterápico. Regressão logística foi utilizada para identificar os fatores associados com a MOG, por grupo de malignidade (tumores hematológicos ou sólidos) (Sig.=5%). Para pacientes com tumores hematológicos foram encontrados fatores associados com a MOG em duas semanas de tratamento: na 6ª semana (aumento na frequência de doses de quimioterapia (OR=3,02)) e na 7ª semana (sexo feminino (OR=21,28); e aumento na frequência de doses de quimioterapia (OR=2,51)); e para pacientes com tumores sólidos foram encontrados fatores associados com MOG em cinco semanas de tratamento: na 1ª semana (sexo feminino (OR=14,43), aumento na idade (OR=1,24)); na 2ª semana (Miscelânea (OR=6,39)); na 5ª semana (Antimetabólitos (OR=17,44); Miscelânea (OR=45,42); e redução de plaquetas (OR=1,12)); na 6ª semana (aumento na creatinina (OR=1,63)); e na 7ª semana (aumento na creatinina (OR=2,39)). Para pacientes com tumores hematológicos, ser do sexo feminino e o aumento na frequência de doses de quimioterapia aumentou o risco para MOG; e, para pacientes com tumors sólidos, ser do sexo feminino, o aumento na idade e nos níveis de concentração sanguínea de creatinina, a redução no número de plaquetas e o uso de quimioterapia com agentes das classes Miscelânea e Antimetabólitos estiveram associados com o aumento no risco para a ocorrência de MOG.

Occurrence and Severity of Oral Mucositis in Brazilian Pediatric Cancer Patients

Abstract Objective: To determine the occurrence and severity of oral mucositis (OM) and the factors associated with the onset of severe oral mucositis (SOM) in pediatric cancer patients. Material and Methods: This was a longitudinal and prospective study with 85 children and adolescents (aged 0 to 19 years) admitted to the Pediatric Oncology Sector of Napoleão Laureano Hospital between November 2016 and July 2019. The patients' sociodemographic and epidemiological information, as well as hematological and biochemical parameters, were obtained from their medical charts. The oral mucosa of study participants was assessed through the modified Oral Assessment Guide (OAG) at baseline and after the 2nd, 5th and 10th week of antineoplastic treatment. Data were analyzed by Chi-square test to determine the factors associated with the occurrence of SOM (p<0.05). Results: The occurrence of OM was more frequent in the 2nd (60%), 5th (40.9%) and 10th week (43.2%) of antineoplastic treatment. During the follow-up period, SOM was more frequent in the 5th week (34.7%), followed by the 2nd (32.3%) and 10th weeks (29.7%). There was no association between the occurrence of SOM and the patient's age, type of tumor, chemotherapy regimen, and hematological and biochemical parameters. Conclusion: The occurrence of oral mucositis in pediatric cancer patients was significant, especially in the 2nd week of antineoplastic treatment. Severe oral mucositis was more prevalent in the 5th week of treatment and was not associated with any of the study variables.

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Abstract Objective: This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment. Methodology: This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases. Results: Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6th until the 10th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors. Conclusion: It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

Clinical and microbiological effects of dialyzers reuse in hemodialysis patients / Efeitos clínicos e microbiológicos do reúso de dialisadores em pacientes em hemodiálise

Abstract Introduction: Chronic kidney disease (CKD) has a high prevalence and is a worldwide public health problem. Reuse of dialyzers is a cost reduction strategy used in many countries. There is controversy over its effects on clinical parameters and microbiological safety. Methods: In this clinical crossover study, 10 patients performed consecutive hemodialysis (HD) sessions divided in two phases: "single use" sessions (N = 10 HD sessions) followed by "dialyzer reuse" sessions (N = 30 HD sessions). Clinical, laboratory, and microbiological parameters were collected in the following time points: "single use", 1st, 6th, and 12th sessions with reuse of dialyzers, including bacterial cultures, endotoxins quantification in serum and dialyzer blood chamber, and detection of hemoglobin and protein residues in dialyzers. Results: Mean age of the sample was 37 ± 16 years, 6 (60%) were men, and 5 (50%) were white. CKD and HD vintage were 169 ± 108 and 47 (23-111) months, respectively. Serum C-reactive protein (CRP) [4.9 (2.1) mg/mL], ferritin (454 ± 223 ng/mL), and endotoxin levels [0.76 (0.61-0.91) EU/mL] were high at baseline. Comparison of pre- and post-HD variations of serum levels of CRP and endotoxins in the "single use" versus "reuse" phases did not result in differences (p = 0.8 and 0.4, respectively). Samples of liquid in the dialyzer inner chamber were negative for the growth of bacteria or endotoxins. There was no significant clinical manifestation within and between the phases. Conclusion: Dialyzers reuse was safe from a clinical, microbiological, and inflammatory point of view. The dialyzer performance remained adequate until the 12th reuse.

Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial de alta prevalência. O reúso de dialisadores é uma estratégia de redução de custos empregada em muitos países. Seus efeitos sobre parâmetros clínicos e de segurança microbiológica são alvo de controvérsia. Métodos: No presente estudo clínico cruzado, 10 pacientes realizaram sessões consecutivas de hemodiálise (HD) divididas em duas fases: a primeira com sessões de "uso único" (N = 10 sessões de HD) e a segunda com sessões com "reúso de dialisadores" (N = 30 sessões de HD). Parâmetros clínicos, laboratoriais e microbiológicos foram registrados nos seguintes momentos: "uso único", 1a, 6a e 12a sessões com reúso de dialisadores, incluindo culturas bacterianas, quantificação de endotoxinas no soro e na câmara interna do dialisador e detecção de hemoglobina e resíduos de proteína nos dialisadores. Resultados: A idade média da amostra foi de 37 ± 16 anos seis (60%) eram homens e cinco (50%) eram brancos. Os tempos com DRC e em HD foram de 169 ± 108 e 47 (23-111) meses, respectivamente. Os níveis séricos de proteína C-reativa (PCR) [4,9 (2,1) mg/mL], ferritina (454 ± 223 ng/mL) e endotoxinas [0,76 (0,61-0,91) UE/mL] estavam elevados no início do estudo. A diferença dos níveis séricos de PCR e endotoxinas pré e pós-HD nas fases de "uso único" e "reúso" não foi significativa (p = 0,8 e 0,4, respectivamente). As amostras de líquido retiradas da câmara interna do dialisador foram negativas para crescimento de bactérias e endotoxinas. Não houve registro de manifestações clínicas significativas nas fases do estudo. Conclusão: O reúso de dialisadores foi seguro dos pontos de vista clínico, microbiológico e inflamatório. O desempenho do dialisador permaneceu adequado até o 12º reuso.

Efeito da ocratoxina A em suco de uva tinto sobre sobrevivência e geração de EROs em Caenoaerbiditis elegans / Effects of ochratoxin A in red grape juice on survival rate and ROs generation in Caenoaerbiditis elegans

O consumo do suco de uva vem crescendo ao longo dos anos em função das suas propriedades funcionais. No entanto, este produto não está livre de contaminantes como a ocratoxina A (OTA). O presente trabalho teve por objetivo avaliar o efeito da presença de OTA em suco de uva Concord sobre geração de espécies reativas de oxigênio (EROs) e taxa de sobrevivência em Caenoarbiditis elegans. Os vermes foram expostos por 30 minutos ao suco na presença de OTA (0, 1, 2 e 4 µg∙L-1). O suco em presença de OTA não afetou a sobrevivência do C. Elegans. A adição de suco livre de OTA reduziu a sobrevivência dos nematoides, embora não tenha influenciado a geração de EROs. Contudo o suco com a concentração mais elevada de OTA reduziu a geração de EROs. Assim, são necessários maiores estudos para entender os mecanismos de toxicidade da OTA neste modelo vivo.

Aplicabilidade do volume da câmara pulpar para a estimativa de idade em adultos a partir de tomografias computadorizadas de feixe cônico: um estudo piloto / Applicability of the pulp chamber volume for the estimation of age in adults from Cone Beam Computed Tomography: a pilot study

Introdução: A demanda forense de estimativa de idade em indivíduos vivos repercutiu no desenvolvimento de metodologias fundamentadas em recursos imaginológicos, notadamente, a Tomografia Computadorizada de Feixe Cônico (TCFC). Objetivo: Avaliar a aplicabilidade do volume da câmara pulpar para estimar a idade em indivíduos adultos através de imagens de TCFC. Material e Método: Estudo cego e transversal com 26 TCFC, que apresentaram incisivos central e lateral superiores (ICS; ILS), 2º pré-molar superior (2PMS), incisivo lateral (ILI), canino (CI) e 1º pré-molar inferior (1PMI) hígidos. Em cada dente, mediu-se o comprimento dental, pulpar e radicular, e a largura radicular e pulpar em três níveis (junção amelo-cementária (A), meio da raiz (C) e entre as duas anteriores (B)), no plano sagital e coronal. Calculou-se razões entre as medidas pulpares e dentais, procedendo-se à análise de regressão linear (α=5%). Resultados: Das 108 medições, duas demonstraram maior correlação com a idade: comprimento pulpar do ILI, no corte sagital (R2=0,273), e largura pulpar no nível C do 1PMI, no corte coronal (R2=0,289). Obteve-se maior poder de estimativa com a média das razões entre a largura pulpar e dental do ICS e ILS nos três níveis no sentido sagital (R2=0,374), seguido da razão do comprimento polpa/dente do ILI (R2=0,368). Conclusão: As medidas da câmara pulpar em TCFC apresentam aplicabilidade moderada para estimar a idade. O cálculo de razões melhora o poder de estimativa, devendo-se privilegiar os incisivos superiores e o incisivo lateral inferior. Pretende-se aumentar a amostra para realizar validação cruzada das equações geradas

Introduction: The forensic demand of age estimation in living individuals had repercussions on the development of methodologies substantiated on imaging resources, notably, the Cone-beam Computed Tomography (CBCT). Objective: To evaluate the applicability of pulp chamber volume to estimate age in adults individuals through CBCT's images. Material and methods: blind and transverse study with 26 CBCT, that presented maxillary central, lateral incisors and second premolar, and mandibular lateral incisor, canine and first premolar healthy. In each tooth, was measured the dental, pulp and radicular length, and the pulp and radicular width in three levels (enamel-cementum junction (A), middle of the root (C) and between the two previous ones (B)), in the sagittal and coronal plane. Reasons were calculated between pulp and dental measurements, proceeding to linear regression analysis (α=5%). Results: 2 out of 108 measurements demonstrated greater correlation with age: pulp length of mandibular lateral incisor, in sagittal cut (R²=0,273), and pulp width at level C of mandibular first premolar, in coronal cut (R²=0,289). Greater estimative power was obtained with the average between pulp and dental width of maxillary central and lateral incisors in the three levels in sagittal direction (R²=0,374), followed by the reason of dental/pulp length of mandibular lateral incisor (R²=0,368). Conclusion: measurements of pulp chamber in CBCT presented moderate applicability to estimate age. The calculation of the reasons improves the estimation's power, and the maxillary incisors and mandibular lateral incisor should be privileged. It's intended to increase the sample to perform the cross-validation of the equations generated.

Social, Educational and Dental Profiles of Brazilian Patients with Special Needs Attended at a Center for Dental Specialties

Objective: To identify the profiles of patients with special needs attended at a Center for Dental Specialties. Material and Methods: This was a cross-sectional and quantitative study using an inductive approach, and a comparative and statistical procedure for analysis of the patients with special needs. Information concerning socioeconomic, medical and dental conditions was collected. The data were analyzed using IBM SPSS, adopting a significance level of 5%. Results: It was observed that 58.6% of the users were males, single (54.7%), in the age group from 19 to 59 years (41.1%), being 97.4% without schooling. The most frequent clinical diagnoses were: deviations in intelligence (18.4%), behavioral deviations (18.4%) and physical defects (17.9%). We observed for oral health the presence of gingivitis (33.0%), and healthy gums (47.8%); the presence of caries (64.9%), with restored teeth (28.5%), and edentulism (12.3%). Dental intervention procedures were initiated with emphasis on: fluoride applications (39.7%) and subgingival scraping (34.9%). Topical fluoride applications (p=0.010) and prophylaxis (p=0.010) were realized in patients without autism. Also, prophylaxis (p=0.007) was more frequently performed and gingival alterations were more often verified (p=0.020) in patients without Down's syndrome. Conclusion: The users of the patients with special needs dental service can be generally described as male, single, aged between 19 and 54 years, with the special conditions of intelligence and behavioral deviation.

Candida on oral cavity of pediatric individuals with ALL and its susceptibility to nystatin and amphotericin B / Candida na cavidade oral de indivíduos pediátricos com LLA e sua susceptibilidade à nistatina e à anfotericina B

ABSTRACT Objective: The aim of this study was to evaluate the prevalence of Candida colonizationon oral cavity of pediatric individuals with acute lymphocytic leukemia (ALL) and its susceptibility/resistance to nystatin and amphotericin B. Methods: This was a cross sectional study with observational, descriptive and analytic approach. Saliva was collected from40 individuals diagnosed with ALL and from40 healthy subjects, as a comparative group, matched by age and gender with ALL group. The mean age for both groups were 8 years-old. The isolation and identification of the Candidaspecies were performed using the CHROMagarCandidaTM and confirmed by polymerase chain reaction. The samples were subjected to antifungal susceptibility by microdilution assay for nystatin and amphotericin B. Salivary alterations and chemotherapy-induced oralmucositis were evaluated using modifiedOral Assessment Guide. Results: The positivity to Candida was higher inALL individuals (32.5%,13/40)than in a comparative group(2.5%, 1/40) (p<0.001). Candida albicans was the most prevalent strain (86.6%). The mucositis was directly associated with positive Candidacolonization (p=0.017) in the ALL group but not related with salivary alterations (p= 0.479). Six strains of C. albicans (54.5%), on ALL group, were resistant to nystatin and all strains were not susceptible to amphotericin B. Conclusion: Candida colonization was associated with ALL condition and with oral mucositis in these individuals. C. albicans was the prevalent strain and most samples were resistant to antifungal agents tested, nystatin and amphotericin B.

RESUMO Objetivo: o objetivo deste estudo foi avaliar a prevalência e colonização de Candida na cavidade oral de indivíduos pediátricos com leucemia linfocítica aguda (LLA) e sua susceptibilidade/resistência à nistatina e à anfotericina B. Métodos: estudo transversal observacional com abordagem descritiva e analítica. A saliva foi coletada de 40 indivíduos diagnosticados com LLA e de 40 indivíduos saudáveis, como grupo comparativo, combinados por idade e sexo com o grupo LLA. A idade média para ambos os grupos foi de 8 anos de idade. O isolamento e a identificação das espécies de Candida foram realizados utilizando o CHROMagarCandidaTM e confirmados pela reação em cadeia da polimerase. As amostras foram submetidas a susceptibilidade antifúngica por meio de ensaio de microdiluição para nistatina e anfotericina B. As alterações salivares e a mucosite oral induzida por quimioterapia foram avaliadas utilizando o Guia de avaliação modificada. Resultados: A positividade para Candida foi superior aos indivíduos in situ (32,5%, 13/40) do que em um grupo comparativo (2,5%, 1/40) (p <0,001). Candida albicans foi a cepa mais prevalente (86,6%). A mucosite foi diretamente associada à colonização positive por Candida (p = 0,017) no grupo LLA, mas não relacionada com alterações salivares (p = 0,479). Seis estirpes de C. albicans (54,5%), no grupo LLA, eram resistentes à nistatina e todas as cepas não eram suscetíveis à anfotericina B. Conclusão: A colonização por Candida foi associada à condição LLA e à mucosite oral nesses indivíduos. C. albicans era a cepa predominante e a maioria das amostras eram resistentes aos agentes antifúngicos testados, nistatina e anfotericina B.

Salivary Flow in Pediatric Cancer Patients Compared to Healthy Children and Adolescents

Abstract Objective: To verify differences between salivary flow in pediatric cancer patients before starting antineoplastic treatment and in healthy pediatric patients. Material and Methods: This is an observational, cross-sectional, paired study with sample of 120 children and adolescents (3-18 years). Thirty pediatric cancer patients were selected for convenience at "Napoleão Laureano" Hospital (G1). Another group was composed of 90 individuals attended at the School of Dentistry Clinics of the Federal University of Paraíba, matched by age (G2). Data collection was performed in two steps for both groups. Information regarding pediatric cancer patients was obtained by interview with parents / guardians and searching medical records, while in the other group by interview with parents / guardians. Saliva collection was performed using standard method in both groups: unstimulated salivary flow rate (USFR) being the mean volume expelled in 1 minute. Data were analyzed by the Shapiro-Wilk, Kolmogorov-Smirnov and Mann-Whitney tests (α = 5%) Results: Mean USFR for G1 and G2 was 0.52 mL / min and 0.66 mL / min, respectively (p>0.05) and, in both groups, significant difference was observed (p <0.05) between the mean USFR values of its subgroups, and values of adolescents being higher than those of children Conclusion: There is no difference in unstimulated salivary flow of pediatric cancer patients before starting antineoplastic treatment compared with healthy pediatric patients.

Oral health actions in the primary health care network of northeastern brazil in relation to oral cancer / Ações de saúde frente ao câncer bucal na atenção básica do nordeste brasileiro

ABSTRACT Objective: To describe oral health actions against oral cancer promoted by Primary Health Care Teams in northeastern Brazil. Methods: This is a descriptive and inferential study based on data related to detection, referral, registration, follow-up and documents related to these actions in the External Evaluation of the 1st and 2nd Program for Improving Access and Quality of Primary Care Cycles. Results: Overall, 5,599 and 7,700 teams were evaluated, respectively, in the first and second cycles, with the highest and lowest concentrations in the states of Bahia / Maranhão and Bahia / Sergipe. In all, 58.9% / 79.7% Health Teams conducted campaigns to detect oral lesions and referred suspected cases of oral cancer, and 43.9% / 23% of them recorded and followed suspicious / confirmed cases and only 20.7% / 16.2% had documents proving these records in the respective cycles. There was statistical significance in the comparisons of actions and the evaluation cycles (p ? 0.01). Conclusion: Health teams in northeastern Brazil need to improve actions related to detection, referral, registration, follow-up and verification of oral health documents related to oral cancer.

RESUMO Objetivo: Descrever as ações em saúde bucal frente ao câncer de boca promovidas pelas Equipes de Saúde da Atenção Básica do nordeste brasileiro. Métodos: Estudo descritivo e inferencial a partir de dados referentes à detecção, encaminhamento, registro, acompanhamento e documentos comprovatórios relacionados a estas ações relativos ao 1º e 2º Ciclo de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Os dados foram analisados pelos testes Qui-Quadrado e McNemar (?=0,05). Resultados: Foram avaliadas 5.559 e 7.700 equipes, respectivamente, nos 1º e 2º ciclos, sendo, a maior e menor concentração na Bahia/Maranhão e Bahia/Sergipe. 58,9%/79,7% das Equipes realizam campanhas para detecção de lesões bucais e encaminham os casos suspeitos de câncer de boca. Além disso, 43,9%/23% delas registram e acompanham os casos suspeitos/confirmados e apenas 20,7%/16,2% possuem documentos que comprovem esses registros, nos respectivos ciclos. Houve significância estatística nas comparações das ações e os ciclos de avaliação (p ? 0,01). Conclusão: As Equipes de Saúde na região nordeste necessitam melhorar as ações referentes à detecção, encaminhamento, registro, acompanhamento e documentos comprovatórios em saúde bucal frente ao câncer de boca.