Quality of life in Brazilian medical students: a systematic review and meta-analysis

Abstract Objectives Medical training negatively impacts the quality of life of students. Assessing the well-being of medical students could guide academic policies and future research for improving the mental and physical health status of the population at risk. This study aimed to identify the influence of medical training on the quality of life of Brazilian medical students. Methods A systematic review and meta-analysis was conducted according to the Cochrane criteria and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA). The search was performed by two independent investigators using a predefined protocol registered on the PROSPERO database (CRD42021237926). Data were extracted from PubMed, Embase, and Biblioteca Virtual de Saúde (BVS). For quantitative synthesis, a meta-analysis was conducted to assess the mean difference in the quality of life between medical students at different stages in the academic cycle, stratified by sex. All data were analyzed using the random-effects model, with a confidence interval of 95% (95%CI). Results After evaluating the eligibility criteria, five studies were included in the meta-analysis. The data revealed that students in the pre-clinical cycle of the course exhibited higher quality of life scores in the physical (3.05 [1.48-4.62], p < 0.0001) and psychological (3.05 [0.80-5.30], p < 0.0001) domains than students in the clerkship cycle. No statistically significant differences were observed in the environmental (0.78 [-2.92-4.49], p = 0.68) or social domains (1.41 [-0.52-3.34], p = 0.15). Conclusion Our analysis revealed that the medical course is associated with decreased quality of life of medical students in the physical and psychological domains. This finding was observed in both men and women. However, these findings should be interpreted with caution given the study limitations. Registration number PROSPERO, CRD42021237926.

Análise de impacto orçamentário dos inibidores da PARP no tratamento do carcinoma de ovário avançado a partir de evidências de mundo real sob a perspectiva de um hospital federal referência em oncologia / Budget impact analysis of PARP inhibitors in the treatment of advanced ovarian cancer from on real-world evidence the perspective of a federal hospital reference in oncology

Objetivo: Avaliar o impacto orçamentário do tratamento com iPARP como primeira linha de manutenção, comparado ao tratamento-padrão a partir de evidências de mundo real sob a perspectiva de um hospital público referência em oncologia no Rio de Janeiro. Métodos: Foi aplicada uma análise de impacto orçamentário para estimar a introdução das tecnologias iPARP, olaparibe e niraparibe, em comparação com o cenário referência, utilizando dados de eficácia e evidências de mundo real, e considerando os custos globais de tratamento da doença em cinco anos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa, CAAE: 95157018.9.0000.5274. Resultados: A análise demonstrou que o cenário referência apresentou um impacto orçamentário no valor de R$ 3.578.768,04 em cinco anos. No cenário alternativo, o custo incremental do olaparibe chegou a ser 23,8% maior, comparado ao niraparibe, atingindo um custo de R$ 23.736.459,20 versus R$ 18.076.951,81, respectivamente. Os parâmetros que apresentaram maior impacto nas análises para a tecnologia olaparibe foram a difusão da tecnologia e o preço do medicamento. Contudo, para o niraparibe, os parâmetros de maior impacto foram a duração do tratamento, a difusão da tecnologia e a dose utilizada, demonstrando maior suscetibilidade de variação. Conclusão: Os iPARP no tratamento de pacientes com carcinoma de ovário avançado, apesar de apresentarem custo incremental de aproximadamente R$ 23 milhões em cinco anos, apontam para uma potencial redução de custos associados à progressão da doença.

Objective: Assess the budgetary impact of treatment with iPARP as a first line of maintenance, compared to standard treatment based on real-world evidence from the perspective of a public hospital reference in oncology at Rio de Janeiro. Methods: A budget impact analysis was applied to estimate the introduction of iPARP, olaparib and niraparib technologies, compared to the reference scenario, using efficacy data and real-world evidence, and considering the global costs of treating the disease in five years. This study was approved by the Research Ethics Committee, CAAE: 95157018.9.0000.5274. Results: The analysis showed that the reference scenario presented a budgetary impact of R$ 3,578,768.04 in five years. In the alternative scenario, the incremental cost of olaparib reached 23.8% higher compared to niraparib, reaching a cost of R$ 23,736,459.20 versus R$ 18,076,951.81, respectively. The parameters that had the greatest impact on the analyzes for the olaparib technology were technology diffusion and drug price. However, for niraparib, the parameters with the greatest impact were the duration of treatment, the diffusion of the technology and the dose used, demonstrating greater susceptibility to variation. Conclusion: iPARP in the treatment of patients with advanced ovarian carcinoma, despite having an incremental cost of approximately R$ 23 million in five years, point to a potential reduction in costs associated with disease progression.

Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose

Abstract Objective: To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients. Methods: Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vaccine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Antibodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240). Results: At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- positivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naïve-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and prednisone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with prednisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05-0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05-0.88, p = 0.034). After six months (D69-D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduction occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attributable to the vaccine were observed. Conclusion: This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).

Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition

Abstract Background Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. Methods Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. Results ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. Conclusion We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).

Risk Factors for the Incidence of Dental Caries in Low, Very Low, and Extremely Low Birth Weight Children: A Cohort Study

Abstract Objective: To assess the incidence of caries in a two-year period among low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW) children considering socioeconomic indicators, dietary factors and oral hygiene. Material and Methods: A convenience sample was formed of 42 low birth weight children aged two to five years at baseline. Two examiners diagnosed caries using the World Health Organization criteria. Birth weight, socioeconomic indicators and diet were collected from medical records and questionnaires. Binomial models were used to estimate unadjusted and adjusted rate ratios (RR) and respective 95% confidence intervals for the factors evaluated. Results: Thirty-six children were re-examined after two years. The incidence of dental caries was 36.7%. The dmft index was 0.44 (±1.25) at baseline and increased to 1.36 (±3.85) at follow-up. VLBW children (1,000 to 1,500 g) (RR=0.23; 95%CI: 0.08-0.72) and LBW children (1,500 to 2,500 g) (RR=0.06; 0.01-0.55) had fewer carious lesions compared to ELBW children (<1,000 g). Carious lesions were more frequent among children with a lower income (RR=6.05; 1.05-34.84) and less frequent among those who did not consume sweetened juice, tea or yogurt (RR: 0.21; 0.07-0.62). Conclusion: An inverse dose-response relation was found between birth weight and the incidence of caries. A lower income and the consumption of sweetened beverages were risk factors for the development of caries (AU).

The importance of full text screening when judging eligibility criteria in a systematic review: a systematic survey / A importância da avaliação do texto completo ao julgar os critérios de elegibilidade em uma revisão sistemática: uma revisão de métodos

Aim: To evaluate if statistically significant results are more likely to be reported in title/abstracts compared to non-significant outcomes. Methods: In this methodological survey, we reanalyzed 59 observational studies from a previous systematic review. The PECO question was: Patient (P): children with primary teeth; Exposure (E): low birth weight and/or preterm; Comparison (C): normal birth weight and/or full-term; Outcome (O): dental caries. We analyzed the presence of key terms in the titles and abstracts, such as gestational age, preterm, full-term, birth weight, low/normal birth weight. Full texts were analyzed for "positive outcomes" (statistically significant association, p < 0.05 or 95% CI not crossing the null effect line) related to the association between the outcome and the exposure; and "negative outcomes" (when the outcome had statistically similar occurrence between the exposure and the comparison group). The odds ratio (OR) was calculated between the presence of key terms in titles/abstracts and the type of outcome (positive or negative). Results: Of 59 studies, 66% cited the key terms in titles/abstracts, and 75% reported negative outcomes. Studies with positive outcomes were more likely to report key terms in the titles/abstracts compared to studies with negative outcomes (OR: 4.5; 95% CI: 0.9-22.4; Chi-square test: p = 0.06). Studies with statistically significant outcomes, favoring the exposure or the comparison, were more likely to report these data in the titles/abstracts. Conclusion: When conducting a systematic review, the final decision related to the inclusion of a study must be based on a full-text level.

Objetivo: Avaliar se os resultados estatisticamente significativos são mais prováveis de serem relatados nos títulos/resumos dos artigos do que os resultados não significativos. Métodos: Neste levantamento metodológico, foram reanalisados 59 estudos observacionais de uma revisão sistemática anterior. A questão PECO foi: Paciente (P): crianças com dentes decíduos; Exposição (E): baixo peso ao nascer e/ou pré-termo; Comparação (C): peso normal ao nascer e/ou a termo; Resultado (O): cárie dentária. Foi analisada a presença de termos-chave nos títulos/resumos, como idade gestacional, pré-termo, a termo, peso ao nascer, baixo/peso normal ao nascer. Textos completos foram analisados para "desfechos positivos" (associação estatisticamente significativa, p < 0,05 ou IC 95% não cruzando a linha de efeito nulo) relacionados à associação entre o desfecho e a exposição; e "desfechos negativos" (quando o desfecho teve ocorrência estatisticamente semelhante entre a exposição e o grupo de comparação). Foi calculada a odds ratio (OR) entre a presença de termos-chave nos títulos/resumos e o tipo de resultado (positivo ou negativo). Resultados: Dos 59 estudos, 66% citaram os termos-chave nos títulos/resumos e 75% relataram resultados negativos. Estudos com resultados positivos foram mais propensos a relatar os termos-chave nos títulos/resumos em comparação com estudos com resultados negativos (OR: 4,5; IC 95%: 0,9-22,4; teste do qui-quadrado: p = 0,06). Estudos com significância estatística os desfechos, favorecendo a exposição ou a comparação, foram mais propensos a relatar esses dados nos títulos/resumos. Conclusão: Ao realizar uma revisão sistemática, a decisão final quanto à inclusão de um estudo deve ser baseada por meio da análise do texto completo.

Perfil das Discrepâncias Obtidas por meio da Conciliação Medicamentosa em Pacientes Oncológicos: Revisão Integrativa da Literatura / Profile of the Medication Reconciliation Discrepancies in Oncology Patients: Integrative Literature Review / Perfil de las Discrepancias Obtenidas por la Conciliación de Medicamentos en Pacientes Oncológicos: Revisión Integradora de la Literatura

Introdução: O cuidado ao paciente oncológico demanda ações de uma equipe multiprofissional em virtude da complexidade do seu tratamento. Um dos serviços oferecidos pelo farmacêutico, visando a contribuir para segurança do paciente, é a conciliação medicamentosa capaz de detectar discrepâncias nas prescrições e prevenir erros de medicação. Objetivo: Traçar o perfil das principais discrepâncias encontradas na literatura em pacientes oncológicos durante a prática da conciliação medicamentosa realizada por farmacêuticos. Adicionalmente, visa-se a uma abordagem descritiva sobre as intervenções farmacêuticas realizadas nos estudos. Método: Revisão integrativa da literatura. Foram utilizados os descritores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para as estratégias de busca. As bases de dados selecionadas foram: PubMed, Web of Science, Embase e Scopus. Resultados: Inicialmente, identificaram-se 141 artigos. Destes, foram selecionados 11 trabalhos para serem discutidos. A conciliação medicamentosa foi realizada em pacientes na admissão hospitalar (27,3%), alta hospitalar (18,2%), e acompanhamento ambulatorial (54,5%). A maior parte era de estudos observacionais (72,7%) seguidos dos estudos de intervenção (27,3%). A principal discrepância relatada foi a de omissão/necessidade de adição de um medicamento (81,5%). As intervenções farmacêuticas estavam descritas mais detalhadamente em 36,4% das publicações. Conclusão: O estudo demonstrou a necessidade de mais trabalhos que correlacionem a prática da conciliação medicamentosa com a detecção de discrepâncias e intervenções farmacêuticas em Oncologia. Os farmacêuticos, objetivando a segurança do paciente, devem estruturar essa prática na vivência clínica dos pacientes oncológicos

Introduction: Cancer patient care requires actions of a multi-professional team due to the complexity of the treatment. One of the pharmacist's services to contribute for the patient safety is the medication reconciliation, able to detect discrepancies in prescriptions and preventing medication errors. Objective: Draw a profile of the main discrepancies found in the literature in cancer patients during the practice of medication reconciliation performed by pharmacists. Additionally, a descriptive approach of the pharmaceutical interventions found in the studies was also attempted. Method: Integrative review of the literature with descriptors "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" utilized to search in the following databases: PubMed, Web of Science, Embase and Scopus. Results: Initially, 141 articles were found and eleven were selected for discussion. Medication reconciliation was performed in patients at admission (27.3%), discharge from hospital (18.2%), and outpatient follow-up (54.5%). Observational Studies were the majority (72.7%) followed by intervention studies (27.3%). The main discrepancy reported was Omission/Need to add a medicine (81.5%). Pharmaceutical interventions were described in more detail in 36.4% of the publications. Conclusion: This study demonstrates the need for more articles that correlates the practice of medication reconciliation with the detection of discrepancies and pharmaceutical interventions in Oncology. Pharmacists should structure the practice of medication reconciliation in the clinical experience with cancer patients to improve their safety

Introducción: La atención a los pacientes con cáncer exige las acciones de un equipo multidisciplinario debido a la complejidad de su tratamiento. Uno de los servicios ofrecidos por el farmacéutico para contribuir a la seguridad del paciente es la conciliación de medicamentos, capaz de detectar discrepancias en las recetas y prevenir errores de medicación. Objetivo: Obtener un perfil de las principales discrepancias encontradas en la literatura en pacientes con cáncer durante la práctica de conciliación de medicamentos realizada por farmacéuticos. Además, también está dirigido a un enfoque descriptivo sobre las intervenciones farmacéuticas llevadas a cabo en los estudios. Método: Estudio de revisión integradora. Se ha utilizado los descriptores: "Medication Reconciliation", "Neoplasms", "Pharmacists", "Medication Errors" para las estrategias de búsqueda. Las bases de datos seleccionadas fueron: PubMed, Web of Science, Embase y Scopus. Resultados: Inicialmente, se encontraron 141 artículos. Se seleccionaron 11 documentos a ser discutidos. La conciliación de medicamentos se realizó en pacientes con ingreso hospitalario (27,3%), alta hospitalaria (18,2%) y seguimiento ambulatorio (54,5%). La mayoría fue de estudios observacionales (72,7%) seguidos de estudios de intervención (27,3%). La principal discrepancia reportada fue la Omisión/Necesidad de añadir un medicamento (81,5%). Las intervenciones farmacéuticas se describieron con más detalle en el 36,4% de las publicaciones. Conclusión: El estudio demostró la necesidad de más trabajos que correlacione la conciliación de la medicación con la detección de discrepancias e intervenciones farmacéuticas en Oncología. Los farmacéuticos que buscan la seguridad del paciente deben estructurar esta práctica clínica en la experiencia clínica de los pacientes con cáncer

Formulations of desensitizing toothpastes for dentin hypersensitivity: a scoping review

Abstract Objective: This study aimed to review evidence from randomized controlled trials (RCTs) to describe: 1) the active ingredients and desensitizing toothpaste brands; 2) the evaluation of these active ingredients over time, and 3) the fluoride and abrasive content in the formulations designed to treat dentin hypersensitivity (DH). Methodology: In total, 138 RCTs and their tested toothpastes were included. Searches were updated up to August 19, 2021. Formulations, reported brands, active ingredients over time, and type of fluoride (ionizable or ionic fluoride) and abrasive (calcium or silica-based) were analyzed (PROSPERO #CRD42018086815). Results: Our trials assessed 368 toothpaste formulations, including 34 placebo (9%), 98 control toothpastes with fluoride (27%), and 236 (64%) with active ingredients to treat DH. We tested the following active ingredients: potassium compounds (n=68, 19%), calcium sodium phosphosilicate (CSP) (n=37, 10%), strontium compounds (n=28, 8%), arginine (n=29, 8%), stannous fluoride (SnF2) (n=21, 6%), hydroxyapatite (n=9, 2%), potassium combined with another active ingredient (n=19, 5%), inorganic salt compounds (n=11, 3%), citrate (n=5, 1%), formaldehyde (n=3, 1%), herbal (n=4, 1%), copolymer (n=1, 0.5%), and trichlorophosphate (TCP) (n=1, 0.5%). The number of toothpaste formulations increased since 1968, with the greatest increment after 2010. Most toothpastes described their type of fluoride as sodium monofluorphosphate (MFP) (n=105, 29%) and NaF (n=82, 22%), with silica-based (n=84, 23%) and calcium-based (n=64, 17%) abrasives. Conclusion: Patients and dentists enjoy an increasing number of brands and active ingredients to decide what desensitizing toothpaste to use. The most common types of fluoride are MFP and NaF.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Prevalence of active and passive smoking during pregnancy: a cross-sectional study / Prevalência de tabagismo ativo e passivo durante a gravidez: estudo transversal

Purpose: The aim of the present study was to evaluate the prevalence of active and passive smoking during pregnancy and its association with sociodemographic indicators, as well as perinatal and postnatal outcomes in newborns. Methods: This cross-sectional study was comprised of 431 pairs of mothers/ newborns. The study variables were: preterm birth, birth weight, oral mucosal lesions, sociodemographic indicators and smoking data. We collected data from medical records and through a self-administered questionnaire answered by mothers. A pediatric dentist examined the newborns for oral mucosal lesions. Bivariate and multivariate logistic regression models were used to evaluate the association between active and passive smoking and the other variables (α=5%). Results: The prevalence of active (9.5%) and passive smoking (4.2%) during pregnancy was low. Active smoking was statistically associated with low birth weight (OR: 2.4; 95%CI:1.1-5.3), lower schooling level (OR: 0.2; 95%CI:0.1-0.5) and mothers aged ≥36 years old (OR: 4.9; 95%CI:1.2-20.0). Passive smoking was not statistically associated with the other variables. There was no association between active or passive smoking during pregnancy and premature birth and oral lesions of the newborn. Conclusions: The prevalence of active and passive smoking were low. Active smoking was associated with low birth weight, maternal age and mother's schooling, suggesting a social influence of smoking behavior among a population with a lower educational level. There was no association between active and passive smoking and prematurity and oral lesions of the newborn. (AU)

Objetivo: O objetivo do estudo foi avaliar a prevalência de tabagismo ativo e passivo durante a gestação e a associação entre indicadores sociodemográficos, bem como desfechos pré e pós-parto em recém-nascidos. Metodologia: Este estudo transversal foi composto por 431 pares de mães/recém-nascidos. As variáveis estudadas foram: nascimento prematuro, peso ao nascer, lesões mucosas orais, indicadores sociodemográficos e dados sobre tabagismo. Coletamos dados por meio de prontuários e por questionário auto-aplicado respondido pelas mães. Um dentista pediátrico examinou os recém-nascidos para lesões mucosas orais. A regressão logística foi utilizada para a análise bivariada e multivariada dos dados (α=5%). Resultados: Prevalência de tabagismo ativo (9,5%) e tabagismo passivo (4,2%) durante a gravidez foi baixo. O tabagismo ativo foi estatisticamente associado ao baixo peso ao nascer (OR: 2,4; 95%CI:1,1-5,3), às mães com menor escolaridade (OR: 0,2; 95%CI:0,1-0,5), e mães com idade ≥36 anos (OR: 4,9; 95%CI:1,2-20,0); enquanto o tabagismo passivo não esteve estatisticamente associado a nenhuma variável. Não houve associação entre tabagismo durante a gestação com nascimento prematuro e lesões orais de recém-nascidos. Conclusões: As prevalências de tabagismos passivo e ativo foram baixas. O tabagismo ativo esteve associado ao baixo peso ao nascer, à idade materna e à escolaridade da mãe, sugerindo influência social do comportamento do tabagismo entre a população com menor escolaridade. Não houve associação entre tabagismo ativo e passivo com prematuridade e lesões de mucosa oral em recém-nascido. (AU)

Does fluoride cause neurotoxic effects in humans? The importance of critically analyzing the scientific evidence / O fluoreto tem efeito neurotóxico? A importância da análise crítica da informação

The lack of critical interpretation of scientific information resulting from foundational data and evidence can jeopardize the shared decision between a clinical practitioner and the patient. This commentary analyzes the scientific evidence of a systematic review about the neurotoxic effect of fluoride in humans. The systematic review included observational studies from Chinese and Iranian populations exposed to a high-fluoridated water supply. The meta-analysis indicated that these populations had lower scores of the intelligence coefficient (IQ). However, the review is limited by the lack of methodological quality and the certainty of the scientific evidence. To critically analyze the evidence, we should avoid the "wireless phone effect" that considers the information without checking the original data source. Moreover, we should always base our analysis on the full text and never on the abstract alone.

Chronic kidney disease is a main confounding factor for 25-vitamin D measurement / A doença renal crônica é um importante fator de confusão para a dosagem de 25-hidroxivitamina D

Abstract Background: Current guidelines recommend assessment of 25-vitamin D status in patients with chronic kidney disease (CKD). Although significant differences among assays have been described, the impact of CKD on this variability has never been tested. Methods: We tested the variability between two 25-vitamin D assays in patients with CKD (eGFR < 60 mL/min/1.73m2) who had consecutive 25-vitamin D measurements in 2015 (Assay 1 - Diasorin LIASON 25 TOTAL - D assay®) and 2016 (Assay 2 - Beckman Coulter Unicel Xl 800®). The cohort consisted of 791 adult patients (122 with normal renal function and 669 with CKD - 33, 30, and 37% in stages 3, 4, and 5 on dialysis, respectively). Results: Levels of 25-vitamin D were lower and the prevalence of hypovitaminosis D using assay 1 was higher than using assay 2 in patients with CKD, regardless of similar levels of calcium, phosphate, and parathyroid hormone. As kidney function decreased, the percentage of disagreement between the assays increased. Conclusion: There is a noteworthy variability between assays in patients with CKD such that the diagnosis of hypovitaminosis D is modified. The mechanism behind this result is still unclear and might be due to a possible interference in the analytical process. However, the clinical significance is unquestionable, as the supplementation of vitamin D can be erroneously prescribed to these patients.

Resumo Antecedentes: As diretrizes atuais recomendam a avaliação do estado da 25-hidroxivitamina D em pacientes com doença renal crônica (DRC). Embora significativas diferenças entre os ensaios tenham sido descritas, o impacto da nesta variabilidade DRC nunca foi testado. Métodos: Testamos a variabilidade entre dois ensaios de 25-hidroxivitamina D em pacientes com DRC (TFGe < 60 mL/min/1,73 m2) que realizaram medidas consecutivas de 25-hidroxivitamina D em 2015 (Ensaio 1 - Diasorin LIASON 25 TOTAL - D assay® ) e 2016 (Ensaio 2 - Beckman Coulter Unicel Xl 800®). A coorte consistiu de 791 pacientes adultos (122 com função renal normal e 669 com DRC - 33, 30 e 37% nos estágios 3, 4 e 5 em diálise, respectivamente). Resultados: Os níveis de 25-hidroxivitamina D foram menores e a prevalência de hipovitaminose D foi maior utilizando o ensaio 1 do que com o ensaio 2 em pacientes com DRC, independentemente dos níveis similares de cálcio, fosfato e paratormônio. Quando a função renal diminuiu, a porcentagem de discordância entre os ensaios aumentou. Conclusão: Existe uma notável variabilidade entre os ensaios em pacientes com DRC, de modo a modificar o diagnóstico de hipovitaminose D. O mecanismo por trás desse resultado ainda não está claro e pode ser devido a uma possível interferência no processo analítico. Entretanto, o significado clínico é inquestionável, pois a suplementação de vitamina D pode ser erroneamente prescrita a esses pacientes.

Avaliação do conhecimento de Graduandos do curso de Odontologia sobre o uso de fluoretos em Odontopediatria: um estudo coorte / Evaluation of the knowledge of undergraduate dental students regarding the indications of fluoride for children: a cohort study

Objetivo: O objetivo do estudo foi avaliar o conhecimento de Graduandos da Faculdade de Odontologia da Universidade Federal de Minas Gerais (FAO-UFMG) quanto às indicações de uso de fluoretos em crianças. Métodos: Em 2015, dois grupos de estudantes foram convidados a participar do estudo: Grupo 1 (G1): 78 alunos do 1º período e Grupo 2 (G2): 72 alunos do 9º período (baseline). Em 2016, o G1 participou da reaplicação do mesmo questionário e a amostra de alunos recuperada foi de 66 graduandos (tempo 2 ­ T2). Foi realizada análise estatística dos dados usando os Testes Qui-quadrado de Pearson, Exato de Fisher e McNemar. Resultados: Comparando as respostas, houve diferenças de resposta em todas as questões entre G1 em baseline e G2 (p < 0,05). O conhecimento entre G1 no T2 e G2 foi semelhante (p > 0,05). As respostas foram diferentes entre G1 em baseline e G1 em T2 (p < 0,05), mostrando uma melhora do conhecimento para os mesmos alunos. Conclusão: No geral, pode-se dizer que ainda há uma defasagem no conhecimento, visto que muitas questões foram respondidas de maneira insatisfatória. (AU)

Aim: This study s oughtto compare the knowledge of undergraduate students from the Dental School of Universidade Federal de Minas Gerais (FOUFMG) regarding the recommendations of fluoride use for children. Methods: In 2015, two groups of students took part in the study: Group 1 (G1): 78 students from the 1stsemester and Group 2 (G2): 72 students from the last semester (baseline). In 2016, G1 answered the same questionnaire, and the sample retrieved was of 66 students (time 2). Pearson's Chi-square, Fisher's exact, and McNemar tests were used for statistical analysis. Results: Comparing the responses, the answers were different between G1 at the baseline and G2 (p < 0.05). The answers of the questionnaire were similar between G1 at time 2 and G2 at the baseline (p > 0.05). The answers were different between G1 at the baseline and G1 at time 2 (p < 0.05), illustrating an improvement in knowledge. Conclusion:In conclusion, there is still a lack of knowledge, as many questions were not properly answered by the students. (AU)

Adult primary liver sarcoma: systematic review / Sarcoma primário de fígado em adultos: revisão sistemática

ABSTRACT Introduction: primary liver sarcoma is a rare type of tumor, more common in children. Among adults, it represents a spectrum of neoplasms with reserved prognosis. There is no consensus on the treatment of choice of these lesions, justifying a systematic review of the literature on treatment options, prognostic factors, and survival. Material/Methods: a systematic review of articles published in Pubmed, Medline, LiLacs e SciElo, from 1966 to March/2019, presenting the keywords: primary-liver-sarcoma and primary-hepatic-sarcoma was undertaken. Studies including patients older than 18 years, and published in English, Portuguese and Spanish were included. Case reports, metastatic tumors and multiple oncologic diagnosis were excluded. The initial search listed 1,318 articles. 1,206 did not meet the inclusion criteria. After reviewing 112 eligible articles, 15 were selected (14 case series and 1 retrospective-cohort). Results: proposed treatment modalities for primary liver sarcoma included surgery and/or chemotherapy and/or radiotherapy or liver transplantation. The most common histological types were angiosarcoma (32%), leiomyosarcoma (29%), epithelioid hemangioendothelioma (15%) and embryonal sarcoma (7%). Histology, degree of differentiation and R0 resection were mentioned positive prognostic factors. Median survival ranged from two to 23 months. Five-year survival rate varied from 0% to 64%, on average 21%. Conclusion: surgical resection (R0 resection) is the main treatment for primary liver sarcomas. Development of effective systemic therapies are required to improve prognosis of patients harboring this type of tumor.

RESUMO Introdução: o sarcoma primário do fígado é uma neoplasia rara, que acomete mais frequentemente crianças. Nos adultos, representa espectro de neoplasias de prognóstico reservado. Entretanto, em nenhuma faixa etária há consenso sobre a terapêutica de escolha dessas lesões, motivando revisão sistemática com objetivo de elencar opções de tratamento, fatores prognósticos e sobrevida. Material/Método: realizamos revisão sistemática dos artigos publicados nas bases de dados Pubmed, Medline, LiLacs e Scielo, de 1966 a março/2019, contendo as palavras-chaves: primary-liver-sarcoma e primary-hepatic-sarcoma. Foram incluídos estudos que incluíram pacientes com idade a partir de 18 anos e publicados em inglês, português e espanhol. Relatos de caso, tumores metastáticos e pacientes com múltiplos diagnósticos oncológicos foram excluídos. Foram encontrados inicialmente 1.318 artigos, desses, 1.206 foram excluídos por estarem fora dos critérios de inclusão. Dos 112 artigos analisados e discutidos, 15 foram incluídos nesse artigo (14 séries de casos e 1 estudo de coorte retrospectivo). Resultado: os tratamentos propostos para o sarcoma primário do fígado em adultos incluíram cirurgia e/ou quimioterapia e/ou radioterapia ou transplante hepático. Os tipos histológicos mais frequentemente relados foram angiossarcoma (32%), leiomiossarcoma (29%), hemangioendotelioma epitelioide (15%) e sarcoma embrionário (7%). Tipo histológico, grau de diferenciação e resseção R0 foram os principais fatores de bom prognóstico. A sobrevida média total variou de dois a 23 meses. A sobrevida em cinco anos variou entre 0 e 64%, em média 21%. Conclusão: ressecção cirúrgica R0 é a base do tratamento dos sarcomas primários do fígado. Esse grupo heterogêneo de tumores requer desenvolvimento de terapias sistêmicas efetivas para melhoria do prognóstico.

Perfil de Utilização de Imunossupressores para Profilaxia de Doença Enxerto versus Hospedeiro em Pacientes Submetidos ao Transplante de Células-Tronco Hematopoiéticas / Utilization Profile of Immunosuppressants for Graft-Versus-Host Disease Prophylaxis in Patients Submitted to Hematopoietic Stem Cell Transplantation / Perfil de Uso de Inmunosupresores para Profilaxis de Enfermedad Injerto versus Huésped en Pacientes Sometidos al Trasplante de Células Madre Hematopoyéticas

Introdução: Imunossupressores apresentam alta toxicidade associada à estreita faixa terapêutica, devendo-se ter controle de níveis séricos. Assim, é necessário o estudo de utilização de medicamentos em clínicas que os utilizam, fornecendo uma visão geral de seu consumo e uso racional em uma dada população. Objetivo: Identificar o perfil de utilização de imunossupressores para profilaxia de doença enxerto versus hospedeiro em pacientes submetidos a transplante de células-tronco hematopoiéticas, em um centro de transplante de medula óssea. Método: Trata-se de um estudo transversal realizado em um centro de transplante de medula óssea brasileiro. Os imunossupressores utilizados em 2017 foram classificados segundo um sistema de classificação internacional; seu consumo, expresso em dose diária definida; e seus protocolos, analisados segundo as Diretrizes para profilaxia de doença do enxerto contra hospedeiro do Consenso da Sociedade Brasileira de Transplante de Medula Óssea de 2015. Resultados: O regime de condicionamento mieloablativo foi o mais frequente (51,7%). O protocolo de imunossupressão mais prescrito foi ciclosporina com metotrexato (37,9%). Dos 29 pacientes elegíveis, 23 (79,3%) tiveram protocolos seguindo as recomendações do Consenso de 2015. Metotrexato, ciclosporina intravenosa e micofenolato foram responsáveis por 85,64% do consumo. Conclusão: Neste trabalho, só foi possível identificar um perfil de uso de imunossupressores e realizar comparações dentro da instituição, em virtude da escassez de estudos de utilização desses medicamentos. Portanto, novos estudos devem ser realizados, a fim de promover seu uso racional e elaborar políticas públicas com acesso a esses medicamentos.

Introduction: Immunosuppressants have high toxicity associated to a narrow therapeutic range, and serum levels should be controlled. Thus, it is necessary to study the use of drugs in clinics that use them, providing an overview of their intake and rational use in a given population. Objective: Identify the profile of the use of immunosuppressants for prophylaxis of graft versus host disease in patients submitted to hematopoietic stem cell transplantation in a bone marrow transplant center. Method: It is a cross-sectional study performed at a Brazilian bone marrow transplant facility. The immunosuppressants used in 2017 were classified according to an international classification system, their intake expressed in defined daily dose and their protocols analyzed according to the "Consenso da Sociedade Brasileira de Transplante de Medula Óssea" of 2015. Results:The myeloablative conditioning regimen was the most frequent (51.7%). The most prescribed immunosuppressive protocol was cyclosporine with methotrexate (37.9%). Of the 29 eligible patients, 23 (79.3%) had protocols following the 2015 "Consenso" recommendations. Methotrexate, intravenous cyclosporine and mycophenolate were responsible for 85.64% of the intake. Conclusion: In this study, it was only possible to identify a profile of use of immunosuppressants and compare within the institution due to the scarcity of studies about the use of these drugs. Therefore, new studies should be conducted to promote their rational use and to develop public policies with access to these drugs.

Introducción: Inmunosupresores presentan una alta toxicidad asociada a la estrecha banda terapéutica, debiendo tener control de niveles séricos y alta vigilancia en cuanto a toxicidad y efectividad. Así, es necesario el estudio de uso de medicamentos en clínicas que los utilizan, proporcionando una visión general de su consumo en una determinada población. Objetivo: Identificar el perfil de uso de Inmunosupresores para profilaxia de enfermedad injerto contra huésped en pacientes sometidos al trasplante de células madre hematopoyéticas en un centro de trasplante de médula ósea. Método: Se trata de un estudio transversal realizado en un centro brasileño de trasplante de médula ósea. Los Inmunosupresores utilizados en 2017 se clasificaron según un sistema de clasificación internacional, su consumo expresado en Dosis Diaria Definida y sus protocolos analizados según el consenso de la sociedad brasileña de trasplante de médula ósea de 2015. Resultados: El régimen de condicionamiento mieloablativo fue el más frecuente (51,7%). El protocolo de inmunosupresión más prescrito fue ciclosporina con metotrexato (37,9%). De 29 pacientes elegibles, 23 (79,3%) tuvieron protocolos siguiendo recomendaciones del consenso de 2015. Metotrexato, ciclosporina intravenosa y micofenolato fueron responsables del 85,64% del consumo. Conclusión: En este trabajo, sólo fue posible identificar un perfil de uso de Inmunosupresores y realizar comparaciones dentro de la institución debido a la escasez de estudios de utilización de esos medicamentos. Por lo tanto, nuevos estudios deben ser realizados a fin de promover su uso racional y elaborar políticas públicas con acceso a esos medicamentos.

Mechanical and optical properties of conventional restorative glass-ionomer cements - a systematic review

Abstract Objectives To perform a systematic review of test methodologies on conventional restorative glass-ionomer cement (GIC) materials for mechanical and optical properties to compare the results between different GICs. Material and Methods Screening of titles and abstracts, data extraction, and quality assessments of full-texts were conducted in search for in vitro studies on conventional GICs that follow the relevant specifications of ISO standards regarding the following mechanical and optical properties: compressive strength, flexural strength, color, opacity and radiopacity. Sources The Latin American and Caribbean Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO) databases from Latin-American and Caribbean System on Health Sciences Information (BIREME) and PubMed/Medline (US National Library of Medicine - National Institutes of Health) databases were searched regardless of language. Altogether, 1146 in vitro studies were selected. Two reviewers independently selected and assessed the articles according to pre-established inclusion/exclusion criteria. Among all the properties investigated, only one study was classified as being of fair quality that tested compressive strength and was included. It was observed that many authors had not strictly followed ISO recommendations and that, for some properties (diametral tensile strength and microhardness), there are no guidelines provided. Conclusions It was not possible to compare the results for the mechanical and optical properties of conventional restorative GICs due to the lack of standardization of studies.

Viabilidade de bactéria lática em bebida láctea fermentada adicionada de albedo de maracujá

A conversão do soro líquido em bebidas lácteas é uma das mais atrativas opções para as indústrias devido à simplicidade do processo, a possibilidade de uso dos equipamentos já existentes na usina de beneficiamento de leite reduzindo custos, além da redução de problemas relativos ao seu descarte. O objetivo do presente estudo, portanto, foi desenvolver formulações de bebida láctea acrescida de albedo de maracujá e Lactobacillus casei e verificar o efeito prebiótico do albedo de maracujá na viabilidade do probiótico. Foram elaboradas bebidas lácteas com L. casei e diferentes concentrações do albedo de maracujá (1, 2 e 3%). Os produtos foram avaliados quanto às características físico-químicas e microbiológicas nos tempos 0, 15 e 30 dias de fabricação, além da verificação da fibra (albedo de maracujá) no crescimento de bactérias láticas. Quanto às análises de umidade, acidez, gordura e proteína, não houve diferença significativa entre as amostras. A contagem de coliformes totais e termotolerantes indicaram que os produtos foram elaborados de acordo com as Boas Práticas de Fabricação e a contagem de bactérias láticas nas amostras com albedo de maracujá e L. casei foi superior quando comparada ao controle, podendo ser um produto potencialmente probiótico

The conversion of liquid whey into dairy drinks is one of the most attractive options for the industry due to the simplicity of the process, the possibility of using existing equipment in the milk processing plant, reducing costs and reducing the problems related to its disposal. Therefore, the objective of the present study was to develop formulations of milk beverage plus passion fruit albedo and Lactobacillus casei and to verify the prebiotic effect of passion fruit albedo on probiotic viability. Milk drinks with L. casei and different concentrations of passion fruit albedo (1, 2 and 3%) were elaborated. The products were evaluated for the physico-chemical and microbiological characteristics at the 0, 15 and 30 days of manufacture, as well as the verification of the fiber (passion fruit albedo) in the growth of lactic acid bacteria. Regarding the analyzes of the evaluation, moisture, acidity, fat and protein, there was no significant difference between the samples. The total and thermotolerant coliforms counts indicated that the products were elaborated according to the Good Manufacturing Practices and the lactic acid bacteria counts in the albedo samples of passion fruit and L. casei were superior when compared to the control, can be potentially probiotic product

Viabilidade de bactéria lática em bebida láctea fermentada adicionada em albedo de maracujá

A conversão do soro líquido em bebidas lácteas é uma das mais atrativas opções para as indústrias devido à simplicidade do processo, a possibilidade de uso dos equipamentos já existentes na usina de beneficiamento de leite reduzindo custos, além da redução de problemas relativos ao seu descarte. O objetivo do presente estudo, portanto, foi desenvolver formulações de bebida láctea acrescida de albedo de maracujá e Lactobacillus casei e verificar o efeito prebiótico do albedo de maracujá na viabilidade do probiótico. Foram elaboradas bebidas lácteas com L. casei e diferentes concentrações do albedo de maracujá (1, 2 e 3%). Os produtos foram avaliados quanto às características físico-quimicas e microbiológicas nos tempos 0, 15 e 30 dias de fabricação, além da verificação da fibra (albedo de maracujá) no crescimento de bactérias láticas. Quanto às análises de umidade, acidez, gordura e proteína, não houve diferença significativa entre as amostras. A contagem de coliformes totais e termotolerantes indicaram que os produtos foram elaborados de acordo com as Boas Práticas de Fabricação e a contagem de bactérias láticas nas amostras com albedo de maracujá e L. casei foi superior quando comparada ao controle, podendo ser um produto potencialmente probiótico.

The conversion of liquid whey into dairy drinks is one of the most attractive options for the industry due to the simplicity of the process, the possibility of using existing equipment in the milk processing plant, reducing costs and reducing the problems related to its disposal. Therefore, the objective of the present study was to develop formulations of milk beverage plus passion fruit albedo and Lactobacillus casei and to verify the prebiotic effect of passion fruit albedo on probiotic viability. Milk drinks with L. casei and different concentrations of passion fruit albedo (1, 2 and 3%) were elaborated. The products were evaluated for the physico-chemical and microbiological characteristics at the 0, 15 and 30 days of manufacture, as well as the verification of the fiber (passion fruit albedo) in the growth of lactic acid bacteria. Regarding the analyzes of the evaluation, moisture, acidity, fat and protein, there was no significant difference between the samples. The total and thermotolerant coliforms counts indicated that the products were elaborated according to the Good Manufacturing Practices and the lactic acid bacteria counts in the albedo samples of passion fruit and L. casei were superior when compared to the control, can be potentially probiotic product.

Preterm birth, pacifier use and breastfeeding: is there a relationship?

Abstract The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.

Resumo A imaturidade no nascimento para pretermos pode os predispor a dificuldades de sucção. Esta pesquisa teve como objetivo avaliar se o uso de chupeta está associado ao nascimento prematuro e ao tipo de alimentação infantil. Este estudo transversal comparativo foi realizado em Belo Horizonte, Brasil e avaliou 250 crianças de 3 a 5 anos. A amostra foi composta por dois grupos: o grupo de crianças nascidas a termo (n = 125) que foi selecionado em uma creche e o grupo de crianças pré-termo (125) que foi contatado em um hospital universitário público vinculado a um projeto de cuidados pré-termo desde o nascimento até os sete anos de idade. Para coletar dados, um questionário pretextado sobre informações da idade gestacional, desenvolvimento infantil, alimentação infantil e hábitos de sucção não nutritiva foram utilizados para ambos os grupos. Análises bivariada e Regressão de Poisson multivariada foram utilizadas para a análise estatística. O uso de chupeta foi mais prevalente no grupo pré-termo (RP = 1,20, IC95% = 1,02-1,42), que usou a mamadeira (RP = 1,38; IC95% = 1,15-1,64) e foram amamentados ao seio por menos de seis meses (RP = 1,19, 95% IC = 1,01-1,41). A maioria das crianças amamentadas ao seio nasceram a termo (RP = 1,14, 95% IC = 1,04-1,20) e com renda familiar mensal maior que USD 450,28 (RP = 1,10, 95% IC = 1,01-1,20). Neste estudo, o uso de chupeta foi mais prevalente entre os prematuros e associado com a amamentação ao seio por menos de seis meses e uso de mamadeira. A renda familiar mensal associou-se a uma prevalência de prática da amamentação ao seio.

Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis / Os efeitos do tabagismo sobre a perda dentária em indivíduos em terapia periodontal de suporte: uma revisão sistemática e meta-análise / Los efectos del consumo de tabaco en la pérdida de dientes entre personas con una terapia de mantenimiento periodontal: un revisión sistemática y metaanálisis

Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.

Resumo: A perda dentária tem sido relatada em estudos longitudinais sobre terapia periodontal de suporte (TPS), mas houve menos investigação sobre o efeito independente do tabagismo sobre a perda dentária, ajustado por importantes variáveis de confusão. Esta revisão sistemática teve como objetivo avaliar e analisar o efeito isolado do tabagismo sobre perda dentária em indivíduos em TPS. A estratégia incluiu fontes eletrônicas, busca manual, literatura cinzenta e artigos recentes (publicados a partir de abril de 2018), sem restrição quanto ao idioma; as datas de publicação foram incluídas. Foram selecionados estudos clínico-epidemiológicos com dados sobre perda dentária entre tabagistas em TPS, comparado com grupos-controle de não-tabagistas. A qualidade metodológica foi avaliada com a Escala de Newcastle-Ottawa. Foi realizada uma meta-análise, assim como, I2 testes de heterogeneidade e de sensibilidade. A qualidade das evidências foi avaliada com a escala GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Onze artigos foram incluídos na revisão sistemática, sendo quatro estudos de casos e controles e sete estudos de coorte. Dez dos 11 estudos concluíram que o tabagismo é importante fator de risco para a ocorrência de perda dentária. De acordo com a meta-análise de quatro dos estudos de coorte, os tabagistas em TPS apresentavam risco 3,24 vezes maior de ocorrência de perda dentária quando comparados aos não tabagistas (IC95%: 1,33-7,90). O risco global de viés nos estudos foi baixo. A revisão mostrou qualidade moderada das evidências científicas de que os tabagistas em TPS apresentam risco maior de perda dentária do que os não-tabagistas.

Resumen: La mortalidad dental ha sido estudiada en estudios longitudinales acerca de la terapia de mantenimiento periodontal (TMP), pero el efecto independiente de fumar en la pérdida de dientes (PD), ajustado a variables de confusión importantes, se ha evaluado muy poco. Esta revisión sistemática tuvo como objetivo evaluar y analizar el efecto aislado de fumar en la PD con personas bajo TMP. Se investigó en medios electrónicos, manuales, literatura gris, y artículos recientes (desde abril 2018), sin restricciones respecto a la lengua; incluyendo sus respectivas fechas de publicación. Además, se seleccionaron estudios clínicos epidemiológicos que trabajaban sobre datos de PD entre fumadores que estaban bajo TMP, en comparación con grupos de control de no fumadores. La calidad metodológica se evaluó usando la Escala de Newcastle-Ottawa. Se realizó un metaanálisis, así como tests de heterogeneidad I2 y sensibilidad. La evidencia de calidad fue evaluada usando GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Se incluyeron once trabajos en la revisión sistemática (cuatro de caso-control y siete estudios de cohortes). Diez de los once estudios concluyeron que fumar era un factor de riesgo importante para la ocurrencia de PD. Los metaanálisis de cuatro de los estudios de cohorte descubrieron que los fumadores tenían 3,24 veces más la oportunidad de sufrir PD, en comparación con los no fumadores TMP (IC95%: 1,33-7,90). En general, el riesgo de sesgo en los estudios fue bajo. La calidad de la evidencia científica respaldó moderadamente que los fumadores bajo TMP contaban con más oportunidad de PD que los no fumadores.