Surgical rehabilitation of cleft lip and/or palate: evaluation of the Brazilian public health system

Abstract Objective: To evaluate the surgical rehabilitation of cleft lip and/or palate by the Brazilian public health system. Methods: Retrospective, analytical and comparative ecological study, with information on hospital procedures performed on individuals with cleft lip and/or palate in Centers authorized by the Brazilian public health system, between the years 2008 and 2020. The information was collected in databases Ministry of Health data. Results: Between 2008 and 2020, there was an increase of 8 (36.4%) qualified Centers in Brazil, currently having 30 Centers in 100% of the geographic regions. The surgical procedures performed totaled 68,716; with multiple surgeries being the most frequent. Complete cleft lip and palate was the most frequent type in hospital admissions. The public financial resources invested in the surgical rehabilitation of cleft lip and palate in the qualified Lip and Palate Malformation Treatment Centers were US$ 39,693 million, making an average value per procedure of US$ 577.64. Conclusions: In Brazil, public health system performed and financed, over the years 2008 and 2020, an important volume of surgical procedures for cleft lip and/or palate, which presented a polarization in the Southeast region but with a slight tendency expansion to other regions of the country. The most performed surgical procedures were multiple surgeries and mostly for individuals with cleft lip and palate. The amounts paid showed a heretogeneous distribution in the national territory. Level of evidence: Level 5: Report containing program evaluation data.

Surgical rehabilitation of cleft lip and/or palate: evaluation of the Brazilian public health system.

OBJECTIVE: To evaluate the surgical rehabilitation of cleft lip and/or palate by the Brazilian public health system. METHODS: Retrospective, analytical and comparative ecological study, with information on hospital procedures performed on individuals with cleft lip and/or palate in Centers authorized by the Brazilian public health system, between the years 2008 and 2020. The information was collected in databases Ministry of Health data. RESULTS: Between 2008 and 2020, there was an increase of 8 (36.4%) qualified Centers in Brazil, currently having 30 Centers in 100% of the geographic regions. The surgical procedures performed totaled 68,716; with multiple surgeries being the most frequent. Complete cleft lip and palate was the most frequent type in hospital admissions. The public financial resources invested in the surgical rehabilitation of cleft lip and palate in the qualified Lip and Palate Malformation Treatment Centers were US$ 39,693 million, making an average value per procedure of US$ 577.64. CONCLUSIONS: In Brazil, public health system performed and financed, over the years 2008 and 2020, an important volume of surgical procedures for cleft lip and/or palate, which presented a polarization in the Southeast region but with a slight tendency expansion to other regions of the country. The most performed surgical procedures were multiple surgeries and mostly for individuals with cleft lip and palate. The amounts paid showed a heretogeneous distribution in the national territory. LEVEL OF EVIDENCE: Level 5: Report containing program evaluation data.

Enamel Renal Syndrome: A Systematic Review.

The enamel renal syndrome (ERS) is a rare autosomal recessive disease that is associated with mutations in the FAM20A gene. The syndrome is characterized by impaired amelogenesis of the hypoplastic type and nephrocalcinosis, presenting with presence of thin or absence of enamel, late dental eruption, intrapulpal calcifications, bilateral nephrocalcinosis, and normal plasma calcium level. The objective is to characterize ERS by systematically literature reviewing, highlighting the main findings of the syndrome to increase knowledge about this condition in the health professionals. The study is a systematic review of the scientific literature, whose research was developed in the PubMed database in March 2018. A total of 69 articles were found. Two authors analyzed their abstracts and selected, according to the language and main subject, 30 articles to write this study. A total of 69 patients were cited in the studies and their data were analysed. There was gender equivalence and the ages ranged from 1 to 64 years old. There is a clear hereditary relation of the syndrome, since there was consanguinity in 18 cases, indicating a percentage of 26.08% and family history in 30 cases (43.47%). Laboratory changes vary greatly from patient to patient and may even remain unchanged. The relationship between the syndrome and the mutation in the FAM20A gene can be proven from the data, since all patients with ERS screened by the mutation were positive. With the advancement of the ERS studies, some associations with the syndrome are suspected, such as the presence of gingival fibromatosis, hearing loss, and hypertrichosis. Thus, it is noticed that the syndrome does not show a predilection for gender or age and there is a strong hereditary character, marked by the consanguinity and family history of the patients. The association with the FAM20A gene is reinforced, since the mutation was identified in all patients analyzed.

Clinical relevance of breast and gastric cancer-associated polymorphisms as potential susceptibility markers for oral clefts in the Brazilian population.

BACKGROUND: Epidemiological studies have indicated a higher incidence of breast and gastric cancer in patients with nonsyndromic cleft lip with or without cleft palate (NSCL ± P) and their relatives, which can be based on similar genetic triggers segregated within family with NSCL ± P. METHODS: This multicenter study evaluated the association of 9 single nucleotide polymorphisms (SNP) in AXIN2 and CDH1, representing genes consistently altered in breast and gastric tumors, with NSCL ± P in 223 trios (father, mother and patient with NSCL ± P) by transmission disequilibrium test (TDT). RESULTS: Our results showed that the minor A allele of rs7210356 (p = 0.01) and the T-G-G-A-G haplotype formed by rs7591, rs7210356, rs4791171, rs11079571 and rs3923087 SNPs (p = 0.03) in AXIN2 were significantly under-transmitted to patients with NSCL ± P. In CDH1 gene, the C-G-A-A and A-G-A-G haplotypes composed by rs16260, rs9929218, rs7186053 and rs4783573 polymorphisms were respectively over-transmitted (p = 0.01) and under-transmitted (p = 0.008) from parents to the children with NSCL ± P. CONCLUSIONS: The results suggest that polymorphic variants in AXIN2 and CDH1 may be associated with NSCL ± P susceptibility, and reinforce the putative link between cancer and oral clefts.

A review of seasonality of cleft births - The Brazil experience.

AIMS: Evaluate the seasonal influence in nonsyndromic cleft lip and/or palate (NSCL/P) in Brazilian patients. METHODS: A case-control study, with 361 unrelated patients with NSCL/P and 481 healthy individuals, was done on a reference service for craniofacial deformities in Minas Gerais State, Brazil. Information was collected from clinical records considering gender, month of birth, as well as with the seasons. RESULTS: Nonparametric tests did not show a seasonal variation in month of birth and in seasons of year of NSCL/P compared to a control group (p = 0.902 and p = 0.679, respectively). A difference in births between the groups was identified only in January, however, was not significant. Moreover, among the control group there were more births in the months of February and August, and for the cleft group, more in July and August. The males were more affected by cleft lip with or without palate (CLP) and the females by isolated cleft palate (CP) manifestation. The ratio of CL:CLP:CP indicated that CLP was predominant when compared with CL and CP, CLP was more frequent in male patients, and CP predominance was seen in females. CONCLUSION: This study did not show seasonal differences in births on NSCL/P in a Brazilian group, emphasizing that environmental factors may be related to oral clefts. These results provide a basis for further epidemiological studies of orofacial clefts in Brazil.

Evaluating fluctuating asymmetry in a Brazilian population with non-syndromic cleft lip and/or palate.

OBJECTIVE: The objective of this work was to analyse the levels of dermatoglyphic asymmetry between both parents and individuals with non-syndromic cleft lip and/or palate (NSCL/P) and unaffected control trios. METHODS: A case-control analysis was carried out of 51 affected trios (unaffected parents and NSCL/P subjects), and 50 unaffected control trios. Finger and palm prints were taken from each participant, and dermatoglyphic patterns, the number of lines on the digits, and the palmar angles were recorded. To determine the level of fluctuating asymmetry the case group was compared with the control group, significance accepted at p ≤ 0.05. RESULTS: There was a statistically significant difference between the atd angles (angle between the lines triradii a and t and triradii t and d) of fathers of those affected by NSCL/P, and the dermatoglyphic patterns of the affected mothers, with significantly more arches in the control group. However, in this study, multiple comparisons were used, and the results must be evaluated as initial findings and evaluated carefully since the significance disappears after correction for multiple comparisons. Other parameters did not differ between groups. There was no difference in parameters among patients affected by NSCL/P. CONCLUSIONS: Based on these results it is speculated that the mechanisms responsible for the formation of NSCL/P may be associated with those responsible for deviations in the asymmetry of the atd angles in the fathers and dermatoglyphic patterns of the mothers of affected patients. Besides, further studies are required to determine the real relationship between these conditions.

Profile and scientific production of Brazilian National Council of Technological and Scientific Development researchers in Pediatrics.

OBJECTIVE: To evaluate the profile and the scientific production of researchers in Pediatrics with scholarship from the National Counsel of Technological and Scientific Development. METHODS: The Lattes curricula of 34 researchers in Pediatrics with active scholarships, from 2006 to 2008 were included in the analysis. The variables of interest were: gender, affiliation, time since PHD, tutoring of undergraduate students, mentorship of masters and doctors, scientific production and the papers' impact. RESULTS: In a total of 411 researchers in Medicine, 34 (8%) belonged to Pediatrics. Males (77%) and scholars in the category 2 of productivity (62%) prevailed. Three states of Brazil were responsible for approximately 90% of the researchers: São Paulo (53%), Minas Gerais (21%), and Rio Grande do Sul (15%). During their academic career, the Pediatrics researchers have published 3,122 articles with a median of 89 articles per researcher (interquartile range - IQ=51-119). Of the total, 40 and 59% articles were indexed in the Web of Science and Scopus databases, respectively. The Pediatrics researchers have published papers in 599 journals with a median impact factor of 2.35 (IQ=1.37-3.73) for the 323 indexed journals. CONCLUSIONS: The Pediatrics researchers have a relevant scientific output from the quantity point of the view, but there is a need to improve quality.

Profile and scientific production of Brazilian National Council of Technological and Scientific Development researchers in Pediatrics / Perfil y produccion cientifica de los investigadores del Consejo Nacional de Desarrollo Cientifico y Tecnologico en el area de Pediatria / Perfil e producao cientifica dos pesquisadores do Conselho Nacional de Desenvolvimento Cientifico e Tecnologico na area de Pediatria

OBJECTIVE: To evaluate the profile and the scientific production of researchers in Pediatrics with scholarship from the National Counsel of Technological and Scientific Development. METHODS: The Lattes curricula of 34 researchers in Pediatrics with active scholarships, from 2006 to 2008 were included in the analysis. The variables of interest were: gender, affiliation, time since PHD, tutoring of undergraduate students, mentorship of masters and doctors, scientific production and the papers' impact. RESULTS: In a total of 411 researchers in Medicine, 34 (8%) belonged to Pediatrics. Males (77%) and scholars in the category 2 of productivity (62%) prevailed. Three states of Brazil were responsible for approximately 90% of the researchers: São Paulo (53%), Minas Gerais (21%), and Rio Grande do Sul (15%). During their academic career, the Pediatrics researchers have published 3,122 articles with a median of 89 articles per researcher (interquartile range - IQ=51-119). Of the total, 40 and 59% articles were indexed in the Web of Science and Scopus databases, respectively. The Pediatrics researchers have published papers in 599 journals with a median impact factor of 2.35 (IQ=1.37-3.73) for the 323 indexed journals. CONCLUSIONS: The Pediatrics researchers have a relevant scientific output from the quantity point of the view, but there is a need to improve quality. .

OBJETIVO: Evaluar el perfil y la producción científica de los investigadores en Pediatría catastrados como becarios de productividad científica del Consejo Nacional de Desarrollo Científico y Tecnológico. MÉTODOS: Se incluyó en el análisis el currículo Lattes de 34 investigadores en Pediatría con becas activas en el trienio 2006 a 2008. Las variables de interés fueron: sexo, institución, tiempo de doctoramiento, orientación de alumnos de la carrera, maestros y doctores, artículos publicados e impacto de la publicación. RESULTADOS: De un total de 411 investigadores en Medicina, 34 (8%) fueron identificados como del área de Pediatría. Hubo una predominancia del género masculino (77%) y de becarios en la categoría 2 (62%). Tres provincias fueron responsables por un 90% de los investigadores: São Paulo (53%), Minas Gerais (21%) y Rio Grande do Sul (15%). En el total de la carrera académica, los investigadores en Pediatría publicaron 3.122 artículos, siendo la mediana de 89 artículos por investigador (intervalo intercuartil - IQ=51-119). De ese total, 40 y 58,5% fueron artículos indexados en las bases de datos Web of Science y Scopus, respectivamente. Los investigadores en Pediatría publicaron en 599 periódicos, con mediana de factor de impacto de 2,35 (IQ=1,37-3,73) para los 323 periódicos indexados. CONCLUSIONES: En la presente investigación, se observó que los investigadores en el área de Pediatría presentan una producción científica relevante desde la mirada cuantitativa, pero hay necesidad de perfeccionamiento cualitativo de las publicaciones. .

OBJETIVO: Avaliar o perfil e a produção científica de pesquisadores de Pediatria, cadastrados como bolsistas de produtividade científica do Conselho Nacional de Desenvolvimento Científico e Tecnológico. MÉTODOS: O currículo Lattes de 34 pesquisadores em Pediatria, com bolsas ativas no triênio 2006 a 2008, foram incluídos na análise. As variáveis de interesse foram: sexo, instituição, tempo de doutoramento, orientação de alunos de graduação, mestres e doutores, artigos publicados e impacto da publicação. RESULTADOS: De um total de 411 pesquisadores em Medicina, 34 (8%) foram identificados como da área de Pediatria. Houve uma predominância do gênero masculino (77%) e de bolsistas na categoria 2 (62%). Três estados foram responsáveis por aproximadamente 90% dos pesquisadores: São Paulo (53%), Minas Gerais (21%) e Rio Grande do Sul (15%). No total da carreira acadêmica, os pesquisadores em Pediatria publicaram 3.122 artigos, sendo a mediana de 89 artigos por pesquisador (intervalo interquartil - IQ=51-119). Desse total, 40 e 58,5% foram artigos indexados nas bases de dados Web of Science e Scopus, respectivamente. Os pesquisadores em Pediatria publicaram em 599 periódicos, com mediana de fator de impacto de 2,35 (IQ=1,37-3,73) para os 323 periódicos indexados. CONCLUSÕES: Na presente investigação, observou-se que os pesquisadores na área de Pediatria apresentam uma produção científica relevante do ponto de vista quantitativo, mas há necessidade de aprimoramento qualitativo das publicações. .

Characteristics of women with breast cancer seen at reference services in the North of Minas Gerais.

OBJECTIVE: To describe the main characteristics, including stage of disease and local treatment of patients admitted to two reference services for the treatment of breast cancer in the North of Minas Gerais. METHODS: We conducted a cross-sectional descriptive study. We evaluated medical records of 288 female patients with breast cancer admitted between January 2006 and December 2009, referred from a public hospital and a private clinic. Variables were analyzed using the chi-square test and multinomial logistic regression. RESULTS: 68.1% of patients were referred from the public hospital. There was a predominance of patients over 50 years old (54.5%), married (59%) and with children (87.8%). The mean age of the population studied was 63 years old. Time between suspected cancer and confirmation of diagnosis was over six months in 42.7% of patients. Cancer diagnosis was late (stage III and IV) in 47.6% of patients. Family history of breast cancer was present in 20.1%, 20.8% of them had performed self-breast examination, and 41% had been submitted to a mammogram. CONCLUSION: There was a higher prevalence of stage III/IV patients from the public service when compared to the private sector. We found that the major factors associated with the late diagnosis of breast cancer were the delay between suspected and confirmed diagnosis, the absence of family history of breast cancer and not having a mammogram.

Características das mulheres com câncer de mama assistidas em serviços de referência do Norte de Minas Gerais / Characteristics of women with breast cancer seen at reference services in the North of Minas Gerais

OBJETIVOS: Descrever as principais características de pacientes com câncer de mama admitidas em dois serviços de referência para o tratamento desse tipo de câncer no norte de Minas Gerais, incluindo estágio da doença ao diagnóstico e local de tratamento. MÉTODOS: Realizou-se estudo transversal e descritivo, avaliando 288 prontuários de pacientes do gênero feminino com câncer de mama, admitidas entre janeiro de 2006 a dezembro de 2009, oriundas de um serviço público e de um privado. As variáveis analisadas foram submetidas a tratamento estatístico por meio dos testes qui-quadrado e regressão logística multinomial. RESULTADOS: Observou-se que 68,1% da população analisada procediam do serviço público. Predominaram pacientes com mais de 50 anos (54,5%), casadas (59%) e com filhos (87,8%). Dentre a população estudada, a média de idade foi de 63 anos, sendo que em 42,7% dos casos prevaleceu o intervalo de tempo acima de 6 meses entre a suspeita clínica e a confirmação diagnóstica. Em 47,6% das mulheres o diagnóstico foi tardio (estágios III e IV). 20,1% tinham histórico familiar de câncer de mama; 20,8% faziam autoexame das mamas e 41% faziam mamografia. CONCLUSÃO: Verificou-se maior prevalência de pacientes nos estágios III e IV no serviço público quando comparado ao privado. O tempo prolongado entre a suspeita clínica e a confirmação diagnóstica, a ausência de história familiar de câncer de mama e a não realização de mamografia de rastreamento são observados, neste estudo, como os principais fatores associados ao diagnóstico tardio.

OBJECTIVE: To describe the main characteristics, including stage of disease and local treatment of patients admitted to two reference services for the treatment of breast cancer in the North of Minas Gerais. METHODS: We conducted a cross-sectional descriptive study. We evaluated medical records of 288 female patients with breast cancer admitted between January 2006 and December 2009, referred from a public hospital and a private clinic. Variables were analyzed using the chi-square test and multinomial logistic regression. RESULTS: 68.1% of patients were referred from the public hospital. There was a predominance of patients over 50 years old (54.5%), married (59%) and with children (87.8%). The mean age of the population studied was 63 years old. Time between suspected cancer and confirmation of diagnosis was over six months in 42.7% of patients. Cancer diagnosis was late (stage III and IV) in 47.6% of patients. Family history of breast cancer was present in 20.1%, 20.8% of them had performed self-breast examination, and 41% had been submitted to a mammogram. CONCLUSION: There was a higher prevalence of stage III/IV patients from the public service when compared to the private sector. We found that the major factors associated with the late diagnosis of breast cancer were the delay between suspected and confirmed diagnosis, the absence of family history of breast cancer and not having a mammogram.

Profile and scientific production of Brazilian researchers in dental materials

Aim: To describe the demographic characteristics and academic production of the NationalCouncil for the Development of Science and Technology (CNPq) researchers whose areas ofexpertise focus on dental materials. Methods: Secondary data were obtained from the detailsof dentistry researchers registered as receiving a CNPq grant for scientific productivity. Variablessuch as gender, category of scientific productivity grant, time of completion of PhD program,geographical distribution and affiliated institution, scientific production and human resources trainingwere analyzed. Data from 2007-2009 triennium were considered. Mann-Whitney and chisquaretests compared the variables. Results: Researchers in categories 1A + 1B are thosewho completed their PhD program more than 14 years ago. All (100%) of dental materialresearchers are dentists and affiliated to universities, being approximately 92% of those affiliatedto public institutions. Male gender (62.2%) and category 2 grant (40.5%) are prevalent, and ahigh concentration of CNPq grantees in the southeastern region (75.7%) was observed. Ingeneral, there was a predominance of publications in CAPES Qualis B journals (59.0%), but apredominance of publications by new doctors in CAPES Qualis A2 and B1 journals was found.A higher mean of publications of book chapters (0.97) compared with full publications of books(0.43) per researcher was observed. Annually, researchers supervised more scientific initiationgrants (median = 0.45), followed by doctoral (mean = 0.36) and master students (median =0.30). Conclusions: There is a high concentration of researchers in the southeastern region,predominance of male gender and scholars in grant category 2. Publications are mainly inCAPES Qualis B journals. and researchers in grant categories 1C and 1D and with less timedoctoral produce more publications. The publication of books chapters is larger than entirebooks...