ABSTRACT
CONTEXT: It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates. OBJECTIVE: We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery. DESIGN, SETTING AND PARTICIPANTS: Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53). INTERVENTION: a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning. PRIMARY OUTCOME: the presence of infection. RESULTS: The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days. CONCLUSION: The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events. CLINICAL TRIAL REGISTRATION: Site Ensaclinicos.gov.br number U1111-1214-2862. DESCRIPTORS: Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.
ABSTRACT
BACKGROUND: Alterations of ß-catenin can promote cancer progression, but there has been little analysis of this protein in oral squamous cell carcinoma (OSCC). The objective of this study was to investigate the role of ß-catenin in OSCC development. MATERIALS AND METHODS: Expression of ß-catenin and Ki-67 from 92 OSCC was immunohistochemically studied in tissues close to the tumor invasion point and, in 37 cases, in tissues distant from the invasion point. RESULTS: Loss of membranous ß-catenin expression was observed in 77.2% of "close" samples and 94.4% of "distant" samples. Nuclear ß-catenin expression was detected in 35.9% of adjacent samples and 44.4% of "distant" samples. Nuclear ß-catenin expression in ≥10% of cells was observed in 6.6% of "close" samples and 25% of "distant" samples. No relationship was found between ß-catenin expression and cell proliferation. CONCLUSION: ß-Catenin plays a major oncogenic role in OSCC, principally through increase in invasiveness due to loss of its membranous expression.
Subject(s)
Carcinoma, Squamous Cell/metabolism , Mouth Neoplasms/metabolism , beta Catenin/metabolism , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Female , Humans , Ki-67 Antigen/metabolism , Male , Middle Aged , Mouth Neoplasms/pathology , Neoplasm InvasivenessABSTRACT
OBJECTIVE: Investigating oral health-related quality of life's (OH-QoL) relationship with cognitive state. BACKGROUND: Oral health affects OH-QoL and is poor in institutionalised and cognitively impaired people. MATERIAL AND METHODS: This was a cross-sectional study involving 215 institutionalised elderly (82.9 mean age), who were interviewed, examined and cognitively screened using the Pfeiffer test. RESULTS: Mean GOHAI score was 53.1; only 43.7% of the participants reported having a good OH-QoL. Needing help with dressing or washing (OR 2.14; p = 0.004), having one to nine teeth (OR 4.65; p ≥ 0.001), eight or less occluding pairs (OR 2.74; p = 0.002), one to three caries (OR 1.85; p = 0.005) and being cognitive impaired (OR 0.54; p = 0.034) were significantly associated with altered OH-QoL in bi-variate analysis. Being edentulous (OR 3.18; p = 0.0046), having 1-9 teeth (OR 2.62; p = 0.056) and presenting mild cognitive impairment (MCI) (OR 0.32; p = 0.016) appeared as predictive variables in logistic regression for having an altered OH-QoL. CONCLUSIONS: Participants having MCI had significantly better GOHAI score than cognitively normal residents. Performing cognitive screening parallel to applying any OH-QoL instrument would make the results more reliable and would benefit cognitively impaired people.
Subject(s)
Attitude to Health , Cognition Disorders/psychology , Oral Health , Quality of Life , Activities of Daily Living , Aged , Aged, 80 and over , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Dental Care , Dental Caries/psychology , Eating/physiology , Educational Status , Esthetics, Dental , Female , Geriatric Assessment , Humans , Institutionalization , Jaw, Edentulous, Partially/psychology , Longitudinal Studies , Male , Mastication/physiology , Mouth, Edentulous/psychology , Oral Hygiene , Pain Measurement , Spain , Speech/physiology , ToothbrushingABSTRACT
Objetivo: Descrever a assistência à saúde bucal nas residências geriátricas da Província de Granada, Espanha, e Estado de Santa Catarina, Brasil, e comparar os dados obtidos. Metodologia: Trata-se de estudo exploratório, transversal. Os dados foram coletados por meio de questionário fechado, enviado pelo correio, para todas as residências geriátricas cadastradas em Granada (99) e Santa Catarina (78), em 2005. Resultados: O perfil das residências (29 em SC e 30 em Granada) foi semelhante, com predominância de instituições privadas. Não houve diferenças estatísticas significativas quanto aos residentes, exceto quanto ao número de instituições acima da mediana combinada para quantidade de mulheres e idosos totalmente dependentes, superiores em Granada. Embora as residências granadinas apresentassem maior número de profissionais da saúde, não houve diferenças quanto à insuficiente assistência à saúde bucal aos idosos, considerados: registro das condições de saúde bucal, circunstâncias em que essas condições são (re)avaliadas e realização sistemática de higiene bucal. Em face de um problema de saúde bucal apresentado pelo idoso, a família é comunicada, com maior frequência, nas residências granadinas. Conclusões: A assistência à saúde bucal n??o é prática sistemática nas instituições investigadas, em ambas as regiões, que transferem à família ou aos serviços locais de saúde o encaminhamento quando surgem problemas. Os procedimentos de higiene mais apontados foram escovação de dentes e próteses, porém práticas ineficazes são citadas. Foi frequente a alegação de falta de cooperação dos idosos para justificar a ausência de uma higiene bucal sistemática, revelando transferência de responsabilidades das instituições e cuidadores para o idoso.
