Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer.

BACKGROUND: The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than 100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public system aids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients with oral cancer is associated with socioeconomic factors. MATERIAL AND METHODS: A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019. Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementary education; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) were analyzed by multiple logistic regression (p<0.05). RESULTS: Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018 (OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender, men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-white individuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referred by the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796). CONCLUSIONS: It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associated with socioeconomic factors.

Maxillofacial trauma due to traffic accidents and falls: an exploratory study of associated factors.

BACKGROUND: This study aimed to determine the pattern of Maxillofacial trauma (MFT) due to traffic accidents and falls in a reference hospital in a rural region of northeastern Brazil between December 2011 and December 2018 and to identify associated factors. MATERIAL AND METHODS: This was a cross-sectional study using 585 medical records of patients with MFT. The data were subjected to a Poisson-Tweedie multiple regression analysis to estimate the Prevalence ratio (PR), with a 95% confidence interval (95% CI) and a significance level of p<0.05. RESULTS: MFT due to traffic accidents was more prevalent among patients 21 to 40 years old (PR=2.30; 95% CI=1.20-4.41; p<0.001) diagnosed with zygomatic-orbital complex fractures (PR=1.80; 95% CI=1.08-2.98; p=0.023). Falls were more frequent among older groups of 41 to 60 years (PR=1.83; 95% CI=1.09-3.06; p=0.022) and over 61 years (PR=2.23; 95% CI=1.09-3.06; p=0.022). In traffic accidents, alcohol consumption increased the length of stay (PR=2.081; 95% CI=1.553-2.787; p<0.001), and patients who did not use personal protective equipment (PPE) had higher hospital costs (PR=179.964; 95% CI=1.485-1.994; p<0.001) for this etiology. Traffic accidents and falls are two of the main etiologies of MFT, especially for males in the young adult age group (traffic accidents) and those above 41 years (falls). Alcohol consumption and the nonuse of PPE influenced the length of the hospital stay and hospital costs. CONCLUSIONS: Strategies to confront this problem, such as road and highway improvements, effective enforcement of laws and intersectoral coordination involving the entire community to implement policies and prevention programs targeted at these populations, can be implemented.

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017.

BACKGROUND: This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. MATERIAL AND METHODS: This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (α<0.05). RESULTS: There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p=0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p<0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases. CONCLUSIONS: Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil.

Socio-demographic characteristics are related to the advanced clinical stage of oral cancer.

BACKGROUND: Social determinants may be associated with the onset and progression of the clinical stage of oral cancer. AIM: To evaluate the impact of socio-demographic characteristics on the prevalence of advanced clinical stage of oral cancer. MATERIAL AND METHODS: Information about 51,116 cases of oral cancer, from all Brazilian states, between 2000 and 2012, was obtained from the Cancer Registry Information System. The clinical stage of oral cancer (dependent variable) was classified as initial (stages I and II) or advanced (stages III and IV). The relationship between the clinical stage of oral cancer and the following independent variables was analyzed: sex, age, schooling, marital status, family history of cancer, and origin of referral. Analyses on frequency distribution and multivariate binary logistic regression model were performed (α<0.05). RESULTS: Compared to individuals with no schooling, those who attended elementary to high school (OR=2.461) and college education (OR = 3.050) had a higher prevalence of advanced cases of oral cancer. Individuals without a partner (OR = 14,209) demonstrated a higher prevalence compared to married individuals. Subjects aged 20-44 years (OR = 4.081) and 45-64 years (OR = 14.875) had a higher prevalence compared to those aged 15-19 years. The variables gender, family history of cancer and origin of referral integrated the binary model of logistic regression, but did not present statistical significance. CONCLUSIONS: Socioeconomic factors may be related to the advanced clinical stage of oral cancer.

Assessment of artefacts produced by metal posts on CBCT images.

AIM: To evaluate artefact intensity in cone beam computed tomography (CBCT) images of two alloys used in metal posts scanned using different exposure parameters. METHODOLOGY: The sample consisted of 20 single-rooted teeth divided into two groups for use with either a NiCr post or AgPd post. All teeth were scanned with and without their corresponding metal posts and with and without the presence of an extra restored tooth in the arch. The samples were scanned using CS 9000 3D scanner with two exposure protocols: 85 kV 6.3 mA and 85 kV 10 mA. Voxel size and FOV were fixed at 0.100 mm and 5 cm × 3.75 cm. The presence of artefacts was assessed qualitatively by two calibrated observers using the CBCT volume and paired 2D images, and quantitatively by one trained observer, using ImageJ software. Wilcoxon's signed rank, Mann-Whitney, kappa and chi-square tests were used for qualitative analyses. Two-way anova and Tukey's tests were used for quantitative analyses. All analyses were conducted considering the 95% confidence level (α < 0.05). RESULTS: For the CBCT volume qualitative analysis, significant differences were observed between the metal alloys in the presence of an extra restored tooth, with higher artefact intensity for AgPd when assessing hypodense halos and lines (P = 0.006). Images with two restored teeth had significantly more hypodense and hyperdense lines (P = 0.033). When evaluating exposure parameters and number of restored teeth, the paired image quality analysis revealed significant disagreement between observers for diagnostic image quality (P = 0.001). Quantitative artefact analysis revealed higher artefact intensity for the AgPd posts in the presence of two restored teeth. CONCLUSION: Although the exposure parameters tested did not interfere with artefact intensity, post alloys with a higher atomic number and the presence of another metal structure in the arch increased artefact intensity and impaired the diagnostic quality of CBCT images.

Impact of the anatomical location, alcoholism and smoking on the prevalence of advanced oral cancer in Brazil.

BACKGROUND: To evaluate the prevalence of oral cancer in Brazil according to the clinical stage, anatomical location, alcoholism and smoking. MATERIAL AND METHODS: Data referring to 31,217 cases of oral cancer, from 2000 to 2010, were obtained from the Integrator Module of the Hospital Registry of Cancer. Inconsistent data ("non-classified" cases) was eliminated and 21,160 cases were analyzed. The frequency distribution according to clinical stage, anatomical location, alcoholism and smoking was analyzed descriptively and through a binary logistic regression model (α<0.05). The clinical stage (dependent variable) was dichotomized in early stage (I and II) or advanced stage (III and IV). The year of diagnosis, anatomical location and deleterious habits (alcoholism and smoking) were considered independent variables. RESULTS: The most frequent characteristics were: oropharynx location (n=3856, 18.41%), clinical stage IV (n=11924, 56.09%) and combined use of alcohol and tobacco (n=19226; 61.59%). The year 2009 (p<0.01, PR = 1.162, CI-95%=1.053-1.283) and location at the base of tongue (p<0.01, PR = 2.485, CI-95% = 2.182-2.807) presented a higher prevalence ratio for advanced stage oral cancer. The combined use of alcohol and tobacco showed a higher prevalence rate for the advanced clinical stage of cancer (p<0.01, PR =1.449, CI-95%=1.382-1.520) if compared to individuals without habits, or just alcoholics. CONCLUSIONS: Higher prevalence of advanced stage of oral cancer is related to the localization at the base of the tongue and to the concomitant use of alcohol and tobacco. Therefore, it can be suggested that all these characteristics lead to a worse prognosis of oral cancer.

Atividade antibacteriana de Óleos Essenciais sobre Streptococcus mutans e Staphylococcus aureus / Antibacterial Activity of Essential Oils against Strains of Streptococcus and Staphylococcus

Este trabalho objetivou avaliar a ação antimicrobiana in vitro dos óleos essenciais de Ocimum basilicum (Manjericão Exótico), Thymus vulgaris (Tomilho Branco), e de Cinnamomum cassia (Canela da China) sobre cepas bacterianas de Streptococcus mutans (ATCC 25175) e Staphylococcus aureus (ATCC 25923). A atividade antibacteriana dos óleos essenciais foi determinada pela Concentração Inibitória Mínima (CIM) e a Concentração Bactericida Mínima (CBM) através da técnica de microdiluição e do esgotamento. Para a CIM, foram utilizadas placas de 96 poços e inseriu-se 100µL de caldo BHI, 100µL da diluição dos óleos essenciais no primeiro poço e 10µL da suspensão bacteriana (1,5x10(6) microrganismos/mL). Realizou-se a diluição seriada partindo-se da concentração inicial de 8% até 0,0625%. A CIM correspondeu à última diluição na qual não foi verificada a presença de bactérias. Para obter a CBM, realizou-se a semeadura em Ágar Miller-Hinton das diluições correspondentes a CIM, 2CIM e 4CIM. As placas foram incubadas a 37º C em estufa bacteriológica por 24 horas. Os testes foram realizados em triplicata tendo a clorexidina como controle positivo. Para S. aureus (ATCC 25923) a CIM e CBM dos óleos essenciais de C. cassia, O. basilicum e T. vulgaris foram 0,0625%, 4% e 0,0625%, respectivamente. Para S. mutans a CIM e a CBM dos óleos essenciais de C. cassia e T. vulgaris foram 0,125% e 0,25%, respectivamente. Já a CIM do O. basilicum foi 4% e não apresentou ação bactericida. Conclui-se que os óleos essenciais avaliados apresentaram ação antibacteriana frente a cepas de S. mutans e S. aureus, sendo que os menores valores de CIM e de CBM foram provenientes dos óleos de C. cassia e T. vulgaris.

The aim of this study is to evaluate the in vitro antimicrobial activity of essential oils of Ocimum basilicum (basil), Thymus vulgaris (thyme) and Cinnamomum cassia (Chinese cinnamon) against strains of Streptococcus mutans (ATCC 25175) and Staphylococcus aureus (ATCC 25923). The antibacterial activity of the essential oils was determined by Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). The MIC was obtained by the microdilution technique using 96-well microplates, in which we inserted: 100µL of Brain Heart Infusion broth at double concentration, 100µL of the dilution of the essential oils and 10µL of bacterial suspension (1.5 x 10(6) organisms / mL). The products were diluted from the initial concentration of 8% up to 0.0625%. The MIC corresponded to the last dilution in which there was no presence of bacteria or turbidity in the culture medium. The MBC was obtained by seeding, in Mueller-Hinton agar, 10µL aliquots of dilutions corresponding to the MIC and the two immediately preceding ones (2MIC and 4MIC). The plates were incubated at 37°C in a bacteriological incubator for 24 hours. The tests were performed in triplicate, and 2% Chlorhexidine Digluconate was the control product. For S. aureus, the MIC and MBC of the essential oils of C. cassia, O. basilicum and T. vulgaris were 0.0625%, 0.0625% and 4%, respectively. For S. mutans, the MIC and MBC of the essential oils of C. cassia and T. vulgaris were 0.125% and 0.25%, respectively. The MIC of O. basilicum against S. mutans was 4% and the essential oil showed no bactericidal action. Chlorhexidine Digluconate presented antibacterial activity against all organisms. The evaluated essential oils presented antibacterial activity against the strains of S. mutans and S. aureus, and we highlight the essential oils from C. cassia and T. vulgaris with the lowest MIC and MBC.

Atividade antifúngica de óleos essenciais frente a amostras clínicas de Candida albicans isoladas de pacientes HIV positivos / Antifungal activity of essential oils against clinical samples of Candida albicans isolated from HIV-positive patients

Objetivou-se avaliar a atividade antifúngica dos óleos essenciais de Ocimum basilicum L. (manjericão), Cymbopogon martinii L. (palmarosa), Thymus vulgaris L. (tomilho) e Cinnamomum cassia Blume (canela da china) sobre cepas de Candida albicans isoladas de pacientes HIV positivos e cepa padrão (ATCC 76845). Quinze amostras clínicas de C. albicans (C1-C15) foram repicadas em ágar Sabouraud Dextrose, para confecção de suspensões em solução salina estéril (0,9%) contendo 1,5 x 10(6) UFC mL-1. As emulsões dos óleos essenciais foram preparadas em água destilada estéril e tween 80, com concentrações variando entre 1024 µg mL-1 e 4 µg mL-1. A ação antifúngica foi determinada por meio da Concentração Inibitória Mínima (CIM) utilizando-se a técnica da microdiluição. Foram utilizados como controles positivos a nistatina e o miconazol (50 µg mL-1). Os testes foram realizados em triplicata, sendo a CIM, a menor concentração capaz de inibir o crescimento das leveduras, observada por método visual de acordo com a turvação do meio de cultura. Para C. albicans (ATCC 76845), a CIM do óleo essencial de C. cassia foi 64 µg mL-1, enquanto para óleo de C. martinii foi 1024 µg mL-1. Para as cepas clínicas, verificou-se que a CIM de C. cassia para 80% das cepas foi 64 µg mL-1, sendo a variação dos valores da CIM entre 128 µg mL-1 e 64 µg mL-1. Observou-se que para 66,6% das amostras clínicas, a CIM de C. martinii foi 612 µg mL-1. Constatou-se que a nistatina não apresentou atividade frente às cepas clínicas (C1-C15), enquanto a atividade antifúngica do miconazol foi verificada em 100% das amostras. Não se constatou atividade antimicrobiana dos óleos essenciais de O. basilicum e T. vulgaris, nas concentrações avaliadas. Concluiu-se que os óleos essenciais de C. cassia e C. martinii, em diferentes concentrações, apresentam atividade antifúngica sobre cepas de C. albicans isoladas de pacientes HIV positivos e cepa padrão (ATCC 76845). Entretanto não foi observada inibição antimicrobiana para os óleos de O. basilicum e T. vulgaris.

The aim of this study was to evaluate the antifungal activity of essential oils from Ocimum basilicum L. (basil), Cymbopogon martinii L. (palmarosa), Thymus vulgaris L. (thyme) and Cinnamomum cassia Blume (Chinese cinnamon) against Candida albicans strains isolated from HIV-positive patients and the standard strain (ATCC 76845). Fifteen clinical samples of C. albicans (C1-C15) were subcultured in Sabouraud Dextrose agar to prepare suspensions in sterile saline solution (0.9%) containing 1.5 x 10(6) CFU mL-1. The emulsions of essential oils were prepared in sterile distilled water and Tween 80, with concentrations ranging between 1024 µg mL-1 and 4 µg mL-1. The antifungal action was determined by means of the Minimum Inhibitory Concentration (MIC), using the microdilution technique. Nystatin and miconazole (50 µg mL-1) were used as positive controls. The tests were performed in triplicate and the MIC was the lowest concentration capable of inhibiting the growth of yeasts, which was observed by the visual method, according to the turbidity of the culture medium. For C. albicans (ATCC 76845), the MIC of C. cassia essential oil was 64 µg mL-1, while the MIC for C. martini was 1024 µg mL-1. Considering the clinical strains, the MIC of C. cassia was 64 µg mL-1 for 80% of the strains, and the variation in MIC values was between 128 µg mL-1 and 64 µg mL-1. For 66.6% of the clinical samples, the MIC of C. matinii was 612 µg mL-1. Nystatin did not present activity against the clinical strains (C1-C15), while the antifungal activity of miconazole was noticed for 100% of the samples. The antimicobrial activity of essential oils from O. basilicum and T. vulgaris was not identified at the evaluated concentrations. It was concluded that the essential oils from C. cassia and C. martinii, at different concentrations, presented antifungal activity against C. albicans strains isolated from HIV-positive patients and the standard strain (ATCC 76845). However, antifungal activity was not observed for the essential oils from O. basilicum and T. vulgaris.