Análise dos indicadores de saúde bucal e o risco de pneumonia associada à ventilação mecânica em unidade de terapia intensiva / Analysis of oral health indicators and the risk of pneumonia associated with mechanical ventilation in an intensive care unit

Dentre as infecções relacionadas a assistência à saúde (IRAS), a pneumonia associada à ventilação mecânica (PAV) é a mais comum nas unidades de terapia intensiva (UTI). O controle do biofilme oral tem sido apontado como medida eficaz na prevenção da infecção. No entanto, o risco de adquirir PAV em indivíduos com comprometimento da saúde oral por doenças bucais instaladas permanece incerto. Este estudo se propôs investigar se existe associação entre o status de saúde oral e o risco de PAV por meio da análise de indicadores de saúde bucal e de infecções respiratórias em UTI. Trata-se de um estudo de coorte retrospectivo que analisou dados secundários de pacientes hospitalizados na UTI da Irmandade do Hospital Santa Casa de Poços de Caldas entre o período de janeiro e agosto de 2022. O estudo deu início após aprovação pelo Comitê de Ética e Pesquisa da Faculdade de Saúde Publica da USP. O status de saúde oral foi obtido através da aplicação do Índice de Saúde e Asseio Oral que mensura o comprometimento de saúde e asseio oral numa escala de 0 a 30, atribuindo aos diferentes níveis respectivas categorias: 0-4 baixo, 5-11 moderado, 12-18 alto e 19-30 grave. Dos 182 indivíduos analisados, 39,6% (n = 72) tiveram diagnóstico de PAV. Pacientes com desfecho permaneceram na UTI mais que o dobro de dias 33,66 ± 23,61 do que aqueles sem o desfecho 14,09 ± 21,23 (OR 1,06; IC95% 1,03-1,08 p<0,001). Na análise de indivíduos não expostos ao tratamento odontológico, observou-se que maior tempo médio de internação foi associado à maior chance de PAV sendo o tratamento apontado como modificador de efeito na relação entre ISAO e PAV (OR 1,11; IC95% 1,07-1,17 p<0,001). Não houve associação entre ISAO na admissão e PAV (OR 1,08;0,38-3,07). Novos estudos que investiguem esta associação são necessários, uma vez que o comprometimento da saúde oral pode levar a processos inflamatórios que prejudicam a recuperação e evolução do paciente na UTI.

Among healthcare-associated infections (HAIs), ventilator-associated pneumonia (VAP) is the most common in intensive care units (ICU). The control of the oral biofilm is pointed out as an effective measure in prevent VAP. However, the risk of acquiring VAP in individuals with oral health impairment due to pre-existing diseases remains uncertain. This study aimed to investigate whether there is an association between oral health status and the risk of VAP by analyzing oral health indicators and respiratory infections in the ICU. This retrospective cohort study analyzed secondary data from patients hospitalized in the ICU of the Irmandade do Hospital Santa Casa de Poços de Caldas between January and August 2022. After Ethics Committee approval, the oral health status was obtained by applying the Oral Health and Hygiene Index, which measures oral health and hygiene status on a scale of 0 to 30, assigning different levels to their respective categories: 0-4 low, 5-11 moderate, 12-18 high and 19-30 severe. Of the 182 individuals analyzed, 39.6% (n = 72) were diagnosed with VAP. Patients with the outcome remained in the ICU for over twice as many days 33.66 ± 23.61 than those without the outcome 14.09 ± 21.23 (OR 1.06; 95% CI 1.03-1.08 p<0.001). In the analysis of individuals not exposed to dental treatment, it was observed that a longer average length of stay was associated with a higher chance of VAP, and treatment was identified as an effect modifier in the relationship between ISAO and VAP (OR 1.11; 95% CI 1.07-1.17 p<0.001). There was no association between ISAO on admission and VAP (OR 1.08;0.38-3.07). New studies that investigate this association are required, since compromised oral health may impair patient recovery and outcome in the ICU.

Epithelial membrane antigen and DOG1 expression in minor salivary gland tumours.

Epithelial membrane antigen (EMA) and DOG1 are used as marker of epithelial cells, particularly the luminal cells, of salivary gland tumours. The aim of this study was to compare the EMA and DOG1 expression in tumours of minor salivary glands. Cases of pleomorphic adenoma (PA), basal cell adenoma (BCA), canalicular adenoma (CA), adenoid cystic carcinoma (ACC), polymorphous adenocarcinoma (PAC), mucoepidermoid carcinoma (MEC) and epithelial-myoepithelial carcinoma (EMC) were submitted to immunohistochemistry for EMA and DOG1. In PA and BCA, EMA and DOG1 were observed in luminal cells, while in CA the tumour cells were negative for both proteins. The EMA and DOG1 pattern expression detected in EMC was similar to that one observed in benign tumours. In ACC, both myoepithelial e epithelial expressed EMA and DOG-1. PAC tumour cells were only positive for DOG1, whereas MEC were only positive for EMA. In conclusion, EMA and DOG1 expression in benign salivary gland tumours was similar to normal salivary gland tissue and can be used as good marker of tumoral cells derived from intercalated ducts or its progenitor cells, while in malignant salivary gland tumours EMA expression is, however, better used as an indicator of aggressive behavior than a marker of luminal cells.