Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample.

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.

Daily consumption of ultra-processed foods and cardiometabolic risk factors in children aged 7 to 10 years in Northeast Brazil.

Background: Ultra-processed foods (UPFs) consumption is associated with pediatric overweight and obesity. Aim: To evaluate the UPFs consumption in children classified either as eutrophic or with excess weight (overweight and obesity). It was also described the fasting plasma glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) and the correlation between UPFs consumption and cardiometabolic risk factors. Methods: A total of 139 children aged 7-10years of both sexes, living in Northeast Brazil were classified as eutrophic (n = 65) or excess weight (n = 62). Waist circumference (WC), percentage of body fatness (% BF), fat-free-mass and fat mass were evaluated. Fasting blood sample were collected for biochemical analysis. Food consumption was classified according to the degree of processing. Results: Children with excess weight had a reduction in plasma HDL concentration (45.00; IQR:36.00-54.50 mg/dL vs. 40.00; IQR:35.75-45.25 mg/dL; p = 0.021) and an increase in blood glucose (82.00; IQR:79.00-86.00 mg/dL vs. 86.00; IQR:81.00-90.00 mg/dL; p < 0.001) and TG (64.00; IQR:45.00-92.50 mg/dL vs. 81.00; IQR:57.50-111.75 mg/dL; p < 0.021) when compared with the eutrophic children. UPFs accounted for 43.43% of the total calories consumed by children. Children with excess weight had higher total energy consumption resulting from consumption of UPFs (714.30 ± 26.32 kcal vs. 848.06 ± 349.46 kcal; p = 0.011). The absolute consumption of the UPFs showed a positive correlation with WC (r = 0.202; p = 0.023) and %BF (r = 0.198; p = 0.026). Conclusion: UPFs consumption was higher for children with excess weight and positively correlated with two cardiometabolic risk factors, suggesting the need for strengthening public policies that discourage the consumption of these foods.

The Implementation of an Integrated Oral Care Protocol for Pediatric Cancer Patients: a Qualitative Study.

AIM: In this study, we evaluated the impact of an integrated oral care protocol for pediatric patients undergoing antineoplastic treatment from the perspective of the multidisciplinary team, oral healthcare team, and caregivers. SUBJECT AND METHODS: This was a qualitative study carried out in the pediatric sector of a reference cancer hospital in Brazil. Focus group and individual semi-structured interview techniques were used, and the data were analyzed by the Discourse of the Collective Subject (DCS) method. RESULTS: A total of 44 professionals involved in providing care to children and adolescents with cancer and 38 caregivers were interviewed. All interviewees perceived an improvement in the patients' oral health condition. Health professionals reported a reduction in the occurrence and severity of oral mucositis (OM). Communicating with the medical team and understanding the importance of oral care to the patient's systemic condition were the greatest difficulties reported by the oral healthcare team. CONCLUSION: This implementation project contributed to establishing a complete multidisciplinary team to assist pediatric patients in all their needs during antineoplastic treatment. The integrated oral care protocol further contributed to reducing the occurrence and severity of OM by increasing its surveillance and diagnostic efficiency, which, altogether, improved the patients' quality of life.

Hydrochlorothiazide use is associated with the risk of cutaneous and lip squamous cell carcinoma: A systematic review and meta-analysis.

PURPOSE: The aim of this study is to investigate the association between hydrochlorothiazide (HCTZ) use and the risk of cutaneous and lip squamous cell carcinoma development. METHODOLOGY: We performed a systematic review and meta-analysis of case-control studies. We searched the Cochrane Library, PubMed, Scopus, Web of Science and LILACS. This study was registered in PROSPERO under protocol CRD42019129710. The meta-analysis was performed using the software Stata (version 12.0). RESULTS: A total of 2181 published studies referring to the theme were identified, from which six were included in this systematic review. Men were more frequently affected by cutaneous and lip squamous cell carcinoma than women, with a 1.42:1 ratio. The mean age for cutaneous and lip squamous cell carcinoma development was 73.7 years. This meta-analysis demonstrated a chance of developing cutaneous and lip squamous cell carcinoma in any region of the body in hydrochlorothiazide users of 1.76-fold higher than in non-users. In addition, a risk factor of 1.80 higher (CI 95% = 1.71-1.89) of cutaneous squamous cell carcinoma in the head and neck region was observed in HCTZ users. Moreover, in the analysis of the dose used, the chance of developing squamous cell carcinoma was 3.37-fold lower when the concentration of HCTZ used was less than 50,000 mg. CONCLUSIONS: Our results confirm the association between the use of hydrochlorothiazide and the cutaneous and lip squamous cell carcinoma development.

The impact of oral health education on the incidence and severity of oral mucositis in pediatric cancer patients: a systematic review and meta-analysis.

Oral health education is an effective measure to prevent oral mucositis (OM) by improving self-management and effectively engaging patients in their health care. This systematic review aimed to determine the impact of oral health education interventions on the incidence and severity of OM. Bibliographical searches were carried out by two independent examiners in Medline, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SIGLE, until June 2022. The eligibility criteria were based on the PICO strategy, considering studies with pediatric oncology patients, aged 0 to 19 years, who had attended oral health education activities and had been examined for the incidence and/or severity of OM. Data were extracted for qualitative synthesis and organized in spreadsheets. The quality assessment of the selected studies was performed using the ROBINS-I tool. Meta-analysis was based on the group frequencies of OM ulcerative lesions, adopting a significance level of 5%. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to define the certainty of the evidence. The primary search retrieved 1827 articles. After removing duplicate records and screening titles and abstracts for eligibility, a total of 21 articles were selected for full-text analysis. Of these, seven eligible studies were included for data extraction and qualitative synthesis, while four studies were selected for quantitative synthesis. All studies had a longitudinal design; three performed a before-after comparison and four were controlled studies. OM was assessed by the following scales: OAG, WHO, ChIMES, and WCCNR. While data analysis of the selected studies was heterogeneous, the implementation of oral health education strategies was found to reduce the incidence and severity of OM during the follow-up period. The meta-analysis showed a favorable outcome for the educational intervention. The likelihood of patients attending oral health education activities to manifest OM ulcerative lesions was significantly lower (P = 0.002) than that of the control. The GRADE analysis presented a low certainty of the evidence. To conclude, oral health education interventions improved OM outcomes in pediatric oncology patients with a low quality of evidence.

Food consumption habits, gestational age and birth weight are predictive for children with excess weight: An analysis based on artificial neural network.

The relationship between body weight gain and the onset of obesity is linked to environmental and behavioral factors, and may be dependent on biological predisposing. Artificial neural networks are useful predictive tools in the field of artificial intelligence, and can be used to identify risk factors related to obesity. The aim of this study is to establish, based on artificial neural networks, a predictive model for overweight/obesity in children based on the recognition and selection of patterns associated with birth weight, gestational age, height deficit, food consumption, and the physical activity level, TV time and family context. Sample consisted of 149 children (72 = eutrophic and 77 = overweight/obese). Collected data consisted of anthropometry and demographic characteristics, gestational age, birth weight, food consumption, physical activity level, TV time and family context. The gestational age, daily caloric intake and birth weight were the main determinants of the later appearance of overweight and obesity. In addition, the family context linked to socioeconomic factors, such as the number of residents in the household, had a great impact on excess weight. The physical activity level was the least important variable. Modifiable risk factors, such as the inadequate food consumption, and non-modifiable factors such as gestational age were the main determinants for overweight/obesity in children. Our data indicate that, combating excess weight should also be carried out from a social and preventive perspective during critical periods of development, such as pregnancy, lactation and early childhood, to reach a more effective strategy to combat obesity and its complications in childhood and adult life.

Low-Level Nanog Expression in the Regulation of Quiescent Endothelium.

OBJECTIVE: Nanog is expressed in adult endothelial cells (ECs) at a low-level, however, its functional significance is not known. The goal of our study was to elucidate the role of Nanog in adult ECs using a genetically engineered mouse model system. Approach and Results: Biochemical analyses showed that Nanog is expressed in both adult human and mouse tissues. Primary ECs isolated from adult mice showed detectable levels of Nanog, Tert (telomerase reverse transcriptase), and eNos (endothelial nitric oxide synthase). Wnt3a (Wnt family member 3A) increased the expression of Nanog and hTERT (human telomerase reverse transcriptase) in ECs and increased telomerase activity in these cells. In a chromatin immunoprecipitation experiment, Nanog directly bound to the hTERT and eNOS promoter/enhancer DNA elements, thereby regulating their transcription. Administration of low-dose tamoxifen to ROSAmT/mG::Nanogfl/+::Cdh5CreERT2 mice induced deletion of a single Nanog allele, simultaneously labeling ECs with green fluorescent protein and resulting in decreased Tert and eNos levels. Histological and morphometric analyses of heart tissue sections prepared from these mice revealed cell death, microvascular rarefaction, and increased fibrosis in cardiac vessels. Accordingly, EC-specific Nanog-haploinsufficiency resulted in impaired EC homeostasis and angiogenesis. Conversely, re-expression of cDNA encoding the hTERT in Nanog-depleted ECs, in part, restored the effect of loss of Nanog. CONCLUSIONS: We showed that low-level Nanog expression is required for normal EC homeostasis and angiogenesis in adulthood.

The effectiveness of an oral health education and prevention program on the incidence and severity of oral mucositis in pediatric cancer patients: a non-randomized controlled study.

PURPOSE: To investigate the effectiveness of an Oral Health Education and Prevention Program (OHEPP) on the incidence and severity of oral mucositis (OM) in pediatric cancer patients. The OHEEP was a ludic strategy for promoting oral health and monitoring the oral health condition. METHODS: We compared the incidence and severity of OM in patients who attended the OHEPP against those under similar conditions who did not receive educational interventions. Both groups were examined for 6 weeks by calibrated examiners (k > 0.8) using the modified Oral Assessment Guide (OAG). A total of 14 patients aged 2 to 18 years were included in each group and matched for sex, age, tumor type, and treatment modality. The incidence and severity of OM were compared using the chi-squared test (α = 5%), and the relative risk and effectiveness of the OHEPP were calculated with a statistical power of 0.97. Differences in total OAG scores between the groups were determined by the Mann-Whitney test (α = 5%). RESULTS: There was a higher incidence of OM in patients who did not attend the OHEPP (P = 0.005), and the relative risk of developing OM was significantly lower in OHEPP attendants (RR: 0.73; CI 0.60-0.92). No difference in the occurrence of severe OM was observed. OHEPP reduced the risk of developing OM by 1.4-fold, with an effectiveness of 27%. There was a difference in total OAG scores (P = 0.041). CONCLUSION: Participation in OHEPP was an effective measure to reduce the incidence of OM in pediatric cancer patients.

Integrated oral care contributes positively to the course of treatment of oncopediatric patients.

The purpose of this study was to implement a model of permanent oral health care for oncopediatric patients and to observe its effects on severe oral mucositis and subsequent treatment interruptions. We performed a quasi-experimental study in the Pediatric Department of Napoleão Laureano Hospital, in the city of João Pessoa, Brazil. A integrated oral care was implemented by a dentistry team for prevention of comorbidities, such as infections, oral pain, oral function maintenance, oral mucositis, and interventions for lesions due to severe oral mucositis. The oral comorbidities were compared before and after the implementation. The duration of severe oral mucositis (SOM) before and after the interventions and the interruptions in treatment due to SOM were the main outcome measures. Permanent oral health care reduced the duration of SOM and reduced pediatric chemotherapy interruptions due to SOM by 81.8%.Conclusion: The permanent oral health care to offer to oncopediatric patients increased surveillance regarding oral comorbidities and reduced chemotherapy interruptions due to severe oral mucositis. This care plan could be adopted anywhere around the world. What is Known: • Several studies on oral care for pediatric oncology patients, especially regarding both prevention of and treatment for oral mucositis during antineoplastic therapy, have been published. What is New: • This study describes the benefits of permanent oral care with daily oral surveillance for pediatric patients, which reduced the duration of severe oral mucositis, increased surveillance and the efficiency in diagnostic for signs of oral mucositis, enabling early intervention, and decreased chemotherapy interruptions, contributing positively to the course of treatment.

Is there an association between rheumatoid arthritis and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography? A systematic review and meta-analysis.

OBJECTIVES: Evaluate the relation of rheumatoid arthritis (RA) and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This systematic review and meta-analysis were recorded in the PROSPERO database, using the CRD42020153246 protocol. The electronic searches were performed in the following databases: Pubmed, Scopus, Web of Science, Lilacs, Cochrane, and Open Grey. Cross-sectional studies that evaluated patients with RA with bone changes in the temporomandibular joint diagnosed by CBCT, without language restriction or publication date, were included. Meta-analysis was performed in Stata Software (StataCorp, TX, USA, version 12.0), using the metan, and a random effects model, and the risk of different bone alterations occurring in adults with and without arthritis was estimated using odds ratios (ORs) as a pooled measure of effect. Forest plots were used to present the isolated and the pooled effects (ORs and 95% CI). RESULTS: Six studies were used for qualitative synthesis and 2 studies for quantitative synthesis. All studies diagnosed higher prevalence changes in the bone structures of the TMJ of RA patients, described as erosion, flattening, sclerosis, and osteophytes. Meta-analysis showed that the chance of bone changes occurring in components of the TMJ is greater in individuals who have RA. CONCLUSION: There is an association between RA and bone changes in TMJ structures diagnosed through CBCT, as RA patients were more likely to have osteoarthritic changes in this joint. CLINICAL RELEVANCE: Understanding the existence of an association between bone alterations in TMJ and RA can assist in the management of patients.

Comparative analysis between CDT in serum and Ethyl glucuronide in hair to define the best reliable tool for the diagnosis of alcohol abuse.

The increase in alcohol consumption in society has not only led to a number of medical issues but has also become a matter of considerable legal importance. Thus, there is both scientific interest and the necessity to diagnose alcohol abuse in the application of the provisions of the law through laboratory tests that ensure maximum objectivity. The purpose of this work is to study and compare the diagnostic performance of two of the main markers of alcohol abuse, serum carbohydrate-deficient transferrin (CDT) and Ethyl glucuronide (EtG) in a group of 336 driving under the influence (DUI) of alcohol offenders. Thus, it is possible to establish the best marker of alcohol consumption in order to assess the fitness to drive of DUI subjects.EtG was detected in 55 hair samples, while CDT was detected in 5 blood samples. Of the EtG-positive subjects 96,4% had CDT values below the cut-off. While CDT refers to an alcohol consumption of approximately the previous 10 days, EtG allows to detect an excessive alcohol consumption of the last few months. Because of these two different time-windows, EtG proves to be more reliable, since it is more difficult for subjects to change their drinking practice to test negative to toxicological analysis. The determination of Ethyl glucuronide on hair matrix is a valuable tool for the diagnosis of alcohol abuse, with high sensitivity and specificity and certainly greater reliability than traditional markers such as CDT, being a direct marker of alcohol consumption.

A hospital-based oral health education program impacts in pediatric cancer patients-A pilot study.

OBJECTIVES: To assess the impact of an oral health education and preventive program (OHEPP) for pediatric cancer patients. METHODS: This was a single-arm study with 27 children and adolescents undergoing antineoplastic treatments. Patients were followed up for 10 weeks, and their oral health conditions were evaluated using the Modified Gingival Index (MGI), Visible Plaque Index (VPI), and the modified Oral Assessment Guide (OAG). Audiovisual resources, storytelling, and ludic instruments were used to provide oral health education to patients and parents/caregivers. RESULTS: The patients' mean age was 9.41 (±4.49) years, and acute lymphoblastic leukemia was the most prevalent diagnosis (22.2%). Mean MGI and VPI values were 0.82 (±0.59) and 54.11% (±19.92%) at baseline and 0.33 (±0.29) and 19.83% (± 11.47%) after 10 weeks, respectively (p < .05). The mean OAG score was 9.51 (±2.54) and 36 cases (19.8%) of severe oral mucositis (SOM) were documented. Patients with higher MGI were more likely to develop SOM. CONCLUSION: The OHEPP had a positive impact on pediatric patients undergoing cancer therapy by improving their periodontal health, reducing biofilm accumulation, and preventing the development of OM lesions.

Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study.

INTRODUCTION: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. METHODS: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. RESULTS: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. CONCLUSION: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

Anthropometric analysis of orbital and nasal parameters for sexual dimorphism: New anatomical evidences in the field of personal identification through a retrospective observational study.

Orbital and nasal parameters among modern humans show considerable variation, which affects facial shape, and these characteristics vary according to race, region, and period in evolution. The aim of the study was to ascertain whether there are sex differences in the orbital and/or nasal indexes and/or the single measurements used to calculate these in a Kosovar population. The following parameters were taken into consideration: orbital height (OH), orbital width (OW), nasal height (NH), and nasal width (NW). The ratios between orbital index/nasal index (RONI) were calculated. All measurements were obtained from a population sample comprising 408 individuals. The accuracy in sex prediction was 52.86% (CI95% = 45.05%-60.67%) for NW and 64.96% for NH (CI95% = 57.50%- 72.42%). The difference between male and female indexes was statistically significant (P < 0.05). The anthropometric study revealed that only NW and NH are configured as predictors of sexual dimorphism. It could be useful to increase the number of samples to test the discriminant function in other population groups.

Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis.

The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections.

Molecular and serological diagnosis of toxoplasmosis: a systematic review and meta-analysis.

Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to serious conditions, such as encephalitis, miscarriage and blindness. Therefore, it is of utmost importance to perform a diagnosis with reproducible techniques in order to obtain a good prognosis. The aim of this review was to analyze the efficiency of toxoplasmosis diagnostic techniques based on sensitivity and specificity results. Five research platforms in English language were used (Eric, Elsevier, Google Scholar, PubMed and SciELO), which contained data on the diagnosis of toxoplasmosis. The search and selection were performed for studies published prior to June 2021. The search resulted in the inclusion of 13 articles published from 2005 to 2020. The data revealed the use of different samples in the standardization of techniques such as serum, total blood, colostrum and amniotic fluid. The flow cytometry, lateral flow immunoassay and qPCR techniques showed 100% sensitivity, whereas the ELISA, western blotting, qPCR and RE-LAMP techniques achieved 100% specificity. Significantly, the qPCR and LAMP techniques were more accurate when the likelihood ratio was assessed. The meta-analysis identified that ISAGA and western blotting have low sensitivity values and LIASON, ELFA and ELISA, using a silica bioconjugate, also have low specificity values. It was noted that a wide range of methods have high values of sensitivity and specificity. Therefore, the choice of the method will be based on the conditions and its financial viability.

Molecular characterization and epidemiology of Toxoplasma gondii isolates from free-range chickens in the southwest region of Goiás: new genotypes.

The purpose of this study was to isolate Toxoplasma gondii from tissues of free-range chickens in the southwestern region of Goiás, to detect and molecularly characterize the genetic material of the parasite, and to determine the seroprevalence of the protozoan parasite in these animals. A seroprevalence of T. gondii antibodies of 76% (19/25) was found among the chickens, while genetic material from their tissues was detected in 56% (14/25). A total of 14 isolates was obtained in the bioassay, ten of which were considered acute, eight were considered isolates of high virulence lethal to mice, and four of low virulence, considered non-lethal but with the ability to chronify the infection. Seven of the ten isolates showed significant morphometric differences from the RH strain, in terms of nucleus-complex-apical distance, length and width. Genotyping of the acute isolates was performed by RFLP-PCR, using 11 genetic markers: SAG1, SAG2 (3'SAG2 and 5'SAG2), alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and APICO. The results were compared and classified according to the genotypes listed on the ToxoDB Platform, where different profiles were observed indicating the presence of two known genotypes (#7 and #63) and five new genotypes (NEW 3, NEW4, NEW5, NEW6, NEW 7). The results showed high seroprevalence, isolation rate, molecular detection and genotypic variations of T. gondii in free-range chickens in the southwestern region of Goiás.

Effect of multidrug solution for the treatment of chemotherapy-induced oral mucositis in vivo.

Objective: Evaluate the effect of a multidrug solution, adopted by a referral hospital for cancer to control and treat chemotherapy-induced oral mucositis in rats. Methods: Oral mucositis (OM) was induced by 5-Fluorouracil (5-FU), and the animals were treated with saline (n = 8, G1), 0.12% chlorhexidine (n = 8, G2); and multidrug solution (n = 8, G3). The animals were submitted to clinical and histological analysis of the lesion using mucosal fragments. The animals' food consumption during treatment was also evaluated. Results: Clinical improvement (p < 0.05) was observed in the groups treated with the multidrug solution and 0.12% chlorhexidine digluconate. In G2 and G3, there was a prevalence of reepithelialization covering <50% of the lesion. Evaluation of the inflammatory infiltrate indicated that the G1 treatment permitted an intense inflammatory response in all animals, yet this evaluation parameter was moderate in groups G2 and G3. The G3 group (p < 0.05) presented higher food consumption than the other groups. Conclusions: The multidrug solution improved the clinical and histological parameters of the chemotherapy-induced oral mucositis, as well as promoted an increase in food intake.

Perception of Pediatric Oncological Patients and Their Parents/Guardians about a Hospital Oral Health Program: A Qualitative Study

BACKGROUND: The oral healthcare offered to pediatric cancer patients at the hospital level must include educational and preventive strategies based on dialogical and welcoming professional attitudes. Therefore, the current study aimed to evaluate the perception of pediatric cancer patients and their parents/guardians about an educational and preventive oral healthcare program implemented in a reference hospital for cancer treatment. METHODS: A qualitative follow-up investigation was conducted in which we evaluated the perception of pediatric cancer patients and their parents/guardians regarding an educational and preventive oral health program (OHEPP). The participants were 27 children and adolescents undergoing cancer treatment and their parents/guardians, and the assessment was carried out at 15 and 30 days after beginning the program through semi-structured interviews. The program used audiovisual resources, storytelling and playful instruments for the oral health education of patients and parents/guardians. The interviews were then transcribed and the Discourse of the Collective Speech (DCS) technique was performed for data analysis. RESULTS: Patients and parents/guardians reported improvement in oral hygiene habits and conditions. Patients reported greater enthusiasm for oral care and highlighted the recreational aspect of the program. Parents/guardians reported being more clear about oral changes and paying attention to the appearance of comorbidities resulting from anticancer treatment. CONCLUSIONS: This study suggests that implementation of the oral health program favored communication between health professionals, patients and their parents/guardians, expanding knowledge and generating behavior change in oral healthcare.

A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis.

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach's alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.