IL-17A and IL-17F polymorphisms in rheumatoid arthritis and Sjögren's syndrome.

OBJECTIVE: The aim of this study was to evaluate the influence of Th17 polymorphisms on the susceptibility or severity of rheumatoid arthritis (RA) and Sjögren's syndrome (SS). MATERIALS AND METHODS: The study sample comprised 206 individuals of both genders divided into three groups: exclusive rheumatoid arthritis (RA-100 patients), rheumatoid arthritis and Sjögren's syndrome (RA/SS-31 patients), and healthy controls (C-75 individuals). All the individuals were submitted to clinical evaluation, unstimulated sialometry, and Schirmer test; some patients with RA were also submitted to minor salivary gland biopsy for definition of SS diagnosis. Saliva samples were collected for isolation of DNA and genotyping of Th17 genes; IL-17A (-197G/A) and IL-17F (7488T/C). RESULTS: IL-17A (-197G/A) and IL-17F (7488T/C) SNPs were not associated with susceptibility to RA or secondary SS (sSS, p > 0.05 for both SNPs). In addition, they did not influence RA activity or clinical markers of SS. CONCLUSION: IL-17A (-197G/A) and IL-17F (7488T/C) polymorphisms are not associated with the susceptibility nor to the severity of RA and sSS in the studied population. CLINICAL RELEVANCE: A better understanding of the pathogenesis of SS is demanded to an adequate treatment as well as to the development of new management strategies.

Congenital labial mucocele: rare presentation of a common disease.

Oral mucoceles are common lesions characterized by accumulation of mucus following rupture of a minor salivary gland duct. However, congenital mucoceles are a rare and distinctive oral condition observed in newborns. This case report details the features of a congenital labial nodule diagnosed as congenital mucocele. These lesions are rare in the oral cavity and should be diagnosed in the delivery room, but many cases are referred for further evaluation. Management is simple, and recurrence is not expected.

Effect of Xerostomia on the Functional Capacity of Subjects with Rheumatoid Arthritis.

OBJECTIVE: To evaluate the intensity of xerostomia and hyposalivation in subjects with rheumatoid arthritis (RA) as well as the effects of these conditions on functional incapacity and disease activity. METHODS: The study sample comprised 236 individuals of both sexes who had RA. All the individuals were submitted to clinical evaluation and unstimulated sialometry. Functional capacity was determined by using the Health Assessment Questionnaire (HAQ), xerostomia was assessed using the Xerostomia Inventory, and disease activity was evaluated with the 28-joint Disease Activity Score (DAS28). The effect of Sjögren syndrome (SS) was analyzed, and the sample was divided into 2 groups: RA (191 subjects) and RA/SS (45 subjects). RESULTS: The Xerostomia Inventory showed positive and significant correlation with fatigue (r = 0.243; p < 0.0001), number of painful joints (r = 0.218; p = 0.001), HAQ (r = 0.279; p < 0.0001), and DAS28 (r = 0.156; p < 0.0001). On regression analysis, both xerostomia (OR 3.89, 95% CI 1.84-8.23, p < 0.001) and DAS28 (for severe disease activity: OR 13.26, 95% CI 3.15-55.79, p < 0.001) showed influence on functional incapacity. Forty-five individuals (19.1%) presented with secondary SS, and having this diagnosis was not associated with disease activity or functional capacity. CONCLUSION: Xerostomia demonstrated an adverse effect on quality of life of subjects with RA, being associated with a reduction in functional capacity. In this clinical setting, xerostomia can be monitored as a marker of worse clinical evolution.

Serologic profile and clinical markers of Sjögren syndrome in patients with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to evaluate the clinical relevance of rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) in patients with Sjögren syndrome (SS) secondary to rheumatoid arthritis (RA). METHODS: The study included 118 individuals, and the subjects were divided into three groups: rheumatoid arthritis (RA; n = 46), RA with secondary Sjögren syndrome (RA/SS; n = 20) and healthy controls (C; n = 52). Clinical and laboratory characteristics, including ocular, oral, and serum markers, anti-CCP, and rheumatoid factor (RF), were compared in addition to biopsy of labial minor salivary glands. RESULTS: The RA group exhibited unstimulated salivary flow rate, and Schirmer test results were similar to those for C and higher than those for RA/SS (P < .05). Furthermore, the frequency of xerophthalmia and xerostomia was similar among the RA and C groups, and much higher in the RA/SS group (P < .05). Anti-CCP positivity and serum levels were similar in both RA groups, irrespective of SS diagnosis (RA × RA/SS; P > .05). RF presented a similar frequency and serum level between the RA and RA/SS groups (P > .05). CONCLUSIONS: Secondary SS seems to be a cluster of oral and ocular symptoms among patients with RA. Anti-CCP and RF are not relevant to evaluate the presence of SS among these patients.

Satisfação dos Usuários do Programa Medicamento em Casa em uma Equipe de Saúde da Família em Município Baiano / Users' Satisfaction of Medicine at Home Program in a Family Health Team at in a Municipality of Bahia

Diante da criação do Programa Medicamento em Casa (Medcasa), buscou-se descrever o perfil e a satisfação dos usuários do Programa em uma Unidade de Saúde do município de Itabuna-BA. Trata-se de um estudo quantitativo, descritivo, transversal, realizado com os 39 participantes hipertensos e/ou diabéticos cadastrados. Utilizou-se questionário estruturado com os blocos: perfil, hábitos de vida, doença acometida e satisfação do usuário do programa. Para o armazenamento dos dados foi utilizado o programa Microsoft Excel 2007 e análise por meio da estatística descritiva. Os resultados apontam a predominância do sexo feminino (84,62%), faixa etária entre 60 e 69 anos (35,90%), realização da atividade física três vezes por semana (41,0%), não etilistas (79,49%), não tabagistas (94,87%), hipertensos (76,92%), tempo no programa Medcasa menor que seis meses (38,46%), com frequência mensal de acompanhamento (46,15%), recebendo principalmente anti-hipertensivos(74,36%). Em relação à satisfação e adesão ao programa, 74,36% sempre participaram, 82,05% relataram que não tiveram problemas, 48,72%consideraram ótimo, 94,87% referiram que o programa atendia as suas necessidades, 82,05% apontaram como vantagem não precisar irà Unidade de Saúde para adquirir os medicamentos, 69,23% não ficavam sem o medicamento, pois são fornecidos no prazo estabelecido,48,72% não precisavam enfrentar fila para adquirir os medicamentos. Os resultados mostraram que o programa Medcasa tem elevado índice de satisfação, portanto sua implantação em outras unidades de saúde no Município se apresenta como uma alternativa viável para a melhoria do acesso aos medicamentos de forma equânime, além de contribuir para a manutenção do controle e prevenção de complicações das doenças crônicas não-transmissíveis.

In face of the creation of ?Drug at House? Program (Medcasa), this study aimed to evaluate the user satisfaction of the Program at a HealthUnit in the city of Itabuna-BA. It is a quantitative, descriptive, cross-sectional study, conducted with 39 hypertensive participants and / orregistered diabetics. A structured questionnaire in blocks was used: profile, lifestyle, presence of comorbidities and user satisfaction with theprogram. Microsoft Excel 2007 program was used for data analysis. The results shows the predominance of females (84.62%), aged between 60and 69 years (35.90%), realization of physical activity three times a week (41.0%), non-drinkers (79.49%), non-smokers (94.87%), hypertension(76.92%), less than six in months of participation in the Medcasa program (38.46%), monthly monitoring frequency (46.15%), mostly receivingantihypertensive (74.36%). Regarding the satisfaction and adherence to the program, 74.36% individuals have always participated, 82.05%reported no problems, 48.72% considered great, 94.87% reported that the program attended to their needs, 82,05%pointed out the advantageof not needing to go to the Health Unit to acquire the drugs, 69.23% did not care the medicine because it was delivered on time, 48.72% didnot face lines to purchase the drugs. The results showed that the program Medcasa has a high level of satisfaction and effectiveness, thus itsimplementation in other health units in the city may be a viable alternative to improving access to medicines in an equitable way, and contributeto maintaining control and preventing complications of chronic non-communicable diseases.

Avaliação das manifestações orais em crianças e adolescentes internos em um hospital submetidos à terapia antineoplásica / Oral manifestations in hospitalized children and adolescents subjected to antineoplastic therapy

Objetivo: Identificar a prevalência das alterações bucais decorrentes do tratamento antineoplásico e sua correlação com o hemograma em crianças e adolescentes internos pelo Sistema Único de Saúde (SUS) em um hospital em Maceió-AL. Método: Estudo transversal realizado na enfermaria da Oncologia Pediátrica de um hospital em Maceió-AL, com uma amostra de 40 pacientes oncológicos em terapia antineoplásica, com idade entre 1 e 17 anos, de ambos os gêneros, atendidos no período de fevereiro à setembro de 2011. Foi preenchido um prontuário com dados referentes à história médica, a doença atual, odontológica e nutricional, hábitos de higiene oral, hemogramas realizados, incluindo hematócritos, hemoglobina, plaquetas e leucócitos, bem como exame extra e intra-oral uma ou mais vezes. Foi realizada análise estatística descritiva e utilizado o teste não paramétrico de Mann-Whitney com nível de significância de 5%. Resultados: Houve maior prevalência no gênero masculino (57,5%) e dos tumores sólidos (45%). Em 80% houve alguma alteração oral, com predominância de petéquias (40%), seguida de mucosite (35,5%), boca seca (17,5%), úlcera (15%), sangramento gengival (15%), candidíase (10%), gengivite ulcerativa necrosante (10%) e palidez da mucosa (5%). Houve 15% dos internamentos por alterações orais. Houve relação positiva entre plaquetas e leucócitos e a presença de petéquias (p<0,05). Para sangramento gengival houve relação positiva entre todas as variáveis do hemograma (p<0,05). Para pacientes com mucosite grau III e IV houve relação positiva entre leucócitos e plaquetas. Houve diferença significativa entre as distribuições de idade dos pacientes com gengivite ulcerativa necrosante (GUN) e sem GUN (p<0,05). Conclusão: Houve alta ocorrência de alterações orais, significância para as variáveis do exame hematológico analisadas e a ocorrência de complicações orais e ocorrência de GUN nos adolescentes da pesquisa...

Objective: To identify the prevalence of oral manifestations subsequentto antineoplastic therapy and its correlation with complete blood countin children and adolescents admitted in a public hospital in the city ofMaceió, AL, Brazil.Method: This cross-sectional study was undertaken in the PediatricOncology outpatient service of a hospital located in Maceió, AL, Brazil.Forty male and female 1-17-year-old oncologic patients subjected toantineoplastic therapy between February and September 2011 wereenrolled. A clinical chart was filled out containing data on the medicalhistory, the current disease, dental and nutritional history, oral hygienehabits, results of complete blood counts, including hematocrit,hemoglobin, platelet and leukocyte counts, as well as extra- andintraoral examination performed once or more times. Descriptivestatistical analysis was performed using the non-parametric Mann-Whitney test with a significance level of 5%.Results: There was prevalence of males (57.5%) and solid tumors (45%).Eighty percent of the patients presented some type of oral alterationwith predominance of petechiae (40%), followed by mucositis (35.5%),dry mouth (17.5%), ulcers (15%), gingival bleeding (15%), candidiasis(10%), necrotizing ulcer gingivitis (NUG) (10%) and pale mucosa (5%).In 15% of the cases, oral alterations resulted in hospitalizations. Therewas positive correlation between platelet and leukocyte counts and thepresence of petechiae (p<0.05). Gingival bleeding had positivecorrelation with all complete blood count variables. Patients with gradeIII and IV mucositis presented positive correlation between leukocytesand platelets. There was a statistically significant difference betweenthe age distribution of patients with or without NUG (p<0.05).Conclusion: There was high incidence of oral alterations, significancebetween the hematological exam variables and occurrence oralcomplications and NUG in the adolescents in this study...