Association of tobacco exposure with demographic and clinicopathological factors in patients of oral squamous cell carcinoma - A single-center experience.

INTRODUCTION: Almost a third of the global load of oral squamous cell carcinoma (OSCC) occurs in India and can be attributed to the widespread use of tobacco and tobacco-related products in this part of the sub-continent. MATERIALS AND METHODS: Records of 274 patients of OSCC treated between January 2018 and December 2019 in our institute were analyzed for the study for history of tobacco abuse and distribution of associated demographic, clinical, and pathological factors. RESULTS: The age of the patients in the study ranged from 31 to 82 years with a median age of 60 years. The ratio of oral cancer in males: females was 3:1. Exposure to tobacco was seen in the majority of patients (89%) who reported with oral carcinoma. Smokeless tobacco in the form of gutka was the most common abused tobacco, followed by bidi in our study. Tongue and buccal mucosa (38% and 36%, respectively) were the most common sites. Significant statistical correlation of tobacco use was seen with age, gender, clinical, and pathological tumor stages. CONCLUSION: With tobacco being the main cause of OSCC, further studies with a larger number of patients and preferably with a comparison arm of non-tobacco OSCC would help in elucidating the exact clinical and statistical correlation of tobacco with the clinicopathological factors.

Identifying the Potential Determinants of Tobacco Counseling Implementation among Oral Health Professionals of India: A Cross-Sectional Survey

ABSTRACT Objective: To identify the potential determinants of tobacco counseling implementation among oral health professionals in India. Material and Methods: A cross-sectional survey was carried out among the 298 dentists of Aligarh and Gwalior. The questionnaire used in the study had sections on dentists' sociodemographic data and a 35-item questionnaire to assess the potential determinants of tobacco cessation counseling. Descriptive statistics were carried out, and a Chi-square test was utilized to determine the association. P-value <0.05 was considered statistically significant. Results: Domains "knowledge", "Professional Responsibility and Identity", and "Remembrance, awareness, and judgment" showed a statistically significant correlation with most tobacco cessation counseling behaviors. In addition, undergraduate education received in Tobacco Cessation counseling, and Continuing education received in Tobacco Cessation counseling had significantly impacted the practice of tobacco cessation counseling (p=0.02 and 0.04, respectively). Conclusion: This study suggests that "Knowledge", "Professional Responsibility and Identity" and "Remembrance, awareness, and judgment" are the potential determinants that could be used to design effective strategies to enhance tobacco counseling among dentists in India.

Efeito da fumaça de cigarro sobre alinhadores ortodônticos transparentes / Effect of cigarette smoke on clear orthodontic aligners

O objetivo deste trabalho foi investigar as alterações nas propriedades ópticas de cor e de luz transmitida e na rugosidade de superfície do polímero constituinte de alinhadores transparentes após a exposição à fumaça de cigarro. A amostra foi constituída de 20 superfícies das faces vestibulares de incisivos centrais superiores obtidas através de 10 alinhadores de alinhadores ortodônticos (Invisalign®). As amostras foram divididas igual (n=10) e aleatoriamente em 2 grupos: grupo controle (GC) e grupo experimental (GE). Para a exposição do GE à fumaça de cigarro foi utilizado um dispositivo de acrílico hermeticamente fechado, onde as amostras foram expostas a 21 ciclos de fumaça e posteriormente armazenadas em saliva artificial à 37ºC por 15 dias. O GC foi exposto somente à saliva artificial nas mesmas condições, pelo mesmo período. Para avaliar as mudanças de cor e transmitância foi utilizado um espectrofotômetro calibrado pelo sistema cores CIE (L*a*b*) e utilizado o National Bureal of Standards (NBS) para classificação clínica da alteração de cor. A diferença total de cor (∆E) e o NBS entre os grupos foi calculado. Foram feitas medidas de cor e transmitância inicial (T0), ou seja, antes da exposição à fumaça de cigarro e à saliva artificial e final (T1), registradas após a exposição ao cigarro e à saliva. A rugosidade foi avaliada através do rugosímetro digital e foram medidas a rugosidade em T0 e T1. Foram utilizados os parâmetros de rugosidade Ra (rugosidade média) e Rz (rugosidade de profundidade média). Para comparar os valores dos parâmetros de cor, transmitância e rugosidade entre GC e GE foi utilizado o teste t para amostras independentes. Para comparar os valores dos parâmetros analisados intragrupo ao longo do tempo (T0 e T1) foi utilizado o teste t para amostras pareadas. Em todas as análises foi estabelecido um nível de significância de 0,05. Para todos os parâmetros de cor em T1 houve diferença (p<0,05) quando comparados GC (L: 87,400 ± 0,681; a: 0,746 ± 0,094; b: 3,393 ± 0,171) com GE (L: 77,208 ± 3,337; a: 1,576 ± 0,025; b: 6,747 ± 0,557). O ΔE do GC (2,39) e GE (14,27) apresentaramse diferentes (p=0,002), ao converter tais valores para a escala NBS, resultaram em um valor de 2,20 e 13,13. Ao comparar os grupos houve diminuição da transmitância (p=0,014) sendo de maior magnitude no GE. Em T1 entre GC e GE houve diferença (p=0,046) para Ra (GC: 0,122 ± 0,002; GE: 0,139 ± 0,007), sendo maiores os valores no GE. Para Rz, quando comparados GC (0,616 ± 0,021) e GE (0,741 ± 0,026), em T1, também houve diferença (p=0,002), sendo também maiores os valores encontrados no GE. No GC não houve diferença estatisticamente significativa de Ra (p=0,807) e Rz (p=0,231) quando comparadas as amostras ao longo do tempo T0 e T1. No GE ocorreu tanto aumento de Ra (p=0,003) e de Rz (p=0,014). Conclui-se, portanto, que os alinhadores se tornaram mais escuros, amarelados, diminuíram sua transmissão de luz, tornando-se opacos e tiveram sua rugosidade superficial aumentada, tanto no parâmetro Ra quanto Rz. (AU)

The aim of this study was to investigate the changes in the optical properties of color and transmitted light and in the surface roughness of the constituent polymer of clear aligners after exposure to cigarette smoke. The sample consisted of 20 surfaces of the buccal surfaces of the upper central incisors of aligners (Invisalign®). The samples were divided equally (n=10) and randomly into 2 groups: control group (CG) and experimental group (EG). For the exposure of the EG to cigarette smoke, a hermetically closed acrylic device was used, where the samples were exposed to 21 smoke cycles and later stored in artificial saliva at 37ºC for 15 days. The CG was only exposed to artificial saliva under the same conditions, for the same period. To evaluate changes in color and transmittance, a spectrophotometer calibrated by the CIE color system (L*a*b*) was used and the National Bureau of Standards (NBS) was used for clinical classification of the color change. The total difference in color (∆E) and NBS between groups was calculated. Initial (T0) color and transmittance measurements were taken, that is, before exposure to cigarette smoke and artificial saliva, and final (T1), recorded after exposure to cigarettes and saliva. Roughness was evaluated using a digital roughness meter and roughness was measured at T0 and T1. The roughness parameters Ra (mean roughness) and Rz (mean depth roughness) were used. To compare the values of color, transmittance and roughness parameters between GC and EG, the t test for independent samples was used. To compare the values of the parameters analyzed within the group over time (T0 and T1), the t test for paired samples was used. In all analyses, a significance level of 0.05 was established. There was a difference (p<0.05) for all color parameters in T1 when comparing GC (L: 87.400 ± 0.681; a: 0.746 ± 0.094; b: 3.393 ± 0.171) with GE (L: 77.208 ± 3.337; a: -1.576 ± 0.025; b: 6.747 ± 0.557). The ΔE of the GC (2.39) and GE (14.27) were different (p=0.002), when converting these values to the NBS scale, resulted in a value of 2.20 and 13.13. Comparing the groups there was a decrease in transmittance (p=0.014), with greater magnitude in the GE. At T1, there was a difference (p=0.046) between GC and GE for Ra (GC: 0.122 ± 0.002; GE: 0.139 ± 0.007), with higher values in EG. For Rz, when comparing GC (0.616 ± 0.021) and GE (0.741 ± 0.026), at T1, there was also a difference (p=0.002), with higher values found in GE. In the CG, there was no statistically significant difference in Ra (p=0.807) and Rz (p=0.231) when comparing samples over time T0 and T1. In the GE, there was both an increase in Ra (p=0.003) and Rz (p=0.014). It is concluded, therefore, that the aligners became darker, yellowish, reduced their light transmission, becoming opaque and had their surface roughness increased, both in the Ra and Rz parameters. (AU)

Pancreatitis crónica: análisis de factores de progresión de la enfermedad / Chronic pancreatitis: analysis of disease progression factors

BACKGROUND: Alcohol and tobacco are important risk factors for chronic pancreatitis (CP). AIM: To analyze the effect of etiological factors such as tobacco and alcohol and pancreatic enzyme replacement therapy (PERT) in the progression of CP. MATERIAL AND METHODS: Patients with a diagnosis of CP were recruited and grouped according to variables such as tobacco, alcohol and PERT. They were followed for 18 months. Subsequently, different variables and analytical parameters involved in the progression of the disease were analyzed. RESULTS: A total of 50 patients diagnosed with CP were included. Of these, 28 patients underwent PERT, 39 were smokers and 33 were alcohol users. Compared with patients without PERT, those with PERT had a higher proportion of diabetes (64 and 32%, respectively), had a higher need for endoscopic treatment (25 and 0%, respectively) and a normal body mass index (71 and 27.3%, respectively. The smokers had higher calcium levels and increased lymphocytosis and leukocytosis. The alcohol consumption group had a higher mean age (p = 0.04) CONCLUSIONS: PERT may improve the nutritional status but does not reduce the need for endoscopic or surgical treatment. Smoking and alcohol consumption favored the progression of CP. Also, smoking induced a pro-inflammatory state.

Intoxicación severa por Nicotiana glauca (Palán Palán) con miocardio atontado / Severe poisoning by Nicotiana glauca (Palán Palán) with stunned myocardium

Resumen Nicotiana glauca también llamada Palán Palán, es un arbusto con hojas verdes azuladas y despulidas y una flor amarilla tubular pendulante que presenta alcaloides piridínicos, como nicotina, nornicotina, anatabina y anabastina (análogo estructural de la Nicotina). Se presenta el caso clínico de una paciente de 50 años con cuadro agudo de debilidad muscular generalizada que evoluciona con paro respiratorio, tras la ingesta accidental de una cantidad desconocida de hojas de Nicotiana glauca, cultivadas en una huerta hogareña mediante técnica de hidroponía y confundidas por su conviviente con espinaca. Presentó aumento de lactato y Troponina Ultra Sensible e Hipoquinesia Global de Ventrículo Izquierdo en el ecocardiograma, compatible con Aton tamiento Miocárdico (AM), que evolucionó favorablemente. Si bien hay pocos reportes, se han informado muertes de animales y humanos, tras la ingesta accidental de Nicotiana glauca. El inicio del cuadro es rápido, con patrón bifásico, con vómitos y estímulo simpático, seguido por bloqueo ganglionar y neuromuscular, pudiendo presentar paro respiratorio, shock, convulsiones y coma. El AM es una disfunción miocárdica prolongada con retorno gradual de la actividad contráctil, posterior a un episodio breve de isquemia grave, puede ser asintomático, pudiendo presentar alteraciones en el electrocardiograma, enzimas cardíacas o ecocardiograma. Generalmente presenta pronóstico favorable, pudiendo presentar insuficiencia cardíaca ante patologías concurrentes o aumento de requerimientos de oxígeno.

Abstract Nicotiana glauca is a shrub with bluish green leaves and a pendulous tubular yellow flower. It has pyridine alkaloids, such as nicotine, nornicotine, anatabine and anabastine (structural analog of Nicotine). We present the case of a 50 years old pa- tient with acute generalized muscle weakness that evolves to respiratory arrest, after accidentally ingesting an unknown quantity of Nicotiana glauca leaves, grown in a home vegetable garden, using a hydroponic technique and confused by her cohabiting with spinach. She presented increased lactate and Ultra Sensitive Troponin and Left Ventricular Global Hypokinesia in the echo- cardiogram, compatible with Myocardial Stunned, that it evolved favorably. There are few reports, animal and human deaths have been reported following accidental ingestion of Nicotiana glauca. The onset of the symptoms is early, with a biphasic pattern, with vomiting and sympathetic stimulation, followed by ganglionic and neuromuscular blockage and may present respiratory arrest, shock, seizures and coma. Myocardial Stunned is a prolonged myocardial dysfunction with gradual return of contractile activity after a brief episode of severe ischemia, it can be asymptomatic, and it can present alterations in the electrocardiogram, cardiac enzymes or echocardiogram. Generally presents a benign prognosis, being able to present heart failure with concurrent patholo- gies or increased requirements.

Contribuição para a prevenção e controle do tabagismo: desenvolvimento de um manual digital direcionado aos cirurgiões-dentistas / Contribution to the prevention and control of smoking: development of a digital manual for dentists

O tabagismo é a principal causa de morte evitável no mundo, considerado uma pandemia e um problema de saúde pública. É uma doença crônica definida pela dependência à nicotina, substância presente nos produtos à base de tabaco e um fator de risco para diversas doenças (doenças cardiovasculares, pulmonares e diversos tipos de câncer). O tabaco prejudica também a saúde bucal, sendo fator de risco para o câncer de boca e diversas outras doenças, como a periodontite e periimplantite. O objetivo do presente trabalho foi desenvolver um manual, numa versão digital com ISBN (International Standard Book Number), direcionado aos cirurgiões-dentistas para atualização dos mesmos a respeito do tema tabagismo para que possam orientar melhor seus pacientes e ajudar de forma mais assertiva na prevenção, cessação e encaminhamento do paciente. Outro objetivo foi a elaboração de uma ficha de história tabágica, como uma proposta para ser adicionada à ficha de anamnese dos pacientes tabagistas atendidos na clínica odontológica. A metodologia utilizada foi a revisão da literatura sobre o tema e a experiência em um serviço de cessação de tabagismo (Núcleo de Estudos e Tratamento do Tabagismo -NETT) no Hospital Universitário Clementino Fraga Filho, na UFRJ. A interação ensino-serviço permitiu a elaboração do conteúdo do manual que será divulgado em site do Conselho Regional de Odontologia. Concluiu-se que o controle do tabagismo depende da articulação de diversas estratégias, como ações interprofissionais que podem exercer efeito positivo na saúde das pessoas e de suas famílias, além de reduzir o ônus econômico pessoal e para o sistema de saúde. (AU)

Smoking is the leading cause of preventable death in the world, considered a pandemic and a public health problem. It is a chronic disease defined by dependence on nicotine, a substance present in tobacco-based products and a risk factor for several diseases (cardiovascular diseases, lung diseases and various types of cancer). Passive smoking also increases the risk of developing these diseases. Tobacco also impairs oral health, being a risk factor for oral cancer and several other diseases, such as periodontitis and peri-implantitis. The objective of this work was to develop a manual, in a digital version with ISBN (International Standard Book Number), aimed at dentists to update them on the subject of smoking so that they can better guide their patients and help in a more assertive way in prevention, cessation and referral of the patient. Another objective was to develop of a smoking history form, as a proposal to be added to the anamnesis form of smoking patients seen at the dental clinic. The methodology used was the literature review on the subject and the experience in a smoking cessation service (Center for Studies and Treatment of Smoking - NETT) at the University Hospital Clementino Fraga Filho, at UFRJ. The teaching-service interaction allowed the preparation of the content of the manual that will be published on the website of the Regional Council of Dentistry. It was concluded that the control of smoking depends on the articulation of several strategies, such as interprofessional actions that can have a positive effect on the health of people and their families, in addition to reducing the personal economic burden and the health system. (AU)

Socio-environmental risks associated with the green tobacco sickness in farmers: a case-control study / Riesgos socioambientales asociados a la enfermedad del tabaco verde en agricultores: un estudio caso-control / Riscos socioambientais associados à doença da folha verde do tabaco em agricultores: um estudo caso-controle

ABSTRACT Objective: to determine the presence of socio-environmental risk factors for the development of Green Tobacco Sickness in workers who grow Burley tobacco. Method: matched case-control study. The data collection took place in two moments: from December 2016 to January 2017 and December 2017, when the Burley tobacco was collected, through a household survey with interview application and urine collection for urinary cotinine. Results: the socio-environmental risk factors that remained associated with the disease were: bundling tobacco (p=0.047) and wearing socks (p=0.011); with protective effect were found sticking tobacco seeding of the day (p=0.006) and number of tobacco harvested per day (p=0.021). Conclusion: the steps in the Burley tobacco work process increase the exposure and risk of developing the disease. By identifying these factors, it is possible to address interdisciplinary control and prevention measures.

RESUMEN Objetivo: determinar la presencia de factores de riesgo socioambientales para el desarrollo de la Enfermedad del Tabaco Verde en trabajadores que cultivan el tabaco Burley. Método: estudio del tipo caso-control pareado. La recolección de datos ocurrió en dos momentos: de diciembre de 2016 a enero de 2017 y diciembre de 2017, período en que ocurrió la recolección del tabaco Burley, por medio de encuesta domiciliaria con aplicación de entrevista y recolección de orina para el examen de cotinina urinaria. Resultados: los factores de riesgo socioambientales que permanecieron asociados a la enfermedad fueron aferrar tabaco (p=0,047) y usar medias (p=0,011); con efecto protector fueron encontrados espetar los pies de tabaco del día (p=0,006) y el número de pies de tabaco cosechados por día (p=0,021). Conclusión: las etapas del proceso de trabajo con tabaco Burley aumentan la exposición y el riesgo de desarrollar la enfermedad. Al identificar estos factores, es posible dirigir, de forma interdisciplinaria, medidas de control y prevención.

RESUMO Objetivo: determinar a presença de fatores de riscos socioambientais para o desenvolvimento da Doença da Folha Verde do Tabaco em trabalhadores que cultivam o tabaco Burley. Método: estudo do tipo caso-controle pareado. A coleta de dados ocorreu em dois momentos: de dezembro de 2016 a janeiro de 2017 e dezembro de 2017, período em que ocorreu a colheita do tabaco Burley, por meio de inquérito domiciliar com aplicação de entrevista e coleta de urina para exame de cotinina urinária. Resultados: os fatores de riscos socioambientais que permaneceram associados à doença foram enfeixar tabaco (p=0,047) e usar meias (p=0,011); com efeito protetor foram encontrados espetar pés de tabaco do dia (p=0,006) e número de pés de tabaco colhido por dia (p=0,021). Conclusão: as etapas do processo de trabalho com tabaco Burley aumentam a exposição e o risco de desenvolver a doença. Ao identificar esses fatores, é possível direcionar, de forma interdisciplinar, medidas de controle e prevenção.

Factores ambientales en el desarrollo y evolución de la enfermedad inflamatoria intestinal / Environmental risk factors in the development and evolution of inflammatory bowel disease

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Biomass smoke COPD has less tomographic abnormalities but worse hypoxemia compared with tobacco COPD

Special attention has emerged towards biomass smoke-induced chronic obstructive pulmonary disease (COPD), providing new knowledge for prevention and therapeutic approach of non-smoker COPD patients. However, the understanding of biomass smoke COPD is still limited and somewhat controversial. The aim of the present study was to compare COPD exclusively caused by tobacco smoking with COPD exclusively caused by environmental or occupational exposures. For this cross-sectional study, COPD patients were recruited from outpatient clinics and formed two groups: non-smoker COPD group (n=16) with exposure to biomass smoke who did not smoke cigarette and tobacco smoker COPD group (n=15) with people who did not report biomass smoke exposure. Subjects underwent pulmonary function tests, thoracic high-resolution computed tomography, 6-min walk test, and sputum induction. The non-smoker COPD group had biomass smoke exposure of 133.3±86 hour-years. The tobacco COPD group smoked 48.5±27.4 pack-years. Women were 62.5 and 66.7%, respectively, of non-smokers and smokers. The non-smoker COPD group showed higher prevalence of dyspnea, lower arterial oxygen tension (PaO2), and lower arterial oxygen saturation (SaO2%) with similar spirometry results, lung volumes, and diffusion capacity. Regarding inflammatory biomarkers, differences were detected in sputum number of lymphomononuclear cells and in sputum concentrations of interleukin (IL)-6 and IL-8 with higher values in the smoker group. Emphysema was more prevalent in the tobacco smoker group, which also showed higher relative bronchial wall thickness and lower lung density by quantitative analysis. Biomass smoke induced more hypoxemia compared to tobacco in COPD patients with similar severity.

Low p27kip1 expression in head and neck squamous cell carcinoma: association with risk factors and adverse outcomes

Background: Squamous cell carcinoma (SCC) of head and neck is highly prevalent in South-asian countries, owing to high consumption of areca nut/gutka and chewing tobacco. p27kip1 is a tumor suppressor gene, thought to be downregulated in oral squamous cell carcinoma. Therefore, in the present study we used immunohistochemical analysis to investigate an association between low p27kip1 expression in SCC of the head and neck and adverse outcomes/risk factors. Methods: Total 105 cases of SCC of head and neck excision specimens were selected from records of pathology department archives that underwent surgeries at Liaquat National hospital, Karachi from January 2008 till December 2013. Clinical and pathologic characteristics of patients were evaluated and p27kip1 immunohistochemistry was applied on tumor blocks. Results: In our study, low expression of p27kip1 in SCC of head and neck was seen in 39(37.1%) cases while 66(62. 9%) of the cases showed high expression for p27kip1. Significant association of p27kip1 expression with pan/gutka usage (p = 0.004), and recurrence (p = 0.001) was noted; however, no significant association of p27kip1 expression with other clinicopathologic features was seen. Multivariate binary logistic regression showed cases with history of pan/gutka usage were more likely to show low p27kip1 expression. Similarly, we also found that recurrence was more likely to develop in patients with low expression of p27kip1 in comparison to cases showing high p27kip1 expression. Conclusion: Loss of p27kip1 expression is a significant event involved in the pathogenesis of SCC head and neck especially that of oral cavity. Significant association of gutka/areca nut with low p27kip1 expression in our study suggests that loss p27kip1 expression is a major event involved in areca nut induced SCC of head and neck in this part of the world; however, more large scale molecular based studies are required to validate this observation. Moreover, significant association of low p27kip1 expression with tumor recurrence suggests its importance as a prognostic biomarker in SCC of head and neck (AU)

Hyaluronic acid in tobacco-exposed rats. Inflammatory reaction, and duration of effect

Abstract Purpose: To evaluate the hyaluronic acid (HA) inflammatory reaction, fibroblasts, fibrosis and duration of effect in the dorsal region of tobacco-exposed rats. Methods: Ten Wistar rats were divided into two groups: tobacco-exposed-group (TEG;n=5) and air-control-group (CG;n=5). The TEG animals were tobacco-exposed twice a day, 30-minutes/session, during 60 days. After this period, all animals received 0.1 mL HA subcutaneous injection in the dorsal area. The volume of HA was measured immediately after HA injection and weekly using a hand-caliper in nine weeks. After this period, all the animals were euthanized, and a specimen of was collected to evaluate inflammatory cells, fibroblasts, and fibrosis by HE. Results: This study showed a higher inflammatory reaction in TEG than CG: inflammatory cell-count (CG: 1.07±0.9; TEG: 8.61±0.36, p<0.001); fibroblast count (CG: 2.92±0.17; TEG: 19.14±0.62, p<0.001), and fibrosis quantification (CG: 2.0; TEG: 3.75, p<0.001). The analysis of the HA volume in nine weeks in the dorsal region did not show a difference between groups (p=0.39). Conclusions: This study suggested that the HA injection in the TEG caused an increase in inflammatory cell count, fibroblast, and fibrosis quantification when compared to the CG. There was no difference in the duration of effect of HA between the groups.

Tabagismo e gravidez: influência na morfologia fetal / Smoking and pregnancy: influence on fetal morphology

O hábito de fumar durante a gravidez é uma das causas evitáveis de morbidade e mortalidade infantil e materna. A nicotina tem efeitos principalmente no desenvolvimento cerebral e pulmonar fetal. Considerando que apenas uma minoria das mulheres fumantes em idade fértil consegue parar de fumar ao engravidar, o tabagismo entre mulheres jovens é o principal determinante da prevalência do tabagismo durante a gravidez. Este estudo de revisão sistemática pesquisou nas bases de dados Bireme, Scielo, PubMed, Lilacs e Site Up to Date. A seleção levou em conta seus títulos e resumos relacionados ao assunto, no período entre 2010 e 2017, utilizando os descritores tabaco/tobacco, nicotina/nicotine, hábito de fumar/smoking, gravidez/pregnancy e desenvolvimento fetal/fetal morphology. Foram encontrados 75 artigos; destes, foram selecionados 25, os mais recentes estudos randomizados, relatos de casos, estudos coortes e de alto teor teórico, necessários para a construção do texto. Através desta análise, observou-se a necessidade de uma intervenção política mais intensa para desencorajar o hábito de fumar, ocasionar maior impacto das mídias e redes sociais sobre esse assunto e maior atuação dos profissionais da saúde. Portanto, identificar os fatores associados ao tabagismo no período gestacional pode facilitar a implementação de programas que ajudem a diminuir os malefícios sobre a saúde materno-fetal.(AU)

Smoking during pregnancy is one of the preventable causes of infant and maternal morbidity and mortality. Nicotine has effects primarily on fetal brain and lung development. Considering that only a minority of women of childbearing age can quit when they become pregnant, smoking among young women is the main determinant of the prevalence of smoking during pregnancy. This systematic review study searched the Bireme, Scielo, PubMed, Lilacs and Site Up to Date databases. The selection took into account the titles and summaries related to the subject, from 2010 to 2017, using the descriptors tabaco / tobacco, nicotine / nicotine, smoking tuxedo, pregnancy / fetal development and fetal morphology. We found 75 articles, of which 25 were selected, the most recent randomized studies, case reports, cohort studies, and high theoretical content required for the construction of the text. Through this analysis we observed the need for a more intense political intervention that discourages smoking, greater impact of the media and social networks on this subject and greater performance of health professionals. Therefore, identifying the factors associated with smoking in the gestational period may facilitate the implementation of programs that help reduce the harm to maternal-fetal health.(AU)

É possível parar de fumar?

Entenda as dificuldades que podem surgir no início do tratamento e os principais riscos à saúde do dependente do cigarro.

Costo por años de vida perdidos: una propuesta para estimar el impuesto al tabaco / Cost per year of potential life lost: a proposal to estimate tobacco taxation

RESUMEN Objetivos Determinar y justificar la carga impositiva de los cigarrillos, con base en los años de vida que se pierden por su consumo. Métodos Mediante revisión de literatura se estimó la reducción promedio de la expectativa de vida de un fumador. Se aplicó a cada año perdido el valor empleado en estudios de costo-efectividad, de tres veces el PIB per cápita (COP 16 613.951 de 2015, equivalentes a USD 6 056, aplicando tasa de 1 USD=2 743 COP). A partir de los años de consumo promedio, y de los paquetes que consume en ese lapso, se estimó el impuesto que debería tener cada paquete para que, con un interés de 3 % anual, el fumador al fallecer reuniera el valor correspondiente a los años que pierde. Resultados Dada una reducción promedio de esperanza de vida de seis años, cada fumador debería contribuirle al sistema de salud COP 299 051 115 (USD 109 008). Si en promedio consume 166 paquetes de cigarrillos anuales, durante 50 años, debería reunir COP 2.659 648 (USD 969) cada año, y cada paquete debería tener un impuesto de COP 16 022 (USD 5,84). Conclusiones Si se acepta que el sistema de salud pague hasta tres PIB per cápita por cada año de vida por intervenciones en salud que aporten años, es razonable que aquellas intervenciones que quitan años de vida hagan también un aporte equivalente.(AU)

ABSTRACT Objectives Taxes are the most effective measure to reduce tobacco consumption, although this remains a controversial matter. This study presents a method to determine and justify taxation based on the monetary value of the years of potential life lost due to tobacco consumption. Methods A literature review allowed estimating the average reduction of life expectancy in smokers. The value used in cost-effectiveness studies -three times the GDP per capita (COP 16 613 951 for 2015, equivalent to USD 6 056, applying an exchange rate of USD 1=COP 2743) - was applied to each year lost. Considering the average years of tobacco consumption and the number of packs consumed during that period, the tax that each pack should have was estimated in such a way that, by the time the smoker dies, he or she will have paid for the years lost with an annual interest rate of 3 %. Results Given an average reduction of life expectancy of 6 years, each smoker should contribute to the health system with COP 299 051 115 (USD 109 008). With an annual average consumption of 166 cigarette packs for 50 years, a smoker should pay each year COP 2 659 648 (USD 969), which means that each cigarette pack should have a tax of COP 16 022 (USD 5.84). Conclusions If it is accepted that the health system has to pay up to three times the GDP per capita for each year of life in health interventions that add years, it is reasonable to think that those interventions that take away years of life should also make an equivalent contribution.(AU)

Cigarrillo y cáncer de cuello uterino / Cigarette and cervical cancer

El cáncer es un problema de salud pública mundial y su incidencia sigue elevándose. El 90 a 95% de las causas se deben a factores externos, de esos factores externos, el cigarrillo representa el 20 a 25%. La Agencia Internacional para la Investigación del Cáncer (IARC) han evaluado 62 de los 5.000 compuestos químicos del tabaco o cigarrillo, siendo considerados con suficientes evidencias como carcinogénicos tanto para humanos como para animales. Entre los canceres que han sido asociados con el consumo del cigarrillo, se encuentra el Cáncer del Cuello Uterino (CaCU). El CaCu está asociado a la infección del Virus del Papiloma Humano, sin embargo, hay fuerte evidencias que el cigarrillo es un factor de riesgo independiente en la origen y evolución del CaCU.

Cancer is a worldwide public health problem and its incidence is increasing. External factors are the 90-95% of the causes, cigarette represents the 20-25%. International Agency for Cancer Research has evaluated 62 of the 5.000 cigarette or tobacco chemical compounds; they have been considered with enough evidences as carcinogenic. Among the cancers that have been associated to the cigarette or tobacco, the Cancer of the Cervix (CaC) is one of them. The CaC is associated to the infection of the Human Papillomavirus, however, there are strong evidences that support the cigarette as an independent risk factor in the origin and evolution of the CaC.

Tabaquismo crónico y cirugía plástica / Chronic smoking and plastic surgery

Se describe la repercusión del tabaquismo crónico en el proceso de cicatrización de las heridas, en la actividad del sistema inmunitario y en el proceso de envejecimiento cutáneo. Esto condiciona diversas complicaciones en cirugía plástica de estos pacientes fumadores.

The impact of chronic smoking in the process of wound healing, in the activity of the immune system and in the process of skin aging is described. This conditions various complications in plastic surgery of these smokers.

Dicas em saúde: Câncer: dicas para se prevenir

Informações de utilidade pública sobre doenças, prevenção de acidentes, cuidados com a higiene, entre outros.