Educação permanente centrada na abordagem ao paciente com diabetes mellitus: importância da equipe multiprofissional / Permanent education centered on approaching patients with diabetes mellitus: importance of the multiprofessional team / Educación permanente enfocada en el abordaje de pacientes con diabetes mellitus: importancia del equipo multiprofesional

O diabetes, assim como outras doenças crônicas, exige monitoramento constante e autocuidado. Objetivou-se identificar as contribuições da equipe multiprofissional para a prevenção de complicações e tratamento do diabetes mellitus em pacientes. Trata-se de uma pesquisa exploratória descritiva, com abordagem quantitativa, realizada com 31 profissionais de saúde, lotados em Unidades de Saúde de Curitiba (PR). Resultou na identificação dos assuntos para os quais os profissionais gostariam de ser melhor capacitados e nos itens considerados importantes para estímulo e qualificação do cuidado ao paciente diabético. Foi elaborada uma Carteira de Cuidados, com estímulo ao autocuidado, colocando equipe e paciente como aliados no controle da doença. Considera-se que uma equipe multiprofissional ativa e capacitada, com visão aprimorada sobre a doença e seus determinantes, aliada a um paciente esclarecido sobre o autocuidado, é a combinação favorável para o sucesso do tratamento, prevenção de complicações crônicas e redução de danos à saúde do indivíduo.

Diabetes, like other chronic diseases, requires constant monitoring and self-care. The objective was to identify the contributions of the multidisciplinary team for the prevention of complications and treatment of diabetes mellitus in patients. This is a descriptive exploratory study, with a quantitative approach, carried out with 31 health professionals, working in Health Units in Curitiba/PR. It resulted in the identification of subjects for which professionals would like to be better trained and the items considered important for stimulating and qualifying care for diabetic patients. A Care Card was prepared, encouraging self-care, placing the team and the patient as allies in controlling the disease. It is considered that an active and trained multidisciplinary team, with an improved view of the disease and its determinants, combined with a patient who is knowledgeable about self-care, is a favorable combination for successful treatment, prevention of chronic complications, and reduction of damage to the individual's health

La diabetes requiere un seguimiento y un autocuidado constante. El objetivo fue identificar las contribuciones del equipo multidisciplinario para la prevención de complicaciones y tratamiento de la diabetes mellitus. Se trata de una investigación exploratoria descriptiva, realizada con 31 profesionales de salud, actuando en Unidades de Salud de Curitiba/PR. El resultado fue la identificación de temas para los cuales a los profesionales les gustaría ser mejor capacitados y los ítems considerados importantes para estimular y calificar la atención al paciente diabético. Se elaboró una Tarjeta de Cuidados, incentivando el autocuidado, colocando al equipo y al paciente como aliados en el control de la enfermedad. Se considera que un equipo multidisciplinario capacitado, con una mejor visión de la enfermedad y sus determinantes, combinado con un paciente conocedor del autocuidado, es una combinación favorable para el éxito del tratamiento, la prevención de complicaciones crónicas y la reducción de daños a la salud del individuo.

Vitamin D Receptor Gene Polymorphisms and Environment Influencing the Impact on Survival in Hemodialysis Patients.

INTRODUCTION: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival. MATERIAL AND METHODS: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis. RESULTS: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis. CONCLUSIONS: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.

Association among oral health parameters, periodontitis, and its treatment and mortality in patients undergoing hemodialysis.

BACKGROUND: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD. METHODS: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all-cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group. RESULTS: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow-up time of 64.1 ± 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non-use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model. CONCLUSIONS: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.

Analysis of IL1 gene polymorphisms and transcript levels in periodontal and chronic kidney disease.

UNLABELLED: Chronic kidney disease (CKD) and periodontitis (PD) are complex inflammatory disturbances, influenced by genetic factors. Interleukin (IL)-1 genes code for inflammatory mediators involved in the physiopathogenesis of both diseases. Functional polymorphisms in IL1 genes modulate cytokine levels and have been associated with susceptibility to immune-inflammatory conditions. OBJECTIVES: The aim of this study was investigate the association of functional IL1 gene polymorphisms and transcript levels with susceptibility to CKD and PD. DESIGN: The sample consisted of 246 individuals, mean age 44.8 years, divided into: group 1 (64 patients without CKD and without PD), group 2 (58 without CKD and with PD), group 3 (52 with CKD and without PD) and group 4 (72 with CKD and with PD). DNA was obtained from cells of oral mucosa and polymorphisms IL1AC-889T, IL1BC-511T, IL1BC+3954T and IL1RN (intron 2) were analyzed by PCR-RFLP. Transcript levels from gingival tissues were analyzed by real-time PCR. RESULTS: IL1RN(*)1 allele was associated with almost 4-fold increased risk for CKD (OR 3.92 95% CI=1.6-9.4, p=0.002). IL1RN(*)2 allele was associated with 3-fold increased risk for PD in CKD patients (OR 3.08 95% CI=1.2-7.9, p=0.019). Allele T for polymorphism IL1B+3954 was associated with CKD in PD patients (OR 2.28 95% CI=1.1-4.7, p=0.019). Significantly increased levels of transcripts of IL1A, IL1B and IL1RN genes were found in PD patients. CONCLUSIONS: It was observed an evidence for association of IL1B and IL1RN alleles with susceptibility to CKD and PD. Higher levels of IL1 gene transcripts were found in PD patients.

Oral health in Brazilian patients with chronic renal disease.

BACKGROUND: Poor oral health status may have an impact on the health status of patients with chronic renal failure. AIM: To describe the oral health status of a group of Brazilian patients with chronic renal failure. MATERIAL AND METHODS: Retrospective review of the medical records of patients with chronic renal failure, of whom 13 (4.5%) were in a predialysis stage, 158 (55%) were on hemodialysis, 23 (8.4%) were on peritoneal dialysis and 92 (32.1%) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) index. RESULTS: The sample was composed of 152 men (53%) and 134 women (47%), aged 42+/-13 years. Oral health status was considered defective in most patients (83%). Eighty-seven percent had dental calculus and 55% had halitosis. Transplant patients reported significantly less halitosis (40.2%) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. CONCLUSIONS: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Oral health in Brazilian patients with chronic renal disease / Salud oral en pacientes brasileños con insuficiencia renal crónica

Background: Poor oral health status mayhave an impact on the health status of patients with chronic renal failure. Aim: To describe the oral health status of a group of Brazilian patients with chronic renal failure. Material and methods: Retrospective review of the medical records of patients with chronic renal failure, ofwhom 13 (4.5 percent) werein apre dialysis stage, 158 (55 percent) were on hemodialysis, 23 (8.4 percent) were on peritoneal dialysis and 92 (32.1 percent) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) índex. Resulte: The sample was composed of 152 men (53 percent) and 134 women (47 percent), aged 42±13 years. Oral health status was considered defective in most patients (83 percent). Eighty-seven percent had dental calculus and 55 percent had halitosis. Transplant patients reponed significantly less halitosis (40.2 percent) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. Conclusions: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Introducción: Las alteraciones de la cavidad oral pueden tener impacto en la salud de pacientes con insuficiencia renal crónica. Objetivo: Describir la salud oral de pacientes brasileños con insuficiencia renal crónica. Material y métodos: Revisión retrospectiva de las fichas dentales de pacientes con insuficiencia renal crónica, de los cuales 13 (4,5 por ciento) estaban en etapa prediálisis, 158 (55 por ciento) estaban en hemodiálisis, 23 (8,4 por ciento) estaban en peritoneodiálisis y 92 (32,1 por ciento) habían sido trasplantados. Se registró la salud oral general, la presencia de tártaro y halitosis. El número de piezas faltantes y obturadas fue analizado utilizando el índice DMF-T (Decayed, Missed and Filled Teeth o dientes con cañes, faltantes y obturados). Resultados: La muestra estaba constituida por 152 hombres y 134 mujeres con una edad promedio de 42±13 años. La salud dental general era deficitaria en 83 por ciento y 87 por ciento tenía tártaro. El 55 por ciento tenía halitosis y ¡os pacientes trasplantados tenían este problema con una frecuencia significativamente menor que el resto de ¡os grupos. El índice DMF-T global fue 20,6 y tuvo una correlación positiva con la edad. Conclusiones: La salud oral de estos pacientes con insuficiencia renal crónica es mala. Es importante implementar programas de tratamiento dental para estos pacientes para evitarla exposición a patógenos que pueden causar complicaciones sistémicas.

Prevalência de lesões bucais diagnosticadas pelo Laboratório de Histopatologia do UnicenP / Prevalence of oral lesions diagnosed by UnicenP histopathology laboratory

Foi realizado um estudo retrospectivo de 1.963 lesões bucomaxilofaciais diagnosticadas pelo Laboratório de Histopatologia da Faculdade de Odontologia do UnicenP/PR no período de 2003 a 2006, para demonstrar a prevalência das lesões bucais mais frequentes, correlacionando-as com idade e gênero. Os resultados mostraram 82 variantes histológicas diferentes. O perfil epidemiológico de pacientes acometidos por patologias mostrou percentual maior em indivíduos do sexo feminino (65,82%), com maior frequência na 5a. década de vida (24%) e média de idade de 44,2 anos. Os dados evidenciaram a hiperplasia fibrosa inflamatória como a lesão mais prevalente (30,6%), seguida de fibroma (21,29%), cisto radicular (5,2%) e mucocele (5,04%)

The aim of this study has fundamental importance for the fact belonging to the Public Health area as well as Oral Pathology, whose knowledge favors the prevention, diagnosis, prognosis and a correct therapeutic to be instituted for each case. A retrospective study of 1963 oral and maxillofacial lesions diagnosed by the Histopathology Laboratory of the Scholl of Dentistry ­ UnicenP was carried out over a 3-year period, with an analysis of prevalence of these lesions, correlating them to age and sex, through a study of the respective lauds of histopathologic diagnosis. From the results, 82 different diagnoses were observed. The epidemiologic profile of these patients was characterized by female (65,82 %), with a greater frequency on the 5th decade of life (24%), average of 44,2 year-old age. Data evidenced Inflammatory Fibrous Hyperplasia the most prevalent lesion (30,6%), followed by Fibroma (21,29%), Radicular Cyst (5,2%) and Mucocele (5,04%)

Association between vitamin D receptor gene polymorphisms and susceptibility to chronic kidney disease and periodontitis.

BACKGROUND/AIMS: Chronic kidney disease (CKD) and periodontitis (PD) are serious public-health concerns. Vitamin D is a fat-soluble steroid hormone that interacts with its nuclear receptor (VDR) to regulate a variety of biological processes, such as bone metabolism, immune response modulation and transcription of several genes involved in CKD and PD disease mechanisms. The aim of this work was to investigate the association between polymorphisms in the VDR gene and end-stage renal disease (ESRD) and PD. METHODS: 222 subjects with and without ESRD (in hemodialysis) were divided into groups with and without PD. Polymorphisms TaqI and BsmI in the VDR gene were analyzed by PCR restriction fragment length polymorphism. The significance of differences in allele, genotype and haplotype frequencies between groups was assessed by the chi2 test (p value <0.05) and odds ratio (OR). RESULTS: Allele G was associated with protection against ESRD: groups without versus with ESRD (GG) x (GA+AA): OR = 2.5, 95% CI = 1.4-4.6, p = 0.00; (G x A): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02; (TG + CG) x (TA + CA): OR = 1.5, 95% CI = 1.0-2.3, p = 0.02. No association was observed between the study polymorphisms and susceptibility to or protection against PD. CONCLUSION: Allele G of the VDR BsmI polymorphism was associated with protection against ESRD.

Nevo melanocítico: revisão de literatura e relato de caso clínico / Melanocytic nevi: literature review and clinical case report

Nevo é um termo genérico que se refere a malformações da pele e da mucosa, podendo ser de natureza congênita ou de desenvolvimento. Os nevos surgem nas camadas epiteliais superficiais ou em qualquer uma das variedades de tecido conjuntivo subjacente ao epitélio. Os nevos melanocíticos intrabucais podem ser classificados de acordo com as suas características histológicas em juncionais, compostos ou intramucosos.Existe uma dificuldade no diagnóstico diferencial entre o nevo melanocítico e as lesões com aspectos clínicos similares. Este trabalho tem por objetivo revisar a literatura sobre os nevos melanocíticos e relatar um caso clínico, descrevendo as características clínicas e histopatológicas do nevo melanocítico do tipo juncional e o diagnóstico diferencial com outras lesões bucais, ressaltando que dentre os nevos melanocíticos que prevalecem na cavidade bucal, o nevo melanocítico juncional é considerado incomum