Práticas integrativas e complementares de saúde em Sergipe / Integrative and complementary health practices in Sergipe

A atenção primária em saúde (APS) é o primeiro nível de atenção em saúde, sendo um elo entre a população e o setor de saúde. Tem-se buscado a humanização dos atendimentos, e essa mudança, refletida pelas mudanças da sociedade, trouxe a implementação da Política Nacional de Práticas Integrativas e Complementares (PNPIC) no SUS. O objetivo deste trabalho foi realizar uma análise da tendência da quantidade das práticas integrativas e complementares realizadas nas regionais de saúde de Sergipe de 2017 a 2023, associando com a cobertura da atenção primária. Foi realizada análise de dados secundários através do Departamento de Informática do Sistema Único de Saúde (DATASUS), como forma de organização no período de junho/2015 a junho/2023 por regional de saúde de Sergipe. As análises dos dados foram descritivas e de correlação e por meio de análise de série temporal. A regional de saúde de Lagarto foi a que mais executou as práticas integrativas e complementares no período analisado e algumas regionais não tiveram continuidade na realização destas práticas. A regional de saúde com maior cobertura de APS foi Itabaiana. Não foi possível observar associação entre o número de práticas e a cobertura de atenção primária. Com o intuito de que o atendimento aos indivíduos seja cada vez mais humanizado, e em virtude da realização das práticas integrativas ter baixo índice ou descontinuidade em algumas regiões de Saúde de Sergipe, é relevante que os profissionais de saúde busquem conhecimentos sobre essas práticas, como também, os gestores em saúde incentivem esta ação.

Primary health care (PHC) is the first level of health care, being a link between the population and the health sector. The aim has been to humanize care, and this change, reflected by changes in society, has led to the implementation of the National Policy on Integrative and Complementary Practices (PNPIC) in the SUS. The objective of this work was to carry out an analysis of the trend in the number of integrative and complementary practices carried out in the health regions of Sergipe from 2017 to 2023, associating it with primary care coverage. Secondary data analysis was carried out through the Department of Informatics of the Unified Health System (DATASUS), as a form of organization from June/2015 to June/2023 by health region in Sergipe. Data analyzes were descriptive and correlational and through time series analysis. The Lagarto health region was the one that carried out the most integrative and complementary practices in the period analyzed and some regions did not continue to carry out these practices. The health region with the highest PHC coverage was Itabaiana. Observing an association between the number of practices and primary care coverage was impossible. With the aim that care for individuals is increasingly humanized, and because the implementation of integrative practices has a low rate or discontinuity in some Health regions of Sergipe, health professionals must seek knowledge about these practices as well as health managers encourage this action.

Imaging aspects of maxillomandibular bone alterations in patients with multiple myeloma treated with bisphosphonates: A systematic review.

Purpose: Multiple myeloma (MM) is a rare cancer that is typically managed with bisphosphonates to slow bone resorption and prevent skeletal complications. This study aimed to identify imaging patterns in MM patients receiving bisphosphonate therapy. Materials and Methods: This systematic review included studies investigating maxillomandibular bone alterations based on imaging examinations in MM patients treated with bisphosphonates. The selected studies were qualitatively assessed using the Critical Appraisal Tools from SUMARI. Results: Six studies, involving 669 MM patients, were included, with 447 receiving bisphosphonate treatment. The majority were treated with pamidronate, zoledronate, or a combination of both. Seventy patients developed medication-related osteonecrosis of the jaw (MRONJ), predominantly in the mandible, characterized by the presence of bony sequestrum, bone sclerosis, increased periodontal ligament space, osteolytic lesions, and osteomyelitis as observed in imaging analyses. For non-MRONJ lesions, the mandible also exhibited the highest frequency of asymptomatic bone alterations. These ranged from "punched-out" osteolytic lesions or "soap bubble" lesions to solitary bone lesions, areas of bone sclerosis, abnormalities of the hard palate, osteoporosis, non-healed alveoli, and cortical bone rupture. Conclusion: MM patients treated with bisphosphonates display radiographic patterns of maxillomandibular bone lesions. These patterns aid in diagnosis and facilitate early and targeted treatment, thereby contributing to improved morbidity outcomes for these patients.

Oral Lesions of Immune-Mediated and Autoimmune Diseases: A 12-year Experience at a Single Brazilian Referral Center.

BACKGROUND: Oral lesions of immune-mediated and autoimmune diseases have been well-documented, but studies from Brazil are limited. The varied spectrum of oral lesions within this demographic group poses challenges to clinicians, particularly when they occur in isolation. This study aimed to evaluate the occurrence, clinical characteristics, and management of patients with oral lesions of immune-mediated and autoimmune diseases at a single center in Brazil. METHODS: A retrospective cross-sectional study was conducted from 2010 to 2022. Clinicodemographic data, histopathological features, and treatment modalities were analyzed descriptively and analytically. RESULTS: Of the 3,790 oral and maxillofacial lesions diagnosed, 160 (4.2%) were confirmed as immune-mediated or autoimmune diseases. The population surveyed predominantly consisted of women (73.7%), with a mean age of 60.2 years. Oral lichen planus (51.3%), mucous membrane pemphigoid (MMP) (23.7%), and pemphigus vulgaris (PV) (19.4%) were the most prevalent lesions. The buccal mucosa (59.4%) was predominantly affected, with pain reported in 46.2% of cases, notably in individuals with PV and MMP. The average time to disease stabilization post-local and/or systemic corticosteroid therapy was 15.8 months for systemic lupus erythematosus, 8.7 months for MMP, and 6.5 months for PV. CONCLUSION: Although oral lesions related to immune-mediated and autoimmune diseases are uncommon, their diverse clinicopathological aspects require multidisciplinary management.

Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study.

OBJECTIVE: This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS: Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS: Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION: It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.

Quantification of Torque Teno Virus (TTV) in plasma and saliva of individuals with liver cirrhosis: a cross sectional study.

Introduction: Torque teno virus (TTV) has been pointed as an endogenous marker of immune function, the objective of this study was to investigate the TTV viral load in plasma and saliva of cirrhotic individuals and correlate it with clinical characteristics. Methods: Blood, saliva, clinical data from records and laboratory tests were collected from 72 cirrhotic patients. Plasma and saliva were submitted to real-time polymerase chain reaction for quantification of TTV viral load. Results: The majority of the patients presented decompensated cirrhosis (59.7%) and 47.2% had alterations in the white blood series. TTV was identified in 28 specimens of plasma (38.8%) and in 67 specimens of saliva (93.0%), with median values of TTV copies/mL of 90.6 in plasma and 245.14 in saliva. All the patients who were positive for TTV in plasma were also positive in saliva, with both fluids having a moderately positive correlation for the presence of TTV. There was no correlation between TTV viral load, either in plasma or in saliva, and any of the variables studied. Conclusion: TTV is more frequently found and in greater amount in the saliva than in the plasma of cirrhotic patients. There was no correlation between TTV viral load and clinical parameters.

Orofacial manifestations in Brazilian people living with HIV/AIDS under long-term antiretroviral therapy: a cross-sectional study.

OBJECTIVE: The aim of this study was to assess the prevalence of orofacial manifestations in a Brazilian cohort of people living with HIV/AIDS (PLWHIV) using long-term combined antiretroviral therapy (cART) and to correlate the presence of these manifestations with clinical and laboratory characteristics. STUDY DESIGN: A cross-sectional observational study evaluated 101 Brazilian PLWHIV. Demographic characteristics, medical history, and laboratory data were collected. Physical examination and measurement of stimulated salivary flow were performed. RESULTS: The study included 101 participants who were mainly male (61%) and White (73%), with an average age of 48 years, using long-term cART. The most common oral manifestations were facial lipoatrophy (33%), xerostomia (30%), and salivary gland enlargement (12%). Facial lipoatrophy was linked to a longer duration of cART use (P = .002), whereas hairy leukoplakia was linked to a detectable viral load (P = .031). The salivary flow of <0.7 mL/min was associated with an HIV infection time >20 years (P = .023). CONCLUSIONS: People living with HIV/AIDS who use cART often experience facial lipoatrophy, xerostomia, and bilateral enlargement of the parotid glands. Although opportunistic infections and malignant neoplasms are not frequent occurrences, they can still arise.

Focal melanocytic lesions of the oral mucosa: An epidemiological and morphological study.

OBJECTIVE: This study aimed to analyse the clinical and histopathological characteristics of focal oral melanocytic lesions in a Brazilian reference service in Oral and Maxillofacial Pathology. MATERIALS AND METHODS: A cross-sectional study was conducted over an 18-year period. Demographic data and clinical features were collected from the archives, and all biopsy specimens diagnosed as oral melanocytic lesions were retrieved and reviewed. RESULTS: We identified 339 melanocytic lesions. Of these, 191 were melanotic macules, 112 melanocytic nevi, 14 mucosal lentigo simplex, 12 melanomas, 9 solar lentigos, and 1 melanoacanthoma. Lesions occurred mostly in white-skinned (74.2%) women (65.2%). The main reported clinical aspect was the macule (67.4%), and the most affected site was the lip vermilion (25.4%), followed by the palate (22.9%). Melanomas were larger in size and were observed in older patients with an overall shorter time of onset. The most frequent subtypes of melanocytic nevi were intramucosal (44.6%), compound (24.1%), and blue nevus (20.5%). They showed a heterogeneous architectural pattern with the presence of the three cell types. CONCLUSION: The most frequent lesions are melanotic macule and nevus, especially the intramucosal subtype. Patients are usually white-skinned women presenting a small, long-lasting, macular lesion on the lip vermilion or palate.

Epstein-Barr virus oral shedding and viremia and their association with oral hairy leukoplakia in HIV+ individuals.

OBJECTIVE: To assess the oral shedding and viremia of Epstein-Barr virus (EBV) in HIV-positive patients and their relationship with oral hairy leukoplakia (OHL). METHODOLOGY: A total of 94 HIV-positive patients were included in the study, in which blood and saliva samples were collected for EBV quantification. Data on gender, age, time of HIV seropositivity, combined antiretroviral therapy (cART), CD4+ T-cell counts, and HIV viral load were collected. OHL diagnosis was based on histopathological examination and EBV in situ hybridization. RESULTS: The EBV load in the 94 HIV-positive patients was higher in saliva than in blood (2.4 and 1.6, respectively), and there was a positive correlation between EBV oral shedding and viremia (p = 0.001). Twenty (21.27%) patients had OHL and also a higher EBV load in saliva (mean log10  = 3.11) compared to those who had no OHL (p = 0.045). Presence of OHL was only associated with age (p = 0.030). CONCLUSION: In HIV-positive patients, the presence of OHL was associated with EBV oral shedding but not with viremia, regardless of the amount of circulating CD4+ T cells.

Oral manifestations of autoimmune polyglandular syndrome type 1.

AIMS: Autoimmune polyglandular syndrome type I (APS-I) is a rare condition of autosomal recessive and monogenic inheritance, which is characterized clinically by at least two signs of the classic triad: mucocutaneous candidosis, hypoparathyroidism, and Addison's disease. This study aims to report the oral manifestations of APS-I in a 42-year-old woman, who attended the Special Care Dentistry Center. METHODS AND RESULTS: The patient presented with hypoparathyroidism, diabetes mellitus, and autoimmune hepatitis. Chronic hyperplastic candidosis (CHC) was the main oral manifestation and it was diagnosed based on clinical and cytologic characteristics. Microstomia, angular cheilitis, xerostomia, enamel hypoplasia, and microdontia were also present. CONCLUSIONS: CHC was treated with topical nystatin and oral fluconazole, resulting in a significant improvement of the lesions.

Nitrogenous compounds in the saliva and blood of cirrhotic patients: a cross-sectional study.

OBJECTIVES: Serum increase of nitrogenous compounds (NC) in cirrhotic patients has been associated with the development of hepatic encephalopathy (HE). However, the relation between NC in saliva and HE is unclear. The objective of this study is to measure the levels of nitric oxide and urea in the blood and saliva in 38 cirrhotic patients and correlate them with clinical characteristics and presence and grades of HE. MATERIAL AND METHODS: Automated enzymatic colourimetric assays were performed to determine the levels of NC. Diagnosis and severity of HE were determined based on the West Haven criteria and by using the inhibitory control test. RESULTS: HE was diagnosed in 89.47% of the patients, with the majority (60.50%) presenting covert HE. With regard to the measurement of NC, although nitric oxide is moderately correlated with its amount in blood and saliva (r = 0.630; P < 0.001), only salivary levels were associated with the presence of ascites and ecchymosis (P = 0.013 and P = 0.030, respectively). In patients with HE, the serum levels of urea were higher (P = 0.013) than those in patients without HE or minimal HE. CONCLUSIONS: Nitrogenous compounds in the saliva were correlated with neither the presence nor grades of HE, whereas in the blood, only urea was positively correlated with the severity and presence of HE. CLINICAL RELEVANCE: Saliva is an excellent fluid for diagnosing several diseases, but it does not seem to be able to collaborate with the identification of HE.

Complications related to dental extractions in patients with chronic kidney failure undergoing hemodialysis: a pilot study.

OBJECTIVE: To clinically assess socket healing after tooth extraction and the occurrence of intra- and postoperative complications in patients with chronic kidney failure (CKF) receiving hemodialysis (HD) by comparing them with a control group. STUDY DESIGN: This prospective study involved 48 patients with CKF receiving HD (study group [SG]) and 29 participants without CKF (control group [CG]) undergoing tooth extractions. No prophylactic antibiotic was administered to the participants. One calibrated dentist evaluated all individuals at 3, 7, 21, and 60 days after the tooth extractions and assessed hemostasis time, occurrence of local or distant infection, epithelialization, and deposition of alveolar bone. RESULTS: In the SG, 87 teeth were extracted through 65 interventions, and in the CG, 76 teeth were extracted through 36 interventions. Bleeding beyond 30 minutes was observed in 12 interventions (18.5%) in SG participants and was controlled with local hemostatic agents. Neither group had individuals presenting with postoperative infectious complications at the surgical site or at a distance. After 21 days, we observed delayed epithelialization in 29.9% (26 of 87) of the individuals in the SG compared with 3.9% (3 of 37) of those in the CG (P < .001). After 60 days, all the sockets were epithelialized and showing radiographic signs of alveolar bone neoformation. CONCLUSIONS: Individuals with CKF receiving hemodialysis tend to heal well after dental extractions. They did not have an increased risk of infectious complications after simple tooth extractions, but they showed prolonged bleeding events more often than control subjects. Additional research studies using larger sample sizes of patients with CKF receiving hemodialysis are needed to confirm our findings.

Assessment of bone metabolism biomarkers in serum and saliva of cirrhotic patients.

OBJECTIVE: To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs. MATERIALS AND METHODS: Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1ß, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used. RESULTS: Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 ß (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI. CONCLUSION: RANKL, OPG, IL-1ß, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI. CLINICAL RELEVANCE: This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

Assessment of laboratory tests and intraoperative bleeding in patients with liver cirrhosis undergoing tooth extractions.

OBJECTIVES: The objective of this study was to quantify intraoperative bleeding in patients with cirrhosis and correlate it with clinical characteristics and laboratory coagulation tests. STUDY DESIGN: A case-control study was carried out with 74 patients with cirrhosis who were submitted to preoperative coagulation tests (complete blood count, platelet count, prothrombin time/international normalized ratio, thrombin time, activated partial thrombin time, platelet aggregation, fibrinogen, protein C, protein S, antithrombin, and von Willebrand factor level and activity). The levels of nitrogen compounds that can affect the platelet function were determined in saliva and blood by using automated enzymatic-colorimetric assays. RESULTS: Patients with cirrhosis had changes in almost all coagulation tests. The average volumes of intraoperative bleeding and blood lost per minute in the study group (5.36 mL/min and 0.19 mL/min, respectively) were greater than those in the control group (3.05 mL/min and 0.11 mL/min, respectively; P < .05). In the control group, ascites (P = .012) and presence of periapical lesion (0.034) were positively correlated with bleeding (mL/min). With regard to coagulation tests and nitrogen compounds, only a positively moderate correlation with the platelet aggregation test was observed. CONCLUSIONS: No patients had hemorrhagic events and it was not possible to correlate a greater amount of bleeding with coagulation tests or nitrogen compounds in the study group.

Prevalência e fatores associados a defeitos de desenvolvimento do esmalte em crianças de 5 anos de idade matriculadas em creches na cidade de Teresina, Brasil / Prevalence and factors associated with developmental defects of enamel in five-year-old children enrolled in preschools in the city of Teresina, Brazil

Resumo Introdução Crianças com defeitos de desenvolvimento de esmalte (DDE) são mais suscetíveis à hipersensibilidade dentinária, maloclusões e dificuldades relativas à adesão de materiais restauradores. O conhecimento sobre a prevalência de DDE e seus fatores associados permite aos profissionais obter maior compreensão desse problema de saúde bucal, minimizando, dessa forma, as sequelas e melhorando a saúde bucal e a qualidade de vida dos indivíduos afetados. Objetivo Determinar a prevalência de DDE e seus fatores associados na dentição decídua. Método Trata-se de estudo transversal com amostra probabilística de 566 pré-escolares de 5 anos de idade, matriculados em creches públicas e privadas de Teresina, Piauí, Brasil. Foi aplicado questionário socioeconômico e de história médica da criança aos responsáveis. Os exames clínicos foram conduzidos por um único examinador (kappa = 0,93 para DDE e 0,86 para cárie) que utilizou os índices DDE modificado e ceo-d. Foi realizada a análise descritiva dos dados, além dos testes qui-quadrado e exato de Fisher e a regressão de Poisson, considerando como significativo p ≤ 0,05. Resultados A prevalência de DDE foi de 33,7%. A média de dentes com DDE por criança foi de 3,12 ± 2,23. O tipo mais prevalente de DDE foi opacidade demarcada (9,5%). Os segundos molares superiores foram os dentes mais afetados (11,9%). Houve associação entre DDE e estudar em creche pública (p = 0,026) e cárie (p = 0,012). Crianças com experiência de cárie apresentaram maior prevalência de DDE (RP: 1,29; IC95%: 1,01-1,64). Conclusão A prevalência de DDE na dentição decídua foi de 33,7% e se mostrou associada à experiência de cárie.

Abstract Background Children with Developmental Defects of Enamel (DDE) are more susceptible to dentin hypersensitivity, malocclusions, and difficulties related to the adhesion of restorative materials. Knowledge about the prevalence and factors associated with DDE allows professionals to gain a greater understanding of this oral health problem, minimizing sequelae, improving oral health and quality of life of affected individuals. Objective To determine the prevalence and factors associated with DDE in primary dentition. Method This is a cross-sectional study assessing a random sample of 566 preschool five-year-old children, enrolled in public and private preschools in Teresina, Piauí, Brazil. It was applied the socioeconomic and medical history of the child questionnaire for the parents or guardians. Clinical examinations were conducted by a single examiner (kappa = 0.93 for DDE and 0.86 for caries) that used the modified DDE index and dmft. Descriptive analysis, chi-square and Fisher's exact tests, and Poisson regression were performed, considering significant p ≤ 0.05. Results the prevalence of DDE was 33.7%. The mean DDE teeth per child was 3.12 ± 2.23. The most prevalent type of DDE was demarcated opacity (9.5%). The second molars were the most affected teeth (11.9%). There was an association between DDE and study at public preschool (p = 0.026) and dental caries (p = 0.012). Children with experience of caries were more likely to DDE (PR: 1.29; 95% CI: 1.01 to 1.64). Conclusion prevalence of DDE in the primary dentition was 33.7% and was associated with caries experience.

Assessment of the tongue frenulum in Beckwith-Wiedemann syndrome: Pre- and post-frenectomy findings.

AIM: To report the pre- and post-frenectomy findings of a patient with Beckwith-Wiedemann syndrome. METHODS AND RESULTS: Clinical case report of a patient with a confirmed genetic-molecular diagnosis of the referred syndrome. The minor was evaluated and reassessed by the protocol for the evaluation of the tongue's frenulum for babies in two moments: pre-surgical and 2 months after the frenectomy. The surgical procedure was performed using the traditional technique and, after the procedure, the minor was breastfed and received photobiomodulation with a red laser. The minor obtained 16 points in the neonatal tongue screening test, indicating the need for a frenectomy. Thus, she was referred to a dentist for surgery. After the surgical procedure, macroglossia was observed as a maternal complaint (previously not mentioned). The wound healing was satisfactory, and the total score obtained in the reapplication of the protocol (five points) showed functional results of improvements in sucking and tongue mobility, justifying the importance of the frenectomy. CONCLUSION: Frenectomy, despite showing macroglossia related to the Beckwith-Wiedemann syndrome, allowed anatomical and functional advances of the tongue in the present clinical case.

Detection of calcified atheromas on panoramic radiographs of cirrhotic patients.

BACKGROUND: The present study aimed to investigate the prevalence of calcified atheromas in carotid arteries (CACA) on panoramic radiographs of patients with liver cirrhosis (LC). METHODS AND RESULTS: A case-control study of 67 individuals with LC (case group) and 67 healthy individuals (control group), matched by gender and age, was performed. In addition to demographic information, data on LC were also collected for the case group. Panoramic radiographs were evaluated by two previously calibrated examiners. The sample consisted predominantly of male individuals (n = 50; 74.62%), with mean age of 55 years old. In the case group, the mean value for the model of end-stage liver disease was 16, and the major aetiology of LC was alcoholism (n = 26; 38.8%). Thirteen (19.4%) LC patients had CACA, whereas only four (5.9%) healthy patients had this condition. LC patients are 3.72 times more likely to have CACA compared to healthy individuals (P = .02). The presence of nephropathies increases the risk of development of atheromas by 18.58 times in cirrhotic individuals (P = .04). CONCLUSIONS: Cirrhotic patients are more likely to have CACA compared to healthy patients, and this risk increases significantly when kidney disease is involved.

Prevalence of sublingual varices in patients with cirrhosis and the correlation with nitrogen compounds.

OBJECTIVE: The aim of this study was to verify the presence and severity of sublingual varices in patients with cirrhosis and the correlation between these varices and nitrogen compounds (i.e., ammonia, urea and nitric oxide) in blood and saliva. STUDY DESIGN: This is a case-control observational study of 52 patients with cirrhosis and 52 normoreactive individuals, aimed at assessing the presence (degrees 0 and 1) and severity (mild, moderate, and severe) of sublingual varices. Medical records of the patients with cirrhosis, including complications of cirrhosis, were also obtained. Blood and saliva were collected to evaluate the presence of nitrogen compounds by means of automated enzymatic colorimetric assays. RESULTS: The cirrhosis group had a higher prevalence (n = 39; 75%) compared with controls (n = 22; 42.3%) as well as higher severity (moderate n = 12 [23.1%]; and severe n = 16 [30.0%]) (P = .001 and P < .001, respectively). Of the 39 patients with cirrhosis and sublingual varices, 84.6% had gastroesophageal varices. No correlations were found between the presence/severity of sublingual varices and cirrhotic complications/nitrogen compounds. CONCLUSIONS: The prevalence and severity of varices were higher in the cirrhosis group, but no correlations between the presence/severity of sublingual varices and nitrogen compounds were found.

Is Low Income Associated with Malocclusion in Primary Dentition Among Preschoolers?

Abstract Objective: To determine the prevalence and factors associated with malocclusion in the primary dentition of preschool children in a city of Brazilian Northeast. Material and Methods: A cross-sectional study was conducted with 566 five-years-old preschool children who were enrolled in public and private preschools in the city of Teresina, Piauí, Brazil. Data were collected using a sociodemographic questionnaire administrated to parents/caregivers and clinical oral examination of the children was performed. Foster and Hamilton Index for primary teeth was used for the diagnosis of malocclusions. Descriptive analysis was carried out and Poisson regression was used to assesses the association with independent variables. Results: The prevalence of malocclusion was 51.2%. The most frequent types were Class II canines (17% and 16.8%), increased overjet (15.2%) and reduced overbite (14%). Anterior crossbite was present in 3.5% of the preschool children evaluated. There was an association between malocclusion and low family income (PR = 1.22; 95% CI = 1.01-1.47). Conclusion: The prevalence of malocclusion in the primary dentition was high and associated with a low family income.

Impacto da cárie dentária na qualidade de vida de pré-escolares mensurado pelo questionário PedsQL / Impact of dental caries on the quality of life of preschoolers measured by PedsQL questionnaire

Resumo O objetivo do estudo foi avaliar o impacto da cárie dentária na qualidade de vida de pré-escolares. A população foi constituída por pré-escolares com idade de 5 anos, matriculados em instituições públicas e privadas de Teresina, PI, Brasil. Instrumento de qualidade de vida validado para população brasileira (Pediatric Quality of Life Inventory - PedsQL™) foi aplicado para as crianças e responsáveis, além de questionário socioeconômico-demográfico para os responsáveis. No exame dentário o índice ceod foi utilizado para avaliar a experiência de cárie. Das 566 crianças examinadas, 50,2% apresentaram experiência de cárie. Foi observada associação entre experiência de cárie e pior qualidade de vida no domínio de saúde bucal na percepção das crianças (RR= 0,981; IC95% = 0,97-0,99) e dos pais (RR= 0,955; IC95% = 0,94-0,97). De acordo com a percepção das crianças, cárie em dentes posteriores foi associada a pior qualidade de vida no domínio capacidade física (RR= 0,985; IC95% = 0,97-0,99). Concluiu-se que experiência de cárie impactou negativamente na QVRSB (qualidade de vida relacionada à saúde bucal) no domínio saúde bucal da criança de acordo com a percepção das crianças e dos pais. Cárie localizada em molares impactou negativamente na QVRSB no domínio capacidade física segundo a percepção das crianças.

Abstract The objective of this study was to evaluate the impact of dental caries on the quality of life of preschool children. The population was made up of preschoolers aged 5 years, enrolled in public and private institutions of Teresina, PI, Brazil. The Pediatric Quality of Life Inventory (PedsQL™) was applied to children and caregivers, as well as a socioeconomic-demographic questionnaire for those responsible. In the dental examination the ceod index was used to evaluate the caries experience. Of the 566 children examined, 50.2% presented with caries experience. It was observed an association between caries experience and poorer quality of life in the oral health domain in the children's perception (RR = 0.981, 95% CI = 0.97-0.99) and parents (RR = 0.955, 95% CI = 0, 94-0.97). According to the children's perception, caries in the posterior teeth was associated with poorer quality of life in the physical capacity domain (RR = 0.985, 95% CI = 0.97-0.99). It was concluded that caries experience had a negative impact on the OHRQoL (oral health-related quality of life) in children's oral health according to the perception of children and parents. Caries located in molars had a negative impact on HRQoL in the physical ability domain according to the children's perception.