Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer.

BACKGROUND: The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than 100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public system aids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients with oral cancer is associated with socioeconomic factors. MATERIAL AND METHODS: A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019. Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementary education; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) were analyzed by multiple logistic regression (p<0.05). RESULTS: Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018 (OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender, men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-white individuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referred by the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796). CONCLUSIONS: It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associated with socioeconomic factors.

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017.

BACKGROUND: This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. MATERIAL AND METHODS: This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (α<0.05). RESULTS: There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B=0.043, p<0.001, PR=1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B=0.001, p=0.003, PR=1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B=-0.085, p<0.001, PR =0.918). The increase of ESB (OR=0.998) and CEO (OR=0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR=1.574) was associated with an increase in the number of stage IV cases. CONCLUSIONS: Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil.

Genotoxic effects of tanshinones from Hyptis martiusii in V79 cell line.

The genotoxic effect of two tanshinones isolated from roots of Hyptis martiussi Benth (Labiatae) was studied using V79 (Chinese hamster lung) cells by the alkaline comet assay and micronucleus test. Tanshinones were incubated with the cells at concentrations of 1, 3, 6 and 12 microg/mL for 3 h. Tanshinones were shown to be quite strongly genotoxic against V79 cells at all tested concentrations. The data obtained provide support to the view that tanshinones has DNA damaging activity in cultured V79 cells under the conditions of the assays.

Estudo sobre o uso de plantas medicinais em crianças hospitalizadas da cidade de João Pessoa: riscos e benefícios / Survey on the use medicinal plants in children hospitalized in the city of João Pessoa city: risks and benefits

Trata-se de um estudo com abordagem quantitativa, com o objetivo de investigar o uso de plantas medicinais em crianças na faixa etária de zero a 12 anos internadas no Hospital Infantil Arlinda Marques, da cidade de João Pessoa (PB), entre agosto de 2000 a junho de 2001. Um roteiro de entrevista semi-estruturado foi empregado junto aos 132 acompanhantes das crianças para a obtenção dos dados. Os resultados evidenciaram que as doenças que mais acometeram as crianças foram: 1) pneumonia (26 por cento), 2) infecções intestinais (13 por cento), 3) anemia (8 por cento), 4) afecções renais (7 por cento). Cerca de 27,3 por cento dos acompanhantes usaram plantas medicinais em suas crianças antes de procurarem o Serviço Hospitalar e 41,7 por cento associaram plantas com alguma medicação. Diante destes resultados pode-se concluir que a utilização de plantas medicinais em crianças para o tratamento de doenças possui seus riscos e benefícios que precisam ser avaliados pelos profissionais de saúde.

The aim of this study is to investigate the use of medicinal plants in children of zero to 12 years hospitalized in the "Hospital Infantil Arlinda Marques", City of João Pessoa, State of Paraíba, Brazil between August 2000 and June 2001. For the collection of the data a half-structuralized script interview was applied to 132 children's companions. The results evidenced that the illnesses which mostly affected the children were: 1) pneumonia (26 percent), 2) infections of the intestines (13 percent), 3) anemia (8 percent), 4) kidneys illnesses (7 percent). About 27,3 percent of the companions had used medicinal plants in the children before going to the hospital service; 41,7 percent had associated plants with some medicines. Based on this, it can be concluded that the use of medicinal plants in children for the treatment of illnesses has its risks and benefits that need to be evaluated by health professionals.

Antiproliferative effects of abietane diterpenoids isolated from Hyptis martiusii Benth (Labiatae).

Two abietane diterpenes were isolated from a hexane extract of Hyptis martiusii roots and identified as carnasol 11,14-dihidroxy-8,11,13-abietatrien-7-one. These compounds were tested for their antiproliferative effects on tumor cell lines using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide and on the sea urchin egg development. Both compounds displayed cytotoxic activity against tumor cell lines, but only carnasol was able to inhibit the sea urchin egg cleavages.

Immune defense mechanisms of Culex quinquefasciatus (Diptera: Culicidae) against Candida albicans infection.

Mosquitoes have an efficient defense system against infection. The cellular immune defense mechanism initiated by the mosquito Culex quinquefasciatus infected with the fungus Candida albicans was investigated in this study. Differences in the hemocyte counts in hemolymph perfused from uninoculated, saline-inoculated, and C. albicans-infected mosquitoes were compared using a light microscope. Phagocytosis was also investigated using electron microscopy. Four types of hemocytes were identified in control mosquitoes: prohemocytes (9.8%), plasmatocytes (38.8%), granular cells (44.2%), and oenocytoids (7.3%). Between 3 and 18 h postinoculation the total hemocyte count was significantly higher in infected, compared to uninfected, mosquitoes. Differential hemocyte counts from infected mosquitoes at 3, 6, and 18 h after inoculation showed that the relative proportion of plasmatocytes (48.6, 50.7, 45%) was higher and, concomitantly, the proportion of granular cells was lower (38, 36.8, 35%, respectively). Yeast cells were phagocytosed and limited growth was observed within the plasmatocytes. Melanized nodules were found attached to different insect tissues at 24 to 72 h following infection. These results suggest that phagocytosis, followed by nodule formation, was capable of clearing the hemolymph of yeast cells.

[Congenital syphilis: incidence among newborns] / Sífilis congênita: incidência em recém-nascidos.

OBJECTIVE: To determine the incidence of congenital syphilis among newborns at the maternity of a public hospital. METHODS: The study was conducted at the maternity of Fundação Santa Casa de Misericórdia do Pará, from May to September 1996; 361 mothers were interviewed, and physical examination was performed in their newborns. Serum samples from both, mothers and neonates, were tested using three methods: VDRL, FTA - Abs, ELISA IgM. The diagnosis of congenital syphilis was established according to the criteria defined by Ministério da Saúde in 1993. RESULTS: The rate of congenital syphilis was of 9.1% (33); in 14 cases, there were one or more signs of the disease: prematurity, hepatomegaly, stillbirth, splenomegaly, perinatal death, abdominal distention, nasal stuffiness, jaundice, newborn small for gestational age. The majority of the infected mothers belonged to the age group of 20-35 years (81.8%); 60.6% were married; 63.6% received prenatal care; 48.5% reported previous spontaneous abortion, and 12.1% previous stillbirth. The rate of bisexuality among fathers was of 9.1%. CONCLUSION: The syphilis control measures and the prenatal care, have not been sufficient to prevent the high rate of the disease.

[The political and administrative context of the implementation of Health Districts in the State of Bahia, Brazil]. / O contexto político-administrativo da implantação de Distritos Sanitários no Estado da Bahia, Brasil.

This investigation was conducted in order to determine the political and administrative context prevailing during the implementation of health districts in the state of Bahia, Brazil. The documentary review includes laws, agreements, and contracts at the State and Federal levels from 1987 to 1989. This period corresponded to the first phase of the State government after the 1986 elections. Information was also obtained from key informants and former directors of the State Secretariat of Health at the central level. We describe how the policy for regionalization by territory and population was formulated, and we review both State and national planning procedures, identifying the events leading to the decision to create health districts. We list the political instruments related to this decision and analyze the positions of the various actors in the Brazilian Health System in relation to this strategic choice. Brief comments are given about the difficulties faced by this proposal during the period studied.

[Coronary angioplasty in octogenarians]. / Angioplastia coronária em octogenários.

PURPOSE: To evaluate the indications, results and follow-up of patients with 80 years old and over, who had undergone percutaneous transluminal coronary angioplasty (PTCA). METHODS: From July 1987 through July 1990, 36 patients, 80 years of age and over, had PTCA as an alternative method to treat coronary artery disease. Their age ranged from 80 to 85 (mean = 83) years. Twenty five were male. Significative obstruction was considered when 70% or more of the internal diameter was stenosed. Satisfactory results were achieved when reduction of 50% or more of the coronary artery obstruction was obtained. RESULTS: In 34 of 36 patients (94.4%), PTCA was successfully performed. Forty four of 46 coronary arteries were successfully dilated. One patient had acute coronary occlusion with acute myocardial infarction treated clinically. There were no emergency surgeries or early deaths. Clinical follow-up was obtained in 15 of the 34 patients. Four had repeated coronary arteriography (at 1, 3, 6 and 12 months after primary PTCA) due to angina. Two of them had restenosis and were successfully redilated (the patients restudied at 3 and 6 months, respectively). Within a mean clinical follow-up period of 9.6 (ranging from 1 from 21) months the following features were observed: two of 15 patients (13.3%) had acute myocardial infarction and were clinically followed; late death occurred in 3 patients (20%) with only one related to cardiac events. Survival has been observed in 12 of these 15 patients (80%). CONCLUSION: PTCA represents an alternative, safe and effective invasive procedure to treat octogenarians with coronary artery disease.

[Directional coronary atherectomy. The initial experience]. / Aterectomia coronária direcional. Experiência inicial.

Four male patients, 38 to 59 years old (mean 49 +/- 2.5), with angina and the angiographic features has been the classical indications for the method, underwent directional coronary atherectomy. Vessels treated were, respectively, left anterior descending artery (LAD), right coronary artery (RCA), saphenous vein graft (SVG) to LAD and SVG to left marginal branch. Reductions to 50% or less of the internal diameter was considered a satisfactory result. Early success was obtained in all four patients. Obstructions of 75 to 95% (mean of 83 +/- 7.5%) were reduced to 0-25% (mean 12 +/- 5%) after atherectomy. Only one patient died suddenly five days after de procedure. So, directional coronary atherectomy may represent a reliable and safe method for special situations.

[Angioplasty in native coronary circulation in patients treated with myocardial revascularization]. / Angioplastia na circulação coronária nativa em pacientes submetidos a cirurgia de revascularização miocárdica.

PURPOSE: To evaluate the clinical results after angioplasty in the native coronary vessels in patients who had undergone previous coronary artery surgery. METHODS: From June 1987 to July 1990, 69 patients with previous coronary artery surgery underwent coronary angioplasty in the native arteries. Age ranged from 31 to 82 (mean = 57.5) years, fifty eight were males. Angina was present in all patients. The patients were classified in three groups according to the following criteria: group I--incomplete revascularization following bypass surgery (28 patients); group II--progression of the disease in ungrafted vessels (24 patients) and group III--progression of the disease in grafted vessels (17 patients). RESULTS: Primary success was achieved in 94% (65/69). Ninety-five percent in group I, 92% in group II and 94% in group III. Complications occurred in 4%; emergency surgery or deaths were not observed in this study. Forty patients (61%) repeated coronary arteriography an average follow-up of 4 months and restenosis was detected in 10 (25%); 8 of them were redilated. Survival rates was 95% and 75% of them were free of coronary events after an average follow-up of 13 months. CONCLUSION: Coronary angioplasty in these patients is a safe and effective interventional procedure in the treatment of coronary artery disease in native coronary vessels.

[Directional atherectomy and coronary angioplasty: a therapy complementary to myocardial revascularization surgery]. / Aterectomia direcional e angioplastia coronária. Terapêutica complementar à cirurgia de revascularização miocárdica.

A white male patient, 59 years old, with two prior surgical myocardial revascularization and unstable angina, was submitted to coronary arteriography that showed: all the saphenous vein grafts patent and obstruction of 75% in the saphenous vein graft to the second marginal branch of left circumflex artery. Left internal mammary artery (LIMA) was angiographically normal and 80% stenosis was detected in the distal segment of the left anterior descending coronary artery (LAD). The patient was submitted to directional coronary atherectomy for saphenous vein graft and coronary angioplasty for distal-LAD. Both procedures were successfully performed.

[Anatomical limitations for the performance of angioplasty in coronary multivessel disease]. / Limites anatômicos para a realização de angioplastia na doença coronária multiarterial.

PURPOSE: To study anatomical limitation of coronary angioplasty, as alternative therapy in patients with multivessel disease and submitted to bypass surgery. METHODS: In 380 patients with multivessel disease and submitted to previous coronary bypass surgery, age ranged from 41 to 72 (average = 51) years, being 68% males. The following parameters were analyzed in the coronary arteriographies: anatomic aspects of the coronary arteries and distribution of the atherosclerotic stenosis. The patients were arranged in accordance to the criteria: complete revascularization, incomplete and no indication for coronary angioplasty. RESULTS: The patients were arranged in 3 different groups: I-80 (21%) patients included those in whom complete revascularization would be possible; II--55 (14.5%) patients in whom only incomplete revascularization but satisfactory would be possible and III--245 (65.5%) those patients in whom coronary angioplasty would no have indication. The data referind the patients of groups I and II were analyzed together--135 (35.5%) and arranged according to the number of arteries involved. It was observed: two vessel disease--71.8%, three vessel--18.6% and 4 or more vessel--9.6%. In group III it was observed 51.0% of the patients with 3 or more vessel disease. The major factors to contra indicate coronary angioplasty in group III included: chronic coronary obstruction 99 (40.4%); diffuse disease 11 (4.5%); technical difficulties 10 (4.1%); left main coronary artery obstruction 5 (2%) or when two or more causes were combined 120 (49%). CONCLUSIONS: Patients with multivessel disease and classic indication for coronary bypass surgery, have a basic limitation for angioplasty due to several anatomic factors. However, coronary angioplasty could be beneficial for a selected group of patients (35.5%) whenever a complete or incomplete revascularization could be obtained.

[Coronary angioplasty in young patients]. / Angioplastia coronária em pacientes jovens.

PURPOSE: To evaluate the results of coronary angioplasty in patients at the age of 40 years old or under. METHODS: From July 1987 to July 1990, 878 coronary angioplasty procedures were performed. Sixty six patients (7.5%) were 40 years old or under. The coronary obstruction was considered significant when 70% or more of the arterial diameter was involved and the post angioplasty results were considered satisfactory when residual obstruction was less than the 50%. RESULTS: Fifty four patients (81.8%) were male with an average age of 37 years (ranging from 29 to 40). Forty four patients (67%) had stable angina, 18 (27%) unstable angina, 3 (4%) acute myocardial infarction (AMI) and one (1.5%) AMI after streptokinase treatment. Eight of these patients had previous report of AMI and 3 (4.5%) had undergone coronary bypass grafting surgery. Fifty five patients (83%) had single vessel disease and 11 (17%) had multivessel disease. Eighty coronary arteries had balloon dilatation. In 32 patients (58%) with single vessel artery, 12 (22%) in the RCA, 10 (18%) in the left circumflex and one (2%) into a saphenous vein bypass grafting. In 12 patients (48%) with multivessel disease it was performed in the LAD coronary artery, 8 (32%) in the RCA and 5 (20%) in the left circumflex. Angioplasty was successfully performed in 53 (96%) patients with single vessel disease and in 10 (01%) with multivessel disease. One of the patients died immediately after the procedure. A follow up of 11.6 months (ranged from 1 to 27 months) was possible in 63 patients. Re-stenosis was depicted in 10 (19%) of the 55 patients with single vessel disease and in 3 of the 11 patients (30%) with multivessel disease. Nine patients had a successful redilatation in the first group and 2 in the second one. The two remaining patients had undergone coronary bypass surgery. The clinical evaluation among patients who had been dilated as the first procedure and those who had redilatation (61 patients) showed: 92% were asymptomatic and 8% had mild angina. CONCLUSION: Coronary angioplasty performed in young patients is an effective procedure with very low rate of early complications and favorable clinical follow-up.

[Occlusion of secondary branches after angioplasty of the left descending coronary artery]. / Oclusão de ramos secundários após angioplastia da artéria coronária descendente anterior.

PURPOSE: To evaluate the incidence and clinical presentation of the occlusion of such secondary branches in patients with single vessel coronary artery disease in the left anterior descending artery, who underwent a first elective and successful PTCA. MATERIAL AND METHODS: Two hundred and thirteen side branches of 121 patients considered to be at risk. They were divided into group I (GI-85 side branches, 39.9%), if they originated from the atherosclerotic site; and group II (GII-120 side branches, 61.5%), if their origin would be involved during the balloon inflation. In the GI there were 54 septal branches and 31 diagonal branches, and 36& had angiographic evidence of ostium disease. GII was constituted by 77 septal and 51 diagonal branches, and 7.8% of them had evidence of ostium disease. RESULTS: Seven side branches (3.3%) at risk occluded, 4 from GI (4.7%) and 3 (2.3%) from GII. As for the clinical presentation, 57% of them had angina, where as 28.6% showed minor abnormalities in the ECG. No patient elevated its serum CK-MB, and silent occlusion occurred in 43% of them. CONCLUSION: Occlusion of side branches is a low incidence phenomenon, which happens more often in septal branches with ostium disease that originates from the atherosclerotic site; that about half of the patient had silent occlusion (43%) or mild ischemic manifestations.

[Coronary angioplasty: efficacy of the new low profile balloon catheters]. / Angioplastia coronária: eficácia dos novos cateteres-balão de baixo perfil.

New low profile balloon catheter have allowed the indication of percutaneous transluminal coronary angioplasty (PTCA) for more complex lesions. We report our initial experience with these systems in 50 out of 101 patients (50%) who underwent a PTCA from March 15 to May 15, 1989 in "Instituto Dante Pazzanese de Cardiologia". Mean age was 58.6 +/- 10.4 years and most of the patients were male (78%). We dilated 54 lesions. Single vessel disease was the case for 84% of the patients. As for the localization of the lesions in the coronary arteries, 56% of the lesions were in the proximal or mid segments of the coronary arteries and the mean diameter stenosis pre-PTCA was 84 +/- 10.2%. Left ventricular function was normal in 60% of the patients. Primary success rate (per patient) was 95% and the coronary stenosis was crossed in all the cases. The mean inflation number was 2.7 +/- 0.6 per patient, the mean highest pressure was 8 +/- 1.15 atm and the mean maximum time of inflation was 86.1 +/- 29.6 sec. The mean residual stenosis was 15.2 +/- 10.6%. There was only one major complication, namely an acute myocardial infarction of the lateral wall. There were no emergency CABG surgery or deaths. We conclude that the new low profile balloon catheters have broadened the indication for PTCA in more complicated lesions, showing a high rate of primary success (95%), but did not increase the number of procedural complications (2.5%).

Inappetence in ruminants as a measure of fluoride solubility in various phosphates.

Experiments with soft phosphate and fertilizer grade concentrated superphosphate and diammonium phosphate were to measure effects on voluntary intake of their fluoride in relation to that from calcium fluoride and sodium fluoride given once daily by capsule. Mature wethers were offered 1200 or 1400 g daily of mixed grain-roughage diet, and responses to fluoride were measured by inappetence, consumption of less than 10% of offered diet. When 40 ppm fluoride as sodium fluoride was given for 2 days, inappetence resulted, whereas 2,400 ppm fluoride as calcium fluoride did not decrease feed intake. Time required for recovery of appetite increased with more fluoride. When soft phosphate, concentrated superphosphate, and diammonium phosphate were tested at 100, 200, and 400 ppm fluoride, inappetence occurred always but severity of reduction of intake was related to parts per million fluoride. Solubility of fluoride in soft phosphate, concentrated superphosphate, and diammonium phosphate is more similar to sodium fluoride than to calcium fluoride, and their use should be in keeping with fluoride tolerances established for ruminants fed sodium fluoride.