Surgery is unlikely to be enough for a patient to stop smoking 24 h prior to hospital admission / É improvável que a cirurgia seja suficiente para que o paciente pare de fumar 24 horas antes da internação hospitalar

Abstract Introduction The need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24 h before hospital admission and possible relapse on the last 24 h before hospital admission for ex-smokers. Methods Smoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6 h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements. Results 241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97 ± 6.50 vs. 2.26 ± 1.65 vs. 2.98 ± 2.69; p = 0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93 ± 7.5 vs. 8.65 ± 4.56; p = 0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9 ± 2.3 vs. 2.82 ± 2.15; p = 0.45). Conclusion A medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24 h prior to admission. The proximity of a surgery was not associated with smoking relapse 24 h before the procedure.

Resumo Introdução A necessidade de cirurgia pode ser um fator decisivo para a cessação do tabagismo em longo prazo. Por outro lado, situações que precipitam o estresse podem precipitar a recaída do tabagismo. Decidimos avaliar o impacto de uma cirurgia no esforço do paciente para deixar de fumar durante pelo menos 24 horas antes da internação hospitalar e a possível recaída nas últimas 24 horas anteriores à internação em ex-fumantes. Métodos Fumantes, ex-fumantes e não fumantes adultos, quer de clínica pré-anestésica ou recentemente internados para cirurgias eletivas programadas que ficariam, no máximo, seis horas dentro das unidades hospitalares, foram incluídos no estudo. Os pacientes responderam um questionário na enfermaria ou na entrada da sala de operação (Grupo Internação) ou no início da primeira consulta pré-anestesia (Grupo Clínico) e fizeram mensurações dos níveis de CO. Resultados No total, 241 pacientes foram incluídos: 52 ex-fumantes, 109 que nunca fumaram e 80 não fumantes. Os fumantes apresentaram níveis mais elevados de monóxido de carbono expirado que os não fumantes e ex-fumantes (9,97 ± 6,50 vs. 2,26 ± 1,65 vs. 2,98 ± 2,69;p = 0,02). Entre os fumantes, o Grupo Clínico apresentou níveis de CO não estatisticamente diferentes daqueles do Grupo Internação (10,93 ± 7,5 vs. 8,65 ± 4,56; p = 0,21). Os ex-fumantes não apresentaram diferenças significativas entre os grupos Clínico e Internação para os níveis de monóxido de carbono (2,9 ± 2,3 vs. 2,82 ± 2,15; p = 0,45). Conclusão É improvável que uma condição médica, como uma cirurgia, sem assistência adequada seja suficiente para que um paciente pare de fumar, pelo menos, 24 horas antes da internação. A proximidade de uma cirurgia não foi associada à recaída do tabagismo nas 24 horas anteriores ao procedimento.

[Surgery is unlikely to be enough for a patient to stop smoking 24h prior to hospital admission]. / É improvável que a cirurgia seja suficiente para que o paciente pare de fumar 24 horas antes da internação hospitalar.

INTRODUCTION: The need for surgery can be a decisive factor for long-term smoking cessation. On the other hand, situations that precipitate stress could precipitate smoking relapse. The authors decided to study the impact of a surgery on the patient's effort to cease smoking for, at least, 24h before hospital admission and possible relapse on the last 24h before hospital admission for ex-smokers. METHODS: Smoker, ex-smokers and non-smokers adults, either from pre-anesthetic clinic or recently hospital admitted for scheduled elective surgeries that were, at most, 6h inside the hospital buildings were included in the study. The patients answered a questionnaire at the ward or at the entrance of the operating room (Admitted group) or at the beginning of the first pre-anesthetic consultation (Clinic group) and performed CO measurements. RESULTS: 241 patients were included, being 52 ex-smokers and 109 never smokers and 80 non-smokers. Smokers had higher levels of expired carbon monoxide than non-smokers and ex-smokers (9.97±6.50 vs. 2.26±1.65 vs. 2.98±2.69; p=0.02). Among the smokers, the Clinic group had CO levels not statistically different of those on the Admitted group (10.93±7.5 vs. 8.65±4.56; p=0.21). The ex-smokers presented with no significant differences for the carbon monoxide levels between the Clinic and Admitted groups (2.9±2.3 vs. 2.82±2.15; p=0.45). CONCLUSION: A medical condition, such as a surgery, without proper assistance is unlikely to be enough for a patient to stop smoking for, at least, 24h prior to admission. The proximity of a surgery was not associated with smoking relapse 24h before the procedure.

Repair genes expression profile of MLH1, MSH2 and ATM in the normal oral mucosa of chronic smokers.

OBJECTIVE: The aim of this study was to evaluate the effect of chronic smoking on the expression profile of the repair genes MLH1, MSH2 and ATM in the normal oral mucosa of chronic smokers and never smokers. MATERIALS AND METHODS: The sample consisted of thirty exfoliative cytology smears per group obtained from Smokers and Never Smokers. Total RNA was extracted and expression of the MLH1, MSH2 and ATM genes were evaluated by quantitative real-time and immunocytochemistry. The gene and protein expression data were correlated to the clinical data. Gene expression was analyzed statistically using the Student t-test and Pearson's correlation coefficient, with p<0.05. RESULTS: MLH1, MSH2 and ATM genes were downregulated in the smoking group compared to the control with significant values for MLH1 (p=0.006), MSH2 (p=0.0001) and ATM (p=0.0001). Immunocytochemical staining for anti-MLH1, anti-MSH2 and anti-ATM was negative in Never Smokers; in Smokers it was rarely positive. No significant correlation was observed among the expression of MLH1, MSH2, ATM and age, number of cigarettes consumed per day, time of smoking during life, smoking history or levels of CO in expired air. CONCLUSION: The expression of genes and proteins related to DNA repair mechanism MLH1, MSH2 and ATM in the normal oral mucosa of chronic smokers was reduced.

Comparison of RNA Extraction Methods for Molecular Analysis of Oral Cytology.

OBJECTIVE OF WORK: The aim of this study was to compare three methods of RNA extraction for molecular analysis of oral cytology to establish the best technique, considering its concentration and purity for molecular tests of oral lesions such as real-time reverse transcriptase reaction. MATERIAL AND METHODS: The sample included exfoliative cytology from the oral cavity mucosa of patients with no visible clinical changes, using Orcellex Rovers Brush®. The extraction of total RNA was performed using the following three techniques: 30 samples were extracted by Trizol® technique, 30 by the Direct-zolTM RNA Miniprep system and 30 by the RNeasy mini Kit. The absorbance was measured by spectrophotometer to estimate the purity. The estimated RNA concentration was obtained by multiplying the value of A260 (ng/mL) by 40. Statistical analysis of the obtained data was performed using GraphPad Prism 5.03 software with Student t, analysis of variance and Bonferroni tests, considering p ≤0.05. RESULTS: Trizol® group revealed higher average concentration, followed by Direct-zolTM and Rneasy group. It was observed that the RNA Direct-zolTM group had the highest purity, followed by RNeasy and Trizol® groups, allowing for the two ratios. CONCLUSION: Considering all aspects, concentration, purity and time spent in the procedures, the Direct-zolTM group showed the best results.

CYP2B6 rs2279343 polymorphism is associated with smoking cessation success in bupropion therapy.

BACKGROUND: Previous studies suggested that polymorphisms in the CYP2B6 gene (which encodes an isoenzyme that metabolizes bupropion) and in the ANKK1 gene (which is located in the ANKK1/DRD2 gene cluster) might influence response to therapy. Thus, the aim of the present study was to evaluate whether the CYP2B6 and ANKK1 polymorphisms are associated with the response to smoking cessation therapies in patients from a smoking cessation assistance program. METHODS: The cohort study enrolled 478 smokers who received behavioral counseling and drug therapy (bupropion, nicotine replacement therapy, and/or varenicline). Smoking cessation success was considered for patients who completed 6 months of continuous abstinence. Fagerström test for nicotine dependence (FTND) and Issa situational smoking scores were analyzed for nicotine dependence (ND). The ANKK1 rs1800497, CYP2B6*4 (rs2279343), CYP2B6*5 (rs3211371), and CYP2B6*9 (rs3745274) polymorphisms were genotyped by high resolution melting analysis or by restriction fragment length polymorphism. RESULTS: Patients with CYP2B6 rs2279343 wild-type AA genotype had higher success rate (48.0 %) compared with patients carrying AG or GG genotypes (CYP2B6*4 variant) (35.5 %) on bupropion therapy. The AA genotype was associated with higher OR for success during bupropion therapy (OR = 1.92, 95 % CI = 1.08-3.42, p = 0.03) in a multivariate model. We did not observe significant differences in the FTND and Issa scores according to the studied polymorphisms. CONCLUSION: We showed that patients with CYP2B6*4 (rs2279343) variant had lower success rate with bupropion. Likely, the CYP2B6*4 variant, which leads to a rapid predicted metabolic phenotype for the isoenzyme, influences the pharmacological activity of bupropion. Our finding suggests that CYP2B6*4 may be an important genetic marker for individualized bupropion pharmacotherapy.

Alcoolismo e tabagismo em adolescentes / Alcohol and tobacco consuption among adolescents

A adolescência é uma fase de vulnerabilidade para uso de risco de álcool e tabaco. Estudos epidemiológicos mostram que acerca de 23% dos adolescentes brasileiros fazem uso de drogas, sendo o álcool a substância mais consumida e de início mais precoce, Os adolescentes estão sujeitos a consequências de prejuízos importantes. A patogênese do uso de risco é complexa e multifatorial, composta de genética, grau de desenvolvimento do indivíduo, ambiente, contexto de uso e substância utilizada, havendo interação entre estes fatores. A imprecisão dos critérios diagnósticos empregados pode ser substituída por um espectro de níveis de gravidade de uso de álcool e tabaco. O clínico deve considerar os critérios diagnósticos, além das mudanças de comportamento que podem indicar seu uso e suas consequências nas diversas áreas da vida do adolescente. A avaliação de risco deve sempre estar presente nas consultas e nortear as condutas do profissional. As intervenções devem reduzir ao máximo o contato do paciente com as drogas e, no caso de uso, prevenir a evolução do consumo para padrões mais graves de abuso ou dependência. A avaliação e o tratamento de comorbidades são fundamentais no manejo do tratamento nesta faixa etária e o encaminhamento para um especialista deve ser considerado nos casos de maior risco. A intervenção deve ser abrangente, incluindo atividades escolares e profissionalizantes, relacionamentos sociais, atividades de lazer, fundamentais para a retomada do desenvolvimento normal do adolescente.

Adolescence is a period of vulnerability to risk the use of alcohol and tobacco. Epidemiological studies show that approximately 23 of Brazilian teenager are using drugs and alcohol which is the most consumed substance at a more precocious beginning. Teens are subject to consequences of serious damage. The pathogenesis of risk use is complex and multifactorial composed of genetics, degree of development of the individual, environment the contexto of use, and the substances used, plus the fact there is the interaction between these factors. The inaccuracy of the diagnostic used may be replaced by a spectrum of severity levels of use of alcohol and tobacco. The clinician should consider diagnostic criteria, in addition to the changes in behavior that may indicate their use and the consequences in several áreas of the life of the teenager. The risk assessment should alwas be presente in the consultations in order to guide the professional conduct. Interventions should reduce the patient's contact with drugs and, in case of use, prevent the increase of consumption for more severe patterns of abuse or dependency properties. The evaluation and treatment of comorbidities are essential in order to manage the treatment of this age group and the referral to a specialist should be considered in case of increased risk. The intervention must be comprehensive, including school and vocational activities, social relationship, leisure activities which are essential for the resumption of normal adolescente development.

A new nicotine dependence score and a new scale assessing patient comfort during smoking cessation treatment.

Smoking is considered the leading preventable cause of morbidity and mortality. The pharmacological management of nicotine withdrawal syndrome enables better cessation rates. In our smoking cessation program, we have developed a data collection system, which includes two new instruments: a score that assesses nicotine dependence in smokers of < 10 cigarettes/day; and a patient comfort scale to be used during smoking cessation treatment. Here, we describe the two instruments, both of which are still undergoing validation.

Epidemiologia das doenças cardiovasculares e neoplasias: quando vai ocorrer o cruzamento das curvas? / Epidemiology of cardiovascular diseases and cancer: when will the curves overlap?

As doenças cardiovasculares e neoplásicas tornaram-se, nos últimos anos, temas prioritários na maioria dos países, pelo impacto na mortalidade, na morbidade e nos custos decorrentes da assistência médica. No Brasil, esse cenário está bem documentado nas estatísticas oficiais da vigilância epidemiológica de doenças crônicas do Ministério da Saúde e, principalmente, na série de estudos realizados para determinar a frequência de fatores de risco relacionados a essas doenças. As taxas de câncer, de acordo com relatórios publicados pela Organização Mundial de Saúde (OMS), irão duplicar até 2020, o que tornará as doenças neoplásicas as mais incidentes e prevalente, ultrapassando as doenças cardiovasculares. Atualmente, são diagnosticados, a cada ano, mais de 10 milhões de casos novos de câncer no mundo e a tendência, para a próxima década, é de que esse número ultrapasse os 20 milhões anuais.

Cardiovascular and neoplastic diseases have become priority issues in most countries due to their impact on mortality, morbidity and healthcare costs in the last few years. In Brazil, this scenario is well documented by official epidemiological surveillance statistics of chronic diseases, performed by the Ministry of Health and by the series of studies carried out to determine the frequency of risk factors related to these diseases. Cancer rates, according to estimates reported by the World Health Organization (WHO), will double by 2020, which will make neoplastic diseases the most prevalent and incident diseases, surpassing cardiovascular diseases. Over 10 million new cases of cancer are diagnosed worldwide every year, and the trend for the next decade is that this figure will exceed 20 million per year.

Comparison of exfoliative pap stain and AgNOR counts of the tongue in smokers and nonsmokers.

OBJECTIVE: To compare exfoliative cytology from the oral mucosa of smokers and nonsmokers, with emphasis on proliferative activity. METHODS: Exfoliative cytology specimens were obtained from clinical normal mucosa from the lateral border of the tongue in 30 nonsmokers and 30 smokers ranging in age from 40 to 70 years of age, who were seen at the Heart Institute's Patient Center and the Smoking Cessation Program of the University Hospital, University of São Paulo Medical School (InCor-HCFMUSP). The cytologic specimens were evaluated by Papanicolaou staining and AgNOR quantification in order to evaluate the presence of cytological alterations suggestive of inflammation, dysplasia, keratinization, and proliferative activity of epithelial cells. RESULTS: Only Papanicolaou Class I and Class II smears were observed. Inflammatory alterations were found in 90% of smokers and in 87% of nonsmokers. The number of AgNORs/nucleus differed significantly between smokers and nonsmokers (3.372 +/- 0.375 versus 2.732 +/- 0.236). CONCLUSIONS: Within the limitations of this research, the results indicate higher proliferative activity in smoking patients compared to nonsmoking patients, even in the absence of clinical lesions.

Effectiveness of sustained-release bupropion in the treatment of smoker patients with cardiovascular disease.

OBJECTIVES: To evaluate the effectiveness of and tolerability to sustained-release bupropion, in smokers with cardiovascular diseases treated in a smoking cessation service, as well as to investigate variables predictive of success or failure in smoking cessation. METHODS: Sustained-release bupropion was prescribed to 100 current smokers with cardiovascular disease for 12 weeks. Patients were followed for 52 week. The variables studied were gender, age, number of cigarettes, exhaled carbon monoxide, nicotine dependence (Fagerstrom Tolerance Questionnaire), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), alcohol consumption (Alcohol Use Disorders Identification Test), number of diagnoses other than smoking, adverse events, and use of medications concomitantly with sustained-release bupropion. RESULTS: Abstinence rate was 50% at week 12 and 25% at week 52. The logistic regression analysis showed that ageing was positively associated with success, whereas the worsening of the condition, as verified by the presence of a higher number of other health conditions associated with smoking, was negatively associated with success. CONCLUSION: We conclude that the prescription of bupropion for smokers with cardiovascular diseases proved to be safe and effective, especially during the treatment period (week 12).

Efetividade da bupropiona no tratamento de pacientes tabagistas com doença cardiovascular / Effectiveness of sustained-release bupropion in the treatment of smoker patients with cardiovascular disease

OBJETIVOS: Avaliar a efetividade e a tolerabilidade da bupropiona no tratamento de fumantes com doenças cardiovasculares atendidos em rotina de tratamento ambulatorial do tabagismo, e analisar as variáveis preditoras de sucesso ou fracasso. MÉTODOS: A bupropiona foi prescrita de forma exclusiva para tratamento do tabagismo em 100 pacientes cardiopatas durante 12 semanas. O seguimento foi de 52 semanas. As variáveis estudadas foram sexo, idade, número de cigarros, concentração de monóxido de carbono, escala de dependência de nicotina, escala de depressão, escala de ansiedade, consumo de álcool, número de diagnósticos adicionais ao tabagismo, eventos adversos, e consumo de medicamentos concomitantes à bupropiona. RESULTADOS: A taxa de sucesso depois de 12 semanas foi de 50 por cento e depois de 52 semanas, de 25 por cento. A análise de regressão logística revelou que o envelhecimento foi positivamente associado ao sucesso e que o agravo da condição clínica, observado pelo maior número de diagnósticos associados ao tabagismo, foi negativamente associado ao sucesso. CONCLUSÃO: A bupropiona mostrou-se segura e com boa efetividade no tratamento de fumantes portadores de doenças cardiovasculares, especialmente durante a fase de uso (semana 12).

OBJECTIVES: To evaluate the effectiveness of and tolerability to sustained-release bupropion, in smokers with cardiovascular diseases treated in a smoking cessation service, as well as to investigate variables predictive of success or failure in smoking cessation. METHODS: Sustained-release bupropion was prescribed to 100 current smokers with cardiovascular disease for 12 weeks. Patients were followed for 52 week. The variables studied were gender, age, number of cigarettes, exhaled carbon monoxide, nicotine dependence (Fagerstrom Tolerance Questionnaire), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), alcohol consumption (Alcohol Use Disorders Identification Test), number of diagnoses other than smoking, adverse events, and use of medications concomitantly with sustained-release bupropion. RESULTS: Abstinence rate was 50 percent at week 12 and 25 percent at week 52. The logistic regression analysis showed that ageing was positively associated with success, whereas the worsening of the condition, as verified by the presence of a higher number of other health conditions associated with smoking, was negatively associated with success. CONCLUSION: We conclude that the prescription of bupropion for smokers with cardiovascular diseases proved to be safe and effective, especially during the treatment period (week 12).