RESUMO
Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Falanges dos Dedos da Mão , Análise de Variância , Densidade Óssea , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/fisiopatologia , Remodelação Óssea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Falanges dos Dedos da Mão/patologia , Falanges dos Dedos da Mão/fisiopatologia , Mãos , Arcada Osseodentária/patologia , Arcada Osseodentária , Mieloma Múltiplo/patologia , Osteoporose/induzido quimicamente , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de TempoRESUMO
OBJETIVO: Identificar os fatores associados à pneumonia nosocomial em hospital público de Feira de Santana, Bahia. MÉTODOS: Este estudo caso-controle foi realizado em 211 indivíduos adultos (46 casos e 165 controles), com idade média de 41 anos, atendidos na Clínica Médica, Clínica Cirúrgica ou na Unidade de Terapia Intensiva Adulta do Hospital Geral Clériston Andrade, em Feira de Santana. Os casos foram constituídos por indivíduos que desenvolveram infecção do trato respiratório (pneumonia nosocomial) após admissão hospitalar. Os controles foram formados por não portadores de pneumonia nosocomial. Informações socioeconómicas, história médica, estilo de vida e hábitos de higiene bucal foram obtidos por meio de entrevistas. Os prontuários foram checados para registro da condição de saúde do indivíduo e diagnóstico de pneumonia. Exame clínico bucal foi realizado por cirurgião-dentista treinado. Na análise bivariada, foi estimado o odds ratio (OR) como medida de associação e seus respectivos intervalos de confiança de 95 por cento (IC 95 por cento) com uso do método de Mantel-Haenzel. RESULTADOS: A frequência de pneumonia nosocomial na amostra foi de 21,8 por cento. A ocorrência de hipertensão e o tempo de internamento foram maiores nos casos do que nos controles (p < 0,05). A falta de uso de fio dental e de enxaguatório bucal foram maiores no grupo controle (p = 0,01). CONCLUSÃO: Os achados apontam a hipertensão, tempo de internamento > 5 dias e ausência do fio dental e enxaguatório bucal como fatores possivelmente associados à pneumonia nosocomial, apontando-os como alvos efetivos de prevenção.
OBJECTIVE: To identify factors associated with nosocomial pneumonia in individuals admitted to apublic hospital in Feira de Santana, Bahia. METHODS: This case control study was carried out in 211 adult individuals (46 cases and 165 controls), of a mean age of 41 years, treated at clinical wards, surgical wards or the adult intensive care unit of Cleriston Andrade General Hospital in Feira de Santana. The cases comprised individuals who developed respiratory tract infections (nosocomial pneumonia) after hospital admission. The controls consisted of patients without nosocomial pneumonia. Information on socioeconomic status, medical history, lifestyle and oral hygiene habits was obtained through interviews. The medical records were checked to verify subjects' health status and the diagnosis opneumonia. A clinical oral examination was performed by a trained dental surgeon. Odds ratio (OR) was estimated in the bivariate analysis as an association measurement, along with the respective 95 percent confidence interval through the Mantel-Haenszel method. RESULTS: The frequency of nosocomial pneumonia in the sample was 21.8 percent. The occurrence of hypertension was higher and hospital stay duration was longer in the cases than in controls (p ≤ 0.05). Lack of dental floss and mouthwash use were higher in the controls (p = 0.01). CONCLUSION: The findings indicate that arterial hypertension, length of hospital stay of five days and lack of dental floss and mouthwash use are factors likely associated with nosocomial pneumonia, suggesting that these factors should be targeted for effective prevention.