OBJECTIVE:We evaluated the potential of the Finnish Diabetes Risk Score questionnaire to screen for undiagnosed hyperglycemia in patients with periodontitis, comparing its performance with that of glycated hemoglobin (HbA1c). METHODS:In this cross-sectional pilot study, we included 21 adults (22-64 years) diagnosed with periodontitis. Demographic data, periodontal status, HbA1c levels, and Finnish Diabetes Risk Scores were collected. Based on HbA1c levels, participants were classified as normoglycemic (<5.7%), prediabetic (5.7-6.4%), or diabetic (≥6.5%) according to established diagnostic criteria. Finnish Diabetes Risk Scores ≥12 indicated moderate-to-very-high diabetes risk. Associations between the Finnish Diabetes Risk Score, HbA1c, and periodontal parameters were assessed using Friedman's test and multinomial logistic regression. Diagnostic validity indices and receiver operating characteristic (ROC) curves were calculated. RESULTS:Most participants were women (71.4%) and had advanced disease (71.4% stage IV; 71.4% generalized periodontitis). According to the Finnish Diabetes Risk Score, 71.5% of patients had a high or very high risk of developing type 2 diabetes within 10 years. Mean HbA1c was 5.8±0.4%, ranging from normoglycemic to diabetic levels (≥6.5%). Finnish Diabetes Risk Scores ≥12 were significantly associated with HbA1c-defined prediabetes/diabetes and generalized periodontitis (p<0.001). In the multinomial logistic regression analysis, age, sex, periodontal extent, and HbA1c were identified as independent predictors of higher Finnish Diabetes Risk Scores. Finnish Diabetes Risk Scores ≥12 showed high sensitivity (92-100%) and negative predictive value (80-100%), but low specificity (26-44%); ROC analysis demonstrated acceptable diagnostic performance, particularly for identifying combined prediabetes and diabetes. CONCLUSION:The Finnish Diabetes Risk Score is a practical, non-invasive screening tool for predicting the risk of undiagnosed dysglycemia in patients with periodontitis in dental settings. Its high sensitivity supports its use for risk stratification; however, positive findings require biochemical confirmation. These findings underscore the role of dental professionals in early disease detection.
OBJECTIVE:We aimed to assess the effectiveness of a remote training program designed to improve the ability of education professionals to conduct visual screening in children aged 2-5 years. METHODS:This prospective longitudinal interventional study included 42 early childhood education professionals from a daycare center in São Paulo, Brazil. Participants completed a remote training program consisting of video-based lessons on eye health and visual screening techniques. Pre- and post-training assessments were conducted to evaluate changes in participants' knowledge, confidence, and practical skills related to visual screening. Statistical analyses were performed using the McNemar-Bowker and Wilcoxon tests. RESULTS:Post-training assessments demonstrated statistically significant improvements in participants' knowledge, confidence, and ability to perform and explain visual screening procedures, including the use of the LEA Symbols chart and recognition of conditions such as amblyopia (p<0.001). CONCLUSION:The remote training program improved the preparedness of education professionals to conduct visual screening in young children and may enhance their ability to identify children requiring referral for further ophthalmologic evaluation. This approach may be adapted for broader implementation within eye health promotion initiatives. Study limitations include the absence of a control group, lack of long-term follow-up, use of a single-center convenience sample, and the absence of comparisons with alternative teaching methods.
OBJECTIVE:Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive, and antiangiogenic therapies commonly used to treat osteoporosis, malignant bone tumors, and metastatic diseases. This review provides a comprehensive overview of the pathophysiology, clinical presentation, diagnosis, prevention, and management of MRONJ. METHODS:This narrative review examined the prevalence of MRONJ and its clinical and radiological features, particularly those relevant to disease staging, and outlined current preventive and treatment strategies, aiming to improve patient outcomes and quality of life. RESULTS:Patients with cancer receiving high-dose intravenous antiresorptive medications exhibited a higher incidence of MRONJ than that observed in patients treated for osteoporosis. Clinical staging systems, especially those developed by the American Association of Oral and Maxillofacial Surgeons, facilitate disease classification based on clinical and imaging findings, thereby guiding treatment selection and prognosis assessment. Preventive approaches, conservative management, surgical procedures, and adjunct therapies have been proposed to promote healing of both hard and soft tissues. CONCLUSION:Although emerging therapeutic options are promising, prevention and personalized treatment remain major challenges.
OBJECTIVE:In the Brazilian public health system, referral letters, issued by general dentists and physicians who perform initial clinical assessments, is the main source of information in arriving at a final diagnosis. However, the consistency and completeness of the referral letters remain poorly explored. Therefore, we assessed the quality of referral letters received by an oral medicine service at a dental specialty center over a 2-year period (2023-2024) and characterized the diagnostic profile of referred cases. METHODS:This census-based retrospective cross-sectional study analyzed 430 referral letters using 8 predefined criteria (0-8 points) on lesion characteristics, clinical history, and diagnostic hypothesis. The referral letters were classified as poor (0-1), regular (2-3), good (4-6), or excellent (7-8). RESULTS:All referrals were from public services; 47.0% were issued in 2023 and 53.0% in 2024. Referrals to dentists accounted for 97.2% of the referrals. Most letters were rated as regular (60.5%) or good (23.0%), while 15.6% were classified as poor and only 0.9% as excellent. Frequently reported descriptors included lesion location (84.2%) and primary morphology (76.5%). Clinically relevant details such as symptomatology (22.8%), time of evolution (16.0%), lesion size (3.5%), and limits (2.3%) were mostly absent. Diagnoses included benign lesions (71.9%), potentially malignant disorders (10.7%), normality variations (6.3%), and malignant lesions (3.7%); 7.4% of the referrals had no diagnosis. Referral quality scores differed significantly across diagnostic categories (p=0.0076), with lower scores observed in cases without a final diagnosis. CONCLUSIONS:Despite the predominance of benign lesions, more than one in every seven referrals, which were often incompletely documented, involved potentially malignant disorders or malignant lesions. Strengthening referral documentation through targeted training and standardized electronic templates may improve screening accuracy, support the earlier detection of oral lesions, and reduce diagnostic delays within the Brazilian unified health system.
OBJECTIVE:In this study, we aimed to evaluate the primary health care attribute of first-contact access from the perspective of users of family and oral health teams in São Paulo, Brazil. METHODS:A cross-sectional study was conducted at 12 basic health units between January and November 2021. The adult versions of the Primary Care Assessment Tool (PCATool-Brazil) and PCATool-Oral Health were used to assess first-contact access through its two components of utilization and accessibility. RESULTS:In total, 537 individuals participated, including 129 users of oral health teams and 408 users of family health teams. In both groups, utilization scores were higher than accessibility scores. Among users of oral health teams, the mean scores were 8.08 for utilization and 4.37 for accessibility; among users of family health teams, the corresponding scores were 8.43 and 3.80. For oral and family health teams, high performance for utilization was observed in 85.37% and 87.53% of users, whereas low performance for accessibility was observed in 95.08% and 97.70% of users, respectively. Few differences in participant characteristics were observed among users of oral health teams, with higher utilization scores noted among those without private health insurance. Regarding users of family health teams, higher utilization scores were observed among older adults, retirees, or pensioners; beneficiaries of social programs; those without private health insurance; and those with hypertension and or diabetes. For accessibility, higher scores were observed among men, older adults, and retirees or pensioners. CONCLUSION:Overall, utilization was satisfactory and accessibility was unsatisfactory in both family and oral health teams. Primary health care services were recognized as a usual source of care, but organizational barriers to timely access remain, especially in oral health care. These findings highlight the need to strengthen accessibility in primary health care, particularly through organizational strategies aimed at improving timely access to care.
OBJECTIVES:This study aimed to compare quality of life and caregiver burden between caregivers and guardians of children with autism spectrum disorder and those of neurotypical children. METHODS:A total of 124 caregivers participated and were assigned to two groups: autism spectrum disorder (ASD; n=62) and neurotypical (NT; n=62). Participants were recruited from a specialized multiprofessional dental care institution. Data were collected using a sociodemographic questionnaire, the WHOQOL-BREF, and the Zarit Burden Interview. Data were tabulated and analyzed using a 5% significance level. RESULTS:The mean age of the children was 9.45 years in the ASD Group and 8.29 years in the NT Group. The proportion of boys was higher in the ASD Group than in the NT Group (p<0.001). Regarding functional independence, 69.4% of children with ASD depended on caregivers for activities of daily living, whereas 67.7% of neurotypical children were independent (p<0.001). For oral hygiene, 64.4% of children with ASD required caregiver assistance, whereas 82.3% of neurotypical children performed oral hygiene independently (p<0.001). Overall quality of life did not differ significantly between groups. However, specific items in the physical and psychological domains differed significantly between groups (Q3: p=0.021; Q4: p=0.001; Q26: p=0.003). By contrast, caregiver burden was significantly higher among caregivers of children with autism spectrum disorder than among caregivers of NT children, as reflected by higher total and domain scores (p<0.001). CONCLUSION:Although caregivers in both groups reported moderate quality of life, those caring for children with autism spectrum disorder experienced substantially greater caregiver burden. These findings support the need for targeted strategies to reduce caregiver stress and improve well-being in families of children with autism spectrum disorder.Brazilian Registry of Clinical Trials: RBR-4cvz58n and U1111-1299-9942.
OBJECTIVE:To investigate oral manifestations and the presence of T. pallidum DNA in children exposed to maternal syphilis by integrating epidemiological, clinical, and molecular data. METHODS:This two-phase observational study analyzed health, perinatal, and dental records of children born to mothers diagnosed with syphilis during pregnancy. In Phase 1, demographic characteristics, maternal treatment adequacy, birth conditions, and oral clinical findings were assessed. In Phase 2, a subset of children underwent comprehensive oral examinations, including evaluation for enamel defects associated with congenital syphilis. Oral samples were collected and processed by DNA extraction followed by nested PCR targeting T. pallidum-specific genes. RESULTS:Although no statistically significant differences were observed between maternal treatment groups for some outcomes, children exposed to maternal syphilis showed enamel hypoplasia, Hutchinson-like incisors, and molar defects. PCR amplification identified T. pallidum DNA in oral samples from a subset of participants, suggesting possible persistence of treponemal DNA or residual genetic material after maternal treatment. CONCLUSION:Children exposed to maternal syphilis may present with distinctive oral alterations, and molecular detection of T. pallidum DNA in the oral cavity supports the need for long-term dental follow-up and integration of oral examinations into postnatal care programs.
OBJECTIVE:To evaluate disparities in patients with prostate cancer treated at private or public health systems in Brazil. METHODS:Anonymized retrospective and prospective data were collected from the medical records of patients over 18 years old diagnosed with prostate cancer between 2017 and 2024. RESULTS:A descriptive analysis of 2,387 patients treated at private or public hospitals revealed that more than half were younger than 75 years old. Regarding race, 58% of patients reported their ethnicity: 75.41% identified as white, 13.84% mixed-race, 7.35% Black, 3.32% Asian, and 0.07% Indigenous. Public hospital patients had a 2.5-fold higher risk of metastasis at diagnosis (p<0.01) and longer hospital stays (p<0.01) when compared to private service patients. Black (odds ratio [OR]=2.27) and mixed-race (OR=1.89) patients had a higher risk of metastasis at diagnosis than white patients. Furthermore, Black (OR=0.04), mixed-race (OR=0.26), and Asian (OR=0.14) patients, and those >75 years old (OR=0.42) had lower chances of undergoing advanced surgery techniques such as robotic surgery. Patients older than 75 years had significantly worse overall survival (p<0.01). CONCLUSION:The results of this study highlight significant disparities in patients with prostate cancer. Black and mixed-race patients, as well as those from the public healthcare system, faced a higher risk of metastasis at diagnosis and lower chances of accessing advanced technologies. Additionally, advanced age was associated with shorter overall survival and longer hospitalization. These findings underscore the need for targeted interventions to reduce treatment access inequalities and improve clinical outcomes, particularly in vulnerable populations.
OBJECTIVE:This study aimed to assess the prevalence of abdominal and hiatal hernias in patients with aortic, visceral, and renal aneurysms in a quaternary hospital. METHODS:Computed tomography angiography reports from 2,597 patients with intra-abdominal aneurysms, collected between January 2005 and July 2021 at a private hospital in São Paulo, Brazil, were analyzed. The variables of interest were analyzed descriptively, and inferential statistics (chi-square test and Student's t-test) were applied to explore relationships between sex, age, number of vessels with aneurysms, and number of hernias identified by computed tomography angiography. RESULTS:Of 2,597 patients with abdominal aneurysms, 837 (32.23%) presented with at least one hernia. Among them, 416 patients (16.03%) had abdominal wall hernias, while 421 (16.20%) had hiatal hernias. Patients with hernias were significantly older (72.2±12.0 years; p<0.001) than patients without hernias (68.2±14.0 years); there were no significant age differences between sexes (p=0.714). Hiatal hernias had a high prevalence (50.3%) among both aortic and visceral aneurysms, particularly amnong those with hepatic artery (42.91%) and celiac trunk aneurysms (41.82%). CONCLUSION:A high coexistence of abdominal and hiatal hernias was observed among patients with intra-abdominal aneurysms. These findings highlight a statistical association and should not be interpreted as indicating a causal relationship or as a risk-stratification tool in the absence of prospective, controlled studies.
OBJECTIVE:This study aimed to evaluate the association between the use of extended criteria donors and post-transplant outcomes in a Brazilian liver transplantation center and to compare the prognostic performance of established severity scores. METHODS:We conducted a retrospective observational study of liver transplantation performed between 2016 and 2020. Patient and graft survivals were assessed at 3, 12, 36, and 60 months. Extended criteria donor status was defined according to the Eurotransplant criteria. The predictive values of the Donor-Model for End-Stage Liver Disease, Donor Risk Index, and Balance of Risk scores were analyzed using categorical and continuous models. RESULTS:Among 414 transplants, 62% (n=258) involved extended criteria donor grafts. One- and five-year patient survival rates were 89.5% and 82.5%, respectively, with no significant difference between extended criteria donor and non-extended criteria donor groups (log-rank p=0.074). The extended criteria donor classification was not independently associated with mortality. The Balance of Risk score was the only prognostic model significantly associated with mortality and graft loss. Each one-point increase in the Balance of Risk was associated with a 7.3% increase in mortality risk (hazard ratio [HR]=1.073; 95% confidence interval [95%CI], 1.016-1.133; p=0.012) and a 17.4% increase in graft loss risk (HR=1.174; 95%CI=1.073-1.284; p<0.001). CONCLUSION:In this cohort, extended criteria donor status alone did not predict inferior survival, whereas the Balance of Risk score demonstrated consistent prognostic discrimination. These findings support the use of integrated donor-recipient risk assessment to guide organ acceptance and allocation decisions in liver transplantation.
OBJECTIVE:To describe the long-term outcomes of patients undergoing oral immunotherapy for cow's milk allergy in a pediatric allergy clinic, focusing on treatment efficacy and adverse reactions over 5 years of follow-up. METHODS:This retrospective cohort study reviewed medical records of patients aged 5-18 years who underwent cow's milk oral immunotherapy at Instituto da Criança, São Paulo. All patients initiated treatment between 2013 and 2019 and completed at least 5 years of maintenance follow-up. Evaluated outcomes included treatment adherence, adverse reactions, anaphylaxis, and eosinophilic esophagitis. Data were analyzed descriptively, and statistical tests were applied. RESULTS:Thirty patients entered the maintenance phase (median age, 8.2 years). Most had allergic comorbidities and a history of anaphylaxis. Four patients discontinued treatment within the first trimester: two due to anaphylaxis and two due to eosinophilic esophagitis. Adverse reactions were predominantly mild and decreased significantly over time (p=0.01). Severe reactions accounted for 17% of events, including 22 episodes of anaphylaxis. Eosinophilic esophagitis was diagnosed in 33% of patients and occurred more frequently among those initiating treatment after 12 years of age. CONCLUSION:Long-term oral immunotherapy increased tolerance and enabled regular milk ingestion in most patients. Older age at treatment initiation was associated with a higher incidence of eosinophilic esophagitis. Careful patient selection and structured monitoring during and after treatment are essential for early identification of severe reactions and eosinophilic esophagitis. Larger studies with longer follow-up are needed to optimize protocols and improve safety strategies.
Histoplasmosis is an endemic mycosis in certain regions of Brazil and represents a rare opportunistic infection in solid organ transplant recipients. This report describes the case of a 68-year-old female liver transplant recipient (due to Caroli disease) who presented with abdominal pain, nausea, vomiting, and a distended, tender abdomen. Abdominal computed tomography revealed parietal thickening of the bowel wall, and colonoscopy identified polymorphic ulcers and ileocecal stenosis. Given the suspicion of tuberculosis, chest computed tomography was performed, which demonstrated pulmonary opacities. Although testing for acid-fast bacilli was negative, fungal staining was positive for Histoplasma capsulatum. Antifungal therapy with amphotericin B was initiated; however, due to clinical refractoriness, surgical intervention was required, including ileocecal resection with ileo-ascending anastomosis. A reoperation was performed due to postoperative complications, resulting in the creation of a terminal ileostomy. Following this intervention, the patient showed clinical improvement and tolerated an oral diet. This case highlights an atypical presentation of disseminated histoplasmosis with pulmonary and intestinal involvement, culminating in intestinal subocclusion in a late-stage liver transplant recipient. It underscores the importance of considering histoplasmosis in the differential diagnosis of immunosuppressed patients and the need for early investigation and treatment.
Lactation induction is the process of stimulating milk production when pregnancy has not occurred, but there is still a desire to breastfeed. Initially designed for adoptive mothers and mothers through surrogacy, the protocol does not explore other uses, such as in cases of LGBTQIA+ families, in which breastfeeding may also be a significant symbol in the transition to parenthood. Thus, we seek to explore the complexities of the use of lactation protocols by cisgender women couples who have chosen co-lactate. This article is based on qualitative research conducted through semi-structured interviews with women in São Paulo and Rio de Janeiro, Brazil, between June and October 2024. Seven women participated: three couples and one non-gestational mother. From this analysis, two analytical categories emerged: the first addresses the sources of information used by the participants, highlighting the key role of information networks built through the internet and the notable absence of healthcare professionals as references in this process. The second category discusses the participants' experiences with the induction protocol, highlighting the challenges of balancing their routines with the protocol's demands and the importance of healthcare professionals who act as positive deviants from the hegemonic model of care. We propose a reflection within the field of healthcare on its onto-epistemological assumptions, suggesting the right to opacity as a guiding principle in the construction of healthcare practices, acknowledging that it is not necessary to understand the other - or their life logics - in order to form a care alliance that goes beyond rigid, standardized protocols.
OBJECTIVE:To Describe the prevalence of adenomatous and serrated polyps in ulcerative colitis and investigate risk factors associated with the development and recurrence of preneoplastic polyps. METHODS:In this cross-sectional study, colonoscopy findings and clinical data from patients diagnosed with ulcerative colitis who were treated at a tertiary care center were analyzed. RESULTS:A total of 240 patients were included (56.3% female, 79% with left-sided or extensive colitis, and 7.5% diagnosed with primary sclerosing cholangitis). The prevalence of adenomatous and serrated polyps was 16.2% (39/240). Age >41 (OR=2.85, 95%CI=1.4 - 5.8; p=0.0125), older age at the first colonoscopy (OR=1.04, 95%CI=1.01 - 1.06; p=0.0015), and higher body mass index (OR=1.12, 95% CI=1.0 - 1.1; p=0.0042) were identified as risk factors for polyps development (p<0.05). Regarding recurrence, 11 out of 39 patients presented with polyps on subsequent colonoscopies, with a mean time to recurrence of 47.5 months. No factors were found to be associated with polyp recurrence. CONCLUSION:The prevalence of adenomatous and serrated polyps in patients with ulcerative colitis appeared to be lower than that reported in the general population.
OBJECTIVE:This study aimed to evaluate the effects of resistance exercise associated with photobiomodulation on the popliteal lymph nodes of Wistar rats subjected to an acute-phase experimental model of rheumatoid arthritis. METHODS:The study consisted of 64 male Wistar rats divided into eight groups (n=8), including control, physical exercise, and photobiomodulation groups. The arthritis groups were subjected to an induction protocol using Complete Freund's Adjuvant and underwent an acute inflammatory period of 7 days, during which they received resistance exercise and photobiomodulation according to their respective group assignments. RESULTS:There was a significant increase in the total lymph node area of the groups subjected to rheumatoid arthritis induction. A reduction in the number of lymphocytes and plasma cells in the medullary cord, as well as macrophages in the medullary sinuses, was observed in the groups treated with both resistance exercise and photobiomodulation. Additionally, a reduction in lymphocytes and reticular cells was observed in the groups treated with photobiomodulation alone. CONCLUSION:Treatment with resistance exercise or photobiomodulation was effective in modulating the immune response in the popliteal lymph node during the acute stage of the disease; however, combined therapy did not provide additional benefits compared with either treatment alone.
OBJECTIVE:This study developed and evaluateed a retrieval-augmented generation (RAG)-based large language model system designed to standardize and improve antimicrobial treatment protocol adherence, leveraging the Antimicrobial Treatment Guide from the Hospital Israelita Albert Einstein in São Paulo, Brazil. METHODS:Four modules were used to compose the search system, namely document processing, query processing, large language model, and prompt management. Protocol documents were manually segmented into manageable text chunks, converted into vectors, and stored in a vector database to enable efficient retrieval using the RAG methodology. This approach allows the model to generate responses based on external data without additional training. The evaluation included quantitative metrics, such as the Jaccard index for retrieval accuracy, Public Health System (SUS - Sistema Único de Saúde) usability scale, and behavior change questionnaire to assess user perception and impact on clinical decision-making. RESULTS:The system achieved an SUS score of 82, indicating excellent usability. The system further correctly retrieved the appropriate antimicrobial protocol in 83% of cases. These results suggest effective alignment between system responses and institutional clinical guidelines. CONCLUSION:The RAG-based system demonstrated high usability and reliable retrieval performance, supporting standardized antimicrobial therapy aligned with local guidelines. This approach has the potential to bridge the gap between clinical practice and protocol adherence, enhance diagnostic accuracy and treatment specificity, and potentially reduce the risk of antibiotic resistance while improving patient outcomes.
