Fabrício Bitu Sousa

Introduction: Oral squamous cell carcinoma is the most prevalent malignant neoplasm in the head and neck region, and its prognosis is influenced by various histopathological and clinical factors. pTNM tumor staging and invasion patterns are fundamental for predicting therapeutic response and patient survival. Methods: A retrospective study analyzing 283 cases of oral squamous cell carcinoma treated at Haroldo Juaçaba Hospital. Histopathological and clinical information was collected, including tumor grade, pTNM, invasion pattern, and response to therapy. Statistical analyses were carried out in SPSS software using Fisher's tests, Pearson's chi‐squared, log‐rank Mantel–Cox, and Cox regression. Results: The presence of pN2/pN3 nodal metastases, compromised margins, and a history of smoking were associated with a worse prognosis. Adjuvant radiotherapy alone showed longer disease‐free survival. Perineural invasion and a low stromal infiltrating lymphocyte score were significant negative prognostic factors. Multivariate analysis showed that patients with lymph node involvement (HR = 1.84; 95% CI: 1.02–3.31; p = 0.042) and stromal infiltrating lymphocytes (HR = 0.44; 95% CI: 0.21–0.089; p = 0.022) had an increased risk of recurrence. Conclusion: Lymph node involvement and low lymphocyte infiltration are determining factors for tumor recurrence, as are the presence of comorbidities, alcohol, and smoking, reinforcing the need for continuous monitoring and personalized therapies.

Introdução: O câncer de boca é um problema de saúde pública global, com altas taxas de mortalidade e diagnósticos tardios, impactando negativamente a qualidade de vida dos pacientes. No Brasil, políticas como a PNSB e as Leis dos 30 e 60 Dias buscam melhorar o diagnóstico precoce e o acesso ao tratamento, mas enfrentam desafios. Objetivo: Analisar o comportamento epidemiológico e realizar um mapeamento georreferenciado do câncer de boca no Ceará entre 2017 e 2023, considerando aspectos sociodemográficos, estadiamento tumoral e distribuição geográfica. Método: Estudo ecológico de série temporal com dados secundários do DATASUS. As variáveis analisadas incluíram sexo, idade, estadiamento tumoral, tempo de tratamento e Regiões de Saúde, com apoio do software QGIS para mapeamento geográfico. Resultados: Foi observada maior prevalência da doença em homens acima de 55 anos. Em 2020, houve um aumento significativo nos tratamentos iniciados em até 30 dias (43,3%), mas com redução nos anos seguintes em razão do impacto da pandemia de covid-19. Entre 2017 e 2019, muitos tratamentos foram iniciados após 60 dias do diagnóstico, evidenciando desafios no cumprimento da Lei dos 60 Dias. A Região de Fortaleza concentrou a maioria dos diagnósticos, refletindo desigualdades no acesso aos serviços especializados. Campanhas como o "Julho Verde" foram associadas ao aumento de diagnósticos precoces. Conclusão: O estudo destacou avanços e lacunas na assistência ao câncer de boca no Ceará, apontando a necessidade de um observatório específico para aprimorar o monitoramento e a integralidade do cuidado oncológico.

Introduction: Oral cancer is a global public health problem, characterized by high mortality rates and late diagnoses, with a negative impact on patients’ quality of life. In Brazil, policies such as the National Oral Health Policy (PNSB) and the “30- and 60-Day Laws” aim to improve early diagnosis and access to treatment, but significant challenges remain. Objective: To analyze the epidemiological behavior and perform a georeferenced mapping of oral cancer in Ceará between 2017 and 2023, considering sociodemographic aspects, tumor staging, and geographic distribution. Method: Ecological time-series study using secondary data from DATASUS. Variables included sex, age, tumor stage, time to treatment, and health regions. QGIS software was applied for geospatial mapping. Results: A higher prevalence was observed among men over 55 years old. In 2020, there was a significant increase in treatments initiated within 30 days (43.3%), but this rate declined in subsequent years, largely due to the impact of the COVID-19 pandemic. Between 2017 and 2019, many treatments were initiated after 60 days from diagnosis, highlighting difficulties in complying with the “60-Day Law.” The Fortaleza region concentrated most diagnoses, reflecting inequalities in access to specialized care. Awareness campaigns such as “Julho Verde” were associated with increased rates of early diagnosis. Conclusion: The study revealed both advances and persistent gaps in oral cancer care in Ceará, underscoring the need for a specific observatory to improve monitoring and ensure comprehensive oncological care.

Objetivou-se identificar o perfil do preconceito contra diversidade sexual e de gênero entre graduandos de Odontologia no Ceará. Trata-se de um estudo observacional, transversal, com 276 alunos, por meio de questionário online autoaplicável. A coleta usou instrumento semiestruturado, composto por dados sociodemográficos e pela Escala de Preconceito contra Diversidade Sexual e de Gênero Revisada (EPDSG-R). A análise foi realizada no SPSS 22.0, utilizando os testes T e Mann-Whitney, com nível de confiança de 95%. Os resultados indicaram baixo nível de preconceito entre os alunos, com média geral de 24,75 (DP=8,78). Estudantes do 10º semestre apresentaram menores índices (21,56; DP=3,00) e os do 2º semestre, os maiores (29,20; DP=9,40). A afirmação “Eu preferia que meus filhos fossem heterossexuais” teve o maior nível de intolerância (2,75; DP=1,46), enquanto “Eu acho que os gays homens são nojentos” apresentou o menor (1,08; DP=0,36). O preconceito foi mais elevado entre estudantes heterossexuais (p<0,001), com filhos (p=0,003), praticantes de religião (p=0,002), sem capacitação sobre diversidade fora da universidade (p=0,012) e entre aqueles que não presenciaram (p=0,001) ou não vivenciaram (p=0,001) situações de discriminação. O estudo identificou que o preconceito contra diversidade sexual e de gênero entre estudantes de Odontologia de uma universidade cearense está associado à heteronormatividade, religiosidade, falta de acesso à informação sobre o tema e ausência de vivências em situações de preconceito.

Introdução: A Lei Maria da Penha define a violência doméstica contra a mulher como ação ou omissão baseada no gênero que causa lesão, sofrimento físico, sexual ou psicológico, dano moral, patrimonial ou morte. Objetivo: Avaliar o perfil de mulheres vítimas de violência doméstica antes e durante a pandemia de Covid-19 em uma cidade com cerca de 2,5 milhões de habitantes, a partir de laudos odontológicos periciais da instituição oficial local. Metodologia: Estudo documental, observacional, transversal, descritivo e quantitativo, com análise de informações dos laudos periciais. Os dados foram expressos em frequências absolutas e percentuais, associados a variáveis pelo teste exato de Fisher e qui-quadrado de Pearson, no software SPSS v20.0, com nível de confiança de 95%. Resultados: O perfil mais prevalente foi de mulheres entre 31 e 40 anos, baixa escolaridade, solteiras, em relacionamento estável com o agressor, que sofreram violência em ambiente domiciliar, com predomínio de lesões em tecidos moles. A violência física foi a mais frequente, seguida da moral e psicológica. Conclusão: O cirurgião-dentista forense tem papel essencial na identificação de lesões, auxiliando na responsabilização dos agressores e no fortalecimento de políticas públicas de enfrentamento à violência.

Objectives The present study aimed to evaluate cone beam computed tomography (CBCT) scans of patients who spontaneously sought a diagnostic imaging service for different reasons, comparing the mandibular incisor canal (MIC) and the anterior loop of the mental nerve (ALMN) measurements in dentate and edentulous patients. Methods Cross-sectional observational study was carried out in which the prevalence of morphometric characteristics was evaluated, measuring the values of the ALMN, the MIC, and the mental foramen (MF) in the course of the mandibular canal, correlating them with the gender and age of the patients evaluated. Quantitative data were subjected to the Kolmogorov-Smirnov normality test, and cross-checks with parametric data were subjected to the Student t-test or ANOVA/Bonferroni and non-parametric Mann-Whitney or Kruskal-Wallis/Dunn tests. Categorical data were expressed as absolute and percentage frequency and compared using Fisher's exact test or Pearson's chi-square test. Results The study evaluated 97 patients, 61 (62.9%) females and 36 (37.1%) males. The mean age of the patients was 52±12, with 17 (17.9%) patients between 20-40 years, 51 (53.7%) between 40 and 60 years, and 27 (28.4%) over 60 years. Conclusion The diameter of the MF, the extensions of the MIC and ALMN, and the bone height below and above the MF, did not show differences between the sides and that the factors of gender and age interfered in the height of bone near the MF. Regardless of region, patients who lost more than three teeth in the mandible had less available bone height below and above the MF.

Objectives: This study aimed to evaluate the prevalence of noncarious cervical lesions (NCCLs) and gingival recession (GR) in Guinea‐Bissau and investigate their correlation with oral hygiene practices. Methods: Six calibrated examiners conducted intraoral examinations on individuals aged 12 years and above. A questionnaire gathered sociodemographic and oral hygiene information. NCCLs were identified through visual inspection of buccal and lingual/palatal tooth surfaces, while GR was assessed exclusively on buccal surfaces. The study adhered to World Health Organization (WHO) guidelines for oral health surveys. Results: A total of 233 participants took part, with 132 (56.9%) females and 100 (43.1%) males, of whom 165 (70.8%) lived in the capital and 68 (29.2%) on the Bijagós Islands. Age groups included 12–18 years (86; 36.9%), 19–34 years (67; 28.7%), and >34 years (80; 34.3%). GR was prevalent in 94.4% of the population, and NCCLs were present in 29.4%. Conclusions: There was no statistically significant difference in prevalence between the capital and the islands. The study did not find a significant association between NCCLs, GR, and oral hygiene practices. Nonetheless, both conditions showed correlations with age, gender, and treatment requirements, suggesting that individuals with GR are more predisposed to NCCLs.

Objective: To investigate the prevalence of malocclusions in children and adolescents in a population in Guinea-Bissau, Africa. Material and Methods: The convenience sample comprised 403 individuals of both sexes. Following anamnesis, a clinical examination was conducted to gather occlusion data, including Angle’s molar classification, canine relationship, degree of overjet and overbite, the presence or absence of physiological spaces, and crowding. The data were described using absolute and percentage frequencies and compared using Fisher's exact test or Pearson's chi-square test (p<0.05). Results: Class I molar relationship was observed in 75.2% of patients, while 18.4% exhibited Class II molar relationship, and 6.5% displayed class III. Concerning the canine relationship, 33% of individuals had a Class I relationship, 19% a Class II relationship, and 3% a Class III relationship. Deep bite was observed in 16% of patients, open bite in 20%, and edge-to-edge relationship in 11%. Furthermore, 48% of the patients presented with diastema, and 34% exhibited dental crowding. No significant difference in occlusion findings was noted between the sexes. Conclusion: Half of the population examined had some form of malocclusion, with Class I being the most prevalent. Therefore, further occlusal analysis studies in African populations are crucial to contributing significantly to the planning of public policies and the implementation of preventive action.

Objective To evaluate the influence of MMR complex protein immunoexpression on disease-free survival in oropharyngeal SCC treated non-surgically. Materials and methods: 85 cases of oropharyngeal SCC diagnosed and treated at the Ceará Cancer Institute were surveyed, from which clinical-pathological data and paraffin blocks of incisional biopsies were retrieved for immunohistochemical reaction for MSH2, MSH6, PMS2, MLH1 and p16. Disease-free survival was calculated and Kruskal-Wallis and Friedman/Dunn tests, chi-square and Fisher’s exact, Log-Rank Mantel Cox and Cox regression were performed. Results: In p16- tumors, loss of MSH2 expression was associated with shorter disease-free survival (p = 0.035) and mean MSH6 expression was significantly higher than MSH2 (p = 0.001). Loss of MSH2 expression in p16 + tumors was associated with longer disease-free survival compared to p16- tumors. Imbalance in the MSH6/MSH2 ratio in p16 + tumors was associated with longer survival compared to p16- tumors. MLH1/PMS2 imbalance was significantly higher in p16 + with recurrence (p = 0.003). Low MSH2 immunoexpression increased the risk of relapse by 9.10 times (CI95% 1.99 to 83.06). Conclusion: Microsatellite instability in oropharyngeal SCC is demonstrated by the association between loss of protein expression and its heterodimer imbalance with disease-free survival. It was demonstrated that the imbalance of the MMR complex can consequently lead to resistance to treatment and a decrease in disease-free survival in p16 + oropharyngeal SCC tumors.