M.Dent.(Community Dentistry), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Title: Knowledge, Attitudes and Practices of caregivers about oral lesions in HIV positive patients in NGOs /CBOs in Region 8, Johannesburg, Gauteng. Background: The HIV pandemic continues to be a major public health problem in South Africa where 11% of people were infected with HIV in 2005(HSRC, 2005).The care and support of these patients as they eventually become ill will necessitate the increase in use of community-based/homebased/ hospice institutions. The City of Johannesburg (CoJ), one of the metropolitan municipalities (local government) in Gauteng Province-SA, has been planning the development and implementation of programmes related to the prevention, care and support for people infected and affected by HIV/AIDS. Care and support has been limited to 18 NGOs/ CBOs. Four of these institutions provide palliative care and are staffed by 64 caregivers. Studies done throughout the world indicate that oral lesions associated with HIV occur in over half of HIV/AIDS patients. These oral lesions seriously impair the oral-health-related-quality of life in affected individuals and necessitate the need to provide services to alleviate them and improve patient comfort. The caregivers in the NGOs/CBOs are therefore pivotal in offering care and support in the management of HIV including the management of oral lesions. In order for the caregivers in the NGOs/CBOs to be able to manage the disease in its entirety; they need optimal knowledge of the infection/illness including the oral manifestations associated with the ailment. Objectives: (1.) To determine the knowledge of the caregivers in the NGOs/CBOs providing palliative care in Region 8, CoJ, Gauteng regarding common oral manifestations associated with HIV. of the caregivers in the NGOs/CBOs . (2.) To assess the attitudes of the caregivers in the NGOs/CBOs providing palliative care in Region 8, CoJ, Gauteng on common oral manifestations associated with HIV. (3.) To determine the practices of the caregivers in the NGOs/CBOs in Region 8, CoJ, Gauteng, pertaining to the common oral manifestations associated with HIV. (4.) To determine the sociodemographic profile of the caregivers providing palliative care in the NGOs/CBOs in Region 8, CoJ, Gauteng. Methods: A descriptive cross-sectional study was conducted where all caregivers providing care and support in the four NGOs/CBOs were invited to participate in the study. Data was collected by a customised questionnaire to obtain information on demographics, knowledge, attitudes and practices on providing for HIV positive patients. Results: The results were grouped according to training in oral health care (TOHC) and no training (NTOHC). The mean age was 43.5 years for TOHC and 30.8 years NTOHC and was statistically significant (p<0.005). There were statistical significant differences in the gender proportions in within groups in the both groups, employment status, work experience as a caregiver and training in general home-based care (p<0.05). Most (72.2%) of those NTOHC had little experience (<1 year) of care giving compared to 41.1% (p=0.03) and 33.3% were providing care without training in homebased care (HBC) compared to 100% (p=0.00). The caregivers trained in oral health care had knowledge levels shown by higher knowledge levels on four of seven variables compared to those who were not trained in oral health care (p< 0.05, Table 3.3 p.21). The majority of caregivers NTOHC reported that caring for the mouth of HIV positive patients is an ‘unpleasant difficult task and poses an infection risk to the caregivers’ while these concerns were expressed by the minority of caregivers TOHC (p<0.05). Practices performed by caregivers NTOHC were appropriate for dry mouth, difficulty in swallowing but was inappropriate for bleeding gums and bad breath while those caregivers TOHC provided appropriate advice/practices for oral thrush, bad breath, bleeding gums, dry mouth with statistical difference. Conclusion: The caregivers TOHC had fairly better knowledge, attitudes and practices regarding oral lesions in HIV compared to those NTOHC. There was strong likelihood of knowledge variables and training in oral health care. Recommendations: Bearing in mind the limitations of KAP surveys and the cross sectional nature of the study, it is recommended that training in oral health care and refresher courses for those trained must be incorporated into the programme of all caregivers working in palliative institutions because it will provide specialised knowledge about oral health and oral lesions in HIV improve their knowledge, attitudes and practices and thus provide a better service to their patients.

Objetivou-se fazer um estudo retrospectivo avaliando quais as afecções da cavidade oral foram mais frequentes nos gatos domésticos atendidos no Laboratório de Odontologia Comparada da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, relatando estatisticamente a prevalência das afecções da cavidade oral de gatos, enfatizando se há correlação entre elas e com características como raça, sexo, faixa etária e estado reprodutivo. Os dados analisados dos 754 prontuários foram raça, idade, sexo, estado reprodutivo, diagnóstico, tratamento e, no caso de neoplasia, sua localização e diagnóstico histopatológico. As principais doenças diagnosticadas foram doença periodontal, fratura dentária, gengivoestomatite crônica felina, lesão de reabsorção dentária felina, neoplasia oral e traumatismo do sistema estomatognático (luxação de articulação temporomandibular, fenda palatina, fratura de processo coronoide, fratura de zigomático, disjunção de sínfise, fratura de maxila e mandíbula). A idade dos animais variou de menos de um ano a 20 anos, sendo que, os animais tinham, em média 7,2 anos (desvio padrão &#61; 4,9) e a faixa etária mais frequente foi de um a cinco anos. Os gatos sem raça definida (66,5%), siameses (19,0%) e persas (10,2%) totalizaram 95,7% de todos os felinos atendidos no LOC. A doença periodontal foi a afecção mais frequente e esteve presente em 38,3% da população estudada. A fratura dentária, segunda mais frequente, esteve presente em 27,2% dos animais. Houve associação estatisticamente significativa (p&#61;0,026) entre fratura dentária e faixa etária, já que a proporção de animais entre um e cinco anos de idade com fratura foi maior do que a das outras faixas etárias. A lesão de reabsorção dentária felina (LRDF) esteve presente em 19,6% dos gatos estudados, sendo a terceira afecção mais prevalente dentre as pesquisadas. Esta lesão foi mais frequente em gatos com idade entre 11 e 15 anos e houve associação estatisticamente significativa entre a LRDF e a doença periodontal e entre LRDF e gengivite. A prevalência de gengivoestomatite crônica felina foi de 15,7% entre os felinos pesquisados e a proporção de animais com idades entre seis e dez anos com esta doença foi maior do que em outras faixas etárias. As neoplasias estavam presentes em 9,8% dos gatos, sendo que em 46 dos 72 animais que apresentaram alguma neoplasia tinham mais de dez anos de idade. O carcinoma de células escamosas foi o neoplasma mais comum, correspondendo a 63,2% das neoformações que foram submetidas ao exame histopatológico. As fraturas ósseas do sistema estomatognático corresponderam a 19,3% dos atendimentos, sendo a sínfise mentoniana e o corpo da mandíbula os locais mais comuns de fraturas. Concluiu-se que: existe grande variedade de afecções que acometem a cavidade oral de gatos, sendo a doença periodontal, fratura dentária, lesão de reabsorção dentária, gengivite, gengivoestomatite crônica, neoplasias orais e fraturas dos ossos do sistema estomatognático as mais prevalentes delas; é de extrema importância que as anotações nas fichas de atendimento sejam feitas da maneira mais completa possível, para que informações não sejam perdidas / This study aimed to make a retrospective study assessing which diseases of the oral cavity were more common in domestic cats attended at Comparative Dental Laboratory of the School of Veterinary Medicine and Zootechny of the University of São Paulo, and to report statistically the prevalence of diseases in the oral cavity of cats, emphasizing the correlation between them and with characteristics such as breed, gender, age and reproductive status. The data analyzed from 754 records were breed, age, gender, reproductive status, diagnosis, treatment and in the case of neoplasia, its location and histological diagnosis. The main diagnosed diseases were periodontal disease, tooth fracture, feline chronic gingivostomatitis, tooth resorption lesions, oral cancer and trauma of the stomatognathic system (dislocation of temporomandibular joint, cleft palate, coronoid fracture, zygomatic fracture, symphyseal separation, maxilla and mandible fracture). The age of the animals ranged from less than one year to 20 years, and the animals had an average of 7.2 years (SD &#61; 4.9) and the most frequent age range was from one to five years. Three breeds totaled 95.7% of all cats attended at LOC, which were, Persian (10.2%), Siamese (19.0%) and SRD (66.5%). Periodontal disease was the most common condition and it was present in 38.3% of the studied population. Dental fracture was present in 27.2% of the animals. There was a statistically significant association (p &#61; 0.026) between dental fracture and age, since the proportion of animals between one and five years old with fracture was higher than that of other age groups. The tooth resorption lesions (LRD) were present in 19.6% of the studied cats, being the third most prevalent disease among the survey. This injury was more common in cats aged between 11 and 15 years and there was a statistically significant association between LRD and periodontal and between gum disease and LRD. The prevalence of feline chronic gingivostomatitis was 15.7% among those surveyed cats and the proportion of animals aged between six and ten years with this disease was higher than other age groups. Neoplasia was present in 9.8% of cats, and in 46 of 72 animals that showed some malformation had more than ten years old. The squamous cell carcinoma was the most common neoplasm, corresponding to 63.2% of neoformations that were submitted to histopathology. Bone fractures of the stomatognathic system accounted for 19.3% of cases, the mandibular symphysis and the body of the mandible were the most common sites of fractures. It was concluded that there is a wide range of diseases that affect the oral cavity of cats, and periodontal disease, tooth fracture, dental resorption lesions, gingivitis, gingivostomatitis, oral cancer and fractures of the bones of the stomatognathic system were the most prevalent of them; it is a matter of utmost importance that the notes in all pacient records are done as thoroughly as possible, so that information will not be lost

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A crioterapia à a destruiÃÃo intencional de um tecido por meio da aplicaÃÃo de temperaturas extremamente baixas. à um mÃtodo versÃtil empregado no tratamento de inÃmeras lesÃes benignas e malignas, provenientes de tecidos moles ou duros. A pesquisa teve como objetivo avaliar os efeitos inflamatÃrios produzidos pela criocirurgia quando aplicada em lÃngua de rato. O nitrogÃnio lÃquido foi aplicado a 1 cm da ponta da lÃngua por meio de sonda fechada de 1mm de diÃmetro. Setenta e cinco ratos machos da linhagem Wistar (300-400 g) foram divididos em trÃs grupos de vinte e cinco animais. O grupo A recebeu uma aplicaÃÃo de um minuto, o grupo B duas aplicaÃÃes de um minuto com intervalo de cinco minutos entre as aplicaÃÃes, e o grupo C, trÃs aplicaÃÃes com intervalo de cinco minutos. Os grupos foram subdivididos em cinco subgrupos de cinco animais, cada um. Cada subgrupo foi sacrificado em dias preestabelecidos, a contar do dia da aplicaÃÃo: seis horas, 24 horas, 72 horas, sete dias e 14 dias. Dois animais serviram de grupo-controle, e nenhuma terapia foi instituÃda. ApÃs os perÃodos mencionados, os ratos foram sacrificados, as lÃnguas foram removidas, processadas e coradas pela hematoxilina e eosina (HE). Os parÃmetros histolÃgicos considerados foram: infiltrado inflamatÃrio, hemorragia, vasodilataÃÃo, edema, ulceraÃÃo, reepitelizaÃÃo, caracterÃsticas do tecido muscular e necrose. Foram utilizados escores (0, 1, 2 e 3), de forma que cada amostra recebeu um valor. O estudo demonstrou uma maior intensidade de reaÃÃo inflamatÃria com a repetiÃÃo dos ciclos. A crioterapia à capaz de produzir um grau de inflamaÃÃo capaz de causar destruiÃÃo tecidual / Cryotherapy is the intentional destruction of a tissue by means of applying extremely low temperatures. It is a versatile method that has been used in the treatment of innumerable benign and malignant lesions, either in the soft or hard tissues. The aim of this research was to assess the inflammatory effects produced by cryosurgery when applied to rat tongues. Liquid nitrogen was applied at 1 cm from the tip of the tongue by means of a closed probe 1mm in diameter. Seventy-five male Wistar rats (300-400 g) were divided into three groups of twenty-five animals. Group A received 1 application lasting 1 minute; group B two applications of 1 minute with a 5-minute interval between the applications, and group C, three applications with a 5-minute interval. The groups were subdivided into five subgroups of five animals each. Each subgroup was sacrificed on pre-established times, counted as from the day of the application: 6 hours, 24 hours, 72 hours, 7 days and 14 days. Two animals served as control group, in which no therapy was instituted. After the above-mentioned periods, the rats were sacrificed; the tongues were removed, processed and stained with hematoxylin and eosin (HE). The histological parameters considered were: inflammatory infiltrate, hemorrhage, vasodilatation, edema, ulceration, reepithelization, muscle tissue features and necrosis. Scores were established (0, 1, 2 and 3) so that each sample received a value. The study demonstrated greater inflammatory effects with repetition of the cycles. The cryotherapy may to produce a inflammation degree able to cause tissue destruction

Objetivou-se fazer um estudo retrospectivo avaliando quais as afecções da cavidade oral foram mais frequentes nos gatos domésticos atendidos no Laboratório de Odontologia Comparada da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, relatando estatisticamente a prevalência das afecções da cavidade oral de gatos, enfatizando se há correlação entre elas e com características como raça, sexo, faixa etária e estado reprodutivo. Os dados analisados dos 754 prontuários foram raça, idade, sexo, estado reprodutivo, diagnóstico, tratamento e, no caso de neoplasia, sua localização e diagnóstico histopatológico. As principais doenças diagnosticadas foram doença periodontal, fratura dentária, gengivoestomatite crônica felina, lesão de reabsorção dentária felina, neoplasia oral e traumatismo do sistema estomatognático (luxação de articulação temporomandibular, fenda palatina, fratura de processo coronoide, fratura de zigomático, disjunção de sínfise, fratura de maxila e mandíbula). A idade dos animais variou de menos de um ano a 20 anos, sendo que, os animais tinham, em média 7,2 anos (desvio padrão &#61; 4,9) e a faixa etária mais frequente foi de um a cinco anos. Os gatos sem raça definida (66,5%), siameses (19,0%) e persas (10,2%) totalizaram 95,7% de todos os felinos atendidos no LOC. A doença periodontal foi a afecção mais frequente e esteve presente em 38,3% da população estudada. A fratura dentária, segunda mais frequente, esteve presente em 27,2% dos animais. Houve associação estatisticamente significativa (p&#61;0,026) entre fratura dentária e faixa etária, já que a proporção de animais entre um e cinco anos de idade com fratura foi maior do que a das outras faixas etárias. A lesão de reabsorção dentária felina (LRDF) esteve presente em 19,6% dos gatos estudados, sendo a terceira afecção mais prevalente dentre as pesquisadas. Esta lesão foi mais frequente em gatos com idade entre 11 e 15 anos e houve associação estatisticamente significativa entre a LRDF e a doença periodontal e entre LRDF e gengivite. A prevalência de gengivoestomatite crônica felina foi de 15,7% entre os felinos pesquisados e a proporção de animais com idades entre seis e dez anos com esta doença foi maior do que em outras faixas etárias. As neoplasias estavam presentes em 9,8% dos gatos, sendo que em 46 dos 72 animais que apresentaram alguma neoplasia tinham mais de dez anos de idade. O carcinoma de células escamosas foi o neoplasma mais comum, correspondendo a 63,2% das neoformações que foram submetidas ao exame histopatológico. As fraturas ósseas do sistema estomatognático corresponderam a 19,3% dos atendimentos, sendo a sínfise mentoniana e o corpo da mandíbula os locais mais comuns de fraturas. Concluiu-se que: existe grande variedade de afecções que acometem a cavidade oral de gatos, sendo a doença periodontal, fratura dentária, lesão de reabsorção dentária, gengivite, gengivoestomatite crônica, neoplasias orais e fraturas dos ossos do sistema estomatognático as mais prevalentes delas; é de extrema importância que as anotações nas fichas de atendimento sejam feitas da maneira mais completa possível, para que informações não sejam perdidas / This study aimed to make a retrospective study assessing which diseases of the oral cavity were more common in domestic cats attended at Comparative Dental Laboratory of the School of Veterinary Medicine and Zootechny of the University of São Paulo, and to report statistically the prevalence of diseases in the oral cavity of cats, emphasizing the correlation between them and with characteristics such as breed, gender, age and reproductive status. The data analyzed from 754 records were breed, age, gender, reproductive status, diagnosis, treatment and in the case of neoplasia, its location and histological diagnosis. The main diagnosed diseases were periodontal disease, tooth fracture, feline chronic gingivostomatitis, tooth resorption lesions, oral cancer and trauma of the stomatognathic system (dislocation of temporomandibular joint, cleft palate, coronoid fracture, zygomatic fracture, symphyseal separation, maxilla and mandible fracture). The age of the animals ranged from less than one year to 20 years, and the animals had an average of 7.2 years (SD &#61; 4.9) and the most frequent age range was from one to five years. Three breeds totaled 95.7% of all cats attended at LOC, which were, Persian (10.2%), Siamese (19.0%) and SRD (66.5%). Periodontal disease was the most common condition and it was present in 38.3% of the studied population. Dental fracture was present in 27.2% of the animals. There was a statistically significant association (p &#61; 0.026) between dental fracture and age, since the proportion of animals between one and five years old with fracture was higher than that of other age groups. The tooth resorption lesions (LRD) were present in 19.6% of the studied cats, being the third most prevalent disease among the survey. This injury was more common in cats aged between 11 and 15 years and there was a statistically significant association between LRD and periodontal and between gum disease and LRD. The prevalence of feline chronic gingivostomatitis was 15.7% among those surveyed cats and the proportion of animals aged between six and ten years with this disease was higher than other age groups. Neoplasia was present in 9.8% of cats, and in 46 of 72 animals that showed some malformation had more than ten years old. The squamous cell carcinoma was the most common neoplasm, corresponding to 63.2% of neoformations that were submitted to histopathology. Bone fractures of the stomatognathic system accounted for 19.3% of cases, the mandibular symphysis and the body of the mandible were the most common sites of fractures. It was concluded that there is a wide range of diseases that affect the oral cavity of cats, and periodontal disease, tooth fracture, dental resorption lesions, gingivitis, gingivostomatitis, oral cancer and fractures of the bones of the stomatognathic system were the most prevalent of them; it is a matter of utmost importance that the notes in all pacient records are done as thoroughly as possible, so that information will not be lost