Importância da citologia clínica na detecção de lesões orais em pacientes portadores do virus da imunodeficiência humana(HIV)

Orientadora : Profª. Drª. Maria Soares LeonartCoorientadores: Prof. Dr. Antonio Adilson Soares de Lima, Prof. Dr. Sandro GermanoDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmacêuticas. Defesa: Curitiba, 01/04/2014Inclui referênciasÁrea de concentração: Análises clínicasResumo: O retrovírus HIV é o agente responsável pelo desenvolvimento da AIDS em seu portador. No final da última década, o número aproximado de portadores do vírus no mundo era de 34 milhões de pessoas. No Brasil, o principal problema é o diagnóstico tardio. Cerca de 718 mil brasileiros são portadores do vírus, mas presume-se que em torno de 20% ainda não foram diagnosticados. Muitas pessoas procuram ajuda quando já estão doentes ou com os níveis de linfócitos T CD4+ baixos e, a maioria, descobre o HIV quando procura o serviço de saúde em razão de outras doenças. A detecção do vírus deve ser precoce para que o tratamento seja iniciado na época correta, diminuindo riscos de transmissão e de complicações causadas pela infecção. Lesões orais, principalmente a candidíase e a leucoplasia pilosa, são consideradas dentre os primeiros sinais clínicos, altamente associados à infecção pelo HIV em adultos. Tais lesões têm sido utilizadas como marcadores do início da imunossupressão. Este estudo visa avaliar a capacidade de detecção do exame citológico oral para a presença de candidíase e leucoplasia pilosa, em relação ao exame físico odontológico. Foram selecionados 58 pacientes HIV positivos, internados por complicações de HIV/AIDS no Hospital Oswaldo Cruz – Curitiba-PR, no período de março a agosto de 2013, sendo 41 do sexo masculino (70,7%) e 17 do sexo feminino (29,3%), com idades entre 23 e 72 anos, em geral solteiros, fumantes, etilistas, com baixa renda e ensino médio incompleto. Os resultados mostraram elevada frequência de lesões (67,2%), como esperado em pacientes com baixa imunidade, com incidência de 62,1% de candidíase oral e de 24,1% de leucoplasia pilosa oral. Foram detectados também três casos de herpes simples; um de lesão granulomatosa, confirmado cito e histologicamente como paracoccidioidomicose, e; uma lesão neoplásica, classificada como sarcoma de Kaposi. A incidência de candidíase oral observada por avaliação clínica (27 casos) e por citologia clínica (27 casos), foi maior ao se considerar os resultados de ambas (36 casos), isto porque houve concordância em 18 observações e 9 casos discordantes para cada uma das duas metodologias. Para a leucoplasia pilosa oral, a citologia se mostrou mais sensível (13 casos) em relação ao exame físico (6 casos), com o total de 14 casos. Assim, a discordância entre os dois métodos foi de apenas 1 caso para a citologia e 8 casos para o exame clínico. O maior número de casos positivos para leucoplasia pilosa oral detectados pela citologia sugere que se trata de uma metodologia capaz de rastrear essa lesão em sua fase subclínica. A incidência das lesões ocorreram quase todas em pacientes com contagens de linfócitos T CD4+ abaixo de 250 células/µL, ou seja, com a imunidade comprometida, o que aponta para a importância de se realizar exames clínico e citológico da mucosa oral em pacientes com HIV. Quando o diagnóstico é realizado utilizando-se as duas metodologias, aumenta-se a sensibilidade para a detecção das lesões, além do fato da citologia poder explicar suspeitas não confirmadas pela clínica. A partir dos resultados obtidos neste estudo, pode-se sugerir a investigação mais abrangente de populações de indivíduos portadores de HIV no que se refere a lesões da mucosa oral e ainda, que as pessoas que apresentarem essas lesões orais realizem o teste para HIV, o que facilitaria o tratamento da doença.Abstract: The HIV retrovirus is responsible for the development of AIDS in its carrier. At the end of the last decade, the approximate number of virus carriers worldwide was 34 million people. In Brazil, the main problem is the late diagnosis. About 718 thousand Brazilians are carriers of the virus, but it is assumed that about 20% have not been diagnosed yet. Many people seek help when they are already sick or when presents low levels of CD4+ T lymphocytes; most patients discover be HIV positive when seeking the health service due to others diseases. Therefore, the HIV treatment can be started at the right time, the carrier of the virus must be diagnosticaded as soon as possible, reducing the transmission risks and complications caused by infection. Oral lesions, especially candidiasis and oral hairy leukoplakia, are considered among the earliest clinical signs highly associated with HIV infection in adults. Such lesions have been used as markers of immunosuppression, usually caused by treatment failure. Based on concern to detect the installation of immunosuppression in HIV positive individuals, this study aims to evaluate the detection capability of the oral cytological examination for the presence candidiasis and oral hairy leukoplakia in relation to dental physical examination. From March to August 2013, 41 males (70.7%) and 17 females (29,3%) totalizing 58 HIV positive patients, hospitalized due to complications of HIV/AIDS in the Hospital Oswaldo Cruz were selected, aged 23 to 72 years, usually unmarried, smokers, drinkers, with low income and incomplete secondary education. The results showed high frequency of oral lesions (67.2 %), as expected in patients with low immunity, with an incidence of 62.1 % of oral candidiasis and 24.1% of oral hairy leukoplakia. A granulomatous lesion were cytologically and histologically confirmed as paracoccidioidomycosis and, a neoplastic lesion, classified as Kaposi's sarcoma were also detected, as 3 herpes simplex viruses cases. The incidence of oral candidiasis observed by clinical evaluation (27 cases) and clinical cytology (27 cases) was higher when considering the results of both (36 cases), this is because there was agreement on 18 observations and 9 discordant cases for each the two methodologies. On the other hand, cytology was more sensitive detecting oral hairy leukoplakia (13 cases) compared to clinical examination (6 cases), with a total of 14 cases. Thus, the disagreement between the two methods was only 1 case for cytology and 8 cases for the clinical examination. The highest number of positive cases for oral hairy leukoplakia detected by cytology suggests that it is a methodology able to track this lesion in its subclinical phase. The incidence of lesions were almost all patients with lymphocyte counts T CD4+ below 250 cells/µL, which points to the importance of conducting clinical and cytological oral mucosa in patients with HIV. When the diagnosis is performed using both methodologies, this increases the sensitivity for lesions detection, besides the fact that cytology can explain not confirmed suspicions by clinical detection. The results obtained in this study, may suggest a more comprehensive investigation of populations of HIV-infected individuals with regard to lesions of the oral mucosa

Clinical assessment, oral and cervical cytology profile of women with cervical squamous intraepithelial lesion / Avaliação clínica e citológica da cavidade oral e da cérvice de mulheres com lesões intraepiteliais escamosas cervicais

Introduction: HPV is a DNA virus capable of infecting the skin and mucous membranes inducing cell proliferation. An exfoliative cytology as a diagnostic tool for HPV is useful in the diagnosis of several lesions, such as premalignant or malignant oral mucosa. The combination of the use of specific brushes and the liquid based is a potential method for early detection of injuries both in the cervix and in the mouth. Objective: The aim of this study was to evaluate the frequency of clinical and cytological changes in the oral cavity of women with cervical squamous intraepithelial neoplasms (NIC). Material and methods: Sample was divided into case group (G-NIC) (women with squamous cervical intraepithelial lesions) and control group (CG) (women without changes suggestive of high-grade lesions). Women were evaluated for the presence of oral or cervical lesions. A liquid based exfoliative cytology was collected from both regions, were submitted to Papanicolaou staining and classified according to the Bethesda system. 98 women were evaluated, G-NIC=59 and CG=39. Results: The frequency of oral lesions was G-NIC=6.6% and CG=7.5%. They were inflammatory lesions, lichen planus and soft tissue benign tumor. G-NIC oral cytology analysis: 66% negative for intraepithelial lesion and malignancy, 2% atypical squamous cells of undetermined significance and 32% had processing errors. G-NIC cérvico-vaginal samples: 61% was high-grade intraepithelial lesions, 17% atypical squamous cells of undetermined significance and 22% low-grade intraepithelial lesions. CG showed 92% of oral and 82% of cervical samples was negative to intraepithelial injury and malignancy. Conclusion: There are no clinical and cytological changes in the mouth of women with intraepithelial lesions in the cervical-vaginal region.

Salivary protein candidates for biomarkers of oral disorders in people with a crack cocaine use disorder

The use of cocaine and its main derivative, crack, can cause some systemic effects that may lead to the development of some oral disorders. Objective: To assess the oral health of people with a crack cocaine use disorder and identify salivary protein candidates for biomarkers of oral disorders. Methodology: A total of 40 volunteers hospitalized for rehabilitation for crack cocaine addiction were enrolled; nine were randomly selected for proteomic analysis. Intraoral examination, report of DMFT, gingival and plaque index, xerostomia, and non-stimulated saliva collection were performed. A list of proteins identified was generated from the UniProt database and manually revised. Results: The mean age (n=40) was 32 (±8.88; 18–51) years; the mean DMFT index was 16±7.70; the mean plaque and gingival index were 2.07±0.65 and 2.12±0.64, respectively; and 20 (50%) volunteers reported xerostomia. We identified 305 salivary proteins (n=9), of which 23 were classified as candidate for biomarkers associated with 14 oral disorders. The highest number of candidates for biomarkers was associated with carcinoma of head and neck (n=7) and nasopharyngeal carcinoma (n=7), followed by periodontitis (n=6). Conclusions: People with a crack cocaine use disorder had an increased risk of dental caries and gingival inflammation; less than half had oral mucosal alterations, and half experienced xerostomia. As possible biomarkers for 14 oral disorders, 23 salivary proteins were identified. Oral cancer and periodontal disease were the most often associated disorders with biomarkers

Do commercial whitening dentifrices increase enamel erosive tooth wear?

Objective: This in vitro study evaluated the effect of commercial whitening dentifrices on erosive tooth wear (ETW) of bovine enamel samples, in comparison with commercial regular dentifrices. Methodology: Sixty bovine crowns were embedded in acrylic resin, polished and then had their baseline profile determined. They were randomly assigned to 5 groups (n=12/group), according to the type of commercial dentifrice to be tested: GI – Crest Anti-cavity Regular; GII – Crest 3D White; GIII – Colgate Total 12 Clean Mint; GIV – Colgate Optic White; GV – Placebo (negative control, fluoride-free dentifrice). The samples were submitted to daily erosive and abrasive challenges for 3 days. The erosive challenges were performed 3 times a day by immersing the specimens in 0.1% citric acid solution (pH 2.5) for 90 s. Each day after the first and last erosive challenges, the specimens were subjected to the abrasive challenge for 15 s, using a toothbrushing machine (Biopdi, São Carlos, SP, Brazil), soft toothbrushes and slurry (1:3 g/ml) of the tested toothpastes (1.5 N). The specimens were kept in artificial saliva between the challenges. The final profile was obtained and the ETW (µm) was calculated. Data were analyzed by Kruskal-Wallis and Dunn’s tests (p<0.05). Results: All dentifrices tested significantly reduced the enamel wear in comparison with the Placebo, except GIII. The median (95% CI) ETW was 1.35 (1.25-1.46)bc for GI, 1.17 (1.01-1.34)cd for GII, 1.36 (1.28-1.45)ab for GIII, 1.08 (1.04-1.14)d for GIV and 2.28 (2.18-2.39)a for GV. Conclusion: When dentifrices from the same manufacturer were compared, the whitening dentifrices led to similar or less wear than the regular ones

Importância da citologia clínica na detecção de lesões orais em pacientes portadores do virus da imunodeficiência humana(HIV)

Orientadora : Profª. Drª. Maria Soares LeonartCoorientadores: Prof. Dr. Antonio Adilson Soares de Lima, Prof. Dr. Sandro GermanoDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Ciências Farmacêuticas. Defesa: Curitiba, 01/04/2014Inclui referênciasÁrea de concentração: Análises clínicasResumo: O retrovírus HIV é o agente responsável pelo desenvolvimento da AIDS em seu portador. No final da última década, o número aproximado de portadores do vírus no mundo era de 34 milhões de pessoas. No Brasil, o principal problema é o diagnóstico tardio. Cerca de 718 mil brasileiros são portadores do vírus, mas presume-se que em torno de 20% ainda não foram diagnosticados. Muitas pessoas procuram ajuda quando já estão doentes ou com os níveis de linfócitos T CD4+ baixos e, a maioria, descobre o HIV quando procura o serviço de saúde em razão de outras doenças. A detecção do vírus deve ser precoce para que o tratamento seja iniciado na época correta, diminuindo riscos de transmissão e de complicações causadas pela infecção. Lesões orais, principalmente a candidíase e a leucoplasia pilosa, são consideradas dentre os primeiros sinais clínicos, altamente associados à infecção pelo HIV em adultos. Tais lesões têm sido utilizadas como marcadores do início da imunossupressão. Este estudo visa avaliar a capacidade de detecção do exame citológico oral para a presença de candidíase e leucoplasia pilosa, em relação ao exame físico odontológico. Foram selecionados 58 pacientes HIV positivos, internados por complicações de HIV/AIDS no Hospital Oswaldo Cruz – Curitiba-PR, no período de março a agosto de 2013, sendo 41 do sexo masculino (70,7%) e 17 do sexo feminino (29,3%), com idades entre 23 e 72 anos, em geral solteiros, fumantes, etilistas, com baixa renda e ensino médio incompleto. Os resultados mostraram elevada frequência de lesões (67,2%), como esperado em pacientes com baixa imunidade, com incidência de 62,1% de candidíase oral e de 24,1% de leucoplasia pilosa oral. Foram detectados também três casos de herpes simples; um de lesão granulomatosa, confirmado cito e histologicamente como paracoccidioidomicose, e; uma lesão neoplásica, classificada como sarcoma de Kaposi. A incidência de candidíase oral observada por avaliação clínica (27 casos) e por citologia clínica (27 casos), foi maior ao se considerar os resultados de ambas (36 casos), isto porque houve concordância em 18 observações e 9 casos discordantes para cada uma das duas metodologias. Para a leucoplasia pilosa oral, a citologia se mostrou mais sensível (13 casos) em relação ao exame físico (6 casos), com o total de 14 casos. Assim, a discordância entre os dois métodos foi de apenas 1 caso para a citologia e 8 casos para o exame clínico. O maior número de casos positivos para leucoplasia pilosa oral detectados pela citologia sugere que se trata de uma metodologia capaz de rastrear essa lesão em sua fase subclínica. A incidência das lesões ocorreram quase todas em pacientes com contagens de linfócitos T CD4+ abaixo de 250 células/µL, ou seja, com a imunidade comprometida, o que aponta para a importância de se realizar exames clínico e citológico da mucosa oral em pacientes com HIV. Quando o diagnóstico é realizado utilizando-se as duas metodologias, aumenta-se a sensibilidade para a detecção das lesões, além do fato da citologia poder explicar suspeitas não confirmadas pela clínica. A partir dos resultados obtidos neste estudo, pode-se sugerir a investigação mais abrangente de populações de indivíduos portadores de HIV no que se refere a lesões da mucosa oral e ainda, que as pessoas que apresentarem essas lesões orais realizem o teste para HIV, o que facilitaria o tratamento da doença.Abstract: The HIV retrovirus is responsible for the development of AIDS in its carrier. At the end of the last decade, the approximate number of virus carriers worldwide was 34 million people. In Brazil, the main problem is the late diagnosis. About 718 thousand Brazilians are carriers of the virus, but it is assumed that about 20% have not been diagnosed yet. Many people seek help when they are already sick or when presents low levels of CD4+ T lymphocytes; most patients discover be HIV positive when seeking the health service due to others diseases. Therefore, the HIV treatment can be started at the right time, the carrier of the virus must be diagnosticaded as soon as possible, reducing the transmission risks and complications caused by infection. Oral lesions, especially candidiasis and oral hairy leukoplakia, are considered among the earliest clinical signs highly associated with HIV infection in adults. Such lesions have been used as markers of immunosuppression, usually caused by treatment failure. Based on concern to detect the installation of immunosuppression in HIV positive individuals, this study aims to evaluate the detection capability of the oral cytological examination for the presence candidiasis and oral hairy leukoplakia in relation to dental physical examination. From March to August 2013, 41 males (70.7%) and 17 females (29,3%) totalizing 58 HIV positive patients, hospitalized due to complications of HIV/AIDS in the Hospital Oswaldo Cruz were selected, aged 23 to 72 years, usually unmarried, smokers, drinkers, with low income and incomplete secondary education. The results showed high frequency of oral lesions (67.2 %), as expected in patients with low immunity, with an incidence of 62.1 % of oral candidiasis and 24.1% of oral hairy leukoplakia. A granulomatous lesion were cytologically and histologically confirmed as paracoccidioidomycosis and, a neoplastic lesion, classified as Kaposi's sarcoma were also detected, as 3 herpes simplex viruses cases. The incidence of oral candidiasis observed by clinical evaluation (27 cases) and clinical cytology (27 cases) was higher when considering the results of both (36 cases), this is because there was agreement on 18 observations and 9 discordant cases for each the two methodologies. On the other hand, cytology was more sensitive detecting oral hairy leukoplakia (13 cases) compared to clinical examination (6 cases), with a total of 14 cases. Thus, the disagreement between the two methods was only 1 case for cytology and 8 cases for the clinical examination. The highest number of positive cases for oral hairy leukoplakia detected by cytology suggests that it is a methodology able to track this lesion in its subclinical phase. The incidence of lesions were almost all patients with lymphocyte counts T CD4+ below 250 cells/µL, which points to the importance of conducting clinical and cytological oral mucosa in patients with HIV. When the diagnosis is performed using both methodologies, this increases the sensitivity for lesions detection, besides the fact that cytology can explain not confirmed suspicions by clinical detection. The results obtained in this study, may suggest a more comprehensive investigation of populations of HIV-infected individuals with regard to lesions of the oral mucosa