Relación de los parámetros inmunológicos y virológicos con la aparición de Candidosis Oral en el paciente adulto infectado por el Virus de la Inmunodeficiencia Humana (VIH)

Tesis de la Universidad Complutense de Madrid, Facultad de Odontología, Departamento de Estomatología, leída el 08-10-1999Los objetivos de este proyecto son relacionar la presencia de candidosis oral (CO) en sus diferentes formas clínicas con los parámetros inmunológicos y virológicos como son el recuento/porcentaje de linfocitos CD4 y de CD8, cociente CD4/CD8 y la carga viral en los pacientes infectados por el VIH. La muestra estaba compuesta por 156 pacientes diagnosticados de infección por VIH en el Centro Sanitario Sandoval(CAM). Se les realizó una historia clínica y una exploración de la mucosa oral. El recuento/porcentaje de linfocitos CD4 fue categorizado como 500 CD4/>29%. Se cuantificó la cantidad de ARN viral por militro de sangre periférica mediante la técnica del ADN ramificado (bDNA), en aquellos con 10.000 cop/ml. La toma de muestras microbiológicas consistían en frotis en KOH al 10% y cultivo en agar Saboraud mediante la técnica del enjuague oral concentrado(Samarayanake, 1986). Los datos fueron analizados mediante Epi-Info 6.01 y SAS 6.12. El 55,8% de los pacientes de este estudio observacional transversal pertenecían a la categoría A(CDC,1993), por un 3,8% de pacientes con SIDA. Tan solo 15 pacientes estaban recibiendo terapia antirretroviral. Predominan los pacientes pertenecientes al colectivo homosexual con un 51,9% frente a un 33,3% de pacientes UDI y un 13,4% de pacientes heterosexuales. La media del recuento/porcentaje linfocitos CD4 fue 559 cels/24,7%. La CO apareció en un 37,8% de nuestros pacientes. La variante clinica más frecuente, según la Clasificaron de 1992(EC-Clearinghouse,1993), fue la candidosis pseudomenbranosa(CPS) con un 25,6% seguida de la candidosis eritematosa(CE) con un 17,9% y de la queilitis angular (QA) con un 10,2%. La presentación de CE y CPS de forma simultánea en un mismo paciente se asocia a una peor situación inmunológica basada en el recuento/porcentaje de CD4. La CPS predomina con recuentos >200 CD4(52,6%) y la CE predomina con porcentajes 10.000 com*ml), con porcentajes de CD4 20 cigarrillos/día. El 70,5% de nuestros pacientes tenían un cultivo positivo. La colonización oral por Candida era más elevada en los pacientes que tenían recuentos/porcentajes CD4 inferiores a 500/29%. El porcentaje de linfocitos CD4 sería un marcador inmunológico mas fiable y estable en tomas de muestras sucesivas por lo que debería incluirse junto con el recuento en los estudios de infección por VIH. La CO puede ser utilizada como marcador clínico de cargas virales elevadas. No hemos podido ratificar que la CE sea más frecuente en estadios iniciales y la CPS predomine en los estadios avanzados de infección por VIH. La colonización oral por Candida se correliona con el estado inmunológico pero no con el estado virológico de estos pacientesDepto. de Especialidades Clínicas OdontológicasFac. de OdontologíaTRUEpu

Surgical ciliated cyst of the maxilla. Clinical case

Surgical ciliated cyst is uncommon in Western countries but frequently reported in Asian populations as a delayed complication of surgery, with inclusion in the bone of nasal or sinus mucosa. Isolated cases have also been reported in the mandible after orthognathic surgery. We report a case in the maxillary region three years after radical sinus surgery for chronic sinusitis. Intraoral examination revealed a small painless tumefaction with no color change in the surrounding tissues. Computed tomography demonstrated a well-defined intraosseous lesion lateral to the maxillary sinus. The lesion was completely excised, when histology demonstrated a pseudostratified ciliated epithelial lining. Differential diagnosis from other lesions such as an odontogenic keratocyst or inflammatory cyst were also made. This case report,uncommon in Western countries, of a surgical ciliated cyst illustrates the need for a meticulous surgical technique, proper management of complications, and routine, long-term follow-up of patients undergoing any type of sinus surgery

Retrospective study of 149 cases of salivary gland carcinoma in a Spanish hospital population

The clinical and histological characteristics of salivary gland tumors vary widely, complicating their diagnosis and management, and major differences have been recorded in the distribution of histopathological diagnoses among different countries. This retrospective study reviewed the demographic (age, sex) and clinicopathological (pathology diagnosis and localization) characteristics of cases diagnosed with primary SGC between June 1992 and May 2014 in the Pathology Department of the 12 de Octubre Hospital of Madrid. Diagnoses were recorded according to the 2005 WHO classification. The study included 149 SCG patients, aged between 11 and 94 yrs, with mean age at onset of 55.56 yrs and peak incidence in the eighth decade of life. The male:female ratio was 1.01. The parotid gland was the most frequently involved (75.2%). The most frequent carcinoma was mucoepidermoid carcinoma (24.2%), followed by acinic cell carcinoma (15.4%). The demographic and histopathological characteristics of patients with salivary gland carcinomas in Spain, reported here for the first time, are broadly similar to those found in other countries

Analysis of new diagnostic methods in suspicious lesions of the oral mucosa

Objective: The objective of this study was to analyse publications related to examination techniques that might improve the visualisation of suspicious lesions of the oral mucosa (ViziLite® system and VELscope® system) or that might facilitate the cytological identification of suspicious lesions (OralCDx®).Methods: A literature search was performed, using the PubMed database and the key words “brush biopsy”, “OralCDx”, “ViziLite” and “Velscope”, limiting the search to papers in English or Spanish published from 2002 to 2008.Results: According to the results of studies identified, the ViziLite® system has a sensitivity of 100% and specificity ranging from 0-14.2%, the VELscope® system has a sensitivity of 98-100% and specificity of 94-100% and the Oral CDx® system has a sensitivity of 71.4-100% and specificity of 32-100%.Conclusion: Clinical examination and histopathological confirmation with biopsy remain the gold standard for the detection of oral cancer. More randomised controlled studies are needed to confirm the positive cost-benefit relationship and the true usefulness of these “new diagnostic methods” in oral mucosal pathology

High resolution image in bone biology II : Review of the literature

Bone microstructure has usually been assessed by obtaining samples invasively and analyzing them with conventional histomorphometric methods. Improvements in high-resolution image acquisition systems have enabled non-invasive assessment of bone morphology and a more precise 3-D evaluation by means of ?virtual biopsies?, permitting bone assessment in regeneration or remodeling processes. Among other applications, this imaging technique can be used for the ultrastructural analysis of bone and for studies of regeneration techniques, biomechanics in bone physiotherapy, and periimplant bone healing. This review describes the different applications of high-resolution imaging techniques in bone biology and the morphometric results obtained with these images in mechanobiology in general and maxillary bone in particular

Host defence mechanisms against bacterial aggression in periodontal disease : basic mechanisms

Periodontal diseases are complex bacteria-induced infections characterised by an inflammatory host response to plaque microbiota and their by-products. Most of these microorganisms have virulence factors capable of causing massive tissue destruction both directly, through tissue invasion and the production of harmful substances, or indirectly, by activation of host defense mechanisms, creating an inflammatory infiltrate of potent catabolic activity that can interfere with normal host defense mechanisms. In response to the aggression, host defense mechanisms activate innate and adaptive immune responses. Our aim is to offer a general overview of the main mechanisms involved in the host response to bacterial aggression in periodontitis, such as lipopolysaccharide receptor CD14, complement system, polymorphonuclear neutrophils, antibodies and immunoglobulins

High resolution image in bone biology I : review of the literature

Bone microstructure has usually been assessed by obtaining samples invasively and analyzing them with conventional histomorphometric methods. Improvements in high-resolution image acquisition systems have enabled non-invasive assessment of bone morphology and a more precise 3-D evaluation by means of ?virtual biopsies?, permitting bone assessment in regeneration or remodeling processes. This review describes the characteristics and limitations of bone assessment using different high-resolution image systems (synchrotron-radiation computed tomography, micro-computed tomography, acoustic scanning microscope; micro-magnetic resonance imaging). Morphometric variables that can be obtained from these images are reported and compared with conventional histomorphometric variables

Problem-based learning versus lectures : comparison of academic results and time devoted by teachers in a course on Dentistry in Special Patients

Objectives: Problem-Based Learning (PBL) is a teaching-learning technique centred on the complete development of the student. It has been successfully implemented in several universities, notably in the health sciences. The process of creating the European Higher Education Area, initiated in Bologna, encourages European universities to use new methodologies in the teaching-learning process, including PBL. Our objectives were to analyze the results obtained by using PBL with fifth-year Dentistry students. Study design: Comparison of academic results between students receiving lectures and PBL participants, and assessment of differences between them in the time devoted to tasks by students and teachers. Results: PBL participants obtained higher grades compared to those receiving lectures only(p<0.05). The two student groups devoted the same amount of time to this subject but the time distribution of tasks was very different, with PBL students spending more time on group work and analysis of the literature. The teachers devoted much more time to the PBL group. Conclusions: PBL is a teaching-learning methodology that improves student academic results. PBL diverts student time to more complex tasks but requires a greater commitment from the teachers

Gene therapy in the management of oral cancer: Review of the literature

Gene therapy essentially consists of introducing specific genetic material into target cells without producing toxic effects on surrounding tissue. Advances over recent decades in the surgical, radiotherapeutic and chemotherapeutic treatment of oral cancer patients have not produced a significant improvement in patient survival. Increasing interest is being shown in developing novel therapies to reverse oral epithelial dysplastic lesions. This review provides an update on transfer techniques, therapeutic strategies, and the clinical applications and limitations of gene therapy in the management of oral cancer and precancer. We highlight the combination of gene therapy with chemotherapy (e.g., 5-Fluoracil) and immunotherapy, given the promising results obtained in the use of adenovirus to act at altered gene level (e.g., p53). Other techniques such as suicide gene therapy, use of oncolytic viruses or the use of antisense RNA have shown positive although very preliminary results. Therefore, further research into these promising gene therapy techniques is required to assess their true efficacy and safety in the management of these lesions

Role of the dental surgeon in the early detection of adults with underlying HIV infection / AIDS

A review is made of the late diagnosis of human immunodeficiency virus (HIV) infection, a subject of growing interest in public health. It has been estimated that in Europe 30% of all HIV-infected people are unaware of their seropositive condition, and this in turn is associated with a poorer long-term disease prognosis and an increased risk of transmission to other individuals. The role of the dental surgeon in this context could be of great importance, since there are many oral lesions that can suggest the existence of underlying infection. The study also addresses the controversial subject of rapid HIV testing, and whether these tests should be performed on a routine basis in the dental clinic, or whether it is preferable to refer the patient to a specialized center