Estudo histopatológico e imunoistoquímico de sarcoma de Kaposi oral e glândula tireóide de pacientes com Aids

Orientador: Pablo Agustin VargasTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A síndrome da imunodeficiência adquirida (AIDS) é causada pelo vírus da imunodeficiência humana (HIV). A infecção já acometeu mais de 60 milhões de pessoas em todo o mundo e 25 milhões de mortes. Apesar dos progressos que a comunidade internacional obteve, a AIDS ainda é uma epidemia global e constitui um dos principais problemas de saúde pública mundial. À luz dessa afirmação, este trabalho se fundamenta na abordagem das manifestações dos pacientes com AIDS, dando foco a dois tópicos relativamente distintos, porém de bastante relevância. O primeiro deles se baseia na descrição inédita da diversidade morfológica do sarcoma de Kaposi oral (SKO), o qual é umas das manifestações mais comuns associadas ao HIV, com frequente envolvimento oral. Realizamos um estudo retrospectivo de 135 casos de SKO presentes nos arquivos da Universidade de Pretoria, África do Sul. Após a revisão histológica, o SKO foi classificado em 7 categorias com base no padrão predominante de crescimento, tais como: sólido, limfangioma-like, telangiectásico, desmoplásico, linfangiectatico, equimótico e anaplásico. O significado prognóstico dessas variantes ainda precisará ser determinado, e o reconhecimento da diversidade morfológica do SKO é essencial para evitar erros diagnósticos. Em relação ao segundo capítulo, analisamos 100 tireoides obtidas de autópsias de pacientes com AIDS do Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo. Os casos foram analisados sistematicamente, a fim de determinar a frequência e as principais patologias presentes nesta glândula. Micobacteriose foi à infecção mais frequente, seguida por citomegalovírus (CMV) e criptococose. Envolvimento da glândula tiróide ocorreu geralmente como uma parte da disseminação da doença. Os médicos devem ter atenção especial para a detecção de sinais precoces de doenças na tireoide, que podem ser confundidos com sintomas gerais de manifestações da AIDSAbstract: The acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). The infection has affected more than 60 million people around the world and over 25 million deaths. Despite the progress of the international community, AIDS is still a global epidemic and is a considerable public health problem worldwide. Due to this, this work is based on the approach of the manifestations of AIDS patients, focusing to two relatively distinct topics, but too much relevant. The first description is based on the unpublished morphological diversity oral Kaposi's sarcoma (OKS), which is one of the most common HIV manifestations, with frequent oral involvement. We performed a retrospective study of 135 cases of OKS retrieved from the archives of the University Of Pretoria, South Africa. After histological review, the OKSs were classified into 7 categories based on the predominant pattern of growth, such as solid, lymphangioma-like, telangiectatic, desmoplastic, lymphangiectatic, ecchymotic, and anaplastic. Although the prognostic significance of these variants is yet to be determined, the appreciation and recognition of such morphologic diversity remains essential in distinguishing these lesions from possible mimickers. Regarding the second chapter, we analyzed 100 thyroid obtained from autopsies of patients with AIDS, Department of Pathology, Faculty of Medicine, University of São Paulo. The cases were systematically analyzed in order to determine the frequency and the main pathological features of the gland. Mycobacteriosis infection was the most frequent, followed by cytomegalovirus (CMV) and cryptococcosis. Involvement of the thyroid gland usually occurred as a part of dissemination of the disease. Physicians should pay special attention to the early signs of thyroid disease, which can be misdiagnosed with symptoms of general manifestations of AIDSDoutoradoPatologiaDoutora em Estomatopatologi

Direito à informação para a integralidade do cuidado: informações essenciais a respeito do fluxo assistencial em casos de câncer bucal

Sob o marco dos Direitos Humanos, um conteúdo normativo do direito à saúde é o direito à informação em saúde, o que, em âmbito local, significa ampliar os mecanismos de comunicação e informação entre o sistema e o usuário. Assim este estudo visou revisar informações consideradas essenciais para que o usuário saiba como o sistema de saúde está organizado para lidar com a questão do câncer bucal, como forma de concretizar o direito à informação para garantia da integralidade do cuidado nesta rede de atenção. Para isso, realizou-se uma revisão narrativa conforme descrito por Rothers com a perspectiva de identificar o que há na literatura sobre a articulação ‘direito à informação’ e ‘fluxo assistencial para o câncer bucal’. As informações encontradas puderam ser agrupadas em três grandes temas: a) informações sobre o “fluxo assistencial e a atenção secundária à saúde como elementos do sistema de referência e contra referência”; b) informações sobre o “câncer bucal e as respostas do sistema de serviços de saúde frente ao problema”, e c) como/quando deve ocorrer a “referência de usuários com lesões suspeitas de câncer bucal”. Pode se concluir que o direito à informação para integralidade do cuidado ao câncer bucal ainda é incipiente especialmente no que se refere a organização normativa dos serviços e o quede fato existe na rede

Endodontic Treatment of Complex Dens Invaginatus Teeth with Long Term Follow-Up Periods

Dens invaginatus is characterized by invagination of enamel and dentin in the dental papilla prior to tissue calcification. This malformation commonly occurs in the maxillary lateral incisors. The present study reports two complex endodontic treatments in Oehlers’ type II and III dens invaginatus, with periapical lesion and presence of bone resorption. In the reported cases, conventional endodontic therapy was successful and sufficient enough to eliminate the infectious process, allowing periapical bone neoformation and absence of symptomatology. Dens invaginatus is a relatively easy-to-diagnose dental malformation. However, it is necessary to know its radiographic aspects. The treatment results demonstrated that, although the cases of dens invaginatus of high complexity are challenging, an accurate diagnosis accompanied with proper endodontic treatment can avoid unnecessary surgical intervention and allow great chances of favorable prognosis in long term.Keywords: Anomalies; Classification; Dens Invaginatus; Root Canal Therap

Alterations in the immunoexpression of claudin-1 between different grades of oral epithelial dysplasias

Claudins are transmembrane proteins that play a role in cell proliferation and adhesion and tumourigenesis. This study evaluated the immunoexpression of claudin-1 in the oral epithelial dysplasia (OED) (19 mild, 26 moderate, 3 severe). Diffuse staining predominated in mild (89.4%) and moderate (80.8%) OEDs. Immunoexpression in the middle and upper third was observed in all mild cases, whereas in moderate/severe dysplasias staining was observed in the upper third in 41.4% of cases, in the upper and middle third in 41.4%, and in the upper, middle and lower third in 17.2% (P0.05). The differences in the immunoexpression of claudin-1 between different grades of OEDs suggest the involvement of this protein in the progression of dysplasias

Morphological analysis and immunohistochemical expression in restorations with self-adhesive resin : a randomized split-mouth design-controlled study

To evaluate the morphology and immunohistochemical expression of MMP-9, TIMP-3, COL-I, TNF-alfa and COX-2 in the dentinopulp complex of restorations with self adhesive composite (Vertise Flow/Kerr) compared with conventional resin composite with self-etc

Racial disparity and prognosis in patients with mouth and oropharynx cancer in Brazil

Oral and oropharyngeal cancer (OPC) is an important cause of morbidity and mortality worldwide. Populations in situations of social vulnerability tend to have higher incidences of cancer, a higher proportion of late diagnosis, greater difficulties in accessing health services, and, consequently, worse prognosis. The aim of this study was to evaluate the relationship between race/skin color and OPC prognosis in Brazil. This is a cross-sectional epidemiological study using OPC data from the National Cancer Institute between the years 2000 and 2019. The selected variables were: gender, race/skin color, age, education, smoking and alcohol consumption, stage of the disease and disease status at the end of the 1st treatment. 154,214 cases were recorded. Black men, in the 6th decade of life, were the most affected population. Blacks had a lower level of education when compared to non-blacks (p<0.001). Blacks were more exposed to smoking and alcohol consumption (p<0.001). At the time of diagnosis, the black population was at the most advanced stage when compared to non-blacks (p<0.001). At the end of the 1st treatment, more black patients had disease in progression, as well as more black patients died (p<0.001). Blacks had a worse prognosis for OPC in Brazil. Despite the limitations, these results are important to elucidate the scenario of health disparities in relation to the race/skin color of the Brazilian population

Microscopic diversity in oral Kaposi sarcoma

Kaposi sarcoma is the most common HIV-associated neoplasm, frequently presenting and highlight the histomorphological spectrum of oral Kaposi sarcoma. One hundred and thirty-five cases diagnosed between 1990 and 2011 were retrieved from the archives of the Oral and Dental Hospital of the University of Pretoria, South Africa. Following histological review, each case was placed into one of seven categories based on the predominant pattern of growth. These histological divisions included lesions designated as solid, lymphangioma-like, telangiectatic, desmoplastic, lymphangiectatic, ecchymotic and anaplastic. The presence of co-existent pathology was identified in 25 cases, largely represented by superimposed candidiasis. Concomitant cytomegalovirus and non-necrotizing granulomatous inflammation were also observed. Whilst the prognostic significance of these variants is yet to be determined, the appreciation and recognition of such morphologic diversity remains essential in distinguishing these lesions from possible mimickers.National Research Foundation of South Africa.http://www.elsevier.com/wps/find/journaldescription.cws_home/623240/description#descriptionhb2013ay201

High prevalence of oral potentially malignant disorders and risk factors in a semi-urban brazilian city:a population-based cross-sectional study

Oral Potentially Malignant Disorders (OPMDs) are defined as lesions with a greater likelihood of progressing to cancer. Population-based studies that evaluate the prevalence of OPMDs are scarce in Brazil. The aim of the present study was to determine the prevalence of OPMDs and associated risk factors in a semi-urban Brazilian population. This is a cross-sectional study, whose universe included individuals aged 40 years or older residing in a medium-sized city of northeastern Brazil. Data collection was divided into two steps: interview and oral examination. The outcome variable was the presence of OPMDs. The predictor variables were sociodemographic characteristics and risk habits. The bivariate analysis was performed through chi-square test. The crude prevalence ratios (PR) and its respective 95% confidence intervals (CI) were calculated. Poisson regression analysis with robust variance was used to calculate adjusted PRs and 95% CI. Three hundred fourteen individuals were included in the study. When asked about risk habits, 58.9% reported being current smokers or ex-smokers and 62.2% reported being current drinkers or ex-drinkers. The prevalence of OPMDs was 7.6% and was significantly higher among individuals with black skin color (p < 0.001), alcohol users (p = 0.017), and individuals with both tobacco and alcohol habits (p = 0.012). Therefore, the population in the present study had a high frequency of risk habits associated with PMDs of the oral cavity

CD1a+and CD83+Langerhans cells are reduced in lower lip squamous cell carcinoma

BACKGROUND : Actinic cheilitis (AC) is a potentially malignant lesion diagnosed in the lip of patients chronically exposed to the sun that may give rise to a fully invasive lower lip squamous cell carcinoma (LLSCC). It is known that ultraviolet radiation causes dendritic cells (DCs) depletion in the epidermis, but the role of this cellular population in lip cancer progression remains uncertain. Therefore, this study investigated the distribution of DCs in normal, dysplastic and neoplastic tissues of the lower lip. METHODS : Thirteen cases of lower lip mucocele, 42 of ACs and 21 of LLSCC were retrieved and original diagnoses confirmed by two oral pathologists, who further classified ACs as low- and high-risk lesions. Immunoreactions against CD1a and CD83 identified immature and mature DCs, respectively. RESULTS : Immature CD1a+ Langerhans cells (LCs) were significantly decreased in LLSCC when compared to morphologically normal (P 0.05), but ACs demonstrated a lower concentration of CD1a+ LCs than normal epithelium (P 0.05). CONCLUSION : These results suggest that depletion of epithelial LCs, but not IDCs in the connective tissue, would represent an important step for lip cancer development.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-07142017-07-31hb2016Oral Pathology and Oral Biolog

Evaluation of the use and need of dental prosthesis in a school clinic: a cross-study / Avaliação do uso e necessidade de prótese dentária numa clínica escola: um estudo transversal

Objective: This paper aims to identify the use and need of prosthesis, age and gender of users of the dental service of the school clinic of a private university in Recife. Methodology: A descriptive cross-sectional study was performed through analysis of medical records. From 2,294 records of the semesters 2016.2 and 2017.1, 790 were analyzed that met the inclusion and exclusion criteria. The study was divided into three groups according to the age of the patients (35 - 44, 45 - 64 and 65 - 74 years old) and were analyzed according to gender, prosthesis use, need of prosthesis or use and need of prosthesis. Data were tabulated in Microsoft Excel © and submitted to statistics. Results: Females were the most expressive in the search of the service (66.1%); besides that, 86.8% of the patients did not wear prosthesis and 71.1% needed to use it. Total Prosthesis was the most used (50%) and the Removable Partial Prosthesis presented the greatest need of use (74%). Conclusion: It was concluded that women from 45 – 64 years old seek more the rehabilitation service, and the need is greater in one arcade, showing an evolution to access the dentist.