Oral Lesions of Immune-Mediated and Autoimmune Diseases: A 12-year Experience at a Single Brazilian Referral Center.

BACKGROUND: Oral lesions of immune-mediated and autoimmune diseases have been well-documented, but studies from Brazil are limited. The varied spectrum of oral lesions within this demographic group poses challenges to clinicians, particularly when they occur in isolation. This study aimed to evaluate the occurrence, clinical characteristics, and management of patients with oral lesions of immune-mediated and autoimmune diseases at a single center in Brazil. METHODS: A retrospective cross-sectional study was conducted from 2010 to 2022. Clinicodemographic data, histopathological features, and treatment modalities were analyzed descriptively and analytically. RESULTS: Of the 3,790 oral and maxillofacial lesions diagnosed, 160 (4.2%) were confirmed as immune-mediated or autoimmune diseases. The population surveyed predominantly consisted of women (73.7%), with a mean age of 60.2 years. Oral lichen planus (51.3%), mucous membrane pemphigoid (MMP) (23.7%), and pemphigus vulgaris (PV) (19.4%) were the most prevalent lesions. The buccal mucosa (59.4%) was predominantly affected, with pain reported in 46.2% of cases, notably in individuals with PV and MMP. The average time to disease stabilization post-local and/or systemic corticosteroid therapy was 15.8 months for systemic lupus erythematosus, 8.7 months for MMP, and 6.5 months for PV. CONCLUSION: Although oral lesions related to immune-mediated and autoimmune diseases are uncommon, their diverse clinicopathological aspects require multidisciplinary management.

Osteoarticular Sporotrichosis of the Knee Caused by Sporothrix brasiliensis: Two Similar Cases with Different Outcomes.

Sporotrichosis is the most frequent subcutaneous or implantation mycosis in Latin America, and its transmission occurs as a result of traumatic inoculation into the skin by organic matter containing the thermodimorphic fungi of the genus Sporothrix. Although cutaneous forms are more common, another important site is the osteoarticular system, whose hematogenous involvement is commonly associated with disseminated forms, especially in people who have an immunosuppressive condition, such as HIV/AIDS, chronic steroid use, and alcohol abuse. We present two cases of osteoarticular sporotrichosis of the knee caused by Sporothrix brasiliensis and followed up at our institution, with different outcomes. In the cases presented here, aging, anatomical sites, comorbidities, subtherapeutic serum levels, low adherence to treatment, and late diagnosis for different reasons may explain the observed outcomes. Early diagnosis of Sporothrix infection is critical in preventing complications, including death. We also highlight the importance of multidisciplinary follow-up and adherence to treatment for a favorable outcome.

Clinical Presentation of Parvovirus B19 Infection in Adults Living with HIV/AIDS: A Case Series.

Parvovirus B19 (B19V) infection varies clinically depending on the host's immune status. Due to red blood cell precursors tropism, B19V can cause chronic anemia and transient aplastic crisis in patients with immunosuppression or chronic hemolysis. We report three rare cases of Brazilian adults living with human immunodeficiency virus (HIV) with B19V infection. All cases presented severe anemia and required red blood cell transfusions. The first patient had low CD4+ counts and was treated with intravenous immunoglobulin (IVIG). As he remained poorly adherent to antiretroviral therapy (ART), B19V detection persisted. The second patient had sudden pancytopenia despite being on ART with an undetectable HIV viral load. He had historically low CD4+ counts, fully responded to IVIG, and had undiagnosed hereditary spherocytosis. The third individual was recently diagnosed with HIV and tuberculosis (TB). One month after ART initiation, he was hospitalized with anemia aggravation and cholestatic hepatitis. An analysis of his serum revealed B19V DNA and anti-B19V IgG, corroborating bone marrow findings and a persistent B19V infection. The symptoms resolved and B19V became undetectable. In all cases, real time PCR was essential for diagnosing B19V. Our findings showed that adherence to ART was crucial to B19V clearance in HIV-patients and highlighted the importance of the early recognition of B19V disease in unexplained cytopenias.

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil.

Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30-39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective

Abstract The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Resumo Os achados clinico-patológicos que caracterizam de forma precisa o líquen plano oral (LPO) e as lesões liquenoides orais (LLO) ainda representam um desafio. O objetivo do presente estudo foi analisar, pela perspectiva do patologista oral, os achados clínicos do LPO e das LLO. Espécimes preenchendo os critérios histológicos para o diagnóstico de LPO e LLO, e também aqueles compatíveis com LPO (LPO-C), foram selecionados e as informações clínicas foram obtidas a partir das requisições laboratoriais. A amostra final foi composta de 221 casos, incluindo 119 LPO (53.8%), 65 LPO-C (29.4%) e 37 LLO (16.7%). As mulheres foram mais acometidas nos três grupos, mas o número de homens acometidos foi maior nas LLO. A média de idade foi menor no LPO (52.3 anos) em comparação com as LLO (57.9 anos) (p=0.020). O envolvimento da mucosa jugal e da língua foi mais frequente no LPO; o envolvimento gingival foi incomum nas LLO. O padrão reticular foi mais frequentemente encontrado no LPO, enquanto a associação dos padrões reticular e atrófico/erosivo/ulcerado foi mais comum no LPO-C e nas LLO (p=0.025). Em conclusão, o gênero e a média de idade dos pacientes, assim como a localização anatômica e a manifestação clínica das LLO são diferentes do LPO, e podem ajudar a melhor caracterizar este grupo de condições. Espécimes diagnosticados como LPO-C mostraram parâmetros clínicos mais próximos ao LPO.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective.

The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Antiretroviral therapy and Kaposi's sarcoma trends and outcomes among adults with HIV in Latin America.

INTRODUCTION: Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). METHODS: Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression. RESULTS: Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation. CONCLUSIONS: KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.

Idiopathic Bone Cavity: Clinicopathologic Features from a Case Series with Emphasis on Differential Diagnosis of Chronic Apical Periodontitis.

INTRODUCTION: Idiopathic bone cavity (IBC) is an uncommon bone lesion that usually affects youngsters as an unilocular radiolucency with predilection for the posterior mandible. Because the lesion is frequently located in proximity to the adjacent teeth, chronic apical periodontitis is commonly included as a differential diagnosis. The aim of the present study was to analyze the clinical and radiologic features of a series of IBCs diagnosed in a single service. METHODS: All cases diagnosed as IBC were retrieved from the files of an oral pathology laboratory, and the clinical and radiologic characteristics were described with a focus on the differential diagnosis with chronic apical periodontitis. RESULTS: Thirty cases composed the final sample. The mean age of the affected patients was 22 years old; there was no sex predilection, and most lesions were located on the posterior (47%) and anterior (43%) mandible. Most lesions presented as unilocular radiolucencies (87%), and 90% were located in close association with the adjacent teeth. The associated teeth presented no endodontic involvement, and all proved to be vital. CONCLUSIONS: IBC usually affects young patients as an unilocular radiolucency in close association with the adjacent teeth. Careful radiologic analysis and vitality tests of the adjacent teeth are essential to rule out chronic apical periodontitis, thus avoiding any unnecessary endodontic treatment.

Análise clínico-patológica e qualitativa da expressão de mediadores inflamatórios teciduais no líquen plano oral / Clinicopathological and qualitative analysis of the expression of tissue inflammatory mediators in oral lichen planus

O líquen plano oral (LPO) é uma condição imuno-inflamatória mucocutânea crônica que ainda possui etiologia e patogênese desconhecidas. Estudos mostrando a participação de citocinas no LPO, em especial, interleucinas (IL)-6, IL-17 e IL-18, são escassos, assim como a correlação das características clínicas e histológicas das lesões de LPO com a presença destes mediadores inflamatórios. Todas as lesões de LPO e de lesões liquenoides orais (LLO) foram revisadas a partir do arquivo do laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro e as características clínico-patológicas dos casos foram analisadas. Foram selecionados 40 casos de LPO para realização adicional de reações imuno-histoquímicas para IL-6, IL-17 e IL-18. A amostra total foi composta por 221 casos e mostrou que o LPO apresentou predileção por mulheres adultas, mais frequentemente acometidas pelo padrão reticular e com lesões localizadas predominantemente na mucosa jugal. Os 40 casos selecionados para a avaliação imuno-histoquímica incluíram pacientes com média de idade de 53 anos, sem predileção por gênero, e com lesões localizadas preferencialmente na mucosa jugal (85%), na gengiva/mucosa alveolar (47%) e na língua (42%). Quanto ao padrão clínico, 14 pacientes (35%) mostravam lesões exclusivamente reticulares e 26 (65%) mostravam lesões reticulares associadas a lesões atrófico-erosivas. Sintomas foram relatados por 53% dos pacientes e incluíram principalmente ardência e desconforto local. A análise histológica mostrou que o epitélio das lesões mostrava espessura normal, atrófica ou hiperplásica em, respectivamente, 17 (43%), 9 (22%) e 14 (35%) casos. A presença de hiperqueratose foi observada em 21 casos (53%) e exocitose de linfócitos T CD4+ e T CD8+ estava presente em, respectivamente, 17 (42%) e 30 (75%) casos. A análise imuno-histoquímica revelou que a IL-6 foi, de forma geral, a mais expressa, tanto no epitélio, quanto no conjuntivo. A expressão de IL-17 se mostrou intensa no tecido conjuntivo, em 40% dos casos. A IL-18 mostrou intensidade mais frequente leve/moderada tanto no epitélio (40%), quanto no tecido conjuntivo (45%). A presença de exocitose mostrou relação com a maior expressão das ILs e a expressão de IL-17 foi maior no epitélio mostrando hiperqueratose. Os resultados do presente estudo mostraram que as características clínicas das lesões de LPO e de LLO são distintas e podem ser utilizadas para diferenciação entre as duas entidades. Os achados histológicos e imunohistoquímicos sugerem que as ILs estudadas mostram-se mais presentes quando há exocitose linfócitos T CD4+ e T CD8+ e que sua expressão pode ter relação com as alterações epiteliais encontradas no LPO, participando da patogênese e da modulação da expressão da doença.

Oral lichen planus (OLP) is a chronic immunoinflammatory mucocutaneous condition of unknown etiology and pathogenesis. Studies focusing on the presence of cytokines in OLP, especially interleukin (IL)-6, IL-17 and IL-18, are scarce, as well as the correlation of clinical and histological characteristics with the presence of inflammatory mediators. All lesions diagnosed as OLP and oral lichenoid lesions (OLL) were reviewed from the files of the Oral Pathology laboratory, Dental School, Rio de Janeiro State University, and their clinicopathological characteristics were analyzed. Forty cases diagnosed as OLP were selected for additional immunohistochemical reactions directed against IL-6, IL-17 e IL-18. The total sample was composed by 221 cases and showed that OLP presented a predilection for adult females, mostly affected by lesions with the reticular pattern and located in the buccal mucosa. The 40 cases selected for the immunohistochemical reactions included patients with a mean age of 53 years, with no gender predilection, and with lesions located mostly in the buccal mucosa (85%), gingiva/alveolar mucosa (47%) and tongue (42%). The clinical pattern showed reticular lesions in 14 patients (35%) and reticular and atrophic/erosive lesions in 26 patients (65%). Symptoms were reported by 53% of the patients and included mostly burning sensation and local discomfort. Histological analysis showed that the epithelial thickness was normal, atrophic, or hyperplastic in, respectively, 17 (43%), 9 (22%) and 14 (35%) cases. The presence of hyperkeratosis was observed in 21 cases (53%), and exocytosis of T CD4+ and T CD8+ lymphocytes was present in, respectively, 17 (42%) and 30 (75%) cases. Immunohistochemical analysis showed that, in general, IL-6 was the most expressed IL both in epithelium and connective tissue. IL-17 expression was considered intense in the connective tissue from 40% of the cases. IL-18 expression was considered mostly mild/moderate both in epithelium (40% of the cases) and connective tissue (45% of the cases). The presence of exocytosis was associated with a higher expression of the ILs and expression of IL-17 was higher in epithelium showing hyperkeratosis. The results from the present study showed that the clinical characteristics of OLP and OLL are distinct and can be useful in differentiating these two diagnostic entities. The histological and immunohistochemical features suggest that the studied ILs are more expressed when there is exocytosis of both T CD4+ and T CD8+ lymphocytes. Expression of the ILs can be associated with the epithelial alterations encountered in OLP, participating in the pathogenesis and modulating the expression of the disease.

Prevalencia del Síndrome de Burnout en Estudiantes de Medicina

RESUMEN Introducción: El síndrome de Burnout en estudiantes de Medicina es la sensación de agotamiento, decepción y pérdida de interés por la actividad estudiantil. Objetivo: Analizar la prevalencia del síndrome de Burnout entre los estudiantes de Medicina. Materiales y Métodos: Estudio cuantitativo, observacional, de corte transversal, en el cual se obtuvo informaciones a partir de un cuestionario aplicado a los alumnos del 1° al 4° año de la Carrera de Medicina de la Universidad Internacional Tres Fronteras - UNINTER - Paraguay. Resultados: El 6% de los estudiantes no tiene síntomas del síndrome, 40% tiene la posibilidad de desarrollarlo, 42% presenta una etapa temprana del síndrome, 9% se encuentran con el síndrome instalado y 3% está en fase de agotamiento. Se observó un porcentaje mayor de la presencia de síntomas entre los alumnos del segundo y tercer año. Conclusión: Se percibe que un importante porcentaje de estudiantes de Medicina desarrollan la etapa temprana del síndrome de Burnout, por lo tanto, existe la necesidad de comprender mejor las causas de éste para así poder ayudar en la prevención del síndrome de Burnout en estudiantes de Medicina.

ABSTRACT Introduction: The Burnout syndrome in medical students describes a state of exhaustion, disappointment and loss of interest in student activity. Objective: To analyze the incidence Burnout syndrome among medical students. Methodology: A cross-sectional study in which information was obtained from a questionnaire applied to students from the 1st to 4th year of the course of Medicine of the International University Three Frontiers - UNINTER-PY. Results: 6% of the students do not have symptoms of the syndrome, 40% have the possibility of developing it, 42% present an early stage of the syndrome, 9% find the syndrome installed and 3% are in exhaustion phase. A higher percentage of the presence of symptoms was observed among the second and tree year students Conclusion: It is perceived that a considerable percentage of medical students present early symptoms of Burnout syndrome, therefore there is need to better understand the causes of this and thus be able to help in the prevention of Burnout syndrome.

Intrasocket interventions to prevent alveolar osteitis after mandibular third molar surgery: A systematic review and network meta-analysis.

A systematic review and network meta-analysis was carried out to assess the efficacy of different intrasocket interventions immediately after mandibular third molar surgery to prevent alveolar osteitis (AO). An electronic search was undertaken using EMBASE, Cochrane Library, MEDLINE/PubMed, Web of Science, Scopus, LILACS, and grey literature. We reviewed studies published up to September 2019 and included 37 randomized controlled trials (6175 mandibular third molar surgeries in 4716 patients). The pairwise meta-analysis showed that the incidence of AO decreased significantly when an intrasocket intervention was performed (risk ratio 0.39 [0.30, 0.52]; p < 0.0001). Platelet-rich fibrin (odds ratio 0.28; 95% CI [0.10, 0.71]), chlorhexidine gel 0.2% (0.52 [0.32, 0.95]), eugenol paste (0.06 [0.00, 0.77]), recombinant bovine growth factor (0.07 [0.00, 0.97]), colloidal silver gelatin sponge (0.05 [0.00, 0.74]), and acellular dermal matrix (0.04 [0.00, 0.74]) were significantly more effective than the placebo. Platelet-rich fibrin and chlorhexidine 0.2% gel had a large number of included studies and patients per comparison. Overall, there was moderate evidence to support the use of platelet-rich fibrin or chlorhexidine 0.2% gel in the socket for the prevention of AO after mandibular third molar surgery.

The Effect of Reduction Mammaplasty on Body Posture: A Preliminary Study.

Excess breast volume can lead to changes in the postural pattern that may result in pain. This causes women to seek reduction mammaplasty, a surgical procedure that reduces breast volume and may provide relief from symptoms. The objective of this study was to evaluate whether reduction mammaplasty can influence the posture of women. The postures of women with breast hypertrophy were evaluated using postural assessment software and photographic recording performed on the day of surgery and 3 months after the procedure. After surgical breast reduction, the patients had statistically significant changes in their postural patterns related to the horizontal alignment of the anterosuperior iliac spines and the angle of the acromion and anterior superior iliac spines. The analysis of the results showed statistically significant data on postural changes in the patients 3 months after the surgical procedure.

Introduction of human gammaherpesvirus 8 genotypes A, B, and C into Brazil from multiple geographic regions.

Variations in the open reading frame (ORF) K1 gene sequence of human gammaherpesvirus 8 (HHV-8) has led to the identification of 6 major genotypic clades (A, B, C, D, E, and F) in specimens isolated from around the world. These clades exhibit clear clustering among individuals in different ethnic groups and from different geographic regions. The human population of Brazil varies greatly in ethnicity because of multiple immigration events from Africa, Europe, Asia, and indigenous communities. However, there is scant information about the HHV-8 genotypes currently circulating in Brazil. Here, we describe HHV-8 genotypic diversity in isolates from Brazilian HIV-infected patients living with Kaposi's sarcoma (KS) by analysis of the complete ORF-K1 region. We also identified the most likely geographic origins of these different Brazilian genotypes. We extracted HHV-8 DNA (24 positive samples) from individuals with HIV/KS from the states of São Paulo and Rio de Janeiro, amplified the ORF-K1 gene using nested PCR (about 870 base pairs), performed sequencing and phylogenetic analysis, and then calculated the mean genetic distances of Brazilian sequences from sequences in other regions of the world (523 sequences analyzed). Phylogenetic analysis showed that genotypes C, A, and B were present in 45.8 %, 29.2 % and 25 % of the isolates from Brazil, respectively. These isolates grouped into separate clades, rather than a single monophyletic cluster. Mean genetic distance analyses suggested that these genotypes were introduced into the Brazil multiple times from different geographical regions. HHV-8/A isolates appear to be from Ukraine, Russia, and the Tartar ethnic group; HHV-8/B isolates appear to be from Congo and Democratic Republic of the Congo; and HHV-8/C isolates appear to be from Australia, Algeria, England, and French Guiana. These results contribute to a better understanding of the genetic diversity and origins of HHV-8 strains circulating in Brazil, and will provide a foundation for further epidemiological and evolutionary studies of HHV-8.

Geographic stomatitis: An enigmatic condition with multiple clinical presentations.

Geographic stomatitis is an uncommon inflammatory condition of unknown etiology. It is characterized by reddish areas surrounded by white borders affecting any location in the oral cavity and presenting a migratory and cyclic pattern. The most common affected sites include buccal mucosa, labial mucosa and mucobuccal fold. Some patients can complain of pain or burning sensation. There are few reports in the literature about this entity and its relationship with other oral and cutaneous conditions such as fissured tongue, Reiter's syndrome, atopy and psoriasis has been suggested but it is still controversial. In the present study we describe three cases of geographic stomatitis associated with fissured tongue. Lesions involved the buccal mucosa, labial mucosa, soft palate and mucobuccal fold and all cases were diagnosed based on their clinical features. All patients were oriented about the innocuous behavior of the condition and were advised to avoid exposure of the lesions to irritation factors. The three presented cases highlighted the importance of a detailed oral mucosal examination by clinicians and provided further information about the natural history and clinical presentation of geographic stomatitis. Key words:Geographic stomatitis, geographic mucositis, geographic tongue.

Paciente con vih y co-infectado por el hpv: un estudio de caso

RESUMEN Actualmente las infecciones causadas por el virus y el VPH se consideran un gran problema de salud pública mundial. El objetivo fue analizar el impacto del VIH y el VPH en la vida familiar, sexual y social; Identificar los diagnósticos y relacionar la carga viral y CD4 y evaluar la adhesión a la TARV. Paciente del sexo masculino, 52 años con diagnóstico de VIH y VPH, fue posible identificar los principales diagnósticos multidisciplinarios de acuerdo con la NANDA, siendo un total de 11 diagnósticos. Se sugiere una mirada más reflexiva del médico y su equipo multidisciplinario en lo que se refiere a la salud pública, pues no basta con tratar al paciente infectado, es necesario que el paciente reciba orientaciones sobre el proceso salud-enfermedad del paciente VIH con coinfección por el VIH HPV con el fin de promover la prevención secundaria

ABSTRACT Currently, infections caused by HIV and HPV are considered a major public health problem worldwide. The objective was to analyze the impact of HIV and HPV on family, sexual and social life; To identify the diagnoses and to relate the viral and CD4 load and to evaluate the adherence to ART. A 52-year-old man with a diagnosis of HIV and HPV was able to identify the main multidisciplinary diagnoses according to NANDA, with a total of 11 diagnoses. It is suggested a more reflective look by the physician and his multidisciplinary team regarding public health, since it is not enough to treat the infected patient, it is necessary that the patient receive guidance about the health-disease process of the HIV patient with co-infection by the HPV in order to promote secondary prevention

Anterior lingual mandibular bone depression: differential diagnosis of periapical inflammatory disorders.

Lingual mandibular bone depressions mainly affect the posterior region of the mandible. Depressions in the anterior region are rare, frequently posing difficulties in diagnosis. The aim of this article is to present a case of an anterior lingual mandibular bone depression (ALMBD) that was radiographically superimposed on the roots of anterior teeth. A 43-year-old man was referred for evaluation of a slight depression on the lingual surface of the anterior mandible. The depression was associated with a well-defined radiolucent area superimposed on the roots of the right canine and incisors. All teeth in the area proved to be vital, and cone beam computed tomography (CBCT) revealed a lingual depression in the area. The final diagnosis was an ALMBD, and the patient underwent clinical and radiographic follow-up examinations for 22 months that revealed no alterations in the area. When anterior mandibular radiolucencies are superimposed on the roots of the adjacent teeth, ALMBDs should be considered in the differential diagnosis along with periapical cysts and granulomas. Radiographic and CBCT analyses are useful to avoid unnecessary endodontic and surgical approaches.

Incidencia del uso no prescrito del Metilfenidato entre Estudiantes de Medicina

RESUMEN Introducción: El metilfenidato es un fármaco del grupo de las anfetaminas que mejora el aspecto cognitivo y atrae a personas que buscan potencializar su rendimiento. Objetivo: Con el fin de analizar la incidencia del uso no prescrito de metilfenidato entre los estudiantes de Medicina. Materiales y Métodos: Estudio cuantitativo, observacional, de corte transversal, en el cual se obtuvo informaciones a partir de un cuestionario aplicado a los alumnos del 1° al 5° año de la Carrera de Medicina de la Universidad Internacional Tres Fronteras - UNINTER - Paraguay. Resultados: El 12% de los alumnos hacen uso del metilfenidato por prescripción médica, 33% afirman utilizarla en forma indiscriminada sin prescripción médica y 66% no la utilizan. Se observó un porcentaje mayor de consumo entre el primer año, 21%, y en el segundo año 32% en comparación al 18% tercero, 14%, cuarto y quinto año 14%. En cuanto a los efectos colaterales relatados, 35% manifestaron sentir taquicardia, 18% pérdida de apetito, 23% temblores en las manos, 12% boca seca y 47% dicen sentir otros efectos. Conclusión: Se percibe que un porcentaje considerable de estudiantes de medicina hacen uso sin prescripción médica del metilfenidato, por lo tanto existe la necesidad de comprender mejor los factores que interfieren para eso y así poder ayudar en la prevención del uso inadecuado del metilfenidato.

ABSTRACT Introduction: Methylphenidate is a drug in the amphetamine groups that potentiates the cognitive performance and attracts healthy people who seek to improve their performance. Objective: To analyze the incidence of non-prescribed use of methylphenidate among medical students. Methodology: A cross-sectional study in which information was obtained from a questionnaire applied to students from the 1st to 5th year of the course of Medicine of the International University Three Frontiers - UNINTER-PY. Results: 12% of students use prescription, 33% reported having indiscriminate use of methylphenidate and 66% answered that they did not use the drug. A higher percentage of drug use was observed between the first 21% and second 32% years compared to the third 18%, fourth year 14% and fifth year 14%. Regarding the reported side effects, 35% said they felt tachycardia, 18% felt a loss of appetite, 23% had hand tremors, 12% reported feeling good dryness, 47% said they felt other effects. Conclusion: It is perceived that a considerable percentage of medical students use without medical prescription methylphenidate, therefore there is a need to better understand the factors that interfere with that and to help in the prevention of the misuse of methylphenidate.

Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America.

BACKGROUND: This study aimed to evaluate trends and predictors of survival after cancer diagnosis in persons living with HIV in the Caribbean, Central, and South America network for HIV epidemiology cohort. METHODS: Demographic, cancer, and HIV-related data from HIV-positive adults diagnosed with cancer ≤ 1 year before or any time after HIV diagnosis from January 1, 2000-June 30, 2015 were retrospectively collected. Cancer cases were classified as AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC). The association of mortality with cancer- and HIV-related factors was assessed using Kaplan-Meier curves and Cox proportional hazards models stratified by clinic site and cancer type. RESULTS: Among 15,869 patients, 783 had an eligible cancer diagnosis; 82% were male and median age at cancer diagnosis was 39 years (interquartile range [IQR]: 32-47). Patients were from Brazil (36.5%), Argentina (19.9%), Chile (19.7%), Mexico (19.3%), and Honduras (4.6%). A total of 564 ADC and 219 NADC were diagnosed. Patients with NADC had similar survival probabilities as those with ADC at one year (81% vs. 79%) but lower survival at five years (60% vs. 69%). In the adjusted analysis, risk of mortality increased with detectable viral load (adjusted hazard ratio [aHR] = 1.63, p = 0.02), age (aHR = 1.02 per year, p = 0.002) and time between HIV and cancer diagnoses (aHR = 1.03 per year, p = 0.01). CONCLUSION: ADC remain the most frequent cancers in the region. Overall mortality was related to detectable viral load and age. Longer-term survival was lower after diagnosis of NADC than for ADC, which may be due to factors unrelated to HIV.

Do you know this syndrome? Ascher´s syndrome: clinical findings of little known triad

Abstract: Ascher's syndrome consists of double lip, blepharochalasis and sometimes non-toxic thyroid enlargement. It is a rare, benign, rarely reported, and sometimes misdiagnosed condition that most often affects patients under 20 years old. The etiology remains unknown, although factors such as trauma, hormonal dysfunction and heredity have been suggested. Treatment based on surgical intervention is indicated to improve aesthetics or function. The presented case shows a patient diagnosed with Ascher's syndrome based on clinical findings such as double lip and blepharochalasis.

Reação de corpo estranho a material de preenchimento estético: relato de quatro casos / Foreign body reaction due to aesthetic filling materials: report of four cases

Objetivo: o objetivo deste trabalho é relatar quatro casos de reações de corpo estranho a material de preenchimento estético acometendo a cavidade oral. Relato dos casos: quatro pacientes adultas do sexo feminino compareceram à consulta apresentando nódulos submucosos localizados nos lábios e sulcos nasogenianos com histórico prévio de injeção de materiais de preenchimento estético (ácido hialurônico em duas pacientes e polimetilmetacrilato em duas pacientes). O diagnóstico em três dos quatro casos foi baseado nos achados clínicos e histológicos e apenas nos achados clínicos em um caso. O tratamento consistiu de manejo cirúrgico em três pacientes e corticoterapia em uma paciente e todas se encontram bem e em acompanhamento clínico. Conclusão: os cirurgiões-dentistas devem estar atentos aos efeitos adversos provocados por materiais de preenchimento estético, considerando seus diagnósticos diferenciais e as formas mais adequadas de tratamento.

Objective: The aim of the present study is to report 4 cases of foreign body reactions to dermal fillers affecting the oral cavity. Cases report: Four adult females were referred for evaluation of submerse nodules on the lips and nasolabial folds with a previous history of injection of dermal fillers (hyaluronic acid in two cases and polymethylmethacrylate in two cases). Diagnosis was based on clinical and histological aspects in three cases and solely on clinical aspect in one case. Management consisted in surgical excision in three cases and corticosteroid therapy in one and all 4 patients are well, with no signs of recurrence and remain in clinical follow-up. Conclusion: Dental professionals should be aware of the side effects associated with the use of aesthetic fillers, considering their main differential diagnosis and the most adequate management strategy for each individual case.