Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial.

Importance: Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective: To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants: This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention: The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures: Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results: A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance: The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration: Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Comparative evaluation of vegetable matter involved lesions with oral parasitic infections in the oral cavity.

The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

Proposal of a minimally invasive approach diagnosing desquamative gingivitis-associated diseases.

BACKGROUND: We aimed to present a minimally invasive clinical approach to collect a suitable sample for the laboratory diagnosis of desquamative gingivitis. MATERIALS AND METHODS: The proposed technique involves Nikolsky's test for the collection of tissue samples. It consists of the histopathological analysis of the bullous membrane formed in cases with positive Nikolsky's sign (NS). Three patients without a previous diagnosis of the disease agreed to undergo this protocol before a biopsy. RESULTS: The diagnoses of the three cases reported here were mucous pemphigoid (MP), pemphigus vulgaris (PV), and lichen planus (LP). The tissue samples collected using this technique were sufficient to microscopically observe partial-thickness epithelium (diagnosing PV) or full-thickness epithelium (diagnosing MP). The diagnosis of LP was only possible by conventional biopsy. CONCLUSION: We observed, for different cases, some advantages of the proposed technique: minimally invasive, potentially superior to exfoliative cytology, easily performed, and with low costs.

Metastatic Biphasic Primitive Tumor in the Mandible of a Child.

Pediatric mandibular tumors present an aggressive biological behavior and difficult diagnosis. A wide range of odontogenic and nonodontogenic tumors comprise the spectrum of these lesions. We report a case of a 1-year-old male child patient showing facial asymmetry symptomatic of an expansive lesion extending throughout the body and ramus of the left hemimandible with a diameter of 8 cm. The histopathological report suggested a high-grade mucoepidermoid carcinoma (MEC), recommending further immunohistochemical investigation of the ectomesenchymal or neuroectodermal origin of the tumor cells. The patient evolved with extensive bilateral pleural effusion followed by metastasis in the middle third of the right humerus, and died 2 months after the first biopsy procedure by acute renal failure with tubular necrosis, before a final inconclusive immunohistochemical report was reached. The lack of resources for less-favored regions of Brazil impairs rapid biomolecular examinations such as immunohistochemical resulting in delay of appropriate therapeutic procedures.

Sialadenoma papilliferum: Bibliometric analysis.

BACKGROUND: Sialadenoma papilliferum is a benign rare condition of salivary glands showing a characteristic papillary growth of the ductal epithelium that ends up being confused with more frequent lesions of the oral cavity. Objectives: To perform a bibliometric analysis of all articles about Sialadenoma papilliferum in the oral cavity and to add a singular case report of Sialadenoma in the lower lip. MATERIAL AND METHODS: A total of 36 publications referring to Sialadenoma papilliferum in the oral cavity from the PubMed platform was reviewed. The specific data were collected, and a bibliometric analysis was performed using Microsoft Excel. The results obtained were then compared with this new case report. RESULTS: The people most affected with sialadenoma were white males at the average age of 56. The lesion was asymptomatic, usually white or red, with an average size of 1.4 cm, and the palate was by far the most affected site. The majority of the lesions were excised, and only two cases indicated recurrence. CONCLUSIONS: With surgical removal, Sialadenoma papilliferum has a favorable prognosis and no further treatment is required. Due to few recorded cases of recurrence, a long follow-up period is recommended to ensure that the lesion does not redevelop. Key words:Sialadenoma papilliferum, salivary gland, oral cavity, bibliometric analysis.

Prevalência de jovens hipertensos não diagnosticados atendidos na policlínicao dontológica da Universidade do Estado do Amazonas / Prevalence of undiagnosed hypertensive young people of dental policlinics of University of Amazonas State

Objetivo: avaliar a prevalência de jovens hipertensos não diagnosticados que procuraram atendimento na policlínica odontológica da Universidade do Estado do Amazonas (UEA) quanto a sexo, raça, idade e índices antropométricos. Metodologia: foi entregue um questionário de perguntas fechadas e realizadas duas aferições de pressão arterial com intervalo de 10 minutos entre elas para diagnóstico da hipertensão em 124 sujeitos. Em seguida, os pacientes foram pesados e medidos para obtenção do índice de massa corporal (IMC) e foi obtida a medidad a circunferência abdominal (CA). Os dados foram analisados pelos testes Exato de Fisher e t de Student, com nível de significância de 5%.Resultados: a prevalência de jovens hipertensos não diagnosticados foi de 4,8%(n=6) e a média de idade encontrada foi de 19,3 ± 1,9 anos. O sexo feminino apresentou 8,0% (n=4) e o masculino 2,5% (n=2) de hipertensos. Houve predominância da raça parda (n=4; 5,0%). A prevalência de sobrepeso/obeso foi superior nos jovens hipertensos em comparação aos valores de IMC normal (p<0,05). Não foi observada associação entre hipertensão e CA, em ambos os sexos (p>0,05).Conclusão: a prevalência de hipertensos jovens foi baixa, sendo que a maioria destes era de mulheres de raça parda, sendo associada a indivíduos em sobrepeso ou obesos.

Aim: to evaluate the prevalence of non-diagnosed hypertensive young-adults searching for dental treatment at dentistry policlinics of Amazonas State University in function of gender, race, age and anthropometric indexes. Metodology: a survey with non-open questions was applied along with two measurements of arterial pressure toke 10 minutes apart between them in 124 subjects. The patients were weighed and their height was measured to obtain the body-mass index (BMI). The abdominal circumference (AC) was also obtained. Data were analyzed by Fisher’s exact and Student t tests (alpha=5%).Results: the prevalence of hypertensive young-adults, aging 19.3 ± 1.9 years, was4.8% (n=6), being 8% (n=4) females and 2.5 % (n=2) males. The predominant race was brown (5%, n=4). Overweighed/obese hypertensive subjects were prevalent when compared to normal BMI subjects (p<0.05). There was none association between hypertension and AC in both genders (p>0.05).Conclusion: the prevalence of hypertensive young-adults was low, being the majority of them brown females, being associated with overweigh or obesity.