Might photobiomodulation therapy interfere with the frequency of severe mucositis and oral candidiasis? A retrospective analysis in patients with head and neck carcinoma.

PURPOSE: Considering the tumor in the oral cavity or the oropharynx and nasopharynx region might be an aggravating factor for oral mucositis (OM) manifestation, the present study aimed to evaluate whether the location of the tumor and the use of photobiomodulation therapy (PBMT) might affect the frequency of oral candidiasis (OC) during radiotherapy (RT) and/or chemotherapy (CT) treatments. METHODS: The medial records of seventy-four patients with head and neck cancer treated in a public service from 2016 to 2019 were evaluated. All these patients were submitted to RT in an accumulated dose of 48 to 70 Gy of radiation. Data about OM and OC were collected and presented according to the application of a therapeutic protocol with laser photobiomodulation (PBMT) to control oral mucositis, or not (No-PBM), and the location of tumor (head and neck or oral cavity). In the PBMT group patients, a low-power laser device composed of InGaAlP diode (maximum output power of 86.7 mW, active tip area of 0.1256 cm2, and continuous wavelength of 660 nm), was applied to the lips (three points each), right and left jugal mucosa (three points each), the limit between hard and soft palate (three points), buccal floor/sublingual gland (one point), lateral edge of the tongue (three points on each side), and back of the tongue (six points), three times weekly, for 5 weeks. The dosimetry used in each application was 2 J for 3 s, thus totaling 56 J. The correlation between clinical characteristics such as age, tumor size (T), metastatic lymph node (N), number of RT and CT sessions, candidiasis, and OM were analyzed. RESULTS: Mucositis grades 1 and 2 were the most common among all patients, especially before the 12th radiotherapy session, regardless of the treatment with PBM (p > 0.05). Additionally, no difference in the grade of OM and OC was significantly observed when comparing the two laser therapy groups. OC was more frequent after the 12th radiotherapy session in all groups. Nonetheless, OM and OC had a different correlation regarding to tumor location (head and neck and oral cavity) being PBMT a positive therapy to delay OM. It was observed a positive and statistically significant correlation between tumors at oral cavity and OM, regardless PBMT (R = 0.84, p < 0.05 to PBMT and R = 0.13, p < 0.05 to No-PBM). Otherwise, OC was positively correlated to local metastasis in patients with oral tumors undergoing PBMT (R = 0.84, p < 0.05). CONCLUSION: Patients with oral cavity tumor presented more OM, especially high grades, then patients with tumors in other regions of the head and neck, which seems to be related to the irradiation parameters of radiotherapy and/or with the limitation of conduction of PBMT in tumor areas. OM and OC were not changed by PBMT, although it helped to reduce the incidence of severe cases of OM.

Impact of photobiomodulation for oral mucositis on body weight and BMI of patients with head and neck cancer.

PURPOSE: To evaluate the impact of photobiomodulation for oral mucositis on body weight and body mass index (BMI) in head and neck cancer patients. METHODS: Patients were separated into two groups: photobiomodulation (PBM) (n = 17) and SHAM (n = 19). Participants assigned to the PBM group received the photobiomodulation therapy on alternate days at 33 different sites of the oral mucosa (1 J for 10 s per application point) using a low-power aluminum gallium arsenide (AsGaAl) laser device with a maximum output power of 86.7 mW and a wavelength of 660 nm (red). The same protocol was performed in patients allocated in the SHAM group but with the device turned off. At the first and twenty-fourth radiotherapy sessions, participants from both groups underwent an intraoral examination to assess the presence or absence of mucositis using the WHO scale, and measurements of weight and height for BMI calculation were undertaken. RESULTS: All patients had significant differences in weight and BMI throughout the study period. Patients in the PBM group lost less weight (p < 0.01) and had a reduced BMI loss (p < 0.01) in comparison to patients in the SHAM group. Although PBM did not prevent oral mucositis, it decreased its severity (p < 0.01). CONCLUSION: Photobiomodulation for oral mucositis reduced weight loss and prevented a reduction in BMI in patients who underwent chemoradiotherapy for head and neck cancer. Retrospectively registered at https://data.mendeley.com//datasets/4kd7s49wk4/1 .

Action of Matricaria recutita (chamomile) in the management of radiochemotherapy oral mucositis: A systematic review.

The objective of this study was to evaluate the effect of topical chamomile in the prevention and/or treatment of oral mucositis (OM) in cancer patients. It was a systematic review, which sought articles of the randomized clinical trial according to the PRISMA parameters, registered in the PROSPERO. The databases used were PubMed, Cochrane Library, and Bireme. Descriptors were selected from DeCs/MeSH and the PICO strategy was applied. The search found 148 publications. After all the steps, six articles were selected. The total sample included 492 patients and all studies used the same OM measurement scale. The results showed that the application of topical chamomile was effective in the prevention and/or treatment of OM in four of the six studies, with a dose ranging from 1% to 2.5% and duration that ranged from single to 4 times a day. Some limitations were observed: the minimum age of the patients was not informed, and there was no specification of the sites involved or the chemotherapies used. The application of topical chamomile in the preventive/therapeutic of chemo-induced OM seems to be recommended. In addition, scientific production should be encouraged, as it aims to determine useful protocols for this phytotherapy for the oncology population.

Surgical periodontal treatment of a patient with dentinal hypersensitivity after bariatric surgery: a case report.

The aim of this report is to present the clinical case of a patient with severe symptoms of dentinal hypersensitivity after bariatric surgery. A 40-year-old woman had a complaint of hypersensitivity in all teeth after bariatric surgery to treat morbid obesity. The patient had multiple sites of gingival recession associated with pain symptoms that were characteristic of dentinal hypersensitivity. Subepithelial connective tissue grafting was performed, using either coronal flap displacement techniques or a tunnel-type approach, at the sites of gingival recession and/or dentinal hypersensitivity. Surgery resulted in gains of keratinized mucosa and root surface coverage as well as regression of pain. Patients who undergo bariatric surgery should be monitored for development of oral health-related complications.

Evaluation of the use of chamomile in isolation and in association with laser photobiomodulation in the healing of rats oral mucosa.

Laser photobiomodulation (LPBM) has been shown to be one of the possible modulating agents of inflammation. Similarly, medicinal plants, such as chamomile (Matricaria recutita) are also used with the same purpose. To evaluate tissue repair in the dorsum of the tongue of rats under topical use of chamomile alone and in association with LPBM. Seventy-five male Wistar rats received a standardized wound on the dorsum of the tongue and were allocated into experimental groups: Control (G1), Chamomile Fluid extract (G2), Chamomile Infusion (G3), Laser (G4), Chamomile Infusion + Laser (G5). Euthanasia was done on days 3, 7, and 14 after surgery. Ulcers were evaluated and measured with a caliper. Sections stained with hematoxylin and eosin and Picrosirius Red allowed evaluation of edema, inflammatory infiltrate, cellularity, and re-epithelialization and characterization of total collagen. Histomorphometric analysis of the percentage of total collagen, the distance from the basal layer to the epithelial surface, and the thickness of the stratum corneum were performed. The G2 and G4 groups modulated the exudative and proliferative phases of inflammation, both clinically and histologically. The G3 and G5 groups did not show significant differences in relation to the G1 group in most of the evaluated parameters. Chamomile fluid extract and LPBM alone showed better clinical and histological responses for tissue repair than the association between these therapeutic modalities. There were differences in the parameters of clinical, histological, and histomorphometric patterns between the experimental groups of the present investigation. The LPBM proved to be superior in the performed analysis.

Surgical elevation of bilateral maxillary sinus floor with a combination of autogenous bone and lyophilized bovine bone.

AIM: Realize the surgery of sinus lifting floor to allow the installation of osseointegrated implants for oral rehabilitation, with the combination of different biomaterials, autogenous bone and lyophilized bovine bone. BACKGROUND: Oral rehabilitation using the installation of osseointegrated implants is an alternative surgical approach that results in the satisfactory form, function and esthetics of the dental units. CASE REPORT: After clinical, dental and laboratory assessment, a 47-year-old female patient underwent full maxillary oral rehabilitation involving the installation of osseointegrated implants to allow her to meet the physiological demands of occlusion and mastication. It was found that the patient had fully pneumatized maxillary sinuses with insufficient height to anchor implants, with a loss of the vertical dimension of the occlusal and masticatory functions due to general dental loss, compounded by the use of ill-fitting dentures; hence, the choice was made to take autogenous bone from the patient's chin area and supplement it with lyophilized bovine bone as collateral for larger areas to be grafted. It was also decided to avulse the remaining tooth units due to their impairment by periodontal disease. CONCLUSION: Bone grafts do not constitute suitable alternatives in the cosmetic and functional rehabilitation of the maxilla in patients requiring bilateral sinus elevation. The chin region provides bone tissue that, when complemented by lyophilized bovine bone grafts, ensures greater volume and less invasive surgery. In the case described here, a height gain of approximately 550% was obtained, making it possible to anchor seven implants. CLINICAL SIGNIFICANCE: In this study, the surgical procedures used for grafting a combination of autogenous and lyophilized bovine bone, aimed to elevate the maxillary sinus floor to allow the installation of osseointegrated implants for oral rehabilitation.

Evaluation of the effect of Matricaria recutita monotherapy or in combination with photodynamic therapy on tissue repair in the dorsum of the tongue of rats.

OBJECTIVE: The search for treatments that accelerate the healing of lesions is of constant interest. Matricaria recutita (chamomile) is a plant with antimicrobial, anti-inflammatory, and healing properties, and antimicrobial Photodynamic Therapy (aPDT) eradicates microorganisms, which favors tissue repair. This study aimed to evaluate the effect of the topical use of chamomile with or without aPDT on tissue repair in rats' tongues. METHODOLOGY: A total of 75 male Wistar rats underwent standardized ulceration on the dorsum of the tongue using a punch of 5 mm diameter and were randomly allocated into the following groups: control (G1), chamomile fluid extract (G2), chamomile infusion (G3), aPDT (G4), and chamomile infusion + aPDT (G5). On the 3rd, 7th, and 14th days postoperatively, euthanasia was performed, and the ulcers were measured using calipers. The presence of edema, inflammatory infiltrate, cellularity, re-epithelialization, and characterization of total collagen were evaluated using sections stained with Hematoxylin and Eosin and Red Sirius. Histomorphometry analyses of the percentage of total collagen, the distance from the basal layer to the epithelial surface, and the thickness of the stratum corneum were performed. Descriptive (absolute/relative frequencies and modes) and exploratory analyses were performed. The associations between the groups and the presence of ulcers were analyzed with Fisher's exact test. All analyses were performed using the R program and statistical significance was set at p=0.05. RESULTS: The G2 positively modulated the exudative and proliferative phases of repair, both clinically (p<0.0001) and histologically, whether in descriptive or inferential analyses (p<0.05). The G3 showed a significant difference in clinical parameters compared with G1 (p<0.0001). The G4 and G5 did not positively modulate tissue repair. CONCLUSION: The chamomile fluid extract showed better outcomes for tissue repair in the rat tongue.

Oral manifestations in patients diagnosed with psoriasis: A systematic review.

AIMS: To identify the main types of oral lesions associated with psoriasis. METHODS AND RESULTS: It was a systematic review, based on a search performed in the PubMed/Medline, and Scielo databases, and an associated manual search. Descriptors were selected from DeCs/MeSH and the PICOS strategy (population, intervention, comparison, outcomes, and study design) was applied. Randomized clinical trials and retrospective and prospective studies published from 2000 to 2022 were included, according to the PRISMA parameters (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), registered in the PROSPERO platform. The STROBE quality scale (Strengthening the Reporting of Observational studies in Epidemiology) was also used. One hundred fourteen articles were identified using the search strategy, and nine articles were found in the manual search. Of the sixty-six preselected articles, seven were included in the study. Although it was not possible to identify a specific oral lesion associated with psoriasis, there was a greater occurrence of geographic tongue, fissured tongue, and Candida sp. infection CONCLUSION: Evidence shows that although patients with psoriasis may exhibit lesions in the oral mucosa, they are not specific to this condition. Further epidemiological studies are needed to address the association of psoriasis with possible changes in the oral mucosa.

Oral hyperpigmentation as an initial clinical aspect of hand foot syndrome.

Hand-foot syndrome (HFS) is a common adverse effect of anticancer therapy. It is known to cause dermatological symptoms including acral erythema and dysesthesia of the palms and soles of the feet, swelling, pain, itching, and scaling. Some drugs, like capecitabine, are known to trigger this condition. However, pigmentation of the oral mucosa is a rare adverse effect. This study aims to report a case of oral mucosa hyperpigmentation caused by capecitabine therapy before the clinical diagnosis of HFS. A 58-year-old female, diagnosed with invasive breast duct carcinoma, had the central nervous system, liver, skin, and lung metastasis, using capecitabine every day for 14 cycles. Oral examination revealed multifocal black macules on the hard palate, bilateral buccal mucosa, gingival mucosa, and dorsum of the tongue. The clinical hypothesis was oral mucosa hyperpigmentation by capecitabine use and only periodic follow-up was necessary. Hyperpigmentation of oral mucosa by capecitabine is a rare consequence of neoplastic therapy and your association with HFS is unclear, and poorly reported. The report of these events is important to alert oncology health teams about the individual tolerance to capecitabine therapy.

Oral Lichen Planus: Associations Between Histomorphometric Characteristics and White and Red Lesions.

Histomorphometry seems to provide more rigid quantitative elements for histological analysis and to bring less subjectivity to the diagnosis of oral lichen planus lesions (OLP). This study aimed to verify the association between white and red lesions and histomorphometric characteristics of OLP lesions. This retrospective cross-sectional study assessed 48 hematoxylin- and eosin-stained histological sections from incisional biopsies obtained from OLP cases. A single previously calibrated evaluator performed the light microscopy analyses to evaluate morphological and morphometric parameters. Analyses of associations among variables were performed using the Fisher's exact test. Morphometric variables were assessed using the Mann-Whitney non-parametric test. Comparisons among the three groups (age range) were performed using the Kruskal-Wallis test. In this study, 81.2% of the participants were women aged < 50 years. Keratosis, acanthosis, and inflammatory infiltrates were noted in 10.4, 10.4, and 37.5% of moderate/severe cases, respectively. Inflammatory infiltrate (52.1%), papillary projections (54.2%), saw teeth (12.5%), basal layer degeneration (39.6%), and Civatte bodies (68.8%) were also observed. There was no significant association between lesion type and clinicopathological variables (p > 0.05) or between lesion type and histological (p > 0.05) and morphometric variables (p > 0.05). Furthermore, the morphometric variables analyzed did not differ between white and red lesions (p > 0.05) or in their associations with clinicopathological variables (p > 0.05). The results of this investigation showed no associations between white and red OLP lesions and the histomorphometric characteristics evaluated.

Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review.

BACKGROUND AND AIMS: Oral mucositis is the most common side effect in response to anticancer therapies in the head and neck region. It has a debilitating potential for the health of affected individuals, negatively interfering with nutritional status and quality of life. Due to the great complexity of its pathogenicity, different forms of interventions for prevention and treatment are being studied, including nutritional supplements with vitamin E, zinc and glutamine. This study aimed to review the literature on the influence of nutrients, in supplement form, for prevention and/or treatment of mucositis in patients with head and neck cancer. METHODS: A survey of studies related to the definition, treatment and prevention of mucositis with nutrients was carried out between January 2018 and July 2019, using the Pubmed, Cochrane Library and Scielo databases. In the end, 61 relevant scientific publications were selected between the years 2004 and 2019. RESULTS: Nutrients such as vitamin E, glutamine and zinc are forms of supplementation that have positive effects on the manifestation and severity of oral mucositis due to their antioxidant and immunomodulatory properties. However, some studies reveal that antioxidant properties may reduce the effectiveness of antineoplastic therapy. CONCLUSIONS: This study suggests the effectiveness of vitamin E, zinc and glutamine in preventing and treating oral mucositis. However, the importance of new clinical researches to clarify possible doubts is highlighted, as well as the creation of a protocol that includes the dose, route and time of administration, for greater safety in use.

Adherence of head and neck cancer patients to laser photobiomodulation in a public health service: Pilot study.

OBJECTIVE: The aim of this study was to evaluate the adherence of patients with head and neck cancer who underwent radiotherapy or radio-chemotherapy combined to the preventive laser photobiomodulation protocol in a public health service. MATERIALS AND METHODS: This was a cross-sectional study, whose population sample included patients with malignant head and neck neoplasms. Thirty head and neck cancer patients undergoing cancer treatment, were examined and interviewed through a record of signs and symptoms of oral mucositis (OM) and adherence to the preventive laser photobiomodulation protocol, that began in the first session of radiotherapy, and included the laser application three times a week during the 3-week period. The collected data were documented, and the descriptive and inferential statistics were performed with a significance level of p < 0.05. RESULTS: It was observed that 66.6% of patients developed OM. There was a predominance of degrees I and II, with 36.8% and 31.6%, respectively. A total of fifteen patients (50%) missed one or more laser photobiomodulation sessions. A positive association was found between patients who missed at least two laser photobiomodulation sessions with the development of OM degrees III (p < 0.05). CONCLUSIONS: There was moderate adherence of patients with head and neck cancer to the laser photobiomodulation protocol and the development of more severe degrees of OM was related to individuals that didn't attend scheduled sessions.

Evaluation of preventive laser photobiomodulation in patients with head and neck cancer undergoing radiochemotherapy: Laser in patients with head and neck cancer.

AIMS: This study aimed to evaluate the effect of laser photobiomodulation in the prevention of oral mucositis (OM), salivary hypofunction and referred pain in patients with head and neck cancer. METHODS AND RESULTS: This randomized clinical study divided patients into two groups: the laser group (LG, n = 30) and the control group (CG, n = 24). The LG (InGaAlP, 660 nm, 86.7 mW, 2 J/cm2 ) participated in the preventive protocol, while the CG underwent a simulated procedure without light emission. The degree of OM, salivary flow, and referred pain were evaluated at five different periods of radiotherapy. Both groups showed a significant increase in the degree of OM (P < .01). Regarding OM, salivary flow, and oral pain, there were no significant differences between the groups. CONCLUSIONS: The laser photobiomodulation protocol used in this study was not effective in preventing radiochemotherapy-induced OM, salivary hypofunction, and referred pain in patients with head and neck cancer. Notably, although the development of OM did not differ significantly according to the use of laser therapy, the severity of oral mucositis was reduced in patients who underwent laser therapy compared to that in patients who did not.

Evaluation of the effect of Matricaria recutita monotherapy or in combination with photodynamic therapy on tissue repair in the dorsum of the tongue of rats*

Abstract The search for treatments that accelerate the healing of lesions is of constant interest. Matricaria recutita (chamomile) is a plant with antimicrobial, anti-inflammatory, and healing properties, and antimicrobial Photodynamic Therapy (aPDT) eradicates microorganisms, which favors tissue repair. Objective This study aimed to evaluate the effect of the topical use of chamomile with or without aPDT on tissue repair in rats' tongues. Methodology A total of 75 male Wistar rats underwent standardized ulceration on the dorsum of the tongue using a punch of 5 mm diameter and were randomly allocated into the following groups: control (G1), chamomile fluid extract (G2), chamomile infusion (G3), aPDT (G4), and chamomile infusion + aPDT (G5). On the 3rd, 7th, and 14th days postoperatively, euthanasia was performed, and the ulcers were measured using calipers. The presence of edema, inflammatory infiltrate, cellularity, re-epithelialization, and characterization of total collagen were evaluated using sections stained with Hematoxylin and Eosin and Red Sirius. Histomorphometry analyses of the percentage of total collagen, the distance from the basal layer to the epithelial surface, and the thickness of the stratum corneum were performed. Descriptive (absolute/relative frequencies and modes) and exploratory analyses were performed. The associations between the groups and the presence of ulcers were analyzed with Fisher's exact test. All analyses were performed using the R program and statistical significance was set at p=0.05. Results The G2 positively modulated the exudative and proliferative phases of repair, both clinically (p<0.0001) and histologically, whether in descriptive or inferential analyses (p<0.05). The G3 showed a significant difference in clinical parameters compared with G1 (p<0.0001). The G4 and G5 did not positively modulate tissue repair. Conclusion The chamomile fluid extract showed better outcomes for tissue repair in the rat tongue.

Evaluation of Salivary Flow Rate in Patients undergoing Chemotherapy for Solid Tumors / Avaliação de Fluxo Salivar em Pacientes Submetidos à Quimioterapia para Tumores Sólidos

Chemotherapy for cancer treatment offers the possibility of eradicating neoplastic cells, however, its use can result in systemic and oral adverse effects, with emphasis on the qualitative-quantitative modification of saliva. To evaluate the stimulated salivary flow rate (SFR) in patients undergoing chemotherapy for treatment of solid malignancies. This was a cross-sectional study with twenty patients diagnosed with solid tumors undergoing chemotherapy with cytotoxic drugs. Subjects were submitted to stimulated sialometry in the 1st cycle of chemotherapy (baseline, 7th day and 14th day). Additionally, sociodemographic data regarding these patients were collected in a standardized questionnaire. Descriptive and inferential statistical analysis were performed, with a significance level of p<0.05. There was a predominance of women (75%) aged over 40 years old (90%). The most prevalent tumor location was breast (55%), followed by ovaries (15%), and the most used drug was cyclophosphamide (50%). In the sample, no statistically significant result was observed with regard to SFR (p>0.05) in the studied periods. The data suggest that the 1st cycle of chemotherapy was not able to induce significant changes in the SFR. New studies need to be performed for the prospective identification of potential changes in salivary parameters.(AU)

A quimioterapia para tratamento do câncer oferece possibilidade de erradicação das células neoplásicas, todavia, seu emprego pode resultar em efeitos adversos sistêmicos e em cavidade oral, com destaque para modificação quali-quantitativa da saliva. Avaliar a velocidade de fluxo salivar (VFS) estimulado em pacientes sob quimioterapia para tratamento de neoplasias malignas sólidas. Tratou-se de um estudo transversal, no qual vinte pacientes com tumores sólidos sob regime quimioterápico com drogas sabidamente citotóxicas, foram submetidos à sialometria estimulada no 1º ciclo de quimioterapia (baseline, 7º dia e 14º dia). Adicionalmente, foram coletados dados referentes às características sociodemográficas desses pacientes. Foi realizada análise estatística descritiva e inferencial, com nível de significância p<0,05. Observou-se predominância de mulheres (75%) em idade acima dos 40 anos (90%). A localização do tumor mais prevalente foi a mama (55%), seguida de ovários (15%) e a droga mais utilizada foi a ciclofosfamida (50%). Na amostra não foi observado resultado estatisticamente significativo no que diz respeito à variável VFS (p>0,05) nos períodos estudados. Os dados sugerem que o 1° ciclo de quimioterapia não foi capaz de induzir alterações significativas na VFS. Novos estudos precisam ser realizados para a identificação prospectiva de potenciais alterações nos parâmetros salivares.(AU)

Occurrence of Fatigue and Pain in Oncology Patients: Serie of Case Reports / Ocorrência de Fadiga e Dor em Pacientes Oncológicos: Série de Casos Clínicos

Fatigue is a reversible change in biological, physical and psychic functions, resulting from the imbalance of the organism. In patients with head and neck cancer (HNC), fatigue has been cited as one of the most frequent symptoms, especially in individuals with metastasis. It can significantly limit daily activities in order to be considered as a chronic condition, in particular, when associated with painful symptoms. The objective of this studt was to report the occurrence of fatigue and pain in patients with HNC. This was a series of prospective clinical cases describing the clinical history of four patients with HNC submitted to radio chemotherapeutic treatment, users of a public oncology service. To assess the degree of fatigue, the Brief Fatigue Inventory questionnaire was applied at five different moments during the antineoplastic treatment and pain analysis, an analog pain scale was used. The analysis of the questionnaires showed that fatigue was a frequent complaint and intensified with the advance of antineoplastic therapy. Its occurrence was also related to the difficulty performing daily activities. Painful symptomatology has been reported by patients to varying degrees. The occurrence of fatigue and pain in patients with HNC presents variability due to the individual's own experience, reflected by their socioeconomic and cultural context and their personal perception of the illness process.(AU)

A fadiga é uma alteração reversível das funções biológicas, físicas e psíquicas, proveniente do desequilíbrio do organismo. Em pacientes com câncer de cabeça e pescoço (CCP), a fadiga tem sido citada como um dos sintomas mais frequentes, principalmente em indivíduos com metástase. Pode limitar de forma significativa as atividades diárias, de modo a ser considerada uma condição crônica, em especial, quando associada à sintomatologia dolorosa. Este trabalho objetiva relatar a ocorrência de fadiga e dor em pacientes com CCP. Tratou-se de uma série de casos clínicos, de caráter prospectivo, que descreve a história clínica de quatro pacientes com CCP submetidos ao tratamento radioquimioterápico, usuários de um serviço de oncologia público. Para avaliação do grau de fadiga, foi aplicado o questionário Brief Fatigue Inventory em cinco momentos distintos, durante o tratamento antineoplásico e para a análise da dor, foi utilizada uma escala analógica de dor. A análise dos questionários demonstrou que a fadiga foi uma queixa frequente e se intensificou com o avanço da terapia antineoplásica. Sua ocorrência também esteve relacionada à dificuldade de execução de atividades cotidianas. A sintomatologia dolorosa foi relatada pelos pacientes em diferentes graus. A ocorrência de fadiga e dor em pacientes com CCP apresenta variabilidade em razão da experiência vivida pelo próprio indivíduo refletida pelo seu contexto socioeconômico e cultural e a sua percepção pessoal acerca do processo de adoecimento.(AU)

Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Avaliação da composição e rotulagem de fotoprotetores labiais comercializados em farmácias / Evaluation of the composition and labeling of lip photo protectors marketed in pharmacies

Introdução: os efeitos deletérios da radiação ultravioleta (UV) sobre os tecidos labiais podem desencadear diversas lesões, inclusive de caráter maligno. A utilização de produtos fotoprotetores tem sido a melhor opção contra os efeitos nocivos dessa radiação. Diversas marcas de fotoprotetores labiais (FPL) estão disponíveis no mercado, onde o consumo é diretamente influenciado por qualidade e preço. Objetivo: analisar e comparar FPLs disponíveis em farmácias quanto à composição, ao preço e às características de rotulagem, segundo regulamentações da ANVISA. Metodologia: foi realizado estudo descritivo, que avaliou FPLs, quanto a FPS, indicação, constituintes químicos, FPUVA, preço e rótulo. Informações sobre as substâncias presentes e suas funções foram obtidas no INCI (Comissão Europeia), e os filtros solares foram identificados na INN (Organização Mundial da Saúde). As avaliações de rotulagem foram baseadas nas Resoluções da Diretoria Colegiada da ANVISA de nº 30/12, nº 7/15 e nº 69/16. Resultados: dezessete FPLs foram avaliados. Cinco apresentaram FPS 15; três, FPS 20; seis, FPS 30; e três, FPS 50. Dez filtros UV foram identificados, estando o Ethylhexyl Methoxycinnamate presente em maior número de FPLs. Doze produtos informaram ter proteção UVA. As características dos rótulos se encontravam dentro das determinações da ANVISA, na grande maioria dos casos. Houve alta variação do preço. Conclusão: a partir deste estudo, foi possível conhecer mais sobre a composição e as características dos FPL, principalmente sobre FPS e FPUVA, bem como se estão de acordo com as normas estabelecidas pela ANVISA, propiciando um maior conhecimento dos produtos que estão sendo comercializados.

Introduction: the deleterious effects of ultraviolet (UV) radiation on lip tissues can trigger several lesions, including malignant ones. The use of photoprotective products has been the best option against the harmful effects of this radiation. Several brands of lip sunscreens (FPL) are available on the market, where consumption is directly influenced by quality and price. Objective: to analyze and compare SPFs available in pharmacies in terms of composition, price and labeling characteristics, according to ANVISA regulations. Methodology: a descriptive study was carried out, which evaluated FPLs, in terms of SPF, indication, chemical constituents, PPD, price and label. Information on the substances present and their functions were obtained from the INCI (European Commission), and the sunscreens were identified from the INN (World Health Organization). The labeling evaluations were based on the Resolutions of the Collegiate Board of Directors of ANVISA No. 30/12, No. 7/15 and No. 69/16. Results: seventeen FPLs were evaluated. Five had SPF 15; three, SPF 20; six, SPF 30; and three, SPF 50. Ten UV filters were identified, with Ethylhexyl Methoxycinnamate present in the highest number of FPLs. Twelve products reported having UV protection. The characteristics of the labels were within the determinations of ANVISA, in the vast majority of cases. There was a high price variation. Conclusion: from this study, it was possible to know more about the composition and characteristics of FPL, mainly about SPF and UV, as well as whether they are in accordance with the standards established by ANVISA, providing a greater knowledge of the products that are being marketed.

Photodynamic Therapy in the Treatment of Herpes Simplex Type 1 Virus Infection / Terapia Fotodinâmica no Tratamento de Infecção pelo Vírus Herpes Simples Tipo 1

Herpes simplex virus type 1 (HSV-1) is primarily responsible for the development of painful mucocutaneous viral lesions in the head and neck region. Antimicrobial photodynamic therapy (aPDT) consists of the use of a photosensitizing chemical substance, which interacts with an appropriate light source under the presence of oxygen, with consequent destruction or microorganisms' inactivation . The aim of this study was to conduct a literature review on the use of aPDT in the treatment of HSV-1, as well as to identify and characterize the main photosensitizing agents used in this technique. This was a narrative literature review, based on the research of scientific articles carried out in the PubMed database, from February to June 2021, using the crossing of the descriptors Decs/Mesh "photodynamic therapy" and "viral infection"; "photodynamic therapy" and "herpes virus". According to the established criteria, a total of 27 articles published in the last 20 years were included. The results demonstrate that despite the scarcity of studies involving aPDT in herpetic lesions, a single application of this therapy and with different protocols improved the clinical appearance and associated symptoms. Thus, antiviral PDT has been shown to be effective in in vitro and in vivo studies, regardless of the dye used. However, more controlled clinical trials need to be carried out in order to establish the real effectiveness of this therapeutic resource in viral infections. (AU)

O vírus herpes simples tipo 1 (HSV-1) é o principal responsável pelo desenvolvimento de lesões virais dolorosas mucocutâneas em região de cabeça e pescoço. A terapia fotodinâmica antimicrobiana (aPDT), por sua vez, consiste no uso de uma substância química fotossensibilizadora, que interage com uma fonte de luz apropriada sob a presença de oxigênio, com consequente destruição ou inativação de microrganismos. O objetivo do presente trabalho foi realizar uma revisão de literatura sobre o uso da aPDT no tratamento de HSV-1, bem como identificar e caracterizar os principais agentes fotossensibilizadores utilizados nessa técnica. Tratou-se de revisão narrativa de literatura, com base na pesquisa de artigos científicos realizada na base de dados PubMed, de fevereiro a junho de 2021, utilizando o cruzamento dos descritores Decs/Mesh "photodinamic therapy" and "viral infection"; "photodynamic therapy" and "herpes virus". De acordo com os critérios estabelecidos, um total de 27 artigos publicados nos últimos 20 anos foram incluídos. Os resultados demonstram que apesar da escassez de estudos que envolvam a aPDT em lesões herpéticas, uma única aplicação desta terapia e com diferentes protocolos promoveu melhora do aspecto clínico e dos sintomas associados. Desta maneira, a PDT antiviral demonstrou ser efetiva em estudos in vitro e in vivo, independente do corante adotado. Entretanto, mais ensaios clínicos controlados precisam ser realizados com o objetivo de se estabelecer a real eficácia deste recurso terapêutico em infecções virais. (AU)

Oral hyperpigmentation as an initial clinical aspect of hand foot syndrome

Abstract Hand-foot syndrome (HFS) is a common adverse effect of anticancer therapy. It is known to cause dermatological symptoms including acral erythema and dysesthesia of the palms and soles of the feet, swelling, pain, itching, and scaling. Some drugs, like capecitabine, are known to trigger this condition. However, pigmentation of the oral mucosa is a rare adverse effect. This study aims to report a case of oral mucosa hyperpigmentation caused by capecitabine therapy before the clinical diagnosis of HFS. A 58-year-old female, diagnosed with invasive breast duct carcinoma, had the central nervous system, liver, skin, and lung metastasis, using capecitabine every day for 14 cycles. Oral examination revealed multifocal black macules on the hard palate, bilateral buccal mucosa, gingival mucosa, and dorsum of the tongue. The clinical hypothesis was oral mucosa hyperpigmentation by capecitabine use and only periodic follow-up was necessary. Hyperpigmentation of oral mucosa by capecitabine is a rare consequence of neoplastic therapy and your association with HFS is unclear, and poorly reported. The report of these events is important to alert oncology health teams about the individual tolerance to capecitabine therapy.

Resumo A síndrome mão-pé (SMP) é um efeito adverso comum da terapia anticâncer. Sabe-se que causa sintomas dermatológicos, incluindo eritema acral e disestesia das palmas das mãos e solas dos pés, inchaço, dor, coceira e descamação. Alguns medicamentos como a capecitabina são conhecidos por desencadear essa condição. No entanto, a pigmentação da mucosa oral é um efeito adverso raro. Este trabalho tem como objetivo relatar um caso de hiperpigmentação da mucosa oral causada pela terapia com capecitabina antes do diagnóstico clínico de SMP. Mulher de 58 anos, com diagnóstico de carcinoma invasivo de ducto mamário, apresentou metástase no sistema nervoso central, fígado, pele e pulmão, em uso de capecitabina todos os dias por 14 ciclos. O exame oral revelou máculas negras multifocais no palato duro, mucosa bucal bilateral, mucosa gengival e dorso de língua. A hipótese clínica foi de hiperpigmentação da mucosa oral pelo uso de capecitabina e apenas o acompanhamento periódico foi necessário. A hiperpigmentação da mucosa oral pela capecitabina é uma consequência rara da terapia neoplásica e sua associação com SMP não é clara e pouco relatada. O relato desses eventos é importante para alertar as equipes de saúde oncológica sobre a tolerância individual à terapia com capecitabina.