Mandibular fracture in medication-associated osteonecrosis following infliximab therapy: A case report.

INTRODUCTION: Medication-associated osteonecrosis of the jaws (MRONJ) is characterized by the presence of exposed bone or an intraoral or extraoral fistula in the maxillofacial region in patients with a history of treatment with anti-resorptive and anti-angiogenic drugs, such as monoclonal antibodies, and without a history of radiotherapy or metastatic diseases in the area. OBJECTIVE: The aim of this study is to report a case of a pathological mandibular fracture in an area of MRONJ in a patient diagnosed with Crohn's disease treated with infliximab. CASE REPORT: A 53-year-old male patient, an active smoker for 35 years, diagnosed with Crohn's disease, undergoing intravenous administration of infliximab 300 mg for 1 year and 3 months, with no previous history of anti-angiogenic or anti-resorptive medication, presenting with an extraoral fistula in the submandibular region for 4 months, with painful symptoms, diagnosed as MRONJ. He was initially treated conservatively, using antimicrobial photodynamic therapy (aPDT), antibiotic therapy, and the PENTO protocol. However, the patient evolved with a pathological fracture in the mandibular parasymphysis, requiring surgical reconstruction. FINAL CONSIDERATIONS: Pathological fracture of the mandible is a complication of MRONJ that compromises the patient's quality of life. The management of patients with MRONJ is complex and challenging.

CD1a and factor XIIIa immunohistochemistry in leprosy: a possible role of dendritic cells in the pathogenesis of Mycobacterium leprae infection.

Leprosy is a curable chronic granulomatous infectious disease caused by the bacillus Mycobacterium leprae. This organism has a high affinity for skin and peripheral nerve cells. In the evolution of infections, the immune status of patients determines the disease expression. Dendritic cells are antigen-presenting cells that phagocytose particles and microorganisms. In skin, dendritic cells are represented by epidermal Langerhans cells and dermal dendrocytes, which can be identified by expression of CD1a and factor XIIIa (FXIIIa). In the present study, 29 skin samples from patients with tuberculoid (13 biopsies) and lepromatous (16 biopsies) leprosy were analyzed by immunohistochemistry using antibodies to CD1a and FXIIIa. Quantitative analysis of labeling pattern showed a clear predominance of dendritic cells in tuberculoid leprosy. Difference between the number of positive cells of immunohistochemistry for the CD1a and FXIIIa staining observed in this study indicates a role for dendritic cells in the cutaneous response to leprosy. Dendritic cells may be a determinant of the course and clinical expression of the disease.

Disruption of hippocampal connectivity in children and adolescents with schizophrenia--a voxel-based diffusion tensor imaging study.

INTRODUCTION: One hypothesis that unifies the diversity of symptoms associated with schizophrenia involves the disruption of connectivity between brain regions. As white matter provides rapid and efficient communication between brain regions, this study was initiated to assess the early disruption of white matter pathways in children and adolescent with schizophrenia. MATERIALS AND METHODS: Diffusion tensor images were acquired on 14 children and adolescents with schizophrenia, one subject with schizoaffective disorder, and 15 age and gender matched controls. The DTI images were acquired in twelve directions on a 3 T Siemens Trio scanner. The images were transformed into fractional anisotropy and mean diffusivity maps and a group analysis was performed using SPM2. RESULTS: Children and adolescent patients with schizophrenia demonstrated a significant decrease in FA and associated increase in AD in the left posterior hippocampus (p<0.001, Bonferroni corrected on the cluster-level). These diffusion differences were not statistically significant when IQ was used as a covariate in the analysis. DISCUSSION: These findings suggest hippocampal white matter abnormalities that present early in the development of schizophrenia. The lack of significant differences when IQ is used as a covariate suggests that this hippocampal region is associated with cognitive changes associated with schizophrenia.

Trajectories of social withdrawal and cognitive decline in the schizophrenia prodrome.

OBJECTIVE: Schizophrenia is a heterogeneous neurodevelopmental disorder. Patients with high levels of negative symptoms have been identified as a specific subtype, but little is known about how the neurodevelopmental course may differ in this group. This study aimed to characterize developmental trajectories of premorbid social withdrawal and cognitive decline between patients with high versus low levels of negative symptoms in youth with schizophrenia-spectrum disorders. METHOD: A standardized timeline was used to delineate the emergence of psychosis, social withdrawal, and cognitive decline in 52 subjects aged 8 to 19 with schizophrenia (n=36), schizophreniform (n=6), or schizoaffective disorder (n=10). The sample was divided into subgroups of high- (n=26) versus low- (n=26) negative symptoms, and developmental trajectories of premorbid symptoms were compared between groups. RESULTS: Mean ages for emergence of social withdrawal, cognitive decline, and psychosis were 11.1 years (SD=2.5), 11.9 (SD=4.4) and 13.2 years (SD=1.2), respectively. In the high-negative symptom group, the premorbid developmental trajectory for social withdrawal was more protracted. This group also had more severe cognitive decline at the onset of psychosis, but the premorbid trajectories for cognitive decline did not differ significantly between groups. CONCLUSIONS: This work documents a more severe and protracted trajectory of premorbid social withdrawal in patients with high levels of negative symptoms in comparison to those with low-negative symptoms. The findings reported here are supportive of the hypothesis that patients with illness characterized by high levels of negative symptoms may represent a subgroup with distinct neurodevelopmental abnormalities.

Conhecimentos e hábitos da fotoproteção infantil / Profile and evaluation of knowledge and photoprotection child habits

Objetivo: descrever o perfil socioeconômico e avaliar a prática da fotoproteção em crianças, a partir dos conhecimentos de seus responsáveis, comparando dois centros de atendimento pediátrico de Belém-PA, um público e outro particular. Método: estudo transversal com responsáveis de crianças de seis meses a doze anos de idade, no qual foram aplicados questionários com perguntas sobre dados socioeconômicos, conhecimentos sobre fotoproteção e hábitos de fotopro-teção da criança. Foram utilizados os testes qui-quadrado e G com correção de Williams, sendo significante p<0,05. Resultados: das 191 crianças pesquisadas, foram 58,1% da instituição pública, onde prevaleceram, além das crianças faiodermas (40,3%), os responsáveis com escolaridade média (33,5%) e renda de 1 a 3 salários mínimos mensais (44,5%). Pais e/ou responsáveis que consideraram ser menos necessário o uso do protetor solar também prevaleceram no centro público (42,4%), bem como aqueles que foram informados pela primeira vez sobre o assunto por veículos de comunicação (22,5%). Ainda, foi observada maior frequência do uso do filtro solar no centro particular (19,9%), acrescida pela maior negligência de seu uso (34%) e aplicação de fator de proteção solar minimamente eficaz (21,5%) na instituição pública. Conclusão: não houve diferença estatística significativa entre os centros em conhecimentos so-bre fotoproteção, entretanto, observou-se desigualdade na aplicação desses conceitos, possivelmente influenciada pela menor escolaridade e renda dos pais da instituição pública.

Objective: to describe the socioeconomic profile and evaluate the photoprotection practice in children, based on the knowledge of their parents, comparing two pediatric care centers from Belem-PA, one public and other private. Method: cross-sectional study with guardians of children of six months to twelve years old, in which questionnaires were ap-plied with questions about socioeconomic data, knowledge about sunscreen and photoprotection habits of the child. It were used the chi-square and G with Williams' correction tests, being significant p<0.05. Results: of the 191 children surveyed, 58.1% were of the public institution, where prevailed, besides brown-skin children (40.3%), the parents in mean educational level and income 1-3 minimum wages (44.5%). Parents and/or guardians who considered it be less necessary to use sunscreen also prevailed at the public center (42.4%), as well as those who were informed of the subject for the first time by communication vehicles (22.5%). Still, it was observed higher frequency the use of sunscreen inparticular center (19.9%), increased by greatest neglect of its use (34%) and application sun protection factor minimally effective (21.5%) in the public institution. Conclusion: there was no significant statistical difference between the centers in knowledge of photoprotection, however, there was inequality in the application of these concepts, possibly influenced by lower educational and income of parents of public institution.