Oral pathology and oral medicine in Latin American countries: current stage.

BACKGROUND: Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. MATERIAL AND METHODS: A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. RESULTS: OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). CONCLUSIONS: Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.

Molecular events associated with ciclosporin A-induced gingival overgrowth are attenuated by Smad7 overexpression in fibroblasts.

BACKGROUND AND OBJECTIVE: Ciclosporin A (CsA)-induced gingival overgrowth is attributed to an exaggerated accumulation of extracellular matrix, which is mainly due to an increased expression of transforming growth factor-ß1 (TGF-ß1). Herein, the in vitro investigation of effects of overexpression of Smad7, a TGF-ß1 signaling inhibitor, in the events associated with CsA-induced extracellular matrix accumulation was performed. MATERIAL AND METHODS: The effects of Smad7 were assessed by stable overexpression of Smad7 in fibroblasts from normal gingiva. Smad7-overexpressing cells and control cells were incubated with CsA, and synthesis of type I collagen, production and activity of MMP-2 and cellular proliferation were evaluated by ELISA, zymography, growth curve, bromodeoxyuridine incorporation assay and cell cycle analysis. The effects of CsA on cell viability and apoptosis of fibroblasts from normal gingiva were also evaluated. Western blot and immunofluorescence for phospho-Smad2 were performed to measure the activation of TGF-ß1 signaling. RESULTS: Although the treatment with CsA stimulated TGF-ß1 production in both control and Smad7-overexpressing fibroblasts, its signaling was markedly inhibited in Smad7-overexpressing cells, as revealed by low levels of phospho-Smad2. In Smad7-overexpressing cells, the effects of CsA on proliferation, synthesis of type I collagen and the production and activity of MMP-2 were significantly blocked. Smad7 overexpression blocked CsA-induced fibroblast proliferation via p27 regulation. Neither CsA nor Smad7 overexpression induced cell death. CONCLUSION: The data presented here confirm that TGF-ß1 expression is related to the molecular events associated with CsA-induced gingival overgrowth and suggest that Smad7 overexpression is effective in blocking these events, including proliferation, type I collagen synthesis and MMP-2 activity.

Clinical outcomes and trans-syndesmotic screw frequency after posterior malleolar fracture osteosynthesis.

AIM: This study aimed to evaluate the clinical outcomes and the trans-syndesmotic screw frequency after trimalleolar ankle fractures with a posterior malleolus fracture involving <25% of the articular surface. MATERIAL AND METHODS: Retrospective comparative study. Patients with trimalleolar ankle fracture who underwent surgery between January 2011 and January 2018 were identified within the departments' fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the posterior malleolus fragment treatment: osteosynthesis (group 1) and non-osteosynthesis (group 2). RESULTS: 64 patients, 58.6 ± 17.8 years (range: 23-75), 68.8% female were eligible and follow up time was 43.1 ± 22.2 (range 24-96) months. The mean size of the posterior malleolus fragment was 14.7 ± 5.3% (range: 5-24). Posterior malleolus fragment treatment distribution: osteosynthesis (group 1) 31.2% and non- osteosynthesis (group 2) 68.8%. Group 1 showed significantly better clinical outcomes (p<0.05), AOOS (93.9 ± 5.79 (range: 73-99), AOFAS (91.5 ± 6.22 (range: 72-100) and VAS (0.8 ± 1.22 (range: 0-5) compared to Group 2, AOOS (84.25±8.34 (range: 63-100); AOFAS (84.75±8.05 (range: 58-100) and VAS (1.7 ± 1.38 (range: 0-6). Osteosynthesis of the posterior malleolus fragment significantly reduced the frequency of trans-syndesmotic screw (0%) compared to non-osteosynthesis posterior malleolus fragment (15.9%) (p < 0.05). The EQ-5D score was better in group 1 (1.08±0.27 (range: 1-2.2) compared to group 2 (1.27 ± 0.27 (range: 1-2.4) but with no statistical significance (p> 0.15). CONCLUSION: Posterior malleolus fragments (<25% of the articular surface) have significantly better clinical outcomes and significant decrease in trans-syndesmotic screw need following osteosynthesis.

Age and Environment Influences on Mouse Prion Disease Progression: Behavioral Changes and Morphometry and Stereology of Hippocampal Astrocytes.

Because enriched environment (EE) and exercise increase and aging decreases immune response, we hypothesized that environmental enrichment and aging will, respectively, delay and increase prion disease progression. Mice dorsal striatum received bilateral stereotaxic intracerebral injections of normal or ME7 prion infected mouse brain homogenates. After behavior analysis, animals were euthanized and their brains processed for astrocyte GFAP immunolabeling. Our analysis related to the environmental influence are limited to young adult mice, whereas age influence refers to aged mice raised on standard cages. Burrowing activity began to reduce in ME7-SE two weeks before ME7-EE, while no changes were apparent in ME7 aged mice (ME7-A). Object placement recognition was impaired in ME7-SE, NBH-A, and ME7-A but normal in all other groups. Object identity recognition was impaired in ME7-A. Cluster analysis revealed two morphological families of astrocytes in NBH-SE animals, three in NBH-A and ME7-A, and four in NBH-EE, ME7-SE, and ME7-EE. As compared with control groups, astrocytes from DG and CA3 prion-diseased animals show significant numerical and morphological differences and environmental enrichment did not reverse these changes but induced different morphological changes in GFAP+ hippocampal astroglia. We suggest that environmental enrichment and aging delayed hippocampal-dependent behavioral and neuropathological signs of disease progression.

Bioremediation of a weathered and a recently oil-contaminated soils from Brazil: a comparison study.

The facility with which hydrocarbons can be removed from soils varies inversely with aging of soil samples as a result of weathering. Weathering refers to the result of biological, chemical and physical processes that can affect the type of hydrocarbons that remain in a soil. These processes enhance the sorption of hydrophobic organic contaminants (HOCs) to the soil matrix, decreasing the rate and extent of biodegradation. Additionally, pollutant compounds in high concentrations can more easily affect the microbial population of a recently contaminated soil than in a weathered one, leading to inhibition of the biodegradation process. The present work aimed at comparing the biodegradation efficiencies obtained in a recently oil-contaminated soil (spiked one) from Brazil and an weathered one, contaminated for four years, after the application of bioaugmentation and biostimulation techniques. Both soils were contaminated with 5.4% of total petroleum hydrocarbons (TPHs) and the highest biodegradation efficiency (7.4%) was reached for the weathered contaminated soil. It could be concluded that the low biodegradation efficiencies reached for all conditions tested reflect the treatment difficulty of a weathered soil contaminated with a high crude oil concentration. Moreover, both soils (weathered and recently contaminated) submitted to bioaugmentation and biostimulation techniques presented biodegradation efficiencies approximately twice as higher as the ones without the aforementioned treatment (natural attenuation).

Multidrug-resistant Iberian epidemic clone of methicillin-resistant Staphylococcus aureus endemic in a hospital in northern Portugal.

Forty-two methicillin-resistant Staphylococcus aureus (MRSA) isolates collected during 1992-1995 at a hospital in the north of Portugal were characterized by a variety of genomic fingerprints. Hybridization of ClaI and SmaI restriction digests with the mecA- and Tn554-specific DNA probes was used to identify polymorphs and determine their localization in chromosomal DNA preparations, and pulsed-field gel electrophoretic analysis of SmaI digests was used to determine chromosomal backgrounds. A major clone (and its variants) carrying the mecA polymorph I, Tn554 type E in the PFGE background of pattern A, accounted for 85% of all MRSA tested in 1992-1993 and 66% in 1994-1995. This clone is closely related to the epidemic Iberian clone that was associated with outbreaks in Spain during 1989-1993 and was endemic in 1992-1993 in two hospitals in Lisbon (Portugal).

Itraconazole versus placebo in the management of vaginal candidiasis.

A randomized double-blind trial was carried out with itraconazole versus placebo in the treatment of vaginal candidiasis, confirmed by clinical evaluation, direct microscopic examination and Sabouraud culture. Fifty patients were studied, 25 in the itraconazole group and 25 in the placebo group. Both groups received two capsules once daily (100 mg itraconazole/cap) for 3 days. One week after treatment patients were re-evaluated according to the same parameters as in selection. The scores for clinical symptoms, leukorrhea, vulvar pruritus, vaginitis and vulvitis, were compared in both groups before and after treatment. Statistically significant differences were found for the itraconazole group in pruritus and vaginitis (P less than 0.05) and vulvitis (P less than 0.001), with no significant difference for leukorrhea. As to the mycological evaluation, 7 days after treatment there were negative results for the itraconazole group in 92% of the patients in comparison to 52% in the placebo group (chi-square, P = 0.005).

[Electrical stimulation and swimming in the acute phase of axonotmesis: their influence on nerve regeneration and functional recovery]. / Estimulación eléctrica y natación en la fase aguda de la axonotmesis: influencia sobre la regeneración nerviosa y la recuperación funcional.

INTRODUCTION: Little attention has been given to the influence of low-frequency phasic electrical stimulation (LFPES) and physical exercise on the quality of peripheral nerve regeneration and functional recovery. AIM. To evaluate the influence of LFPES, swimming and the association between the two in terms of the morphology of the regenerated sciatic nerve following axonotmesis. MATERIALS AND METHODS: Thirty Wistar mice (222.05 +/- 42.2 g) were distributed into groups: control (C), denervated (D), denervated + swimming (DS), denervated + electrostimulation (DE) and denervated + swimming + electrostimulation (DSE). After 24 hours of axonotmesis, the soleus muscle of the DE and DSE groups was stimulated electrically. The DS and DSE groups swam over a period of 22 days. The number of axons, morphometric data on the nerve and the functional index of the sciatic nerve (FIS) were evaluated. RESULTS: The number of axons in the denervated groups was higher than in the control group, and in the DE group the figure was higher than in the D group. The axonal diameter was smaller in the denervated groups, yet in the DS group it was higher than in the D group. The other morphometric parameters were quite similar to those of the C group. The FIS between days 7 and 14 of the post-operative period was different to the pre-operative index and that measured on day 21 of the post-operative period; the DSE group, however, differed from the pre-operative values. CONCLUSIONS: Swimming and LFPES, applied on an individual basis, do not affect the maturation of the regenerated fibres or functional recovery. LFPES favoured axonal regeneration and combining the treatments delayed functional recovery without having any influence on nerve regeneration.

[Peripheral nerve regeneration in mice exposed to an enriched environment]. / Regeneración nerviosa periférica en ratones expuestos a un ambiente enriquecido.

INTRODUCTION: Taking into account the fact that the literature contains no studies on how an enriched environment influences peripheral nerve lesions, in this study we analysed the characteristics of the sciatic nerve in mice submitted to axonotmesis and subsequent exposure to an enriched environment. MATERIALS AND METHODS: Twenty-four male Wistar mice (198.66 +/- 11.61 g) were distributed into the following groups: control, lesion, enriched environment grouping (EEG) and simple environment grouping (SEG). Following lesion to the nerve, the animals were placed in different cages according to the groups they had been allocated to. The enriched cage had an exercise wheel, a ladder, a ramp, and mobile food and water compartments, which were randomly changed every day. After 24 days, the sciatic nerve was analysed quantitatively, morphometrically and functionally. RESULTS: The number of axons in the EEG and SEG groups was higher than that of the control group (p < 0.05). The SEG group had a higher number of axons than the lesion and EEG groups. The diameter of the axons in the experimental groups was smaller than that of the control group. The same occurred with the diameter of the nerve fibre. The thickness of the myelin sheath was inferior in the experimental groups compared to the control, and the value for the SEG group was lower than for the lesion group. The G ratio did not differ among groups. There were no differences in the values of the sciatic function index among the groups, while in the intragroup comparison there was a difference between postoperative days 7 and 14 and the preoperative values. Functioning was restored at postoperative day 21. CONCLUSIONS: The enriched environment did not have a negative effect on axonal regeneration and maturation, but neither did it favour the process. Functional recovery was not influenced by this form of intervention.

Exercício imediato versus tardio na regeneração do nervo isquiático de ratos após axoniotmese: análise histomorfométrica e funcional / Immediate versus later exercises for rat sciatic nerve regeneration after axonotmesis: histomorphometric and functional analyses

OBJETIVO: Devido à controvérsia sobre o melhor momento para iniciar o exercício físico, bem como sua influência sobre a regeneração nervosa periférica, este estudo realizou uma análise histomorfométrica e funcional para avaliar a influência do exercício físico em esteira, aplicado nas fases imediata e tardia da regeneração do nervo isquiático de ratos, após axoniotmese. MÉTODOS: Vinte ratos Wistar machos (229,05±18,02g) foram divididos nos grupos: controle (CON); desnervado (D); desnervado+exercício+gaiola (DEG) e desnervado+ gaiola+exercício (DGE). Após 24 horas da axoniotmese, o grupo DEG iniciou o exercício, enquanto o grupo DGE iniciou no 14º dia, com o seguinte protocolo: velocidade=8m/min, inclinação=0 por cento, 30min/dia, durante 14 dias. Em seguida, a porção distal do nervo isquiático foi retirada para análise histomorfométrica. Realizou-se o registro da marcha (pré-operatório e 7º, 14º, 21º, 28º dias pós-operatório (PO)), através do índice funcional do ciático (IFC). RESULTADOS: O número de axônios regenerados nos grupos D foi maior que no CON (p<0,05), não havendo diferença intergrupos D. O diâmetro do axônio do grupo DGE foi maior que do grupo D, enquanto os demais parâmetros morfométricos apenas apresentaram diferença significativa com o grupo CON. Não houve diferença nos valores de IFC intergrupos, enquanto na comparação intragrupos, o 7º e o 14º dias diferem do pré-operatório, 21º e o 28º dias PO. CONCLUSÕES: O protocolo de exercício em esteira aplicado nas fases imediata e tardia, não influenciou o brotamento axonal, o grau de maturação das fibras regeneradas e nem a funcionalidade dos músculos reinervados.

OBJECTIVE: Considering the controversies regarding the best period to begin physical exercise in relation to peripheral nerve regeneration, along with its influence on regeneration, this study accomplished a histomorphometric and functional analysis to evaluate the influence of physical exercise on a treadmill, applied to the immediate and late stages of sciatic nerve regeneration in rats following crushing injury. METHODS: Twenty male Wistar rats (229.05±18.02g) were divided into the following groups: control (CON); denervated (D); denervated+exercise+cage (DEC) and denervated+cage+exercise (DCE). The DEC group started the exercise 24 hours after the nerve injury, while the DCE group started on the 14th day after the injury, with the following protocol: speed=8m/min, inclination=0 percent, 30min/day, for 14 days. The distal segment of the sciatic nerve was then removed for histomorphometric analysis. The gait was recorded before the operation and on the 7th, 14th, 21st and 28th days after the operation, using the sciatic functional index (SFI). RESULTS: The number of regenerated axons in the D groups was greater than in the CON group (p<0.05), without differences between the D groups. The axon diameter in the DCE group was greater than the diameter in the D group, whereas the other morphometric parameters only showed significant differences with the CON group. There was no difference in SFI values between the groups, whereas within the groups, the 7th and 14th days differed from the values before the operation and on the 21st and 28th days after the operation. CONCLUSIONS: The treadmill exercise protocol that was applied to the immediate and late stages of nerve regeneration did not influence the axonal budding, the degree of maturation of the regenerated nerve fibers or the functional performance of the reinnervated muscles.