Epidemiological characteristics and HIV-related oral lesions observed in patients from a Southern Brazilian city / Características epidemiológicas e das lesões bucais associadas ao HIV observadas em pacientes de uma cidade sul-brasileira

PURPOSE: To assess the epidemiological characteristics and associated oral lesions of HIV adult carriers in a southern Brazilian city. METHODS: A retrospective survey was conducted to review the medical records of 534 patients treated at 5 referral health centers. RESULTS: Nearly 52% of the patient sample was male, 88.2% were older than 30 years of age, 58% had been diagnosed with an advanced stage of HIV disease and 78.1% presented rapid rates of HIV progression to AIDS. Harmful habits were common (31.9%), and 35% of the patients were unemployed. Approximately 60% of the subjects used highly active antiretroviral therapy. Tuberculosis was the most commonly observed systemic illness (18.5%), and oral candidiasis was the most prevalent lesion in the oral cavity (50%). A higher risk for tuberculosis onset was associated to illicit drugs use and oral candidiasis and hairy leukoplakia. CONCLUSION: The high prevalence of concurrent diseases and the rapid progression to AIDS highlight the need for early diagnosis and access to treatment. Professionals must be made aware about the onset of HIV-related oral lesions that would be helpful to diagnose HIV or serve as indicators of a worsening condition.

OBJETIVO: Avaliar o perfil epidemiológico de portadores do HIV com manifestações estomatológicas em uma cidade sul brasileira. METODOLOGIA: Conduziu-se um estudo transversal, retrospectivo em 534 prontuários médicos de pacientes atendidos em 5 centros de referência. RESULTADOS: Cerca de 52% dos pacientes eram do gênero masculino; 88,2% eram maiores de 30 anos, 58% foram diagnosticados no estágio avançado da doença e 78,1% apresentaram rápida progressão para AIDS. A prática de hábitos nocivos foi comum (39,1%) e 35% estavam desempregados. Aproximadamente 60% dos sujeitos usavam terapia antirretroviral composta. A tuberculose foi a doença sistêmica mais comumente observada (18,5%) e a candidíase bucal a manifestação estomatológica mais prevalente (50%). Um maior risco para a ocorrência de tuberculose foi observado nos portadores de candidíase bucal e leucoplasia pilosa que faziam uso de drogas ilícitas. CONCLUSÃO: A elevada prevalência de doenças oportunistas e a rápida progressão para AIDS suscitam maior atenção para o diagnóstico precoce e acesso ao tratamento. Os profissionais devem ser alertados sobre a ocorrência de lesões bucais associadas ao HIV, pois podem sugerir a presença de infecção pelo vírus ou indicar uma pior condição de saúde do paciente.

Status of the p53, p16, RB1, and HER-2 genes and chromosomes 3, 7, 9, and 17 in advanced bladder cancer: correlation with adjacent mucosa and pathological parameters.

AIMS: To evaluate a panel of well known genetic alterations for frequency of changes in bladder cancer that could be considered genomic instability determinants or adjunctive prognostic predictors. METHODS: Fluorescence in situ hybridisation analysis was performed to evaluate chromosomes 3, 7, 9, and 17 and the 9p21 (p16), 17p13.1 (p53), 13q14 (RB1), and 17q11.2 (HER-2) chromosomal loci in 48 muscle invasive bladder cancer specimens and the adjacent normal mucosa. RESULTS: There were significant differences between the frequency of chromosome 7 monosomy/polysomy and 17 monosomy in the two groups (tumours and adjacent mucosa) (p = 0.004, p = 0.037, and p = 0.015, respectively). There were no differences in the frequency of gene deletions between tumours and the adjacent mucosa. 17q11.2 amplification was found in 14.5% of tumours examined, but not in the non-malignant epithelium. Chromosome 3, 7, and 17 monosomy and the RB1 heterozygous deletion were significantly associated with stage T3-4 (p = 0.03, p = 0.04, p = 0.04, and p = 0.03, respectively). CONCLUSIONS: These results demonstrate the importance of chromosomes 3, 7, and 17 and gene alterations in bladder cancer progression, highlighting their usefulness as prognostic markers. Larger studies with longterm follow up of these patients are needed to determine the validity and clinical relevance of these genetic findings, and molecular prognostic markers should be incorporated into phase II and III trials to define their roles in predicting clinical outcome.

Analysis of chromosomes 3, 7, X and the EGFR gene in uterine cervical cancer progression.

The aim of this study was to investigate the possible role of genetic alterations in the genesis and progression of cervical carcinomas. We analysed the 3, 7, X aneusomy of chromosomes and the status of the epidermal growth factor receptor (EGFR) gene by fluorescence in situ hybridisation (FISH) analysis. Polysomy of chromosomes 3 and X defined the transition from high-grade squamous intraepithelium lesions (HSIL) to cervical carcinoma. Chromosome 7 monosomy and polysomy did not show any statistical significant differences between the groups examined. When we compared the chromosomal aneusomies in all of the specimens using the Kruskal-Wallis test, significant differences (P = 0.0001, P = 0.0001 for chromosomes 3 and X, respectively) were observed. Using a ratio of the EGFR gene signals and chromosome 7 centromeric signals, no samples showed gene amplification. Our results demonstrate the importance of chromosomal 3 and X aneusomies in the development and progression from HSIL to cervical carcinoma, highlighting their usefulness as genetic markers for identifying SILs at high-risk of progression.

Genetic and pathologic significance of 1p, 17p, and 18q aneusomy and the ERBB2 gene in colorectal cancer and related normal colonic mucosa.

Among chromosome defects in colon cancer, deletions in 1p, 17p, and 18q have been reported as frequent events. To verify this, we investigated 1p, 17p, and 18q aneusomy in 60 colorectal cancers and their surrounding mucosa by means of fluorescence in situ hybridization (FISH). We also evaluated ERBB2 gene (alias HER-2/neu) amplification in a subset of tumors. The genetic picture in tumors was correlated with chromosomal alterations in normal colonic mucosae, as well with clinicopathologic variables. A population of cells in morphologically normal epithelium possesses genetic aberrations common to those in colon cancer, although in different percentages. No significant difference emerged in terms of fraction of nuclei with 17p monosomy between primary tumors and distal mucosal samples. Of tumor samples aneusomic for the three chromosomes, 58.3% also showed aneusomy in related normal colonic mucosa. In neoplastic samples, significant correlation existed between 1p aneusomy and mucosal component (P<0.007), between 17p aneusomy and increased depth of invasion (T3-T4) (P<0.05), and between 18q aneusomy and tumor site (P<0.03). None of the evaluated samples, neoplastic or normal, showed ERBB2 gene amplification.

HER-2/neu oncogene amplification and chromosome 17 aneusomy in endometrial carcinoma: correlation with oncoprotein expression and conventional pathological parameters.

The objective of the present study was to evaluate the correlation between HER-2 gene amplification and HER-2 protein overexpression in endometrial carcinoma using fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). We also analyzed chromosome 17 aneusomy and the association between these biological parameters and conventional clinicopathological variables. FISH analysis was performed on 73 selected paraffin-embedded sections from endometrial carcinomas which previously had HER-2 status determined immunohistochemically using monoclonal antibodies (MoAb) 300G9 and CB11. Using a ratio of more than two oncogene signals/centromere to indicate amplification, a total of 42 out of the 73 endometrial tumors included in this study resulted positive by FISH where as protein overexpression was identified in 29 out of 73 with a concordance rate of 74.3%. However, when the mean signals/centromere per nucleus increased (ratio > 4 < or = 5) a higher concordance between the two assays was seen (p = 0.007). In addition, HER-2 amplification was significantly correlated with tumor stage (p = 0.021) and myometrial invasion (p = 0.010), whereas chromosome 17 polisomy showed a positive correlation only with myometrial invasion (p = 0.004) No significant correlation was found between HER-2 gene amplification, chromosome 17 aneusomy and patient outcome. Nevertheless, the probability of a 5 year overall survival decreased from 70% to 43%, respectively, for ratio > 2 < or = 4 and ratio > 4 < or = 5 when we grouped the amplified cases on the basis of HER-2:CEP17 ratio. In conclusion, molecular characteristics provide objective data that may be useful in predicting prognosis in patients with endometrial cancer.

DNA aberrations in urinary bladder cancer detected by flow cytometry and FISH: prognostic implications.

We evaluated the genetic changes in bladder cancer biopsy by fluorescence in situ hybridization (FISH) and related them to stage and grade of the tumor, ploidy (FCM) and clinical outcome, to determine a simple method to identify tumors with a poorer prognosis. Using FISH the numerical aberrations of chromosomes 1, 7, 9, 17 in tumor's imprints of 70 patients with transitional cell cancer (TCC) were determined. First of all, the data demonstrated that the sensitivity of FISH in detecting quantitative DNA aberrations exceeds FCM's sensitivity. The frequency of chromosome 1 and 9 aberrations did not show significant differences in diploid and aneuploid tumors in different stage and grade. On the contrary, the chromosome 7 and 17 aneusomy showed greater differences between pT1 and pT2-3 tumors (p<0.032 and p<0.0006, respectively) than between stage pTa and pT1. In our investigation, an increasing number of aberrations was observed in all chromosomes examined in tumors of patients who afterwards underwent cystectomy and/or had recurrent tumors. These results suggest that chromosome 7 and 17 aneusomy could be predictive of adverse outcome in a subgroup of patients with superficial tumors at presentation.

Conservative management of posterior tibial tendon dysfunction, subtalar joint complex, and pes planus deformity.

Conservative management of PTTD can present from fairly simple to quite complex based on the wide range of clinical presentation that is inherent to this pathology. Treatment for PTTD ranges from the use of orthopedic footwear to the use of PTB AFOs, which certainly substantiates the prevalence of this disorder and the high rate of conservative management. With the increase in the population number and the fitness and health awareness that pervades our society, PTTD will more than likely continue to be a large part of the conservative footcare practitioner's practice in the future. The footcare team should include the pedorthist and orthotist to care for all the stages of PTTD. Perhaps with the increase in popularity of comfort footwear and increased use of orthoses (over the counter and custom-made), physicians can deter and alter the established pathway of the progression of this disorder. Preventive measures may, in some way, affect the foot health of the aging population. Conservative management of PTTD certainly has a place in today's healthcare climate.

Sex and race differences in the identification of communicative disorders in preschool children as measured by the Miller Assessment for Preschoolers.

Twelve hundred four preschool children were administered the Miller Assessment for Preschoolers (MAP), a screening test for children aged 2.5 to 5.5 years designed to identify children at risk for learning problems. Scores on the Verbal Index of the MAP were analyzed for each of six age groups by sex and race, using six 2-way ANOVA's. Results indicated that boys and girls in all six age groups were equally identified as being at risk for communication disorders. In three of six age groups, black children had a greater likelihood of being identified at risk than white children. Results are discussed in terms of cultural and gender bias and compared with other language screening tests.