Intratarsal Keratinous Cyst Clinically Misdiagnosed as a Chalazion.

The intratarsal keratinous cyst (IKC) is a recently described entity, often clinically misdiagnosed as a chalazion. We report a case of a 61-year-old male patient with a chief complaint of a small lesion on the upper eyelid that evolved over six months. On physical examination, an asymptomatic, firm nodule was identified on the left upper eyelid. The patient reported no history of trauma. A provisional diagnosis of chalazion was established, and an excisional biopsy was performed. Histopathologically, the lesion was lined with a stratified squamous epithelium, with a corrugated epithelial surface showing abrupt keratinization without keratohyalin granules, and compact keratinous-appearing material in the cystic lumen. The diagnosis was IKC. No signs of recurrence were observed after one year of follow-up. It is essential to accurately diagnose IKC and distinguish it from chalazion and epidermal inclusion cysts, because IKC requires complete surgical excision and can exhibit multiple recurrences if not properly removed.

A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Maxillary Surgical Ciliated Cyst After Orthognathic Surgery.

Surgical ciliated cysts, also known as implantation cysts or postoperative maxillary cysts, are uncommon cystic formations predominantly arising in the posterior maxillary region after radical maxillary sinus surgery. Herein, we present the case of a 28-year-old male patient who had previously undergone orthognathic surgery and later experienced a minor car accident without major consequences. Approximately four years after surgery, the patient sought dental care due to the presence of a painless swelling in the maxillary region. Upon intraoral examination, the swelling extended from the area around the right canine to the upper left molar, covered by red mucosa. Image studies revealed an extensive well-defined osteolytic lesion causing thinning, erosion, buccal cortical plate perforation, and root resorption. An incisional biopsy was performed, and microscopic examination revealed a cystic lesion lined by ciliated respiratory-type epithelium and capsule variably fibrotic with sparse chronic inflammation. The final diagnosis was surgical ciliated cysts. The treatment approach involved decompression followed by enucleation and curettage, with the addition of bone grafting and the application of Leukocyte-Platelet Rich Fibrin (L-PRF). The patient has been under clinical follow-up for approximately 17 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach. In conclusion, this case highlights the importance of accurate diagnosis and appropriate treatment approaches for surgical ciliated cysts to ensure favorable patient outcomes.

Basal cell adenocarcinoma of the soft palate: A closer look for an exceedingly rare salivary gland tumor.

Basal cell adenocarcinoma (BCAd) is an extremely rare primary biphasic carcinoma of the salivary glands with few well-documented cases reported in the literature. Herein, we report a rare case of a 44-year-old male patient who presented an oral medicine service with an erythematous nodular lesion on the soft palate, measuring 1.5 cm in its largest diameter, with a 5-year duration. The clinical diagnosis was pleomorphic adenoma, and an excisional biopsy was performed. Histopathological analysis revealed a biphasic infiltrative tumor composed of a mixture of central ductal cells and abluminal basal cells with slight atypia arranged in solid, trabecular, tubular and cribriform growth patterns in a loose stroma. The peripheral cells show a palisading arrangement with round hyperchromatic nuclei and scanty cytoplasm. Occasional mitotic figures were seen. Few spindle-shaped cells suggestive of myoepithelial cells were present in the stroma surrounding the basaloid tumor nests. The diagnosis was BCAd. The patient was referred to a head and neck service and has been followed up for 8 months with no signs of recurrence. In conclusion, although the diagnosis of BCAd can be challenging due to its rarity and morphological overlap with other salivary gland lesions, a meticulous morphological assessment is key for accurate diagnosis, especially in cases originating from minor salivary glands. Surgical excision with a wide safety margin is the treatment of choice and long-term follow-up is recommended to monitor possible recurrences.

Relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú

Objetivo : Determinar la relación entre sobrecompromiso y síntomas somáticos en enfermeras de un hospital de II nivel en Perú. Material y métodos : Investigación observacional, transversal y correlacional, con una muestra probabilística de 106 enfermeras. Se aplicó el Cuestionario de Siegrist y Meter para medir sobrecompromiso y desequilibrio esfuerzo recompensa, y el Cuestionario de Salud (PHQ15) para síntomas somáticos. Se construyó un modelo de regresión logística, considerando variables sociodemográficas y laborales. Resultados : En las enfermeras que presentaron síntomas somáticos moderados-graves, el 68,3% tuvo un nivel de sobrecompromiso alto. El modelo de regresión mostró que sobrecompromiso (OR = 6,25, p < 0,01), tiempo laboral (OR = 0,74, p < 0,01) y la condición de personal (nombrado o contratado, OR = 49,20, p < 0,01) influyeron en el nivel de síntomas somáticos. El modelo discriminó correctamente el 79% (IC 95%: 0,70 - 0,88) de los casos con síntomas somáticos, siendo el valor 0,43, el que se usò para la clasificaciòn en leve-mìnimo y moderado-grave con una sensibilidad de 73% y especificidad del 74%. Conclusión : Se corroboró una relación significativa entre sobrecompromiso y síntomas somáticos, con un modelo predictivo que logró un nivel elevado de discriminación para identificar personal de enfermería en riesgo.

SUMMARY Objective : To determine the relationship between over commitment and somatic symptoms among nurses in a type II hospital in Peru. Methods : A cross-sectional study with a probabilistic sample of 106 participants was carried-out. The Siegrist and Meter questionnaire was applied to measure over commitment and imbalance effort-recompense and the Health Questionnaire (PHQ15) was applied to evaluate somatic symptoms. A logistic regression model was built considering sociodemographic and labor variables. Results : The 68.3% of nurses that presented with moderate to severe somatic symptoms had a high level of over commitment. The regression model showed that over commitment (OR = 6.25, p < 0.01), time in the working place (OR = 0.74, p < 0.01) and labor status (staff or hired temporarily OR = 49.20, p < 0.01) influenced the level of somatic symptoms. The model discriminated well the 79% (95% CI: 95%: 0.70 - 0.88) of somatic cases. A value of 0.43 was selected to discriminate between mild to moderate-severe with a sensitivity of 73% and 74% specificity. Conclusions : A signifcant correlation between over commitment and somatic symptoms ws found. The regression model attained a high discriminative level to identify nurses at risk.

Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study.

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.

Salivary gland tumors: A 13-year clinicopathologic retrospective study in a Brazilian northeast population.

Background: The present study aimed to evaluate the clinicopathologic features of salivary gland tumors (SGTs) in a Brazillian northeast population. Material and Methods: A retrospective descriptive cross-sectional study was performed (1995-2009). All cases of SGTs diagnosed in a private surgical pathology service in Brazil were reviewed, and clinicopathological data were collected. Results: A total of 23.258 histopathological records of biopsies were analyzed, and 174 cases were diagnosed as SGTs (0.7%). Of these, 117 (67.2%) were classified as benign, and 57 (32.8%) were malignant. The series comprised 89 females (51.1%) and 85 males (48.9%), with a mean age of 50.2 years (range: 3-96 years) and a roughly equal female-to-male ratio (1:1). Most tumors occurred in the parotid gland (n = 82, 47.1%), followed by the palate (n = 45, 25.9%), submandibular gland (n = 15, 8.6%). Pleomorphic adenoma (n = 83; 70.9%) and mucoepidermoid carcinoma (n = 19, 33.3%) were the most frequent benign and malignant tumors, respectively. After reevaluation of morphology and immunohistochemical analysis, seven tumors (4.0%) were reclassified following the current WHO Classification of the Head and Neck Tumors. Conclusions: The general features of SGT from the studied Brazilian population were similar to previously published reports in other countries. However, SGTs do not show any sex predilection. Although careful morphological analysis is the key to the correct diagnosis of these tumors, immunohistochemical analysis is essential to establish an accurate diagnosis in the face of challenging cases. Key words:Salivary gland tumors, epidemiology, head and neck pathology.

Immunoexpression of CXCL12 and CXCR4 in Radicular Cysts, Dentigerous Cysts, and Odontogenic Keratocysts.

The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs ( P <0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs ( P <0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs ( P <0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs ( P <0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs ( P >0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups ( P <0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.

A retrospective multicenter study of oral and maxillofacial lesions in older people

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population.

BACKGROUND: The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients. METHODS: A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers. RESULTS: CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80. CONCLUSIONS: This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).

Red Cell Distribution Width as a Predictive Factor of Celiac Disease in Middle and Late Adulthood and Its Potential Utility as Celiac Disease Screening Criterion.

Red cell distribution width (RDW) could be of interest by its potential use in the assessment of celiac disorder (CD). The main objective of this study was to evaluate the case positive rate of CD and the utility of red cell distribution width (RDW) in the CD diagnosis. This prospective study included 9.066 middle adult (≥45 years old) and elderly patients (≥60 years old) from 2012 to 2021. CD diagnosis was performed by CD antibody tests (serology and Human Leucocyte Antigen genotype (HLA)) and biopsy. Gastrointestinal and extra-intestinal manifestations as well as hematological and biochemical parameters were analyzed. CD diagnoses were confirmed in 101 patients (median (IQR) age = 62 (52.3−73); 68.32% women) by serologic tests (100%) and intestinal biopsy (88.12%), showing mainly marked or complete atrophy (76.24%, MARSH 3a−c). Anemia was the most commonly presenting extra-intestinal manifestation (28.57%). Among 8975 individuals without CD, 168 age and sex matched were included. By comparison of CD and no CD individuals, we observed that high >14.3% RDW was exhibited by 58.40% and 35.2% individuals with CD and without CD, respectively. Furthermore, high RDW is associated with CD and grade III atrophy. We suggest that RDW could be used as a CD screening criterion.

Efecto del programa SERUMS en la equidad de la distribución de recursos humanos del primer nivel de atención en Perú

Introducción. La adecuada dotación y distribución con equidad de recursos humanos son fundamentales para el desempeño del sistema de salud, especialmente en el primer nivel de atención. El Programa Servicio Rural y Urbano Marginal (SERUMS) es la principal estrategia desarrollada por el Estado peruano para este fin. Objetivo. Describir el efecto de la dotación de médicos, enfermeros y obstetras del Programa SERUMS en la equidad de la distribución de recursos humanos en el primer nivel de atención. Métodos. Estudio observacional, descriptivo y transversal, de carácter censal con base en el Registro Nacional de Personal de Salud - INFORHUS, agosto 2019. Se aplicó indicadores de dotación, se verificó si existe diferencia entre la distribución porcentual de profesionales SERUMS y no SERUMS, se calculó la densidad (profesionales/10 000 hab. a nivel departamental, quintil de pobreza y ruralidad) y coeficientes de Gini (departamental). Resultados. La población estuvo constituida por 6037 profesionales SERUMS y 27 495 no SERUMS. El Programa SERUMS incrementó de manera importante la dotación y densidad de profesionales en casi todas las regiones del país. En 5 regiones los profesionales SERUMS representaron más del 50% de la dotación. Incrementos importantes se encontraron en el análisis por quintil de pobreza y en el ámbito rural, especialmente en la dotación de médicos. El programa SERUMS evidenció una mayor desigualdad en su distribución, según los coeficientes de Gini, a favor de las poblaciones más vulnerables. Conclusiones. El Programa SERUMS incrementa de manera importante la dotación y densidad de profesionales, especialmente en los distritos más pobres del Perú.

Introduction. The adequate allocation and equitable distribution of human resources are essential for the health system›s performance, especially at the first level of care. The Rural and Urban Marginal Service Program (SERUMS) is the primary strategy developed by the Peruvian State for this purpose. Objective. To describe the effect of the number of doctors, nurses, and midwives of the SERUMS Program on the equity of the distribution of human resources at the primary care level. Methods. Observational, descriptive, and cross-sectional study of a census nature based on the National Registry of Health Personnel - INFORHUS, August 2019. Staffing indicators were applied, it was verified if there is a difference between the percentage distribution of SERUMS and non-SERUMS professionals, density (professionals per 10 000 inhabitants at the departmental level, poverty quintile, and rurality), and Gini coefficients (departmental) were calculated. Results. The population consisted of 6037 SERUMS professionals and 27 495 non-SERUMS professionals. The SERUMS Program significantly increased the number and density of professionals in almost all departments. In 5 regions, SERUMS professionals represented more than 50% of the workforce. Significant increases in the number of doctors were found in the poverty quintile and rural areas analysis. According to the Gini coefficients, the SERUMS program showed greater inequality in its distribution in favor of the most vulnerable populations. Conclusions. The SERUMS Program significantly increases the number and density of healthcare professionals, especially in the poorest districts of Peru.

FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients.

Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

FoxP3+ regulatory T cells in oral tongue squamous cell carcinoma in young and older patients

Abstract Regulatory T (Treg) cells can suppress antitumor immune response, but little is known about possible age-related differences in the number of these cells in the microenvironment of oral tongue squamous cell carcinoma (OTSCC). The aim of this study was to determine the number of FoxP3+ Treg cells in the microenvironment of OTSCC in young (≤ 45 years) and older (≥ 60 years) patients, and to correlate the findings with clinicopathological parameters (sex, tumor size/extent, regional lymph node metastasis, clinical staging, and histopathological grade of malignancy). Forty-eight OTSCCs (24 diagnosed in young patients and 24 diagnosed in older patients) were selected. Lymphocytes exhibiting nuclear immunopositivity for FoxP3 were quantified at the tumor invasive front and the results were analyzed statistically using the non-parametric Mann-Whitney test. FoxP3+ lymphocytes were observed in all cases assessed. The number of FoxP3+ lymphocytes in OTSCC tended to be higher in older patients (p = 0.055). Analysis of OTSCC in males and in early clinical stages revealed a higher number of Treg cells in older patients than in young ones (p < 0.05). In older patients, the number of Treg cells tended to be higher in smaller tumors (p = 0.079). Tumors with intense inflammatory infiltrate exhibited a larger number of Treg cells, both in young (p = 0.099) and older patients (p = 0.005). The results suggest a greater participation of Treg cells in immunoinflammatory responses in the microenvironment of OTSCC in older patients, particularly in males and in early stages.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma.

The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Dos décadas de Acta Colombiana de Psicología: un análisis bibliométrico / Duas décadas de Acta Colombiana de Psicología: uma análise bibliométrica / Two decades of Acta Colombiana de Psicología: a bibliometric analysis

Resumen El objetivo del presente estudio fue realizar un análisis bibliométrico de la revista Acta Colombiana de Psicología, debido a sus dos décadas de trabajo ininterrumpido (1998-2017). Inicialmente, se describen elementos históricos en la trayectoria de la revista y se releva su evolución cronológica a partir de una base de datos que consideró 388 artículos científicos en su muestra final; posteriormente, se realizaron los análisis de los índices de productividad (Lotka) y de las temáticas y metodologías utilizadas. Asimismo, se desarrolló un análisis de los indicadores de colaboración y de las relaciones entre los autores con respecto a los países firmantes. En los resultados se destaca la gran cantidad de trabajos provenientes de instituciones mexicanas, se visualiza un alza sostenida en la colaboración -lo que se evidencia en los índices de Lawani y Subramanyam-, y se encuentra que la mayor cantidad de trabajos se enfocó en las áreas de psicología clínica y de la salud. El análisis realizado permite exhibir lo realizado por la revista a lo largo de dos décadas de trabajo científico en las que se aportó de manera fundamental al desarrollo de la psicología en Hispanoamérica.

Resumo O objetivo do presente estudo foi realizar uma análise bibliométrica da revista Acta Colombiana de Psicología, devido a suas duas décadas de trabalho ininterrupto (1998-2017). Inicialmente, descrevem-se elementos históricos na trajetória da revista e revela-se sua evolução cronológica a partir de uma base de dados que considerou 388 artigos científicos em sua amostra final. Posteriormente, foram realizadas as análises dos índices de produtividade (Lotka) e das temáticas e metodologias utilizadas. Além disso, foi desenvolvida uma análise dos indicadores de colaboração e das relações entre os autores com respeito aos países signatários. Nos resultados, destaca-se a grande quantidade de trabalhos provenientes de instituições mexicanas, visualiza-se uma alta prolongada na colaboração - o que se evidencia nos índices de Lawani e Subramanyam -, e nota-se que a maior quantidade de trabalhos concentrou-se nas áreas de psicologia clínica e da saúde. A análise realizada permite exibir o feito da revista ao longo de duas décadas de trabalho científico nas quais colaborou de maneira fundamental para o desenvolvimento da psicologia na América espanhola.

Abstract The aim of the present study was to conduct a bibliometric analysis of the journal Acta Colombiana de Psicología, by virtue of its two decades of uninterrupted work (1998-2017). Initially, historical elements are described in the trajectory of the journal and its chronological evolution is revealed from a database that in its final sample took into account 388 scientific articles. Subsequently, the appraisal of the productivity indices (Lotka) as well as of the topics and methodologies used was carried out. Likewise, an appraisal of the collaboration indicators and the relationships between the authors with respect to the signatory countries was performed. The results highlight the large number of papers from Mexican institutions, a sustained increase in collaboration is visualized -which is evident in the Lawani and Subramanyam indices-, and it is found that the largest amount of papers focused on the areas of clinical and health psychology. The analysis undertaken allows showing what the journal has achieved throughout two decades of scientific work during which it contributed fundamentally to the development of psychology in Latin America.

Tumores metastáticos para os maxilares: uma revisão integrativa / Metastatic tumors to the jaws: an integrative review

Introdução: Tumores metastáticos na região oral e perioral são extremamente raros. Objetivo: realizar uma revisão integrativa dos casos de metástases nos maxilares e sua relação com os tumores primários, os tipos histológicos e as principais localizações topográficas de ambos. Metodologia: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report e classical articles sobre o tema, utilizando os seguintes descritores: maxilares, mandíbula, maxila, metástases, incidência e seus mesh terms. Resultados: Foram incluídos um total de 35 artigos que cumpriam com todos os critérios. Foram ao todo 452 pacientes com metástases, dos quais 53.1% eram homens. A idade dos pacientes variou dos 4 meses a 90 anos. A mandíbula foi acometida em 55.7% dos casos, e a principal localização primária foi a mama, seguida pelo pulmão com 90 e 87 casos, respectivamente. Em 39% da amostra, os tumores primários eram desconhecidos. O adenocarcinoma foi o principal padrão histopatológico sendo encontrado em 30.3% da amostra. Conclusão: Os tumores metastáticos dos maxilares estão relacionados com um diagnóstico desafiador e tardio com prognóstico sombrio de curta sobrevida. Acometem mais comumente a região posterior mandibular entre a quinta e oitava décadas de vida, em ambos os sexos. O cirurgião dentista tem grande papel no diagnóstico precoce destas lesões. (AU)

Introduction: Metastatic tumors in the oral and perioral region are extremely rare. Objective: To aimed at performing an integrative review of the cases of metastases in the jaws and their relation to primary tumors, histological types and the topographic locations of both. Methods: A search was carried out in the MEDLINE, Google academic and LILACS databases using the following criteria: full articles published, from 2000 to 2016, in English, Portuguese and Spanish, case report and classical articles about the topic, using the following descriptors: jaws, mandible, maxilla, metastasis, incidence and their mesh terms. Results: 35 articles that fulfilled all the criteria were included. There were 452 patients with metastases, of which 53.1% were men. Patient's ages ranged from 4 months to 90 years. The mandible was affected in 55.7% of the cases, and the main primary sites were the breast and lung with 90 and 87 cases each, respectively. In 39% of the sample, the primary tumors were unknown. Adenocarcinoma was the main histopathological pattern found in 30.3% of the sample. Conclusion: Metastatic tumors of the jaws are related to a challenging and late diagnosis with gloomy prognosis of short survival. They most commonly affect the posterior mandibular region between the fifth and eighth decades of life, in both sexes. The dentist practitioner has a great role in the early diagnosis of these lesions. (AU)

Intraoral findings in newborns: prevalence and associated factors

Aim: To investigate the prevalence of intraoral characteristics and associated factors with neonatal and parent variables in a group of Brazilian newborns. Methods: This cross-sectional study with a descriptive and inferential approach, whose data was obtained through clinical examination, interview and the collection of medical record information. The sample was selected from babies up to three days old, of both sexes, and born between January and December 2013 in the Ana Bezerra University Hospital, in the city of Santa Cruz-RN, Brazil. The exposure variables included neonatal (sex, weight, gestational age, type of delivery and Apgar score) and parent (presence of systemic disease(s), drug use and consanguinity between the parents) variables. Descriptive analysis and Poisson regression were performed to estimate the ratio of gross and adjusted prevalence of intraoral findings (Epstein pearls, Bohn's nodule, dental lamina cyst and ankyloglossia) with the neonatal and parent variables (p<0.05). Results: Of a total of 168 examined newborns, 56.5% (n=95) were male. The most prevalent intraoral feature was the fibrous cord of Magitot, 62.5% (n=105), and the most frequent alteration was Epstein pearls, 44.6% (n=75). Female gender was a factor for Bohn's nodule (OR=0.90; 95%CI:0.82-0.99), and no tobacco use by the father was a protective factor for Epstein pearls (OR=0.73;95%CI:0.55-0.97). Additionally, lower mother's age, between 20-34 years of age (OR=1.58;95%CI:1.07-2.35) and under 19 years of age (OR=1.61; 95%CI:1.03-2.52) increases the chance of having Epstein pearls. Conclusion: There was a high prevalence of alterations in the newborns' oral cavities and there were associations between neonatal and parent variables

Riscos e complicações do uso de piercing oral: uma revisão sistemática / Risks and complications of the use of oral piercing: a systematic review

Introdução: O uso de piercing oral tem despertado o interesse dos profissionais da Odontologia devido à associação com diversas complicações locais e sistêmicas. Objetivo: Este trabalho objetivou realizar uma revisão sistemática da literatura sobre riscos e complicações associadas ao uso de piercings orais e periorais. Métodos: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando-se os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report, classical articles e reviews sobre o tema utilizando os seguintes descritores: body piercing, risks management, complications, risk e seus mesh terms. Resultados: Foram incluídos um total de 39 artigos relevantes que cumpriam com todos os critérios. Foi observado que os locais mais frequentemente utilizados para a colocação de piercing oral são os lábios e a língua. As complicações incluem inflamação, infecções locais e sistêmicas, lesões mucocutâneas, lesões vasculares, trauma dental, problemas periodontais, reações de hipersensibilidade, disfonia, deglutição e aspiração do piercing, e até morte etc. Conclusão: Conclui-se que o cirurgião dentista deve exercer um papel importante na orientação da população em geral sobre os riscos e as complicações associadas ao uso de piercing oral, visando evitar tal prática ou minimizar ao máximo os riscos e as complicações naqueles indivíduos que os possuem. (AU)

Introduction: The use of oral piercing has aroused the interest of dental professionals because of its association with various local and systemic complications. Objective: This study aimed to perform a systematic review on risks and complications associated with the use of oral and perioral piercings. Methods: We searched the MEDLINE, Google Scholar and LILACS databases using the following criteria: articles published in full text, from 2000 to 2016 in English, Portuguese and Spanish, case reports, classic articles and reviews about the topic using the following descriptors: body piercing, risk management, complications, risk and their mesh terms. Results: 39 relevant articles that fulfilled all the criteria were included. It has been observed that the most frequently used sites for an oral piercing placement are the lip followed by the tongue. The complications included inflammation, local and systemic infections, mucocutaneous lesions, vascular lesions, dental trauma, periodontal problems, hypersensitivity reactions, dysphonia, swallowing and aspiration of the piercing, and even death etc. Conclusion: Its was conclude that the dentist can play an important role in guiding the population about the risks and complications associated with the use of oral piercing, aiming to avoid such practice or minimizing the maximum the risk and complications in those individuals who possess them. (AU)