Oral focal mucinosis: A multi-institutional study and literature review.

BACKGROUND: Oral focal mucinosis (OFM) is a rare benign condition of unknown etiology, considered the oral counterpart of cutaneous focal mucinosis. We report the clinicopathologic features of 21 cases of OFM in conjunction with a review of the literature. METHODS: Clinical data were collected from the records of five oral and maxillofacial pathology services. All cases were evaluated by hematoxylin and eosin staining, histochemistry, and immunohistochemistry (vimentin, S-100, α-SMA, CD34, and mast cell). RESULTS: The series comprised 14 females (66.7%) and seven males (33.3%), with a mean age of 48.2 ± 20.7 years (range: 8-77 years) and a 2:1 female-to-male ratio. Most of the lesions affected the gingiva (n = 6, 28.6%) and presented clinically as asymptomatic sessile or pedunculated nodules with fibrous or hyperplasic appearance. All cases were negative for S-100 protein, CD34, and α-SMA and positive for Alcian blue staining. Conservative surgical excision was the treatment in all cases, and there was only one recurrence. CONCLUSION: OFM is a rare benign disorder that is often clinically misdiagnosed as reactive lesions or benign proliferative processes. Dermatologists and pathologists should consider OFM in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located in the gingiva.

Expression of mitochondrial dynamics markers during melanoma progression: Comparative study of head and neck cutaneous and mucosal melanomas.

BACKGROUND: Head and neck mucosal melanomas (MMs) are rare tumors with adverse outcomes and poorer prognoses than their more common cutaneous counterparts (cutaneous melanomas-CMs). Few studies have compared the expression of mitochondrial dynamic markers in these tumors. This study aimed to assess the correlations of mitochondrial markers with melanoma progression and their potential as predictors of lymph node involvement and distant metastasis. METHODS: Immunohistochemistry against anti-mitochondrial (AMT), dynamin-related protein 1 (DRP1), mitochondrial fission protein 1 (FIS1), mitofusin-1 (MFN1), and mitofusin-2 (MFN2) antibodies was performed in 112 cases of head and neck CM and MM. A Cox regression multivariate model was used to assess the correlation of AMT, FIS1, and MFN2 expressions considering the risk for nodal and distant metastasis. RESULTS: All markers studied presented higher staining in tumor cells than normal adjacent tissues. Higher mitochondrial content was observed in MM than in CM, and it was significantly associated with nodal metastasis in oral melanomas. Both FIS1 and DRP1 expressions were related to advanced Clark's levels in CM, and they were overexpressed in oral melanomas. Moreover, increased immunoexpression of MFN2 was significantly associated with a higher risk of metastasis in CM, and it was also overexpressed in sinonasal melanomas. CONCLUSIONS: Our results suggest that mitochondrial fission and fusion processes can play an important role during multiple stages of tumorigenesis and the development of nodal and distant metastasis in cutaneous and mucosal melanomas.

Work-related stress in Medical and Dentistry programs.

Introduction: Stress occurs more frequently in groups in which the degree of responsibility and decision-making power play notable roles in society, such as professors and health professionals. Objectives: To measure and understand the stress of professors in the undergraduate course of Medicine and Dentistry of a private educational institution in northeastern Brazil. Methods: Observational, descriptive and exploratory study with a quantitative approach was conducted between November 2018 and September 2019. A total of 184 professors participated in the study, answering the following instruments: demographic sociodata questionnaire, Stress Symptoms Inventory and the Preliminary Burnout Identification Questionnaire. The Post-Traumatic Stress Symptoms Scale was applied to the 60 professors with stress. The data obtained were submitted to data analysis through Pearson's chi-square test and logistic regression. Results: Stress was present in 40.3% of the professors, with a predominance of the resistance phase (85%) and signs indicative of burnout. There was a significant correlation between the presence of stress and the time of traumatic event either with the individual himself or with some relative and/or close friend. There was no correlation between the traumatic events and Post Traumatic Stress Disorder, although a significant correlation was observed between Post Traumatic Stress Disorder and burnout. Conclusions: The results point to the need to properly identify and manage stress so that the teaching experience is healthy and conducive to the teaching-learning process.

Introdução: O estresse ocorre de forma mais recorrente em grupos em que o grau de responsabilidade e poder de decisão perpetram notáveis papéis na sociedade, tais como docentes e profissionais de saúde. Objetivos: Mensurar e compreender o estresse docente dos cursos de graduação de Medicina e Odontologia de uma instituição de ensino privada do Nordeste do Brasil. Métodos: Tratou-se de um estudo observacional, descritivo, analítico e exploratório, com abordagem quantitativa no período de novembro de 2018 a setembro de 2019. Participaram do estudo 184 docentes, respondendo aos seguintes instrumentos: um questionário sociodemográfico, o Inventário de Sintomas de Estresse e o Questionário Preliminar de Identificação de Burnout. Já a Escala de Sintomas de Estresse Pós-Traumático foi aplicada nos 60 docentes com estresse. Foi realizada a análise de dados através do teste de qui-quadrado de Pearson e de regressão logística. Resultados: O estresse estava presente em 40,3% dos docentes, com predomínio da fase de resistência (85%) e sinais indicativos de burnout. Houve correlação significativa entre estresse e tempo de acontecimento traumático, seja com o próprio indivíduo ou com algum familiar e/ou amigo próximo. Não houve correlação entre o acontecimento traumático e o transtorno de estresse pós-traumático, embora tenha sido observada correlação significativa de transtorno de estresse pós-traumático e burnout. Conclusões: Os resultados apontam para a necessidade de identificar e manejar adequadamente o estresse para que a experiência docente seja salutar e propícia ao processo de ensino-aprendizagem.

Childhood pemphigus vulgaris is a challenging diagnosis.

Pemphigus Vulgaris (PV) is an uncommon autoimmune and blistering mucocutaneous disease. Childhood Pemphigus Vulgaris (CPV) is a pediatric variant of PV, which affects children below 12 years, being very rare among children under 10 years of age. CPV has similar clinical, histological, and immunological features as seen in PV in adults. The mucocutaneous clinical presentation is the most common in both age groups. Vesicles and erosions arising from the disease usually cause pain. A few CPV cases have been reported in the literature. This study reports a case of an 8-year-old male patient with oral lesions since the age of 3 years, and the diagnosis of pemphigus was achieved only 2 years after the appearance of the initial lesions. CPV remains a rare disease, making the diagnosis of this clinical case a challenge due to its age of onset and clinical features presented by the patient. Therefore, dentists and physicians should know how to differentiate CPV from other bullous autoimmune diseases more common in childhood.

Knowledge of oral and oropharyngeal cancer by dental surgeons: an integrative review.

OBJECTIVES: to identify the evidence available in the literature on the knowledge of dentists regarding risk factors and early diagnosis of oral and oropharyngeal cancer. METHODS: it is an integrative review of the literature. Boolean descriptors and operators were searched in the PubMed and LILACS databases, using gray literature, in English, Spanish and Portuguese. RESULTS: of the 79 PubMed and 152 LILACS articles, 24 were selected. Of these, eight showed good knowledge of dentists, while most showed low or little knowledge of risk factors and early diagnosis in dentists. All studies, however, highlight the need for continuing education to improve and maintain knowledge about risk factors and early diagnosis. CONCLUSIONS: most dental surgeons have insufficient knowledge of oral/oropharyngeal cancer. Continued education is suggested, aiming at improving knowledge and early diagnosis.

The use of multiple triangulations as a validation strategy in a qualitative study. / O uso de triangulação múltipla como estratégia de validação em um estudo qualitativo.

This paper aims to present the use of triangulation in qualitative research as a strategy to achieve the proposed objectives, to ensure credibility, reliability, and greater scientific accuracy in its achievement. In this sense, triangulation - since it is not restricted to the use of only one method, theory, data source or researcher in the process of analyzing an event - allows the apprehension of a given reality from several angles, enabling information confrontation, in order to minimize bias resulting from a single analytical perspective. Thus, aiming at evidencing the possibilities of using such a methodological design, we used as an example a qualitative study about experiences of caregivers for patients with head and neck neoplasms, developed through multiple triangulation, namely: methodological (intra-method), data, researcher and environmental triangulation. When demonstrating a structured study in the form of triangulation, one aims to guide researchers interested in conducting qualitative studies with greater depth and methodological rigor in qualitative research.

Este artigo objetiva apresentar o uso da triangulação na pesquisa qualitativa como estratégia para atingir os objetivos propostos, garantir credibilidade, confiabilidade e maior rigor científico em sua realização. Nesse sentido, a triangulação ­ por não se restringir à utilização de apenas um método, teoria, fonte de dados ou investigador no processo de análise de um mesmo fenômeno ­ possibilita a apreensão de uma dada realidade sob diversos ângulos, possibilitando o confrontamento de informações, de maneira a minimizar vieses resultantes de uma única perspectiva de análise. Com o intuito de evidenciar as possibilidades do uso de tal desenho metodológico, utilizou-se como exemplo um estudo qualitativo sobre vivências de cuidadores de pacientes com neoplasia de cabeça e pescoço, desenvolvido por meio de triangulação múltipla, a saber: triangulação metodológica (intramétodo), de dados, de investigador e ambiental. Ao se demonstrar um estudo estruturado, em forma de triangulação, tem-se como finalidade orientar pesquisadores interessados em realizar estudos qualitativos com um maior aprofundamento e rigor metodológico em pesquisa qualitativa.

Oral melanomas in HIV-positive patients: Report of two cases and review of the literature.

Oral melanoma in HIV-positive patients is exceedingly rare, with only two cases reported in the literature published in English. Herein, we report two additional cases of oral melanomas which occurred as oral masses in the upper gingiva and hard palate in 35- and 27-year-old HIV-positive women. Significant thrombocytopenia, anemia, reduced CD4 cells, and high HIV load occurred in both patients. Microscopically, the lesions showed a variable proliferation of fusiform and epithelioid-pigmented cells, with cellular pleomorphism and high mitotic index. The diagnosis of melanoma was supported by positive immunoreactivity for S-100, MelanA, and HMB-45. Both cases had an unfavorable outcome, and the patients died a few months after the initial diagnosis. Because of its rarity, oral melanoma occurring in HIV-positive patients can pose problems in diagnosis and should be clinically distinguished from Kaposi's sarcoma, which is more common in the context of the immunodeficiency syndrome.

Counseling practices in Sexually Transmitted Infections/AIDS: the female health professionals' perspective.

OBJECTIVE: to analyze the health professionals' perception about counseling in a Centro de Testagem e Aconselhamento em Infecções Sexualmente Transmissíveis (Center for Testing and Counseling in Sexually Transmitted Infections (STIs) and AIDS) in Maceió, Alagoas. METHOD: it is a qualitative research, with theoretical framework of the Discursive Practices and Production of Senses in the daily life carried out with the participation of 6 counselors. For research material production, the 'Conversation Round' technique and the semi-structured script were used. For material treatment the Discourse Analysis method was used, resulting in the production of analysis categories and Dialogic Maps. RESULTS: in the current policies and actions of STI/AIDS, there is centralization in the procedures of anti-HIV testing and displacement of the professional counselor, undoing the testing and counseling. FINAL CONSIDERATIONS: the study indicates the need to overcome the instrumental and prescriptive models of counseling to produce a dialogical process of care and co-responsibility.

Impacts of health of users with HIV/AIDS in a specialized service.

OBJECTIVE: to understand the perception of users of a Specialized Care Service (SAE- Serviço de Assistência Especializada) in HIV/AIDS about their oral health. METHOD: qualitative research that used the techniques of participant observation and focal group. For the analysis of the material produced, categories of analysis, construction of dialogical map and identification of linguistic repertoires were used. RESULTS: impacts arising from oral health problems such as: inability to eat properly, feeling ashamed due to tooth loss, inability to perform physical exercises and, as the main barrier to access to dental treatment, fear of exposure to practices of discrimination and prejudice. FINAL CONSIDERATIONS: we need the implementation of policies of Permanent Education to all professionals involved in the care for this population, to ensure users' rights, ensure qualified care, and create security and trust relationships with individuals living with HIV/AIDS, in access to services.

Dysphagia due to macroglossia in a patient with amyloidosis associated with multiple myeloma: A case report.

Amyloidosis is a group of heterogeneous conditions characterized by the deposition of extracellular proteinaceous substances called amyloids. The diagnosis is usually confirmed after a particular body organ has been affected. However, oral manifestations have been identified in 39% of affected patients. Systemic amyloidosis may be primary or in association with multiple myeloma and typically affecting elder adults. The diagnosis of amyloidosis is usually associated with clinical features with histopathological findings, which reveal the presence of acellular eosinophilic deposits. The aim of this report is to describe a clinical case of an elderly patient with dysphagia related to macroglossia and enlargement caused by primary amyloidosis associated with multiple myeloma.

Fatal Disseminated Kaposi's Sarcoma in Two Patients with Human Immunodeficiency Virus (HIV) Infection.

BACKGROUND Kaposi's sarcoma (KS) is a common condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In these patients, the occurrence of KS is reduced by treatment with highly active antiretroviral therapy (HAART). Fatal and disseminated KS is presented in two patients with HIV/AIDS. CASE REPORT A 25-year-old man and a 30-year-old man with HIV/AIDS presented with KS affecting the skin, oral cavity, gastrointestinal tract, liver, lungs, kidneys, adrenal glands, and bone. Both patients had a rapidly deteriorating clinical course associated with a low CD4 count and developed respiratory failure and death. CONCLUSIONS Fatal disseminated KS is associated with severe immunosuppression due to with a low CD4 count. The presentation of these two cases highlights the potentially aggressive clinical course of KS in patients with HIV/AIDS and reinforces the need for early diagnosis and rapid treatment with HAART.

Hearing handicap in patients with chronic kidney disease: a study of the different classifications of the degree of hearing loss.

INTRODUCTION: The association between hearing loss and chronic kidney disease and hemodialysis has been well documented. However, the classification used for the degree of loss may underestimate the actual diagnosis due to specific characteristics related to the most affected auditory frequencies. Furthermore, correlations of hearing loss and hemodialysis time with hearing handicap remain unknown in this population. OBJECTIVE: To compare the results of Lloyd's and Kaplan's and The Bureau Internacional d'Audiophonologie classifications in chronic kidney disease patients, and to correlate the averages calculated by their formulas with hemodialysis time and the hearing handicap. METHODS: This is an analytical, observational and cross-sectional study with 80 patients on hemodialysis. Tympanometry, speech audiometry, pure tone audiometry and interview of patients with hearing loss through Hearing Handicap Inventory for Adults. Cases were classified according to the degree of loss. The correlations of tone averages with hemodialysis time and the total scores of Hearing Handicap Inventory for Adults and its domains were verified. RESULTS: 86 ears (53.75%) had hearing loss in at least one of the tonal averages in 48 patients who responded to Hearing Handicap Inventory for Adults. The Bureau Internacional d'Audiophonologie classification identified a greater number of cases (n=52) with some degree of disability compared to Lloyd and Kaplan (n=16). In the group with hemodialysis time of at least 2 years, there was weak but statistically significant correlation of The Bureau Internacional d'Audiophonologie classification average with hemodialysis time (r=0.363). There were moderate correlations of average The Bureau Internacional d'Audiophonologie classification (r=0.510) and tritone 2 (r=0.470) with the total scores of Hearing Handicap Inventory for Adults and with its social domain. CONCLUSION: The Bureau Internacional d'Audiophonologie classification seems to be more appropriate than Lloyd's and Kaplan's for use in this population; its average showed correlations with hearing loss in patients with hemodialysis time≥2 years and it exhibited moderate levels of correlation with the total score of Hearing Handicap Inventory for Adults and its social domain (r=0.557 and r=0.512).

Low Survival Rates of Oral and Oropharyngeal Squamous Cell Carcinoma.

AIM: To assess the epidemiological and clinical factors that influence the prognosis of oral and oropharyngeal squamous cell carcinoma (SCC). METHODS: One hundred and twenty-one cases of oral and oropharyngeal SCC were selected. The survival curves for each variable were estimated using the Kaplan-Meier method. The Cox regression model was applied to assess the effect of the variables on survival. RESULTS: Cancers at an advanced stage were observed in 103 patients (85.1%). Cancers on the tongue were more frequent (23.1%). The survival analysis was 59.9% in one year, 40.7% in two years, and 27.8% in 5 years. There was a significant low survival rate linked to alcohol intake (p = 0.038), advanced cancer staging (p = 0.003), and procedures without surgery (p < 0.001). When these variables were included in the Cox regression model only surgery procedures (p = 0.005) demonstrated a significant effect on survival. CONCLUSION: The findings suggest that patients who underwent surgery had a greater survival rate compared with those that did not. The low survival rates and the high percentage of patients diagnosed at advanced stages demonstrate that oral and oropharyngeal cancer patients should receive more attention.

Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

Prevalence of hypovitaminosis D and its association with oral lesions in HIV-infected Brazilian adults.

INTRODUCTION: This study assessed the prevalence of hypovitaminosis D and its association with oral candidiasis and clinical parameters of periodontitis (CPP) in HIV-infected patients. METHODS: Periodontal examinations for the 113 HIV-infected patients were recorded using the Community Periodontal Index. A cytological smear from the lateral borders of the tongue was performed to evaluate candidiasis. RESULTS: The frequency of hypovitaminosis D was 23.9%. In multivariate analysis, only the duration of exposure to HIV was associated with CPP [OR 4.72 (95% CI: 0.97-23.00)]. CONCLUSIONS: The prevalence of hypovitaminosis D was 23.9% and was not related with oral candidiasis or CPP.

Knowledge of oral and oropharyngeal cancer by dental surgeons: an integrative review / Conocimiento de los quirúrgicos dentistas sobre cáncer de boca y orofaríngeo: una revisión integrativa / Conhecimento dos cirurgiões-dentistas sobre câncer de boca e orofaringe: uma revisão integrativa

ABSTRACT Objectives: to identify the evidence available in the literature on the knowledge of dentists regarding risk factors and early diagnosis of oral and oropharyngeal cancer. Methods: it is an integrative review of the literature. Boolean descriptors and operators were searched in the PubMed and LILACS databases, using gray literature, in English, Spanish and Portuguese. Results: of the 79 PubMed and 152 LILACS articles, 24 were selected. Of these, eight showed good knowledge of dentists, while most showed low or little knowledge of risk factors and early diagnosis in dentists. All studies, however, highlight the need for continuing education to improve and maintain knowledge about risk factors and early diagnosis. Conclusions: most dental surgeons have insufficient knowledge of oral/oropharyngeal cancer. Continued education is suggested, aiming at improving knowledge and early diagnosis.

RESUMEN Objetivos: identificar evidencias disponibles en la literatura sobre el conocimiento de los quirúrgicos dentistas cuanto a los factores de riesgo y diagnóstico precoz del cáncer de boca/ orofaríngeo. Métodos: revisión integrativa de la literatura. Se realizaron búsquedas mediante los descriptores y operadores booleanos en base de datos PubMed y LILACS, con uso de literatura gris, en los idiomas inglés, español y portugués. Resultados: de los 79 artículos del PubMed y 152 del LILACS, 24 seleccionados. De estos, ocho mostraron bueno conocimiento de los dentistas, mientras la mayoría mostró bajo o poco conocimiento sobre factores de riesgo y diagnóstico precoz en dentistas. Todos los estudios, aunque, destacan la necesidad de educación continuada para mejorar y mantener el conocimiento sobre factores de riesgo y diagnóstico precoz. Conclusiones: gran parte de los quirúrgicos dentistas presenta un conocimiento insuficiente sobre cáncer de boca/orofaríngeo. Sugerida educación continuada, objetivando mejorar el conocimiento y el diagnóstico precoz.

RESUMO Objetivos: identificar as evidências disponíveis na literatura sobre o conhecimento dos cirurgiõesdentistas quanto aos fatores de risco e diagnóstico precoce do câncer de boca e orofaringe. Métodos: trata-se de uma revisão integrativa da literatura. Foram realizadas buscas mediante os descritores e operadores booleanos na base de dados PubMed e LILACS, com uso de literatura cinza, nos idiomas inglês, espanhol e portugês. Resultados: dos 79 artigos do PubMed e 152 do LILACS, 24 foram selecionados. Destes, oito mostraram bom conhecimento dos dentistas, enquanto a maioria mostrou baixo ou pouco conhecimento sobre fatores de risco e diagnóstico precoce em dentistas. Todos os estudos, no entanto, destacam a necessidade de educação continuada para melhorar e manter o conhecimento sobre fatores de risco e diagnóstico precoce. Conclusões: grande parte dos cirurgiões-dentistas apresenta um conhecimento insuficiente sobre câncer de boca/orofaringe. É sugerida a educação continuada, visando melhorar o conhecimento e o diagnóstico precoce.

Childhood pemphigus vulgaris is a challenging diagnosis

Pemphigus Vulgaris (PV) is an uncommon autoimmune and blistering mucocutaneous disease. Childhood Pemphigus Vulgaris (CPV) is a pediatric variant of PV, which affects children below 12 years, being very rare among children under 10 years of age. CPV has similar clinical, histological, and immunological features as seen in PV in adults. The mucocutaneous clinical presentation is the most common in both age groups. Vesicles and erosions arising from the disease usually cause pain. A few CPV cases have been reported in the literature. This study reports a case of an 8-year-old male patient with oral lesions since the age of 3 years, and the diagnosis of pemphigus was achieved only 2 years after the appearance of the initial lesions. CPV remains a rare disease, making the diagnosis of this clinical case a challenge due to its age of onset and clinical features presented by the patient. Therefore, dentists and physicians should know how to differentiate CPV from other bullous autoimmune diseases more common in childhood.

Association of T CD4 lymphocyte levels and chronic periodontitis in HIV-infected brazilian patients undergoing highly active anti-retroviral therapy: clinical results.

BACKGROUND: Controversial data regarding the association between immunosuppression and prevalence/ severity of periodontal diseases in HIV infection have been reported. Thus, the aim of this study was to test the hypothesis that lower T CD4 lymphocyte levels are not related to a higher prevalence of chronic periodontitis in HIV-infected Brazilians undergoing highly active anti-retroviral therapy (HAART). METHODS: Sixty-four HIV-infected patients under HAART were classified as having chronic periodontitis; i.e., > or = three sites with probing depth (PD) and/or clinical attachment level (CAL) > or = 5 mm or periodontal healthy (no sites with PD > 3 mm and/or CAL > 4 mm). All subjects received conventional periodontal therapy. Bleeding on probing, plaque accumulation, PD, and CAL were registered at six sites/tooth at baseline and 4 months after therapy. Epidemiological features and levels of T CD4 lymphocytes were obtained from medical records. Significance of differences in periodontal clinical parameters within and between groups were determined using Wilcoxon signed-rank and Mann-Whitney or independent sample t tests. Associations between T CD4 levels and clinical parameters were determined using the chi square test. RESULTS: Sixty-one percent of the HIV-infected patients represented AIDS cases, although 69% of them were periodontally healthy. The overall T CD4 lymphocyte mean levels was 333 +/- 254 cells/mm3 and viral load was 12,815 +/- 24,607 copies/mm3. Yet the prevalence of chronic periodontitis was relatively low (36%). In addition, patients with periodontitis presented a moderate disease (mean PD = 2.2 +/- 0.10; mean CAL = 2.6 +/- 0.13) and responded successfully to periodontal therapy. These subjects showed higher levels of T CD4 cells, but lower counts of neutrophils than periodontally healthy patients. Among periodontally healthy and chronic periodontitis patients, 41.7% and 22.9%, respectively, had low levels of T CD4 lymphocytes. No significant differences between periodontal status and epidemiological and immunological parameters were observed. CONCLUSION: Based on these results, the hypothesis that lower T CD4 lymphocyte levels are not associated with higher prevalence of chronic periodontitis in HIV-infected Brazilians under HAART cannot be rejected.

Lactoferrin levels in gingival crevicular fluid and saliva of HIV-infected patients with chronic periodontitis.

AIM: This study compared lactoferrin (LF) levels in the gingival crevicular fluid (GCF) and saliva between HIV-infected and noninfected patients with chronic periodontitis. METHODS: For each subject, LF levels were analyzed in one shallow site (SS; PD ≤3 mm), one deep site (DS; PD >5 mm) and in resting whole saliva. Two groups, 28 HIV-infected and 10 noninfected, were selected. RESULTS: Although the salivary LF levels were higher in HIV-infected than in noninfected individuals, especially in AIDS patients, this was not statistically significant (P > 0.05). Subgingival LF levels for SS and DS were lower among HIV-infected individuals, although AIDS patients showed the lowest levels. Age, smoking, gender, T CD4 lymphocytes levels and viral load did not influence subgingival LF levels, neither for SS nor for DP. Positive fungal culture was observed in 24 HIV-infected patients, but only observed in one in the control group. Overall, LF concentration was significantly higher in DS than SS, both in HIV-infected and noninfected individuals (P < 0.05) and salivary LF levels were always higher than GCF levels. CONCLUSION: The data indicate that LF levels in the GCF and saliva are not different between HIV-infected and noninfected patients with chronic periodontitis.

Immunoexpression of EGFR and EMMPRIN in a series of cases of head and neck squamous cell carcinoma.

BACKGROUND: The epidermal growth factor receptor (EGFR) and the extracellular matrix metalloproteinase inducer (EMMPRIN) have been identified as oncologically important targets. This study aimed to evaluate the immunoexpression of EGFR and EMMPRIN in a series of cases of head and neck squamous cell carcinoma (HNSCC). METHODS: Forty-five cases of HNSCC were selected for this study and evaluated with anti-EGFR and anti-EMMPRIN antibodies. The percentage of positive cells was determined assessing to the following categories: score 1 (staining in 0-50% of cells), score 2 (staining in 51-75% of cells), and score 3 (staining in >75% of cells). Immunostaining intensity was graded according to the following parameters: score 1 (absent/weak expression) and score 2 (strong expression). RESULTS: For EGFR, a predominance of high median scores was observed in cases of both histological grades of malignancy and in different clinical stages (p>0.05). For EMMPRIN, a statistically significant difference was observed between the histological grades of malignancy (p=0.030). Regarding the immunostaining intensity of EMMPRIN, it was observed a predominance of score 1 in cases with stages I/II, whereas most cases with stages III/IV presented score 2 (p=0.032). Considering the anatomical location, most cases of buccal floor presented higher median score of EMMPRIN in comparison with the other sites (p=0.015). CONCLUSIONS: These findings suggest that both proteins are potential targets for cancer therapy and EMMPRIN can be used as a prognostic marker of a more aggressive biological behavior in patients with HNSCC.