Noninvasive imaging exploration of phacomatosis pigmentokeratotica using high-frequency ultrasound and optical coherence tomography: Can biopsy of PPK patients be avoided?

BACKGROUND: Phacomatosis pigmentokeratotica (PPK) is a distinct and rare type of epidermal nevus syndrome characterized by coexisting nonepidermolytic organoid sebaceous nevus (SN) with one or more speckled lentiginous nevi (SLN). Atypical nevi including compound Spitz and compound dysplastic may manifest within regions of SLN. Patients with PPK, or similar atypical nevus syndromes, may be subject to a significant lifetime number of biopsies, leading to pain, scarring, anxiety, financial burden, and decreased quality of life. The current literature includes case reports, genetics, and associated extracutaneous symptoms of PPK, but use of noninvasive imaging techniques have not been explored. We aim to investigate the value of high-frequency ultrasound (HFUS) and optical coherence tomography (OCT) in discriminating morphological features of pigmented lesions and nevus sebaceous within one patient with PPK. MATERIALS AND METHODS: Two modalities, (1) HFUS imaging, based on acoustic properties and (2) OCT imaging, based on optical properties, were used to image a patient with PPK. Benign pigmented lesions, which may raise clinical suspicion for significant atypia, and nevus sebaceous, were selected on different areas of the body to be studied. RESULTS: Five pigmented lesions and one area of nevus sebaceous were imaged and analyzed for noninvasive features. Distinct patterns of hypoechoic features were seen on HFUS and OCT. CONCLUSION: HFUS provides a deep view of the tissue, with ability to differentiate gross structures beneath the skin. OCT provides a smaller penetration depth and a higher resolution. We have described noninvasive features of atypical nevi and nevus sebaceous on HFUS and OCT, which indicate benign etiology.

Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

How Long does it Take to Examine Young Children with the Caries ICDAS System and how do they Respond?

A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers' informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child's behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.

How long does it take to examine young children with the caries icdas system and how do they respond?

Abstract A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers' informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child's behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.

Resumo Um estudo epidemiológico de cárie usando o sistema ICDAS foi realizado em crianças pequenas colombianas. O objetivo deste estudo foi associar o tempo necessário para o exame clínico da cárie e o risco de cárie em crianças de 1 a 5 anos de acordo com a idade e o risco de cárie e avaliar a autopercepção do comportamento e da dor na criança durante o exame, de acordo com a idade. Após a aprovação do comitê de ética e do consentimento informado dos pais/responsáveis, sete examinadores treinados avaliaram crianças de 1 a 5 anos em creches em condições locais de campo. A experiência de cárie do ICDAS (depiMEmf) foi avaliada da seguinte forma: Epi-depi inicial (ICDAS 1/2 sem secagem ao ar); Moderado-dM (ICDAS 3,4); lesões extensas de dE (ICDAS 5,6); restaurações devido a cárie -f e superfícies/dentes ausentes-m. O risco de cárie foi avaliado com Cariogram®. O comportamento de crianças (Frankl-Behavior-Rating-Scale) e a autopercepção de dor (Escala Visual-Analógica-de-Rostos) durante o exame foram avaliados. O tempo de exame clínico foi registrado com um cronômetro. 592 crianças participaram (1 ano: n = 31; 2 anos: n = 96; 3 anos: n = 155; 4 anos: n = 209, 5 anos: n = 101 ). A prevalência do depiMEmfs foi de 79,9% e a média de 8,4 ± 10,4. A maioria era de crianças com alto risco de cárie (68,9%). A maioria (58,9%) apresentou ≥ comportamento positivo e ≤ autopercepção de dor leve (88,4%). O tempo médio de exame clínico foi em torno de 3,5 min (216,9 ± 133,9 s). Para crianças de 5 anos, correspondeu a 4 min (240,4 ± 145,0 s) vs. 2 min (122,8 ± 80,1 s) para crianças de 1 ano de idade (Kruskal-Wallis; p = 0,00). Para crianças com alto e baixo risco de cárie, foi em torno de 4,3 min (255,7 ± 118,5 s) e 3,3 min (201,3 ± 129,4 s), respectivamente (ANOVA; p = 0,01). Este estudo demonstra que a utilização do sistema ICDAS em crianças pequenas é viável, levando menos de 4 min para o exame clínico sem problemas de autopercepção de comportamento/ dor em crianças.

Perfil de un adolescente con hiperplasia suprarrenal congénita / Profile of a teenage boy with congenital adrenal hyperplasia

La hiperplasia suprarrenal congénita (HSC) es un trastorno genético que produce déficit en la síntesis del cortisol. Esta enfermedad se presenta en ambos géneros, puede ser diagnosticada prenatalmente y recibir tratamiento desde esta etapa. A nivel fisiológico presenta ambigüedad en los órganos sexuales internos y externos que afectan el desarrollo emocional y social. En el nivel cognitivo se pueden encontrar dos posturas una donde se afirma que en pacientes con HSC se presentan puntuaciones bajas en el Coeficiente Intelectual (CI), especialmente en el (CI)verbal y diferencias significativas en pacientes que no han recibido tratamiento a tiempo, la otra considera que esta enfermedad no afecta los procesos cognitivos. En el presente artículo se realiza un estudio de caso único de un adolescente de 13 años con HSC, con el objetivo de describir el perfil cognitivo de un adolescente con hiperplasia suprarrenal congénita y compararlo con los estudios existentes en la actual literatura. Se obtuvo un perfil cognitivo por medio de diferentes pruebas neuropsicológicas, encontrando en el paciente un retardo mental moderado CI 50 y alteraciones importantes del lenguaje y del aprendizaje.

Congenital adrenal hyperplasia (CAH) is a genetic disorder that causes deficits in the synthesis of cortisol. This disease occurs in both genders, it can be diagnosed prenatally and treated from this stage. Physiologically presents ambiguity in the internal and external sex organs that affect the emotional and social development. In the cognitive level can be found two positions one where it is stated that in patients with CAH low scores are presented on IQ (IQ), especially (IQ) verbal and significant differences in patients who have not received treatment in initially time, the other believes that this disease does not affect cognitive processes. In this paper, a single case study of a 13-year HSC is performed in order to describe the cognitive profile of a teenage boy with congenital adrenal hyperplasia and compared with existing studies in the current literature. a cognitive profile was obtained through different neuropsychological tests, finding the patient moderate mental retardation (5Congenital adrenal hyperplasia (CAH) is a genetic disorder that causes deficits in the synthesis of cortisol. This disease occurs in both genders, it can be diagnosed prenatally and treated from this stage. Physiologically presents ambiguity in the internal and external sex organs that affect the emotional and social development. In the cognitive level can be found two positions one where it is stated that in patients with CAH low scores are presented on IQ (IQ), especially (CI) verbal and significant differences in patients who have not received treatment in time, the other believes that this disease does not affect cognitive processes. In this paper, a single case study of a 13-year HSC is performed in order to describe the cognitive profile of a teenage boy with congenital adrenal hyperplasia and compared with existing studies in the current literature. a cognitive profile was obtained through different neuropsychological tests, finding the patient moderate mental retardation and (50 IQ) with major disorders in language and learning.