Association between autoimmune rheumatic diseases and head and neck cancer: Systematic review and meta-analysis.

BACKGROUND: Personal history of autoimmune rheumatic diseases has been implicated in the development of malignant neoplasms. Our aim was to assess the risk of head and neck (H&N) cancers in patients with autoimmune rheumatic diseases. METHODS: The articles search included PubMed, EMBASE, LILACS, The Cochrane Library, CINAHL, Scopus, Web of Science, and Google Scholar with no language restrictions for studies published from inception of the databases to August 20, 2022, assessing the risk of H&N cancer in patients with autoimmune rheumatic diseases. Studies were included if they reported the standardized incidence ratio (SIR) with corresponding 95% confidence intervals (CIs). The primary outcome was risk of H&N cancers in patients with autoimmune rheumatic diseases compared with the general population. Pooled summary estimates were calculated using a random-effects model, and subgroup analyses were done to establish whether risk of H&N cancers varied according to study site. RESULTS: Our search identified 5378 records, of which 32 cohort studies were eligible for systematic review and 24 for meta-analysis (including 273 613 patients). A significant association was found between H&N cancer and autoimmune rheumatic diseases (SIR = 2.35; 95% CI: 1.57-3.50; p < 0.01, I2  = 94%). CONCLUSION: Our study suggests that patients with autoimmune rheumatic diseases had a significantly increased risk of H&N cancer compared with the general population, including thyroid, oral, and nasopharyngeal cancers. These findings have implications for the individualized screening of these patients and the planning of oncology units. The protocol is registered with PROSPERO, number CRD42020197827.

Characterization of clinical, laboratory, IL-6 serum levels, and IL-6-174 G/C genetic polymorphisms in patients with rheumatoid arthritis and Sjögren's syndrome.

OBJECTIVE: This study aimed to characterize the clinical (disease activity and exocrine gland function), laboratory, interleukin 6 (IL-6) serum levels, and IL-6-174G/C (rs1800795) genetic polymorphisms among rheumatoid arthritis (RA), RA plus Sjögren's syndrome (RA+SS), and control subjects. METHODS: A case-control study enrolling 137 women (52±11 years old) were divided into three groups as follows: RA (n=70), RA+SS (n=29), and healthy control (C, n=38). Individuals underwent clinical evaluation composed of Schirmer's test, unstimulated salivary flow rate, and evaluation of disease activity and functional capacity (Disease Activity Score [DAS28] and Health Assessment Questionnaire [HAQ]). IL-6 serum levels and IL-6-174G/C polymorphisms were assessed. RESULTS: RA and RA+SS presented higher serum levels of IL-6 than controls (p<0.001). Also, higher IL-6 levels were related to swollen joints (p=0.038), limited functional capacity (p=0.004), and disease activity (p≤0.001). However, neither IL-6-174G/C genetic polymorphism nor its allele frequency was associated with RA or RA+SS. CONCLUSION: IL-6 serum is an important marker of RA activity and functional incapacity, but IL-6-174G/C genetic polymorphism did not differ among healthy controls and cases.

Approach and conservative surgical treatment of jaw ameloblastoma: case report / Abordagem e tratamento cirúrgico conservador do ameloblastoma da mandíbula: relato de caso / Abordaje y tratamiento quirúrgico conservador del ameloblastoma de mandíbula: reporte de caso

Abstract Ameloblastoma is a benign neoplasm, originated from the odontogenic epithelium. It preferentially affects the mandible and due to its infiltrative growth pattern, it has a tendency to local recurrence. Treatment varies based on clinical, histological and radiographic characteristics. The aggressive treatment, such as marginal resection, has shown good results, however, it also has greater morbidity. Conservative treatments, such as decompression, enucleation and curettage, can also be used, with specific indications, and when carefully performed, it has a good prognosis. Thus, the objective of this work is to describe a case of mandibular ameloblastoma, treated in a more conservative way. Male patient, 53 years old, presented an increase in volume in the anterior region of the mandible. The clinical and radiographic characteristics suggested that it was a cystic lesion, so decompression and incisional biopsy were performed, the diagnosis of which was cystic ameloblastoma. The decompression device was maintained until bone neoformation was no longer observed, with conservative marginal resection being performed, followed by peripheral ostectomy.

Resumo O ameloblastoma é uma neoplasia benigna, originada no epitélio odontogênico. Afeta preferencialmente a mandíbula e, devido ao seu padrão de crescimento infiltrativo, tem tendência à recorrência local. O tratamento varia com base nas características clínicas, histológicas e radiográficas. O tratamento agressivo, como a ressecção marginal, tem mostrado bons resultados, porém também apresenta maior morbidade. Tratamentos conservadores, como descompressão, enucleação e curetagem, também podem ser utilizados, com indicações específicas e, quando realizados com cuidado, apresentam bom prognóstico. Assim, o objetivo deste trabalho é descrever um caso de ameloblastoma mandibular, tratado de maneira mais conservadora. Paciente do sexo masculino, 53 anos, apresentou aumento de volume na região anterior da mandíbula. As características clínicas e radiográficas sugeriram que se tratava de uma lesão cística, pelo que foram realizadas descompressão e biópsia incisional, cujo diagnóstico era ameloblastoma cístico. O dispositivo de descompressão foi mantido até que a neoformação óssea não fosse mais observada, com ressecção marginal conservadora sendo realizada, seguida de ostectomia periférica.

Resumen El ameloblastoma es una neoplasia benigna, originada del epitelio odontogénico. Afecta preferentemente a la mandíbula y, debido a su patrón de crecimiento infiltrativo, tiene tendencia a la recurrencia local. El tratamiento varía según las características clínicas, histológicas y radiográficas. El tratamiento agresivo, como la resección marginal, ha mostrado buenos resultados, sin embargo, también tiene una mayor morbilidad. Los tratamientos conservadores, como la descompresión, la enucleación y el legrado, también se pueden utilizar, con indicaciones específicas, y cuando se realiza con cuidado, tiene un buen pronóstico. Por lo tanto, el objetivo de este trabajo es describir un caso de ameloblastoma mandibular, tratado de una manera más conservadora. Paciente masculino, de 53 años, presentó un aumento de volumen en la región anterior de la mandíbula. Las características clínicas y radiográficas sugirieron que se trataba de una lesión quística, por lo que se realizó descompresión y biopsia incisional, cuyo diagnóstico fue ameloblastoma quístico. El dispositivo de descompresión se mantuvo hasta que ya no se observó neoformación ósea, realizándose una resección marginal conservadora, seguida de ostectomía periférica.

Photobiomodulation for mucosal repair in patients submitted to dental extraction after head and neck radiation therapy: a double-blind randomized pilot study.

OBJECTIVE: The aim of this study was to evaluate the efficacy of photobiomodulation therapy (PBMT) on the mucosal healing of patients submitted to simple dental extractions after head and neck radiation therapy (HNRT). METHODS: Forty surgical procedures were randomly assigned into two groups: G1: dental extraction + PBMT (n = 19) and G2: dental extraction + sham-PBMT (n = 21). All patients received antibiotic therapy and the surgical alveolotomy to promote primary closure of the surgical site. Group 1 was submitted to PMBT according to the following parameters: 808 nm, 40 mW, 100 J/cm2, 70 s, 2.8 J/point, 14 J/session, and area of 0.028cm2. The primary outcome was complete mucosal lining at 14 days, and the secondary outcomes were the presence of infection, postoperative pain, and analgesics intake at 7 days. The patients were evaluated every 7 days until 28 days. RESULTS: Alveolar mucosal lining was faster in G1, and at 14 postoperative days, 94.7% patients evolved with complete alveolar mucosal lining compared to no patient from G2 (p < 0.001). Patients from G1 reported postoperative pain less frequently (G1 = 4, 21.1% × G2 = 14, 66.7%, p = 0.005), and also reported lower intake of analgesic pills at D7 (21.1% × 66.7%, p = 0.005%). PBMT had a significant positive impact on both postoperative pain (NNT = 2.192, CI95% = 1.372-5.445) and mucosal healing (NNT = 1.056, CI95% = 0.954-1.181). CONCLUSIONS: This preliminary study strongly supports the use of PMBT to promote surgical alveolar mucosal lining in a shorter time and with less postoperative pain.

Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ?

Several viruses transmitted through saliva, such as herpes simplex virus, cytomegalovirus, and Zika virus, are capable of infecting and replicating in the oral mucosa, leading to painful oral ulcers. Few studies have described the oral manifestations of coronavirus disease 2019 (COVID-19). There is growing evidence that angiotensin-converting enzyme 2 (ACE2), the main host cell receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed on the epithelial cells of the tongue and of the salivary glands, which may explain the development of dysgeusia in patients with COVID-19. Hence, it is important to understand if SARS-CoV-2 can infect and replicate in oral keratinocytes and fibroblasts, causing oral ulcerations and superficial necrosis. Here, we report a series of 8 cases of COVID-19 infection, with oral necrotic ulcers and aphthous-like ulcerations which developed early in the course of disease after the development of dysgeusia and affected the tongue, lips, palate, and oropharynx. A short review of the literature regarding the important role of ACE2 in SARS-CoV-2 cellular entry is also provided, bringing new insights into oral keratinocytes and minor salivary glands as potential targets.

Review on therapeutic targets for COVID-19: insights from cytokine storm.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been caused the greatest pandemic of our century. Many of the deaths related to it are due to a systemic inflammatory response, which has been called 'cytokine storm'. OBJECTIVES: We developed a comprehensive review of the pathophysiology mechanisms of COVID-19 and of the rationale for drugs and therapeutics that have been tested in clinical trials. METHODS: A narrative review of the literature was conducted using PubMed, SciELO, Bireme, Google Scholar and ClinicalTrials. RESULTS: SARS-CoV-2 has evolutive mechanisms that made it spread all around the globe, as a higher latency period and a lesser lethality than other coronaviruses. SARS-CoV-2 causes a delay in the innate immune response and it disarranges the immune system leading to an overwhelming inflammatory reaction (the 'cytokine storm'). In this scenario, high levels of interleukins (IL), notably IL-6 and IL-1, create a positive feedback of chemokines and immune responses, and powers pulmonary and systemic tissue damage, leading to capillary leakage and SARS, the main cause of death in patients with COVID-19. On 17 July 2020, there were 1450 entries on ClinicalTrials.gov of ongoing studies on COVID-19. The mechanisms of the main therapeutic approaches were comprehensively reviewed throughout the text. Therapies focus on blocking viral entry (remdesivir, umifenovir, among others) and blocking of immune system for cytokine storm control (IL-1 and IL-6 inhibitors, glucocorticoids, convalescent plasma, among others). CONCLUSIONS: Understanding of action mechanisms of SARS-CoV-2 enables us to direct efforts on effective therapeutic targets. This comprehensive review helps to interpret the clinical results of the several trials ongoing.

Headache in Medical Residents: A Cross-Sectional Web-Based Survey.

BACKGROUND: Although a common complaint and related to factors frequently present in medical residency such as psychological distress, depression, and anxiety, headache is an issue poorly explored among medical residents. METHODS: This was a cross-sectional study enrolling medical residents from all geographic regions of Brazil. We applied an online structured survey with demographic and residency program-related questions, as well as validated tools to assess burnout, diurnal somnolence, anxiety, depression, and migraine. RESULTS: The link to the survey received 1989 clicks, of which 1421 individuals completed the questionnaire (71.4% of all clicks). The prevalence of at least 1 headache attack in the last 3 months was 1236/1419 (87.1%); migraine occurred in 400/1419 (28.2%). Frequent headache attacks (headaches occurring daily or often) were associated with female sex (OR = 1.80 [95%CI = 1.36-2.37]), substantial weight gain (1.93 [1.38-2.70]), migraine (5.49 [4.16-7.24]), anxiety (1.45 [1.06-1.98]), depression (1.98 [1.47-2.67]), emotional exhaustion domain of burnout (1.49 [1.09-2.04]), and diurnal somnolence symptoms (1.32 [1.00-1.76]). Headaches with functional impact were associated with female sex (1.39 [1.10-1.74]), clinical training areas (1.32 [1.06-1.65]), anxiety (1.74 [1.38-2.21]), an unsatisfactory work-life balance (1.57 [1.17-2.09]), the emotional exhaustion component of burnout (1.49 [1.14-1.94]), and an unsatisfactory subjective learning curve (1.30 [1.02-1.67]). Migraine was associated with female sex (3.10 [2.34-4.13]), anxiety (2.53 [1.94-3.31]), more than 60 hours duty-hours in residency (1.66 [1.29-2.15]), psychological abuse from patients (1.42 [1.06-1.90]) and a clinical training area (1.34 [1.04-1.73]). CONCLUSION: Headaches among medical residents are frequent and are related not only to depression, anxiety, burnout, and diurnal somnolence, but also to aspects closely related to residency training such as the occurrence of mistreatment, longer duty-hours, a poor work-life balance, and an unsatisfactory learning curve.

Tratamento cirúrgico do lábio duplo: relato de caso / Surgical treatment of the double lip: case report

Introdução: O lábio duplo é caracterizado por excesso de tecido na mucosa labial, de aspecto normal, podendo acometer o lábio superior, inferior ou ambos. Ocorre com maior incidência no lábio superior, de forma uni ou bilateral, podendo ser congênito ou adquirido. A alteração geralmente é perceptível em repouso, durante a fala ou sorriso. O tratamento cirúrgico pode ser necessário, caso o paciente apresente comprometimento estético e/ou funcional. Relato de caso: Neste trabalho, é descrito um caso clínico de lábio duplo, adquirido em paciente do sexo masculino de 40 anos de idade cujas queixas eram estéticas e funcionais. Considerações Finais: Foi realizada cirurgia para remoção do excesso tecidual com incisão por planos em forma de elipse, solucionando, assim, a deformidade... (AU)

Introduction: The double lip is characterized by excess of tissue in the labial mucosa, of normal aspect, being able to affect the upper lip, inferior or both. Occurring with greater incidence in the upper lip of uni or bilateral form, being able to be congenital or acquired. The change is usually noticeable at rest, during speech or smile. Surgical treatment may be necessary if the patient presents with aesthetic and/ or functional impairment. Case report: This paper describes a clinical case of double lip acquired in a 40-year-old male patient, whose complaints were aesthetic and functional. Final considerations: Surgery was performed to remove tissue excess with incision through ellipse-shaped planes, thus solving the deformity... (AU)