Association between Epstein-Barr Virus and Oral Carcinoma: A Systematic Review with Meta-Analysis.

The purpose of this meta-analysis is to evaluate the association of Epstein-Barr virus (EBV) with oral squamous cell carcinoma (OSCC). We searched the electronic scientific databases of PubMed and Scopus and included a total of 53 studies that were published from 1990 to 2019. The analysis yielded a 45.37% (95% confidence interval [CI]: 38.90-51.84; p < 0.001) overall pooled prevalence of EBV. Studies that used the applied methods of in situ hybridization, polymerase chain reaction, immunology, or RNA microarray showed the following pooled prevalence: 46.08%, 40.32, 54.97%, and 74.89%, respectively. EBV-infected individuals have a 2.5 higher risk for developing OSCC (odds ratio: 2.57; 95% CI: 1.23% to 5.36%; p < 0.001). The present meta-analysis supports the hypothesis of EBV association with OSCC, pointing to this virus as a risk factor for neoplasia. Our findings also suggest that EBV latent transcripts (latent membrane protein 1, EBV nuclear antigen 1 and 2, and EBV-encoded small RNAs) have an important role in this process. Furthermore, novel advancements could arise from large and standardized studies that are constructed to probe for other latent gene expression, eliminate confounding factors (tobacco, alcohol, and high-risk human papillomavirus infection), and define the relationship between EBV and oral carcinomas.

Role of Epstein-Barr Virus and Human Papillomavirus Coinfection in Oral and Anogenital Carcinogenesis: Potential Tumorigenic Pathways.

Epstein-Barr virus (EBV) and human papillomavirus (HPV) have been implicated in 38% of all virus-related cancers. Over the past three decades, both have been detected in anogenital and head-and-neck squamous cell carcinomas (HNSCC), with evidence of involvement in tumor genesis and progression. Very little has been published on HPV/EBV coinfection. In this chapter, we review the literature on the role of these viruses in oral carcinoma and draw parallels with other HNSCCs and anogenital carcinomas, with emphasis on their interplay and potential signaling pathways. EBV infection seems to create an environment that favors HPV latency, supporting the claim that EBV is a cofactor in HPV-related carcinomas. In turn, under certain circumstances, HPV appears to be able to induce EBV to switch to the latent or replicative state. The main viral oncogenes expressed in these malignancies are EBNA1, EBNA2, LMP1, EBERs, and the high-risk HPV oncogenes E6 and E7. The most well-documented human proteins involved are p53, pRb, p16INK4a, p19ARF, Myc, E-cadherin, ß-catenin, EGFR, MLH1, and COX-2. These proteins are directly associated not only with viral products but also with one another in the development of malignancy. Knowledge of the molecular machinery behind carcinomas coinfected with HPV and EBV may help understand how these viruses trigger carcinogenesis and subsidize the development of new biomarkers of tumor aggressiveness and prognosis, alternative surrogate virus markers, and possible therapeutic targets.

Perspectivas de docentes de enfermagem dos domínios do core competencies framework for health promotion / Perspectivas de los dominios del core competencies framework for health promotion por docentes de enfermería / Nursing educators' perceptions of the domains of the core competencies framework for health promotion

RESUMO Objetivo: verificar as perspectivas de docentes de um curso de graduação em enfermagem acerca dos domínios do Core Competencies Framework for Health Promotion, e como estes estão presentes em sua prática. Método: o estudo foi realizado no ano de 2017, em uma instituição pública de ensino superior da Região Nordeste. Foram convidados 62 docentes que atenderam aos critérios de inclusão e exclusão estabelecidos, dos quais 15 participaram da pesquisa. Os resultados foram analisados a partir da análise de conteúdo. Resultados: emergiram as categorias: "Saberes dos docentes acerca da promoção da saúde: reconhecendo os domínios" e "Práticas dos docentes em promoção da saúde: aplicabilidade dos domínios do Core Competencies Framework for Health Promotion". Divergências encontradas a respeito dos saberes e práticas podem influenciar a formação dos enfermeiros em relação às competências necessárias à promoção da saúde. Conclusão: é importante oportunizar estratégias de qualificação e formação continuada em torno da temática em questão.

RESUMEN Objetivo: verificar las perspectivas de docentes de un curso de graduación en enfermería acerca de los dominios del Core Competencies Framework for Health Promotion, y como esos dominios se encuentran en su práctica. Método: el estudio ocurrió en el año de 2017, en una institución pública de enseñanza superior de la Región Nordeste. Se invitaron 62 docentes que obedecían a los criterios de inclusión y exclusión establecidos, de los cuales 15 participaron de la investigación. Se analizaron los resultados por medio del análisis de contenido. Resultados: las categorías resultantes fueron: "Saberes de los docentes acerca de la promoción de la salud: reconociendo los dominios" y "Prácticas de los docentes en promoción de la salud: aplicabilidad de los dominios del Core Competencies Framework for Health Promotion". Hubo divergencias acerca de los saberes y prácticas que pueden influenciar la formación de los enfermeros sobre las competencias necesarias a la promoción de la salud. Conclusión: es importante promover estrategias de cualificación y formación continuada al rededor de la temática en cuestión.

ABSTRACT Objective: to investigate the perceptions of nursing professors from an undergraduate course of the domains of the Core Competencies Framework for Health Promotion and find out how these domains are applied in their teaching practice. Method: The study was conducted in 2017 at a public institution of higher education in the Northeastern Region of Brazil. Sixty-two (62) teachers who met the established inclusion and exclusion criteria were invited. Of these, 15 participated in the study. Results: The following categories emerged: "Nursing educators' knowledge about health promotion: recognizing the domains" and "Nurse Educators'' Practices in Health Promotion: Application of the domains of the Core Competencies Framework for Health Promotion." Conclusion: Training and continuing education strategies on the referred subject should be provided.

Association between Epstein-Barr virus (EBV) and cervical carcinoma: A meta-analysis.

OBJECTIVES: Human papillomavirus (HPV) has been implicated as a major factor in cervical carcinogenesis. However, many pieces of evidence gathered over the last two decades suggest Epstein-Barr virus (EBV) plays a secondary role in this process. The purpose of the present meta-analysis was to determine whether the presence of EBV infection increases the risk of cervical carcinoma. METHODS: Based on 25 articles, the analysis yielded a 33.44% overall pooled prevalence of EBV. RESULTS: The pooled prevalence was higher in patients with carcinoma (43.63%) than in healthy patients (19.0%) or patients with cervical intraepithelial neoplasia 1 (CIN1) (27.34%) or CIN2/3 (34.67%). Co-infection with EBV and HPV displayed a similar pattern. EBV infection was significantly and positively associated with lesion grade in cervical epithelia and was more prevalent in malignant lesions. Moreover, cervical carcinoma occurred four times as often among EBV positive women as in women without EBV infection (OR=4.01 [1.87-8.58]; p<0.001). CONCLUSIONS: The existence of EBV(+)HPV(-) carcinomas, the confirmed expression of latent oncoproteins (EBNA1, EBNA2, LMP1) and EBERs in tumor cells, and the association of EBV with the integration of high-risk-HPV DNA in malignant specimens point to EBV as a co-factor (so far underestimated) in the genesis and/or progression of cervical carcinoma. However, further studies are necessary before the link between EBV and cervical carcinoma can be established.

Interpretive description: a viable methodological approach for nursing research / Descripción interpretativa: un enfoque metodológico viable para la investigación en enfermedad / Descrição interpretativa: uma abordagem metodológica viável para a pesquisa em enfermagem

Abstract Objective: To present a theoretical reflection about the origin and the assumptions of the "Interpretive Description" method, and to discuss its applicability in Nursing and Health research. Method: Theoretical-reflective study, based on articles and books published by proponent of this approach, as well as scientific articles in which the authors reported having used this method in their studies. Results: It was evidenced that the "Interpretive Description" arose from the need to generate a better understanding of clinical practices in Nursing. This approach has its roots in the methodological traditions of the Social Sciences, although it differs from them in terms of its excessive rigidity and essentially theoretical objectives. The proposed method has been applied in several studies either in Nursing as other areas of Health. Conclusion: The "Interpretive Description" is considered a feasible approach for the production of knowledge in Applied Sciences such as Nursing.

Resumen Objetivo: Presentar una reflexión teórica sobre el origen y los presupuestos del método de "Descripción Interpretativa", y discutir su aplicabilidad en las investigaciones en Enfermería y Salud. Método: Estudio teórico-reflexivo, teniendo como base artículos y libros publicados por la proponente de este enfoque, así como artículos científicos en los que los autores mencionar on haber usado ese método en sus estudios. Resultados: Se evidenció que la "Descripción Interpretativa" surgió de la necesidad de generar un mejor entendimiento de prácticas clínicas en Enfermería. Este enfoque tiene raíces en las tradiciones metodológicas de las Ciencias Sociales, aunque diferenciándose de éstas en lo que concierne a su excesiva rigidez y objetivos de naturaleza esencialmente teórica. El método propuesto ha sido aplicado en varios estudios tanto de Enfermería y de otras áreas de la Salud. Conclusión: Se considera la "Descripción Interpretativa" una borda je viable para la producción de conocimiento en Ciencias Aplicadas como la Enfermería.

Resumo Objetivo: Apresentar reflexão teórica sobre o método de "Descrição Interpretativa", discutindo sua aplicabilidade às pesquisas em Enfermagem e em Saúde. Método: Estudo teórico-reflexivo, com base em artigos e livros publicados pela proponente dessa abordagem, e em artigos nos quais os autores referiram ter usado o método. Resultados: Evidenciou-se que a "Descrição Interpretativa" surgiu da necessidade de uma opção metodológica mais direcionada às Ciências Aplicadas como a Enfermagem. Essa abordagem tem raízes em tradições metodológicas das Ciências Sociais, mas diferencia-se destas por sua natureza mais prática e pela maior flexibilidade na aplicação das etapas do método. Esse referencial metodológico vem sendo aplicado em estudos tanto de Enfermagem como de outras áreas da Saúde. Conclusão: Considera-se a "Descrição Interpretativa" uma abordagem metodológica viável e exequível para a produção de conhecimento em Enfermagem.

Atypical presentations of cutaneous leishmaniasis: A systematic review.

Cutaneous Leishmaniasis (CL) is endemic in 88 countries, showing relevant prevalences. The aim of this study was to perform a systematic review on atypical lesions of CL around the world, addressing clinico-epidemiological, immunological and therapeutic aspects. A search of the literature was conducted via electronic databases Scopus and PubMed for articles published between 2010 and 2015. The search terms browsed were "cutaneous leishmaniasis", "atypical" and "unusual". Based on the eligibility criteria, 34 out of 122 articles were included in the final sample. Atypical lesions may include the following forms: erythematous volcanic ulcer, lupoid, eczematous, erysipeloid, verrucous, dry, zosteriform, paronychial, sporotrichoid, chancriform and annular. In any cases, they seem to be another disease like subcutaneous and deep mycosis, cutaneous lymphoma, pseudolymphoma, basal and squamous cell carcinoma. The lesions have been reported in the face, cheeks, ears, nose, eyelid, limbs, trunk, buttocks, as well as in palmoplantar and genital regions; sometimes occurring in more than one area. The reason for clinical cutaneous leishmaniasis pleomorphism is unclear but immunosuppression seems to play an important role in some cases. There are no established guidelines for the treatment of atypical cutaneous leishmaniasis. However, pentavalent antimonials remain as first line treatment for all forms of leishmaniasis even for HIV-infected patients and atpical forms. Finally, to diagnose an atypical lesion properly, the focus has to be on the medical history and the origin of the patient, comparing them to the natural history of leishmaniasis and always reminding of possible atypical presentations, to then start searching for the best diagnostic method and treatment, reducing the misdiagnosis rate and, subsequently, controlling the disease progression. Thereby, contributing for breaking the transmission chain of the parasite, due to early correct diagnosis which, in turn, contributes to reduce the prevalence.