Hypovitaminosis D, oral potentially malignant disorders, and oral squamous cell carcinoma: a systematic review.

BACKGROUND: Oral squamous cell carcinoma (OSCC) and potentially malignant oral disorders (OPMDs) could be associated with low levels of vitamin D. This systematic review aimed to determine the relationship between serum levels of vitamin D with OPMDs and OSCC. MATERIAL AND METHODS: This review was conducted according to Cochrane guidelines (PROSPERO CRD42020207382) on literature retrieved from the PubMed, Cochrane, and Web of Science databases. The antecedents extracted were study design, methodology, sample (country, number of patients, age, and sex), oral manifestations (type of lesion, location, prevalence, and follow-up), serum vitamin D levels or use of vitamin D supplements, results, and conclusions. RESULTS: Twelve articles were selected. Some of the most relevant findings were alterations in vitamin D could favor the progress of OPMDs to OSCC. Higher levels of vitamin D can increase levels of anti-inflammatory mediators, CD4+ T lymphocytes and CD8+ T lymphocytes and CD3+ T lymphocytes in intratumoral tissue. The normalization of vitamin D levels in patients with OSCC can increased cytotoxic activity of natural killer cells, favoring antitumor immune response. Vitamin D supplemented can lower adverse effects associated with chemotherapy like mucositis and pain. Tobacco can increase risk of developing OSCC altering vitamin D levels. CONCLUSIONS: Hypovitaminosis D could increase risk of developing OSCC from OPMDs, thus altering the immune response and it is associated with a lower survival rate in patients with OSCC, a greater recurrence of tumors in patients who underwent surgical treatment, and an increase in adverse reactions to chemotherapy. The use of vitamin D supplements can be a complement to primary therapy to prevent the recurrence of lesions and reduce adverse events associated with treatment.

Evaluation of saliva as a complementary technique to the diagnosis of COVID-19: a systematic review.

BACKGROUND: Infectious disease coronavirus 2019 (COVID-19) is caused by the SARS-CoV-2 virus, and it mainly affects the upper respiratory tract. The gold standard for its diagnosis is real-time reverse transcription polymerase chain reaction (RT-qPCR) performed on a nasopharyngeal swab. In contrast, testing saliva has significant advantages as a diagnostic method. MATERIAL AND METHODS: We searched for articles evaluating saliva as a diagnostic method for COVID-19 on the PUBMED/MEDLINE, WEB OF SCIENCE, COCHRANE, and SCIELO platforms. We initially found 233 articles and 20 were selected for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol: 18 cross-sectional studies and 2 case reports, including 8 from America, 8 from Asia, and 4 from Europe. The studies evaluated the presence of viral RNA, IgG, IgM, and IgA in samples of unstimulated saliva from adults with confirmed or suspected COVID-19. The vast majority of the studies performed RT-qPCR on the saliva samples and compared the results with the gold standard (a nasopharyngeal swab of the same patient). RESULTS: Saliva samples analyzed by RT-qPCR, reverse transcription isothermal amplification (RT-LAMP), spectroscopy, and enzyme-linked immunosorbent assay (ELISA) offer high sensitivity to detect SARS-CoV-2 in the early stages of the disease and among asymptomatic patients as compared to nasopharyngeal swab RT-qPCR. In addition, the self-collection of saliva offers the possibility of receiving telemedicine instructions to carry out the test, reducing the risk of contagion. CONCLUSIONS: The diagnosis of COVID-19 through saliva is sensitive, non-invasive, and is of low risk for the healthcare professionals. However, further studies are recommended to validate its clinical use.

Clinicopathologic and immunohistochemical characterization of 14 cases of angioleiomyomas in oral cavity.

BACKGROUND: Angioleiomyoma (ALM) is a benign neoplasm that originates from vascular smooth muscle. It is extremely rare in oral cavity. The objective of this study was to evaluate the clinicopathological and immunohistochemical characteristics of all oral angioleiomyomas registered in a Center of Diagnosis of Oral Diseases from 1959 to 2017. MATERIAL AND METHODS: Slides from 14 cases of ALM stained with hematoxylin and eosin (H&E) were analyzed to confirm the diagnosis. Moreover, an immunohistochemical panel with alpha-smooth muscle actin (alpha-SMA), desmin, AE1/AE3, CD68, S-100, and CD34 antibodies was performed to evaluate semi-quantitatively the positive cells. RESULTS: ALM correspond to 0.08% of all benign oral tumors analyzed during the 57-year period. The mean age of the patients was 45 years with a predilection to males (58%). The most frequently reported site was lips (50%). Microscopic analysis on H&E sections revealed similar pattern in all cases, showing well-circumscribed and encapsulated tumors, characterized by a proliferation of smooth muscle cells and wide vascular spaces of varying sizes. The predominant immuno profiles were: alpha-smooth muscle actin (alpha-SMA) positive (strong immunoreactivity); positive variable pattern for desmin, negative immunoprofile for AE1/AE3, CD68, and S-100. The endothelial cells of vascular spaces were CD34+. CONCLUSIONS: Based on the results, the alpha-SM actin can be elected as a good marker for angioleiomyomas and can help the confirmation of the morphologic diagnosis of this lesion.

Macroglossia, the first manifestation of systemic amyloidosis associated with multiple myeloma: Case report.

Amyloidosis is a group of diseases characterized by an irreversible and extracellular deposition of fibrillar, amorphous protein known as amyloid in different organs and tissues. Amyloid deposits may occur locally in tissues or may involve various organs, resulting in a wide range of clinical manifestations. Amyloidosis of the head and neck is rarely seen and can reflect some plasma cell dyscrasia that affects B lymphocytes. Deposition of amyloid on the tongue is very rare and accounts for less than 9% of all types of amyloidosis. Amyloid involvement of the tongue is almost always secondary to systemic amyloidosis. We report a 73-year-old female who presented with weight loss and macroglossia. Firstly, she was diagnosed only with amyloidosis of the tongue. Her general health condition was evaluated, revealing renal dysfunction, anemia, hypercalcemia, and hyperphosphatemia. The final diagnosis was systemic amyloidosis with multiple myeloma. The patient was referred for emergency hemodialysis and chemotherapy. Her condition progressed to congestive heart failure and recurrent urinary and respiratory infections. After 100 days from diagnosis, the patient died by pulmonary infection as a consequence of her weakened state of health. It is important to highlight role of the dentist especially oral pathologist to the evaluation of local alterations that may reflect systemic deterioration of patients.

Expresión inmunohistoquímica de ki-67 y p53 en tumor odontogénico queratoquístico en comparación con ameloblastoma multiquístico / Immunohistochemical expression of Ki-67 and p53 in odontogenic keratocysts in comparison with ameloblastomas

Introducción: Ha sido descrita la inmunodetección de p53 y Ki-67 en el tumor odontogénico queratoquístico (TOQ) y en ameloblastomas mutiquísticos (AM). Sin embargo, hay escasa y contradictoria evidencia respecto de la comparación de estos dos marcadores entre estas neoplasias. Su estudio podría contribuir a comprender las diferencias que presentan en su comportamiento clínico y ser un complemento discriminatorio al momento de definir tratamiento, pronóstico y recidiva. Objetivo: Comparar el recuento de inmunomarcación de p53 y Ki-67 en células epiteliales de TOQ y AM, presentes en el registro de biopsias del Instituto de Referencia de Patología Oral (IREPO), de la Facultad de Odontología de la Universidad de Chile entre los años 2000-2011. Metodología: Estudio observacional de corte transversal. Se estudiaron mediante inmunohistoquímica 8 casos de TOQ y 6 casos de AM con diagnóstico histopatológico según la clasificación de la OMS del 2005. Las muestras se encontraban en bloques de parafina, fijadas en formalina. Resultados: Los datos mostraron una distribución normal en cuanto al número de células positivas para ambos inmunomarcadores. No hubo diferencias estadísticamente significativas en la inmunomarcación de Ki-67 y p53 para TOQ y AM. Sin embargo, en ambas neoplasias, la inmunomarcación de p53 fue mayor respecto a Ki-67, con una diferencia estadísticamente significativa tanto en TOQ (p=0.0134) como en AM (p=0.0079). Conclusión: Los resultados sugieren que la inhibición de apoptosis predominó en ambos tumores por sobre la multiplicación celular. Estas diferencias podrían relacionarse con su potencial de crecimiento.

Introduction: p53 and Ki-67 immunodetection have been described in the keratocystic odontogenic tumor (TOQ) and multicystic ameloblastomas (AM). However, there is limited and contradictory evidence regarding the comparison of these two markers between these neoplasias. Their study could help to understand the differences that occur in their clinical behavior and be a complement when defining discriminatory treatment, prognosis and recurrence. Objective: To compare the immunomarking count of p53 and Ki-67 in epithelial cells in AM and TOQ present in the biopsies registered at the Oral Pathology Reference Institute (IREPO), Faculty of Dentistry, University of Chile from 2000 to 2011. Methods: Cross-sectional observational study. 8 cases of TOQ and 6 cases of AM with histopathological diagnosis according to the WHO classification of 2005 were studied using immunohistochemistry. The samples were formalin-fixed and paraffin-embedded. Results: The data showed a normal distribution in the number of positive cells for both immunomarkers. There were no statistically significant differences in the Immunohistochemical expression of Ki-67 and p53 of TOQ and AM. However in both tumors, the immunohistochemical expression of p53 was higher compared to Ki-67, with a statistically significant difference in TOQ (p=0.0134) and AM (p=0.0079). Conclusion: The results suggest that inhibition of apoptosis in both tumors predominated over cell multiplication. These differences may be related to their growth potential.

Estudio de confiabilidad de la prueba de sialometría para flujo no estimulado en sujetos adultos clínicamente sanos / Study of reliability of the sialometry test for non-stimulated flow in clinically healthy adult individuals

Introducción: En personas sanas, la velocidad de flujo salival o sialometría (VFS) puede afectarse por la edad, género y ritmo circadiano. No existe evidencia de la reproducibilidad de VFS no estimulada determinada en 5 minutos, en distintos momentos del día en un mismo individuo. Objetivos: Determinar confiabilidad de VFS no estimulada medida en 5 minutos, reproducibilidad en el tiempo y relación con rango etario y género. Metodología: Se determinó VFS durante 15 minutos en 42 individuos clínicamente sanos, con una mediana de 45.5 (30-65) años, entre 9 y 11 AM durante dos mañanas y entre 3 y 5 PM durante la tarde del segundo día de medición. La saliva se colectó en tubos separados durante 5 minutos y durante los 10 minutos restantes. El peso de las muestras fue expresado en ml/min. Los valores entre los grupos de estudio, se compararon mediante test t de Student, ANOVA y coeficiente de correlación de Spearman. Resultados: VFS promedio fue de 0.623 +/- 0.329 y de 0.551 +/- 0.289 a los 5 y 15 minutos respectivamente (p=0.001). VFS fue mayor en hombres a los 5 y 15 minutos (p=0.001). VFS en mujeres, disminuyó al aumentar la edad. No hubo diferencias en VFS a los 5 minutos (p=0.375) y a los 15 minutos (p=0.825), en distintos días y momentos del día, en un mismo individuo. Conclusión: VFS colectada durante 5 minutos, en un mismo individuo, presenta valores constantes en distintos días y momentos del día.

Introduction: In healthy persons, the salivary flow rate (VFS) or sialometry can be affected by the age, the gender and the circadian rhythm. There is no evidence of the reproducibility of the non-stimulated VFS determined in 5 minutes, in different moments of the day in the same individual. Aim: To determine the reliability of the non-stimulated VFS measured in 5 minutes, its reproducibility over time and its relation with the age range and the gender. Methodology: VFS was determined for 15 minutes in 42 clinically healthy individuals, with a median age of 45.5 (30-65), between 9 and 11 AM in two mornings and between 3 and 5 PM in the evening of the second day of measurement. The saliva was collected in 2 separated pipes, one for the first 5 minutes and one for the 10 remaining minutes. The weight of the samples was expressed in ml/min. The values between the groups of study were compared by means of the Student’s t-test, ANOVA and the Spearman’s correlation coefficient. Results: The average VFS was of 0.623 +/- 0.329 and of 0.551 +/- 0.289 after 5 and 15 minutes respectively (p=0.001). VFS was higher in men after 5 and 15 minutes (p=0.001). VFS in women diminished as the age increased. There were no differences in VFS after 5 minutes (p=0.375) and after 15 minutes (p=0.825), in different days and moments of the day, in the same individual. Conclusion: VFS collected for 5 minutes in the same individual presents constant values in the different days and moments of the day.