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BACKGROUND: Oral cancer (OC) and oral potentially malignant disorders (OPMD) pose significant challenges to public health in Brazil. This study aimed to estimate the prevalence of oral cancer (OC) and oral potentially malignant disorders (OPMD) among patients who would be treated by Brazilian dentists during their careers. MATERIAL AND METHODS: Data on the number of dentists in Brazil were extracted from the 2022 census data, while incidence rates for OC cases were sourced from the Brazilian National Cancer Institute (INCA). Population estimates for Brazil and data on dental check-up rates were obtained from relevant national sources. RESULTS: Our analysis indicates that a general dentist in Brazil can expect to encounter on average two to three OC patients and on average 675 patients with OPMDs over a 35-year career. Regional disparities were observed, with certain regions showing higher than the average number of encounters due to low density of dentists in some rural districts. CONCLUSIONS: Brazilian dentists are likely to confront a substantial number of OPMD cases during their professional tenure, emphasizing the need for public health policies aimed at enhancing dental surgeons' education in oral cancer prevention and early detection.
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Primaquine is the mainstream antimalarial drug to prevent Plasmodium vivax relapses. However, this drug can induce hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. Nanostructure formulations of primaquine loaded with D-galactose were used as a strategy to target the drug to the liver and decrease the hemolytic risks. Nanoemulsion (NE-Pq) and nanochitosan (NQ-Pq) formulations of primaquine diphosphate containing D-galactose were prepared and characterized by their physicochemistry properties. Pharmacokinetic and biodistribution studies were conducted using Swiss Webster mice. A single dose of 10 mg/kg of each nanoformulation or free primaquine solution was administered by gavage to the animals, which were killed at 0.5, 1, 2, 4, 8, and 24 hours. Blood samples and tissues were collected, processed, and analyzed by high-performance liquid chromatography. The nanoformulation showed sizes around 200 nm (NE-Pq) and 400 nm (NQ-Pq) and physicochemical stability for over 30 days. Free primaquine solution achieved higher primaquine Cmax in the liver than NE-Pq or NQ-Pq at 0.5 hours. However, the half-life and mean residence time (MRT) of primaquine in the liver were three times higher with the NQ-Pq formulation than with free primaquine, and the volume distribution was four times higher. Conversely, primaquine's half-life, MRT, and volume distribution in the plasma were lower for NQ-Pq than for free primaquine. NE-Pq, on the other hand, accumulated more in the lungs but not in the liver. Galactose-coated primaquine nanochitosan formulation showed increased drug targeting to the liver compared to free primaquine and may represent a promising strategy for a more efficient and safer radical cure for vivax malaria.
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Antimaláricos , Quitosano , Galactosa , Hígado , Primaquina , Primaquina/farmacocinética , Primaquina/química , Animales , Ratones , Hígado/metabolismo , Hígado/efectos de los fármacos , Galactosa/química , Quitosano/química , Antimaláricos/farmacocinética , Nanopartículas/química , Distribución Tisular , Nanoestructuras/química , MasculinoRESUMEN
BACKGROUND: The Latin American region represents a hotspot for oral cancer incidence and mortality. To reduce oral cancer mortality rates, screening for early detection of subjects with suspicious or innocuous oral lesions has been promoted. A systematic review was performed to assess the outcomes of oral cancer screening in the Latin American region. MATERIAL AND METHODS: An electronic search was conducted in eight databases and grey literature. The eligibility criteria included screening where adult participants underwent any screening test during an organized screening program. Screening programs were assessed to understand trends in oral cancer diagnosis. Rates of oral cancers diagnosed in screening programs were classified as increase, decrease, or stable based on each year assessed. RESULTS: Following our searches, twelve studies conducted in Brazil and Cuba were included. The screening tests reported were visual oral examination (VOE) and in one study in addition light-based fluorescence testing. 13,277,608 individuals were screened and a total of 1,516 oral cancers were detected (0.01%). Only two studies aimed to screen high-risk individuals (smokers and drinkers). Oral cancer cases diagnosed during screening programs were proportionately stable over the years 1997 to 2009 but increased from 2010 to 2021. The fluorescence-associated VOE test demonstrated a sensitivity of 100% and a specificity of 90%. Similarly, the VOE test alone exhibited a sensitivity of 100%, with specificity ranging from 75% to 90%. CONCLUSIONS: Screening studies conducted in Latin American countries had serious limitations both in methodology (lack of examiner training) and in reporting data (lack of description of clinical categories of screen positives). Capacitation of health workers to perform VOE in well-designed screening programs should be implemented.
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Detección Precoz del Cáncer , Neoplasias de la Boca , Humanos , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/epidemiología , Brasil/epidemiología , Cuba/epidemiología , América Latina/epidemiologíaRESUMEN
The isolation of multidrug-resistant Klebsiella pneumoniae in hospitals is a major public health threat, increasing patient hospitalization costs, morbidity and mortality. Therefore, this work investigated the resistance mechanisms that produced different carbapenems susceptibility profiles in two isogenic strains of K. pneumoniae isolated from the same patient in a public hospital in Recife, Pernambuco. The genes that encode the main porins in K. pneumoniae, ompK35 and ompK36, and several beta-lactamase genes were analyzed. The expression of these genes was evaluated by quantitative real time PCR (polymerase chain reaction) with reverse transcriptase (RT-qPCR). SDS-PAGE (sodium dodecyl sulphate-polyacrylamide gel electrophoresis) was performed to analyze the outer membrane proteins. The analysis of the ompK36 genetic environment disclosed an IS903 insertion sequence disrupting this gene in the ertapenem resistant isolate (KPN133). The blaKPC-2 gene showed down-regulated expression in both isolates. Our findings show that changes in porins, especially OmpK36, are more determinant to carbapenems susceptibility profile of bacterial isolates than variations in blaKPC gene expression.
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Carbapenémicos , Infecciones por Klebsiella , Humanos , Carbapenémicos/farmacología , Carbapenémicos/metabolismo , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/metabolismo , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Infecciones por Klebsiella/microbiología , Porinas/genética , Porinas/metabolismo , Pruebas de Sensibilidad MicrobianaRESUMEN
BACKGROUND: This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. MATERIAL AND METHODS: This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. RESULTS: A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient's emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. CONCLUSIONS: The lack of training and low confidence in dealing with patients' emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals.
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Neoplasias Orofaríngeas , Revelación de la Verdad , Humanos , Estudios Transversales , Odontólogos/psicología , Autoevaluación (Psicología) , Encuestas y CuestionariosRESUMEN
Soret effect and diffusion in triethylene glycol (TEG)-water mixtures were investigated as a function of concentration at 25 °C by means of optical digital interferometry, with the use of a classical Soret cell. Diffusion D, thermal diffusion DT, and Soret ST coefficients are described for the full concentration range and an analysis is made individually for TEG-water mixture and within a series of n-ethylene glycol (n-EG) aqueous systems. All coefficients decrease with increasing the concentration of TEG and n-EG. ST shows a change of sign with concentration, and this change is directly related to the ability of the n-EG molecule to establish hydrogen bonding with water. Diffusion and thermal diffusion coefficients present a plateau behavior with increasing concentration, showing the occurrence of changes in the preferential interactions in aqueous solution with concentration and meaning that, at high TEG composition, ether oxygens can be involved in the molecular interactions.
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Glicol de Etileno , Agua , Difusión , PolietilenglicolesRESUMEN
BACKGROUND: HIV-related non-Hodgkin lymphomas of the oral cavity are rare lesions with aggressive clinical behaviour. The aim of this study is to describe the clinicopathological features of a series of HIV-related oral non-Hodgkin lymphomas. MATERIAL AND METHODS: Eleven cases of oral lymphomas affecting HIV-positive patients were retrieved from 2012 to 2019. Clinicopathological features regarding age, sex, tumour location, clinical presentation, laboratory findings, disease stage and follow-up were obtained. Histologic, immunohistochemical and in situ hybridization for EBV detection were done for diagnosis confirmation. Overall survival was estimated by Kaplan-Meier curve. RESULTS: Males predominated, with a mean age of 40.3 years-old. Maxilla and mandible were the mostly affected. Plasmablastic lymphoma and diffuse large B-cell lymphoma not otherwise specified (NOS) were the main histological types. Lesions presented as reddish ulcerated swellings, representing the first sign of AIDS in six cases. Stage IV were common (7 cases) and the mean HIV viral load was 10,557 copies/mL, with a mean of 266 CD4+ cells/mm3, 1,278 CD8+ cells/mm3 and a CD4+/CD8+ ratio of 0.26. Eight patients died of the disease (72.7%). Overall survival revealed that 78.2% of the patients died after 21 months of follow-up. CONCLUSIONS: HIV-related oral lymphomas present a poor prognosis usually diagnosed in advanced stages and in our series plasmablastic lymphoma was the most common subtype.
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Infecciones por VIH , Linfoma de Células B Grandes Difuso , Linfoma no Hodgkin , Adulto , Infecciones por VIH/complicaciones , Humanos , Hibridación in Situ , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patología , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/patología , Masculino , Boca/patologíaRESUMEN
BACKGROUND: Kaposi's sarcoma (KS) is an uncommon, multifocal and angioproliferative lesion, which demonstrates a poor prognosis. The aim of the present research was to explore the association of HIV viral load, CD4+ and CD8+ counts and the CD4+/CD8+ ratio on the risk of oral Kaposi's sarcoma (KS) development. MATERIAL AND METHODS: A total of 62 patients were retrieved from March 2008 to October 2020 from the files of two oral pathology centres. Clinical, laboratory and follow-up data were retrieved from their medical files. Poisson regression was used to explore the role of history of immunosuppression and its association with oral KS development. A P-value <0.05 was considered significant. RESULTS: Sixty-two patients were included in the present study (32 with oral KS and 30 with no presentation of lesions anywhere on the body). Patients with oral KS presented a mean age of 32.6 years, and male patients were more affected. The hard palate (15 cases; 46.8%) was the main anatomical site affected. The lesions were mostly presented as swellings (13 cases; 40.6%) and nodules (12 cases; 37.5%). Systemic manifestations were also observed, including candidiasis (4 cases; 12.5%), bacterial infection (3 cases; 9.3%), tuberculosis (3 cases; 9.3%), herpes simplex (3 cases; 9.3%) and pneumonia (3 cases; 9.3%). A significant correlation was observed between HIV viral load, CD4+ count and the CD4+/CD8+ ratio with oral KS development. CONCLUSIONS: HIV viral load, CD4+ count and the CD4+/CD8+ ratio are associated with oral KS development.
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Infecciones por VIH , Sarcoma de Kaposi , Adulto , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , Infecciones por VIH/complicaciones , Humanos , Masculino , Sarcoma de Kaposi/complicaciones , Carga ViralAsunto(s)
Infecciones Asintomáticas , Infecciones por Coronavirus , Disgeusia , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2 , Glándulas SalivalesRESUMEN
BACKGROUND: Although new digital pathology tools have improved the positive cell quantification, there is a heterogeneity of the quantification methods in the literature. The aim of this study was to evaluate and propose a novel dendritic cells quantification method in squamous cell carcinoma comparing it with a conventional quantification method. MATERIAL AND METHODS: Twenty-six squamous cell carcinomas HIV-positive cases affecting the oropharynx, lips and oral cavity were selected. Immunohistochemistry for CD1a, CD83, and CD207 was performed. The immunohistochemical stains were evaluated by automated examination using a positive pixel count algorithm. A conventional quantification method (unspecific area method; UA) and a novel method (specific area method; SA) were performed obtaining the corresponding density of positive dendritic cells for the intratumoral and peritumoral regions. The Mann-Whitney U test was used to verify the influence of the quantification methods on the positive cell counting according to the evaluated regions. Data were subjected to the ANOVA and Student's t-test to verify the influence of the tumour location, stage, histological grade, and amount of inflammation on the dendritic cells density counting. RESULTS: The cell quantification method affected the dendritic cells counting independently of the evaluated region (P-value <0.05). Significant differences between methods were also observed according to the tumour features evaluations. CONCLUSIONS: The positive cell quantification method influences the dendritic cells density results. Unlike the conventional method (UA method), the novel SA method avoids non-target areas included in the hotspots improving the reliability and reproducibility of the density cell quantification.
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Carcinoma de Células Escamosas , Infecciones por VIH , Células Dendríticas , Humanos , Proyectos Piloto , Reproducibilidad de los ResultadosRESUMEN
The study aimed to verify whether a hormone protocol started at Day 13 (D13) after Timed Artificial Insemination (TAI) influences the conception rate. Nelore cows (primiparous and multiparous) from two commercial beef farms (n = 1,431) were first TAI (D0). Timed AI was performed in lots (TAI Lots) ranging from 187 to 346 cows. On D13, regarding the TAI lot, cows were assigned for either receiving (Resynch group, n = 1,002) or not (Control group, a subset of approximately 30%, n = 429) another hormone protocol for resynchronization. The same hormone protocol was used for the first TAI and for the resynchronization, except for 1 mg instead of 2 mg of estradiol benzoate (EB) at the begging of the protocol. Eight days later (D21), the Resynch group was checked for corpus luteum blood flow by color Doppler ultrasonography, and in those detected as non-pregnant, the protocol was completed and a 2nd TAI was performed at D23. Pregnancy diagnosis was later (D30) performed by B-mode ultrasonography in the control group and confirmed in the presumptive pregnant cows from the 1st TAI of the Resynch group. The remaining cows were checked for pregnancy 30 days after the 2nd TAI (experimental Day 53). The statistical model to explain conception rate considered the effects of Group (Control or Resynch), Farm, Parity (primiparous or multiparous), Sire, Technician (who perform AI), TAI Lot and pertinent interactions (Group*Parity, Group*Farm and Group*TAI Lot). The statistical analyses of the model were performed using the Proc Glimmix (SAS virtual University Edition). The conception rate for the 1st TAI was similar (P > 0.4) between Control (50.3%, 216/429) and Resynch group (52.6%, 527/1002). The positive predictive diagnostic on D21 showed high relation with PD30 (90.7%, 527/581). In Resynch group, non-pregnant cows (n = 421, 1002 minus 581) were re-inseminated. The conception rate of the 2nd TAI (42.8%, 180/421) was affected (P < 0.002) by side effects of the Farm (48.5 vs. 33.1%) and Parity (51.2 vs. 40.3%, for multiparous vs. primiparous, p < 0.001). Nevertheless, after the 2 TAIs of the Resynch group, the cumulative conception rate was 70.5% (707/1002). In conclusion, the early resynchronization of cows with a low (1 mg) EB dose and progesterone device at D13 after TAI can be used as a strategy to reduce conception interval in beef cattle, and thus to increase the number of pregnant cows from artificial insemination after the breeding season.
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Bovinos , Cloprostenol/farmacología , Cuerpo Lúteo/fisiología , Estradiol/farmacología , Sincronización del Estro , Hormona Folículo Estimulante/farmacología , Animales , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Cloprostenol/administración & dosificación , Estradiol/administración & dosificación , Estrógenos/administración & dosificación , Estrógenos/farmacología , Femenino , Hormona Folículo Estimulante/administración & dosificación , Hormonas/administración & dosificación , Hormonas/farmacología , Luteolíticos/administración & dosificación , Luteolíticos/farmacología , EmbarazoRESUMEN
Bovine tuberculosis is a worldwide spread zoonotic disease. Intradermal tuberculinizations are the most used diagnostic tests in the world. Serological tests can be an ancillary diagnosis for bovine tuberculosis. The objective of this study was to evaluate the diagnostic performance of the ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ™ in infected herds, which were in different disease control stages. One hundred and twenty animals from two dairy herds of Minas Gerais state, Brazil, were subjected to the ELISA serological test and the comparative cervical tuberculin test (CCT). Diagnostic test parameters were estimated using Bayesian latent class models and concordance between tests estimated by the frequentist approach. The ELISA test presented lower sensitivity than CCT in both herds. Its sensitivity was higher in the herd in sanitation process. Specificity estimates were above 95% in both herds. Kappa index indicated low concordance or even disagreement between tests. According to the results, the ELISA IDEXX should not be used as substitution for CCT. The tests must not be associated in series. Parallel association increased diagnostic sensitivity in the herd which was in the process of sanitation.(AU)
A tuberculose bovina é uma zoonose de distribuição mundial cujos testes mais utilizados para o diagnóstico são as tuberculinizações intradérmicas, simples e compartivas. Contudo, testes sorológicos podem constituir diagnósticos auxiliares. O objetivo deste estudo foi avaliar o desempenho diagnóstico do teste ELISA Mycobacterium Bovis Antibody Test Kit IDEXX ® em rebanhos bovinos infectados, que se encontravam em diferentes estágios de controle da doença. Cento e vinte animais de dois rebanhos leiteiros provenientes do estado de Minas Geais-Brasil foram submetidos ao ELISA e à tuberculinização cervical compartiva (TCC). Avaliou-se o desempenho dos testes por meio de modelos Bayesianos de classe latente e a concordância entre os eles, por meio de estatística frequentista. Uma maior sensibilidade do teste foi observada no rebanho previamente tuberculinizado. Em ambos os rebanhos o TCC foi mais sensível que o ELISA. Especificidade acima de 95% foi encontrada em ambos os rebanhos. Foram observadas baixa concordância ou mesmo discordância entre os testes. De acordo com os resultados obtidos, o teste ELISA-IDEXX não deve ser utilizado em substituição à TCC, tampouco devem ser associados em série. Houve aumento da sensibilidade quando os testes foram associados em paralelo no rebanho que já se encontrava em processo de saneamento.(AU)
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Animales , Bovinos , Tuberculosis Bovina/diagnóstico , Ensayo de Inmunoadsorción Enzimática/veterinaria , Control de Enfermedades Transmisibles/métodos , Aprobación de Pruebas de DiagnósticoRESUMEN
BACKGROUND: Radiotherapy is widely used in contemporary head and neck cancer treatment protocols. The ability of head and neck radiotherapy (HNRT) to cause direct radiogenic destruction to the teeth is one of the most controversial topics in the field of oral oncology. Therefore, this systematic review aimed to investigate ionising radiation as an independent factor for physical and chemical changes on the dentine-enamel junction (DEJ), a pivotal dental topography for the onset and progression of radiation-related caries (RRC) and enamel delamination. MATERIAL AND METHODS: Systematic searches were conducted on three databases: Scopus, MEDLINE (Via PubMed) and Embase (Elsevier). Laboratory studies evaluating the effects of simulated or in vivo HNRT on the DEJ were included. The GRADE tool adapted for in vitro studies was used to assess the methodological quality. RESULTS: Of the 154 initially selected studies, eight met the inclusion criteria, from which five studies were graded as high quality of evidence, two studies were graded as moderate quality and one as low quality. Two studies did not demonstrate DEJ alterations following HNRT while the other six articles described several organic and inorganic changes in the DEJ of irradiated teeth samples. These radiogenic events were mostly detected through micro and nanoindentation, Raman micro-spectroscopy, confocal microscopy, Western blotting and optical coherence tomography. CONCLUSIONS: HNRT may have a negative impact on the physical and chemical aspects of the DEJ, predisposing cancer patients to RRC and enamel delamination.
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Caries Dental , Neoplasias de Cabeza y Cuello , Diente , Esmalte Dental , Dentina , HumanosRESUMEN
Objetivo: analisar a incidência de infecção do sítio cirúrgico em revascularizações do miocárdio. Métodos: estudo quantitativo com 314 prontuários de pacientes submetidos às revascularizações no período de 2014 a 2016, do serviço de cirurgia cardíaca. Foram avaliadas as relações de variáveis operatórias com o aparecimento de infecção de sítio cirúrgico para determinar os fatores significativos. Para a coleta dos dados utilizou-se as fichas de circulação extracorpórea e para a análise as definições estabelecidas pela Agência Nacional de Vigilância Sanitária. Resultados: 66,2% eram do sexo masculino; 62,1%, brancos; 47,3%, hipertensos; 22,8%, diabéticos e 91,7%, cirurgias eletivas. Evidenciou-se que febre, edema local em 24 horas, dor, necrose em lesão operatória e (re)abordagem cirúrgica são os principais fatores para incidência de infecções relacionada ao tempo médio de circulação extracorpórea e de cirurgia. Conclusão: a infecção de sítio cirúrgico em revascularizações está relacionada com o tempo de cirurgia e de circulação extracorpórea.
Objective: to analyze the incidence of surgical site infection in myocardial revascularizations.Methods: a quantitative study with 314 medical records of patients submitted to revascularizationin the period from 2014 to 2016, of the cardiac surgery service. The relationships of operativevariables with the appearance of surgical site infection were evaluated to determine the significantfactors. Data collection was done using the cardiopulmonary bypass records and for the analysis thedefinitions established by the National Sanitary Surveillance Agency. Results: 66,2% were male;62,1% white; 47,3% hypertensive and 22,8% diabetic; 91.7% were elective surgeries. It was evidencedthat fever, local edema in 24 hours, pain, necrosis in operative lesion and surgical intervention are the main factors for the incidence of infections related to the mean time of extracorporealcirculation and surgery. Conclusion: the surgical site infection in revascularizations is related to thetime of surgery and extracorporeal circulation.
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Humanos , Circulación Extracorporea , Cirugía Torácica , Enfermería , Infección HospitalariaRESUMEN
BACKGROUND: Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. MATERIAL AND METHODS: Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. RESULTS: Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. CONCLUSIONS: Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy.
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Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeza y Cuello/radioterapia , Enfermedades de la Boca/etiología , Mucocele/etiología , Traumatismos por Radiación/etiología , Enfermedad Aguda , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. MATERIAL AND METHODS: One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. RESULTS: MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately. CONCLUSIONS: All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions.
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Neoplasias Óseas/diagnóstico por imagen , Huesos Faciales/diagnóstico por imagen , Mieloma Múltiple/diagnóstico por imagen , Radiografía Panorámica , Cráneo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
INTRODUCTION: Cancer patients have increased stroke risk from direct and indirect malignancy effects. Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is standard medical treatment for acute ischemic stroke (AIS). AIM: To review rtPA use in AIS patients with active cancer. SUBJECTS AND METHODS: Retrospective observational case-control study evaluating patients with AIS and cancer admitted to our stroke unit between January/2010 and June/2015. RESULTS: Seven cases were identified (86% male; median age: 76), and 20 controls were included matched for age and Oxfordshire Community Stroke Project classification. 29% experienced direct procedure complications vs 30% within the control group, 14% suffered haemorrhagic transformation (vs 20%), one patient experienced serious systemic haemorrhage (case) and one patient experienced serious intracerebral haemorrhage (control). After three months' follow-up, 43% were independent compared with 25% controls, and 29% had died (vs 30%). Undetermined aetiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (71% vs 20%). CONCLUSION: Severe haemorrhagic complications, potentiated by rtPA, carry increased risk of morbidity and mortality. Nevertheless, selected cancer patients with AIS may benefit from rtPA treatment. Active cancer should not be considered an absolute contraindication to rtPA use. Risk of complications and life expectancy should be assessed when making this decision.
TITLE: Seguridad y efectividad del rtPA en el ictus isquemico agudo en pacientes con cancer activo: estudio de casos y controles.Introduccion. Los pacientes con cancer tiene un mayor riesgo de ictus debido a los efectos malignos directos e indirectos. La trombolisis intravenosa con activador tisular del plasminogeno recombinante (rtPA) constituye un tratamiento medico estandar para el ictus isquemico agudo. Objetivo. Revisar el uso de rtPA en el ictus isquemico agudo en pacientes con cancer activo. Sujetos y metodos. Estudio retrospectivo observacional de casos y controles para evaluar pacientes con ictus isquemico agudo y cancer admitidos en la unidad de ictus entre enero de 2010 y junio de 2015. Resultados. Se identificaron siete casos (86% varones; mediana de edad: 76 años) y tambien se incluyeron 20 controles pareados por edad y clasificacion del Oxfordshire Community Stroke Project. Un 29% de casos experimento complicaciones directas del procedimiento frente a un 30% en el grupo control. Un 14% sufrio transformacion hemorragica (frente a un 20%). Un paciente (caso) sufrio una hemorragia sistemica grave, y otro (control), una hemorragia intracerebral grave. A los tres meses, un 43% era independiente (frente a un 25% de los controles) y un 29% habia fallecido (frente a un 30%). Un subtipo etiologico indeterminado (clasificacion TOAST) era mas frecuente en pacientes con cancer (71% frente a 20%). Conclusion. Complicaciones hemorragicas graves, potenciadas por el rtPA, pueden incrementar el riesgo de morbilidad y mortalidad. Sin embargo, pacientes seleccionados con cancer que padecen un ictus isquemico agudo pueden beneficiarse del tratamiento con rtPA. Un cancer activo no deberia considerarse una contraindicacion de uso de rtPA, aunque debe evaluarse el riesgo de complicaciones y la esperanza de vida para tomar la decision.
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Isquemia Encefálica/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Accidente Cerebrovascular/complicacionesRESUMEN
BACKGROUND: Orbital apex syndrome (OAS) is a complex and uncommon disorder that typically damages multiple cranial nerves in association with optic nerve dysfunction. OAS is associated with several different pathologies, however; only a few cases have been reported in association with head and neck cancer (HNC) so far. MATERIAL AND METHODS: A case series of HNC patients diagnosed with OAS is described including clinicopathological data, image findings, and disease outcome. RESULTS: Ptosis and diplopia were diagnosed in four male patients with mean age of 61.2 years who were undergoing treatment for late-stage carcinomas of the tongue, larynx, and nasopharynx, eventually leading to the diagnosis of OAS. The mean overall survival rate after the diagnosis of OAS was 9.5 months. CONCLUSIONS: The current study reinforces evidence that OAS indicates poor prognosis and highlights the importance of early diagnosis.
Asunto(s)
Neoplasias de Cabeza y Cuello/complicaciones , Enfermedades del Nervio Óptico/etiología , Anciano , Enfermedades de los Nervios Craneales/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SíndromeRESUMEN
BACKGROUND: The aims of this study were to verify if head and neck radiotherapy (RT) is able to induce calcified carotid artery atheroma (CCAA) in a large head and neck cancer (HNC) population and also to compare the socio-demographic and clinical findings of patients with and without CCAA detected on panoramic radiographs. MATERIAL AND METHODS: Panoramic radiographs taken before and after head and neck radiotherapy (RT) of 180 HNC patients were selected and analyzed in order to identify the presence of CCAA. In addition, CCAA presence or absence on panoramic radiographs were compared and correlated with clinicopathological findings. RESULTS: A high overall prevalence of CCAA was found on panoramic radiographs (63 out of 180 = 35%) of HNC patients. No significant difference of CCAA before and after RT was observed. There were also no differences between groups (with and without CCAA) regarding age, gender, tobacco and alcohol use, arterial hypertension, diabetes mellitus, acute myocardial infarction, hypercholesterolemia, tumor location, clinical stage of disease and RT dose. However, there was a greater prevalence of strokes in patients with CCAA (p<0.05). CONCLUSIONS: Although CCAA were frequently found in panoramic radiographs of patients with HNC, RT seems not to alter the prevalence of these calcifications.
Asunto(s)
Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/radioterapia , Placa Aterosclerótica/diagnóstico por imagen , Traumatismos por Radiación/diagnóstico por imagen , Radiografía Panorámica , Calcificación Vascular/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/complicaciones , Traumatismos por Radiación/complicaciones , Estudios Retrospectivos , Calcificación Vascular/complicaciones , Adulto JovenRESUMEN
BACKGROUND: Radiation related caries (RRC) can cause rapid progression, with a high potential for dental destruction affecting mainly cervical and incisal areas. Unlike the injuries that occur in the conventional caries, incipient RRC present in unusual surfaces have difficult diagnosis and classification stages of cavitation. MATERIAL AND METHODS: Evaluate the radiographic patterns of demineralization of RRC by using micro-CT. Ten teeth with incipient RRC and 10 teeth with incipient conventional caries (control group) matched by anatomic teeth group and caries affected surfaces were evaluated by X-ray microtomography (micro-CT) Skyscan 1174V2 (50Kv, 1.3 megapixel, Kontich, Belgium). Teeth were placed in a standard position for micro-CT (coronal, transaxial and sagittal sections) during images acquisition. Lesions were classified according to the depth of invasion and relationship with enamel, dentin and pulp. RESULTS: RRC samples presented deeper lesions with higher involvement of enamel and dentin. Control group presented focal and superficial lesions with lower involvement of enamel and dentin. CONCLUSIONS: Incipient RRC present aggressive microtomographic patterns of demineralization when compared to conventional caries, as indicated by deep lesions, regardless of its clinically incipient aspects.