COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia

[RESUMO]. Objetivo. Analisar as tendências de incidência e mortalidade por COVID-19 no Brasil, nas unidades da fede- ração e nas capitais. Método. Realizou-se um estudo ecológico com dados de incidência e de mortalidade por COVID-19 referen- tes ao período de 25 de fevereiro de 2020 (primeiro caso notificado no Brasil) a 31 de julho de 2021. Os dados foram agrupados por mês para cálculo das taxas brutas (por 100 000 habitantes) e avaliação das tendências temporais das unidades da federação e de suas capitais. As modificações significativas nas tendências tem- porais foram analisadas pelo método de regressão por joinpoint. Resultados. Foram identificadas duas ondas de novos casos e óbitos. As unidades da federação com as maiores taxas de incidência foram Amapá, Rio Grande do Norte, Rondônia e Roraima; Amazonas e Rondônia tiveram as maiores taxas de mortalidade. Em geral, as taxas de incidência e mortalidade foram piores na segunda onda. Na primeira onda, a média de meses até o início de uma redução de casos novos foi maior nas capitais, enquanto na segunda onda, o início da redução demorou mais nos estados. Quanto aos óbitos, as capitais necessitaram de menos tempo para apresentar redução tanto na primeira quanto na segunda onda. Conclusão. A heterogeneidade regional detectada reforça a ideia de que a incidência e a mortalidade por COVID-19 estão associadas a fatores políticos, geográficos, culturais, sociais e econômicos.

[ABSTRACT]. Objective. To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method. An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results. Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whe- reas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion. The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

[RESUMEN]. Objetivo. Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método. Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados. Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión. La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

ALDH1 expression and potential clinical implications in chronic inflammatory periapical lesions.

Aldehyde dehydrogenase 1 (ALDH-1) is a marker of stem cells in a variety of diseases, but its role in individuals with chronic inflammatory periapical lesions remains unknown. The aim of this study was to investigate the presence of cells with a stem cell profile based on the immunoexpression of ALDH-1 in periapical granulomas (PGs) and radicular cysts (RCs). A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to immunohistochemical study. The anti-ALDH-1 antibody was applied using the immunoperoxidase technique. An immunoexpression score (intensity vs. percentage of cells) was used, with the cases being classified as low expression (score: 0 to 4) and high expression (score: 6 to 9). The Chi-square test was used with a 5% level of significance. Immunoexpression of ALDH-1 was detected in all cases of PGs and RCs. In PG cases, the expression was diffuse in connective tissue cells, with most cases exhibiting high expression (n = 18; 69.2%), while in RC cases the expression revealed focal distribution in cells of the capsule and epithelial cells of the cystic lining, with most cases classified as low expression (n = 18; 72%). Significant differences in the expression scores of ALDH-1 were observed in PGs (p = 0.003). The variable expression of ALDH-1 suggests the presence of cells with stem cell profiles in PGs and RCs. These findings suggest that periapical tissues infiltrated by chronic inflammation can recruit important cells for the repair or evolution of periapical lesions.

ALDH1 expression and potential clinical implications in chronic inflammatory periapical lesions

Abstract: Aldehyde dehydrogenase 1 (ALDH-1) is a marker of stem cells in a variety of diseases, but its role in individuals with chronic inflammatory periapical lesions remains unknown. The aim of this study was to investigate the presence of cells with a stem cell profile based on the immunoexpression of ALDH-1 in periapical granulomas (PGs) and radicular cysts (RCs). A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to immunohistochemical study. The anti-ALDH-1 antibody was applied using the immunoperoxidase technique. An immunoexpression score (intensity vs. percentage of cells) was used, with the cases being classified as low expression (score: 0 to 4) and high expression (score: 6 to 9). The Chi-square test was used with a 5% level of significance. Immunoexpression of ALDH-1 was detected in all cases of PGs and RCs. In PG cases, the expression was diffuse in connective tissue cells, with most cases exhibiting high expression (n = 18; 69.2%), while in RC cases the expression revealed focal distribution in cells of the capsule and epithelial cells of the cystic lining, with most cases classified as low expression (n = 18; 72%). Significant differences in the expression scores of ALDH-1 were observed in PGs (p = 0.003). The variable expression of ALDH-1 suggests the presence of cells with stem cell profiles in PGs and RCs. These findings suggest that periapical tissues infiltrated by chronic inflammation can recruit important cells for the repair or evolution of periapical lesions.

Polymorphisms of matrix metalloproteinase-7 and -9 are associated with oral tongue squamous cell carcinoma

Abstract Matrix degradation is an important event in the progression, invasion and metastasis of malignant head and neck lesions. Imbalances, mutations and polymorphisms of MMPs and their inhibitors are observed in several cancer subtypes. The aim of this study was to evaluate the association of the MMP-7 gene promoter (181 A/G) and MMP-9 (-1562 C/T) polymorphisms in oral tongue squamous cell carcinoma (OTSCC). MMP-7 (rs11568818) and MMP-9 (rs3918242) single-nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 71 cases of OTSCC. Normal tissue specimens were obtained from 60 healthy volunteers to serve as the control. The MMP-7 G allele and MMP-9 T allele were more frequent in the OTSCC group than the control group, but only when these two SNPs were taken together was a significant association found with the nodal metastasis of OTSCC (p < 0.001). Based on our results, SNPs in the promoter region of MMP-7 and MMP-9 appear to be associated with greater risk of developing OTSCC, and with a higher propensity to form metastatic tumors. In this respect, molecular studies investigating polymorphisms may be useful in predicting tumor behavior.

Polymorphisms of matrix metalloproteinase-7 and -9 are associated with oral tongue squamous cell carcinoma.

Matrix degradation is an important event in the progression, invasion and metastasis of malignant head and neck lesions. Imbalances, mutations and polymorphisms of MMPs and their inhibitors are observed in several cancer subtypes. The aim of this study was to evaluate the association of the MMP-7 gene promoter (181 A/G) and MMP-9 (-1562 C/T) polymorphisms in oral tongue squamous cell carcinoma (OTSCC). MMP-7 (rs11568818) and MMP-9 (rs3918242) single-nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 71 cases of OTSCC. Normal tissue specimens were obtained from 60 healthy volunteers to serve as the control. The MMP-7 G allele and MMP-9 T allele were more frequent in the OTSCC group than the control group, but only when these two SNPs were taken together was a significant association found with the nodal metastasis of OTSCC (p < 0.001). Based on our results, SNPs in the promoter region of MMP-7 and MMP-9 appear to be associated with greater risk of developing OTSCC, and with a higher propensity to form metastatic tumors. In this respect, molecular studies investigating polymorphisms may be useful in predicting tumor behavior.

Análise da relação entre a expressão de marcadores de células tronco tumorais (ALDH-1 e SOX-2) e as características clinico patológicas de neoplasias de glândulas salivares / Analysis of the relationship between the expression of tumor stem cell markers (ALDH-1 and SOX-2) and the clinicopathological characteristics of salivary gland neoplasms

Os mecanismos moleculares e celulares que estão associados a patogênese, baixa resposta ao tratamento, recidiva e óbito em tumores de glândula salivar não são totalmente conhecidos. Nesse sentido, é importante ressaltar que as células-tronco (CT) dentro de um tumor (CTT) estão relacionadas com a tumorigenicidade e progressão em neoplasias humanas. Diante do exposto, o objetivo desse trabalho foi avaliar a expressão de marcadores relacionados às CT (ALDH-1 e SOX-2) em neoplasias de glândula salivar e verificar se suas expressões apresentam associação com dados clinicopatológicos e desfecho dos pacientes. Foram selecionados 103 casos de neoplasias malignas (25 CME; 15 CCA; 13 CAC; 10 ACP; 13 ACSOE; 8 CEME; 7 CAEXAP; 5 CDS; 4 ACCB; 3 CCC) e 51 casos de neoplasias benignas (25 AP; 9 MIO; 7 TW; 5 ACA; 5 ACB). Os dados obtidos foram analisados no software Statistical Package for Social Science, GraphPad Prism e STATA. O nível de significância de 5% foi adotado para os testes estatísticos (p<0.05). Os pacientes do estudo foram principalmente do sexo masculino, com média de idade de 52 anos; a parótida foi o sítio anatômico mais afetado. A maioria das neoplasias malignas, foi classificada como T1-T2, N0 e M0. A expressão das proteínas foi avaliada através de imuno-histoquímica e confirmadas por meio de Western-blot, verificando-se que os resultados foram semelhantes entre as técnicas e que estavam correlacionados estatisticamente, tanto para SOX-2 (p<0.001) quanto para ALDH-1 (p=0.039). Em relação a expressão da SOX-2, a maioria dos tumores benignos foi negativa (n=39; 76.5%), sendo constatada expressão apenas nos tumores sem diferenciação mioepitelial (ACA e TW) (p<0.0001). Em contraparte a maioria dos tumores malignos estudados foi positiva para SOX-2 (n=54; 52.4%) sendo esse resultado estatisticamente significativo (p=0.002). Também foi evidenciada que essa expressão ocorreu em casos sem diferenciação mioepitelial (p=0.006) principalmente em CME e CCC. Não foram evidenciadas associações estatisticamente significativas entre a expressão de SOX-2 e parâmetros clínicos. A proteína ALDH-1 esteve frequentemente expressa no parênquima de neoplasias malignas (n=88; 85.6%) e benignas (100%). De maneira geral, a expressão da ALDH-1 no parênquima não se associou com parâmetros clínicos das neoplasias malignas, entretanto, os casos de CME com alta expressão no parênquima estavam associados com tumores de estadiamento clínico avançado (p=0.047). Foi constatada expressão da ALDH-1 em células do estroma tumoral, principalmente de neoplasias malignas (n=67; 65.0%), estando associada com metástase em linfonodos (p=0.032), estadiamento clínico avançado (p=0.008), recorrência tumoral (p=0.006) e óbito (p=0.013). A sobrevida global e livre de doença em 5 e 10 anos foi menor em pacientes diagnosticados com CAC, estadiamento clínico avançado, que apresentaram recorrência e com expressão estromal de ALDH-1. Destaca-se que na análise multivariada, o estadiamento clínico avançado e expressão estromal da ALDH-1 representaram fatores prognósticos independentes na sobrevida livre de doença. Com base nos resultados apresentados pode-se concluir que o perfil que caracteriza as CTT apresenta variações nos diferentes tumores de glândula salivar. A expressão diferencial da SOX-2 e ALDH-1 nessas neoplasias sugere que existem subtipos diferentes de CTT que podem ser ativadas por vias moleculares distintas. Conclui-se também que a presença de marcação estromal para ALDH-1 caracteriza células com perfil de CT mesenquimais que podem estar diretamente relacionada com o comportamento biológico e progressão de tumores malignos em glândula salivar (AU).

The molecular and cellular mechanisms that are associated with pathogenesis, poor treatment response, recurrence, and death in salivary gland tumors are not fully known. In this matter, stem cells (SC) within a tumor (TSC) are related to tumorigenicity and progress in human neoplasms. As such, the aim of this study was to evaluate the expression of SC-related markers (ALDH-1 and SOX-2) in salivary gland neoplasms and their possible association with clinicopathological data and patient outcomes. We selected 103 cases of malignant neoplasms (25 mucoepidermoid carcinoma; 15 acinic cell carcinoma; 13 adenoid cystic carcinoma; 10 polymorphous adenocarcinoma; 13 adenocarcinoma NOS; 8 epithelial-myoepithelial carcinoma; 7 carcinoma ex pleomorphic adenoma; 5 salivary duct carcinoma; 4 basal cell adenocarcinoma; 3 clear cell carcinoma) and 51 cases of benign neoplasms (25 pleomorphic adenoma; 9 myoepithelioma; 7 Warthin tumor; 5 canalicular adenoma; 5 basal cell adenoma). Data were analyzed in Statistical Package for Social Science, GraphPad Prism and STATA softwares. A significance level of 5% was adopted for the statistical tests (p<0.05). Most patients were male, with a mean age of 52 years, and the parotid was the most common anatomical site. Most malignant neoplasms were classified as T1-T2, N0 and M0. Protein expression assessed by immunohistochemistry and confirmed by western blot showed similar results that were statistically correlated for both SOX-2 (p<0.001) and ALDH-1 (p=0.039). Regarding the expression of SOX-2, most benign tumors were negative (n=39; 76.5%), and expression was only observed in tumors without myoepithelial differentiation (p<0.0001). In the other hand, most of the malignant tumors were positive for SOX-2 (n=54; 52.4%), being statistically significant (p=0.002). The expression occurred in cases without myoepithelial differentiation (p=0.006) mainly in mucoepidermoid carcinoma and clear cell carcinoma. No association was found between SOX-2 expression and clinical parameters. ALDH-1 was frequently expressed in the parenchyma of malignant (n=88; 85.6%) and benign (100%) neoplasms. Overall, the presence of ALDH-1 in the parenchyma was not associated with clinical data of malignant neoplasms; nevertheless, the cases of mucoepidermoid carcinoma with high expression in the parenchyma were associated with advanced clinical stage (p=0.047). The expression of ALDH-1 in tumor stroma cells occurred mainly in malignant neoplasms (n=67; 65.0%), being associated with lymph node metastasis (p=0.032), advanced clinical stage (p=0.008), recurrence (p=0.006) and death (p=0.013). Overall survival and Diseasefree survival at 5 and 10 years were lower in patients diagnosed with adenoid cystic carcinoma, advanced clinical stage, recurrence and stromal expression of ALDH-1. Multivariate analysis showed advanced clinical stage and stromal expression of ALDH1 were independent prognostic factors for disease-free survival. Based on the results, the profile of TSC presents variations in different salivary gland tumors. The differential expression of SOX-2 and ALDH-1 in these neoplasms suggests that there are different subtypes of TSC that can be activated by distinct molecular pathways. Also, the presence of ALDH-1 stromal expression characterizes cells with mesenchymal CT profile that may be directly related to the biological behavior and progress of malignant tumors in the salivary gland (AU).

Expression of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of the oral tongue.

Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) act in the proteolysis of basement membrane and extracellular matrix structures, facilitating tumor invasion. The purpose of this study was to evaluate the relationship between these proteins and clinicopathological parameters in squamous cell carcinoma of the oral tongue (SCCOT). Sixty cases of SCCOT were submitted to immunohistochemistry and analyzed semiquantitatively at the invasion front and in the tumor core. The results were associated with lymph node metastasis, clinical stage, locoregional recurrence, clinical outcome and histological grade of malignancy. A higher expression of uPA was observed in cases of tumors of high-grade versus low-grade malignancy (p = 0.010). Moreover, the cases with the worst pattern of invasion presented an overexpression of uPA (p = 0.011). The presence of locoregional recurrence was associated with uPAR (p = 0.039), and the expression of both biomarkers was much higher at the invasion front than in the tumor core (p < 0.001). The results suggest uPA and uPAR are involved in the progression and aggressiveness of SCCOT, mainly at the tumor-host interface.

Expression of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of the oral tongue

Abstract Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) act in the proteolysis of basement membrane and extracellular matrix structures, facilitating tumor invasion. The purpose of this study was to evaluate the relationship between these proteins and clinicopathological parameters in squamous cell carcinoma of the oral tongue (SCCOT). Sixty cases of SCCOT were submitted to immunohistochemistry and analyzed semiquantitatively at the invasion front and in the tumor core. The results were associated with lymph node metastasis, clinical stage, locoregional recurrence, clinical outcome and histological grade of malignancy. A higher expression of uPA was observed in cases of tumors of high-grade versus low-grade malignancy (p = 0.010). Moreover, the cases with the worst pattern of invasion presented an overexpression of uPA (p = 0.011). The presence of locoregional recurrence was associated with uPAR (p = 0.039), and the expression of both biomarkers was much higher at the invasion front than in the tumor core (p < 0.001). The results suggest uPA and uPAR are involved in the progression and aggressiveness of SCCOT, mainly at the tumor-host interface.

Immunohistochemical expression of TGF-ß1 and MMP-9 in periapical lesions.

The objective of this study was to evaluate the expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-ß1) in periapical lesion samples correlated with the intensity of the inflammatory infiltrate and thickness of the epithelial lining. Forty-five cases of periapical lesions (23 periapical granulomas and 22 radicular cysts) were subjected to morphological and immunohistochemical analyses using anti-MMP-9 and anti-TGF-ß1 antibodies. The data were analyzed using the following tests: non-parametric Mann-Whitney, chi-square, Fisher's exact test and Spearman's correlation test (P<0.05). Analysis of inflammatory infiltrate revealed that 78% of periapical granulomas presented infiltrate grade III, in contrast with 32% of radicular cysts (P<0.001). Morphological evaluation of the epithelial thickness in radicular cysts revealed the presence of atrophic epithelium in 86% of the cysts. The immunostaining of MMP-9 was score 2 in 67% of the granulomas and 77% of the cysts. Both lesions were predominantly score 1 for TGF-ß1. Significant differences were confirmed between the expression scores of TGF-ß1 and MMP-9 in periapical granulomas (p = 0.004) and in radicular cysts (p < 0.001). Expression of TGF-ß1 was different for periapical granulomas and radicular cysts. This immunoregulatory cytokine seems more representative in asymptomatic lesions. The extracellular matrix remodeling process dependent on MMP-9 seems to be similar for both periapical granulomas and radicular cysts. TGF-ß1 and MMP-9 may play an important role in the maintenance of periapical lesions.

Immunohistochemical expression of TGF-ß1 and MMP-9 in periapical lesions

Abstract The objective of this study was to evaluate the expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta (TGF-β1) in periapical lesion samples correlated with the intensity of the inflammatory infiltrate and thickness of the epithelial lining. Forty-five cases of periapical lesions (23 periapical granulomas and 22 radicular cysts) were subjected to morphological and immunohistochemical analyses using anti-MMP-9 and anti-TGF-β1 antibodies. The data were analyzed using the following tests: non-parametric Mann-Whitney, chi-square, Fisher's exact test and Spearman's correlation test (P<0.05). Analysis of inflammatory infiltrate revealed that 78% of periapical granulomas presented infiltrate grade III, in contrast with 32% of radicular cysts (P<0.001). Morphological evaluation of the epithelial thickness in radicular cysts revealed the presence of atrophic epithelium in 86% of the cysts. The immunostaining of MMP-9 was score 2 in 67% of the granulomas and 77% of the cysts. Both lesions were predominantly score 1 for TGF-β1. Significant differences were confirmed between the expression scores of TGF-β1 and MMP-9 in periapical granulomas (p = 0.004) and in radicular cysts (p < 0.001). Expression of TGF-β1 was different for periapical granulomas and radicular cysts. This immunoregulatory cytokine seems more representative in asymptomatic lesions. The extracellular matrix remodeling process dependent on MMP-9 seems to be similar for both periapical granulomas and radicular cysts. TGF-β1 and MMP-9 may play an important role in the maintenance of periapical lesions.

Imunoexpressão da proteína endonuclease apurínica/apurimidínica (APE-1) em adenomas pleomórficos e carcinomas ex-adenomas pleomórficos / Immunoexpression endonuclease protein apurínica / pyrimidine (APE-1) in pleomorphic adenomas and carcinomas ex pleomorphic adenomas

Introdução: A endonuclease apurínica/apurimidínica (APE-1) é uma proteína essencial para a via do reparo por excisão de bases (BER) do DNA, além de regulação de atividades redox. A capacidade de células malignas em reconhecer e reparar danos no DNA é um mecanismo importante para sobrevivência tumoral, e estudos recentes sugerem que a superexpressão da APE-1 pode se relacionar com o pobre prognóstico em alguns tumores. Objetivo: Analisar a imunoexpressão da APE-1 em Adenomas Pleomórficos (AP) e Carcinomas Ex-Adenomas Pleomórficos (CaExAP) de glândulas salivares. Materiais e Métodos: Foram selecionados 49 tumores fixados em formol e incluídos em parafina (33 AP e 16 CaExAP) que foram submetidos a estudo imuno-histoquímico pela técnica da imunoperoxidase. A imunoexpressão da APE-1 foi avaliada de forma quantitativa pelo percentual de células imunopositivas. Para análise estatística foi adotado nível de significância de 5% (p ≤ 0,05). Resultados: Todos os casos de AP e CaExAP (n=49) foram positivos para APE-1, no entanto, houve maior expressão em CaExAP havendo diferença estatisticamente relevante (p<0,001). Não foi encontrada associação da expressão da APE-1 entre tumores de glândula salivar maior ou menor, entretanto, em AP não encapsulados (Mediana de expressão= 54,2%) houve maior expressão quando comparados a tumores encapsulados (p=0,02). A superexpressão da APE-1 foi constatada principalmente em casos de CaExAP com metástase linfonodal (Mediana de expressão= 90,3% - p=0,002) e padrão invasivo (Mediana de expressão= 89,9% - p=0,003) quando comparados aos casos sem metástase e intracapsulares. Conclusão: Este estudo sugere que a APE-1 encontra-se desregulada nos tumores estudados. A maior expressão da APE-1 está associada com a ausência de cápsula completa em AP e a superexpressão está relacionada com o comportamento mais agressivo do CaExAP. (AU)

Introduction: Apurinic/Apyrimidinic Endonuclease 1 (APE-1) is an essential protein for DNA base excision repair (BER) pathway and regulation of redox activities. The ability of malignant cells to recognize and repair DNA damage is an important mechanism for tumor survival, and recent studies suggest that APE-1 overexpression is related to poor prognosis in some tumors. Purpose: To analyze the immunoreactivity of APE-1 in Pleomorphic Adenomas (PA) and Carcinomas Ex Pleomorphic Adenomas (CaExPA) of salivary glands. Materials and Methods: A total of 49 tumors fixed in formalin and embedded in paraffin (33 PA and 16 CaExPA) underwent immunohistochemical study by the immunoperoxidase technique. APE-1 immunoreactivity was evaluated quantitatively by the percentage of immunopositive cells. For statistical analysis a significance level of 5% (p≤ 0.05) was adopted. Results: All cases of PA and CaExPA (n=49) were positive for APE-1, however, there was a higher expression in CaExPA, with statistically significant difference (p<0.001). There was no association between APE-1 expression and tumors of major or minor salivary gland, however, not encapsulated PA (median expression = 54.2%) showed higher expression when compared to encapsulated tumors (p=0.02). APE-1 overexpression was found mainly in cases of CaExAP with lymph node metastasis (median expression = 90.3% - p=0.002) and invasive pattern (median expression = 89.9% - p=0.003), when compared to cases without metastasis and intracapsular pattern. Conclusion: This study suggests that APE-1 is deregulated in the studied tumors. The increased expression of APE-1 is associated with the absence of complete capsule in PA and it is associated with more aggressive behavior in CaExPA. (AU)

Reabilitação com oftalmopróteses em dois pacientes com distintas etiologias de perda ocular / Rehabilitation with ophthalmic prosthesis in two patients with different from lost eye etiologies

A tentativa do homem em restaurar aloplasicamente a região bucomaxilofacial mutilada é tão antiga quanto a formação das civilizações, tendo em vista a importância do olho como uma das estruturas mais importantes na individualização e harmonia da face. Na atualidade, algumas entidades públicas promovem atendimentos a pacientes mutilados que necessitam de uma reabilitação por meio de Prótese Bucomaxilofacial (PBMF), sendo a maior procura pelas oftalmopróteses devido ao grande número de traumas nessa região da face. A prótese ocular é importante para reconstruir a estética, embelezar o rosto cuja harmonia está comprometida, promover a sustentação e a tonicidade muscular palpebral, proteger a cavidade anoftálmica, evitar atresias, entre outros. Tal reabilitação faz parte dos cuidados necessários e representa uma conquista de melhor qualidade de vida para os pacientes e suas famílias. Neste trabalho, os relatos de dois casos clínicos visam apresentar duas reabilitações com oftalmopróteses individualizadas em pacientes com idades diferentes e etiologia da anoftalmia também distintas que resultaram em estéticas favoráveis. Após a confecção das próteses, foi observado que a reabilitação protética anterior ao desenvolvimento ou agravamento de dificuldades de relações interpessoais tende a melhorar a qualidade de vida, visto que a queixa principal quando inexistente melhora o desenvolvimento psicossocial dos pacientes... (AU)

Man’s attempt to restore so alloplastic the maxillofacialregion is as old as the formation of civilizations. Given the importance of the eye as the most significant structure in the individualization and harmony of the face. Nowadays some public entities promote special care to patients who need a mutilated rehabilitation through Maxillofacial Prosthodontics (MFP), the highest demand is for eye prosthesis due to the large number of injuries in this region of the face. The ocular prosthesis aims to reconstruct the aesthetic, beautify the face whose harmony is committed to promote and support the eyelid muscle tone, protect the anophthalmic socket, avoid closure, among others.Such rehabilitation is part of palliative care and is an achievement of better quality of life for patients and their families. In this study, reports of two cases aim to present two eye prosthesis individualized rehabilitation in patients with different ages and different etiology of anophthalmic also resulted in favorable aesthetic. Thus it can be concluded that the prosthetic rehabilitation prior to the development or worsening of interpersonal difficulties relations tends to improve the quality of life of patients, since the main complaint nonexistent improves psychosocial development of these... (AU)

Expressão da metaloproteinase 9 no carcinoma de células escamosas oral / Expression of matrix metalloproteinase 9 in oral squamous cell carcinoma

A metaloproteinase-9 (MMP-9) ou gelatinase B pertence à família das metaloproteinases da matriz, enzimas que degradam componentes da matriz extracelular (MEC) e da membrana basal e estão implicadas no processo de carcinogênese, contribuindo para a progressão tumoral, invasão e metástase. Neste trabalho, a MMP-9 foi utilizada como marcador imuno-histoquímico, a fim de correlacionar sua expressão com a gradação histológica de 28 casos de carcinoma de células escamosas oral (CCEO) obtidos do Laboratório de Patologia Bucal da Faculdade de Odontologia de Pernambuco (FOP/UPE). As amostras foram classificadas quanto ao grau de malignidade em carcinoma in situ, baixo grau, grau moderado e alto grau de malignidade. A técnica imuno-histoquímica foi realizada através do método estreptavidina-biotina, utilizando o anticorpo anti-MMP9. Na análise estatística, foi utilizado o teste Exato de Fischer, com nível de significância de p=0.05. Verificou-se que a MMP-9 apresentou positividade em 24 casos (85.7%) de CCEO, sendo observada correlação estatisticamente significativa entre a expressão da MMP-9 e o grau de malignidade (p=0.002). Os resultados indicam que a expressão da MMP-9 pode ser sugerida como fator preditivo de comportamento biológico agressivo no CCEO... (AU)

The metalloproteinase-9 (MMP-9) or gelatinase B belongs to the family of matrix metalloproteinases, enzymes which degrade extracellular matrix (ECM) and basement membrane components and are implicated in the carcinogenesis process, contributing to tumor progression, invasion and metastasis. In this work, MMP-9 was used as an immunohistochemical marker in order to correlate its expression with histological grading of 28 cases of oral squamous cell carcinoma (OSCC) obtained from the Laboratory of Oral Pathology, School of Dentistry of Pernambuco (FOP / UPE). The samples were classified according to the malignancy grade as in situ carcinoma, low grade, intermediate grade and high grade of malignancy. The immunohistochemistry technique was performed by the streptavidin-biotin method using the antibody anti-MMP9. The statistical analysis used the Fisher's exact test, with a significance level of p=0.05. It was verified that MMP-9 expression was positive in 24 OSCC cases (85.7%). Significant statistical correlation was observed between the expression of MMP-9 and the degree of malignancy (p=0.002). The results indicate that expression of MMP-9 may be suggested as a predictor of aggressive biological behavior in OSCC... (AU)

Estudo da expressão imuno-histoquímica da metaloproteinase – 9 (MMP-9) em lesões periapicais / Study of the immunohistochemical expression of metalloproteinase –9 (MMP-9) in periapical lesion

Objetivo: avaliar através da técnica imuno-histoquímica a expressão da metaloproteinase-9 (MMP-9) em granulomas periapicais e cistosradiculares. Metodologia: Foram selecionados 47 casos de lesõesperiapicais dos quais 26 eram granulomas periapicais e 21 cistosradiculares no período de 14 anos no Laboratório de Patologia Cirúrgica Profº Rildege Accioly, da Faculdade de Odontologia de Pernambuco FOP/UPE. Os dados demográficos analisados foram: sexo, raça, idade, sintomatologia, aspecto radiográfico e localizaçãoanatômica. A amostra composta por47 casos foi submetida à técnicaimuno-histoquímica que foi realizada através do método estreptavidina -biotina, utilizando o anticorpo anti-MMP9. O teste estatístico utilizado foi o exato de Fisher (p≤0,05). Resultado: 55,3% das lesões encontradas corresponderam a granuloma periapical. A faixa etária prevalente foi de 31 a 40 anos de idade(40,9%). Observou-se maior número de casos da raça branca (68,2%) e do sexo feminino (59,6%). Quanto à sintomatologia 72,1% corresponderam a lesões assintomáticas, e quanto ao aspecto radiográfico radiolúcida em 88,6% dos casos, sendo a maxila alocalização anatômica mais acometida (59,1%). Em relação à expressão imuno- histoquímica da MMP-9, 19 cistos (90,5%) e 25granulomas (96,2%) foram positivos, exibindo intensidade de expressão variada. Conclusão: O granuloma periapical é a lesão periapical inflamatória de origem odontogênica mais comum em indivíduos da raça branca na faixa etária entre 31– 40 anos. A MMP-9 parece participardo processo de desenvolvimento e manutenção dos cistos e granulomas periapicais, participando do processo inicial de osteólise principalmente por degradar vários componentes damatriz extracelular.

Purpose: evaluate the immunohistochemical technique using the expression of metalloproteinase-9 (MMP-9) in periapical granulomasand cysts root. Methods: We selected 60 cases of periapical lesions of which 31 were peria pical granulomas and 29 radicular cysts in 14 years in the Laboratory of Surgical Pathology Professor, Rildege Accioly, Faculty of Dentistry of Pernambuco FOP / UPE. Demographic data were collected through biopsy referral sheets on file in the laboratory. The sample comprised47 cases were subjected to immuno histochemical technique that was performed using the streptavidin- biotin method, using anti-MMP7. The statistical test used was Fisher's exact test (p≤0.05). Results: 55.3% of the lesions corresponded to periapical granuloma while 44.7% corresponded tocysts. The most prevalent age group was 31-40 years old (40.9%).There was a higher number of cases were white (68.2%) and females(59.6%). Regarding symptoms accounted for 72.1% of asymptomaticlesions and radiographic radiolucent (88.6%), and the jaw anatomiclocation most affected (59.1%). Regarding the immunohistochemicalexpression of MMP-9 in periapical lesions, 19 cysts (90.5%) and 25 granulomas (96.2%) were positive showing intensities. Conclusion:The periapical granuloma is inflammatory periapical lesion odontogenic more common in Caucasians aged 31-40 years. TheMMP-9 seems to participate in the process of development and maintenance of periapical cysts and granulomas, participating in the initial process of osteolysis primarily degrade various components of the extracellular matrix.