The surgical management of a patient with chronic renal failure and macrothrombocytopenia related to the MYH9 gene mutation: A case report.

MYH9 disease is a rare genetic disorder in which there is a mutation in the gene for the non-muscle myosin heavy chain IIA. It initially causes macrothrombocytopenia followed by other clinical manifestations. When the patient reaches adulthood, he can develop chronic kidney failure. Thus, the risk of suffering a hemorrhage, difficulty in repairing and, infections increases in individuals with this disease. In addition, the use of drugs in these patients should be carefully evaluated. An adult patient sought dental care with a complaint associated with a tooth with advanced dental caries. He had severe thrombocytopenia (7000 platelets/mm3 ), hearing loss, and chronic kidney failure. The diagnosis of MYH9 disease was confirmed through genotyping. After clinical examination, extraction was planned. Local and systemic procedures were used to prevent hemorrhage, especially postoperatively. Although the patient had an infection at the surgical wound site and no episode of postoperative bleeding, the repair process occurred normally. The purpose of this article is to report the surgical management of a patient with MYH9 disease.

Condição bucal de comunidades em vulnerabilidade social: análise descritiva de um projeto voluntário paranaense / Oral health condition of communities in social vulnerability: descriptive analysis of a volunteer project in Paraná

O presente trabalho relata o impacto social e o papel do cirurgião--dentista nas ações do Projeto Pró-Riso por meio de análise descritiva das ações. O projeto Pró-Riso é uma iniciativa voluntária, sem fins políticos, religiosos ou lucrativos, que leva atendimento odontológico, assistência médica e educação em saúde a comunidades em vulnerabilidade social. Foi realizada a análise dos prontuários dos pacientes atendidos pelo projeto em 2019. As ações ocorreram nas comunidades do Pilarzinho e Caximba (Bairros do município de Curitiba) e Amparo (comunidade isolada em Área de Proteção Ambiental no município litorâneo de Paranaguá), locais de elevada prevalência de doenças bucais. Tal situação reflete uma importante questão de Saúde Pública para o país. Os resultados mostram que foram atendidos 260 pacientes, com diversas necessidades de tratamento bucal. Destes, 63% tiveram seus tratamentos concluídos nas ações. Ressalta-se, assim, a importância de trabalhos sociais que proporcionem melhor qualidade de vida e saúde a comunidades em vulnerabilidade social. (AU)

This paper reports the social impact and role of the dentist in the actions of the Pró-Riso Project through descriptive actions analysis. The Pró-Riso project is a voluntary, non-political, religious or for profit initiative that takes dental care, medical assistance and health education to communities in social vulnerability. An analysis of the medical patients records assisted by the project in 2019 was carried out. The actions took place in the communities of Pilarzinho and Caximba (Curitiba Municipality neighborhoods) and Amparo (isolated community in an Environmental Protection Area in the coastal municipality of Paranaguá), places of high prevalence of oral diseases. This situation reflects an important Public Health issue for the country. The results show that 260 patients were treated, with different needs for oral treatment. Of these, 63% had their treatments completed in the actions. Thus, the importance of social work that provides better health life quality to communities in social vulnerability is highlighted. (AU)

Alterações no perfil da microbiota bucal durante permanência na UTI: colonização por patógenos respiratórios potenciais / Changes in the oral microbiota profile during ICU stay: colonization by potential respiratory pathogens / Alteraciones en el perfil de la microbiota bucal durante permanencia en la UTI: colonización por patógenos respiratorios potenciales

Introdução: Pacientes hospitalizados em Unidade de Terapia Intensiva (UTI) geralmente mostram má higiene bucal, o que contribui significativamente para o agravamento da contaminação local, com a presença de patógenos respiratórios potenciais. Objetivo: Caracterizar qualitativamente o perfil da microbiota bucal durante permanência na UTI, além da identificação de alterações bucais e salivares. Materiais e métodos: Foi realizado um estudo prospectivo em pacientes internados na UTI de um hospital oncológico, os quais foram avaliados clínica e microbiologicamente após 24 (T1), 72 (T2) e 120 (T3) horas consecutivas à admissão na UTI. Foram identificados os principais patógenos em cada momento e o perfil da microbiota oral foi comparado. Resultados: A amostra final foi de 30 pacientes, 23 homens e 7 mulheres, com idade média de 61 anos. Em T1, 96,67% dos pacientes apresentaram crescimento de microorganismos patogênicos, sendo identificados 14 tipos diferentes. Em T2 18 tipos de patógenos diferentes e em T3, 21 tipos, dos quais os mais prevalentes nas três coletas foram Staphylococcus não produtor de coagulase e Candida albicans. Clinicamente foram observados presença e progressão do biofilme visível (61%), cálculo (36,89%), condição periodontal deficiente (33,11%). Em relação à condição salivar verificou-se saburra lingual (92,11%), ressecamento labial (86,67%), hipossalivação (36,67%), assialia (52%) e escoamento salivar (8,89%). Conclusão: O biofilme do dorso de língua de pacientes em UTI pode representar um nicho considerável de patógenos respiratórios potenciais, uma vez que microorganismos etiológicos relacionados à pneumonia nosocomial foram isolados já no primeiro dia de internação, com a colonização subsequente por uma variedade de microorganismos predominantemente gram-negativos(AU)

Introduction: Hospitalized patients receiving treatment at Intensive Care Units (ICU) usually show poor oral hygiene, and may have the mouth and oropharingeal region colonized by pathogens involved in nosocomial pneumonia. The presence of these pathogens may increase the risk for respiratory diseases. OBJECTIVES: The aim of this study was to qualitatively characterize the oral microbiota profile of critical patients during ICU stay, besides the identification of oral and salivary alterations. Materials and Methods: A prospective study was carried out on patients admitted to the ICU from a cancer hospital, who were evaluated clinically and microbiologically (tongue-to-mouth swabs) after 24h (T1), 72h (T2) and within 120 consecutive hours (T3) after ICU admission to the ICU. The main pathogens were identified at each moment and the oral microbiota profile was compared. In addition, the major oral and salivary changes were identified. Results: The final sample consisted of 30 patients, 23 men and 7 women, with a mean age of 61 years. The reasons for hospitalization were 30% postoperative of oncological surgeries and 70% of medical emergencies. In T1, 96.67% of the patients presented growth of pathogenic microorganisms, being identified 14 different types. In T2, 18 different pathogen types were identified, and in T3, 21 pathogens, of which the most prevalent Coagulase negative staphylococcus and Candida albicans were the most prevalent in the three collections. It was observed the presence and progression of visible biofilm (61%), calculus (36.89%), poor periodontal condition (33.11%), partial teeth presence (26.67%), total edentulism (23.33%), cavities (10%), presence of residual root (20%). In relation to the salivary condition, there was accumulation of lingual (92.11%), labial dryness (86.67%), hyposalivation (36.67%), asialia (52%) and salivary flow (8.89%). Conclusion: The tongue dorsum biofilm of ICU patients may represent a considerable niche of potential respiratory pathogens, since etiological microorganisms related to nosocomial pneumonia were isolated on the first day of hospitalization, with subsequent colonization by a variety of microorganisms predominantly gram-negatives. The introduction of professional care directed to oral health and biofilm control in this group of patients could represent a significant contribution to the reduction of diseases to the health of the patient in the ICU(AU)

Introducción: Pacientes hospitalizados en UTI generalmente muestran mala higiene bucal, lo que contribuye significativamente al agravamiento de la contaminación local, con la presencia de patógenos respiratorios potenciales. Objetivo: Caracterizar cualitativamente el perfil de la microbiota bucal durante permanencia en la UTI, además de la identificación de alteraciones bucales y salivares. Materiales y métodos: Se realizó un estudio prospectivo en pacientes internados en la UTI de un hospital oncológico, los cuales fueron evaluados clínica y microbiológicamente después de 24 (T1), 72 (T2) y 120 (T3) horas consecutivas a la admisión en la UTI. Se identificaron los principales patógenos en cada momento y el perfil de la microbiota oral fue comparado. Resultados: La muestra final fue de 30 pacientes, 23 hombres y 7 mujeres, con edad media de 61 años. En T1, el 96,67% de los pacientes presentaron crecimiento de microorganismos patógenos, siendo identificados 14 tipos diferentes. En T2 18 tipos de patógenos diferentes y en T3, 21 tipos, de los cuales los más prevalentes en las tres colectas fueron Staphylococcus no productor de coagulasa y Candida albicans. Se observó la presencia y progresión del biofilme visible (61%), cálculo (36,89%), condición periodontal deficiente (33,11%). En cuanto a la condición salivar se verificó saburra lingual (92,11%), resecamiento labial (86,67%), hiposalivación (36,67%), asialia (52%) y flujo salivar (8,89%). Conclusión: El biofilm del dorso de lengua de pacientes en UTI puede representar un nicho considerable de patógenos respiratorios potenciales, ya que microorganismos etiológicos relacionados a la neumonía nosocomial se aislaron ya en el primer día de internación, con la colonización subsecuente por una variedad de microorganismos predominantemente gram-negativa(AU)

Analysis of IL1 gene polymorphisms and transcript levels in periodontal and chronic kidney disease.

UNLABELLED: Chronic kidney disease (CKD) and periodontitis (PD) are complex inflammatory disturbances, influenced by genetic factors. Interleukin (IL)-1 genes code for inflammatory mediators involved in the physiopathogenesis of both diseases. Functional polymorphisms in IL1 genes modulate cytokine levels and have been associated with susceptibility to immune-inflammatory conditions. OBJECTIVES: The aim of this study was investigate the association of functional IL1 gene polymorphisms and transcript levels with susceptibility to CKD and PD. DESIGN: The sample consisted of 246 individuals, mean age 44.8 years, divided into: group 1 (64 patients without CKD and without PD), group 2 (58 without CKD and with PD), group 3 (52 with CKD and without PD) and group 4 (72 with CKD and with PD). DNA was obtained from cells of oral mucosa and polymorphisms IL1AC-889T, IL1BC-511T, IL1BC+3954T and IL1RN (intron 2) were analyzed by PCR-RFLP. Transcript levels from gingival tissues were analyzed by real-time PCR. RESULTS: IL1RN(*)1 allele was associated with almost 4-fold increased risk for CKD (OR 3.92 95% CI=1.6-9.4, p=0.002). IL1RN(*)2 allele was associated with 3-fold increased risk for PD in CKD patients (OR 3.08 95% CI=1.2-7.9, p=0.019). Allele T for polymorphism IL1B+3954 was associated with CKD in PD patients (OR 2.28 95% CI=1.1-4.7, p=0.019). Significantly increased levels of transcripts of IL1A, IL1B and IL1RN genes were found in PD patients. CONCLUSIONS: It was observed an evidence for association of IL1B and IL1RN alleles with susceptibility to CKD and PD. Higher levels of IL1 gene transcripts were found in PD patients.

Clinical oral findings in dialysis and kidney-transplant patients.

OBJECTIVES: Oral lesions secondary to chronic renal failure or related to immunosuppressive therapy after transplant are reported in the literature, but their prevalence is still obscure. The aim of this study was to investigate oral clinical findings in patients undergoing renal dialysis and renal transplant recipients. METHOD AND MATERIALS: Forty-six patients treated with dialysis (DL), 33 kidney-transplant (KT) patients, and 37 control (C) patients were examined intraorally. Oral clinical findings were diagnosed and treated. RESULTS: The results showed that 95.6% (44/46) of the DL group, 93.9% (31/33) of KT patients, and 56.7% (21/37) of the control group presented at least one pathological entity in the oral mucosa. A high prevalence of oral lesions, such as saburral tongue and xerostomia, was found in the DL and KT groups. Certain oral lesions demonstrated a predisposition toward one type of group, such as a higher prevalence of metallic taste in the DL group and gingival overgrowth in the KT group. CONCLUSION: The prevalence of oral lesions was significantly higher in renal patients (DL and KT groups). The most prevalent oral clinical findings were saburral tongue and xerostomia for both groups. Metallic taste was more prevalent in the DL group. Although geographic tongue was more frequent in KT patients and melanin pigmentation in the control group, the number of lesions was low for all groups. In addition, gingival overgrowth was more prevalent in the KT group; however, the difference was not significant (P = .06).

Analysis of the association of IL1B(C-511T) polymorphism with dental implant loss and the clusterization phenomenon.

OBJECTIVES: Endosteous dental implants consist in the treatment of choice to replace tooth loss. The knowledge that implant loss tends to cluster in subsets of individuals may indicate that host immune-inflammatory response is influenced by genetic factors. Interleukin-1 (IL-1) is a key mediator of inflammatory processes and functional polymorphisms in IL1 gene could be candidate genetic risk factors to study susceptibility to implant failure. The objective of this study was to investigate the association between IL1B (C-511T) genetic polymorphism and dental implant loss in a Brazilian population and its influence in the clusterization phenomenon. MATERIAL AND METHODS: The sample composed of 277 unrelated, both gender, mean age 53.63 ± 11.14 years individuals, divided into test group - 92 subjects with implant loss, and control group - 185 subjects with no implant loss. Patients' socioeconomic profile and clinical variables were investigated. Genomic DNA from oral mucosa was analyzed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: There was significant difference between the groups in medical treatment (P=0.040), edentulism (P=0.019), and mean number of placed implants (P=0.001). There was difference between groups with and without implant loss neither considering genotypes (P=0.279) nor alleles (P=0.168) for IL1B (C-511T) polymorphism. When individuals showing up to one implant failure (n=254) were investigated vs. patients presenting multiple implant loss (n=23), no difference was either observed between groups for genotype (P=0.083) and allele (P=0.838) frequencies. CONCLUSIONS: The borderline association of the study polymorphism with implant loss suggests further IL1 haplotype analysis to elucidate the global involvement of IL-1 proteins in the modulation of the osseointegration process.

Cisto glandular odontogênico: uma lesão incomum que requer tratamento agressivo / Glandular odontogenic cyst: an uncommon lesion that requires aggressive treatment

O cisto glandular odontogênico (CGO) é uma rara lesão, descrita em 1988. Seu tratamento preferencialmente consiste em cirurgia radical, com ressecção em bloco, seguido de reconstrução. Os autores relatam um caso em paciente masculino, 59 anos, que procurou atendimento odontológico com queixa de aumento de volume em mandíbula. Realizou-se exame radiográfico panorâmico, que mostrou lesão cística em região anterior de mandíbula. Foi realizada biópsia, cujo diagnóstico foi cisto odontogênico não classificado. O paciente foi submetido à curetagem intra-lesional e o exame anatomo-patológico definitivo mostrou ser CGO. Com base nesse resultado, optou-se pela ampliação de margens com ressecção em bloco da lesão, seguida de reconstrução primária. O paciente encontra-se bem com seguimento de seis meses.

The glandular odontogenic cyst (GOC) is a rare lesion, first described in 1988. Radical surgery is the first choice of treatment through an en-bloc resection and reconstruction. The authors report a case in a 59 years old male patient that was referred to the oral surgeon for evaluation of localized mandible enlargement. The oral surgeon obtained a panoramic radiography that showed a cystic lesion in anterior region of mandible. The patient underwent mandible cyst biopsy witch reveals an odontogenic cyst with no classification. He underwent intralesional curettage and the final pathology diagnosis was GOC. In base of these results, the oral surgeon opted to perform a radical en-bloc resection followed by primary reconstruction. Nowadays, the patient is asymptomatic and his clinical examination was unremarkable. He has a six month period of follow-up with no evidence of disease.

Oral focal mucinosis.

Oral focal mucinosis is an uncommon clinicopathologic condition that is considered the oral counterpart of cutaneous focal mucinosis. It is a disease of unknown etiology where the connective tissue undergoes a focal myxoid degeneration. A literature review disclosed 47 published cases of oral focal mucinosis. An additional case is presented; the clinical and histologic differential diagnosis, sex, age, location, treatment, and recurrence are discussed.