Serological biomarkers for monitoring response to treatment of pulmonary and extrapulmonary tuberculosis in children and adolescents.

Key measures to halt the spread of tuberculosis (TB) include early diagnosis, effective treatment, and monitoring disease management. We sought to evaluate the use of serum immunoglobulin levels against antigens present in cell envelope of Mycobacterium tuberculosis to monitor TB treatment response in children and adolescents with pulmonary (PTB) or extrapulmonary TB (EPTB). Blood samples were collected prior to and one, two, and six months following treatment initiation. Serum immunoglobulin levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein were measured by ELISA. Serum from 53 TB patients and 12 healthy participants were analyzed. After six months of successful treatment, there was a significant decrease (p < 0.0001) in IgM levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein and IgG levels against Mce1A protein when compared to baseline immunoglobulin levels. There was no significant variation in antibody levels during follow-up between participants with PTB and EPTB, confirmed and unconfirmed TB diagnosis, and HIV infection status. Antibody levels in control participants without TB did not decrease during follow-up. These results suggest that immunoglobulin responses to mycobacterial cell wall products may be a useful tool to monitor treatment response in children and adolescents with PTB or EPTB.

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro.

AIM: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. METHODS: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. RESULTS: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). CONCLUSIONS: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

Uso do 5-Fluorouracil tópico para tratamento de cistos odontogênicos produtores de ceratina: experiência do Hospital de Força Aérea do Galeão e proposta de protocolo de tratamento / Use of 5-Fluorouracil for the treatment of keratin-producing odontogenic cysts: experience of Galeão Air Force Hospital and a proposed treatment protocol

O Ceratocisto Odontogênico (CO) e o Cisto Odontogênico Ortoceratinizado (COO) apresentam características clínico-radiográficas semelhantes, porém comportamento biológico e aspectos histológicos distintos. Diferentes modalidades de tratamento têm sido propostas para essas lesões que variam desde descompressão e marsupialização seguidas de enucleação, associadas ou não à osteotomia periférica e/ou à aplicação de solução de Carnoy, à crioterapia, até a ressecção marginal ou segmentar. Contudo, a tendência a recidiva, principalmente do CO, as injúrias às estruturas adjacentes relacionas aos tratamentos conservadores e a mutilação da face do paciente associada à ressecção, são fatores de difícil resolução. O antimetabólico 5- Fluorouracil (5-FU) é amplamente utilizado para o tratamento tópico do Carcinoma Basocelular (CBC) e da Ceratose Actínica e sua ação tem sido evidenciada pela inibição da via de sinalização Hedgehog (SHH), comumente alterada nessas doenças principalmente associada à ocorrência de mutações do gene PTCH. Coincidentemente, o desenvolvimento do CO e do COO também ocorrem devido a mutações nas mesma via de sinalização. Assim sendo, neste estudo foram relatados casos clínicos de Cisto Odontogênico Ortoceratinizado e de Ceratocisto Odontogênico, ambos tratados com a técnica da marsupialização associada à aplicação tópica do 5-FU a 5%, seguido por enucleação e reaplicação tópica de 5-FU a 5%. Após acompanhamento por período superior a 2 anos, houve rápida reparação óssea, ausência de recidiva e de danos às estruturas adjacentes. Foi proposto um protocolo de tratamento conservador, utilizando-se o 5-FU a 5%, para CO e COO. (AU)

Odontogenic Keratocyst (OK) and Orthoceratinized Odontogenic Cyst (OOC) have similar clinical-radiographic characteristics, but different biological behavior and histological aspects from each other. Some treatment modalities have been proposed for these lesions, ranging from decompression and marsupialization followed by enucleation, associated or not with peripheral osteotomy and/or with application of Carnoy's solution, with cryotherapy, to marginal or segmental resection. However, tendency to relapse, mainly with respect to KO, injuries to adjacent structures related to conservative treatments and mutilation of patient's face associated with resection are difficult factors to be resolved. Antimetabolic 5-Fluorouracil is widely used as topical treatment of the Basal Cell Carcinoma and Actinic Keratosis and its action has been evidenced by inhibition of the Hedgehog signaling pathway, commonly altered in these diseases mainly associated with the occurrence of PTCH gene mutations. Coincidentally, the development of OK and OOC also occurs due to mutations in the same signaling pathway. Therefore, in this study a clinical case of Orthoceratinized Odontogenic Cyst and Odontogenic Keratocyst was reported, both treated with the marsupialization technique associated with topical application of 5-FU at 5%, followed by enucleation and topical reapplication of 5-FU at 5 %. After more than 2 years of follow-up, it was noticed the occurrance of a rapid bone healing process, as well as the absence of both recurrence and damage to adjacent structures. A conservative treatment protocol was proposed, using 5-FU at 5%, for OK and OOC. (AU)

Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery.

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.

Odontoma complexo extenso em mandíbula: revisão e relato / Complex odontoma extensive in jaw: review and report

Os odontomas são os tumores odontogênicos mais comumente encontrados nos maxilares, formados por esmalte, dentina, cemento e polpa, que podem estar dispostos de forma organizada ou não. Não são considerados neoplasmas verdadeiros, mas sim, anomalias de desenvolvimento - hamartomas. Geralmente são assintomáticos, e o tratamento preconizado na literatura é a sua remoção cirúrgica por enucleação. Porém, casos de odontomas complexos extensos e localizados mais profundamente, como o descrito neste trabalho podem se tornar um tratamento desafiador. Apesar de serem lesões de fácil diagnóstico e bom prognóstico, um correto planejamento e diagnóstico precoce é fundamental para se evitaram complicações, sequelas futuras e condições estigmatizantes, promovendo reabilitação precoce e saúde do paciente... (AU)

Odontomas are odontogenic tumors most commonly found in the jaws formed by enamel, dentin, cementum and pulp, which can be arranged in an organized way or not. They are not considered true neoplasms but, developmental abnormalities - hamartomas. They are usually asymptomatic and the recommended treatment is the surgical removal by enucleation. But cases of extensive and complex odontoma located deeper, as described in this article can become a challenging treatment. Although they are easy to diagnose injuries and good prognosis, correct planning and early diagnosis is essential to prevent complications, future sequels and stigmatizing conditions, promoting early rehabilitation and patient health... (AU)