Preoperative oral practices and incidence of postoperative complications in hospital medical-surgical procedures: A meta-analysis.

BACKGROUND:  Oral decay prior to a hospital medical-surgical procedure is a risk factor for the development of postoperative complications. However, perioperative oral practices as a protective factor have not been studied. This review aims to evaluate the effectiveness of perioperative oral practices in the reduction of risk of developing postoperative complications in in-hospital medical surgical procedures. MATERIAL AND METHODS: This review and meta-analysis was conducted according to Cochrane guidelines. Medline, Scopus, Scielo, and Cochrane were consulted. Articles of the previous 10 years concerning adult patients undergoing perioperative oral practices prior to hospital medical-surgical procedures, were included. Data of the type of perioperative oral practice, type of postoperative complication and measures of effect on the development of complications were extracted. RESULTS: Of a pool of 1470 articles, 13 were included for systematic review and 10 for meta-analysis. The most common perioperative oral procedures were focalized approach (FA), referred to only the elimination of infectious foci in the oral cavity and comprehensive approach (CA), referred to a integral approach of the patient's oral health, both of which were mainly performed in oncologic surgeries, both were effective in the reduction of postoperative complications (RR=0.48, [95% CI 0.36 - 0.63]). The most reported postoperative complication was postoperative pneumonia. CONCLUSIONS: Perioperative oral management proved to be a protective factor against the development of postoperative complications.

Oral Human Papillomavirus: a multisite infection.

BACKGROUND: The Human Papillomavirus (HPV) has different strategies for persist in the cells. This characteristic has led us to consider the presence of the virus in tissues of the oral cavity that had no clinical signs of infection. The aim of this study was to detect the presence of DNA-HPV at multiple sites of the oral cavity. MATERIAL AND METHODS: A case-control study was designed: Oral Squamous Carcinoma Group (OSCG), healthy n=72 and Control Group (CG), n=72, healthy volunteers paired by sex and age with OSCG. Four samples were taken from OSCG: saliva, biopsy, brush scraping of lesion and contralateral healthy side. In CG a saliva sample and a scratch of the posterior border of tongue were collected. HPV was detected by PCR using Bioneer Accuprep genomic DNA Extraction kit, and consensus primers MY09 and MY11. Chi square test was applied. RESULTS: 432 samples were obtained from 144 individuals. DNA-HPV was detected in 30 (42%) of OSCG subjects and 3(4%) of CG. Two or more positive samples were obtained in 67% of the OSCG, 67% in saliva and 60% in biopsy; in CG 100% of the individuals were positive in the two samples. CONCLUSIONS: HPV is frequently present in oral cavity as a multifocal infection, even without the presence of clinical lesions.

Transepithelial heme-iron transport: effect of heme oxygenase overexpression.

BACKGROUND: Heme iron is found in the diet mainly in the form of hemoglobin and myoglobin. It is known that heme iron (heme-Fe) and inorganic iron are absorbed differently. Intracellularly, heme oxygenase-1 (HO1) participates in the cleavage of the heme ring producing biliverdin, CO and ferrous iron. Iron released from heme becomes part of labile iron pool, and it can be stored in ferritin or released through the basolateral membrane. The mechanism by which heme-Fe is metabolized within cells is not completely understood. OBJECTIVE: This study focused on the uptake and transport of heme iron and on the role of heme oxygenase-1 on heme iron metabolism. DESIGN: Caco-2 cells were incubated with different concentrations of heme-Fe. A full-length heme oxygenase-1 cDNA was expressed in Caco-2 cells and intracellular iron and heme-Fe content, heme uptake, heme and iron transport and heme oxygenase-1 immunolocalization were assessed in these cells. RESULTS: Heme-Fe was bioavailable and induced an intracellular increase in iron, ferritin and HO1 levels and a decrease in DMT1 expression. In cells overexpressing HO1, heme-Fe uptake and transepithelial Fe transport was higher than in controls. Most heme-Fe was metabolized to free iron, most of which was found mainly in the basolateral chamber. However, there is a fraction of heme that is delivered intact to the basolateral side. In a high heme-Fe condition, HO1 is found near the plasma membrane. CONCLUSIONS: These results suggest that heme oxygenase-1 catabolizes most of the heme-Fe and favors iron influx and efflux in intestinal cells.

Diagnostic delay of oral squamous cell carcinoma in two diagnosis centers in Córdoba Argentina.

UNLABELLED: The aim of the present study was to investigate diagnostic delay in oral cancer (OC) in two diagnosis centers in Córdoba, Argentina. Special attention was paid to the role of the patient and the professional in the diagnostic delay. METHODS: Seventy clinical records of patients with newly diagnosed oral squamous cell carcinoma were included. RESULTS: Both patients and professionals were responsible for the delay in diagnosis. This delay was longer for tumors in early stages. Multiple logistic regression analysis indicated that the professional delay was the most associated variable to the stage of tumor (P = 0.03). CONCLUSIONS: Continuing education in OC and pre-cancerous lesions is important to reduce the professional delay. The findings of the present study also indicate that 58% of the patients are partially responsible for delay in the diagnosis of OC. Intensive public promotion and educational campaigns against OC are also needed to increase patient awareness.

Oral histoplasmosis associated with HIV infection: a comparative study.

OBJECTIVE: Histoplasmosis is a granulomatous fungal disease caused by Histoplasma capsulatum. The objective of the present paper was to describe the prevalence of oral histoplasmosis (OH) in two services from an endemic area in Argentina between 1991 and 2002 and to compare the clinicopathological profile of OH between HIV-positive and HIV-negative patients. METHODS: About 733 HIV+ (group A) and 14 260 patients (group B) were examined. Clinical diagnosis was confirmed by cytology, biopsy or culture. RESULTS: About 21 (3%) and 10 (0.07%) cases of OH were diagnosed in group A and B respectively. Most patients were male. A total of 90% of patients in group A were <45 years old whereas 70% of group B were more than 45 years old. Palate, gingiva and oropharynx were the most frequent locations. The importance of including histoplasmosis in the differential diagnosis of ulcerated oral lesions in immunocompromised patients was discussed.

Bacillary angiomatosis affecting the oral cavity. Report of two cases and review.

Bacillary angiomatosis (BA) is an infectious disease characterized by proliferative vascular lesions; it mainly affects HIV-positive patients. Multiple cutaneous nodular lesions together with fever, chills, malaise, anorexia, vomiting and headache are the most important clinical manifestations. It may also involve the heart, liver, spleen, bones, lung, muscles, lymph nodes, central nervous system and other organs. Erythromycin, 500 mg four times a day, is the drug of choice. The importance of this lesion lies in its clinical and histological similarity with other diseases. Cutaneous and oral lesions of BA clinically resemble Kaposi's sarcoma (KS). Histopathologically, BA may be confused with angiosarcoma, pyogenic granuloma and epithelioid hemangioma. We report two HIV-positive men with BA lesions in the oral mucosa. Diagnosis was confirmed by biopsy and Warthin-Starry silver staining.

Evolution of saliva and serum components in patients with oral candidosis topically treated with Ketoconazole and Nystatin.

The present study involves the analysis of some saliva components (SC) and serum components in patients with oral candidosis topically treated with Ketoconazole 2% (K) or Nystatin 100,000 IU (N). Twenty-four male and female patients, age range 39-82 years, were included in the study. A double-blind study was undertaken in which the patients were divided into 2 treatment groups. These groups were compared with a control group (CG) of 16 healthy patients, both male and female, age-matched with the treated groups. The parameters evaluated were oral mucous membrane lesion index (MLI), CFU of Candida, saliva flow rate, protein-bound Fe (Fe-prot), Fe-prot binding capacity (Fe-prot cap), IgAs, peroxidase activity (PA), hypothiocyanite and thiocyanite. The values of Candida CFU and MLI were significantly reduced in patients treated with K and N. The pre-treatment values of SC as compared to the CG revealed a reduction in Fe-prot and Fe-prot cap. These parameters reach values similar to control towards the end of the treatment. The PA was significantly higher in candidosis patients and fell to control values with treatment. The other SC and serum components did not exhibit significant differences with the CG. Patients with oral candidosis treated locally exhibit not only an improvement in clinical manifestations but also a return to control values of altered SC.

Evaluation of serum and saliva components in candidosis patients.

The serum and saliva components of 36 chronic Candidosis patients, both male and female, ages 38-82 who attended the Department of Clinical Stomatology were studied. Total Mucous Lesion Index (TMLI) and salivary flow rate were assessed. The following parameters were evaluated: iron bound protein, unsaturated iron binding capacity, peroxidase activity, protein content, OSCN-, SCN-, IgAs, Candida and St. mutans levels and lactobacilli activity. Candidosis patients exhibited higher Candida CFU values and increased activity of the peroxidase system (p < 0.05) whereas unsaturated iron binding capacity was significantly lower as compared to healthy subjects (p < 0.05). Furthermore, TMLI and Candida CFU values were higher in diseased subjects wearing complete prosthesis as compared to those without complete prosthesis. Diseased subjects with < 1.2 ml/min salivary flow rate exhibited even greater differences with control. This subgroup exhibited a marked reduction in IgAs. The serum components assayed were iron bound protein, unsaturated iron binding capacity, IgG, IgA and IgM. Unsaturated iron binding capacity was significantly lower in the Candidosis group (p = 0.03). Subjects suffering from oral Candidosis display deficiencies in some of their saliva components, evidencing impaired oral defense capacity.

A comparative study of oral lichen planus and leukoplakia in two Argentine populations.

Oral Lichen Planus and Leukoplakia are two precancerous lesions of great relevance in oral pathology. A total of 4183 patients from the National University of Córdoba (UNC) and 4838 patients from the University of Buenos Aires (UBA) who had been admitted to the corresponding Oral Pathology Departments were analyzed. Of the total number of patients, 476 corresponded to Lichen Planus cases and 418 to Leukoplakia cases. Of the 476 Lichen Planus cases, 330 came from UBA and 146 from UNC, whereas of the 418 cases of Leukoplakia, 284 came from UNC and 134 from UBA. These differences were statistically significant (p < 0.02). Distribution according to sex and age was similar for Lichen Planus and Leukoplakia patients from both Oral Pathology Departments. The association between diabetes and Lichen Planus was similar for both centers, 11.5% for UNC and 14% for UBA. Similarly, no differences were found in terms of the association with tobacco consumption and dental microtrauma. Twenty-two percent of UNC patients were smokers whereas only 11% of UBA patients were smokers. This finding could explain the larger amount of Leukoplakia in UNC. The differences in the incidence of Lichen Planus could be attributed to the fact that the Buenos Aires population is under greater stress and the higher incidence of Leukoplakia in UNC could be related to the smoking habits of this population.

Study of the vascular pattern in oral lichen planus.

Oral Lichen Planus is a relatively frequent disease. Its etiopathogenesis is still unknown and it can undergo malignant transformation during its evolution. Thus, data which could contribute to the knowledge of the biology of this disease are particularly significant. The present study involves a quantitative evaluation of the vascular pattern of oral lichen planus. A portion of biopsy specimens taken for histopathologic diagnosis was processed to mark vascular walls using the histoenzymic technique for ATPase activity demonstration. Stained Sections were then evaluated in a semi-automatic magnetic image analyser. The stereologic parameters studied, showed there is no vascular increase in lichen with regard to normal mucosae or leukoplakias, since the number of vascular walls did not show significant differences. Instead, a significant increase was observed in the vascular area. The association of these parameters, indicates that lichen is a more congestive lesion than the other two conditions studied. These findings indicate that the modifications of the vascular pattern could play a role in the etiopathogenesis of oral lichen planus and suggest that the observation of these changes could be a useful element in the histopathologic diagnosis.

Genetic structure of a tribal population, the Yanomama Indians. XIII. Dental microdifferentiation.

Data are presented on the frequency of the following eight dental traits in 635 Yanomama and 65 Makiritare Indians: upper central incisor rotation or winging, shoveling of maxillary incisors, maxillary molar hypocone reduction, Carabelli's trait, mandibular molar cusp number, mandibular molar cusp pattern rotation of second lower premolar, and pattern of second lower premolar cusps. Yanomama dentition is unusual in the high frequency of six cusps on the mandibular molars. There is marked dental microdifferentiation between villages; significant agreement was observed between a matrix of pairwise "dental distances" based on six morphological traits and corresponding matrices based on 11 genetic systems and on geographic location.