Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial.

Importance: Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective: To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants: This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention: The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures: Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results: A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance: The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration: Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Comparative evaluation of vegetable matter involved lesions with oral parasitic infections in the oral cavity.

The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

Prevalência de lesões bucais em tecidos mole e duro diagnosticadas em idosos em um serviço histopatológico de referência / Prevalence of oral lesions in soft and hard tissue in elderly patients in a single histopathological service / Prevalencia de lesiones bucales en tejido blando y duro enancianos diagnosticadas en un servicio de referencia histopatológico

O envelhecimento populacional é um fenômeno mundial, sendo percebido também no estado do Amazonas. Com a alta expectativa de vida, o enfoque na saúde geral e bucal impactam diretamente a qualidade de vida da pessoa. Desta forma, os levantamentos acerca da população geriátrica não devem ser restritos às alterações fisiológicas da idade, devendo abordar também as manifestações patológicas, retratando assim quais são as lesões bucais mais recorrentes. O trabalho em questão visa levantar o número de lesões bucais prevalentes em tecido mole e duro em idosos. Sendo feito a partir de um levantamento das lesões bucais prevalentes em tecido mole e duro que acometeram os idosos registrados nos laudos do Serviço de Patologia Oral e Maxilofacial da Universidade do Estado do Amazonas, SEPAT-UEA, entre os anos de 2012 a 2018. Segundo os dados coletados, a categoria de neoplasias de tecido mole (28,94%) teve o maior número de casos, em que a lesão mais prevalente, sendo esta do mesmo grupo, foi a hiperplasia fibrosa inflamatória (14,04%). Teve maior acometimento em mulheres (54,91%), pessoas com 60-69 anos (74,77%), usuários de próteses removíveis (15,56%) e a mandíbula (17,28%) foi a localização mais comum. Com as informações adquiridas, a partir de um serviço de referência do estado do Amazonas, é possível ter um melhor direcionamento dos recursos para a população geriátrica tendo um maior enfoque para as lesões mais prevalentes visando assim uma melhor saúde bucal e consequentemente uma melhor qualidade de vida(AU)

Population aging is a worldwide phenomenon, and is also noticed in the state of Amazonas. According to the high life expectancy, the focus on general health and the oral impact directly on the person's quality of life. Thus, surveys about thegeriatric population should not be restricted as physiological changes in age, but should also be addressed as pathological manifestations, thus portraying which are the most recurrent oral lesions. The aim of the study is to raise the frequency of the most prevalent of oral lesions in soft and hard tissue in the elderly. Being made from a survey of oral lesions in soft and hard tissue that affected the elderly registered in the reports of the Oral and Maxillofacial Pathology Service of the Amazonas State University, SEPAT-UEA, between the years 2012 to 2018. According to collected data, the category of soft tissue neoplasms (28.94%) had the highest number of cases, in which the most prevalent lesion, being the same group, for an inflammatory fibrous hyperplasia (14.04%). It was more recurrent in women (54.91%), elderly in 60-69 years (74.77%), users of removable prosthesis (15.56%) and the mandible (17.28%) was the most common location. With the information acquired, from a reference service in the state of Amazonas, it is possible to have a better targeting of resources for the geriatric population, with agreater focus on the most prevalent injuries, thus better oral health and consequently a better quality of life care(AU)

El envejecimiento de la población es un fenómeno mundial, se percibe también en el estado de Amazonas. Con la alta expectativa de vida, el enfoque en la salud general y bucal impactan directamente la calidad de vida de la persona. De esta forma, las encuestas sobre la población geriátrica no deben restringir a los cambios fisiológicos de la edad, sino que deben abordar también las manifestaciones patológicas, describiendo así cuáles son las lesiones bucales más recurrentes. El trabajo en cuestión tiene por objeto levantar el número de lesiones bucales prevalentes en tejido blando y duro en ancianos. Se realiza a partir de um estudio de las lesiones bucales prevalentes que han afectado a los ancianos registrados en los informes del Servicio de Patología Oral y Maxilofacial de la Universidad del Estado de Amazonas, SEPAT-UEA, entre los años 2012 a 2018. Según los datos recogidos, la categoría de neoplasias de tejidos blandos (28,94%) presentó el mayor número de casos, en la que la lesión más prevalente fue la hiperplasia fibrosa inflamatoria (14,04%). Fue más afectado por mujeres (54,91%), personas de 60 a 69 años (74,77%), usuarios de prótesis removibles (15,56%) y la mandíbula (17,28%) fue la localización más común. Con la información adquirida, de un servicio de referencia en el estado de Amazonas, es posible tener una mejor focalización de recursos para la población geriátrica, con un mayor enfoque en las lesiones más prevalentes, apuntando así a una mejor salud bucal y consecuentemente una mejor calidad de vida(AU)

Proposal of a minimally invasive approach diagnosing desquamative gingivitis-associated diseases.

BACKGROUND: We aimed to present a minimally invasive clinical approach to collect a suitable sample for the laboratory diagnosis of desquamative gingivitis. MATERIALS AND METHODS: The proposed technique involves Nikolsky's test for the collection of tissue samples. It consists of the histopathological analysis of the bullous membrane formed in cases with positive Nikolsky's sign (NS). Three patients without a previous diagnosis of the disease agreed to undergo this protocol before a biopsy. RESULTS: The diagnoses of the three cases reported here were mucous pemphigoid (MP), pemphigus vulgaris (PV), and lichen planus (LP). The tissue samples collected using this technique were sufficient to microscopically observe partial-thickness epithelium (diagnosing PV) or full-thickness epithelium (diagnosing MP). The diagnosis of LP was only possible by conventional biopsy. CONCLUSION: We observed, for different cases, some advantages of the proposed technique: minimally invasive, potentially superior to exfoliative cytology, easily performed, and with low costs.

Metastatic Biphasic Primitive Tumor in the Mandible of a Child.

Pediatric mandibular tumors present an aggressive biological behavior and difficult diagnosis. A wide range of odontogenic and nonodontogenic tumors comprise the spectrum of these lesions. We report a case of a 1-year-old male child patient showing facial asymmetry symptomatic of an expansive lesion extending throughout the body and ramus of the left hemimandible with a diameter of 8 cm. The histopathological report suggested a high-grade mucoepidermoid carcinoma (MEC), recommending further immunohistochemical investigation of the ectomesenchymal or neuroectodermal origin of the tumor cells. The patient evolved with extensive bilateral pleural effusion followed by metastasis in the middle third of the right humerus, and died 2 months after the first biopsy procedure by acute renal failure with tubular necrosis, before a final inconclusive immunohistochemical report was reached. The lack of resources for less-favored regions of Brazil impairs rapid biomolecular examinations such as immunohistochemical resulting in delay of appropriate therapeutic procedures.

Sialadenoma papilliferum: Bibliometric analysis.

BACKGROUND: Sialadenoma papilliferum is a benign rare condition of salivary glands showing a characteristic papillary growth of the ductal epithelium that ends up being confused with more frequent lesions of the oral cavity. Objectives: To perform a bibliometric analysis of all articles about Sialadenoma papilliferum in the oral cavity and to add a singular case report of Sialadenoma in the lower lip. MATERIAL AND METHODS: A total of 36 publications referring to Sialadenoma papilliferum in the oral cavity from the PubMed platform was reviewed. The specific data were collected, and a bibliometric analysis was performed using Microsoft Excel. The results obtained were then compared with this new case report. RESULTS: The people most affected with sialadenoma were white males at the average age of 56. The lesion was asymptomatic, usually white or red, with an average size of 1.4 cm, and the palate was by far the most affected site. The majority of the lesions were excised, and only two cases indicated recurrence. CONCLUSIONS: With surgical removal, Sialadenoma papilliferum has a favorable prognosis and no further treatment is required. Due to few recorded cases of recurrence, a long follow-up period is recommended to ensure that the lesion does not redevelop. Key words:Sialadenoma papilliferum, salivary gland, oral cavity, bibliometric analysis.

Disfunção massetérica e sialoadenite de refluxo: relato de caso / Masseteric dysfunction and reflux sialoadenite: case report / Disfunción massetérica y sialoadenita de reflujo: reporte de caso

A sialoadenite é uma inflamação das glândulas salivares que pode ser de origem infecciosa ou não, caracterizada por edema, dor e diminuição ou ausência de salivação da glândula afetada. A redução do fluxo salivar pode ser encontrada também em casos de hipertrofia das glândulas parótidas, como observado nos casos de diabetes, alcoolismo, desnutrição, anorexia, bulimia e, dentre elas, a estenose ductal, que pode ocorrer, em razão de sialólitos, mas também devido à contratura muscular em indivíduos com disfunção muscular mastigatória, cronificada pela perda de dimensão vertical decorrente da não reabilitação protética e potencializada por razões ambientais diversas. Este trabalho apresentará um caso em paciente de 61 anos de idade, sexo feminino, com queixa de fortes dores na região de glândula parótida direita, edema ipsilateral, mioespasmo com presença de pontos gatilhos massetéricos e ordenha negativa, levando a hipótese diagnóstica de Sialoadenite de Refluxo. Houve indicação da confecção de um aparelho protético inferior com plano deslizante de resina acrílica para aumentar a Dimensão Vertical de Oclusão (DVO) e restabelecer a dinâmica maxilomandibular, regularizando o fluxo salivar do ducto parotídeo e restaurando a homeostasia glandular até a aquisição de novas próteses reabilitadoras totais para paciente(AU)

Sialoadenitis is an inflammation of the salivary glands that may be of infectious origin or not, characterized by edema, pain and decreased or no salivation of the affected gland. The reduction of salivary flow can also be found in cases of hypertrophy of the parotid glands, as observed in cases of diabetes, alcoholism, malnutrition, anorexia, bulimia and, among them, ductal stenosis, which may occur due to sialoliths, but also due to muscular contracture in individuals with masticatory muscular dysfunction chronified by the loss of vertical dimension due to non-prosthetic rehabilitation and potentiated by diverse environmental reasons. This paper aims to present a case in 61 years old patient, women, with complain of severe pain in the right parotid gland region, with ipsilateral edema, myospasm with the presence of trigger points masseteric and negative milking, taking to diagnostic hypothesis as Sialoadenitis Reflux. A lower prosthetic device with an acrylic resin sliding plane was made to increase the Vertical Occlusion Dimension (OVD) and to restore the maxillomandibular dynamics, regulating the salivary flow of the parotid duct and restoring glandular homeostasis until the acquisition of new rehabilitation prostheses for patients(AU)

La sialoadenitis es una inflamación de las glándulas salivares que puede o no tener origen infeccioso y se caracteriza por edema, dolor y disminución o ausencia de salivación de la glándula afectada. La reducción del flujo salivar puede encontrarse también en casos de hipertrofia de las glándulas parótidas, como se observa en los casos de diabetes, alcoholismo, desnutrición, anorexia, bulimia y, entre ellas, la estenosis ductal; esta puede ocurrir en razón de sialolitos o debido a la contractura muscular en individuos con disfunción muscular masticatoria cronificada por la pérdida de dimensión vertical, resultante de la falta de rehabilitación protética y potencializada por razones ambientales diversas. Este trabajo expondrá un caso en paciente de 61 años de edad, del sexo femenino, con queja de fuertes dolores en la región de glándula parótida derecha, edema ipsilateral, mioespasmo con presencia de puntos gatillos masetéricos y ordeño negativo, llevando la hipótesis diagnóstica de Sialoadenite de reflujo. Se indicó la confección de un aparato protético inferior con plano deslizante de resina acrílica para aumentar la Dimensión Vertical de Oclusión (DVO) y restablecer la dinámica maxilomandibular, normalizando el flujo salivar del ducto parotídeo y restaurando la homeostasia glandular hasta la adquisición de nuevas prótesis rehabilitadoras para el paciente(AU)

Prevalência de jovens hipertensos não diagnosticados atendidos na policlínicao dontológica da Universidade do Estado do Amazonas / Prevalence of undiagnosed hypertensive young people of dental policlinics of University of Amazonas State

Objetivo: avaliar a prevalência de jovens hipertensos não diagnosticados que procuraram atendimento na policlínica odontológica da Universidade do Estado do Amazonas (UEA) quanto a sexo, raça, idade e índices antropométricos. Metodologia: foi entregue um questionário de perguntas fechadas e realizadas duas aferições de pressão arterial com intervalo de 10 minutos entre elas para diagnóstico da hipertensão em 124 sujeitos. Em seguida, os pacientes foram pesados e medidos para obtenção do índice de massa corporal (IMC) e foi obtida a medidad a circunferência abdominal (CA). Os dados foram analisados pelos testes Exato de Fisher e t de Student, com nível de significância de 5%.Resultados: a prevalência de jovens hipertensos não diagnosticados foi de 4,8%(n=6) e a média de idade encontrada foi de 19,3 ± 1,9 anos. O sexo feminino apresentou 8,0% (n=4) e o masculino 2,5% (n=2) de hipertensos. Houve predominância da raça parda (n=4; 5,0%). A prevalência de sobrepeso/obeso foi superior nos jovens hipertensos em comparação aos valores de IMC normal (p<0,05). Não foi observada associação entre hipertensão e CA, em ambos os sexos (p>0,05).Conclusão: a prevalência de hipertensos jovens foi baixa, sendo que a maioria destes era de mulheres de raça parda, sendo associada a indivíduos em sobrepeso ou obesos.

Aim: to evaluate the prevalence of non-diagnosed hypertensive young-adults searching for dental treatment at dentistry policlinics of Amazonas State University in function of gender, race, age and anthropometric indexes. Metodology: a survey with non-open questions was applied along with two measurements of arterial pressure toke 10 minutes apart between them in 124 subjects. The patients were weighed and their height was measured to obtain the body-mass index (BMI). The abdominal circumference (AC) was also obtained. Data were analyzed by Fisher’s exact and Student t tests (alpha=5%).Results: the prevalence of hypertensive young-adults, aging 19.3 ± 1.9 years, was4.8% (n=6), being 8% (n=4) females and 2.5 % (n=2) males. The predominant race was brown (5%, n=4). Overweighed/obese hypertensive subjects were prevalent when compared to normal BMI subjects (p<0.05). There was none association between hypertension and AC in both genders (p>0.05).Conclusion: the prevalence of hypertensive young-adults was low, being the majority of them brown females, being associated with overweigh or obesity.