Peripheral nerve blocks for acute trigeminal neuralgia involving maxillary and mandibular branches: a case report.

Trigeminal neuralgia (TN) is neuropathic pain that affects the trigeminal nerve branches. Facial pain experienced by patients with TN is typically intense and excruciating. The second and third branches (maxillary and mandibular) are commonly affected. This case report focuses on the potential treatment options for acute TN attacks involving these branches. The proposed approach involves extra-oral peripheral blocks using local anesthetics. Pain levels were measured using a visual numeric scale (VNS) with potential side effects and other relevant documented information. The patients showed responses from high pain levels to almost complete remission (from 8 to 2 and from 10 to 2 on the final VNS), with no significant side effects. This technique provides immediate pain relief and complements oral medications by offering comfort and confidence until the desired drug effect is achieved.

Clinical diagnostic approach for oral lymphomas: a multi-institutional, observational study based on 107 cases.

OBJECTIVE: To evaluate oral lymphomas' clinical manifestations and investigate whether clinical features are associated with lymphoma subtypes. STUDY DESIGN: Oral lymphomas with at least 1 representative clinical image were evaluated. They were classified according to their microscopic grade (high vs low), predominant cell size (small vs medium/large), and cellular lineage (B cell vs T cell). Clinical images were described according to tumor location, number, swelling, ulcer, necrosis, telangiectasia, predominant color, and lobulation. Lymphomas affecting the palate were compared with salivary gland tumors (SGTs) affecting this location. RESULTS: Data from 107 cases were included. High-grade subtypes (80.4%), with medium/large-sized cells (52.3%), and diagnosed as diffuse large B cell lymphomas (29%) predominated. High-grade lymphomas often presented as painful, ulcerative, and osteolytic diseases (P < .05). Tumors predominantly composed of medium/large-sized cells were associated with painful lesions, ulcerated, with necrosis and bone destruction (P < .05). When only palate tumors were considered, multiple and bilateral lesions, the presence of pain, ulceration, and necrosis were significantly more associated with a diagnosis of lymphoma than SGT (P < .001). CONCLUSION: High-grade oral lymphomas are more associated with destructive presentation than low-grade subtypes, and bilateral lesions in the palate are more associated with a lymphoma diagnosis than SGT.

Simultaneous occurrence of Epstein-Barr virus (EBV) in periodontal pockets and in oral squamous cell carcinoma: a cross-sectional study.

OBJECTIVES: This study aimed to investigate the detection of Epstein-Barr virus (EBV) in oral squamous cell carcinoma (OSCC) and to verify the concordance of EBV-DNA frequency in subgingival sites and in the OSCC. METHODS: A cross-sectional study with 30 OSCC patients, aged from 44 to 88 years old, was conducted. Samples were collected in subgingival sites and at the OSCC, then submitted to DNA isolation, qPCR, and genotyping. Descriptive statistic was performed to report the frequency of EBV-DNA in all samples, and McNemar test was applied to verify the concordance among the EBV-DNA frequency in both sites. RESULTS: The individuals presented 62 years old in average, and the majority were male (66.6%). EBV-DNA was detected in 56.7% OSCC lesions. Among the subgroup of 19 dentate individuals, high concordance (73.7%) in both EBV-DNA detection and the absence in subgingival sites and OSCC was observed, and it was statistically significant (p < 0.05). CONCLUSIONS: We report the notable occurrence of EBV-DNA in OSCC; also, the presence of EBV in periodontal sites may contribute to find it in OSCC, although the possible contribution of EBV in the OSCC remains to be investigated. CLINICAL RELEVANCE: The identification of this easily accessible site of EBV latent infection may help to improve the patient's quality of life by maintenance of oral/periodontal health condition and preventing further possible disorders related to the virus, and also encourages new approaches for investigating EBV, periodontitis, and OSCC.

Aplicação do laser de baixa intensidade no tratamento do eritema multiforme: relato de caso / Low intensity laser application in the treatment of erythema multiforme: case report

Objetivo: Este trabalho tem como objetivo relatar um caso de Eritema Multiforme (EM) menor desencadeado por amoxicilina oral, tratado a partir de aplicação de laser de baixa intensidade na região afetada pela doença. Relato de caso: Paciente de 12 anos, atendido no Hospital Metropolitano Odilon Behrens (HMOB), apresentando úlceras em mucosa jugal, lábios e língua, disfagia, dislalia e febre, recebeu diagnóstico clínico de EM e tratamento com aplicação de laser vermelho de baixa intensidade, emitindo em 660nm, com potência de 100mW, sendo aplicado uma dose de 33 J/cm², em pontos com distância aproximada de 1 cm entre eles. Houve resolução das lesões em 7 dias após instituição do tratamento. Conclusão: O presente trabalho mostrou que a Terapia de Fotobiomodulação (TF) com laser de baixa intensidade associado à substituição do medicamento detectado como causa foram fundamentais para a resolução do EM, evidenciando as propriedades bioestimulantes do laser nas lesões ulceradas de mucosa bucal.

Aim: This paper aims to report a case of minor Erythema Multiforme (EM) triggered by oral amoxicillin, treated with low-level laser applications in the region affected by the disease. Case report: A 12-year-old patient, treated at the Metropolitan Hospital Odilon Behrens, presenting ulcers in the buccal mucosa, lips, tongue, dysphagia, dyslalia, and fever, received a clinical diagnosis of EM and treatment with low-intensity red laser applications, emitted at 660 nm, with a power of 100 mW, with a dose of 33 J/cm² being applied, in points with an approximate distance of 1 cm between them. The lesions resolved within 7 days after treatment were instituted. Conclusion: This present paper shows a successful therapeutic, non-pharmacological alternative for the management of EM, showing the bio stimulating properties of laser in ulcerated lesions of the oral mucosa.

Odontologia hospitalar no Brasil: onde estamos? Uma análise do cenário dos últimos anos / Hospital dentistry in Brazil: where are we? An analysis of the scenario of the past few years

A Odontologia Hospitalar visa à manutenção e aos cuidados prestados a pacientes sob internação hospitalar. O cirur-gião-dentista é um profissional devidamente capacitado para identificação, prevenção e tratamento de alterações na cavidade bucal. A inserção do CD em ambiente hos-pitalar tem sido instituída mediante resoluções e leis para beneficiar quem carece desse atendimento. Sendo assim, o objetivo deste trabalho é apresentar trajetória da Odontologia Hospitalar no Brasil, verificar seu panorama atual e mostrar sobre a importância desse profissional na equipe multidisciplinar dos hospitais. As buscas foram realizadas, entre os anos de 2001 e 2019, em bases de dados bibliográficos nacionais e como complemento no manual de odontologia hospitalar, em matérias publicadas pela Agência Nacional de Vigilância Sanitária e em leis publi-cadas nos diários oficiais dos municípios, estados e união. Os dados mostram que muitos estados já se adequaram, do ponto de vista legal, no sentido de tornar a Odontologia Hospitalar uma realidade. No entanto, ainda falta fiscaliza-ção e profissionais ocupando todos os postos de trabalho. Logo, percebe-se que a última década foi decisiva em prol da Odontologia Hospitalar, mas ainda há muito o que se fazer para que novos avanços aconteçam.

Hospital Dentistry aims at the maintenance and care provided to patients under hospitalization. The dental surgeon is a professional duly trained to identify, pre-vent and treat changes in the oral cavity. The insertion of the DS in a hospital environment has been instituted through resolutions and laws to benefit those who need this service. Therefore, the objective of this work is to present the trajectory of OH in Brazil, to verify its cur-rent panorama and to show about the importance of this professional in the multidisciplinary team of hospitals. The searches were carried out between 2001 and 2019 in national bibliographic databases and as a complement to the hospital dentistry manual, in articles published by the National Health Surveillance Agency and in laws published in the official diaries of the municipalities, states and union. The data show that many states have already adapted, from the legal point of view, to make hospital dentistry a reality. However, inspection and professionals are still lacking in all jobs. Therefore, the last decade has been decisive in favor of hospital dentistry, but there is still a lot to be done for new advances to happen.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center / Diagnosticando sífilis adquirida através de lesões orais: a experiência de 12 anos de um Centro de Medicina Oral

Abstract Introduction: A resurgence of syphilis in Brazil has been reported in recent years. Objective: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. Methods: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. Results: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). Conclusion: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Resumo Introdução: Um ressurgimento da sífilis no Brasil tem sido relatado nos últimos anos. Objetivo: Investigar a frequência, as características demográficas e clínicas dos pacientes com sífilis adquirida com envolvimento oral que receberam atendimento médico em um centro de referência em medicina oral em um hospital público brasileiro. Método: Estudo retrospectivo, abrangeu 12 anos, feito para identificar tendências de mudança na sífilis. Registros médicos de todos os pacientes diagnosticados com sífilis adquirida que receberam atendimento médico na clínica de medicina oral do hospital de 2005 a 2016 foram revisados e os dados demográficos e clínicos foram coletados. Resultados: Foram diagnosticas 85 pacientes com sífilis adquirida, com um aumento significativo no número de casos nos últimos 5 anos. A idade dos pacientes variou de 16 a 76 anos, com pico na terceira e quarta décadas; 48 casos eram do sexo masculino (56,5%) e 37 do sexo feminino (43,5%). A maioria das lesões orais apareceu como úlceras ou placas únicas, os lábios e a língua representaram os locais mais afetados. Todos os casos foram positivos para Venereal Disease Research Laboratory e Fluorescent Treponemal Antibody Absorption Test e o tratamento foi feito com penicilina G benzatina na maioria dos casos (84,7%). Conclusão: A frequência da sífilis oral tem aumentado com o tempo e as lesões orais podem representar uma pista diagnóstica; portanto, os profissionais de saúde bucal devem ser conscientizados e devidamente treinados na tentativa de desenvolver um alto grau de suspeição clínica no diagnóstico da sífilis.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center.

INTRODUCTION: A resurgence of syphilis in Brazil has been reported in recent years. OBJECTIVE: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. METHODS: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. RESULTS: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). CONCLUSION: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Tratamento fechado em fratura mandibular: parassinfisária e côndilar bilateral ­ relato de caso clínico / Closed treatment in mandibular fracture: bilateral parasymphyseal and condyle ­ clinical case report

Objetivo: relatar um caso de fratura na região parassinfisária e côndilar bilateral após acidente ciclístico, tratada pela técnica de bloqueio maxilomandibular. Relato de caso: paciente do gênero feminino, 21 anos, deu entrada no Hospital Municipal Waldemar das Dores, Barão de Cocais, MG, vítima de acidente ciclístico, apresentando fratura de esmalte e dentina nos dentes 11 e 21, mordida aberta anterior, com incapacidade de atingir a máxima intercuspidação, juntamente com uma limitação de excursão lateral para o lado direito. Após exames tomográficos, foi constatada fratura completa de colo de côndilo direito, fratura em galho verde em côndilo esquerdo e fratura de cortical lingual parassinfisária. Por se tratar de uma paciente jovem e por apenas uma de suas fraturas apresentar-se completa (colo do côndilo direito), foi proposto tratamento fechado, por meio do bloqueio maxilomandibular. Conclusão: o bloqueio maxilomandibular foi considerado um tratamento eficaz no caso em questão, no qual foi possível estabelecer a consolidação das fraturas sem ocorrência de complicações pós-tratamento.(AU)

Objective: to report a case of fracture in the bilateral parasymphyseal and condylar region after a cycling accident, treated with the maxillomandibular block technique. Case report: a 21-yearold female patient was admitted to the Waldemar das Dores Municipal Hospital, Barão de Cocais, MG, Brazil, victim of a cycling accident, showing enamel and dentin fracture in teeth 11 and 21, anterior open bite, inability to reach maximum intercuspation, and a lateral excursion limitation to the right side. Tomographic examinations showed complete fracture of the right condyle neck, greenstick fracture in the left condyle, and parasymphyseal lingual cortical fracture. Considering it is a young patient with only one complete fracture (neck of the right condyle), a closed treatment was proposed through maxillomandibular block. Conclusion: maxillomandibular block was considered an effective treatment for the case in question, allowing to establish fracture consolidation without post-treatment complications.(AU)

Low-level laser as a complementary therapy in orofacial granulomatosis management: a case report.

Orofacial granulomatosis (OFG) is a chronic inflammatory disease that typically affects the soft tissues of the orofacial region. The most common clinical manifestation of OFG is lip swelling, which may be associated with intrabuccal ulcerations and increased growth of the gingiva and mucosa, as well as cutaneous erythema and facial edema. The treatment for OFG is challenging, and sometimes considered unsatisfactory. Thus, this study presents a case report of OFG and the therapeutic regimen applied. A 47-year-old man presented with increased lip volume which had started 10 months earlier. His lips were thick with a fibroelastic consistency, which were painless upon palpation. Incisional biopsy and histopathological analysis of the upper lip revealed non-specific granulomatous inflammation and the diagnosis of OFG was subsequently made. Low-level laser therapy was successfully used to treat OFG in this case, and appears to be an efficient treatment for OFG when corticosteroid therapy is not enough.

DNA methylation patterns of genes related to immune response in the different clinical forms of oral lichen planus.

BACKGROUND: The oral lichen planus is a chronic inflammatory disease. Although its aetiology is not well understood, the role of T lymphocytes in its inflammatory events is recognised. Identifying the epigenetic mechanisms involved in the pathogenesis of this immune-mediated condition is fundamental for understanding the inflammatory reaction that occurs in the disease. The purpose of this work was to evaluate the methylation pattern of 21 immune response-related genes in the different clinical forms of oral lichen planus. METHODS: A cross-sectional study was performed to analyse the DNA methylation patterns in three distinct groups of oral lichen planus: (i) reticular/plaque lesions; (ii) erosive lesions; (iii) normal oral mucosa (control group). After DNA extraction from biopsies, the samples were submitted to digestions by methylation-sensitive and methylation-dependent enzymes and double digestion. The relative percentage of methylated DNA for each gene was provided using real-time polymerase chain reaction arrays. RESULTS: Hypermethylation of the STAT5A gene was observed only in the control group (59.0%). A higher hypermethylation of the ELANE gene was found in reticular/plaque lesions (72.1%) compared to the erosive lesions (50.0%). CONCLUSION: Our results show variations in the methylation profile of immune response-related genes, according to the clinical type of oral lichen planus after comparing with the normal oral mucosa. Further studies are necessary to validate these findings using gene expression analysis.

Mucosal leishmaniasis in Brazilian patients: two case reports with similar clinical presentation and different approaches.

Mucosal leishmaniasis is a chronic infection that affects the upper respiratory tract and/or the oral mucosa caused by Leishmania protozoan parasites. We present two cases of oral leishmaniasis and discuss the different diagnostic strategies and treatment. In both cases, the patients were male, 60 and 94 years of age, and presented with lesions on the soft palate. In the first patient, the final diagnosis was made on the basis of histopathologic examination. In the second case, polymerase chain reaction and Montenegro skin test were necessary to confirm the diagnosis. The first patient was treated with meglumine antimoniate (Glucantime), and the lesions healed after 2 months. In the second case, the patient received treatment with liposomal amphotericin B but later died as a result of generalized infection. Mucosal leishmaniasis is a highly disfiguring disease. Early diagnosis is important to prevent a lethal outcome.

Análise da prevalência de carcinoma de células escamosas da cavidade bucal no Serviço de Estomatologia do Hospital Metropolitano Odilon Behrens em Belo Horizonte, Minas Gerais / Analysis of the prevalence of squamous cell carcinoma of the oral cavity in the Stomatology Service of Hospital Metropolitano Odilon Behrens in Belo Horizonte, Minas Gerais, Brazil

O objetivo desse trabalho foi determinar a prevalência de carcinoma de células escamosas (CCE) em pacientes atendidos no serviço de Estomatologia do Hospital Metropolitano Odilon Behrens (HMOB) de Belo Horizonte (BH) no período de maio de 2012 a maio de 2014. Métodos: Trata-se de um estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva de prontuários de pacientes atendidos no serviço de Estomatologia do HMOB, com abordagem quantitativa dos dados. Resultados: Foram avaliados 139 prontuários de pacientes diagnosticados com CCE. Quanto à faixa etária dos pacientes diagnosticados, houve maior prevalência em torno da 5ª e 6ª década de vida. Em relação ao gênero, o sexo masculino foi o mais atingido em todas as faixas etárias. Com relação aos principais fatores de risco, 60 pacientes (75,94%) relataram ser tabagistas e etilistas. Quanto à classificação dos pacientes em relação ao consumo diário de tabaco, 33 (50%) foram considerados tabagista grave (mais de 20 cigarros/ dia). Em relação ao tamanho das lesões, uma larga parcela dos pacientes (48,51%) diagnosticados com CCE de cavidade bucal, apresentaram lesão medindo de 30 a 60 mm. Na distribuição dos pacientes segundo a localização anatômica e sexo, a língua foi o sítio mais acometido (32,82%), seguido do assoalho bucal (29,95%), em ambos os gêneros. Conclusão: Este estudo mostrou, de forma pioneira, o perfil epidemiológico dos pacientes diagnosticados com câncer da cavidade bucal no Serviço de Estomatologia do HMOB, referência na região de Belo Horizonte. Percebe-se que houve uma preponderância de pacientes do sexo masculino, faixa etária acima dos 50 anos e que faz uso frequente de tabaco e\ou álcool.(AU)

Objective: This study aimed to determine the prevalence of squamous cell carcinoma (SCC) in patients who received dental care at the Stomatology Service of Hospital Metropolitano Odilon Behrens (HMOB) in Belo Horizonte, MG, Brazil, from May 2012 to May 2014. Methods: This is a cross-sectional, epidemiological study based on the retrospective and descriptive analysis of the medical records of patients who received dental care at the HMOB Stomatology Service, using a quantitative data approach. Results: This study evaluated 139 medical records of patients diagnosed with SCC. Regarding the age of the diagnosed patients, a higher incidence was observed around the fifth and sixth decades of life. Regarding gender, males were the most affected in all age groups. Regarding the main risk factors, 60 patients (75.94%) reported being smokers and drinkers. The classification of patients in relation to daily tobacco consumption, 33 (50%) were considered severe smokers (more than 20 cigarettes/day). Regarding the size of the lesions, a large portion of the patient (49 patients = 48.51%) diagnosed with oral cavity SCC presented lesions measuring 30 to 60 mm. In the distribution of patients according to gender and anatomical location, the tongue was the most commonly affected site (43 patients = 32.82 %), followed by the floor of the mouth (34 patients = 29.95%) in both genders. Conclusion: This unprecedented study showed the epidemiological profile of patients diagnosed with oral cavity cancer in the HMOB Stomatology Service, a reference hospital in the Belo Horizonte region. It was observed that there was a preponderance of male patients, who are 50 years of age or older and who frequently use of tobacco and/ or alcohol.(AU)

Análise do perfil de encaminhamentos realizados pela Atenção Básica/Saúde da Família do município de Belo Horizonte ao serviço de Estomatologia do Hospital Municipal Odilon Behrens / Profile analysis of referrals made by primary care/family health program to the stomatology service of the Odilon Behrens Municipal Hospital

Objetivo: Avaliar o tipo e a relevância dos encaminhamentos feitos pela Atenção Básica/ Saúde da Família, do município de Belo Horizonte (BH), ao serviço de Estomatologia do Hospital Municipal Odilon Behrens (HOB) e analisar os critérios do Protocolo de Regulação da Saúde Bucal de BH. Material e Métodos: Para isso, realizou-se estudo epidemiológico transversal, fundamentado na análise retrospectiva e descritiva dos livros de registro do HOB e das listagens de marcação de consulta especializada de todos os pacientes encaminhados ao serviço de Estomatologia do HOB do período de janeiro de 2013 a junho de 2014. Resultados: Foram avaliados os encaminhamentos de 1992 pacientes, dos quais 71% (1414) compareceram às consultas agendadas. Houve predominância feminina entre os participantes e idade média de 54 anos. Quanto à prioridade dos encaminhamentos, foram encontrados: 513 (37%) prioridades alta, 422 (30%) prioridades média e 231 (16%) prioridades baixa. 75 (5%) dos encaminhamentos recebidos apresentavam alterações cujas características não estão descritas nos critérios do protocolo. 62 (4%) foram encaminhados erroneamente e 105 (8%) não possuíam alterações no momento da consulta. Assim, os encaminhamentos realizados pela atenção básica estão em conformidade com os critérios estabelecidos pelo Protocolo de Regulação. Mas, ao se comparar as alterações encontradas com o protocolo, observou-se critérios pouco objetivos, ocasionando discrepância entre a orientação do Ministério da Saúde e os atendimentos realizados pelo serviço de Estomatologia no município de BH. Conclusão: Sendo assim, ainda há a necessidade de revisão do protocolo atual, além da necessidade de instituir uma política de educação permanente na atenção básica.(AU)

Aim: This study aimed to evaluate the type and relevance of referrals by Primary Care / Family Health Program to the Stomatology Department of Odilon Behrens Municipal Hospital (HOB) and analyzed the criteria of the Belo Horizonte Oral Health Regulation Protocol. Methods: The authors conducted a cross-sectional epidemiological study, based on retrospective and descriptive analysis of the HOB's logs and specialized consultation appointment listings of all patients referred to the HOB's Stomatology Department from January 2013 to June 2014. Results: This study evaluated 1,992 patient referrals, of which 71% (1414) attended the scheduled visits. There was a predominance of female participants and the average age was 54 years. Regarding the prioritization of referrals, the following data were found: 513 (37%) high priorities, 422 (30%) average priorities, and 231 (16%) low priorities; 75 (5 %) of the received referrals presented changes, whose characteristics are not described in the protocol criteria; 62 (4%) were wrongly referred to the stomatology department, and 105 (8%) presented no change at the time of the doctor's appointment. Thus, the referrals made by primary care are in accordance with the criteria established by the oral health regulation protocol. However, upon comparing the changes found through the protocol, what could be observed was that the criteria presented little objectivity, resulting in adiscrepancy between the advice provided by the Ministério da Saúde and the services performed by the stomatology services in Belo Horizonte. Conclusion: Therefore, the results indicate the need to revise the current protocol and reveal the need to establish a permanent education policy in primary care.(AU)

IL-17 genetic and immunophenotypic evaluation in chronic graft-versus-host disease.

Although interleukin-17 (IL-17) is a recently discovered cytokine associated with several autoimmune diseases, its role in the pathogenesis of chronic graft-versus-host disease (cGVHD) was not established yet. The objective of this study was to investigate the association of IL17A and IL17F genes polymorphisms and IL-17A and IL-17F levels with cGVHD. IL-17A expression was also investigated in CD4(+) T cells of patients with systemic cGVHD. For Part I of the study, fifty-eight allo-HSCT recipients and donors were prospectively studied. Blood samples were obtained to determine IL17A and IL17F genes polymorphisms. Cytokines levels in blood and saliva were assessed by ELISA at days +35 and +100 after HSCT. In Part II, for the immunophenotypic evaluation, eight patients with systemic cGVHD were selected and the expression of IL-17A was evaluated. We found association between recipient AA genotype with systemic cGVHD. No association was observed between IL-17A levels and cGVHD. Lower IL-17A levels in the blood were associated with AA genotype. In flow cytometry analysis, decreased expression of IL-17A was observed in patients with cGVHD after stimulation. In conclusion, IL-17A may have an important role in the development of systemic cGVHD.

Association between IL1B (+3954) polymorphisms and IL-1ß levels in blood and saliva, together with acute graft-versus-host disease.

Graft-versus-host disease (GVHD) is associated with morbidity and mortality in the recipients of allogeneic hematopoietic stem cell transplants (allo-HSCTs). Interleukin-1ß (IL-1ß) is a potent inflammatory mediator involved in different inflammatory conditions. Therefore, we aimed to investigate the association of IL1B gene polymorphism in recipients and donors in cases in which acute GVHD (aGVHD) has been reported and the impact of this gene polymorphism on the level of cytokines in the blood and saliva. Fifty-eight consecutive allo-HSCT recipients and their donors were prospectively studied. Saliva and/or blood samples were obtained from the recipients and donors to identify the IL1B gene polymorphism, and cytokine levels were assessed by ELISA. Samples were collected weekly from 7 days before transplantation (day -7) to 100 days after allo-HSCT (day+100), for a total of 16 weeks or until death. aGVHD occurred in 27 individuals evaluated. A significant association was identified between the IL1B polymorphism in the donor and aGVHD development in the corresponding recipients. However, no significant association was detected between the IL1B polymorphism in recipients and the development of aGVHD. In the recipients who were diagnosed with aGVHD, the level of IL-1ß in the saliva and blood were increased. In the saliva, IL-1ß levels increased progressively from the time before the diagnosis of aGVHD until weeks after the diagnosis, whereas in the blood, IL-1ß peak levels could be observed within the time allotted for diagnosis, followed by a decrease in the levels. In addition, we observed a significant association between the IL1B genotype of the recipient (CC) and high IL-1ß levels in the saliva at week 13. In conclusion, IL-1ß could be considered a useful predictor of aGVHD development.

Análise sociodemográfica e clínica de pacientes submetidos ao transplante alogênico de células-troncos hematopoiéticas / Sociodemographic and clinical analysis of patients subjected to allogeneic hematopoietic stem cell transplantation

Objetivo: Descrever os achados clínicos e sociodemográficos dos pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH) e encaminhados à Faculdade de Odontologia da Universidade Federal de Minas Gerais (FO-UFMG). Metodologia: Foram selecionados 39 pacientes pré-TCTH alogênico entre 2006 e 2008. Os dados sociodemográficos e clínicos foram obtidos dos prontuários médicos do dia - 7 ao dia +360 pós-TCTH. Resultados: Foi possível observar que 59% dos pacientes eram homens, 25,6% eram melanoderma e 53,8% eram solteiros. Trinta e três por cento deles possuíam o ensino fundamental, 38,5% eram católicos e 56,4% residiam em casa, sendo que (51,2%) residem em casa própria e, (61,5%) em zona urbana. O saneamento básico estava presente em 64,1%, a coleta seletiva em 69,2% e a água encanada em 64,1%. A medula óssea foi a fonte de células-tronco para o TCTH usada em 61,5% dos casos, a doença de base mais prevalente foi a leucemia (46,4%) e 41% dos pacientes foram a óbito após o TCTH. Além disso, 43,6% dos pacientes apresentaram a doença do enxerto contra o hospedeiro aguda (DECHa) e 62,5% DECHc sistêmica e 58,3% DECHc bucal. Conclusão: Assim, este estudo adiciona ao conhecimento no contexto do TCTH dados referentes ao perfil clínico e sociodemográfico dos pacientes e com isso, sugere que o êxito do transplante compreende na sinergia de todos os aspectos referentes ao transplantado.

Objective: To describe the clinical and sociodemographic findings of the patients subjected to hematopoietic stem cell transplantation (HSCT) and referred to the School of Dentistry of the Federal University of Minas Gerais (FO-UFMG). Method: Thirty-nine pre-allogeneic HSCT patients were selected between 2006 and 2008. The clinical and sociodemographic data were obtained from the medical charts from day -7 to day +360 post-HSCT. Results: It was found that 59% of the patients were male, 25.6% were Black and 53.8% were single. Thirty-three percent of them completed the elementary school, 38.5% were Catholic and 56.4% lived at home; of these, 51.2% owned their houses and 61.5% lived in the urban area. As much as 64.1%, 69.2%, 64.1% of the patients had access to basic sanitation, selective collection of residues and water supply pipelines. The bone marrow was the source of stem cells for the HSCT used in 61.5% of the cases, leukemia was the most prevalent base disease (46.4%), and 41% of the patients died after HSCT. Additionally, 43.6% of the patients presented acute graft-versus-host disease (GVHD), 62.5% presented chronic systemic GVHD, and 58.3% presented oral GVHD. Conclusion: This study adds to the knowledge of HSCT information about the clinical and sociodemographic profile of the patients, suggesting that the success of transplantation encompasses the synergy of all aspects associated with the transplant recipient.

Oral cGVHD screening tests in the diagnosis of systemic chronic graft-versus-host disease.

To determine the diagnostic properties of oral manifestations and histological features of graft-versus-host disease (GVHD) screening tests in the diagnosis of systemic chronic graft-versus-host disease (cGVHD). Sixty patients having undergone allogeneic haematopoietic stem cell transplantation were selected. The patients were submitted to a clinical oral examination to assess symptoms and clinical changes in the oral mucosa. Histopathologic analysis of the lower lip oral mucosa (LLOM) and salivary glands (SG) was also performed. Systemic cGVHD was used for a comparison to oral cGVHD. The accuracy of oral cGVHD tests was low for all methods (58.4% and 52.6% for white lesions and white/red lesions, respectively, in the clinical analysis; 50.4% for the presence of oral pain; and 66.8% and 55.1% for LLOM and SG histopathologic tests, respectively). However, the presence of oral pain had good diagnostic properties [specificity: 100.0, 95% confidence interval (CI): 88.0-100.0; positive predictive value (PPV): 100.0, 95% CI: 94.4-100.0; and negative predictive value (NPV): 72.0, 95% CI: 57.3-83.3]. Moreover, SG alterations revealed by the histopathological analysis also exhibited good diagnostic properties (sensitivity: 98.6, 95% CI: 81.5-99.8; PPV: 71.1, 95% CI: 62.1-79.7; NPV: 85.9 95% CI: 32.9-99.4). The clinical severity of oral lesions and histophatological changes in the LLOM did not exhibit adequate diagnostic properties, whereas both oral pain and SG histopathological analysis exhibited adequate properties for the diagnosis of systemic cGVHD. Histological changes in lip oral mucosa and salivary glands together with a clinical manifestation of the disease in the oral mucosa can be useful to determining the systemic cGVHD.

Imatinib-associated hyperpigmentation of the palate in post-HSCT patient.

Pigmentation of the oral mucosa can indicate a wide range of lesions or conditions. Some drugs are associated with pigmented lesions of oral cavity. Imatinib mesylate (Gleevec(®)) is a protein inhibitor used in the management of several hematological malignancies associated with dermatological side effects, like hyperpigmentation. We report the case of a 38-year-old male post-HSCT patient who had been using imatinib mesylate for over 5 years and presented with blue pigmentation on the hard palate, the left side of the nose and both ear lobes. The differential diagnosis of hyperpigmented lesions in the oral mucosa is also presented.

Association between polymorphisms in interleukin-17A and -17F genes and chronic periodontal disease.

OBJECTIVE: Interleukin-17 (IL-17) is a cytokine that induces neutrophil recruitment and the release of inflammatory mediators in several inflammatory conditions; nevertheless, the involvement of IL-17 gene polymorphisms in chronic periodontitis (CP) has not been addressed yet. Our aim was to evaluate the association between periodontal status and the polymorphisms IL-17A G197A and IL-17F C7488T in subjects with CP along with their impact on levels of inflammatory mediators. MATERIAL AND METHODS: Genomic DNA was obtained from 30 CP patients and 30 healthy controls (HCs). IL-17A G197A and IL-17F C7488T polymorphisms were determined using PCR-RFLP. Serum and periodontal tissues were collected and processed for ELISA, myeloperoxidase (MPO), and/or microscopic analysis. RESULTS: The frequencies of genotypes in the CP group were significantly different from those of HC. Odds ratio indicated that increased risks for CP were associated with the -197A allele, not with the -7488T allele. In addition, the -197A allele was correlated with worse clinical parameters, higher MPO activity, and increased expression of inflammatory mediators (IL-17A and IL-8) than the other genotypes. CONCLUSIONS: These results indicate that the IL-17A -197A allele is associated with increased risk for CP, likely because this genotype relates to the enhanced inflammation in periodontal tissues.