Interleukin-17 plays a role in dental pulp inflammation mediated by zoledronic acid: a mechanism unrelated to the Th17 immune response?

Abstract Objective To evaluate the influence of RORγT inhibition by digoxin on inflammatory changes related to interleukin-17 (IL-17) in the pulp of rats treated with zoledronate (ZOL). Methodology Forty male Wistar rats were divided into a negative control group (NCG) treated with saline solution, a positive control group (PCG) treated with ZOL (0.20 mg/kg), and three groups treated with ZOL and co-treated with digoxin 1, 2, or 4 mg/kg (DG1, 2, and 4). After four intravenous administrations of ZOL or saline solution in a 70-day protocol, the right molars were evaluated by histomorphometry (number of blood vessels, blood vessels/µm2, cells/µm2, total blood vessel area, and average blood vessel area) and immunohistochemistry (IL-17, TNF-α, IL-6, and TGF-β). The Kruskal-Wallis/Dunn test was used for statistical analysis. Results PCG showed an increase in total blood vessel area (p=0.008) and average blood vessel area (p=0.014), and digoxin treatment reversed these changes. DG4 showed a reduction in blood vessels/µm2 (p<0.001). In PCG odontoblasts, there was an increase in IL-17 (p=0.002) and TNF-α (p=0.002) immunostaining, and in DG4, these changes were reversed. Odontoblasts in the digoxin-treated groups also showed an increase in IL-6 immunostaining (p<0.001) and a reduction in TGF-β immunostaining (p=0.002), and all ZOL-treated groups showed an increase in IL-17 (p=0.011) and TNF-α (p=0.017) in non-odontoblasts cells. Conclusion ZOL induces TNF-α- and IL-17-dependent vasodilation and ectasia, and the classical Th17 response activation pathway does not seem to participate in this process.

Development and professional validation of an App to support Oral Cancer Screening

Abstract The objective of this study was to develop and validate an App for identifying risk factors for oral cancer. To this end, we developed an App (OCS: Oral Cancer Screening) with predictors of Oral Cancer (OC) and algorithm assembly to estimate the risk of its development. Methodology: Simulated clinical cases were designed so that 40 professionals with expertise in oral diagnostics could validate the algorithm and test its usability (SUS: System Usability Score) and acceptability (TAM: Technology Acceptance Model). Cronbach's alpha coefficient, Friedman/Dunn tests, and Spearman correlation evaluated the SUS and TAM scales. ROC curve was plotted to estimate the cutoff point of the algorithm in suggesting a high risk for OCS of the simulated cases. Chi-square and Fisher's exact tests were additionally used (p<0.05, SPSS v20.0). Results: Professionals with expertise in oral diagnosis had usability of 84.63±10.66 and acceptability of 84.75±10.62, which correlated positively (p<0.001, r=0.647). Acting in clinical areas of dentistry (p=0.034) and history of performing OC risk factor orientation (p=0.048) increased acceptability while acting in higher education increased usability (p=0.011). The cutoff point suggested by the App after validation of the simulated clinical cases showed high sensitivity of 84.8% and lower specificity of 58.4%. Conclusion: The OCS was effective and with adequate sensitivity, usability, and acceptability and may contribute to the detection of early oral lesions.

Resumo O objetivo deste estudo foi desenvolver e validar um aplicativo para identificação de fatores de risco para câncer bucal. Para tanto, desenvolvemos um aplicativo (OCS: Oral Cancer Screening) com preditores de Câncer Oral (CO) e montagem de algoritmo para estimar o risco de seu desenvolvimento. Metodologia: Casos clínicos simulados foram projetados para que 40 profissionais com expertise em diagnóstico oral pudessem validar o algoritmo e testar sua usabilidade (SUS: System Usabilidade Score) e aceitabilidade (TAM: Technology Acceptance Model). O coeficiente alfa de Cronbach, os testes de Friedman/Dunn e a correlação de Spearman avaliaram as escalas SUS e TAM. A curva ROC foi traçada para estimar o ponto de corte do algoritmo ao sugerir um alto risco para OCS dos casos simulados. Os testes do qui-quadrado e exato de Fisher foram usados adicionalmente (p<0,05, SPSS v20.0). Resultados: Profissionais com expertise em diagnóstico oral tiveram usabilidade de 84,63±10,66 e aceitabilidade de 84,75±10,62, que se correlacionaram positivamente (p<0,001, r=0,647). Atuar em áreas clínicas da odontologia (p=0,034) e histórico de realização de CO orientação de fator de risco (p=0,048) aumentaram a aceitabilidade enquanto atuar no ensino superior aumentou a usabilidade (p=0,011). O ponto de corte sugerido pelo App após validação dos casos clínicos simulados apresentou alta sensibilidade de 84,8% e baixa especificidade de 58,4%. Conclusão: O OCS foi eficaz e com sensibilidade, usabilidade e aceitabilidade adequadas e pode contribuir para a detecção de lesões orais precoces.

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients / Fatores prognósticos e sobrevida global em um seguimento de 15 anos de pacientes com tumores malignos da glândula salivar: uma análise retrospectiva de 193 pacientes

Abstract Introduction Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Resumo Introdução Os tumores malignos das glândulas salivares são entidades patológicas incomuns, representam menos de 5% das neoplasias de cabeça e pescoço. O prognóstico dos pacientes com tumores malignos das glândulas salivares é altamente variável e alguns fatores clínicos podem influenciar significativamente a sobrevida global. Objetivo Analisar as características clinicopatológicas e sociodemográficas que influenciam a sobrevida em pacientes com tumores malignos das glândulas salivares. Método Este estudo retrospectivo analisou sexo, idade, etnia, nível de escolaridade, localização do tumor, tamanho do tumor, envolvimento linfonodal, metástase distante, margens, tipo de tratamento, estado civil, método de acesso à assistência médica e sobrevida global em 15 anos de 193 pacientes com tumores malignos das glândulas salivares. Foram usados os testes X2, log-rank Mantel-Cox, regressão multinomial e regressão logística de Cox (SPSS 20.0, p < 0,05). Resultados Os tipos histológicos mais comuns foram adenocarcinoma (32,1%), carcinoma adenoide cístico (31,1%) e carcinoma mucoepidermoide (18,7%). A taxa de sobrevida global em 15 anos foi de 67,4%, com média de 116 ± 6 meses. A análise univariada revelou que sexo masculino (p = 0,026), idade > 50 anos (p = 0,001), origem de referência do sistema público de saúde (p = 0,011), estádio T (p = 0,007), estádio M (p < 0,001)), estágio clínico (p < 0,001), margens cirúrgicas comprometidas (p = 0,013) e quimioterapia (p < 0,001) foram associados a um prognóstico ruim. As análises multivariadas também mostraram que a idade > 50 anos foi associada independentemente a um prognóstico ruim (p = 0,016). O nível de escolaridade foi o único fator mais prevalente em pacientes idosos (p = 0,011). Conclusão Pacientes com tumores malignos das glândulas salivares acima de 50 anos apresentam pior prognóstico e associação independente com baixo nível de escolaridade.

Distance education in dentistry in Brazil: a critical STROBE-based analysis

Abstract The COVID-19 pandemic has forced dentistry schools (DSs) to adapt their teaching techniques to digital platforms. Therefore, we aimed to evaluate distance classes in the Brazilian DS curriculum. After an online search of higher education institutions (HEIs) with DS on the e-Ministry of Education (MEC) platform, we included institutions with at least one graduated class to extract the age/localization of the DS, funding, number of authorized seats, MEC-grade, ENADE-score, and workload. HEIs' webpages were consulted to identify the curriculum, subjects offered in the distance education (DE) format, extracurricular programs, scientific events, postgraduate programs, and institutional YouTube channels. Chi-square/Fisher's tests plus binary logistic regression were performed (SPSS 20.0, p < 0.05). Of the 241 DSs evaluated, 82 (34.0%) offered distance classes, and a high prevalence was observed in the southeast region (p <0.001) and private HEIs (p = 0.001). HEIs with distance classes had lower ENADE scores (p = 0.004), lower workload (p = 0.007), and higher workload for optional subjects (p = 0.016), doctoral programs (p = 0.041), specialization courses (p = 0.017), and institutional YouTube channels (p < 0.001). Southern dental schools (p < 0.001), lower workload (p = 0.022), optional subjects (p = 0.033), and institutional YouTube channels (p = 0.005) were independently associated with distance classes. In one-third of the Brazilian DSs, distance classes and institutional YouTube channels were strongly associated variables. The association of distance learning with lower workload and low academic performance draws attention to the need for regulatory bodies for controlling the quality of DE.

Histórico de Consumo de Álcool como Fator Preditivo de Sobrevida em Pacientes com Carcinoma de Células Escamosas de Boca e Orofaringe: Follow-up de 15 Anos / Alcohol Consumption History as a Predictive Factor of Survival in Patients with Mouth and Oropharyngeal Squamous Cell Carcinoma: Follow-up of 15 Years / Historia del Consumo de Alcohol como Factor Predictivo para la Supervivencia en Pacientes con Carcinoma de Células Escamosas Bucales y Orofaríngeas: Seguimiento de 15 Años

Introdução: O carcinoma de células escamosas é o tumor de maior importância na região de cabeça e pescoço, em razão da sua incidência e mortalidade. Sabe-se que fatores como consumo de álcool estão relacionados à diminuição da sobrevida de tumores tanto estimulando a progressão tumoral como causando comorbidades importantes, sendo um fator relevante para estudo. Objetivo: Avaliar a influência do histórico de álcool em características clinicoprognósticas de pacientes com carcinoma de células escamosas de boca e orofaringe (CCEBO). Método: Estudo de coorte, retrospectivo, no qual 156 prontuários de pacientes etilistas e 78 prontuários de pacientes não etilistas com CCEBO diagnosticados no Hospital Haroldo Juaçaba, em Fortaleza, Ceará, foram avaliados, entre 2000 e 2014, para análise de dados como idade, sexo, raça, localização do tumor, estadiamento TNM, tratamentos realizados e sobrevida em 15 anos por meio dos testes X², Long-Rank e modelos de regressão multinomial e de Cox (SPSS 20,0; p<0,05). Resultados: Houve maior prevalência de homens entre os pacientes etilistas (p<0,001), com tumores T3-T4 (p=0,003), linfonodos positivos (p=0,006) que realizaram tratamentos paliativos (p<0,001) e menor prevalência abaixo de 65 anos (p<0,001), quando havia histórico familiar de câncer (p=0,043). A sobrevida dos pacientes etilistas foi menor (p=0,040) e os fatores que diminuíram a sobrevida de maneira independente foram sexo masculino (p=0,042), estadiamento T3-T4 (p=0,004), metástase linfonodal (p=0,012), idade >65 anos (p=0,035) e localização na língua (p=0,042). O sexo masculino foi independentemente associado ao etilismo (p<0,001). Conclusão: O álcool é um fator de prognóstico em pacientes com CCEBO, mostrando maior prevalência em pacientes T3-T4 e, assim, influenciando negativamente no prognóstico.

Introduction: Squamous cell carcinoma is the most important tumor in the head and neck region, due to its incidence and mortality. It is known that factors as alcohol consumption are related to the decrease of the survival of tumors, either stimulating tumor progression or causing considerable comorbidities, being an important study factor. Objective: Evaluate the influence of alcohol history on clinical and prognostic characteristics of patients with mouth oropharynx squamous cell carcinoma (MOSCC). Method: A retrospective cohort study in which 156 charts of alcoholic patients and 78 medical charts of non-alcoholic patients with MOSCC diagnosed at Haroldo Juaçaba Hospital in Fortaleza, state of Ceará were evaluated between 2000 and 2014 for data analysis such as age, gender and race, tumor location, TNM staging, treatments performed and 15-year survival through X², Long-Rank and Cox and multinomial regression models (SPSS 20.0; p <0.05). Results: Men were more prevalent among alcoholic patients (p <0.001), with T3/4 tumors (p = 0.003), positive lymph nodes (p = 0.006) who submitted to palliative treatments (p<0.001) and lower prevalence under 65 years (p <0.001), when there was a family history of cancer (p = 0.043). The survival of alcoholic patients was lower (p = 0.040) and the factors that independently reduced survival were male sex (p = 0.042), T3-T4 staging (p = 0.004), lymph node metastasis (p = 0.012), age> 65 years (p = 0.035) and tumor in the tongue (p = 0.042). Male sex was independently associated with alcohol consumption (p<0.001). Conclusion: Alcohol is a prognostic factor in patients with MOSCC, showing a higher prevalence in T3-T4 patients and, thus, negatively influencing the prognosis.

Introducción: El carcinoma de células escamosas es el tumor de mayor importancia en la región de cabeza y cuello, debido a su incidencia y mortalidad. Se sabe que factores como el consumo de alcohol están relacionado con la disminución de la supervivencia de tumores tanto estimulando la progresión tumoral, como provocando comorbilidades considerables, siendo un factor de estudio importante. Objetivo: Evaluar la influencia del historial del consumo de alcohol en las características clínicas-pronósticas de pacientes con carcinoma de células escamosas oral y orofaringe (CCEOO). Método: Estudio retrospectivo en el que se evaluaron 156 registros médicos de pacientes consumidores de alcohol y 78 de pacientes no alcohólicos con CCEOO diagnosticados en el Hospital Haroldo Juaçaba, en Fortaleza, Ceará, entre 2000 y 2014, para el análisis de datos como edad, sexo raza, escolaridad, los antecedentes familiares, vínculo matrimonial, registro en el servicio, ubicación del tumor, clasificación de TNM, los tratamientos realizados y la supervivencia durante 15 años a través de las pruebas X² Long-Rank y modelos de regresión multinomial y de Cox (SPSS 20.0; p<0,05). Resultados: Hubo una mayor prevalencia de hombres entre pacientes alcohólicos (p<0,001), con tumores T3-T4 (p=0,003), ganglios linfáticos positivos (p=0,006), y realizó tratamientos paliativos (p<0,001) y menor prevalencia en paciente menores de 65 años (p <0,001); cuando se presentaron antecedentes familiares de cáncer (p=0,043). La supervivencia de los pacientes alcohólicos fue menor (p=0,040); y los factores que disminuyeron la supervivencia de forma independiente fueron hombres (p=0,042); estadificación t3-t4 (p=0,004); metástasis a ganglios linfáticos (p=0,012); edad > 65 años (p=0,035); localización de la lengua (p=0,042). El sexo masculino se asoció independientemente con el consumo de alcohol (p<0,001). Conclusión: El alcohol define el pronóstico en pacientes con CCEOO, muestra una mayor prevalencia en pacientes con T3-T4, por lo tanto, influye negativamente en el pronóstico.

Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report

SUMMARY Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.