Características Clínicas y Epidemiológicas en Pacientes Diagnosticados con Síndrome de Sjögren en un Hospital Universitario de Cuarto Nivel

El síndrome de Sjögren es la segunda enfermedad autoinmune crónica más prevalente; factores hereditarios y medioambientales interactúan provocando una "epitelitis autoinmune" que daña el tejido glandular exocrino principalmente, pero también a otros órganos; debido a esta heterogeneidad clínica, el diagnóstico y tratamiento constituyen un desafío. Estudios demuestran que afecta al 0,1-0,6 % de la población, con predilección por el sexo femenino (9:1). En Colombia existen pocos estudios epidemiológicos descriptivos y de caracterización en este síndrome. Caracterizar los parámetros clínicos y epidemiológicos de pacientes con síndrome de Sjögren. Se realizó un estudio observacional descriptivo de corte transversal, se revisaron historias clínicas de 409 pacientes con el síndrome que asistieron al Hospital Universitario San Ignacio entre 2012 y 2019. Los datos se analizaron usando estadística descriptiva. La edad promedio de diagnóstico fue 59 años, la relación mujer: hombre 9:1, (91,7 % y 8,3 % respectivamente). Hubo mayor prevalencia en pacientes de 51 a 60 años (131) seguido por los de 61-70 años (114). La manifestación clínica más común fue la xerostomía (90 %); la biopsia de glándula salival menor fue el examen complementario más solicitado (65 %). El compromiso óseo-articular, fue la enfermedad concomitante más asociada. La etiología de la enfermedad es poco conocida, sin embargo, su caracterización, así como la identificación de medios diagnósticos y terapéuticos ayuda en la comprensión de la clínica; dicha información permitirá el desarrollo de tratamientos cada vez más efectivos y específicos.

Sjögren syndrome is the second most common chronic autoimmune disease, environmental and hereditary mechanisms causes an autoimmune epithelitis that affect the exocrine glandular tissue mainly, but also other organs; because this broad spectrum of clinical characteristics, the diagnostic and treatment become a challenge. Studies has shown that 0.1-0.6 % of the population is affected, with predominance of females over males (9:1). In Colombia there are few descriptive epidemiological studies and characterization of the affected population. Clinical and epidemiological characterization of Sjögren syndrome patients. A descriptive cross-sectional observational study was conducted, 409 clinical histories of patients with the syndrome at San Ignacio University Hospital from 2012 to 2019 were analized. The data collected were subjected to a descriptive statistic. The average age of diagnosis was 59 years, the ratio female: male 9:1 (91.7 % and 8.3 % respectively), the highest frequency of the syndrome was found in the 51 to 60 years old group (131) followed by the 61 to 70 years old group (114). The most common clinical manifestation was xerostomia (90 %), minor salivary gland biopsy was the most frequent test requested (65 %). The osseoarticular involvement was the most frecuent concomitant disease. Although the etiology of Sjögren syndrome is little known, its characterization, as well as the identification of the diagnostic and therapeutic means used, is of great help in understanding the disease; this information will allow the development of increasingly effective and specific treatments. More studies are required, in different locations, which will highlight the differences between populations.

Hiposialia y Xerostomía Post Irradiación: Terapias Innovadoras en el Campo Biomolecular / Hyposialia and Xerostomy Post Irradiation: Innovative Therapies in the Biomolecular Field

Las glándulas salivales humanas pueden ser gravemente lesionadas por la radioterapia utilizada contra neoplasias de cabeza y cuello, produciendo hiposialia y xerostomía, las cuales afectan la salud oral y sistémica, mermando la calidad de vida de la persona. Los tratamientos convencionales actuales están diseñados para disminuir los síntomas, sin actuar sobre los cambios fisiopatológicos que se dan a nivel glandular. Esta revisión intenta analizar aquellas terapias preventivas y/o curativas que están desarrollándose en el campo biomolecular y que tienen un futuro prometedor por sus características innovadoras: terapia génica, terapia con células madre y terapia con factores de crecimiento. Se evidencia un aporte adicional de la nanotecnología, la cual está mejorando las vías de aplicación de los tratamientos.

Human salivary glands can be seriously injured by the radiotherapy used against head and neck neoplasms, producing hyposialia and xerostomy, which affect oral and systemic health, diminishing the person's quality of life. Current conventional treatments are designed to reduce symptoms, without acting on the pathophysiological changes that occur at the glandular level. This review attempts to analyze those preventive and /or curative therapies that are developing in the biomolecular field and that have a promising future due to their innovative features: Gene therapy, stem cell therapy and growth factor therapy. An additional contribution of nanotechnology is evident, which is improving the routes of treatment application.

Estomatotoxicidad bucal inducida por quimioterapia / Chemotherapy-induced oral stomatotoxicity

El objetivo principal de este estudio fue determinar el tipo de lesiones bucales más frecuentes en las pacientes con cáncer de mama tratadas con quimioterapia en el Hospital General de México, y establecer en qué condiciones se presentan dichas manifestaciones. Se realizó una revisión de expedientes entre los años de 1994 y 1999, estableciendo los criterios de inclusión y exclusión. De un total de 405 que fueron considerados, se incluyeron en la muestra 327 expedientes. De ellos, la incidencia de estomatotoxicidad se presentó en 122 casos, 89 de los cuales presentaron una sola manifestación bucal, 19 presentaron dos, y 14 pacientes reportaron más de dos. La relación entre la estirpe histológica del tumor se refleja presentándose en el canalicular infiltrante, lobular y otros (p < .005). Los esquemas de tratamiento con quimioterapia fueron integrados con: 5-fluoracilo, adriamicina, ciclofosfamida y metotrexato (p < .005). La dosis y estomatotoxicidad se relacionaron con p < .005.

The principal aim of the present study was to determine the type of oral lesions most frequently found in breast cancer patients treated with chemotherapy at the General Hospital in Mexico City and establish under which circumstances these manifestations occur. A file review was undertaken, spanning from 1994 to 1999. Inclusion and exclusion criteria were established. Out of 405 cases under consideration, 327 cases were included in the sample. In these selected cases, stomatotoxicity was present in 129 cases: 89 cases exhibited only a single oral manifestation, 19 cases showed two and 14 cases exhibited more than two (three or more). Relationship between histological lineage was reflected; it was present in the infiltrating ducts, lobular and others (p < .005). Treatment schemes with chemotherapy were integrated with 5-fluorouracil, adriamycin, cyclophosphamide and methrotrexate (p < .005) dosage and stomatotoxicity were related (p < .005).

Correlación de hallazgos serológicos y compuestos orgánicos en saliva en el Síndrome de Sjõgren / Correlation of serological findings and saliva’s organic compounds in Sjõgren’s Syndrome

Introducción: El objetivo del presente trabajo es evaluar los cambios en flujo y composición orgánica en saliva, así como la presencia de anticuerpos anti Ro/SSA y La/SSB séricos y salivales y su implicancia en el diagnóstico no invasivo del SS. Diseño del estudio: Estudio de corte transversal, de 73 pacientes distribuidos en los siguientes grupos experimentales: Síndrome de Sjõgren primario (SSp) (n = 15), SS secundario (SSs) (n = 17), boca seca y ojo seco sin Síndrome de Sjõgren (BO) (n = 20), y controles sanos (C) (n = 21). Se realizó una determinación del flujosalivalbasal y una toma de muestras de saliva para la medición de proteínas totales, IgA, urea y anticuerpos. Se determinaron anticuerpos anti Ro/SSA y La/SSB en muestras de suero y saliva. Resultados: El flujo salival en SSp, SSs, BO fue significativamente menor (p < 0,001) comparado con C. La composición salival de SS mostró modificaciones de componentes estudiados. Los anticuerpos anti Ro/SSA y anti La/SSB aparecieron con mayor frecuencia en suero y saliva en pacientes con SS en comparación con BO y C, siendo la frecuencia de positividad superior en suero en comparación con saliva. Conclusión: La determinación de anticuerpos Ro/SSA en saliva podrían ayudar a diagnosticar a pacientes con xerostomía como el Síndrome de Sjõgren.

Introduction: The aim of this study was to evaluate changes in flow andorganic composition in saliva, the presence of anti Ro/SSA and La/SSBantibodies in serum and saliva and its implication in the noninvasivediagnosis of SS.Study Design: Cross sectional study, 73 patients divided into four experimentalgroups: Primary Sjögren's syndrome (pSS) (n = 15), secondarySS (sSS) (n = 17), dry eye and dry mouth syndrome without Sjögren's(DEMS) (n = 20) and healthy controls (C) (n = 21). We performed a determinationof basal salivary flow and saliva sampling for measurement oftotal protein, IgA, urea and antibodies. We determined anti Ro/SSA andLa/SSB in serum and saliva.Results: The salivary flow in pSS, sSS, DEMS patients was significantlylower (p <0.001) compared with C. The composition of SS salivary componentsstudied showed changes. The anti Ro/SSA and anti La/SSB occurredmore frequently in serum and saliva in SS patients comparedwith DEMS and C, the frecuency of positivity was higher in serum thanin saliva.Conclusion: The determination in saliva of antibodies Ro/SSA may helpdiagnose patients with xerostomy as Sjögren's Syndrome.

Xerostomy, dental caries and periodontal disease in HIV+ patients

We studied xerostomy and its correlation with periodontal and dental cavity diseases in HIV patients, through measurement of salivary flow and through variables such as saliva buffer capacity, salivary pH, periodontal index, MDF index, dental carie risk and risk of periodontal disease. One hundred patients were analyzed. They were distributed into two groups: Group I (test) - 50 patients evidently HIV+, from whom information was collected and analyzed regarding age, gender, skin color, habits, general and oral diseases, levels of T-CD4 lymphocytes, viral load and highly active antiretroviral therapy (HAART); and Group II - (control) 50 HIV- patients, from whom information was collected and analyzed regarding age, gender, skin color, habits, general and oral diseases. In both groups, measurement of salivary flow, pH and buffer capacity was made. Group I presented high MDF, bacteria plaque and bleeding, with a greater susceptibility to the risks of oral cavities and periodontal disease. The salivary flow and the buffering capacity of the saliva were low, indicating a high level of xerostomy. Two important modifying factors influence these pathologies in an incisive way: one is immunossuppression and the other is HAART therapy. The control exhibited results that are closer to normality; it had better oral-health conditions.

Colonização e espécies de Candida em pacientes submetidos à radioterapia cervicofacial / Candida colonization and species in patients submitted to head and neck radiotherapy

Os objetivos deste estudo foram investigar a colonização por Candida associada à redução do fluxo salivar e identificar as espécies antes, durante e após a radioterapia em 20 pacientes portadores de carcinomas de células escamosas, comparando com dados obtidos em dois grupos-controle, um formado por 24 pacientes saudáveis e o outro, por nove pacientes submetidos à radioterapia por pelo menos um ano. A saliva total de todos os pacientes foi coletada pelo método não-estimulado. As unidades formadoras de colônia de Candida foram quantificadas e identificadas pelos testes bioquímicos, CHROMagar e Api 20 Aux. Os resultados evidenciaram, no grupo de estudo, redução progressiva do fluxo salivar entre a primeira e a terceira coleta (p = 0,001) e aumento da positividade de espécies, com predominância das espécies C. albicans e C. tropicalis, bem como de sua diversificação. Houve correlação significativa entre redução do fluxo salivar e colonização por Candida (p = 0,009). Após 12 meses, o fluxo salivar apresentavase baixo e houve maior incidência das espécies C. albicans e C. tropicalis. Em suma, os pacientes irradiados com doses tumoricidas em campos cervicofaciais apresentaram redução do fluxo salivar, aumento na colonização fúngica e diversificação das espécies durante e no final do tratamento.

The aims of this study were to investigate Candida carriage associated with reduced salivary flow and to identify Candida species in 20 patients with squamous cell carcinoma before, during and after head and neck radiotherapy, comparing with 2 control groups, one compounded by 24 healthful patients and the other, by nine patients submitted to head and neck radiotherapy one year at least. Whole non stimulated saliva were collected from all patients. Candida unit form colonies were quantified and identified using biochemistry tests, CHROMagar and API 20 Aux. The results showed progressive reduction of salivary flow during radiotherapy (p = 0.001) and increased Candida carriage, mainly C. tropicalis and C. albicans, with species diversification. The correlation between reduced salivary flow and increased Candida carriage was statistically demonstrated (p = 0.009). After 12 months of the radiotherapy, the patients showed higher incidence of C. albicans and C. tropicalis. In conclusion, head and neck irradiated patients showed reduced salivary flow during radiotherapy, increasing of Candida colonization and higher variety of Candida species on saliva than non irradiated patients during and after radiotherapy.

Prevalência da xerostomia relacionada à medicação nos pacientes atendidos na área de Odontologia da UNIVILLE / Xerostomy prevalence related to medication on patients assisted by the dentistry area of the UNIVILLE

Este trabalho tem por objetivo determinar a prevalência da xerostomia nos pacientes que procuraram atendimento na Área de Odontologia da UNIVILLE e sua relação com medicamentos utilizados no tratamento de doenças como hipertensão, convulsão, depressão e outros. A metodologia consistiu em fornecer aos pacientes um questionário sobre as condições de saúde geral, sintoma de xerostomia e uso de medicamentos. Os pacientes foram separados e analisados de acordo com o medicamento utilizado no tratamento das doenças, bem como o sintoma isoladamente. De todos os pacientes atendidos, 24,8% relataram xerostomia. Dos que fazem uso de medicamentos o sintoma esteve associado a 35,9%. Os principais medicamentos relacionados ao sintoma nesse estudo foram anti-hipertensivos, antidepressivos e anticonvulsivantes. A xerostomia tem maior prevalência nos pacientes que fazem uso dos medicamentos mencionados

The aim of this research was to know the xerostomy prevalence on patients who have been assisted by the Dentistry Area of the Univille and its relation with some drugs for the following treatments: arterial hypertension disease, seizure, depression and other diseases which require medication. The methodology consists of bringing a questionnaire referent to patients' health conditions, xerostomy symptoms and medications use. Patients were separated and analyzed depending on the medication drug used for their disease treatment and patients presenting isolated xerostomy. From all studied patients,24.8% of them were related with xerostomy. Patients who were relatedto drug medication use presented a 35.9% of this symptom. The main medications related to this xerostomy on this research were: antidepressives, antihypertensives and antiseizure. Xerostomy has a greater prevalence on patients who use the mentioned medications