Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia / Patient- and provider-related factors in the success of multidrug tuberculosis treatment in Colombia / Fatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia

RESUMEN Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.

ABSTRACT Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

RESUMO Objetivo. Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. Métodos. Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. Resultados. Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. Conclusões. Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

Patient- and provider-related factors in the success of multidrug-resistant tuberculosis treatment in Colombia / Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia / Fatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia

ABSTRACT Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

RESUMEN Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.

RESUMO Objetivo. Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. Métodos. Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. Resultados. Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. Conclusões. Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

Relationship between depression, alcohol and / or tobacco abuse of those responsible and children's oral health

Objective :To investigate the influence of parental depression and smoking and alcohol use by parents/caregivers use on oral health in children aged 5-11 years of both sexes. Methods: A cross-sectional study was conducted involving 85 children and their parents/caregivers. Adult respondents completed three questionnaires to assess depression and alcohol and tobacco use: two versions of the PHQ (PatientHealth Questionnaire; PHQ-2 and PHQ-9), AUDIT (Alcohol Use DisordersIdentification Test) for risk assessment of alcohol dependence and abuse, and the Fagerström Test for Nicotine Dependence (FTND). The PHQ-2 contained two questions requiring an affirmative or negative answer. Children underwent oral examinations to evaluate biofilm control, gingival bleeding and caries index, specifically DMFT index. Relationships among variables were evaluated using chi-squared tests and Fisher's exact test. Results: Only 10.6% of parents and caregivers consumed tobacco and 24,7% of parents or caregivers manifested depressive symptoms. Regarding alcohol consumption, 10.6% of caregivers presented risk consumption or dependence. A positive association was found between children'sgingival bleeding and their caregivers' risk of alcohol dependence (p=0.038). Conclusion: A positive association between caregivers' risk of alcohol dependence and the presence of gingival bleeding in children was found. Caregivers' depression and alcohol and tobacco use did not influence children's caries.

Objetivo: Investigar a influência da depressão parental e do uso de cigarro e álcool pelos pelos pais/cuidadores na saúde bucal de crianças de 5 a 11 anos de ambos os sexos. Métodos: Um estudo do tipo transversal foi conduzido com 85 crianças e seus respectivos cuidadores. Para detectar a presença de depressão, duas versões do PHQ (Pacient Health Questionnaire) foram aplicadas: o PHQ-2, contendo duas perguntas com opção de resposta afirmativa ou negativa e o segundo, PHQ-9. Para o uso de álcool foi aplicado o AUDIT (Alcohol Use Disorders Identification Test) para avaliação do risco de dependência e abuso de álcool; e o Fagerstrom para dependência de nicotina. As crianças foram submetidas a exames orais para avaliação do controle de biofilme, sangramento gengival e presença de cárie (índices CPO-D e ceo-d). Para verificar a associação entre as diferentes variáveis, foram utilizados os testes Qui-quadrado e Exato de Fisher. Resultados: Somente 10,6% dos responsáveis faziam uso de tabaco e 24,7% dos mesmos apresentavam sintomas de depressão. Em relação ao consumo de álcool, 10,6% apresentavam consumo de risco ou dependência. Verificou-se associação entre sangramento gengival nas crianças e o risco de dependência de álcool dos responsáveis (p=0,038). Conclusão: Concluiu-se que há uma associação positiva entre o risco de dependência de álcool dos responsáveis e a presença de sangramento gengival no paciente e que a depressão, o uso de álcool e de tabaco pelos cuidadores não influência na experiência de cárie das crianças.

Alagille syndrome: facial characteristics, rare oral manifestations, and management of the case

Introduction: Alagille syndrome (AGS) is an autosomal dominant disease with variable expressiveness that can affect the liver, heart, kidneys, blood vessels, eyes, face and skeleton. Objective: To describe a case of a pediatric patient with Alagille syndrome. Case report: The family history was negative for even the mildest manifestations of AGS. Clinically, the patient had a triangular face, hypertelorism, short philtrum and flat midface. Intraoral examination revealed the absence of the permanent upper lateral incisors, enamel hypoplasia and agreenish color in some teeth, gingival hyperplasia, retention of two primary lower incisors, presence of a supernumerary tooth, and a pediculated nodule of soft tissue on the lingual aspect of the left permanent mandibular first molar. Results: The dental treatment required the extraction of the retained primary teeth and the supernumerary tooth, excisional biopsy and histopathological examination of the lesion were performed and also application of topical fluoride. Also dietary and oral hygiene instructions were given. Conclusion: Currently, the patient makes frequent follow-up visits to monitor the dental development.

Introdução: A síndrome de Alagille (AGS) é uma doença autossômica dominante com expressividade variável que podem afetar o fígado, coração, rins, vasos sanguíneos, olhos, rosto e esqueleto. Objetivo: Descrever um caso de um paciente pediátrico com síndrome de Alagille. Relato do caso: A história familiar era negativa até mesmo para as manifestações mais leves de AGS. Clinicamente, o paciente apresentava face triangular, hipertelorismo, filtro curto e face média plana. O exame intraoral revelou ausência dos incisivos laterais superiores permanentes, hipoplasia de esmalte e aspecto esverdeado em alguns dentes, hiperplasia gengival, retenção de dois incisivos inferiores decíduos, presença de um dente supranumerário, e um nódulo de tecido mole pediculado na face lingual do primeiro molar inferior permanente esquerdo. Resultados: O tratamento odontológico exigiu a extração dos dentes decíduos retidos e do dente supranumerário, biópsia excisional e exame histopatológico da lesão além da aplicação de fluoreto tópico. Também foi realizada instrução dietética e de higiene oral. Conclusão: Atualmente, o paciente faz visitas de acompanhamento frequentes para monitorar o desenvolvimento dentário.

Uso de métodos anticonceptivos de larga acción en mujeres adolescentes en hospitales de Honduras / Use of long-acting contraceptive methods in adolescent women in hospitals in Honduras

Antecedentes: Aproximadamente 80% de embara-zos en adolescentes se consideran involuntarios, 95% ocurren en países en vías de desarrollo. Entre las características de estas jóvenes destacan: un sinfín de adversidades sociales, maduración temprana, actividad sexual prematura, bajo nivel educativo, ausencia de pareja, historia materna de embarazo en adolescencia y, falta de conocimiento/acceso a métodos contraceptivos. Objetivo: Determinar el uso de métodos anticonceptivos de larga acción (MLA) entre adolescentes en condición de aborto en cuatro hospitales de Honduras, enero 2017-julio 2019. Métodos:Estudio descriptivo transversal utilizando la base de datos Sistema Informático Perinatal (SIP) módulo aborto (SIPA). Incluyó registros de pacientes de 19 años y menos. Se describen variables preestablecidas en la hoja SIP (demográficas, antecedentes patológicos, obstétricos, de uso de anticonceptivos, deseo de anticoncepción y provisión de métodos), analizando frecuencias y porcentajes. Resultados: De 1117 pacientes registradas, 84.9% (949) estaba en el rango de edad 16-19 años, 24.7% (276) había tenido al menos una gesta; 72.4% (809) recibió consejería/información de planificación familiar, 75.5% (843) solicitó un método y 53.1% (448) iniciaron alguno; 84.9% (949) no había usado contraceptivos antes del embarazo actual. Discusión: La información del SIPA en las instituciones participantes muestra la descripción del uso de anticonceptivos en adolescentes en situación de aborto, donde una cuarta parte de ellas había tenido gestas previas. La necesidad de información efectiva sobre uso de métodos anticonceptivos y la existencia de una brecha entre la demanda y la entrega de anticonceptivos en las unidades de salud incluidas, deben ser atendidas urgentemente...(AU)

Management of an unerupted tooth and odontoma after trauma in predecessor

The purpose of this case report was to describe the surgical exposure and orthodontic management of an unerupted and ectopic maxillary right central incisor after trauma to the primary predecessor. Case report: An 11-year-old girl was referred to the Pediatric Dentistry Clinic due to eruption failure of the maxillary right central incisor. Radiographs showed the impacted central incisor located below the anterior nasal spine and its apex parallel to the palatal plane and the presence of an odontoma. General surgery was performed to remove the odontoma and two perforations in the crown of the impacted tooth were made to carry out orthodontic traction. Correct alignment was achieved after 18 months and no significant clinical or radiographic alterations were founded. Conclusion: The orthodontic management was performed successfully, and a positive esthetic outcome combined with adequate occlusion demonstrated the satisfactory results of this case.

Objetivo: O objetivo deste relato de caso foi descrever a exposição cirúrgica e o tratamento ortodôntico de um incisivo central superior direito ectópico e não irrompido após trauma do predecessor decíduo. Relato do caso: Uma menina de 11 anos de idade foi encaminhada à Clínica de Odontopediatria devido ao atraso na erupção do incisivo central superior direito. As radiografias mostraram o incisivo central impactado localizado abaixo da espinha nasal anterior e seu ápice paralelo ao plano palatino e a presença de um odontoma. A cirurgia para remoção do odontoma foi realizada sob anestesia geral e duas perfurações na coroa do dente impactado foram realizadas para a tração ortodôntica. O alinhamento correto foi alcançado após 18 meses e não foram encontradas alterações clínicas ou radiográficas significativas. Conclusão: O manejo ortodôntico foi realizado com sucesso, e um resultado estético positivo combinado à oclusão adequada demonstrou os resultados satisfatórios deste caso.

Impaction of mandibular canine associated with a dentigerous cyst: a 2. 5 - year follow-up report

Introduction: Dentigerous cyst is an odontogenic cyst lesion surrounding the crown of an unerupted or impacted tooth in the jaw. Objective: The aim of this case report is to describe the treatment planning and follow-up of a dentigerous cyst associated with the impaction of the permanent mandibular right canine tooth in an 11-year-old female. Case report: Radiographic assessment revealed a radiolucent unilocular round-shaped lesion localized in the mandibular symphysis. Enucleation was performed and the affected tooth was removed under general anesthesia. The patient is under follow-up due to orthodontic treatment. The affected area healed without complications. Conclusion: Two and a half years after the enucleation, the cyst had totally disappeared, and no recurrences were observed. Bone remodeling and neoformation were noticed.

Introdução: O cisto dentígero é uma lesão odontogênica ao redor da coroa de um dente não irrompido ou impactado na mandíbula. Objetivo: O objetivo deste relato de caso é descrever o plano do tratamento e o acompanhamento de um cisto dentígero associado à impactação do canino permanente inferior direito em uma criança do gênero feminino de 11 anos de idade. Relato do caso: A avaliação radiográfica revelou lesão unilocular radiolúcida de forma arredondada, localizada na sínfise mandibular. A enucleação foi realizada e o dente afetado foi removido sob anestesia geral. A paciente encontra-se em acompanhamento devido o tratamento ortodôntico. A área afetada curou sem complicações. Conclusão: Dois anos e meio após a enucleação, o cisto desapareceu totalmente e não houve recidivas. Remodelação óssea e neoformação foram observadas.

Types of Feeding and Presence of Harmful Oral Habits in Children with Cleft Lip and/or Palate: A Pilot Study

Abstract Objective: To verify the relationship between the types of feeding and presence of harmful oral habits (HOH) in children with cleft lip (CL), palate (CP) and cleft lip and palate (CLP), as well as to compare the different types of cleft to each other. Material and Methods: A form was applied to the parents of 162 children (3-5 years old), addressing the following variables: gender, cleft type, age, socioeconomic conditions, type of breastfeeding, presence of HOH, and the parents' knowledge about the consequences of oral habits. The data obtained were analyzed by chi-square test (p<0.05). Results: The majority of children (83.3%) were bottle-fed and 12.3% were exclusively maternal breastfed. The main reason for weaning was the presence of cleft (59.9%). Breastfeeding was significantly higher in children with CL (75%) in comparison with CP (20%) and CLP (5%) (p<0.001). Children with CLP were 12 times more likely to be bottle-fed than children with CL (OR=12.21; CI=4.09-36.45). The prevalence of HOH was 37%. Sociodemographic characteristics were not associated with the presence of HOH (p>0.05). The type of feeding and cleft were not decisive to present some type of HOH (p>0.05) and 87% of parents stated that HOH could lead to serious complications of tooth misalignment. Conclusion: The type of feeding and fissure did not determine the acquisition of harmful oral habits in children with cleft. However, the greater the fissure's complexity, the lesser the chance of children receiving exclusive breastfeeding.

Oral findings in Robinow Syndrome: a case report in pediatric patient

Objective: The aim of this article was to describe a case of Robinow syndrome in a pediatric patient. Case Report: Clinically, the patient had frontal bossing, flat facial profile with macrocephaly, midfacial hypoplasia, hypertelorism, wide palpebral fissures, triangular mouth, short upturned nose, short philtrum, ankyloglossia, prolonged retention of primary teeth and abnormal aligment of teeth. The radiographic exams indicated the presence of three impacted permanent supernumerary teeth, agenesis of eight permanent teeth and dental root shortening of all permanent teeth. The treatment proposed was the extraction of all retained primary teeth and the supernumerary teeth, dietary and oral hygiene instructions and orthodontic treatment. Also, important aspects to avoid complications associated with Robinow syndrome were discussed. Conclusion: This case describes uncommon oral findings and some important aspects to avoid complications associated with the Robinow syndrome. Early professional advice, treatment, and periodical follow-ups can improve the quality of life of these patients.

Objetivo: O objetivo deste artigo foi descrever um caso de síndrome de Robinow em um paciente pediátrico. Relato de Caso: Clinicamente, o paciente apresentava bossas frontais, perfil facial plano com macrocefalia, hipoplasia da face média, hipertelorismo, fissuras palpebrais amplas, boca triangular, nariz curto, filtro curto, anquiloglossia, retenção prolongada de dentes decíduos e dentes desalinhados. Os exames radiográficos indicaram a presença de três elementos supranumerários permanentes impactados, agenesia de oito dentes permanentes e encurtamento radicular de todos os dentes permanentes. O tratamento proposto foi a extração de todos os dentes decíduos retidos e os elementos supranumerários, instruções de higiene bucal e dietética e tratamento ortodôntico. Além disso, aspectos importantes para evitar complicações associadas à síndrome de Robinow são discutidos. Conclusão: Este caso descreve achados orais incomuns e alguns aspectos importantes para evitar complicações associadas à síndrome de Robinow. Aconselhamento profissional precoce, tratamento e acompanhamento periódico podem melhorar a qualidade de vida desses pacientes.

Dentomaxillofacial sequelae resulting from a chemoradiotherapy against rhabdomyosarcoma: 6-year follow-up

Introduction: Rhabdomyosarcoma is an aggressive malignant soft tissue neoplasm of immature mesenchymal cells treated with surgery and chemoradiotherapy. The effects of chemoradiotherapy in head induce a series of sequelae on oral cavity and growth development. Objectives: Report the case of a child undergoing treatment for rhabdomyosarcoma whose effects on the dento-maxillofacial development were cared for in order to safe guard the patient's quality of life. Case report: Describes a case of severe dento-maxillofacial defects resulting from chemoradiation therapy for embryonal rhabdomyosarcoma in a child as well as the dental management performed. Clinically, the patient had gingivitis, severe mobility of permanent teeth, hyposalivation, mucositis and severe trismus. The radiologic exams showed interruption of root formation of all permanent teeth and over-retention of primary teeth. Cephalometric analyses revealed mandibular and maxillary hypoplasia. Results: Was made extraction of the overretained primary teeth associated with a prophylactic program and use of artificial saliva due to hyposalivation in order to improve the quality of life of the patient. After 6 years of dental and phonoaudiologic follow-up her oral opening has increased and chewing and swallowing difficulties have decreased, there is no gingivitis or mucositis and she has remained free of recurrent or metastatic diseases 11 years after the initial diagnosis. Conclusion: Our report emphasizes the importance of dental treatment with a program of prevention and follow-up for patients undergoing anticancer therapies.

Introdução: O rabdomiossarcoma é uma neoplasia maligna agressiva de tecido mole de células mesenquimais imaturas tratadas com cirurgia e quimioradioterapia. Os efeitos da quimioradioterapia na cabeça induzem uma série de sequelas na cavidade oral e no desenvolvimento do crescimento. Objetivo: Relatar o caso de uma criança em tratamento de rabdomiossarcoma cujos efeitos no desenvolvimento dento-maxilofacial foram cuidados a fim de salvaguardar a qualidade de vida do paciente. Relato de caso: Descreve um caso de defeitos dento-maxilo-faciais graves resultante de quimioradioterapia para rabdomiossarcoma embrionário em uma criança, bem como o manejo realizado. Clinicamente, a paciente apresentava gengivite, severa mobilidade dos dentes permanentes, hipossalivação, mucosite e trismo severo. Os exames radiográficos mostraram interrupção da formação radicular de todos os dentes permanentes e retenção dos dentes decíduos. Análises cefalométricas revelaram hipoplasia mandibular e maxilar. Resultados: Foi realizada a extração dos dentes decíduos retidos associado a um programa profilático e uso de saliva artificial devido à hipossalivação, a fim de melhorar a qualidade de vida do paciente. Após 6 anos de acompanhamento odontológico e fonoaudiológico, sua abertura bucal aumentou e as dificuldades de mastigação e deglutição diminuíram, não há gengivite ou mucosite e ela permaneceu livre de doenças recorrentes ou metastáticas 11 anos após o diagnóstico inicial. Conclusão: Nosso relato enfatiza a importância do tratamento odontológico com um programa de prevenção e acompanhamento para pacientes submetidos a terapias antineoplásicas.

Unusual case of ankyloglossia recurrence after frenectomy in a child with cerebral palsy

Introduction: Frenectomy is the most indicated treatment for ankyloglossia in children and adolescents, with recurrence being extremely rare. Objective: Here, we report the unusual case of an 8-year-old boy with cerebral palsy presenting recurrence of ankyloglossia 2 years after undergoing lingual frenectomy. Case report: On physicalexamination, in a follow-up, 2 years after a lingual frenectomy, we observed a slightly elastic, short and adhered lingual frenulum and the presence of a heart-shaped tongue, with severe restriction of lateral and superior movements, and difficulties in speech and swallowing. A new frenectomy was performed under local anesthesia, restoring lingual mobility. The patient has been followed-up periodically and has undergone speech therapy; 2 years after the second surgery, firm insertion of the frenulum and the continuity of the bifid aspect of the tongue have been again verified, but the tongue movements and oral functions remain satisfactory. The patient will continue to be followed periodically and a new intervention will be performed if there are changes in oral functions. Conclusion: Beyond the need forperiodic clinical follow-up, the diagnosis and multidisciplinary treatment of ankyloglossia are fundamental for identifying possible cases of recurrence, which, although rare, can occur.

Introdução: A frenectomia é o tratamento mais indicado para os casos de anquiloglossia em crianças e jovens, sendo a recorrência extremamente rara. Objetivo: O objetivo é relatar o caso incomum de um menino de 8 anos, com paralisia cerebral, apresentando recidiva de anquiloglossia dois anos após a realização de frenectomia lingual. Relato de caso: Ao exame físico, em consulta de revisão, 2 anos após uma frenectomia lingual observou-se freio lingual levemente elástico, curto e aderido, presença de formato de coração na língua, restrição severa dos movimentos laterais e superiores, além de dificuldades na fala e deglutição. Uma nova frenectomia foi realizada após dois anos da primeira frenectomia , sob anestesia local, restaurando a mobilidade lingual. O paciente foi acompanhado periodicamente junto com a fonoaudiologia e após 2 anos da segunda cirurgia, a inserção firme do freio e a continuidade do aspecto bífido da língua foram novamente verificadas, porém, os movimentos da língua e as funções orais mantiveram-se satisfatórios. O paciente continuará a ser acompanhado periodicamente e, se houver alterações nas funções orais, uma nova intervenção será realizada. Conclusão: É fundamental o diagnóstico e tratamento multidisciplinar da anquiloglossia, além da necessidade de acompanhamento clínico periódico para identificar possíveis casos de recidiva, que, embora raros, podem ocorrer.

Candida spp. In Linear gingival erythema lesions in HIV-Infected children: report of six cases

Introduction: Linear gingival erythema (LGE), formally referred to as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infected individuals These lesions have been recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. Dubliniensis, have also been identified in some HIV-infected subjects. Objective: This case report reveals the presence of typical LGE lesions in six HIV-infected children, and also investigates the etiologic agent through microbiological exams and correlates this oral manifestation with the patients' systemic conditions. Case report: Microbiological analyses showed growth for Candida spp in all patients; all of whom had severe immunosuppression. However, the regression of lesions was noted after antifungal medication. Conclusion: The presence of LGE in pediatric patients with AIDS may be a predictive marker in the progression of AIDS or it may be the first clinical manifestation of HIV infection in children. Hence it is important for dentists to be aware of such lesions.

Introdução: O eritema gengival linear (LGE), normalmente referido como gengivite do HIV, é a forma mais comum de doença periodontal presente em indivíduos infectados pelo HIV. Recentemente, estas lesões foram consideradas como uma possível forma de candidíase oral eritematosa causada por Candida. Albicans . Outras espécies, como C. tropicalis, C. stellatoidea,C. krusei, C. parapsilosis, C. glabrata e C. Dubliniensis também foram identificadas em indivíduos infectados pelo HIV associadas ao LGE. Objetivo: O presente artigo mostra a presença de lesões típicas de LGE em seis crianças infectadas pelo HIV e também investigou o agente etiológico das lesões orais através de exames microbiológicos, correlacionando o LGE com as condições sistêmicas dos pacientes. Case report: Análises microbiológicas mostraram crescimento positivo para Candida spp em todos os pacientes, os quais possuiam imunossupressão grave. Adicionalmente, a regressão total das lesões foi observada após medicação tópica antifúngica. Conclusão: A presença de LGE em pacientes pediátricos com AIDS pode ser um marcador preditivo da progressão.

A successful dental management in a child with Cornelia de Lange Syndrome: rare case of Cornelia de Lange Syndrome in child / O sucesso do manejo odontológico em criança com Síndrome Cornelia de Lange: um caso raro da Síndrome Cornelia de Lange em criança

Background: the Cornelia de Lange Syndrome (CDLs) is a rare and complex syndrome characterized, basically, by psychomotor retardation associated with a number of congenital malformations. Aims: this paper reports the case of an 11-year-old female child diagnosed with Cornelia de Lange Syndrome (CdLS) and her successful dental management. Case report: the patient had severe mental retardation, definite negative behavior and the clinical findings included oral and physical changes. The patient's oral hygiene was deficient with the presence of calculus and gingivitis, besides several active caries lesions in permanent and deciduous dental elements. The treatment consisted in guidance for caregivers about oral hygiene and diet, and the dental procedures were performed under general anesthesia. Currently, the patient is accompanied by monthly follow-ups. Conclusions: the lack of knowledge about oral hygiene and cariogenic diets was identified as a one of the reasons for the oral diseases present. Due to the need to care for the other more serious and complex health problems, the oral diseases had evolved faster than usual and thus were difficult to treat and maintain thereafter. Under such conditions, the dentist plays a key role within a multidisciplinary team. From the guidance and knowledge provided in the dental clinic, there was a significant improvement in the life quality of the child and her family

Role of Candida species from HIV infected children in enamel caries lesions: an in vitro study

Abstract Objectives This study analyzed the capacity of Candida spp. from dental biofilm of HIV infected (HIV+) children to demineralize primary molar enamel in vitro by Transversal Microhardness (TMH), Polarized Light Microscopy (PLM) and the quantity of calcium ions (Ca2+) released from the enamel. Material and Methods Candida spp. samples were isolated from the supragingival biofilm of HIV+ children. A hundred and forty (140) enamel blocks were randomly assigned to six groups: biofilm formed by C. albicans (Group 1); mixed biofilm formed by C. albicans and C. tropicalis (Group 2); mixed biofilm formed by C. albicans and C. parapsilosis (Group 3); mixed biofilm formed by C. albicans, C. parapsilosis and C. glabrata (Group 4); biofilm formed by C. albicans ATCC (Group 5) and medium without Candida (Group 6). Enamel blocks from each group were removed on days 3, 5, 8 and 15 after biofilm formation to evaluate the TMH and images of enamel were analyzed by PLM. The quantity of Ca2+ released, from Groups 1 and 6, was determined using an Atomic Absorption Spectrophotometer. The SPSS program was used for statistical analysis and the significance level was 5%. Results TMH showed a gradual reduction in enamel hardness (p<0.05) from the 1st to 15th day, but mainly five days after biofilm formation in all groups. The PLM showed superficial lesions indicating an increase in porosity. C. albicans caused the release of Ca2+ into suspension during biofilm formation. Conclusion Candida species from dental biofilm of HIV+ children can cause demineralization of primary enamel in vitro.

Tuberculosis por Mycobacterium bovis en trabajadores de fincas en saneamiento para tuberculosis bovina, de Antioquia, Boyacá y Cundinamarca / Tuberculosis caused by Mycobacterium bovis in workers of bovine tuberculosis sanitation farms in Antioquia, Boyacá and Cundinamarca

RESUMEN Objetivo Realizar la vigilancia epidemiológica clásica y molecular de la tuberculosis (TB) humana causada por Mycobacterium bovis en manipuladores de la cadena de producción bovina en fincas con bovinos PPD positivos de los Departamentos de Antioquia, Boyacá y Cundinamarca en un periodo de un año. Métodos Se visitaron las fincas ganaderas, con bovinos o bufalinos PPD positivos de los departamentos de estudio según información del Programa Nacional de Tuberculosis bovina del ICA. Se recolectó la información socio-demográfica y a los factores de riesgo para adquirir TB asociados a la ocupación a través de una encuesta aplicada a todos los trabajadores de las fincas visitadas. Se recolectaron muestras de esputo luego de haber obtenido un consentimiento informado. Los esputos fueron sometidos a pruebas microbiológicas y moleculares para la identificación de los miembros del complejo M. tuberculosis. Resultados Se visitaron 33 fincas ganaderas y se recolectó información para 164 trabajadores de la cadena de producción bovina. Se identificaron como posibles factores de riesgo para el desarrollo de TB la permanencia en la finca PPD positiva por más de un año, desconocimiento de la enfermedad y presencia de posibles reservorios como perros y gatos. No se encontraron casos de TB por M. bovis ni por M. tuberculosis en los trabajadores de las fincas visitadas. Conclusión No se documentaron casos de la enfermedad por este agente zoonótico en los departamentos de Antioquia, Boyacá y Cundinamarca.(AU)

ABSTRACT Objective To perform classic and molecular epidemiological surveillance of human tuberculosis caused by Mycobacterium bovis in bovine supply chains at farms with PPD positive bovines in the departments of Antioquia, Boyacá and Cundinamarca during a one-year period. Methods Livestock farms with PPD positive bovines or buffalos were visited in the study departments according to information obtained in the "Programa Nacional de Tuberculosis bovina" (National program on bovine Tuberculosis) released by ICA (Colombian Agriculture and Livestock Institute). Data on socio-demographic information and tuberculosis risk factors associated to the occupation were collected through a survey applied to all workers at the visited farms. Sputum samples were obtained after informed consent. The sputa underwent microbiological and molecular testing to identify members of the M. tuberculosis complex. Results Thirty-three livestock farms were visited and information of 164 workers from the bovine supply chain was collected. Staying in a PPD positive farm for more than a year, ignorance about the disease and the presence of possible vectors, like dogs and cats, were identified as possible risk factors for developing tuberculosis. No cases of tuberculosis caused by M. bovis or M. tuberculosis in workers of the visited farms were found. Conclusion No cases of the disease caused by this zoonotic agent were documented in the departments of Antioquia, Boyacá and Cundinamarca.(AU)

A molecular platform for the diagnosis of multidrug-resistant and pre-extensively drug-resistant tuberculosis based on single nucleotide polymorphism mutations present in Colombian isolates of Mycobacterium tuberculosis

Developing a fast, inexpensive, and specific test that reflects the mutations present in Mycobacterium tuberculosis isolates according to geographic region is the main challenge for drug-resistant tuberculosis (TB) control. The objective of this study was to develop a molecular platform to make a rapid diagnosis of multidrug-resistant (MDR) and extensively drug-resistant TB based on single nucleotide polymorphism (SNP) mutations present in therpoB, katG, inhA,ahpC, and gyrA genes from Colombian M. tuberculosis isolates. The amplification and sequencing of each target gene was performed. Capture oligonucleotides, which were tested before being used with isolates to assess the performance, were designed for wild type and mutated codons, and the platform was standardised based on the reverse hybridisation principle. This method was tested on DNA samples extracted from clinical isolates from 160 Colombian patients who were previously phenotypically and genotypically characterised as having susceptible or MDR M. tuberculosis. For our method, the kappa index of the sequencing results was 0,966, 0,825, 0,766, 0,740, and 0,625 forrpoB, katG, inhA,ahpC, and gyrA, respectively. Sensitivity and specificity were ranked between 90-100% compared with those of phenotypic drug susceptibility testing. Our assay helps to pave the way for implementation locally and for specifically adapted methods that can simultaneously detect drug resistance mutations to first and second-line drugs within a few hours.

Lack of associaiion between herpesvirus detectin in saliva and gingivitis in hhiv‑infected children / Ausência de associação entre a detecção de herpesvírus na saliva e gengivite em crianças infectadas pelo HIV

The aims of this study were to compare the detection of human herpesviruses (HHVs) in the saliva of HIV-infected and healthy control children, and to evaluate associations between viral infection and gingivitis and immunodeficiency. Saliva samples were collected from 48 HIV-infected and 48 healthy control children. Clinical and laboratory data were collected during dental visits and from medical records. A trained dentist determined gingival indices and extension of gingivitis. Saliva samples were tested for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by nested polymerase chain reaction assays. Thirty-five HIV-infected and 16 control children had gingivitis. Seventeen (35.4%) HIV-infected children and 13 (27%) control children were positive for HHVs. CMV was the most commonly detected HHV in both groups (HIV-infected, 25%; control, 12.5%), followed by HSV-1 (6.2% in both groups) and HSV-2 (HIV-infected, 4.2%; control, 8.3%). The presence of HHVs in saliva was not associated with the presence of gingivitis in HIV-1-infected children (p = 0.104) or healthy control children (p = 0.251), or with immunosuppression in HIV-infected individuals (p = 0.447). Gingivitis was correlated with HIV infection (p = 0.0001). These results suggest that asymptomatic salivary detection of HHVs is common in HIV-infected and healthy children, and that it is not associated with gingivitis.

Os objetivos deste estudo foram detectar a presença de herpesvírus humanos (HHVs) na saliva de crianças infectadas pelo HIV, em comparação com controles saudáveis e avaliar a associação entre infecção viral, gengivite e imunodeficiência. Para este fim, foram colhidas amostras de saliva de 48 crianças HIV-positivas e 48 controles saudáveis. O índice gengival e extensão de gengivite foram determinados por um dentista treinado. Informações clínicas e laboratoriais foram obtidas durante a consulta odontológica e dos registros médicos. As amostras de saliva foram testadas para detecção de vírus herpes simplex tipos 1 e 2 (HSV-1 e HSV-2), vírus da varicela-zoster (VVZ), vírus Epistein-Barr (EBV) e citomegalovírus (CMV) através de nested-PCR. Trinta e cinco crianças HIV-positivas e 16 crianças do grupo controle apresentavam gengivite. Dezessete (35,4%) crianças HIV-positivas e 13 (27%) crianças controle testaram positivo para a presença de HHVs. CMV foi o vírus mais comum detectado em ambos os grupos (25% HIV-positivas e 12,5% de controle), seguido por HSV-1 (6,2% de ambos os grupos) e HSV-2 (4,2% HIV-positivas e 8,3% de controle). Não houve associação entre a detecção de HHVs na saliva e a presença de gengivite em ciranças HIV-positivas (p = 0.104) ou crianças saudáveis (p = 0,251), ou com imunossupressão em indivíduos HIV-positivos (p = 0,447). Foi observada uma correlação entre a infecção por HIV e a presença de gengivite (p = 0,0001). Os resultados sugerem que a detecção salivar assintomática de HHVs é comum entre crianças HIV-positivas e crianças saudáveis, e não está associada à gengivite.

Effect of highly active antiretroviral therapy use on oral manifestations in pediatric patients infected with HIV.

Aims: The aim was to assess the prevalence of oral lesions in HIV‑infected children undergoing highly active anti‑retroviral therapy (HAART), and the association between the duration of HAART usage and oral lesions. Subjects and Methods: Totally, 111 medical and dental records of HIV‑infected children, aged from 2 to 16 years old were reviewed for medical data, presence of oral lesions, and caries prevalence. According to the type of medication, the children were grouped as follows: 51 were under HAART (G1), 46 were using anti‑retroviral medication (G2), and 14 were using no medication (G3). Results: The majority of the HIV children had AIDS (65.8%), of which 86.3% were in G1, 63% in G2, and 0% in G3. The mean length of therapy was 34.4 months, with no difference between groups (Kruskal–Wallis; P = 0.917). The prevalence of the oral lesions was 23.4%, namely, G1 was 27.5%, G2 was 21.7%, and G3 was 14.3% (P > 0.05). Gingivitis was the most common oral manifestation (15.3%) seen in the three groups, followed by gingival linear erythema and pseudomembranous candidiasis in G1 and G2. The mean values regarding deft and DMFT indexes were, respectively, 3.2 and 1.9 (G1), 2.8 and 1.6 (G2), and 3.8 and 3.0 (G3). For the patients without AIDS (n = 38), oral manifestations were seen in 29.4% of G2 compared to G1, with 0% (Chi‑square; P > 0.05). In terms of therapy duration, 47.65% of the patients who had been under HAART for 18 months or less had oral manifestations, compared to 13.3% of those who had been treated for a longer time (Chi‑square; P = 0.007). Conclusions: Although the prevalence of oral lesions was similar between the groups, it was less in patients without AIDS and those under HAART. The duration of HAART usage had a significant influence on the prevalence of these lesions.

Terapia fotodinâmica antimicrobiana aplicada à periodentia: revisão da literatura e novas perspectivas / Antimicrobial photodynamic therapy applicated on Periodontology: review and news perspective

A terapia fotodinâmica antimicrobiana (TFDa) tem sido amplamente investigada devido à propriedade de reduzir microrganismos. Este estudo se propôs, por meio de revisão da literatura, a avaliar a aplicabilidade da TFDa em Periodontia. Para tal, foram levantados, nos bancos de dados Medline-PubMed, ISI Web of Knowledge, Bireme, Cochrane e SciELO, artigos científicos publicados nos últimos dez anos. A busca dos artigos se restringiu a trabalhos realizados in vivo, tanto em animais quanto em humanos. Os arquivos foram sistematicamente organizados e analisados. Houve expressivo aumento no número de publicações nos últimos dez anos, apontando para o grande interesse científico e clínico no desenvolvimento da TFDa em Periodontia. A diversidade de parâmetros de irradiação e de fotossensibilizantes (FTZs) que atingiram bons resultados inviabiliza indicar um protocolo ideal para a aplicação da terapia. Contudo, clinicamente existe uma maior efetividade dos corantes à base de azul de toluidina, irradiados com lasers de diodo com comprimentos de onda na região do vermelho (l 630-680 nm). A concentração e o tempo de incubação dos FTZs podem variar de acordo com a intensidade da fonte de irradiação, de forma inversamente proporcional. Os resultados clínicos alcançados nos últimos dez anos subsidiam efetivamente a aplicabilidade da TFDa em Periodontia, como importante ferramenta no controle bacteriano em doença periodontal,associado ou não à raspagem e alisamento radicular.

Current status of herpesvirus identification in the oral cavity of HIV-infected children

INTRODUCTION: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). CONCLUSIONS: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.