MARPE expander activation load with different configurations of extender arms heights: in-vitro evaluation.

OBJECTIVE: Evaluate the load mini-implants exert on the artificial bone when expanding the MARPE EX in three different extension arm configurations. METHODS: A device simulating the human palate was fabricated and attached to a universal testing machine, for conducting tests with different MARPE expanders (n=5): non-adjustable/control (MARPE SL, Peclab) or with low, intermediate, and high extender arms (MARPE EX, Peclab). The expanders were manually activated until failure of the device occurred, and maximum load values were recorded. Load averages were also calculated for every five activations until the twentieth activation. RESULTS: The generalized linear mixed model for repeated measures over time showed that there was significant increase in load with activations for all expanders (p=0.0004). Up to the twentieth activation, the expander with low extender arms presented higher load than the others, while the expander with high extender arms showed lower load values (p<0.05). There was no significant difference among expanders regarding the number of activations (p=0.0586), although there was a trend towards fewer activations until fracture for the control expander. It was observed that the higher the configuration, the lower the force the mini-implants delivered to the bone. The control expander provided a force magnitude similar to that of the adjustable expander when positioned at the intermediate height. CONCLUSIONS: The activation load of MARPE expanders is influenced by the type of presentation of the extensor arms, with higher configurations resulting in lower force delivered by the mini-implants to the bone.

Oral epithelial dysplasia grading: Comparing the binary system to the traditional 3-tier system, an actuarial study with malignant transformation as outcome.

BACKGROUND: Establishing the risk of malignant transformation (MT) in oral leukoplakia is usually based on grading oral epithelial dysplasia (OED) on biopsy tissue, for which two systems are proposed: a 3-tier and a binary system. Only very few actuarial studies have tested the accuracy of such methods in predicting MT, especially for the binary system. This study aimed to assess the accuracy of the two grading systems in predicting MT in a cohort of oral leukoplakia (OL) from Brazil, with follow-up data. METHODS: The sample comprised 878 individuals diagnosed with OL from 2005 to 2018. Follow-up data were obtained both locally and from the regional cancer registry. All lesions were graded using both the 3-tier and the binary systems. Kaplan-Meier curves (Log-rank Mantel-Cox) were used to assess risk and kappa to assess interobserver agreement. RESULTS: Thirty-five individuals underwent MT (4%). Both systems demonstrated prognostic value, though the 3-tier system proved superior, with OR 9.23 (3.42-23.69), PPV 0.152, NPV 0.98, compared to binary OR 3.49 (1.79-6.79), PPV 0.079, NPV 0.976. Interobserver agreement was also superior in the 3-tier system (0.47, p < 0.05) compared to the binary system (0.139, p = 0.39). Combining the two systems enhanced prognostic values (OR 14.28, PPV 0.217, NPV 0.981). CONCLUSION: The 3-tier system presented superior prognostic value to the binary system. Combining both systems to double-grade intermediate lesions might enhance risk assessment.

Assessment of a Biosafety Device to Control Contamination by Airborne Transmission during Orthodontic/Dental Procedures.

During the COVID-19 pandemic, dental professionals have faced high risk of airborne contamination between dentists, staff, and patients. The objective of this study was to evaluate the effect of an individual biosafety capsule in dentistry (IBCD) on reducing the dispersion of droplets and aerosols during orthodontic treatment and evaluate the clinician and patient's perception of using the IBCD. For the in-vitro part of the study, aerosol quantification was performed with and without the IBCD, using a nonpathogenic bacterial strain and viral strain in the reservoir and high-speed dental handpiece. Petri dishes with MRS agar were positioned from the head of the equipment at distances of 0.5, 1, and 1.5 m. After 15 minutes of passive aerosol sampling, the dishes were closed and incubated using standard aerobic conditions at 37°C for 48 hours to count colony forming units (CFUs). For the clinical part of the study, a questionnaire was sent to clinicians and patients to understand their perception of orthodontically treat and receive treatment using the barrier. The use of IBCD showed an effective means to reduce the dispersion of bacterial and viral contamination around 99% and 96%, respectively, around the main source of aerosol (p < 0.05). Clinical results showed a 97% bacterial reduction during patient's consultations (p < 0.05). The vast majority of clinicians and patients understand the importance of controlling the airborne dispersion to avoid contamination.

Epidermal cyst: a rare case report in a 5-month-old child / Cisto epidérmico: relato de caso raro em criança de 5 meses

ABSTRACT The epidermal cyst is a rare, benign lesion, usually asymptomatic and slowly enlarging, more frequently located in the submandibular region. Its etiology is believed to be associated with the epithelial residual tissues retained in the midline during the closure of the first and second brachial arches, in the third and fourth weeks of intra-uterine life. Its clinical characteristics are of a rubbery consistency to palpation, well defined borders, with the absence of skin appendages within their squamous epithelium lined walls. The final diagnosis is confirmed through histopathological examination with stratified squamous epithelium findings in the cystic fluid lumen or keratin. The treatment is usually surgical and without recurrence and the final diagnosis is confirmed through histopathological examination. This paper aims to present a case report of a congenital epidermal cyst in a 5-month-old female patient located in the mouth floor near the sublingual gland duct. The case was treated with excisional biopsy and after follow-up, there was no recurrence.

RESUMO O cisto epidérmico é um cisto de desenvolvimento, benigno, raro, localizado com maior frequência na região submandibular, geralmente assintomático e de evolução lenta. Acredita-se que a sua etiologia esteja associada aos restos epiteliais retidos na linha média durante o fechamento do primeiro e segundo arcos braquiais, na terceira ou quarta semana de vida intrauterina. Suas características clínicas são de uma consistência borrachóide à palpação, bordas delimitadas e sem apêndices de pele no seu interior. O diagnóstico é confirmado através do exame histopatológico com achados de epitélio escamoso estratificado e no lúmen fluído cístico ou queratina. O tratamento é geralmente cirúrgico e sem recidivas. Este trabalho relata um caso de cisto epidérmico congênito de uma paciente pediátrica, do sexo feminino, de cinco meses de idade e localizado no assoalho de boca próximo ao ducto da glândula sublingual. O caso foi tratado com a enucleação cirúrgica e em seis meses de acompanhamento não apresentou recidiva.

Influence of apical preparation size and final irrigation protocol on the debridement of oval root canals

Abstract This study assessed the influence of apical preparation size and final irrigation protocol on the debridement of the apical third of oval root canals of mandibular molars. Seventy-seven distal roots were divided into 7 groups (n = 11): Control: without instrumentation or irrigation; Group 30CI: ProTaper Next (up to size 30; PTN) + conventional irrigation (CI); Group 30UAI: PTN + ultrasonically activated irrigation (UAI); Group 30XPF: PTN + XP-endo Finisher (XPF); Group 40CI: PTN + ProDesign Logic (up to size 40; PDL) + CI; Group 40UAI: PTN + PDL + UAI; and Group 40XPF: PTN + PDL + XPF. The total volume of irrigating solutions used per root canal in all the experimental groups was 33 mL of 2.5% sodium hypochlorite (NaOCl) and 6 mL of 17% ethylenediaminetetraacetic acid (EDTA). After specimen processing and histological analysis under a digital microscope (100x), the percentages of untouched canal walls (UCW) and remaining debris (RD) were assessed using Image J software. A descriptive and exploratory analysis was conducted, indicating that the data failed to meet the assumptions of an analysis of variance. Therefore, generalized linear models were used to assess the effects of the different instrumentation and irrigation protocols, as well as the interaction among them, on the percentage of UCW and RD. No significant difference was found among the irrigation protocols regarding the percentage of UCW, irrespective of apical preparation size (p>0.05). However, UCW and RD were significantly lower in groups 40CI, 40UAI and 40XPF than in groups 30CI, 30UAI and 30XPF (p<0.05). The percentage of RD was significantly lower in the UAI and XPF groups than in the CI groups, irrespective of apical preparation size (p<0.05). The difference between preparation sizes 30 and 40, with respect to RD, was higher when CI was used (p<0.05). In conclusion, instrumentation up to apical preparation size 40 resulted in lower percentages of UCW and RD than up to apical preparation size 30. Use of UAI or XPF resulted in lower percentages of RD than CI.

Resumo Este estudo avaliou a influência do tamanho do preparo apical e do protocolo de irrigação final sobre o debridamento do terço apical de canais radiculares ovais de molares inferiores. Setenta e sete raízes distais foram selecionadas e divididas em 7 grupos (n = 11): Grupo controle: sem instrumentação nem irrigação; Grupo 30IC, ProTaper Next (até o tamanho 30; PTN) + irrigação convencional (IC); Grupo 30IAU, PTN + irrigação ativada ultrassonicamente (IAU); Grupo 30XPF, PTN + XP-endo Finisher (XPF); Grupo 40IC, PTN + ProDesign Logic (até o tamanho 40; PDL) + IC; Grupo 40IAU, PTN + PDL + IAU; e Grupo 40XPF, PTN + PDL + XPF. Os volumes totais dos irrigantes utilizados por canal radicular em todos os grupos experimentais foram 33 mL de hipoclorito de sódio (NaOCl) a 2,5% e 6 mL de ácido etilenodiamino tetracético (EDTA) a 17%. Após o processamento dos espécimes e a análise das secções histológicas sob um microscópio digital (100x), as porcentagens de paredes não instrumentadas (PNI) e detritos remanescentes (DR) foram avaliadas utilizando-se o software Image J. Uma análise descritiva e exploratória foi realizada, indicando que os dados não atenderam aos pressupostos de uma análise de variância. Modelos lineares generalizados foram, portanto, utilizados para avaliar os efeitos dos diferentes protocolos de instrumentação e irrigação, bem como da interação entre eles, sobre as porcentagens de PNI e DR. Não houve diferença significativa entre os protocolos de irrigação final quanto à porcentagem de PNI, independentemente do tamanho do preparo apical (p>0,05). Entretanto, as porcentagens de PNI e DR foram significativamente menores nos grupos 40IC, 40IAU e 40XPF do que nos grupos 30IC, 30IAU e 30XPF (p<0,05). A porcentagem de DR foi significativamente menor nos grupos em que se utilizou a IAU ou o XPF do que naqueles em que se utilizou a IC, independentemente do tamanho do preparo apical (p<0,05). A diferença entre os tamanhos de preparo apical 30 e 40 com relação aos DR foi maior quando se utilizou a IC (p<0,05). Concluiu-se que a instrumentação até um preparo apical de tamanho 40 resultou em menores porcentagens de PNI e DR do que até um preparo apical de tamanho 30. A utilização da IAU ou do XPF resultou em uma menor porcentagem de DR do que a utilização da IC.

Biosafety devices to control the spread of potentially contaminated dispersion particles. New associated strategies for health environments.

Dental procedures produce a large amount of spatter and aerosols that create concern for the transmission of airborne diseases, such as Covid-19. This study established a methodology with the objective of evaluating new associated strategies to reduce the risk of cross-transmission in a health environment by simulating spread of potentially contaminated dispersion particles (PCDP) in the environment. This crossover study, was conducted in a school clinic environment (4 clinics containing 12 dental chairs each). As a positive control group (without barriers), 12 professionals activated at the same time the turbine of dental drill, for one minute, with a bacterial solution (Lactobacillus casei Shirota, 1.5x108 CFU/mL), which had been added in the cooling reservoir of the dental equipment. In the experimental groups, the professionals made use of; a) an individual biosafety barrier in dentistry (IBBD) which consists of a metal support covered by a disposable PVC film barrier; b) a Mobile Unit of Disinfection by Ultraviolet-C, consisting of 8 UV lamps-C of 95W, of 304µW/cm2 of irradiance each, connected for 15 minutes (UV-C) and; c) the association between the two methods (IBBD + UV-C). In each clinic, 56 Petri dishes containing MRS agar were positioned on the lamps, benches and on the floor. In addition, plates were placed prior to each test (negative control group) and plates were also placed in the corridor that connects the four clinics. In the groups without barrier and IBBD + UV-C the passive air microorganisms in Petri dishes was also evaluated at times of 30, 60, 90 and 120 minutes after the end of the dental's drill activation. The mean (standard deviation) of CFU of L. casei Shirota for the positive control group was 3905 (1521), while in the experimental groups the mean using the IBBD was 940 (466) CFU, establishing a reduction on average, of 75% (p<0.0001). For the UV-C group, the mean was 260 (309) CFU and the association of the use of IBBD + UV-C promoted an overall average count of 152 (257) CFU, establishing a reduction on average of 93% and 96%, respectively (p<0.0001). Considering these results and the study model used, the individual biosafety barrier associated with UV-C technology showed to be efficient strategies to reduce the dispersion of bioaerosols generated in an environment with high rate of PCDP generation and may be an alternative for the improvement of biosafety in different healthy environment.

Bilateral Sinonasal Inverted Papilloma: Report of an Uncommon Case Involving Sinuses of the Face and Orbital Cavity.

BACKGROUND Nasosinusal papilloma is a benign aggressive tumor. It usually occurs unilaterally in the nasal cavity and can extend to the sinuses. The diagnosis is made by the correlation of findings observed in tomographic and histopathological exams. The recommended treatment is surgical excision with clinical monitoring. Orbital involvement occurs in about 9% of cases of advanced SIP. However, there is no report of cases of a benign tumor that invaded the adjacent soft tissues. Therefore, our objective is to report an unusual case of SIP that bilaterally involved the nasal cavity and maxillary sinuses, and extended to involve the ethmoidal cells and sphenoid and frontal sinuses. CASE REPORT In this article, we report an unusual presentation of sinonasal inverted papilloma (SIP) in a 60-year-old man. The tumor bilaterally involved the nasal cavity and maxillary sinuses and extended to involve the ethmoidal cells and the sphenoid and frontal sinuses, as well as the orbital cavity on the right side. An open surgical procedure was performed for complete removal of the lesion and follow-up with imaging exams. CONCLUSIONS The involvement of these structures is uncommon in SIP. This highlights the importance of this case report. Diagnosis and surgical treatment must be carefully planned. In this work, we describe all the steps that helped guide the choice of the best surgical technique to be performed and offer the best clinical follow-up.

A novel dental biosafety device to control the spread of potentially contaminated dispersion particles from dental ultrasonic tips.

Strategies to return to dental practice in pandemic times is a new challenge due to the generation and spread of potentially contaminated dispersion particles (PCDP) that may contain the SARS-CoV-2, the etiological factor of the COVID-19 disease. Due to the significant dispersion of PCDP in the dental environment, the use of equipment such as ultrasonic tips have been inadvisable during the pandemic. Several clinical procedures, however, benefit from the use of such equipment. Thus, using a microbial dispersion model of PCDP, the aim of this study was to compare the dispersion caused by the dental drill (DD) an ultrasonic tip (UT) alone and the UT coupled with a Spray control (SC) device. The DD, UT (with or without the SC) were activated for one minute having had the water from the reservoir replaced with a suspension of Lactobacillus casei Shirota (1.5 x 108 CFU/mL). Petri dishes containing MRS agar were positioned at 50cm, 100cm and 150cm from the headrest of the dental chair at different angles (0 degree and 90 degrees). At 50 cm, the mean CFU (standard deviation) of L. casei Shirota was 13554.60 (4071.03) for the DD, 286.67 (73.99) for the US (97.89% reduction), and 4.5 (0.58) CFU for the UT-SC (p < 0.0001), establishing a further 98.43% reduction between UT and UT with SC. The UT with SC model proved effective in reducing dispersion from the UT, endorsing its use as an additional strategy to reduce PCDP in the dental environment in times of pandemic.

Influence of apical preparation size and final irrigation protocol on the debridement of oval root canals.

This study assessed the influence of apical preparation size and final irrigation protocol on the debridement of the apical third of oval root canals of mandibular molars. Seventy-seven distal roots were divided into 7 groups (n = 11): Control: without instrumentation or irrigation; Group 30CI: ProTaper Next (up to size 30; PTN) + conventional irrigation (CI); Group 30UAI: PTN + ultrasonically activated irrigation (UAI); Group 30XPF: PTN + XP-endo Finisher (XPF); Group 40CI: PTN + ProDesign Logic (up to size 40; PDL) + CI; Group 40UAI: PTN + PDL + UAI; and Group 40XPF: PTN + PDL + XPF. The total volume of irrigating solutions used per root canal in all the experimental groups was 33 mL of 2.5% sodium hypochlorite (NaOCl) and 6 mL of 17% ethylenediaminetetraacetic acid (EDTA). After specimen processing and histological analysis under a digital microscope (100x), the percentages of untouched canal walls (UCW) and remaining debris (RD) were assessed using Image J software. A descriptive and exploratory analysis was conducted, indicating that the data failed to meet the assumptions of an analysis of variance. Therefore, generalized linear models were used to assess the effects of the different instrumentation and irrigation protocols, as well as the interaction among them, on the percentage of UCW and RD. No significant difference was found among the irrigation protocols regarding the percentage of UCW, irrespective of apical preparation size (p>0.05). However, UCW and RD were significantly lower in groups 40CI, 40UAI and 40XPF than in groups 30CI, 30UAI and 30XPF (p<0.05). The percentage of RD was significantly lower in the UAI and XPF groups than in the CI groups, irrespective of apical preparation size (p<0.05). The difference between preparation sizes 30 and 40, with respect to RD, was higher when CI was used (p<0.05). In conclusion, instrumentation up to apical preparation size 40 resulted in lower percentages of UCW and RD than up to apical preparation size 30. Use of UAI or XPF resulted in lower percentages of RD than CI.

Soluble epoxide hydrolase inhibitor, TPPU, increases regulatory T cells pathway in an arthritis model.

Epoxyeicosatrienoic acids (EET) and related epoxy fatty acids (EpFA) are endogenous anti-inflammatory compounds, which are converted by the soluble epoxide hydrolase (sEH) to dihydroxylethersatrienoic acids (DHETs) with lessened biological effects. Inhibition of sEH is used as a strategy to increase EET levels leading to lower inflammation. Rheumatoid arthritis is a chronic autoimmune disease that leads to destruction of joint tissues. This pathogenesis involves a complex interplay between the immune system, and environmental factors. Here, we investigate the effects of inhibiting sEH with 1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU) on a collagen-induced arthritis model. The treatment with TPPU ameliorates hyperalgesia, edema, and decreases the expression of important pro-inflammatory cytokines of Th1 and Th17 profiles, while increasing Treg cells. Considering the challenges to control RA, this study provides robust data supporting that inhibition of the sEH is a promising target to treat arthritis.

Benign odontogenic ghost cell lesions revisited and new considerations on dysplastic dentin.

OBJECTIVES: This study aimed to revisit benign odontogenic ghost cell lesions (BOGCL) by hematoxylin and eosin staining and immunohistochemistry. MATERIALS AND METHODS: Thirty cases of calcifying odontogenic cyst (COC) and 6 cases of dentinogenic ghost cell tumor (DGCT) were selected for histopathological and immunohistochemical analysis. Sections stained for cytokeratin (K) 14, K-19, amelogenin, collagen type 1 (COL-1), and dentin matrix acidic phosphoprotein 1 (DMP-1) were evaluated using qualitative analysis. Sections stained for Ki-67 and minichromosome maintenance protein-2 (MCM-2) were evaluated using semi-quantitative analysis. RESULTS: A morphologic overlap was noticed in all BOGCL. Moreover, no differences were detected in the expression of K-14 and K-19. The expression of proliferative markers Ki-67 and MCM-2 was similar between cystic and tumor lesions (p > .05). The presence of COL-1 and absence of amelogenin in the so-called dysplastic dentin, associated with its histologic pattern, suggest that this is in fact an enameloid-like tissue. CONCLUSIONS: The dysplastic dentin should be considered an enameloid-like tissue in these lesions. CLINICAL RELEVANCE: The similarity in histology, protein expression, and proliferative marker indices between COC and DGCT suggest that they are a sole entity and likely represent types of the same neoplasia.

Role of apoptotic, autophagic and senescence pathways in minor salivary gland adenoid cystic carcinoma.

BACKGROUND: Adenoid cystic carcinoma (ACC) is a salivary gland malignancy with poor long-term survival, which warrants studies aimed at clarifying the pathogenesis of this disease in order to widen the scope of therapeutic options currently available. Alterations in regulatory mechanisms relating to vascular support, cell death and autophagy are important pathways for tumor growth in cancer. Thus, the present study aimed to access vascular supply, apoptosis, autophagy and cell senescence in ACC of minor salivary glands. METHODS: We analyzed 25 cases of minor salivary gland ACC by immunohistochemistry using anti-CD34, anti-CD105, anti-D2-40, anti-Bax, anti-Bcl-2, anti-Beclin-1, anti-LC3B, anti-p21 and anti-p16. RESULTS: Microvessel density was low and based on anti-CD34, anti-CD105 and anti-D2-40 immunostaining. There was positivity for anti-CD34, anti-Bcl-2, anti-Beclin, anti-LC3B and anti-p21 and a positive correlation between Bcl-2 and Beclin (p = 0.014). CONCLUSIONS: Our results showed that ACC does not depend on neo-angiogenesis and is probably associated to anti-apoptotic, autophagic and anti-senescence events.

Percepções acerca da importância das vacinas e da recusa vacinal numa escola de medicina / Perceptions on the importance of vaccination and vaccine refusal in a medical school

RESUMO Objetivo: Identificar a percepção da importância das vacinas e os riscos da recusa vacinal entre alunos de Medicina e médicos. Métodos: Estudo transversal realizado por meio da aplicação de questionários sobre vacinas, recusa vacinal e suas repercussões acerca da saúde pública e individual. A amostra, de 92 sujeitos, foi selecionada numa escola privada de Medicina: grupo 1 (53 estudantes do primeiro ao quarto ano) e grupo 2 (39 médicos). Os dados colhidos foram tabulados no programa Microsoft Excel e analisados estatisticamente com o teste exato de Fisher. Resultados: Os dois grupos consideram o Programa Nacional de Imunizações confiável e reconhecem a importância das vacinas, mas 64,2% dos estudantes e 38,5% dos médicos desconhecem o número de doenças infecciosas evitáveis pelas vacinas no calendário básico. A maioria dos entrevistados possuía carteira de vacinas, mas nem todos receberam vacina influenza 2015. Conheciam pessoas que recusavam vacinas e/ou recusavam vacinar seus filhos (respectivamente, 54,7 e 43,3% dos estudantes e 59,0 e 41,0% dos médicos). Dos médicos, 48,7% já atenderam pacientes que se recusaram a receber vacinas. Consideram causas de recusa vacinal: medo de eventos adversos, razões filosóficas, religiosas e desconhecimento sobre gravidade e frequência das doenças. Aspectos éticos da recusa vacinal e possibilidades legais de exigir vacinas para crianças não são consenso. Conclusões: Alunos de Medicina e médicos não se vacinam adequadamente, apresentam dúvidas sobre calendário vacinal, segurança das vacinas e recusa vacinal. Melhorar sua capacitação é importante estratégia para manter as coberturas vacinais e abordar a recusa vacinal de forma ética.

ABSTRACT Objective: To identify the perception of medical students and physicians on the importance of vaccination and the risks of vaccine refusal. Methods: Cross-sectional study with application of questionnaires about vaccines, vaccine refusal and its repercussions on public and individual health. A sample of 92 subjects was selected from a private medical school: group 1 (53 students from first to fourth grades) and group 2 (39 physicians). Data collected were tabulated in the Microsoft Excel Program and analyzed by Fisher's exact test. Results: Both groups considered the National Immunization Program reliable and recognized the importance of vaccines, but 64.2% of students and 38.5% of physicians are unaware of the vaccine-preventable infectious diseases in the basic immunization schedule. Most of the interviewees had a personal vaccine registry, but not all had received the 2015 influenza vaccine. Both groups had known people who refused vaccines for themselves or for their children (respectively, 54.7 and 43.3% of students and 59.0 and 41.0% of physicians). The total of 48.7% of physicians had already assisted vaccine refusers. Appointed causes of vaccine refusal were: fear of adverse events, philosophical and religious reasons and lack of knowledge about severity and frequency of diseases. Ethical aspects of vaccine refusal and legal possibilities of vaccine requirements for children are not consensus. Conclusions: Medical students and doctors are not adequately vaccinated and have queries about the vaccination schedule, vaccine safety and vaccine refusal. Improving these professionals' knowledge is an important strategy to maintain vaccine coverage and address vaccine refusal ethically.

PERCEPTIONS ON THE IMPORTANCE OF VACCINATION AND VACCINE REFUSAL IN A MEDICAL SCHOOL. / PERCEPÇÕES ACERCA DA IMPORTÂNCIA DAS VACINAS E DA RECUSA VACINAL NUMA ESCOLA DE MEDICINA.

OBJECTIVE: To identify the perception of medical students and physicians on the importance of vaccination and the risks of vaccine refusal. METHODS: Cross-sectional study with application of questionnaires about vaccines, vaccine refusal and its repercussions on public and individual health. A sample of 92 subjects was selected from a private medical school: group 1 (53 students from first to fourth grades) and group 2 (39 physicians). Data collected were tabulated in the Microsoft Excel Program and analyzed by Fisher's exact test. RESULTS: Both groups considered the National Immunization Program reliable and recognized the importance of vaccines, but 64.2% of students and 38.5% of physicians are unaware of the vaccine-preventable infectious diseases in the basic immunization schedule. Most of the interviewees had a personal vaccine registry, but not all had received the 2015 influenza vaccine. Both groups had known people who refused vaccines for themselves or for their children (respectively, 54.7 and 43.3% of students and 59.0 and 41.0% of physicians). The total of 48.7% of physicians had already assisted vaccine refusers. Appointed causes of vaccine refusal were: fear of adverse events, philosophical and religious reasons and lack of knowledge about severity and frequency of diseases. Ethical aspects of vaccine refusal and legal possibilities of vaccine requirements for children are not consensus. CONCLUSIONS: Medical students and doctors are not adequately vaccinated and have queries about the vaccination schedule, vaccine safety and vaccine refusal. Improving these professionals' knowledge is an important strategy to maintain vaccine coverage and address vaccine refusal ethically.

OBJETIVO: Identificar a percepção da importância das vacinas e os riscos da recusa vacinal entre alunos de Medicina e médicos. MÉTODOS: Estudo transversal realizado por meio da aplicação de questionários sobre vacinas, recusa vacinal e suas repercussões acerca da saúde pública e individual. A amostra, de 92 sujeitos, foi selecionada numa escola privada de Medicina: grupo 1 (53 estudantes do primeiro ao quarto ano) e grupo 2 (39 médicos). Os dados colhidos foram tabulados no programa Microsoft Excel e analisados estatisticamente com o teste exato de Fisher. RESULTADOS: Os dois grupos consideram o Programa Nacional de Imunizações confiável e reconhecem a importância das vacinas, mas 64,2% dos estudantes e 38,5% dos médicos desconhecem o número de doenças infecciosas evitáveis pelas vacinas no calendário básico. A maioria dos entrevistados possuía carteira de vacinas, mas nem todos receberam vacina influenza 2015. Conheciam pessoas que recusavam vacinas e/ou recusavam vacinar seus filhos (respectivamente, 54,7 e 43,3% dos estudantes e 59,0 e 41,0% dos médicos). Dos médicos, 48,7% já atenderam pacientes que se recusaram a receber vacinas. Consideram causas de recusa vacinal: medo de eventos adversos, razões filosóficas, religiosas e desconhecimento sobre gravidade e frequência das doenças. Aspectos éticos da recusa vacinal e possibilidades legais de exigir vacinas para crianças não são consenso. CONCLUSÕES: Alunos de Medicina e médicos não se vacinam adequadamente, apresentam dúvidas sobre calendário vacinal, segurança das vacinas e recusa vacinal. Melhorar sua capacitação é importante estratégia para manter as coberturas vacinais e abordar a recusa vacinal de forma ética.

The effect of L-Lysine in recurrent herpes labialis: pilot study with a 8-year follow up / O efeito da L-Lisina na herpes labial recorrente: estudo piloto com 8 anos de seguimento

ABSTRACT Several treatments for recurrent herpes labialis have been tested, including intradermal snake venom, camphor compresses, psychiatric treatments, vitamin C and other vitamin complexes. Nowadays, topical and systemic retroviral drugs such as acyclovir, valacyclovir and vadarabina are the drugs of choice. However they are only effective for symptoms minimization of existing lesions, without eliminating the virus permanently. In this study an alternative treatment with oral L-lysine is presented. This is one of the eight essential not manmade amino acids which should be acquired through feeding since they are important for protein synthesis and organism development. It was observed a significant effect on the annual incidence reduction of recurrent herpes in 12 patients with 8-year follow up.

RESUMO Vários tratamentos para herpes labial recorrente foram testados, incluindo veneno de cobra intradérmica, compressas de cânfora, tratamentos psiquiátricos, vitamina C e outros complexos vitamínicos. Atualmente, as drogas retrovirais tópicas e sistêmicas, como o aciclovir, o valaciclovir e a vadarabina são as drogas de escolha. No entanto, eles são eficazes apenas para minimizar os sintomas das lesões existentes, sem eliminar o vírus permanentemente. Neste estudo é apresentado um tratamento alternativo com L-lisina oral. Este é um dos oito aminoácidos essenciais não fabricados pelo homem, que devem ser adquiridos através da alimentação, uma vez que são importantes para a síntese de proteínas e o desenvolvimento do organismo. Foi observado um efeito significativo na redução da incidência anual de herpes recorrente em 12 pacientes com 8 anos de seguimento.

Resultados negativos na pesquisa científica: aspectos éticos / Negative results in scientific research: ethical aspects / Resultados negativos en la investigación científica: aspectos éticos

Resumo Resultados nulos, negativos ou inesperados são ocorrências possíveis para pesquisadores em todo o mundo. Não publicar tais resultados representa desperdício de recursos (de tempo, dinheiro e esforços). O objetivo deste estudo foi avaliar, mediante aplicação de questionário, o que estudantes de medicina e médicos pensam sobre a publicação de resultados inesperados ou negativos em pesquisa e discutir os aspectos éticos da questão. As questões foram respondidas por 40 alunos e 30 médicos de uma faculdade privada de medicina. Conclui-se que ainda é pouco discutida e aceita a publicação de resultados negativos ou inesperados, persistindo a crença que publicar tais resultados pode prejudicar a reputação dos pesquisadores. Quase todos os participantes acreditam ser importante a publicação desse tipo de resultados, mas apenas cerca de 60% os publicariam. Torna-se, então, importante e necessário ampliar a discussão sobre o assunto nas escolas médicas para se criar nova mentalidade acadêmica.

Abstract Null, negative or unexpected results are possible occurrences for researchers around the world. Not publishing such results is a waste of resources (time, money, and effort). The objective of this study was to evaluate, through a questionnaire, what medical students and physicians thought about the publication of unexpected or negative results in research and to discuss the ethical aspects of the matter. The questions were answered by 40 students and 30 physicians from a private medical school. It is concluded that the publication of negative or unexpected results is still insufficiently discussed and accepted, perpetuating the belief that publishing such results may harm the researchers' reputation. Almost all participants believe it is important to publish these kind of results, but only about 60% of them would publish such results. It is therefore important and necessary to broaden the discussion on this subject in medical schools to create a new academic mindset.

Resumen Los resultados nulos, negativos o inesperados son acontecimientos posibles para los investigadores en todo el mundo. No publicar tales resultados representa un desperdicio de recursos (de tiempo, dinero y esfuerzos). El objetivo de este estudio fue evaluar, a través de la aplicación de un cuestionario, qué piensan los estudiantes de medicina y los médicos sobre la publicación de resultados inesperados o negativos en la investigación y discutir los aspectos éticos de la cuestión. 40 alumnos y 30 médicos de una facultad privada de medicina respondieron al cuestionario. Se concluye que aún es poco discutida y aceptada la publicación de resultados negativos o inesperados, persistiendo la creencia de que publicar tales resultados puede perjudicar la reputación de los investigadores. Casi todos los participantes creen que es importante la publicación de este tipo de resultados, pero solo el 60% de ellos los publicaría. Se hace importante y necesario, entonces, ampliar la discusión sobre este tema en las facultades médicas para crear una nueva mentalidad académica.

A rápida evolução clínica de um nevo de spitz: acompanhamento de três anos em criança / The fast clinical evolution of a spitz nevus: three-year follow-up of a child

RESUMO Objetivo: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. Descrição do caso: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. Comentários: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

ABSTRACT Objective: To report the clinical evolution and handling of a Spitz nevus, from its initial flat feature to becoming an irregular, nodular, reddish lesion. Case description: Female child, phototype II, with a small congenital nevus on the left lower limb and other sustained small nevi. The patient went through annual clinical and dermoscopic evaluations between the ages of three and seven, period during which the nevi located on the left thigh grew rapidly. The clinical hypothesis was Spitz nevus, with indication of surgical removal with a safety margin and anatomopathological study. Considering patient's age and clinical/histological aspects, the diagnosis of Spitz nevus was confirmed. Comments: Initial globular pattern and size under 5 mm upon dermoscopy allowed clinical follow-up. However, onset of hyperchromia and rapid growing of the lesion, along with aesthetic concerns, possibility of trauma in the region, and risk of malignancy at puberty guided the decision of total resection and follow-up for recurrence.

THE FAST CLINICAL EVOLUTION OF A SPITZ NEVUS: THREE-YEAR FOLLOW-UP OF A CHILD. / A RÁPIDA EVOLUÇÃO CLÍNICA DE UM NEVO DE SPITZ: ACOMPANHAMENTO DE TRÊS ANOS EM CRIANÇA.

OBJECTIVE: To report the clinical evolution and handling of a Spitz nevus, from its initial flat feature to becoming an irregular, nodular, reddish lesion. CASE DESCRIPTION: Female child, phototype II, with a small congenital nevus on the left lower limb and other sustained small nevi. The patient went through annual clinical and dermoscopic evaluations between the ages of three and seven, period during which the nevi located on the left thigh grew rapidly. The clinical hypothesis was Spitz nevus, with indication of surgical removal with a safety margin and anatomopathological study. Considering patient's age and clinical/histological aspects, the diagnosis of Spitz nevus was confirmed. COMMENTS: Initial globular pattern and size under 5 mm upon dermoscopy allowed clinical follow-up. However, onset of hyperchromia and rapid growing of the lesion, along with aesthetic concerns, possibility of trauma in the region, and risk of malignancy at puberty guided the decision of total resection and follow-up for recurrence.

OBJETIVO: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. DESCRIÇÃO DO CASO: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. COMENTÁRIOS: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

Unusual Case of Graphite Tattoo in a Pediatric Patient: Clinical Presentation and Differential Diagnosis.

Graphite tattoo, a rare finding in children, is characterized by a localized blue-grey macule of variable sizes and shapes. Intraoral graphite implantation may cause this pigmentation through accidental injury with a graphite pencil. The purpose of this paper is to report an unusual case of graphite tattoo involving the anterior palate region in a seven-year-old girl. A diagnosis was made based on clinical and radiographic examinations and histopathology features. This report also highlights the importance of differential diagnosis and management of oral benign and malignant pigmented lesions in children.

Estudantes e Professores da Área da Saúde Conhecem o Programa Mais Médicos? / Familiarity with the More Doctors Program Among Health Sciences Professors and Students

RESUMO Diminuir as iniquidades na assistência à saúde continua sendo um grande desafio para países tanto pobres quanto ricos. No Brasil, o Programa Mais Médicos (PMM) foi instituído pelo governo federal em 2013 com a proposta de formar recursos humanos na área médica para o Sistema Único de Saúde (SUS), diminuir a carência de médicos, reduzir as desigualdades regionais na área da saúde e aprimorar a formação médica, ampliando a inserção do médico em formação nas áreas onde ele possa conhecer melhor a realidade da saúde da população. Considerando que os estudantes da área da saúde estão diretamente envolvidos com as propostas e os desfechos desse programa, o objetivo deste estudo foi avaliar o conhecimento e posicionamento não só dos estudantes, mas também de seus professores sobre o PMM. Um questionário foi aplicado a 106 alunos e 53 professores de uma faculdade privada na área da saúde (Medicina e Odontologia). A taxa de acerto das 25 questões sobre os objetivos e propostas de ação do PMM variou de 38,4% a 50,6%. A maioria dos docentes e alunos de Medicina referiu conhecer o PMM e reconhecia como proposta do programa diminuir a carência de médicos e melhorar a atuação nas políticas públicas de saúde. A proposta de aprimoramento da formação médica, oferta de cursos de Medicina e de vagas para residência médica, entretanto, era desconhecida por mais de 60% dos entrevistados. A contratação de médicos estrangeiros foi erroneamente considerada não só como um dos objetivos do programa, mas também como a ação proposta para atingir seus objetivos. Em conclusão, alunos e professores de instituições da área da saúde, embora sendo atores importantes na estratégia de atingir os objetivos propostos, conhecem pouco o PMM, particularmente nas ações relacionadas ao currículo das escolas e à residência médica. Estimular debates sobre o programa em escolas médicas pode modificar essa situação e favorecer o seu desfecho.

ABSTRACT Tackling unequal access to healthcare is a major challenge in both developed and developing countries. In Brazil, the Programa Mais Médicos (More Doctors Program – PMM) was created by the federal government in 2013 in order to reduce the shortage of doctors, address regional inequalities in healthcare access and improve medical education, expanding doctors’ training in fields where they can better understand the reality of the population’s health. Considering that students in the healthcare field are directly involved with the proposals and outcomes of this program, the objective of this study was to evaluate student knowledge and positioning and also that of their teachers on the PMM. A questionnaire was therefore administered to 106 students and 53 professors at a private medical and dentistry school. The hit rate for the 25 questions on the PMM’s objectives and proposals ranged from 38.4% to 50.6%.The majority recognized the PMM’s aim to reduce the shortage of doctors and improve public policies related to healthcare. The PMM’s aim to improve medical training, increasing the availability of medical courses and medical residencies, proved, however, to be unknown to over 60% of respondents. The hiring of foreign doctors was mistakenly considered not only to be the objective of the program, but also part of the initiatives designed to achieve the program objectives. The conclusion reached is that although university health sciences students and professors serve as important actors in the strategy for achieving the PMM’s goals, they have limited knowledge on the program, particularly in terms of the initiatives related to medical curricula and medical residencies. Discussion on the program could be introduced to medical courses in order to address this situation and improve the program’s outcomes.