Oral HPV-associated dysplasia: is koilocytic dysplasia a separate entity?

Oral epithelial dysplasia associated with high-risk HPV infection has received different names since its initial description, such as oral Bowenoid lesions, HPV-associated intraepithelial neoplasia, and oral koilocytic dysplasia. Some features, identified in more or less quantity in some of the descriptions, like apoptotic keratinocytes, karyorrhexis, and mitosoid figures, are intricately connected to viral transcriptional status and, consequently, viral load. Since the variety in terminology has introduced diagnostic confusion within medical and research communities, establishing a uniform and standardized approach to diagnosing HPV-oral epithelial dysplasia is crucial for accurate and early diagnoses and holds significant implications for patient outcomes, particularly in high-risk individuals.

Impaired intratumoral dendritic cell function and potential predictive value of dendritic cells markers for metastasis in malignant salivary gland tumors

Background: The differentiation between primary and metastatic salivary gland neoplasms (SGNs) helps in determining appropriate management strategies, including the need for additional diagnostic tests, surveillance, or aggressive treatment. The purpose of this study was to identify and quantify the immature and mature dendritic cells (DCs) in metastatic and no metastatic SGNs and determine its association with clinicopathological findings. Material and Methods: Cross-sectional, observational, and descriptive study that includes 33 malignant salivary gland neoplasms [MSGN (6, 18.1% metastatic)], and 22 pleomorphic adenomas (PA), as a control group. Clinical and histopathological characteristics were obtained. Immunohistochemistry for human leukocyte antigen Drelated (HLA-DR), CD1a, CD83, and Ki-67 proteins was done. Positive intra- and peritumoral DCs were counted. Results: Individuals with MSGN had a lower density of intratumoral HLA-DR+ cells than those with PA (p=0.001), Ki-67 immunostaining was significantly higher in MSGN than in PA (6% vs. 1.4%, p<0.001). Metastatic MSGN showed less intratumoral CD1a+ than non-metastatic (3.2 vs. 165.1, p=0.001). No differences in intra- and peritumoral CD83+ cells were found between benign and malignant SGN. Conclusions: These results suggest that the immune-protective function of intratumoral DCs is compromised in MSGNs. DCs markers may represent useful prediction tools for metastases in salivary gland malignancies, with crucial implications in the implementation of appropriate disease management strategies. (AU)

Clinicopathological and molecular approaches to the diagnosis of oral lesions in Mpox: Case report.

Mpox virus infection (MPXV) has recently been recognized as a public health emergency by the World Health Organization. While several studies have described the clinical characteristics of MPXV-oral lesions, there remains a dearth of information regarding the histological and ultrastructural oral findings. A 24-year-old HIV-positive man presented with a shallow ulcer, covered by a fibrinoid membrane, and surrounded by an erythematous halo in the hard and soft palate. The clinical appearance of the lesion raised suspicion of a viral infection; thus, the diagnosis was based on histological and electronic microscopy findings and confirmed by RT-PCR testing in the skin specimen. This case report aims to offer comprehensive insights into the clinical, histopathological, and ultrastructural features of oral lesions caused by MPXV in an individual with HIV. This report provides valuable information about the characteristics of MPXV infection in the oral mucosa, particularly in people living with HIV.

Oral cancer and precancer in Oral Pathology and Medicine curricula of Mexican dental schools.

OBJECTIVE: To identify the teaching-learning process characteristics of Oral Pathology and Medicine (OP&M) related to oral potentially malignant disorders (OPMDs) and oral cancer (OC), in the dental schools' curricula in Mexico, to analyze the approach given to this topic worldwide, and to provide the possible solution strategies. MATERIALS AND METHODS: Questionnaires were sent to OP&M deans and professors from public Mexican Universities to explore the curriculum and academic profile of the dental schools. The recommendations gathered from a workshop with expert professors on the challenges in OPMD/OC teaching were reported. RESULTS: Twenty-two dental schools participated (22 deans, 30 professors). The most widely used strategies were clinical-case resolving (86%) and presentations (73%). Although 77.3% of the programs included maxillofacial lesions, only 40.9% contemplated OPMD/OC. Only 45% of the programs developed community activities for early OC detection. The workshop recommendations were (i) multidisciplinary approach to OPMD/OC teaching, involving OP&M professors in other dental and nondental courses; (ii) implementation of the most effective teaching techniques (currently, problem-based learning and clinical-case presentation) in OP&M curricula; (iii) education of OP&M professors on teaching-learning processes. CONCLUSIONS: These recommendations from the Mexican context, integrated with similar experiences from other countries could contribute to develop a unique, internationally acknowledged OP&M curriculum.

Exposing the Great Imitator: Proposal for a Holistic Diagnosis of Oral Secondary Syphilis in People Living with HIV.

Oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes; hence, its diagnosis may represent a challenge. Early diagnosis of syphilis, a disease that has increased in recent decades, is essential for adequate management, particularly in people living with HIV (PLWH). This study aimed to comprehensively characterize oral secondary syphilis in a group of 47 PLWH. A group of PLWH with oral secondary syphilis attending four HIV-referral centers in Mexico City was included (2004-2021). Clinical and laboratory data were retrieved, and an exhaustive oral examination was performed following the established criteria. Demographic, clinicopathological, immunohistochemical, and serological features of the patients were analyzed. Approximately 11% of PLWH with oral secondary syphilis demonstrated negative Venereal Disease Research Laboratory tests. A noticeable feature was the absence of symptoms in 95.7% of cases, despite the clinically evident appearance of the lesions. In contrast to previous results, 18% of ulcerations were detected to be deep, crateriform, and infiltrative, and 22% of the mucous patches were highly keratotic lesions. Most samples (77.3%) showed superficial lymphoplasmacytic infiltrates in the superficial lamina propria, with perivascular and perineural patterns, and immunohistochemistry was positive in 66.7% of the cases. The "great imitator" appears not only clinically but also histopathologically and immunohistochemically, where features may be comparable with those of chronic inflammatory processes, deep infections, or malignant processes. Although not recommended as a routine assay, IHC could be a critical tool, particularly in PLWH with atypical clinical features or with negative and/or dubious serology.

Viruses and oral diseases in HIV-infected individuals on long-term antiretroviral therapy: What are the risks and what are the mechanisms?

As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS-defining cancers, some non-AIDS-defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non-HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high-risk human papillomaviruses (HR-HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non-invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.

Clinical manifestations and risk factors for oral immune reconstitution inflammatory syndrome in Mexico.

The immune reconstitution inflammatory syndrome (IRIS) is a rare acute complication presenting in people living with HIV (PLWH) within the first 6 months of starting combined antiretroviral therapy (cART). While there is relevant information about its pathogenesis and clinical spectrum, IRIS-oral lesions (IRIS-OLs) have been scarcely described. Thus, to establish the incidence and clinical characteristics of IRIS-OLs, data from a cohort of 158 HIV individuals starting cART, followed for 6 months, were obtained retrospectively. IRIS-OLs developed in 11.4% of the individuals, in a median time of 87.5 days, with oral candidiasis being the most frequent manifestation detected in eight individuals (5.1%). The study emphasizes the importance of the correct diagnosis and management of these lesions.

The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology.

The prevalence of oral syphilis, known as "the great imitator" because of its diagnostic complexity and varied clinical manifestations, is increasing worldwide, particularly in people living with HIV (PLWH), who could present false-negative serological results. Although some studies have described the variable presentation of oral syphilis in the context of HIV infection, the difficulty in distinguishing between the primary and secondary stages, clinically and histopathologically, underscores the need to describe atypical cases. We report the case of a 28-year-old HIV-positive man presenting with a 3-month history of painless white/red ulcerated lesion on the soft palate. Physical examination revealed an ulcerated lesion with local signs of inflammation. Initial biopsy revealed a nonspecific inflammatory process and immunohistochemistry (IHC) using anti-Treponema pallidum antibodies showed negative results. The results of serological tests for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody-absorption test) were negative on repeated occasions. Nonetheless, polymerase chain reaction (PCR) assay and subsequent IHC for T. pallidum showed positive results, confirming the diagnosis of oral syphilis. This case illustrates that the diagnosis of oral syphilis is challenging in the absence of serological evidence, and specific tests such as PCR and IHC are useful complementary diagnostic tools.

Impact of early recognition of potentially malignant oral disorders on the prognosis in people living with HIV.

Despite the success of combination antiretroviral therapies, people living with HIV (PLWH) are at an increased risk of developing diverse malignancies, including oral cancer. We here present two cases of PLWH where the early diagnosis of potentially malignant disorders in the oral cavity impacted their treatment and survival, remaining free of disease after their complete elimination. These cases demonstrate the importance of oral examinations and tissue biopsies as a part of the close monitoring of PLWH.

Prevalence of ADHD in Mexican schoolchildren through screening with Conners scales 3.

INTRODUCTION: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in children varies due to the methodology used. In Mexico, the health sector recognizes difficulties in measuring and treating it, so the WHO recommends carrying out screening in populations with a probability of presenting it. The objective was to measure the prevalence of ADHD for screening purposes in second-grade students, their comorbidity, and to describe the experience using version 3 of the Conners scale. METHOD: Descriptive observational study, with the purpose of screening, applying the short versions to parents and teachers of 3,985 schoolchildren in a sample of 55 public schools obtained at random from two delegations in Mexico City, the cases were referred to psychology and psychiatry to corroborate diagnosis and treatment. Results We detected 458 (16%) cases, both informants, the prevalent subtype was hyperactive in both sexes, predominantly male, learning problems and executive functions more frequent in girls with hyperactive and combined subtype, only completed the psychological evaluation 150 schoolchildren and 127 attended with the paidopsiquiatra, who confirmed 72% of the cases. CONCLUSIONS: The prevalence for screening purposes, subtype of ADHD and affected gender is similar to that reported in the literature, the comorbidity identified by both informants is an advantage offered by the Conners scale 3, the limiting factor to corroborate the diagnosis was the resistance of the parents to go with the specialists. It is necessary to guide and inform parents more about the disorder to achieve better participation.

Prevalencia de TDAH en escolares mexicanos a través de un cribado con las escalas de Conners 3 / Prevalence of ADHD in Mexican schoolchildren through screening with Conners scales 3

Introducción. La prevalencia del Trastorno de Déficit de atención e hiperactividad TDHA en población infantil varia debido a la metodología empleada, en México el sector salud reconoce dificultades para medirla y tratarla, asi la OMS recomienda realizar cribados en poblaciones con probabilidad de presentarla. El objetivo fue medir la prevalencia de TDAH con propósitos de cribado en escolares de segundo grado, su comorbilidad, y describir la experiencia utilizando la versión 3 de la escala de Conners. Método. Estudio observacional descriptivo, con propósito de cribado aplicando las versiones cortas a padres y maestros de 3,985 escolares en una muestra de 55 escuelas publicas obtenidas al azar de dos delegaciones en la Ciudad de México, los casos fueron referidos a psicología y Psiquiatría para corroborar diagnostico y tratamiento. Resultados. Se detectaron 458(16%) casos, por ambos informantes, el subtipo prevalente fue hiperactivo en ambos sexos con predominio masculino, los problemas de aprendizaje y funciones ejecutivas mas frecuentes en niñas con subtipos hiperactivo y combinado, solo completaron la evaluación psicológica 150 escolares y 127 acudieron con el paidopsiquiatra, quien confirmo 72% de los casos. Conclusiones. La prevalencia con fines de cribado, subtipo de TDAH y genero afectado es semejante a la reportada en la literatura, la comorbilidad identificada por ambos informantes es una ventaja que ofrece la escala Conners 3, la limitante para corroborar el diagnostico fue la resistencia de los padres para acudir con los especialistas. Es necesario orientar e informar mas a los padres sobre el trastorno para lograr una mejor participación

Introduction. The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in children varies due to the methodology used. In Mexico, the health sector recognizes difficulties in measuring and treating it, so the WHO recommends carrying out screening in populations with a probability of presenting it. The objective was to measure the prevalence of ADHD for screening purposes in second-grade students, their comorbidity, and to describe the experience using version 3 of the Conners scale. Method. Descriptive observational study, with the purpose of screening, applying the short versions to parents and teachers of 3,985 schoolchildren in a sample of 55 public schools obtained at random from two delegations in Mexico City, the cases were referred to psychology and psychiatry to corroborate diagnosis and treatment. Results We detected 458 (16%) cases, both informants, the prevalent subtype was hyperactive in both sexes, predominantly male, learning problems and executive functions more frequent in girls with hyperactive and combined subtype, only completed the psychological evaluation 150 schoolchildren and 127 attended with the paidopsiquiatra, who confirmed 72% of the cases. Conclusions. The prevalence for screening purposes, subtype of ADHD and affected gender is similar to that reported in the literature, the comorbidity identified by both informants is an advantage offered by the Conners scale 3, the limiting factor to corroborate the diagnosis was the resistance of the parents to go with the specialists. It is necessary to guide and inform parents more about the disorder to achieve better participation

CD117 immunoexpression in oral and sinonasal mucosal melanoma does not correlate with somatic driver mutations in the MAPK pathway.

BACKGROUND: Mutations on KIT and downstream genes of MAPK pathway that overstimulate cellular proliferation have been associated with primary oral and sinonasal melanomas (POSNM), but there is limited information that allows the use of personalized therapy. Thus, the aim of the present study was to determine a possible association between the C-KIT immunohistochemical expression with the presence of somatic driver mutations in NRAS, BRAF, KIT, MITF and PTEN on POSNM. METHODS: A retrospective study included 62 tumour samples of an oncological reference centre in Mexico City (17-year period). Immunohistochemistry stain of C-KIT was carried out. Genomic DNA was obtained and used to assess hotspot mutations of KIT, NRAS, BRAF, MITF and PTEN through qPCR. Chi-square, Fisher's exact and the Mann-Whitney U tests were applied when necessary. The significance was set at P < 0.05. RESULTS: Sixty-two cases were included, 74% were positive for C-KIT immunoexpression, all exhibited moderate/strong intensity. Ten (16.1%) samples harboured at least one mutation, 6.4% and 6.6% for NRASQ 61R and BRAFV 600E , respectively, followed by KITK624E (3.2%). No KITL 576P , MITF or PTEN mutations were identified. No significant correlation was observed between mutations and immunostaining (rs = -0.057, P = 0.765). CONCLUSIONS: Regardless of the high immunoexpression of C-KIT, there was no association with the MAPK mutations among POSNM samples. Thus, C-KIT immunohistochemistry is not a reliable tool to detect POSNM candidates for biological therapy.

Type-specific persistence and clearance rates of HPV genotypes in the oral and oropharyngeal mucosa in an HIV/AIDS cohort.

BACKGROUND: Oral high-risk human papillomavirus (HR-HPV) infections are frequent and persistent among the HIV-positive population and are associated with an increased risk for head and neck cancer (HNC). In this study, we sought to determine the incidence, persistence and clearance of HPV infections in oral and oropharyngeal samples from HIV/AIDS subjects. METHODS: A longitudinal, observational and analytical study was performed with an ongoing cohort of HIV/AIDS subjects in Mexico City (September 2013-February 2015). The study was approved by institutional committees, and demographic and clinical data were registered. At the baseline and three-month visits, oral examinations and cytobrush samples were obtained. DNA was purified, quantified and used to detect an HPV-L1 gene fragment by nested PCR, using MY09/MY11 and GP5 + /GP6 + primers. HPV DNA products were purified, sequenced and typed according to HPV databases. Risk factors were assessed, and a multivariate modelling approach was used to determine independent effects. RESULTS: This study included 97 HIV/AIDS individuals (91% men [86.4% of which are men who have sex with men], median age: 36 years, 72.2% under HAART). From the baseline visit, HPV was observed in 55.7% (HR-HPV: 26.8%; HPV-18: 24.1%), with a higher HPV-positive samples for smokers (61.1 vs 32.6%, P = .005). The three-month overall HPV incidence was 33.9%; type-specific HPV persistence was 33.3% (HR-HPV: 13.3%); and 13 of the 33 (39.4%) baseline HPV-positive individuals cleared the infection (HR-HPV: 53.8%). CONCLUSIONS: Although HR-HPV persistence was low, and clearance of the infection was observed in most cases, a close follow-up is necessary, given the increase in HNC among HIV-subjects, particularly HPV-related cancer.

Experimental oscillation death in two mutually coupled light-controlled oscillators.

We characterized the synchronous behavior of two mutually coupled light-controlled oscillators to determine their relevant parameters allowing validation of our model that predicts oscillation death for strong coupling. We experimentally verified the predictions mentioned above and identified the critical coupling (distance) for which oscillation death starts to manifest itself.

Independent Preharvest Applications of Methyl Jasmonate and Chitosan Elicit Differential Upregulation of Defense-Related Genes with Reduced Incidence of Gray Mold Decay during Postharvest Storage of Fragaria chiloensis Fruit.

The Chilean strawberry (Fragaria chiloensis) fruit has interesting organoleptic properties, but its postharvest life is affected by gray mold decay caused by Botrytis cinerea. The effect of preharvest applications of methyl jasmonate (MeJA) or chitosan on the molecular defense-related responses and protection against gray mold decay were investigated in Chilean strawberry fruit during postharvest storage. Specifically, we inoculated harvested fruit with B. cinerea spores and studied the expression of genes encoding for the pathogenesis-related (PR) proteins ß-1,3-glucanases (FcBG2-1, FcBG2-2 and FcBG2-3) and chitinases (FcCHI2-2 and FcCHI3-1), and for polygalacturonase inhibiting proteins (FcPGIP1 and FcPGIP2) at 0, 2, 24, 48, and 72 h post inoculation (hpi). Remarkably, MeJA- and chitosan-treated fruit exhibited a lower incidence of B. cinerea infection than the control-treated at 48 and 72 hpi. At the molecular level, both are efficient elicitors for priming in F. chiloensis fruit since we observed an upregulation of the FcBG2-1, FcBG2-3, FcPGIP1, and FcPGIP2 at 0 hpi. Moreover, a chitosan-mediated upregulation of FcPGIPs at early times post inoculation (2-24 hpi) and MeJA upregulated FcBGs (24-72 hpi) and FcPGIP1 at later times could contribute to reduce B. cinerea incidence by differential upregulation of defense genes. We concluded that preharvest applications of MeJA or chitosan had a long-lasting effect on the reduction of B. cinerea incidence during postharvest as well as an enhancer effect on the induction of PR and PGIP gene expression.

Los estereotipos sobre el psicólogo y su repercusión en la búsqueda de ayuda profesional

La investigación presentada a continuación trata sobre los estereotipos que tiene la población acerca del Psicólogo, de sus roles y funciones y la influencia que tienen estos estereotipos al momento de la búsqueda de ayuda profesional en la ciudad de La Paz. Se trabajó con el método cualitativo utilizando como técnica de recopilación de información los Grupos Focales, mismos que se dividieron por rangos de edad. Es importante tanto para los profesionales en psicología, como para los estudiantes y población en general el conocer los estereotipos que se manejan, sean estos positivos o negativos, ya que solo así se puede expandir el campo de intervención del psicólogo y planificar estrategias que permitan acercarse más a la población. Según los resultados obtenidos se puede evidenciar la existencia de una relación entre los estereotipos y la búsqueda de ayuda profesional pero que además está ligado a otros factores, además en el presente artículo se hace una análisis de cómo se podrían cambiar esos estereotipos y recomendaciones de futuros estudios con respecto al tema.

The research presented below deals with the stereotypes that the population has aboutthe Psychologist, their roles and functions and the influence of these stereotypes when seeking professional help in the city of La Paz. The qualitative method was used, using the Focal Groups as a technique for gathering information, which were divided by age group. It is important both for professionals in psychology, as for students and the population in general, to knowthe stereotypes that are handled, whether positive or negative, since this is the only way to expand the field of intervention of the psychologist and plan strategies to get closer more to the population. According to the results obtained, the existence of a relationship between stereotypes and the search for professional help can be evidenced, but it is also linked to other factors, and in this article an analysis is made of how those stereotypes and future recommendations could be changed studies regarding the subject.

A pesquisa apresentada abaixo trata dos estereótipos que a população tem sobre o psicólogo, seus papéis e funções e a influência desses estereótipos ao procurar ajuda profissional na cidade de La Paz. O método qualitativo foi utilizado, utilizando os Grupos Focais como técnica de coleta de informações, que foram divididos por faixa etária. É importante tanto para os profissionais em psicologia quanto para os estudantes e a população em geral, conhecer os estereótipos que são tratados, sejam positivos ou negativos, uma vez que este é o único meio de expandir o campo de intervenção do psicólogo e planejar estratégias para se aproximar mais para a população. De acordo com os resultados obtidos, a existência de uma relação entre estereótipos e busca de ajuda profissional pode ser evidenciada, mas também está relacionada a outros fatores, e neste artigo é feita uma análise de como esses estereótipos e futuras recomendações poderiam ser alterados Estudos sobre o assunto.

Effects of preharvest applications of methyl jasmonate and chitosan on postharvest decay, quality and chemical attributes of Fragaria chiloensis fruit.

Fragaria chiloensis fruit has a short postharvest life mainly due to its rapid softening. In order to improve its postharvest life, preharvest applications of methyl jasmonate (MeJA) and chitosan were evaluated during postharvest storage at room temperature. The quality and chemical parameters, and protection against decay were evaluated at 0, 24, 48 and 72 h of storage from fruits of two subsequent picks (termed as first harvest and second harvest). In general, fruits treated with MeJA and chitosan maintained higher levels of fruit firmness, anthocyanin, and showed significant delays in decay incidence compared to control fruit. MeJA-treated fruits exhibited a greater lignin content and SSC/TA ratio, and delayed decay incidences. Instead, chitosan-treated fruits presented higher antioxidant capacity and total phenol content. In short, both the elicitors were able to increase the shelf life of fruits as evidenced by the increased levels of lignin and anthocyanin, especially of the second harvest.