Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews.

BACKGROUND: Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. MATERIAL AND METHODS: An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. RESULTS: We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. CONCLUSIONS: Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies.

Steroid receptors in a group of Brazilian melanoma patients.

Melanoma biopsies from 22 Brazilian patients were evaluated for estrogen (ER), progesterone (PR) and glucocorticoid receptors (GR) by the dextran-coated charcoal method. Fifty percent (11/22) of the tumors exhibited specific estrogen and progesterone binding activities ranging from 5 to 25 fmol/mg protein for ER and from 18 to 200.75 fmol/mg protein for PR; 20/22 (90%) of the biopsies displayed significant quantities of GR, which ranged from 10.0 to 362.5 fmol/mg protein. The incidence and concentration of positive receptors in melanoma samples from Brazilian patients are similar to those of countries with populations of Caucasian origin.

Actinomicetoma por Actinomadura madurae, com extensas lesoes osseas. Registro de um caso. / Actinomycetoma with extensive lesions caused by actinomadura madurae. Report of a case

Os autores descrevem um caso de actinomicetoma da mao e antebraco, em mulher de 32 anos, cujo processo teve inicio em 1973, provocado por actinomiceto identificado como Actinomadura madurae. Em 1982, como o processo evoluia com extensas lesoes osseas, foi indicada amputacao, devido a progressao da infeccao para o antebraco. O exame histopatologico revelou graos parasitarios basofilicos, com a tipica franja periferica eosinofilica (fenomeno de Splendore-Hoeppli). O cultivo do material permitiu o isolamento de um actinomiceto, identificado como Actinomadura madurae (graos branco-amarelados). Tudo faz crer que o presente caso represente o 11o. publicado na literatura nacional

Treatment of disseminated malignant melanoma with high-dose oral BCG.

Thirty patients with unresectable disseminated melanoma (Stage IV) were treated with Bacillus Calmette-Guerin (BCG) (Moreau strain--Rio de Janeiro) by mouth, with weekly doses ranging between 200 mg and 28,000 mg. Five patients died in the first two months of treatment. Of the remaining 25 patients, two (8%) showed complete regression, and one (4%) partial regression. Seven patients (28%) had stabilization of the disease for a six-month period, and 15 (60%) had progression of the disease. Complete and partial regressions were seen only in patients with extravisceral (subcutaneous) metastases, and were associated with a longer survival time. Regression of the subcutaneous metastatic nodules was always accompanied by the following local phenomena: increased temperature; local inflammation; softening, pain and pruritus at the nodule site; and a gradual decrease in size. At the site of the tumor mass, a hypochromic halo appeared. This halo remained permanently and was pathognomonic of the metastatic nodule rejection. When the halo was fully established, the inflammatory infiltrate was minimal and the malignant cells disappeared. If the area contained hairs, they underwent complete albinization. Serial biopsies of the nodules undergoing inflammatory changes and decreased consistency exhibited an intense cellular infiltration of lymphocytes, macrophages, and plasma cells around the malignant cells. This sometimes simulated lymphoid follicle formation involving the melanoma cells associated with necrosis in a centripetal way. Some patients with visceral metastases (particularly pulmonary) had an unexpectedly long survival, apparently associated with interruption of the growth rate of the masses. Eleven out of 20 deaths were due to cerebral metastases. When cerebral disease was diagnosed, BCG was discontinued and the administration of corticoids was usually associated with a disappearance of the inflammatory signs at the nodule sites, but with progression of the disease. Toxicity was minimal.