Single ulcers on the tongue dorsum: differential diagnosis between paracoccidioidomycosis and squamous cell carcinoma.

BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.

Oral Manifestations in Patients with COVID-19: A 6-Month Update.

This is the first update of the previously published living systematic review that summarized evidence on the prevalence of oral signs and symptoms in patients with COVID-19. Hitherto, 183 studies were included, reporting data from 64,876 patients with COVID-19 worldwide. The overall prevalence of taste disorders was 38% (95% CI = 22% to 56%, I2 = 98%). Hypogeusia, dysgeusia, and ageusia were also evaluated by a meta-analysis, and the pooled prevalence was 34% for hypogeusia, 33% for dysgeusia, and 26% for ageusia. Taste disorders were associated with a positive COVID-19 test (odds ratio [OR] = 7.54, 95% CI = 5.24 to 10.86, I2 = 93%, P < 0.00001), showing high certainty of evidence. However, the association between taste disorders and mild/moderate severity of COVID-19 (OR = 1.63, 95% CI = 1.33 to 1.99, I2 = 69%, P < 0.0001) and female patients with COVID-19 (OR = 1.77, 95% CI = 1.26 to 2.48, I2 = 79%, P = 0.001) presented low certainty of evidence. Xerostomia was a new feature of this update, and the pooled data demonstrated a prevalence of 43% (95% CI = 36% to 50%, I2 = 71%) in patients with COVID-19. Regarding oral mucosal lesions, the most common clinical pattern was aphthous like, followed by herpes-like lesions, candidiasis, glossitis/depapillation/geographic tongue, parotitis, and angular cheilitis. Oral lesions were more frequent in the tongue, lips, and palate, presenting miscellaneous clinical aspects that are more likely to represent coinfections. Therefore, the reanalysis of current evidence suggests the triad xerostomia, taste dysfunction, and oral mucosal lesions as common manifestations in patients with COVID-19. However, these outcomes are under discussion, and more studies will be necessary to confirm their association with direct SARS-CoV-2 infection in the oral cavity.

The effect of laryngeal elevation training on swallowing function in patients with dysphagia.

OBJECTIVE: To investigate the effect of laryngeal elevation training without highly loaded head lifting on swallowing function in patients with dysphagia. METHODS: Fifty-seven patients with dysphagia (36 men; mean age, 78.5 ± 11.4 years) were included. All participants performed the swallowing forehead exercise and the chin push-pull manoeuvre for two months. Videoendoscopy to assess swallowing function, the peak expiratory flow test and the hand grip strength test were performed at the initial visit (time 1) and two months after the start of the intervention (time 2). We used the Hyodo score, a scoring method for videoendoscopic assessment, for evaluation of swallowing function. RESULTS: The linear mixed model showed a significant main effect of time (the Hyodo score at time 1 was greater than the score at time 2). The effects of the co-variates were not significant. CONCLUSION: The present study demonstrated the significant effect of laryngeal elevation training without head lifting on the Hyodo score.

Oral Manifestations in Patients with COVID-19: A Living Systematic Review.

This living systematic review aims to summarize evidence on the prevalence of oral signs and symptoms in patients with COVID-19. The review was reported per the PRISMA checklist, and the literature search was conducted in 6 databases and in gray literature. Studies published in any language mentioning oral symptoms and signs in patients with COVID-19 were included. The risk of bias was assessed by the Joanna Briggs Institute appraisal tools. The certainty of evidence was evaluated through GRADE assessment. After a 2-step selection, 40 studies were included: 33 cross-sectional and 7 case reports. Overall, 10,228 patients (4,288 males, 5,770 females, and 170 unknown) from 19 countries were assessed. Gustatory impairment was the most common oral manifestation, with a prevalence of 45% (95% CI, 34% to 55%; I2 = 99%). The pooled eligible data for different taste disorders were 38% for dysgeusia and 35% for hypogeusia, while ageusia had a prevalence of 24%. Taste disorders were associated with COVID-19 (odds ratio [OR], 12.68; 95% CI, 6.41 to 25.10; I2 = 63%; P < 0.00001), mild/moderate severity (OR, 2.09; 95% CI, 1.25 to 3.49; I2 = 66%; P = 0.005), and female patients (OR, 1.64; 95% CI, 1.23 to 2.17; I2 = 70%; P = 0.0007). Oral mucosal lesions presented multiple clinical aspects, including white and erythematous plaques, irregular ulcers, small blisters, petechiae, and desquamative gingivitis. Tongue, palate, lips, gingiva, and buccal mucosa were affected. In mild cases, oral mucosal lesions developed before or at the same time as the initial respiratory symptoms; however, in those who required medication and hospitalization, the lesions developed approximately 7 to 24 d after onset symptoms. Therefore, taste disorders may be common symptoms in patients with COVID-19 and should be considered in the scope of the disease's onset and progression. Oral mucosal lesions are more likely to present as coinfections and secondary manifestations with multiple clinical aspects (PROSPERO CRD42020184468).

Meta-analysis of genome-wide association studies for panic disorder in the Japanese population.

Panic disorder (PD) is a moderately heritable anxiety disorder whose pathogenesis is not well understood. Due to the lack of power in previous association studies, genes that are truly associated with PD might not be detected. In this study, we conducted a genome-wide association study (GWAS) in two independent data sets using the Affymetrix Mapping 500K Array or Genome-Wide Human SNP Array 6.0. We obtained imputed genotypes for each GWAS and performed a meta-analysis of two GWAS data sets (718 cases and 1717 controls). For follow-up, 12 single-nucleotide polymorphisms (SNPs) were tested in 329 cases and 861 controls. Gene ontology enrichment and candidate gene analyses were conducted using the GWAS or meta-analysis results. We also applied the polygenic score analysis to our two GWAS samples to test the hypothesis of polygenic components contributing to PD. Although genome-wide significant SNPs were not detected in either of the GWAS nor the meta-analysis, suggestive associations were observed in several loci such as BDKRB2 (P=1.3 × 10(-5), odds ratio=1.31). Among previous candidate genes, supportive evidence for association of NPY5R with PD was obtained (gene-wise corrected P=6.4 × 10(-4)). Polygenic scores calculated from weakly associated SNPs (P<0.3 and 0.4) in the discovery sample were significantly associated with PD status in the target sample in both directions (sample I to sample II and vice versa) (P<0.05). Our findings suggest that large sets of common variants of small effects collectively account for risk of PD.

Intraoral carcinosarcoma on the floor of the mouth mimicking a benign lesion.

Carcinosarcoma is a rare malignant disease with aggressive behaviour rarely producing oral manifestations. This article reports a case of an intraoral carcinosarcoma affecting a 71-year-old black male; the diagnosis was made by histopathological and immunohistochemical analyses. Computed tomography scanning showed metastatic masses in the lungs. The patient was underwent a chemotherapy protocol regimen, but died as a consequence of the disease within 10 months of diagnosis. Distinctive characteristics of this presentation were the location of the lesion (floor of the mouth) and its clinical features resembling a benign lesion. A brief review of intraoral carcinosarcoma cases in the literature is also presented.

A comparative study of the 1918-1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning.

Historical studies of influenza pandemics can provide insight into transmission and mortality patterns, and may aid in planning for a future pandemic. Here, we analyse historical vital statistics and quantify the age-specific mortality patterns associated with the 1918-1920 influenza pandemic in Japan, USA, and UK. All three countries showed highly elevated mortality risk in young adults relative to surrounding non-pandemic years. By contrast, the risk of death was low in the very young and very old. In Japan, the overall mortality impact was not limited to winter 1918-1919, and continued during winter 1919-1920. Mortality impact varied as much as threefold across the 47 Japanese prefectures, and differences in baseline mortality, population demographics, and density explained a small fraction of these variations. Our study highlights important geographical variations in timing and mortality impact of historical pandemics, in particular between the Eastern and Western hemispheres. In a future pandemic, vaccination in one region could save lives even months after the emergence of a pandemic virus in another region.

The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia.

AIM: This study evaluated the effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia. METHODS: Twelve patients with severe xerostomia were treated with acupuncture after radiation therapy. The baseline data were obtained preceding acupuncture treatment, and used as reference values. Acupuncture was performed in 12 sessions, 20 min each, twice a week, during a 6-week period. Clinical response was evaluated objectively by saliva collection measuring resting and stimulated whole salivary flow rates, and subjectively by a visual analogue scale patients' self-evaluation questionnaire. Statistical analyses were performed with a repeated-measures analysis of variance by using a mixed-effect modeling procedure. RESULTS: The results showed a statistically significant improvement for salivary flow rates on both objective and subjective evaluations (P<0.05). On objective evaluation there was an increase for resting salivary flow of 142.2% (mean=0.04 mL/min to 0.12 mL/min) and of 73.5% (mean=0.09 mL/min to 0.21 mL/min) for stimulated salivary flow. On subjective evaluation, visual analogue scale raised 36 points (mean=18.4 to 53.8) for sensation of more saliva production. CONCLUSION: According to the results of the present study, acupuncture showed a significant effect on saliva production, suggesting this therapy as a useful treatment for patients suffering from radiation-induced xerostomia.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients.

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients.

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47%), atrophic (24%), erosive (21%) and plaque-like (8%). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5% of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used.

Oral lichen planus. Clinical aspects and management in fifty-two Brazilian patients

This study aimed to characterize the clinical profile of patients with oral lichen planus (OLP) and to evaluate the efficacy of topical, systemic and/or intralesional corticosteroids in the management of symptomatic cases. Fifty-two patients with OLP, 33 females and 19 males, aged from 17 to 75 years (mean 49.7 years) were studied. Information regarding the clinical forms, sites of involvement, patients' medical history and habits were recorded. Diagnosis of OLP was made using clinical criteria alone in 32 cases, while biopsy examination was required in the remaining 20. Symptomatic lesions were seen in 29 patients, who were treated with corticosteroid. Asymptomatic cases (23) were only clinically monitored. The forms of OLP found in this study were reticular (47), atrophic (24), erosive (21) and plaque-like (8). The buccal mucosa was the site predominantly affected. Systemic diseases were found in 17 patients (seven diabetic and ten with hypertension) but these data lacked statistical significance (p > 0.05) when compared with a control group of age and gender matched patients without any type of mucocutaneous disease. A habit of tobacco and/or alcohol use was reported by 11.5 of the patients, most of them with the reticular form of the disease. Topical corticosteroid therapy alone was effective in producing relief of symptoms in 18 of the 29 patients, although some relapses occurred after discontinuation. For lesions non-responsive to topical treatment, intralesional injection and/or short-term use of systemic corticosteroids were used

[Evaluation of immunochromatography method for rapid detection of influenza A and B viruses].

We have evaluated a new rapid detection kit for influenza A and B viruses, known as the QuickVue Influenza test (Quidel Coporation, USA); which is based on immunochromatography using virus isolates and clinical specimens. Twelve strains of influenza A and B were tested for evaluate the reactivity and detection limits of this test. The QuickVue Influenza test showed a positive result for all twelve strains of influenza virus and a negative result for fourteen different kinds of other respiratory viruses. The detection limits for six strains were 5 to 30 pfu/ml for a cell culture, 1.0 x 10(3) to 6.0 x 10(4) pfu/ml for 1st PCR, 1 to 50 pfu/ml for nested PCR, 3.0 x 10(5) to 6.0 x 10(5) pfu/ml for the QuickVue Influenza test, 1.5 x 10(5) to 1.0 x 10(6) pfu/ml for the Directigen Flu A, and 7.5 x 10(5) to 5.0 x 10(6) pfu/ml for the FLU OIA. Furthermore, the QuickVue Influenza test were clinically evaluated using 92 throat swab specimens collected from patients with influenza-like illnesses. By cell culture, influenza viruses were detected in 49 of the 92 specimens (AH1N1: 20, AH3N2: 7, B: 22); the titers of the influenza viruses were between 2.5 pfu/ml and 7.0 x 10(5) pfu/ml. Compared to cell culture, the QuickVue Influenza test showed a sensitivity of 75.5%, a specificity of 93.0%, a positive predictive value of 92.5%, a negative predictive value of 76.9%, and an efficiency value of 83.7%. On the other hand, influenza viruses were detected in 54 of the 92 specimens (AH1N1: 19, AH 3N2: 10, B: 25) by RT-PCR. Compared to RT-PCR, the QuickVue Influenza test showed a sensitivity of 72.2%, a specificity of 97.4%, a positive predictive value of 97.5%, a negative predictive value of 71.2%, and an efficiency value of 82.6%. Overall, only one throat swab specimen produced a false positive result using the QuickVue Influenza test; thus, this test appears to have a high specificity. We conclude that the QuickVue Influenza test is a simple one-step test with a sensitivity and specificity equivalent to those of other conventional diagnostic kits. The test is useful and suitable for the diagnosis of influenza and for identifying influenza patients requiring antiviral therapy.

[Patient assessment for zanamivir therapy--a survey of patients with influenza who were prescribed zanamivir during the 2000/2001 season in Japan].

Patients clinically diagnosed as influenza who were prescribed zanamivir were surveyed from December 2000 to March 2001 in Japan. A total of 723 survey questionnaires were returned. Following the first zanamivir treatment, symptom relief was reported by 34.9% of the patients within 12 hours, 63.1% within 24 hours and 85.7% within 48 hours. 46.1% of the patients resumed normal activities within 48 hours and 78.0% within 72 hours. 98.8% of the patients reported that the Diskhaler could be used as instructed by the doctor or pharmacist and 92.5% found the device easy or very easy to use. 70.8% of the patients were satisfied or very satisfied with zanamivir, and 89.0% of the patients would recommend zanamivir to a friend. These results showed that 1) the effect of zanamivir started very fast, especially for the vaccinated patients where the effect was more rapid, 2) most of the patients managed to use the diskher properly and felt "very easy to use" or "easy to use", 3) there is no difference of efficacy in spite of with/without underlying disease, and the diskhaer was well accepted by pediatric and elderly patients.

Leiomyomatous hamartoma of the incisive papilla.

A case of unusual hamartoma in a six-year-old otherwise healthy Brazilian girl is reported, with emphasis on histological and immunohistochemical features. A mass observed in the incisive papilla was detected whose appearance was similar to congenital epulis or fibroma. Histological findings showed interlacing fascicles of large spindle cells resembling smooth muscle cells. Immunohistochemical staining for desmin and for smooth-muscle actin was positive. The histological diagnosis was leiomyomatous hamartoma, based on clinical and microscopic observations.

The Japanese experience with vaccinating schoolchildren against influenza.

BACKGROUND: Influenza epidemics lead to increased mortality, principally among elderly persons and others at high risk, and in most developed countries, influenza-control efforts focus on the vaccination of this group. Japan, however, once based its policy for the control of influenza on the vaccination of schoolchildren. From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. When most schoolchildren were vaccinated, it is possible that herd immunity against influenza was achieved in Japan. If this was the case, both the incidence of influenza and mortality attributed to influenza should have been reduced among older persons. METHODS: We analyzed the monthly rates of death from all causes and death attributed to pneumonia and influenza, as well as census data and statistics on the rates of vaccination for both Japan and the United States from 1949 through 1998. For each winter, we estimated the number of deaths per month in excess of a base-line level, defined as the average death rate in November. RESULTS: The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased. CONCLUSIONS: The effect of influenza on mortality is much greater in Japan than in the United States and can be measured about equally well in terms of deaths from all causes and deaths attributed to pneumonia or influenza. Vaccinating schoolchildren against influenza provides protection and reduces mortality from influenza among older persons.

The influence of selection on the evolutionary distance estimated from the base changes observed between homologous nucleotide sequences.

In most studies of molecular evolution, the nucleotide base at a site is assumed to change with the apparent rate under functional constraint, and the comparison of base changes between homologous genes is thought to yield the evolutionary distance corresponding to the site-average change rate multiplied by the divergence time. However, this view is not sufficiently successful in estimating the divergence time of species, but mostly results in the construction of tree topology without a time-scale. In the present paper, this problem is investigated theoretically by considering that observed base changes are the results of comparing the survivals through selection of mutated bases. In the case of weak selection, the time course of base changes due to mutation and selection can be obtained analytically, leading to a theoretical equation showing how the selection has influence on the evolutionary distance estimated from the enumeration of base changes. This result provides a new method for estimating the divergence time more accurately from the observed base changes by evaluating both the strength of selection and the mutation rate. The validity of this method is verified by analysing the base changes observed at the third codon positions of amino acid residues with four-fold codon degeneracy in the protein genes of mammalian mitochondria; i.e. the ratios of estimated divergence times are fairly well consistent with a series of fossil records of mammals. Throughout this analysis, it is also suggested that the mutation rates in mitochondrial genomes are almost the same in different lineages of mammals and that the lineage-specific base-change rates indicated previously are due to the selection probably arising from the preference of transfer RNAs to codons.

Traumatic bone cyst: report of two cases and review of the literature.

Traumatic bone cysts usually are found in young individuals and most frequently have the radiographic appearance of well-circumscribed radiolucent lesions with a tendency to scallop between the roots of the teeth. Two well-documented cases of traumatic bone cysts are presented in which some differences related to their radiographic features were observed. The possible explanations for these differences are discussed and a brief review of the literature regarding the main characteristics of traumatic bone cyst lesions also is provided.