Study of the association between human leukocyte antigens (HLA) and pemphigus vulgaris in Brazilian patients.

BACKGROUND: Pemphigus vulgaris is a mucocutaneous blistering autoimmune disease that manifests as painful blisters or erosions on the skin and/or mucosal surfaces. IgG autoantibodies target desmoglein, playing a major role in disease pathogenesis. Genetic predisposal to pemphigus vulgaris, especially the HLA DR and DQ alleles, has been known since the 1980s. The unique constitution of the Brazilian population favors exploratory genetic studies. METHODS: The study group included 51 patients with a confirmed diagnosis of pemphigus vulgaris from a tertiary hospital in Sao Paulo city, Sao Paulo, southeast Brazil. DNA was extracted from peripheral blood, and HLA A, B, C, DR, and DQ typing was performed. The control group was composed of a database of 297 deceased donors from the city of São Paulo typed with the same method. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA A, HLA B, HLA C, HLA DRB1, DQA1, and HLA DQB1. RESULTS: The alleles HLA-B*57, HLA-C*15, HLA-DRB1*04:02, HLA-DRB1*08:04, HLA-DRB1*14:01, DQA1*03:01, DQB1*03:02, and DQB1*05:03 were associated with susceptibility. Alleles HLA DRB1*04:02 and HLA-DRB1*14:01 and their respective haplotypes DRB1*04-DQA1*03:01-DQB1*03:02, and DRB1*14-DQA1*01:01-DQB1*05:03 conferred a risk of the disease. CONCLUSIONS: The DRB1*04:02 and DQB1*05:03 alleles are associated with pemphigus vulgaris in our study as well as in various populations. The association with HLA-DRB1*08:04 in our study was confirmed to be specific to this allele and not to linkage disequilibrium to any adjacent gene. The association between HLA-B*57 and pemphigus vulgaris is reported for the first time in the present study.

Oral lesions in Brazilian HIV-infected children undergoing HAART.

INTRODUCTION: The advent of new antiretroviral drugs such as protease inhibitors (PI) has generated sensible changes in oral manifestation patterns in human immunodeficiency virus (HIV) infected adult patients. OBJECTIVES: The purpose of the present study was to assess whether the use of highly active antiretroviral therapy (HAART) has brought changes to pattern and prevalence of oral lesions related to HIV in the HIV-infected pediatric population. CASUISTIC AND METHOD: We analyzed medical charts of 471 children aged zero to 12 years and 11 months with HIV infection and followed up by the Ambulatory of AIDS, Clinical Otorhinolaryngology, Hospital das Clinicas, Medical School, Sao Paulo University, from January 1990 to December 2004. Four hundred and fifty-nine children were divided into two groups, according to age range: X (0-5 years and 11 months) and Y (6-12 years and 11 months). These groups were subdivided into four subgroups, according to use of ART (antiretroviral therapy without PI) or HAART. We recorded data related to type of oral lesion presented, as well as serum CD4+ lymphocyte count. The groups were compared concerning prevalence and presentation pattern of oral manifestations. RESULTS: Out of 459 children, 144 (31.4%) had oral lesions. We observed that in children aged 6-12 years and 11 months who were taking HAART, there was lower prevalence of oral lesions (p=0.005), specially hairy leukoplakia (p<0.02), without any affection to the common presentation pattern of these lesions. The same subgroup also had higher serum CD4+ lymphocyte counts (p<0.001). CONCLUSION: We concluded that use of HAART could lead to reduction in prevalence of oral lesions in HIV-infected children.

Tuberculosis affecting the oral cavity in Brazilian HIV-infected patients.

OBJECTIVE: Tuberculosis (TB) affecting the oral cavity is a very rare disease. We reviewed the medical data of 18 HIV(1)-infected patients referred to the Stomatology Group, Ear, Nose, and Throat Department, São Paulo University Medical School, who had a diagnosis of oral tuberculosis, between 1991 and 2002. This retrospective study aimed to analyze the relationship between oral tuberculosis and HIV infection. STUDY DESIGN: The clinical records of the patients were reviewed to note age and gender, symptoms, and site and type of the lesions in the oral mucosa. Results of CD4+ T-lymphocyte count, sputum analysis, tuberculin skin test, histopathologic characteristics, cultures of the specimens (that were taken during the biopsy), chest x-ray findings, and the type of treatment they received were also reviewed. RESULTS: The most affected sites were palate and tongue. All patients had culture confirming tuberculosis. CONCLUSION: Patients with HIV and nonhealing oral lesions or papillomatous masses in the oral mucosa should be screened for the presence of pulmonary tuberculosis.

Lateral pharyngoplasty versus uvulopalatopharyngoplasty: a clinical, polysomnographic and computed tomography measurement comparison.

STUDY OBJECTIVE: To compare the lateral pharyngoplasty procedure with uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). DESIGN: Prospective randomized study. SETTING: Academic tertiary center. PATIENTS: Twenty-seven adults with OSAHS originally selected for treatment with UPPP. INTERVENTIONS: Patients were randomly assigned to 2 groups: in one group, we performed the lateral pharyngoplasty (15 cases), and in the other, we did the UPPP (12 cases). MEASUREMENTS AND RESULTS: We compared treatment outcomes through the evaluation of OSAHS-related symptoms and the analysis of polysomnographic tests and computed tomography measurements of pharyngeal airway. The lateral pharyngoplasty group achieved a statistically greater reduction in body weight, excessive daytime sleepiness, and apnea-hypopnea index. In addition, only in this group did we observe a statistically significant increase in the amount of deep sleep stages and improvement in morning headaches. Patients from the UPPP group did not present significant changes in the polysomnographic parameters. Pharyngeal airway measurement outcomes were similar in both groups and did not reflect the clinical and polysomnographic differences we observed. CONCLUSIONS: Lateral pharyngoplasty produces better clinical and polysomnographic outcomes in the treatment of OSAHS than does UPPP, without resultant differences in the cross-sectional measurements of the pharyngeal airway between these treatments.

Complicações pós-operatórias em tonsilectomias / Post-operatory complications in adenotonsillectomy

Adenoidectomia e amigdalectomia são as cirurgias mais freqüentemente realizadas na prática otorrinolaringológica diária. Em geral, são procedimentos seguros, que não requerem internação prolongada. Em nosso serviço, o paciente recebe alta hospitalar cerca de seis horas após a intervenção, e são utilizadas diferentes técnicas cirúrgicas. OBJETIVO:Avaliar a segurança da liberação do paciente no mesmo dia e as complicações pós-operatórias, e compará-las às técnicas cirúrgicas utilizadas. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO:Avaliamos prospectivamente 147 pacientes submetidos a adenoidectomia e/ou amigdalectomia por três técnicas diferentes no Hospital das Clínicas da FMUSP. Um protocolo foi aplicado pelo médico que realizou a cirurgia no pós-operatório imediato, após uma semana e um mês, pesquisando a presença de episódios de sangramento, febre, náuseas, vômitos, dor, disfagia a líquidos e a sólidos. RESULTADOS: A incidência de hemorragia pós-operatória foi de 7,48 por cento no primeiro pós-operatório. Houve sangramento discreto em 3,4 por cento dos pacientes durante a primeira semana. Não houve diferença estatística entre os grupos em relação à técnica cirúrgica utilizada, quanto às complicações estudadas. CONCLUSÃO: A liberação do paciente após 6 horas de cirurgia é uma conduta segura. Como não há diferença estatística quanto às complicações de acordo com a técnica cirúrgica utilizada, acreditamos que o cirurgião deva utilizar a técnica com a qual é mais familiarizado.

Epistaxes recorrentes: estudo dos fatores clínicos e laboratoriais associados / Recurrent epistaxis: study of the clinical and laboratory associated factors

As epistaxes de repetiçäo säo motivo de consulta ao otorrinolaringologista; porém, existem poucos estudos a respeito do tema. Neste trabalho, os autores analisam diversos fatores clínicos e laboratoriais associados a tal afecçäo em adultos e crianças. Foram avaliados 41 pacientes atendidos no Pronto Socorro de Otorrinolaringologia do Hospital das Clínicas Medicina da Universidade de Säo Paulo, com queixa de pelo menos três episódios de epistaxe, com intervalo maior do que um mês entre eles, nos últimos dois anos. A idade variou de seis a 73 anos e os pacientes foram divididos em dois grupos: grupo A (menores de 18 anos) e grupo B (maiores de 17 anos). O grupo A foi composto por 12 casos; e o grupo B, por 29. Com relaçäo aos grupos A e B, encontramos, respectivamente, diagnóstico de sinusite em 58,3 por cento e 48,3 por cento dos pacientes, diagnóstico de rinite em 41,7 por cento e 65,5 por cento, coagulopatia ou plaquetopatia prévias em 8,3 por cento e 6,9 por cento, desvio septal em 41,7 por cento e 72,4 por cento, inflamaçäo da mucosa nasal em 66,7 por cento e 79,3 por cento e alteraçäo no coagulograma em 41,6 por cento e 37,9 por cento dos casos. Os autores concluem que: os fatores locais apresentam importante associaçäo com os quadros de epistaxe de repetiçäo; devem ser investigadas discrasias sanguíneas nestes quadros, pois as epistaxes podem ser manifestaçäo inicial das mesmas; e é importante a investigaçäo de todos os possíveis fatores associados que possam estar envolvidos no quadro

Avaliaçäo comparativa quanto a eficácia e tolerabilidade do cefadroxil e cefaclor nas faringites estreptocócicas / Comparative evaluation of efficacy and safety of cefadroxil monohydrate and cefaclor in patients with Streptococcal pharingitis

O objetivo deste estudo foi comparar a eficácia e segurança do cefadroxil e cefaclor em pacientes com faringo-amigadalites. Foram incluídos 40 doentes com idades entre um e 54 anos. Todos os doentes tiveram teste de coaglutinaçäo e cultura de material de garganta positivos para estreptococo beta-hemolítico do grupo A. Vinte doentes receberam cefadroxil e o restante recebeu cefaclor. Cefadroxil foi usado sob a forma de suspensäo oral (25-50mg/Kg/dia) ou cápsulas (500mg) administradas cada 12 horas durante 10 dias. Cefaclor foi usado como suspensäo oral (20-40mg/Kg/dia) ou cápsulas (250mg) administrados cada 12 horas, durante 10 dias. Näo houve diferença entre dois grupos quanto à gravidade dos sintomas iniciais. Os pacientes foram examinados durante e após o tratamento para detectar recidivas. O controle dos doentes demonstrou cura clínica em todos, com uma única exceçäo no grupo que recebeu cefaclor. A cultura de secreçäo faríngea realizada após o tratamento demonstrou ausência de crescimento de estreptococo beta-hemolítico do grupo A. Pode-se concluir que cefadrozil e cefaclor säo úteis para o tratamento da faringite estreptocócica e que as diferenças entre os dois grupos näo apresentaram significado estatístico