CHOROIDAL NEOVASCULARIZATION AS A LATE COMPLICATION OF SYPHILITIC CHORIORETINITIS MANAGED WITH INTRAVITREAL AFLIBERCEPT.

PURPOSE: To report a rare case of choroidal neovascular membrane (CNV) developed three years after acquired syphilitic chorioretinitis successfully treated with intravitreal aflibercept. METHODS: Case report. RESULTS: A 44-year-old woman with bilateral decreased vision and a history of syphilitic chorioretinitis 3 years prior to presentation. Her best-corrected visual acuity was <20/400 in the right eye and 20/70 in the left eye. There was no evidence of anterior chamber or vitreous inflammation. Fundoscopy revealed a fibrovascular macular lesion associated with hemorrhages in both eyes. Optical coherence tomography (OCT) and OCT angiography confirmed the diagnosis of bilateral CNV. After ruling out other systemic diseases, the diagnosis of CNV as a late complication of syphilitic chorioretinitis was established. Although treatment was not recommended in the right eye, the left eye was treated with 3 monthly intravitreal injections of aflibercept as a solo therapy. Three weeks after the last injection, the visual acuity improved to 20/25 and remained stable at the 6-month follow-up with no evidence of CNV reactivation. CONCLUSION: Choroidal neovascular membranes can occur as a late complication of syphilitic chorioretinitis. Solo treatment with intravitreal injections of the anti-vascular endothelial growth factor aflibercept effectively controlled CNV activity and improved visual acuity.

Oral Paracoccidioidomycosis, Clinical Characteristics, Diagnosis and Treatment

Paracoccidioidomycosis (PCM) is an infection caused by the dimorphic fungus Paracoccidioides brasiliensis, which has a predilection for hot and humid places; thus, this disease has a particularly high incidence in Brazil. Children, adolescents, and adults can be affected by acute/subacute or chronic PCM. To describe the clinical-pathological characteristics and treatment of a case of chronic PCM oral lesion. The oral examination of a 57-year-old male patient revealed moriform stomatitis on the perioral region (irregular shape), lips vermilion, and continuity with the jugal mucosa. After an incisional biopsy, the anatomopathological analysis confirmed the diagnosis of PCM. The patient was referred to a reference center for tropical diseases and treated with 400mg sulfamethoxazole and 80mg trimethoprim twice a day. Since some adverse effects were observed, the treatment was switched to 100mg of itraconazole twice a day. The follow-up examination revealed accelerated healing of the oral lesions and reduction of the inflammatory process. Stomatologists play a key role in the identification of PCM oral lesions and referral for adequate treatment by an infectious disease specialist. (AU)

Oral complications of head and neck radiotherapy: the importance of the dental surgeon / Complicações orais da radioterapia de cabeça e pescoço: a importância do cirurgião-dentista

ABSTRACT Objective: radiotherapy can lead to different adverse effects in the oral epithelial cells. This article aimed to address the main oral manifestations associated with radiotherapy of head and neck neoplasms, highlighting the importance of the dental practitioners' participation within the skilled multidisciplinary personnel to treatment. Methods: Research was conducted in the PubMed, Lilacs, SciELO, and Google Scholar databases using the keywords "head and neck radiotherapy", "oral manifestations'', and "head and neck neoplasm". Eighteen out of 533 articles published between 2015 and 2022 were selected after duplicates removal and eligibility criteria application. Results: xerostomia, hyposalivation, trismus, dysgeusia, dysphagia, dentin hypersensitivity, fungal and viral infections, radiation caries, osteoradionecrosis, mucositis, periodontal alterations, and tooth development abnormalities were the most frequently reported oral effects of radiotherapy. Conclusions: The participation of dentists in the multidisciplinary team that treats patients with head and neck cancers is fundamental since several oral complications of radiotherapy are observed. Dentists can prevent, reduce and treat some detrimental effects whether the patient is followed-up since the beginning of radiotherapy.

RESUMO Objetivo: A radioterapia pode levar a diferentes efeitos adversos nas células epiteliais orais. Este artigo teve como objetivo abordar as principais manifestações bucais associadas à radioterapia de neoplasias de cabeça e pescoço, destacando a importância da participação do cirurgião-dentista na equipe multidisciplinar apta ao tratamento. Métodos: foi realizada uma busca nas bases de dados PubMed, Lilacs, SciELO e Google Acadêmico utilizando as palavras-chave "radioterapia cabeça e pescoço", "manifestações orais" e "neoplasma de cabeça e pescoço". Dezoito dos 533 artigos publicados entre 2015 e 2022 foram selecionados após a remoção das duplicatas e aplicação dos critérios de elegibilidade. Resultado: xerostomia, hipossalivação, trismo, disgeusia, disfagia, hipersensibilidade dentinária, infecções fúngicas e virais, cárie de radiação, osteorradionecrose, mucosite, alterações periodontais, e anormalidades do desenvolvimento dentário foram os efeitos orais da radioterapia mais relatados. Conclusão: A participação dos dentistas na equipe multidisciplinar que atende pacientes com câncer de cabeça e pescoço é fundamental, pois são observadas diversas complicações bucais da radioterapia. Os dentistas podem prevenir, reduzir e tratar alguns efeitos deletérios se o paciente for acompanhado desde o início da radioterapia.

Management of Mucocele of the Glands of Blandin-Nuhn With a High-Intensity Laser: A Case Report.

Introduction: The glands of Blandin-Nuhn are mucous and serous salivary glands situated on both sides of the midline of the ventral surface of the tongue. In this area, a mucocele generally results from trauma. The diagnosis of mucoceles is based on clinical and histopathological examinations and the recommended treatment is surgical excision. Case Report: This report describes a case of mucocele of the glands of Blandin-Nuhn (MGBN) affecting a 20-year-old male. Oval-shaped swelling with a smooth and bright surface of soft consistency was observed on the ventral surface of the individual's tongue. The diagnostic hypothesis was mucocele. Surgical excision was performed in a single session with a diode laser. A histopathological examination revealed mucus extravasating into connective tissue, with foamy macrophages and granulation tissue. Conclusion: The high-intensity laser was a safe and effective tool for treating MGBN. No need for a suture, minimal or no intraoperative bleeding, and a minimal report of pain and edema by the patient were observed. A diode laser may be a helpful tool because it is less invasive and it is safe and effective.

Acidente vascular cerebral associado à presença de anticorpo anticardiolipina na infância / Brain vascular accident associated with the presence of anticardiolipin antibody in childhood

OBJETIVO: Relatar o caso de uma paciente na faixa etária pediátrica, diagnosticada com acidente vascular cerebral, associado à presença de níveis séricos aumentados de anticorpo anticardiolipina. DESCRIÇÃO DO CASO: Paciente de 13 anos de idade com oclusão trombótica de segmento M2 da artéria cerebral média à direita e trombose da veia femoral esquerda associada a anticorpos anticadiolipina positivos. Os dados foram coletados por meio de anamnese, exame físico e exames complementares da paciente. COMENTÁRIOS: A incidência de Acidente Vascular Cerebral em crianças é baixa, sendo de grande importância o conhecimento das diferentes manifestações clínicas na faixa etária pediátrica e associados dessa condição com a presença de doenças autoimunes

OBJECTIVE: To report the case of a patient in the pediatric age group, diagnosed with stroke, associated with the presence of increased serum levels of anticardiolipin antibody. CASE DESCRIPTION: A 13-year-old patient with thrombotic occlusion of the M2 segment of the right middle cerebral artery and thrombosis of the left femoral vein associated with positive anticardiolipin antibodies. The data were collected through anamnesis, physical exam and complementary exams of the patient. COMMENTS: The incidence of stroke in children is low, and knowledge of the different clinical manifestations in the pediatric age group and associated with this condition with the presence of autoimmune diseases is of great importance

An Alternative Approach for Treating Severe Injured Temporomandibular Joints by Gunshot Wounds.

Temporomandibular joint (TMJ) reconstruction is a challenging clinical problem that has been revolutionized due to the development of total alloplastic TMJ replacement (TMJ-TJR); however, the costs are still very high. We used an alternative approach to treat comminuted mandibular condyle fracture with an unviable condyle head caused by gunshot wounds. Our surgical technique consisted of an extended preauricular incision; removal of the fractured condyle, bone fragments, and foreign bodies; reshape/flattening of the fracture edge; fixation of the articular disc (if viable); lining of the TMJ with temporalis muscle/fascia; application of Erich arch bars; and early elastic therapy. We successfully used this approach in five sequential cases that resulted in a good mouth opening (>35 mm) and satisfactory occlusion with teeth in maximum intercuspation. We believe that this technique is an excellent option for treating severe injured TMJs in places where TMJ-TJR is not available.

Use of gas combination cryosurgery for treating ameloblastomas of the jaw.

This study evaluated the results of curettage followed by spray propane, butane, and isobutane gas combination cryosurgery in 10 patients with ameloblastoma. The patients' age ranged from 7 to 87 years (mean, 31 years), with equal prevalence in both men and women. Five cases were diagnosed as solid ameloblastomas and 5 as unicystic ameloblastomas. Before enucleation and cryosurgery, the unicystic lesions received marsupialisation to decrease their size. No patient showed evidence of clinical or radiographic recurrence, pathologic fracture, or infection after treatment with enucleation and cryosurgery. The most common complication was wound dehiscence, which was observed in all cases. The average follow-up period was 60.5 months (range 48-108 months). These results show that enucleation followed by cryosurgery is an effective therapy for managing ameloblastomas.

Avaliação clínica e microbiológica de prótese total deidosos em instituições assistenciais / Assessment clinical and microbiological of complete dentures in aged from health care institution

Introdução: O Brasil possui mais de sete milhões de idosos desdentados e a prótese totaldentária ainda é a principal forma de reabilitar esses indivíduos. O objetivo deste trabalhofoi avaliar clínica e microbiologicamente próteses totais usadas por idosos de instituiçõesassistenciais. Métodos - Foram avaliados 55 idosos, acima de 60 anos de idade, portadoresde prótese total superior. Foi utilizado um questionário para coleta de informações. Exameclínico do palato foi realizado para detecção de lesões inflamatórias, seguido de quantificaçãoda placa bacteriana visível e colheita de biofilme microbiano da região de palato da prótesetotal superior. As amostras de biofilme foram processadas para cultivo de leveduras do gêneroCandida. Resultados - O tempo de uso da prótese foi superior a 10 anos, com conservaçãoinsatisfatória. A higienização prevalente foi o uso de escova dental com dentifrício, comfrequência de três vezes ao dia, mas 56,4% das próteses apresentaram higienização precária.Lesões inflamatórias estavam presentes em 72,7% dos idosos e a colonização por Candidafoi detectada em 60% das próteses. O estudo das correlações revelou significância estatísticado padrão de higienização com a colonização de levedura e também com a presença de lesãono palato, enquanto o aumento no número de colônias de espécies de Candida correlacionou--se com lesões inflamatórias no palato. Conclusão - Os idosos são portadores de prótesesantigas e deterioradas, com higienização inadequada. As lesões inflamatórias fúngicas sãoprevalentes no palato. Faltam informações adequadas e programas de atendimento ao idosopara garantir melhores condições de saúde bucal.

Introduction: There are more than seven millions of completely edentulous aged in Braziland complete dentures are still the main way of rehabilitating these individuals. The purposeof this study was to appraise clinically and microbiologically complete dentures in aged fromhealth care institutions. Methods - 55 aged have been evaluated, over 60 years old, usingupper complete dentures. Questionnaire is used for take information about patients. Palateclinical examinations were made in order to detect de inflammatory lesions, in accordancewith the quantification of the visible bacterial plaque and collection of microbial biofilmof the palate region from upper complete denture. The biofilm samples were processed forcultivation of yeasts of Candida. Results - Used time of the prosthesis was above 10 years,which presented an unpleasant state of conservation. The common form of hygienization wasthe toothbrush with dentifrice, with frequency of three times a day, but 56,4% of the prosthesispresented precarious hygienization. The inflammatory lesions were present in 72,7% ofthe aged and the colonization by Candida was detected in 60% of the prosthesis. The studyof the correlations revealed statistical significance of the hygienization pattern along withthe colonization of yeasts and also with the presence of inflammatory lesions in the palate.Conclusion - The aged are users of old and damaged prosthesis, with inadequate hygienization.The colonization of Candida is prevalent, as well as the inflammatory lesions. Thereis a lack of appropriate information and assisting programs to aged in order to guaranteebetter mouth health conditions.

Serum leptin in overt and subclinical hypothyroidism: effect of levothyroxine treatment and relationship to menopausal status and body composition.

BACKGROUND: The relationship between thyroid status, including subclinical hypothyroidism (SH) and serum leptin is controversial or uncertain. Therefore we evaluated serum leptin in SH and overt hypothyroidism (OH) and determined the effects of levothyroxine (LT(4)) replacement on serum leptin in these disorders. METHODS: Serum leptin, thyrotropin (TSH), free thyroxine, insulin, glucose, and body composition parameters were compared in 55 SH, 20 OH, and 28 euthyroid (EU) pre- and postmenopausal women. In addition, the effect of LT(4) treatment on serum leptin in SH and OH was assessed. RESULTS: The mean +/- SD (median) serum leptin concentrations in the OH and SH groups were higher than in the EU group (35.1 +/- 27.2 [33.0] and 36.6 +/- 21.9 [30.6] ng/mL, respectively, vs. 23.2 +/- 19.3 [17.9] ng/mL, p = 0.011), but the difference was only significant in postmenopausal women. The body mass index (BMI), fat mass index (FMI), and the homeostasis model assessment-insulin resistance (HOMA-IR) index values were not different among these groups. In premenopausal women there was no correlation between leptin, BMI, or FMI and serum TSH levels (r(s) = 0.009, p = 0.474; r(s) = 0.043, p = 0.367; r(s) = 0.092, p = 0.232). In the postmenopausal women, the partial correlation coefficient between TSH and leptin was present, even when controlling for BMI (r(s) = 0.297, p = 0.042) and FMI (r(s) = 0.275, p = 0.050). LT(4) treatment was associated with a reduction of serum leptin concentrations in the OH group (p = 0.008). In SH group there were no differences between LT(4) replacement or no treatment, since a fall in serum leptin levels was detected in both SH subgroups, despite a more pronounced fall with LT(4) use. Treatment of the SH and OH groups with LT(4) did not influence HOMA-IR index or body composition. CONCLUSIONS: Serum leptin concentrations are elevated in postmenopausal women with SH or OH. A relationship between thyroid status and serum leptin is further supported by the fact that LT(4) treatment, to restore the EU status, reduced serum leptin levels in OH in the absence of significant effects on BMI. In women, hypothyroidism influences either leptin secretion or degradation and this effect is more pronounced in postmenopausal than in premenopausal women.

Qualidade de vida em diabetes mellitus e Classificação Internacional de Funcionalidade, Incapacidade e Saúde: estudo de alguns aspectos / Quality of life in diabetes mellitus and the International Classification of Functioning Disability and Health: a study of some aspects

Introdução: O diabetes mellitus (DM) pode ter um efeito profundo na qualidade de vida dos pacientes e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é um instrumento válido para verificar a influência dos componentes de saúde na qualidade de vida. O objetivo deste estudo, é apresentar a distribuição de freqüência das categorias das CIF do Core Set resumido para DM, com comprometimento grave em um grupo de pacientes com a qualidade de vida muito afetada pelo diabetes. Métodos: Foram estudados 38 pacientes diabéticos, 76,3 % com DM2 e 23,7 % com DM1, utilizando-se dados clínicos, informação de qualidade de vida associada ao diabetes do questionário AddQoL e incapacidade associada ao diabetes: categorias do Core Set resumido da CIF com comprometimento grave e completo, e categorias cuja informação era insuficiente para especificar a gravidade do comprometimento. Análise estatística: análise descritiva dos dados. Resultados: Categorias de funções corporais mais gravemente afetadas foram b130, b210, b530, b540, de estruturas corporais foram s220, s410, s740, de atividades/participação foram d240, d570 e de fatores ambientais foram e110, e115. As estruturas menos classificadas foram pâncreas (s550), globo ocular (s220) e sistema nervoso parassimpático (s150). Conclusão: No grupo estudado de diabéticos com complicações crônicas, controle metabólico inadequado e qualidade de vida muito afetada pela doença, a presença de incapacidade no cuidado pessoal e de barreiras ambientais, é sugestivo de que estes fatores possam contribuir para uma pior qualidade de vida, embora comprometimentos nas funções e estruturas corporais tenham sido os mais prevalentes.