Carina Domaneschi

Oral colonization by Candida species in AIDS pediatric patients

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

Cryptococcus albidus var. albidus Isolated from Turquoise-Fronted Parrots ( Amazona aestiva : Psittacidae) Kept in Captivity: A Probable Reservoir Ecological of Fungal Specimen

Cryptococcus is an opportunistic yeast that causes life-threatening infections as meningoencephalitis primarily in immunocompromised hosts, generally associated with AIDS. The source of this organism is mainly pigeon excreta; however, other avian species’ excreta are implicated as a source of this yeast. The aim of this study was to perform the isolation of yeasts of the Cryptococcus genus from the cloacae of 40 parrots kept in captivity area of the genus Amazona aestiva. These birds were anesthetized, the cloacae washed, and then swabs from the cloaca collected. The yeasts isolated from cloacae birds were studied by phenotypic and genotypic methods. The production of extracellular enzymes as virulence factors (protease and phospholipase) was performed too. From the total of parrots studied, 10 strains of yeasts were isolated. Nine of the strains belonged to the specie Cryptococcus albidus var. albidus and one sample belonged to the specie Cryptococcus laurentti. The extracellular enzymes research demonstrated that 80% of the isolates were phospholipase producers and all of them were protease positives. These results suggest that not just the environment but also the birds of A. aestiva genus may be the carriers of C. albidus. We point out that the strains produced virulence factors. This is the first report of the isolation of C. albidus var. albidus of A. aestiva parrots and to assert that this bird is a special ecological niche of capped yeast.

Noninferiority trials in oral medicine

More than a century ago, Greenwood and Yule (1915) published a seminal paper explaining the epidemiological assessment of vaccine effectiveness. To illustrate their argument, they compared the incidence of typhoid fever among vaccinated and non-vaccinated British troops stationed in France and Belgium, based on the previously available information.Little consideration was given to issues that we would care so much afterward; nothing was said about why and how some were, and others were not vaccinated. This article is protected by copyright. All rights reserved.

Treatment of symptomatic benign migratory glossitis: a systematic review

ObjectiveThe aim of this systematic review is to summarize the results of all published studies on symptomatic benign migratory glossitis and evaluate the best available treatment.MethodsWe searched the Cochrane Library, EMBASE, LILACS, PubMed, Scopus, and Web of Science for articles published up to September 2017, with no time restriction. We considered only articles published in English that evaluated the treatment of symptomatic benign migratory glossitis in children and adults. The protocol for this systematic review was registered at the international prospective register of systematic reviews (PROSPERO) as CRD42017074096.ResultsOf the 840 identified studies, 11 were included in our sample. Multiple treatment modalities were described for the treatment of symptomatic benign migratory glossitis.ConclusionsThere is a very low level of evidence for the treatment of symptomatic benign migratory glossitis, with substantial methodological heterogeneity among the evaluated studies. In summary, we could identify no specific treatment for symptomatic benign migratory glossitis.Clinical relevanceIn clinical practice, at the outpatient clinic of oral medicine, we attend to many patients diagnosed with benign migratory glossitis, with varying intensity of pain ranging from mild to severe. Treating this disease is a formidable challenge for clinicians. Therefore, we performed a systematic review of benign migratory glossitis to identify the best evidence-based treatment available for this condition. We believe that this article may be useful in guiding clinicians on the choice of treatment.

Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

Introducao A Sindrome de Ardencia Bucal (SAB) e uma condicao caracterizada pelo sintoma de ardencia na mucosa oral na ausencia de qualquer sinal clinico. Sua etiologia ainda e desconhecida e, ate o momento, nao dispoe de tratamento efetivo. Objetivo Avaliar o perfil do paciente portador de SAB, as terapias instituidas e seus resultados em estudo retrospectivo. Material e metodo Foram coletados os dados clinicos e terapeuticos dos prontuarios de pacientes diagnosticados com SAB, no periodo de janeiro de 2013 a abril de 2015, no Ambulatorio da Disciplina de Estomatologia Clinica da Faculdade de Odontologia da Universidade de Sao Paulo. Os criterios para o diagnostico utilizados se basearam nos estabelecidos pela International Headache Society em 2013 e foram observadas as terapeuticas empregadas e seus resultados. Resultado Doze pacientes foram diagnosticadas com SAB neste periodo, todas do sexo feminino, media de idade 61,18 anos, e a principal regiao acometida pelo sintoma de ardor foi o apice de lingua. O tempo de duracao deste sintoma variou de 6 meses a 25 anos. As terapias utilizadas para o controle de sintomas da SAB foram capsaicina, clonazepan topico, laserterapia e homeopatia. Dentre as terapias instituidas, a capsaicina apresentou efeito imediato na reducao dos sintomas. Conclusao O presente estudo demonstrou que os desafios que circundam a obtencao de um tratamento efetivo para a SAB sao diversos e estao principalmente relacionados ao desconhecimento da etiopatogenia da doenca. O perfil demografico dos pacientes aqui estudados foi semelhante ao descrito na literatura disponivel, entretanto, as variaveis representadas por sintomas secundarios (historia medica, niveis de ansiedade e depressao) podem constituir fatores modificadores da resposta terapeutica e da propria etiopatogenia da doenca.

Giant submandibular sialolith conservatively treated

Sialolithiasis is the most common non-neoplastic disease of the salivary glands, which is characterized by the development of sialoliths inside these glands, particularly in the submandibular gland. It is estimated that 12 of every 1,000 adult patients present sialolithiasis. Diagnosis is not challenging. Symptoms comprise local swelling, signs of infection, and pain–although the latter may be absent in 17% of the cases.1 Perforation of the mouth floor by a giant sialolith is extremely rare.2 It is believed that the physiopathology of sialoliths comprises the deposition of minerals around a niche of bacteria, mucus, or desquamated cells; increased calcium concentration and alkalinity in the saliva; and infection, inflammation, or trauma of the salivary gland or its duct. The submandibular glands are more likely to form calculus because their saliva is more alkaline and has a higher concentration of calcium and phosphate.3,4 Approximately 80-90% of all cases of sialolithiasis occur in the submandibular glands.5 The size of sialoliths ranges from less than 1 mm to a few centimeters and most of the calculi (88%) are less than 10 mm in size.6,7 However, giant sialoliths (>15 mm) in the submandibular duct have rarely been reported and may reach from 35 mm to 70 mm.2,3,8 The etiology of submandibular gland’s sialoliths is not well established,3 and males are affected twice as much as females.9 These cases are associated with long and large gauge ducts, slow salivary flow, alkaline pH of the saliva, high mucin concentration, and a high rate of calcium.3 Sialolithiasis is often accompanied by recurrent episodes of pain and swelling in the involved salivary gland. Patients often look for medical care later rather than sooner, when the calculus has already become large. Episodes of local pain and swelling are usually associated with eating.10 Interestingly, our patient has never presented pain associated with the left submandibular region swelling, which may have permitted the development of such a large sialolith. The aim of the treatment of giant sialoliths is to restore the normal salivary secretion, which generally requires a minimally invasive intraoral sialotomia.11 We describe the case of a 48-year-old female patient that looked for the Stomatology Outpatient Clinic complaining of a painless mass in the neck over the last 3 years. She denied any other comorbidity. On intraand extra-oral examination, a hard, painless, and mobile nodule was palpable in the region of the left submandibular gland. Radiographically, an extensive radiolucent area with defined limits was observed in the area of the left submandibular gland consistent with the diagnosis of sialolith (Figure 1A). Surpr i s ing ly , dur ing examinat ion of the submandibular gland, a calculus of 45 mm was exteriorized from an epithelialized fouling site, and Letter to the Editor

Evaluation of infections by Candida at a university hospital of Vale do Paraíba region, São Paulo State, Brazil: species distribution, colonization, risk factors and antifungal susceptibility

The present research aimed to carry out an epidemiological study, recording the prevalence of Candida spp. causing infection, as well as the colonization, distribution of the different species in clinical specimens from different sectors of a university hospital, risk factors and their susceptibility to antifungal drugs. Over a one-year period, 100 samples of Candida from 67 patients were isolated and identified, which 74% were characterized as colonization and 26% as nosocomial infections. C. albicans was the most frequent (40%), followed by C. tropicalis (25%), C. parapsilosis (21%), C. glabrata (9%), C. rugosa (2%), C. novergensis (1%), C. krusei (1%) and C. guilliermondii (1%). Non-albicans Candida species represented 71.4% of the colonization cases and 52.1% of infection. C. albicans was the most common species found in secretions and blood, C. parapsilosis was the most isolated from venous catheter, while C. tropicalis and C. glabrata were the most frequently isolated species in probes. The hospital wards with the largest number of yeasts were the Intensive Care Units (45%). Renal failure and multiple traumas were the most frequent underlying diseases and the mainly risk factors for colonization or infection were antibiotic therapy and invasive procedures. Most of the samples showed high susceptibility to the antifungal agents studied. Epidemiological investigations of these agents in the hospital environment are very important, especially at the studied hospital, so that preventive measures may be taken against infections.