Fernando Ricardo Xavier da Silveira

Alpha lipoic acid in burning mouth syndrome - a randomized double-blind placebo-controlled trial

UNLABELLED The burning mouth syndrome (BMS) is a chronic condition characterized by oral burning pain in the absence of clinical abnormalities and without established therapy. OBJECTIVES The purpose of this study was to evaluate the effectiveness of alpha lipoic acid (ALA) in the management of BMS symptoms through a randomized double-blind placebo-controlled trial. METHODS Thirty-eight patients (34 women and four men, median age 62.9 years, range 36-78) were included and 31 completed the study. The patients were randomized into two cycles of treatment: one with alpha lipoic acid and one with placebo both administered in identical capsules. These cycles were separated by a washout period of 20 days. The oral symptoms and the treatment response were assessed using a 100-mm visual analog scale before and after each cycle and the global perceived effect score, using a 5-point scale after each treatment cycle. RESULTS The level of reduction on burning was significant for both treatments (paired t-test: P < 0.05; rp = 0.011; ral < 0.001). Considering the two cycles together, 22 patients reported at least some improvement after ALA use and 23 patients after placebo. CONCLUSIONS Comparison of the oral assessment scores of the two cycles failed to demonstrate the effectiveness of ALA over placebo (t-test: P > 0.05; r = 0.75).

Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of Candida species.

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.

Freqüência e atividade enzimática (proteinase e fosfolipase) de Candida albicans de pacientes desdentados totais, com e sem estomatite protética

A Estomatite Protetica (EP) e frequentemente observada em pacientes portadores de protese total, sendo a presenca de fungos considerada um importante fator para o seu aparecimento. Baseado neste fato, avaliamos pacientes edentulos com e sem estomatite protetica, identificando os fungos presentes, e os niveis de proteinase e fosfolipase produzidos por Candida albicans. Os resultados mostraram que C. albicans foi a especie mais frequente, prevalecendo em pacientes com EP. Todas as cepas de C. albicans isoladas foram fortemente positivas para proteinase, diferentemente da atividade de fosfolipase.

Oral candidiasis in HIV+ patients under treatment with protease inhibitors

The purpose of this work was to evaluate the influence of Protease Inhibitors (PI) on the occurrence of oral candidiasis in 111 HIV+ patients under PI therapy (Group A). The controls consisted of 56 patients that were not using PI drugs (Group B) and 26 patients that were not using any drugs for HIV therapy (Group C). The patients cd4 cell counts were taken in account for the correlations. One hundred and ninety three patients were evaluated. The PI did not affect the prevalence of oral candidiasis (p = 0.158) or the frequency of C. albicans isolates (p = 0.133). Patients with lower cd4 cell counts showed a higher frequency of C. albicans isolates (p = 0.046) and a greater occurrence of oral candidiasis (p = 0.036).

Kaposi's sarcoma in brazilian AIDS patients: a study of 144 cases

Foram estudados pacientes brasileiros portadores de SIDA apresentando sarcoma de Kaposi (SK). O perfil de idade mostrou um grupo com media de idade entre 21 e 40 anos, sendo que 11,1% da amostra apresentava SK exclusivamente na cavidade bucal, observando-se em 25% da amostra uma associacao de lesoes bucais e na pele. Somente quatro pacientes apresentaram associacao de lesoes bucais e viscerais, enquanto 49,3% eram portadores de lesoes exclusivamente em pele. O palato duro foi a regiao intrabucal mais afetada, seguida de orofaringe, lingua, gengiva entre outras localizacoes menos frequentes. Doenca fungica, principalmente candidiase, foi observada exclusivamente na cavidade bucal. Paracoccidioidomicose e criptococose estavam presentes em menor escala. Doencas bacterianas foram representadas quase exclusivamente pela tuberculose, com apenas um caso de sifilis. Entre as doencas virais, herpes simples recidivante foi a mais encontrada, seguida de casos de molusco contagioso, condiloma acuminado e citomegaloviroses, em menor escala. Em relacao as doencas causadas por protozoarios foram identificados pneumonia por Pneumocystes carinii e toxoplasmose. E enfatizada pelos autores a necessidade de um exame bucal acurado nos portadores de SIDA, tendo em vista os varios aspectos clinicos, principalmente relacionados ao SK. Ha uma necessidade de constante atuacao interdisciplinar, com vistas nao so a obtencao de maior qualidade de vida para esses pacientes bem como para maior rapidez no diagnostico e tratamento.

Notas cartográficas do trabalho na Estratégia Saúde da Família: relações entre trabalhadores e população

Essa pesquisa-intervencao teve como objetivo cartografar os movimentos instituidos e instituintes presentes no trabalho da Estrategia Saude da Familia, no que tange a composicao de suas praticas cuidativas. O referencial teorico metodologico fundamentou-se na analise institucional, linha esquizoanalitica. Foram realizados encontros grupais com uma equipe para discutir o modo como realizavam os cuidados coletivos em acao de educacao permanente em saude. Os sujeitos da pesquisa foram trabalhadores da equipe e estudantes em atividade academica no servico. A media de participacao foi de doze pessoas por encontro, sendo que se desenvolveram oito encontros no periodo de marco a julho de 2010. Os dados foram agrupados em dois estratos imanentes: as relacoes da equipe e a relacao com os usuarios. Os estratos apontaram para o atravessamento das instituicoes de educacao, justica e da divisao tecnica e social do trabalho. A reflexao coletiva em grupo mostrou-se potente, para desnaturalizar processos instituidos e interrogar lugares, saberes e praticas.The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.

Adherence to HeLa cells, typing by killer toxins and susceptibility to antifungal agents of Candida dubliniensis strains

The aim of this study was to evaluate the adherence capability to HeLa cells, the susceptibility to killer toxins and the in vitro susceptibility to antifungal agents (eTest method--AB Biodisk, Solna, Sweden) of 9 Candida dubliniensis isolates recovered from HIV+ and AIDS patients. The adherence test was strongly positive for strain ATCC 777 and positive for all other strains. Typing by killer toxins revealed two different biotypes among the 9 isolates studied: 888 and 688. Only biotype 688 (ATCC 777) was susceptible to the K2 toxin. There was a significant inverse correlation between adherence and killer toxin susceptibility (r = -0.8525 - p = 0.0035). No strains presented resistance to fluconazole, itraconazole, ketoconazole, voriconazole, flucytosine or amphotericin-B. With the exception of ATCC 777, all the other isolates presented similar behavior.

BSCL2 N88S mutation in a Portuguese patient with the Silver syndrome.

of-differentiation (CD) B cells, CD4, and CD8 cytotoxic T cells. There may be variable expression of interleukin-1b (IL-1b), tumor necrosis factor-a (TNF-a), interferon-c (INF-c), migration inhibitory factor–related protein 8 (MRP8), MRP14, and endothelial versican-1 (VCAN-1) in the spinal cord of affected patients. The etiopathogenesis of HAM/TSP is attributed to inflammatory and immune responses induced by penetration of HTLV-I into the nervous system with spread between lymphocytes. The virus appears to spread directly between lymphocytes through specialized viral cell–cell synapses and, instead of making extracellular virions, HTLV-I uses the mobility of the host cell to spread within and between hosts. However, once acquired, predictive risk factors for progression of HTLV-I infection to HAM/TSP have included increased proviral load, HTLV-I tax subgroup 1, host human leukocyte antigen (HLA) determinants, and cytokine transcription. A strong cytotoxic T-cell response to HTLV-I appears to protect against the associated central nervous system inflammatory disease by reducing the proviral load; however, when the latter exceeds a threshold level, cytotoxic T cells can contribute to infection. Although the effect of immunosuppression on the development of HAM/TSP in the patient described here is not well understood, posttransplant immunosuppression could theoretically slow progression of HAM/TSP by suppressing proliferation of infected T cells. The Organ Procurement Transplantation Network/United Network of Organ Sharing recommends confirmatory immunoblot testing for positive HTLV-I results by ELISA to assure that non-diseased organs are not discarded unnecessarily.

The interaction of several fields of knowledge for the articulation of collective oral health actions: the mapping of a family health team

This paper maps the experience of a family health team (FHT) in the creation of a knowledge and responsibility field to practice Oral Health (OH). Institutional analysis was used to establish the theoretical and methodological framework, supported by the concept analyzers, implication analysis, territorialization and deterritorialization. Cartography was used to monitor the procedures and the order of events and to facilitate understanding. The subjects were members of an FHT in a training context. Data production took place during the FHT meetings on administrative and family discussion matters. The case study presented here was one of the research analyzers. As results, the process of building the case study was identified, which revealed how the FHT took the family into care; the movements broadening the perspective of care, finding ways for disciplinary interactions in order to construct a collective OH approach, which emerged from the day-to-day tensions of the FHT work process. The conclusion reached is that this case study revealed the stresses involved in the process of deconstruction of dental assistance and the movement towards the interaction of several fields of knowledge and practices for the production of care from the perspective of OH attention.

Oral and maxillofacial trauma in Brazilian children and adolescents

Children and adolescents are frequently victims of oral and maxillofacial trauma. The purpose of this study was to determine the characteristics of oral and maxillofacial trauma that resulted in police records, in children and adolescents aged between 0 and 16 years during a period of 5 years. Among the 28,200 reports analyzed, 463 were included in the study. The men:women ratio observed was 1.6:1 and the most prevalent age range was between 15-16 years (44.40%). Most trauma cases resulted from physical assault (64.50%) and culminated in soft-tissue lesion (80.36%). Excoriations (28.64%) leaded as the most frequent type of lesion, and the maxillary region (22.63%) was the most common location of injury. The most common type of dental lesion was dental trauma (54.76%), and bone fractures prevailed in the nasal region (36.7%). The findings of this survey may contribute to plan and execute preventive measures as well as to guide curative measures aimed at this population group.