Ivan Dieb Miziara

Group psychotherapy: An additional approach to burning mouth syndrome

INTRODUCTION Glossodynia or burning mouth syndrome (BMS) is a common and poorly understood disorder. Its treatment is uncertain. Otherwise, there is some evidence of the importance of psychological factors in the genesis of this disease. OBJECTIVES Verify the usefulness of group psychotherapy as an adjuvant therapeutic method in the treatment of BMS. CASUISTICS AND METHODS: The study group consisted of 64 consecutive patients with a clinical diagnosis of BMS seen at the Stomatology Outpatient Clinic, ENT Department, Sao Paulo University Medical School, between May 2002 and May 2007. All the patients were submitted to physical examination, laboratorial screening tests, psychological assessment (Crown-Crisp Experimental Inventory), and answered a short form of the McGill Pain Questionnaire. Only 44 patients who did not show any abnormality in the protocol exams entered the study. Twenty-four of them underwent group psychotherapy. Twenty patients received placebo. Chi-square test was applied to compare the results of treatment with or without psychotherapy. RESULTS There were 15 men and 29 women in the study group. Tongue burning was the main complaint of the patients. Improvement of symptoms was reported by 17 (70.8%) of the patients undergoing psychotherapy, while among those who did not eight (40%) had improvement of symptoms (P=.04). CONCLUSION Psychological assessment demonstrated a close correlation between symptoms and psychological factors, suggesting that group psychotherapy is an important alternative to conventional treatment methods.

Oral lesions as predictors of highly active antiretroviral therapy failure in Brazilian HIV‐infected children

OBJECTIVES Evaluate the accuracy of HIV-related oral lesions to predict immune and virologic failure on HIV-infected children in use of highly active antiretroviral therapy (HAART). STUDY DESIGN Data for this cross-sectional analysis come from a longitudinal study being conducted through the HIV-AIDS Outpatient Unit, ENT Division, Hospital das Clinicas, Sao Paulo University Medical School. The study began in January 1990 and is still ongoing. The cut-off point for analyses purposes was December 2004. Subjects were 471 HIV-infected consecutive children attending the outpatient unit during this period, who enrolled regardless of medical or immunological status. The children have undertaken oral cavity examination, serum CD4(+) T-lymphocyte count, and, 271 of them, viral load measurement. Sensitivity, specificity, positive predictive value, negative predictive value and relative risk were calculated. RESULTS Oral lesions had moderate sensitivity, high specificity and positive predictive value to predict immune failure. It had low sensitivity and positive predictive value, and high specificity to predict virologic failure. DISCUSSION AND CONCLUSIONS Oral manifestations of HIV can be important markers for immune suppression and for virologic failure, in Brazilian children undergoing HAART.

AIDS and recurrent aphtous stomatitis

UNLABELLED The immunodeficiency state in HIV infected patients has been the cause of severe episodes of Recurrent Aphthous Stomatitis (RAS). AIM Our study aims to establish correlation between the manifestations of RAS and the immunosuppression state caused by HIV infection, through counting of CD4+ cells, CD8+ cells, CD4+:CD8+ cells ratio and viral load. STUDY DESIGN Series study. MATERIAL AND METHOD Ninety-four HIV infected patients (25 women and 69 men) with RAS were evaluated in the ENT Department of the University of Sao Paulo-Medical School from January 1998 to December 2003. The age ranged between 19 and 63 years (mean = 35.3 years). The patients were divided in two groups: AIDS group and HIV infected group. RESULTS The patients with AIDS and HIV infection presented, respectively, eight ulcers and two ulcers by outbreaks. Similarly, patients with major RAS presented smaller counting of cells CD8+, CD4+ and CD4+/CD8+ cells, and higher mean value of viral load than the patients with herpetiform and minor RAS. Between patients with minor and herpetiform RAS there were no statistical differences. CONCLUSIONS The emergence of the lesions, mainly in major RAS, is directly related to the immunological state of the HIV infected patient. These patients frequently present nutritional deficits and worsening in life style. Thus, diagnosis and treatment of RAS is a challenge that should not be neglected.

Ética da pesquisa em modelos animais

UNLABELLED The use of animals in scientific experiments has been described since the fifth century BC. A number of scientific advances in health are attributed to animal models. The issue of the moral status of animals has always been debated. OBJECTIVES This article aims to review and to present a historical summary of the current laws, to guide researchers who wish to use animal models in otolaryngology research. MATERIAL AND METHODS Research on the medline database. RESULTS For many years there were no laws ruling the use of animals in scientific experimentation in Brazil. Standards set by national and international organizations were followed. Recently, Law No. 11.794/08 established procedures for the scientific use of animals. Studies in otolaryngology have used the larynxes of rabbits, pigs, dogs, guinea pigs (Cavia porcellus), and mice. There were also studies comparing rabbits, rats, and dogs, rhinoplasty on rabbits, and inner ear studies on rats and guinea pigs (albino). CONCLUSIONS The researchers involved in scientific work with animals should know the principles of Law 11.794/08 and investigate what animals are appropriate for each area of study in their models. Otolaryngologists, especially those dedicated to research, need to be mindful of the ethical rules regarding the use of animals in their studies.

Therapeutic options in idiopathic burning mouth syndrome: literature review.

Introduction Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue, palate, lips, or gums of no well-defined etiology. The diagnosis and treatment for primary BMS are controversial. No specific laboratory tests or diagnostic criteria are well established, and the diagnosis is made by excluding all other possible disorders. Objective To review the literature on the main treatment options in idiopathic BMS and compare the best results of the main studies in 15 years. Data Synthesis We conducted a literature review on PubMed/MEDLINE, SciELO, and Cochrane-BIREME of work in the past 15 years, and only selected studies comparing different therapeutic options in idiopathic BMS, with preference for randomized and double-blind controlled studies. Final Comments Topical clonazepam showed good short-term results for the relief of pain, although this was not presented as a definitive cure. Similarly, α-lipoic acid showed good results, but there are few randomized controlled studies that showed the long-term results and complete remission of symptoms. On the other hand, cognitive therapy is reported as a good and lasting therapeutic option with the advantage of not having side effects, and it can be combined with pharmacologic therapy.

Correlation between histocompatibility antigens and recurrent aphthous stomatitis in the brazilian population

A Estomatite Aftoide Recorrente e uma doenca oral com incidencia em 20% da populacao mundial, caracterizada por ulceras mucosas de carater recidivante. O diagnostico baseiase principalmente na historia clinica do paciente. Hereditariedade pode ser um fator de risco para doenca, entretanto, os estudos disponiveis nao sao conclusivos quanto aos resultados obtidos, variando segundo a populacao estudada. OBJETIVO: Tipificar moleculas HLA de classe I e de classe II e avaliar a frequencia destas moleculas em pacientes brasileiros, portadores de Estomatite Aftoide Recorrente, comparando com grupo controle. MATERIAL E METODO: Este trabalho possui um desenho prospectivo, transverso e investigativo. Foram estudados 31 pacientes com suspeita diagnostica de Estomatite Aftoide Recorrente no periodo de fevereiro de 2004 a maio de 2006. Os pacientes foram submetidos a protocolo de exames e, daqueles que obedeceram aos criterios de inclusao, foi extraido o DNA e realizada a tipificacao HLA por Reacao de Polimerizacao em Cadeia. RESULTADO: Nos pacientes portadores de Estomatite Aftoide Recorrente do tipo minor encontramos as frequencias HLA A33 e B35 estatisticamente significantes. CONCLUSAO: As frequencias HLA-A33 e HLA-B35 podem estar associadas a Estomatite Aftoide Recorrente minor na populacao brasileira.

Aids e estomatite aftóide recidivante

The immunodeficiency state in HIV infected patients has been the cause of severe episodes of Recurrent Aphthous Stomatitis (RAS). AIM: Our study aims to establish correlation between the manifestations of RAS and the immunosuppression state caused by HIV infection, through counting of CD4+ cells, CD8+ cells, CD4+:CD8+ cells ratio and viral load. STUDY DESIGN: series study. MATERIAL AND METHOD: Ninety-four HIV infected patients (25 women and 69 men) with RAS were evaluated in the ENT Department of the University of Sao Paulo-Medical School from January 1998 to December 2003. The age ranged between 19 and 63 years (mean = 35.3 years). The patients were divided in two groups: AIDS group and HIV infected group. RESULTS: The patients with AIDS and HIV infection presented, respectively, eight ulcers and two ulcers by outbreaks. Similarly, patients with major RAS presented smaller counting of cells CD8+, CD4+ and CD4+/CD8+ cells, and higher mean value of viral load than the patients with herpetiform and minor RAS. Between patients with minor and herpetiform RAS there were no statistical differences. CONCLUSIONS: The emergence of the lesions, mainly in major RAS, is directly related to the immunological state of the HIV infected patient. These patients frequently present nutritional deficits and worsening in life style. Thus, diagnosis and treatment of RAS is a challenge that should not be neglected.

Impacto da Haart na prevalência de otite média crônica em crianças brasileiras infectadas pelo HIV

O advento de novas drogas anti-retrovirais como os inibidores de protease provocou mudancas sensiveis na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto das novas drogas anti-retrovirais (Highly Active Anti-retroviral Therapy - HAART) na prevalencia de otite media cronica em populacao pediatrica infectada pelo HIV. METODOS: Analisamos os prontuarios de 471 criancas com idade entre zero e 12 anos e 11 meses portadoras de HIV atendidas no ambulatorio de AIDS de Clinica Otorrinolaringologica do HCFMUSP. As criancas foram divididas em dois grupos, de acordo com a faixa etaria: 0 a 5 anos e 11 meses e 6 a 12 anos e 11 meses, e classificadas como portadoras de otite media cronica, baseadas em achados de anamnese, otoscopia, audiometria e imitanciometria. As prevalencias de otite media cronica apresentadas e as contagens de linfocitos T CD4+ foram comparadas entre as criancas em uso ou nao de HAART. RESULTADOS: Das 459 criancas atendidas, 65 (14,2%) apresentavam otite media cronica. Observamos, nas criancas de 0 a 5 anos e 11 meses que o uso de HAART esteve associado a significante menor prevalencia de otite media cronica (p = 0,02), e maior contagem de linfocitos T CD4+ (p < 0,001). CONCLUSAO: O uso de HAART esteve associado a menor prevalencia da forma cronica de otite media entre criancas menores de 6 anos infectadas pelo HIV, provavelmente como consequencia do aumento promovido na contagem de linfocitos T CD4+.

Infantile recurrent parotitis: follow up study of five cases and literature review

UNLABELLED Recurrent parotitis (RP) is defined as recurrent parotid inflammation, generally associated with non-obstructive sialectasis of the parotid gland. It is a rare condition, and its etiology remains an enigma. AIM The purposes of the present study were (1) to relate the follow up of five RP cases; (2) to examine the role of sialography and ultrasound in diagnosis and follow up; and (3) to make a literature review. STUDY DESIGN Series review. MATERIAL AND METHOD We reviewed all recurrent parotitis cases from the files of the Otolaryngology Division at University of Sao Paulo, Brazil. The criteria for inclusion were at least two years of evolution and more than one year and a half follow-up in our service. We included five children in the study. Sialography was performed in the first evaluation and sonography was executed annually. Recurrent parotitis showed male predominance, and affected mainly children between the ages of 3 and 6. Frequency of crisis improved with time in all cases. Sialography showed sialectasis aspect in the affected glands and sonographic exams demonstrated hypoechoic and heterogeneous internal echoes. One case showed regression of ultrasound changes after clinical improvement.

Acometimento oral no pênfigo vulgar

Pemphigus vulgaris (PV) is a bullous disease characterized by the presence of autoantibodies against intra-epidermal adhesion molecules. AIM: The aim of this study was to identify the characteristics of PV in each gender, forms of clinical presentation, age, diagnosis methods and management. STUDY DESIGN: historical cohort. METHOD: Patients with PV treated in Otolaryngology Department from HC-FMUSP between 1990 and 2001. RESULTS: From 23 patients, 91,3% were women and 8,7% men (p <0,01), proportion of 9:1. The age of diagnosis varied between 26 and 80 years, with average of 53 ± 18,4 years. In males, PV begun 24,6 ± 5,9 years earlier than in females (p=0,026). The most frequently sign in physical examination were bullous lesions in oral mucosa. Biopsy was used in 95% of the cases, direct immunofluorescence in 17,4% and indirect 8,7%. Prednisona was the therapeutic option in 78% of the patients, while deflazacort was used in 22%. Dapsona was associated in 4 cases. We obtained control of the disease in 74% of the cases and loss of the continuation after partial improvement in more 13% of the patients. We observed larger difficulty in disease control in males (p=0,04). CONCLUSIONS: The females prevailed over males. The age of diagnosis was higher in women. The treatment of choice was prednisona. PV was more easily controlled in females.