RESUMEN

BACKGROUND: Both zoledronic acid, a potent bisphosphonate, and the antiangiogenic drug sunitinib are included in anticancer protocols and have also been associated with jaw osteonecrosis. Our aim was to compare the effect of these drugs on tissue repair at tooth extraction sites. METHODS: Wistar rats were allocated into four groups: (1) sunitinib; (2) sunitinib/zoledronic acid; (3) zoledronic acid; (4) control group. The animals underwent tooth extractions and maxillae were macro- and microscopically analyzed. RESULTS: On macroscopic evaluation, the zoledronic acid group showed a significantly higher frequency of oral mucosal lesion; lesions in the sunitinib/zoledronic acid group were larger, albeit not significantly so. The sunitinib/zoledronic acid group had significantly less epithelium than the zoledronic acid and control group, but showed no significant difference compared to the sunitinib group. The sunitinib/zoledronic acid and zoledronic acid groups did not differ from each other, but had significantly less connective tissue and more non-vital bone and microbial colonies than sunitinib and control groups, whereas these latter two groups did not significantly differ from each other. Vital bone and inflammatory infiltrate did not significantly differ between groups. CONCLUSION: Sunitinib alone is not associated with non-vital bone, whereas the sunitinib/zoledronic acid combination and zoledronic acid alone are.

Asunto(s)

Osteonecrosis de los Maxilares Asociada a Difosfonatos , Conservadores de la Densidad Ósea , Ratas , Animales , Ácido Zoledrónico , Conservadores de la Densidad Ósea/farmacología , Sunitinib , Osteonecrosis de los Maxilares Asociada a Difosfonatos/patología , Ratas Wistar , Difosfonatos/farmacología , Extracción Dental

RESUMEN

OBJECTIVE: To perform a literature review addressing the therapeutic strategies for salivary hypofunction. BACKGROUND: Qualitative and quantitative salivary dysfunctions predispose to changes in the oral mucosa and teeth, cause impairment to oral functions and negative impact on quality of life. MATERIALS AND METHODS: A MEDLINE/PubMed search was conducted using the terms "Xerostomia" AND, "Saliva Artificial" OR, "Citric Acid," "Malic Acid," "Chewing Gum," "Acupuncture" OR, "Pilocarpine" OR, "Bethanechol" OR, "Cevimeline" OR, "Hyperbaric Oxygen Therapy" OR, "Stem Cell Therapy" OR "Genetic Therapy" and their Mesh Terms. RESULTS: We selected 25 clinical trials investigating the effects of salivary substitutes, chewing gum, malic and citric acids, pilocarpine, cevimeline, bethanechol, acupuncture, hyperbaric oxygen therapy and regenerative therapies on salivary hypofunction. In most studies, the number of participants was low and the follow-up times short. The therapeutic modalities were classified according to the level of evidence on salivary dysfunction. CONCLUSIONS: Pilocarpine and cevimeline had the strongest evidence of beneficial effect on salivary hypofunction. Citric and malic acids increase salivary flow but also increase the risk of erosion and dental caries. There are no controlled clinical trials supporting the efficacy of acupuncture, stem cell therapy and gene therapy on salivary dysfunction, although clinical observations suggest a promising effect. There is no evidence supporting salivary substitutes, chewing gum, bethanechol or hyperbaric oxygen on the treatment of salivary hypofunction.

Asunto(s)

Agonistas Muscarínicos/uso terapéutico , Pilocarpina/uso terapéutico , Quinuclidinas/uso terapéutico , Tiofenos/uso terapéutico , Xerostomía/terapia , Terapia por Acupuntura , Betanecol/uso terapéutico , Goma de Mascar , Humanos , Oxigenoterapia Hiperbárica , Xerostomía/tratamiento farmacológico

RESUMEN

OBJECTIVES: To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy. METHODS: A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX). RESULTS: Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups. CONCLUSIONS: BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.

Asunto(s)

Osteonecrosis de los Maxilares Asociada a Difosfonatos/sangre , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Anciano , Biomarcadores/sangre , Femenino , Humanos , Masculino , Radiografía Panorámica , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

The degree of admixture in Brazil between historically isolated populations is complex and geographically variable. Studies differ as to what the genetic and phenotypic consequences of this mixing have been. In Northeastern Brazil, we enrolled 522 residents of Salvador and 620 of Fortaleza whose distributions of self-declared color were comparable to those in the national census. Using the program Structure and principal components analysis there was a clear correlation between biogeographic ancestry and categories of skin color. This correlation with African ancestry was stronger in Salvador (r=0.585; P<0.001) than in Fortaleza (r=0.236; P<0.001). In Fortaleza, although self-declared blacks had a greater proportion of European ancestry, they had more African ancestry than the other categories. When the populations were analyzed without pseudoancestors, as in some studies, the relationship of 'race' to genetic ancestry tended to diffuse or disappear. The inclusion of different African populations also influenced ancestry estimates. The percentage of unlinked ancestry informative markers in linkage disequilibrium, a measure of population structure, was 3-5 times higher in both Brazilian populations than expected by chance. We propose that certain methods, ascertainment bias and population history of the specific populations surveyed can result in failure to demonstrate a correlation between skin color and genetic ancestry. Population structure in Brazil has important implications for genetic studies, but genetic ancestry is irrelevant for how individuals are treated in society, their health, their income or their inclusion. These track more closely with perceived skin color than genetic ancestry.

Asunto(s)

Población Negra/genética , Genética de Población , Pigmentación de la Piel/genética , Población Blanca/genética , Teorema de Bayes , Brasil/etnología , Análisis por Conglomerados , Frecuencia de los Genes , Variación Genética , Genotipo , Geografía , Haplotipos , Humanos , Polimorfismo de Nucleótido Simple , Análisis de Componente Principal , Análisis de Secuencia de ADN

RESUMEN

OBJECTIVE: To conduct a literature review on sodium alendronate, focusing on osteonecrosis of the jaws, a serious potential side effect. BACKGROUND: Sodium alendronate is a bisphosphonate that is widely used for the treatment of osteopenia, osteoporosis and Paget's disease. Like other bisphosphonates, it inhibits bone resorption by inactivating osteoclasts. Alendronate has evident benefits in the treatment of these diseases, but it is associated with jaw osteonecrosis, although less frequently compared with intravenous bisphosphonates. Therefore, some preventive measures should be taken to avoid this side effect. MATERIAL AND METHODS: We reviewed the literature regarding the pharmacological aspects, mechanism of action, indications of use and side effects of sodium alendronate, as well as the management of patients under this therapy. CONCLUSION: The benefits of sodium alendronate are scientifically proven, but a serious adverse effect is osteonecrosis. Therefore, it is crucial to prepare the oral cavity before bisphosphonate therapy, providing a careful dental evaluation and all needed dental treatment.

Asunto(s)

Alendronato/efectos adversos , Conservadores de la Densidad Ósea/efectos adversos , Enfermedades Maxilomandibulares/inducido químicamente , Osteonecrosis/inducido químicamente , Humanos

RESUMEN

Foi feito um levantamento epidemiológico buscando identificar, classificar e quantificar as patologias presentes na estrutura da língua dos pacientes atendidos no Serviço de Estomatologia e Prevenção do Câncer do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), contemplando um período de 35 anos. Método: estudo retrospectivo, executado a partir da análise de 5928 prontuários onde constavam lesões de língua. Resultados: encontrou-se uma gama variada de patologias, totalizando 7862 lesões localizadas na região, sendo estas classificadas em 14 grupos distintos. As lesões específicas da língua foram as mais frequentes, sendo a língua saburrosa a enfermidade com a maior casuística. A hiperplasia da mucosa, glossite rômbica mediana, hemangioma e carcinoma espinocelular somaram o maior número de casos respectivamente nos grupos de lesões traumáticas, infecções fúngicas, neoplasias benignas e malignas. O carcinoma espinocelular, tumor maligno mais prevalente na boca, comprometeu principalmente o bordo posterior da língua, preferentemente acometendo homens acima de 40 anos. Conclusão: a identificação de diversas lesões favorece o estabelecimento do diagnóstico precoce bem como o tratamento das enfermidades presentes e reforça a importância do exame sistemático desta área anatômica, no dia a dia do cirurgião-dentista.

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Epidemiological data were obtained on tongue diseases of patients treated at the Oral Medicine and Maxilofacial Cancer Prevention Centre of São Lucas Hospital at the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil, for a period of 35 years. Methods: a retrospective study was performed, assessing 5928 patients' folders which tongue lesions were observed. Results: a myriad of lesions, totalizing 7862 lesions could be found in the tongue, being classified into 14 distinct groups. Lesions that occur specifically in the tongue were the most frequent. Coated tongue was the lesion with most cases. Mucosal hyperplasia, median rombic glossitis, hemangioma and spindle cell carcinoma were, respectively, found to be the most frequent in cases of trauma, fungal infections, benign and malign tumors. Spindle cell carcinoma, the most prevalent malign tumor of the mouth, compromised mostly the posterior tongue border, being most occurrent in men aging over 40 years. Conclusion: the identification of various lesions allows the early diagnosis and proper treatment of diseases. It is important that the dental surgeon systematically proceeds with the examination of this important anatomic site.

RESUMEN

O câncer bucal é prioridade do Ministério da Saúde e o cirurgião-dentista (CD) deve comprometer-se efetivamente com sua prevenção e diagnóstico. Objetivos: Estabelecer e comparar o conhecimento dos acadêmicos de Odontologia da PUCRS sobre fatores de risco e condutas vinculadas ao câncer bucal e verificar o grau de interesse na educação continuada sobre o tema. Materiais e Métodos: Foram aplicados questionários a 289 acadêmicos dos 5 anos da graduação. Os resultados foram analisados pelo software SPSS versão 10.0 e considerados significativos quando p ? 0,05. Resultados: 100% dos formandos identificaram o carcinoma como a neoplasia maligna bucal mais prevalente. Independente do ano em curso, demostraram adequado conhecimento sobre câncer bucal e alto índice de acerto na identificação dos fatores de risco. O conhecimento aumentou com o avanço no curso, sendo o melhor desempenho obtido no 2º e 5º anos, quando cursaram respectivamente as disciplinas de Patologia Bucodental, Saúde Coletiva II e Estomatologia. Constatou-se que existem diferenças significativas para o total de acertos entre os semestres, demonstrando que o avanço no curso reflete em um maior número de respostas corretas. A maioria dos acadêmicos não participou de cursos temáticos de educação continuada, entretanto identificaram a importância do CD na prevenção e diagnóstico do câncer bucal.

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Oral cancer is a priority of the Ministry of health and dentists should be able to adhere to the available programs providing adequate prevention and diagnosis. Objectives: To assess level of knowledge of PUCRS?s dentistry students about risk factors and behaviors linked to oral cancer and verify the amount of interest in continuing education on the topic. Materials and methods: Questionnaires were applied to 289 students of 5 years of graduation. Results were analyzed using SPSS version 10.0 and considered significant when p ? 0.05. Results: 100% of students identified carcinoma as the most prevalent malignant oral disease. They demonstrated adequate knowledge about oral cancer and high rate of accuracy in identification of risk factors, regardless of the year of graduation. Knowledge increased with the advancement in the course, being the best performance obtained in 2nd and 5th years, when taking classes of Oral Pathology, Public Health II and Oral Medicine, respectively. Conclusions: There were significant differences of correctness amongst semesters, demonstrating that the advance in course reflects in a higher education in this . Most students did not attend thematic courses in continuing education, however identified the importance of dentist in the prevention and diagnosis of oral cancer.

RESUMEN

BACKGROUND: Lupus erythematosus is a serious autoimmune disease, which can cause oral mucosal lesions, manifesting as white striae and erythematous, atrophic and hyperkeratotic areas, as well as erosions and ulcerations. Sometimes, these signs can be misdiagnosed as other oral diseases such as lichen planus. Also, on histopathological examination with haematoxylin-eosin staining (HE), the features of these diseases can overlap. MATERIALS AND METHODS: The authors report here two cases of oral lesions of lupus erythematosus, with a discussion of their clinical features and the process of differential diagnosis. CONCLUSIONS: It is crucial to consider in the diagnostic process for lupus erythematosus the whole clinical information as well as haematological tests, histopathological features in HE and direct immunofluorescence, not only at first evaluation but also during patient follow-up.

Asunto(s)

Enfermedades de los Labios/diagnóstico , Lupus Eritematoso Discoide/diagnóstico , Lupus Eritematoso Sistémico/diagnóstico , Adulto , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Técnica del Anticuerpo Fluorescente Directa/métodos , Estudios de Seguimiento , Humanos , Enfermedades de la Boca/diagnóstico , Mucosa Bucal/patología , Hueso Paladar/patología

RESUMEN

BACKGROUND: This study aimed to analyze the oral lesions of chronic paracoccidioidomycosis concerning their histomorphometric, immunohistochemical, and clinical features in a standardized sample. METHODS: Fifty biopsy specimens of oral lesions of chronic paracoccidioidomycosis were submitted to hematoxylin and eosin (H&E), Grocott-Gomori and immunohistochemical staining. Data regarding disease duration and size and number of oral lesions, as well as erythrocytes, leukocytes, lymphocytes, hematocrit, hemoglobin, and erythrocyte sedimentation rate, were collected from medical charts. Granuloma density and number and diameter of buds and fungal cells, and IL-2, TNF-alpha and IFN-gamma expression, as well as clinical and hematological features, were quantified and correlated. RESULTS: Bud diameter was significantly greater in intermediate density granulomas compared to higher density granulomas. The other variables (number of buds, number and diameter of fungi, expression of IL-2, TNF-alpha and IFN-gamma, and clinical and hematological features) did not significantly change with the density of granulomas. There was a positive correlation between bud number and fungal cell number (r = 0.834), bud diameter and fungal cell diameter (r = 0.496), erythrocytes and number of fungi (r = 0.420), erythrocytes and bud number (r = 0.408), and leukocytes and bud number (r = 0.396). Negative correlation occurred between number and diameter of fungi (r = -0.419), bud diameter and granuloma density (r = -0.367), TNF-alpha expression and number of fungi (r = -0.372), and TNF-alpha expression and bud number (r = -0.300). CONCLUSION: The histological, immunological, and clinical features of oral lesions evaluated did not differ significantly between patients in our sample of chronic paracoccidioidomycosis. TNF-alpha levels were inversely correlated with intensity of infection.

Asunto(s)

Enfermedades de la Boca/microbiología , Paracoccidioidomicosis/patología , Adulto , Anciano , Biopsia , Sedimentación Sanguínea , Enfermedad Crónica , Recuento de Colonia Microbiana , Eritrocitos/patología , Femenino , Granuloma/microbiología , Hematócrito , Hemoglobinas/análisis , Humanos , Hifa/citología , Inmunohistoquímica , Interferón gamma/análisis , Interleucina-2/análisis , Leucocitos/patología , Linfocitos/patología , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/sangre , Paracoccidioides/citología , Paracoccidioidomicosis/sangre , Factor de Necrosis Tumoral alfa/análisis

RESUMEN

BACKGROUND: The aim of this study was to compare clodronate and zoledronic acid regarding their influence on the repair of surgical wounds in maxillae (soft tissue wound and tooth extraction) and their relation to osteonecrosis. MATERIAL AND METHODS: Thirty-four Wistar rats were allocated into three groups according to the treatment received: (i) 12 animals treated with zoledronic acid, (ii) 12 animals treated with clodronate and (iii) 10 animals that were given saline solution. All animals were subjected to tooth extractions and surgically induced soft tissue injury. Histological analysis of the wound sites was performed by means of hematoxylin-eosin (H&E) staining and immunohistochemical staining for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), von Willebrand factor, and caspase-3. RESULTS: The zoledronic acid group showed higher incidence of non-vital bone than did the clodronate group at the tooth extraction site. At the soft tissue wound site, there were no significant differences in non-vital bone between the test groups. RANKL, OPG, von Willebrand factor, and caspase-3 did not show significant differences between the groups for both sites of surgical procedures. CONCLUSION: Both of the bisphosphonates zoledronic acid and clodronate are capable of inducing maxillary osteonecrosis. Immunohistochemical analysis suggests that the involvement of soft tissues as the initiator of osteonecrosis development is less probable than has been pointed out.

Asunto(s)

Conservadores de la Densidad Ósea/farmacología , Ácido Clodrónico/farmacología , Difosfonatos/farmacología , Imidazoles/farmacología , Maxilar/cirugía , Animales , Carga Bacteriana , Caspasa 3/análisis , Tejido Conectivo/efectos de los fármacos , Tejido Conectivo/patología , Epitelio/efectos de los fármacos , Epitelio/patología , Femenino , Maxilar/efectos de los fármacos , Maxilar/microbiología , Maxilar/patología , Enfermedades Maxilares/inducido químicamente , Enfermedades Maxilares/patología , Mucosa Bucal/efectos de los fármacos , Mucosa Bucal/lesiones , Osteonecrosis/inducido químicamente , Osteonecrosis/patología , Osteoprotegerina/análisis , Ligando RANK/análisis , Ratas , Ratas Wistar , Extracción Dental , Alveolo Dental/efectos de los fármacos , Alveolo Dental/microbiología , Alveolo Dental/patología , Cicatrización de Heridas/efectos de los fármacos , Ácido Zoledrónico , Factor de von Willebrand/análisis

Asunto(s)

Trasplante de Células Madre Hematopoyéticas/efectos adversos , Neoplasias de la Boca/etiología , Recurrencia Local de Neoplasia , Adolescente , Enfermedad Injerto contra Huésped/etiología , Encuestas Epidemiológicas , Humanos , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/terapia , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

RESUMEN

Oral myiasis is a rare disease in humans associated with poor oral hygiene, suppurative oral lesions, alcoholism and senility, among other conditions. A case of oral myiasis in a 34-year-old white male with advanced periodontal disease and neurologic deficit is reported. Treatment consisted of manual removal of the larvae, one by one, with the help of clinical forceps and subsequent management of the periodontal disease.

Asunto(s)

Enfermedades de la Boca/parasitología , Miasis/terapia , Adulto , Humanos , Masculino , Respiración por la Boca/complicaciones , Miasis/etiología , Mordida Abierta/complicaciones , Oxígeno/administración & dosificación , Enfermedades Periodontales/complicaciones , Agua/química

RESUMEN

The aim of the present study was to compare results obtained using the manual point-counting method with results obtained using the semi-automated segmentation method, in the quantitative evaluation of histological sections by light microscopy. The tongues of 40 rats (Ratus norvergicus) were processed using the paraffin technique, in which a 5-mum-thick tissue slice cut from each tongue is stained with picrosirius and methyl green. Three digital images were captured randomly from each section, which were later converted to black-and-white. The collagen fibers shown in each image were quantified using the semi-automated segmentation method and the manual point-counting method. The results obtained using the 2 different quantification methods were compared using the paired t-test and Pearson's correlation test, with statistical analysis using the methods of Bland and Altman. The t-test indicated that there was no significant difference in results between the 2 different quan-tification methods. Pearson's correlation test indicated a strong correlation (r = 0.987), and a comparison of the methods using the Bland and Altman plot indicated no significant error. These findings indicate that both quantification methods can be reliably used to evaluate tissue sections, without discrepancies between the 2 methods.

Asunto(s)

Técnicas Histológicas , Procesamiento de Imagen Asistido por Computador/métodos , Animales , Colágenos Fibrilares/análisis , Ratas , Estadísticas no Paramétricas , Lengua/anatomía & histología

RESUMEN

A agranulocitose induzida por fármacos, tem sido definida como uma severa e seletiva neutropenia, devido a uma inesperada relação medicamentosa. Apesar de ser incomum, esta é a mais freqüente forma fatal de citopenia induzida por droga. Esse artigo relata um caso de agranulocitose induzida por metimazol, utlilizado para tratamento de hipertiroidismo que ocorreu em uma mulher leucoderma, com 59 anos de idade. As lesões bucais eram ulceradas e dolorosas, associadas a febre e tosse como principais manifestações clínicas. O tratamento instituído foi a suspensão do uso do metimazol e a utilização de profilaxia antibiótica para prevenir à infecção. Aproximadamente seis dias após estabelecido o tratamento, houve uma recuperação rápida da contagem dos leucócitos, que aumentaram de 1.200 células/mm³ para 4.000 células/mm³, normalizando o quadro hematológico

Asunto(s)

Humanos , Femenino , Persona de Mediana Edad , Agranulocitosis , Antitiroideos , Metimazol , Neutropenia

RESUMEN

Este artigo revisa os mecanismos genéticos básicosenvolvidos no desenvolvimento do carcinoma espinocelular da cavidade bucal. Além disso, introduzir e familiarizar os profissionais da área de saúde aos conceitos contemporâneos de oncogênese, às técnicas atualmente utilizadas em biologia molecular, bem como suas aplicabilidades clínicas e no campo das pesquisas. Foi feita uma revisão bibliogáfica não sistemática sobre o tema abordado, utilizando-se base de dados do MEDLINE. O carcinoma espinocelular (CEC) é a neoplasia maligna mais frequente da cavidade bucal . A epidemiologia do CEC é complexa devido à natureza multigênica dessa lesão e ao número de fatores ambientais que os indivíduos estão, tais como: tabaco, álcool infecções virais e radiações. Estes fatores produzem mutações em diversos cromossomos e as consequências desses danos genéticos são defeitos na regulamentação de algumas funções celulares, como a perda de sinalização, alterações no ciclo celular ou nos mecanismos de reparo e eliminação de células defeituosas. O conhecimento das bases genéticas que participam no desenvolvimento do CEC é fundamental, pois permite aos profissionais da saúde uma nova abordagem para a comprensão da sua etiopatogenia, diagnóstico, estadiamento, prognóstico e tratamento dessa lesão.

Asunto(s)

Humanos , Masculino , Femenino , Boca/lesiones , Carcinoma de Células Escamosas/genética

RESUMEN

El Rinoescleroma es una infección crónica granulomatosa progresiva causada por un bacilo Gram negativo Klebsiella rhinoescleromatis. Afecta usualmente la cavidad nasal y disemina rápidamente a estructuras vecinas es inespecifica: rinorrea purulenta, obstrucción nasal, epistaxis. El diagnóstico se basa en la demostración del microorganismo causal por biopsia o cultivo. En la biopsia del tejido afectado se aprecian células de MIKULICZ patognomónicas. El tratamiento consiste en la antibióticoterapia adecuada. Describimos un caso histológicamente de mostrado de Rinoescleroma, en un escolar masculino de 11 años de edad. Hacemos énfasis en la importancia de conocer esta patología debido a su poca frecuencia en nuestro medio, además de presentarse atípicamente en un escolar y de sexo masculino, ya que predomina entre la tercera y cuarta década de la vida, en el sexo femenino, y es el primer caso reportado en el Hospital Padre Justo de Rubio. Estado Táchira

Asunto(s)

Humanos , Masculino , Niño , Enfermedad Granulomatosa Crónica/diagnóstico , Enfermedad Granulomatosa Crónica/etiología , Infecciones/complicaciones , Klebsiella pneumoniae/fisiología , Rinoscleroma , Pediatría , Venezuela