RESUMO
Patients who undergo allogeneic stem cell transplantation frequently develop an immunologic disease caused by the reactivation of the graft to the host tissues. This disease is called graft-versus-host disease (GVHD) and it is usually a systemic disorder. In a large proportion of cases, oral disorders that are related to a chronic phase of GVHD (cGVHD) occur, and their treatment involves the use of topical immunosuppressive drugs. Several medications have been studied for this purpose, but only a small number of clinical trials have been published. The present study is a randomized, double-blind clinical trial that compares topical clobetasol and dexamethasone for the treatment of symptomatic oral cGVHD. Patients were randomly assigned to treatment with clobetasol propionate .05% or dexamethasone .1 mg/mL for 28 days. In both arms, nystatin 100,000 IU/mL was administered with the corticosteroid. Oral lesions were evaluated by the modified oral mucositis rating scale (mOMRS) and symptoms were registered using a visual analogue scale. Thirty-five patients were recruited, and 32 patients were randomized into the study groups: 18 patients (56.3%) to the dexamethasone group and 14 patients (43.8%) to the clobetasol group. The use of clobetasol resulted in a significant reduction in mOMRS total score (P = .04) and in the score for ulcers (P = .03). In both groups, there was significant symptomatic improvement but the response was significantly greater in the clobetasol group (P = .02). In conclusion, clobetasol was significantly more effective than dexamethasone for the amelioration of symptoms and clinical aspects of oral lesions in cGVHD.
Assuntos
Anti-Inflamatórios/uso terapêutico , Clobetasol/uso terapêutico , Dexametasona/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/métodos , Doenças da Boca/tratamento farmacológico , Condicionamento Pré-Transplante/métodos , Transplante Homólogo/métodos , Administração Tópica , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study is to describe the use of the Ergonomic Analysis of Work (EAW) in the process of rehabilitating workers, insured by the National Institute of Social Security (INSS) in Brazil, and to conduct a brief analysis of the instrument used by this body. Information obtained from EAW enabled the demand, the requirements of the activity and the skills needed to perform the tasks in the workplace to be determined, thus aiding the decision of the INSS as to rehabilitating the workers and their return to their jobs.
Assuntos
Ergonomia , Doenças Profissionais/reabilitação , Reabilitação Vocacional , Análise e Desempenho de Tarefas , Adulto , Brasil , Humanos , Entrevistas como Assunto , Descrição de Cargo , Masculino , Pessoa de Meia-Idade , Ocupações , Local de TrabalhoRESUMO
Oral manifestations are common in patients who are diagnosed with chronic graft-versus-host-disease (cGVHD). These manifestations can present as oral mucosal lesions, salivary gland dysfunction, or reduction of the mouth opening due to cutaneous sclerosis. Although several studies have reported the prevalence of oral involvement in cGVHD, few have reported details of different types and severity of oral lesions of cGVHD, according to the NIH. Furthermore, the authors are aware of only one published study concerning oral manifestations of cGVHD in Brazil. The purpose of this study was to evaluate the prevalence and severity of oral involvement of cGVHD. Oral evaluation of hematopoietic stem cell transplant (HSCT) recipients was conducted on 22 patients (12 men and 10 women) from December 2007 to May 2009. The following categories were assessed: Age, gender, underlying disease, time postHSCT, history of GVHD, therapy for GVHD, oral lesions, xerostomia, resting salivary flow rate, and mouth opening. Oral lesions were classified according to NIH criteria, and the results were submitted to a descriptive analysis. According to the NIH, patients presented diagnostic (40.9%), distinctive (31.9%), and common (9.1%) features of oral cGVHD. Oral involvement of cGVHD was identified in 81.8% of patients, 68.2% as mucosal lesions and 59.1% as salivary gland dysfunction. Reduced mouth opening was observed in 12 patients (80%), with one case associated with cutaneous sclerosis. Oral involvement was frequent in these patients; for many, it was the first clinical manifestation of cGVHD.
Assuntos
Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Doenças da Boca/epidemiologia , Doença Aguda , Adolescente , Adulto , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Feminino , Doenças da Gengiva/epidemiologia , Humanos , Imunossupressores/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mieloide Aguda/epidemiologia , Leucoplasia Oral/epidemiologia , Erupções Liquenoides/epidemiologia , Masculino , Pessoa de Meia-Idade , Úlceras Orais/epidemiologia , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Saliva/metabolismo , Taxa Secretória/fisiologia , Doenças da Língua/epidemiologia , Xerostomia/epidemiologia , Adulto JovemRESUMO
Pemphigus vulgaris (PV) is an autoimmune dermatosis that may evolve to severely compromise the skin and/or mucosa. Autoantibodies directed against epithelial cadherins, such as desmogleins 1 and 3, lead to acantholysis and culminate in blister formation. Involvement of the oral mucosa is common, but other squamous stratified epithelia may also be the target of the autoimmune aggression. We report a woman with PV that was in partial remission, who developed an unusual acute phenomenon, known as oesophagitis dissecans superficialis.
Assuntos
Esofagite/patologia , Mucosa Bucal/patologia , Pênfigo/patologia , Trato Gastrointestinal Superior/patologia , Adulto , Autoanticorpos , Esofagite/etiologia , Esofagoscopia , Feminino , Humanos , Pênfigo/complicaçõesRESUMO
Aids é uma infecção causada pelo HIV que se caracteriza por imunodepressão profunda, levando ao surgimento de diversas infecções oportunistas, dentre as quais manifestações orais como a candidíase oral. Além disso, no início da epidemia pelo HIV, os pacientes eram predominantemente homens, adultos, de diferentes classes sociais contaminados por relação sexual homossexual ou uso de drogas injetáveis. Todavia, nestes últimos anos, o perfil social da infecção pelo HIV/aids vem mudando. Logo, este artigo propõe-se a realizar uma revisão de literatura sobre os aspectos sociais e as lesões orais associadas ao HIV no mundo, ressalatndo o importante papel do cirurgião-dentista em um adequado atendimento multidisciplinar ao paciente HIV positivo