RESUMO
Chikungunya virus (CHIKV) was first isolated in humans in 1952, following an epidemic in Tanzania. The origin of the name means "to bend forward or become contorted," in reference to the posture adopted by patients due to the joint pain that occurs during the infection. Epidemiology data suggest that by the end of 2015, about 1.6 million people had been infected with CHIKV. The acute period of the disease is characterized by high fever, myalgia, joint pain, and severe and disabling polyarthritis, sometimes accompanied by headache, backache, and maculopapular rash, predominantly on the thorax. Around half of the patients will progress to the subacute and chronic phases, that is manifested by persistent polyarthritis/polyarthralgia, accompanied by morning stiffness and fatigue, which could remain for years. Oral features may include gingivitis possibly as a consequence of arthralgia of the hands leading to limited oral health measures as well as burning sensation and oral mucosal ulceration. Treatment in the acute phase includes acetaminophen, and weak opioids (tramadol or codeine) should be used in cases of severe or refractory pain. For patients who have progressed to the subacute stage and who have not had notable benefit from common analgesics or opioids, NSAIDs, or adjunctive pain medications (anticonvulsants or antidepressants) may be of benefit. In patients with moderate-to-severe musculoskeletal pain or in those who cannot be given or tolerate NSIADs or opiates, prednisolone should be prescribed.
Assuntos
Artralgia/tratamento farmacológico , Reação de Arthus/tratamento farmacológico , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Mialgia/tratamento farmacológico , Artralgia/virologia , Reação de Arthus/virologia , Terapia por Exercício , Gengivite/virologia , Humanos , Mialgia/virologiaRESUMO
BACKGROUND: Desquamative gingivitis (DG) is usually a manifestation of immunologically mediated mucocutaneous disorders, although it was previously suggested to be hormonally related. METHODS: One hundred and eighty-seven Caucasian UK residents with clinical features of DG (126 female, median age of 51 years, range 23-93 years) were retrospectively evaluated. RESULTS: It was established that, in this population, the largest cohort yet reported, oral lichen planus was most common (70.5%) while mucous membrane pemphigoid (14%), pemphigus vulgaris (13%), linear IgA disease (1.6%), dermatomyositis (0.5%) and mixed connective tissue disease (0.5%) were less common. CONCLUSION: Oral lichen planus is the main disorder associated with DG. However, DG may be a feature of bullous disease and connective tissue disease.
Assuntos
Gengivite/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dermatomiosite/complicações , Feminino , Gengivite/imunologia , Herpes Simples/complicações , Humanos , Imunoglobulina A/imunologia , Líquen Plano Bucal/complicações , Masculino , Pessoa de Meia-Idade , Doença Mista do Tecido Conjuntivo/complicações , Doenças da Boca/imunologia , Penfigoide Mucomembranoso Benigno , Pênfigo/complicações , Estudos Retrospectivos , Dermatopatias Vesiculobolhosas/imunologia , Adulto JovemRESUMO
Hepatitis C virus (HCV) infection is a common worldwide problem, giving rise to long-term viral carriage and risk of chronic hepatic disease, hepatic malignancy and a wide spectrum of immunologically mediated disorders. The present report describes relevant data suggesting that nosocomial transmission to oral health care workers is unlikely, but in view of medical and occupational consequences of such infection, and the absence of long-term effective treatment or vaccine, the oral surgery profession must continue to be vigilant and to maintain the highest standards of infection control procedures to minimize the possible acquisition of HCV during dental treatment.
Assuntos
Hepatite C/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Transmissão de Doença Infecciosa do Profissional para o Paciente , Saliva/virologia , Cirurgia Bucal , Antivirais/administração & dosagem , Patógenos Transmitidos pelo Sangue , Infecção Hospitalar/transmissão , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Masculino , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Doenças Virais Sexualmente Transmissíveis/transmissão , Abuso de Substâncias por Via Intravenosa/virologiaRESUMO
The aim of the present work was to assess the knowledge and attitudes of Brazilian General Dental Practitioners with regard to aspects of the aetiology, early diagnosis and prevention of oral cancer relevant for general dental practice. A convenience sample of 129 dentists in Brazil was randomly selected and asked to complete a questionnaire. Results of bi-variated analysis revealed that a self-perceived good knowledge regarding relevant aspects of oral cancer was statistically significantly associated with male gender (Chi square=4.59, P<0.05). Simple logistic regression revealed that male professionals were 2.9 times more knowledgeable than their female colleagues (OR=2.9, 1.1-8.1 95% CI, P=0.037), although, this association was not statistically significant when adjusted for age using multiple regression analysis (OR=2.7, 0.9-7.5 95% CI, P=0.059). There were no significant differences in relevant knowledge and attitudes of private compared with public dentists. Importantly, General Dental Practitioners who spent more than half of time of a patient's initial consultation undertaking a clinical examination were the more likely to detect oral cancer (Chi square=4.245, P=0.039) than those who set aside little time examining their patients. It is concluded that the knowledge of dentists in Brazil regarding relevant aspects of oral cancer is suboptimal, and may not be associated with any examined social-demographic variables. Further research is required to clarify the role of continuing professional education in improving the knowledge and attitudes of dentists relevant to oral cancer in Brazil.
Assuntos
Odontólogos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/psicologia , Adulto , Brasil , Competência Clínica , Estudos Transversais , Feminino , Odontologia Geral , Humanos , Modelos Logísticos , Masculino , Padrões de Prática Odontológica , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
Orofacial granulomatosis is an uncommon clinicopathological entity describing patients who have oral lesions characterized by persistent and/or recurrent labial enlargement, oral ulcers and a variety of other orofacial features, who on lesional biopsy have lymphoedema and non-caseating granulomas. The aetiology of oral lesions with non-caseating granulomas includes oral Crohn's disease (some patients with oral lesions will develop typical bowel symptoms of Crohn's disease in ensuing months to years), tooth-associated infections, sarcoidosis and food or contact allergies. Treatment of orofacial granulomatosis is not reliably effective and may not be always necessary, although most patients do require some medical intervention.
Assuntos
Dermatoses Faciais/patologia , Granuloma/patologia , Doenças da Boca/patologia , Diagnóstico Diferencial , Dermatoses Faciais/etiologia , Dermatoses Faciais/terapia , Granuloma/etiologia , Granuloma/terapia , Humanos , Doenças da Boca/etiologia , Doenças da Boca/terapia , RecidivaRESUMO
Enfuvirtide is the first of a new class of antiretroviral agents recently approved for the treatment of human immunodeficiency virus (HIV)-1 infection. Present available data suggest that enfuvirtide may be a promising agent for the control of HIV infection in patients who have previously received reverse transcriptase inhibitor and protease inhibitor regimens and who are either intolerant to such drugs and/or who have gone into virological failure. Perhaps the greater limitation to the clinical use of enfuvirtide is the cost, limiting its use in the developing world.
Assuntos
Linfócitos T CD4-Positivos/efeitos dos fármacos , Proteína gp41 do Envelope de HIV/administração & dosagem , Inibidores da Fusão de HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Fragmentos de Peptídeos/administração & dosagem , Enfuvirtida , Proteína gp41 do Envelope de HIV/efeitos adversos , Inibidores da Fusão de HIV/efeitos adversos , Humanos , Infusões Parenterais , Fragmentos de Peptídeos/efeitos adversosRESUMO
OBJECTIVE: The purpose of this report was to review the current literature on human herpesvirus 8 (HHV-8) with particular attention to the aspects of interest for dental health care workers. MATERIAL AND METHODS: The authors searched original research and review articles on specific aspects of HHV-8 infection, including virology, epidemiology, transmission, diagnosis, natural history, therapy, and oral aspects. The relevant material was evaluated and reviewed. RESULTS: HHV-8 is a recently discovered DNA virus that is present throughout the world but with major geographic variation. In the Western world, the virus, transmitted mainly by means of sexual contact, is strongly associated with Kaposi's sarcoma and body cavity-based lymphoma and more controversially with multiple myeloma and non-neoplastic disorders. There is no specific effective treatment, but human immunodeficiency virus protease inhibitors may play an indirect role in the clearance of HHV-8 DNA from peripheral blood mononuclear cells of patients infected with human immunodeficiency virus. HHV-8 DNA is present in saliva, but as yet, there are no documented instances of nosocomial transmission to health care workers. The prevalence of HHV-8 among dental health care workers is probably similar to that in the general population. CONCLUSION: HHV-8 does not appear to be ubiquitous in most populations, particularly in western Europe and the United States, where it may be restricted to a population at risk of having Kaposi's sarcoma develop (men infected with human immunodeficiency virus and patients who are iatrogenically immunosuppressed). Most serologic studies suggest a global HHV-8 seroprevalence of 2% to 10% and show that the virus may be under immunologic control in people who are healthy but infected with HHV-8. Also, HHV-8 certainly has the means to overcome cellular control and immune responses and thus predispose to malignancy. To date, there are no data to suggest that health care staff members are at particular risk of HHV-8 acquisition through occupational routes.
Assuntos
Infecções por Herpesviridae/virologia , Herpesvirus Humano 8 , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Recursos Humanos em Odontologia , Europa (Continente)/epidemiologia , Genes Virais , Infecções por Herpesviridae/tratamento farmacológico , Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/transmissão , Herpesvirus Humano 8/química , Herpesvirus Humano 8/genética , Herpesvirus Humano 8/patogenicidade , Humanos , Transtornos Linfoproliferativos/virologia , Masculino , Exposição Ocupacional , Oncogenes , Saliva/virologia , Sarcoma de Kaposi/virologia , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia , Proteínas ViraisRESUMO
The effect of human immunodeficiency virus-1 protease inhibitors on the frequency of human herpesvirus 8 DNA detection from peripheral blood of human immunodeficiency virus-positive persons was evaluated. Thirty-three human immunodeficiency virus-seropositive male patients were studied longitudinally. DNA from open reading frame 26 of the human herpesvirus 8 genome was amplified by the polymerase chain reaction from the CD45+ fraction of peripheral blood before and after the introduction of protease inhibitor therapy. Human herpesvirus 8 IgG status, CD4+ cell counts, and human immunodeficiency virus-1 plasma viral load were also assessed before and after therapy. When both reverse transcriptase inhibitor and protease inhibitor treatment were introduced at the same time, there was an increase in CD4+ T cell counts (P=0.0041), a decrease in human immunodeficiency virus plasma load (P=0.0584), and a decrease in the detection rate of human herpesvirus 8 DNA (P=0.0077). Introducing protease inhibitor to patients already receiving reverse transcriptase inhibitor treatment was associated with an increase in CD4+ T cell counts (P=0.0003), a decrease in human immunodeficiency virus plasma viral load (P=0.0911), and a decrease in the human herpesvirus 8 detection rate (P=0.0412). No significant changes in the titters of anti-human herpesvirus 8 IgG were observed. Treatment with human immunodeficiency virus-1 protease inhibitors is therefore associated with the clearance of human herpesvirus 8 DNA from peripheral blood of human immunodeficiency virus-infected patients. The concomitant decrease in the human immunodeficiency virus plasma load and increase in the peripheral CD4+ cell count suggest that an amelioration in the immune defect following reduction in the burden of human immunodeficiency virus-1 infection is responsible for the clearance of human herpesvirus 8 by protease inhibitors.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Herpesvirus Humano 8/efeitos dos fármacos , Ritonavir/uso terapêutico , Saquinavir/uso terapêutico , Sarcoma de Kaposi/virologia , Adulto , Idoso , Anticorpos Antivirais/sangue , Contagem de Linfócito CD4 , DNA Viral/sangue , Infecções por HIV/complicações , Infecções por HIV/imunologia , Infecções por HIV/virologia , Protease de HIV , HIV-1/genética , Herpesvirus Humano 8/genética , Herpesvirus Humano 8/imunologia , Humanos , Imunoglobulina G/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sarcoma de Kaposi/sangue , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/imunologia , Carga ViralRESUMO
Computers have increasingly found application in dentistry over the past 15 years, but at present there has been no investigation of the application of the Internet for distance diagnosis purposes in oral medicine. As a consequence, the objective of this article was to determine the acceptability to patient and clinician of the distant diagnosis of common orofacial diseases using the Internet. The study group comprised 20 patients who attended the Oral Medicine unit of the Eastman Dental Institute and Hospital, London, UK, for the diagnosis and management of oral mucosal diseases. Digital images of each patient's oral mucosal lesion were captured and stored on a personal computer and later transmitted via the Internet to a distant site. Patients were asked to complete a self-administered questionnaire detailing their opinion of the use of an intra-oral camera and a group of clinicians were asked to compare and contrast the original and transmitted images. The majority of patients found the procedure of recording images of their mouth very comfortable, were happy to view the inside of their mouths, and found the procedure generally useful in understanding their clinical problem. The clinicians were often not able to differentiate between the original and transmitted image but were able to accurately diagnose the patient's oral mucosal problems in 64% of the instances. The results of the present study suggest that telediagnosis of orofacial disease may be a feasible prospect.
Assuntos
Doenças da Boca/diagnóstico , Telepatologia , Adulto , Idoso , Diagnóstico por Computador , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Aceitação pelo Paciente de Cuidados de Saúde , Fotografia DentáriaRESUMO
A series of dental outpatients in Brazil was anonymously screened for HIV antibodies in whole unstimulated saliva with an immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Salivary HIV antibodies were detected in 40 patients in the control group who were known to be HIV-seropositive but were not detected in any of a series of 40 known HIV-seronegative patients in the control group, confirming the very high sensitivity and specificity of the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Only one patient from 84 consecutive dental outpatients of unknown HIV serostatus who were examined anonymously for HIV by immunoglobulin G antibody-capture enzyme linked immunosorbent assay showed HIV positivity (1.2% of the population).
PIP: Dental outpatients in Sao Paulo, Brazil, were anonymously screened for HIV through use of a salivary immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. The ages of the 84 consecutive emergency dental patients ranged from 16 to 52 years. Pretesting of the saliva test in 40 patients confirmed to be HIV-positive through two serum assays, and 40 known HIV-seronegatives indicated this method is 100% accurate. Only 1 salivary test (1.2%) among the dental outpatients was positive for HIV antibodies. Salivary antibody testing has the advantages of absence of needlestick injuries, simplicity, ease of collection, lack of need for trained staff, greater compliance in high-risk groups, and better acceptability by children. Moreover, because of the lower titer of HIV in saliva than in blood and the HIV inhibitory action of saliva, this diagnostic method is associated with a reduced risk of occupational hazard during sample collection.
Assuntos
Infecções por HIV/epidemiologia , Soropositividade para HIV/epidemiologia , Adolescente , Adulto , Assistência Ambulatorial , Western Blotting , Brasil/epidemiologia , Assistência Odontológica , Ensaio de Imunoadsorção Enzimática , Feminino , Anticorpos Anti-HIV/análise , Soronegatividade para HIV , Humanos , Imunoglobulina G/análise , Masculino , Pessoa de Meia-Idade , Prevalência , Saliva/imunologia , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To establish normal values and determine the impact of congenital or acquired heart disease on serum cardiac troponin I (cTnI). METHODS: Concentrations of cTnI were measured in two groups of children. Group A represented ambulatory pediatric patients with no apparent cardiac disease (n = 120) and patients in stable condition with known congenital or acquired cardiac abnormalities (n = 96); group B was composed of patients admitted to intensive care units with normal echocardiograms (n = 16), with abnormal echocardiograms (n = 36), and those with blunt chest trauma who were thought to have cardiac contusions (n = 7). RESULTS: The cTnI concentrations were generally less than 2.0 ng/ml in group A and frequently below the level of detection for the assay (1.5 ng/ml). There was no statistical difference between the two outpatient subgroups (p = 0.66). Nine intensive care patients had cTnI values greater than 2.0 ng/ml. Six of these patients, all with abnormal echocardiograms, had values less than 7.7 ng/ml. All improved and had subsequent normal cTnI concentrations. None of the three remaining patients (two with systemic illness (trauma and sepsis) and one with severe pulmonary hypertension), all with values greater than 8.0 ng/ml, survived. Three of the four patients with high likelihood of cardiac contusion had cTnI concentrations greater than 2.0 ng/ml (including one patient who died). CONCLUSIONS: Cardiac troponin-I values are generally not elevated in children with stable cardiac disease or general pediatric conditions. In the context of severe acute illness, significant elevation of cTnI may be an indicator of poor outcome. Elevation of cTnI may also have diagnostic value in cases when cardiac contusion is suspected.
Assuntos
Cardiopatias/sangue , Troponina I/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Cardiopatias/diagnóstico , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/diagnóstico , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
The demographics of 147 HIV-infected persons attending a special care dental clinic in South West England are reported. The majority of attendants were homosexual/bisexual males, reflecting the UK epidemiology of HIV disease at the time of study. There was a substantial rise in patient numbers from 1988 onwards but patients often did not reveal their route of HIV acquisition or increasingly had acquired HIV disease via heterosexual routes. Patients were usually referred for routine dental treatment, not HIV-related oral disease. The HIV-infected patients generally attended the clinic irregularly, despite being offered many appointments. It is concluded that most patients with HIV disease attend clinics for routine dental care, yet many may be unable or unwilling to attend regularly.
Assuntos
Clínicas Odontológicas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Adolescente , Adulto , África/etnologia , Distribuição por Idade , Agendamento de Consultas , Bissexualidade/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Criança , Pré-Escolar , Demografia , Inglaterra/epidemiologia , Europa (Continente)/etnologia , Feminino , Infecções por HIV/etiologia , Infecções por HIV/transmissão , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Gravidez , Encaminhamento e Consulta/estatística & dados numéricos , Distribuição por Sexo , Abuso de Substâncias por Via Intravenosa/complicações , Reação Transfusional , Estados Unidos/etnologia , Índias Ocidentais/etnologiaRESUMO
A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44% of dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease.
Assuntos
Atitude do Pessoal de Saúde , Assistência Odontológica para Doentes Crônicos/psicologia , Odontólogos/psicologia , Soropositividade para HIV/psicologia , Recusa em Tratar/estatística & dados numéricos , Adulto , Brasil , Assistência Odontológica para Doentes Crônicos/estatística & dados numéricos , Odontologia Geral , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Odontalgia/terapiaRESUMO
A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44 percent dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease