Enterobacteriaceae ISOLATES FROM THE ORAL CAVITY OF WORKERS IN A BRAZILIAN ONCOLOGY HOSPITAL

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.

RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS

The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. Aims: The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. Results: Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

Utilidade da Broncofibroscopia no Diagnóstico de Neoplasia do Pulmão em Doentes com Pneumonia Arrastada

A broncofibroscopia (BF) é frequentemente efectuada em doentes com pneumonias de evolução arrastada com o objectivo de excluir patologia endobrónquica de etiologia neoplásica. Dado que a resolução radiográfica das pneumonias da comunidade é variável, sendo dependente de vários factores (agente etiológico, idade, doenças associadas) a decisão para efectuar uma BF é muitas vezes empírica. Com o objectivo de descrever a nossa experiência neste problema estudámos retrospectivamente 123 doentes com o diagnóstico de pneumonia da comunidade baseado em critérios clínicos e radiográficos e que, apesar da antibioferapia considerada adequada, não apresentavam melhoria radiográfica significativa ao fim de pelo menos 2 semanas. Obtivemós um diagnóstico histológico de neoplasia maligna do pulmão em 7 doentes (5,6° o), sendo todos do sexo masculino, com idade superior a 55 anos efuínadores de pelo menos 40 U.M.A. A análise comparativa com os restantes doentes mostrou diferenças com significado~estatístico em relação à idade e ao consumo tabágico. O tempo de evolução da doença,valores médios de hemoglobina, leucocitos, VS, existência ou não de alterações da função renal ou hepática não foram significativamente diferentes nos dois grupos. Concluimos que a BF deve ser efectuada precocemente nos doentes pertencentes ao grupo de risco identificado (fumadores, com mais de 55 anos) não se justificando a sua realização nos restantes doentes antes das 4 a 8 semanas de evolução, a menos que estejam presentes critérios clínicos objectivos tais como progressão da doença ou agravamento do estado geral.

Mutational Analysis of Portuguese Families with Multiple Endocrine Neoplasia Type 1 Reveals Large Germline Deletions

OBJECTIVE: To determine the spectrum of MEN1 mutations in Portuguese kindreds, and identify mutation-carriers. PATIENTS, DESIGN AND RESULTS: Six unrelated MEN1 families were studied for MEN1 gene mutations by single-strand conformational polymorphism (SSCP) and DNA sequence analysis of the coding region and exon-intron boundaries of the MEN1 gene. These methods identified 4 different heterozygous mutations in four families: two mutations are novel (mt 1539 delG and mt 655 ims 11 bp) and two have been previously observed (mt 735 del 46p and mt 1656 del C) all resulting in a premature stop codon. In the remaining two families, in whom no mutations or abnormal MEN1 transcripts were detected, segregation studies of the 5' intragenic marker D11S4946 and codon 418 polymorphism in exon 9 revealed two large germline deletions of the MEN1 gene. Southern blot and tumour loss of heterozygosity analysis confirmed and refined the limits of these deletions, which spanned the MEN1 gene at least from: exon 7 to the 3' untranslated region, in one family, and the 5' polymorphic site D11S4946 to exon 9 (obliterating the initiation codon), in the other family. Twenty-six mutant-gene carriers were identified, 6 of which were asymptomatic. CONCLUSIONS: These results emphasize the importance of the detection of MEN1 germline deletions in patients who do not have mutations of the coding region. Important clues indicating the presence of such deletions may be obtained by segregation studies using the intragenic polymorphisms D11S4946 and at codon 418. The detection of these mutations will help in the genetic counselling of clinical management of the MEN1 families in Portugal.

Hidatidose policística: cisto hidático calcificado, simulando neoplasia mesentérica, descoberto acidentalmente

É descrito um caso de hidatidose abdominal, sem comprometimento hepático, em paciente do Estado do Acre. O cisto, já em degeneração e parcialmente calcificado, foi descoberto, por acaso, mediante estudo radiológico da coluna vertebral feito para avaliação de hérnia de disco, detectada algum tempo antes. Embora as imagens sugerissem uma neoplasia do mesentério, o achado de acúleos rostelares no conteúdo pastoso da hidátide, removida cirurgicamente, permitiu reconhecer-se a natureza parasitária da lesão.

Nódulo pulmonar esquistossomótico simulando neoplasia: relato de caso

Paciente sadio em que, ao exame de rotina, foi detectado nódulo pulmonar esquistossomótico com verme adulto, 25 anos após o tratamento específico com oxamniquine® e distante da região endêmica. O nódulo simulava clinicamente neoplasia.

Esquistossomose mansônica simulando neoplasia da bexiga

Paciente de 36 anos de idade, proveniente de zona endêmica foi admitido com episódios de hematúria macroscópica total e disúria terminal. A citoscopia mostrou um tumor exofítico na parede anterior da bexiga, sugestivo de câncer. A biópsia revelou esquistossomose mansônica. Ressecção transuretral confirmou o diagnóstico. O paciente foi clinicamente tratado com oxamniquine, obtendo cura. O caso apresentado nesse trabalho enfatiza que nem todos os tumores de bexiga com hematúria microscópica são cânceres de bexiga.

Oral cavity lymphoma as secondary AIDS-defining neoplasm in a patient on HAART with immune reconstitution

Lymphomas of the oral cavity are a rare complication of advanced HIV/AIDS disease. The clinical appearance of these neoplasms includes masses or ulcerative lesions that involve the oral soft tissue and the jaw as the predominant manifestation. We report the case of a patient with AIDS who developed diffuse large B-cell non-Hodgkin’s lymphoma of the oral cavity during highly active antiretroviral therapy, with undetectable plasma viral load and immune reconstitution.

Current status of herpesvirus identification in the oral cavity of HIV-infected children

INTRODUCTION: Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS: The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS: Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). CONCLUSIONS: The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Dirofilariasis involving the oral cavity: report of the first case from South America

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

PURPOSE: We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS: Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination. RESULTS: In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion. CONCLUSIONS: In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.

Anphira branchialis GEN. ET SP. NOV. (CRUSTACEA, ISOPODA, CYMOTHOIDAE) A GILL CAVITY PARASITE OF PIRANHAS (Serrasalmus SPP.) IN THE BRAZILIAN AMAZON

Anphira branchialisgen. et sp. nov. (Crustacea, Isopoda, Cymothoidae) is described from the dorsal areas of the gill chambers of three species of piranhas (Serrasalmusspp.). The fishes were caught in rivers near Manaus, Amazonas State and on Maracá island, Federal Territory of Roraima, Brasil. The new genus and species is characterized by having large, flat coxal plates on ail 7 pereonites. These plates usually extend beyond the margins of the following segments and the 7th ones extend nearly to the pleotelson and cover the lateral margins of the pleonites. The mandible of this species is rounded, "foot shaped" and without incisor. The mandibular palp is short and stout. The maxillules have 3 terminal and 2 subterminal spines. The pleopods are simple lamellar structures with rounded tips. Evidence is presented that these parasites feed on gill filaments.

Silver nanoparticles to fight Candida coinfection in the oral cavity

[Exert] This chapter is focused on the activity of silver nanoparticles (SN) as an antifungal agent against Candida albicans and Candida glabrata biofilms, which are involved in oral candidosis. A discussion focusing on the influence of the stabilizing agent, diameter of SN on its antibiofilm activity, influence of chemical stability of SN on Candida biofilms, the effect of SN against adhered cells and biofilms, the effect on extracellular matrix composition and structure of Candida biofilms, the combination of SN with conventional antifungal drugs, and the incorporation of SN into denture acrylic resin is incorporated in the present chapter. Because of the resistance of Candida biofilms to conventional drugs and the positive effect of SN against them, these nanoparticles can be used as an alternative antifungal agent (...).

Interação entre especialidades: miocardiopatia dilatada e neoplasia de mama HER2 positiva

O progresso no conhecimento dos mecanismos da doença e suas potenciais possibilidades de tratamento, têm com o incremento da pesquisa básica, trazido a algumas situações inusitadas. Como quando algo observado em uma situação específica, definida na prática clínica, pode ser transportado para o laboratório, instigando a investigação de uma provável terapêutica em uma doença não relacionada e fazendo o caminho inverso da "bench-to-bedside". Nos últimos anos, o uso de um anticorpo monoclonal, o trastuzumabe, mostrou-se imprescindível no tratamento das neoplasias de mama com amplificação/superexpressão de HER2, com ganho de sobrevida significativo nos contextos adjuvante e terapêutico. A observação da ocorrência de cardiotoxicidade induzida pelo trastuzumabe, assim como a identificação dos mecanismos relacionados a esse efeito colateral, possibilitaram a pesquisa desses mesmos fatores na miocardiopatia dilatada, de uma forma muito interessante.