Abstract Schinus terebinthifolia Raddi green fruits essential oil (EO) was evaluated regarding its phytochemical profile, antimicrobial and cytotoxic activities, and toxicity. Gas chromatography with mass spectrometry was applied to identify its constituents, thereafter the minimum inhibitory concentration, minimum bactericidal and fungicidal concentrations, and its antibiofilm activity were evaluated. The EO cytotoxicity was assessed in tumor and non-tumor human cells, and in vivo toxicity was evaluated in a Galleria mellonella model. The major constituents of S. terebinthifolia EO were alpha-phellandrene and beta-phellandrene. The EO had a weak activity against all strains of Candida albicans (MIC 1000μg/mL) and had no activity against non-albicans strains, bacteria, and C. albicans biofilm. Cytostatic activity against all tumor cell lines was shown. Additionally, cell viability remained at EO concentrations up to 62.5 μg/mL. At 16 mg/mL, 50% hemolysis was observed, and it had low toxicity in vivo. Overall, the S. terebinthifolia EO was characterized by low antimicrobial and antibiofilm activities, with no evidence of toxicity to human tumor and non-tumor cells.

ABSTRACT Objective: To compare salivary and serum biochemical levels in patients with chronic renal failure undergoing hemodialysis. Material and Methods: The sample was composed of 57 patients treated in Hemodialysis Reference Centers, from a state of Northeastern Brazilian, with age ≥21 years old with at least 3 months of hemodialysis treatment time. Serum data were obtained from records. Unstimulated and stimulated saliva were collected. Flow rate (mL/min) was measured. Spectrophotometry was performed for the measurement of salivary levels of calcium (570 nm), urea (340 nm), and creatinine (510 nm). Statistical analysis used Mann Whitney and Kruskal-Wallis tests (p<0.05). Results: Unstimulated and stimulated salivary flow rates were 0.43 mL/min and 1.69 mL/min, respectively. There was significant difference (p<0.001) of levels of calcium (5.41 mg/dL and 9.70 mg/dL), urea (118.03 mg/dL and 183.22 mg/dL) and creatinine (0.59 mg/dL and 9.20 mg/dL) between saliva and serum, respectively. Concerning the time of hemodialysis, salivary and serum calcium not exhibited significant association; however, serum urea (p=0.012) and serum creatinine (p=0.025) showed significant association to the time of hemodialysis. Conclusion: Salivary biochemical levels of urea, creatinine and calcium can indicate the presence of a possible chronic renal failure and the saliva demonstrated to be a potential auxiliary biofluid for clinical monitoring renal alterations.

Abstract: The aim of the present study was to analyze the epidemiology of maxillofacial odontogenic and non-odontogenic cysts diagnosed for 30 years in a Brazilian population. A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of a Brazilian referral center between 1989 and 2019. Data regarding age, gender, anatomical location, and histopathological diagnosis were collected and categorized. Further, a literature search for similar studies was performed. A total of 6.994 biopsy records were evaluated, but only 367 (5.24%) cases were classified as odontogenic cysts (OC) or non-odontogenic cysts (NOC). Among all cystic lesions, 341 cases (92.9%) were OC and 26 cases (7.1%) were NOC. These lesions were more common in females (n = 208 / 56.67%) and located mostly in the mandible (n = 195 / 53.1%). In patients with OC, the radicular cyst was the most frequent (n = 134 / 36.5%), followed by the dentigerous cyst (n = 101 / 27.5%) and the odontogenic keratocyst (n = 52 / 14.2%). Patients with NOC had a higher frequency of epidermoid cyst (n = 12 / 3.3%), oral lymphoepithelial cyst (n = 7 / 1.9%), and nasopalatine duct cyst (n = 4 / 1.1%). The OCs were more prevalent than NOCs, and inflammatory cysts were the most common among all the OCs.

Resumo: Introdução: Os cuidados paliativos (CP) consistem na assistência multidisciplinar e holística ao paciente para melhoria de sua qualidade de vida e de seus parentes, por meio da prevenção e do alívio de enfermidades, de modo a amenizar seus aspectos físicos, sociais, psicológicos e espirituais. Ressalta-se a crescente necessidade de CP, posto que, com o envelhecimento populacional e o aumento da prevalência de doenças crônicas não transmissíveis, há, no mundo, milhões de pessoas que necessitam de CP por ano, das quais apenas 14% recebem esses cuidados até o final da vida. Objetivo: Este estudo teve como objetivo verificar o conhecimento dos formandos de Medicina de 2020 de uma instituição de ensino superior do interior de Goiás acerca dos CP. Método: Este trabalho foi feito por meio de um estudo descritivo, transversal e de natureza quantitativa, no qual se utilizou o Questionário Geral sobre Cuidados Paliativos (QGCP), com adaptações e perguntas objetivas. Aplicou-se o QGCP de forma on-line. O universo amostral foi constituído por 74 formandos. As participações foram de caráter voluntário e, exclusivamente, para fins científicos, respaldando as recomendações éticas de anonimato e confidencialidade. Resultado: Notou-se que a maioria dos participantes considerou os CP como “importantes” ou “muito importantes”, embora uma minoria deles tenha se interessado em realizar alguma formação específica nessa área em sua prática clínica. Além disso, apesar de apenas uma questão do questionário aplicado ter apresentado mais de 50% de erro, inferindo que os participantes demonstram um certo conhecimento em CP, 86,5% (n = 64) dos avaliados não consideraram seu conhecimento acerca de CP como “apropriado” ou “muito apropriado”. Conclusão: Os resultados revelam que, embora os acadêmicos reconheçam a importância dos CP, o desconhecimento acerca da sua filosofia e de seus princípios e a insegurança quanto às condutas a serem prescritas destacam a necessidade de uma educação permanente sobre o assunto. Esses achados corroboram estudos nacionais e internacionais que afirmam a necessidade da disseminação do conhecimento sobre a filosofia e os princípios dos CP.

Abstract: Introduction: Palliative care (PC) consists of multidisciplinary and holistic assistance to the patient to improve their quality of life and that of their relatives, through the prevention and relief of illnesses, seeking to soften their physical, social, psychological and spiritual aspects. There is an outstanding and growing need for PC, given that, with an aging population and increased prevalence of chronic non-communicable diseases, millions of people require PC every year, and only 14% of those people actually receive such services care until the end of life. Objective: To gauge the knowledge of medical graduates in 2020 from a Higher Education Institution in the state of Goiás about PC. Method: This work was conducted through a descriptive, transversal and quantitative study, using the validated questionnaire “General Questionnaire on Palliative Care - QGCP”, containing adaptations and objective questions, performed online. The sample universe consisted of 74 graduates. Participation was voluntary and, exclusively for scientific purposes, in line with the ethical recommendations for anonymity and confidentiality. Results: It was found that the majority of the participants considered PC to be “important” or “very important”, although only a minority were interested in undergoing specific training in this area in their clinical practice. Furthermore, although only one question in the questionnaire was answered incorrectly more than 50% of the time, inferring that the participants demonstrate a certain knowledge in PC, 86.5% (n=64) of the participants did not consider their knowledge about PC as “appropriate” or “very appropriate”. Conclusion: The results reveal that although academics recognize the importance of PC, a lack of knowledge about the underlying philosophy and principles, as well as insecurity regarding the conducts to be prescribed, highlight the need for permanent education on the subject. These findings corroborate national and international studies, which affirm the need to disseminate knowledge about the philosophy and principles of PC.

Abstract Objective: To perform an in vitro analysis of antibacterial and antifungal potential of an alcoholic extract from the leaves of Guapira Graciliflora Mart. against oral microorganisms and determine its chemical composition. Material and Methods: A hydroalcoholic extract of the leaves form G. graciliflora was obtained through maceration, vacuum concentration and freeze-drying. Antibacterial and antifungal activities were evaluated against Streptococcus mutans, Streptococcus salivarius, Streptococcus oralis, Streptococcus parasanguinis, Streptococcus mitis and strains of Candida albicans using broth microdilution method. Phytochemical analysis determined the total phenolic compounds, protein concentration and total of sugars present in the extract. Results: G. Graciliflora demonstrated antifungal activity against the LM 11 and LM 410 clinical isolates of C. albicans (MIC 0.5 mg/mL and 2 mg/mL, respectively). The other microorganisms tested were resistant to the extract. The phytochemical analysis revealed 3% proteins, 13% total sugars and 17% phenolic compounds. Conclusion: G. Graciliflora has antifungal activity against clinical strains of C. albicans and exhibits proteins, sugars and phenolic compounds in its chemical composition.

Resumo Introdução A queilite actínica e uma condição de natureza inflamatória que acomete o lábio inferior, e é causada pela exposição prolongada e crônica dos lábios à radiação ultravioleta proveniente dos raios solares. Objetivo Identificar as características clínicas e histopatológicas em uma série de 40 casos diagnosticados histopatologicamente como queilite actínica. Além disso, investigar possíveis associações entre estes aspectos. Método Caracterizado como um estudo observacional, transversal, retrospectivo e descritivo. Foram registrados dados a respeito da idade, gênero, ocupação, sintomatologia, histórico de exposição ao sol, uso de proteção solar, tabagismo, cor da pele, aspecto clínico e classificação histopatológica. Os dados foram submetidos ao teste de Qui-Quadrado de Pearson (p<0,05). Resultado Houve uma prevalência do gênero masculino, leucodermas, com faixa etária entre 50 e 60 anos e a ocupação mais presente foi a de agricultor. Da amostra, 85% apresentou histórico de exposição crônica ao sol, onde 50% relatou uso de algum tipo de proteção solar e apenas 25% era tabagista. A principal apresentação clínica foi leucoplasia não ulcerada, e no estudo histopatológico as hiperceratoses foram as mais presentes. Não foi possível correlacionar o grau de alteração tecidual verificada no diagnóstico histopatológico com as variáveis clínicas estudadas (p=0,112). Conclusão Não foi possível correlacionar o grau de alteração tecidual verificada no diagnóstico histopatológico com os aspectos clínicos observados. O aspecto clínico da lesão pode mascarar alterações teciduais em diversos estágios, o que enaltece a importância do diagnóstico precoce.

Abstract Introduction Actinic cheilitis is a inflammatory condition affecting mainly the lower lip and it is caused by chronic and excessive exposure of the lips to the ultraviolet radiation in sunlight. Objective Identifying clinical and histopathologic characteristics in 40 cases histopathologically diagnosed as actinic cheilitis. In addition, to investigate possible associations between these aspects. Method Defined as an observational, transversal, retrospective and descriptive study, it registered data regarding age, gender, occupation, symptomatology, records of sun exposure, frequency of sunblock use, tabagism, skin color, clinical aspect and histopathological classification. The data was submitted to the chi square test of Pearson (p<0.05). Result There was a predominance of male gender, leucodermia, and ages ranging between 50 and 60 years. The most common occupation was farming. From our sample, 85% had history of chronic sun exposure, in which 50% reported the use of some type of sunblock and only 25% were smokers. The main clinical condition was non-ulcerated leukoplakia and in the histopathological study, the hyperkeratosis were more common. A correlation between the degree of tissue alteration verified in the histopathological diagnosis and the studied clinical variables was not established (p=0.112). Conclusion The clinical aspect of the wound can conceal tissue alterations in different stages, emphasizing the importance of a premature diagnosis.

Abstract: We evaluated the antifungal and antibiofilm potential of the hydroalcoholic extract of bark from Anadenanthera colubrina (vell.) Brenan, known as Angico, against Candida spp. Antifungal activity was evaluated using the microdilution technique through the Minimum Inhibitory and Fungicide Concentrations (MIC and MFC). The antibiofilm potential was tested in mature biofilms formed by Candida species and analyzed through the counting of CFU/mL and scanning electron micrograph (SEM). In vivo toxicity and therapeutic action was evaluated in the Galleria mellonella model. The treatment with the extract, in low doses, was able to reduce the growth of planktonic cells of Candida species. MIC values range between 19.5 and 39 µg/mL and MFC values range between 79 and 625 µg/mL. In addition was able to reduce the number of CFU/mL in biofilms and to cause structural alteration and cellular destruction, observed via SEM. A. colubrina showed low toxicity in the in vivo assay, having not affected the viability of the larvae at doses below 100mg/kg and high potential in the treatment of C. albicans infection. Considering its high antifungal potential, its low toxicity and potential to treatment of infections in in vivo model, A. colubrina extract is a strong candidate for development of a new agent for the treatment of oral candidiasis.

Abstract Purpose: To evaluate clinically dogs that underwent tibial tuberosity advancement (TTA) six months previously. Methods: Dogs of various breeds, gender, weight, and age that had CCL rupture and underwent TTA for treatment were included in this study. Parapatellar arthrotomy was performed in all patients to assess the joint for a ruptured ligament and meniscal injury before the TTA. The appropriate cage for the TTA was chosen with planning surgery. The surgical procedure was performed according to the literature, using a modified Maquet technique. Six months after surgery, lameness during walking; muscular atrophy; crepitation, cranial drawer and tibial compression tests and quality of life based on owner’s evaluation were assessed. Results: Postoperative complications were observed in only one knee (4.76%), with a surgical site seroma. The mean lameness score at walking was 0.29 (± 0.64). The mean score regarding muscular atrophy was 0.95 (± 1.56). The mean score of the cranial drawer test, in a range from 0 to 5, was 1.52 (± 1.54). The owners rated the dog’s quality of life as excellent in 44%, good in 30%, and moderate in 17%. Conclusion: This clinical study supports the affirmation that patients who undergo TTA for treatment of CCL rupture have an acceptable response.

Abstract: The aim of this study was to evaluate in vitro the antifungal, antibiofilm and antiproliferative activities of the extract from the leaves of Guapira graciliflora Mart. The phytochemical characterization of the extract was performed using electrospray ionization mass spectrometry (ESI-MS). The antimicrobial activity of the extract and its fractions was evaluated using the broth microdilution method against species of Candida. The inhibition of C. albicans biofilm was evaluated based on the number of colony-forming units (CFU) and metabolic activity (MTT). The antiproliferative activity of the extract and its fraction was evaluated in the presence of human tumor and non-tumor cells, and the cytotoxicity of the extract was determined on the RAW 264.7 macrophage line – both using the sulforhodamine B method. The phytochemical characterization indicated the presence of the flavonoids rutin and kaempferol. The extract and the methanol fraction exhibited moderate antifungal activity against C. albicans, C. krusei, and C. glabrata, and strong activity against C. dubliniensis. In the biofilms at 24 and 48 hours, the concentration of 12500 µg/mL of the extract was the most effective at reducing the number of CFU s/mL (44.4% and 42.9%, respectively) and the metabolic activity of C. albicans cells (34.6% and 52%, respectively). The extract and its fractions had no antiproliferative effect on the tumor lines tested, with mean activity (log GI50) equal to or greater than 1.71 µg/mL. Macrophage cell viability remained higher than 80% for concentrations of the extract of up to 62.5 µg/mL. G. graciliflora has flavonoids in its chemical composition and demonstrates potential antifungal and antibiofilm activity, with no evidence of a significant change in the viability of human tumor and non-tumor cell lines.

RESUMO Os cistos odontogênicos ortoceratinizados são cistos de desenvolvimento de origem odontogênica, de baixa frequência, etiopatogenia desconhecida e baixa taxa de recorrência. Radiograficamente, apresenta-se como uma área radiolúcida em região posterior de mandíbula. O objetivo deste artigo é descrever um caso não usual de cistos odontogênicos ortoceratinizados, que exibia, radiograficamente, focos radiopacos semelhantes à calcificações, no interior da lesão, sugerindo diagnóstico clínico de fibro-odontoma ameloblástico. Após a biópsia incisional e análise microscópica, o diagnóstico conclusivo foi de cistos odontogênicos ortoceratinizados. Observou-se que os focos radiopacos estavam associados, microscopicamente, a presença de uma reação de células gigantes multinucleadas por corpo estranho. O paciente foi tratado cirurgicamente, sob anestesia local, com acesso intrabucal para remoção total da lesão, com o restabelecimento da estética e sem sinais de recidiva após 24 meses. A importância do conhecimento deste tipo de reação dar-se pelo risco de mimetizar uma lesão potencialmente mais agressiva, direcionando a escolha do tratamento da lesão.

ABSTRACT Orthokeratinized odontogenic cysts are developmental odontogenic cysts, presenting with low frequency, low rate of recurrence and their ethiopathogenesis is unknown. Radiographically, they show a radiolucent area in the mandibular posterior region. The aim of this report is to describe an unusual case of orthokeratinized odontogenic cysts, radiographically exhibiting radiopaque areas with an aspect of calcifications in the lesion. Based on this, the clinical hypothesis of ameloblastic fibro-odontoma was suggested. After incisional biopsy and microscopic analysis, the conclusive diagnosis was orthokeratinized odontogenic cysts. The radiopaque foci were observed to be associated with a foreign body reaction. The patient was submitted to surgery under local anesthesia, with intraoral access for complete excision of the lesion and to re-establish esthetics. After follow-up of 24 months there were no signs of recurrence. Knowledge of this type of reaction is important because of the risk that the lesion may mimic a potentially more aggressive lesion, affecting the choice of treatment.

Abstract: Background: The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. Objective: To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. Methods: We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. Results: Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. Conclusion: This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis.

Abstract: The aim of this study was to determine the number of FoxP3+ regulatory T (Treg) cells in the microenvironment of lower lip squamous cell carcinomas (LLSCCs) and to correlate the findings with clinicopathological parameters (tumor size/extent, regional lymph node metastasis, clinical stage, and histopathological grade of malignancy). Fifty cases of LLSCC were selected. Lymphocytes exhibiting nuclear immunostaining for FoxP3 were quantified in 10 microscopic fields at the deep invasive front of LLSCCs. The results were analyzed statistically using the nonparametric Mann-Whitney test and Fisher's exact test. FoxP3+ lymphocytes were observed in all cases studied. The number of these cells tended to be higher in smaller tumors, tumors without regional lymph node metastasis, and tumors in early clinical stages, but the difference was not statistically significant (p > 0.05). Low-grade tumors contained a larger number of FoxP3+ lymphocytes than high-grade tumors (p = 0.019). Tumors with an intense inflammatory infiltrate exhibited a larger number of Treg cells (p = 0.035). On the other hand, the number of FoxP3+ lymphocytes was smaller in tumors arranged in small cell clusters (p = 0.003). No significant differences in the number of FoxP3+ lymphocytes were observed according to the degree of keratinization (p = 0.525) or nuclear pleomorphism (p = 0.343). The results suggest the participation of Treg cells in immune and inflammatory responses in the microenvironment of LLSCCs. These cells may play a more important role in early stages rather than in advanced stages of lip carcinogenesis.

Abstract The objective of this study was to analyze the presence of tumor-associated macrophage (TAM) subpopulations M1 and M2 in squamous cell carcinoma of the lower lip (SCCLL) by immunohistochemitry, and to evaluate the possible role of these subtypes in the development of regional lymph node metastasis and their association with clinical and pathological parameters. Forty-two cases of SCCLL were divided into two groups (21 with and 21 without regional lymph node metastasis). The histopathological grade of malignancy was determined and the material was submitted to double staining with anti-CD68/anti-CD163 and anti-CD68/anti-HLA-DR monoclonal antibodies. The results were analyzed statistically using the Wilcoxon signed-rank and Spearman correlation tests. The M1 and M2 subpopulations were observed in all cases studied. No significant difference was observed between the quantities of M1 and M2 TAMs regarding tumor size (p > 0.05). A significantly larger number of M2 compared to M1 TAMs was observed in tumors without regional lymph node metastasis, tumors in early stages, and low-grade tumors (p < 0.05). No significant difference between the numbers of M1 and M2 TAMs was observed in tumors with regional lymph node metastasis, tumors in advanced stages, and high-grade tumors (p > 0.05). There was a positive weak correlation between M1 and M2 TAMs (r = 0.361; p = 0.019). The results suggest a more important role of M2 TAMs in early stages than advanced stages of lip carcinogenesis. The progression of SCCLL does not seem to be related to an imbalance of macrophage polarization in the microenvironment of these tumors.

BACKGROUND: Patients with diabetes mellitus have been associated with a number of changes in the oral cavity, such as gingivitis, periodontitis, mucosal diseases, salivary dysfunction, altered taste, and burning mouth. OBJECTIVES: To determine the prevalence of oral mucosal lesions in patients with diabetes mellitus. METHODS: A cross-sectional observational study between August and October 2012 with a convenience sampling was performed for 51 patients with diabetes mellitus (type 1 and type 2). The study consisted of two phases: 1) a questionnaire application; 2) intraoral clinical examination. For the analysis of data, we used descriptive statistics, Fisher's exact test in bivariate analysis (significance level of 0.05), and Poisson Regression. RESULTS: The prevalence of oral lesions was 78.4%. Traumatic ulcers (16.4%) and actinic cheilitis (12.7%) were the most prevalent lesions. The lips (35.3%) and tongue (23.5%) were the most common location. The bivariate analysis showed an association with the type of diabetes, and two variables (age and comorbidity) were quite close to the significance level. In the Poisson Regression analysis, only diabetes type 2 remained significant after adjusting the model. CONCLUSIONS: The results of this study show a high prevalence of oral mucosal lesions in diabetic patients. The oral mucosal lesions are mostly associated with diabetes type 2.