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Dantas TS, Silva PGDB, de Oliveira Filho OV, Magalhães IA, Alves APNN, Cunha MDPSS, Mota MRL, Leitão RFDC, Sousa FB. Mu and Kappa opioid receptor immunolabeling indicates the prognosis of oropharyngeal squamous cell carcinoma: A cross-sectional observational study. J Stomatol Oral Maxillofac Surg 2023; 124:101554. [PMID: 37453566 DOI: 10.1016/j.jormas.2023.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Opioids are the most effective drugs currently available for cancer pain management. The administration of morphine, in addition to its analgesic effect, can alter tumor development. OBJECTIVE To characterize the immunoexpression of opioid receptors µ and κ in oropharyngeal squamous cell carcinoma, and correlate it with prognostic factors, proliferation markers, and cell death. MATERIALS AND METHODS A retrospective, cross-sectional observational study was carried out with 50 patients diagnosed at Haroldo Juaçaba Hospital. Sociodemographic, clinicopathological, and overall survival data were collected, and excisional biopsies were taken for immunohistochemistry using tissue microarrays for opioid receptors µ and κ, Ki-67, and caspase-3. Immunolabeling was evaluated and correlated with other variables using Mann-Whitney, Kruskal-Wallis, Spearman correlation, log-rank (Mantel-Cox), and Cox regression tests. RESULTS Immunoexpression of opioid receptors µ and κ, Ki-67, and caspase-3 was significantly higher in p16+ and p16- primary tumors and lymph node metastases than in surgical resection margins. The overall survival of patients with p16- tumors was 57.53 ± 8.43 months and that of patients with p16+ tumors was slightly higher at 75.92 ± 11.14 months. Multivariate analysis showed that the expression of opioid receptors µ and κ in the nucleus was directly associated with a lower and higher risk of death, respectively. CONCLUSION We found increased expression of opioid receptors µ and κ in tumor tissues. The nuclear expression of opioid receptors µ and κ influences overall survival and may be a prognostic factor of oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- Thinali Sousa Dantas
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
| | - Paulo Goberlânio de Barros Silva
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil; Ceará School of Oncology, Haroldo Juaçaba Hospital, Fortaleza, Ceará, Brazil.
| | | | | | | | | | - Mário Rogério Lima Mota
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Ceará, Brazil
| | | | - Fabrício Bitu Sousa
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil; Ceará School of Oncology, Haroldo Juaçaba Hospital, Fortaleza, Ceará, Brazil
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Carlos ACAM, Lemos JVM, Borges MMF, Albuquerque MCP, Sousa FB, Alves APNN, Dantas TS, Silva PGDB. Interleukin-17 plays a role in dental pulp inflammation mediated by zoledronic acid: a mechanism unrelated to the Th17 immune response? J Appl Oral Sci 2023; 31:e20230230. [PMID: 37820184 PMCID: PMC10567106 DOI: 10.1590/1678-7757-2023-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To evaluate the influence of RORγT inhibition by digoxin on inflammatory changes related to interleukin-17 (IL-17) in the pulp of rats treated with zoledronate (ZOL). METHODOLOGY Forty male Wistar rats were divided into a negative control group (NCG) treated with saline solution, a positive control group (PCG) treated with ZOL (0.20 mg/kg), and three groups treated with ZOL and co-treated with digoxin 1, 2, or 4 mg/kg (DG1, 2, and 4). After four intravenous administrations of ZOL or saline solution in a 70-day protocol, the right molars were evaluated by histomorphometry (number of blood vessels, blood vessels/µm2, cells/µm2, total blood vessel area, and average blood vessel area) and immunohistochemistry (IL-17, TNF-α, IL-6, and TGF-β). The Kruskal-Wallis/Dunn test was used for statistical analysis. RESULTS PCG showed an increase in total blood vessel area (p=0.008) and average blood vessel area (p=0.014), and digoxin treatment reversed these changes. DG4 showed a reduction in blood vessels/µm2 (p<0.001). In PCG odontoblasts, there was an increase in IL-17 (p=0.002) and TNF-α (p=0.002) immunostaining, and in DG4, these changes were reversed. Odontoblasts in the digoxin-treated groups also showed an increase in IL-6 immunostaining (p<0.001) and a reduction in TGF-β immunostaining (p=0.002), and all ZOL-treated groups showed an increase in IL-17 (p=0.011) and TNF-α (p=0.017) in non-odontoblasts cells. CONCLUSION ZOL induces TNF-α- and IL-17-dependent vasodilation and ectasia, and the classical Th17 response activation pathway does not seem to participate in this process.
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Affiliation(s)
| | - José Vitor Mota Lemos
- Universidade Federal do Ceará, Departmento de Patologia Oral, Fortaleza, Ceará, Brasil
| | | | | | - Fabrício Bitu Sousa
- Universidade Federal do Ceará, Departmento de Patologia Oral, Fortaleza, Ceará, Brasil
- Centro Universitário Christus, Departamento de Patologia, Fortaleza, Ceará, Brasil
| | | | - Thinali Sousa Dantas
- Centro Universitário Christus, Departamento de Patologia, Fortaleza, Ceará, Brasil
| | - Paulo Goberlânio de Barros Silva
- Universidade Federal do Ceará, Departmento de Patologia Oral, Fortaleza, Ceará, Brasil
- Centro Universitário Christus, Departamento de Patologia, Fortaleza, Ceará, Brasil
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Lima KLDF, Magalhães IA, Arruda LMD, Dantas TS, Silva PGDB. A simple and low-cost technic for immobilization of mandible during head and heck radiotherapy: a technical note. Int J Radiat Biol 2022; 99:875-878. [PMID: 36374113 DOI: 10.1080/09553002.2023.2146229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immobilization protocols for head and neck radiotherapy (HNR) are needed to reduce radiation dispersion in non-tumoral tissues and to reduce damage to noble structures; however, involuntary mandibular movements require additional adaptations of thermoplastic masks. PURPOSE Our objective was to describe an easy and low-cost disposition to help thermoplastic masks immobilize the mandible during HNR. MATERIALS AND METHODS We created Styrofoam models to stabilize the mandible which was used to make adaptation to the thermoplastic masks. The Styrofoam model was inserted into alginate to construct a mold and a self-curing acrylic resin was added into the mold. After the acrylic resin hardened, the dispositive mandibular immobilizer was removed from the alginate mold and adjusted with Maxicut and Minicut or other drills and sandpaper. The alginate mold can be used on the same day to create backup devices. RESULTS AND CONCLUSIONS Our device was made in a simple way, has a low cost, and helps the thermoplastic masks to immobilize the mandible, leading to a more precise individualization of head and neck immobilization that can reduce unanticipated radiation scatter and improve radiation distribution.
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Affiliation(s)
- Karisa Lorena de Freitas Lima
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital da Liga Mossoroense de Estudos e Combate ao Câncer, Mossoró, Rio Grande do Norte, Brazil
| | | | | | | | - Paulo Goberlânio de Barros Silva
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
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do Rêgo TJR, Lemos JVM, Matos APL, Caetano CFF, Dantas TS, Sousa FB, de Barros EM, Silva PGDB. Development and professional validation of an App to support Oral Cancer Screening. Braz Dent J 2022; 33:44-55. [PMID: 36477964 PMCID: PMC9733366 DOI: 10.1590/0103-6440202204895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to develop and validate an App for identifying risk factors for oral cancer. To this end, we developed an App (OCS: Oral Cancer Screening) with predictors of Oral Cancer (OC) and algorithm assembly to estimate the risk of its development. METHODOLOGY Simulated clinical cases were designed so that 40 professionals with expertise in oral diagnostics could validate the algorithm and test its usability (SUS: System Usability Score) and acceptability (TAM: Technology Acceptance Model). Cronbach's alpha coefficient, Friedman/Dunn tests, and Spearman correlation evaluated the SUS and TAM scales. ROC curve was plotted to estimate the cutoff point of the algorithm in suggesting a high risk for OCS of the simulated cases. Chi-square and Fisher's exact tests were additionally used (p<0.05, SPSS v20.0). RESULTS Professionals with expertise in oral diagnosis had usability of 84.63±10.66 and acceptability of 84.75±10.62, which correlated positively (p<0.001, r=0.647). Acting in clinical areas of dentistry (p=0.034) and history of performing OC risk factor orientation (p=0.048) increased acceptability while acting in higher education increased usability (p=0.011). The cutoff point suggested by the App after validation of the simulated clinical cases showed high sensitivity of 84.8% and lower specificity of 58.4%. CONCLUSION The OCS was effective and with adequate sensitivity, usability, and acceptability and may contribute to the detection of early oral lesions.
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Affiliation(s)
- Talita Jordânia Rocha do Rêgo
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - José Vitor Mota Lemos
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | - Amanda Pinheiro Leitão Matos
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará. Fortaleza, Ceará, Brazil
| | | | - Thinali Sousa Dantas
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil
| | - Fabrício Bitu Sousa
- Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brazil
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Dantas TS, de Sousa ASA, Sales TOP, deOliveira Filho OV, de Barros Silva PG, Alves APNN, Mota MRL, Sousa FB. Outcomes of Oral and Oropharyngeal Squamous Cell Carcinoma Related to Healthcare Coverage: A Retrospective Cohort Study in Brazil. Cancer Invest 2022; 40:680-692. [PMID: 35731734 DOI: 10.1080/07357907.2022.2092634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.
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Affiliation(s)
- Thinali Sousa Dantas
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
| | | | | | - Osias Vieira deOliveira Filho
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Paulo Goberlânio de Barros Silva
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
| | | | - Mário Rogério Lima Mota
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Fabrício Bitu Sousa
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
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Silva PGDB, Neto RADLP, Lima LA, Lemos JVM, Rodrigues MIDQ, Alves APNN, Dantas TS, Lima RA. Photodynamic therapy and photobiomodulation therapy in zoledronic acid-induced osteonecrosis in rats. Photodiagnosis Photodyn Ther 2022; 38:102889. [PMID: 35489689 DOI: 10.1016/j.pdpdt.2022.102889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the effect of antimicrobial photodynamic therapy (PDT), using methylene blue (MBO) and photobiomodulation therapy (PT), on the alveolar bone of rats submitted to bisphosphonate-induced osteonecrosis of the maxillaries (OMB) model using zoledronic acid (ZA). METHODS Sixty rats divided into six groups were used: SALINE, PDT, ZA, ZA+PDT, ZA+PT, and ZA+MBO. Three weekly administrations (Days 0, 7, and 14) of ZA 0.20 mg/kg or saline solution were performed. After one month (Day 42), the exodontia of the left lower first molars were performed. An additional dose of ZA was administered at Day 49. PDT was performed on days 42, 45, 49, and 54. One month after exodontia (Day 70), the animals were euthanized to obtain samples for imaging and microscopic analysis. ANOVA/Bonferroni tests were used for statistical analysis. RESULTS The ZA+PDT group showed a significantly lower percentage of apoptotic osteocytes than the ZA group (p<0.001). The ZA+MBO, ZA+PT, and PDT groups significantly reduced the number of mononuclear cells compared to the ZA group (p<0.001). The ZA+PT and ZA+PDT groups showed a significant reduction in the number of CD 68+ (p<0.001) and CD3+ (p=0.002) cells compared to the ZA group. The number of cells expressing INF-y had a significant reduction in the groups co-treated with PT and PDT compared to the ZA group (p<0.001). CONCLUSIONS We conclude that PDT and PT attenuated the severity of OMB and the inflammatory process due to a reduction of macrophages, T lymphocytes, and cytokines that stimulate the activity of these cells.
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Affiliation(s)
- Paulo Goberlânio de Barros Silva
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | | | - Laís Aragão Lima
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - José Vitor Mota Lemos
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Maria Imaculada De Queiroz Rodrigues
- Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Ana Paula Negreiros Nunes Alves
- Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Thinali Sousa Dantas
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Ramille Araújo Lima
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil.
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Magalhães IA, Dantas TS, de Paulo JPM, Marçal FF, Viana TSA, Sousa FB, Barros Silva PGD. Sociodemographic factors affect the quality of life and burden of caregivers in special care in dentistry. Spec Care Dentist 2022; 42:464-475. [PMID: 35325480 DOI: 10.1111/scd.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/08/2021] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
AIMS To analyze the epidemiological profile and quality of life (QoL) of patients with special needs and overload their caregivers. METHODS AND RESULTS Health-related QoL was assessed in a quantitative, observational, cross-sectional study of prospective characteristics using the WHOQOL-BREF and ZARIT-22 questionnaires. This study included 122 patients were included; they were divided into patients without caregiver assistance (n = 63) who answered WHOQOL-BREF, 49 caregivers (n = 49) who responded to ZARIT-22, and 10 patients were secondarily caregivers of their parents and answered the ZARIT-22 + WHOQOL-BREF questionnaires. The WHOQOL-BREF general score was 71.94 ± 10.58, and patients born in urban areas and married had positive correlations (p < .05) with the QoL scores in the physical and social domains. ZARIT-22 scores showed an average of 58.63 ± 14.07. Data cross-checking revealed that patients of white races (p = .030) and who lived in urban regions (p = .003) generated less overload to caregivers. CONCLUSION In the WHOQOL-BREF analysis, family income was a factor with direct impact, and all caregivers referred to moderate-to-high overload, with an increase in prevalence as far away from the service the patient resides.
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Affiliation(s)
| | - Thinali Sousa Dantas
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil
| | | | | | | | - Fabrício Bitu Sousa
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil.,Department of Stomatology and Oral Pathology, Federal University of Ceara, Fortaleza, Brazil
| | - Paulo Goberlânio de Barros Silva
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil.,Department of Stomatology and Oral Pathology, Federal University of Ceara, Fortaleza, Brazil
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de Barros Silva PG, Filho ELC, Nigri FMN, Dantas TS, de Miranda Candeiro GT, Neri JR. Photobiomodulation Reduces Pain-Related Symptoms Without Interfering in the Efficacy of In-Office Tooth Bleaching: A Systematic Review and Meta-Analysis of Placebo-Controlled Clinical Trials. Photobiomodul Photomed Laser Surg 2022; 40:163-177. [DOI: 10.1089/photob.2021.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paulo Goberlânio de Barros Silva
- Department of Dentistry, University Center Christus, Fortaleza, Brazil
- Graduate School of Dentistry, University Center Christus, Fortaleza, Brazil
| | - Edson Luiz Cetira Filho
- Department of Dentistry, University Center Christus, Fortaleza, Brazil
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - George Táccio de Miranda Candeiro
- Department of Dentistry, University Center Christus, Fortaleza, Brazil
- Graduate School of Dentistry, University Center Christus, Fortaleza, Brazil
| | - Jiovanne Rabelo Neri
- Department of Dentistry, University Center Christus, Fortaleza, Brazil
- Graduate School of Dentistry, University Center Christus, Fortaleza, Brazil
- Graduate School of Dentistry, University of Fortaleza, Fortaleza, Brazil
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Silva PGDB, Dias CC, Machado LC, Carlos ACAM, Dantas TS, Ximenes J, Sousa RMRB, Sousa FB. Distance education in dentistry in Brazil: a critical STROBE-based analysis. Braz Oral Res 2021; 35:e109. [PMID: 34816897 DOI: 10.1590/1807-3107bor-2021.vol35.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has forced dentistry schools (DSs) to adapt their teaching techniques to digital platforms. Therefore, we aimed to evaluate distance classes in the Brazilian DS curriculum. After an online search of higher education institutions (HEIs) with DS on the e-Ministry of Education (MEC) platform, we included institutions with at least one graduated class to extract the age/localization of the DS, funding, number of authorized seats, MEC-grade, ENADE-score, and workload. HEIs' webpages were consulted to identify the curriculum, subjects offered in the distance education (DE) format, extracurricular programs, scientific events, postgraduate programs, and institutional YouTube channels. Chi-square/Fisher's tests plus binary logistic regression were performed (SPSS 20.0, p < 0.05). Of the 241 DSs evaluated, 82 (34.0%) offered distance classes, and a high prevalence was observed in the southeast region (p <0.001) and private HEIs (p = 0.001). HEIs with distance classes had lower ENADE scores (p = 0.004), lower workload (p = 0.007), and higher workload for optional subjects (p = 0.016), doctoral programs (p = 0.041), specialization courses (p = 0.017), and institutional YouTube channels (p < 0.001). Southern dental schools (p < 0.001), lower workload (p = 0.022), optional subjects (p = 0.033), and institutional YouTube channels (p = 0.005) were independently associated with distance classes. In one-third of the Brazilian DSs, distance classes and institutional YouTube channels were strongly associated variables. The association of distance learning with lower workload and low academic performance draws attention to the need for regulatory bodies for controlling the quality of DE.
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Affiliation(s)
| | - Camila Costa Dias
- Centro Universitário Christus, Department of Odontology, Fortaleza, CE, Brazil
| | | | | | | | - Juliana Ximenes
- Centro Universitário Christus, Department of Odontology, Fortaleza, CE, Brazil
| | | | - Fabrício Bitu Sousa
- Centro Universitário Christus, Department of Odontology, Fortaleza, CE, Brazil
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De Sousa AM, Dantas TS, Barros Silva PGD, Martins CDS, Freire GE, Junior HLR, Brito GADC, Pereira KMA, Leitão RFDC. Analysis of the Immunoexpression of Opioid Receptors and their Correlation with Markers of Angiogenesis, Cell Proliferation and Apoptosis in Breast Cancer. Asian Pac J Cancer Prev 2021; 22:633-640. [PMID: 33639684 PMCID: PMC8190334 DOI: 10.31557/apjcp.2021.22.2.633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Breast cancer is a disease of great concern. The prognosis of this tumor is related to its staging. Opioids are widely used to minimize pain in oncology clinics; however, the relationship between the administration of opioids and their effects on tumor cells has yet to be elucidated. Therefore, this study aimed to evaluate the immunoexpression of mu- (μ) and kappa- (κ) opioid receptors and their correlation with markers of angiogenesis, cell proliferation, and apoptosis in biopsies of breast tumors. Methods: Demographic data, tumor characteristics, opioid use, and prognostic factors were collected from medical records. After the selection of the excisional biopsies, immunohistochemistry was performed for μ- and κ-opioid receptors, vascular endothelial growth factor (VEGF), Ki-67, and TUNEL. Results: A significant predominance of Ki-67 and μ-opioid receptor immunoexpression in the lymph nodes was observed in patients administered opioid medications. The luminal A subtype showed higher apoptosis levels (TUNEL) compared to the luminal B subtype. Patients with T4 tumor who had recurrence demonstrated a reduced expression of κ-opioid receptors at the lymph node location. Correlation analyses between the μ and κ opioid markers, VEGF, Ki-67, and TUNEL showed that these findings are likely involved in the same mechanisms the cancer of T4 stage breast cancer. Conclusion: The κ-opioid receptor has a lower immunoexpression in nodal tumor metastasis with recurrence, whereas the μ-opioid receptor is directly related to expression of TUNEL-positive cells in tumors and indirectly to Ki-67 in nodal metastasis. Neither of the two receptors was expressed in the primary tumor or nodal metastasis in relation to VEGF.
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Affiliation(s)
- Alceu Machado De Sousa
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Thinali Sousa Dantas
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Gildenio Estevam Freire
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Magalhães IA, Forte CPF, Viana TSA, Teófilo CR, Lima Verde RDMB, Magalhães DP, Praxedes Neto RADL, Lima RA, Dantas TS. Photobiomodulation and antimicrobial photodynamic therapy as adjunct in the treatment and prevention of osteoradionecrosis of the jaws: A case report. Photodiagnosis Photodyn Ther 2020; 31:101959. [PMID: 32818642 DOI: 10.1016/j.pdpdt.2020.101959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023]
Abstract
CASE REPORT We report on a patient with a history of radiotherapy to the head and neck region exhibiting necrotic bone exposure associated with fistula and purulent exudation in the mandible, with the diagnosis of stage 3 osteoradionecrosis, in addition to a periapical cyst in the maxillary anterior region and multiple root remnants. An antibiotic coverage protocol with amoxicillin and metronidazole was prescribed for subsequent necrotic bone removal. The surgical procedure was performed along with the aPDT using methylene blue and red light, followed by coaptation of the edges of the surgical wound and the healing protocol with LLLT. The extraction of non-rehabilitated teeth was performed two per session using antibiotic coverage, aPDT, and LLLT and mouthwash with 0.12 % chlorhexidine was prescribed until the complete closure of the surgical wound was achieved. Additionally, two aPDT sessions and four LLLT protocols were performed for complete healing of the surgical sites. Extra and intraoral examinations and panoramic and periapical radiographs were performed. No emergence or recurrence of osteonecrosis was observed after 12 months of follow-up.
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Filho OVDO, Rêgo TJRD, Mendes FHDO, Dantas TS, Cunha MDPSS, Malta CEN, Silva PGDB, Sousa FB. Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients. Braz J Otorhinolaryngol 2020; 88:365-374. [PMID: 32855094 PMCID: PMC9422552 DOI: 10.1016/j.bjorl.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. OBJECTIVE To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands METHODS: This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). RESULTS The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116±6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p=0.001), referral origin from the public health system (p=0.011), T stage (p= 0.007), M stage (p< 0.001), clinical stage (p< 0.001), compromised surgical margins (p= 0.013), and chemotherapy (p< 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p= 0.016). The level of education was the only factor more prevalent in older patients (p= 0.011). CONCLUSIONS Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.
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Affiliation(s)
- Osias Vieira de Oliveira Filho
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Divisão de Patologia Oral, Fortaleza, CE, Brazil
| | | | | | - Thinali Sousa Dantas
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Divisão de Patologia Oral, Fortaleza, CE, Brazil; Centro Universitário Christus (Unichristus), Departamento de Odontologia, Fortaleza, CE, Brazil
| | | | - Cássia Emanuella Nóbrega Malta
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Divisão de Patologia Oral, Fortaleza, CE, Brazil
| | - Paulo Goberlânio de Barros Silva
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Divisão de Patologia Oral, Fortaleza, CE, Brazil; Centro Universitário Christus (Unichristus), Departamento de Odontologia, Fortaleza, CE, Brazil.
| | - Fabrício Bitu Sousa
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Divisão de Patologia Oral, Fortaleza, CE, Brazil; Centro Universitário Christus (Unichristus), Departamento de Odontologia, Fortaleza, CE, Brazil
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De Barros Silva PG, Leite Soares I, De Oliveira Mendes FH, Sales de Paula Campêlod C, Saldanha de Cunha MDPS, Lima Mota MR, Sousa Dantas T, Bitu Sousa F. Histórico de Consumo de Álcool como Fator Preditivo de Sobrevida em Pacientes com Carcinoma de Células Escamosas de Boca e Orofaringe: Follow-up de 15 Anos. Rev Brasileira De Cancerologia 2020. [DOI: 10.32635/2176-9745.rbc.2020v66n1.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introdução: O carcinoma de células escamosas é o tumor de maior importância na região de cabeça e pescoço, em razão da sua incidência e mortalidade. Sabe-se que fatores como consumo de álcool estão relacionados à diminuição da sobrevida de tumores tanto estimulando a progressão tumoral como causando comorbidades importantes, sendo um fator relevante para estudo. Objetivo: Avaliar a influência do histórico de álcool em características clinicoprognósticas de pacientes com carcinoma de células escamosas de boca e orofaringe (CCEBO). Método: Estudo de coorte, retrospectivo, no qual 156 prontuários de pacientes etilistas e 78 prontuários de pacientes não etilistas com CCEBO diagnosticados no Hospital Haroldo Juaçaba, em Fortaleza, Ceará, foram avaliados, entre 2000 e 2014, para análise de dados como idade, sexo, raça, localização do tumor, estadiamento TNM, tratamentos realizados e sobrevida em 15 anos por meio dos testes X², Long-Rank e modelos de regressão multinomial e de Cox (SPSS 20,0; p<0,05). Resultados: Houve maior prevalência de homens entre os pacientes etilistas (p<0,001), com tumores T3-T4 (p=0,003), linfonodos positivos (p=0,006) que realizaram tratamentos paliativos (p<0,001) e menor prevalência abaixo de 65 anos (p<0,001), quando havia histórico familiar de câncer (p=0,043). A sobrevida dos pacientes etilistas foi menor (p=0,040) e os fatores que diminuíram a sobrevida de maneira independente foram sexo masculino (p=0,042), estadiamento T3-T4 (p=0,004), metástase linfonodal (p=0,012), idade >65 anos (p=0,035) e localização na língua (p=0,042). O sexo masculino foi independentemente associado ao etilismo (p<0,001). Conclusão: O álcool é um fator de prognóstico em pacientes com CCEBO, mostrando maior prevalência em pacientes T3-T4 e, assim, influenciando negativamente no prognóstico.
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Mesquita KC, Dantas TS, de Barros Silva PG, de Queiroz Rodrigues MI, Alves APNN, Mota MRL, Sousa FB. Abatacept treatment impairs the cell migration and wound healing of oral ulcers in rats: Role of interleukin (IL)-1β, -6 and -10 and CD8/CD30 cells: Influence of abatacept treatment on oral wound healing: Experimental model on rats. Life Sci 2020; 243:117243. [PMID: 31917994 DOI: 10.1016/j.lfs.2019.117243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
The present study aimed to evaluate the healing process of ulcers in the jugal mucosa of Wistar rats treated with abatacept. The rats were randomly assigned to four groups: saline-treated control (0.3 mL/kg) abatacept-treated groups at dosages of 3.2, 8.0 and 20.0 mg/kg/week. After two weeks of subcutaneous (SC) administration, ulcers were introduced into the left jugal mucosa with an 8-mm diameter punch. SC administration was continued until euthanasia (after 1, 3, 7, 14 and 21 days of ulceration), and ulcers were clinically measured and animals weighed. Histological slides were evaluated (healing scores and polymorphonuclear, mononuclear, vessel, and fibroblast/myofibroblast counts). We also performed collagenesis analysis (Picrosirius Red) and immunohistochemistry (induced nitric oxide synthase (iNOS), interleukin (IL)-1beta (1β), -6, -10, plus the analysis of CD8 and CD30). The experiment was repeated to perform a vascular permeability assay. ANOVA 1-way or 2-way/Bonferroni and Kruskal-Wallis/Dunn tests were used for statistical analysis (GraphPad Prism 5.0®, p < 0.05). Abatacept treatment reduced the ulcer diameter and the numbers of polymorphonuclear and mononuclear cells; reduced the CD8+/CD30+ ratio and vascular permeability; and increased collagenesis and IL-10 expression at the beginning of the protocol. At the highest dose, there was a delay in repair and vascular proliferation; a reduction in the number of fibroblasts/myofibroblasts; and prolongation of iNOS, IL- and IL- expression. We conclude that abatacept accelerates the healing of oral ulcers by reducing the migration of inflammatory cells, but overdose of abatacept leads to delayed repair and prolongation of proinflammatory cytokine expression.
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Affiliation(s)
- Karine Cestaro Mesquita
- Division of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
| | - Thinali Sousa Dantas
- Division of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
| | - Paulo Goberlânio de Barros Silva
- Division of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
| | | | | | | | - Fabrício Bitu Sousa
- Division of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
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Dantas TS, Silva PGDB, Verde MEQL, Júnior ADLR, Cunha MDPSS, Mota MRL, Alves APNN, Leitão RFDC, Sousa FB. Role of Inflammatory Markers in Prognosis of Oral Squamous Cell Carcinoma. Asian Pac J Cancer Prev 2019; 20:3635-3642. [PMID: 31870104 PMCID: PMC7173367 DOI: 10.31557/apjcp.2019.20.12.3635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This estudie evaluated the immunostaining of cytokines in oral carcinoma, in tissue of margin of surgical resecate (MSR) and metastatic lymph nodes, as well as their role in patient prognosis. METHODS A retrospective study was carried out in patients with oral squamous cell carcinomas, and sociodemographic and clinical-pathological data were evaluated. In addition, surgical site analysis of the patients was conducted by immunohistochemistry, using a tissue microarray for inflammatory (Tumor Necrosis Factor-alpha, Interleukin-1beta, Interleukin-6, interleukin-10), transcription NF-kappa B and CD68 markers. Immunoexpression was assessed qualitatively and quantitatively using ImageJ software, and data were correlated with the prognostic factors and patient survival rates. RESULTS There was a greater immunoexpression of inflammatory and CD68 cytokines in primary tumour and lymph node metastasis than in MSR. In a multinomial logistic regression model, patients with low education (p = 0.041) and a high histoscore for TNF-α (p = 0.021) showed a survival rate of 15.64 (95% CI = 1.13-217.24) and 6.81 (95% CI = 1.02-105.96). CONCLUSION Therefore, despite there is an increased immunoexpression of cytokines in the primary tumour, only TNF-α was the inflammatory cytokine that influenced the survival of patients with oral cancer.
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Colares N, Souza Rodrigues DF, Freitas MO, Dantas TS, Cunha MDPSS, Sousa FB, Barros Silva PGD. Smoking History Decreases Survival in Patients with Squamous Cell Carcinoma of the Mouth: A Retrospective Study with 15 Years of Follow-up. Asian Pac J Cancer Prev 2019; 20:1781-1787. [PMID: 31244300 PMCID: PMC7021610 DOI: 10.31557/apjcp.2019.20.6.1781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The purpose of this study was to evaluate the influence of smoking history on the clinical-pathological, sociodemographic and prognostic characteristics of patients with oral squamous cell carcinoma (SCC). Materials and Methods: A retrospective cohort study was carried out with the records of 136 smokers with SCC and 68 nonsmokers with oral SCC who were diagnosed and treated at Haroldo Juaçaba Hospital (2000-2014). Data on patient sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, treatment type, marital status, method of health care access (public or private health systems) and overall survival (15 years) were analyzed by the X² test, Mantel-Cox tests and multinomial and Cox logistic regression models (SPSS 20.0, p <0.05). Results: Smoking history was directly associated with male sex (p <0.001), low levels of education (p = 0.001), tumors of the mouth and palate (p = 0.001), stage T3/4 tumors (p = 0.014), lymph node metastasis (N+) (p = 0.024), palliative treatment (p = 0.024) and receiving health care through the public health system (p = 0.006), with education level being the only independently associated factor (p = 0.039). Lower survival was observed in patients who were smokers (p = 0,002), with low levels of education (p = 0.001), who had stage T3/4 tumors (p = 0.004), with N+ (p = 0.021), and had received palliative treatment (p = 0.002). Age (>65 years old, p = 0.015) and T staging (T3/4, p = 0.033) decreased the survival of SCC patients regardless of the other factors. Conclusions: Smoking history had an independent association with low education level and a history of alcoholism, and survival was negatively associated with older age and larger tumor size, which were more prevalent in smokers.
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Affiliation(s)
- Naiara Colares
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil.
| | | | | | - Thinali Sousa Dantas
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil.
| | | | - Fabrício Bitu Sousa
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil. ,Haroldo Juaçaba Hospital, Ceará Cancer Institute, Rua Papi Júnior, 1222, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Paulo Goberlânio de Barros Silva
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil. ,Haroldo Juaçaba Hospital, Ceará Cancer Institute, Rua Papi Júnior, 1222, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
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Dantas TS, Nascimento IVD, Verde MEQL, Alves APNN, Sousa FB, Mota MRL. Multifocal oral melanoacanthoma associated with Addison’s disease and hyperthyroidism: a case report. Arch Endocrinol Metab 2017; 61:403-407. [PMID: 28658350 PMCID: PMC10118927 DOI: 10.1590/2359-3997000000273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/02/2017] [Indexed: 11/22/2022]
Abstract
Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.
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Dantas TS, de Barros Silva PG, Sousa EF, da Cunha MDP, de Aguiar ASW, Costa FWG, Mota MRL, Alves APNN, Sousa FB. Influence of Educational Level, Stage, and Histological Type on Survival of Oral Cancer in a Brazilian Population: A Retrospective Study of 10 Years Observation. Medicine (Baltimore) 2016; 95:e2314. [PMID: 26817864 PMCID: PMC4998238 DOI: 10.1097/md.0000000000002314] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The mortality rate associated with oral cancer is estimated at approximately 12,300 deaths per year, and the survival rate is only 40% to 50% for diagnosed patients and is closely related to the duration of time between disease perception and its diagnosis and treatment. Socioeconomic risk factors are determinants of the incidence and mortality related to oral cancer. We conducted a retrospective, cross-sectional study of 573 records of patients with oral cancer at Haroldo Juaçaba Hospital - Cancer Institute of Ceará from 2000 to 2009 to evaluate the influence of socioeconomic factors on survival and epidemiological behavior of this neoplasia in a Brazilian population. In this study, patients with oral cancer were males greater than 60 years of age, presented squamous cell carcinoma in the floor of mouth and were characterized by low education levels. A total of 573 lesions were found in oral cavities. Cox proportional hazards regression model showed that the histological type, tumor stage, and low degree of education significantly influenced survival. A lower patient survival rate was correlated with a more advanced stage of disease and a worse prognosis. Squamous cell carcinoma is associated with a higher mortality when compared with other histological types of malign neoplasia.
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Affiliation(s)
- Thinali Sousa Dantas
- From the Laboratory of Oral Pathology, Federal University of Ceará (TSD, PGDBS); Ceará School of Oncology, Haroldo Juaçaba Hospital (EFS, MDPDC, FBS); Division of Diplomacy Health (ASWDA); Division of Oral Radiology and Imaginology (FWGS); Laboratory of Oral Pathology (MRLM, APNNA); and Laboratory of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil (FBS)
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