Background: Pain remains one of the main causes of apprehension during dental procedures. In this context, topical anesthetics play an essential role in reducing discomfort, and new compounds such as amitriptyline and jambu (Acmella oleracea) extract have been investigated as promising alternatives. Drug delivery systems, such as PentravanⓇ , a nanosomal transdermal base, are also of interest; however, their application on oral mucosa has not yet been clinically evaluated. Therefore, this study aimed to compare the anesthetic efficacy of lidocaine (LDC) and prilocaine (PLC) combined with either amitriptyline or jambu, formulated as ointments or incorporated into PentravanⓇ , for topical anesthesia of the buccal and palatal mucosa of maxillary premolars, using pulpal response and puncture sensitivity as outcome measures. Methods: A randomized, blinded, crossover clinical trial was conducted with 40 healthy volunteers who received six formulations: (1) LDC 2.5% + PLC 2.5% (positive control); (2) LDC 2.5% + PLC 2.5% + amitriptyline 5%; (3) LDC 2.5% + PLC 2.5% + jambu extract 20% (7.5% spilanthol); (4) LDC 2.5% + PLC 2.5% + amitriptyline 5% in PentravanⓇ ; (5) LDC 2.5% + PLC 2.5% + jambu extract 20% in PentravanⓇ ; and (6) base ointment without active ingredients (placebo). Pain upon needle puncture was assessed using the visual analog scale, and pulpal anesthesia was evaluated with an electric pulp tester. Results: Formulations 1 and 2 produced the lowest pain scores in the buccal mucosa, with Formulation 1 showing statistically superior results than Formulations 3, 4, 5, and 6 (P < 0.05). Formulation 6 yielded the highest pain scores, while Formulations 2–5 demonstrated intermediate efficacy without significant differences.Formulations 1 and 2 were also the most effective on the palatal mucosa. None of the formulations achieved significant pulpal anesthesia. Adverse effects were mild and self-limiting, with mucosal desquamation observed only with Formulation 2. Conclusion Amitriptyline demonstrated relevant clinical potential, whereas jambu extract showed intermediate efficacy. PentravanⓇ -based formulations did not exhibit clinical superiority. Future studies should focus on optimizing these combined formulations to enhance the efficacy of topical anesthesia in dentistry.

Background and Objectives: Chloroquine and its analog hydroxychloroquine are derivatives of 4-aminoquinoline and are regularly used in the treatment of malaria and autoimmune diseases. Among the side effects of these drugs, alterations associated with the auditory system are frequently mentioned. Thus, the aim of this systematic review is to systematically review publications on hearing disorders and chloroquine or hydroxychloroquine use. Materials and Methods: Inclusion criteria were observational or interventional studies on audiological assessment in participants who were using chloroquine or hydroxychloroquine. The methodological quality was independently assessed by two reviewers using the Meta-Analysis of Statistics: assessment and review Instrument. The certainty of the evidence was assessed using the GRADE tool. Results: A total of 1,372 non-duplicate papers were screened, out of which 17 were included in the final qualitative synthesis, and 5 studies in the meta-analysis. The odds ratio for the two subgroups evaluated did not show significance with no heterogeneity between the effects observed between the different diseases (I2=0%) and obtaining the global estimate of 0.76 (95% confidence interval [CI]=0.41–1.39; p>0.05). Despite the inclusion of papers with different disease samples, the heterogeneity observed in the analysis was low (I2= 0%) and prediction interval (95% PI=0.32–1.80; p>0.05) remained close to that estimated by the CI (95% CI=0.41–1.39; p>0.05). The certainty of the evidence assessed by the GRADE tool was considered very low due to the risk of bias, indirect evidence, and imprecision. Conclusions The findings of this study suggest that the use of chloroquine/hydroxychloroquine is not associated with hearing disorders.

Rationale: Co-infection of human immunodeficiency virus (HIV) and Leishmania spp. has impact on clinical and therapeutic outcomes of leishmaniases. Most studies do not present the identification of Leishmania species causing American tegumentary leishmaniasis in co-infections. In the Americas, Leishmania (L.) Viannia (V.) braziliensis and L. (V.) guyanensis have been identified. Patient concerns: In this study, two cases of American tegumentary leishmaniasis in patients infected with HIV are described. Patients presented several lesions with rapid dissemination and mucosal involvement. Diagnosis: Disseminated cutaneous leishmaniasis caused by L. amazonensis was identified by molecular test. Interventions: The patients were treated with conventional therapies for HIV infection and American tegumentary leishmaniasis. Outcomes: In co-infection, the clinical manifestations are atypical and the treatment response can be impaired. Lessons: These cases show that HIV infection impacts L. amazonensis infection and point to the relevance of identifying Leishmania species, which can lead to a better patient management.

To evaluate the effect of diet on metabolic control and zinc metabolism in patients with type 2 diabetes mellitus (T2DM). One-week balanced diet was provided to 10 Brazilians patients with T2DM. Nutritional assessment, laboratorial parameters and expression of zinc transporter and inflammatory genes in peripheral blood mononuclear cells (PBMC) were performed. Healthy non-diabetic subjects of the same demographic were recruited to provide baseline data. Diabetic patients had higher body mass index and greater fasting plasma glucose, plasma tumor necrosis factor alpha (TNFalpha) and plasma interleukin 6 (IL6) levels compared with healthy subjects. In addition, the expression of transporters 4 (ZnT4) mRNA was lower and IL6 mRNA was higher in PBMC of these diabetic patients than in healthy subject. One week after a balanced diet was provided, fasting plasma glucose decreased significantly as did TNFalpha, IL6 and Metallothionein 1 (MT1) mRNAs. No change was observed in zinc transporter expression in PBMC after the dietary intervention. A healthy eating pattern maintained for one week was able to improve metabolic control of diabetic patients by lowering fasting plasma glucose. This metabolic control may be related to down-regulation of zinc-related transcripts from PBMCs, as TNFalpha, IL6 and MT1 mRNA.
Blood Glucose ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Diet* ; Down-Regulation ; Eating ; Fasting ; Humans ; Inflammation* ; Interleukin-6 ; Metabolism* ; Metallothionein ; Nutrigenomics ; Nutrition Assessment ; Plasma ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Zinc*