MMed (Otorhinolaryngology), Faculty of Health Sciences, University of the Witwatersrand / The submandibular space is part of the deep neck fascial spaces. Infection within these spaces can cause significant mortality and morbidity. The infections are usually opportunistic, being commensal micro-organisms from the oral cavity and oro-pharynx. The study is a review of the microbiology of the submandibular space infections seen at the tertiary academic referral hospitals, University of the Witwatersrand. The period of the study is from the 1st January 2006 to 31st December 2006. 93 patients were reviewed of which 52 had aspirates taken. The predominant micro-organisms were the Gram positive anaerobic cocci. Their resistance and sensitivity pattern was also studied. A literature search for this category of infection was also conducted. The most commonly isolated micro-organisms were the gram positive cocci.

Master of Dental Surgery / History has recorded the antiquity of serious infections in the region of the head and neck. Today, our community still experiences major life-threatening infections in these anatomical locations, which pose significant management difficulties to the oral and maxillofacial surgeon. The aim of this thesis is to review the aetiology, diagnosis and treatment of some bacterial infections involving structures of the head and neck. Such infections may spread, causing serious complications with severe morbidity and occasionally death. This theses deals only with infections of bacterial origin and does not attempt to cover viral, or fungal agents or the chronic specific diseases of tuberculosis and syphilis, and makes no attempt to address the old question of focal infection. The literature review relates especially to Ludwig’s Angina which was first described so dramatically in 1836. To this day it remains as a clinically potentially lethal disease despite the progress of modern medicine. Numerous descriptions in the literature warn of the rapid appearance of symptoms and the danger of respiratory obstruction when management of the airway is not satisfactorily undertaken. Both odontogenic and non-odontogenic causes of orofacial and neck infections are reviewed. Odontogenic problems are given special emphasis as they are now of major concern. The significance of the potential fascial spaces in the face and neck which allow the spread of dental infections is also highlighter. A thorough knowledge of these anatomical relationships is still of the utmost importance to the surgeon if he is to be successful in treatment. The principle of surgical drainage of pus is as important in 1990 as it was 150 years ago. The biological basis for the onset and progress of such fulminating infections in the head and neck region is still poorly understood. One constant need is that the bacteria, both aerobic and anaerobic, be correctly identified. Microbiological techniques are constantly improving and provide an important adjuvant investigation, which then allows the surgeon to provide the most appropriate antimicrobial therapy. Principal to the many aspects of treatment is the ability to maintain the airway of the patient and to provide the depth of anaesthesia necessary to undertake the required surgery. Major bacterial orofacial infections may have severe local and far-reaching systemic effects. Such complications are discussed in all their ramifications. It should be realised that the presentation of these patients at a late stage, when complications have already supervened, may make diagnosis difficult. There is always a necessity to ensure that the underlying cause of the disease is accurately defined and that complication are not allowed to progress further. Finally, a retrospective study of the management of 90 patients with major bacterial orofacial infections who have been treated at Westmead Hospital is presented. The outcome of this study of some major bacterial orofacial infections of the head and neck is the need to stress the importance of urgent surgical management and maintenance of the airway, together with the microbiological determination of the causative organisms and their sensitivities, so that other than empirical antibiotics can be instituted early. This must be combined with an upgrading of the patients’ medical and dental status. It was demonstrated that, in the majority of these patients, ignorance and fear combined with a lack of routine dental care resulted in major infections arising from relatively simple odontogenic causes such as dental caries, periodontal disease and pericoronal infection related to impacted teeth. Without doubt, the immediate care of these patients demanded intensive management. However, it is important to recognise that dental education forms an integral part not only of the recovery programme for the afflicted patient, but also as a community health preventive measure of profound significance.

Master of Dental Surgery / History has recorded the antiquity of serious infections in the region of the head and neck. Today, our community still experiences major life-threatening infections in these anatomical locations, which pose significant management difficulties to the oral and maxillofacial surgeon. The aim of this thesis is to review the aetiology, diagnosis and treatment of some bacterial infections involving structures of the head and neck. Such infections may spread, causing serious complications with severe morbidity and occasionally death. This theses deals only with infections of bacterial origin and does not attempt to cover viral, or fungal agents or the chronic specific diseases of tuberculosis and syphilis, and makes no attempt to address the old question of focal infection. The literature review relates especially to Ludwig’s Angina which was first described so dramatically in 1836. To this day it remains as a clinically potentially lethal disease despite the progress of modern medicine. Numerous descriptions in the literature warn of the rapid appearance of symptoms and the danger of respiratory obstruction when management of the airway is not satisfactorily undertaken. Both odontogenic and non-odontogenic causes of orofacial and neck infections are reviewed. Odontogenic problems are given special emphasis as they are now of major concern. The significance of the potential fascial spaces in the face and neck which allow the spread of dental infections is also highlighter. A thorough knowledge of these anatomical relationships is still of the utmost importance to the surgeon if he is to be successful in treatment. The principle of surgical drainage of pus is as important in 1990 as it was 150 years ago. The biological basis for the onset and progress of such fulminating infections in the head and neck region is still poorly understood. One constant need is that the bacteria, both aerobic and anaerobic, be correctly identified. Microbiological techniques are constantly improving and provide an important adjuvant investigation, which then allows the surgeon to provide the most appropriate antimicrobial therapy. Principal to the many aspects of treatment is the ability to maintain the airway of the patient and to provide the depth of anaesthesia necessary to undertake the required surgery. Major bacterial orofacial infections may have severe local and far-reaching systemic effects. Such complications are discussed in all their ramifications. It should be realised that the presentation of these patients at a late stage, when complications have already supervened, may make diagnosis difficult. There is always a necessity to ensure that the underlying cause of the disease is accurately defined and that complication are not allowed to progress further. Finally, a retrospective study of the management of 90 patients with major bacterial orofacial infections who have been treated at Westmead Hospital is presented. The outcome of this study of some major bacterial orofacial infections of the head and neck is the need to stress the importance of urgent surgical management and maintenance of the airway, together with the microbiological determination of the causative organisms and their sensitivities, so that other than empirical antibiotics can be instituted early. This must be combined with an upgrading of the patients’ medical and dental status. It was demonstrated that, in the majority of these patients, ignorance and fear combined with a lack of routine dental care resulted in major infections arising from relatively simple odontogenic causes such as dental caries, periodontal disease and pericoronal infection related to impacted teeth. Without doubt, the immediate care of these patients demanded intensive management. However, it is important to recognise that dental education forms an integral part not only of the recovery programme for the afflicted patient, but also as a community health preventive measure of profound significance.

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Orientador: Luciane Dias de Oliveira / Coorientador: Jonatas Rafael de Oliveira / Banca: Claudemir de Carvalho / Banca: Graziella Nuernberg Back Brito / Resumo: Os seres humanos vivem em constante relação com micro-organismos, comensais e patogênicos, que podem ameaçar a homeostase do hospedeiro. Espécies patogênicas apresentam mecanismos capazes de contornar as barreiras de defesa do hospedeiro, facilitando sua disseminação e proliferação nos tecidos invadidos. Cepas resistentes aos antimicrobianos disponíveis surgem diariamente, por isso, é relevante encontrar métodos alternativos para controla-las. Produtos de plantas medicinais vem sendo investigados para essa finalidade. No presente estudo, foi avaliada a capacidade do extrato de C. longa em controlar infecções in vitro por S. aureus, P. aeruginosa e C. albicans em macrófagos murinos (RAW 264.7). Para isto, foram aplicadas as concentrações inibitórias mínimas (CIM) do extrato vegetal nas infecções e por meio de análise da fagocitose foi analisado a contribuição delas para a eliminação destes micro-organismos. A viabilidade dos macrófagos foi analisada por meio de teste colorimétrico com corante vermelho neutro. Foram checadas a produção de citocinas inflamatórias (IL-1β, IL-6, TNF-α e IL-10) e óxido nítrico (NO), por ELISA e com reagente de Griess, respectivamente. Os resultados foram analisados por ANOVA e Tukey's Test (P ≤ 0.05). Foi verificado que o extrato de C. Longa auxiliou de maneira efetiva os macrófagos na fagocitose dos micro-organismos avaliados, apresentando reduções significativas de unidades formadoras de colônia por mililitro (UFC/mL), e atuou mediação da síntese... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Humans live in constant contact with microorganisms, commensals and pathogens, which may threaten host homeostasis. Pathogenic species present mechanisms able circumventing the host defense barriers, facilitating their dissemination and proliferation in invaded tissues. Antimicrobial-resistant strains emerge daily, then it is important finding an alternative method to control them. Medicinal plant products have been investigated for this purpose. In this study, the ability of C. longa extract to control in vitro infections by S. aureus, P. aeruginosa and C. albicans in murine macrophages (RAW 264.7) was evaluated. For this, the minimum inhibitory concentrations (MIC) of the plant extract were used in the infections. Phagocytosis was analyzed to check if they would contribute to eliminate these microorganisms. The viability of the macrophages was analyzed by colorimetric test using neutral red dye. Productions of inflammatory cytokines (IL-1β, IL-6, TNF-α and IL-10) and nitric oxide (NO) were verified during infection by ELISA and Griess's reagent, respectively. The results were analyzed by ANOVA and Tukey's Test (P ≤ 0.05). C. Longa L. extract effectively assisted the macrophages in the phagocytosis of the evaluated microorganisms, presenting significant reductions of colony-forming units per milliliter (CFU/mL), and mediated the synthesis of cytokines and NO. In addition, macrophages were viable during infection. C. Longa L. extract assisted in vitro the macrophages in the elimination of S. aureus, P. aeruginosa, and C. albicans, promoting immunomodulatory effect in the synthesis of IL-1β, TNF-α, IL-10 and NO, in order to control microbial infections in vitro / Mestre

Orientador: Marlus Chorilli / Coorientador: Lívia Nordi Dovigo / Banca: Adriano Antunes de Souza Araujo / Banca: Carolina Patrícia Aires / Banca: Ana Claudia Pavarina / Banca: Michelle Franz Montan Braga Leite / Resumo: A candidose bucal é causada principalmente pela levedura oportunista Candida albicans. O tratamento envolve a administração de antifúngicos de uso tópico ou sistêmico, para os quais se tem observado casos de resistência. Pesquisadores estão buscando métodos alternativos, como a terapia fotodinâmica antimicrobinana e a descoberta de substâncias de origem natural que possam apresentar interesse terapêutico no tratamento da candidose bucal, como a curcumina, cuja ação antifúngica pode ser potencializada pelo emprego da luz, uma vez que atua também como fotossensibilizador. Todavia, esse fármaco apresenta características físico-químicas limitantes, como baixa solubilidade aquosa. Logo, sua incorporação em sistemas precursores de cristais líquidos (SPCL) acrescidos de polímeros mucoadesivos demonstra ser uma opção interessante para viabilizar o seu uso. O trabalho objetiva a avaliação de SPCL mucoadesivos para administração bucal de curcumina, bem como verificar o efeito do tratamento da candidose bucal com o uso da terapia fotodinâmica, empregando estudos in vitro e in vivo. Para isso, foram desenvolvidos SPCL compostos de ácido oleico, álcool cetílico etoxilado e propoxilado (Procetyl® AWS) e dispersão polimérica de poloxamer (16%) e/ou polietilenoimina (0,5%), capazes de incorporar a curcumina, os quais foram caracterizados empregando microscopia de luz polarizada (MLP), reologia, espalhamento de raios X de baixo ângulo (SAXS) e mucoadesão in vitro, antes e após a diluição com ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Oral candidiasis is caused mainly by the opportunistic yeast Candida albicans. Treatment involves the administration of topical or systemic antifungal for which resistance has been observed. Researchers are looking for alternative methods, such as photodynamic therapy and the discovery of substances of natural origin that may be of therapeutic interest in the treatment of oral candidiasis, such as curcumin, whose antifungal action may be enhanced by the use of light, it also acts as a photosensitizer. However, this drug has limiting physical-chemical characteristics, such as low aqueous solubility. Therefore, its incorporation in liquid crystal precursor systems (LCPS) plus mucoadhesive polymers proves to be an interesting option to make its use feasible. The objective of this study is to evaluate the LCPS mucoadhesive for buccal administration of curcumin, as well as to verify the effect of oral candidosis treatment with the use of photodynamic therapy, using in vitro and in vivo studies. For this, LCPS compounds of oleic acid, ethoxylated and propoxylated cetyl alcohol (Procetyl® AWS) and polymer dispersion of poloxamer (16%) and/ or polyethyleneimine (0.5%), capable of incorporating curcumin, were developed. The compounds were characterized by using polarized light microscopy (PLM), rheology, scattering small angle X-ray scattering (SAXS) and mucoadhesion in vitro, before and after dilution with artificial saliva. In vitro release, permeation and retention ex vivo studies were carried out, as well as in vitro and in vivo biological assays for the evaluation of curcumin incorporated in LCPS versus Candida albicans. In PLM, it was possible to visualize the transition of LCPS, characterized as dark field, for hexagonal and lamellar mesophases, characteristics of liquid-crystalline... (Complete abstract click electronic access below) / Doutor