Association between TNFα - 308 G/A polymorphism and oral lichen planus (OLP): a meta-analysis

Objectives: To determine whether Tumor Necrosis Factor alpha (TNFα) –308 G/A polymorphism is associated with oral lichen planus (OLP). Material and Methods: A systematic electronic search of the literature was conducted to identify all published studies on the association between TNFα –308 G/A polymorphism and OLP. All case-control studies evaluating the TNFα –308 G/A polymorphisms in OLP were selected. A meta-analysis of the studies that fulfilled the inclusion criteria was performed. Odds ratios (OR) with 95% confidence intervals (CI) were also calculated. Results: Seven studies comprising 450 OLP cases and 867 controls were included in the meta-analysis. In the pooled analysis, TNFα –308 G/A polymorphism was associated with OLP with random effects and OR of 2.33 (95%CI=1.07-5.11; p=0.03), assuming a dominant mode of inheritance (AA+GA vs. GG). In the subgroup analysis by ethnicity, TNFα –308 G/A was associated with a significantly increased odds ratio of OLP in mixed ethnicity (OR=5.22; 95%CI=1.93-14.15; p=0.001), but not in Asians (OR=1.57; 95%CI=0.54-4.54; p=0.41) or Caucasians (OR=1.45; 95%CI=0.19-11.22; p=0.72). For subgroup analysis based on HCV (hepatitis C virus) infection status, significant increased risk of OLP was found among patients with mixed HCV infection status (OR=3.77; 95%CI=1.07-13.2; p=0.038), but not in patients without HCV infection (OR=2.09; 95%CI=0.63-6.91; p=0.22) and patients with HCV infection (OR=0.48; 95%CI=0.13-1.69; p=0.25). Conclusion: Our results suggest that –308 G/A polymorphism in TNFα is a potential genetic marker for OLP

Worse Caries Experience Does Not Lead to Worse Overall Health

Objective: To analyze caries experience depending on periodontitis affection concomitant or not with cardiovascular risks or mental health issues with the hypothesis that worse accumulated caries experience is not necessarily the result of the presence of concomitant overall health issues. Material and Methods: All subjects of this cross-sectional study were participants of the Dental Registry and DNA Repository project. Variables age, ethnicity, sex, caries experience, periodontitis and mental disease statuses and blood pressure assessment, dental clinical data (DMFT, DMFS and periodontitis) were evaluated and collected from the clinical records. We used chi-square, Fisher’s exact, or Student’s t-tests to determine differences in frequencies of sex, age, ethnicity, and dental clinical data depending on caries experience, periodontitis, mental health status, and cardiovascular risks. The established alpha was 5%. Results: Of the total 1,437 subjects included in this study, 407 were individuals with high blood pressure and 1,030 were individuals without high blood pressure. Also, 558 were individuals with mental disease and 879 were individuals without mental disease. High blood pressure patients were mostly men (47.17%) and women were the majority when analyzing patients with mental illness (60.04%). Most of the patients in the different groups were white, with a mean age ranging from 15.4 to 88 years. Conclusion: We concluded that caries experience concomitant or not with periodontitis affection does not associate with high blood pressure and mental disease

O cuidado integral em tempos de COVID-19: uma reflexão

La pandemia SARS-CoV-2/COVID-19 ha generado muchos cambios en el contexto público y privado, planteando problemas morales, legales, políticos y sociales para la vida diaria de la sociedad planetaria. Este artículo hace reflexiones sobre los temas de la ética y el cuidado con la vida, cuyos cambios bruscos se asociaron al desafío de la viabilidad de supervivencia y la importancia del cuidado relacional en el contexto de la pandemia. Ante el imperativo del aislamiento y el distanciamiento social, se buscaron estrategias de protección para un continuum social. En ese contexto, las dimensiones del cuidado se construyeron desde la noción de salutogénesis y autocultivo, que fundamenta un sistema de valores que incorpora saberes para la salud, la calidad de vida y el bienestar. Se infiere que en una mirada sistémica, por medio de políticas públicas y ayuda humanitaria, nuevos principios y valores orientarán la experiencia futura enfocada en la preservación de la vida humana, el cuidado ético con la salud y el cultivo planetario para el buen vivir de la humanidad.The SARS-CoV-2/COVID-19 pandemic has caused various changes in the public and private context, raising moral, legal, political and social challenges for the daily life of the society around the world. This paper offers some reflections on the ethics and care for life, in a time when sudden changes were associated with the challenge of survival viability and the importance of relational care in the context of the pandemic. In view of the mandate for social isolation and distancing, protection strategies were sought for a social continuum. In this context, the care framework was built around the notion of salutogenesis and self-preservation, which underlies a value system incorporating knowledge related to health, quality of life and well-being. In a systemic view, through public policies and humanitarian aid, there is the assumption that new principles and values will guide the future experience focusing on the preservation of human life, ethical health care and planetary preservation for the good living of humanity.A pandemia do SARS-CoV-2/COVID-19 gerou muitas mudanças no contexto público e privado, levantando questões morais, legais, políticas e sociais para o cotidiano da sociedade planetária. Esse artigo trata de reflexões acerca das temáticas da ética e do cuidado com a vida, as quais bruscas mudanças associaram-se ao desafio da viabilidade de sobrevivência e importância do cuidado relacional no contexto da pandemia. Ao imperativo do isolamento e distanciamento social, buscaram-se estratégias de proteção para um continuum social. Nesse contexto, as dimensões do cuidado edificaram-se a partir da noção da salutogênese e auto cultivo, que fundamenta um sistema de valores incorporando saberes para a saúde, qualidade de vida e o bem-viver. Infere-se que numa visão sistêmica, por meio de políticas públicas e de ajuda humanitária, novos princípios e valores nortearão a vivência futura tendo como foco a preservação da vida humana, o cuidado ético com a saúde e o cultivo planetário para ao bem viver da humanidade

COVID-19-related challenges in dental education: experiences from Australia, Brazil, and the USA

Aim: To describe the management of dental education in three dental schools during the COVID-19 crisis. Methods: Adopted strategies in the Federal University of Paraíba (UFPB), Brazil, University of Pittsburgh (UP), USA, and Griffith University (GU), Australia were detailed. Results: In the UFPB, all on-site teaching was suspended, and resources for distance learning set up as a supplementary semester to be available as face to face classes later. A protocol for clinical care followed safety measures recommended by Brazilian official health institutions. The adequacy of the physical structure, human resources, and personal protective equipment (PPE) acquisition for the return to clinical activities are currently under discussion. In the UP, learning activities were shifted to virtual teaching using lecture recordings and live sections. All elective patients care was postponed. Urgent dental cases were discussed via teledentistry. The physical layout of the dental clinics and pre-clinical laboratories were changed, allowing a safe distance between students. In the GU, all clinical and pre-clinical activities were cancelled, and theoretical activities were maintained online for all students. Several clinically based scenarios where created and delivered in the format of online problem-based learning. The reception area was redesigned, ensuring social distancing. Safety measures follow the Australia Dental Association. Conclusions: Dealing with dental education depends on the stage of the epidemic and the characteristics of each country

Análise de segregação complexa de 1.792 famílias com fenda lábio-palatina na América do Sul: 1967-1997

Although several studies have demonstrated familial aggregation of nonsyndromic cleft lip with or without cleft palate (CL/P), its model of inheritance remains uncertain. We report the results of complex segregation analysis performed in South American families with a newborn affected with CL/P. Families of 1,792 consecutive newborns affected with CL/P and registered during the period 1967 to 1997 were studied. A model that did not include a major locus was the best-fitting model for CL/P families. This result is in agreement with previous studies which showed a significant association of several putative susceptibility loci and CL/P, indicating that the genes involved in CL/P are likely to have only a very modest impact on disease risk.Os estudos sobre fendas lábio-palatinas (FL/P) demonstram existir uma maior incidência do defeito nas famílias de afetados, mas seu modo de herança permanece indefinido. Esse trabalho apresenta os resultados de uma análise de segregação complexa realizada em 1.792 famílias sul-americanas que possuíam um recém-nascido com FL/P. Essas crianças foram registradas entre 1967 e 1997 e os nascimentos foram consecutivos. Um modelo sem um locus principal foi o que melhor se adequou às famílias de FL/P estudadas. Esse resultado está de acordo com estudos anteriores que mostraram uma significativa associação entre vários loci de suscetibilidade e FL/P, indicando que os genes relacionados com FL/P, isoladamente, contribuem pouco para o risco desse defeito

Risk Of Leukemia In First Degree Relatives Of Patients With Nonsyndromic Cleft Lip And Palate.

The aim of this study was to determine the frequency of leukemia in parents of patients with nonsyndromic cleft lip and/or cleft palate (NSCL/P). This case-control study evaluated first-degree family members of 358 patients with NSCL/P and 1,432 subjects without craniofacial alterations or syndromes. Statistical analysis was carried out using Fisher's test. From the 358 subjects with NSCL/P, 3 first-degree parents had history of leukemia, while 2 out of 1,432 subjects from the unaffected group had a family history of leukemia. The frequency of positive family history of leukemia was not significantly increased in first-degree relatives of patients with NSCL/P.281-

Epidemiology of Severe Sepsis in the Emergency Department and Difficulties in the Initial Assistance

BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis

Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance

BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis

Influence of Environmental Factors on the Presence and Severity of Molar Incisor Hypomineralization

Objective: To assess the association between environmental factors during pregnancy and early childhood with the presence and severity of Molar Incisor Hipomineralization (MIH). Material and Methods: This cross-sectional study was conducted with 120 patients between 7 and 14 years of age. MIH was evaluated according to EAPD criteria. Data collected included the child’s medical history and the mother’s health. Chi-square and logistic regression were performed to determine any statistical evidence of the environmental factors, with the significance level set at 5%. Results: The participants were divided into groups with MIH (n=60) and without MIH (n=60), with average ages of 9.9 (±1.9) and 9.7 (±1.7) years, respectively. There was a statistically significant difference between intercurrences during pregnancy (OR=3.55; IC95%=1.35-10.57) and medication taken by the child (OR=3.01; IC95%=1.74-8.42) and the presence of MIH. In addition, other variables were also associated with the MIH (p≤0.05). However, there was no association with variables and degree of MIH severity (p>0.05). Conclusion: The use of medications in childhood and complications during pregnancy can be association to the presence of MIH. However, these factors do not interaction to MIH severity