Genetics and environment: Legal and ethical derivations of ecogenetics

O presente trabalho tem por escopo analisar as decorrências éticas, sociais e jurídicas de um específico ramo da genética: a ecogenética. Para tanto, foi adotada pesquisa bibliográfica, com base em fontes doutrinárias interdisciplinares, para se revisar a literatura sobre o tema, que ainda é escassa. O objeto de estudo da ecogenética é a inter-relação entre o meio ambiente e as características genéticas individuais que alteram as condições gerais de saúde. O atual desenvolvimento da biociência provocou uma alteração no foco, do tratamento e cura para a prevenção das doenças, assim como despertou questionamentos éticos sobre a influência das características genéticas e da atuação do meio ambiente sobre elas. Desloca-se o agir humano para a perspectiva da responsabilidade conferida tanto ao indivíduo, isoladamente, quanto à coletividade, em relação às gerações presentes e futuras. A importância do estudo no campo da ecogenética espraia-se para além de interesses individuais e familiares e traduz-se também na importância da adoção de medidas governamentais de prevenção. This paper analyzes the ethical, social and legal derivations of a specific branch of genetics – ecogenetics. For this, a bibliographic methodology was adopted, based on interdisciplinary doctrinal sources, to review the literature on the subject, which is still scarce. The study object of ecogenetics is the relationship between the environment and the individual genetic characteristics that alter the general health conditions. The current bioscience developments moved the focus from treatment and cure to disease prevention as well as raised ethical questions about the influence of knowledge of genetic traits and the environmental factors that act on them. Moves the human act to the perspective of responsibility, both for the individual, as the community in relation to present and future generations. The importance of the ecogenetics research spreads beyond the individual and family interests, converting into important preconditions for governmental adoption of preventive measures

Clinical Aspects of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Severe Ocular Complications in Brazil

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis)

Genética e meio ambiente: decorrências éticas e jurídicas da ecogenética = Genetics and environment: Legal and ethical derivations of ecogenetics

- DOI: http://dx.doi.org/10.11606/issn.2316-9044.v18i1p13-3

Building an explanatory model for snakebite envenoming care in the Brazilian Amazon from the indigenous caregivers' perspective.

BackgroundIn the Brazilian Amazon, snakebite envenomings (SBE) disproportionately affect indigenous peoples. Communication between indigenous and biomedical health sectors in regards to SBEs has never been explored in this region. This study aims to build an explanatory model (EM) of the indigenous healthcare domain for SBE patients from the perspective of the indigenous caregivers.Methodology/principal findingsThis is a qualitative study involving in-depth interviews of eight indigenous caregivers who are representatives of the Tikuna, Kokama and Kambeba ethnic groups, in the Alto Solimões River, western Brazilian Amazon. Data analysis was carried out via deductive thematic analysis. A framework was built containing the explanations based on three explanatory model (EM) components: etiology, course of sickness, and treatment. To indigenous caregivers, snakes are enemies and present conscience and intention. Snakebites have a natural or a supernatural cause, the last being more difficult to prevent and treat. Use of ayahuasca tea is a strategy used by some caregivers to identify the underlying cause of the SBE. Severe or lethal SBEs are understood as having been triggered by sorcery. Treatment is characterized by four components: i) immediate self-care; ii) first care in the village, mostly including tobacco smoking, chants and prayers, combined with the intake of animal bile and emetic plants; iii) a stay in a hospital, to receive antivenom and other treatments; iv) care in the village after hospital discharge, which is a phase of re-establishment of well-being and reintroduction into social life, using tobacco smoking, massages and compresses to the affected limb, and teas of bitter plants. Dietary taboos and behavioral interdictions (avoiding contact with menstruating and pregnant women) prevent complications, relapses, and death, and must be performed up to three months after the snakebite. Caregivers are in favor of antivenom treatment in indigenous areas.Conclusions/significanceThere is a potential for articulation between different healthcare sectors to improve the management of SBEs in the Amazon region, and the aim is to decentralize antivenom treatment so that it occurs in indigenous health centers with the active participation of the indigenous caregivers