Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented

Functional phage display of leech-derived tryptase inhibitor (LDTI): construction of a library and selection of thrombin inhibitors

The recombinant phage antibody system pCANTAB 5E has been used to display functionally active leech-derived tryptase inhibitor (LDTI) on the tip of the filamentous M13 phage, A limited combinatorial library of 5.2 x 10(4) mutants was created with a synthetic LDTI gene, using a degenerated oligonucleotide and the pCANTAB 5E phagemid. the mutations were restricted to the P1-P4' positions of the reactive site. Fusion phages and appropriate host strains containing the phagemids were selected after binding to thrombin and DNA sequencing. the variants LDTI-2T (K8R, I9V, S10, K11W, P12A), LDTI-5T (K8R, I9V, S10, K11S, P12L) and LDTI-10T (K8R, I9L, S10, K11D, P12I) were produced with a Saccharomyces cerevisiae expression system. the new inhibitors, LDTI-2T and -5T, prolong the blood clotting time, inhibit thrombin (Ki 302 nM and 28 nM) and trypsin (K-i 6.4 nM and 2.1 nM) but not factor Xa, plasma kallikrein or neutrophil elastase, the variant LDTI-10T binds to thrombin but does not inhibit it, the relevant reactive site sequences of the thrombin inhibiting variants showed a strong preference for arginine in position P1 (K8R) and for valine in P1' (I9V), the data indicate further that LDTI-5T might be a model candidate for generation of active-site directed thrombin inhibitors and that LDTI in general may be useful to generate specific inhibitors suitable for a better understanding of enzyme-inhibitor interactions. (C) 1999 Federation of European Biochemical Societies.UNIFESP, Dept Bioquim, EPM, BR-04044020 São Paulo, BrazilUniv Munich, Klinikum Innenstadt, Chirurg Klin & Poliklin, Klin Chem & Klin Biochem Abt, D-8000 Munich, GermanyUNIFESP, Dept Med, Disciplina Hematol, EPM, BR-04044020 São Paulo, BrazilUNIFESP, Dept Bioquim, EPM, BR-04044020 São Paulo, BrazilUNIFESP, Dept Med, Disciplina Hematol, EPM, BR-04044020 São Paulo, BrazilWeb of Scienc

Acidentes ocupacionais com exposição a material biológico: retrato de uma realidade

Objective: to characterize occupational accidents with exposure to biological material reported in thereferral services in the micro region of Votuporanga, SP, Brazil between 2001 and 2005. Material andMethod: this is a descriptive survey, retrospective documentary survey of occupational accidents withexposure to biological material obtained from 273 report forms from the accident report system forwarded to the database of the Serviço de Vigilância Epidemiológica da Secretaria Municipal de Saúde deVotuporanga, SP and to the Direção Regional de Saúde XXII (DIRXXII) de São José do Rio Preto, SP,Brazil. Results: of the 273 reported accidents, 78.4% occurred with female workers and 69.6% wereindividuals between 20 and 40 years of age. Votuporanga was the city with the most reported accidents(89.0%) and nursing auxiliaries were the most exposed professionals (48.4%). In 99.6% of cases, carewas provided within 72 hours. Percutaneous injury was the most frequent (86.8%), blood was the biological material with which there was the most contact (98.5%), and lumen needles accounted for 72.1%of the accidents. A total of 87.5% of the victims were vaccinated against Hepatitis B and 67.0% had notbeen tested for anti-HBs. The serological status against HIV of the source patient was unknown in 16.1%of the reports and in 78,8% was known for HBV. Hepatitis C serological tests for 78.8% of patient-sourcewere verified, of which 3.3% tested positive, 25.9% whose source was unknown did not follow-up. Conclusions: data indicate the need to develop a local intervention plan with the consent of the community,which is undoubtedly co-responsible for proposals of change.Objetivo:  caracterizar os acidentes ocupacionais por exposição à material biológico notificados nosserviços de referência da micro região de Votuporanga- SP, no período de 2001 a 2005. Material emétodo: trata-se de uma pesquisa descritiva, do tipo levantamento documental retrospectivo, dos casos de acidentes ocupacionais por exposição a material biológico obtidos das 273 fichas de notificaçãodo SINABIO encaminhadas aos bancos de dados do Serviço de Vigilância Epidemiológica da SecretariaMunicipal de Saúde de Votuporanga-SP e da Direção Regional de Saúde XXII (DIRXXII) de São José doRio Preto-SP. Resultados: dos 273 acidentes notificados, 78,4% ocorreram em trabalhadores do sexofeminino e 69,6% entre 20 e 40 anos. Votuporanga foi o município que mais notificou (89,0%) e o auxiliarde enfermagem a categoria mais exposta (48,4%). Em 99,6% dos casos, o atendimento se deu dentrodas 72 horas. A exposição mais frequente foi a percutânea (86,8%), o sangue o material biológico demaior contato (98,5%) e a agulha com lúmen a que mais provocou acidentes (72,1%). Dos acidentados,87,5% eram vacinados contra HBV e desses, 67,0% não haviam realizado o anti-HBs. Em 16,1% dasnotificações a fonte HIV era desconhecida e em 78,8% era conhecida para o HBV. Para o HCV, detectouse 78,8% de sorologias de pacientes-fonte, das quais 3,3% eram positivas, sendo que 25,9% dos comfonte desconhecida não fizeram acompanhamento. Conclusões: os dados indicam a necessidade deelaboração de um plano de intervenção local, com a aquiescência da comunidade que é,inquestionavelmente, co-responsável pelas propostas de mudança

Knowledge and attitude of parents or caretakers regarding transmissibility os caries disease

Dental caries is a transmissible infectious disease in which mutans streptococci are generally considered to be the main etiological agents. Although the transmissibility of dental caries is relatively well established in the literature, little is known whether information regarding this issue is correctly provided to the population. The present study aimed at evaluating, by means of a questionnaire, the knowledge and usual attitude of 640 parents and caretakers regarding the transmissibility of caries disease. Most interviewed adults did not know the concept of dental caries being an infectious and transmissible disease, and reported the habit of blowing and tasting food, sharing utensils and kissing the children on their mouth. 372 (58.1%) adults reported that their children had already been seen by a dentist, 264 (41.3%) answered that their children had never gone to a dentist, and 4 (0.6%) did not know. When the adults were asked whether their children had already had dental caries, 107 (16.7%) answered yes, 489 (76.4%) answered no, and 44 (6.9%) did not know. Taken together, these data reinforce the need to provide the population with some important information regarding the transmission of dental caries in order to facilitate a more comprehensive approach towards the prevention of the disease

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study

BackgroundThe alarming increase in annual deforestation rates has had devastating consequences in climate change, and it is affecting Indigenous people, who depend entirely on the land for survival and has also weakened the rainforest's crucial role in stabilizing the global climate. Recognizing and respecting Indigenous people's needs and social, economic, and historical conditions influence health and healthcare. This study aimed to conduct online concept mapping workshops with university students to identify perceived important and feasible actions for improving the mental health of Indigenous people living in their territory in association with climate change.MethodsConcept mapping, a participatory mixed methodology, was conducted virtually with 20 Indigenous students at two universities in Brazil. A focus prompt was developed from consultations with Indigenous stakeholders and read—“To improve the mental health of Indigenous peoples in their territory during climate change crises, it is necessary to….”ResultsUniversity students organized 42 unique statements in 6 clusters that cover a wide range of topics: family support, 0.68 (SD 0.19); respect and understanding, 0.37 (SD 0.08); improvement actions, 0.52 (SD 0.07); public policies in favor of Indigenous people's mental health, 0.24 (0.09); health actions, 0.15 (SD 0.08); Indigenous training in health and its importance in improving mental health 0.32 (SD 0.07).ConclusionThese clusters range from community initiatives, public policies, health actions, and strengthening professional services in Indigenous communities. These all provide numerous concrete ideas for developing interventions designed to address mental health challenges associated with climate change