Demographic characteristics and knowledge about dental trauma by physical education teachers in João Pessoa, Paraíba, Brazil / Características demográficas e conhecimento sobre traumatismos buco-dentários de profissionais de educação física do município de João Pessoa, PB

ABSTRACT Objective: To evaluate the demographic characteristics of physical education professionals, their knowledge on dental trauma, and related first aid management. It is well known that physical activities may pose dental trauma risks, and urgent care is essential to minimize damages. Methods: Exploratory research with descriptive nature and quantitative approach. The sample was selected by convenience and comprised 31 physical education professionals. A structured questionnaire developed on Google Forms® system was sent to the participants. The collected data were organized and analyzed. Results: Among the total sample, only 5 (16.1%) had information on the subject. When asked about specific actions to manage dental trauma, only few participants stated to the most appropriate approach. Conclusion: There is a widespread lack of knowledge on dental trauma and the correct and immediate management of such injuries. As these injuries occur frequently in the target population of their daily work, this lack of preparation can hinder and undermine the work of the dentist and cause irreversible harm to the victims.

RESUMO Objetivo: Avaliar as características demográficas de profissionais de educação física, seu conhecimento sobre traumatismos buco-dentários e condução nos primeiros socorros. É sabido que atividades físicas são de risco para tais traumatismos e o pronto atendimento é primordial para minimizar os danos causados. Métodos: Trata-se uma pesquisa exploratória, de natureza descritiva, com abordagem quantitativa. A amostra foi selecionada por conveniência e constituída por 31 profissionais Educadores Físicos. Foi desenvolvido um questionário estruturado transcrito para o sistema Google Formulários® e enviado aos participantes. Os dados coletados foram catalogados e analisados. Resultados: Do total da amostra, apenas 5 (16,1%) já tiveram alguma instrução sobre o tema. Quando questionados sobre ações mais específicas diante de traumatismos buco dentários, poucos apontaram a conduta mais indicada. Conclusão: Há um desconhecimento generalizado sobre traumatismo buco dentários e na correta e imediata condução em casos de tais ocorrências. Considerando que esses acidentes ocorrem com considerável frequência na população alvo de seu labor diário, essa falta de preparo pode dificultar e comprometer o trabalho do cirurgião-dentista e trazer prejuízos irreversíveis às vítimas.

Maternal high-fat diet aggravates fructose-induced mitochondrial damage in skeletal muscles and causes differentiated adaptive responses on lipid metabolism in adult male offspring.

Maternal high-fat diet (HFD) is associated with metabolic disturbances in the offspring. Fructose is a highly consumed lipogenic sugar; however, it is unknown whether skeletal muscle of maternal HFD offspring respond differentially to a fructose overload. Female Wistar rats received standard diet (STD: 9% fat) or isocaloric high-fat diet (HFD: 29% fat) during 8 weeks before mating until weaning. After weaning, male offspring received STD and, from 120 to 150 days-old, they drank water or 15% fructose in water (STD-F and HFD-F). At 150th day, we collected the oxidative soleus and glycolytic extensor digitorum longus (EDL) muscles. Fructose-treated groups exhibited hypertriglyceridemia, regardless of maternal diet. Soleus of maternal HFD offspring showed increased triglycerides and monounsaturated fatty acid content, independent of fructose, with increased fatty acid transporters and lipogenesis markers. The EDL exhibited unaltered triglycerides content, with an apparent equilibrium between lipogenesis and lipid oxidation markers in HFD, and higher lipid uptake (fatty acid-binding protein 4) accompanied by enhanced monounsaturated fatty acid in fructose-treated groups. Mitochondrial complexes proteins and Tfam mRNA were increased in the soleus of HFD, while uncoupling protein 3 was decreased markedly in HFD-F. In EDL, maternal HFD increased ATP synthase, while fructose decreased Tfam predominantly in STD offspring. Maternal HFD and fructose induced mitochondria ultrastructural damage, intensified in HFD-F in both muscles. Thus, alterations in molecular markers of lipid metabolism and mitochondrial function in response to fructose are modified by an isocaloric and moderate maternal HFD and are fiber-type specific, representing adaptation/maladaptation mechanisms associated with higher skeletal muscle fructose-induced mitochondria injury in adult offspring.

Escherichia coli Strains Responsible for Cystitis in Female Pediatric Patients with Normal and Abnormal Urinary Tracts Have Different Virulence Profiles.

The role of uropathogenic Escherichia coli (UPEC) in colonization and infection of female patients with anatomical and functional abnormalities of the urinary system is elusive. In this study, the phenotype, genotype and the phylogeny of UPEC strains isolated from the urine of pediatric female patients with cystitis of normal and abnormal urinary tract were determined. Multiplex PCR results demonstrated that 86% of the strains isolated from female patients with normal urinary tract (NUT), belonged to the phylo-groups B2 and D. Their prevalence decreased to 23% in strains isolated from patients with abnormal urinary tract (AUT). More of the isolates from AUT patients produced a biofilm on polystyrene and polyvinyl chloride (PVC), adhered to epithelial cells, and encoded pap and sfa genes than strains isolated from female patients with NUT. In contrast, a higher number of hemolysin-producing strains with serogroups associated with UPEC were isolated from patients with NUT. In summary, the results suggest that cystitis in female patients with NUT is associated with ExPEC, whereas cystitis in female patients with AUT is associated with pathogenic intestinal E. coli strains that have acquired the ability to colonize the bladder.

Maternal Isocaloric High-Fat Diet Induces Liver Mitochondria Maladaptations and Homeostatic Disturbances Intensifying Mitochondria Damage in Response to Fructose Intake in Adult Male Rat Offspring.

SCOPE: Perinatal maternal obesity and excessive fructose consumption have been associated with liver metabolic diseases. The study investigates whether moderate maternal high-fat diet affects the liver mitochondria responses to fructose intake in adult offspring. METHODS AND RESULTS: Wistar female rats have received a standard diet (mSTD) or high-fat diet (mHFD) (9% and 28.6% fat, respectively), before mating until the end of lactation. Male offspring were fed standard diet from weaning to adulthood and received water or fructose-drinking water (15%) from 120 to 150 days old. Fructose induces liver mitochondrial ultrastructural alterations with higher intensity in mHFD offspring, accompanied by reduced autophagy markers. Isolated mitochondria respirometry shows unaltered ATP-coupled oxygen consumption with increased Atp5f1b mRNA only in mHFD offspring. Fructose increases basal respiration and encoding complex I-III mRNA, only in mSTD offspring. Uncoupled respiration is lower in mHFD mitochondria that are unable to exhibit fructose-induced increase Ucp2 mRNA. Fructose decreases antioxidative defense markers, increases unfolded protein response and insulin resistance only in mHFD offspring without fructose-induced hepatic lipid accumulation. CONCLUSION: Mitochondrial dysfunction and homeostatic disturbances in response to fructose are early events evidencing the higher risk of fructose damage in the liver of adult offspring from dams fed an isocaloric moderate high-fat diet.

In Silico Prediction and Design of Uropathogenic Escherichia coli Alpha-Hemolysin Generate a Soluble and Hemolytic Recombinant Toxin.

The secretion of α-hemolysin by uropathogenic Escherichia coli (UPEC) is commonly associated with the severity of urinary tract infections, which makes it a predictor of poor prognosis among patients. Accordingly, this toxin has become a target for diagnostic tests and therapeutic interventions. However, there are several obstacles associated with the process of α-hemolysin purification, therefore limiting its utilization in scientific investigations. In order to overcome the problems associated with α-hemolysin expression, after in silico prediction, a 20.48 kDa soluble α-hemolysin recombinant denoted rHlyA was constructed. This recombinant is composed by a 182 amino acid sequence localized in the aa542-723 region of the toxin molecule. The antigenic determinants of the rHlyA were estimated by bioinformatics analysis taking into consideration the tertiary form of the toxin, epitope analysis tools, and solubility inference. The results indicated that rHlyA has three antigenic domains localized in the aa555-565, aa600-610, and aa674-717 regions. Functional investigation of rHlyA demonstrated that it has hemolytic activity against sheep red cells, but no cytotoxic effect against epithelial bladder cells. In summary, the results obtained in this study indicate that rHlyA is a soluble recombinant protein that can be used as a tool in studies that aim to understand the mechanisms involved in the hemolytic and cytotoxic activities of α-hemolysin produced by UPEC. In addition, rHlyA can be applied to generate monoclonal and/or polyclonal antibodies that can be utilized in the development of diagnostic tests and therapeutic interventions.

Levantamento das decisões judiciais brasileiras a respeito da responsabilidade civil do cirurgião-dentista no Superior Tribunal de Justiça / Survey of Brazilian judicial decisions with regard to the civil liability of the dentist in the Superior Court of Justice

A responsabilidade civil é o instituto que se vincula ao dever de não causar prejuízo injustamente, proporcionando a busca da indenização pelos danos sofridos, podendo ser aplicada ao cirurgião-dentista. Este trabalho objetivou levantar e investigar as jurisprudências e decisões monocráticas no Superior Tribunal de Justiça (STJ) que versam sobre a responsabilidade do cirurgião-dentista. Trata-se de uma pesquisa quali-quantitativa, com caráter descritivo realizada na plataforma do STJ. A amostra foi composta por 5 jurisprudências e 20 decisões monocráticas para extrair as seguintes informações: data de julgamento; estado oriundo da ação; tipo de ação; tipo de sentença ­ a favor ou contra o Cirurgião-Dentista; tipo de obrigação - meio ou resultado; fundamento - Teoria subjetiva ou objetiva; tipo de erro em relação a figura jurídica da culpa - imperícia, negligência ou imprudência; e as especialidades envolvidas. Verificou-se a presença de decisões judiciais no STJ relacionadas a ações de indenização movidas por pacientes contra cirurgiões-dentistas, que versam, em sua maioria, sobre a teoria subjetiva da reponsabilidade nas decisões monocráticas (75%; n=15) e nas jurisprudências (n=4), tendo origem em vários estados brasileiros e com a Cirurgia e a Implantodontia como as especialidades odontológicas mais demandadas. A figura jurídica da culpa foi observada em apenas três decisões monocráticas e a maioria das decisões se apresentaram desfavoráveis ao cirugião-dentista. Assim, a presente pesquisa serve de alerta para os cirurgiões-dentistas da existência de ações de indenização no STJ, que denotam um processo longo, oneroso e desgastante, e que chegaram a essa instância superior em virtude dos dissídios jurisprudenciais.

The civil liability is the institute that is bound to the duty of not causing unjust damage, providing the search for indemnity for the damages suffered, which can be applied to the dentist. This work aimed to raise and investigate the jurisprudence and monocratic decisions in the Superior Court of Justice (STJ) that deal with the responsibility of the dentist. This is a qualitative and quantitative research, with a descriptive character, carried out on the STJ platform. The sample consisted of 5 jurisprudences and 20 monocratic decisions to extract the following information: trial date; state arising from the action; type of action; type of sentence - for or against the dentist; type of obligation - means or result; foundation - subjective or objective theory; type of error in relation to the legal figure of fault - malpractice, negligence or imprudence; and the specialties involved. It was verified the presence of judicial decisions in the STJ related to compensation actions filed by patients against dental surgeons, which mostly deal with the subjective theory of responsibility in monocratic decisions (75%; n = 15) and in jurisprudence (n = 4), originating in several Brazilian states and with Surgery and Implantology as the most demanded dental specialties. The legal figure of guilt was observed in only three monocratic decisions and most of the decisions were unfavorable to the dentist. Thus, this research serves as a warning to dentists of the existence of indemnity actions in the STJ, which denote a long, costly and exhausting process due to jurisprudential disagreements

Differentiated Hepatic Response to Fructose Intake during Adolescence Reveals the Increased Susceptibility to Non-Alcoholic Fatty Liver Disease of Maternal High-Fat Diet Male Rat Offspring.

SCOPE: Non-alcoholic fatty liver disease (NAFLD) among adolescents has been related to fructose intake. Additionally, maternal high-fat diet (mHFD) increases the offspring susceptibility to NAFLD at adulthood. Here, it is hypothesized that mHFD may exacerbate the fructose impact in adolescent male rat offspring, by changing the response of contributing mechanisms to liver injury. METHODS AND RESULTS: Female Wistar rats receive standard (mSTD: 9% fat) or high-fat diet (mHFD: 29% fat) prior mating throughout pregnancy and lactation. After weaning, offspring receive standard chow and, from the 25th to 45th day, receive water or fructose-drinking water (15%). At 46 days old, fructose groups show increased adiposity, increased serum and hepatic triglycerides, regardless of maternal diet. Fructose aggravates the hepatic imbalance of redox state already exhibited by mHFD offspring. The hepatic activation of cellular repair pathways by fructose, such as unfolded protein response and macroautophagy, is disrupted only in mHFD offspring. Fructose does not change the liver morphology of mSTD offspring. However, it intensifies the liver injury already present in mHFD offspring. CONCLUSION: Fructose intake during adolescence accelerates the emergence of NAFLD observed previously at the adult life of mHFD offspring, and reveals a differentiated hepatic response to metabolic insult, depending on the maternal diet.

Development and Validation of Shiga Toxin-Producing Escherichia coli Immunodiagnostic Assay.

Shiga toxin (Stx)-producing Escherichia coli (STEC) and its subgroup enterohemorrhagic E. coli are important pathogens involved in diarrhea, which may be complicated by hemorrhagic colitis and hemolytic uremic syndrome, the leading cause of acute renal failure in children. Early diagnosis is essential for clinical management, as an antibiotic treatment in STEC infections is not recommended. Previously obtained antibodies against Stx1 and Stx2 toxins were employed to evaluate the sensitivity and specificity of the latex Agglutination test (LAT), lateral flow assay (LFA), and capture ELISA (cEIA) for STEC detection. The LAT (mAb Stx1 plus mAb stx2) showed 99% sensitivity and 97% specificity. Individually, Stx1 antibodies showed 95.5% and 94% sensitivity and a specificity of 97% and 99% in the cEIA and LFA assay, respectively. Stx2 antibodies showed a sensitivity of 92% in both assays and a specificity of 100% and 98% in the cEIA and LFA assay, respectively. These results allow us to conclude that we have robust tools for the diagnosis of STEC infections.

Structural Changes in Stx1 Engineering Monoclonal Antibody Improves Its Functionality as Diagnostic Tool for a Rapid Latex Agglutination Test.

Stx1 toxin is one of the AB5 toxins of Shiga toxin-producing Escherichia coli (STEC) responsible for foodborne intoxication during outbreaks. The single-chain variable fragment (scFv) is the most common recombinant antibody format; it consists of both variable chains connected by a peptide linker with conserved specificity and affinity for antigen. The drawbacks of scFv production in bacteria are the heterologous expression, conformation and stability of the molecule, which could change the affinity for the antigen. In this work, we obtained a stable and functional scFv-Stx1 in bacteria, starting from IgG produced by hybridoma cells. After structural modifications, i.e., change in protein orientation, vector and linker, its solubility for expression in bacteria was increased as well as the affinity for its antigen, demonstrated by a scFv dissociation constant (KD) of 2.26 × 10-7 M. Also, it was able to recognize purified Stx1 and cross-reacted with Stx2 toxin by ELISA (Enzyme-Linked Immunosorbent Assay), and detected 88% of Stx1-producing strains using a rapid latex agglutination test. Thus, the scFv fragment obtained in the present work is a bacteria-produced tool for use in a rapid diagnosis test, providing an alternative for STEC diagnosis.

Large-scale evaluation of a rapid diagnostic test for diarrhea caused by enterotoxigenic Escherichia coli targeting the heat-labile toxin.

We standardized an immunochromatographic test (IC) for heat-labile toxin I (LT-I) detection using LT-I antibodies and a specific platform containing the apparatus for application, assembly and cutting. IC detected as little as 62.5ng/mL of purified LT-I toxin and presented 91% sensitivity, 99.5% specificity and 96.0% accuracy, thereby proving to be an excellent point-of-care test for the diagnosis of enterotoxigenic E. coli infection in low-income countries.

Immunogenic Domains and Secondary Structure of Escherichia coli Recombinant Secreted Protein Escherichia coli-Secreted Protein B.

Several pathogenic bacteria are able to induce the attaching and effacing (A/E) lesion. The A/E lesion is caused by effector proteins, such as Escherichia coli-secreted protein B (EspB), responsible together with Escherichia coli-secreted protein D for forming a pore structure on the host cell, which allows the translocation of effector proteins. Different variants of this protein can be found in E. coli strains, and during natural infection or when this protein is injected, this leads to variant-specific production of antibodies, which may not be able to recognize other variants of this bacterial protein. Herein, we describe the production of a hybrid recombinant EspB toxin that comprises all known variants of this protein. This recombinant protein could be useful as an antigen for the production of antibodies with broad-range detection of EspB-bearing bacteria, or as an antigen that could be used in vaccine formulation to generate antibodies against different EspB variants, thereby increasing immunization potential. In addition, the recombinant protein allowed us to analyze its secondary structure, to propose the immunogenic regions of EspB variants, and also to characterize anti-EspB antibodies. Our results suggest that this hybrid protein or a protein composed of the conserved immunogenic regions could be used for a variety of clinical applications.

Epitope Sequences in Dengue Virus NS1 Protein Identified by Monoclonal Antibodies.

Dengue nonstructural protein 1 (NS1) is a multi-functional glycoprotein with essential functions both in viral replication and modulation of host innate immune responses. NS1 has been established as a good surrogate marker for infection. In the present study, we generated four anti-NS1 monoclonal antibodies against recombinant NS1 protein from dengue virus serotype 2 (DENV2), which were used to map three NS1 epitopes. The sequence 193AVHADMGYWIESALNDT209 was recognized by monoclonal antibodies 2H5 and 4H1BC, which also cross-reacted with Zika virus (ZIKV) protein. On the other hand, the sequence 25VHTWTEQYKFQPES38 was recognized by mAb 4F6 that did not cross react with ZIKV. Lastly, a previously unidentified DENV2 NS1-specific epitope, represented by the sequence 127ELHNQTFLIDGPETAEC143, is described in the present study after reaction with mAb 4H2, which also did not cross react with ZIKV. The selection and characterization of the epitope, specificity of anti-NS1 mAbs, may contribute to the development of diagnostic tools able to differentiate DENV and ZIKV infections.