Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial.

Importance: Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective: To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants: This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention: The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures: Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results: A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance: The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration: Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil.

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

História em quadrinhos para educação em saúde bucal: construção, validação e análise da eficácia / Comics for oral health education: construction, validation, and analysis of efficacy

As tecnologias ilustradas tem sido um artifício amplamente utilizado para a educação em saúde bucal, sendo as histórias em quadrinhos um formato ainda pouco explorado no que se refere à validação e análise da sua eficácia para com o público-alvo. Este estudo objetivou avaliar a efetividade de uma história em quadrinhos no processo de educação em saúde bucal a crianças entre 06 e 12 anos atendidas na clínica de Odontopediatria de uma policlínica odontológica na Amazônia brasileira. Uma revista em quadrinhos lúdico-educativa foi confeccionada, validada e incorporada em um kit contendo 01 escova dental, 01 fio dental e 01 creme dental. Posteriormente foi aplicado um questionário com os pais (N=50), antes e depois da entrega dos kits, que avaliava os cuidados de higiene bucal da criança e as impressões sobre o impacto dos quadrinhos sobre a higiene bucal de seus filhos. Os resultados foram analisados descritivamente, por meio de frequências absolutas e porcentagens sendo usado o teste de McNemar (p<0,05). Verificou-se o aumento de 55,32% das crianças que passaram a usar o fio dental após implementação metodológica. Constatou-se, ainda, não haver diferença estatística entre a frequência de escovação após a entrega do kit (p=0.873), havendo, entretanto, aumento significativo na frequência do uso do fio dental entre as crianças avaliadas (p=0.0401). Os quadrinhos mostraram-se estatisticamente eficazes no aumento da frequência do uso do fio dental, tendo a HQ uma boa aceitação tanto das crianças como dos pais.

Illustrated media has been a widely used device for oral health education, with comics being a format that is still under explored in terms of validation and analysis of their effectiveness towards the target audience. This study aimed to evaluate the effectiveness of a comic book in the process of oral health education to children between 6 and 12 years of age attended at the pediatric dentistry clinic of a dental polyclinic in the Brazilian Amazon. A playful-educational comic book was made, validated, and incorporated into a kit containing 01 toothbrush, 01 floss, and 01 toothpaste. Subsequently, a questionnaire was applied with the parents (N=50), before and after the delivery of the kits, which evaluated the child's oral hygiene care and the impressions on the impact of the comics on the oral hygiene of their children. The results were analyzed descriptively, through absolute frequencies and percentages using the McNemar test (p<0.05). There was an increase of 55.32% of the children who started flossing after methodological implementation. It was also found that there was no statistical difference between the frequency of brushing after delivery of the kit (p=0.873), but there was a significant increase in the frequency of flossing among the children evaluated (p=0.0401). The comics were statistically effective in increasing the frequency of flossing, with comic books having a good acceptance of both children and parents.

A educação em saúde como medida de prevenção e promoção da saúde bucal / Health education as a measure of prevention and promotion of oral health

O objetivo deste estudo foi conhecer os projetos desenvolvidos na área de educação em saúde nas escolas públicas, bem como aceitação de pais, educadores e alunos. Foi feito um estudo epidemiológico quantitativo. A população estudada foi constituída de crianças do sexto ao nono ano do ensino fundamental, seus respectivos responsáveis e professores. A maioria dos participantes aceitaram o projeto de educar em saúde. Os professores afirmaram que 70% dos alunos demonstram interesse pelo tema de educação em saúde bucal. Os entrevistados se puseram dispostos a participar de um programa em conjunto envolvendo pais, professores e alunos. Todos os professores participantes consideraram essa integração importante, podendo ocorrer, principalmente, através de projetos pedagógicos. O grupo estudado, além de obter mais conhecimento em saúde bucal, também destacou a importância da presença dos alunos de Odontologia da UEA na escola...

The objective of this study was to get to know health education projects developed in public schools, as well as to assess acceptance of parents, educators, and students. The study samples was composed by students from sixth to ninth grade; their guardians and teachers. Most participants accepted well the health education project. Teachers stated that 70% of students were interested in oral health education. Respondents stood ready to participate in a joint program between parents, teachers and students. All teachers considered this integration important, and pointed out the possibility of it occurrence mainly through educational projects. The studied group, gained knowledge on oral health, and highlighted the importance of the presence of dentistry students from UEA at the school...

Uso da clorexidina como agente preventivo e terapêutico na Odontologia / Chlorhexidine use as a preventive and therapeutic agent in Dentistry

A clorexidina é um antimicrobiano sintético que apresenta alto nível de atividade sem, no entanto, ter os efeitos secundários que a maioria dos antimicrobianos apresenta. Pequenas concentrações de sais de clorexidina são geralmente suficientes para inibir o processo reprodutivo ou exterminar a maioria dos microrganismos, além do que, sendo praticamente isenta de toxicidade e efeitos corrosivos, proporciona extrema segurança no seu emprego. O conhecimento das propriedades e o uso da clorexidina permitem ao cirurgião-dentista desenvolver suas atividades com segurança, voltadas à prevenção e ao tratamento de doenças, além de minimizar os riscos de infecção cruzada à equipe odontológica e ao paciente.

The chlorhexidine is a synthetic antimicrobial agent that has a high level of activity without having side effects that most of antimicrobial present. Small concentrations of chlorhexidine salts are usually sufficient to inhibit the reproductive process or exterminate the most of microorganisms, in addition to that, being free of toxicity and corrosive effects, it provides extreme security in its use. The knowledge of properties and use of chlorhexidine allows dentists to develop their activities in safety and direct to the prevention and treatment of diseases, and minimize the risk of cross infection to dentistry staff and patient.