The severity of malnutrition in children with epidermolysis bullosa correlates with disease severity

Practical considerations relevant to treatment with the gene therapy beremagene geperpavec-svdt for dystrophic epidermolysis bullosa

BACKGROUND/PURPOSE

Dystrophic epidermolysis bullosa (DEB), a rare genetic skin disease caused by loss-of-function mutations in COL7A1, the gene encoding type VII collagen (COL7), is characterized by skin blistering, scarring, and extracutaneous manifestations that markedly reduce patient quality-of-life. Beremagene geperpavec-svdt ('B-VEC') is a gene therapy employing a non-integrating, replication-defective herpes simplex virus type 1 (HSV-1)-based vector encoding two copies of full-length human COL7A1 to restore COL7 protein after topical administration to DEB wounds. B-VEC was approved in the United States in 2023 as the first topical gene therapy and the first approved treatment for DEB. However, few providers have experience with use of this gene therapy.

METHODS

Data was obtained through literature review and the experience of providers who participated in the B-VEC clinical study or initiated treatment after B-VEC approval.

RESULTS

This review discusses the burden of disease, describes the clinical trial outcomes of B-VEC, and provides physician and patient/caregiver recommendations as a practical guide for the real-world use of B-VEC, which can be administered in-office or at the patient's home.

CONCLUSIONS

By continuing to optimize the practical aspects of B-VEC administration, the focus will continue to shift to patient-centric considerations and improved patient outcomes.

Psychometric Properties of the Instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa patient score (iscorEB-p): a patient-reported outcome measure

BACKGROUND

In contrast to clinical diagnosis via external examination, patient-related outcome measures (PROMs) allow access to patients' internal perceptions. In the case of epidermolysis bullosa (EB) - a rare disease characterized by a wide variety of symptoms and individual disease courses - it is important to integrate the patient's perspective into diagnostic processes. The Instrument for Scoring Clinical Outcomes of Research for EB (iscorEB) is an EB-specific measurement tool, combining a clinician score (iscorEB-c) and a patient questionnaire (iscorEB-p).

OBJECTIVES

The aim of this study is to establish the iscorEB-p as an independent PROM tool by exploring its psychometric properties.

METHODS

Sample-based psychometric testing and evaluation were performed on data collected via a multinational online cross-sectional study.

RESULTS

Data analysis was performed with n = 95 participants across all EB types. The reliability and internal consistency of the iscorEB-p was excellent (α = 0.90). Principal component analysis with a varimax rotation resulted in a two-factor solution, explaining 55.6% of the total variance, with the distinct factors 'everyday life functioning' and 'specific EB symptoms'. Convergent validity was shown by high correlations to the Satisfaction With Life Scale (r = -0.52, P < 0.001), the Quality of Life in Epidermolysis Bullosa questionnaire (r = 0.72, P < 0.001) and the Epidermolysis Bullosa Family Burden of Disease questionnaire (r = -0.73, P < 0.001).

CONCLUSIONS

The iscorEB-p is a reliable and valid instrument to assess patient-reported health status of people with EB.

Evaluation of Clinical and Oral Findings in Patients with Epidermolysis bullosa

Introduction: Epidermolysis bullosa (EB) is a genetically inherited disease characterized by recurrent bullae and erosions on the skin with numerous signs of dental caries and poor oral hygiene. The aim of this study was to investigate the general clinical and oral findings of patients with EB. Materials and Methods: In this prospective study, the clinical and oral findings and family history of 26 cases with EB were evaluated. The type of EB, gender, age, parental consanguinity, dental caries, oral findings, distribution of lesions and presence of associated anomalies, clinical and oral findings correlated with gender were recorded. Results: All 26 patients with EB had a history of consanguinity and siblings with EB to varying degrees. In our study, malnutrition, anemia and growth retardation, gastrointestinal system complications, hair thinning, hand and nail deformity, ocular problems and renal disease (in one case) were observed with variable frequencies. When the intraoral findings of the patients were investigated, extensive dental caries in all EB types, enamel hypoplasia in junctional EB (JEB) and the presence of tooth-root to be extracted in dystrophic EB (DEB), intraoral bullae and lesions, ankyloglossia, vestibular sulcus insufficiency, microstomia and maxillary atrophy were observed. Three cases had restorative treatment and one case had prosthetic rehabilitation. Conclusions: Oral involvement can be seen with varying frequencies depending on the type of EB and the severity of the disease. It may result from delayed oral and dental rehabilitation due to physical disabilities, limitations and more pressing medical problems. Microstomy, pain from mucosal lesions, and restricted access to the mouth can be caused by poor oral hygiene. Oral complications and caloric needs of individuals with EB should be determined, and individual prophylaxis should be applied to prevent caries formation and protect teeth.

Mapping and determinants of consumption of egg and/or flesh foods and zero vegetables or fruits among young children in SSA

Zero vegetable or fruit and egg and/or flesh foods are the latest indicators for assessing infant and young child feeding practices. Understanding national and subnational heterogeneity and regional clustering in children with SSA is becoming increasingly essential for geographic targeting and policy prioritization. Geographical case identification, determinants, and impacts were all investigated. SSA children's consumption of vegetable or fruit, egg and/or flesh food, and both were low. In SSA, some portions of the Southern, South direction of the Western and Central regions have a lower weight of all bad conditions than others, although children continue to suffer in considerable numbers in all disadvantage circumstances. Children under the age of 1 year, from rural areas, uneducated families, and low income were all disadvantaged by both feeding techniques. To improve child nutrition status, multisectoral collaboration is essential. This framework allows for the tracking, planning, and implementation of nutritional treatments.

Plasma metabolomic profiling reflects the malnourished and chronic inflammatory state in recessive dystrophic epidermolysis bullosa

BACKGROUND

Recessive dystrophic epidermolysis bullosa (RDEB) is a hereditary blistering disorder characterized by skin fragility, chronic inflammation, malnutrition, and fibrosis. Metabolomics is an emerging investigative field that helps elucidate disease pathophysiology and identify biomarkers. However, previous metabolomic studies in RDEB are limited.

OBJECTIVE

To investigate the plasma metabolomic profiles in RDEB patients.

METHODS

We recruited 10 RDEB patients and 10 age-/gender-matched healthy controls. Peripheral blood samples were collected and plasma metabolomic profiling was performed by LC-MS/MS analysis. MS data processing and compound identification were executed by MS-DIAL. Enrichment analysis was performed by MetaboAnalyst 5.0.

RESULTS

Metabolomic analyses demonstrated that most amino acid levels were downregulated in RDEB patients, and the extent of insufficiency correlated with clinical severity. Several metabolites were dysregulated in RDEB, including glutamine and glutamate metabolism, tryptophan-to-kynurenine ratio, phenylalanine-to-tyrosine ratio, and succinate accumulation.

LIMITATIONS

The study was limited by small case numbers and the unrepresentativeness of a single time-point blood sample.

CONCLUSION

Our study demonstrated the altered metabolomic profiles in RDEB, reflecting the disease severity, the chronic inflammatory and malnourished status, while the fibrotic signatures were not evident.

Epidermolysis Bullosa: A case study in Cyprus and the nursing care plan

PURPOSE

To present a case study with Epidermolysis bullosa (EB) in Cyprus and to determine the nursing care plan, explaining the nursing interventions and showing the importance of nursing care of patients with EB.

METHODS

Literature review on EB and semi-structured interviews commenced through a direct discussion with open-ended questions to the research subject as well as to a close relative describing his feelings, experiences, and concerns about the disease.

FINDINGS

Thematic analysis approach was used to identify and analyze patterns in the data. Then, data were synthesized using the standardized nursing terminology of NANDA-I and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient.

CONCLUSIONS

Nurses should apply evidence-based practice interventions for EB wound care, pain management, nutrition, psychological and social support to these patients.

IMPLICATIONS FOR NURSING PRACTICE

Although EB is classified in the category of rare diseases, the presentation of a case study in Cyprus and the nursing care plan contribute further bibliographically to the holistic and at the same time individualized nursing practice.