Pityriasis versicolor: clinical-epidemiological characterization of patients in the urban area of Buerarema-BA,Brazil

BACKGROUND:

Pityriasis versicolor (PV) is a cutaneous pigmentation disorder caused by a lipophilic yeast of the genus Malassezia sp. It is a superficial mycosis characterized by well-defined, slightly scaly skin lesions of variable color. In Brazil, the number of reported cases is small, and there are few epidemiological studies.

OBJECTIVES:

to assess incidence, characteristics of the lesions, effectiveness of the Zileri''s Sign procedure, and the epidemiological profile of PV in the urban area of Buerarema - Bahia.

METHODS:

Biological samples were collected on pre-established days at Basic Health Care Units from July to September 2010. Sample collection was followed by laboratory diagnosis using Porto''s Method.

RESULTS:

Of the 158 patients with suspected PV participating in the study, 105 (66.5%) were positive; 72 (68.6%) were female and 33 (31.4%) were male. Sex and location of lesions showed statistically significant differences (p<0.05). The region with the highest rate of cases of PV was found to be the center of the city, with 40.9% of diagnosed cases. The most affected age group was between 10 and 19 years. There was a significant association between the results produced through Zileri''s Sign and Porto''s Method in relation to positive and negative results (p<0.05).

CONCLUSIONS:

The results showed a higher prevalence of PV among individuals at puberty. The Zileri''s Sign method proved to be counterproductive, because it showed low efficacy as a method for clinical diagnosis, yielding negative results for 36 (34.3%) patients who had been diagnosed with PV through laboratory examination.     

Epidemiological study and considerations of primary focal hyperhidrosis in Japan: From questionnaire analysis

Primary hyperhidrosis is a disorder of excessive, bilateral and relatively symmetrical sweating occurring in the palms, soles and axillae regions without obvious etiology. There have been some reports of the epidemiology of primary hyperhidrosis abroad so far, but there has never been any research performed in Japan. We performed a questionnaire survey for people aged 5–64 years who agreed with the purpose of this study at 20 companies or schools, and received 5807 valid responses. From this survey, each prevalence could broken down into 5.33% for primary palm hyperhidrosis, 2.79% for primary plantar hyperhidrosis, 5.75% for primary axillae hyperhidrosis and 4.7% for primary head hyperhidrosis. Patients with severe symptoms were estimated to be approximately 616 000 for primary palmar hyperhidrosis and 2 239 000 for primary axillae hyperhidrosis in Japan. These findings reveal that many patients feel a decreased quality of life because of symptoms of hyperhidrosis every day. However, only 6.2% of the patients had visited medical institutions. Moreover, few patients take appropriate treatment even after visiting the hospital.     

Brazilian guidelines for diagnosis,treatment and follow-up of primary cutaneous melanoma - Part II

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?     

培养救援医学学员医学科普实践能力的意义及途径探讨

医学科普实践包括医学科普创作、医学科普宣讲、医学科普组织等过程.部队医学院校培养救援医学学员医学科普实践能力,在服务部队官兵、胜任第一任职需要、突出救援医学特色教学、引导学员开展医学研究、凸显医学教育以人为本的时代要求以及更好地贯彻宣传科普法等方面,具有重要的意义.采用参加社会实践方式、组织学员参与医学科普课题的攻关、开展医学科普宣传教育活动、把医学科普教育纳入教学计划、加大对学员科普实践活动的指导力度等途径,培养救援医学学员的医学科普实践能力.     

Evaluation of anxiety and depression prevalence in patients with primary severe hyperhidrosis

BACKGROUND

Primary hyperhidrosis (PH) can lead to mood changes due to the inconveniences it causes.

OBJECTIVE

This study aimed to examine the existence of anxiety and depression in patients with severe primary hyperhidrosis who sought treatment at a medical office.

METHODS

The questionnaire "Hospital Anxiety and Depression Scale" was used for 197 individuals, in addition to the chi square test and Fisher exact test, p <0.05.

RESULTS

There was an increased prevalence of anxiety (49.6%) but not of depression (11.2%) among patients with PH, with no link to gender, age or amount of affected areas. Palmar and plantar primary hyperhidrosis were the most frequent but when associated with the presence of anxiety, the most frequent were the axillary (p = 0.02) and craniofacial (p = 0.02) forms. There was an association between patients with depression and anxiety (p = 0.001).

CONCLUSIONS

the involvement of Primary hyperhidrosis was responsible for a higher prevalence of anxiety than that described among the general population and patients with other chronic diseases. Depression had a low prevalence rate, while mild and moderate forms were the most common and frequently associated with anxiety. The degree of anxiety was higher in mild and moderate types than in the severe form.     

Cutaneous leukocytoclastic vasculitis in the presence of methimazole therapy

Treatment with antithyroid drugs may be accompanied by side effects. We present apatient diagnosed with Grave''s Disease who developed extensive vasculitis in thelower limbs during methimazole use. After suspension of the methimazole and theintroduction of prednisone in immunesupressor doses the cutaneous lesions started toinvolute.     

Adenosine: an endogenous mediator in the pathogenesis of psoriasis

It is known that inflammatory and immune responses protect us from the invasion of micro-organisms and eliminate "wastes" from the injured sites, but they may also be responsible for significant tissue damage. Adenosine, as a purine nucleoside, which is produced in inflamed or injured sites, fulfills its role in limiting tissue damage. Although, it may have a pleiotropic effect, which signals it with a proinflammatory state in certain situations, it can be considered a potent anti-inflammatory mediator. The effects of adenosine, which acts through its receptors on T cell, on mast cell and macrophages, on endothelial cells, on neutrophils and dendritic cells, as they indicate TNF-alpha and cytokines, show that this mediator has a central role in the pathogenesis of psoriasis. The way it acts in psoriasis will be reviewed in this study.     

Long-term results of oxybutynin use in treating facial hyperhidrosis

BACKGROUND

Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear.

OBJECTIVE

To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months.

METHODS

61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites.

RESULTS

Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites.

CONCLUSION

Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.     

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

BACKGROUND

The gynoidlypodystrophy, known as cellulitis or cellulite, refers to a condition that gives the skin an undulating and uneven appearance, affecting 80-90% of women after puberty.

OBJECTIVES

to investigate the efficacy and safety of manual lymphatic drainage for cellulite management.

METHODS

this was an open, prospective, intervention study including 20 women aged from 20 to 40 years. Fourteen sessions of manual lymphatic drainage were performed once a week on lower limbs and buttocks.

RESULTS

Fifteen women completed the study. A significant improvement on quality of life was observed (p=0.018). A significant reduction (p=0.023), estimated at 0.3±0.8 cm, in hip circumference was found, but no difference was found in thighs circumference (p>0.05). A significant reduction elastic recuperation of skin on buttocks, which means skin elasticity worsening, was observed. All measures obtained by ultrasound images showed no changes (p>0.05).

CONCLUSION

manual lymphatic drainage was safe but not effective as an isolated approach for cellulite management. Further randomized, controlled or comparative studies about manual lymphatic drainage for cellulite control, as unique or combined therapeutic modality, are necessary.     

青岛地区中小学生泌尿生殖道解脲脲原体及人型支原体分子流行病学调查

目的 探讨解脲脲原体（Uu）和人型支原体（Mh）在健康中小学生泌尿生殖道中的定植情况,以及Uu的分群分型状况。方法 培养法对青岛地区957名中小学生的尿沉渣进行Uu和Mh培养,培养阳性者用PCR确证,并对Uu阳性标本进一步分群分型。结果 Uu阳性46例,占4.81%,生物一群占69.57%,生物二群30.43%。小学生Uu阳性12例,占2.97%,生物一群9例（75.00%）,生物二群3例（25.00%）。初中生Uu阳性8例,占3.08%：生物一群5例（62.50%）,生物二群3例（37.50%）。高中生Uu阳性26例,占8.87%：生物一群18例（69.23%）,生物二群8例（30.77%）。Mh阳性9例（0.94%）,其中小学生Mh阳性1例,初中生Mh阳性1例,高中生Mh阳性7例。3个组Uu阳性率女生均高于男生（P < 0.05）。 结论 Uu和Mh在中小学生泌尿生殖道中存在无症状的携带状态。尽管各年龄组检出的Uu均以生物一群为主,但生物二群也占有不小的比例,提示Uu可能是健康中小学生人群正常定植菌,且女性携带率高于男性。     

Trend of leprosy detection rate in Brazil, 1990 to 2016

The objective of this study was to describe the trend of detection of the disease in Brazil from 1990 to 2016. The joinpoint regression model was used. There was a significant trend of decreased detection in the country (average annual percent change  −1.8%) and in the South (average annual percent change = −3.5%) and Southeast regions (average annual percent change = −4.5%). The Northeast (average annual percent change = 0.2%), the Central-West (average annual percent change = −1.5%), and the North (average annual percent change = −2.6%) showed a stationary trend (p > 0.05). Eleven states showed a decreasing trend. Alagoas (average annual percent change = 2.1%) and Rio Grande do Norte (average annual percent change = 1.4%) presented significant increase (p < 0.001). The heterogeneous pattern of trend between regions and states shows that efforts are needed to eliminate the disease.     

Clinical epidemiological profile of vitiligo in children and adolescents

94 children and 25 adolescents, 42% male and 58% female, aged predominantly betweensix and ten years old (40%) were studied at the Martagão Gesteira Childcare andPediatrics Institute (Rio de Janeiro Federal University) between 2005 and 2011. Theprevalent clinical form of vitiligo was the generalized type (34%). Although theclinical response was similar between the treatment modalities, we decided for lowand high power topical steroids in our routine. Halo nevi were found in seven (5.9%)cases. Thirty (25%) patients underwent specialized evaluation and 18 (60%) reportedsome relevant psychological situation.     

Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010

BACKGROUND

While representing only 3-4% of malignant skin tumors, cutaneous melanoma is the most aggressive and lethal. Statistical knowledge about the biological behavior of this tumor is essential for guiding daily outpatient practice and aiding public health policies.

OBJECTIVES

To analyze the profile of patients with cutaneous melanoma attending a pathology department in Teresina (state of Piauí) between 2000 and 2010.

METHODS

Retrospective study of melanoma patients diagnosed between 2000 and 2010 in the São Marcos Hospital in the city of Teresina. The pathology laboratory reports were studied and all the statistical analyses performed using SPSS 19.0.

RESULTS

A total of 25 in situ, 199 invasive and 89 metastatic melanomas of unknown primary site were observed. Histological types found were nodular (52.8%), superficial spreading melanoma (18.6%), acral (10.6%) and lentigo maligna (9.5%). In 144 (73.4%) cases the Breslow thickness was >1 mm. Metastasis was found in 28.6% of invasive melanomas and nodular melanoma, Clark IV/ V, Breslow > 1 mm, mitotic index ≥ 6 and ulcerated lesions were more likely to metastasize.

CONCLUSION

Most melanomas presented Breslow> 1mm. The main factors associated with metastasis were nodular type, Clark IV / V, Breslow> 1mm, mitotic index ≥ 6 and ulcerated lesions.     

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND

notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits.

OBJECTIVES

To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica.

METHODS

We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching.

RESULTS

The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat.

CONCLUSION

Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica.     

Reviewing the therapeutic management of leprosy in primary care: demand case series referred to a University Hospital in the Midwest region of Brazil

BackgroundLeprosy still represents a negleted public health problem in Brazil. Early and adequate treatment of leprosy, carried out in a primary health network is essential to reduce morbidity and sequelae.ObjectiveTo analyze the therapeutic management of leprosy patients referred from primary healthy services to a specialized service.MethodsAn analytical retrospective study using medical records and the Notifiable Diseases Information System. Patients diagnosed with leprosy, referred to a specialized outpatient clinic, between 2016 and 2017, in Goiás state, were included. The treatment carried out in the primary health services was compared to the Ministry of Health guidelines.ResultsTwo-hundred twenty-five leprosy patients were included, of whom 33.3% were referred by leprosy reactions, 27.1% by sequelae, and 10.2% by suspected recurrence or reinfection. Reviewing the therapeutic management, 123 (54.7%) were considered inadequate, 92 (40.9%) adequate, and 10 (4.4%) inconclusive. Of the 200 multibacillary patients, 39.5% had adequate management. In contrast, 12 (85.1%) out of 14 paucibacillary patients had adequate management (χ² = 11.43 and p < 0.001). Regarding the leprosy reactions and sequelae management, 56.9% and 19.5% were considered inadequate, respectively. There was no difference between the percentage of adequate or inadequate management when considering the Goiás health macroregions (χ² = 7.23; 4 degrees of freedom; p = 0.12).Study limitationsUse of recorded data, with incomplete medical records and lack of patient follow-up.ConclusionsThe study demonstrated the equivocal multibacillaryleprosy management conducted in healthy primary care, with an emphasis on leprosy reactions and sequelae. Training and monitoring the medical staff in the primary healthy services could reduce the morbidity and sequelae of leprosy.     

Differences in the diagnosis of primary cutaneous melanoma in the public and private healthcare systems in Joinville,Santa Catarina State,Brazil

Background:Cutaneous melanoma accounts for up to 80% of deaths caused by skin cancer. Diagnostic suspicion and access to medical care and early intervention in suspected cases is vital to the patient’s prognosis.Objectives:To compare demographic and histopathological characteristics of primary cutaneous melanoma diagnosed in the public healthcare system (Sistema Único de Saúde SUS) and the private system in Joinville, Santa Catarina State, Brazil.Methods:This cross-sectional retrospective study analyzed primary cutaneous melanoma cases recorded from 2003 to 2014 in the resident population of Joinville. Ethical approval was obtained from the local Research Ethics Committee.Results:893 cases of primary cutaneous melanoma were identified. Patients in the private system were mostly younger, while there were more elderly patients in the public healthcare system (p <0.001). There was no statistically significant association between type of care (public/private) and gender or presence of multiple primary cutaneous melanomas. Histological diagnosis of superficial spreading melanoma was more common in patients treated in private healthcare, while nodular melanoma was more frequent in patients in the public healthcare system (p <0.001). Mean Breslow depth in patients treated in private healthcare was 1.35mm, compared to 2.72mm in the public system (p <0.001).Study limitations:This was a retrospective study using secondary databases.Conclusions:thin cutaneous melanoma (in situ cutaneous melanoma and Breslow T1) showed the strongest association with the private healthcare system, while thick cutaneous melanoma was more frequent in the public system (Breslow category T3 and T4) (p <0.001).     

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus,Leporidae): the role of dermoscopy in diagnosis

We report a case of Tinea nigra in an adolescent living in Itapema,Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the lefthand, close to another erythematous macule caused by a rabbit bite. The patientreceived guidance on accidents and animal bites and evolved well treated with topicalbutenafine for the dermatomycosis. The authors also highlight the efficacy of thedermoscopic exam in diagnosing Tinea nigra with animal bite lesionsand other traumas.     

Patients' attitudes to the presence of medical students in a genitourinary medicine clinic: a cross sectional survey

OBJECTIVES: It is recommended that medical students learn how to take a sexual history and gain experience in genital examination, but patients' reluctance may make this difficult to achieve, especially for male students. METHODS: We performed a survey of 250 male and 250 female patients attending a genitourinary medicine (GUM) clinic to determine their attitudes towards the involvement of medical students during their visit. Data were collected on the patients' age, ethnic origin, parity, number of visits to the clinic, and the sex of the student. RESULTS: 92.8% of women and 79.2% of men participated. Younger women and men, those visiting the clinic for the first time, and women with no children were less likely to accept a student of either sex to take their history or observe their examination. Women were less likely than men to accept students of either sex to take their sexual history or be present during their examination, but were more likely than men to accept only same sex students. CONCLUSIONS: There was a high level of acceptability for the involvement of medical students; only 12.5% of women and 15% of men declined any medical student participation. Older women with children, and older men, were more likely to accept a student of either sex for all parts of the consultation. This information can be used to enhance the experience of male and female students and to minimise distress for those patients who are less likely to accept the presence of a medical student.