Cultural adaptation and validation of the Ghent global IAD monitoring tool (GLOBIAD-M) for Brazilian Portuguese.

BACKGROUND: Incontinence-associated dermatitis (IAD) poses a significant challenge for individuals experiencing incontinence, characterized by irritative contact dermatitis due to prolonged exposure to urine and/or faeces. OBJECTIVE: This study aimed to culturally adapt the Ghent Global IAD Monitoring Tool - GLOBIAD-M to Brazilian Portuguese and to assess the adapted version's measurement properties quality. METHOD: A clinimetric study was conducted, comprising cultural adaptation and psychometric assessment. Cultural adaptation followed international guidelines, while psychometric properties were evaluated for content validity, inter-rater reliability, and correlation with other variables (thermography). Inter-rater reliability was assessed through clinical and photographic evaluations. The study samples included linguists and, IAD specialists, nurses, and adult patients with IAD according to the cultural adaptation or psychometric evidence assessment. RESULT: The process of cultural adaptation resulted in a cumulative coefficient of variation ratio (CVR) of 0.66. Subsequently, the study included 57 patients and 57 nurses for clinical assessments, totalling 166 evaluations of IAD. The inter-rater reliability among nurses was deemed satisfactory, with a Gwet coefficient of 0.77. Moreover, out of 215 photographic assessments conducted by 54 nurses, there was a 92.1 % concurrence in the categorization of IAD. Furthermore, thermography analysis revealed significant temperature differences between healthy individuals and those with IAD, particularly in patients categorized under IAD Cat. 1B, showing a difference of 1.90 °C. CONCLUSION: and Impact on Clinical Practice: The results confirm the availability of the GLOBIAD-M in its Brazilian Portuguese version. This tool will allow health professionals to obtain a standardized IAD classification and monitoring in Brazil, enhancing its diagnostic accuracy and aiding clinical decision-making.

Diaper dermatitis and associated factors among 1-24 months children visiting public health facilities of Arba Minch town, Gamo zone, southern Ethiopia.

Background: Diaper dermatitis is one of infants and toddlers' most common skin diseases; it accounts for 10-20 % of all skin diseases and 25 % of pediatric dermatology visits. Diaper dermatitis also increases parents' mental health problems and compromises the quality of life. Despite its ill outcome, diaper dermatitis's burden and risk factors are poorly studied in Ethiopia. Therefore, this study aimed to assess the magnitude of diaper dermatitis and associated factors among 1-24 months children visiting public health facilities in Arba Minch town, southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 671 mother-child pairs from May 15 to June 15, 2022. A structured and pretested interviewer-administered questionnaire and observational checklist were used to collect the information. The data was collected using an open data kit tools and analyzed using Stata version 17.0. Bivariable and multivariable analyses were carried out to identify factors associated with diaper dermatitis. P-value <0.05 was considered to declare statistical significance. Results: In this study, 664 mother-child pairs, yielded a response rate of 98.96 %, were involved. Overall, 35.69 % [95 % CI: 32.04, 39.47] of children encountered diaper dermatitis. Being government-employed (AOR: 2.49, 95 % CI: 1.42, 4.35), primiparity (AOR: 1.52, 95 % CI: 1.03, 2.23), unplanned pregnancy (AOR: 1.93, 95 % CI: 1.22, 3.04), having poor knowledge about diaper dermatitis (AOR: 1.74, 95 % CI: 1.19, 2.56), using both disposable and non-disposable diapers alternatively (AOR: 3.35, 95 % CI: 1.55, 7.22), and applying ointments on diaper area (AOR: 1.93, 95 % CI: 1.26, 2.97) all increase the likelihood of diaper dermatitis. Conclusion: Diaper dermatitis was high in the study hospitals; over one-third experienced it. Maternal occupation, parity, pregnancy status, maternal knowledge of diaper dermatitis, diaper type, and ointment application were significantly associated with diaper dermatitis. Improving maternal/guardian knowledge about diapering and diaper dermatitis is critical to reducing the burden and severity of the problem.

Betamethasone cream to treat diapers rash causing Cushing syndrome.

OBJECTIVES: Betamethasone causing iatrogenic Cushing's syndrome (CS) in infants are rarely reported. CASE PRESENTATION: In this case report, there were severe signs of CS, such as considerable weight acceleration and concurrent height deceleration, hirsutism and ecchymosis of the face, and buffalo pad, which are often found in adults. Clobetasol propionate, diflucortolone valerate, and dexamethasone nasal sprays were used in the majority of previously reported cases of corticosteroid abuse, whereas this is the first case of CS in an infant as a result of the use of betamethasone cream, also known as betnesol, which is frequently used by mothers in developing countries as a treatment for rashes. In this instance, a severe medication interaction caused by systemic betamethasone cream buildup led to the creation of CS. For the professionals, these patients are a challenge because of drug use without prescription. CONCLUSIONS: Topical corticosteroid usage puts infants at risk for CS. Because of excessive betamethasone treatment in this child with diaper dermatitis, he acquired CS. It is said to draw attention to the risks of self-medication in developing nations.

The factors related to recovery time of diaper dermatitis in infants: A prospective observational study.

AIM: Prolonged diaper dermatitis may increase the risk of atopic dermatitis or infections. This prospective observational study aimed to investigate the prevalence, symptoms, areas, and recovery time of diaper dermatitis in infants aged 1 month and identify the factors related to recovery time. METHODS: Diaper dermatitis was defined as the presence of erythema, papules, dryness, erosion, or ulceration in the diapered area. Recovery time was days between infant's 1-month medical check-up and disappearance of symptoms. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used to identify the factors related to recovery time. RESULTS: Among 113 infants, 66 (58.4%) had diaper dermatitis, with erythema at the perianal area being the most common symptom. The median recovery time was 10 days. Four infants (6.1%) had diaper dermatitis for >5 weeks. Severity was not related to recovery time. CONCLUSIONS: A frequency of diaper changing of ≤10 times per day was a risk factor for recovery time. Our data showed recovery in approximately 10 days, regardless of severity at study enrollment. Health care professionals could inform parents of recovery time and recommended diaper changing frequency.

Intervenção Educativa Sobre Dermatite Associada à Incontinência: Estratégia de Ensino no Instagram / Educational Intervention on Incontinence-associated Dermatitis: Teaching Strategy on Instagram / Intervención Educativa en Dermatitis Asociada a Incontinencia: Estrategia Didáctica Sobre Instagram

Objetivos:Descrever e avaliar intervenção educativa realizada por meio de mídia social sobre dermatite associada à incontinência (DAI) com profissionais de enfermagem. Métodos:Estudo de intervenção educativa com abordagem qualitativa pela mídia social Instagram para veiculação dos conteúdos do curso sobre a DAI. A coleta de dados foi realizada com 30 profissionais de enfermagem da clínica médica e unidade de terapia intensiva adulta de hospital de ensino público de Mato Grosso do Sul, de fevereiro a março de 2022. Os dados foram coletados durante o curso e apreciados pela análise de conteúdo de Bardin e à luz do referencial teórico da aprendizagem significativa de Ausubel. Resultados: Da análise dos comentários dos cursistas, emergiram quatro categorias temáticas: ancoragem, que retrata o saber prévio; aprendizagem significativa subordinada, a qual apresenta a construção de conhecimento ancorada no saber prévio; aprendizagem por descoberta, evidenciando a autonomia do participante no aprendizado; e avaliação do processo de ensino-aprendizagem, que revela a avaliação do processo educativo. Conclusão: Os resultados mostraram que a intervenção educativa obteve êxito no que tange ao compartilhamento de evidências sobre DAI aos participantes e que a ferramenta Instagram pode ser adotada para ações educativas mesmo em ambiente hospitalar.

Objectives:To describe and evaluate, in a formative way, an educational intervention carried out through social media on incontinence-associated dermatitis with nursing professionals from a public hospital. Method: Educational intervention study with a qualitative approach conducted in a virtual way through the social media Instagram as a platform for the dissemination of course content on the subject. Data collection was carried out with 30 nursing professionals from the medical clinic and adult intensive care unit of a public teaching hospital in the state of Mato Grosso do Sul, Brazil, between February and March 2022. Data were collected during the course and analysed through content analysis and according to Ausubel's meaningful learning theoretical framework perspective. Results: From the analysis of the participants' comments, four thematic categories emerged: anchoring; subordinated meaningful learning; discovery learning; and evaluation of the teaching-learning process. Conclusion: Through the results found, it was identified that the educational intervention conducted was successful in terms of sharing evidence on the subject to the participants. It was found that the Instagram can be adopted as a tool to carry out educational actions, including in a hospital environment.

Objetivo:Describir y evaluar, de forma formativa, una intervención educativa realizada a través de las redes sociales sobre dermatitis asociada a incontinencia con profesionales de enfermería de un hospital público. Métodos: Estudio de intervención educativa, con enfoque cualitativo, realizado de forma virtual, a través de la red social Instagram® como plataforma de difusión de contenidos de cursos sobre el tema. La recolección de datos se realizó con 30 profesionales de Enfermería de la Clínica Médica y UTI Adultos de un hospital público de enseñanza en el estado de Mato Grosso do Sul, entre febrero y marzo de 2022. Este estudio fue aprobado por el Comité de Ética en Investigación. Los datos fueron recolectados durante el curso y analizados a través del análisis de contenido ya la luz del marco teórico del Aprendizaje Significativo de Ausubel. Resultados: Del análisis de los comentarios de los participantes surgieron cuatro categorías temáticas: anclaje; aprendizaje significativo subordinado; aprendizaje por descubrimiento; y evaluación del proceso de enseñanza-aprendizaje. Conclusión: A través de los resultados encontrados, se identifica que la intervención educativa realizada fue exitosa en cuanto a compartir evidencias sobre el tema a los participantes. Se constató que la herramienta Instagram® puede ser adoptada para realizar acciones educativas, incluso en ambiente hospitalario.

Baby wipes and nappy rash - what is the relationship? A review.

Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.

[Sevestre-Jacquet posterosive syphilitic dermatitis associated with the use of reusable diapers: A clinical case]. / Dermatitis sifiloide posterosiva de Sevestre-Jacquet asociada al uso de pañales reutilizables: caso clínico.

BACKGROUND: Diaper dermatitis is a skin problem that has decreased with the development of new technologies in disposable diapers that prevent excessive moisture in the perianal region. The following clinical case shows the relationship between the use of cloth reusable diapers and the appearance of Jacquet erosive diaper dermatitis, a serious and rare complication of diaper dermatitis. CLINICAL CASE: We present the case of a 1-year-11-month-old patient, taken to the Dermatology department due to the presence of a lesion in the gluteal region. The mother reported the onset of the condition four months ago after the presence of semi-liquid stools. Localized dermatosis is observed on both lower limbs, affecting the genital region in the labia majora and the perianal region at the level of the intergluteal folds bilaterally and symmetrically. In the histopathological study, a posterosive Sevestre-Jacquet syphilid was diagnosed. CONCLUSION: Sevestre-Jacquet's posterosive syphilitic dermatitis is a rare dermatological condition and its risk of occurrence is greater due to the use of ecological cloth diapers.

INTRODUCCIÓN: la dermatitis de pañal es un problema cutáneo que ha disminuido con el desarrollo de nuevas tecnologías en los pañales desechables, los cuales impiden la humedad excesiva en la región perianal. En el siguiente caso clínico se muestra la relación entre el uso de pañales de tela y la aparición de dermatitis sifiloide posterosiva de Sevestre-Jaquet, una complicación grave y poco frecuente de la dermatitis de pañal. CASO CLÍNICO: presentamos el caso de una paciente de 1 año y 11 meses de edad, llevada a la consulta externa de Dermatología por la presencia de una lesión en la región glútea. La madre refirió inicio del padecimiento cuatro meses atrás y posterior a la presencia de evacuaciones semilíquidas. Se observa dermatosis localizada en ambos miembros inferiores, que afecta la región genital en labios mayores y región perianal a nivel de pliegues interglúteos de forma bilateral y simétrica. En el estudio histopatológico se emite el reporte diagnóstico de sifiloide posterosivo de Sevestre-Jacquet. CONCLUSIÓN: la dermatitis sifiloide posterosiva de Sevestre-Jacquet es una condición dermatológica poco frecuente y su riesgo de ocurrencia es mayor debido al uso de pañales ecológicos de tela.

A Smart Diaper System Using Bluetooth and Smartphones to Automatically Detect Urination and Volume of Voiding: Prospective Observational Pilot Study in an Acute Care Hospital.

BACKGROUND: Caregivers of patients who wear conventional diapers are required to check for voiding every hour because prolonged wearing of wet diapers causes health problems including diaper dermatitis and urinary tract infections. However, frequent checking is labor intensive and disturbs patients' and caregivers' sleep. Furthermore, assessing patients' urine output with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness detection technology was developed to solve these issues. OBJECTIVE: We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy in measuring voiding volume, and its effect on incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. METHODS: This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper becomes wet, the smart diaper system notifies the caregiver to change the diaper and measures voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on frequency volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the urine volume as automatically calculated by the smart diaper system with the volume recorded on FVCs. Agreement between the two measurements was estimated using a Bland-Altman plot. We also checked for the occurrence or aggravation of IAD and bed sores. RESULTS: A total of 30 participants completed the protocol and 390 episodes of urination were recorded. There were 108 records (27.7%) on both the FVCs and the smart diaper system, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and 6 (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). When analyzing records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P<.001). The Bland-Altman assessment showed good agreement between the two measurements, with a mean difference of -4.2 mL and 95% limits of agreement of -96.7 mL and 88.3 mL. New occurrence and aggravation of IAD and bed sores were not observed. Bed sores improved in one participant. CONCLUSIONS: The smart diaper system showed acceptable accuracy for measuring urine volume and it could replace conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system has the potential advantage of preventing IAD development and bed sore worsening. However, the detection rate of the smart diaper system was lower than expected. Detection rate polarization among participants was observed, and improvements in the user interface and convenience are needed for older individuals who are unfamiliar with the smart diaper system.

Characterization of the microbiome in the infant diapered area: Insights from healthy and damaged skin.

It has been recognized for nearly a century that human beings are inhabited by a remarkably dense and diverse microbial ecosystem, yet we are only just beginning to understand and appreciate the many roles that these microbes play in human health and development. Establishment of the microbiome begins at birth, but many previous studies on infant skin health have focused on Candida species. Little is known on the full microbial composition across different areas and even less is known on how these communities change during disease/inflammatory states. In this clinical study, infants were recruited during periods of diaper dermatitis (DD) and health to characterize the skin microbiome in these two states. Substantial shifts in the skin microbiome were observed across four sites in the diapered area (genitals, intertriginous, buttocks and perianal), as well as during periods of DD. As DD scores increased, there was a shift in relative abundance that demonstrated higher community percentages of faecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. In high-rash samples, the predominant Staphylococcus species is S aureus, potentially implicating S aureus as a DD aetiological agent. This study provides new information related to the microbiome on infant skin in the diapered area and provides insights into the role of the microbiome in the development of DD.

Diaper rashes can indicate systemic conditions other than diaper dermatitis.

BACKGROUND: Although the majority of rashes in the diaper area are caused by irritation from urine and feces, irritant diaper dermatitis; IDD, there are some less common but potentially serious cutaneous eruptions associated with systemic diseases that should not be discounted. METHODS: This prospective descriptive study aimed to explore variation in cutaneous disease in the diaper area. It was conducted as a prospective descriptive study between October 2016 and November 2019 in the pediatric department of a tertiary-level hospital. RESULTS: Three hundred consecutive patients with rashes in the diaper area were enrolled. The most common diagnosed was IDD (125 cases; 41.7%), followed by rashes exacerbated by the diaper (101 cases; 33.67%) and non-diaper-related rashes (74 cases; 24.67%). CONCLUSIONS: Our finding suggests that when diagnosing rashes that occur in the diaper area, general pediatricians should consider, in addition to IDD, the possibility of less-common conditions. The simultaneous presence of cutaneous lesions at other sites was linked to diagnoses of systemic diseases other than IDD, (P < 0.001).

Timing of the definitive procedure and ileostomy closure for total colonic aganglionosis HD: Systematic review.

AIM: To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD). METHOD: Medline, PubMed, Cochrane, and the ClinicalKey databases were searched without date restriction. The studies that reported TCA-HD cases were evaluated for the number of cases, age at the definitive procedure, age at the ileostomy closure, reported complications, and the type of procedure. Perianal excoriation and diaper rash rates were analyzed using SPSS software, with p < 0.05 considered significant. RESULTS: Twenty-five studies mentioned TCA-HD findings between 1968 and 2019. The total number of patients who had definitive surgery was 218. Analysis showed no correlation between development of diaper rash and the age of the patient at the time of the definitive surgery or ileostomy closure. Studies scored between six and nine of nine possible stars on the NOS scoring system. CONCLUSION: There is no correlation between age of surgery and postoperative diaper rash. Delaying the definitive procedure or ileostomy closure for TCA-HD has limited support on a review of current studies. The perianal excoriation/diaper rash is not reported in the literature at a high enough frequency to warrant keeping a diverting ileostomy until toilet trained of urine. TYPE OF STUDY: Systematic review and meta-analysis. Levels of evidence IV.

Short-term skin problems in infants aged 0-3 months affect food allergies or atopic dermatitis until 2 years of age, among infants of the general population.

BACKGROUND: This study examined whether infants aged 0-3 months exhibited long-term effects of using a moisturizer skincare intervention and whether a short-term skin problem resulted in the subsequent development of food allergies or atopic dermatitis (AD) until the age of 2 years. METHODS: This study was a follow-up of a completed randomized control trial (RCT) of moisturizer skincare for infants aged 0-3 months. A self-reported questionnaire was mailed to the parents of children aged 1-2 years who had participated in the RCT. Data were analyzed using a Chi square test, by intention to treat analysis, and by multiple logistic regression. RESULTS: Of 155 infants, 22 (14.2%) and 28 (18.1%) had food allergies and AD/eczema until 2 years of age, respectively. No significant difference was seen in food allergies or AD between the group that received moisturizer skincare intervention and the control group. On the contrary, food allergies until 2 years of age were significantly associated with short-term (4-7 days) and long-term (more than 7 days) body skin problems occurring in the first 3 months of life, a family history of AD, and the time of starting complementary food. High value of face transepidermal water loss at 3 months of age was also associated with food allergies. Moreover, a short duration of severe diaper dermatitis during the first 3 months, a family history of AD, and being male were significantly associated with AD/eczema until the age of 2 years. CONCLUSIONS: After adjusting for family history of AD, a short-term skin problem in the first 3 months of life was significantly associated with the development of food allergies or AD/eczema until the age of 2 years. Prevention or prompt treatment of skin problems in newborns is essential for preventing future allergic diseases.Trial registration This was a follow-up study conducted 2 years after the completed RCT of a moisturizer skincare intervention for early infants, which was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013260).

Ensino sobre dermatite associada à incontinência subsidiado pela metodologia da problematização / Teaching about incontinence-associated dermatitis informed by problematization methodology / La enseñanza sobre dermatitis asociada a la incontinencia subsidiada por la metodología de la problematización

Objetivo: avaliar de modo formativo um processo de intervenção educativa sobre dermatite associada à incontinência com profissionais de enfermagem de um hospital público. Método: estudo de intervenção educativa, com abordagem qualitativa, realizado em 2017, com sete profissionais da equipe de enfermagem do setor de clínica médica, de um hospital universitário da Região Centro-Oeste do Brasil. Investigada amostra não probabilística por conveniência. Os encontros foram gravados na sua totalidade em áudio e para tratamento dos dados utilizou-se a técnica de análise de conteúdo. Estudo aprovado por Comitê de Ética em Pesquisa. Resultados: nos depoimentos foram identificadas as seguintes categorias temáticas: curiosidade epistemológica, pesquisa/investigação, avaliação e alegria. Conclusão: os participantes relataram ter compreendido o tema, bem como afirmaram que a condução dos encontros ocorreu de forma eficiente, alegre e dinâmica. Destaca-se que os profissionais realizaram discussão sobre o problema, mobilizando o grupo para reflexão e mudança das práticas de cuidados em saúde.

Objective: to evaluate as training a process of educational intervention on incontinence-associated dermatitis with nursing professionals from a public hospital. Method: qualitative, educational intervention study conducted in 2017 with seven internal medicine nursing professionals at a university hospital in the Midwest region of Brazil, using a non-probabilistic convenience sample. The meetings were recorded in their entirety in audio, and the data were treated using the content analysis technique. The study was approved by the research ethics committee. Results: the following thematic categories were identified: epistemological curiosity, research/investigation, evaluation, and joy. Conclusion: the participants reported having understood the subject, and stated that the meetings were conducted efficiently, cheerfully and dynamically. Note that the professionals discussed the problem, which mobilized the group to think about and change health care practices.

Objetivo: evaluar de modo formativo un proceso de intervención educativa sobre dermatitis asociada a la incontinencia con profesionales de enfermería de un hospital público. Método: estudio de intervención educativa, con enfoque cualitativo, realizado en 2017, junto a siete profesionales del equipo de enfermería del sector de clínica médica, de un hospital universitario de la región del Centro Oeste de Brasil, siendo la muestra no probabilística por conveniencia. Todos los encuentros fueron grabados en audio y, para el tratamiento de los datos, se utilizó la técnica del análisis de contenido. Estudio aprobado por el Comité de Ética en Investigación. Resultados: por los testimonios, se identificaron las siguientes categorías temáticas: curiosidad epistemológica, encuesta/investigación, evaluación y alegría. Conclusión: los participantes relataron haber comprendido el tema, afirmaron que los encuentros fueron conducidos de forma eficiente, alegre y dinámica. Se resalta que los profesionales realizaron discusiones sobre el problema, movilizando al grupo para la reflexión y el cambio de las prácticas de cuidados en salud.

Adverse Events of Antibiotics Used to Treat Acute Otitis Media in Children: A Systematic Meta-Analysis.

OBJECTIVE: To characterize the incidence of adverse events (AEs) associated with antibiotics used to treat acute otitis media in children. STUDY DESIGN: We searched MEDLINE for studies conducted between January 1, 1966, and August 25, 2018. Two authors independently assessed potential studies and extracted the data. We included published randomized controlled trials, cross-sectional studies, and cohort studies that evaluated the incidence of diarrhea, generalized rash, diaper rash, and candidal diaper dermatitis associated with the use of amoxicillin, amoxicillin/clavulanate, azithromycin, cefdinir, and placebo in children with acute otitis media. RESULTS: We included 82 studies in the meta-analysis. The incidence of diarrhea, listed from lowest to highest, was azithromycin (2.2%), placebo (6.9%), low-dose amoxicillin (8.7%), cefdinir (13.0%), high-dose amoxicillin (13.8%), and high-dose amoxicillin/clavulanate (18.9%). The incidence of generalized rash, listed from lowest to highest, was azithromycin (1.4%), placebo (2.3%), low-dose amoxicillin (2.9%), high-dose amoxicillin/clavulanate (4.9%), and high-dose amoxicillin (6.5%). In studies of low-dose amoxicillin, we found a higher incidence of diarrhea in studies that used daily diaries to collect information about diarrhea and a lower incidence of generalized rash in studies that reported only rashes judged to be secondary to antibiotic use. CONCLUSIONS: The incidence of AEs varies widely depending on which antibiotic is used and how the information on AEs was collected or reported. The AEs rates reported here may be helpful to clinicians when choosing an antibiotic to treat acute otitis media.

Premature Pubarche due to Exogenous Testosterone Gel or Intense Diaper Rash Prevention Cream Use: A Case Series.

BACKGROUND/AIMS: Premature pubarche is associated with conditions such as virilizing congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous exposure to androgen products. We describe the clinical and hormonal features of a series of children who were referred to endocrine evaluation due to premature pubarche. METHODS: This is a retrospective case series study of 14 children with premature pubarche and/or virilization. Five were unintentionally exposed to testosterone gel (parental use). Nine patients were intensely exposed to diaper rash prevention creams. Clinical and laboratory data were revised. RESULTS: Moderate to severe virilization was detected in the 5 patients (2 boys and 3 girls) who were exposed to testosterone gel. These patients had pubic hair development associated with clitoromegaly (3/3), penile enlargement (2/2), and accelerated growth (5/5). Testosterone levels were elevated in 4/5 patients associated with normal prepubertal gonadotropin levels and adrenal androgen precursors. The 9 children who were intensely exposed to diaper rash prevention creams had mild pubarche (intermediate hair) without any other clinical manifestation of pubertal development. Three of them exhibited pubic hair thinning after cream withdrawal. CONCLUSION: Unintentional topical androgen exposure or the intense use of diaper rash prevention cream should be ruled out in children with precocious pubarche and/or virilization signs to avoid misdiagnosis and expendable investigation.

Conhecimento dos profissionais de enfermagem sobre dermatite associada a incontinência e lesão por pressão / Knowledge of nursing professionals about dermatitis associated with incontinence and pressure injury / Conocimiento de los profesionales de enfermería sobre la dermatitis asociada con la incontinencia y lesión por presión

A dermatite associada a incontinência (DAI) e lesão por pressão (LP) é dano que acomete a pele, principalmente de indivíduos hospitalizados em situações críticas. Esses eventos podem ter apresentação clínica semelhante, sendo fundamental que os profissionais de saúde saibam diferenciá-los. Este estudo visa avaliar o conhecimento da equipe de Enfermagem quanto à LP nos estágios 1 e 2 e da DAI em relação ao conceito, identificação, prevenção e tratamento. É pesquisa descritiva exploratória, transversal, com análise quantitativa, realizada com 76 profissionais de Enfermagem. Os dados foram coletados no mês de outubro de 2017 e foi realizada abordagem prévia com os profissionais para informá-los sobre a pesquisa e o questionário. O instrumento foi distribuído aos participantes durante o horário de trabalho, e estes o preencheram e retornaram aos pesquisadores. Foi aplicado questionário com questões sobre definição, avaliação e prevenção e tratamento da DAI e LP. O estudo revelou no teste de conhecimento que, entre as alterações cutâneas de DAI e LP, os acertos foram maiores naquelas questões sobre a DAI. Em relação à categoria avaliação, o índice de acertos foi próximo do médio (56,58%). Na categoria prevenção e tratamento, o maior percentual de acertos foi entre questões que envolviam a importância da capacitação dos profissionais e medidas de cuidados diretos ao paciente. Concluiu-se que, entre as afecções cutâneas DAI e LP nos estágios iniciais, os profissionais demonstraram menos conhecimento sobre a LP.(AU)

Incontinence-associated dermatitis (IAD) and pressure injury (PI) are problems that affect the skin, especially in the case of hospitalized individuals in critical situations. These events may have a similar clinical presentation and it is essential that health professionals know how to differentiate them. This study aims to evaluate the knowledge of the nursing team about PI in stages 1 and 2 and of IAD regarding the concept, identification, prevention and treatment. This is a descriptive, exploratory, cross-sectional study with quantitative analysis performed with 76 nursing professionals. The data were collected in October 2017 and professionals were first approached to pass on information about the research and the questionnaire. The instrument was distributed to participants during working hours, and they filled it out and returned it to the researchers. The questionnaire applied had questions on definition, evaluation, prevention and treatment of IAD and PI. The study revealed that, with respect to skin changes caused by IAD and PI, the correct answers were more frequent in questions about IAD. Regarding evaluation, the rate of correct answers was close to the average (56.58%). In the prevention and treatment category, the highest percentage of correct answers was found in questions that referred to the importance of professional qualification and direct care measures to patients. The study led to the...(AU)

La dermatitis asociada a la incontinencia (DAI) y lesión por presión (LP) afectan la piel, principalmente de pacientes hospitalizados en situación crítica. La presentación clínica de ambos trastornos es parecida y por ello es imprescindible que los profesionales de salud sepan distinguirlos. El presente estudio busca evaluar el conocimiento del equipo de enfermería en LP en las etapas 1 y 2 y en concepto, identificación, prevención y tratamiento de DAI. Investigación descriptiva, exploratoria, transversal con análisis cuantitativa, llevada a cabo con 76 profesionales de enfermería. La recogida de datos se realizó en octubre de 2017; antes se les informó a los profesionales sobre la investigación y el cuestionario. Durante el horario de trabajo, los participantes recibieron un cuestionario con preguntas sobre definición, evaluación, y prevención y tratamiento de DAI y LP, que completaron y devolvieron a los investigadores. A través de la prueba de conocimiento, el estudio reveló que, en los trastornos cutáneas de DAI y LP, había más respuestas correctas referentes a DAI. En la categoría evaluación, el índice de respuestas correctas fue equilibrado (56%). En prevención y tratamiento, el mayor porcentaje de respuestas correctas era sobre la importancia de la capacitación profesional y medidas de cuidados directos al paciente. Se concluye que, entre los trastornos de la piel DAI y LP en las primeras etapas, los profesionales demuestran tener menos conocimiento en LP.(AU)

[Knowledge of Diaper Dermatitis and Diaper Hygiene Practices among Mothers of Diaper-wearing Children]. / ì˜ìœ ì•„ 어머니의 ê¸°ì €ê·€ 발진에 대한 지식 및 ê¸°ì €ê·€ 관리 실태.

PURPOSE: The purpose of this study was to investigate the prevalence of diaper dermatitis (DD), knowledge of DD prevention and treatment, and diaper hygiene practices among mothers with diaper-wearing children. METHODS: The participants were 176 mothers who presented to an outpatient clinic at a children's hospital with diaper-wearing children. Data were collected using a structured self-administered questionnaire. RESULTS: The percent of correct answer for knowledge about DD was 59.7%. Almost half of the participants' children had experienced at least 1 episode of DD during the last 6 months. Inappropriate diaper hygiene practices, such as using talcum powder on DD and rubbing with a dry towel after cleansing, were reported. Moreover, only 37% of mothers used the recommended skin barrier to prevent DD. Although many children suffer from DD, levels of educational experience and perceived need for education on this topic were low. Almost 70% of mothers obtained DD-related information through internet sites. CONCLUSION: Educating parents about the etiology of DD and evidence-based diaper hygiene practices is an important aspect of effective DD prevention and treatment. Internet sites or smartphone apps may be effective methods for education on DD prevention and treatment considering parents' preferences for ways to obtain health information.

Cuidados relacionados à dermatite na área de fraldas em idosos hospitalizados / Care related to diaper rash in hospitalized eldery

Objetivo: identificar a ocorrência da dermatite na área de fraldas em idosos hospitalizados. Método: trata-se de um estudo descritivo, transversal, com abordagem quantitativa e epidemiológica. O estudo foi desenvolvido em unidade de Clínica Médica de um hospital universitário, localizado no Distrito Federal, Brasil e foi utilizado um instrumento de coleta de dados com as seguintes variáveis: características sociodemográficas, morbidades associadas, hábitos de vida e cuidados realizados diante da dermatite na área de fraldas, além do exame físico da pele na região da genitália e áreas adjacentes. A amostra foi composta por 40 idosos. Resultados: em relação à ocorrência da dermatite na área de fraldas, 42% dos idosos apresentaram a alteração na pele, 55% realizavam a troca de fraldas pelo menos a cada 4horas ou menos; quanto à frequência da higiene íntima, 60% a realizavam uma vez ao dia, sendo que 32% realizavam esta limpeza somente utilizando água. Conclusão: foi possível verificar que uma parcela significativa dos idosos internados na unidade de clínica médica, utilizando fraldas e/ou dispositivos para controle de incontinência, desenvolveram a dermatite na área de fraldas, gerando a necessidade de um diagnóstico precoce por parte da equipe multiprofissional e medidas de baixa complexidade para a prevenção do problema.

Objective: to identify the occurrence of dermatitis in diaper areas in hospitalized elderly. Method: this is a descriptive, crosssectional study with a quantitative and epidemiological approach. The study was carried out in a Clinical Medical Unit of a university hospital, located in the Federal District, Brazil, and a data collection instrument was used. It has the following variables: sociodemographic characteristics, associated morbidities, life habits, and care given to dermatitis in diaper areas, in addition to the physical examination of the skin on and around the genital area. The sample consisted of 40 elderly people. Results: in relation to the occurrence of dermatitis in diaper areas, 42% of the elderly had a change in their skin, 55% performed diaper changes at least every 4 hours or less; regarding to the intimate hygiene frequency, 60% performed it once a day; and 32% performed it using only water. Conclusion: a significant proportion of the elderly hospitalized in the medical clinic, wearing diapers and/or using incontinence control devices, developed diaper dermatitis, generating the need for an early diagnosis by the multiprofessional team and low complexity measures to prevent the problem

Objetivo: identificar la ocurrencia de la dermatitis en el área de pañales en ancianos hospitalizados. Método: se trata de un estudio descriptivo, transversal, con abordaje cuantitativo y epidemiológico. El estudio fue desarrollado en unidad de Clínica Médica de un hospital universitario, localizado en el Distrito Federal, Brasil y se utilizó un instrumento de recolección de datos con las siguientes variables: características sociodemográficas, morbilidades asociadas, hábitos de vida y cuidados realizados frente a la dermatitis en el área de pañales, además del examen físico de la piel en la región de los genitales y áreas adyacentes. La muestra fue compuesta por 40 ancianos. Resultados: en relación a la ocurrencia de la dermatitis en el área de pañales, 42% de los ancianos presentaron la alteración en la piel, 55% realizaban el cambio de pañales por lo menos cada 4 horas o menos; en cuanto a la frecuencia de la higiene íntima, el 60% la realizaban una vez al año día, siendo que el 32% realizaba esta limpieza solamente utilizando agua. Conclusión: fue posible verificar que una parte significativa de los ancianos internados en la unidad de clínica médica, utilizando pañales y/o dispositivos para control de incontinencia desarrollaron la dermatitis en el área de pañales, generando la necesidad de un diagnóstico precoz por parte del equipo multiprofesional y medidas de baja complejidad para la prevención del problema

Differential diagnoses of diaper dermatitis.

Diaper dermatitis is the most common contact eczema present in early childhood. The main cause is an irritant reaction to urine and feces, which is facilitated by the occlusive conditions under the diaper, leading to hyperhydration of the stratum corneum (diaper dermatitis). In addition, diaper pressure and friction can increase the risk of skin inflammation, which also opens the skin up to other irritant agents, allergens, and infectious agents, such as candida albicans. However, a variety of diseases are associated with inflammation of the skin in the diaper region, therefore the term "diaper dermatitis" is merely descriptive and does not reflect anything about the etiopathogenesis. The term diaper dermatitis refers only to an inflammation in the diapering area and should not be automatically equated with reactions to diapers. Making the correct diagnosis requires a thorough examination of the skin in its entirety and a detailed report of the patient's medical and family history. Once a specific pattern is identified, a precise diagnosis, and an appropriate therapy, can be determined.