Equivalent therapeutic efficacy and safety of ivermectin and lindane in the treatment of human scabies.

OBJECTIVE: To compare the therapeutic efficacy and safety of ivermectin and lindane for the treatment of human scabies. DESIGN: Randomized, prospective, controlled, double-blind, "double-dummy," and parallel clinical study. SETTING: A single department of dermatology at a hospital in Buenos Aires, Argentina. PATIENTS: Patients were outpatients, hospitalized patients, and those referred to our hospital from nursing homes and asylums. Fifty-three patients had clinical signs and symptoms compatible with scabies. INTERVENTION: Patients received either a single oral dose of ivermectin (150-200 microg/kg of body weight) or a topical application of 1% lindane solution. Treatment was repeated after 15 days if clinical cure had not occurred. MAIN OUTCOME MEASURES: Clinical healing and adverse effects. RESULTS: Of 53 patients, 43 (81%) completed the study, 19 in the group treated with ivermectin and 24 in the group treated with lindane. At day 15, 14 patients (74%; 95% confidence interval, 48.8%-90.8%) in the group receiving ivermectin showed healing of their scabies and 13 patients (54%; 95% confidence interval, 32.8%-74.4%) in the group treated with lindane were healed. At 29 days, both treatments resulted in statistically equivalent therapeutic efficacy: 18 patients (95%; 95% confidence interval, 74.0%-99.9%) were healed with ivermectin and 23 patients (96%; 95% confidence interval, 78.9%, 99.9%) were healed with lindane (P<.02). Adverse effects from the treatments were few, mild, and transient. Results from laboratory tests showed no major abnormalities and no difference between treatments. CONCLUSIONS: Ivermectin is as effective as lindane for the treatment of scabies. Ivermectin is simpler to use and, therefore, is a promising tool to improve compliance and to control infestations.

[Painful palmoplantar nodules as the initial manifestation of sarcoidosis]. / Nódulos dolorosos palmoplantares como manifestación inicial de sarcoidosis.

A 23 year-old woman with sarcoidosis initiated her illness with painful nodules located in palms and soles. This is un unusual clinical finding. Sarcoidosis must be included in the differential diagnosis of painful palmoplantar nodules.

Frecuencia de trastornos mentales en adultos que concurren a un centro de salud de un barrio de la ciudad de Córdoba / Frequência dos transtornos mentais em adultosatendidos em um centro de saúde de um bairroda cidade de Córdoba / Frequency of mental disorders in adults who attend a health centre in a neighborhood, in the city of Cordoba

Estudios previos revelan que una proporción importante de losconsultantes del primer nivel de atención de salud presentanalgún tipo de Trastorno Mental y del Comportamiento, por loque este nivel ofrece una oportunidad en el manejo oportunode esta problemática.Objetivo: Caracterizar la prevalencia de TMyC enconsultantes de un centro de salud de un barrio de la ciudadde Córdoba.Material y Método: Se utilizó CIDI 3.0, en una muestraprobabilística de 100 consultantes adultos del primer nivelde atención.Resultados: El 96,4% de los entrevistados fueron mujeresy la media de edad de 35±2,6. La frecuencia de TMyC a lolargo de la vida fue del 33,33%. 7,1% de los entrevistadospresentó Trastornos Generalizados de la Ansiedad, 3,6%Desorden Obsesivo Compulsivo y 22,22% algún episodio deDepresión. A partir de estos primeros resultados, el equipode salud local podrá orientar estrategias y políticas públicasque aborden integralmente al consultante.

Previous studies have shown that an important proportion of the patients in first levelhealth care present some kind of Mental and Behavioral Disorder (MBD); thus, this leveloffers a possibility to timely deal with this problem.Objective: To characterize the prevalence of MBD in patients who attend a health carecenter in a neighborhood in the city of Cordoba.Material and Method: CIDI 3.0 was used in a probability sample of 100 adult consultantsat primary level of care.Results: Out of the patients interviewed, 96.4% were women and the mean age was35±2.6. The frequency of MBD along lifetime was 33.33%. A 7.1% of the interviewedpatients presented Generalized Anxiety Disorders, 3.6% Obsessive Compulsive Disorderand 22.22% some Depressive episode. Using these first results, the local health team willbe able to direct strategies and public policies to deal with the patients comprehensively.

Mortalidad por trastornos mentales y por causas externas: análisis de una Década en Argentina / Mortality due to mental disorders and external causes: analysis of a decade in Argentina

Objetivo: analizar las tasas de mortalidad de Trastornos Mentales y del Comportamiento (TMyC) y de las Causas Externas (CE) en las Estadísticas Vitales de Argentina, periodo 2000-2009.Metodología: se utilizó las bases de datos de defunciones, Argentina, años 2000 a 2009, de la Dirección de Estadísticas e Información en Salud Ministerial. Se construyeron tasas generales y específicas. Las estimaciones poblacionales, se obtuvieron a partir del aplicativo AGEINT. Según la distribución de la variable, se utilizó análisis de la varianza o test no paramétricos. Resultados: se observa un comportamiento disímil de la tasa de mortalidad por TMyC según sexo, pero con un comportamiento similar por cada año. Los TMyC y las CE, comprometen a la población adulta del país, con tasas mayores en el grupo de varones.Conclusión: tener en cuenta el impacto de los TMyC y CE, permite diseñar políticas públicas en salud adecuadas a las realidades de cada contexto

Objective: To analyze mortality rates due to mental and behavioral disorders (MBD) and external causes (EC) using Vital Statistics of Argentina, 2000-2009.Methods: Mortality data 2000-2009 were obtained from the Bureau of Statistics and Information, Ministry of Health, Argentina. General and specific rates were set up. Population estimates were obtained from the AGEINT application. According to the distribution of the variable, analysis of variance or nonparametric tests were used.Results: Dissimilar MBD mortality rates according to sex were observed, but with a similar pattern each year. The MBD and EC affect the adult population of the country, with higher rates in the male group.Conclusion: Taking into account the impact of MBD and EC, allows the design of public policies suitable to the realities of each health context

Sunbed use in Buenos Aires, Argentina.

The objectives were to survey tanning salons in a defined geographic area of Buenos Aires city and to assess the information offered to consumers regarding chronic exposure to ultraviolet radiation, types of radiation used, and safety measures employed. A prospective study using a standardized interview with limited multiple choice responses for data collection was conducted. Results of the interview survey were that 35% of the establishments (tanning salons) said they used UVA exclusively, 6% UVB, and 25% both; 35% did not know the type of radiation to which their clients were exposed. Sunbeds were promoted as healthy in 56% of the tanning salons, whereas potential risks were mentioned in only 15%. One to 3 sessions on the same day were allowed by 84%, while 40% allowed customers to choose the number of weekly sessions. The use of goggles was optional in 65% of the establishments and 21% did not even provide goggles. Use of sunscreens was not compulsory, and none of the salons had associated physicians. Previous history of skin cancer, sunburn or potential photosensitive drug intake were never recorded, and the age of access was not restricted in 71% of the establishments. In Argentina there are no guidelines to regulate the operation of tanning salon establishments or the equipment they use, and there are no specific measures taken to prevent skin and ocular pathologies. Ways to reduce the risks of ocular and skin pathologies from artificial tanning in Argentina are urgently needed.

Development of cutaneous sarcoidosis in a patient with chronic hepatitis C treated with interferon alpha 2b.

BACKGROUND: Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis inpatients with chronic hepatitis C under interferon treatment have been reported. OBJECTIVE: We describe a 50-year-old woman with chronic hepatitis C who developed lesions of cutaneous sarcoidosis three months after IFN treatment. CONCLUSIONS: The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis C should be considered.

Head louse infestations: epidemiologic survey and treatment evaluation in Argentinian schoolchildren.

BACKGROUND: Our aim was to demonstrate that the treatment of individual cases is effective, but not sufficient, to control endemic Pediculus capitis, and that eradication of the epidemiologic school focus may lower significantly the prevalence of infestation. Statistical data on the degree of infestation relating to socio-economic and cultural variables were also updated. Therapeutic effects and educational impact were evaluated. METHODS: An educational and motivational program was designed for pupils, parents, and teachers: 326 children and 15 adults were subjected to clinical and parasitologic evaluation. The recorded parameters included the age, sex, hair style and length, presence of other dermatologic diseases, degree of infestation, clinical remission, parasitologic remission, dwelling type and features, need to share a bed with co-dwellers, availability of home tap water supply, level of family income, and periodic medical controls. The entire population received treatment with neutral shampoo and rinsing cream containing 1% permethrin. Exclusion criteria were the presence of acute scalp inflammation and a history of pyrethrin and/or pyrethroid sensitivity. Statistical analysis was performed as required on data expressed as frequencies, percentages, means, and standard deviations by chi-square and Fisher exact tests. RESULTS: The overall infestation prevalence rate was 81.5%, the highest values corresponding to children from 6 to 11 years of age, with a slight predominance in males (55.4% vs. 44.6%). A significantly greater rate of clinical remission was observed in subjects enjoying home tap water supplies (p < 0.01). CONCLUSIONS: The model of research plus action adopted allows the following conclusions to be drawn: (i) individual and isolated treatments for pediculosis are useful, but will not by themselves allow for the epidemiologic control of this parasitosis; (ii) massive, complete, and simultaneous treatments lead to a significant decrease in infestation prevalence; (iii) educational measures tending to foster collective awareness enable greater epidemiologic surveillance to be achieved; (iv) careful inspection of the entire scalp is essential with the use of a powerful light source and lenses with high magnification, as the parasite has no predilection for any given area; (iv) socio-economic and cultural conditions are not relevant for infestation, although a good home tap water supply is essential for treatment.

Hepatitis C virus antibody (anti-HCV): prevalence in psoriasis.

BACKGROUND: In cases of psoriasis (PS), the etiology of the underlying liver disease is occasionally unknown. To investigate antibodies to hepatitis C virus (anti-HCV), their prevalence and clinical significance, 118 unselected outpatients with PS were studied prospectively. METHODS: Anti-HCV was assayed in serum by second-generation enzyme-linked immunosorbent assay (ELISA), considering a serum anti-HCV (+), when the optical density ratio was equal to or greater than three times the cut-off value, in duplicate determinations, whereas anti-HBc, anti-HBs, HBsAg, anti-HBe, and HBeAg were also evaluated by ELISA, as were the transaminases. As controls we took the 1.2% anti-HCV prevalence found in 60,000 blood donors from Buenos Aires city. RESULTS: Nine of 118 serum samples (7.6%) proved to be anti-HCV (+) (P < 0.001). There were no differences between positive and negative cases as regards gender, age, history of hepatitis, transfusions, or parenteral exposure, disease duration, or psoriasis type, and prior treatment with methotrexate and etretinate. Fifteen percent (17/113) were anti-HBc (+), 64.7% anti-HBs (+) (11/17) and 2.5% HBsAg (+) (3/17), whereas 3/17 (2.5%) showed isolated anti-HBc positivity. Liver biopsies in six anti-HCV patients disclosed four with chronic active hepatitis, one with cirrhosis, and one with steatosis. CONCLUSIONS: In the presence of liver disease in PS patients, an HCV infection should be considered as an alternative diagnosis. The high anti-HCV prevalence in this series is attributable to infection by inapparent parenteral routes, through minute skin abrasions, as reported for hepatitis B virus in PS.

Tuberculosis cutánea e inmunodepresión / Cutaneous tuberculosis and immunodeficiency

Se presentan dos casos de tuberculosis cutánea en pacientes inmunodeprimidos. El primero es un paciente HIV+ y el segundo es una mujer inmunodeprimida por corticoterapia. Es muy importante realizar un diagnóstico temprano para implementar un tratamiento exitoso

Indice de sospecha de malignidad del médico no dermatólogo / Malignancy suspicious index of non dermatologist physicians

Introducción: Las necesidades dermatológicas de un número importante de pacientes son cubiertas por médicos no especializados en dermatología. El aumento creciente de la incidencia del cáncer de piel, requiere estrategias adecuadas de asistencia y educación sanitaria tendientes al diagnóstico precoz. Objetivo: Determinar el índice de sospecha de malignidad del médico no dermatólogo. Motivar al personal médico del hospital a ser participe de la Campaña Nacional de Prevención del Cáncer de Piel. Material y método: Médicos no dermatólogos completaron una grilla con las opciones: lesión benigna, lesión maligna o lesión sospechosa de malignidad, en respuesta a 39 diapositivas con patología dermatológica benigna tumoral o no tumoral y tumores malignos. Se determinaron los siguientes índices: índice de certeza diagnóstica de patología neoplásica, índice de sospecha de malignidad, índice de derivación y de capacidad diagnóstica del médico no dermatólogo. Resultados: Fueron encuestados 85 médicos no dermatólogos: 63,50 por ciento de sexo masculino, 36,50 por ciento femenino. Treinta y tres médicos tenían menos de 5 años de egresados, 15 entre 5 y 10 años de egreso; y 37 con más de diez. El 65,90 por ciento tenían orientación clínica y el 34,10 por ciento orientación quirúrgica. La media fue de 11 respuestas correctas. El índice de certeza de patología neoplásica fue de 21,81 por ciento, de sospecha de malignidad de 34,43 por ciento, de derivación de 56,24 por ciento y de capacidad diagnóstica de 28,99 por ciento. La erosión, ulceración y el aspecto verrugoso de la lesión eran asociados con malignidad, mientras que la ausencia de esas características y la falta de relieve sobre la superficie de la piel inducían diagnóstico de benignidad. Conclusión: Con los bajos índices de certeza diagnóstica, de sospecha de malignidad y de capacidad diagnóstica hallados, se puede inferir que estamos frente a un grave problema de salud pública. Los errores diagnósticos y las demoras en el tratamiento pueden generar aumento en la morbimortalidad. Un adecuado entrenamiento de los médicos de cabecera y la derivación oportuna al médico especialista pueden mejorar el manejo del paciente con cáncer de piel

Micosis fungoide folicular / Follicular mycosis fungoides

La micosis fungoide folicular (MFF) es una variante clínica infrecuente de MF. Presentamos el caso de un paciente de 51 años de edad con localización en cuero cabelludo y buena respuesta al tratamiento. Realizamos además una revisión de la literatura