Videolaryngoscopy vs. direct Macintosh laryngoscopy in tracheal intubation in adults: a ranking systematic review and network meta-analysis.

Videolaryngoscopes are thought to improve glottic view and facilitate tracheal intubation compared with the Macintosh direct laryngoscope. However, we currently do not know which one would be the best choice in most patients undergoing anaesthesia. We designed this systematic review with network meta-analyses to rank the different videolaryngoscopes and the Macintosh direct laryngoscope. We conducted searches in PubMed and a further five databases on 11 January 2021. We included randomised clinical trials with patients aged ≥16 years, comparing different videolaryngoscopes, or videolaryngoscopes with the Macintosh direct laryngoscope for the outcomes: failed intubation; failed first intubation attempt; failed intubation within two attempts; difficult intubation; percentage of glottic opening seen; difficult laryngoscopy; and time needed for intubation. We assessed the quality of evidence according to GRADE recommendations and included 179 studies in the meta-analyses. The C-MAC and C-MAC D-Blade were top ranked for avoiding failed intubation, but we did not find statistically significant differences between any two distinct videolaryngoscopes for this outcome. Further, the C-MAC D-Blade performed significantly better than the C-MAC Macintosh blade for difficult laryngoscopy. We found statistically significant differences between the laryngoscopes for time to intubation, but these differences were not considered clinically relevant. The evidence was judged as of low or very low quality overall. In conclusion, different videolaryngoscopes have differential intubation performance and some may be currently preferred among the available devices. Furthermore, videolaryngoscopes and the Macintosh direct laryngoscope may be considered clinically equivalent for the time taken for tracheal intubation. However, despite the rankings from our analyses, the current available evidence is not sufficient to ensure significant superiority of one device or a small set of them over the others for our intubation-related outcomes.

Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG).

BACKGROUND: Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. OBJECTIVES: To enable data to be collected worldwide on FFA using common criteria and assessment methods. METHODS: A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. RESULTS: Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. CONCLUSIONS: These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.

Use of solid-phase extraction and high-performance liquid chromatography for the determination of triazine residues in water: validation of the method.

A method for determination of some triazine residues in water has been developed. The method involves concentration with C18 solid-phase extraction cartridges followed by high-performance liquid chromatographic analysis using a C18 column with UV detection at 230 nm, a mobile phase of methanol-water (60:40, v/v) at pH 4.6 (phosphoric acid) and a flow-rate of 0.8 ml/min. After optimization of the extraction and separation conditions, the method was validated. The method can be used for determination of atrazine, simazine, cyanazine and ametryn in water, within the international limits of 0.1 microg/l.

Determination of bentazon residues in water by high-performance liquid chromatography. Validation of the method.

A method for determination of bentazon residues in water has been developed. The method involves solid-phase extraction with C18 extraction tubes and high-performance liquid chromatographic analysis. A C18 column and guard column were used with UV detection at 230 nm, a mobile phase of methanol-water (60:40, v/v) at pH 4.6 (phosphoric acid) and a flow-rate of 0.8 ml/min. After optimization of the extraction and separation conditions, the method was validated. The method developed can be used for determination of bentazon in water, within the international limits of 0.1 microgram/l, with a 500-fold pre-concentration.

Acrokeratosis paraneoplastica (Bazex syndrome) with oropharyngeal squamous cell carcinoma.

A 65-year-old white man presented with all the clinical features of acrokeratosis paraneoplastica of Bazex, characterized by violaceous erythema and scaling of the nose, aural helices, fingers, and toes, with keratoderma and severe nail dystrophy. Examination of the patient for possible associated malignancy disclosed an asymptomatic squamous cell carcinoma at the oropharyngeal region. The skin lesions resolved almost completely following radiation therapy of the neoplasm, but the onychodystrophy persisted. This case report illustrates the importance of early recognition of Bazex syndrome.

Pityriasis rotunda.

Pityriasis rotunda is an uncommon cutaneous disorder consisting of asymptomatic, strikingly circular, scaly lesions on the trunk and extremities, with the histologic appearance of ichthyosis vulgaris. Previous cases have been described in Japanese, South African, and West Indian persons, usually in association with an underlying serious systemic disease. A case of pityriasis rotunda in a 32-year-old black man in whom no diagnosable disorder could be demonstrated is presented.

[Psoriasis]. / Psoríase.

The purpose of these Guidelines is to summarize the most relevant features of the pathogenesis, clinical presentation and treatment of psoriasis. Patient education should include the deleterious effects that some drugs, trauma, alcohol, infection and stress may have on psoriasis; the beneficial action of careful sunlight exposure should also be emphasized. Topical treatment--emollients, keratolytics, coal tar preparations, anthralin, corticosteroids, calcipotriol--is essential for the control of plaque-type psoriasis and is also an important adjuvant therapy in more severe cases; the relative strength and the potential adverse effects of topical steroids are also referred. UV therapy (phototherapy and photochemotherapy) is recommended for psoriasis with generalized plaque, guttate or palmoplantar psoriasis refractory to topical therapies. Systemic therapy--retinoids, methotrexate, cyclosporine--is limited to severe plaque psoriasis unresponsive to topical or UV therapy, erythrodermic, pustular or arthropatic psoriasis. Combination and rotational therapies are likely to reduce the risks of each individual therapy and should be encouraged. Finally, a few diagrams are included, pointing out the scientific validity of the therapies currently available to help clinicians to optimize their management of psoriasis.

[Lichen amyloidosis with extensive skin lesions]. / Líquen amilóide com lesões cutâneas extensas.

Lichen amyloidosus is a chronic pruritic skin disorder, unusual among Europeans, and classically seen over the shins. The exact nature of the amyloid fibril protein, in lichen amyloidosus, is a matter of controversy and no specific treatment is available. Diffuse cutaneous involvement in a 60-year-old portuguese man is described. New pathogenic aspects and recent therapeutic approaches are discussed.

[Polyarteritis nodosa. Considerations on a clinical case]. / Poliarterite nodosa. Considerações a propósito de um caso clínico.

A case of polyarteritis nodosa is reported. The patient, a 56-year-old white woman, had cutaneous nodules, ulcers and livedo reticularis over the limbs. Abdominal angiography revealed the presence of microaneurysms. Hypertension, rheumatic heart disease (under anticoagulation therapy) and diabetes mellitus, were also detected. The controversial attempt in distinguishing between systemic and cutaneous polyarteritis is emphasized, and the influence of warfarin on skin lesions morphology is discussed.

Particular clinical presentations of psoriasis in HIV patients.

Patients with HIV infection have a higher propensity for infectious, inflammatory, neoplastic and metabolic disorders. The link with psoriasis vulgaris is explained by well-known pathophysiological phenomena and can be observed at any stage of infection. The aim of our study was to characterize the clinical spectrum of psoriasis in a group of 50 patients with HIV. Our findings showed particular clinical presentations of psoriasis in those patients, suggesting a predilection for scalp lesions, palmoplantar keratoderma and flexural involvement, as well as a trend towards severe immunodeficiency. Psoriasis, a frequent reason for consultation, allows earlier suspicion and diagnosis of HIV in the presence of these particular patterns.

Captopril-induced pemphigus vegetans with Charcot-Leyden crystals.

A 78-year-old woman developed intertriginous vegetating plaques, mouth ulcers, and a cerebriform tongue after 11 months of captopril therapy. Findings of clinical, histologic, and immunofluorescence testing were consistent with a diagnosis of pemphigus vegetans. In addition, Charcot-Leyden crystals were observed within some of the intraepidermal, eosinophilic abscess cavities, which were bordered by granular cells undergoing keratinization. The skin lesions cleared rapidly after discontinuation of captopril. To the best of our knowledge, this report describes the first case of pemphigus vegetans induced by captopril.

Pyoderma gangrenosum associated with systemic lupus erythematosus: response to pulse steroid therapy.

Pyoderma gangrenosum in a 35-year-old woman with long-standing systemic lupus erythematosus was treated with pulse steroid therapy. Significant improvement in the ulceration and control of the lupus erythematosus occurred. The unusual association of these disorders is reviewed, and the efficacy of pulse therapy in the treatment of refractory cases of pyoderma gangrenosum is discussed.

A case of lymphomatoid papulosis and Hodgkin's disease.

Lymphomatoid papulosis is a unique paradoxic entity characterized by recurrent self-healing papulonodular lesions with histologic features of malignancy. Usually the disease has a protracted benign course; however, it can be associated with or evolve to a lymphoproliferative disorder. Thus "lymphoma-associated papulosis" represents the malignant end of a wide spectrum. We describe a case of a patient with lymphomatoid papulosis who developed Hodgkin's disease 8 years after the onset of skin lesions. Systemic chemotherapy achieved complete remission of Hodgkin's disease, but recurrent papulonodular lesions continued to form in the subsequent 18 months.