Identifying gram-positive cocci in dermatoscopes and smartphone adapters using MALDI-TOF MS: a cross-sectional study

Abstract Background: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. Objectives: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. Methods: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. Results: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. Study limitations: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. Conclusion: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.

Ensaio clínico randomizado e unicego comparando a aplicação de toxina onabotulínica intradérmica versus intramuscular na região frontal / Randomized, single-blind clinical study comparing the application of intradermal versus intramuscular onabotulinum toxin in the frontal region

Introdução: A aplicação-padrão da toxina botulínica para linhas frontais é feita no plano intramuscular. Alguns autores têm sugerido que a combinação com pontos intradérmicos pode trazer resultado mais natural, evitando o efeito muito paralisante do uso apenas intramuscular. Objetivo: Estabelecer se o efeito paralisante da toxina onabotulínica tipo A na fronte, aplicada de forma intradérmica, é tão efetivo quanto o da mesma toxina aplicada de forma intramuscular após: 48 horas, uma, duas, quatro, oito e 12 semanas para o tratamento de linhas frontais. Materiais e métodos: 16 pacientes com rugas frontais foram randomizadas para receber toxina onabotulínica intramuscular ou intradérmica e foram reavaliadas em 48 horas, uma e duas semanas, um, dois, e três meses. Resultados: Foram coletados dados de 16 pacientes. A média de idade foi 33 anos (desvio-padrão 5,96). Em duas semanas a paralisia ocorreu em 93,3% no lado intramuscular e em 53,5% no lado intradérmico (p = 0,07). A nota mediana de dor foi 2,69 no lado intramuscular e 4 no lado intradérmico (p = 0,072). Conclusões: apesar da mais alta frequência da presença de paralisia no lado intramuscular em todas as avaliações, não houve diferença estatisticamente significativa entre os lados.

Introduction: The standard application of botulinum toxin for frontal wrinkles is at the intramuscular level. Some authors have suggested that the combination with intradermal application can bring about a more natural result, avoiding the paralyzing effect of the intramuscular application only. Objective: Establish if the paralyzing effect of type A onabotulinum toxin in the forehead, applied intradermally, is as effective as of the same toxin applied intramuscularly after: 48 hours, one, two, four, eight and 12 weeks for the treatment of frontal wrinkles. Material and Methods: Sixteen patients with frontal wrinkles were randomized to receive intramuscular or intradermal onabotulinum toxin and were reevaluated after 48 hours, one and two weeks, one, two and three months. Results: Data were collected from 16 patients. Mean age was 33 years (standard deviation 5.96). Paralysis occurred in 93.3% in the intramuscular side and in 53.5% in the intradermal side in two weeks (p= 0.07). Median pain grade was 2.69 in the intramuscular side and 4 in the intradermal side (p=0.072). Conclusions: Despite the highest frequency of the presence of paralysis in the intramuscular side in all evaluations, there was no statistically significant difference between the sides.

Estudo randomizado comparando toxina onabotulínica diluída em lidocaína e epinefrina versus solução salina para o tratamento das linhas perioculares / Randomized study comparing onabotulinum toxin diluted in lidocaine and epinephrine versus saline solution for the treatment of periocular lines

Introdução: A diluição-padrão da toxina botulínica é feita com solução salina 0,9%. Alguns estudos mostram que diluída em lidocaína e epinefrina a toxina mantém sua função sem comprometer a eficácia ou segurança. Objetivo: Estabelecer se o efeito paralisante da toxina onabotulínica tipo A reconstituída em anestésico (lidocaína a 2%) e agente vasoconstritor (epinefrina 1:50.000) é tão efetivo quanto o da mesma toxina reconstituída em solução salina em 48 horas, uma semana, duas, quatro,12 e 24 semanas para o tratamento de linhas perioculares e comparar a tolerância à dor de uma e outra possibilidade. Métodos: 15 pacientes com rugas perioculares foram randomizadas para receber toxina onabotulínica diluída em lidocaína com adrenalina ou diluída em solução salina e foram reavaliadas em 48 horas, uma semana, duas, quatro, 12 e 24 semanas. Resultados: Os dados indicam que não houve diferença na simetria e na durabilidade da toxina botulínica, nem tampouco na dor durante a aplicação. Conclusões: Não houve diferença estatisticamente significativa na frequência de paralisia muscular periocular lateral e na simetria decorrente das aplicações de toxina botulínica reconstituída em lidocaína com epinefrina ou em solução salina, resultado consistente com estudos prévios.

Introduction: Standard dilution of botulinum toxin is performed with 0.9% saline solution. Some studies show that when diluted in lidocaine and epinephrine, the toxin preserves its function without compromising effectiveness or safety. Objective: To establish whether the paralyzing effect of ona-toxin type A reconstituted in anesthetic (2% lidocaine) and vasoconstrictor agent (1: 50,000 epinephrine) is as effective as that of the same toxin reconstituted in saline solution, at 48 hours, 1 week, 2, 4, 12 and 24 weeks, for the treatment of periocular lines. To compare the tolerance to pain between the two reconstitution alternatives. Methods: Fifteen patients with periocular wrinkles were randomized to receive onabotulinum toxin diluted in lidocaine with epinephrine or in saline. Re-evaluations were carried out in 48 hours, 1 week, 2, 4, 12 and 24 weeks. Results: The data indicate that there was no difference in the symmetry and durability of the botulinum toxin, nor in the pain during the application. Conclusions: There was no statistically significant difference in the frequency of lateral periocular muscle paralysis and symmetry resulting from the applications of onabotulinum toxin reconstituted in lidocaine with epinephrine or in saline solution. This outcome is consistent with those of previous studies.

Zoon vulvitis

Abstract Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Deficiency of the eighth component of complement associated with recurrent meningococcal meningitis: case report and literature review

The authors report a case of deficiency of the eighth component of complement in a young adult with a history of three episodes of meningitis; one of them proved to be meningococcal. The literature was reviewed and meningitis due to Neisseria meningitidis strains causing disease in complement-deficient and complement-sufficient patients was demonstrated. Meningococcal disease may be the first manifestation of complement deficiency; screening for complement function must be considered for those with invasive meningococcal disease, with posterior evaluation of the components of the terminal pathway of complement.

Tuberculose pulmonar no paciente HIV positivo / Pulmonary tuberculosis in HIV positive patients

Os autores apresentam a análise retrospectiva de doze pacientes HIV positivos com diagnóstico de tuberculo pulmonar internados no HUSVP de Passo Fundo, RS, durante o ano de 1997. Foram observados o perfil dos pacientes, sinais clínico-radiológicos e laboratoriais, métodos diagnósticos e o tratamento utilizado

Infarto agudo do miocárdio e Síndrome da Imunodeficiência Adquirida / Acute myocardial infarction in patient with AIDS

Os autores relatam o caso de um paciente com AIDS que apresentou infarto agudo do miocárdio durante internaçäo hospitalar. Além disso, säo feitas consideraçöes sobre a possibilidade do HIV estar relacionado, como fator predisponente, no desenvolvimento de infarto agudo do miocárdio