Comportamiento clínico-epidemiológico del eritema nudoso en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio / Epidemiological clinical behavior of erythema nodosum at the Provincial Teaching Clinical Surgical Hospital Leon Cuervo Rubio

RESUMEN Introducción: el eritema nudoso es la variante clínico-patológica más frecuente de la paniculitis. Es una reacción cutánea inmunológica en respuesta a un amplio espectro de agentes etiológicos. Objetivo: caracterizar el comportamiento clínico-epidemiológico del eritema nudoso. Materiales y métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en pacientes con diagnóstico de eritema nudoso, ingresados en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio, de Pinar del Río, en el período de enero de 2017 a diciembre de 2018. El universo estuvo constituido por 34 pacientes con diagnóstico clínico de eritema nudoso, hospitalizados en los servicios de Medicina Interna y Dermatología. Para la recogida de la información se utilizaron la historia clínica, el examen físico y los exámenes de laboratorio. Se utilizaron métodos teóricos, empíricos y estadísticos; de los últimos se empleó la estadística descriptiva a través de frecuencias absolutas y porcentaje. Resultados: el mayor grupo de pacientes estuvo entre 30 y 39 años, y fue del sexo femenino. Las lesiones fueron más frecuentes en los meses de invierno. El tipo de eritema nudoso idiopático prevaleció. Predominó el tiempo de evolución de 1 a 3 meses. Como causa secundaria predominaron las infecciones, y los tratamientos más usado fueron los antiinflamatorios no esteroideos. Conclusiones: se trata de una importante enfermedad de salud, cuyo un diagnóstico etiológico temprano permite un tratamiento adecuado. Resulta difícil su identificación y manejo tanto en la atención primaria como en la secundaria (AU).

ABSTRACT Introduction: erythema nodosum is the most common clinical-pathological variant of panniculitis. It is an immunological skin reaction in response to a wide spectrum of etiologic agents. Objective: to characterize the clinical-epidemiological behavior of erythema nodosum. Materials and methods: a descriptive, prospective and longitudinal study was carried out in patients with diagnosis of erythema nodosum, admitted to the Provincial Teaching Clinical Surgical Hospital León Cuervo Rubio, of Pinar del Río, in the period January 2017 to December 2018. The universe was formed by 34 patients with clinical diagnosis of erythema nodosum, hospitalized in the services of Internal Medicine and Dermatology. Medical records, physical examination and laboratory tests were used for the collection of information. Theoretical, empirical and statistical methods were used; descriptive statistics was used through absolute frequencies and percentage. Results: the largest group of patients was between 30 and 39 years, and they were female. Injuries were more frequent in the winter months. The type of idiopathic erythema nodosum prevailed. The time of evolution prevailed from 1 to 3 months. Infections predominated as a secondary cause, and the most commonly used treatments were non-steroidal anti-inflammatory drugs. Conclusions: it is an important health condition, whose early etiological diagnosis allows the proper treatment. Its identification and management in both primary and secondary care is difficult (AU).

Incidência de dermatite associada à incontinência em pacientes de unidade de internação clínica / Incidence of incontinence-associated dermatitis among clinical inpatients / Incidencia de la dermatitis asociada a la incontinencia en pacientes de unidad de internación clínica

Objetivo: identificar a incidência de Dermatite Associada à Incontinência (DAI) e os fatores de risco em pacientes de uma unidade de internação clínica. Método: estudo de coorte prospectivo com 197 pacientes de unidade de internação clínica. Utilizou-se estatística descritiva e analítica e calculou-se o Risco Relativo com intervalo de confiança de 95%, considerando-se significativos quando p bicaudal <0,05. Estudo aprovado pelo Comitê de Ética em Pesquisa da Instituição. Resultados: a incidência de DAI foi de 20,3% (40 pacientes). O risco relativo para DAI foi significativamente maior em idosos, em uso de alimentação enteral, fraldas, oxigenoterapia, antifúngico, corticoide, glicosídeo cardíaco, vasodilatador ou antidispéptico. Também foi maior nos pacientes com 15 ou mais dias de internação ou naqueles com doenças classificadas como Transtornos Mentais e Comportamentais ou como Causas Externas Traumáticas. Conclusão: foi alta a incidência de DAI na população pesquisada, estando associada a fatores de risco que envolvem, sobretudo, dependência de cuidado.

Objective: to ascertain the incidence of Incontinence-Associated Dermatitis (IAD) and related risk factors among inpatients in a clinical unit. Method: in this prospective cohort study of 197 patients in an inpatient unit, descriptive and analytical statistics were used, and Relative Risk was calculated with a 95% confidence interval; these were considered significant at two-tailed p < 0.05. The research protocol was approved by the ethics commission. Results: incidence of IAD was 20.3% (40 patients). The relative risk IAD was significantly higher in the elderly, when using enteral feeding, diapers, oxygen therapy, antifungal, corticosteroids, cardiac glycoside, vasodilator or anti-dyspeptic. It was also higher in those with 15 or more days' hospitalization or with diseases classified as Mental and Behavioral Disorders or from External Traumatic Causes. Conclusion: the incidence of AID was high in the study population, and associated with risk factors that involved, above all, dependence on care. Descriptors: Nursing; Dermatitis; Urinary Incontinence; Fecal Incontinence.

Objetivo: determinar la incidencia de dermatitis asociada a incontinencia (DAI) y factores de riesgo relacionados entre pacientes hospitalizados en una unidad clínica. Método: en este estudio de cohorte prospectivo de 197 pacientes en una unidad de internación, se utilizó estadística descriptiva y analítica y se calculó el Riesgo Relativo con un intervalo de confianza del 95%; estos se consideraron significativos en p <0,05 de dos colas. El protocolo de investigación fue aprobado por la comisión de ética. Resultados: la incidencia de DAI fue del 20,3% (40 pacientes). El riesgo relativo de DAI fue significativamente mayor en los ancianos, al utilizar alimentación enteral, pañales, oxigenoterapia, antifúngicos, corticosteroides, glucósidos cardíacos, vasodilatadores o antidispépticos. También fue mayor en aquellos con 15 o más días de hospitalización o con enfermedades clasificadas como trastornos mentales y del comportamiento o de causas traumáticas externas. Conclusión: la incidencia de DAI fue alta en la población de estudio, y se asoció a factores de riesgo que involucraron, sobre todo, dependencia del cuidado.

Primary skin diseases and cutaneous manifestations of systemic diseases in swine / Doenças primárias da pele e manifestações cutâneas de doenças sistêmicas em suínos

Skin diseases in pigs can negatively impact the production. They cause losses related to the death of the affected pigs, to the cost with the treatment, growth retardation and condemnations in the slaughterhouses. This study was developed to determine the frequency and describe the histopathological findings of skin diseases in pigs in different age groups through a retrospective study from 2006 to 2018. A total of 154 conclusive cases were analyzed, including skin restricted diseases (allergic dermatitis, exudative epidermitis, vesicular dermatitis, pityriasis rosea, swinepox, follicular cyst, papilloma and scrotal hemangioma) or skin lesions secondary to systemic diseases (erysipelas, porcine dermatitis and nephropathy syndrome (PDNS), bacterial septicemia and multiple hemorrhages without definite cause). The skin lesions were classified as bacterial (46.1%), viral (26.6%), allergic (12.3%), neoplastic (1.3%) and others (13.6%). Swine erysipelas was the most frequent diagnosis (47/154), followed by PDNS (23/154), allergic dermatitis (19/154) and exudative epidermitis (15/154). Vesicular dermatitis (9/154), pityriasis rosea (9/154), septicemia with cutaneous manifestations (9/154), swinepox (9/154) and multiple hemorrhages without definite cause (7/154) were also observed. Follicular cyst (3/154), hyperkeratosis without definite cause (2/154), papilloma (1/154), and scrotal hemangioma (1/154) were less frequently described. Of the conclusive diagnosis, age was reported in 138 cases, with the highest frequency of skin lesions observed at the inspection process during slaughter (56/138).(AU)

As doenças de pele em suínos podem impactar negativamente a produção. Estas causam perdas relacionadas à morte dos acometidos, a custo com tratamentos, atraso no crescimento e condenações nos frigoríficos. Este trabalho foi desenvolvido para determinar a frequência e descrever os achados histopatológicos das doenças de pele em suínos nas diferentes faixas etárias, através de um estudo retrospectivo no período de 2006 a 2018. Foram analisados 154 casos conclusivos incluindo as doenças restritas a pele (dermatites alérgicas, epidermite exsudativa, dermatite vesicular, pitiríase rósea, varíola suína, cisto folicular, papiloma e hemangioma escrotal) e as secundárias a doenças sistêmicas (erisipela, síndrome dermatite nefropatia suína (SDNS), septicemia bacteriana e hemorragias múltiplas de causa não determinada). Estas foram classificadas em bacterianas (46,1%), virais (26,6%), alérgicas (12,3%), neoplásicas (1,3%) e outras (13,6%). A erisipela suína foi a enfermidade mais diagnosticada (47/154), seguida por SDNS (23/154), dermatite alérgica (19/154) e epidermite exsudativa (15/154). Observamos ainda dermatite vesicular (9/154), pitiríase rósea (9/154), septicemia bacteriana com manifestações cutâneas (9/154), varíola suína (9/154) e hemorragias múltiplas de causa não determinada (7/154). Em menor número, cisto folicular (3/154), hiperqueratose sem causa definida (2/154), papiloma (1/154) e hemangioma escrotal (1/154). Dos casos conclusivos, a idade foi informada em 138 casos, sendo a maior frequência das lesões de pele observadas na linha de inspeção, durante o abate (56/138).(AU)

Elevadas concentrações de metais em águas do córrego São José, Cascavel (PR), e possíveis riscos à saúde / High metal concentrations in the stream São José, Cascavel (PR) and possible health risks

O objetivo deste estudo foi avaliar a qualidade da água do córrego São José, afluente do rio Boi Piguá, e seu risco à saúde da população do entorno do Aterro Sanitário Municipal da cidade de Cascavel (PR). Foram monitorados parâmetros físico-químicos e elementos em nível de traço, em quatro pontos ao longo do córrego São José durante vinte e quatro meses. Também foi aplicado questionário à população, que mantém contato com a água desse córrego. Foram detectadas concentrações dos elementos químicos As, Pb, Cr, Cu, Hg, Se e V em desconformidade aos limites máximos permitidos pela legislação ambiental, além dos valores de oxigênio dissolvido e condutividade elétrica. Verificou-se que a qualidade da água foi influenciada negativamente pela presença do aterro sanitário. Além disso, doenças gastrointestinais, dermatites e alterações organolépticas na água foram relatadas pela comunidade. Problemas de saúde da população no entorno podem estar possivelmente vinculados ao uso das águas do córrego

The water quality of the stream São José, an effluent of the river Boi Piguá, and health risks to the population living around the Municipal Landfill in Cascavel, Brazil, is assessed. Physical and chemical parameters and trace elements were monitored at four sites throughout the stream São José during twenty-four months. A questionnaire was applied to people who were in contact with water from the stream. Concentrations of the chemical elements As, Pb, Cr, Cu, Hg, Se and V were detected, in non-compliance with maximum limits permitted by environmental legislation, coupled to rates of dissolved oxygen and electric conductivity. Water quality was negatively affected by the proximity of the sanitary landfill. Gastrointestinal diseases, dermatitis and organoleptic modifications in the water were reported. Health problems of the people living in the area may be related to the use of the stream water

Sensitive skin: review of an ascending concept

Abstract: Sensitive skin is a condition characterized by stinging, burning and itching sensations. The diagnosis, pathophysiology and treatment of sensitive skin are still under discussion. In the last years, studies on its epidemiology have been performed, showing a high prevalence and impact on quality of life. Brazilian population was also considered in these studies. Cosmetics, climate changes and skin barrier impairment are the main factors that contribute for skin hyperreactivity. New studies are trying to bring new knowledge about the theme. This review will describe data on epidemiology, triggering factors, pathophysiology, diagnosis and treatment.

Epidemiología de dermatosis pediátricas: experiencia de 30 años en Antofagasta, Chile / Epidemiology of pediatric dermatoses: experience of 30 years in Antofagasta, Chile

Introducción: La consulta por dermatología pediátrica es prevalente en dermatología general, por lo que estudiamos su importancia relativa y los motivos de consulta, en un periodo de 30 años en Antofagasta, Chile. Material y método: Se analizó el principal motivo de consulta en los menores de 15 años en una consulta dermatológica privada en 3 décadas, de 1984 a 2013. Se consideró diagnóstico, género, edad, previsión y se estudiaron las diferencias epidemiológicas entre las décadas en estudio. Resultados: El 26,6% de la consulta fue por dermatología pediátrica (15.742 pacientes). Los 10 principales motivos de consulta fueron prurigo insectario, dermatitis atópica, verrugas, escabiosis, impétigo, acné, estigmas atópicos, hemangioma, tiña y nevus melanocítico. Según décadas en estudio, la dermatitis atópica pasó del tercer al primer lugar en el periodo. Asimismo, disminuyeron escabiosis e impétigo y aumentaron acné y nevus melanocítico. Discusión: La dermatitis atópica ha llegado a ser el principal motivo de consulta dermatológica pediátrica en gran parte del mundo, especialmente en países desarrollados. Igualmente, la disminución de enfermedades bacterianas y parasitarias también es propia de países en desarrollo. Conclusiones: El volumen de consulta dermatológica pediátrica es importante, por lo que debe considerarse cuidadosamente en el currículo formativo del dermatólogo. Asimismo, los cambios epidemiológicos demostrados sugieren que nuestro país ha mutado a una epidemiología de país desarrollado.

Introduction: Consultation for pediatric dermatology is prevalent in general dermatology, that's why we studied the relative importance and motives of children's consultation in a period of 30 years in Antofagasta, Chile. Material and method: We analyzed the main motive of consultation in children under 15 years of age at a private dermatological clinic in 3 decades, from 1984 to 2013. Diagnosis, gender, age and social security system were considered and we studied the epidemiological differences between the decades in review. Results: 26,6% of the consultation was for pediatric dermatology (15.742 patients). The 10 main reasons for consultation were papular urticaria, atopic dermatitis, wart, scabies, impetigo, acne, atopic stigma, hemangioma, tinea and melanocytic nevus. According to decades under study, atopic dermatitis went from third to first place in the period. Likewise, scabies and impetigo diminished and acne and melanocytic nevus increased. Discussion: atopic dermatitis has become the main reason for pediatric dermatological consultation largely in the world, especially in developed countries. Similarly, the decline in bacterial and parasitic diseases is characteristic of developing countries. Conclusion: The volume of pediatric dermatological consultation is important, so it should be carefully considered in the training curriculum of the dermatologist. Likewise, the epidemiological changes demonstrated suggest that our country has mutated to a developed country epidemiology. Capsule Summary: Pediatric dermatology consultation is prevalent at a global level and atopic dermatitis is its main reason. In our investigation, both premises are fulfilled, important information that is partly extrapolable to guide public policies in dermatological formation and resource distribution.

Dermatite associada à incontinência: estudo de coorte em pacientes críticos / Incontinence-associated dermatitis: a cohort study in critically ill patients

A Unidade de Terapia Intensiva (UTI) é o local destinado ao atendimento de pacientes graves e durante a internação esses estão expostos a diversos fatores que podem levar a ocorrência de danos na pele. Dentre esses danos, a dermatite associada à incontinência (DAI). O objetivo geral do estudo é analisar o problema da DAI em pacientes adultos internados em uma UTI de um hospital público de Belo Horizonte - MG. Já os objetivos principais foram:identificar na literatura os fatores de risco para DAI em pacientes adultos,caracterizar os pacientes que desenvolveram a DAI, estimar a incidência,determinar os fatores de risco de DAI na UTI e propor um modelo de predição de risco. Trata-se de um estudo realizado em três etapas: revisão integrativa(RI), grau de concordância e estudo de coorte concorrente. Os fatores de risco para DAI identificados na RI foram: idade, comorbidades, nutrição, oxigenação,perfusão, temperatura, incontinência fecal e/ou urinária, atrito mecânico, uso agentes irritantes, capacidade cognitiva. Obteve-se uma incidência global de20,4% e uma densidade de incidência de 2,5 casos/100 pessoas -dia. Foram encontrados 19 fatores de risco que apresentaram associação significativa coma DAI. No modelo final de predição de risco encontrou-se: sexo masculino,trauma, hipnótico/sedativos, lactulona, suporte nutricional, fezes pastosas e ardência. Os resultados mostraram que a DAI é um achado comum em pacientes internados em UTI adulto e por isso merece atenção especial para que se tenha melhoria na qualidade da assistência de enfermagem prestada a esses pacientes.

The Intensive Care Unit (ICU) is the place for the care of critically ill patients during hospitalization and these are exposed to several factors that can lead to damage to the skin. Among such damage, dermatitis associated with incontinence (DAI). The overall objective of the study is to analyze the problemof DAI in adult patients admitted to the ICU of a public hospital in Belo Horizonte- MG. Since the main objectives were to identify the literature the risk factors forDAI in adult patients, to characterize patients who developed DAI estimate theincidence, determine the DAI risk factors in ICU and propose a risk prediction model. This is a study carried out in three stages: an integrative review (RI),degree of concordance and study concurrent cohort. The risk factors identifiedin DAI RI were age, comorbidities, nutrition, oxygenation, perfusion,temperature, fecal and / or urinary incontinence, mechanical friction, use irritants, cognitive ability. This yields an overall incidence of 20.4% and an incidence density of 2.5 cases / 100 person-days. They found 19 risk factors significantly associated with DAI. In the final model of risk prediction met: male,trauma, hypnotic / sedative, lactulona, nutritional support, loose stools and burning. The results showed that the DAI is a common finding in patients admitted to adult ICUs and therefore deserves special attention in order to have better quality of nursing care provided to these patients.

Paederus beetles: the agent of human dermatitis

Background Rove beetles of the genus Paederus cause dermatitis when they come in contact with human skin. This condition is prevalent in some tropical and subtropical regions, such as in northern Pakistan, where it was recorded for the first time by US troops. Despite much research from other countries on this subject, few studies, mostly clinical, have been performed in a Pakistani context. A survey was carried out in villages, towns and cities of Punjab province, Pakistan, to explore the rove beetle population dynamics and to develop a model to elucidate the symptoms, preventive measures and treatment strategies for this dermatitis. Methods The prospective observational and patient surveys were performed bimonthly over a period of two years, in different districts of Punjab province. Collection was carried out in fields, gardens and houses during every visit with the aid of a pitfall trap, light trap, flight intercept trap, Berlese funnel trap and sweep netting. These traps were installed for four days during every visit. Interviews of ten individuals of different ages and sexes from each site were recorded during each visit. Results Out of 980 individuals, 26.4% were found to suffer from Paederus dermatitis. Lesions were most commonly found on the neck followed by the face. In July-August during the rainy season, this skin irritation was most prevalent and the population of these beetles peaked (36.2%). During May-June, the beetle population was lowest (7.85%) due to soil dryness. About 70% of such irritation cases were from individuals living in farming villages or in farmhouses. Their houses typically (80%) had broken doors and screen-less windows while 97% of the residents were unaware of how they may have come into contact with these beetles. In most cases (91% from villages/small towns and 24% from cities and adjoining areas) the local residents were unaware of modern treatment strategies. Paederus dermatitis is extremely frequent in villages with poor housing facilities and could be avoided via community awareness.(AU)

Morphometric study of microvessels, epidermal characteristics and inflammation in psoriasis vulgaris with their correlations.

Background: Vascular proliferation, inflammation and epidermal changes are important features in the pathogenesis of psoriasis. Aims: In this study we attempted an objective evaluation of these parameters using morphometry. Methods: Inflammation, microvessels and epidermal parameters were assessed in 50 newly diagnosed cases of psoriasis vulgaris (between 01 Nov 2008 and 31 Oct 2011) by morphometry. Parameters studied were microvessel density, microvessel caliber, inflammatory cell density in dermis, ratio between inner and outer epidermal length, maximum epidermal thickness, minimum epidermal thickness and difference between maximum epidermal thickness and minimum epidermal thickness. Results: Microvessel caliber showed moderate correlation (r = 0.645) and microvessel density, weak correlation (r = 0.226) with inflammatory cell density in dermis. Both these parameters also showed mild positive correlation with "ratio between inner and outer epidermal length". All parameters except minimum epidermal thickness showed mild positive correlation with inflammatory cell density in dermis. Conclusion: All microvessels and epidermal parameters showed positive correlation with dermal inflammation; and epidermal parameters exhibited positive correlation with micro-vascular dilation. It is likely that inflammation is a key factor in the pathogenesis of psoriasis.

Dermatite multifatorial em um canino / Multifactorial dermatitis in a dog

Relatou-se um caso clínico de dermatite multifatorial em cão, envolvendo Demodex canis, Sporothrix schenckii e bactérias dos gêneros Staphylococcus e Streptococcus. O animal, macho, da raça Pit Bull, com um ano e três meses de idade, apresentou lesões úmidas, hiperêmicas, descamativas e ulcerativas nas regiões do pescoço e do tórax. Exames laboratoriais confirmaram o diagnóstico de infecção concomitante por fungo, bactéria e parasito. A terapia antimicrobiana com moxidectina, itraconazol e amoxicilina foi efetiva, com remissão dos sinais clínicos após 30 dias de tratamento. Este relato salienta a importância do diagnóstico de certeza, que foi determinante para estabelecimento da terapêutica adequada e recuperação do animal.

A clinical case of dermatitis multifactorial in a dog was reported, involving Demodex canis, Sporothrix schenckii, and bacteria of the genera Staphylococcus and Streptococcus. The animal, male, Pit Bull, with a year and three months of age had soaked lesions, was hyperemic, scaly and had an ulcer in the neck and chest. Laboratory tests confirmed the diagnosis of concomitant infection by fungi, bacteria and parasites. Antimicrobial therapy with moxidectin, itraconazol and amoxicillin was effective, with remission of clinical signs after 30 days of treatment. This report emphasizes the importance of an accurate diagnosis, which was crucial to establish the correct treatment and recovery of the animal.

Physicians’ responsibility for antibiotic use in infants from periurban Lima, Peru / Responsabilidad del médico en el uso de antibióticos en niños menores de 1 año de zonas periurbanas de Lima, Perú

Objetivo. Describir el uso de antibióticos en niños de 2 a 12 meses de edad en entornos donde estos medicamentos se pueden obtener sin prescripción. Métodos. Se analizaron los datos de un estudio de cohorte efectuado entre septiembre del 2006 y diciembre del 2007 en 1 023 niños menores de 2 meses de la zonaperiurbana de Lima, Perú, cuyo seguimiento se realizó hasta el año de edad. Resultados. De los 1 023 niños, 770 (75,3%) tomaron 2 085 tandas de tratamiento antibiótico. Se registraron dos tandas por niño por año (rango 0–12). Las tasas más elevadas de uso de antibióticos se encontraron en los niños de 3 a 6 meses (37,2%). Los niños recibieron antibióticos para 8,2% de los resfriados comunes, 58,6% de las faringitis, 66,0% de las bronquitis, 40,7% de las diarreas, 22,8% de las dermatitis y 12,0% de las obstruccionesbronquiales. La prescripción de un médico fue la razón más frecuente para el uso de antibióticos (90,8%). Se comprobó el uso de medicamentos sin prescripción en 6,9% de los niños, y en 63,9% de ellos este fue precedido por una prescripción médica. Conclusiones. En el entorno estudiado, los niños menores de 1 año a menudo estánexpuestos a los antibióticos. El abuso de los antibióticos es frecuente ante enfermedades como faringitis, bronquitis, obstrucción bronquial y diarrea, pero por lo general es inadecuado (83,1% de las tandas de tratamiento antibiótico) según las etiologías más comunes en este grupo etario. Las intervenciones dirigidas a mejorar el uso de los antibióticos deben concentrarse en los médicos, ya que la prescripción médica fue la razón más común para el uso de antibióticos.

Objective. To describe the use of antibiotics in Peruvian children under 1 year in a setting where they are available without a prescription. Methods. Data were analyzed from a cohort study between September 2006 and December 2007 of 1 023 children < 2 months old in periurban Lima, Peru, followed until they were 1 year old. Results. Seven hundred seventy of 1 023 (75.3%) children took 2 085 courses of antibiotics. There were two courses per child per year (range 0–12). Higher rates of antibiotic usewere found in children 3–6 months old (37.2%). Antibiotics were given to children for 8.2% of common colds, 58.6% of all pharyngitis, 66.0% of bronchitis, 40.7% of diarrheas, 22.8%of dermatitis, and 12.0% of bronchial obstructions. A physician’s prescription was the most common reason for antibiotic use (90.8%). Medication use without a prescription was found in 6.9% of children, and in 63.9% of them it was preceded by a physician’s prescription. Conclusions. Infants are often exposed to antibiotics in this setting. Overuse of antibiotics is common for diagnoses such as pharyngitis, bronchitis, bronchial obstruction, and diarrhea but is typically inappropriate (83.1% of courses) based on the most common etiologies for this age group. Interventions to improve the use of antibiotics should focus on physicians, since a physician’s prescription was the most common reason for antibiotic use.

Dermatitis gravitacional / Gravitational dermatitis

La dermatitis gravitacional es una dermatosis inflamatoria crónica de la piel, que ocurre en las piernas de personas de edad avanzada, de etiopatogenia compleja y multifactorial, caracterizada clínicamente por placas de aspecto eczematosas, eritematosas, escamosas, fisuradas e hiperpigmentadas, asociada con frecuencia a insuficiencia venosa crónica. En este artículo se discuten la etiopatogenia, factores de riesgo, las manifestaciones clínicas y la conducta terapéutica en la dermatitis gravitacional.

Gravitational dermatitis is a chronic inflammatory dermatosis that occurs in the legs of elderly of complex and multifactorial pathogenesis that is clinically characterized by eczematous, erythematous, scaly, fissured and noninflammatory plates, often associated with chronic venous insufficiency. This article discusses the etiopathogenesis, risk factors, clinical manifestations and therapeutical behavior.

Prevalence of common skin diseases among the elderly patients at Assiut University Hospital

To identify the prevalence of common skin diseases among elderly patients attending to the Dermatology Outpatient Clinics at Assiut University Hospital. Patient and methods: This study was conducted in Dermatology Out-patient Clinics at Assiut University Hospital. The sample of this study included all elderly patients attending to the previously mentioned setting during one year starting from the first of May 2009 to the end of April 2010. The total numbers of them were 450 elderly patients suffering from skin diseases. An interview sheet, which include Part I: It includes items related to socio-demographic characteristics such as age, sex, resident, marital status, level of education. Part II: Present, past history of skin diseases, and Family history of skin diseases. Among elderly patients 75.3% aged between [60- <70] years, 68.9% were males and 80.7% from rural areas. Also, 72.2% of the elderly patients had non-infectious skin diseases, while 27.8% of them had infectious skin disease. The highest percent 29.8% of skin diseases among of the elderly patients were in spring season. Less than three quarters of the studied sample had non-infectious skin diseases, while more than one quarters of them had infectious skin disease. Encouragement of the elderly people about the importance of follow up and periodic check-up to detect early health deviation to make early management and to prevent complication or any deterioration of the skin health. Utilizing the mass media, health classes in different health agencies could be achieved to increasing awareness of elderly people about the importance of prevention, early detection and control of skin diseases

Pattern of skin diseases in the central Iran, Yazd Province

The pattern of skin diseases differs from region to region based on geographical, racial and cultural circumstances. For the purpose of education and reeducation of physicians, it is necessary to have knowledge of the conditions and distribution of diseases. To elicit pattern of common skin diseases in the region of Central Iran, Yazd Province. Two separate descriptive studies were conducted in order to analyze the dermatoses seen in outpatients and inpatients at the Dermatology Department, Shahid Sadoughi Medical Science University, Yazd, Iran. Patient files who visited the dermatologists were reviewed. Diagnosis was coded, categorized, discussed and analyzed according to International Classification of Diseases, revision 10 [ICD-10]. Skin infections with 23.4% were the most common cause of referral to dermatology outpatients, followed by dermatitis 19.2%, acne 10.8%, melasma 7.8% and urticaria 5.3%. Melasma in women and psoriasis in men were significantly more common. In inpatient group skin infections were the most common 34.3%, followed by dermatitis 13.2%, drug reactions 11.2%, psoriasis 9.6% and malignant tumors. Psoriasis was significantly more common in men and viral infections [herpes zoster] in women. The high occurrence rate of skin infections and dermatitis in our study population requires further study in order to pinpoint its root causes. Improving the socio-economic status, environmental and personal hygiene, as well as specific instruction to the at-risk group can be beneficial

Aspectos epidemiológicos e clínicos da estefanofilariose em vacas leiteiras e comparação entre métodos de diagnóstico / Epidemiological and clinical features of stephanofilariasis in dairy cows and diagnosis methods confrontation

A estefanofilariose é uma doença mundialmente distribuída e caracteriza-se por lesões na pele causadas por nematódeo do gênero Stephanofilaria. Nos bovinos manifesta-se por uma dermatite crônica associada com erupção papular progredindo para nódulos, alopecia e ulceração crostosa. Apesar de reconhecida há muitos anos, há poucos estudos e relatos sobre a mesma. A literatura é particularmente escassa no Brasil. Esse trabalho teve como objetivos investigar aspectos epidemiológicos e clínicos da estefanofilariose em vacas leiteiras naturalmente acometidas e comparar dois métodos para a confirmação do diagnóstico, o exame histopatológico e o exame direto. Foram investigados aspectos clínicos relacionados à ocorrência natural da estefanofilariose em 58 vacas de leite de sete rebanhos criados nos municípios de Santana do Itararé, PR e de Itaberá, SP durante o período de janeiro de 2006 a agosto de 2008. Dois métodos foram comparados para confirmação do diagnóstico a partir de tecido colhido por biópsia da borda das lesões, o histopatológico (n=24) e o exame direto do sedimento da solução salina isotônica na qual o tecido permaneceu embebido (n=20). A maior prevalência ocorreu de dezembro a março (57 por cento) e a maioria das vacas era lactante (87,9 por cento). As lesões se localizavam nos quartos anteriores do úbere em seu aspecto cranial (96,7 por cento), principalmente próximo à linha média (55 por cento). A lesão típica tinha formato circular era ulcerada com crostas e exibia exsudato sero-sanguinolento. No exame histopatológico evidenciou-se uma dermatite crônica com infiltrado mononuclear e eosinofílico. A presença do parasita não foi detectada em nenhum dos cortes examinados. O exame direto possibilitou a demonstração do agente em todas as amostras examinadas, comprovando-se como um método eficiente para a confirmação do diagnóstico.

Stephanofilariasis is a worldwide disease caused by the nematode Stephanofilaria that determines skin lesions. In cattle, the chronic dermatitis is characteristic begining with papules that progress to nodules, alopecia and ulcers with crusts. Despite it's long time recognition, there are few studies and reports about this disease, specially in Brazil. This work was conducted in order to investigate epidemiological and clinical features of stephanofilariasis in dairy cows and to compare two methods for the diagnosis confirmation. Fifty-eight naturally affected dairy cows from seven herds located in Santana do Itararé, state of Paraná, and Itaberá, state of São Paulo, were studied from January 2006 through August 2008. Two methods for the diagnosis confirmation were compared using biopsied tissues from the border of the skin lesion: the histopathological examination (n=24) and the direct sediment examination of an isotonic saline solution in which the tissue fragment remained soaked (n=20). The prevalence was higher from December to March (57 percent) and lactating cows were primarily affected (87,9 percent). The cranial aspect of the fore mammary glands was the main site of the skin lesions (96,7 percent), chiefly near the ventral midline (55 percent). The characteristic wound was of circular shape, ulcerated with crusts and serosanguineous exudation. Chronic dermatitis with eosinophilic and mononuclaer cell infiltrates was the histopathologic change pattern present. The parasite was not detected in any histologic section examined. The direct sediment examination otherwise proved to be efficient for the diagnosis confirmation revealing the nematode adult and larval forms in all the specimens.

Seabather's eruption: a clinical and epidemiological study of 38 cases in Santa Catarina State, Brazil / Prurido do traje de banho: estudo clínico e epidemiológico de 38 casos no Estado de Santa Catarina, Brasil

Seabather's eruption (SBE) is an intensely itchy, papule-erythematous dermatitis that occurs predominantly in regions of the body covered by bathing costumes, after exposure to marine water. The planulae larvae of Linuche unguiculata scyphomedusae (thimble jellyfish) are the etiologic agent of the dermatitis, which is frequent in waters of Caribbean, Gulf of Mexico and Florida. The authors report 38 cases of SBE in the State of Santa Catarina (Southern region of Brazil), with emphasis on their clinical and epidemiological aspects, such as profile of victim, topography of the papules and conditions predisposing to the accident.

Os Cnidários são animais marinhos que estão relacionados com uma variedade de acidentes acometendo banhistas em regiões litorâneas. A larva plânula da cifomedusa Linuche unguiculata (uma pequena água-viva) é o agente etiológico de uma dermatite pápulo-eritematosa, intensamente pruriginosa, denominada Prurido do Traje de Banho. Acomete principalmente áreas do corpo cobertas pelo traje de banho, após exposição à água do mar. Sua presença é freqûente nas águas do Caribe, Golfo do México e da Flórida (Estados Unidos), local onde foi descrita pela primeira vez. Os autores relatam uma série de casos de Prurido do Traje de Banho ocorridos no Estado de Santa Catarina (região do sul do Brasil), com ênfase em seus aspectos clínicos e epidemiológicos.

Utilización de la terapia floral de Bach según patrón transpersonal en las dermatitis de causa externa / Using Bach Flower therapy according to the transpersonal pattern in external cause dermatitis

Se trata de un estudio descriptivo que se efectuó en la Clínica de Medicina Natural y Tradicional del hospital universitario Faustino Pérez de la ciudad de Matanzas, con el propósito de evaluar la evolución clínica de pacientes con dermatitis de causa externa utilizando terapia floral por patrón transpersonal. Se tomó como base 100 ml de una crema hidratante a la que se le adiciona 5 gotas de cada esencia floral indicándosele al paciente tres veces por día, se usó en forma de fomentos en caso necesario al que se le agrega la misma cantidad de gotas; se seleccionaron las flores teniendo en cuenta los cambios en el estado de la piel, los síntomas y los signos propios de la enfermedad. Observamos los siguientes resultados: el 82.2 por ciento de los pacientes comenzó a notar mejoría de las lesiones en las primeras 24 h de tratamiento, el 95.1 por ciento de los pacientes después de 10 días de tratamiento mejoraron considerablemente el estado de la piel y solo en 3 pacientes la lesión no tuvo modificación alguna. Los síntomas y signos que mejor y más rápido evolucionaron fueron el prurito, la ardentía y el eritema. La mayor incidencia de dermatitis de causa externa, un 43.5 por ciento de los casos, se localizó en la zona de los pies, seguida de la localizada en brazos y cara, siendo la localización en tórax la menos frecuente con solo 6 por ciento. Las lesiones remitieron totalmente en 10 sesiones de tratamiento. Llegamos a la conclusión de que este tipo de terapia es efectiva.

This is a descriptive study carried out at the traditional and natural medicine clinic of the teaching hospital Faustino Pérez of Matanzas with the purpose of evaluating the clinical evolution of the patients with external cause dermatitis using flower therapy by transpersonal pattern. We took 100 ml of hydrating cream and added 5 drops of each flower essence, indicating it to the patients three times a day. It was used as fomentation when it was necessary, adding the same quantity of drops; the flowers were selected taking into account the changes at the skin status, the symptoms and the proper signs of the disease. We obtained the following results: 82.2 percent of the patients began to feel an improvement of the lesions during the first 24 h of the treatment. The status of the skin of 95.1 percent of the patients improved considerably after ten days from the beginning of the treatment, and only in 3 patients, lesions did not showed any change. The symptoms and signs that better and faster evolved were the pruritus, burning, and erythema. The highest incidence of the external cause dermatitis; 43.5 percent of the cases was in the feet, followed by arms and face, being the less frequent the thorax with only 6 percent. The lesions remitted totally in 10 treatment sessions. We arrived to the conclusion that this kind of therapy is effective.

Doença das mucosas associada à dermatite generalizada em bovinos, Mato Grosso do Sul / Mucosal disease associated with generalized dermatitis in cattle, Mato Grosso do Sul, Brazil

São descritos os aspectos epidemiológicos, clínicos, patológicos e diagnósticos de uma forma de dermatite associada à doença das mucosas (DM) em bovinos. Também são abordadas metodologias para a identificação de animais persistentemente infectados (PI) e o impacto nos índices zootécnicos no rebanho afetado. Os casos de dermatite associados com DM ocorreram em dois bovinos Nelore, de 12 e 24 meses de idade, pertencentes a uma fazenda de ciclo completo de bovinos de corte no estado de Mato Grosso do Sul. Os sinais clínicos nesses animais consistiam de emagrecimento lento e progressivo, formação de crostas difusas na pele de todo o corpo, pele ressecada, múltiplas ulcerações nas gengivas e face dorsal da língua, que evoluíram para fendas longitudinais, formação de projeções cornificadas e desprendimento dos cascos. Em um caso, também ocorreu diarréia no estágio final da doença. Na necropsia observaram-se ainda erosões longitudinais no esôfago. O exame histológico revelou focos de necrose de coagulação na mucosa do esôfago e língua, com infiltrado de neutrófilos e linfócitos. As lesões da pele consistiam de necrose de coagulação da epiderme associada com infiltrado de neutrófilos e hiperqueratose. Nos dois casos, a suspeita clínica foi confirmada pelo isolamento viral e identificação dos biótipos citopático e não-citopático do vírus da diarréia viral bovina (BVDV), além da detecção de antígenos virais em tecidos por imunoistoquímica. De um lote de 300 bovinos que tiveram contato com animais afetados, 38 foram testados e apresentaram altos títulos de anticorpos para o BVDV. Amostras de sangue coletadas de 1.025 animais jovens e 40 touros da propriedade foram submetidas a pesquisa de vírus para se identificarem possíveis animais persistentemente infectados (PI). O vírus foi isolado do sangue de três bezerros no teste inicial e, 12 meses depois, em dois deles que permaneceram na propriedade. Imunoistoquímica realizada em biópsia de orelhas identificou...

This paper reports epidemiological, clinical, pathological and laboratory diagnostic aspects of a form of dermatitis associated with mucosal disease (MD) in cattle. It also focuses on the methods used for identifying persistently infected (PI) animals and on the impact of the disease on fertility and weaning rates in the affected herd. Cases of dermatitis associated with MD were diagnosed in two 12 and 24-month-old Nelore calves belonging to a beef cattle farm that operates the full cycle of production (calving, rearing, finishing) in Mato Grosso do Sul, Midwest Brazil. The clinical signs exhibited by affected cattle 0included slow, progressive weight loss; formation of diffuse skin crusts in multiple body areas; skin dryness; multiple ulcerations on the gums and dorsal surface of the tongue which evolved to longitudinal fissures; formation of keratinized projections; and detachment of hoof horn. In addition, diarrhea affected one animal in the late stage of the disease. Necropsies also revealed longitudinal erosions in the esophagus. Histological examination showed coagulation necrosis foci in esophageal and lingual mucosae, with neutrophil and lymphocyte infiltration. Skin lesions consisted of epidermal coagulation necrosis associated with neutrophil infiltration and hyperkeratosis. In both cases, clinical diagnosis was confirmed by the isolation and identification of cytopathic and noncytopathic biotypes of the bovine viral diarrhea virus (BVDV) and immunohistochemical detection of viral antigens in formalin fixed tissues. Out of 300 cattle that had contact with the affected animals, 38 were found to be seropositive - in high neutralizing titers - to BVDV. Blood samples from 1,025 young animals and 40 bulls from the farm were examined for the presence of BVDV to identify potential PI animals. The virus was isolated from blood of three calves in the initial test and, 12 months later, from two of them which had remained...

Pênfigo foliáceo em eqüino: relato de caso / Equine pemphigus foliaceous: case report

Diagnosticou-se pênfigo foliáceo em um eqüino macho, castrado, quatro anos de idade da raça Árabe apresentando dermatite generalizada caracterizada por placas escamo-crostosas e presença de dermatite pustular acantolítica subcorneal

Pemphigus foliaceus was diagnosed in a four-year-old Arabian equine gelding, with generalized dermatitis characterized by scaling and crusting plaques and acantholytic subcorneal pustular dermatitis

Perdas econômicas ocasionadas pelas enfermidades podais em vacas leiteiras confinadas em sistema free stall / Economic losses caused by sequels of lameness in free-stall-housed dairy cows

Avaliaram-se 55 casos clínicos de manqueira em um rebanho de 100 vacas em lactação confinadas em sistema de free stall, durante um ano. As afecções mais observadas foram abscessos de sola e talão, úlcera de sola e dermatite digital que representaram 87,3 por cento (48/55) das ocorrências. O tratamento empregado mostrou-se satisfatório com recuperação de todos os animais tratados com 24,5 dias, em média, sem ocorrência de descarte. O custo com tratamento e redução na produção de leite foi de US$95.80/vaca, o que representou US$52.69 por vaca alojada/ano. Quando se computaram as perdas reprodutivas e com mastite, obtiveram-se US$227.94 adicionais em vaca com problema de manqueira. O custo adicional anual total no rebanho decorrente de seqüelas de manqueira foi de US$12,536.70, que representou US$125.36 por vaca alojada/ano. O período de serviço e o número de serviços por concepção em vacas com problemas de manqueira e normais foram 266 e 200,5 dias e 4,3 e 3,3 serviços, respectivamente. As incidências de mastite e metrite na mesma ordem de citação anterior foram 60 por cento e 25 por cento e 29 por cento e 12,5 por cento.

Fifty-five clinical cases of lameness were evaluated in 100 lactating cows housed in a free-stall system during one year. The most observed affections were sole and heel abscesses, sole ulcers and digital dermatitis that accounted for 87.3 percent (48/55) of the occurrences. The treated cows showed satisfactory recovery (24.5 average days) without culling. The total individual cost including treatment and reduction of milk production was US$95.80/cow or US$52.69 per housed cow/year. When reproductive losses and mastitis were considered an additional cost of US$227.94 per lameness cow was estimated. The total additional annual cost from sequels of lameness was US$12.536.70 or US$152.36 per housed cow/year. The number of days open and the number of services per conception in lameness and normal cows were, respectively, 266 and 200.5 days and 4.3 and 3.3 services. Mastitis and metritis incidences, regarding the same animals, were, respectively, 60 percent and 25 percent and 29 percent and 12.5 percent.