Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance / Skin Preparation for the Prevention of Surgical Site Infection: A Scoping Review

Introducción: La Infección del sitio operatorio genera un impacto económico y social debido a los altos costos durante la recuperación, la estancia hospitalaria y la afectación de la calidad de vida, por esto, es necesario identificar las intervenciones y recomendaciones para la preparación de la piel, encaminadas a la prevención de la infección del sitio operatorio, basado en la evidencia científica. Materiales y Métodos: Se realizó una revisión sistemática de alcance en el marco del Instituto Joanna Briggs y los parámetros Prisma-P. En las bases de datos Medline, OVID, Pubmed, Scielo, BVS y Cochrane, publicadas entre los años 2010­2019, en los idiomas inglés, portugues y español. Resultados: Se analizaron 28 artículos. De estos, se identificaron 6 de la categoría general incluidas las guías de prevención de infección del sitio operatorio, 6 para el baño preoperatorio, 6 para la realización del rasurado y 10 de asepsia y antisepsia. Discusión: Con respecto al baño preoperatorio, es una práctica recomendada internacionalmente, la evidencia demuestra que esta actividad no representa ningún beneficio; en la categoría de rasurado, la recomendación es no remover el vello a menos que sea absolutamente necesario. Frente a la asepsia del sitio quirúrgico, el aporte es más que todo informativo acerca de los antisépticos y se recomienda el uso de la clorhexidina. Conclusiones: De acuerdo a la revisión sistemática de alcance de la literatura, no se evidencia una estandarización en las recomendaciones e intervenciones, para la preparación de la piel en la prevención de Infección del Sitio Operatorio.

Abstract Introduction: Surgical Site Infections have an economic and social impact due to high costs during recovery, hospital stay and deterioration in quality of life. Therefore, it is required to identify interventions and recommendations for skin preparation aimed at preventing surgical site infection based on a scientific evidence-based approach. Materials and Methods: A systematic scoping review was conducted on English, Portuguese and Spanish articles published in Medline, Ovid, PubMed, Scielo, BVS, and Cochrane in 2010-2019 using the Joanna Briggs Institute approach and Prisma-P parameters. Results: After analyzing a total of 28 articles, 6 articles were found to be related to the general category (including guidelines for prevention of surgical site infection), 6 for preoperative bathing, 6 for preoperative hair removal and 10 for asepsis and antisepsis. Discussion: Although preoperative bathing is an internationally recognized practice, scientific evidence shows that this activity does not have any benefit. As for preoperative hair removal, it is not recommended except where absolutely necessary. As for surgical asepsis, mostly informative aspects are found about the use of antiseptics and chlorhexidine. Conclusions: Based on the systematic scoping review of the literature, a lack of standardization was found regarding interventions and recommendations for skin preparation for the prevention of Surgical Site Infection

Introdução: A Infecção do Local Operatório gera impacto econômico e social devido aos altos custos durante a recuperação, internação e o impacto na qualidade de vida, portanto, é necessário identificar as intervenções e recomendações para o preparo da pele, visando à prevenção de cirurgias da infecção local operativo, com base em evidências científicas. Materiais e Métodos: Uma revisão sistemática de alcance foi realizada dentro da estrutura do Instituto Joanna Briggs e dos parâmetros Prisma-P. Nas bases de dados Medline, OVID, Pubmed, Scielo, BVS e Cochrane, publicadas entre os anos 2010-2019, nos idiomas inglês, português e espanhol. Resultados: Foram analisados 28 artigos. Destes, 6 foram identificados na categoria geral, incluindo as diretrizes de prevenção de infecção de local cirúrgico, 6 para o banho pré-operatório, 6 para barbear e 10 para assepsia e antissepsia. Discussão: Em relação ao banho pré-operatório, é uma prática recomendada internacionalmente, as evidências demonstram que esta atividade não representa nenhum benefício; na categoria de barbear, a recomendação é não remover os pelos, a menos que seja absolutamente necessário. Dada à assepsia do local cirúrgico, a contribuição é principalmente informativa sobre os antissépticos e recomenda-se o uso da clorexidina. Conclusões: De acordo com a revisão sistemática do alcance da literatura, não há evidências de uma padronização nas recomendações e intervenções, para o preparo da pele na prevenção da Infecção do Local Operatório.

Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance / Skin Preparation for the Prevention of Surgical Site Infection: A Scoping Review / Preparação da pele para a prevenção da infecção do sítio operatório: revisão do escopo

Resumen Introducción La Infección del sitio operatorio genera un impacto económico y social debido a los altos costos durante la recuperación, la estancia hospitalaria y la afectación de la calidad de vida, por esto, es necesario identificar las intervenciones y recomendaciones para la preparación de la piel, encaminadas a la prevención de la infección del sitio operatorio, basado en la evidencia científica. Materiales y Métodos Se realizó una revisión sistemática de alcance en el marco del Instituto Joanna Briggs y los parámetros Prisma-P. En las bases de datos Medline, OVID, Pubmed, Scielo, BVS y Cochrane, publicadas entre los años 2010-2019, en los idiomas inglés, portuges y español. Resultados Se analizaron 28 artículos. De estos, se identificaron 6 de la categoría general incluidas las guías de prevención de infección del sitio operatorio, 6 para el baño preoperatorio, 6 para la realización del rasurado y 10 de asepsia y antisepsia. Discusión Con respecto al baño preoperatorio, es una práctica recomendada internacionalmente, la evidencia demuestra que esta actividad no representa ningún beneficio; en la categoría de rasurado, la recomendación es no remover el vello a menos que sea absolutamente necesario. Frente a la asepsia del sitio quirúrgico, el aporte es más que todo informativo acerca de los antisépticos y se recomienda el uso de la clorhexidina. Conclusiones De acuerdo a la revisión sistemática de alcance de la literatura, no se evidencia una estandarización en las recomendaciones e intervenciones, para la preparación de la piel en la prevención de Infección del Sitio Operatorio.

Abstract Introduction Surgical Site Infections have an economic and social impact due to high costs during recovery, hospital stay and deterioration in quality of life. Therefore, it is required to identify interventions and recommendations for skin preparation aimed at preventing surgical site infection based on a scientific evidence-based approach. Materials and Methods A systematic scoping review was conducted on English, Portuguese and Spanish articles published in Medline, Ovid, PubMed, Scielo, BVS, and Cochrane in 2010-2019 using the Joanna Briggs Institute approach and Prisma-P parameters. Results After analyzing a total of 28 articles, 6 articles were found to be related to the general category (including guidelines for prevention of surgical site infection), 6 for preoperative bathing, 6 for preoperative hair removal and 10 for asepsis and antisepsis. Discussion Although preoperative bathing is an internationally recognized practice, scientific evidence shows that this activity does not have any benefit. As for preoperative hair removal, it is not recommended except where absolutely necessary. As for surgical asepsis, mostly informative aspects are found about the use of antiseptics and chlorhexidine. Conclusions Based on the systematic scoping review of the literature, a lack of standardization was found regarding interventions and recommendations for skin preparation for the prevention of Surgical Site Infection

Resumo Introdução A Infecção do Local Operatório gera impacto econômico e social devido aos altos custos durante a recuperação, internação e o impacto na qualidade de vida, portanto, é necessário identificar as intervenções e recomendações para o preparo da pele, visando à prevenção de cirurgias da infecção local operativo, com base em evidências científicas. Materiais e Métodos Uma revisão sistemática de alcance foi realizada dentro da estrutura do Instituto Joanna Briggs e dos parâmetros Prisma-P. Nas bases de dados Medline, OVID, Pubmed, Scielo, BVS e Cochrane, publicadas entre os anos 2010-2019, nos idiomas inglês, português e espanhol. Resultados Foram analisados 28 artigos. Destes, 6 foram identificados na categoria geral, incluindo as diretrizes de prevenção de infecção de local cirúrgico, 6 para o banho pré-operatório, 6 para barbear e 10 para assepsia e antissepsia. Discussão Em relação ao banho pré-operatório, é uma prática recomendada internacionalmente, as evidências demonstram que esta atividade não representa nenhum benefício; na categoria de barbear, a recomendação é não remover os pelos, a menos que seja absolutamente necessário. Dada à assepsia do local cirúrgico, a contribuição é principalmente informativa sobre os antissépticos e recomenda-se o uso da clorexidina. Conclusões De acordo com a revisão sistemática do alcance da literatura, não há evidências de uma padronização nas recomendações e intervenções, para o preparo da pele na prevenção da Infecção do Local Operatório.

Transient skin and fur color change after trichotomy of the sacrococcygeal region for epidural anesthesia in a domestic cat (Felis catus) / Mudança transitória da cor da pele e pelo após tricotomia da região sacrococcígea para anestesia epidural em gata doméstica (Felis catus)

A clinical case in which skin and hair color change occurred after sacrococcygeal epidural anesthesia in a nine-month-old Siamese cross queen undergoing ovariohysterectomy (OHE) is described. Six weeks after surgery, during a re-check, it was noted that in the sacrococcygeal region the color of the skin and new hair growth was dark with a color comparable to the color present on the body extremities (muzzle, pinnae, legs, and tail). The skin and new hair growth of the shaved abdomen presented a standard color. The key enzyme of the melanogenic pathway in mammals is tyrosinase (TYR), and the Siamese temperature-sensitive phenotype is the result of genetic mutations that makes TYR function thermolabile. The activity of TYR in these cats is limited to the extremities where the temperature is lower while pigment production is impaired in the other body areas. The trichotomy of the sacrococcygeal region performed during wintertime in an outdoor cat was probably the trigger for increased activity of TYR in this area promoting pigment production. The absence of the same alterations in the abdominal area may be justified by less exposure of that region to the external environment, as well as to the feline habits of sedentarism, that avoid significant cooling in these regions. This report highlights the importance of taking this type of occurrence into account when performing an epidural in the Siamese cat breed. Also, to avoid skin color change in this breed, the authors recommend a midline abdominal instead of a flank approach to perform OHE.(AU)

Descreve-se um caso clínico no qual ocorreu mudança na cor da pele e do pelo após anestesia epidural sacrococcígea numa gata cruzada de raça Siamês de nove meses submetida à ovariohisterectomia (OVH). Seis semanas após a cirurgia, durante uma avaliação pós-operatória, notou-se que na região sacrococcígea, a cor da pele e o crescimento do pelo apresentavam uma cor escura, comparável à das extremidades do corpo (face, orelhas, membros e cauda). A pele e o crescimento do pelo do abdómen, que também havia sido tosquiado, apresentavam uma cor padrão. A enzima chave da via melanogênica em mamíferos é a tirosinase (TYR) e o fenótipo siamês sensível à temperatura é o resultado de mutações genéticas que tornam a função TYR termolábil. A atividade da TYR nestes gatos é limitada às extremidades onde a temperatura é mais baixa, enquanto a produção de pigmento é prejudicada em outras áreas do corpo. A tricotomia da região sacrococcígea realizada durante o inverno nesta gata com acesso livre ao ambiente externo, provavelmente determinou um aumento da atividade da TYR nesta área, promovendo a produção de pigmento. A ausência das mesmas alterações na região abdominal pode ser justificada pela menor exposição desta área do corpo ao ambiente externo, também devido aos hábitos felinos de sedentarismo, que evitam resfriamento significativo nestas regiões. Este relato destaca a importância de se levar em consideração a possibilidade deste tipo de ocorrência quando da realização de uma anestesia epidural nesta raça de gatos. Além disso, os autores recomendam uma abordagem abdominal na linha média ao invés de uma abordagem de flanco para realizar a OVH nesta raça, a fim de evitar a alteração da cor da pele.(AU)

Analysis on the Current Situation of Regulations and Standards for Home Photoepilators / 中国医疗器械杂志

This article introduces the safety risks of the novel light-based home-use hair removal device, and analyzes the differences in regulation among China, the United States and the European Union. In China, household intense pulsed light hair removal devices will also be supervised in accordance with medical device regulations. Therefore, the safety standards adopted in the absence of specific regulations are no longer applicable to the new regulatory requirements. It is imperative to adopt the new standards available to home photoepilators, so as to ensure the safety and effectiveness of the approved devices.

Impact of genital hair removal on female skin microenvironment: barrier disruption and risk of infection, a literature review / Impacto da depilação genital no microambiente da pele feminina: ruptura de barreira e risco de infecção, uma revisão da literatura / Impacto de la depilación genital en el microambiente de la piel femenina: interrupción de la barrera y riesgo de infección, una revisión de la literatura

Abstract Genital hair is one of the secondary sexual traits that marks the beginning of puberty; its removal has been part of human culture since ancient times. This practice may lead to modifications in vaginal microbiome with potential repercussions on skin health and balance. We conducted a narrative review with the purpose of describing normal skin microbiota, its impact under microenvironment changes and genital hair removal. Menses, pathological conditions and pubic hair removal may alter vaginal microbiota, being the latter of special relevance giving the risk of hair microtrauma, irritations and potential spread of infectious agents. MÉD.UIS.2019;32(3):27-33

Resumo O cabelo genital é um dos traços sexuais secundários que marcam o início da puberdade; sua remoção faz parte da cultura humana desde os tempos antigos. Essa prática pode levar a modificações no microbioma vaginal com possíveis repercussões na saúde e equilíbrio da pele. Realizamos uma revisão narrativa com o objetivo de descrever a microbiota normal da pele, seu impacto nas alterações do microambiente e na remoção de pelos genitais. A menstruação, as condições patológicas e a remoção de pelos pubianos podem alterar a microbiota vaginal, sendo esta última de especial relevância dando o risco de microtraumatismo capilar, irritações e potencial disseminação de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Resumen El vello genital es uno de los rasgos sexuales secundarios que marca el comienzo de la pubertad; su eliminación ha sido parte de la cultura humana desde la antigüedad. Esta práctica puede conducir a modificaciones en el microbioma vaginal con posibles repercusiones potenciales en la salud y el equilibrio de la piel. Realizamos una revisión narrativa con el propósito de describir la microbiota cutánea normal, su impacto bajo los cambios del microambiente y la depilación genital. La menstruación, las condiciones patológicas y la depilación púbica pueden alterar la microbiota vaginal, siendo esta última de especial relevancia dado el riesgo de microtraumatismos, irritaciones y posible propagación de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Daily genital cares of female gynecologists: a descriptive study

SUMMARY INTRODUCTION: Genital hygiene can play an essential role in avoiding vulvovaginal discomfort and preventing infections. The scientific evidence on best practices on genital hygiene is scarce, and without doubt, gynecologists should be the best person to discuss and guide the subject. OBJECTIVE: Evaluate the general genital female gynecologist hygiene. METHODS: This descriptive analytic study identified genital hygiene and sexual practices of 220 female gynecologists, through a questionnaire with 60 self-answered questions. The data were analyzed and presented using frequency, percentage, mean and standard deviation. RESULTS: The studied population was constituted by middle age (37.3 years) and white (71.3%) female gynecologists. More than a half (53.6%) declared spending over 10 hours a day away from home and complained of vaginal discharge in 48.1% of the cases. Regular vulvovaginal hygiene: 17.8% reported washing genitals once a day and 52% twice a day. The use of dry paper alone was reported in 66.4% post urination and 78.5% post-evacuation. Using running water and soap was practiced by 25.9% and 21.5% respectively. Vulvovaginal hygiene related to sex: More than half of them had intercourse 1-3 times a week, and 37.4% and 24.1% had frequent oral sex and eventually anal sexof the participants, respectively. Genital hygiene before sex was positive in 52.7% of the subjects and, post-sex hygiene in 78.5% of them. Conclusion: Genital hygiene habits of female gynecologists can be improved, despite the high grade of scientific knowledge they hold.

RESUMO INTRODUÇÃO: A higiene genital pode desempenhar um papel importante na prevenção de desconfortos vulvovaginais e infecções. Evidências científicas sobre as melhores práticas em higiene genital são escassas, e o ginecologista, sem dúvida, é a melhor pessoa para discutir e orientar o assunto. OBJETIVO: Avaliar a higiene genital feminina usual de médicas ginecologistas. MÉTODOS: Estudo analítico descritivo que identificou higiene genital e práticas sexuais de 220 ginecologistas por meio de um questionário com 60 perguntas autorrespondidas. Os dados foram analisados e apresentados por frequência, porcentagem, média e desvio padrão. Resultados: A população estudada consistiu de médicas ginecologistas femininas brancas (71,3%) com idade média de 37,3 anos. Mais da metade (53,6%) relatou ficar fora de suas casas por períodos superiores a 10 horas por dia e queixaram-se de descarga vaginal em 48,1% dos casos. Higiene vulvovaginal regular: 17,8% relataram lavar os genitais uma vez por dia e 52%, duas vezes por dia. O uso apenas de papel (seco) foi relatado em 66,4% dos casos após micção e em 78,5% após a evacuação. A higiene ideal com água corrente e sabão foi praticada apenas em 25,9% e 21,5%, respectivamente. Higiene vulvovaginal relacionada ao sexo: mais da metade delas relatou relações sexuais 1-3 vezes por semana, sexo oral frequente e anal eventual em 37,4% e 24,1%, respectivamente. A higiene genital pré-sexo foi relatada por 52,7% das pessoas e em 78,5% após o coito. Conclusão: Os hábitos de higiene genital dos ginecologistas femininos estão sujeitos a melhorias, mesmo considerando o alto grau de conhecimento científico que possuem.

Penile Prosthesis Infection: Myths and Realities

Penile prosthesis infection is the most significant complication following prosthesis implant surgery leading to postoperative morbidity, increased health care costs, and psychological stress for the patient. We aimed to identify risk factors associated with increased postoperative penile prosthesis infection. A review of the literature was performed via PubMed using search terms including inflatable penile prosthesis, penile implant, and infection. Articles were given a level of evidence score using the 2011 Oxford Centre for Evidence-Based Medicine Guidelines. Multiple factors were associated with increased risk of post-prosthesis placement infection (Level of Evidence Rating) including smoking tobacco (Level 1), CD4 T-cell count 8.5 (Level 2). Factors with no effect on infection rate include: preoperative cleansing with antiseptic (Level 4), history of prior radiation (Level 3), history of urinary diversion (Level 4), obesity (Level 3), concomitant circumcision (Level 3), immunosuppression (Level 4), age >75 (Level 4), type of hand cleansing (Level 1), post-surgical drain placement (Level 3), and surgical approach (Level 4). Factors associated with decreased rates of infection included: surgeon experience (Level 2), “No Touch” technique (Level 3), preoperative parenteral antibiotics (Level 2), antibiotic coated devices (Level 2), and operative field hair removal with clippers (Level 1). Optimization of pre-surgical and intraoperative risk factors is imperative to reduce the rate of postoperative penile prosthesis infection. Additional research is needed to elucidate risk factors and maximize benefit.

A prospective, comparative evaluation of axillary hair removal with an 808-nm diode laser at different fluences

BACKGROUND: Diode lasers are the gold standard for removing unwanted hair. Lowering the energy should result in less pain and could theoretically affect therapeutic efficacy. This study evaluated the efficacy of an 808-nm diode laser at different fluences for permanent axillary hair removal in Korean women. METHODS: Twenty-four Korean women were divided into two groups. Each patient received laser treatment at both axillae, which were divided into upper and lower parts. Each part received different fluence from an HR808 prototype diode at 1-month intervals: 8, 10, 12, and 14 J/cm². Hair count and thickness were recorded at each follow-up visit and at a 3-month follow-up after the final laser treatment by photography and using a folliscope. At the final visit, pain and patient satisfaction were surveyed. Three plastic surgeons assessed the results on photographs. RESULTS: The mean hair follicle density reduction was 62.18%, 65.28%, 73.08%, and 78.29% on the right upper side, right lower side, left upper side, and left lower side, respectively. The mean hair follicle thickness reduction was 45%, 48%, 54%, and 59% on the right upper side, right lower side, left upper side, and left lower side, respectively. In the plastic surgeons' assessment, the left upper and lower sides scored 2.71. The right upper and lower sides scored 2.38 and 2.04, respectively. CONCLUSIONS: High-fluence (14 J/cm²) treatment with an HR 808 prototype diode laser efficiently removed unwanted hair. No significant difference in comfort was reported compared to the low-fluence mode (8–10 J/cm²).

Influence of facial threading on various physiological parameters of the skin: non-randomized trial involving adult women in Taiwan

Abstract: Background: Facial threading involves the removal of hairs to restore facial skin smoothness. However, its effectiveness has not been rigorously evaluated. Objective: To evaluate effects of facial threading on skin roughness, hydration, melanin index, and vellus hair on the face, complemented by a subjective evaluation of the tactile feel of the skin and improvement in skin color. Method: Participants who had not used exfoliators for two weeks before the experiment were included. Each participant underwent one session of facial threading every 21 days, for a total of 3 sessions. A three-dimensional skin roughness instrument and a multifunctional skin testing system were used to evaluate changes in roughness, hydration, and pigmentation on the forehead, cheeks, and corners of the mouth. A photomicrographic camera was used to record changes in vellus hair. Subjective reports of skin smoothness and color were recorded. Result: Eighteen participants completed the study. Facial threading produced a significant decrease in skin roughness on the forehead (22.42%, p = .013), right cheek (77%, p = .02), and left corner of the mouth (33.02%, p = .001). Subjective improvement in tactile feel of the skin and coloring were reported. Study Limitations: The study did not include randomization, with further limitations of a small sample size and a single site. Conclusion: Facial threading reduced skin roughness by 26.74% after three threading sessions, with improved subjective assessment of tactile feel and coloring. Future research should include a comparison with other cosmetic products with similar beautifying effects or a control group.

Efeitos do banho prévio, da tricotomia e da antissepsia na redução da contaminação do sítio cirúrgico em cadelas submetidas à OSH eletiva / Effects of the previous bath, trichotomy and antisepsis in reducing contamination of the surgical site in bitches undergoing elective OSH

O objetivo deste estudo foi analisar a influencia do banho 24 horas antes do procedimento cirúrgico e da tricotomia pré-operatória na redução da contagem microbiana da pele do campo operatório, bem como a eficiência antisséptica do gluconato de clorexidina 0,5% e da polivinilpirrolidona iodada 10% para antissepsia do sítio cirúrgico, verificando sua ação 4 minutos e 2 horas após aplicação. Utilizaram-se 20 cadelas hígidas, alocadas ao acaso em 2 grupos de 10 animais: os animais do Grupo I foram submetidos ao banho 24 horas antes do procedimento cirúrgico, enquanto os do Grupo II não passaram por este procedimento. Foram isolados diversos gêneros bacterianos antes e após o uso dos antissépticos. Significância estatística foi verificada entre os grupos quanto ao efeito do banho prévio à cirurgia, apenas 2 horas após a aplicação de clorexidina. A tricotomia reduziu 26,48% da carga microbiana nos animais do Grupo I e elevou a carga microbiana em 41,19% nos animais do Grupo II, revelando diferença estatística. Após o uso dos antissépticos, não foi observada diferença estatística entre os grupos em nenhum momento. Do mesmo modo, a comparação da eficiência dos antissépticos com ou sem banho, não revelou significância estatística. A polivinilpirrolidona iodada causou reação alérgica em 15% dos animais e não foi observada irritação cutânea causada pela clorexidina. Conclui-se que o banho prévio tem efeito na redução da carga bacteriana apenas após 2 horas de antissepsia com clorexidina; a tricotomia é mais eficaz na redução microbiana quando o animal é submetido ao banho e os dois antissépticos são igualmente eficazes na antissepsia cirúrgica por até 2 horas quer o animal tome banho ou não previamente à cirurgia.(AU)

The objective of this study was to analyze the influence of bath 24 hours before surgery and preoperative shaving in reducing microbial count of the operating field skin and antiseptic efficiency of 0.5% chlorhexidine gluconate and 10% iodine polyvinylpyrrolidone for antisepsis of the surgical site, by checking its action 4 minutes and 2 hours after application. We used 20 healthy bitches, randomly allocated into 2 groups of 10 animals: Group I underwent bath 24 hours before surgery, whereas Group II did not undergo this procedure. Many bacterial genera have been isolated before and after use of antiseptics. Statistical significance was observed between the groups regarding the effect of bath prior to surgery, just two hours after application of chlorhexidine. Shaving reduced 26.48% of the microbial load in Group I and increased the microbial load in 41.19% in Group II, showing statistical difference. After the use of antiseptics, there was no statistical difference between the groups at any time. Similarly, comparison of the efficiency of the bath with or without antiseptic showed no statistical significance. The iodine polyvinylpyrrolidone caused allergic reaction in 15% of animals and was not observed skin irritation caused by chlorhexidine. We conclude that the prior bath is effective in reducing bacterial load just after 2 hours of antisepsis with chlorhexidine; shaving is more effective in reducing microbial when the animal is subjected to the bath and the two antiseptic agents are equally effective in surgical antisepsis or for up to 2 hours the animal did not take a bath or prior to surgery.(AU)

Nonshaved Ear Surgery: Effect of Hair on Surgical Site Infection of the Middle Ear/Mastoid Surgery and Patients' Preference for the Hair Removal

BACKGROUND AND OBJECTIVES: This study aimed 1) to compare the rates of surgical site infection (SSI) between two groups with and without preoperative hair shaving, 2) to compare the bacterial colonization just before the skin incision between them, and 3) to evaluate people’s preference for the hair shaving. SUBJECTS AND METHODS: The retrospective study enrolled cases in which middle ear and mastoid surgery was performed with as well as without hair removal. Main measurement outcomes were the SSI rate within 3 months following the surgery, bacterial culture results obtained from the incision area just before the skin incision, and questionnaire to evaluate the preference for hair shaving from patients with chronic suppurative otitis media but without experience with the ear surgery. RESULTS: This study did not show any difference in the rates of SSI and bacterial colonization between two groups with and without preoperative hair shaving. Most patients without experience with the ear surgery chose the nonshaved ear surgery, even though the questionnaire presented a comment as follow; “Your hair will always grow back as the growth speed of about 1.25 cm per month.” CONCLUSIONS: There is no evidence showing that preoperative shaving of the surgical site is helpful for the SSI than no hair removal. Nonshaved middle ear and mastoid surgery via postauricular approach appears to be preferable. Contrary to doctors’ popular belief, the hair shaving can cause psychological discomfort, especially for women. Now is the time to keep the balance between the professional’s perspective and the patients’ preferences.

The Preference of Women and Men Regarding Female Genital Depilation / A preferência de mulheres e homens em relação à depilação genital feminina

Abstract Purpose To evaluate the preferences of women and men regarding female pubic hair depilation and identify possible reasons for these preferences. Methods This is a cross-sectional study of men and women over 18 years old who were invited by the official blog of our institution to respond anonymously to an online and self-administered questionnairemade by the researchers. The analyses weremade using the Statistical Analysis System (SAS, SAS Inc., Cary, NC, US) software, version 9.3, and contingency tables were used to verify the distribution of variables. The univariate statistical analysis was performed using the Pearson chi-squared test, and the differences for values of p < 0.05 were considered significant. Results We obtained data from 69,920 subjects (52,787 women and 17,133 men). Themean age was 31.9 years formen, and 28.5 years for women. Most women (64.3%) and men (62.2%) preferred complete removal of female pubic hair, and this preference wasmore pronounced in younger women andmen. Most women reported performing depilation at home (55.8%), with 44.4% using hot wax and 40.1% using a razor blade. About half of the women (44.7%) and men (50.1%) reported sexual activity, having intercourse 2 to 3 times per week. The frequency of intercourse and sexual satisfaction in women correlated with total pubic hair removal. Conclusion Most Brazilian women and men prefer the complete removal of female pubic hair, especially those who are younger andmore sexually active.Women who are satisfied with the appearance of their own genitalia have a stronger preference for complete removal of pubic hair.

Resumo Objetivos Avaliar a preferência de mulheres e homens emrelação à depilação genital feminina, e identificar possíveis razões envolvidas nessa preferência. Método Estudo transversal em que homens e mulheres com mais de 18 anos foram convidados por meio do blog oficial de nossa instituição a responder anonimamente a um formulário on-line e autoadministrado de autoria dos pesquisadores. As análises foram realizadas no programa Statistical Analysis System (SAS, SAS Inc., Cary, Carolina do Norte, EUA), versão 9.3, e tabelas de contingência foram construídas para verificar a distribuição entre as variáveis. A análise estatística univariada foi realizada com o teste qui-quadrado de Pearson, e foram consideradas significativas as diferenças para p < 0,05. Resultados Foram obtidos dados de 69.920 indivíduos (52.787 mulheres e 17.133 homens). A idade média dos indivíduos foi de 31,9 anos entre os homens, e de 28,5 entre as mulheres. A maioria das mulheres (64,3%) e dos homens (62,2%) preferiram a genitália feminina completamente depilada, e essa preferência foi mais pronunciada em mulheres e homens mais jovens. A maioria das mulheres afirmaram se depilar em casa (55,8%), e 44,4% delas usam cera quente, e 40,1% utilizam lâmina de barbear. Quase metade das mulheres (44,7%) e metade dos homens (50,1%) alegaram ter frequência sexual de 2 a 3 vezes por semana. A frequência sexual das mulheres e a satisfação com sua própria genitália foram positivamente relacionadas com a preferência pela remoção total dos pelos pubianos. Conclusões A maioria das mulheres e dos homens brasileiros preferem a remoção completa dos pelos genitais femininos, o que é ainda mais pronunciado nos indivíduos mais jovens e sexualmente ativos. As mulheres satisfeitas com a aparência de sua própria genitália tendem a preferir a remoção completa dos pelos pubianos.

A península na ritidoplastia / The peninsula in rhytidoplasty

Introdução: A ascensão do pé do cabelo é um estigma frequente e desagradável nas ritidoplastias. Para contornar esse problema, criamos a técnica da Península em meados de 1999. Inicialmente utilizada nas faces secundárias, sua indicação foi ampliada, tornando-se imprescindível nos casos primários de implantação alta do cabelo e naqueles pacientes que necessitariam de grande ressecção de pele. Métodos: O total de ritidoplastias realizadas foi de 7356, tendo sido operados 2512 pacientes utilizando a técnica da Península, no período que cursa entre 1999 e 2016, com idade média de 48 anos, sendo 98% dos pacientes do sexo feminino e 2% do sexo masculino. A técnica apresenta três variantes. Resultados: Os pacientes continuaram, posteriormente, em acompanhamento mensal até a alta ao final de 6 meses. Dentre os resultados, surgiram algumas complicações, comuns a qualquer tipo de cirurgia da face. Na grande maioria dos casos, com a utilização da Península, foi possível a realização de uma boa tração cutânea, com maior correção do terço médio, mantendo a linha de implantação capilar. Conclusão: Podemos concluir que a técnica da Península é um recurso único, de fácil reprodução, capaz de reduzir a curva de aprendizado em ritidoplastias, uma vez que permite generosa ressecção de pele sem alteração da implantação capilar, atuando de modo a evitar estigmas pós-cirúrgicos e otimizando a qualidade dos resultados e satisfação por parte dos pacientes, com pequeno ônus cicatricial.

Introduction: High implantation of the hairline by the ear is a frequent, unpleasant stigma in rhytidoplasties. To overcome this problem, we created the Peninsula technique in the mid-1999. Initially used in secondary face liftings, its indication has since been broadened, becoming indispensable in primary cases of high hair implantation and in patients requiring major skin resection. Methods: The total number of rhytidoplasties performed was 7,356, with 2,512 patients operated using the Peninsula technique from 1999 to 2016. Mean age was 48, 98% were females and 2% males. The technique presents three variants. Results: Patients were monitored on a monthly basis until discharge at the end of six months. Among the results, there were some complications, which are usual in any type of facial surgery. In the great majority of cases, with the use of the Peninsula, it was possible to obtain good skin traction, with the greater correction of the mid third, maintaining the capillary implantation line. Conclusion: We can conclude that the Peninsula technique is a unique resource, easily reproducible, capable of reducing the learning curve in rhytidoplasty, as it allows generous skin resection without changing capillary implantation, avoiding post-surgical stigma and optimizing the quality of the results and patient satisfaction, with a little scar burden.

Two Cases of Adverse Events Following Illegal Practices by Non-medical Personnel / 대한피부과학회지

Dermatologists often treat patients with complications arising from illegal cosmetic practices. Large numbers of non-medical personnel who claim to be “beauty experts” currently offer laser treatment, surgery, or injections that result in serious complications. Here we report two cases of adverse events: one after epilation with an unidentified laser device and the other after rhytidectomy performed using an unproven surgical method. Dermatologists should be aware of these complications and be able to educate both patients and fellow doctors about the potential risks.

Effect of Shirexiao waist hot-compress on the expressions of Th17/Treg-specific factors in the mouse model of experimental autoimmune prostatitis with damp heat syndrome / 中华男科学杂志

Objective@#To investigate the effect of waist hot-compress with the Shirexiao (SRX) pad on the expressions of Th17/Treg-specific factors in the prostatic tissue of the mouse model of experimental autoimmune prostatitis (EAP) with damp heat syndrome, and explore its possible action mechanisms.@*METHODS@#Twenty healthy male mice were included as normal controls and another 100 chosen for establishing the model of EAP with damp heat syndrome by subcutaneous injection of purified prostate protein solution from the Wistar rat and Freund's complete adjuvant using the TCM method. The model mice were randomly divided into five groups: model control, matrix, and low-, medium- and high-dose SRX. After chemical removal of the hair at lumbar vertebrae 1－3, the animals of the low-, medium- and high-dose SRX groups were treated with the SRX pad heated to 45℃ and externally applied to the non-hair area, qd, bid, and tid, respectively, 10 minutes each time, those of the matrix group with the vaseline pad, and those of the normal and model control groups with the saline pad. After 4 weeks of continuous treatment, all the mice were sacrificed for determination of the protein and mRNA expressions of RORγt and Foxp3 in the prostate tissue by Western blot and quantitative real-time PCR.@*RESULTS@#The symptoms, signs and pathological changes of the EAP model mice were similar to the manifestations of chronic prostatitis. After intervention, the protein and mRNA expressions of Foxp3 were significantly down-regulated while those of RORγt markedly up-regulated in the EAP model group as compared with the normal control (P 0.05).@*CONCLUSIONS@#The Shirexiao waist hot-compress therapy plays a positive role in the treatment of autoimmune prostatitis with damp heat syndrome by reducing the expression of RORγt, inhibiting the differentiation of Th17 and thus checking the differentiation imbalance of Th17/Treg.

Photo Epilation with Intense Pulsed Light for Thinning of Anterior Hairline after Hairline Correction Surgery in East Asians

BACKGROUND: Thin hairs are critical to achieve natural result in female hairline correction surgery. However, there are few studies on the usefulness of hair thinning by intense pulsed light (IPL) after hairline correction surgery in East Asian females. METHODS: Hair thinning using IPL was performed in 54 women who had complained about thick hairs along the frontal hairline after hairline correction surgery. Patient mean age was 31.2 years old and patients were an average of 2.1 years post-hairline correction surgery. Initial treatment used 10 J, while second and third sessions were conducted with 10 to 15 J according to responsiveness to treatment. RESULTS: Mean thickness of individual hairs assessed before the procedure was 78.86 µm. The mean number of procedures was 1.6 per patient. Forty of 54 subjects (74%) achieved satisfactory hair thinning with only one procedure from 78.01 to 66.14 µm after treatment. The measured thickness was 66.43 µm at the end of the first year in patients who were satisfied after one procedure. Thirteen cases achieved satisfactory hair thinning after two sessions. Mean thickness was 74.44 µm and 67.51 µm, before and after the second session. One case required a third session with 15J, thinning from 89.00 to 66.50 µm. CONCLUSIONS: Hair thinning by IPL is a very useful method to provide a natural look after hairline correction surgery in East Asians, who have naturally thick hair.

Gold thread implantation promotes hair growth in human and mice / 한국실험동물학회지

Thread-embedding therapy has been widely applied for cosmetic purposes such as wrinkle reduction and skin tightening. Particularly, gold thread was reported to support connective tissue regeneration, but, its role in hair biology remains largely unknown due to lack of investigation. When we implanted gold thread and Happy Lift™ in human patient for facial lifting, we unexpectedly found an increase of hair regrowth in spite of no use of hair growth medications. When embedded into the depilated dorsal skin of mice, gold thread or polyglycolic acid (PGA) thread, similarly to 5% minoxidil, significantly increased the number of hair follicles on day 14 after implantation. And, hair re-growth promotion in the gold threadimplanted mice were significantly higher than that in PGA thread group on day 11 after depilation. In particular, the skin tissue of gold thread-implanted mice showed stronger PCNA staining and higher collagen density compared with control mice. These results indicate that gold thread implantation can be an effective way to promote hair re-growth although further confirmatory study is needed for more information on therapeutic mechanisms and long-term safety.

Prevalência da medicalização do trabalho de parto e parto na rede pública de saúde / Prevalencia del medicalización del trabajo del parto yparto en la red públicade salud / Prevalence of medicalization of labor and delivery in the public health network

RESUMO O estudo teve por objetivo verificar a prevalência da medicalização do trabalho de parto e parto na rede pública de saúde. Foi realizado um estudo transversal com 358 puérperas atendidas pelo Sistema Único de Saúde. As entrevistas foram feitas no hospital no período pós-parto e os prontuários e cartão da gestante foram verificados. A medicalização do parto foi considerada presente quando houve pelo menos uma destas intervenções: tricotomia; enteroclisma; indução/condução do parto; amniotomia; episiotomia ou cesariana. Além disso, a medicalização foi analisada segundo variáveis sociodemográficas, obstétricas e assistenciais, por meio do teste Qui-quadrado, considerando p≤ 0,05. O percentual de mulheres com pelo menos uma intervenção no trabalho de parto e parto foi de 92,7%. Houve associação com mulheres primigestas e histórico de cesariana prévia em mulheres multigestas. A tricotomia esteve associada à cesariana e, a indução/condução à amniotomia e episiotomia, sugerindo o efeito cascata. Conclui-se que as altas taxas de medicalização e a associação entre as intervenções demonstram a necessidade de vigilância e humanização da assistência à saúde da mulher durante o trabalho de parto e parto.

RESUMEN Objetivo: verificar la prevalencia de la medicalización del trabajo de parto y parto en la red pública de salud. Método: estudio transversal con 358 puérperas atendidas por el Sistema Único de Salud (SUS). Las entrevistas fueron realizadas en el hospital en el período posparto y los registros médicos y la tarjeta de la gestante fueron verificados. La medicalización del parto fue considerada presente cuando hubo por lo menos una de estas intervenciones: tricotomía; enema; inducción/conducción del parto; amniotomía; episiotomía o cesariana. Además, la medicalización fue analizada según variables sociodemográficas, obstétricas y asistenciales, por medio de la prueba ji-cuadrado, considerando p≤ 0,05. Resultados: el porcentual de mujeres con por lo menos una intervención en el trabajo de parto y parto fue de 92,7%. Hubo asociación con mujeres primigestas e histórico de cesariana previa en mujeres multíparas. La tricotomía estuvo asociada a la cesariana y la inducción/conducción a la amniotomía y episiotomía, sugiriendo el efecto cascada. Conclusión: las altas tasas de medicalización y la asociación entre las intervenciones demuestran la necesidad de vigilancia y humanización de la atención a la salud de la mujer durante el trabajo de parto y parto.

ABSTRACT The study aimed to verify the prevalence of medicalization of labor and delivery in the public health system. A cross-sectional study was carried out with 358 puerperal patients attended by the Unified Health System. Interviews were performed at the hospital in the postpartum period and the patient's charts and card were checked. The medicalization of labor was considered present when there was at least one of these interventions: trichotomy; enteroclysis; induction/conduction of labor; amniotomy; episiotomy or cesarean section. In addition, the medicalization was analyzed according to sociodemographic, obstetric and care variables, using the Chi-square test, considering p≤0.05. The percentage of women with at least one intervention in labor and delivery was 92.7%. There was an association with primigravida women and previous cesarean history in multigesta women. The trichotomy was associated with cesarean section, and induction/conduction to amniotomy and episiotomy, suggesting the cascade effect. It is concluded high medicalization rates and the association between interventions demonstrate the need for vigilance and humanization of women's health care during labor and delivery.

Follicular traction urticaria

Abstract Inducible urticaria is a heterogeneous subgroup of chronic urticarias caused by a wide variety of environmental stimuli, such as exercise, cold, heat, pressure, sunlight, vibration, and water. A new term, follicular traction urticaria, was suggested as an unusual form of inducible urticarias. We report a patient who was diagnosed with follicular traction urticaria.