Efficacy and safety of dimeticones in the treatment of epidermal parasitic skin diseases with special emphasis on tungiasis: an evidence-based critical review

ABSTRACT Epidermal parasitic skin diseases encompass scabies, pediculosis, cutaneous larva migrans, myiasis, and tungiasis. Tungiasis is probably the most neglected of all Neglected Tropical Diseases (NTD). It occurs in South America, the Caribbean and Sub-Saharan Africa and affects marginalized populations where people live in extreme poverty. In endemic communities the prevalence can be up to 30% in general population and 85% in children. Over time, chronic pathology develops characterized by hyperkeratosis, edema around the nail rim, fissures, ulcers, deformation and loss of nails. This leads to a pattern of disabilities, eventually resulting in impairment of mobility.Dimeticones are a family of silicon oils with a potential to kill parasites located on top or inside the epidermis by a physical mode of action. They are considered the treatment of choice for pediculosis capitis and pediculosis pubis. With regard to tungiasis, the so called rear abdominal cone of the parasites has been identified as a target for treatment with dimeticones. NYDA®, a mixture of two dimeticones with different viscosity, is the only dimeticone product for which data on the mode of action, efficacy and safety with regard to tungiasis exists. The product has been shown highly effective against embedded sand fleas, even in very intense infection with more than 500 parasites situated on top of each other. A randomized controlled trial showed that seven days after a targeted application of NYDA® 97% (95% CI 94-99%) of the embedded sand fleas had lost all signs of viability.Comprehensive toxicological investigations on the dimeticones contained in NYDA® showed that there is practically no risk of embryotoxicity, fetotoxicity, teratogenicity, and other toxicity. The safety of dimeticones was also demonstrated in clinical trials with a total of 106 participants with tungiasis, in which not a single adverse event was observed.

Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

ABSTRACT Objective To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Materials and Methods Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. Results From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). Conclusion Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

Comparação do uso de implante de Silastic(r) com titânio pré-fabricado na tireoplastia tipo I / Comparison of the use of silastic with titanium prefabricated implant in type I thyroplasty

Introdução: A tireoplastia tipo I é o tratamento de escolha nas paralisias unilaterais das pregas Análise de custo-bene-vocais que não se recuperam espontaneamente. fício. Objetivos: Comparar o uso de implante de Silastic® com o uso de titânio pré-fabricado TVFMI® (Titanium Vocal Fold Medializing Implant) na tireoplastia tipo I para o tratamento da paralisia unilateral das pregas vocais com relação à melhora subjetiva e objetiva da voz, às alterações endoscópicas nas pregas vocais, ao tempo de cirurgia e à relação custo-benefício. Método: Trata-se de um estudo prospectivo com 40 pacientes portadores de paralisia unilateral das pregas vocais submetidos à tireoplastia tipo I com implante de silastic® ou TVFMI®. A avaliação e comparação estatística foram realizadas antes e quatro semanas depois da cirurgia por meio de videolaringoscopia, estroboscopia, análise perceptiva (escala GRBAS-Grade, Roughness, Breathiness, Asthenia, Strain) e subjetiva (IDV-índice de desvantagem vocal) da voz e avaliação eletroglotográfica e avaliação acústica computadorizada. Também foram observados o tempo de cirurgia e o custo do implante. Resultados: Embora os dois implantes mostrem melhora na qualidade da voz após a tireoplastia, o TVFMI® teve um resultado ligeiramente melhor na análise objetiva da voz. O TVFMI® levou menos tempo de cirurgia para ser inserido, porém foi mais caro. Conclusão: O TVFMI® poderá ser preferencial na tireoplastia de medialização, já que possui melhores resultados vocais e leva menos tempo de cirurgia, porém é mais caro que o implante de Silastic®. .

Introduction: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. Objectives: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. Methodology: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. Results: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. Conclusion: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant. .

Sequela de injeção de silicone em lábio inferior: correção cirúrgica pela técnica do biquíni modificada / Sequelae of inferior lip silicone injection: surgical correction using the modified "bikini" technique

Pacientes portadores de sequelas devido a injeções de substâncias inabsorvíveis tem se tornado cada vez mais frequentes. O silicone injetável ou polidimetilsiloxano fluido é um polímero manufaturado que contém silicone elementar. As complicações consequentes ao uso desta substância podem ser precoces ou tardias. Apresentamos um relato de caso onde uma deformidade por injeção de silicone em lábios foi tratada cirurgicamente usando a técnica do biquíni modificada obtendo um bom resultado funcional e estético.

Increasing numbers of patients have sequelae due to the injection of non-absorbable substances. Injectable silicone or polydimethylsiloxane fluid is a manufactured polymer containing elemental silicon. The complications associated with the use of this substance can present early or late. Here we present a case report in which a deformity due to a silicone injection in the lips was surgically treated using the modified "bikini" technique that produced a functionally and aesthetically favorable result.

Síndrome tóxica do segmento anterior / Toxic anterior segment syndrome

A síndrome tóxica do segmento anterior (STSA) é uma severa reação inflamatória aguda causada por agente não infeccioso que entra no segmento anterior, resultando em lesão celular tóxica com necrose e apoptose mediado por resposta imunológica. Neste relato de caso de STSA são enfatizadas as causas mais comuns para o aparecimento da síndrome, apontam para os cuidados que devem ser tomados no processo de esterilização do material cirúrgico além de revisar a melhor conduta diante desses casos. Em conclusão notou-se que o foco principal deve ser a prevenção, pois o tratamento busca apenas suprimir a resposta inflamatória secundária. O tratamento nos casos de STSA consiste em intensa instilação de esteróides tópicos com seguimento rigoroso e controle de complicações tardias como o glaucoma.

Toxic anterior segment syndrome is acute inflammatory reaction caused by a noninfectious substance that enters the anterior segment, resulting in extracellular damage with necrosis and apoptosis during an immune response. We have the report of a case of toxic anterior segment syndrome (TASS), in which the authors seek to emphasize the most common causes of the appearance of these syndrome. They point out the care that must be taken in the process of sterilization of surgical material, in addition to reviewing the best conduct when faced with these cases. In conclusion, it was noted that the main focus should be on prevention, as treatment only seeks to suppress the secondary inflammatory response. Treatment in cases of toxic anterior segment syndrome (TASS) consists of intense instillation of topical steroids with strict follow-up and control of late complications such as glaucoma.

Hardness evaluation of prosthetic silicones containing opacifiers following chemical disinfection and accelerated aging

We evaluated the effects of disinfection and aging on the hardness of silicones containing opacifiers and intended for use in facial prosthetics. A total of 90 samples were produced using a cylindrical metal mold 3 mm in height and 30 mm in diameter. The samples were fabricated from Silastic MDX 4-4210 silicone in three groups: GI contained no opacifier, GII contained barium sulfate (Ba), and GIII contained titanium dioxide (Ti). The samples were disinfected using effervescent tablets (Ef), neutral soap (Ns), or 4 percent chlorhexidine (Cl) 3 times a week for 60 days. After this period the samples underwent 1,008 hours of accelerated aging. The hardness was measured using a durometer immediately following the disinfection period and after 252, 504, and 1,008 hours of aging. The data were statistically analyzed using 3-way ANOVA and the Tukey test (p < .05). The GIII group exhibited the greatest variation in hardness regardless of elapsed time. All groups displayed greater hardness after 1,008 hours of accelerated aging independent of disinfectant type. All of the hardness values were within the clinically acceptable range.

Fibroma osificante / Ossifying fibroma

El trabajo del equipo multidisciplinario fue el camino para obtener las ventajas biológicas, psicológicas, cosméticas y funcionales. La prótesis interna fue importante para mantener la simetría de la cara; el obturador sostuvo el colgajo palatino en su lugar manteniendo su nutrición y la vitalidad del mismo. Después de este tratamiento, el paciente se recuperó totalmente y no tuvo secuelas psicológicas ya que nadie podía percibir su defecto

Experiência com dispositivo intrauterino de levonorgestrel / An experience with the levonorgestrel intrauterine device

Atualizaçäo dos dados da pesquisa sobre o dispositivo intrauterino (DIU) liberador de 20 mcg/dia de levonorgestrel (DIU-LNG) comparado com o DIU de cobre, TCu 380A, em estudo multicêntrico da Organizaçäo undial da Saúde (OMS), desenvolvida na Maternidade Therezinha de Jesús e no CEPECS, para o Centro de Biologia da Reproduçäo da UFJF. Em 200 mulheres, foram avaliados os índices de continuaçäo, os abandonos, os efeitos colaterais e outros eventos ao longo de 4 anos com 3972 meses/mulher para o TCu 380A e com 3544 meses/mulher de observaçäo com o DIU-LNG. Neste período houve 21 descontinuaçöes com o TCu 380A e 35 com o DIU-LNG. Considerando-se que 19 usuárias pediram para retirar o DIU porque queriam nova gestaçäo o índice de continuaçäo com os dois DIUs é bastante aceitável (79 por cento com o DIU de cobre e 65 por cento com o DIU-LNG). Os efeitos colaterais mais frequentes com o uso do DIU-LNG foram o sangramento irregular e a amenorréia, mas apenas 6 tiveram seu DIU removido por esta causa, as demais aceitaram continuar. Näo houve neste período nenhuma gravidez, e apenas 4 pacientes foram perdidas no seguimento. O DIU-LNG por sua alta eficácia e poucos efeitos colaterais é uma promessa de um novo e excepcional método contraceptivo.

Uso de un regulador de la motilidad digestiva en el tratamiento de las afecciones digestivas altas, diagnósticadas mediante exámenes paraclínicos

Se realizó un estudio en 277 pacientes con cuadro dispéptico lográndose un diagnóstico causal mediante endoscopia o radiología de las vías digestivas altas, siendo la gastritis y la hernia hiatal con reflujo los diagnósticos más frecuentes. Todos los pacientes fueron tratados con una asociación de Bromopride, un enzimatico y DMP, permitiéndose una medicación concomitante en algunos casos. El 95.3 por ciento de los pacientes al final del estudio reportaron ausencia de los síntomas estudiados; y el 98.2 por ciento tuvieron una respuesta terapéutica considerada entre buena y muy buena. Los pacientes tratados con medicaciones concomitantes (anti-H2 o antiácidos) tuvieron tasas de mejoría similares o mejores que no fueron estadísticamente significativas con el resto del grupo. Se concluyó en este trabajo que la medicación propuesta, es efectiva para el tratamiento de estos cuadros y que es necesario para el médico y beneficioso para el paciente identificar la causa de dispepsia

Comprobación clínica del efecto terapéutico en gastroenterología de la combinación metoclopramida, dimetilpolisiloxano y diazepam en las principales manifestaciones del tránsito gastrointestinal alterado / Clinical evaluation of the therapeutic effect in gastroenterology of the combination methochlopramide, dimethicone and diazepam on main manifestations of gastrointestinal transit

Se comprobó clínicamente el efecto de la combinación metoclopramida, dimetilólisiloxano y diazepam en las principales alteraciones del tránsito gastrointestinal en 30 pacientes de la consulta de gastroenterología. La sintomatología considerada fue: aerofagia, eructo, meteorismo, ansiedad, náusea, vómito, pirosis, regurgitación ácida, hipo, dispepsias (biliares o colónicas); así como dificultad en el tránsito y vacinamiento gástrico e intestinal (constipación, diarrea o ambos). Los pacientes, de uno u otro sexo, tenían edades entre 20 y 70 años; con promedio de 44.23 + 13.58 años; presentaron cuando menos tres de los síntomas mencionados, en la intensidad suficiente para ser incluidos en este estudio. La posología inicial fue de un comprimido contenido 100 mg de dimetilpolisiloxano, 5 mg de monoclorhidrato de metoclopramida y 2.5 mg de diazepam; administrado antes de las tres comidas, con la opción de reducir la dosis de acuerdo a los resultados obtenidos. Los síntomas presentes fueron atenuados en forma marcada o suprimidos en la totalidad de los pacientes. La conclusión es que la combinación de medicamentos mencionada es activa para el tratamiento de las principales manifestaciones de alteración en el tránsito gastrointestinal, producidas o concomitentes con síndrome de colon irritable, en la especialidad de gastroenterología; su tolerancia es alta, y no se presentaron reacciones indeseables ni fenómenos de acostumbramiento, dosificada en forma individualizada