Light therapies for acne: abridged Cochrane systematic review including GRADE assessments.

We undertook a Cochrane review of randomized controlled trials (RCTs) evaluating the effects of light-based interventions for acne vulgaris. We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science and grey literature sources (September 2015). We used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach to assess the quality of evidence (QoE). We included 71 RCTs (4211 participants, median sample size 31). Results from a single study (n = 266, low QoE) showed little or no difference in effectiveness on participants' assessment of improvement between 20% aminolaevulinic acid (ALA) photodynamic therapy (PDT), activated by blue light, vs. vehicle plus blue light, whereas another study (n = 180) comparing ALA-PDT (red light) concentrations showed that 20% ALA-PDT was no more effective than 15% ALA-PDT but better than 10% and 5% ALA-PDT. Pooled data from three studies (n = 360, moderate QoE) showed that methyl aminolaevulinate PDT, activated by red light, had a similar effect on changes in lesion counts vs. placebo cream with red light. Several studies compared yellow light with placebo or no treatment, infrared light with no treatment, gold microparticle suspension with vehicle and clindamycin/benzoyl peroxide (C/BPO) combined with pulsed dye laser with C/BPO alone. None of these showed any clinically significant effects. Most studies reported adverse effects, but inadequately, with scarring reported as absent, and blistering only in studies on intense pulsed light, infrared light and PDT (very low QoE). Carefully planned studies, using standardized outcome measures and common acne treatments as comparators, are needed.

Laser and other light therapies for the treatment of acne vulgaris: systematic review.

BACKGROUND: Acne is common and can lead to scarring of the skin, as well as to psychological distress and reduced self-esteem. Most topical or oral treatments for acne are inconvenient and have side-effects. Laser and other light therapies have been reported to be convenient, safe and effective in treating acne. OBJECTIVES: To carry out a systematic review of randomized controlled trials of light and laser therapies for acne vulgaris. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycInfo, LILACS, ISI Science Citation Index and Dissertation Abstracts International for relevant published trials. RESULTS: We identified 25 trials (694 patients), 13 of light therapy and 12 of light therapy plus light-activated topical cream (photodynamic therapy, PDT). Overall, the results from trials of light alone were disappointing, but the trials of blue light, blue-red light and infrared radiation were more successful, particularly those using multiple treatments. Red-blue light was more effective than topical 5% benzoyl peroxide cream in the short term. Most trials of PDT showed some benefit, which was greater with multiple treatments, and better for noninflammatory acne lesions. However, the improvements in inflammatory acne lesions were not better than with topical 1% adapalene gel, and the side-effects of therapy were unacceptable to many participants. CONCLUSIONS: Some forms of light therapy were of short-term benefit. Patients may find it easier to comply with these treatments, despite the initial discomfort, because of their short duration. However, very few trials compared light therapy with conventional acne treatments, were conducted in patients with severe acne or examined long-term benefits of treatment.

Descriptions of members of the Simulium damnosum complex (Diptera: Simuliidae) from southern Africa, Ethiopia and Tanzania.

This paper presents cytotaxonomic details of five populations of the Simulium damnosum complex from South Africa, Swaziland and Ethiopia. The 'Nkusi SW' and 'Pienaars' forms are newly designated members of the complex from South Africa, but the taxonomic rank of an isolate indistinguishable chromosomally from the 'Nkusi' cytoform remains unclear. From Ethiopia two cytoforms were identified, one of which shares two diagnostic chromosome inversions with the cytoform 'Kisiwani' from Tanzania. The second form belongs to S. kaffaense, and is the suspected local vector of Onchocerca volvulus. In addition, a re-analysis of the cytoform 'Kibwezi' from north-eastern Tanzania provided further insights into its population subdivision, and its genetic and morphological characteristics. Cytotaxonomic similarities between 'Kibwezi', S. mengense and S. pandanophilum, along with their biogeography, indicate a relict status of each of these taxa.

[Daily living with hypertension: changes, restrictions and reactions]. / O cotidiano da vida de hipertensos: mudanças, restrições e reações.

Aiming to describe daily living of hypertensive people after Arterial Hypertension (AH) diagnoses and to identify changes in their lives. The method of inquiry used was descriptive and qualitative using discursive method to figure out theme factors. The results showed different behaviors/reactions of being sick according to their daily living after discovering AH, that not always happened at the same time that the antihypertensive treatment began. Those differences seems to be associated with individual understanding of sickness itself and of impact in their lives. So, getting along with hypertension is to learn about the sickness and symptoms and also make the necessary changes.

[Problems and solutions for patients with hypertension]. / Dificuldades e facilidades dos doentes no seguimento do tratamento da hipertensão arterial.

This study aims to identify difficulties and facilities of the patients in following the treatment of the arterial hypertension; and, to verify differences that exist between those difficulties and facilities in two moments of the trajectory--in the ambulatorial treatment and in the hospital stay. For this quantitative, descriptive study, 34 patients with medical diagnosis of arterial hypertension or its complications were interviewed, being 17 registered in the ambulatorial unit and 17 hospitalized in the nephrology unit. The results of the study revealed that, in general, there were no differences among the difficulties and the facilities referred by the patients for the following of the treatment in the two studied moments. The difficulties and facilities pointed out by the patients refer to the financing of the treatment (medication purchase and expenses with transport); accessibility to the service (easiness in marking medical consultation and distance of the service of health); change of alimentary habit (hipossodic diet), and the importance of the family support in this trajectory.

Treatment of oroantral communications after tooth extraction. Is drainage into the nose necessary or not?

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.

[Cerebrovascular and cardiovascular mortality and the problems of control of arterial hypertension]. / A mortalidade cárdio-cerebrovascular e os problemas da prática no controle da hipertensão arterial.

This article is a literature review of evolution of cardiocerebrovascular mortality and the practical control of arterial hypertension. The importance of investigation is focalized on access to health system, knowledge of diagnosis and compliance to arterial hypertension treatment.

[Case report of a female patient with autoimmune hemolytic anemia and cold agglutinin antibodies]. / Prikaz bolesnice s autoimunom hemolitickom anemijom s hladnim protutijelima.

We report a case of acute transient cold agglutinin disease, the etiology of which we could not determine with the available methods. Cold autoagglutinins had anti I specificity, high titers of the autoantibody (> 1:1,000) and the thermal range was relative wide. Our patient had severe haemolysis and immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered. It is a question how much these immunosuppresive agents influenced the recovery, and in what extent it was a self limited disease with spontaneous recovery.

The connection between absence-like seizures and hypothermia induced by penicillin: possible implication on other animal models of petit mal epilepsy.

In this study we investigated the relationship between penicillin-induced hypothermia and petit mal epilepsy induced by this proconvulsant antibiotic. In order to find a possible dose-dependent relationship, we used two doses: 1500.000 and 1000.000 U/kg b.wt., both known as being sufficient to induce absence-like attacks with subsequent spike and wave discharges (SWD) in electrocorticogram (ECoG). Because of experimental data suggesting penicillin binding to benzodiazepine receptor recognition site, we also studied penicillin-induced changes in body temperature after diazepam pretreatment. Results of this study clearly show that penicillin in doses known to induce petit mal-like epilepsy concomitantly induces statistically significant dose-dependent decrease in body temperature. Pretreatment with diazepam completely prevents both penicillin-induced hypothermia and SWDs. On the other hand, both the diazepam and mixed diazepam + penicillin treatments did not significantly alter body temperature. These results suggest, however, that at least some of the penicillin effects described could be assigned to its binding to the benzodiazepine receptor recognition site at GABA(A) ionophore. This may have an important clinical implication because the inhibitory action of penicillin at the benzodiazepine receptor recognition site could account for the mechanism of penicillin-induced unspecific encephalopathies in humans. The relationship between petit mal epilepsy and hypothermia sheds new light on the action mechanisms of penicillin-induced absence seizures.

[Personal experience in the treatment of war injuries of the jaw and face at the Clinical Hospital Center in Rijeka]. / Nasa iskustva u lijecenju ratnih ozljeda celjusti i lica u klinickom bolnickom centru Rijeka.

In this paper we have presented 38 cases of wounded persons who had sustained war injuries in maxillo-facial and neck region. All of them were injured in Croatia during the war period of 1991 and 1992, and treated at the Maxillo-Facial Surgery Department of the Clinical Hospital of Rijeka. The wounded persons were observed and monitored from the moment of their injury through the first aid on the spot, up to the surgical treatment of the wounds, subsequent primary and secondary reconstruction, and the final medical treatment. This paper describes for wounded persons with injuries of bones and soft tissue of the face. In two thirds of the wounded persons with the primary medical treatment and reconstruction, the cure terminated, while in one third it was necessary to provide for a secondary reconstructive operation. At the end of the treatment, all the wounded persons were successfully cured, functionally and aesthetically restored, so they were able to leave the Clinic to return to their everyday life and work. Such result has been particularly gratifying because they were mostly young men.

[Dialectics of the working process of the Arterial Hypertension League]. / Dialética do processo de trabalho da Liga de Hipertensão Arterial.

This study deals with the health assistance phenomena as it occurs in a hypertension league. The purpose of this research is to aprehend the contradictions, both internal and external, to the League labour process phenomena and, doing so, to enable the quest of alternative solutions to the quality assistance of transformation. The investigation reveals that the health workers conceptions about their labour process express a reiterative, non-creative and non-reflexive praxis. This way, it configures itself as a dominant and ideological one, beyond the fact of being an instrumental knowledge of intervention over the Object.

[Nursing process in the ambulatory care of adults with arterial hypertension: concepts and contradictions]. / Processo de trabalho da enfermagem na atenção ambulatorial ao adulto com hipertensão arterial: representações e contradições.

This study deals with the health assistance phenomena in general, and the nursing assistance in particular, as it occurs in Hypertension League. Its main theoretical framework, supported by the historical and dialectical materialism, it the labour process theory and its elements: Finality, Object and Means/Instruments. The investigation reveals that the workers conceptions about their labour process express a reiterative, non-creative and non-reflexive praxis. The labour process of nursing assistance was reiterated with Mean to the medical labour process, and to be seem emptied of the an scientific knowledge.

Training for the transition to case management in home care.

Hospital nurses who wish to enter home care offer a gold mine of clinical skills. The only thing missing is case management experience. How can agencies help nurses acquire this last commodity and take the final step to home care? Training programs may be the answer.

The radial forearm free flap: our experience in solving donor site problems.

Special attention is paid to the problems of the donor site (the forearm) in a series of 75 patients who underwent orofacial malignancy excision. An island skin flap from the ulnar aspect of the forearm, used in 15 patients, is reported to be an improvement of the surgical technique. No healing complications were observed, and the aesthetic and functional results were very good.

[An instrument for the nursing consultation of patients with arterial hypertension under outpatient treatment]. / Instrumento de consultana de enfermagem a pessoas com hipertensão arterial em tratamento ambulatorial.

The purpose of this article is to emphasize the nurse's role toward persons with arterial hypertension. Therefore it's introduced an application form that is used for nursing consultation to outpatients.

[The influence of the education process on the control of arterial hypertension]. / Estudo sobre a influência do processo educativo no controle da hipertensão arterial.

A study was carried out with 23 hypertensive individuals after educational process in order to verify the retention of knowledge and its influence on the hypertension control. After drug treatment it was observed that the level of knowledge was inversely proportional to the blood pressure levels.

A field evaluation of Bacillus thuringiensis var. israelensis as a biological control agent for Simulium chutteri (Diptera:Nematocera) in the middle Orange River.

Bacillus thuringiensis Berliner var. israelensis de Barjac (Serotype H-14) (B.t.i.) at a concentration of 1.6 ppm/10 min and a toxicity of 1500 AAU/mg was tested against Simulium chutteri Lewis larvae in the Orange River near Prieska, South Africa. Samples of benthic fauna from the stones-in-current biotope were collected before application of the product and at various intervals up to 80 h afterwards at 4 stations from 200 m to 11 km downstream of the application site. Fauna drift increased slightly after the arrival of the Bacillus at 2 stations 1.4 and 6 km respectively downstream of the application site. Large numerical decreases in benthic simuliid larval numbers after the application of B.t.i. in the Orange River were not statistically different (P greater than 0.05). This indicated that the size of replicated samples that showed significant decreases (P less than 0.05) of simuliid numbers in the Vaal River was not adequate to show statistical differences in the Orange River. The quantity of dead larvae on stones collected from rapids after application of the B.t.i., and the numerical decreases found by comparing median values of larval counts on stones indicated that B.t.i. effectively killed simuliid larvae. Three days after application of the Bacillus, recruitment of small simuliid larvae on stones 1.4 km downstream of the application site was discernible again. Tanytarsini were also numerically reduced after B.t.i. application. At a flow rate of 38 m3/s B.t.i. was visibly effective in killing S. chutteri up to 6 km downstream of the application site and statistically significant decreases (P less than 0.05) in numbers of larvae were seen at a site 11 km downstream of the application site.(ABSTRACT TRUNCATED AT 250 WORDS)