Controversies concerning the treatment of lice and scabies

Description of the calf thymus DNA-malathion complex behavior by multi-spectroscopic and molecular modeling techniques: EMF at low and high frequency approaches

OBJECTIVES

Small molecules can bind to DNA via covalent or non-covalent interactions, which results in altering or inhibiting the function of DNA. Thus, understanding the interaction patterns of medicines or other small molecules can be very crucial. In this study, the interaction between malathion and calf thymus DNA (ctDNA), in the absence and presence of electromagnetic field (EMF) at low and high frequencies, was investigated through various spectroscopies and viscosity measurements.

MATERIALS AND METHODS

The interaction studies were performed by means of absorbance, circular dichroism, fluorescence spectroscopy, viscosity, thermal melting, and molecular modeling techniques.

RESULTS

The fluorescence intensity of the ctDNA-malathion complex in the presence of EMF, has revealed quenching of fluorescence emission curves. The dynamic interaction and RLS studies have implied the changes in ctDNA-malathion complex throughout the presence of EMF which suggested that hydrophobic forces play the main role in the binding. Studies have revealed that malathion does not have any effect on binding ethidium bromide to ctDNA, which signifies the groove binding. The viscosity of ctDNA increased as the malathion concentration was enlarged. The circular dichroism technique suggested that the ellipticity values of the ctDNA-malathion complex have not increased with enhancing the malathion concentration. Molecular docking and dynamics studies have indicated a potent electrostatic interaction between ctDNA and malathion in the groove binding site.

CONCLUSION

The results of spectroscopic studies reinforced a potent interaction between malathion and ctDNA in the absence and presence of EMF which can help us for further pharmaceutical drug discoveries.

Impact of socio-demographic factors on knowledge, attitude and practices toward scabies among syrian refugees in Jordan: A prospective cross sectional study

Background

Scabies is one of the prevalent dermatological conditions, accounting for a substantial proportion of skin diseases in developing countries. It represents a significant health challenge when an outbreak appears in homecare and refugee camps as it may lead to enormous morbidity and high treatment costs. Because Scabies can be easily prevented through education, the purpose of this study was to assess the impact of socio-demographic factors on the level of knowledge, attitude, and practices among Syrian refugees in Jordan's northern region.

Methods

A prospective cross-sectional study was conducted among Syrian refugees attending primary health centers in northern Jordan, Ramtha, Mafraq, and Irbid, from February 2021 to May 2021. The targeted population was adult Syrian refugees above the age of 18. Two thousand participants were included in this study using simple random selection. The study questionnaire included socio-demographic characteristics and knowledge questions such as hearing about Scabies, causes of Scabies, signs and symptoms of Scabies, and its way of transmission. The data was analyzed using (SPSS) version 25.

Results

Females with a mean age of 37.9 years old comprised the majority of the participants. The majority of the participants were married and had intermediate levels of education. The knowledge about Scabies lacked among the majority of the respondents (N = 1259); 321 respondents had moderate knowledge, while only 650 had good knowledge. A statistically significant association was found between knowledge scores and all demographic characteristics, including gender, marital status, income, and educational level.

Conclusion

The general knowledge about Scabies among Syrian refugees is relatively low, with 1259 out of 2000 participants having a bad knowledge score. Moreover, the level of knowledge, attitude, and practices toward Scabies is highly affected by the demographic factors of the Syrian refugees' Health education for refugees is needed to improve their knowledge and help implement prevention programs.

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Scabies is quite a common medical problem among Syrian Refugees in Jordan.

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The socio-demographics of Syrian Refugees affect the level of knowledge and attitude toward scabies infestation.

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The level of knowledge regarding scabies infestation is poor among Syrian Refugees in Jordan.

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Health education for refugees is needed to improve their knowledge and help implement prevention programs.

Different Toxic Effects of Racemate, Enantiomers, and Metabolite of Malathion on HepG2 Cells Using High-Performance Liquid Chromatography-Quadrupole-Time-of-Flight-Based Metabolomics

Commercial malathion is a racemic mixture that contains two enantiomers, and malathion has adverse effects on mammals. However, whether these two enantiomers have different effects on animals remains unclear. In this study, we tested the effect of racemate, enantiomers, and metabolite of malathion on the metabolomics profile of HepG2 cells. HepG2 cells showed distinct metabolic profiles when treated with rac-malathion, malaoxon, R-(+)-malathion, and S-(-)-malathion, and these differences were attributed to pathways in amino acid metabolism, oxidative stress, and inflammatory response. In addition, malathion treatment caused changes in amino acid levels, antioxidant activity, and expression of inflammatory genes in HepG2 cells. S-(-)-Malathion exhibited stronger metabolic perturbation than its enantiomer and racemate, consistent with the high level of cytotoxicity of S-(-)malathion. R-(+)-Malathion treatment caused significant oxidative stress in HepG2 cells but induced a weaker disturbance in the amino acid metabolism and a pro-inflammatory response compared to S-(-)-malathion and rac-malathion. Malaoxon caused more significant perturbation on antioxidase and a stronger antiapoptosis effect than its parent malathion. Our results provide insight into the risk assessment of malathion enantiomers and metabolites. We also demonstrate that a metabolomics approach can identify the discrepancy of the toxic effects and underlying mechanisms for enantiomers and metabolites of chiral pesticides.

Malathion, an organophosphate insecticide, provokes metabolic, histopathologic and molecular disorders in liver and kidney in prepubertal male mice

The present study was undertaken to determine the effects of malathion exposure on oxidative stress, functional and metabolic parameters in kidney and liver of prepubertal male mice. For this reason, two separated groups of prepubertal male mice were used in this experiment. Animals were divided into two groups, group 1 served as a control and received the corn oil and group 2 was treated with 200 mg/kg body weight (b.w.) of malathion for 30 days. In result, we found that the malathion administration led to the perturbation of biochemical markers and histopathological as well as molecular damages. These changes were accompanied by an oxidative alternation which was evaluated by lipoperoxidation process and MDA production, a diminution of sulfhydril groups (-SH) content and an antioxidant enzyme activities depletion such as total superoxide dismutase (SOD) and its isoforms, catalase (CAT) and glutathione peroxidase (GPx) in both kidney and liver tissues. These changes were related with many histopathological lesions in the liver and kidney tissues. More importantly, this insecticide clearly caused a decline in the GPx-4 expression in liver as well as GPx-3 in kidney. These data suggest that prepubertal male mice exposure to malathion showed a marked deregulation of liver and kidney functions.

Oral ivermectin versus malathion lotion for difficult-to-treat head lice

BACKGROUND

Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old. Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure. The efficacy of alternative agents is controversial.

METHODS

We conducted a multicenter, cluster-randomized, double-blind, double-dummy, controlled trial comparing oral ivermectin (at a dose of 400 microg per kilogram of body weight) with 0.5% malathion lotion, each given on days 1 and 8, for patients with live lice not eradicated by topical insecticide used 2 to 6 weeks before enrollment. The cluster was defined as the household. Infestation was confirmed and monitored by means of fine-toothed combing. Patients were at least 2 years of age and weighed at least 15 kg; all were treated at the study sites. The primary end point was the absence of head lice on day 15.

RESULTS

A total of 812 patients from 376 households were randomly assigned to receive either ivermectin or malathion. In the intention-to-treat population, 95.2% of patients receiving ivermectin were lice-free on day 15, as compared with 85.0% of those receiving malathion (absolute difference, 10.2 percentage points; 95% confidence interval [CI], 4.6 to 15.7; P<0.001). In the per-protocol population, 97.1% of patients in the ivermectin group were lice-free on day 15, as compared with 89.8% of those in the malathion group (absolute difference, 7.3 percentage points; 95% CI, 2.8 to 11.8; P=0.002). There were no significant differences in the frequencies of adverse events between the two treatment groups.

CONCLUSIONS

For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment. (ClinicalTrials.gov number, NCT00819520.)

Scabies

Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var hominis, an obligate human parasite. There are about 300 million cases of scabies in the world each year. Common predisposing factors are overcrowding, immigration, poor hygiene, poor nutritional status, homelessness, dementia, and sexual contact. Direct skin-to-skin contact between 15 and 20 minutes is needed to transfer the mites from one person to another. The diagnosis suspected with a clinical history of itch, worse at night, affecting other family members, clinical distribution, and appearance. Definite diagnosis relies on microscopic identification of the mites, eggs, or fecal pellets with 10% potassium hydroxide, ink enhancement, tetracycline fluorescence tests, or mineral oil; other methods include: epiluminescence light microscopy and S. scabiei DNA. The most commonly used treatment modalities are permethrin and ivermectin. Persistence of symptoms for 2-6 weeks after successful treatment is common. Most recurrences are because of reinfection from untreated contacts.

The Scourge of Sarcoptes: Oral Ivermectin for Scabies

OBJECTIVE

To review the use of the oral antiparasitic ivermectin in the treatment of scabies, with an emphasis on its use in the elderly and in long-term care settings.

DATA SOURCE

A MEDLINE/PUBMED search was conducted to identify pertinent studies, case reports, letters, and reviews in the English language. All articles published from 1980 to October 2003 were reviewed. Additional references were obtained from the bibliographies of these articles.

STUDY SELECTION

All studies evaluating ivermectin in the context of scabies mite infestation.

DATA SYNTHESIS

The semisynthetic macrocyclic lactone ivermectin has been available since the early 1980s as a broad-spectrum antiparasitic agent in animals and humans. This agent, which works by suppressing motor nerve conduction leading to parasite paralysis and death, was first used in ectoparasitic diseases (i.e., those caused by lice and mites) shortly after commercial introduction. A large body of literature, mainly uncontrolled case reports and series, has since evolved. However, these reports and results of the small number of placebo- and/or active-controlled studies have demonstrated the favorable response of both classic and crusted scabies to single- and multiple-dose oral ivermectin. Adverse reactions to the drug are uncommon, with the exception of a transient, new onset, or mild increase in existing pruritus soon after drug ingestion, which is thought to be a hypersensitivity reaction to dead mites and/or their products.

CONCLUSION

Oral ivermectin may prove to be a time- and labor-saving alternative to topical scabicide treatments, especially in the institutional setting where labor shortages make the management of scabies outbreaks a true challenge. However, the use of this agent does not change the need to decontaminate the environment (clothing, bedding, bed clothes, and, in selected cases, floors and walls) in order to truncate an outbreak and prevent reinfestation.

Effects of subchronic malathion exposure on the pharmacokinetic disposition of pefloxacin

Malathion is one of the most extensively used organophosphorus pesticides applied in agriculture, mosquito eradication and in the control of animal ectoparasites and human body lice. The widespread use of malathion has raised concern over its potential to cause untoward health effects in humans, animals and birds. Malathion inhibits cytochrome P450 monooxygenases and has the potential to alter pharmacokinetic profiles of therapeutic agents that are metabolized in the liver. The present study was undertaken to evaluate the impact of subchronic exposure of malathion on the pharmacokinetic disposition of pefloxacin. Chickens were given either normal diet or malathion through food at a concentration of 1000ppm for 28 days. Subsequently, pefloxacin was administered either intravenously or orally (control) to birds fed normal diet and orally to malathion-exposed chickens at a dosage of 10mgkg(-1) body weight. Blood samples were drawn from the brachial vein at predetermined time intervals after drug administration. Plasma was separated and analyzed for pefloxacin by reverse-phase high performance liquid chromatography. The plasma concentration-time data were analyzed by non-compartmental techniques. Following intravenous administration of pefloxacin, elimination half-life (t(1/2β)), area under the plasma concentration-time curve (AUC) and mean residence time (MRT) were 8.2±0.7h, 66±9μghml(-1) and 10.5±1.1h, respectively, and when the drug was administered orally, the respective values of pharmacokinetic parameters were 8.2±0.4h, 31±3.1μghml(-1) and 11.7±0.6h. Malathion exposure significantly increased maximum plasma drug concentration, t(1/2β), AUC and MRT of pefloxacin to 54, 22, 117 and 37% of control, respectively. These findings provide evidence that subchronic malathion exposure markedly influences the elimination kinetics of pefloxacin which may be due to malathion-mediated inhibition of metabolism of pefloxacin.

Scabies, pediculosis, bedbugs, and stinkbugs: uncommon presentations

Parasitic agents determine some of the most common skin disorders. Although well known, they could present different manifestations or be modified by individual or external factors that make their diagnosis or treatment difficult. This review will discuss some of the most prevalent parasitic infections, scabies, and pediculosis and also mention reactions determined by contact with certain insects that, although rarely found, could induce important skin reactions.

Arthropods in dermatology

Arthropods are important in medicine for a multitude of reasons. Their bites and stings may induce allergic reactions, ranging from annoying to life-threatening. Many arthropod products are also capable of inciting allergic responses in sensitized persons. In recent years, bites and stings have gained greater attention owing to increased concern about disease transmission. A common hypersensitivity response to arthropod bites, stings, and products is papular urticaria. This eruption occurs primarily in children, who eventually "outgrow" this disease, probably through desensitization after multiple arthropod exposures. Papular urticaria is most often caused by fleas or bedbugs, but virtually any arthropod is capable of inducing such a reaction. Two arthropod classes of medical importance are the Arachnida (spiders, scorpions, ticks, and mites) and the Insecta (lice, fleas, bedbugs, flies, bees, and ants). Animals in these two classes are probably responsible for more morbidity and mortality worldwide than are any other group of venomous creatures. In general, the diagnosis of arthropod bites and stings is dependent on maintenance of a high index of suspicion and familiarity with the arthropod fauna not only in one's region of practice, but also in the travel regions of one's patients. Learning objective At the completion of this learning activity, participants should be familiar with the clinical manifestations caused by a variety of arthropods as well as the treatment and possible sequelae of arthropod attacks.

Pediculosis

The 3 major lice that infest humans are Pediculus humanus capitis (head louse), Pthirus pubis (crab louse), and Pediculus humanus humanus (body louse). Patients with louse infestation present with scalp pruritus, excoriations, cervical lymphadenopathy, and conjunctivitis. A hypersensitivity rash, or pediculid, may mimic a viral exanthem. Head lice infestation crosses all economic and social boundaries, whereas body lice infestation preferentially affects the homeless and displaced. Body lice are major vectors of diseases such as typhus, trench fever, and relapsing fever. Pubic lice infestation often is acquired as a sexually transmitted disease and may be a marker to screen for other sexually transmitted diseases. Treatment of louse infestation can be challenging. Mechanical measures, such as combing, are helpful as adjunctive measures, but most studies suggest they are not as effective as chemical agents. Resistance to chemical agents is a growing problem. Major types of resistance include knock-down resistance, glutathione-S-transferase-based resistance, and monooxygenase-based resistance. Research is needed to identify new effective treatments.