Scabies in Koranic schools in Dakar, Senegal: Comparison of two therapeutic modalities

Background: In 2017, WHO recognized scabies as a neglected tropical disease. The optimal treatment is not well defined in some communities.Objective: This study aimed to compare ivermectin and benzyl benzoate in the treatment of scabies in Koranic schools (or "daara") in Dakar (region).Methods: This was a prospective randomized trial conducted from January to October 2018 in Senegal. Any resident living in the selected "daara" and diagnosed with scabies was included. The administered treatments were benzyl benzoate (BB) or ivermectin. At the outset, if one case of scabies was diagnosed, all residents received treatment. Ivermectin was given at the dose of 200 mg/kg. The same treatment was repeated on day 7 for each group, the endpoint was at D14, and the data were analyzed with STATA 14.Results: Fifteen "daara" were included. Of the 959 residents, 70 were diagnosed with scabies: prevalence of 7.29%. All patients except one were male; the mean age was 9.98 years (4-17). At D14, in the BB arm, cure rate was 42.85% (n = 15) while in the ivermectin arm, this rate was 5.71% (n = 2) with a significant difference (p = 0.01). On D28, the cure rate was still higher in the BB group 57.14 (n=20) versus ivermectin 21.42 (n = 6) with a significant difference (p = 0.004). On D42, all patients except eight were cured. At D14, we found a link between the cure rate, the number of people in the room (p = 0.01), and the number of showers per week (p = 0.01) but no link with the number of people per "daara" (p = 0.163). At D28, we found a link between the cure rate, the number of people sleeping in the room (p = 0.03), and the number of showers per week (p = 0.01) but not with the number of people per "daara" (p = 0.07).Conclusion: In Koranic schools, the cure rate is higher with benzyl benzoate compared to ivermectin.

Tracheal Tube-Mounted Camera Assisted Intubation vs. Videolaryngoscopy in Expected Difficult Airway: A Prospective, Randomized Trial (VivaOP Trial)

Background: Tracheal intubation in patients with an expected difficult airway may be facilitated by videolaryngoscopy (VL). The VL viewing axis angle is specified by the blade shape and visualization of the larynx may fail if the angle does not meet anatomy of the patient. A tube with an integrated camera at its tip (VST, VivaSight-SL) may be advantageous due to its adjustable viewing axis by means of angulating an included stylet.Methods: With ethics approval, we studied the VST vs. VL in a prospective non-inferiority trial using end-tidal oxygen fractions (etO2) after intubation, first-attempt success rates (FAS), visualization assessed by the percentage of glottis opening (POGO) scale, and time to intubation (TTI) as outcome parameters.Results: In this study, 48 patients with a predicted difficult airway were randomized 1:1 to intubation with VST or VL. Concerning oxygenation, the VST was non-inferior to VL with etO2 of 0.79 ± 0.08 (95% CIs: 0.75–0.82) vs. 0.81 ± 0.06 (0.79–0.84) for the VL group, mean difference 0.02 (−0.07 to 0.02), p = 0.234. FAS was 79% for VST and 88% for VL (p = 0.449). POGO was 89 ± 21% in the VST-group and 60 ± 36% in the VL group, p = 0.002. TTI was 100 ± 57 s in the VST group and 68 ± 65 s in the VL group (p = 0.079). TTI with one attempt was 84 ± 31 s vs. 49 ± 14 s, p < 0.001.Conclusion: In patients with difficult airways, tracheal intubation with the VST is feasible without negative impact on oxygenation, improves visualization but prolongs intubation. The VST deserves further study to identify patients that might benefit from intubation with VST.