BACKGROUND: Treatment failure is considered to be an important factor in relation to the increase in scabies incidence over the last decade. However, the regional and temporal differences, in addition to the predictors of therapy failure, are unclear.
OBJECTIVE: We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors.
METHODS: We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies.
RESULTS: A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9-17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5-41.2). Oral ivermectin (11.8%, 95% CI 8.4-15.4), topical ivermectin (9.3%, 95% CI 5.1-14.3) and permethrin (10.8%, 95% CI 7.5-14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1-12.3) compared with those treated with one dose (15.2%, 95% CI 10.8-20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983-2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance.
CONCLUSIONS: A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.

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The relation between pesticides exposure and metabolic syndrome (MetS) has not been clearly identified. Performing a systematic review and meta-analysis, PubMed, Cochrane Library, Embase, and ScienceDirect were searched for studies reporting the risk of MetS following pesticides exposure and their contaminants. We included 12 studies for a total of 6789 participants, in which 1981 (29.1%) had a MetS. Overall exposure to pesticides and their contaminants increased the risk of MetS by 30% (95CI 22%-37%). Overall organochlorine increased the risk of MetS by 23% (14-32%), as well as for most types of organochlorines: hexachlorocyclohexane increased the risk by 53% (28-78%), hexachlorobenzene by 40% (0.01-80%), dichlorodiphenyldichloroethylene by 22% (9-34%), dichlorodiphenyltrichloroethane by 28% (5-50%), oxychlordane by 24% (1-47%), and transnonchlor by 35% (19-52%). Sensitivity analyses confirmed that overall exposure to pesticides and their contaminants increased the risk by 46% (35-56%) using crude data or by 19% (10-29%) using fully-adjusted model. The risk for overall pesticides and types of pesticides was also significant with crude data but only for hexachlorocyclohexane (36% risk increase, 17-55%) and transnonchlor (25% risk increase, 3-48%) with fully-adjusted models. Metaregressions demonstrated that hexachlorocyclohexane increased the risk of MetS in comparison to most other pesticides. The risk increased for more recent periods (Coefficient = 0.28, 95CI 0.20 to 0.37, by year). We demonstrated an inverse relationship with body mass index and male gender. In conclusion, pesticides exposure is a major risk factor for MetS. Besides organochlorine exposure, data are lacking for other types of pesticides. The risk increased with time, reflecting a probable increase of the use of pesticides worldwide. The inverse relationship with body mass index may signify a stockage of pesticides and contaminants in fat tissue.

Investigations about the remediation of Hexachlorocyclohexane (HCH), a persistent organic pollutant of global concern, have been extensively reported to treat the HCH contaminated soil. The difficulty arising due to desorption and long ageing procedures of this hydrophobic organic compound in the soil, make it necessary to exploit techniques like soil washing or addition of surfactants, for enhancing the mass transfer rate of hydrophobic compounds. However, this technique gives rise to the generation of a large quantity of waste solution containing the pollutant and various other toxic substances. Moreover, it is challenging to deal with the complex soil washing solution, and thus a follow-up treatment of such washing solution is essentially required before its discharge. This follow-up treatment could be the bioreactor system to efficiently treat the pollutant in the wash solution, thereby reducing the amount of contaminated soil that has to be treated. Among many suggested remediation methods and treatment technologies, integrated soil washing and post-treatment with the bioreactor system could be an environmentally viable method for the remediation of HCH contaminated sites. This review focuses on the soil washing procedures applied so far for the HCH contaminated soil and various factors affecting the efficiency of separation of the target pollutant. Furthermore, the environmental and reactor design-related factors are also discussed for degradation of HCH in the reactor system. Finally, advantages and environmental feasibility of this proposed combined technology and the challenges that need to be encountered are envisaged.

The environmental impacts of persistent organic pollutants (POPs) is an increasingly prominent topic in the scientific community. POPs are stable chemicals that are accumulated in living beings and can act as endocrine disruptors or carcinogens on prolonged exposure. Although efforts have been taken to minimize or ban the use of certain POPs, their use is still widespread due to their importance in several industries. As a result, it is imperative that POPs in the ecosystem are degraded efficiently and safely in order to avoid long-lasting environmental damage. This review focuses on the degradation techniques of hexachlorocyclohexane (HCH), a pollutant that has strong adverse effects on a variety of organisms. Different technologies such as adsorption, bioremediation and advanced oxidation process have been critically analyzed in this study. All 3 techniques have exhibited near complete removal of HCH under ideal conditions, and the median removal efficiency values for adsorption, bioremediation and advanced oxidation process were found to be 80%, 93% and 82% respectively. However, it must be noted that there is no ideal HCH removal technique and the selection of removal method depends on several factors. Furthermore, the fates of HCH in the environment and challenges faced by HCH degradation have also been explained in this study. The future scope for research in this field has also received attention.

Lindane (γ-hexachlorocyclohexane) and its isomers (HCH) are some of the most common and most easily detected organochlorine pesticides in the environment. The widespread distribution of lindane is due to its use as an insecticide, accompanied by its persistence and bioaccumulation, whereas HCH were disposed of as waste in unmanaged landfills. Unfortunately, certain HCH (especially the most reactive ones: γ- and α-HCH) are harmful to the central nervous system and to reproductive and endocrine systems, therefore development of suitable remediation methods is needed to remove them from contaminated soil and water. This paper provides a short history of the use of lindane and a description of the properties of HCH, as well as their determination methods. The main focus of the paper, however, is a review of oxidative and reductive treatment methods. Although these methods of HCH remediation are popular, there are no review papers summarising their principles, history, advantages and disadvantages. Furthermore, recent advances in the chemical treatment of HCH are discussed and risks concerning these processes are given.

Due to their low temperatures, the Arctic, Antarctic and Tibetan Plateau are known as the three polar regions of the Earth. As the most remote regions of the globe, the occurrence of persistent organic pollutants (POPs) in these polar regions arouses global concern. In this paper, we review the literatures on POPs involving these three polar regions. Overall, concentrations of POPs in the environment (air, water, soil and biota) have been extensively reported, with higher levels of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) detected on the Tibetan Plateau. The spatial distribution of POPs in air, water and soil in the three polar regions broadly reflects their distances away from source regions. Based on long-term data, decreasing trends have been observed for most \"legacy POPs\". Observations of transport processes of POPs among multiple media have also been carried out, including air-water gas exchange, air-soil gas exchange, emissions from melting glaciers, bioaccumulations along food chains, and exposure risks. The impact of climate change on these processes possibly enhances the re-emission processes of POPs out of water, soil and glaciers, and reduces the bioaccumulation of POPs in food chains. Global POPs transport model have shown the Arctic receives a relatively small fraction of POPs, but that climate change will likely increase the total mass of all compounds in this polar region. Considering the impact of climate change on POPs is still unclear, long-term monitoring data and global/regional models are required, especially in the Antarctic and on the Tibetan Plateau, and the fate of POPs in all three polar regions needs to be comprehensively studied and compared to yield a better understanding of the mechanisms involved in the global cycling of POPs.

BACKGROUND: Many drugs have been used to treat scabies, but it is unclear which of them is the most efficacious.
OBJECTIVE: To evaluate the comparative efficacy and safety of antiscabietic agents.
METHODS: A systematic review of randomized controlled trials was conducted. Direct and network meta-analyses were applied to 13 antiscabietic agents on 3 outcomes (cure, persistent itching, and adverse events). Their probability of having highest efficacy and safety was estimated and ranked.
RESULTS: A network meta-analysis of 52 trials including 9917 patients indicated that permethrin (the reference treatment) had a significantly higher cure rate than sulfur, malathion, lindane, crotamiton, and benzyl benzoate. Combination permethrin plus oral ivermectin had a nonsignificantly higher cure rate than permethrin. Combination permethrin plus oral ivermectin was ranked highest in terms of cure, topical ivermectin in terms of persistent itching, and synergized pyrethrins in terms of adverse events. On the basis of clustered ranking, permethrin, oral ivermectin, and synergized pyrethrins seemed to retain balance between cure and adverse events.
CONCLUSIONS: There are small numbers of trials and patients in some comparisons and a high risk of bias in some trials.
CONCLUSIONS: There is no 1 treatment that ranked highest in all aspects. Physicians should consider the drug\'s efficacy and safety profiles, along with ease of administration.

This review reports on how Ghanaian scientists analyse insecticide residues in various matrices in their laboratories as well as the levels of insecticides found in Ghana. It covers different sample preparation methods such as solid-liquid and liquid-liquid extraction. The main technique used for this analysis was gas chromatography (GC) with various detectors such as electron capture, flame photometric, nitrogen phosphorus, and mass spectrometric detection. Liquid chromatography (LC) with mass spectrometric detection was sometimes used to determine the levels of very polar insecticide residues. From the articles reviewed 74% of the insecticides detected were organochlorines with DDTs, lindanes, and endosulfans as most abundant ones. Levels of the insecticides of interest analysed, varied from below the detection limits to clearly above the safety limits. The lowest detected concentration of insecticide residues reported in fruits and vegetables was δ-lindane in pawpaw (0.06 mg/kg) while the highest was fenvalerate (25.6 mg/kg). Insecticide residues reported in sediment were predominantly organochlorines with concentrations ranging from 9.68 ng/kg to 10.98 µg/kg. Endosulfan and its metabolites were the main insecticides found in water bodies with concentrations ranging from 0.036 µg/L to 62.3 µg/L. DDT and its metabolites were the dominant insecticides found in human fluids.

Head lice are a source of scalp irritation, social disruption, and loss of school time. Health care providers need authoritative information to help avoid the costs and risks of ineffective treatment. A review was completed to provide relevant information on infestation treatments available in the United States. Three major biomedical databases were searched from 1985, when current products were first available, to 2014, focusing on U.S.
METHODS: A total of 579 references remained after duplicates were removed. A search of the U.S. Food and Drug Administration website and labels of approved products were reviewed. A marked decline in the effectiveness of permethrin and synergized pyrethrins was found, probably because of resistance arising from widespread and indiscriminate use, and the emergence of knockdown resistance mutations. The potential toxicity of lindane in the setting of readily available, safer, and more effective alternatives, should limit its use. Prescription products shown to be safe and effective with a single application, without nit combing, are topical ivermectin, malathion, and spinosad, whereas benzyl alcohol requires two applications. Home remedies such as mayonnaise, and essential oils, have not been demonstrated to be safe or effective, and may carry potential for severe adverse events. The high risk of failure of over-the-counter treatments in eliminating head louse infestations drives a need for health care provider recognition of the limitations of current treatments and for judicious use of treatments that remain effective.