Five dimensions of cleansing: A holistic view on the facets and importance of skin cleansing.

Cleansing is an important human ritual practised for hygiene, well-being and relaxation over centuries. As part of body care it is often taken for granted, yet its relevance cannot be underestimated. Although cleansing the skin may seem trivial to some, it is accepted, that this fundamental function of skin cleansing products is highly complex, diverse and crucial for a variety of reasons in the personal, public, healthcare and dermatological settings. Employing a comprehensive and strategic approach in viewing cleansing and its rituals, supports innovation, understanding and development. Apart from being a fundamental function, as far as we know, there is no comprehensive presentation of skin cleansing with all its effects besides 'removing dirt'. To our knowledge, comprehensive analyses on the multi-dimensional facets of skin cleansing are either rare or not published. Against this background, we examine the importance of cleansing in terms of function, relevance and concepts. First, the key functions and efficacies of skin cleansing were investigated by literature research. Based on this survey, the functions were analysed, sorted and merged and a novel approach to skin cleansing 'dimensions' was developed. Herewith, we took into consideration the evolution of skin cleansing in terms of concept evolution, complexity and testing methods for cleansing products and their claims. Several multi-dimensional functions of skin cleansing were identified and then established into five skin cleansing dimensions, namely: hygienic and medical importance; socio-cultural and interpersonal relevance; mood, emotion and well-being; cosmetic and aesthetic function; corneobiological interactions. It became obvious, that these five dimensions with their corresponding 11 sub-dimensions, are influenced by each other throughout history by culture and society, technical progress, scientific knowledge and consumer trends. This article presents the enormous complexity of skin cleansing. Skin cleansing has evolved from basic care up to a highly complex and diverse cosmetic product category in terms of technology, efficacy and usage routine(s). In view of future challenges, such as the effects of climate and associated lifestyle changes, the development of skin cleansing will remain an exciting and important topic and thus will finally, again, further increase the complexity of skin cleansing itself.

OBJECTIF: La toilette est un rituel humain important pratiqué depuis des siècles pour l'hygiène, le bien-être et la relaxation. Les soins du corps sont souvent considérés comme allant de soi, mais leur importance ne doit pas être sous-estimée. Bien que le nettoyage de la peau puisse paraître trivial pour certains, il est admis que cette fonction fondamentale des produits de nettoyage de la peau est hautement complexe, variée et cruciale pour diverses raisons dans les contextes de l'hygiène personnelle et publique, de la santé en général et de la dermatologie. Adopter une approche globale et stratégique pour visualiser le nettoyage de la peau et ses rituels permet d'améliorer son innovation, sa compréhension et son développement. En dehors de sa fonction fondamentale, il n'existe pas, à notre connaissance, de présentation complète des effets du nettoyage de la peau au-delà de la simple « élimination des impuretés ¼. D'après ce que nous savons, des analyses complètes sur les facettes multiples du nettoyage de la peau sont rare, voire jamais publiées. Dans ce contexte, nous examinons l'importance du nettoyage en termes de fonction, de pertinence et de concepts. MÉTHODES: Tout d'abord, les fonctions clés et l'efficacité du nettoyage de la peau ont été étudiées en effectuant des recherches dans la littérature. Sur la base de cette enquête, ces fonctions ont été analysées, triées et fusionnées, et une nouvelle approche des différentes « dimensions ¼ du nettoyage de la peau a été développée. Ici, nous avons pris en compte l'évolution du nettoyage de la peau en ce qui concerne l'évolution de ses concepts, sa complexité et les méthodes de test des produits de nettoyage et de leurs caractéristiques. CONCLUSION: Plusieurs fonctions multidimensionnelles de nettoyage de la peau ont été identifiées, puis appliquées à cinq dimensions de nettoyage de la peau, à savoir : L'importance sanitaire et médicale ; la pertinence socioculturelle et interpersonnelle ; l'humeur, l'émotion et le bien-être ; la fonction esthétique et cosmétique ; les interactions cornéobiologiques. Il est devenu évident que ces cinq dimensions, avec leurs onze sous-dimensions respectives, se sont interinfluencées tout au long de l'histoire selon la culture, la société, les progrès techniques, les connaissances scientifiques et les tendances des consommateurs. Cet article présente l'énorme complexité du nettoyage de la peau. Le nettoyage de la peau est passé des soins de base à une catégorie de produits cosmétiques hautement complexes et variés en termes de technologie, d'efficacité et de routine(s) d'utilisation. Compte tenu des défis futurs, comme les effets du climat et les changements de mode de vie associés, le développement du nettoyage de la peau restera un sujet important et passionnant, et finira par augmenter encore davantage la complexité du nettoyage de la peau.

'I Am they.' Non-Binary Representation in Television Fiction as a Manifestation of Social Conceptions.

This qualitative research uses a case study to observe non-binary representation in TV fiction. The Dan character from the Spanish series HIT (RTVE, 2020-present), who is the first openly non-binary character in Spanish TV fiction, is analyzed through the lens of Queer Media Studies. The research applies a combination of content and discourse analysis. Qualitative content categories include a character's visibility, identity, relevance, embodiment, and social interaction. Discourse analysis categories include character's construction, lexicalization, propositional framing, and focus. Results show that Dan's non-binary depiction revolves around three significant axes: dualism, confusion, and exceptional talent. These axes frame social attitudes toward non-binary people and are composed by a set of features identified in Dan's case which also informs society's mind-sets. These traits are proposed as an analytical-theoretical tool for further analyses of non-binary representation in different cultural contexts. The outcomes of this research may inform audiovisual industries, regulations and academia, and are useful to consolidate non-binary media studies.

Full-mouth disinfection as a nonsurgical treatment approach for drug-induced gingival overgrowth: a series of 11 cases.

The treatment of drug-induced gingival overgrowth is compounded by the high recurrence rate resulting from chronic use of the medication and the persistence of other risk factors. In this case series, the treatment outcome of a nonsurgical periodontal therapy, according to the concept of full-mouth disinfection in 11 patients with drug-induced gingival overgrowth, is described. All clinical parameters improved significantly after therapy. Only 6% of teeth received further surgical treatment. The clinical situation remained stable during the recall. The present case series suggests that full-mouth disinfection might be a beneficial treatment concept for drug-induced gingival overgrowth, reducing the need for further surgical intervention.

Antimicrobial Resistance Patterns in Clostridioides difficile Strains Isolated from Neonates in Germany.

Young children are frequently colonized with Clostridioides (C.) difficile. Depending on their resistance patterns, antibiotic treatment can facilitate gastrointestinal spreading in colonized individuals, potentially leading to transmission to others. C. difficile was isolated from stool samples from infants born in two hospitals in Göttingen and Darmstadt, Germany. All isolates were subjected to phenotypic antimicrobial resistance testing, PCR-based screening for toxin genes and mass spectrometry-based exclusion of ribotypes 027 and 176. Within an initial cohort of 324 neonates with a longitudinal survey of C. difficile, 137 strains were isolated from 48 individuals. Antimicrobial resistance was recorded against metronidazole in one (0.7%), erythromycin in 16 (11.7%) and moxifloxacin in 2 (1.5%) of the strains, whereas no resistance was observed against vancomycin (0.0%) or rifampicin (0.0%). Newly observed resistance against erythromycin in children with detection of previously completely sensitive isolates was reported for C. difficile isolates from 2 out of 48 children. In 20 children (42%), non-toxigenic strains were detected, and from 27 children (56%), toxigenic strains were isolated, while both toxigenic and non-toxigenic strains were recorded for 1 child (2%). Ribotypes 027 or 176 were not observed. In conclusion, the German C. difficile strains isolated from the children showed mild to moderate resistance with predominance of macrolide resistance, a substance class which is frequently applied in children. The observed switches to the dominance of macrolide-resistant isolates suggests likely selection of resistant C. difficile strains already in children.

Vitamin D, an inflammatory activity marker for spondyloarthritis?

In this study, a relationship between low levels of vitamin D and other markers of inflammation is observed in patients with spondyloarthritis. Therefore, insufficient levels of vitamin D could be used as a marker of inflammation, so they would help to have a better follow-up of the patient. PURPOSE: The aim of this study is to determine the association between 25-hydroxyvitamin D deficiency and level of disease activity in patients suffering from spondyloarthritis. METHODOLOGY: This study is an observational, descriptive and transversal study. A retrospective review of patients with spondyloarthritis under treatment at the Rheumatology Department of Hospital General Universitario de Ciudad Real between September 2016 and September 2018 is under consideration. The association between 25-hydroxyvitamin D deficiency and levels of disease activity was calculated using odds ratio (OR) with a 95% confidence level. RESULTS: Initial study developments are reported. A group of 147 patients was analyzed. The average disease activity was 4.3 (according to BASDAI) and 11.4 (according to DAPSA). Twenty-eight percent of patients showed increased levels of acute-phase reactants, and 82% exhibited 25-hydroxyvitamin D deficiency/insufficiency. Analysis of the association between vitamin D deficiency/insufficiency and BASDAI/DAPSA activity degree revealed an OR of 7.9 (CI95%: 2.92-21.23, p = < 0.0001). CONCLUSION: In this study, an association was found between those patients with spondyloarthritis who had a 25-hydroxyvitamin D deficiency and disease activity. Despite these results, a 1-year follow-up of these patients using two or more measurements of activity and 25-hydroxyvitamin D levels would be needed to corroborate these data.

Acute tubulointerstitial nephritis in an HLA-B27-positive patient with axial spondyloarthritis being treated with adalimumab. / Nefritis túbulo-intersticial aguda en paciente con espondiloartritis axial HLA-B27 en tratamiento con adalimumab.

Antagonists of tumor necrosis factor-alpha (ATNF) are used for the treatment of multiple diseases such as psoriatic arthritis, Crohn's disease, ankylosing spondylitis and juvenile idiopathic arthritis, usually, when they are refractory to first-line treatment1. The use of ATNF has been associated with the induction of autoimmune diseases such as systemic lupus erythematosus-like disease, vasculitis, sarcoidosis-like diseases and, recently, acute granulomatous tubulointerstitial nephritis. We report a case of acute nongranulomatous tubulointerstitial nephritis in an HLA-B27-positive patient with axial spondyloarthritis and Crohn's disease being treated with adalimumab.

Self-management model in the scheduling of successive appointments in rheumatology. / El modelo de autogestión en la agenda de consultas sucesivas en reumatología.

INTRODUCTION: The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. MATERIAL AND METHODS: A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. RESULTS: In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. CONCLUSION: Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations.

Analysis of the human Atox 1 homologue in Wilson patients.

AIM: To analyze the metallochaperone antioxidant-1 (Atox1) gene sequence in Wilson disease patients. METHODS: Mutation analysis of the four exons of the Atox1 gene including the intron- exon boundaries was performed in 63 Wilson disease patients by direct sequencing. RESULTS: From 63 selected patients no mutations were identified after the entire coding region including the intron- exon boundaries of Atox1 were sequenced. One known polymorphism within the Atox1 gene (5'UTR -99 T>C) in 31 (49%) of the Wilson patients as well as one previously undescribed variation (5'UTR -68 C>T) in 2 of the Wilson patients could be detected. Statistical analyses revealed that the existence of a variation within the Atox1- gene showed a tendency towards an earlier onset of the disease. CONCLUSION: Based on the data of this study, no major role can be attributed to Atox1 in the pathophysiology or clinical variation of Wilson disease.

[Kikuchi disease: Evolution during outbreaks and its response to antimalarial treatment]. / Enfermedad de Kikuchi-Fujimoto: evolución en brotes con respuesta a antipalúdicos.

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a syndrome characterized by the presence of usually painful cervical lymphadenopathy with fever and night sweats. It is a rare clinical entity that mainly affects young Asian women, although it found worldwide. It is a benign and self-limiting condition; however, its importance lies in its differential diagnosis with other clinical entities such as lymphoma or histiocytoma. We present a case of Kikuchi-Fujimoto disease, with special emphasis on its clinicopathological significance and its evolution during outbreaks. Antimalarial therapy causes remission and we discuss the use of hydroxychloroquine for reoccurring cases.

Cardiovascular and metabolic monitoring of children and adolescents on antipsychotic treatment: A cross-sectional descriptive study. / Monitorización del riesgo cardiovascular y metabólico en niños y adolescentes en tratamiento antipsicótico: un estudio descriptivo transversal.

BACKGROUND: Cardiovascular and metabolic monitoring of patients on antipsychotic medication is essential. This becomes more important in those of paediatric age, as they are more vulnerable, and also because prescriptions of this kind of drugs are still increasing. AIM: To evaluate the monitoring of cardiovascular and metabolic risk factors in a group of children and young people on antipsychotic medication. METHOD: A descriptive cross-sectional study was conducted in which a group of 220 patients aged 8-17 years, diagnosed with a mental disorder and on antipsychotic treatment. They were compared to a control group of 199 asthmatic patients not exposed to antipsychotic drugs. Data was extracted from the computerised clinical history ECAP in 2013. RESULTS: The mean age of the children was 12 years (8-17). Risperidone (67%) was the most frequent treatment. The recording of Body Mass Index (BMI) and blood pressure (AP) was 50% in Mental Disorder (MD) patients. A higher number of cardiovascular monitoring physical parameters (weight, height, BMI and BP) were observed in the MD group compared to the control Asthma control group. Altogether, more physical parameters than biochemistry parameters were recorded. CONCLUSIONS: This study shows that the recording of cardiovascular parameters and metabolic studies needs to be improved in children and adolescents on treatment with antipsychotics.

Circulating osteoprotegerin is increased in the metabolic syndrome and associates with subclinical atherosclerosis and coronary arterial calcification.

CONTEXT: The relationship between osteoprotegerin (OPG) a glycoprotein related to bone metabolism and the metabolic syndrome (MS) has not been established. OBJECTIVE: The aim of this study is to evaluate OPG concentration in patients with MS and its association with subclinical atherosclerosis and coronary arterial calcification (CAC). MATERIALS/METHODS: The study included 238 asymptomatic patients. MS was diagnosed according to the NCEP/ATPIII guidelines. OPG was measured by ELISA. All subjects underwent ultrasonography of the common carotid arteries to measure intima-media thickness (IMT) and evaluate the presence of atheroma plaques. In a subgroup (n=39) CAC was quantified by ECG-triggered cardiac computed tomography. Adipose tissue was excised from 25 patients and OPG expression by RT-PCR and immunohistochemistry was studied. RESULTS: Patients with the MS (n=60) had higher OPG than patients without (n=178) (p<0.05). OPG correlated with IMT (r=0.2, p=0.005) and patients with atheroma plaques had higher OPG (p=0.008) and also those with coronary artery calcification (p<0.05). OPG expression was confirmed in adipose tissue (n=12) and the expression was significantly higher in patients with MS than in those without (p=0.003). CONCLUSIONS: This study shows that OPG may potentially be a biomarker for cardiovascular risk/damage in the MS and identifies adipose tissue as a potential source of OPG.

Factor structure and measurement invariance of the Difficulties Emotion Regulation Scale (DERS) in Spanish adolescents.

BACKGROUND: Emotion dysregulation is a unifying dimension of several psychopathological symptoms such as prolonged dysphoria, labile mood, high anger, persistent fear and excessive worry. Deficits in emotion regulation (ER), or emotion dysregulation, appear to be relevant to the development, maintenance, and promising treatment target in a broad range of mental disorders. The Difficulties in Emotion Regulation Scale (DERS) is the most comprehensive measure of emotion dysregulation to date, but the Spanish version has not been validated in adolescents. METHOD: A community sample of 642 Spanish adolescents aged 12-18 responded to the DERS. RESULTS: Factor analysis suggested a six-factor solution, and strict measurement invariance across sex was achieved. Internal consistency for the subscales was moderate to satisfactory (.71-.88), except for Awareness (α = .62). We found some sex differences on subscale scores, with small effect sizes. CONCLUSIONS: The results obtained for the Spanish version of the DERS are promising for investigating emotion dysregulation in Spanish adolescents.