Lessons learned in a decade: Medical-toxicological view of tattooing.

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical-toxicological view of tattooing'-a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical-toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks.

Quantification of preservatives in tattoo and permanent make-up inks in the frame of the new requirements under the REACH Regulation.

BACKGROUND: According to the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) restriction, tattoo and permanent make-up (PMU) inks placed on the European Union market after January 4, 2022, shall not contain methylisothiazolinone, benzisothiazolinone (BIT), octylisothiazolinone (OIT), or other skin sensitizers in concentrations of 10 mg/kg or higher and phenoxyethanol (PE) or other eye irritants or damaging substances in concentrations of 100 mg/kg or higher. In addition, preservatives and other substances enlisted in Annex II to Cosmetic Product Regulation shall not be present in concentrations of 0.5 mg/kg or higher. OBJECTIVES: This study aims to quantify 14 preservatives in 99 tattoo and 39 PMU inks from the Italian market and presents a comparison with concentration limits set by the REACH restriction. METHODS: Inks were analysed by applying validated analytical methods based on liquid chromatography techniques. RESULTS: About 24.0%, 15.2% and 1.5% of the overall samples contained BIT, PE and OIT, respectively, at concentrations exceeding REACH concentration limits. The number of noncompliant tattoo inks (49.5%) would be significantly greater than that of the PMU inks (17.9%). CONCLUSIONS: About 40.6% of the samples would be noncompliant with the restriction for the presence of preservatives above the permitted level. Additional concentration limits will apply to skin sensitizing preservatives for proper labelling of inks under CLP (Classification, Labelling and Packaging) Regulation.

Liquid chromatography with tandem mass spectrometry method for the determination of nicotine and minor tobacco alkaloids in electronic cigarette refill liquids and second-hand generated aerosol.

A liquid chromatography with tandem mass spectrometry method for the simultaneous quantification of nicotine and seven minor tobacco alkaloids in both refill liquids for electronic cigarettes and their generated aerosol was developed and validated. The limit of detection and limit of quantification values were 0.3-20.0 and 1.0-31.8 ng/mL, respectively. Within-laboratory reproducibility was 8.2-14.2% at limit of quantification values and 4.8-12.7% at other concentration levels. Interday recovery was 75.8-116.4%. The method was applied to evaluate the compliance of commercial liquids (n = 95) with their labels and to assess levels of minor alkaloids. Levels of nicotine and its corresponding compounds were also evaluated in generated aerosol. About 47% of samples showed differences above ±10 % of the stated nicotine concentration. About 78% of the "zero nicotine" liquids showed traces in the range of 1.3 ± 0.1-254.0 ± 14.6 µg/mL. Nicotine-N'-oxides, myosmine, and anatabine were the most common minor alkaloids in liquids containing nicotine. Nicotine and N'-oxides were detected in all air samples when aerosol was generated from liquids containing nicotine. Nicotine average emissions from electronic cigarette (2.7 ± 0.9 µg/m3 ) were significantly lower (p < 0.01, t-test) with respect to conventional cigarette (30.2 ± 1.5 µg/m3 ).

The chemical components of electronic cigarette cartridges and refill fluids: review of analytical methods.

INTRODUCTION: To date, several concerns have been raised on the purity of ingredients employed in the manufacturing processes of refill fluids and cartridges, the device functionality, and the quality control of electronic cigarettes. This article reviews analytical methods so far described for the analysis of liquids to detect their chemical components and to investigate the presence of toxicants and carcinogens that can potentially occur as impurities of ingredients or as a consequence of their degradation. RESULTS AND DISCUSSION: Based on the scientific literature, high-performance liquid chromatography with diode-array detection (HPLC/DAD) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) are most appropriate for determining nicotine and related compounds in fluids and cartridges, whereas LC-MS/MS has been successfully used to determine nitrosamines. Content analyses of glycols have been performed using gas chromatography equipped with flame ionization detector or gas chromatography/mass spectrometry (GC/MS), whereas carbonyl and other volatile organic compounds determinations have been performed by HPLC/DAD and GC/MS, respectively. Content analyses of heavy metals have been performed by inductively coupled plasma optical emission spectroscopy or inductively coupled plasma mass spectrometry. Since new potentially toxic substances may be created during heating, it is also necessary to investigate the chemical composition of generated aerosol. In this case, similar methods applied for tobacco smoke can be adopted. CONCLUSIONS: A broad range of analytical techniques are available for the detection of constituents and toxicants in e-liquids and cartridges. Analyses of liquids have been performed with pharmacopeia procedures and methods (International Organization for Standardization, Environmental Protection Agency, and American Public Health Association) developed for other matrices but applicable to e-liquids. Because new potentially harmful substances may be produced during heating process, analyses of aerosol are needed to correlate its composition to the chemical components of liquids.

Dangerous exposures to chemicals managed by Poison Centers all around the world during the COVID-19 pandemic: a systematic review and proportional meta-analysis.

INTRODUCTION: During COVID-19 pandemic, cleaning/disinfection activities were highly recommended. This study summarizes the state of art and estimates the prevalence of dangerous exposures to specific chemicals managed by Poison Centers (PCs) from all over the world during 2020 vs 2019, trying to overcome the critical aspects of the product categorization systems used by PCs. MATERIALS AND METHODS: A systematic research was conducted in 3 major databases and 2 websites of PCs associations. Proportional meta-analyses were performed to estimate the prevalence of exposures to disinfectants, household products and hand sanitizers in 2020 vs 2019. RESULTS: The pooled prevalence of exposures to disinfectants, household products and hand sanitizers were respectively 5.9% (95% CI 4.9-7.0) (2019: 4.4% vs 2020: 7.8%; p=0.22), 25.9% (95% CI 24.0-27.7) (2019: 25.0% vs 2020: 28.6%; p=0.71) and 1.6% (95% CI 1.3-1.9) (2019: 0.6% vs 2020: 2.8%; p<0.001). CONCLUSIONS: This study detected overall increases of exposures to specific chemicals in 2020, suggesting that the awareness on topics related to the safe use of these products should be improved, especially during health emergencies, highlighting the need to develop standardized systems to better compare data coming from PCs all over the world.

Monitoring of alcohol-based hand rubs in SARS-CoV-2 prevention by HS-GC/MS and electrochemical biosensor: A survey of commercial samples.

Alcohol-based hand rubs (ABHRs) have found large diffusion during the Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2, thus becoming the most widespread means for hand hygiene. Whereby, it is fundamental to assess the alignment of commercial ABHRs to the indications provided by the principal health agencies regarding alcohol content and possible impurities. In this work, a novel improvement of previous existent methods for the determination of alcohol content in such products was reported. In particular, two alternative sensitive and reproducible methods, such as an electrochemical screen-printed based enzymatic (alcohol oxidase) biosensor and a Headspace Gas Chromatography coupled with Mass Spectrometry (HS-GC/MS) were proposed. The electrochemical device represents a rapid, low-cost and accurate fraud screening method for alcohol-based hand rubs. The second technique confirms, identifies and simultaneously determines ethyl alcohol, isopropyl alcohol, n-propyl alcohol and methyl alcohol, improving their extraction through acidification in the sample pre-treatment step. The developed specific HS-GC/MS method was in-house validated according to ISO/IEC 17025 requirements. Analytical parameters such as limit of detection (LoD 0.13%v/v - 0.17%v/v), limit of quantification (LoQ 0.44% v/v - 0.57% v/v), inter-day repeatability (RSDR 2.1-10.7%) and recovery (80-110%) were assessed. The relative expanded uncertainties range (between 0.1%v/v and 3.4%v/v) for all the analytes were evaluated. Results obtained using the different analytical approaches were compared and indicated that the two data sets were comparable (median; HS-GC/MS, 56%v/v; electrochemical biosensor, 62%v/v) and were not statistically different (one-way ANOVA test; p = 0.062). In addition, a good correlation (95%) was found. This study noticed that only 39% of the tested hand sanitiser products had the recommended average alcohol content, thus highlighting the need for analytical controls on this type of products.

Comparison of ropivacaine plasma concentration after posterior Quadratus Lumborum Block in Cesarean Section with ropivacaine with epinephrine vs. plane.

BACKGROUND: The posterior quadratus lumborum block (pQLB) has been used in postoperative pain management after cesarean section (CS). However, clinicians have no data about pQLB safety in pregnants, at increased risk of local anesthetic systemic toxicity (LAST). The purpose of the present study was to explore the efficacy and the safety of adding epinephrine to ropivacaine for bilateral pQLB vs. bilateral pQLB performed with ropivacaine alone in CS. METHODS: In this prospective trial 52 pregnants, ASA 2 physiological status, were consecutively allocated to one of two groups, e-pQLB and pQLB; e-pQLB group received 0.375% ropivacaine+100 mcg epinephrine, 20 mL each side; pQLB received 0.375% ropivacaine alone, 20 mL each side. The primary and secondary outcomes were to evaluate if the adjunct of epinephrine to ropivacaine increases efficacy and safety of pQLB, respectively. RESULTS: Authors found in e-pQLB group vs. p-QLB group: a total mean morphine consumption statistically lower during the first 24 postoperative hours (5.08±3.12, vs. 9.11±4.67 SD mg, P=0.0002); NRS values statistically lower at six hours from block, both at rest (1.73±1.88 SD vs. 2.88±2.53, P=0.03) and with movement (3.03±1.98 SD vs. 4.23±2.87, P=0.04); a longer time between block and the first opioid request (5.92±2.48 vs. 3.78±2.68 SD hrs, P<0.003); venous ropivacaine concentrations significantly lower at any time of samples but at 120 minutes. CONCLUSIONS: Adding epinephrine to ropivacaine increases efficacy and duration of pQLB. Moreover it increases block safety, reducing peak and mean venous ropivacaine concentration.

Evaluation of Second-Hand Exposure to Electronic Cigarette Vaping under a Real Scenario: Measurements of Ultrafine Particle Number Concentration and Size Distribution and Comparison with Traditional Tobacco Smoke.

The present study aims to evaluate the impact of e-cig second-hand aerosol on indoor air quality in terms of ultrafine particles (UFPs) and potential inhalation exposure levels of passive bystanders. E-cig second-hand aerosol characteristics in terms of UFPs number concentration and size distribution exhaled by two volunteers vaping 15 different e-liquids inside a 49 m3 room and comparison with tobacco smoke are discussed. High temporal resolution measurements were performed under natural ventilation conditions to simulate a realistic exposure scenario. Results showed a systematic increase in UFPs number concentration (part cm-3) related to a 20-min vaping session (from 6.56 × 103 to 4.01 × 104 part cm-3), although this was one up to two order of magnitude lower than that produced by one tobacco cigarette consumption (from 1.12 × 105 to 1.46 × 105 part cm-3). E-cig second-hand aerosol size distribution exhibits a bimodal behavior with modes at 10.8 and 29.4 nm in contrast with the unimodal typical size distribution of tobacco smoke with peak mode at 100 nm. In the size range 6-26 nm, particles concentration in e-cig second-hand aerosol were from 2- (Dp = 25.5 nm) to 3800-fold (Dp = 9.31 nm) higher than in tobacco smoke highlighting that particles exhaled by users and potentially inhaled by bystanders are nano-sized with high penetration capacity into human airways.

Proof of nicotine transfer to rat pups through maternal breast feeding to evaluate the neurobehavioral consequences of nicotine exposure.

This study investigates the transfer of nicotine from lactating dams to their offspring through breast milk, in the frame of a research focused to ascertain toxicological and neuro-behavioural effects on pups as consequence of either unavoidable ("yoked & forced") or voluntary ("freely-chosen") maternal nicotine exposure. To this aim, plasmatic concentrations of nicotine and cotinine were determined by LC-MS/MS in Wistar rat pups whose mothers were orally administered with nicotine during lactation. Mothers were divided into a voluntary drinking group, an unavoidable consumption group, and controls. The limits of detection and quantification of the LC-MS/MS method were 0.20 and 0.65 ng/mL, respectively. Within-laboratory reproducibility (CV%) was <12%, with recovery of 86.2-118.8%. Results showed the presence of nicotine in 67% of samples from freely-chosen consumption group (1.30 ± 0.31 ng/mL) and in 60% of samples from yoked-consumption group (1.19 ± 0.62 ng/mL); cotinine was found in all the samples from freely-chosen (1.92 ± 0.77 ng/mL) and yoked-consumption groups (1.43 ± 0.30 ng/mL). Data provide an evidence-based support to maternal/offspring nicotine transfer as function of different ways of oral exposure.

Forced but not free-choice nicotine during lactation alters maternal behavior and noradrenergic system of pups: Impact on social behavior of adolescent isolated male rats.

Adverse effects of nicotine during pregnancy have been greatly studied, while nowadays few works are focused on consequences of maternal tobacco smoking after birth. The present study investigated the behavioral and early neurochemical effects of nicotine treatment during first weeks of post-natal life in rats. We used "free choice" treatment (H2O+NIC dams could drink from two bottles, containing 10mg/L nicotine hydrogen tartrate salt, or water) versus "forced choice" (NIC+NIC mothers could drink from two bottles both containing nicotine hydrogen tartrate salt, range from 0.75mg/L to 4.09mg/L). We found that only "forced nicotine" had impact on maternal behavior, causing increased high-quality maternal care. This immediately impacted on neuro-chemical development, affecting NE levels (only males) in pup's striatum and prefrontal cortex (pFC) at PND 12. After weaning, animals were reared in normal conditions (two brother rats) or in Social Isolation. After two weeks, they were tested with Social Interaction Test (isolated rats met non-isolated opponents, siblings vs. non-siblings). As expected, isolated rats displayed an aggressive form of soliciting behavior: when facing an isolated unknown partner, the non-isolated rat tried to escape. Interestingly, if their dams were exposed to forced nicotine, both rats sooner behaved very affiliative (possibly empathic) between non-sibling partners. As expected, being exposed to post-natal nicotine could alter neuro-chemical development, but with important interactions between both maternal care and adolescent social behavior.

Excretion profile of corticosteroids in bovine urine compared with tissue residues after therapeutic and growth-promoting administration of dexamethasone.

The illicit use of dexamethasone as growth-promoting agent in animal breeding is still practiced within the EU constituting a health risk for meat consumers. An experimental study was developed to assess dexamethasone urinary excretion and tissue distribution (liver, kidney, and muscle) in male calves after therapeutic and growth-promoting administration. Urine and tissue samples collected from treated and untreated bovines were also investigated for the presence of other natural and synthetic corticosteroids (prednisolone, prednisone, hydrocortisone, and cortisone), in order to study a possible correlation with dexamethasone administration and to clarify prednisolone origin. Analyses were performed by a multi-residue LC-MS/MS method developed and validated according to the Commission Decision 2002/657/EC. The results confirm the rapid rate of dexamethasone urinary excretion, irrespective of the dosage, the duration and the route of administration, and the disappearance of cortisone and hydrocortisone during the treatment. Dexamethasone was distributed to the tissues where the elimination rate proceeded relatively slower as suggested by the presence of residues one month after the withdrawal of the therapeutic treatment. An increase in the number of positive findings for prednisolone, in association with higher levels of cortisone and hydrocortisone, was observed in urine samples collected from slaughterhouse rather than those collected at the farm. Prednisone residues were found only in one urine sample that showed the highest levels of prednisolone, hydrocortisone, and cortisone. The occurrence of prednisolone residues in urine and even in tissue samples confirms the endogenous nature of this molecule.