Do lead (Pb) content of lipsticks expose a health risk to children? A risk assessment study.

BACKGROUND: Lead (Pb) content in lipsticks and potential life-long exposure of which might cause severe effects in consumers are an important concern for public. Thus, studies emphasize that lead exposure has no safe levels. METHODS: From 10 different brands, in total, 25 solid, gloss and creamy lipsticks are deployed from Turkish markets that are also categorized in two different price ranges. In order to evaluate the blood Pb levels in children, the United States Environmental Protection Agency's 'Exposure Uptake Biokinetic Model' is utilized. To assess the health risk of chronic usage both for children and adults, oral daily systemic exposure levels are calculated with the worst-case scenario and are compared with Maximum Allowable Dose Level for lipsticks. For lifetime risk assessment, exposure is assumed to start by age 7, and four different exposure scenarios have been deployed. RESULTS: The mean lead content of lipsticks shows significant statistical differences between the high- and low-priced lipstick groups. Daily level and total risk for lifetime Pb exposure from deployed lipsticks are below the acceptable risk levels but long-worn usage of products with routine monitoring of metal content is crucial for sensitive and unintended exposure groups.

Assessment of Patients with Hirschsprung Disease and the Use of Laparoscopy.

OBJECTIVES: This study aims to evaluate patients who were diagnosed and treated due to Hirschsprung disease (HD) in our clinic. METHODS: We retrospectively evaluated the demographic and clinical findings of the patients with HD, who were operated in our clinic between January 2010 and December 2015. RESULTS: During study period, 28 patients (19 male 9 female) were found to be operated due to HD in our clinic. Mean age was 16.8 months (1-168). "Transanal Endorectal Pull-through (TERPT)" was performed to 20 of them, Duhamell procedure to five and Soave procedure to three of them. TERPT was applied as laparoscopy assisted in four of them and biopsies were taken laparoscopically preoperatively from one of the patients from each group. Soave procedure was performed in three patients; one had anal stenosis and history of recurrent enterocolitis after TERPT procedure and pathologic analysis revealed neuronal intestinal dysplasia and the other one had total colonic HD and performed Soave procedure with colonic patch. Seven (25%) patients had enterocolitis. Frequencies of enterocolitis were three in two patients, two in two patients and one in three patients. Broad spectrum anibiotics and rectal washouts were supplied to these patients. Five of the seven patients with enterocolitis were operated with TERPT; two patients were operated with Duhamell procedure. Only one of them had total colonic HD. Three patients had total colonic HD diagnosis. Two of them were operated with Duhamell-Martin procedure and one was with Soave procedure with colonic patch according to Kimura technique. Anal stenosis developed in two patients after TERPT and treated with dilatations. Soiling rate was 3% (1/28) and this single patient was treated with laxatives and toilet training. Mean duration of hospitalization was 8.75 (2-14) days. Mean length of the removed intestinal segment was 23.6 (5-38) cm. Mean follow-up was for 35.5 (2-56) months. Neither of the patients was followed in the intensive care unit postoperatively nor died. CONCLUSION: TERPT procedure win priority in HD, but other procedures keep importance. Recently, laparoscopy-assisted TERPT is preferred in our clinic in HD therapy due to easy biopsy, full exposure to the transitional zone, the advantage of meso preparation of colon and prevention of strained anastomosis.

Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio.

BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. METHODS: 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). RESULTS: In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ±â€¯18.13 ml and 53.24 ±â€¯22.11 ml vs 48.85 ±â€¯12.89 ml and 42.08 ±â€¯13.85 (p = 0.037). LAVi were 20.9 ±â€¯8.91 ml/m2 and 26.85 ±â€¯11.28 ml/m2 vs 25.36 ±â€¯6.21 and 21.87 ±â€¯6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ±â€¯4.09 ng/ml and 6.02 ±â€¯2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ±â€¯1.07 103/µl and 1.98 ±â€¯0.66 103/µl (p = 0.674). CONCLUSION: LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.

Expert panel on cost analysis of atrial fibrillation.

OBJECTIVE: To estimate total cost of atrial fibrillation (AF) management concerning acute coronary syndrome, heart failure, stroke and drug related adverse events with respect to clinical practice and available guidelines. METHODS: This cost analysis study was based on identification of total costs related to management of acute coronary syndrome, heart failure, stroke and the drug related adverse events in patients with AF based on standardized questionnaire forms filled by experts according to their daily clinical practice and also to ACCF/AHA/ESC guidelines. Total cost included cost items related to treatment, healthcare resources utilization, and diagnostic test and consultations. RESULTS: The yearly cost of acute coronary syndrome per patient was 5.478.43 TL according to expert's view reflecting real clinical practice whereas it was 11.319.44 TL when calculation was based on recommendations in the guidelines. The average total cost of heart failure was 4.523.74 TL according to expert's view whereas it was 2.925.86 TL based on guidelines. The average total cost of stroke was 5.719.25 TL according to expert's view but 7.931.18 TL based on guidelines. Among drug related adverse events, only those related to cardiac adverse events were estimated to be higher according to expert view as compared to guideline recommendations (288.65 vs. 150.99 TL). CONCLUSIONS: Reflecting the treatment algorithms in the management of AF and related adverse events, our findings seem to emphasize the extra burden on health economics posed by patients suffering from the uncontrolled disease.

Systolic tissue velocity is a useful echocardiographic parameter in assessment of left atrial appendage function in patients with mitral stenosis.

BACKGROUND: The incidence of thromboembolism remains high in patients with mitral stenosis (MS). The left atrial appendage (LAA) is a potential site for development of thrombus and LAA dysfunction is an independent predictor of thromboembolism. The LAA dysfunction is represented by reduced LAA late emptying velocity. But the magnitude of LAA flow velocities is dependent on acute changes in loading conditions. AIM: To investigate the value of the LAA tissue velocities obtained by tissue Doppler imaging (TDI) in assessment of LAA function in MS patients with and without thromboembolic events. METHODS: The study population consisted of 98 isolated MS patients of 32 age and sex-matched healthy controls. All subjects underwent transesophageal echocardiography (TEE). LAA late peak emptying (LAAEV) and filling (LAAFV) flow velocities were recorded. LAA peak late tissue systolic (LSV) and diastolic (LDV) tissue velocities by TDI were measured. The patients were divided into three groups as Group I (n = 38, sinus rhythm and LAAEV > or = 25 cm/s), Group II (n = 26, sinus rhythm and LAAEV < 25 cm/s), and Group III (n = 34, atrial fibrillation). RESULTS: Twenty-one patients had thromboembolic events. LAAEV, LAAFV, LSV, and LDV were significantly reduced in patients with embolic events. Spontaneous echo contrast (SEC) density was strongly negative correlated with LSV, whereas weakly negative correlated with LAAEV. Multivariate regression analysis showed that LSV and the presence of SEC were independently associated with embolic events. CONCLUSION: LSV seems more reliable and useful parameter in evaluating LAA function. LAA function is more depressed among patients with embolic events.