Toxico-clinical study of patients poisoned with household products; a two-year cross-sectional study.

BACKGROUND: Several studies worldwide have investigated household product poisoning. We conducted a toxico-clinical study on the two-year prevalence of poisoning with household products. METHODS: This cross-sectional study was performed in Khorshid Hospital, the main referral center for poisoning cases in Isfahan, affiliated to Isfahan University of Medical Sciences, Isfahan, central Iran. All patients with intentional or unintentional household substance poisoning, referring to the poisoning emergency center of the hospital, were evaluated with respect to epidemiological and toxico-clinical features and outcomes. RESULTS: During the study period, 5946 patients were hospitalized, of which 83 (1.39%) had been poisoned with household products including 48 (57.8%) men and 35 (42.2%) women with a mean ± SD age of 34.40 ± 17.71 years. Most patients (54.2%) were in the 20-40-year-old age group. Accidental poisoning (63.9%) was the most common type of exposure (P = 0.02) predominantly in men (57.8%, P = 0.51). The most common household products were sodium hypochlorite (32.53%) followed by petroleum hydrocarbon (21.68%). Most of the accidental poisonings (77.8%) were due to petroleum hydrocarbon. 59% of cases were poisoned at home (P < 0.0001). No patient died. CONCLUSION: Household products were not common means of poisoning in our referral center. Sodium hypochlorite and petroleum hydrocarbon were the most common substances. Most of the patients were men with accidental exposure at home. Because of the availability of the household product, the frequency and outcomes may be varied in different societies.

Remote psychophysical evaluation of olfactory and gustatory functions in early-stage coronavirus disease 2019 patients: the Bologna experience of 300 cases.

BACKGROUND: An objective evaluation of coronavirus disease 2019 in the first days of infection is almost impossible, as affected individuals are generally in home quarantine, and there is limited accessibility for the operator who should perform the test. To overcome this limitation, a recently validated psychophysical self-administered test was used, which can be performed remotely in the assessment of early-stage coronavirus disease 2019 patients. METHODS: Olfactory and gustatory functions were objectively assessed in 300 patients in the first 7 days from coronavirus disease 2019 symptom onset. RESULTS: Seventy per cent of the patients presented olfactory and/or gustatory disorders. The dysfunctions detected were mainly complete anosmia (47 per cent) or ageusia (38 per cent). A significant correlation was found between taste dysfunction and female gender (odds ratio = 1.936, p = 0.014) and fever (odds ratio = 2.132, p = 0.003). CONCLUSION: The psychophysical evaluation protocol proposed is an effective tool for the fast and objective evaluation of patients in the early stages of coronavirus disease 2019. Chemosensitive disorders have been confirmed to be frequent and early symptoms of the coronavirus infection, and, in a significant number of cases, they are the first or only manifestation of coronavirus disease 2019.

Preservatives in Personal Hygiene and Cosmetic Products, Topical Medications, and Household Cleaners in Spain. / Conservantes en productos de higiene y cosméticos, medicamentos tópicos y productos de limpieza doméstica en España.

INTRODUCTION: Preservatives are added to cosmetic, household cleaning, and other industrial products to prevent the growth of microorganisms. Unfortunately, exposure to these substances can cause sensitization. MATERIAL AND METHODS: Between January and June 2015, we analyzed the ingredients of 2300 products commercially available in Spain to identify the frequency of a wide variety of preservatives in different product categories. We analyzed 1093 skin care and cosmetic products sold exclusively in pharmacies (dermocosmetics), 458 household cleaning and personal hygiene and cosmetic products sold in supermarkets, 636 topical medications, and 113 cosmetic products sold in a herbal shop. RESULTS: Phenoxyethanol, citric acid, sodium benzoate, and potassium sorbate were very common in all the cosmetic product categories. Parabens were present in 16.1% of dermocosmetic products, 14.45% of cosmetic products available in supermarkets, 0.88% of cosmetic products available in the herbal shop, 5.18% of topical medications, and in none of the cleaning products. Isothiazolinones were identified in 2.56% of dermocosmetic products, 18% of cosmetic products in supermarkets, 7.9% of cosmetic products in the herbal shop, 63.63% of household cleaners, and in none of the topical medications. Formaldehyde releasers were detected in 5.76% of dermocosmetic products, 6.42% of cosmetic products sold in supermarkets, 7.96% of cosmetic products sold in the herbal shop, 3.93% of topical medications, and 16.74% of household cleaners. CONCLUSIONS: Evaluation of the presence of preservatives in everyday products allows us to indirectly estimate exposure levels to each one. Measures restricting the use of the most problematic preservatives need to be strengthened.

Development of herbal disinfectants formulation for mopping households and its antibacterial activity.

There are many household products like detergents, disinfectants, stain removers and cosmetics releasing chemicals that may be harmful to human health as well as cause hazardous effect on environment. Global world is now focusing on use of herbal products. They are eco-friendly and more suitable to household applications than chemicals. The present study focused on preparation of three plant-based formulations for household cleaning applications. Result showed antibacterial activity against most commonly available microbes viz. Escherichia coli and Staphylococcus aureus. This is the first report of Terminalia chebula for preparation of herbal cleaners.

A model for screening and prioritizing consumer nanoproduct risks: A case study from South Africa.

The potential risks of the increasing variety and volume of engineered nanomaterials (ENMs) entering into the ecosystem remain poorly quantified. In recent years, information essential to evaluate the ecological risks of ENMs has increased. However, the data are highly fragmented, limited, or severely lacking. This limits the usefulness of the information to support holistic screening and prioritization of potentially harmful ENMs. To screen and prioritize ENMs risks, we adopted a two-phased approach. First, a holistic framework model was developed to integrate a diverse set of factors aimed to assess the potential hazard, exposure, and in turn, risk to the ecosystem of ENMs from a given consumer nanoproduct. Secondly, using published literature we created a database of consumer nanoproduct categories, and types based on embedded ENMs type. The database consisted of eight consumer product categories, eleven different types of ENMs, and twenty-three nanoproduct types. The model results indicates the largest quantities of ENMs were released from sunscreens, textiles, cosmetics and paints with dominant ENMs quantities in descending order (based on quantity) as nTiO2>nZnO>nSiO2>nAg, and nFe2O3. In addition, according to the results from this study, nAg from washing machine were found to likely the highest risk to the environment. Overall, our model-derived results based on the case study illustrated: (i) the holistic framework's ability to screen, prioritize, rank, and compare ENMs potential exposure and risks among different nanoproducts categories and types, (ii) the derived risk estimations could support nanowastes classification with likelihood of non-uniformity of nanowastes classes even from the same nanoproduct category (e.g. cosmetics), and (iii) the lack of a mass-based criteria specific for EMNs impedes realistic exposure and risk evaluation in the ecological systems.

Determination of Common Adulterants in Herbal Medicine and Food Samples using Core-shell Column Coupled to Tandem Mass Spectrometry.

High-performance liquid chromatography coupled to tandem mass spectrometry was used to develop and validate a rapid method to qualitatively and quantitatively analyse 18 common adulterants in herbal medicine and food samples. Initially, the mobile phase composition was optimized in three different columns: core-shell, monolithic and standard 3.5-µm-particle-size columns. The results show that the core-shell column provides the best separation. Moreover, the tandem mass spectrometry was optimized. The linear range for all adulterants was 0.5-500 µg mL-1. Finally, the samples that were supplied by the Public Authority of Customer Protection, Ministry of Health, and those collected from the local market were analysed. The results indicate that 7 of 33 analysed samples contained adulterants. The adulterated samples mainly contain sildenafil, tadalafil or vardenafil. The concentrations of these three adulterants in the samples were 0.18-39 wt%. This study is the first report in the Sultanate of Oman about adulteration in herbal medicine and food samples. The results clearly raise some concern and require proper plan of action to increase public awareness about this serious issue.

Effects of reclaimed water matrix on fate of pharmaceuticals and personal care products in soil.

Reclaimed water is increasingly used to supplement water resources. However, reclaimed water has a complex matrix, which includes emerging chemical contaminants, that is introduced to the soil when this water is used for irrigation. The effects of microbial activity, dissolved matter, nutrients, and particulate matter in reclaimed water on half-life of 11 pharmaceutical and personal care products (PPCPs) in soil were investigated with 7 treatment waters, namely swine lagoon effluent (either unaltered, sterilized, or filtered and sterilized) and nanopure water (either unaltered or with added nitrogen, phosphorus, or potassium). The extractable residues of the parent PPCPs were measured over 35 d. Lagoon microbial activity was significantly (p ≤ 0.05) related to increased half-life of 4 PPCPs (carbamazepine, fluoxetine, ibuprofen, sulfamethoxazole) by 14-74%, and to decreased half-life of 3 others (caffeine, gemfibrozil, naproxen) by 13-25%. The presence of lagoon dissolved matter was significantly correlated with a 20-110% increase in half-life for 6 PPCPs (caffeine, estrone, gemfibrozil, ibuprofen, naproxen, triclocarban). However, lagoon particulate matter was significantly correlated with 9-52% decrease in half-life for these same compounds, as well as trimethoprim. The levels of nitrogen, phosphorous, and potassium in the lagoon effluent were not significantly related to half-life for most PPCPs, except caffeine. Overall, specific components of reclaimed water matrix had different effects on the soil half-lives of PPCPs, suggesting that the composition of reclaimed water needs to be considered when evaluating PPCP fate after land application.

A Qualitative Exploration of Less Acculturated Mexican Mothers' Safety Perceptions of Herbs, Medicines, and Cleaners in the Home.

Childhood poisoning is a leading public health concern in our society. The death rate from unintentional poisonings among children has increased by 80% from 2000 to 2009. Immigrant children are also at-risk. A qualitative study, consisting of a pile sort, was conducted among immigrant Mexican mothers to determine their safety perceptions of commonly used medicines, herbs, and cleaners. Participants (N = 35) were selected for semi-structured interviews from a pediatric primary care clinic in the Dallas/Fort Worth Metroplex. Some mothers over-estimated their children's ability to discern the dangers of substances, relied heavily on sensory skills of children, and perceived a medicine as safe after successful use in the past. Other mothers were more cognizant of allergic reactions, ingestion, and the need to store substances carefully. Brief interventions that incorporate culturally-appropriate safety messages are needed to assist Mexican mothers in creating a safe home environment.

An autopsy case of fatal repellent air freshener poisoning.

We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1h after the collapse, he was in cardiopulmonary arrest and subsequently died 10h after his arrival. The forensic autopsy performed 5.5h after death revealed the 380ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1µg/ml and 558.2µg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household.

Contribution of plants and traditional medicines to the disparities and similarities in acute poisoning incidents in Botswana, South Africa and Uganda.

BACKGROUND: Acute poisoning incidents are one of the leading causes of morbidity and hospitalization in several countries. The purpose of this analysis was to compare the patterns of acute poisoning in three countries namely, Botswana, South Africa and Uganda; and examine the similarities and disparities in the patterns of occurrence of acute poisoning based on the sociodemographic factors of the victims, the toxic agents involved, the circumstances surrounding the incidents and their outcomes. MATERIALS AND METHODS: This paper is based on the re-analysis of data that were collected from January to June 2005 by some Master of Public Health students using a similar data collection tool. A single dataset made of the original individual datasheets was constituted and analysed. RESULTS: Overall, it was found that the mean age of victims of acute poisoning was 20.9 ± 14.5 years; the youngest victim was a 3 months old boy from South Africa; and the oldest was a 75 years old man from Uganda. In descending order, the most common toxic agents involved in poisoning incidents were household products (46.1%), agrochemicals (18.8%), pharmaceuticals (14.0%), animal and insect bites (13.0%), food poisoning (4.5%), as well as plants and traditional medicines (3.6%). Across the three countries, acute poisoning occurred mainly by accident, but the contextual factors of each country led to a pattern of acute poisoning that showed some similarities with regard to the distribution of deliberate self-poisoning among females, teenagers, and young adult victims. There were disparities related to the differential access to toxic agents, based on the age and gender of the victims. Of the 17 deaths reported, 2 (11.7%) were due to traditional medicines; household products were implicated in fatal outcomes in all three countries, though the extent of their involvement varied from country to country. CONCLUSION: Although plant and traditional medicines caused fewer cases of acute poisoning incidents, they contributed considerably to fatal outcomes.

The optimal patch test concentration for ascaridole as a sensitizing component of tea tree oil.

BACKGROUND: Tea tree oil is used as a natural remedy, but is also a popular ingredient in household and cosmetic products. Oxidation of tea tree oil results in degradation products, such as ascaridole, which may cause allergic contact dermatitis. OBJECTIVES: To identify the optimal patch test concentration for ascaridole, and to investigate the relationship between a positive reaction to ascaridole and a positive reaction to oxidized tea tree oil. PATIENTS/MATERIALS/METHODS: Three hundred and nineteen patients with eczema were patch tested with ascaridole 1%, 2%, and 5%, and 250 patients were patch tested with oxidized tea tree oil 5%. Readings were performed on D3 and D7 according to a patch test calibration protocol. RESULTS: With an increasing ascaridole test concentration, the frequency of positive reactions increased: ascaridole 1%, 1.4%; ascaridole 2%, 5.5%; and ascaridole 5%, 7.2%. However, the frequencies of irritant and doubtful reactions also increased, especially for ascaridole 5%. A positive reaction to ascaridole was related to a positive reaction to tea tree oil. CONCLUSIONS: This study is in support of ascaridole being a sensitizer. We recommend patch testing with ascaridole at 2%. The finding that every positive reaction to oxidized tea tree oil is accompanied by a positive reaction to ascaridole suggests that ascaridole might be a contact allergen in oxidized tea tree oil.

[Acute intoxication in adults - what you should know]. / Akute Intoxikationen bei Erwachsenen - was Sie wissen sollten.

Ingestion of household products and plants are the leading cause for calls to the poison control centres as far as children are involved. Severe intoxication in children has become infrequent due to childproofed package and blister packs for drugs. Chemical accidents in adults give rise to hospital admission in only 5 %. Suicidal selfpoisonings are still a challenge for paramedics, emergency and hospital doctors. Natural toxins as amatoxins, cholchicine and snakebites can lead to severe intoxication. Sedatives, antidepressants and analgesics are the drugs which are often used for suicidal intent due to their availability. Quetiapine and paracetamol are the drugs which are ingested for attempted suicide/ suicide mostly. The treatment of poisoning centers on the severity which can be judged by the poison severity score, the Reed classification or the GCS.Most intoxicated patients can be treated symptomatically or by intensive care measurements. Antidotal treatment however is needed for some specific poisonings.Exact sample drawing is essential for diagnostic and forensic purposes. There is no evidence based proof for the effectiveness of primary detoxification from the gastrointestinal tract like forced emesis, gastric lavage or the use of cathartics. Early after the ingestion of a harmful substance the administration of activated charcoal seems advisable. Hemodialysis can remove water soluble substances with a small volume of distribution. Multiple charcoal administration may exhibit some influence on secondary detoxification. Provision of evidence of the efficacy for newer antidotes like hydroxocobalamin in smoke inhalation, fomepizol for toxic alcohols and silibinin for amanita poisoning are emerging. Two recently recommended therapeutic principles have still to demonstrate their ability: Firstly the treatment of patients with calcium receptor antagonistic and beta-receptor antagonistic agents poisoning by high dose of insulin plus glucose, secondly the treatment for severe intoxication with cardiotoxic and psychotropic drugs with a lipid emulsion (Lipid rescue).It is essential for all doctors to contact a poison control center whenever they are confronted with an intoxicated patient. There they can get advice about which dose is toxic and about the newest therapeutic procedure.

Maize flour fortification in Africa: markets, feasibility, coverage, and costs.

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries.

Domestic source of phosphorus to sewage treatment works.

Phosphorus is an element essential for life. Concerns regarding long-term security of supply and issues related to eutrophication of surface waters once released into the aquatic environment have led governments to consider and apply measures for reducing the use and discharge of phosphorus. Examples of source control include legislation to reduce phosphorus use in domestic detergents. This research shows that other domestic sources of phosphorus also contribute significantly to the domestic load to sewer and that overall, domestic sources dominate loads to sewage treatment works. Estimates provided here show that although the natural diet contributes 40% of the domestic phosphorus load, other potentially preventable sources contribute significantly to the estimated 44,000 tonnes of phosphorus entering UK sewage treatment works each year. In the UK, food additives are estimated to contribute 29% of the domestic load; automatic dishwashing detergents contribute 9% and potentially increasing; domestic laundry 14%, including contributions from phosphonates, but decreasing; phosphorus dosing to reduce lead levels in tap water 6%; food waste disposed of down the drain 1%; and personal care products 1%. Although UK data is presented here, it is anticipated that similar impacts would be expected for other developed economies. Consideration of alternatives to all preventable sources of phosphorus from these sources would therefore offer potentially significant reductions in phosphorus loads to sewage treatment works and hence to the aquatic environment. Combining all source control measures and applying them to their maximum extent could potentially lead to the prevention of over 22,000 tonnes-P/year entering sewage treatment works.

Membrane bioreactor and nanofiltration hybrid system for reclamation of municipal wastewater: removal of nutrients, organic matter and micropollutants.

A membrane bioreactor (MBR) and nanofiltration (NF) hybrid system was investigated to demonstrate the performance of treating nitrogen, phosphorus and pharmaceuticals and personal care products (PPCPs) in municipal wastewater. With the MBR and NF (molecular weight cut off (MWCO): 210 Da), the concentration of total nitrogen (TN) and total phosphorus (TP) was effectively reduced by nitrification by MBR and negatively charged surface of NF (TN: 8.67 mgN/L and TP: 0.46 mgP/L). Biosorption and microbial decomposition in MBR seem to be major removal mechanisms for the removal of PPCPs. Among various parameters affecting the removal of PPCPs by NF, namely, physicochemical properties of the PPCPs (charge characteristics, hydrophobicity and M(W)) and membranes (MWCO and surface charge), the MWCO effect was found to be the most critical aspect.

The changing trends of childhood poisoning at a tertiary children's hospital in South Africa.

CONTEXT: Information on childhood poisoning in the developing world, including South Africa, is scarce, despite its contribution to morbidity and mortality. OBJECTIVE: We describe the profile of children with exposures and poisonings presenting to Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa, from 2003 to 2008 and compare the trends of causative agents over the past two decades. METHODS: Cases were identified by review of the RCWMCH case records. RESULTS: Of the total incidents (N=2 872), paraffin (kerosene) was the commonest agent (n=692, 24%) with 124 poisonings including two deaths. Drugs were the most common toxin group (n=988, 34%), including 139 single-drug poisonings with 5 deaths; 4 associated with traditional medicine use. Household cleaning product incidents (n=302, 10%) resulted in 29 single product poisonings with no deaths. Pesticide incidents (n=311, 10%) included 6 deaths; 203 (65%) incidents were due to organophosphates or carbamates. The suburban distribution of the main toxin groups varied. Comparing 1987 and 2008, the number of incidents decreased from 1 116 to 447; drug and paraffin incidents decreased respectively (from 673 to 150 and from 332 to 87), household cleaning products and cosmetics increased (21 to69) and pesticide incidents increased (7 to 69). CONCLUSION: Despite a decrease in the overall number of incidents over two decades at RCWMCH, paraffin and drugs remain the principal agents responsible for paediatric exposures and poisonings, with increasing incidents due to household cleaning products and pesticides. Identification of these toxin groups coming from specific suburbs allows for targeted prevention initiatives.

Comparison between Emergency Patient Poisoning Cases and the Tox-Info System Database

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.

[Migration of eight harmful elements from household products made with synthetic resin that infants may swallow by mistake].

Harmful elements are used as stabilizers and colorants in synthetic resin products. Accidental ingestion of harmful elements from such synthetic resins by infants is a dangerous health hazard. The Japanese Food Sanitation Law and the International Standard ISO 8124-3 "Safety of toys-Part 3: Migration of certain elements" control the levels of migrated harmful elements, such as lead or cadmium, from infants toys. However, the levels of migrated harmful elements from household products that are not infants toys are not controlled, since they are not covered by the law or standard. Therefore, we investigated the level of eight harmful elements (antimony, arsenic, barium, cadmium, chromium, lead, mercury and selenium) migrated from household products made of synthetic resin that infants may swallow by mistake. The extraction test of ISO 8124-3: 2010 was executed in 135 products (total 150 specimens), and the concentration of these elements was measured by inductively coupled plasma mass spectroscopy (ICP-MS). As a result, 1810 mg/kg and 1660 mg/kg of lead, exceeding the maximum acceptable level of the ISO standard, migrated from two products. In addition, lead and/or chromium at levels more than 1/10 of the maximum acceptable levels of the ISO standard migrated from four products. Household products that infants may swallow by mistake should ideally not release harmful elements such as lead and chromium.