Skin cleansing and topical product use in patients with epidermolysis bullosa: Results from a multicenter database.

BACKGROUND/OBJECTIVES: Epidermolysis bullosa (EB) comprises a group of inherited skin blistering diseases. There is currently no cure, and management includes skin protection and prevention of infection. To date, there has been no systematic investigation of home skin care practices among EB patients on a multicenter scale. METHODS: This cross-sectional, observational study included data collected from patients with EB enrolled in the Epidermolysis Bullosa Characterization and Clinical Outcomes Database (EBCCOD) who provided answers to a patient-directed questionnaire between January 1, 2017, and December 31, 2017. RESULTS: Of 202 respondents, 130 (64.4%) had dystrophic EB, 51 (25.2%) had EB simplex, 21 (7.4%) had junctional EB, 3 (1.5%) had Kindler syndrome, and 3 (1.5%) had an unspecified subtype. Seventy-eight patients reported cleansing in plain water only (39%). Of those who used an additive in their cleansing water, 75 (57%) added salt, 71 (54%) added bleach, 36 (27%) added vinegar, and 34 (26%) endorsed the use of an "other" additive (multiple additives possible). Reported concentrations of additives ranged widely from 0.002% sodium hypochlorite and 0.002% acetic acid solutions, which are thought to have negligible effects on microbes, to 0.09% sodium hypochlorite and 0.156% acetic acid, concentrations shown to be cytotoxic. One hundred eighty-eight patients answered questions regarding topical product use (93%). Of those, 131 reported topical antimicrobial use (70%). Mupirocin and bacitracin were the most commonly reported topical antibiotics (59, 58 [31.4%, 30.9%], respectively). CONCLUSIONS: These findings highlight the variety of skin care routines and frequent use of topical antimicrobials among EB patients and have potential implications for antibiotic resistance. The reported range of bleach and vinegar additives to cleansing water, including cytotoxic concentrations, emphasizes the need for clear and optimized skin cleansing recommendations.

Ethanolamines permeate slowly across human skin ex vivo, but cause severe skin irritation at low concentrations.

Skin exposures are common during cleaning activities, and may contribute to the overall body burden. Cleaning products may contain irritants such as monoethanolamine (MEA) and diethanol amine (DEA). The significance of the skin exposure route is unknown, as no estimates for MEA skin permeation are available. We used in vitro flow-through diffusion cells with excised fresh human skin to measure skin permeation, and assessed skin damage with histological methods. MEA(aq) by itself (2%) or as a constituent in cleaning products (0.25% working solution) did not permeate after 1 h or 24 h of exposure. MEA(aq) (10%) did not permeate skin after 1 h but after 24 h with a delay (Tlag; 7 h) and a moderate permeation rate (J; 26.6 µg/cm2/h). MEA permeation rate was 20-fold greater (544 µg/cm2/h) and » of the time lag (1.5 h) when applied as undiluted cleaning product (13% MEA) compared to 10% MEA(aq). DEA in cleaning products did not permeate skin after 24 h. MEA and DEA produced skin irritations at low concentrations (1% MEA) and severe skin irritations when tested as a constituent in cleaning products. Absorption increased from 0 to 3% after 24 h to 14-29% after 88 h of MEA exposure, and is likely explained by the increased damage of the skin barrier. Limitations of this study are the low number of skin donors (N = 5) available. Our results demonstrate that topically applied MEA permeates across human skin relatively slowly and not below 5% while relatively extensively as a constituent of a commercial cleaning product.

A Cohort Study Using a Facial Cleansing Brush With Acne Cleansing Brush Head and a Gel Cleanser in Subjects With Mild-to-Moderate Acne and Acne-Prone Skin

Introduction: Acne vulgaris is a highly prevalent skin condition that can adversely affect the quality of life. Acne-predisposed skin is in a state of subclinical inflammation leading to skin barrier dysfunction. A multi-center cohort study was designed to evaluate clinical efficacy and safety of twice daily facial cleansing using an oscillatory sonic brush, acne brush head, and cleansing gel for 4 weeks. Methods: Subjects with mild-to-moderate acne and acne-prone skin used the cleansing regime after which they applied the skin care products they routinely used. Physician-assessed skin condition comparing baseline versus week 4 using the FDA/IGA scale and subject satisfaction with cleansing efficacy and handling properties of the regime were scored during the last visit. Results: Forty-six subjects completed the study. Physician-scored skin condition showed a statistically significant improvement in FDA/IGA scores and a significant reduction of inflammatory and non-inflammatory lesions comparing baseline versus 4 weeks. Thirty-five (76.0%) subjects had cleared or almost cleared. Subjects similarly assessed their skin to be improved. Conclusion: Both the physician and subject scores revealed the gentle cleansing routine using the sonic brush to be effective reducing the number of acne lesions, improving skin condition. No adverse events were reported during the study period. The cleansing regime may offer an attractive, safe option for maintenance and treatment of subjects with mild-to-moderate acne and acne-prone skin. J Drugs Dermatol. 2019;18(11):1140-1145.

WITHDRAWN: Ear drops for the removal of ear wax.

BACKGROUND: Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use. OBJECTIVES: To assess the effectiveness of ear drops (cerumenolytics) for the removal of symptomatic ear wax. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was April 2008. SELECTION CRITERIA: We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted ear wax, and in which the proportion of participants with sufficient clearance of the external canal to make further mechanical clearance unnecessary (primary outcome measure) was stated or calculable. DATA COLLECTION AND ANALYSIS: The two authors reviewed all the retrieved trials and applied the inclusion criteria independently. MAIN RESULTS: Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention.Overall, results were inconclusive. The majority of comparisons showed no difference between treatments.  Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments.In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate ear drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'.One trial of moderate methodological quality found all three treatments - sodium bicarbonate ear drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing.None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons. AUTHORS' CONCLUSIONS: Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic ear wax. Using drops of any sort appears to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.

Fragrance allergens in household detergents.

Consumers are confronted with a large number of fragrance allergens from various sources. Until now, the discussion of exposure sources has mainly addressed cosmetic products and neglected other scented products in households. For the first time, fragrance allergens were evaluated in a complete set of detergents in households. In 131 households, we investigated the prevalence of detergents and searched their lists of ingredients for 26 fragrance allergens liable to be indicated on products according to the European Detergents Regulations. On the ingredient lists of 1447 products, these 26 fragrance substances were named almost 2000 times, most often limonene, linalool and hexyl cinnamal. Benzyl salicylate was used frequently in all-purpose cleaners. Linalool and limonene, hexyl cinnamal and butylphenyl methylpropional and citronellol and linalool co-occurred most often together in products. Fragrance allergens co-occurring together most frequently within households were eugenol, coumarin and cinnamyl alcohol. The study shows that detergents could play a relevant role for the exposure of consumers towards fragrance allergens and that they should not be underestimated as an exposure source during the exposure assessment.

The Effect of an Anti-Inflammatory Botanical Cleanser/Night Mask Combination on Facial Redness Reduction.

Facial redness is a common difficult to control cosmetic problem representing various phases of rosacea. Using anti-inflammatory/antioxidant botanicals in moisturizer formulations is a possible approach to minimizing the erythema. This research utilized a common facial cleanser, but only applied the botanically based moisturizer to one half face to properly assess efficacy. 30 female subjects Fitzpatrick skin types I-IV 30-55 years of age with mild to moderate chronic facial redness, defined as a redness score of 3-6 on a 10-point scale, were enrolled. By the end of week 4, statistically significant improvement was seen on the cleanser/mask treated side in scaling (P less than 0.001), flaking (P less than 0.001), tactile smoothness (P less than 0.001), textural smoothness (P less than 0.001), firmness (P less than 0.001), radiance (P less than 0.001), luminosity (P less than 0.001), and overall appearance (P less than 0.001). Thus, cosmetic moisturizers may be useful in reducing facial redness. J Drugs Dermatol. 2018;17(6):671-676.

Chlorine Dioxide Complex Cleanser: A New Agent With Rapid Efficacy for Keratosis Pilaris.

Chlorine dioxide complex™ is a new molecule to dermatology that is a unique, non-toxic, broad spectrum anti-microbial and keratolytic compound. Chlorine dioxide has been used as an antiseptic in industrial settings for decades, primarily in water treatment facilities for municipal water supplies and food preparation. The compound has exceptional antiseptic properties with no known potential for development of resistance. It is a true keratolytic and anti-inflammatory, but is non-toxic to human tissue due to its unique mechanism of action. Chlorine dioxide's use in consumer products was previously limited because it is inherently an unstable molecule that had to be used quickly after it was produced. However, the recent development of a complexed form of chlorine dioxide that retains its antimicrobial and keratolytic activity has allowed the development of products (AsepticMD, Aseptic Plus, Nashville, TN) that take advantage of the properties of this unique molecule. Here we report a case series demonstrating its efficacy as a cleanser in keratosis pilaris. J Drugs Dermatol. 2018;17(5):554-556.

Evaluation of the Efficacy of Ultrasound-Guided Local Lauromacrogol Injection Combined with Aspiration for Cesarean Scar Pregnancy: A Novel Treatment.

OBJECTIVES: To evaluate the efficacy of ultrasound-guided local lauromacrogol injection combined with aspiration for treating cesarean scar pregnancy (CSP). METHODS: From July 2016 to December 2016, 18 patients diagnosed with CSP were treated with ultrasound-guided local lauromacrogol injection combined with aspiration. Clinical data and outcome were analysed. RESULTS: All patients were treated successfully. The amount of bleeding ranged between 10 and 50 mL. The duration of hospitalization ranged between 2 and 11 days. Serum ß-human chorionic gonadotropin (ß-hCG) decreased to the nondetectable level within 19-41 days. Menstruation recovery occurred after 10-24 days of normalization of serum ß-hCG level. Reproductive functions were preserved, and there were no untoward effects or complications. CONCLUSIONS: Ultrasound-guided local lauromacrogol injection combined with aspiration is an effective CSP therapy, as it was associated with a high success rate, short hospitalization and fast recovery. However, its wider application and popularization have to be validated on a larger patient population affected by CSP.

[Influence of probiotics on the establishment of a competitive flora, as well as on antibiotic use and performance parameters in pig breeding farms]. / Einfluss von Probiotika auf die Etablierung einer Konkurrenzflora sowie auf den Antibiotikaverbrauch und die Leistung in Schweinezuchtbetrieben.

INTRODUCTION: The aim of the present study was to investigate the effect of Probiotics in Progress (PIP) on the establishment of a competitive flora as well as on antibiotic use and losses of suckling piglets in pig breeding farms. The tested products were PIP AHC® and PIP AHS® produced by "Chrisal AG" in Lommel, Belgium. PIP`s are cleaning products containing Bacillus spores. According to the manufacturer's specifications, they are able to establish a steady non-pathogenic stable flora. In a field trial in 19 pig breeding farms, the use of PIP-products did not lead to any reduction of antibiotic use or improvement of fertility parameters, especially in relation to losses of suckling piglets. In addition, we compared the bacterial flora using PIP products with the flora under conventional management conditions in a farrowing pen by means of swab samples. The use of PIP-products did not lead to any significant effect on the pen flora. Only very few swab samples contained a majority of probiotic Bacillus spp.

INTRODUCTION: Le but de la présente étude était d'étudier l'effet de Probiotica in Progress (PIP) sur l'établissement d'une flore concurrente ainsi que son effet sur la consommation d'antibiotiques et sur les pertes chez les porcelets dans les porcheries d'élevage. On a utilisé pour ce faire les produits PIP AHC® et PIP AHS® de la maison "Chrisal SA" à Lommel en Belgique. Les PIP sont des produits de nettoyage auxquels ont été adjoints des spores de Bacillus et qui, selon les informations du fabriquant, conduisent à l'établissement d'une flore d'écurie apathogène stable. Dans le cadre d'un essai de terrain dans 19 porcheries d'élevage, l'utilisation des produits PIP n'a amené aucune réduction de la consommation d'antibiotiques et aucune amélioration des performances, en particulier en ce qui concerne les pertes au niveau des porcelets. En outre on a comparé dans une porcherie, sur la base d'échantillons d'essuyage, la flore bactérienne présente sous l'effet de PIP à celle recueillie avec un management usuel. L'utilisation des produits PIP n'a pas amené d'effet significatif ou d'influence sur la flore bactérienne. Ce n'est que dans quelques échantillons qu'il a été possible de constater une présence augmentée de Bacillus spp. probiotiques.

Effect of commercial cleansers on skin barrier permeability.

BACKGROUND: Addition of hydrophobically modified polymers (HMPs) to cleansers can reduce the negative impact of surfactant-based cleansers. In this study, the effects of a cleanser containing HMPs, a gentle lotion cleanser (GLC), water, and 1% sodium lauryl sulfate (SLS) on barrier permeability, were evaluated in vitro in pig skin and in vivo in humans. METHODS: Skin stratum corneum (SC) barrier function was quantitated by imaging fluorescence intensity of the sulforhodamine B (SRB) in a pig skin model system using 2-photon and conventional fluorescence confocal microscopy. Solutions containing SRB were applied to pig skin in Franz diffusion cells over a period of 2 h. Penetration of SRB into the skin was monitored from 2 µm to 38 µm. In vivo surfactant/cleanser penetration in human skin was determined using tape stripping. RESULTS: After 2 h, water, 1% SLS, and GLC, significantly increased SRB intensity at all depths measured. SRB intensity was reduced in the HMP-cleanser group compared with other groups at each depth. In vivo, the presence of HMP reduced SLS penetration as measured by tape stripping. CONCLUSION: The cleanser containing HMP prevented changes in SC permeability and surfactant penetration, indicating a protective effect on skin barrier properties.

Facial skin physiology recovery kinetics during 180 min post-washing with a cleanser.

BACKGROUND/PURPOSE: Facial cleansing is important to clean and exfoliate the skin while maintaining optimal physiologic function. However, there is insufficient data on the very early stage of skin change after applying soap or cleansing foam. We investigated the recovery kinetics of facial skin physiology during 180 min after exposure to the cleanser. METHODS: For the study, 22 Korean female subjects with normal and dry to oily skin type were recruited in this study. Study subjects were required to have face washing done within the 12 hours prior to visiting the research center, with only toner, lotion, or cream applied. The next day, the subjects visited the research center without face washing. We evaluated the skin hydration (Corneometer(®) CM 825), sebum (Sebumeter(®) SM 815), transepidermal water loss (Tewameter(®) TM 300), and pH (Skin-pH-Meter(®) PH 905) to define recovery kinetics of facial skin physiology during 180 min exposure post-cleansing. RESULTS: Skin hydration, sebum, and TEWL were significantly decreased at 20 min after washing, as compared to the baseline (P < 0.05). And skin hydration returned at 40 min, and skin sebum and TEWL returned at 120 min after washing. However, skin pH did not show significant differences at all times points. CONCLUSIONS: This study indicated that each of the skin parameters was restored at defined time points post-cleansing. Our result could be a useful reference to set the resting time in the estimation of skin bioengineering parameters.

Over-the-counter treatments for acne and rosacea.

Acne and rosacea are common inflammatory processes historically classified in the same disease category, but evolving understanding of their disparate pathophysiology and exacerbating factors have generated an enormous armamentarium of therapeutic possibilities. Patients seek over-the-counter therapies first when managing cutaneous disease; therefore, this review defines ingredients considered to be effective over-the-counter acne and rosacea products, their mechanisms, and safe formulations, including botanical components, oral supplements, and other anecdotal options in this vast skin care domain.

Self-injection of household cleaning detergents into a ventriculoperitoneal shunt reservoir during a suicide attempt: a case report and literature review.

Self-injection of household cleaning detergents (more specifically, commercial toilet bowl cleaner) into the reservoir of a ventriculoperitoneal shunt (VPS) has never been reported in the neurosurgical literature. A right-handed 41-year-old female with a past medical history significant for bipolar depression (with multiple prior hospital admissions for suicide attempts) and pseudotumor cerebri (status-post VPS placement from a right frontal approach) successfully injected ∼5 ml of toilet bowl cleaner into her ventricular shunt reservoir during a suicide attempt. She was found unresponsive by a family member 48 h after this event and presented to our hospital in moribund neurological condition (bilaterally fixed and dilated pupils with decerebrate posturing). Head computed tomography (CT) demonstrated marked ventriculomegaly. She was taken emergently to the operating room for placement of a left frontal ventriculostomy. Cerebrospinal fluid (CSF) sampled intraoperatively showed numerous Gram-positive cocci (later determined to be Staphylococcus epidermidis). For this reason, her right-sided shunt system was also removed in its entirety. She was treated with broad-spectrum intravenous and intraventricular antibiotics for her bacterial ventriculitis and her CSF was aggressively drained to treat her hydrocephalus. Once her infection had resolved, the shunt was replaced (using a right parietal approach) and she went on to make an excellent neurological recovery. Here, the authors present the case of a patient who self-injected household cleaning detergents into her VPS reservoir-and, likely, the ventricular system-during a suicide attempt and subsequently developed hydrocephalus and ventriculitis. Following this infrequent clinical scenario, consideration should be given to temporary ventriculostomy placement and shunt removal. Moreover, in patients with a known history of psychiatric co-morbidities-and particularly those patients with prior suicide attempts-the neurosurgeon should give serious consideration to placing the shunt system in an anatomical region which is difficult for the patient to self-access based upon their handedness.

Effects of washing of the face with a mild facial cleanser formulated with sodium laureth carboxylate and alkyl carboxylates on acne in Japanese adult males.

BACKGROUND/PURPOSE: Washing the face with a mild cleanser is generally recommended for acne care. Occasionally, the general public has the misconception that acne is exacerbated by cleansers and furthermore it has concerns about inducing skin irritation and xerosis by intensive washing. Recently, we developed a new cleanser based on sodium laureth carboxylate and alkyl carboxylates (AEC/soap) that cleans sebum well without penetrating the stratum corneum. METHODS: We designed a controlled clinical trial conducted on adult Japanese males with moderate or less acne. Twenty subjects washed their faces with AEC/soap base cleanser twice a day for 4 weeks. Assessment of the efficacy was conducted prior to the start of the study, and at the end of weeks 2 and 4. RESULTS: Significant improvement of the acne was observed within 2 weeks, and acne lesions were not detectable in 25% of the subjects at week 4. Sebum secretion levels on the skin significantly increased on the forehead, but significantly decreased on the cheek which correlated with the improvement. No complaints of dryness or irritation occurred during the study. CONCLUSION: Washing the face twice a day with facial cleanser based on AEC/soap is an effective care for moderate or less grade facial acne.

Biotransformation of trans-1-chloro-3,3,3-trifluoropropene (trans-HCFO-1233zd).

trans-1-Chloro-3,3,3-trifluoropropene (trans-HCFO-1233zd) is a novel foam blowing and precision cleaning agent with a very low impact for global warming and ozone depletion. trans-HCFO-1233zd also has a low potential for toxicity in rodents and is negative in genotoxicity testing. The biotransformation of trans-HCFO-1233zd and kinetics of metabolite excretion with urine were assessed in vitro and in animals after inhalation exposures. For in vitro characterization, liver microsomes from rats, rabbits and humans were incubated with trans-HCFO-1233zd. Male Sprague Dawley rats and female New Zealand White rabbits were exposed to 2,000, 5,000 and 10,000ppm for 6h and urine was collected for 48h after the end of the exposure. Study specimens were analyzed for metabolites using (19)F NMR, LC-MS/MS and GC/MS. S-(3,3,3-trifluoro-trans-propenyl)-glutathione was identified as predominant metabolite of trans-HCFO-1233zd in all microsomal incubation experiments in the presence of glutathione. Products of the oxidative biotransformation of trans-HCFO-1233zd were only minor metabolites when glutathione was present. In rats, both 3,3,3-trifluorolactic acid and N-acetyl-(3,3,3-trifluoro-trans-propenyl)-l-cysteine were observed as major urinary metabolites. 3,3,3-Trifluorolactic acid was not detected in the urine of rabbits. Quantitation showed rapid excretion of both metabolites in both species (t1/2<6h) and the extent of biotransformation of trans-HCFO-1233zd was determined as approximately 0.01% of received dose in rabbits and approximately 0.002% in rats. trans-HCFO-1233zd undergoes both oxidative biotransformation and glutathione conjugation at very low rates. The low extent of biotransformation and the rapid excretion of metabolites formed are consistent with the very low potential for toxicity of trans-HCFO-1233zd in mammals.

Solvent detergent vs. fresh frozen plasma in cirrhotic patients undergoing liver transplant surgery: a prospective randomized control study.

BACKGROUND: Although orthotopic liver transplantation (OLT) is nowadays considered standard practice at experienced centres, it can still be affected by a significant risk of massive bleeding and its related complications. Solvent/detergent plasma (S/D Plasma) has been proposed as an alternative to fresh frozen plasma (FFP) to curtail such complications. This study aimed at evaluating the efficacy of S/D Plasma in OLT patients by comparing it to FFP. MATERIALS AND METHODS: Sixty-three OLT patients were randomized into two groups depending on whether they were transfused with FFP or S/D plasma. A thromboelastography-based protocol aimed at achieving and maintaining predetermined coagulation goals was used to guide plasma transfusions. At the beginning and the end of surgery, standard laboratory coagulation tests were performed together with the assessment of the VII, VIII, V, XII factors and S protein blood levels. RESULTS: The two study groups equally achieved the thromboelastography goals but with a reduced amount of transfusions in the S/D plasma group (P < 0.0001). At the end of surgery, factors V and XII and S protein blood levels were lower in the S/D plasma patients who also showed lower INR, aPTT and antithrombin III levels. CONCLUSION: In cirrhotic patients undergoing OLT, the use of S\D plasma associated with thromboelastography allows the same clinical results but with a significant reduction in the amount of plasma transfusions.

Gas-producing cellulitis from injection of spot remover fluid (n-Hexane).

BACKGROUND: Subcutaneous administration of hydrocarbons, categorized according to their toxicological profiles, is rare compared to oral, inhalational, and cutaneous routes of exposure. Furthermore, injection of n-hexane in humans has not been described. OBJECTIVES: This report demonstrates a singular case of subcutaneous administration of n-hexane. CASE REPORT: A 21-year-old man presented to the Emergency Department (ED) 7 h after injecting his left antecubital fossa with approximately 5 cc of spot remover fluid, which contained more than 95% n-hexane, in a suicide attempt. There was redness in the left forearm, but no apparent swelling was observed. He was administered tetanus prophylaxis and discharged with follow-up. However, the patient returned to the ED 14 h later, complaining of progression of the swelling around the injection site extending to the axilla. Significant volume of air in the soft tissue of the affected extremity was noted on both the radiograph and computed tomography scan; therefore, an immediate extensive incision and debridement of the diseased limb was performed. The postoperative course was uneventful, and a complete resolution of emphysema without any functional deficits was obtained for 5 months of follow-up. CONCLUSION: In patients suffering from n-hexane injection, initial physical examination findings may not be apparent. Thus, the patient must be monitored closely for evidence of a spread of subcutaneous gas with elevation and immobilization. If increase in tissue pressure or spread of gas is not prevented, as in our case, immediate incision and removal of the toxic substances should be planned.

Study to assess in vitro antimicrobial activity of nine ear cleaners against 50 Malassezia pachydermatis isolates.

BACKGROUND: Ear cleaning is an important part of the successful therapy of otitis externa. HYPOTHESIS/OBJECTIVES: To evaluate the in vitro activity of nine commercially available ear cleaners (Cerumaural(®), CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Otoclean(®), Otodine(®), Sancerum(®), Surosolve(®) and TrizUltra™ + Keto) against 50 Malassezia pachydermatis isolates from clinical cases of canine otitis externa. To the authors' knowledge, this is the first study to analyse the in vitro susceptibility of a large number of M. pachydermatis isolates to a variety of ear cleaner products. ANIMALS: Forty-nine hospital population dogs diagnosed with otitis externa with Malassezia spp. present on cytological examination of ear swabs and culture. METHODS: The antimicrobial activity of nine ear cleaners was tested against 50 M. pachydermatis isolates from 49 clinical cases of canine otitis externa using an in vitro agar diffusion test. RESULTS: There were statistically significant differences in activity between ear cleaners, with five showing excellent in vitro anti-Malassezia activity (CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Sancerum(®) and TrizUltra™ + Keto), two moderate activity (Otodine(®) and Surosolve(®)), one variable activity (Otoclean(®)) and one no activity (Cerumaural(®)). There was a significant overall difference in susceptibility between M. pachydermatis isolates tested (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Ear cleaners with activity against Malassezia may help to reduce the unnecessary use of antibiotic-containing polypharmaceutical ear medications. This study shows that the use of a large number of isolates may provide a more accurate account of the in vitro activity of a product.

Effectiveness of implant surface decontamination using a high-pressure sodium bicarbonate protocol: an in vitro study.

OBJECTIVES: To evaluate the effectiveness of a high-pressure sodium bicarbonate spray protocol to decontaminate implant surfaces intentionally inoculated with bacteria. MATERIALS AND METHODS: Twenty commercially pure titanium implants, 10 with machined surfaces and 10 with rough surfaces, were inoculated with Streptococcus sanguis and then submitted to a decontamination protocol using a high-pressure sodium bicarbonate spray device for 1 minute under aseptic conditions. RESULTS: After the application of the decontamination protocol, all bacterial cells were removed from the tested implants, regardless of surface roughness. CONCLUSION: The results suggest that regardless of the implant surface roughness, the protocol using high-pressure sodium bicarbonate spray for 1 minute, under aseptic conditions, was effective in removing all the viable bacterial cells.

Geospatial correlation between COVID-19 health misinformation and poisoning with household cleaners in the Greater Boston Area.

INTRODUCTION: Calls to poison control about exposure to household cleaners have increased during the COVID-19 pandemic. This dynamic may reflect increased exposure from public health efforts as well as health misinformation shared on social media. METHODS: We analyzed the dynamics of calls to the Regional Center for Poison Control and Prevention serving Massachusetts and Rhode Island (MARI PCC) and tweets discussing treating COVID-19 with house cleaners from January 20, 2020 to May 5, 2020. We obtained publicly available tweets discussing the use of household cleaners to "cure COVID" from the same time period with geographic co-ordinates indicating that they were emitted from the Greater Boston Area. RESULTS: Our main finding is that public health efforts were followed by a sustained increase in calls after March 15, 2020 (10 ± 2 calls per day before to 15 ± 2.5 after) while misinformation on social media was associated with intermittent spikes in calls. Overall, calls significantly increased during the study period by 34% as compared to the previous 8 years, mostly reporting unintentional ingestions with no serious effects. The daily volume of tweets and retweets was significantly correlated with daily call rates to MARI PCC for the surrounding 7-10 days. CONCLUSIONS: Health misinformation on social media about using household cleaning agents to treat COVID-19 and public health efforts lead to different dynamics in PCC calls. Public health efforts were followed by a sustained increase in calls after March 15, 2020 while misinformation on social media was followed by intermittent spikes in calls. This analysis is the first to link the geospatial dynamics of social media and public health interventions to poison center calls about exposure to household cleaners.