Microbial contamination of tattoo and permanent makeup inks marketed in the US: a follow-up study.

In a 2018 survey, U.S. Food and Drug Administration (FDA) identified microbial contamination in 42 (49%) of 85 unopened tattoo and permanent makeup (PMU) inks purchased from 13 manufacturers in the US between November 2015 and April 2016. To confirm the results of our previous survey, we evaluated the level of microbial contamination in an additional 27 samples from 10 manufacturers from September 2017 to December 2017, including 21 unopened tattoo and PMU inks which were selected based on our previous survey results and 6 ink diluents that were not previously analysed. Aerobic plate count and enrichment culture methods from the FDA's Bacteriological Analytical Manual revealed 11 (52%) out of 21 inks, from six manufacturers, were contaminated with micro-organisms, with contamination levels up to 3·6 × 108  CFU per gram, consistent with our previous survey results. We identified 25 bacterial strains belonging to nine genera and 19 species. Strains of Bacillus sp. (11 strains, 44%) were dominant, followed by Paenibacillus sp. (5 strains, 20%). Clinically relevant strains, such as Kocuria rhizophila and Oligella ureolytica, were also identified, as similar to the findings in our previous survey. No microbial contamination was detected in any of the six ink diluents.

FDA 2014 survey of eye area cosmetics for microbiological safety.

In an attempt to assess cosmetics containing 'nontraditional' preservatives, 93 eye area cosmetic products were selected based on labelled or marketed claims that these products were 'green', 'natural', 'paraben-free', 'preservative-free' or contained nontraditional preservatives (e.g. botanical extracts). Products were analysed for water activity, pH and microbiological content, which included enumeration of aerobic micro-organisms, detection of microbial growth after a 7-day enrichment and identification of microbial isolates. The survey found that 60% (56/93) of the eye area cosmetics were free of microbiological growth under test conditions, 32% (30/93) showed the presence of micro-organisms at low levels (<100 CFU per ml or g) and 8% (7/93) showed microbiological growth at higher levels (> 100 CFU per ml or g). Gram-positive bacteria such as Bacillus and Staphylococcus were the dominant genera identified in these cosmetic products, whereas Gram-negative species were relatively uncommon. The survey found a positive association between lower water activity cosmetics and the presence of micro-organisms in these products. Similarly, colour cosmetics were more likely to contain micro-organisms than noncolour cosmetics. The most represented micro-organisms in the survey were from genus Bacillus, suggesting that the natural raw materials are the likely source of observed microbial loads. SIGNIFICANCE AND IMPACT OF THE STUDY: In the United States, cosmetic products are regulated postmarket; therefore, surveillance programmes are one of FDA's most important tools for monitoring microbiological safety of cosmetics. 'Traditional' preservatives, such as parabens and formaldehyde releasers, are perceived unfavourably by some consumers, resulting in cosmetic manufacturers increasingly using 'nontraditional' preservatives. FDA conducted an analytical survey of eye area cosmetics that claimed to be free of traditional preservatives and determined microbiological loads in tested products. This study explores the association of microbial loads with the physical and chemical characteristics of the cosmetic products, and points to the limits of preservative activity in cosmetics.

Giant Left Atrium - A Rare Case of Acute Upper Gastrointestinal Bleeding.

Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Various rare causes have been described in the literature but there are very few cases of giant left atrium leading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumatic valvular heart disease with giant left atrium who presented in our department with acute upper GI bleeding.

A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding.

BACKGROUD: Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality. OBJECTIVE: To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome. METHOD: This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis. RESULT: Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6. CONCLUSION: Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

A national survey of consultants, specialists and specialist registrars in restorative dentistry for the assessment and treatment planning of oral cancer patients.

AIMS: To investigate the approach of restorative dentists towards the assessment and treatment planning of oral cancer patients in the UK. MATERIAL AND METHODS: The survey was conducted at the annual meeting of the Association of Consultants in Restorative Dentistry (ACSRD) and Specialist Registrar in Restorative Dentistry group (SRRDG) in September 2011. Delegates were requested to fill in a two-section questionnaire; the first section included 16 questions, evaluating cancer service provision in their units, and the second included five questions based on a clinical scenario evaluating dental management of a patient undergoing pre-radiotherapy treatment. RESULTS: Ninety-four questionnaires were distributed; 65 (69.1%) were returned. Thirty (46.1%) respondents were consultants, 27 (41.5%) were specialist registrars and the remaining 8 (12.3%) were either specialist practitioners or trust grade dentists working in the speciality of restorative dentistry. Forty-eight (73%) of the respondents worked in NHS posts and the remaining 17 (27%) worked in academic posts. A total of 50 (77%) respondents carried out clinical work which regularly included the dental assessment or treatment of head and neck (H&N) oncology patients, before or post radiotherapy. Among the respondents who were involved in the dental assessment of oncology patients, 32% of them did not have a protocol for review appointments in their units. Ninety-one percent of respondents said that they used dental implants for rehabilitation post cancer surgery and 80% also used implants either always or sometimes in irradiated bone. Answers to scenario questions highlighted that all the respondents would extract very poorly prognostic tooth (that is, root stumps) before radiotherapy, irrespective of it being at the side of the planned radiotherapy field. Fifty-eight percent of respondents preferred to extract a non-functional, heavily restored, non-carious, distal maxillary molar tooth which was not in the area of radiotherapy beam and the majority (84%) chose to carry out root canal treatment (RCT) of a functional premolar tooth if considered non vital. CONCLUSION: This study highlights the variability in the approach of clinicians in dental and oral rehabilitation of patients undergoing radiotherapy treatment for oral cancer patients.

A study of seven day mortality in acute ischemic stroke in a teaching hospital in Chitwan.

BACKGROUND: Stroke mortality rate indicates a measure in hospital quality care. Most of the available data are from developed countries and are for late mortality. Only few studies on 7-day fatality, a recently implemented indicator of early stoke mortality, are reported. We attempted to identify the predictors of clinical outcome by 7th day in acute ischemic stroke. METHODS: This descriptive study included 100 consecutive cases of acute ischemic stroke admitted to Neurology center of a teaching hospital in Chitwan, Nepal. Common risk factors were identified. The cases were classified as per TOAST classification and severity at admission assessed using National Institutes of Health Stroke Scale. Univariate and multivariate analysis was used to analyze the data. RESULTS: Thirteen percent patients expired by 7th day. On univariate analysis severity of stroke, fever, atrial fibrillation, hypertension at admission and early neurological deterioration were related to early 7-day mortality where as age, gender, smoking, diabetes mellitus, coronary artery disease, early onset seizures, dyslipidemaia, and hematocrit were unrelated to early mortality. Multivariate analysis showed that only NIHS score was significantly correlated with early mortality. CONCLUSIONS: A mortality rate of 13 percent was noted by 7th day. A positive association was noted with stroke severity, early neurological deterioration, arterial fibrillation, hypertension and fever at onset.

C-reactive protein and early mortality in acute ischemic stroke.

BACKGROUND: There is growing evidence that inflammation plays an important role in atherogenesis. Several studies have shown that C-reactive protein (CRP), an inflammatory marker, is associated with stroke severity and outcome. But limited studies are there which show the relationship of CRP with early mortality i.e within seven days. OBJECTIVE: To study the association of CRP within 24 hours after acute ischemic stroke onset with severity during admission, types of ischemic stroke and outcome. METHODS: This cross sectional study was done including 100 consecutive cases of acute ischemic stroke admitted to Neurology center of College of Medical Sciences, Bharatpur (Chitwan), Nepal. The cases were classified as per TOAST classification and severity at admission assessed using National Institutes of Health Stroke Scale. C-reactive protein (CRP) level was estimated by latex particle agglutination test. RESULT: Thirteen percent patients expired by 7th day. In the expired group, CRP was positive in 15.3 percent, 15.3 percent and 61.5 percent in patients with lacunar, cardioembolic and large artery atherosclerotic infarction respectively (p 0.19). CRP was positive in all 7 patients (53.8%) who had expired with severe NIHS scale (p 0.004). CONCLUSION: High CRP level is associated with stroke severity at admission and is an independent predictor of early seven day mortality after ischemic stroke.

Characterization of a hemoglobin variant: HbQ-India / IVS 1-1 [G>T]-ß-thalassemia.

Hemoglobin Q- India (alpha) 64 Asp → His is an alpha chain variant which is generally found in heterozygous state and presents normal hematological blood picture. Here we report a rare case of HbQ-India with a thalassemic phenotype that has been analyzed using a combination of mass spectrometry, gene sequencing and PCR analysis. This combined analyses revealed the HbQ variant to be associated with a beta chain mutation, IVS 1-1 [G>T]. Though HbQ has earlier been reported with thalassemic trait using different techniques, this is the first report of a compound α and ß chain Hb heterozygous mutant involving HbQ and IVS1-1 being validated using Mass Spectrometry and Reverse dot blot hybridization.

A national survey of oral and maxillofacial surgeons' attitudes towards the treatment and dental rehabilitation of oral cancer patients.

AIMS: To investigate the attitudes of maxillofacial surgeons in the treatment and dental rehabilitation of oral cancer patients in the UK. MATERIAL AND METHODS: The survey was conducted by postal questionnaires with 17 close-ended questions. A total of 229 questionnaires were sent to members of the British Association of Oral and Maxillofacial Surgeons over a one week period. A follow-up was sent if a reply was not received within 12 weeks. These results were compared to a similar study that was carried out approximately 15 years ago. RESULTS: The response rate was 65.5% (150/229). Overall 62% of respondents (92/150) carried out maxillary resections, which represents a decline of 23% on the previous study. There has been an increase in surgeons reconstructing the maxillary defect from 38% in the 1995 study to 91% in the present study. Ninety-eight percent of respondents had their patients seen in a multidisciplinary team (MDT) clinic, but in only 30% of the cases was a restorative dentist present on these clinics. There has been an improvement in the accessibility of a restorative dentist for this patient cohort, from 65% to 90%. The use of implants for dental rehabilitation post-cancer surgery has increased from 43% to 93%. CONCLUSION: This study highlights the changes in the dental and oral rehabilitation of patients undergoing resective surgery for oral cancer and especially those undergoing a maxillectomy procedure. It illustrates the increased use of implants for post-surgery rehabilitation and shows the different trends in which these implants are placed. An important aspect of this study is the input of the dental team. Current national guidelines state that a consultant restorative dentist needs to be a member of the MDT; this survey shows that this was the case in only 30% of responses.

Management of patients on warfarin by general dental practitioners in South West Wales: continuing the audit cycle.

AIMS: To ascertain the current management protocols of patients on warfarin by general dental practitioners (GDPs) in South West Wales and to compare these findings with current guidelines and the results from a previous audit published in 2003. MATERIALS AND METHODS: A questionnaire similar to that used in the first audit was sent to 447 GDPs in South West Wales. In addition, questions were included on factors which might affect international normalised ratio (INR), the timing of pre-operative INR assessment and the risk of bleeding associated with implant surgery. GDPs' details were derived from the online GDC database of registered dental practitioners. Registered specialists and GDPs who practised only orthodontics were excluded. RESULTS: Of the 447 questionnaires distributed, 332 (74%) were returned. Eight percent (n = 26) of the respondents did not treat patients on warfarin. Two hundred and forty-seven respondents (74%) considered implant placement as a procedure with high risk of bleeding, with inferior dental block, sub-gingival restorations and sub-gingival debridement receiving a lower response (45%, 28% and 12%, respectively). When planning a high risk procedure, 206 respondents (63%) indicated they would seek advice from a cardiologist or general medical practitioner; none of the respondents would advise the patient to reduce their warfarin dose, while 1% indicated they would ask the patient to stop taking warfarin without seeking any medical opinion. A total of 278 respondents (84%) stated they would check the INR before treatment and of these, 214 (65%) indicated they would do so within 24 hours of treatment and 60 (18%) within 48 hours. Ten respondents said they would not normally check INR. One hundred and twelve respondents (34%) considered 2.5 as the safe upper INR limit for performing high risk procedures, 21 (6%) considered an INR of between 1 and 2 as the safe limit, 99 (30%) considered and INR of 3 as safe, 36 (10%) considered 3.5 as safe and 36 (10%) considered an INR of 4 as safe. Finally, 286 respondents (86%) considered drug interactions and 236 (71%) considered alcohol as significant influencing factors on INR. CONCLUSIONS: The findings demonstrate a broad change in practice towards the new recommendations produced in 2001 but also highlight that further education and support may be necessary, as well as greater consistency in published guidelines.

Maintaining a high level of suspicion for recurrent malignant disease: report of a case with periapical involvement.

AIM: To report the unusual endodontic presentation and radiographic features of a subgroup of pleomorphic adenoma called carcinoma ex pleomorphic adenoma and to stress the importance of maintaining a high level of suspicion in cases where primary or recurrent neoplasia is included in the differential diagnosis. SUMMARY: This paper describes a case in which a patient with a previous history of malignant neoplasm presented with signs and symptoms similar to a dental infection. The pathology report however confirmed recurrence of the previous tumour in a malignant fashion. The importance of maintaining a high level of suspicion in early management of such disease is highlighted. KEY LEARNING POINTS: *Pleomorphic adenomas, also known as benign mixed tumours, are common salivary gland tumours, which infrequently undergo malignant transformation, with potentially devastating consequences. *Malignant salivary gland tumours can present as dental swelling, dental pain and sudden loss of vitality of teeth so both general practitioners and specialists have the responsibility to evaluate such patients with a broad vision. *Radiographic differential diagnosis of periapical radiolucency should also include malignant salivary gland tumours. *This case highlights the need of vigilance at all times and emphasizes the benefits of biopsy and histological examination in the diagnosis of recurrent malignant salivary gland tumours.

Growth rate effects of mutations conferring streptomycin-dependence and of ancillary mutations in the rpsL gene of Escherichia coli: implications for the clustering (hypermutation) hypothesis for spontaneous mutation.

Colonies of newly arising streptomycin-dependent (SmD) mutants frequently contain a high proportion of cells with additional mutations (ancillary mutations) in the same gene (rpsL). The ancillary mutations appear to have arisen at a rate greatly above expectation. To better estimate this rate it is necessary to allow for any selective advantage conferred by the ancillary mutations. We have previously measured their effect on growth rate of established SmD strains in the presence of streptomycin. In the present work a pair of single and double mutant alleles (rpsL832 and rpsL852 respectively) has been employed together with the wild-type allele to model the situation soon after such mutations first arise, i.e. when the cell still contains wild-type S12 protein (the rpsL gene product). When these alleles, under the control of an IPTG-inducible promoter and carried on a plasmid, were expressed in the presence of a chromosomal wild-type allele, the double mutant allele permitted much faster cell growth than the single mutant allele. In the presence of streptomycin, and with rpsL+ on a plasmid, bacteria with a double mutant chromosomal gene grew faster than those with a single mutant chromosomal gene. If these results can be extrapolated to a bacterial cell in which an SmD mutation has just occurred, the ancillary mutation should be able to confer a selective advantage during a limited period when wild-type S12 protein is still present, both in the absence and in the presence of streptomycin.(ABSTRACT TRUNCATED AT 250 WORDS)

Anhidrotic Ectodermal Dysplasia with Palmo-plantar Keratoderma.

A patient with anhidrotic ectodermal dysplasia and palmo-plantar keratoderma is presented. Palmo-planta keratoderma is an unusual association with this disease. Atopic dermatitis was another associated condition in this patient.