Capacidad olfativa y niveles de hormonas tiroideas en artesanos fabricantes de joyas expuestos al cianuro en Chordeleg, Ecuador / Alterations of sensitivity to contrast and stereopsis in workers exposed to aromatic hydrocarbons

Antecedentes: La exposición laboral crónica al cianuro se ha asociado con toxicidad en el sistema nervioso central caracterizada por alteraciones en la capacidad olfativa, así como disfunción de la glándula tiroides; se ha evidenciado lo anterior en individuos dedicados a oficios relacionados con la metalurgia y la joyería para extracción y purificación de metales como el oro y la plata, como los artesanos fabricantes de joyas en Chordeleg, Ecuador Objetivo: Evaluar la capacidad olfativa y funcionamiento de la glándula tiroides en artesanos fabricantes de joyas expuestos al cianuro en Chordeleg, Ecuador. Material y Métodos: Se estudiaron 69 individuos, realizando la medición los niveles séricos de hormonas tiroideas, la capacidad olfativa se evaluó por medio del Sniffin Stick Test, el análisis estadístico se realizó en el programa SPSS 15.0. Resultados: La capacidad olfativa de los participantes en este estudio expuestos al cianuro se encontró disminuida, hiposmia 33,3% y anosmia 27,5%, los valores medios para T3, T4 y TSH según la presencia o no de alteraciones en los niveles de tiocianato en orina no presentaron diferencias significativas entre los grupos, asimismo no se presentó una correlación entre estas variables. Conclusiones: No se demostraron los efectos de la exposición ocupacional crónica al cianuro sobre la capacidad olfativa y la función de la glándula tiroides de artesanos fabricantes de joyas en Chordeleg, Ecuador (AU)

Background: Chronic occupational exposure to cyanide has been associated with central nervous system toxicity characterized by alterations in olfactory capacity as well as dysfunction of the thyroid gland; has evidenced the above in individuals dedicated to trades related to metallurgy and jewelry for extraction and purification of metals such as gold and silver, as artisans jewelry manufacturers in Chordeleg, Ecuador. Objective: Evaluate the olfactory capacity and functioning of the thyroid gland in artisan jewelry manufacturers exposed to cyanide in Chordeleg, Ecuador. Materials and Methods: Sixty-nine individuals were studied and serum levels of thyroid hormones were measured. The olfactory capacity was evaluated by the Sniffin Stick Test, the statistical analysis was performed in the SPSS 15.0 program. Results: The olfactory capacity of participants in this study exposed to cyanide was decreased hyposmia 33.3% and anosmia 27.5%, mean values for T3, T4 and TSH according to the presence or not of alterations in the levels of thiocyanate in urine did not present significant differences between the groups, and there was no correlation between these variables. Conclusions: The effects of chronic occupational exposure to cyanide on the olfactory capacity and function of the thyroid gland of jewelry makers in Chordeleg, Ecuador, were not demonstrated (AU)

Chromium and cobalt release from metallic earrings from the Danish market.

BACKGROUND: Chromium and cobalt are important skin sensitizers. It has, however, been difficult to identify causative exposures. Studies on nickel allergy have demonstrated piercing as critical for both sensitization and elicitation. It may be speculated that the same applies for chromium and cobalt. OBJECTIVE: To examine the content and release of chromium and cobalt from earrings randomly purchased in Denmark. METHODS: Three hundred four earrings were examined with x-ray fluorescence (XRF) spectrometry. Earrings with measured content of chromium or cobalt were spot tested with diphenylcarbazide spot test (n = 166) or Nitroso-R spot-test (n = 99), respectively. Chromium and cobalt release were quantified in a selected subsample (n = 100) with the artificial sweat test (EN 1811). RESULTS: Chromium was present in 54.6% (166/304) of earrings and cobalt was present in 72.0% (219/304),- measured by XRF. All chromium spot tests for chromium VI were negative. The cobalt spot test was positive for one component. Chromium release was found from 59/100 (median concentration = -0.06 µg/cm2 /week) and cobalt release from 29/100 (median concentration = -0.06 µg/cm2 /week) of earrings in tested subsample. CONCLUSION: Earrings for piercing release chromium and cobalt and may on a case basis be a source of chromium and cobalt allergy.

Quick cuts: A comparative study of two tools for ring tourniquet removal.

BACKGROUND: Ring tourniquet occurs when a ring becomes entrapped due to swelling or trauma. As the finger expands the blood flow restriction causes additional swelling, which can lead to nerve damage and other complications. Ring tourniquet can be an emergency that requires rapid ring removal. Standard devices for ring removal have been described but rarely tested. We conducted a randomized study to compare removal time, user and participant satisfaction and complications between a motorized diamond disc ring cutter (MDDRC) and a ring cutter attached to trauma shears (TS). METHODS: In pairs, emergency medicine providers removed rings using both devices and wore randomized rings to be removed (silver or steel). Each effort was timed from initiation to removal. After each effort both user and subject rated their satisfaction with the device, using a visual analog scale and reported any complications. Median and interquartile ranges were generated for the primary and secondary outcomes with 95% confidence intervals where applicable. Wilcoxon Rank Sum tests were calculated with a = 0.05 to compare removal time and secondary outcomes between the two tools. RESULTS: Thirty subjects completed the study. Median time to ring removal was significantly lower with the TS compared to the MDDRC (7.7 vs 67.0 s, p < .0001). Device user satisfaction (9.7/10 vs 3.8/10, p < .0001) and participant satisfaction (9.7/10 vs 6.8/10, p < .0001) were significantly higher with the TS, while participant discomfort was significantly lower with the TS (0.0/10 vs 2.2/10, p < .0001). CONCLUSION: This study is the first to compare efficacy, satisfaction and complications of two standard tools for removal of ring tourniquets. The TS took significantly less time than the GEM MDDRC and demonstrated significantly better satisfaction for both the ring wearer and ring remover.

Implicações do uso de adornos por profissionais de saúde na biossegurança da assistência ao paciente / Implication of the use of adornments by health professionals in the biosafety of patient care

Introdução: as infecções relacionadas à assistência à saúde (IRAS) são consideradas um problema de saúde global, pois colocam em risco a segurança do paciente e a qualidade assistencial. Considera-se que a principal via de disseminação de microrganismos relacionados a IRAS ocorre pelas mãos dos trabalhadores de saúde, destacando-se a utilização de adornos por profissionais de saúde como um agravante no âmbito a disseminação de microrganismos. Estudos revelam que a utilização desses objetos, principalmente anéis e alianças, propiciam maior impacto na carga bacteriana nas mãos dos trabalhadores. A Norma Regulamentadora 32 (NR32) visa estabelecer as diretrizes básicas para a implementação de medidas de proteção à segurança e à saúde dos trabalhadores dos serviços de saúde, dentre essas medidas está a proibição do uso de adornos por profissionais de saúde que prestam cuidados aos pacientes, principalmente profissionais que mantem contato com materiais biológicos. Objetivos: Analisar o uso de adornos por profissionais de saúde e as suas implicações na carga bacteriana das mãos e anéis após a realização de técnicas de higienização das mãos com uso de preparação alcoólica em gel a 70% ou com água e sabonete líquido. Método: Trata-se de um estudo, realizado em duas etapas. Na primeira realizou-se um estudo observacional e de prevalência por meio de inquérito realizado via mídia social para determinar se o uso de adornos por profissionais de enfermagem no ambiente hospitalar relaciona-se as variáveis sociodemográficas e ocupacionais, e os motivos da não adesão a NR32 por esses profissionais. Na segunda etapa realizou-se um experimento microbiológico por meio de contaminação artificial das mãos e alianças com Lactobacilos casei e posteriormente o protocolo de higienização das mãos para verificar a carga bactéria encontrada nas mãos e anéis de profissionais e estudantes da área da saúde. Resultados: A utilização de adornos por profissionais de enfermagem é frequente, pincipalmente o uso de aliança, relógio e brincos. Embora a 85% dos participantes conheça as normativas da NR32 referentes a remoção de adornos para a realização das atividades laborais, 15% profissionais informaram desconhecimento total ou parcial dessa recomendação o que remete a necessidade de revisão das práticas formativas e do frequente oferecimento de capacitação em serviço/treinamento. Com relação os resultados do experimento sobre o uso de alianças por profissionais de saúde constataram-se que não houve diferença entre a contaminação bacteriana das mãos dos participantes com e sem aliança. Porém, verificou-se que entre os grupos que higienizaram as mãos com o uso de preparação alcoólica em gel a 70% ou com água e sabonete líquido houve redução na carga bacteriana das mãos quando comparados ao grupo controle, grupo que higienizou as mãos com água e sabonete líquido demonstrou uma redução ainda maior das Unidades Formadoras de Colônias (UFC) Conclusão: A utilização de adornos por profissionais da enfermagem ainda é fonte de preocupação para as instituições de saúde devido a frequência do uso desses objetos mesmo diante do desencorajamento de uso e das recomendações legais. Pode-se perceber que a falta de capacitação em serviço/treinamento e de cobrança para remoção dos adornos são fatores dificultadores nesse processo. No que diz respeito ao uso de aliança por profissionais de saúde durante o procedimento de higienização das mãos fica evidente as implicações do seu uso principalmente quando a higienização não é realizada por remoção mecânica da sujidade, como é o caso da higienização das mãos com preparação alcoólica em gel a 70%.

Introduction: healthcare-related infections (HAI) are considered a global health problem, as they put patient safety and quality of care at risk. It is considered that the main way of dissemination of microorganisms related to HAI occurs through the hands of health workers, highlighting the use of adornments by health professionals as an aggravating factor in the scope of the spread of microorganisms. Studies reveal that the use of these objects, especially rings and wedding rings, provide a greater impact on the bacterial load on workers' hands. Regulatory Standard 32 aims to establish the basic guidelines for the implementation of measures to protect the safety and health of workers in health services, among these measures is the prohibition of the use of adornments by health professionals who provide care to patients, especially professionals that maintains contact with biological materials. Objectives: To analyze the use of adornments by health professionals and its implications on the bacterial load on hands and rings after performing hand hygiene techniques with the use of an alcoholic preparation in gel at 70% or with water and liquid soap. Method: This is a carried out in two stages. In the first, an observational and prevalence study was carried out through a survey conducted via social media to determine whether the use of adornments by nursing professionals in the hospital environment is related to sociodemographic and occupational variables, and the reasons for non-adherence to NR32 by these professionals. In the second stage, a microbiological experiment was carried out through artificial contamination of the hands and alliances with Lactobacilli casei and later the hand hygiene protocol to verify the bacterial load found in the hands and rings of health professionals and students. Results: The use of adornments by nursing professionals is frequent, especially the use of wedding rings, watches and earrings. Although 85% of the participants are aware of the NR32 regulations regarding the removal of adornments for the performance of work activities, 15% professionals reported total or partial lack of knowledge of this recommendation, which points to the need to review training practices and the frequent offer of training in service/training. Regarding the results of the experiment on the use of rings by health professionals, it was found that there was no difference between bacterial contamination of the hands of participants with and without rings. However, it was found that among the groups that cleaned their hands using an alcoholic preparation in gel at 70% or with water and liquid soap, there was a reduction in the bacterial load on the hands when compared to the control group, a group that cleaned their hands with water and liquid soap showed an even greater reduction in Colony Forming Units (CFU). Conclusion: The use of adornments by nursing professionals is still a source of concern for health institutions due to the frequency of use of these objects even in the face of discouragement of use and of the legal recommendations. It can be seen that the lack of in-service training/training and charging for the removal of adornments are hindering factors in this process. With regard to the use of a wedding band by health professionals during the hand hygiene procedure, the implications of its use are evident, especially when the cleaning is not carried out by mechanical removal of dirt, as is the case of hand hygiene with alcoholic preparation in 70% gel

DNA damage analysis concerning GSTM1 and GSTT1 gene polymorphism in gold jewellery workers from Peshawar Pakistan.

PURPOSE: To evaluate the genotoxic effects of gold jewellery fumes and its association with GSTM1 and GSTT1 genetic polymorphisms. MATERIALS AND METHODS: We examined 94 subjects including 54 gold jewellery workers and 40 controls. The DNA damage was evaluated by alkaline comet assay and genotyping by PCR. RESULTS: The mean total comet score (TCS) in gold jewellery workers was significantly higher as compared to the control subjects (128.0 ± 60.6 versus 47.7 ± 21.4; p = 0.0001). Duration of occupational exposure had positive correlation (r = 0.453, p < 0.01) with DNA damage. Age and tobacco use had significant effects on the TCS of the exposed group as compared to the control group (p < 0.05). The frequency of the GSTM1-null genotype in the exposed group was significant (p = 0.004) as compared to the control group. No significant association (p > 0.05) between the GSTM1 and GSTT1 genotypes and DNA damage was found. CONCLUSIONS: Our results suggest that there is increased DNA damage in gold jewellery workers due to their occupational surroundings. Hence there is a strong need to educate the workers about the adverse health effects of potentially hazardous chemicals and highlight the importance of using protective measures.

Prevalence of contact allergy to metals: nickel, palladium, and cobalt in Southern Sweden from 1995-2016.

BACKGROUND: In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel. OBJECTIVES: To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis. METHODS: A retrospective analysis of patch test results from 1995-2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations. RESULTS: The prevalence of nickel allergy decreased significantly in the youngest age group (6-30 years) for both female and male patients from 1995-1999 to 2012-2016: females: 33.4% to 19.1% (P < .001); males: 5.9% to 2.1% (P < .05). The concomitant reactions between nickel and palladium and nickel and cobalt among young females, respectively, also decreased significantly. Isolated palladium and cobalt allergy remained stable (1.4% and 2.3%, respectively) during the same time period for both men and women. CONCLUSIONS: The prevalence of nickel has decreased among young females and males suspected of contact allergy in Southern Sweden after the introduction of the EU nickel directive. There has been no change in isolated palladium or cobalt allergy.

Nickel allergy and allergic contact dermatitis: A clinical review of immunology, epidemiology, exposure, and treatment.

Nickel is the most frequent cause of contact allergy worldwide and has been studied extensively. This clinical review provides an updated overview of the epidemiology, exposure sources, methods for exposure quantification, skin deposition and penetration, immunology, diagnosis, thresholds for sensitization and elicitation, clinical pictures, prevention, and treatment. The implementation of a nickel regulation in Europe led to a decrease in the prevalence of nickel allergy, and changes in the clinical picture and disease severity. Nevertheless, the prevalences of nickel allergy in the European general population are approximately 8% to 19% in adults and 8% to 10% in children and adolescents, with a strong female predominance. Well-known consumer items such as jewellery and metal in clothing are still the main causes of nickel allergy and dermatitis, although a wide range of items for both private and occupational use may cause dermatitis. Allergic nickel dermatitis may be localized to the nickel exposure site, be more widespread, or present as hand eczema. Today, efficient methods for exposure quantification exist, and new insights regarding associated risk factors and immunological mechanisms underlying the disease have been obtained. Nevertheless, questions remain in relation to the pathogenesis, the persistent high prevalence, and the treatment of severe cases.

Causative exposures and temporal development of cobalt allergy in Denmark between 2002 and 2017.

BACKGROUND: Cobalt contact allergy is common, but clinical relevance is often difficult to determine. OBJECTIVES: To examine the aetiology, prevalence and clinical characteristics of cobalt-allergic patients who were patch tested between 2002 and 2017 at the Department of Dermatology and Allergy, Herlev-Gentofte Hospital. METHODS: Patch test data, along with patient characteristics and causative exposures, from all adult dermatitis patients seen and tested between 2002 and 2017 were analysed. Associations were tested with the χ 2 test and logistic regression. RESULTS: A total of 13 475 adults aged 18 to 99 years were patch tested. The overall prevalence of cobalt allergy and the prevalence of isolated cobalt allergy were 3.3% and 1.5%, respectively. The prevalence of isolated cobalt allergy decreased from 2.4% in 2006 to 2009 to 1.1% in 2014 to 2017 (Ptrend = 0.00003). Leather exposure as a relevant cause of allergic cobalt dermatitis increased from 3.7% in 2002 to 2009 to 8.3% in 2010 to 2017 (P = 0.04). The current clinical relevance of positive patch test reactions, that is, a positive reaction to cobalt combined with a history of current skin exposure to a source of cobalt, was 20.1%. CONCLUSIONS: We conclude that cobalt allergy is relatively common, but causative exposures are largely unknown, and the proportion of positive patch test reactions with clinical relevance is low. It is therefore currently unclear how we can better protect consumers and workers from cobalt exposure.

Nickel dermatitis from earrings 15 years after EU directive implementation: a clinical-epidemiological study and a market survey in Rome, Italy.

BACKGROUND: Nickel (Ni) dermatitis remains a highly prevalent allergic condition in Italy. There is a continuous need for clinical and epidemiological surveillance to evaluate whether or not European Ni Directive has been effective in contact allergy prevention. OBJECTIVES: To assess the prevalence of Ni dermatitis among patch-tested patients and self-interviewed school students and to analyse Ni release from earlobe jewellery. METHODS: Results of patch tests performed in 2006-2007, 2015-2016 and 2017-2018 were retrieved. A questionnaire was compiled by 315 secondary school students. Ni release from earring parts was analysed with the EN1811:2015 method. RESULTS: A significant time trend of decreasing Ni positivity from 2006-2007 to 2017-2018 was observed both in the overall population (44.1% in 2006-2007, 33.0% in 2015-2016, 31.6% in 2017-2018, P < 0.0001) and in female patients (P < 0.0001). Conversely, change was not significant in males (P = 0.16). Decrease was significant for all age groups, except for those aged >60 years (P = 0.51). Among 242 students who reported earring use, 130 (54%) reported symptoms at earlobes, mostly associated with jewellery of materials other than gold and silver (59% of those with earlobe symptoms). Ni release exceeded the migration limit in 4/21 (20%) earring parts. CONCLUSIONS: A high prevalence of Ni dermatitis and earlobe symptoms were found in Rome. A decreasing time trend was noted, with a significant decline in Ni sensitivity compared to the situation observed right after Ni Directive implementation. This most likely represents the consequence of reduced Ni content in earring parts, although a major care in the use of Ni-containing objects could contribute to explain these findings.

Epidemiology of nickel sensitivity: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data 1994-2014.

BACKGROUND: Nickel is a common allergen. OBJECTIVE: To examine the epidemiology of nickel sensitivity in North America. METHODS: Retrospective, cross-sectional analysis of 44,097 patients patch tested by the North American Contact Dermatitis Group from 1994 to 2014. Nickel sensitivity was defined as a positive patch test for nickel. We evaluated the frequency of nickel sensitivity and patient demographics. For each positive reaction to nickel, we tabulated clinical relevance, occupational relatedness, and exposure sources. RESULTS: The average frequency of nickel sensitivity was 17.5% (1994-2014). Nickel sensitivity significantly increased over time (from 14.3% in 1994-1996 to 20.1% in 2013-2014 [P < .0001]). Nickel-sensitive patients were significantly more likely to be female, young, nonwhite, and atopic (have eczema and asthma) and/or have dermatitis affecting the face, scalp, ears, neck, arm, or trunk (P values ≤ .0474). Overall, 55.5% of reactions were currently clinically relevant; this percentage significantly increased over time (from 44.1% in 1994-1996 to 51.6% in 2013-2014 [P < .0001]). The rate of occupational relatedness was 3.7% overall, with a significant decrease over time (from 7.9% in 1994-1996 to 1.9% in 2013-2014 [P < .0001]). Jewelry was the most common source of nickel contact. LIMITATIONS: Tertiary referral population. CONCLUSIONS: Nickel allergy is of substantial public health importance in North America. The frequency of nickel sensitivity in patients referred for patch testing has significantly increased over a 20-year period.

[Coiling method combined with bloodletting from the corpus cavernosum for penile incarceration with a metal ring: A case report and literature review].

OBJECTIVE: To explore the treatment of penile incarceration with a metal ring. METHODS: Based on our experience in the successful management of a case of penile incarceration with a metal ring by coiling and bloodletting from the corpus cavernosum, we reviewed the relevant literature and analyzed the indications, advantages and disadvantages of different methods for the treatment of penile incarceration with a circular foreign body. RESULTS: The clamping and cutting methods were non-invasive, fast, effective, and with few complications, which could be applied to the treatment of penile strangulation at all levels. However, clamping was not desirable enough for a hard metal ring and the cutting method took a longer time and might increase the risk of unnecessary damage to the penile skin, urethra and cavernous body. Prepuce edema decompression and the thin tube-coiling method, with the advantages of minimal invasiveness, simple operation and no need of special tools, were suitable for penile strangulation injury under level 3, but might cause penile skin injury and potential postoperative erectile dysfunction. Surgical resection, as an invasive procedure, could be applied to severe penile strangulation at level 4 or 5. CONCLUSIONS: The principle for the treatment of penile incarceration with a circular foreign body is to remove the foreign object as soon as possible and not to add secondary damage.

A Modified String Technique for Atraumatic Ring Removal.

BACKGROUND: We describe a modified string technique for ring removal from an edematous finger, a critical step in the initial treatment of a patient with upper-extremity trauma. TECHNIQUE: This technique involves multiple sutures looped around the ring to provide differential tension on the ring as it is advanced distally over a lubricated digit. With the use of an assistant, the ring can be advanced in caterpillar fashion without sliding back proximal when the direct pressure is released as a result of edema. CONCLUSIONS: This multisuture technique adds to the armamentarium of methods for ring removal in the setting of upper-extremity trauma without reverting to alternate techniques for cutting or shattering the ring.