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Allergy, Asthma, and Clinical... Mar 2021Atopic diseases, such as atopic dermatitis (AD) and food allergy (FA), have increased in prevalence in industrialized countries during the past few decades and pose a... (Review)
Review
BACKGROUND
Atopic diseases, such as atopic dermatitis (AD) and food allergy (FA), have increased in prevalence in industrialized countries during the past few decades and pose a significant health burden. They appear to have a common underlying mechanism and a natural disease progression. AD is generally the first atopic disease to manifest followed by other atopic diseases, such as FA, allergic rhinitis, or allergic asthma suggesting that they are likely different manifestations of the same disease. BODY: Evidence suggests that allergic sensitization occurs through an impaired skin barrier, while consumption of these foods at an early age may actually result in tolerance. This has been termed the Dual-Allergen-Exposure hypothesis. Loss of barrier integrity has been hypothesized to enable penetration of allergens, pollutants, and microbes and initiation of an inflammatory immune cascade of events leading to sensitization. The immune dysfunction is thought to further exacerbate the impaired skin barrier to form a vicious cycle. There is much interest in preventing or protecting the skin barrier from developing a proinflammatory atopic state, which may potentially lead to the development of AD and subsequently, FA.
CONCLUSION
Research on preventing or treating skin barrier dysfunction is ongoing. A number of studies have evaluated the efficacy of emollients in preventing AD and FA with mixed results. Studies have differed in the study design, population characteristics, emollients type, and frequency, duration, and area of application. Emollient type has varied widely from oils, creams, petrolatum-based lotions, and trilipid creams. Current research is directed towards the use of trilipid emollients that are similar to the skin's natural lipid composition with a 3:1:1 ratio of ceramides, cholesterol and free fatty acids and a pH that is similar to that of skin to determine their effectiveness for skin barrier repair and prevention of AD and FA.
PubMed: 33726824
DOI: 10.1186/s13223-021-00531-8 -
International Dental Journal Oct 2022The aim of this work was to review the protocol of the use of silver diamine fluoride (SDF) for arresting caries, specifically the application time. (Review)
Review
OBJECTIVE
The aim of this work was to review the protocol of the use of silver diamine fluoride (SDF) for arresting caries, specifically the application time.
METHOD
Two researchers searched manufacturers' instructions, YouTube videos, and 5 databases (Embase, Medline, PubMed, Scopus, and Web of Science). Manufacturers' instructions, videos from national dental organisations, and peer-reviewed journal articles that published the SDF application protocol in English for arresting caries were selected.
RESULTS
The review included 14 protocols from 15 publications from 4 manufacturers, 3 dental associations, and 7 author teams (one team had 2 articles). The American Dental Association and the British Society of Paediatric Dentistry provided their SDF application protocols on YouTube. The American Academy of Paediatric Dentistry and 7 author teams published their protocols in journal articles. Seven publications suggested an SDF application time of 60 seconds. Seven publications suggested a time range of 10 seconds to 240 seconds. Two publications suggested caries excavation, but 4 publications suggested no caries excavation before SDF application. The procedures from at least 5 publications involved protecting the gingiva with petroleum jelly, isolating the carious tooth with cotton rolls, drying the carious lesion with a 3-in-1 syringe, applying SDF solution with a micro brush for 60 seconds, removing excess SDF solution with gauze, and applying fluoride varnish to the SDF-treated lesion.
CONCLUSIONS
Although the SDF application protocol is simple and straightforward, the published protocols could be different. Most publications suggested an SDF application time of 60 seconds, which can be long, particularly for young children and older adults.
Topics: Aged; Cariostatic Agents; Child; Child, Preschool; Dental Caries; Fluorides, Topical; Humans; Petrolatum; Quaternary Ammonium Compounds; Silver Compounds
PubMed: 35843730
DOI: 10.1016/j.identj.2022.06.006 -
Archives of Razi Institute Aug 2022Mineral oil as a barrier can minimize temperature, osmolality, and pH fluctuation of the media in the embryo production system (IVP). Regardless of these advantages,... (Review)
Review
Mineral oil as a barrier can minimize temperature, osmolality, and pH fluctuation of the media in the embryo production system (IVP). Regardless of these advantages, mineral oil quality is varied and may deteriorate during storage or transport conditions. So, it can affect the IVP outcome by absorbing the essentials factors or realizing the toxic components into the media. Although, some methods have already been developed to reduce these side effects, still there is a big concern about the safety and use of mineral oil in the IVP system. In this review, we provided an overview of the advantages and disadvantages of using mineral oil in the IVP system. We also reviewed available methods for its quality control and finally, we introduced some methods for reducing the side effects of mineral oil.
Topics: Animals; Mineral Oil; Temperature
PubMed: 36883153
DOI: 10.22092/ARI.2022.358955.2343 -
The Journal of Allergy and Clinical... Feb 2020p-Phenylenediamine (PPD) is a strong contact allergen used in hair dye that is known to cause allergic contact dermatitis (ACD). Both private and occupational exposure...
BACKGROUND
p-Phenylenediamine (PPD) is a strong contact allergen used in hair dye that is known to cause allergic contact dermatitis (ACD). Both private and occupational exposure to PPD is frequent, but the effect of PPD exposure in nonallergic occupationally exposed subjects is unknown.
OBJECTIVE
We sought to investigate the effects of PPD exposure on the skin of occupationally exposed subjects with and without clinical symptoms.
METHODS
Skin biopsy specimens were collected from 4 patients with mild and 5 patients with severe PPD-related ACD and 7 hairdressers without contact dermatitis on day 4 after patch testing with 1% PPD in petrolatum. RNA sequencing and transcriptomics analyses were performed and confirmed by using quantitative RT-PCR. Protein expression was analyzed in skin from 4 hairdressers and 1 patient with ACD by using immunofluorescence staining. Reconstructed human epidermis was used to test the effects of PPD in vitro.
RESULTS
RNA sequencing demonstrated downregulation of tight junction and stratum corneum proteins in the skin of patients with severe ACD after PPD exposure. Claudin-1 (CLDN-1), CLDN8, CLDN11, CXADR-like membrane protein (CLMP), occludin (OCLN), membrane-associated guanylate kinase inverted 1 (MAGI1), and MAGI2 mRNA expression was downregulated in patients with severe ACD. CLDN1 and CLMP expression were downregulated in nonresponding hairdressers and patients with mild ACD. Filaggrin 1 (FLG1), FLG2, and loricrin (LOR) expression were downregulated in patients with ACD. Confocal microscopic images showed downregulation of CLDN-1, FLG-1, and FLG-2 expression. In contrast, 3-dimensional skin cultures showed upregulation of FLG-1 in response to PPD but downregulation of FLG-2.
CONCLUSION
PPD-exposed skin is associated with extensive transcriptomic changes, including downregulation of tight junction and stratum corneum proteins, even in the absence of clinical symptoms.
Topics: Adult; Dermatitis, Allergic Contact; Female; Filaggrin Proteins; Hair Dyes; Humans; Occupational Exposure; Phenylenediamines; Skin; Tight Junction Proteins
PubMed: 31783056
DOI: 10.1016/j.jaci.2019.11.023 -
Turkiye Parazitolojii Dergisi Mar 2021Phthiriasis palpebrarum is a rare eyelid infestation caused by (pubic lice) that is often confused with other causes of blepharoconjunctivitis. In this study, we report...
Phthiriasis palpebrarum is a rare eyelid infestation caused by (pubic lice) that is often confused with other causes of blepharoconjunctivitis. In this study, we report the case of a 49-year-old male patient with phthiriasis palpebrarum who presented with itching and eye irritation in the left eye and had undergone treatment for conjunctivitis in the past month. Biomicroscopic examination revealed a dense population of motile and translucent lice and eggs, more intensely on the upper lid. For treatment, the lice were first cleaned mechanically, eyelashes were cut from the bottom, and eggs and lice were removed from the eye, after which petrolatum jelly (vsaseline) was applied to the lids for 10 days. In the control examination, no lice and eggs were observed.
Topics: Animals; Blepharitis; Eyelashes; Humans; Lice Infestations; Male; Middle Aged; Petrolatum; Phthirus; Treatment Outcome
PubMed: 33685072
DOI: 10.4274/tpd.galenos.2020.6937 -
Journal of Taibah University Medical... Jun 2022Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study...
OBJECTIVES
Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study explores the impact of different topical creams on facemask tolerability and complications.
METHODS
This was a prospective observational study involving 80 adults. Participants voluntarily chose and used topical creams during facemask use. Data were collected using validated scales before and after topical cream application.
RESULTS
About 23.8% of the participants used lidocaine gel, 17.5% used petrolatum, 16.2% used hydrocortisone cream, 16.2% used diphenhydramine cream, 13.8% used arnica cream, and 12.5% used zinc oxide cream. Duration of facemask use was 6 h amongst staff and 4 h amongst patients, and was similar both with and without topical cream. Facial temperature rise was lower with all creams ( = 0.033), as was facial redness ( = 0.037) and facial pain ( = 0.025). Facemask compliance was better for all creams ( = 0.015). The facial temperature rise was the lowest with topical lidocaine ( = 0.021). Early facial redness was lowest with topical hydrocortisone or diphenhydramine ( = 0.042). Severe redness was lowest with topical hydrocortisone or zinc oxide ( = 0.044). Facemask pain was lowest with topical lidocaine ( = 0.035), and facemask compliance was best with topical lidocaine ( = 0.001). Petrolatum had the best user satisfaction and odour ratings ( = 0.041).
CONCLUSION
Topical creams minimise facemask complications, thereby promoting compliance; topical lidocaine was the most effective in reducing pain and enabling facemask compliance. Topical hydrocortisone, diphenhydramine, and zinc oxide were effective in reducing facial redness, and topical petrolatum produced the best user satisfaction.
PubMed: 35250427
DOI: 10.1016/j.jtumed.2021.12.012 -
Plastic Surgery (Oakville, Ont.) Nov 2018To describe characteristics of dog bites and their treatment in a pediatric population including infection, medical specialties involved, rates of admission, and need...
OBJECTIVE
To describe characteristics of dog bites and their treatment in a pediatric population including infection, medical specialties involved, rates of admission, and need for surgery.
METHOD
Patients presenting with a dog bite to the emergency department of a tertiary care pediatric hospital between January 1, 2015, and June 30, 2017, were included. Details related to demographics, complications, consultations, and treatment were extracted from the patients' records. Descriptive statistics were performed and binary logistic regression was used to assess potential predictors of infection.
RESULTS
One hundred fifty-eight dog bite patients were identified. Most patients were male (53.8%) and less than 5 years of age (50%). Bites occurred most frequently in June (13.3%) and July (16.5%). The face was most commonly involved (42.9%), followed by the hands (12.6%) and the scalp (26.6%). Pit bulls (11.4%), Labrador retrievers (7.0%), and German shepherds (4.4%) were the most common offending breeds. Most bites were superficial (91.1%). Half were treated conservatively with dressings and petrolatum-based ointment, with 41.1% requiring simple primary closure. Ten (6.3%) cases necessitated primary repair in the main operating room under general anesthesia. More than half of patients were treated with prophylactic systemic antibiotics (55.1%). Plastic surgery was the most common service involved (24.7%). Seven (4.4%) patients developed an infection and there were no mortalities or long-term complications. Rates of infection did not differ between patients who did or did not receive prophylactic systemic antibiotics ( = .88). Regression analysis revealed no significant predictors of infection.
CONCLUSIONS
Most dog bites are superficial and involve the head and hands. Infection rate is low, with no significant difference in infection rates between patients treated with or without prophylactic antibiotics.
PubMed: 30450344
DOI: 10.1177/2292550318767924 -
JAMA Otolaryngology-- Head & Neck... Jun 2020The fibula free flap donor site is associated with both short-term and long-term morbidity. Split-thickness skin graft (STSG) loss can lead to long delays in donor site...
IMPORTANCE
The fibula free flap donor site is associated with both short-term and long-term morbidity. Split-thickness skin graft (STSG) loss can lead to long delays in donor site healing and is associated with significant adverse sequelae. Patients may experience initial good STSG uptake after bolster removal but may have subsequent partial or total loss related to contact pressure or shearing.
OBJECTIVE
To determine if increased duration of bolster use is associated with increased STSG uptake rates following fibula free flap reconstruction.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included patients 18 years and older undergoing fibula free flap reconstruction following head and neck extirpative surgery at a tertiary care academic medical center from May 2013 to March 2019. The donor sites were photographed 4 weeks postoperatively, and areas of graft uptake were measured using image processing software. The baseline demographic, comorbidity, and operative characteristics were also collected.
INTERVENTIONS
A fine mesh gauze with 3% bismuth tribromophenate and petrolatum blend bolster was sutured over leg STSGs placed on fibula free flap donor sites intraoperatively, and the ankle and lower leg were immobilized for 5 days in a plaster splint. Bolsters were either removed on postoperative day 5 or 14. Thereafter, the STSGs were covered with a petroleum and bismuth gauze and a cotton dressing.
MAIN OUTCOMES AND MEASURES
Rates of donor site infection and STSG percentage uptake at 4 weeks.
RESULTS
Of the 42 included patients, 31 (74%) were male, and the mean (SD) age was 62.1 (13.1) years. A total of 20 patients were included in the 5-day group, and 22 were included in the 14-day group. The 14-day bolster group had a higher mean percentage skin graft uptake rate compared with the 5-day bolster duration group (77.5% vs 59.9%), with an effect size of -0.632 (95% CI, -1.260 to -0.004). Patients with Adult Comorbidity Evalution-27 scores of 3 had poorer rates of STSG uptake compared with patients with Adult Comorbidity Evalution-27 scores of 0 to 2 (65.9% vs 82.9%), with an effect size of 0.599 (95% CI, -0.191 to 1.389). No donor site infections were noted in either group.
CONCLUSIONS AND RELEVANCE
Fourteen-day bolster application to the fibula free flap donor site was associated with better STSG uptake rates than 5-day bolster application.
Topics: Aged; Bandages; Female; Fibula; Free Tissue Flaps; Graft Survival; Humans; Male; Middle Aged; Ointment Bases; Petrolatum; Phenols; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Splints; Time Factors; Transplant Donor Site; Wound Healing
PubMed: 32297916
DOI: 10.1001/jamaoto.2020.0160 -
The Cochrane Database of Systematic... Sep 2015Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice... (Review)
Review
BACKGROUND
Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this.
OBJECTIVES
To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers.
SEARCH METHODS
In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies.
SELECTION CRITERIA
We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta-analysis was not possible.
DATA COLLECTION AND ANALYSIS
Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author.
MAIN RESULTS
We identified 10 RCTs involving 715 participants. Eight RCTs evaluated autolytic debridement and included the following agents or dressings: biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze. Two RCTs evaluated enzymatic preparations and one evaluated biosurgical debridement. No RCTs evaluated surgical, sharp or mechanical methods of debridement, or debridement versus no debridement. Most trials were at a high risk of bias.Three RCTs assessed the number of wounds completely debrided. All three of these trials compared two different methods of autolytic debridement (234 participants), with two studies reporting statistically significant results: one study (100 participants) reported that 40/50 (80%) ulcers treated with dextranomer beads and 7/50 (14%) treated with EUSOL achieved complete debridement (RR 5.71, 95% CI 2.84 to 11.52); while the other trial (86 participants) reported the number of ulcers completely debrided as 31/46 (76%) for hydrogel versus 18/40 (45%) for paraffin gauze (RR 0.67, 95% CI 0.45 to 0.99). One study (48 participants) reported that by 12 weeks, 15/18 (84%) ulcers treated with BWD had achieved a 75% to 100% clean, granulating wound bed versus 4/15 (26%) treated with non-adherent petrolatum emulsion-impregnated gauze.Four trials assessed the mean time to achieve debridement: one (86 participants) compared two autolytic debridement methods, two compared autolytic methods with enzymatic debridement (71 participants), and the last (12 participants) compared autolytic with biosurgical debridement; none of the results achieved statistical significance.Two trials that assessed autolytic debridement methods reported the number of wounds healed at 12 weeks. One trial (108 participants) reported that 24/54 (44%) ulcers treated with honey healed versus 18/54 (33%) treated with hydrogel (RR (adjusted for baseline wound diameter) 1.38, 95% CI 1.02 to 1.88; P value 0.037). The second trial (48 participants) reported that 7/25 (28%) ulcers treated with BWD healed versus 7/23 (30%) treated with non-adherent dressing.Reduction in wound size was assessed in five trials (444 participants) in which two autolytic methods were compared. Results were statistically significant in one three-armed trial (153 participants) when cadexomer iodine was compared to paraffin gauze (mean difference 24.9 cm², 95% CI 7.27 to 42.53, P value 0.006) and hydrocolloid compared to paraffin gauze (mean difference 23.8 cm², 95% CI 5.48 to 42.12, P value 0.01). A second trial that assessed reduction in wound size based its results on median differences and, at four weeks, produced a statistically significantly result that favoured honey over hydrogel (P value < 0.001). The other three trials reported no statistically significant results for reduction in wound size, although one trial reported that the mean percentage reduction in wound area was greater at six and 12 weeks for BWD versus a non-adherent dressing (44% versus 24% week 6; 74% versus 54% week 12).Pain was assessed in six trials (544 participants) that compared two autolytic debridement methods, but the results were not statistically significant. No serious adverse events were reported in any trial.
AUTHORS' CONCLUSIONS
There is limited evidence to suggest that actively debriding a venous leg ulcer has a clinically significant impact on healing. The overall small number of participants, low number of studies and lack of meta-analysis in this review precludes any strong conclusions of benefit. Comparisons of different autolytic agents (hydrogel versus paraffin gauze; Dextranomer beads versus EUSOL and BWD versus non-adherent dressings) and Larvae versus hydrogel all showed statistically significant results for numbers of wounds debrided. Larger trials with follow up to healing are required.
Topics: Bandages, Hydrocolloid; Borates; Debridement; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Randomized Controlled Trials as Topic; Sodium Hypochlorite; Varicose Ulcer; Wound Healing
PubMed: 26368002
DOI: 10.1002/14651858.CD008599.pub2 -
Central European Journal of Public... Sep 2022This study aimed to assess the predictors of allergic sensitisation to titanium and nickel in patients undergoing orthodontic treatment.
OBJECTIVES
This study aimed to assess the predictors of allergic sensitisation to titanium and nickel in patients undergoing orthodontic treatment.
METHODS
A total of 250 patients undergoing orthodontic treatment were invited to participate, and 235 were analysed (67% females). A patch test was performed using nickel sulphate, titanium, titanium dioxide, titanium oxalate, titanium nitride, and petrolatum as control. In addition, clinical signs of the oral mucosa, gingiva, tongue, lips, and allergological history were assessed.
RESULTS
The predictors of metal allergic sensitisation in patients undergoing orthodontic treatment were adult age (OR = 2.6; 95% CI: 1.2-5.5; p = 0.016), female sex (OR = 3.0; 95% CI: 1.1-7.9; p = 0.025), exfoliative cheilitis (OR = 4.8; 95% CI: 1.9-12.4; p = 0.001), history of contact hypersensitivity (OR = 7.0; 95% CI: 1.3-35.4; p = 0.025), history of contact hypersensitivity to metals (OR = 8.3; 95% CI: 1.4-50.2; p = 0.021), and piercings (OR = 5.4; 95% CI: 2.1-13.9; p = 0.001). When predictors were analysed separately for these two metals, titanium sensitisation predictors were contact hypersensitivity to metals and piercing, whereas nickel sensitisation predictors were age and piercing.
CONCLUSION
A positive patch test alone cannot draw definite conclusions regarding allergy. However, metal allergies in patients with orthodontic appliances could be considered in cases of previous contact hypersensitivity, previous reactions to metals, exfoliative cheilitis, and piercing.
Topics: Adult; Cheilitis; Dermatitis, Contact; Female; Humans; Hypersensitivity; Male; Nickel; Oxalates; Petrolatum; Titanium
PubMed: 36239365
DOI: 10.21101/cejph.a7122