Skin Contamination Research Articles

A Case of Dimethoate Poisoning Requiring Prolonged Skin Decontamination

Background Decontamination is a critical medical counter measure in reducing toxic exposure following poisoning. Little is known on the effectiveness of this procedure and its impact in the context of preventing secondary exposure of healthcare workers and secondary contamination of facilities. Presented here is a case of dimethoate poisoning that required a prolonged period of skin decontamination to remove residual skin contamination. Case Report A young gardener consumed dimethoate at the workplace witnessed by a colleague who called the emergency services immediately. Paramedics noted the patient to be drowsy with stable vital signs and 100% oxygen saturation. En-route to the hospital the patient vomited multiple times and was drenched in vomitus with a pungent odour. Upon arrival at the emergency department (ED), vital signs remained stable with a Glasgow Coma Scale (GCS) of 10. Due to gross external contamination from the vomitus and pungent odours emanating suggestive of chemical fumes off-gassing, the hospital decontamination shower was activated for patient decontamination. Staff donned protective suits and proceeded to disrobe and bag all the patient’s clothing before showering the patient for 10-minutes using soap and water. Post-decontamination a chemical agent monitor (CAM) were used to screen for residual chemicals following the hospital’s decontamination protocol. The chemical alarm was triggered twice, first around the left mastoid region and again just below the left breast. This required targeted re-showering for a further 10-minutes before patient was finally cleared of contamination. Subsequently, the patient was given atropine (2.4 mg) and pralidoxime (1 g) followed by an infusion at the intensive care unit (ICU). The patient made an uneventful recovery and was discharged 5-days later. Conclusion This case of dimethoate poisoning is notable for the prolonged period of skin decontamination to remove residual skin contamination and illustrates potential implications to patient and health care worker safety. Past mass casualty incidents involving chemicals, such as the sarin attack in Tokyo, highlight the high incidence of secondary exposures amongst healthcare workers due to the lack of casualty decontamination. As a result, many hospitals have developed capacity to conduct rapid and timely decontamination at their premises to prevent further complications from secondary chemical exposure. However, the effectiveness of this process of decontamination needs further evaluation.

A case of vulgar sycosis scalp in a child

Pustular skin diseases (pyoderma) are one of the most common human pathologies. In terms of their frequency, pyodermas compete for the first place with dermatomycoses. They occur in adults and children, women and men and are acute and chronic, can develop initially or as a complication of other skin diseases. The high incidence of pyoderma is caused by the significant spread of pyococci in the environment, on the skin and mucous membranes of humans, contamination and microtrauma of the skin, reduction of the overall and local antibacterial resistance of the body. They have many clinical forms due to the pathogen (staphylodermatitis, streptodermatitis, Pseudomonas aeruginosa, etc.), localization, lesions of skin appendages, etc.Vulgar sycosis occupies a prominent place among chronic pyoderma. The disease mainly affects adult men, rarely women and very rarely — children. The primary morphological elements are pustules — osteofolliculites, which are localized mainly on the beard and mustache in men, on the pubis in women, on the scalp (Sycosis vulgaris capilliti infantum), eyelashes and hair of the nasal passages — in children. Sycosis vulgaris in children is a chronic disease that lasts for months, years, and is difficult to treat. Relapses are more likely to occur after irritation with detergents, application of moisturizing bandages, compresses, irritating solutions, traumas to the skin with a comb or a hat. Often the cause of recurrence of vulgar sycosis can not be established.For more than half a century of dematological practice, we have observed two cases of vulgar sycosis. This publication describes one of them. Clinic, diagnosis, comprehensive treatment, recurrence prevention methods are described.

Development of a reversed‐phase high‐performance liquid chromatographic method for the determination of propranolol in different skin layers

The aim of this work was to develop and validate an analytical method using HPLC for the determination of propranolol in the different layers of the skin to be used in kinetic studies of skin permeation. The development of the method was based on the suitability of the chromatogram, and the validation followed the international health regulation for bioanalytical methods. In addition, the method was tested in an in vitro permeation assay using porcine skin. The drug was determined using an RP-C18 column at 30°C, a mobile phase comprising acidic aqueous phase:acetonitrile (75:25 v/v), at a flow rate of 1.0 mL min-1 , and UV detection at 290 nm. The method was demonstrated to be selective against skin contaminants, linear in a wide range of concentrations (3-20 μg mL-1 ), sensitive enough to quantify less than 0.1% of the drug dosage in skin matrices, and precise regardless of analysis variations such as day of analysis, analyst, or equipment. In addition, the method presented a high drug extraction capacity greater than 90% for all skin layers (stratum corneum, hair follicle, and remaining skin). Finally, the method was successfully tested in skin permeation assays, proving its value in the development of topical formulations containing propranolol.

Follicular pathway role in chemical warfare simulants percutaneous penetration.

Chemical warfare (CW) exposure could be fatal to military and civilians through skin contamination. Our work and others focus on investigating stratum corneum reservoir with less regards to skin appendageal routes including hair follicles. Here, C-14 CW simulants (CWS) with specific activity of 0.1 mCi/ml were tested on abdominal and scalp human cadaver skin using flow-through diffusion system. Quantitative analysis of simulants in skin compartments were performed using scintillation counter. Scalp permeation of dipropylene glycol monomethyl ether (DPGME), diisopropyl methylphosphonate (DIMP) and methyl salicylate (MeS) exceed abdominal skin by 8%, 15%, and 6% (p value < 0.05) of applied dose, respectively. DPGME and DIMP (most hydrophilic) showed earlier permeation peak time (Tmax) through scalp skin at 2 and 4 h, respectively, comparing with 6 h with abdominal skin. The percentage of applied dose of DPGME and DIMP retained in human skin membrane (SC, epidermis, and viable dermis) showed no statistically significant difference between tested abdominal and scalp skin samples (p value >0.05). The percentage of applied dose of MeS in scalp showed higher partitioning in stratum corneum and viable epidermis than abdominal skin (p value <0.05). In conclusion, human scalp showed greater total skin absorption than abdominal skin. This work points to a qualitative importance of high follicular density body regions in percutaneous penetration and suggests that transfollicular pathway might have a significant role in early stage permeation of chemical warfare simulants. However, the difference noticed here between scalp and abdominal skin could be attributed to regional variability in anatomy, physiology, and barrier characteristics.

Investigation of protective exposure risk events in nurses against corona virus disease 2019 in Wuhan

Objective To investigate the current situation of virus exposure risk incidents of nurses against corona virus disease 2019 (COVID-19) in Wuhan, and to provide reference evidence for nursing managers to protect nursing staff who were working in the isolation ward. Methods In the study, 308 nursing staff against COVID-19 working in the isolation ward in Wuhan were conveniently selected to participate in the investigation. The designed questionnaires including 7 kinds of protective exposure risk events were made by the team of researchers on the basis of literature review and interview with the nurses in Wuhan. All the participants recalled their working experience in the status of dressing in personal protective equipment and filled in the questionnaires online by WeChat according to the same instruction. Results The questionnaires were filled in validly by a total of 304 nursing staff, of whom 88.8% received emergency training on the prevention and dealing measurement of exposure risk events. The incidence of shoe cover contamination, falling off or torn was relatively high, about 53.6%. Due to the protection of gloves, the incidence of hand or skin contamination was relatively low, about 14.1%. The most nervousness of protective exposure risk event for nurses was N95 mask contamination, falling off or shifting, with a score of 8.2±2.3, showing a higher psychiatric burden. Single factor analysis found that the number of days in Wuhan was different, the number of the types of protective risk events occurred was different (χ2=14.562, P=0.024), orderly multivariate Logistic regression found that men were the independent protective factor for the number of the types of protective exposure risk events that occurred (P=0.019). Conclusion Protective exposure risk events may occur in the work of nursing staff working in the isolation ward in Wuhan. It is necessary to guide nurses to prevent the occurrence of protective exposure risk events and effectively deal with them, so as to prevent virus exposure and reduce psycholo-gical burden.

Операционные величины радиоактивного загрязнения кожи в случае радиационной аварии

Purpose: Development of recommendations on the use in medical practice of institutions under FMBA of Russia of operational values of radioactive skin contamination in the event of radiological accidents.&#x0D; Material and methods: The easily measured radiation parameters were used as operational values: ambient dose equivalent rate (ADER) of γ-radiation, density of skin contamination with γ-, β- and α-emitting radionuclides. Operational values ​​of skin contamination were estimated on the basis of experimental data described in the literature and models on the kinetics of radioactive substances transport in the body, accepted values ​​of dose criteria for deterministic and stochastic effects. The estimation of radioactive material resorption through the skin was based on the results of experimental studies in laboratory animals (mainly piglets) for a limited set of chemical compounds of radionuclides.&#x0D; Results: The values of γ-ADER of the main dose-forming radionuclides measured at a distance of 10 cm from the skin surface in the range of 10–1000 μSv/h and the possible health effects due to the skin exposure and the intake of radioactive substances into the body were presented. In the IAEA recommendations, the level of skin contamination at 1 µSv/h is considered as a significant operational value according to the criterion of radioactive substances intake through the mouth from the contaminated surface of the hands. However, in our opinion, this estimate is excessively conservative; therefore it is not included in the recommended operational values. If the skin is contaminated with γ-β-emitting radionuclide solutions at a surface contamination higher than 106 Bq/cm2 (ADER ≥1000 µSv/h), the out of turn emergency decontamination should be carried out. Obligatory indications for the whole body counter examination after thorough decontamination and conducting biophysical analysis of bioassay are the following operational values: γ-ADER from the skin &gt; 10 µSv/h; surface contamination of intact skin with β-active radionuclides &gt; 20 000 β-part./(cm2·min); surface contamination of intact skin with α-active radionuclides &gt; 200 α-part./ (cm2·min).&#x0D; Conclusion: The recommended operational values allow preliminarily and promptly to assess the health risk not only in the case of external (contact) exposure of the skin and underlying tissues, but also due to the intake of soluble radioactive substances into the body through intact and damaged (injured) skin. Taking into account the high degree of uncertainty of the estimates obtained, the operational values ​​should be considered as strictly conservative. They should be used only to determinate of urgency of decontamination carrying out for the provision of medical care during the prehospital and early hospital periods with the obligatory follow-up dosimetry examination for the final assessment of absorbed dose.

Internal Validation Process of Health Care-associated Infections (HAI) Data in a Group of Private Hospitals from Brazil

Background The primary goal of health care-associated infections (HAI) surveillance is to identify and measure the progress towards achieving the lowest number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In 2018, with a perspective of strengthening the patient's quality and safety strategies, one group of 21 general private hospitals in Brazil were updated the system of reporting data of HAIs including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (PAV). These data began to be manage by a corporate infection control team. Aim: to test the accuracy of HAI rate, notified by a group of private hospitals in Brazil. Methods Based on NHSN diagnostic criteria HAIs, all infections notified in 21 hospitals from five different states in Brazil was validate by four Infection Control Preventionists (corporative team). The validation process included a systematic retrospective chart review associated with the analysis of positive cultures over a period of five months (August to December 2018). Results 1357 cultures was evaluate of which 1314 (97%) met the NHSN definition for HAI. The HAI compliance rate separated by topography was: CLABSI 96%; CAUTI: 86% and PAV: 96%. Components of the case definition that were a source of misinterpretation included the following: CLABSI – misinterpretation of NHSN criteria between primary and secondary bacteremia, and differentiation regarding laboratory-confirmed bloodstream criteria 1 (recognized pathogen) and criteria 2 (skin contaminant); PAV - pneumonia cases notified only by clinical and non-epidemiological definition; CAUTI – reports of asymptomatic bacteriuria. Conclusions The data of the hospitals studied are generally reliable. However, this study shows the need for systematic validation process and continuous training of the infection control preventionists to maintain the accuracy, transparency, safe and comparability of surveillance data. The primary goal of health care-associated infections (HAI) surveillance is to identify and measure the progress towards achieving the lowest number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In 2018, with a perspective of strengthening the patient's quality and safety strategies, one group of 21 general private hospitals in Brazil were updated the system of reporting data of HAIs including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (PAV). These data began to be manage by a corporate infection control team. Aim: to test the accuracy of HAI rate, notified by a group of private hospitals in Brazil. Based on NHSN diagnostic criteria HAIs, all infections notified in 21 hospitals from five different states in Brazil was validate by four Infection Control Preventionists (corporative team). The validation process included a systematic retrospective chart review associated with the analysis of positive cultures over a period of five months (August to December 2018). 1357 cultures was evaluate of which 1314 (97%) met the NHSN definition for HAI. The HAI compliance rate separated by topography was: CLABSI 96%; CAUTI: 86% and PAV: 96%. Components of the case definition that were a source of misinterpretation included the following: CLABSI – misinterpretation of NHSN criteria between primary and secondary bacteremia, and differentiation regarding laboratory-confirmed bloodstream criteria 1 (recognized pathogen) and criteria 2 (skin contaminant); PAV - pneumonia cases notified only by clinical and non-epidemiological definition; CAUTI – reports of asymptomatic bacteriuria. The data of the hospitals studied are generally reliable. However, this study shows the need for systematic validation process and continuous training of the infection control preventionists to maintain the accuracy, transparency, safe and comparability of surveillance data.

The management of the shoulder skin microbiome (Cutibacterium acnes) in the context of shoulder surgery: a review of the current literature.

This review aims to establish current knowledge of the shoulder skin microbiome and how to manage the bacteria that reside within it. A review was undertaken of the current literature through OvidSP. All abstracts were reviewed by three independent researchers. Thirty-five studies met the inclusion criteria. With forward referencing an additional 14 were included. None commented on organisms specific to the shoulder microbiome other than Cutibacterium acnes. Therefore, this review is focussed on the current knowledge of C. acnes. C. acnes is a skin commensal within the pilo-sebaceous glands reported to be the primary pathogen in up to 86% of shoulder joint infections. Pre-operative culture of unprepared skin can be indicative of underlying joint infection in shoulder arthroplasty revision. Intra-articular biopsies may have a high false positive due to skin contamination. Correlating the number of positive samples and certain associated signs can give a greater than 90% probability of a true infection. Standard surgical skin preparation, peri-surgical intravenous antibiotics and oral pre-operative antibiotics do not reduce bacterial load within the skin. However, topical benzoyl peroxide and clindamycin have both demonstrated significantly reduced bacteria load. Phylogenetically there are six main types. Patients may have more than one phenotype present during infection.

Analysis of Chemical Simulants in Urine: A Useful Tool for Assessing Emergency Decontamination Efficacy in Human Volunteer Studies.

To date, all human studies of mass-casualty decontamination for chemical incidents have relied on the collection and analysis of external samples, including skin and hair, to determine decontamination efficacy. The removal of a simulant contaminant from the surface of the body with the assumption that this translates to reduced systemic exposure and reduced risk of secondary contamination has been the main outcome measure of these studies. Some studies have investigated systemic exposure through urinary levels of simulant metabolites. The data obtained in these studies were confounded by high background concentrations from dietary sources. The unmetabolized simulants have never been analyzed in urine for the purposes of decontamination efficacy assessment. Urinary simulant analysis could obviate the need to collect skin or hair samples during decontamination trials and provide a better estimate of both decontamination efficacy and systemic exposure. The study objective therefore was to determine whether gross skin contamination as part of a decontamination study would yield urine levels of simulants sufficient to evaluate systemic availability free from dietary confounders. In this study, a gas chromatography-tandem mass spectrometry method was developed for the analysis of two chemical simulants, methyl salicylate (MeS) and benzyl salicylate (BeS), in urine. An extraction and sample clean-up method was validated, enabling quantitation of these simulants in urine. The method was then applied to urine collected over a 24-hour period following simulant application to the skin of volunteers. Both MeS and BeS were present in all urine samples and were significantly increased in all post-application samples. The MeS levels peaked one hour after skin application. The remaining urinary levels were variable, possibly due to additional MeS exposures such as inhalation. In contrast, the urinary excretion pattern for BeS was more typical for urinary excretion curves, increasing clearly above baseline from four hours post-dose and peaking between 12.5 and 21 hours, a pattern consistent with dermal absorption and rapid excretion. The authors propose BeS is a useful simulant for use in decontamination studies and that its measurement in urine can be used to model systemic exposures following skin application and therefore likely health consequences.

Abstract B37: Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices

Abstract Introduction: The purpose of the present study was to investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials, promoting the dissemination of cancerous cells from existing tumors to previously unaffected regions of the body. Methods: Pilot prospective study over a 6-month period (April-August 2018) at Rush University Medical Center of glove and instrument washings from 15 high-risk head and neck cancer resection cases (30 samples total). Each case maintained at least one of the following features in addition to a biopsy-proven diagnosis of squamous cell carcinoma or sarcoma of the head and neck: palliative surgery or salvage surgery, positive initial or final margins, extensive tumor burden, and/or extracapsular extension (ECE). After completion of each ablative procedure, surgical gloves of the primary surgeon and the four main surgical instruments in direct contact with the tumor were placed through washings for cytologic assessment (2 samples per case). Tumor and case characteristics were recorded. Samples were blindly evaluated by a board-certified cytopathologist for cytologic assessment. Results: 15 patients (11 males, 4 females, average age 65.13 years) undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned additional characteristics were included in the study. 26.7% of cases had ECE, 40.0% of cases had positive final margins, and 46.7% of cases had close final margins. Resected tumor locations included the oral cavity (7 cases), neck (4 cases), parotid gland (2 cases), and skin (2 cases). Malignant cells were isolated on glove washings in 1 case (6.7% of cases). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin contamination were isolated from 93.3% of instrument washings and 93.3% of glove washings. These squamous cells were differentiated from mature cells of the oral cavity by the absence of nuclei. Conclusions: Malignant squamous cells can be isolated from surgical glove washings. This supports the common practice of changing gloves during major head and neck cancer resections and may have important implications for intraoperative practices. Additional investigation is needed to assess for viability of detected malignant cells. Citation Format: Hannah N. Kuhar, Aryan Shay, Peter C. Revenaugh, Kerstin Stenson, Bobby Tajudeen, Paolo Gattuso, Samer Al-Khudari. Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B37.

Onychomycosis: a review.

Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non-dermatophyte moulds (NDMs) are more prevalent than previously thought, especially in warmer climates. Microscopy and fungal culture are the gold standard techniques for onychomycosis diagnosis, but high false-negative rates have pushed for more accurate methods, such as histology and PCR. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. There are several treatment options available, including oral antifungals, topicals and devices. Oral antifungals have higher cure rates and shorter treatment periods than topical treatments, but have adverse side effects such as hepatotoxicity and drug interactions. Terbinafine, itraconazole and fluconazole are most commonly used, with new oral antifungals such as fosravuconazole being evaluated. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens. New topical formulations are being investigated as faster-acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven. Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurrence.

ASSESSMENT OF NURSES’ PRACTICES REGARDING BED-BATH OF CRITICALLY ILL PATIENTS IN TERTIARY CARE HOSPITAL LAHORE

Introduction: Every day bed-bath are normally accommodated most basically sick patients to improve their cleanliness, advance solace and improve wellbeing results. Fundamentally sick patients are at more serious hazard for skin colonization and contamination with multidrug-resistance pathogenic organisms. Hence, it is imperative to furnish basically sick patient with powerful close to home cleanliness particularly bed-bath as poor cleanliness may expand the danger of contamination. Methodology: quantitative observational descriptive study design was used to assess the nurses’ practices regarding bed-bath of critically ill patients. In order to assess nurses practiced, data was collected through the standardized checklist regarding bed bath. The check consists of 51 items. Results: The findings of this study revealed that there is poor practices of nurses regarding bed bath of critically ill patients. Conclusion: This study has described an important basic nursing care that is bed-bath practice in critically ill patient. Although, bed-bath is a routine nursing procedure, critical care nurses in the current study had poor skills and practices regarding it. This study has implications for clinical practice and nursing research. Bed-bath is a routine nursing care; many nurses understand that bathing is just for cleaning. Therefore, Inservice training program should be conducted Key words: bed bath, practice, critical, patient. DOI: 10.7176/JHMN/74-08 Publication date: May 31 st 2020

Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment

This study uses an atomizer and fluorescent markers to simulate contamination of uncovered skin and hair of health care workers wearing personal protective equipment after intubating patient manikins under emergency conditions.

Occupational Contamination with a Highly Enriched Uranium Solution

This medical case report describes the first reported instance of occupational skin contamination with a uranyl nitrate solution containing highly enriched uranium. The report provides an overview of the unique medical treatment and management considerations in such a case. Internal dose assessment is covered in detail. The discussion covers key points regarding uranium characteristics, chemical and radiological damage to body tissues from HEU exposure, and resources available for assistance with a case of radiological contamination. This information adds to the limited medical literature on this topic and provides a valuable reference for medical personnel when dealing with this uncommon problem.

Активность фагоцитоза у больных атопическим дерматитом c подтвержденной контаминацией кожи дрожжами рода Candida spp

Фагоцитоз является неотъемлемой частью защиты организма от патогенов: его нарушения обусловливают развитие сопутствующих заболеваний и осложнений у больных атопическим дерматитом (АтД). Цель работы - оценка активности фагоцитоза у больных АтД c подтвержденной контаминацией кожи грибками рода Candida и определение экспрессии рецепторов нейтрофилов, необходимых для осуществления завершенного фагоцитоза. Методика. В исследовании приняли участие 70 больных АтД и 22 донора, все подписывали форму информированного согласия. Работа с кровью людей проводилась по международным правилам. Наличие контаминации микроскопическими грибками верифицировали методом полимеразо-цепной реакции в реальном времени (ПЦР). Нейтрофилы периферической крови выделяли на градиенте Перколла в интерфазе между 81% и 70%, отмывали, переводили в полную среду и анализировали ex vivo на активность фагоцитоза с дрожжами Candida tropicalis. Клетки обрабатывали антителами к рецепторам, а также пропидиумом иодидом, и анализировали на проточном цитометре FACSCalibur. Статистическую обработку результатов проводили по программе ANOVA. Результаты. Было установлено нарушение фагоцитарной активности нейтрофилов у больных АтД с сопутствующим поражением кожи грибками, что коррелировало с тяжестью течения АтД и статистически значимо отличалось от показателей больных АтД, не контаминированных возбудителями микозов. Экспрессия рецепторов, ассоциированных с фагоцитозом, различалась у больных АтД в зависимости от наличия или отсутствия Candida spp. Заключение. Установлены нарушения фагоцитарной активности нейтрофилов у больных АтД с верифицированной контаминацией кожи Candida spp., а также различия в экспрессии рецепторов фагоцитоза по сравнению с больными АтД без контаминации кожи дрожжами рода Candida.Phagocytosis is an integral part of the body defense against pathogens. Disturbance of phagocytosis results in development of concomitant diseases and complications in patients with atopic dermatitis (AD). The aim of this study was to measure the activity of phagocytosis in AD patients with fungal contamination of skin and to determine the expression of neutrophil receptors required for completing phagocytosis. Methods. 70 patients with AD and 22 donors participated in this study and signed an informed consent form. All experiments were performed in compliance with international rules for work with human biological materials. The presence of fungi on the skin was verified using the polymerase chain reaction in real time (PCR). Peripheral blood neutrophils were isolated on the Percoll gradient in the interphase between 81% and 70%, washed, transferred to the complete medium, and analyzed ex vivo for phagocytosis activity using yeast Candida tropicalis as a model system. Neutrophils were stained with monoclonal antibodies to the phagocytosis receptor and propidium iodide for DNA visualization and analyzed on a FACSCalibur flow cytometer. Statistical analysis was performed using ANOVA. Results. Impaired neutrophil phagocytic activity was found in AD patients with concomitant fungal contamination of the skin, which correlated with severity of AD and statistically significantly differed from that in AD patients without contamination with Candida spp. pathogens. The expression of phagocytosis-associated receptors varied in AD patients depending on the presence or absence of Candida spp. contaminants. Conclusion. Disordered neutrophil phagocytic activity was found in AD patients with verified Candida spp. contamination; the expression of phagocytosis receptors was different from that in AD patients without Candida contamination of the skin.

Cutibacterium (Propionibacterium) Acnes Is Observed as an Intraarticular and Intracellular Commensal of the Human Shoulder Joint During First-Time Surgery

Cutibacterium acnes is a mysterious member of the shoulder microbiome. It has been multiply associated with chronic postoperative complications and low-grade infections in orthopedic surgery. Still, it is unclear whether it should be either linked to skin contamination or to true deep infections. Some authors hypothesized C. acnes to be a commensal of deep, intraarticular tissues and linked it to osteoarthritis. Further, C. acnes is reported to persist in macrophages as a niche for its survival and spread.

Rapid identification of organophosphorus pesticides on contaminated skin and confirmation of adequate decontamination by ambient mass spectrometry in emergency settings.

Dermal exposure to pesticides may cause severe intoxication and even result in a fatal outcome. To expedite rescue in the emergency department, it is mandatory to develop a point-of-care analytical method for immediate identification of pesticides on the skin of exposed personnel, and to perform immediate dermal decontamination to prevent further harm and optimize the chance for full clinical recovery. Four of the most commonly used highly toxic pesticides that contaminate the skin were rapidly characterized by thermal desorption electrospray ionization mass spectrometry. The technique was also applied to confirm the completeness of pesticide decontamination from the skin. Pesticide sampling, desorption, ionization, and detection altogether took less than 30 s. In addition, different fabrics of protective garments worn by farmers were assessed with this efficient ambient mass spectrometric technique for their protective capabilities against dermal exposure to pesticides, and scanning electron microscopy was used to observe their different microstructures. The decontaminating efficacies of different cleansing agents for these skin contaminants were also evaluated by this technical platform. The repeatability of this method had a low relative standard deviation (<22%) for the detection of pesticides on the surface of swine skin. The detection limits of the pesticides in solution were found to be in the range of 3-20 ng/mL. Linearity was observed between the signal intensities and the concentrations of the four pesticides in solution within the range of 50 ng/mL to 50 μg/mL (R2 between 0.9921 and 0.9966). In addition, it was found that PVC fabric is optimal in preventing skin contamination by fenthion and detergent had the best efficiency for fenthion decontamination. Since the whole analytical process is extremely fast, this technique allows early point-of-care identification of contaminating pesticides on the skin of exposed patients in the emergency room, as well as rapid assessment of the adequacy of decontamination.

Skin Barrier Impairment due to the Occlusive Effect of Firefighter Clothing.

At fire scenes, firefighters are exposed to potentially harmful substances. Besides inhalation of these products, also skin contamination and the risk of dermal absorption is getting more attention. In this perspective, skin barrier impairment due to the occlusive effect of firefighter clothes could enhance the risk of penetration of hazardous substances. The effect of a firefighter jacket and cellophane on the skin was studied in a paired comparison involving 16 volunteers. Biophysical parameters were measured before, immediately after and 30 min after ending the occlusion. Reflectance confocal microscopy was used to study the skin morphology. Immediately after wearing a firefighter jacket, Transepidermal Water Loss values were significantly increased. This is an indication of an occlusive effect of the firefighter jacket. The skin barrier was fully restored after 30 min after occlusion with cellophane or wearing a firefighter jacket.

Skin Diseases Prediction: Binary Classification Machine Learning Multi Model Ensemble Techniques

Unlike many other diseases, the skin disease has more irritability. Dermatology sicknesses incorporates normal skin rashes to serious skin contaminations, which happens because of scope of things, like diseases, warm, allergens, framework issue and drugs. First regular skin issue are dermatitis. Atopic dermatitis is relating current (perpetual) condition that causes eager, aroused skin. Most much of the time it appears as patches on the face, neck, trunk or appendages. It will in general erupt sporadically so die down for a period. A large portion of the dermatological sicknesses are not reparable but rather most the treatments depend on the administration of the side effects related with it. The focus of this research will be the Dermatology database. The problem is to determine the type of Eryhemato-Squamous disease like psoriasis, seboreic dermatitis, lichen planus, pityriasis rosea, cronic dermatitis and pityriasis rubra pilaris. The differential analysis of erythemato-squamous maladies is a genuine issue in dermatology. They all offer the clinical highlights of erythema and scaling, with next to no distinctions. Each pattern is a set of 33 numbers in the range linear values and one of them is nominal. The 80% of the dataset utilize for demonstrating and keep down 20% for approval. Objective is to accomplish best performer algorithm which will convey in dermatology informational collection so for this reason the gut feel recommends distance based calculations like k-Nearest Neighbors and Support Vector Machines may progress admirably. By using 10-fold cross validation and assess calculations utilizing the accuracy metric.

Reaching consensus on a home infusion central line-associated bloodstream infection surveillance definition via a modified Delphi approach

A consensus on a central line-associated bloodstream infection (CLABSI) surveillance definition in home infusion is needed to standardize measurement and benchmark CLABSI to provide data to drive improvement initiatives METHODS: Experts across fields including home infusion therapy, infectious diseases, and healthcare epidemiology convened to perform a 3-step modified Delphi approach to obtain input and achieve consensus on a candidate home infusion CLABSI definition. The numerator criterion was identified by participants as involving one of the 2 following: (1) recognized pathogen isolated from blood culture and pathogen is not related to infection at another site, or (2) one of the following signs or symptoms: fever of 38°C (100.4°F), chills, or hypotension (systolic blood pressure ≤90 mm Hg), and one of the 2 following: (A) common skin contaminant isolated from 2 blood cultures drawn on separate occasions and organism is not related to infection at another site, or (B) common skin contaminant isolated from blood culture from patient with intravascular access device and provider institutes appropriate antimicrobial therapy. The criteria for a denominator included days from the day of admission with a central venous catheter to day of removal of central venous catheter. In addition, 11 inclusion criteria and 4 exclusion criteria were included. Home infusion therapy and healthcare epidemiology experts developed candidate criteria for a home infusion CLABSI surveillance definition. Home care and home infusion agencies can use this definition to monitor their own CLABSI rates and implement preventative strategies.