Dangerous non-food products : Products with serious risks Click to enlarge 1 of 1 photo Share on Alert number: A12/0321/19 Category: Gadgets Product: Waterproof phone case Brand: Unknown Name: Waterproof Case Type / number of model: B74031 Batch number / Barcode: Unknown Risk type: Environment The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 0.32%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation). Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor Click to enlarge 1 of 1 photo Share on Alert number: A12/0318/19 Category: Hand tools Produc

Products with serious risks 

1 of 1 photo Share on             Alert number: A12/0321/19        Category:  Gadgets   Product:  Waterproof phone case   Brand: Unknown   Name: Waterproof Case   Type / number of model:  B74031   Batch number / Barcode: Unknown   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 0.32%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0318/19        Category:  Hand tools   Product:  Garden hose   Brand: Green>it   Name: Green hose set   Type / number of model:  9025811   Batch number / Barcode:  5708614912768   Risk type:  Environment   The hose contains short-chain chlorinated paraffins (SCCPs) (measured value up to 4.66%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment.  The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0300/19        Category:  Hobby/sports equipment   Product:  Fitness mat   Brand: Deuser   Name: Fitness-Matte   Type / number of model:  121041R   Batch number / Barcode:  4007480015704   Risk type:  Chemical, Environment   The plastic in the mat contains short-chain chlorinated paraffins (SCCPs) (measured value: 2.2%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. SCCPs are suspected human carcinogens. Prolonged exposure to them through the skin may cause cancer.  The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0330/19        Category:  Hobby/sports equipment   Product:  Bicycle saddle cover   Brand: Unknown   Name: Unknown   Type / number of model:  248   Batch number / Barcode: Unknown   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 1.12%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the persecutor

1 of 1 photo Share on             Alert number: A12/0334/19        Category:  Hobby/sports equipment   Product:  Football   Brand: Unknown   Name: Unknown   Type / number of model:  9048306   Batch number / Barcode:  5706245581810   Risk type:  Chemical   The plastic ball contains di-2-ethylhexyl phthalate (DEHP) (measured value up to 0.13% by weight). This phthalate may harm the health of children, causing possible damage to their reproductive system.  The product does not comply with the REACH Regulation.   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 2 photos PreviousNext Share on             Alert number: A12/0332/19        Category:  Jewellery   Product:  Necklace   Brand: Jewelry Fashion   Name: Unknown   Type / number of model:  54314   Batch number / Barcode:  6 438278 543143   Risk type:  Chemical   The smaller round medallion contains cadmium (measured value: 94 % by weight). Cadmium is harmful to human health because it accumulates in the body, can damage organs and may cause cancer. The product does not comply with the REACH Regulation.   Measures ordered by public authorities (to: Importer): Import rejected at border

1 of 1 photo Share on             Alert number: A12/0319/19        Category:  Lighting equipment   Product:  LED helmet light   Brand: STEEDS   Name: Unknown   Type / number of model:  940150   Batch number / Barcode:  4052083104386   Risk type:  Environment   The solder in the product contains lead above limit values (measured value up to 46% by weight). Lead poses a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0325/19        Category:  Lighting equipment   Product:  Foldable desk lamp   Brand: Unknown   Name: Unknown   Type / number of model:  93302   Batch number / Barcode:  PO702084   Risk type:  Environment   The solder contains lead (measured value up to 71% by weight) in concentrations above limit values. Lead poses a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0329/19        Category:  Lighting equipment   Product:  Torch   Brand: Unknown   Name: Unknown   Type / number of model:  P513.822   Batch number / Barcode: Unknown   Risk type:  Environment   The solders contain cadmium (measured value up to 0.39% by weight) and lead (measured value up to 48% by weight) in concentrations above limit values. Cadmium and lead pose a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0331/19        Category:  Lighting equipment   Product:  Torch   Brand: Unknown   Name: Unknown   Type / number of model:  341377VN   Batch number / Barcode: Unknown   Risk type:  Environment   The solder contains lead (measured value up to 50% by weight) in concentrations above limit values. Lead poses a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 3 photos PreviousNext Share on             Alert number: A12/0337/19        Category:  Lighting equipment   Product:  Table lamp   Brand: ArtHome   Name: Lume   Type / number of model:  SM1451   Batch number / Barcode:  8034048202029 (on the product); 8034048202128 (on the packaging)   Risk type:  Burns, Electric shock   The insulation is inadequate. Moreover, the power cord can easily detach or become damaged, giving access to live parts. The user can touch live or hot parts and receive an electric shock or suffer burns. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60598-1.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

Share on             Alert number: A12/0309/19        Category:  Motor vehicles   Product:  Passenger car   Brand: Porsche   Name: Cayenne - conventional and hybrid(PHEV), Macan   Type / number of model:  Cayenne: Type-approval numbers: e13*2007/46*1085* (92A M1G) e13*2007/46*1106* (92A N1G) e13*2007/46*1107* (92AH N1G) e13*2007/46*1108* (92AH M1G) Types: 92A, 92AN, 92AH, 92AHN, Macan: Type-approval numbers: e13*2007/46*1165 (M1) e13*2007/46*1164 (N1) Types: 95B, 95BN   Batch number / Barcode:  The vehicles in question were manufactured between January 2017 and February 2018.   Risk type:  Injuries   The retaining straps on the vehicle's ski bag may be defective. The ski bag may not stay in position when subjected to a high load.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

1 of 2 photos PreviousNext Share on             Alert number: A12/0315/19        Category:  Protective equipment   Product:  Inflatable armbands   Brand: Numerous Star   Name: Arm circle   Type / number of model:  8" X 6"   Batch number / Barcode:  50112393   Risk type:  Chemical   The valve of the inflatable armband contains di(2-etylhexyl) phthalate-DEHP (measured value 21 % by weight) and di-'isononyl' phthalate (DINP) (measured value: 0.3 % by weight). These phthalates may harm the health of children, causing possible damage to the reproductive system and the liver. The product does not comply with the REACH Regulation and the Personal Protective Equipment regulation.   Measures ordered by public authorities (to: Retailer): Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0322/19        Category:  Protective equipment   Product:  Safety reflector   Brand: Unknown   Name: Unknown   Type / number of model:  731211-z   Batch number / Barcode: Unknown   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 0.38%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0328/19        Category:  Protective equipment   Product:  Safety reflector   Brand: Unknown   Name: Unknown   Type / number of model:  288   Batch number / Barcode: Unknown   Risk type:  Environment   The solders contain lead (measured value up to 81%) above limit values and the plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 0.931%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. Lead poses a risk to the environment.  The product does not comply with the Regulation on persistent organic pollutants (POP Regulation) and with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 7 photos PreviousNext Share on             Alert number: A12/0312/19        Category:  Childcare articles and children's equipment   Product:  Baby carrier   Brand: Kekk   Name: Backpack Plus Black   Type / number of model:  Backpack Plus / Baby Pack Plus 015-014-004   Batch number / Barcode:  8 718531 445109   Risk type:  Injuries   The frame of the product is not strong enough and has no locking mechanism. It could break or spontaneously fold while still carrying a baby, causing the baby to fall. The product does not comply with the relevant European Standard EN 13209-1.   Measures taken by economic operators: Recall of the product from end users (By: Manufacturer)

1 of 3 photos PreviousNext Share on             Alert number: A12/0298/19        Category:  Toys   Product:  Inflatable swim-ring   Brand: Sainteve   Name: Swim Ring   Type / number of model:  ITEM N0: SY-A1098   Batch number / Barcode: Unknown   Risk type:  Chemical   The plastic of the swim-ring and the valve contain bis (2-ethylhexyl) phthalate (DEHP) (measured value: 5% and 0.9% by weight, respectively). This phthalate may harm the health of children, causing possible damage to their reproductive system. The product does not comply with the REACH Regulation.   Measures ordered by public authorities (to: Retailer): Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0299/19        Category:  Toys   Product:  Toy Microphone   Brand: Johntoy   Name: Microphone - Mit light - Avec lumiére - Con luz   Type / number of model:  Item Number: 29389   Batch number / Barcode:  8 711866 293896   Risk type:  Chemical, Environment, Injuries   The microphone can easily break, causing the button batteries to become accessible. A child may put them in the mouth, causing damage to the gastrointestinal tract. Additionally, the solder in three different places inside the toy contains too much lead (measured value up to: 70% by weight). Lead poses a risk to the environment.  The product does not comply with the requirements of the Toy Directive, the relevant European standard EN 62115 and the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures ordered by public authorities (to: Importer): Recall of the product from end users

1 of 3 photos PreviousNext Share on             Alert number: A12/0303/19        Category:  Toys   Product:  Glow stick   Brand: Unknown   Name: Unknown   Type / number of model:  2151-7/1.75   Batch number / Barcode:  8591044542172   Risk type:  Chemical, Choking   The battery compartment can easily be opened without the use of any tools, leaving button cell batteries accessible. A child may put these in the mouth, which could cause damage to the child's gastrointestinal tract. They may also cause choking if swallowed by a small child. The product does not comply with the requirements of the Toy Safety Directive and with the relevant European standard EN 71-1 and EN 62115.   Measures ordered by public authorities (to: Retailer): Withdrawal of the product from the market

1 of 4 photos PreviousNext Share on             Alert number: A12/0304/19        Category:  Toys   Product:  Toy pushchair with doll   Brand: Unknown   Name: Baby Small Cart   Type / number of model:  No. S876   Batch number / Barcode:  6998880080035   Risk type:  Chemical, Injuries   The pushchair is not sufficiently resistant to load and can easily collapse, causing injuries. In addition, the doll contains di-(2-ethylhexyl) phthalate (DEHP) (measured value up to 4.8% by weight). This phthalate may harm the health of children, causing possible damage to their reproductive system.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0305/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: Crystal Mud   Type / number of model:  CX-1731   Batch number / Barcode:  6 951325 166800   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value: 879 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 4 photos PreviousNext Share on             Alert number: A12/0307/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: Pu Noise Putty   Type / number of model:  LCP-001   Batch number / Barcode:  Lot No. 0019/12 8 435124 170858   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value: 981 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0308/19        Category:  Toys   Product:  Children's fancy-dress costume   Brand: Star Wars   Name: Executioner Trooper   Type / number of model:  Item No 640110   Batch number / Barcode:  Code: 8 83028 23993, Lot No 7045   Risk type:  Burns   The fancy-dress costume is easily flammable and the flame propagation is too high. If it catches fire, the child could suffer burns. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-2.   Measures taken by economic operators: Withdrawal of the product from the market (By: Retailer)

1 of 7 photos PreviousNext Share on             Alert number: A12/0310/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: Slyme clay   Type / number of model:  55-2   Batch number / Barcode:  6 958455 624569, 6 987542 687507   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value: up to 546 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0313/19        Category:  Toys   Product:  Plastic doll   Brand: ABABABY, SMILE   Name: Annie Baby   Type / number of model:  Item Nr.: KJ883, HKJ368D, YKJ368B   Batch number / Barcode:  6920778206622   Risk type:  Chemical   The plastic material of the doll's head contains 2-ethylhexyl phthalate (DEHP) (measured value: 31 % by weight). This phthalate may harm the health of children, causing possible damage to the reproductive system. The product does not comply with the REACH Regulation.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 2 photos PreviousNext Share on             Alert number: A12/0314/19        Category:  Toys   Product:  Soft toy   Brand: Baby Gong Wei Gang   Name: Unknown   Type / number of model:  V51-3   Batch number / Barcode: Unknown   Risk type:  Choking   The eyes and nose of the toy can easily detach. In addition, the fibrous stuffing material of the toy is easily accessible due to the weakness of the plastic zipper. A small child may put the small parts in the mouth and choke. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-1.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0333/19        Category:  Toys   Product:  Wooden toy rattle   Brand: Classic World   Name: Unknown   Type / number of model:  3053   Batch number / Barcode:  6927049001185   Risk type:  Choking   The product contains a small wooden ball that can easily fall out between the bars of the rattle. A small child could put it in the mouth and choke on it. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-1.   Measures taken by economic operators: Recall of the product from end users (By: Distributor)

1 of 3 photos PreviousNext Share on             Alert number: A12/0338/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: Unknown   Type / number of model:  Unknown   Batch number / Barcode:  6 958455 624569   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value: 533 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 4 photos PreviousNext Share on             Alert number: A12/0339/19        Category:  Toys   Product:  Toy Slime   Brand: Unknown   Name: Unicorn Crystal Mud   Type / number of model:  Unknown   Batch number / Barcode:  6 958455 624569   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value: 506 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system.  The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 6 photos PreviousNext Share on             Alert number: A12/0341/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: CRYSTAL SOIL - HELLO SUMMER   Type / number of model:  PL00605   Batch number / Barcode:  2 900000 225268   Risk type:  Chemical   The migration of boron from the toy slimes is too high (measured value: up to 874 mg/kg for red). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system.  The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 6 photos PreviousNext Share on             Alert number: A12/0342/19        Category:  Toys   Product:  Toy slime   Brand: Unknown   Name: CRYSTAL MUD   Type / number of model:  PL00604   Batch number / Barcode:  2 900000 225251   Risk type:  Chemical   Due to the container's characteristic form, appearance and size, this product may be mistaken for a foodstuff. This may lead consumers, and specially children, to put them in the mouth and ingest its content. The migration of boron from the toy slime is too high (measured value: up to 1461 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system.  The product does not comply with the requirements of the Food Imitating Products Directive, the Toy Safety Directive and the relevant European standard EN 71-3.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0345/19        Category:  Toys   Product:  Play tent   Brand: Eureka Kids   Name: My Little Explorer   Type / number of model:  Ref. 94570874   Batch number / Barcode:  8435404813369   Risk type:  Choking   Some pieces of velcro on the tent can become detached, generating a small part. A small child may put them in the mouth and choke. The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-1.   Measures ordered by public authorities (to: Importer): Import rejected at border

1 of 6 photos PreviousNext Share on             Alert number: A12/0346/19        Category:  Toys   Product:  Toy slime   Brand: HTI   Name: Teamsterz Slime   Type / number of model:  1374304   Batch number / Barcode:  Batch: 05BB1 5 050837 430414   Risk type:  Chemical   The migration of boron from the toy slime is too high (measured value up to 2165 mg/kg). Ingestion or contact with an excessive quantity of boron may harm the health of children by damaging their reproductive system.  The product does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-3.   Measures taken by economic operators: Voluntary withdrawal (By: Manufacturer)

1 of 2 photos PreviousNext Share on             Alert number: A12/0301/19        Category:  Clothing, textiles and fashion items   Product:  Children's dress   Brand: Cutey Pie   Name: Unknown   Type / number of model:  50JTC1005   Batch number / Barcode:  3 664795 008992   Risk type:  Chemical   The dress contains azo-dyes releasing the aromatic amine 4-methyl-m-phenylenediamine (2,4-toluenediamine) (measured concentration: 342 mg/kg). When in direct and prolonged contact with the skin, the aromatic amines may be absorbed by the skin. Aromatic amines can cause cancer, cell mutations and affect reproduction. The product does not comply with the REACH Regulation.   Measures ordered by public authorities (to: Other): Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0335/19        Category:  Clothing, textiles and fashion items   Product:  Children's sweatshirt   Brand: Hello baby   Name: Unknown   Type / number of model:  XH-9119   Batch number / Barcode:  2100005300094, 5272017091196   Risk type:  Strangulation   The drawstrings may become trapped during various activities of the child, leading to strangulation. The product does not comply with European standard EN 14682.   Measures ordered by public authorities (to: Distributor): Withdrawal of the product from the market

1 of 1 photo Share on             Alert number: A12/0320/19        Category:  Communication and media equipment   Product:  iPad holder   Brand: Unknown   Name: Unknown   Type / number of model:  R.320.601   Batch number / Barcode: Unknown   Risk type:  Environment   The holder contains short-chain chlorinated paraffins (SCCPs) (measured value up to 2.75%). The placing on the market and use of articles containing SCCPs is banned. SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment.  The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market, Withdrawal of the product from the market (By: Distributor, Importer) Measures ordered by public authorities (to: Distributor): Recall of the product from end users

1 of 1 photo Share on             Alert number: A12/0323/19        Category:  Communication and media equipment   Product:  Earbuds   Brand: Unknown   Name: Unknown   Type / number of model:  P326.231   Batch number / Barcode:  8714612097212   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 1.89%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0324/19        Category:  Communication and media equipment   Product:  Earbuds   Brand: Unknown   Name: Unknown   Type / number of model:  1899   Batch number / Barcode: Unknown   Risk type:  Environment   The solder contains lead (measured value up to 83% by weight) in concentrations above limit values. Lead poses a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0326/19        Category:  Communication and media equipment   Product:  Headphones   Brand: Unknown   Name: Unknown   Type / number of model:  86004-14   Batch number / Barcode:  7393107720340   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 0.32%). SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment. The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 1 photo Share on             Alert number: A12/0327/19        Category:  Communication and media equipment   Product:  Headphones   Brand: Unknown   Name: Unknown   Type / number of model:  91268   Batch number / Barcode:  PO6022829   Risk type:  Environment   The solder contains lead (measured value up to 54% by weight) in concentrations above limit values. Lead poses a risk to the environment.  The product does not comply with the requirements of the Commission Directive on the restriction of the use of certain hazardous substances in electrical and electronic equipment (RoHS 2 Directive).   Measures taken by economic operators: Withdrawal of the product from the market (By: Importer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 2 photos PreviousNext Share on             Alert number: A12/0302/19        Category:  Cosmetics   Product:  Body lotion   Brand: Judith Leiber   Name: Night   Type / number of model:  150 ml reference 17X610203   Batch number / Barcode:  barcode 899219002819   Risk type:  Chemical   The body lotion contains isobutylparaben which has a potential endocrine disrupting activity. At the same time, the product contains limonene, linalool, coumarin, citronellol, alpha-isomethyl ionone (measured values: more than 0.001% by weight). These substances can induce allergic reactions and sensitisation. Consumers are not aware of their presence because they are not indicated in the list of ingredients. The product does not comply with the Cosmetic Products Regulation.   Measures taken by economic operators: Recall of the product from end users (By: Retailer)

1 of 1 photo Share on             Alert number: A12/0317/19        Category:  Electrical appliances and equipment   Product:  Power supply   Brand: Unknown   Name: Powerbank   Type / number of model:  PB0041   Batch number / Barcode: Unknown   Risk type:  Environment   The plastic contains short-chain chlorinated paraffins (SCCPs) (measured value up to 1.65 % by weight). The placing on the market and use of articles containing SCCPs is banned. SCCPs persist in the environment, are toxic to aquatic organisms at low concentrations and bioaccumulate in wildlife and humans, posing a risk to human health and the environment.  The product does not comply with the Regulation on persistent organic pollutants (POP Regulation).   Measures taken by economic operators: Withdrawal of the product from the market (By: Manufacturer) Measures ordered by public authorities (to: Other): The company is reported to the prosecutor

1 of 3 photos PreviousNext Share on             Alert number: A12/0336/19        Category:  Electrical appliances and equipment   Product:  Power Inverter   Brand: Clear view   Name: Unknown   Type / number of model:  H130609520 and H130609476   Batch number / Barcode:  5 999885 948178   Risk type:  Electric shock   Single-pole or partial insertion of a plug into the product's socket is possible. When using the inverter, live pins of the inserted plug could remain accessible, which could result in the user receiving an electric shock. The product does not comply with the requirements of the Low Voltage Directive and the relevant standards EN 60950 and IEC 60884.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 3 photos PreviousNext Share on             Alert number: A12/0340/19        Category:  Electrical appliances and equipment   Product:  Electric shaver   Brand: Surker   Name: RECHARGEABLE SHAVER   Type / number of model:  RSCW-2015 REF: 10105   Batch number / Barcode:  6 955519 320153 (on the packaging); 5 995858 101052 (on a label)   Risk type:  Electric shock   The dimensions of the socket outlet on the mains lead of the shaver are not suitable. The user could consequently touch live parts while connecting the mains lead to the shaver, leading to electric shock. The insulation between live parts and the accessible metal housing is insufficient. Consequently accessible parts could become live, this could cause the user to receive an electric shock when holding the shaver. The product does not comply with the requirements of the Low Voltage Directive and the relevant European standard EN 60335.   Measures ordered by public authorities (to: Distributor): Recall of the product from end users, Withdrawal of the product from the market

1 of 2 photos PreviousNext Share on             Alert number: A12/0344/19        Category:  Electrical appliances and equipment   Product:  Electrical plug cover   Brand: Eastern   Name: 13A Socket Cover Safety Plug   Type / number of model:  SW201   Batch number / Barcode:  3 579901 283883   Risk type:  Electric shock   The product does not have shutters on live parts, nor a fuse. A user could touch live parts of the socket and receive an electric shock. The product does not comply with the relevant National standards BS 1363-3 and BS 8546.   Measures ordered by public authorities (to: Importer): Withdrawal of the product from the market

Products with other risk levels 

1 of 1 photo Share on             Alert number: A11/0009/19        Category:  Toys   Product:  Soft toy animal   Brand: Greenlife   Name: Hibou brun (brown owl)   Type / number of model:  ref 11053413   Batch number / Barcode: Unknown   Risk type:  Choking   The stuffing material is easily accessible. Young children may put it in the mouth, ingest it and choke on it.  The toy does not comply with the requirements of the Toy Safety Directive and the relevant European standard EN 71-1.    Measures taken by economic operators: This product listing was removed by Amazon., Withdrawal of the product from the market (By: Other)

The Onco Fertility Journal (Onco Fertil J)

Ethical concerns in fertility preservation in the young Nalini Mahajan The Onco Fertility Journal 2018 1(2):59-60

Breast cancer and Fertility Part 2- Pregnancy Associated Breast Cancer Nalini Mahajan The Onco Fertility Journal 2018 1(2):61-70 Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy or within the first postpartum year. The increasing incidence follows the increase in age at first childbirth. Diagnostic delay due to physiological breast changes of pregnancy leads to the tumor being diagnosed at a more advanced stage. Since the termination of pregnancy does not alter the course of disease, patients can be offered BC management during pregnancy with a good outcome. Chemotherapy (CT) can be given safely during the second and third trimester of pregnancy. In the first trimester, the option of surgery is available while during puerperium, radiotherapy can be safely administered in addition to CT. Prognosis is related to the stage and grade of the tumor. Neonatal outcomes are reassuring. This article gives an overview of the diagnosis, management, and prognosis of PABC.

Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan Yasushi Takai The Onco Fertility Journal 2018 1(2):71-73 Fertility preservation (FP)/oncofertility is a crucial facet of cancer supportive care. The publication of FP guidelines is becoming increasingly prevalent in Japan. However, the viability of the guidelines is predicted on a well-developed FP network comprising of cancer hospitals, assisted reproductive technology (ART) hospitals/clinics, and oncofertility center, and the quality of the FP network in Japan varies greatly based on the region. Oncofertility care availability is influenced by the sustainability of each network and public financial support which may be facilitated by oncofertility registry system which recently launched in Japan.

Comparison of ovarian reserve and response to gonadotropin stimulation in fertile and infertile Indian women based on ovarian reserve markers, anti-Mullerian hormone and antral follicle count Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):74-80 Background: Poor ovarian response to gonadotropin (GT) stimulation during assisted reproductive technology cycles is often encountered in infertile women and is considered to be a cause of their infertility. Poor ovarian response is mostly a result of a low ovarian reserve (OR), implying that there may be an earlier depletion of the oocyte pool in infertile women. Aim of the Study: To evaluate whether infertile Indian women below the age of 35 years have an earlier depletion of their OR and a lower ovarian response to GT in comparison to age-matched fertile controls. Materials and Methodology: A total of 146 women undergoing in vitro fertilization-intracytoplasmic sperm injection at our fertility center between March 2017 and August 2017 were prospectively enrolled in this study. Anti-Mullerian hormone and antral follicle count (AMH and AFC) assessment was done for women enrolled in the study in the early follicular phase. Flexible GnRH antagonist protocol was followed. Age, AMH, AFC, body mass index, and response to ovarian stimulation (OS) were compared between the fertile and infertile groups. We also sought to determine which among these had the best prediction for ovarian response to controlled OS. Statistical Analysis: Chi-square test was used for comparisons between study groups with respect to percentages. P < 0.05 was considered to be statistically significant. Results: When adjusted for the differences in the demographic variables, we found no difference in the AMH (P = 0.298) and AFC (P = 0.302) between the fertile and infertile women. In addition, there was no difference in the ovarian response; the mean number of oocytes retrieved was 15.8 ± 7.5 in the fertile group and 14.3 ± 7.5 in the infertile group (P = 0.510). AMH had the strongest correlation with the number of oocytes retrieved (r = 2.11) in comparison to AFC (r = 0.08) and age (r = −0.45) Conclusion: There is no difference in OR and response in fertile and infertile Indian having similar demographics and basal characteristics.

Intrauterine autologous platelet-rich plasma therapy to improve implantation rates in patients undergoing frozen embryo transfer: A pilot study Anju Madhavan, Padmaja Naidu, Kum Kum Rani, Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):81-85 Background: Successful implantation is a well-orchestrated event requiring the presence of a healthy embryo, a receptive endometrium, appropriate embryo endometrial cross-talk, and adequate maternal immune protection. Despite advances in assisted reproductive technology, there are insignificant improvements in the implantation and pregnancy rates. Intrauterine infusion of platelet-rich plasma (PRP) might improve implantation rates through its paracrine effects by recruiting growth factors and cytokines that favor decidualization and implantation. Objectives: The objective of the study is to study whether intrauterine PRP improves implantation rates in patients undergoing frozen embryo transfer (FET). Subjects and Methods: In this retrospective study, we collected data of patients who underwent FET in Mother and Child Hospital for 11 months from January 2018 to November 2018. We screened data of 98 patients who had at least one previous failed FET and underwent subsequent FET. The patients were divided into a study and control group. The study group received Intrauterine PRP before FET, while the control group did not. All patients underwent the same hormone replacement therapy regimen for endometrial preparation. Main Outcome Measure: The main outcomes studied were the implantation rates and clinical pregnancy rates (CPR) after embryo transfer. Results: Patient demographics such as mean age, body mass index, and anti-mullerian hormone of both groups were comparable. Overall, the CPR was 42.8% in the control group and 47.6% in the intervention group, and the difference was not statistically significant. Conclusion: Intrauterine PRP does not increase the implantation rates/CPR significantly in patients who have had one previous FET failure.

Strategies for fertility preservation in young patients with cancer Devika Gunasheela, Jyothi Menon, N Ashwin The Onco Fertility Journal 2018 1(2):86-88 Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.

Fertility preservation in testicular seminoma Madhuri Patil, Priyanka Reddy The Onco Fertility Journal 2018 1(2):89-95 Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1% of all cancers in men. Germ cell tumors (GCTs) account for 95% of testicular cancers. Two broad categories of testicular tumors have been described, one pure seminoma (no nonseminomatous elements present) and the other is nonseminomatous GCTs. It is one the most curable neoplasm with 5 years survival rate of 98%–99% when diagnosed at an early stage. We present here one such case of metastatic seminoma, where the semen was cryopreserved for fertility preservation. Although the sample was oligoasthenospermic, a successful pregnancy and live birth was obtained with intrauterine insemination of the frozen sample in an controlled ovarian stimulation cycle. Testicular tumors can impair fertility after treatment in majority of patients. Fertility preservation methods such as semen freezing, sperm freezing using epididymal or testicular sperm extraction (TESE) or testicular tissue freezing provides hope for those who wish to father a child latter.

Fertility preservation in a premenarcheal female with sickle cell anemia Sonu Balhara Ahlawat, Sarabpreet Singh The Onco Fertility Journal 2018 1(2):96-98 The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.

A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen Sankar Kumar Das, Priyanka Roy The Onco Fertility Journal 2018 1(2):99-102 Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.

Beware of bleomycin toxicity: Fertility preservation for dysgerminoma Ashraf M Ali, Paapa Dasari The Onco Fertility Journal 2018 1(2):103-106 An 18-year-old female who underwent fertility preservation surgery for dysgerminoma Stage IIa received adjuvant chemotherapy and bleomycin, etoposide and cisplatin of four cycles. She presented with cough and breathlessness after 45 days of the last cycle of chemotherapy. She was tachypneic and had decreased SpO2 and was managed by supportive therapy. Her X-ray chest revealed bilateral ground-glass nodular opacity and computed tomography thorax showed evidence of pulmonary fibrosis in the form of intra- and inter-lobular septal fibrosis with surrounding ground-glass opacity. She ultimately died after 5 days of admission due to respiratory failure. Her body weight was 37 kg and she received standard dose of bleomycin and the cumulative dose was 360 U. Bleomycin dose recommendation is not per kg bodyweight, and the complication of pulmonary fibrosis could have been prevented if the dosage schedule as per bodyweight (0.25–0.5 U/kg) is advocated.

Squamous cell carcinoma around a dental implant: A case report and literature review

Publication date: Available online 22 February 2019

Source: Oral Oncology

Author(s): Eve Malthiéry, Marie De Boutray, Charlotte Koren, Jean-Pierre Albouy, Jacques-Henri Torres, Marie-Alix Fauroux

https://ift.tt/2Sj1Knl

Efficacy of β-caryophyllene for periodontal disease related factors

Publication date: Available online 21 February 2019

Source: Archives of Oral Biology

Author(s): Hyun-Jun Yoo, Su-Kyung Jwa

Abstract

Objective

This study aimed to investigate the antimicrobial activity of β-caryophyllene against periodontopathogens as well as its inhibitory effects on the expression of inflammatory cytokines and production of volatile sulfur compounds by lipopolysaccharide and periodontopathogenic enzymes, respectively.

Design

The antimicrobial activity of β-caryophyllene againstPorphyromonas gingivalis, Tannerella forsythia, and Treponema denticola was investigated via a susceptibility assay using a microplate reader. THP-1 cells were treated with lipopolysaccharide in the presence or the absence of β-caryophyllene, and the expression and production of inflammatory cytokines were then analyzed by a real-time reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. After fluorescence-labelling lipopolysaccharide, the effect of β-caryophyllene on the binding of lipopolysaccharide to the cell wall was investigated via flow cytometry. The spent culture media of P. gingivalis was shaken with or without β-caryophyllene and gaseous volatile sulfur compounds (VSCs) were measured by a gas chromatograph.

Results

β-caryophyllene showed strong the antimicrobial activity against periodontopathogens. It also reduced lipopolysaccharide-induced expression and production of cytokines, thereby inhibiting the binding of lipopolysaccharide-binding to toll-like receptors by interfering with the complex of lipopolysaccharide and CD14 or lipopolysaccharide-binding protein. β-caryophyllene also inhibited the emission of gaseous VSCs produced byP. gingivalis.

Conclusions

β-caryophyllene may improve periodontal health via antimicrobial activity against periodontopathogens, reducing inflammation caused by lipopolysaccharide, and by neutralizing VSCs.

https://ift.tt/2Vgh6ee

Oral administration of an herbal medicine to prevent progressive hearing loss in a mouse model of diabetes

Publication date: Available online 22 February 2019

Source: Auris Nasus Larynx

Author(s): Takeshi Hori, Kazuma Sugahara, Junko Tsuda, Yoshinobu Hirose, Makoto Hashimoto, Yousuke Takemoto, Shunsuke Tarumoto, Hiroshi Yamashita

Abstract

Objective

Tsumura Suzuki Obese Diabetes (TSOD) mice exhibit early age-associated hearing loss. Histopathological analysis of these mice shows narrowing of capillaries in the stria vascularis and chronic reduction of blood flow in the cochlea. In this study, we investigated the effect of oral administration of a herbal medicine or calorie restriction on hearing in TSOD mice.

Methods

TSOD mice were divided into 4 groups: CR (calorie restriction), BF and DS (treated with the herbal medicines, Bofutsushosan and Daisaikoto, respectively), and the control group. Body weight, blood glucose levels, and auditory brainstem responses (ABRs) were measured. The cochleae were excised and evaluated histopathologically.

Results

Blood glucose levels were suppressed in the CR, BF, and DS groups. In addition, the elevation of ABR thresholds was inhibited in the CR, BF, and DS groups. Cochlear blood vessels remained wide in the three treatment groups compared with the control group. These results suggested that the administration of these herbal medicines improved glucose tolerance and yielded results similar to those on calorie restriction.

Conclusion

Oral administration of 2 herbal medicines can prevent hearing function disorder in a model mouse of diabetes. The results may clarify the possibility of clinical application.

https://ift.tt/2It3afa

Clinical management for T1 and T2 external auditory canal cancer

Publication date: Available online 21 February 2019

Source: Auris Nasus Larynx

Author(s): Hirotaka Shinomiya, Natsumi Uehara, Masanori Teshima, Akinori Kakigi, Naoki Otsuki, Ken-ichi Nibu

Abstract

Objective

The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC).

Materials and methods

Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection.

Results

The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively.

Conclusions

Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins.

Levels of evidence: 4.

https://ift.tt/2TcOfKf

Issue Information

https://ift.tt/2EojeL3

Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study

Abstract

Purpose

The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.

Methods

We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I–IV according to Myer–Cotton grading system), number of subsites involved ("a" to "d" for 1–4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.

Results

The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).

Conclusions

The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.

https://ift.tt/2SkeauW

Intermittierender Tinnitus – eine empirische Beschreibung

Zusammenfassung

Hintergrund

Tinnitus wird oft in eine akute und eine chronische Form eingeteilt. Allerdings ergaben epidemiologische Studien als häufigste Form intermittierenden Tinnitus (IT), der keiner dieser Kategorien eindeutig zugehört.

Ziel der Arbeit

Ziel war eine weitergehende empirische Beschreibung des IT.

Material und Methoden

In einer exploratorischen Querschnittstudie wurden 320 Tinnitusbetroffene zu Soziodemografie, Tinnitusmerkmalen, begleitenden Beschwerden, wahrgenommenen Auslösern und hilfesuchendem Verhalten befragt. Sie wurden eingeteilt in: chronischer Tinnitus (CT), wenn sie den Tinnitus in den letzten 12 Monaten ständig bemerkten, IT, wenn sie den Tinnitus nur zeitweise wahrnahmen, oder Einzelepisode (SET), wenn der Tinnitus nur einmal, aber für mehrere Tage aufgetreten war.

Ergebnisse

Von 62 % der Stichprobe wurde IT angegeben, von 23 % SET und von 16 % CT. Der Beginn lag im Mittel 36 (CT), 28 (IT) bzw. 19 Monate (SET) zurück. Dabei dauerten IT-Episoden bei den meisten Betroffenen wenige Tage, bei 25 % 1–4 Wochen, im Durchschnitt 1,6 Wochen. Sie traten in einer Häufigkeit zwischen alle paar Tage und halbjährlich auf, im Mittel alle 7 Wochen. Führende Auslöser waren beruflicher oder privater Stress. Abnahme der Leistungsfähigkeit, Depression, soziale Isolation, psychiatrische Störungen und Innenohrerkrankungen waren bei CT häufiger als bei IT. Hilfesuchendes Verhalten war zwischen CT und IT vergleichbar.

Schlussfolgerung

Emotionale Reaktionen und situative Beeinträchtigung führen bei IT zu multiplen Behandlungsversuchen, i. Allg. aber nicht zu schwerer Beeinträchtigung. Innenohrerkrankungen und psychische Veränderungen sind seltener als bei CT, daher könnten Therapieansprechen und Prognose besser sein. Die Autoren schlagen eine Einteilung in akute Einzelepisode (<3 Monate), intermittierende und chronisch persistierende Form (>3 Monate) vor.

https://ift.tt/2BHyBN5

Comparison of Bethesda cytopathology classification to surgical pathology across racial‐ethnic groups

Abstract

Background

The Bethesda System standardized the reporting of thyroid cytopathology and created categories to provide an estimation of a nodule's risk of malignancy. There are limited data describing their utility in different racial‐ethnic groups.

Methods

A retrospective chart review of thyroid fine‐needle aspirations (FNA) was performed within our health‐care systems. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated for the total cohort, and racial‐ethnic groups.

Results

The sensitivity, specificity, PPV, and NPV of the entire cohort was 93%, 77%, 57%, and 97%. Among patients who underwent surgery, African Americans contained a high number of Bethesda II FNAs (63%) compared to Hispanics (48%) and whites (45%). The sensitivity, specificity, and NPV were comparable among groups, the PPV was lowest for African Americans (43%), followed by Hispanics (60%) and whites (69%).

Conclusions

The Bethesda system's predictive value may differ among racial‐ethnic groups.

https://ift.tt/2SSyTv6

Discarded in the trash: burials of African enslaved individuals in Valle da Gafaria, Lagos, Portugal (15th‐17th centuries)

Abstract

In 2009, an excavation carried out in Valle da Gafaria, Lagos, Portugal, allowed for the recovery of the skeletal remains of 158 individuals buried in a dump used during the 15^th‐17^th centuries. The archaeological context of the findings, the presence of African items associated with the skeletons, the skulls' morphology, and the presence of intentionally modified teeth, suggest that these individuals were African enslaved individuals. The aim of this work is to analyse how these men, women, and children were inhumed according to their sex and age (adults vs. non‐adults). Adults were mostly buried in supine position (54.3%). However, more women (27.3%) than men (9.5%) were inhumed in prone position. In non‐adults, the most common positions were the supine (36.2%) and the lateralis (38.8%). The foetal position was more commonly found in non‐adults (25.0%) than adults (4.3%, only women). Both adults (79.4%) and non‐adults (80.0%) were mostly buried with an orientation other than the typical Christian canonical practice at the time (head to west and feet to east). More non‐adult individuals (66.7%) appear to have been buried with care than adults (38.8%). Regarding both the orientation and the burial care, no differences were found between the sexes. Pieces of evidence of having been tied were found in four females, one male, and one non‐adult individual. All these results support the hypothesis that these individuals were discarded, bringing light to the way these African enslaved individuals were treated even at their death.

https://ift.tt/2XkJYU6

Issue Information ‐ TOC

No abstract is available for this article.

https://ift.tt/2GUahec

Our experience of stapes superstructure and incudostapedial joint preservation in otosclerosis surgery

Abstract

Key points

•Preservation of the stapes anterior crus and incudostapedial joint can be considered an evolution of the stapedotomy technique, which itself has evolved from stapedectomy.

•This approach can be adopted as part of a 'reversal steps' stapedotomy.

•Removing the stapes superstructure is a surgical step associated with risk of footplate mobilization or fracture, and in selected cases may be avoided.

•We report an average hearing gain of 26dB when using this technique in 21 patients, compared to 28dB when using a conventional technique.

•Randomised studies would be necessary to demonstrate non‐inferiority of a stapes preservation stapedotomy technique.

This article is protected by copyright. All rights reserved.

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Clinical Infectious Diseases

The Association of Antibiotic Stewardship With Fluoroquinolone Prescribing in Michigan Hospitals: A Multi-hospital Cohort Study Abstract Background Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown. Methods This study is a 48-hospital, retrospective cohort of general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015–September 2017. Hospitals were surveyed on their use of pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing during hospitalization (fluoroquinolone stewardship). After controlling for hospital clustering and patient factors, aggregate (inpatient and post-discharge) fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) exposure was compared between hospitals with and without fluoroquinolone stewardship. Results There were 11 748 patients (6820 pneumonia; 4928 positive urine culture) included at 48 hospitals. All hospitals responded to the survey: 29.2% (14/48) reported using pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. After adjustment, fluoroquinolone stewardship was associated with fewer patients receiving a fluoroquinolone (37.1% vs 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1000 patients (2282 vs 3096 days/1000 patients; P = .01), driven by lower inpatient prescribing. However, most (66.6%) fluoroquinolone treatment days occurred after discharge, and hospitals with fluoroquinolone stewardship had twice as many new fluoroquinolone starts after discharge as hospitals without (15.6% vs 8.4%; P = .003). Conclusions Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge. To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing.

Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF–identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012–2017: A Retrospective Province-Wide Cohort Study Abstract Background Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. Methods of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan–Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death. Results Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63–3.59), retreatment of TB (aOR 4.92, 95% CI 2.31–10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01–3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3–60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P = .06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2–6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88–9.71). Conclusions Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes. The Association of Antibiotic Stewardship With Fluoroquinolone Prescribing in Michigan Hospitals: A Multi-hospital Cohort Study Abstract Background Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown. Methods This study is a 48-hospital, retrospective cohort of general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015–September 2017. Hospitals were surveyed on their use of pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing during hospitalization (fluoroquinolone stewardship). After controlling for hospital clustering and patient factors, aggregate (inpatient and post-discharge) fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) exposure was compared between hospitals with and without fluoroquinolone stewardship. Results There were 11 748 patients (6820 pneumonia; 4928 positive urine culture) included at 48 hospitals. All hospitals responded to the survey: 29.2% (14/48) reported using pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. After adjustment, fluoroquinolone stewardship was associated with fewer patients receiving a fluoroquinolone (37.1% vs 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1000 patients (2282 vs 3096 days/1000 patients; P = .01), driven by lower inpatient prescribing. However, most (66.6%) fluoroquinolone treatment days occurred after discharge, and hospitals with fluoroquinolone stewardship had twice as many new fluoroquinolone starts after discharge as hospitals without (15.6% vs 8.4%; P = .003). Conclusions Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge. To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing. Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF–identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012–2017: A Retrospective Province-Wide Cohort Study Abstract Background Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program. Methods of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan–Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death. Results Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63–3.59), retreatment of TB (aOR 4.92, 95% CI 2.31–10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01–3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3–60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P = .06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2–6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88–9.71). Conclusions Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes. Glycocalyx Breakdown is Associated with Severe Disease and Fatal Outcome in Plasmodium falciparum Malaria Abstract Background Interactions between the endothelium and infected erythrocytes, microvascular dysfunction and parasite sequestration play major roles in the pathogenesis of severe falciparum malaria. The glycocalyx is a carbohydrate-rich layer lining the endothelium mediating NO production and vascular homeostasis. The role of the glycocalyx in falciparum malaria and the association with disease severity is not known. Methods We prospectively enrolled Indonesian inpatients (≥18 years old) with severe (SM) or moderately-severe (MSM) falciparum malaria and healthy controls (HCs). Glycocalyx breakdown products were measured in enrolment samples of urine (glycosaminoglycans; dimethylmethylene blue [GAG-DMMB] and liquid chromatography-tandem mass spectrometry [GAG-MS] assays) and plasma (syndecan-1; ELISA), and related to vascular NO bioavailability (reactive hyperemia-peripheral arterial tonometry). Results A total of 129 subjects (SM=43, MSM=57, HC=29) were recruited. Syndecan-1 (µg/ml), GAG-DMMB and GAG-MS (g/mol creatinine) were increased in SM [median (range) 332.4 (85-3-1913), 3.16 (0.04-27.9) and 4.73 (2.02-27.13)] compared to MSM [99.1 (19.9-767.6), 1.28 (0.03-9.3) and 4.44 (1.19-13.87)], and HCs [48.9 (32.3-88.3), 0.11 (0.02-1.9) and 2.55 (0.73-10.19)]; P<0.001. In SM, GAG-DMMB and GAG-MS were increased in non-survivors (n=3) [median (IQR): 6.72 (3.80-27.87) and 12.15 (7.88-17.20)] compared to survivors n=39 [(3.10 (0.46-4.5) and 4.64 (2.02-15.20)]; P=0.03. Glycocalyx degradation was associated with parasite biomass in MSM (r=0.31, P=0.03 [syndecan-1]; r=0.48 [GAG-DMMB] and r=0.43 [GAG-MS], P<0.001), and SM patients (r=0.29, P=0.04, r=0.47; P=0.002 and r=0.33, P=0.04), and inversely associated with endothelial NO bioavailability. Conclusions Increased endothelial glycocalyx breakdown is associated with impaired vascular NO, severe disease and fatal outcome in adults with falciparum malaria, likely contributing to pathogenesis. Impact of rotavirus vaccine introduction in children less than 2 years of age presenting for medical care with diarrhea in rural Matlab, Bangladesh Abstract Background Following the conclusion of a Rotarix vaccine (HRV) cluster-randomized controlled trial (CRT) in Matlab, Bangladesh, HRV was included in Matlab's routine immunization program. We describe the population-level impact of programmatic rotavirus vaccination in Bangladesh in children <2 years of age Methods Interrupted time series were used to estimate the impact of HRVintroduction. Diarrheal surveillance collected between 2000 and 2014 within the two service delivery areas (icddr,b service area [ISA] and government service area [GSA]) of the Matlab Health and Demographic Surveillance System administered by icddr,b was used. Age-group specific incidence rates were calculated for both rotavirus-positive (RV+) and rotavirus-negative (RV-) diarrhea of any severity presenting to the hospital. Two models were used to assess impact within each service area: Model 1 used the pre-vaccine time period in all villages (HRV- and control-only) and Model 2 combined the pre-vaccine time period and the CRT time period using outcomes from control-only villages. Results Both models demonstrated a downward trend in RV+ diarrheal incidence in the ISA villages during 3.5 years of routine HRV use, though only Model 2 was statistically significant. Significant impact of HRV on RV+ diarrhea incidence in GSA villages was not observed in either model. Differences in population-level impact between the two delivery areas may be due to varied rotavirus vaccine coverage and presentation rate to the hospital. Conclusions This study provides initial evidence of the population-level impact of rotavirus vaccines in children <2 years of age in Matlab, Bangladesh. Further studies of rotavirus vaccine impact after nationwide introduction in Bangladesh are needed. Transmission-blocking effects of primaquine and methylene blue suggest P. falciparum gametocyte sterilisation rather than effects on sex ratio Abstract Gametocyte density and sex-ratio can predict the proportion of mosquitoes that become infected after feeding on blood of patients receiving non-gametocytocidal drugs. Because primaquine and methylene blue sterilize gametocytes before affecting their density and sex-ratio, mosquito feeding experiments are required to demonstrate their early transmission-blocking effects. Principal Controversies in Vaccine Safety in the United States Abstract Concerns about vaccine safety can lead to decreased acceptance of vaccines and resurgence of vaccine-preventable diseases. We summarize the key evidence on some of the main current vaccine safety controversies in the United States, including: 1) MMR vaccine and autism; 2) thimerosal, a mercury-based vaccine preservative, and the risk of neurodevelopmental disorders; 3) vaccine-induced Guillain-Barré Syndrome (GBS); 4) vaccine-induced autoimmune diseases; 5) safety of HPV vaccine; 6) aluminum adjuvant-induced autoimmune diseases and other disorders; and 7) too many vaccines given early in life predisposing children to health and developmental problems. A possible small increased risk of GBS following influenza vaccination has been identified, but the magnitude of the increase is less than the risk of GBS following influenza infection. Otherwise, the biological and epidemiologic evidence does not support any of the reviewed vaccine safety concerns. Insertion as resistance mechanism against integrase inhibitors in several retroviruses Birth Cohort Studies Assessing Norovirus Infection and Immunity in Young Children: A Review Abstract Globally, noroviruses are among the foremost causes of acute diarrheal disease, yet there are many unanswered questions on norovirus immunity, particularly following natural infection in young children during the first 2 years of life when the disease burden is highest. We conducted a literature review on birth cohort studies assessing norovirus infections in children from birth to early childhood. Data on infection, immunity, and risk factors are summarized from 10 community-based birth cohort studies conducted in low- and middle-income countries. Up to 90% of children experienced atleast one norovirus infection and up to 70% experienced norovirus-associated diarrhea, most often affecting children 6 months of age and older. Data from these studies help to fill critical knowledge gaps for vaccine development, yet study design and methodological differences limit comparison between studies, particularly for immunity and risk factors for disease. Considerations for conducting future birth cohort studies on norovirus are discussed. In the Literature Saddle Nose Deformity in an Immunosuppressed Patient Cover News Ebola's Curse: 2013–2016 Outbreak in West Africa By OldstoneMichael and OldstoneMadeleine. Elsevier, 2017. 126 pp. $89.95 (hardcover). ISBN: 9780128138885. Cost-effectiveness and Cost-utility of the Adherence Improving Self-management Strategy in Human Immunodeficiency Virus Care: A Trial-based Economic Evaluation Abstract Background Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven-effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration NCT01429142 First Human Case of Metacestode Infection Caused by Versteria sp. in a Kidney Transplant Recipient Abstract Cestodes are emerging agents of severe opportunistic infections among immunocompromised patients. We describe the first case of human infection, with the recently-proposed genus Versteria causing an invasive, tumor-like hepatic infection with regional and distant extension in a 53-year-old female kidney transplant recipient from Atlantic Canada. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate is Non-inferior to Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate in Treatment-naive Adults With Human Immunodeficiency Virus–1 Infection: Week 48 Results of the DRIVE-AHEAD Trial Abstract Background Doravirine (DOR), a novel non-nucleoside reverse-transcriptase inhibitor (NNRTI), is active against wild-type Human Immunodeficiency Virus (HIV)-1 and the most common NNRTI-resistant variants, and has a favorable and unique in vitro resistance profile. Methods DRIVE-AHEAD is a phase 3, double-blind, non-inferiority trial. Antiretroviral treatment–naive adults with ≥1000 HIV-1 RNA copies/mL were randomized (1:1) to once-daily, fixed-dose DOR at 100 mg, lamivudine at 300 mg, and tenofovir disoproxil fumarate (TDF) at 300 mg (DOR/3TC/TDF) or to efavirenz at 600 mg, emtricitabine at 200 mg, and TDF at 300 mg (EFV/FTC/TDF) for 96 weeks. The primary efficacy endpoint was the proportion of participants with <50 HIV-1 RNA copies/mL at week 48 (Food and Drug Administration snapshot approach; non-inferiority margin 10%). Results Of the 734 participants randomized, 728 were treated (364 per group) and included in the analyses. At week 48, 84.3% (307/364) of DOR/3TC/TDF recipients and 80.8% (294/364) of EFV/FTC/TDF recipients achieved <50 HIV-1 RNA copies/mL (difference 3.5%, 95% CI, -2.0, 9.0). DOR/3TC/TDF recipients had significantly lower rates of dizziness (8.8% vs 37.1%), sleep disorders/disturbances (12.1% vs 25.2%), and altered sensorium (4.4% vs 8.2%) than EFV/FTC/TDF recipients. Mean changes in fasting low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) (-3.83 vs +13.26 mg/dL) were significantly different between DOR/3TC/TDF and EFV/FTC/TDF (−1.6 vs +8.7 mg/dL and −3.8 vs +13.3 mg/dL, respectively). Conclusions In HIV-1 treatment-naive adults, DOR/3TC/TDF demonstrated non-inferior efficacy to EFV/FTC/TDF at week 48 and was well tolerated, with significantly fewer neuropsychiatric events and minimal changes in LDL-C and non–HDL-C compared with EFV/FTC/TDF. Clinical Trials Registration NCT02403674 A 44-Year-Old Female With Overwhelming Sepsis sepsisaspleniaRPSA geneHowell-Jolly bodiesStreptococcus pneumonia Concurrent Seroprevalence of Antibodies to Toxoplasma gondii and Toxocara Species in the United States, 2011–2014 To the Editor—We report supplemental findings incorporating Toxoplasma gondii serology results from our study of risk factors for Toxocara seropositivity in the United States [1] using stored serum samples collected from the National Health and Nutrition Examination Survey (NHANES), 2011–2014. Whereas T. gondii is a protozoan parasite and Toxocara is an intestinal nematode, both share ingestion of contaminated soil as means of exposure in humans. Both parasites can contaminate soil when environmentally resistant T. gondii oocysts or Toxocara cati eggs are shed in the feces of infected cats [2, 3].

Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection Abstract Recognizing the importance of timely guidance regarding the rapidly evolving field of hepatitis C management, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed a web-based process for the expeditious formulation and dissemination of evidence-based recommendations. Launched in 2014, the hepatitis C virus (HCV) guidance website undergoes periodic updates as necessitated by availability of new therapeutic agents and/or research data. A major update was released electronically in September 2017, prompted primarily by approval of new direct-acting antiviral agents and expansion of the guidance's scope. This update summarizes the latest release of the HCV guidance and focuses on new or amended recommendations since the previous September 2015 print publication. The recommendations herein were developed by volunteer hepatology and infectious disease experts representing AASLD and IDSA and have been peer reviewed and approved by each society's governing board.

Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections

Abstract

Purpose of Review

The treatment of debilitating pain and loss of function secondary to lumbar stenosis is in high demand with the aging patient population. Options, including epidural steroid injections (ESIs) and medication therapy, are limited and it is unclear if they provide any functional improvements. In this prospective study, we evaluate functional outcomes in older adults with symptomatic lumbar stenosis treated with ESIs compared to those managed with medications by introducing the Short Physical Performance Battery (SPPB). Our study was IRB-approved and included 16 patients, 68 to 83 years old, with symptomatic back and radicular leg pain secondary to lumbar stenosis. Patients could elect to undergo a lumbar ESI (n = 11) or be treated via medication management (n = 5). Numeric pain score, SPPB score, and adverse events were measured and compared at baseline and a 1-month follow-up visit.

Recent Findings

Statistically significant improvements were observed from baseline compared to the 1-month follow-up for total SPPB score in the injection group. Similar improvements in the injection group were observed for pain scores and the SPPB subcomponents such as the 4-m walk test, chair stand time, and balance score. Comparatively, no statistically significant improvements were observed in the medication group.

Summary

Lumbar ESIs improved objective physical capacity parameters and pain scores in elderly patients with symptomatic lumbar stenosis compared to medication management. In addition, the SPPB is an easy-to-use tool to measure changes in physical function in older adults and could easily be integrated into an outpatient pain clinic.

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