Cold burns as a result of cosmetic cryolipolysis: An emerging concern from the NSW Statewide Burn Injury Service.

Cold burns are an uncommon mechanism of burn injury in Australia, where environmental exposure to freezing temperatures is rare. Aetiological research shows that most likely causes are related to intentional injury or industrial accidents1 Cryolipolysis, a cosmetic technique advertised as 'fat freezing', has recently emerged as a method of fat reduction and body contouring. Whilst perceived as safe4,5, this study presents the world's first case series on cold burns sustained from cryolipolysis. A retrospective review was undertaken of the New South Wales Statewide Burn Injury Service (SBIS) Registry, a prospectively collected database of all patients treated by NSW burns units. Ten patients from 2012 to 2020 were identified who sustained cold burns as a direct complication of cosmetic cryolipolysis. Mean total body surface area (TBSA) injured was 1% (range 0.5-3%). Burn depth ranged from superficial to full thickness. Two patients required excision and split-thickness skin grafts. Mean time to complete healing was 10 days (range 7-13) for those patients with partial thickness injuries, and 38 days (range 32-45) for those who required skin grafts. This case series provides strong evidence that cyrolipolysis can cause cold burns leading to varying degrees of skin injury, even requiring skin grafts. These injuries should be classified as burns and referred to specialist burn centres for treatment. Further research is needed to determine the specific aspects of cryolipolysis cold burn risk, and practitioners trained to reduce this risk and include it in consent processes. The authors advocate for education and regulation to prevent such injuries, and challenge perceptions of the technique as a minor, risk-free cosmetic treatment.

Unilateral Pterional Polycraniosynostosis Treated with Craniectomy and Helmet Therapy.

Craniosynostosis is a condition in which one or more of the cranial sutures have fused prematurely, affecting the growth pattern and contours of the infant skull. The pterion is the junction of temporal, frontal, parietal, and sphenoid bones of the skull. We present a case of unilateral pterional craniosynostosis, which was treated with strip craniectomy and helmet therapy.

Influenza A Viruses from Overwintering and Spring-Migrating Waterfowl in the Lake Erie Basin, United States.

Influenza A virus (IAV) surveillance in migratory waterfowl in the United States has primarily occurred during late summer and the autumn southern migration. Data concerning the presence and ecology of IAVs in waterfowl during winter and spring seasons in the U.S. northern latitudes have been limited, mainly due to limited access to waterfowl for sampling. The southwestern Lake Erie Basin is an important stopover site for waterfowl during migration periods, and over the past 28 years, 8.72% of waterfowl sampled in this geographic location have been positive for IAV recovery during summer and autumn (June-December). To gain a better understanding of influenza A viral dynamics in waterfowl populations during winter and spring migration (February through April), cloacal swabs were collected from overwintering and spring-migrating waterfowl in Ohio and Michigan in 2006, 2007, 2013, and 2014. A total of 740 cloacal swabs were collected and tested using virus isolation in embryonating chicken eggs, resulting in the recovery of 33 (4.5%) IAV isolates. The influenza A isolates were recovered from eight waterfowl species in the order Anseriformes. Antigenically, the IAV isolates represent 15 distinct hemagglutinin (HA) and neuraminidase (NA) combinations, with seven (21%) of the isolates reported as mixed infections based on antigenic HA subtyping, NA subtyping, or both. This effort demonstrates the presence of antigenically diverse IAV in waterfowl during overwintering and spring migration at northern latitudes in the United States, thereby contributing to the understanding of the maintenance of diversity among waterfowl-origin IAVs.

Oral rabies vaccination of a northern Ohio raccoon population: relevance of population density and prebait serology.

Ohio's oral rabies vaccination (ORV) program was established to prevent the westward spread of the raccoon (Procyon lotor) rabies virus (Lyssavirus, Rhabdoviridae) in Ohio, USA. The program, which targets raccoons, distributes vaccine-bait units (VBU) at a target density of 75 units/km2. Few studies have examined the relationship of VBU density and target population density to the prevalence of rabies virus-neutralizing antibodies (RVNA). We conducted experimental VBU distributions in August 2003 and August 2004, 150 km west of the ORV zone where there was no history of raccoon rabies. We measured change in RVNA titers in blood collected from live-trapped raccoons before and after VBU distributions. A closed population mark-recapture estimate of the size of the target population was 91 raccoons/km2, compared to the realized VBU distribution density of 70 units/km2. Surprisingly, 41% of 37 serum samples were RVNA-positive (>or=0.05 IU/ml) before VBU distribution in 2003, but all titers were <0.25 IU/ml. Although viable VBUs were distributed in August 2003, only 21% of 315 samples were RVNA-positive before VBU distribution in 2004, but 9% had titers>or=0.25 IU/ml. Tetracycline (biomarker in bait) prevalence in teeth indicated that 57% of raccoons ingested VBUs after distribution in 2003, and 54% ingested VBUs after distribution in 2004. However, only 8% and 11% of sera were positive for RVNA (>or=0.05 IU/ml) after VBU distribution in 2003 and 2004, respectively. Only 4-5% of sera collected after bait distribution had titers>or=0.25 IU/ml each year. The standard distribution density of 75 VBUs/km2 was insufficient to produce a population-wide immunoprotective response against rabies infection in our high-density target population. Presence of RVNA in a presumed naïve population before baiting demonstrates that estimating prevalence of RVNA after oral rabies vaccination can be problematic without knowledge of background titers and seasonal changes in prevalence of RVNA before and after baiting.