Dangerous exposures to chemicals managed by Poison Centers all around the world during the COVID-19 pandemic: a systematic review and proportional meta-analysis.

INTRODUCTION: During COVID-19 pandemic, cleaning/disinfection activities were highly recommended. This study summarizes the state of art and estimates the prevalence of dangerous exposures to specific chemicals managed by Poison Centers (PCs) from all over the world during 2020 vs 2019, trying to overcome the critical aspects of the product categorization systems used by PCs. MATERIALS AND METHODS: A systematic research was conducted in 3 major databases and 2 websites of PCs associations. Proportional meta-analyses were performed to estimate the prevalence of exposures to disinfectants, household products and hand sanitizers in 2020 vs 2019. RESULTS: The pooled prevalence of exposures to disinfectants, household products and hand sanitizers were respectively 5.9% (95% CI 4.9-7.0) (2019: 4.4% vs 2020: 7.8%; p=0.22), 25.9% (95% CI 24.0-27.7) (2019: 25.0% vs 2020: 28.6%; p=0.71) and 1.6% (95% CI 1.3-1.9) (2019: 0.6% vs 2020: 2.8%; p<0.001). CONCLUSIONS: This study detected overall increases of exposures to specific chemicals in 2020, suggesting that the awareness on topics related to the safe use of these products should be improved, especially during health emergencies, highlighting the need to develop standardized systems to better compare data coming from PCs all over the world.

Quantification of preservatives in tattoo and permanent make-up inks in the frame of the new requirements under the REACH Regulation.

BACKGROUND: According to the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) restriction, tattoo and permanent make-up (PMU) inks placed on the European Union market after January 4, 2022, shall not contain methylisothiazolinone, benzisothiazolinone (BIT), octylisothiazolinone (OIT), or other skin sensitizers in concentrations of 10 mg/kg or higher and phenoxyethanol (PE) or other eye irritants or damaging substances in concentrations of 100 mg/kg or higher. In addition, preservatives and other substances enlisted in Annex II to Cosmetic Product Regulation shall not be present in concentrations of 0.5 mg/kg or higher. OBJECTIVES: This study aims to quantify 14 preservatives in 99 tattoo and 39 PMU inks from the Italian market and presents a comparison with concentration limits set by the REACH restriction. METHODS: Inks were analysed by applying validated analytical methods based on liquid chromatography techniques. RESULTS: About 24.0%, 15.2% and 1.5% of the overall samples contained BIT, PE and OIT, respectively, at concentrations exceeding REACH concentration limits. The number of noncompliant tattoo inks (49.5%) would be significantly greater than that of the PMU inks (17.9%). CONCLUSIONS: About 40.6% of the samples would be noncompliant with the restriction for the presence of preservatives above the permitted level. Additional concentration limits will apply to skin sensitizing preservatives for proper labelling of inks under CLP (Classification, Labelling and Packaging) Regulation.

Monitoring of alcohol-based hand rubs in SARS-CoV-2 prevention by HS-GC/MS and electrochemical biosensor: A survey of commercial samples.

Alcohol-based hand rubs (ABHRs) have found large diffusion during the Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2, thus becoming the most widespread means for hand hygiene. Whereby, it is fundamental to assess the alignment of commercial ABHRs to the indications provided by the principal health agencies regarding alcohol content and possible impurities. In this work, a novel improvement of previous existent methods for the determination of alcohol content in such products was reported. In particular, two alternative sensitive and reproducible methods, such as an electrochemical screen-printed based enzymatic (alcohol oxidase) biosensor and a Headspace Gas Chromatography coupled with Mass Spectrometry (HS-GC/MS) were proposed. The electrochemical device represents a rapid, low-cost and accurate fraud screening method for alcohol-based hand rubs. The second technique confirms, identifies and simultaneously determines ethyl alcohol, isopropyl alcohol, n-propyl alcohol and methyl alcohol, improving their extraction through acidification in the sample pre-treatment step. The developed specific HS-GC/MS method was in-house validated according to ISO/IEC 17025 requirements. Analytical parameters such as limit of detection (LoD 0.13%v/v - 0.17%v/v), limit of quantification (LoQ 0.44% v/v - 0.57% v/v), inter-day repeatability (RSDR 2.1-10.7%) and recovery (80-110%) were assessed. The relative expanded uncertainties range (between 0.1%v/v and 3.4%v/v) for all the analytes were evaluated. Results obtained using the different analytical approaches were compared and indicated that the two data sets were comparable (median; HS-GC/MS, 56%v/v; electrochemical biosensor, 62%v/v) and were not statistically different (one-way ANOVA test; p = 0.062). In addition, a good correlation (95%) was found. This study noticed that only 39% of the tested hand sanitiser products had the recommended average alcohol content, thus highlighting the need for analytical controls on this type of products.

Comparison of ropivacaine plasma concentration after posterior Quadratus Lumborum Block in Cesarean Section with ropivacaine with epinephrine vs. plane.

BACKGROUND: The posterior quadratus lumborum block (pQLB) has been used in postoperative pain management after cesarean section (CS). However, clinicians have no data about pQLB safety in pregnants, at increased risk of local anesthetic systemic toxicity (LAST). The purpose of the present study was to explore the efficacy and the safety of adding epinephrine to ropivacaine for bilateral pQLB vs. bilateral pQLB performed with ropivacaine alone in CS. METHODS: In this prospective trial 52 pregnants, ASA 2 physiological status, were consecutively allocated to one of two groups, e-pQLB and pQLB; e-pQLB group received 0.375% ropivacaine+100 mcg epinephrine, 20 mL each side; pQLB received 0.375% ropivacaine alone, 20 mL each side. The primary and secondary outcomes were to evaluate if the adjunct of epinephrine to ropivacaine increases efficacy and safety of pQLB, respectively. RESULTS: Authors found in e-pQLB group vs. p-QLB group: a total mean morphine consumption statistically lower during the first 24 postoperative hours (5.08±3.12, vs. 9.11±4.67 SD mg, P=0.0002); NRS values statistically lower at six hours from block, both at rest (1.73±1.88 SD vs. 2.88±2.53, P=0.03) and with movement (3.03±1.98 SD vs. 4.23±2.87, P=0.04); a longer time between block and the first opioid request (5.92±2.48 vs. 3.78±2.68 SD hrs, P<0.003); venous ropivacaine concentrations significantly lower at any time of samples but at 120 minutes. CONCLUSIONS: Adding epinephrine to ropivacaine increases efficacy and duration of pQLB. Moreover it increases block safety, reducing peak and mean venous ropivacaine concentration.