No combinar cianoacrilatos con algodón !

Wounds

Unusual Wounds: Cyanoacrylate Burn Injuries

Two Unusual Cases and a Review of the Literature

Christian P. Eyth, MD; Kezia Echlin, MD; and Isabel Jones, MD, MBBS, FRCS(Plast)

Disclosures

Wounds. 2016;28(12):E53-E59. 

Abstract and Introduction 

Abstract

The authors present 2 cases of cyanoacrylate glue ("Super Glue") burns, with a review of the literature and a discussion on the mechanism of action. The authors found all reported cases were with domestic — not medical-grade — cyanoacrylate glue in the presence of cotton fabric. Often erroneously designated as chemical burns, they are thermal burns caused by an intensive exothermic reaction. Cotton acts as a highly potent catalyst, speeding up the polymerization reaction leading to high-peak temperatures capable of causing burns and spontaneous ignition of the fabric. The authors identify factors that explain the different risk profiles of domestic and medical cyanoacrylate glues and could be addressed to improve safety

• Abstract and Introduction
• Case Reports
• Literature Review
• Discussion
• Conclusion

• References

Tratamiento Dual de radifofrecuencia y luz infrarroja es util para arrugas.

High-Energy Protocol Improves Photoaged Facial Skin

MONDAY, Feb. 13, 2017 (HealthDay News) -- For patients with mild-to-moderate facial wrinkles, a high-energy protocol with combined bipolar radiofrequency and infrared light energies improves facial skin, according to a study published online Feb. 8 in the Journal of Cosmetic Dermatology.

Michael H. Gold, M.D., from the Tennessee Clinical Research Center in Nashville, and colleagues examined a high-energy protocol with combined bipolar radiofrequency and infrared light energies for improving photoaged facial skin. Seventy-two patients with mild-to-moderate facial wrinkles underwent a single full-face treatment or two treatments (54 and 18 patients, respectively) at six-week intervals.

Following a single treatment or two treatments with the enhanced-energy protocol, the researchers found that all patients achieved some degree of improvement in their wrinkles and skin appearance. At the 12- and 24-week follow-ups after treatment, 71 and 70 percent of the patients, respectively, showed improvement of one unit of greater on the Fitzpatrick Scale. At six, 12, and 24 weeks after treatment end, 87, 91, and 81 percent of patients, respectively, showed improvement under the Global Aesthetic Improvement Scale. The treatments were well tolerated and patients were satisfied with the clinical results.

"The enhanced-energy treatment protocol, with fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light applications, yields significant improvement of skin texture, wrinkling, and overall appearance following a single treatment," the authors write.

The study was funded by Syneron Candela.

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Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

2224-0654

2208-8206

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Identification of High-Risk Melanomas Improves With Combined Predictors | PracticeUpdate

http://www.practiceupdate.com/c/48924/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=NjA4ODYxMjU4ODkS1&lid=10332481

Identification of High-Risk Melanomas Improves With Combined Predictors

This study was designed to compare the independent risk prediction of stage I and II melanoma by the American Joint Committee on Cancer (AJCC) vs a 31-gene expression profile (GEP) test and to demonstrate the utility of combining the two prognosticators. Findings identified the GEP test as a strong independent predictor of risk, and combining results from the two tools enhanced sensitivity, reflecting a more accurate identification of patients with high-risk stage I and II melanoma. 

BACKGROUND

A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described.

OBJECTIVE

We sought to compare accuracy of the GEP in combination with risk determined using the web-based AJCC Individualized Melanoma Patient Outcome Prediction Tool.

METHODS

GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5-year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk.

RESULTS

Cox univariate analysis revealed significant risk classification of distant metastasis-free and overall survival (hazard ratio range 3.2-9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC.

LIMITATIONS

Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual.

CONCLUSIONS

The GEP provides valuable prognostic information and improves identification of high-risk melanomas when used together with the AJCC online prediction tool.

UV Disinfection Appears Effective Against C. difficile - NEJM Journal Watch

http://www.jwatch.org/na43312/2017/02/01/uv-disinfection-appears-effective-against-c-difficile?ijkey=BtZS2SYhZ5Sag&keytype=ref&siteid=jwatch&query=pfw&jwd=000100713143&jspc=D&variant=full-text

UV Disinfection Appears Effective Against C. difficile

Clostridium difficile is responsible for one of the most prevalent healthcare-acquired infections. Because C. difficile forms spores that can survive on environmental surfaces for months, environmental contamination is a major route of transmission. Several approaches have been developed to enhance standard cleaning of hospital rooms to eradicate the pathogen, but efficacy data are sparse. Researchers at one academic medical center that had already implemented multiple measures to reduce C. difficile infection (CDI) conducted a prospective controlled study of CDI incidence before and after terminal disinfection of rooms previously occupied by CD-infected patients using ultraviolet wavelength C germicidal irradiation (UVGI).

During a 12-month period, UVGI was used after 541 of 2569 discharges (21.6%) on three hematology-oncology units. CDI incidence in the study units was reduced by 25% compared with a 12-month preintervention baseline period. In contrast, CDI incidence in the non–study units (all other inpatient units combined) increased 16% over baseline. UVGI use lengthened the mean room turnaround time by 6.9 minutes for study units compared with non–study units (66.7 minutes vs. 59.8 minutes).

Editor Disclosures at Time of Publication

• Disclosures for Richard T. Ellison III, MD at time of publication Consultant / Advisory board Philips Healthcare Grant / Research support Philips Healthcare

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Clorhexidina puede dar anafilaxia, hay que preguntar.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm539575.htm

Chlorhexidine Gluconate: Drug Safety Communication - Rare But Serious Allergic Reactions

[Posted 02/02/2017]

AUDIENCE: Nursing, Surgery, Dentistry, Patient

ISSUE: FDA is warning that rare but serious allergic reactions have been reported with the widely used skin antiseptic products containing chlorhexidine gluconate. Although rare, the number of reports of serious allergic reactions to these products has increased over the last several years. See the FDA Drug Safety Communication for a data summary.

As a result, FDA is requesting the manufacturers of over-the-counter (OTC) antiseptic products containing chlorhexidine gluconate to add a warning about this risk to the Drug Facts labels.

BACKGROUND: Chlorhexidine gluconate is mainly available in OTC products to clean and prepare the skin before surgery and before injections in order to help reduce bacteria that potentially can cause skin infections. These products are available as solutions, washes, sponges, and swabs and under many different brand names and as generics. Chlorhexidine gluconate is also available as a prescription mouthwash to treat gingivitis and as a prescription oral chip to treat periodontal disease.

Prescription chlorhexidine gluconate mouthwashes and oral chips used for gum disease already contain a warning about the possibility of serious allergic reactions in their labels.

In 1998, FDA issued a Public Health Notice to warn health care professionals about the risk of serious allergic reactions with medical devices such as dressings and intravenous lines that contain chlorhexidine gluconate.

RECOMMENDATION: Health care professionals should always ask patients if they have ever had an allergic reaction to any antiseptic before recommending or prescribing a chlorhexidine gluconate product. Advise patients to seek immediate medical attention if they experience any symptoms of an allergic reaction when using the products. Consider using alternative antiseptics such as povidone-iodine, alcohols, benzalkonium chloride, benzethonium chloride, or parachlorometaxylenol (PCMX) when any previous allergy to chlorhexidine gluconate is documented or suspected.

Patients and consumers should stop using the product that contains chlorhexidine gluconate and seek medical attention immediately or call 911 if they experience symptoms of a serious allergic reaction. These reactions can occur within minutes of exposure. Symptoms include wheezing or difficulty breathing; swelling of the face; hives that can quickly progress to more serious symptoms; severe rash; or shock, which is a life-threatening condition that occurs when the body is not getting enough blood flow.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

• Complete and submit the report Online: www.fda.gov/MedWatch/report
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

[02/02/2017 - Drug Safety Communication - FDA]

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.