Allergic contact dermatitis to cell phone

No abstract availabl

Allergic contact dermatitis to cell phone

No abstract availabl

Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Background: In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods: Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results: Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1' vs 10.4 ± 2.3'; p < 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions: Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting

Allergic Contact Dermatitis to a Cell Phone

Dear Editor, Nickel is a ubiquitous allergen and an important cause of allergic contact dermatitis (ACD). Sensitized patients generally develop a localized eruption after cutaneous exposure to nickel, characterized by erythema, vesicles, eczematous plaques, and itching. Nickel is frequently found in several everyday objects. It is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life (1). This metal may be found in a wide variety of items, such as jewelry, belt buckles, buttons, glasses, coins, and keys. More recently, items such as mobile phones, laptop computers, video game controllers, and other technological accessories have also been identified as a source of nickel. The use of mobile phones has risen exponentially in recent decades. Nickel has been detected in cell phones, and reports of contact dermatitis due to metals contained in cell phones are present in the literature (2,3). Allergic contact dermatitis to a mobile phone was first described in 2000, when Pazzaglia et al. reported two cases of nickel allergy due to mobile phone use (4). In addition to nickel, cobalt, which is frequently used in hard metal alloys and observed to be present in mobile phones, is a frequent cause of allergic contact dermatitis (5). Herein we present a case of allergic contact dermatitis, possibly caused by the use of a mobile phone. A 38-year-old woman was admitted to our Department of Dermatology for the presence of a pruritic eczematous solitary lesion on the face. At physical investigation, we observed the presence of confluent erythematous and squamous plaques localized at the pre-auricular and auricular region of the left ear. These lesions varied in size from 1 to 4 cm (Figure 1). As reported by the patient, the symptoms had been present for 6 months. No other cutaneous diseases or photodermatoses were reported. As reported by the patient during the anamnestic interview, she worked as a manager for a big commercial company and used to spend many hours per day using her cell phone. She had a familiar history of atopic dermatitis and a personal history of metal allergy. A patch test SIDAPA series was performed (Table 1). After 48 hours, the patch was removed and a preliminary reading of the skin was done. The final reading was performed after 72 hours from the patch application. The test was positive for nickel sulfate (++ after 48 hours and +++ after 72 hours) and for cobalt chloride (+ after 48 hours and ++ after 72 hours). We also performed a patch test Metal series (Table 2), which was negative at 48 and 72 hours. Based on the patch test results and the information revealed by the patient, we hypothesized a triggering role of the cell phone to the onset of the pre-auricular dermatitis. This hypothesis stems from the literature regarding cases of dermatitis due to allergenic metals contained in cell phones. Oral antihistamines and topical steroids were prescribed to treat the eczematous plaques. After one week of therapy, a partial improvement of the skin condition was observed. In line with our hypothesis of a causal role of the cell phone, our patient's dermatitis completely disappeared when her usual auricular contact with her mobile phone was avoided. Following our suggestion, the patient started to use the speakerphone when needed. Six months later, she had a complete remission of the cutaneous lesions and did not present recurrences of the auricular dermatitis. Dermatologists should be aware that mobile phone dermatitis is an emerging phenomenon, especially among young adults and adolescents. Despite efforts to control the presence of allergen metals in phones, many phones present levels of metals such as nickel and cobalt, known to induce allergic contact dermatitis. In conclusion, it is important to suspect this diagnosis in case of patients with dermatitis of the face, neck, hands, or auricular region, especially when the lesions are unilateral. Patch test for common metal allergens may be helpful for diagnosis

Atypical koebner phenomenon on a tattoo

Tattooing is more and more popular in developed countries in recent years and many side effects are associated with this practice, including psoriatic lesions and Koebner phenomenon. We report the case of a lichenoid reaction to red pigment in a patient affected by psoriasis

Brain tissue oxygenation monitoring in subarachnoid hemorrhage for the detection of delayed ischemia: a systematic review and meta-analysis

Introduction: Subarachnoid hemorrhage (SAH) is a severe subtype of stroke which can be caused by the rupture of an intracranial aneurysm. Following SAH, about 30% of patients develop a late neurologic deterioration due to a delayed cerebral ischemia (DCI). This is a metanalysis and systematic review on the association between values of brain tissue oxygenation (PbtO2) and DCI in patients with SAH. Evidence acquisition: The protocol was written according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and approved by the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42021229338). Relevant literature published up to August 1, 2022 was systematically searched throughout the databases MEDLINE, WEB OF SCIENCE, SCOPUS. A systematic review and metanalysis was carried out. The studies considered eligible were those published in English; that enrolled adult patients (≥18years) admitted to neurointensive care units with aneurysmal SAH (aSAH); that reported presence of multimodality monitoring including PbtO2 and detection of DCI during the period of monitoring. Evidence synthesis: We founded 286 studies, of which six considered eligible. The cumulative mean of PbtO2was 19.5 mmHg in the ischemic group and 24.1mmHg in the non ischemic group. The overall mean difference of the values of PbtO2 between the patients with or without DCI resulted significantly different (-4.32 mmHg [IC 95%: -5.70, -2.94], without heterogeneity, I2 = 0%, and a test for overall effect with P<0.00001). Conclusions: PbtO2 values were significantly lower in patients with DCI. Waiting for definitive results, monitoring of PbtO2 should be considered as a complementary parameter for multimodal monitoring of the risk of DCI in patients with SAH

Pharmacokinetics of high-dose tigecycline in critically ill patients with severe infections

Background: In critically ill patients, the use of high tigecycline dosages (HD TGC) (200 mg/day) has been recently increasing but few pharmacokinetic/pharmacodynamic (PK/PD) data are available. We designed a prospective observational study to describe the pharmacokinetic/pharmacodynamic (PK/PD) profile of HD TGC in a cohort of critically ill patients with severe infections. Results: This was a single centre, prospective, observational study that was conducted in the 20-bed mixed ICU of a 1500-bed teaching hospital in Rome, Italy. In all patients admitted to the ICU between 2015 and 2018, who received TGC (200 mg loading dose, then 100 mg q12) for the treatment of documented infections, serial blood samples were collected to measure steady-state TGC concentrations. Moreover, epithelial lining fluid (ELF) concentrations were determined in patients with nosocomial pneumonia. Amongst the 32 non-obese patients included, 11 had a treatment failure, whilst the other 21 subjects successfully eradicated the infection. There were no between-group differences in terms of demographic aspects and main comorbidities. In nosocomial pneumonia, for a target AUC0-24/MIC of 4.5, 75% of the patients would be successfully treated in presence of 0.5 mcg/mL MIC value and all the patients obtained the PK target with MIC 64 0.12 mcg/mL. In intra-abdominal infections (IAI), for a target AUC0-24/MIC of 6.96, at least 50% of the patients would be adequately treated against bacteria with MIC 64 0.5 mcg/mL. Finally, in skin and soft-tissue infections (SSTI), for a target AUC0-24/MIC of 17.9 only 25% of the patients obtained the PK target at MIC values of 0.5 mcg/mL and less than 10% were adequately treated against germs with MIC value 65 1 mcg/mL. HD TGC showed a relevant pulmonary penetration with a median and IQR ELF/plasma ratio (%) of 152.9 [73.5-386.8]. Conclusions: The use of HD TGC is associated with satisfactory plasmatic and pulmonary concentrations for the treatment of severe infections due to fully susceptible bacteria (MIC < 0.5 mcg/mL). Even higher dosages and combination strategies may be suggested in presence of difficult to treat pathogens, especially in case of SSTI and IAI

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome