Entheseal changes in Ancient Egyptians from the Pyramid Builders of Giza‐Old Kingdom

Abstract

Entheseal changes are distinct skeletal markings that occur where a muscle, tendon, or ligament inserts into bone cortex, in response to many factors including physical activity. Therefore, entheseal changes have been frequently used to reconstruct habitual life activities of ancient populations. The present study examines a sample of 195 ancient Egyptians from Giza ‐ Old Kingdom (2700‐2190 BC), the period of pyramid builders. The material consists of two burials that were identified as belonging to individuals of different socioeconomic classes, Workers and High Officials. This distinction between the socioeconomic classes is based on evidence including location and design of cemeteries, contents of goods, and writings and drawings on tombs. Entheseal changes at 14 sites, representing the main articulations of the body, were examined to assess any association between entheseal expression and physical activities. The results of this study suggest that the frequency and severity of entheseal changes varied between Workers and High Officials, and between males and females. As expected, males exhibited higher levels of entheseal expression, suggesting sexual dimorphism in activity. No clear bilateral asymmetry was observed, except for in female High Officials, who exhibited higher levels of entheseal expression at the right hand. A direct comparison of frequencies of entheseal changes between the two social classes, by sex and age, revealed that male and female Workers had higher levels of entheseal expression than High Officials, suggesting a division in labor. Together, these data suggest that entheseal changes can be used, cautiously, to study activity patterns in ancient Egyptian populations.

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Unusual KRAS missense mutation (p.E63K) in patient with juvenile pilocytic astrocytoma of the tectum

https://ift.tt/2No6Bm7

Post pulmonary embolism syndrome: a common, underdiagnosed complication that is not well recognised

A 56-year-old man developed chronic breathlessness which persisted for years after he suffered acute pulmonary embolism (PE) despite all investigations being subsequently normal. This case illustrates a very common complication which occurs in up to half of all patients after an acute PE which has been labelled 'post pulmonary embolism syndrome', yet it is not well recognised and at present there is not much research into the prevention or even possible treatment options for patients who develop these symptoms.

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Oesophageal atresia with tracheo-oesophageal fistula, ileal atresia and Hirschsprungs disease: outcome of a rare phenotype

Oesophageal atresia with or without tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease are surgical malformations of the gastrointestinal tract typically diagnosed early in the neonatal period and varying in severity and prognosis. This report describes a full-term male newborn presenting simultaneous oesophageal atresia with distal tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease. In addition to the complex types of gastrointestinal malformations involved, the combination of ileal atresia and Hirschsprung's disease, as well as ganglion cells distal to intestinal atresia, resulted in a challenging diagnosis. Despite a successful outcome, the patient presented increased morbidity and prolonged hospitalisation. We highlight some important findings that may aid the early diagnosis of Hirschsprung's disease in this clinical setting. To our knowledge, the association of oesophageal atresia/tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease has not been previously reported.

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Transient sinus arrest due to sinus node artery thrombus after revascularisation of the left circumflex artery

We present a case of sinus arrest and junctional escape rhythm from sinus node artery (SNA) thrombus in a 55-year-old man after revascularisation of right coronary and proximal circumflex arteries for infero-posterior wall ST-segement elevation myocardial infarction (STEMI). Sinus arrest from occlusion of the SNA is uncommon. The ensuing bradycardia may have haemodynamic consequences requiring temporary pacing but is almost always self-limited.

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Rare presentation of granulomatosis with polyangiitis

A 62-year-old man with no pertinent medical history presented with lower extremity weakness and worsening distal fingertips and toe cyanosis/gangrene. In the outpatient setting, he was initially being treated for Raynaud's phenomenon with a calcium channel blocker. On presentation, the patient had elevated inflammatory markers and white blood cell count. Serum vasculitis panel (proteinase-3 antibody) supported the diagnosis of granulomatosis with polyangiitis. His hospital course was complicated by ischaemic stroke and a diagnosis of mononeuritis multiplex in his lower extremities. After initiating therapy with intravenous steroid and rituximab, his symptoms overall improved including cyanotic fingertips/toes. His inflammatory markers and leucocytosis also improved. Outpatient follow-up consisted of further rituximab infusions and unrelated umbilical hernia incarceration which required surgery. He was found incidentally to have subsegmental pulmonary emboli which most likely occurred during the initial presentation prior to his diagnosis. The patient moved out of state and was lost to follow-up.

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Atrial myxoma presenting as abdominal pain: an unusual association

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Bouverets syndrome treated with endoscopic electrohydraulic lithotripsy

Bouveret's syndrome is a rare form of small bowel obstruction caused by a large biliary stone entering the lumen of the duodenum or the stomach through a bilioenteric fistula. Treatment options include various surgical techniques. However, recent advances in endoscopy also allow non-surgical endoscopic treatment options. We report a 68-year-old man, with a disseminated small intestinal neuroendocrine tumour, presenting with Bouveret's syndrome without any previously reported biliary disease. He experienced a number of symptoms 1 month prior to his admittance, which were difficult to differentiate from other infectious diseases and complications due to his neuroendocrine tumour. Abdominal CT showed a biliary stone impacted in the duodenal bulb, small bowel obstruction, pneumobilia and a bilioenteric fistula. The patient was treated with endoscopic electrohydraulic lithotripsy to fragment the large gallstone in smaller retractable pieces. The patient avoided major surgery and was discharged the following day.

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Tuberculosis of the breast: an uncommon presentation of an old disease

Breast tuberculosis (TB) is considered an uncommon disease with an estimated incidence of 0.1% of all breast lesions reported in developed countries. A 53-year-old Caucasian woman, with a medical history of Crohn's disease, previously treated with infliximab for 3 months suspended due to a presumptive diagnosis of TB for which antitubercular regimen was started. Five months after, a painful lump in the left breast was identified by the patient. Mammary ultrasound confirmed left breast nodules and axillary adenopathies. Histology and microbiology of both lesions confirmed breast TB. Molecular drug susceptibility testing in both samples revealed no resistance to first line anti-TB drugs and the regimen was maintained for 1 year, with clinical and radiological improvement. Mammary gland involvement usually results from lymphatic extension and differential diagnosis frequently includes breast cancer or bacterial abscess.

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Liver haematoma as a presentation of peliosis hepatis

Peliosis hepatis (PH) is an uncommon, benign hepatic vascular condition involving liver lesions consisting of dilated sinusoidal spaces that ultimately lead to numerous blood-filled cavities within the liver parenchyma. We detail the case of a 62-year-old woman who presented with a large hepatic haematoma resulting from intracystic haemorrhage. She was subsequently diagnosed with PH via arteriogram. Her symptoms were successfully treated surgically with open fenestration. Patient's postoperative course was unremarkable, with no recurrence of symptoms to date.

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Stroke in a young man: a late complication of radiation therapy

This 37-year-old man presented with left sided facial warmth and numbness associated with new sudden-onset right hemiparesis. The patient first developed sudden numbness of his left lip and warmth in left ear which travelled to the rest of left face. His past medical history was significant for hypertension, Hodgkin lymphoma treated with radiation therapy at the age of 10, and sleeve gastrectomy for obesity 1 year ago complicated by bilateral ischaemic cerebral infarctions with residual left hemiparesis. No acute infarcts were found on MRI. Transesophageal echocardiography revealed a complex atheroma near the sinotubular junction in ascending aorta.

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Transient iatrogenic Horners syndrome following carotid endarterectomy

We present a case of a 72-year-old man who developed a transient Horner's syndrome in the immediate postoperative period after right carotid endarterectomy which resolved within 3 months. Although Horner's syndrome has been reported with several disorders of the carotid artery, our case documents a rare iatrogenic oculosympathetic paresis after elective carotid endarterectomy.

https://ift.tt/2No6E1h

Peripheral ulcerative keratitis with corneal melt as the primary presentation in a case of human immunodeficiency virus

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It is thought to be the result of immune complex deposition at the limbus, resulting in corneal inflammation and stromal melt. We present a case of a 43-year-old female patient of African origin, presenting with PUK and associated corneal perforation as the primary presentation of HIV infection. An urgent tectonic deep anterior lamellar keratoplasty was performed under general anaesthesia with excellent outcome. The patient was referred to the sexual health clinic and anti-retroviral treatment was initiated. This case is to the best of our knowledge the first report from the UK of PUK with corneal perforation as the primary presentation of HIV infection. As highlighted in this report, infection with HIV may initially be silent; therefore, it is vital to consider HIV infection when dealing with PUK of unknown aetiology.

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Pulmonary embolism with right ventricular thrombus: a management dilemma

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Voigt‐Futcher pigmentary demarcation lines

Abstract

Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. They are seen in a majority of dark‐complexioned women and a substantial percentage of light‐complexioned ones too. We review this salient finding and approaches to its management.

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Cancer immunology, inflammation, and tolerance: an introduction

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Effects of Testosterone Undecanoate vs Placebo on Intrahepatic Fat Content in Obese Men With T2DM and Hypogonadism

Conditions:   Fatty Liver;   Obesity;   Type2 Diabetes Mellitus;   Hypogonadism, Male
Interventions:   Drug: Testosterone Undecanoate;   Drug: Placebo
Sponsors:   Alexandra Kautzky-Willer;   Bayer
Not yet recruiting

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Randomized Phase 3 Evaluation of Trifarotene 50 μG/G Cream Treatment Of Moderate Facial And Truncal ACNE

Acne vulgaris often affects the face, shoulders, chest, and back but treatment of non-facial acne has not been rigorously studied.

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Basal Cell Carcinoma: Additional Subtypes and Therapeutic Advances

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Refining Techniques in Eyebrow Transplantation

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Management of Acute Radiation Dermatitis: A Review of the Literature and Proposal for Treatment Algorithm

Radiation dermatitis is a common sequela of radiation therapy; up to 95% of patients will develop moderate-to-severe skin reactions. No gold-standard currently exists for the treatment of acute radiation-induced skin toxicity. It is, therefore, imperative to develop a greater understanding of management options available to allow clinicians to make informed decisions when managing radiation oncology patients. This literature review discusses the topical agents studied for the treatment of acute radiation dermatitis, reviews their mechanisms of action, and presents a treatment algorithm for clinicians managing patients suffering from radiation dermatitis.

https://ift.tt/2TebSlC

Retrospective Review of Insurance Coverage for Patch Testing

Insurance coverage and prior authorization (PA) requirements imposed by insurance companies have resulted in widespread barriers to care for both dermatology and allergy patients.1–3 In a recent survey conducted by the American Academy of Dermatology (AAD), greater than two-thirds of 177 respondents from US-based AAD committee/task force members under the Council on Government Affairs, Health Policy, and Practice and Association of Dermatology Administrators/Managers members reported that PA requirements negatively affect at least 1 patient daily.

https://ift.tt/2SSOQS8

Normalization of breathing with adenotonsillectomy in Japanese pediatric OSA

Since reports on surgical results for pediatric obstructive sleep apnea (OSA) in Japan are insufficient for debate, this study aimed to evaluate the feature of Japanese OSA children and surgical result and document whether is obesity and affecting factor similar to non-Asian countries.

https://ift.tt/2NnIYtV

Utilization of high-fidelity simulation for medical student and resident education of allergic-immunologic emergencies

Anaphylaxis is an acute, systemic hypersensitivity reaction with an estimated lifetime prevalence of 0.05-2%.1 Epinephrine is the first line treatment while other therapies such as anti-histamines and systemic steroids have limited evidence for the acute management of anaphylaxis. Anaphylaxis is frequently under-diagnosed and not treated with epinephrine in health care settings.2-3 Delayed administration of epinephrine represents a significant risk factor for severe and fatal anaphylaxis.4-5 Furthermore, there are wide variations in epinephrine auto-injector (EAI) administration technique among patients, caregivers, and healthcare professionals alike.

https://ift.tt/2EarxJ4

Perspective Pro Debate: To introduce solids early or not to introduce, this is the question.

Early life nutrition has the potential to influence long-term health; what an infant consumes and when they consume it is an important and potentially contentious topic. Breast milk alone will not sustain adequate infant growth beyond 6 months of age, solid food introduction is therefore essential to ensure normal growth through childhood. In the following pro debate, we discuss the evidence for solid food introduction commencing early in an infant's life. The ages we refer to throughout reflect the ages of babies born at full term as prematurity was an exclusion criterion for most studies investigating timings of solid food introduction.

https://ift.tt/2STCaKD

Cockroach, Dust Mite, and Shrimp Sensitization Correlations in The National Health and Nutrition Examination Survey

Shellfish allergy is a common condition, affecting 1-2% of the U.S. population.1 Tropomyosin, the primary allergen in shrimp, is a muscle protein found in other arthropods, including cockroaches and dust mites (DM), and cross-sensitization to these allergens has been hypothesized to drive shrimp sensitization.2,3 In the National Health and Nutrition Examination Survey (NHANES), it was recently demonstrated that there was a marked decrease in the prevalence of shrimp sensitization between NHANES III (1988-1994) and NHANES 2005-2006.

https://ift.tt/2E48Qac

FDA Proposes Major Changes to Sunscreen Rules

The agency plans to update regulations that cover the safety of ingredients, sunscreen dosage forms, SPF, and requirements for testing and labeling.
WebMD Health News

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Important Parenting Talks | Communicating with Your Teen

Parent-teen communication on topics like sex, drugs & alcohol, and responsible driving have a big impact on teenage development. While some of these topics may be intimidating for parents, it's important to communicate your family values and expectations. Let's dive in and share our thoughts on these important parenting talks.

The post Important Parenting Talks | Communicating with Your Teen appeared first on ChildrensMD.

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Amino acid metabolism as drug target in autoimmune diseases

Publication date: Available online 22 February 2019

Source: Autoimmunity Reviews

Author(s): Giada Mondanelli, Alberta Iacono, Agostinho Carvalho, Ciriana Orabona, Claudia Volpi, Maria T. Pallotta, Davide Matino, Susanna Esposito, Ursula Grohmann

Abstract

In mammals, amino acid metabolism has evolved to control immune responses. Autoimmune diseases are heterogeneous conditions that involve the breakdown of tolerogenic circuitries and consequent activation of autoreactive immune cells. Therefore, critical enzymes along amino acid degradative pathways may be hijacked to keep in check autoimmunity. We examined here current knowledge of indoleamine 2,3-dioxygenase 1 (IDO1) and arginase 1 (ARG1), the main enzymes catabolizing tryptophan and arginine, respectively, in organ-specific and systemic autoimmune diseases as well as in the development of autoantibodies to therapeutic proteins. At variance with neoplastic contexts, in which it is known to act as a pure immunosuppressive molecule, ARG1 exhibited a protective or pathogenetic profile, depending on the disease. In contrast, in several autoimmune conditions, the bulk of data indicated that drugs capable of potentiating IDO1 expression and activity may represent valuable therapeutic tools and that IDO1-based immunotherapeutic protocols could be more effective if tailored to the genetic profile of individual patients.

https://ift.tt/2BHF7U3

Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

Summary

Background

The increasing incidence of actinic keratosis (AK) is causing a large burden on health care systems. The current management of AK patients seems to vary within and between primary and secondary care; however, an in‐depth understanding of healthcare providers' management of AK is currently lacking.

Objective

To gain insight into the management of AK by exploring underlying motives of current practices among general practitioners (GPs) and dermatologists in The Netherlands.

Methods

A qualitative study was conducted consisting of semi‐structured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim, and inductively analysed by two researchers drawing on elements of grounded theory.

Results

GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK, mainly applying cryotherapy or referral to secondary care due to lack of experience, varying in their applications and providing mostly patient‐driven follow‐up care; they also reported a high need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated to pursue proactive clinical assessments of cutaneous photodamage and the goal of providing guideline‐driven AK care. Patient preferences, though, still largely influence both treatment choices and follow‐up regimens. Furthermore, dermatologists reported the need for improving AK and skin cancer management in primary care.

Conclusions

For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.

This article is protected by copyright. All rights reserved.

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Characterization of a subgroup of non-type 2 asthma with cow’s milk hypersensitivity in young subjects

Asthma with atopy is often characterized by type 2 inflammation but less progress has been made in defining non-type 2 asthma. We have previously identified a subgroup of young non-atopic asthmatics with perce...

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Two Mutations in Thyroid Hormone Receptor Beta Gene (P453A and C36Y) in a Family with Resistance to Thyroid Hormone with Comorbid Myotonic Dystrophy

Thyroid, Ahead of Print.


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Thyroid Function Reference Values in Healthy Iodine-Sufficient Pregnant Women and Influence of Thyroid Nodules on Thyrotropin and Free Thyroxine Values

Thyroid, Ahead of Print.


https://ift.tt/2tBmcWg

Nasal lavage cytology and mucosal histopathological alterations in patients with rhinitis

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Loreni C.S. Kovalhuk, Ederaldo Queiroz Telles, Monica Nunes Lima, Nelson A. Rosario Filho

Abstract

Introduction

The extent of epithelial lesion in allergic and non-allergic rhinitis and its association with inflammatory changes in nasal lavage has not been clarified.

Objective

To verify the association between the inflammatory cells in the nasal lavage, epithelial lesion extent and basement membrane thickness, in the nasal mucosa of patients with rhinitis; to determine the cutoff point of the percentage of eosinophils in the nasal lavage associated with the atopic patients.

Methods

Patients with rhinitis and indication for septoplasty and (or) turbinectomy for turbinate hypertrophy were selected, and were submitted to allergy skin tests, nasal lavage with measurement of albumin and interleukin-8 levels, total and differential counting of cells, and mucosal histopathological analysis to determine the extent of epithelial lesion, and degree of basement membrane thickening.

Results

Fifty-six patients with a median age of 24.5 years and a diagnosis of allergic rhinitis (n = 36) and non-allergic rhinitis (n = 20) were studied. In atopic subjects, allergy skin tests were positive for Dermatophagoides pteronyssinus in 35 (97.0%) and Lolium perenne in 18 (50.0%). Atopic subjects showed a higher clinical score index of rhinitis compared to non-atopic ones. The total count of cells, neutrophils, and levels of albumin and IL-8 were not different in the nasal lavage of atopic and non-atopic subjects. The cutoff point for eosinophil count in nasal fluid for the distinction between allergic rhinitis and non-allergic rhinitis was 4%. Some degree of epithelial lesion was more frequent in allergic rhinitis (94%) than in non-allergic rhinitis (65%) patients. In the presence of basement membrane thickness, as a marker of remodeling, there was no difference in the nasal lavage of patients with allergic rhinitis and non-allergic rhinitis.

Conclusion

In this series, 4% was the cutoff point for the number of eosinophils in the nasal lavage, for atopy differentiation. Upper airway remodeling accessed by basement membrane thickness showed similar inflammatory cell infiltrate in the nasal lavage, regardless of the presence of atopy.

Resumo

Introdução

A extensão da lesão epitelial na rinite alérgica e não alérgica e sua associação com alterações inflamatórias no lavado nasal, ainda não estão esclarecidas.

Objetivo

Verificar a relação entre o processo inflamatório no lavado nasal, extensão da lesão epitelial e espessamento da membrana basal na mucosa nasal de pacientes com rinite; determinar o ponto de corte do percentual de eosinófilos no lavado nasal associado à presença de atopia.

Método

Foram selecionados pacientes com rinite e indicação de septoplastia e (ou) turbinectomia por hipertrofia de conchas nasais, os quais foram submetidos aos testes cutâneos alérgicos, lavado nasal com determinação das concentrações de albumina, interleucina-8 (IL-8), contagem total e diferencial de células, análise da extensão da lesão epitelial, e grau de espessamento da membrana basal por meio de histopatologia da mucosa.

Resultados

Foram estudados 56 pacientes, mediana de idade de 24,5 anos com diagnóstico de rinite alérgica (n = 36) e rinite não alérgica (n = 20). Nos atópicos os testes cutâneos alérgicos foram positivos para D. pteronyssinus em 35 (97,0%) e L. perenne em 18 (50,0%). Atópicos apresentaram maior índice de escore clínico para rinite em comparação a não atópicos. A contagem total de células, neutrófilos e níveis de albumina e IL-8, não foi diferente entre o lavado nasal de atópicos e não atópicos. O ponto de corte da contagem de eosinófilos no fluido nasal para a distinção de rinite alérgica e rinite não alérgica foi de 4%. Algum grau de lesão epitelial foi mais frequente em pacientes com rinite alérgica (94%) do que em pacientes com rinite não alérgica (65%). Na presença de espessamento da membrana basal, como marcador de remodelamento, não houve diferença no lavado nasal entre pacientes com rinite alérgica e não alérgica.

Conclusão

Nesta casuística, 4% foi o ponto de corte do número de eosinófilos no lavado nasal, para diferenciação de atopia. Remodelamento da via aérea superior pelo espessamento da membrana basal, revelou infiltrado semelhante de células inflamatórias no lavado nasal, independentemente da presença de atopia.

https://ift.tt/2Sk2g4a

Factors influencing the quality of life of children with cochlear implants

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Joice de Moura Silva, Midori Otake Yamada, Elida Garbo Guedes, Adriane Lima Mortari Moret

Abstract

Introduction

The multidimensional impact of hearing loss on the various demands of life in children using cochlear implants is represented by variables that can influence the hearing, language and quality of life outcomes of this population.

Objective

To evaluate the factors influencing the quality of life of children with cochlear implantation, considering age, hearing age, age at evaluation, hearing skills, spoken language, family degree of receptiveness, schooling and socioeconomic status of the parents.

Methods

30 children using cochlear implants, aged 6–12 years and their respective parents participated. The children were evaluated by the "Categories of Auditory Performance", by "Language Category", and by the "Children with Cochlear Implants: Perspectives of Parents" questionnaire. Parents were assessed by the "Family Involvement Scale".

Results

The cochlear implant impacted the quality of life of the children, with more significant results on the increase of the social relations domain and the decrease of the family support domain. Overall, the increase of the age in the evaluation, better hearing and language skills, the mother's level of schooling and the family receptiveness correlated with the quality of life of children with cochlear implants.

Conclusion

The influencing factors that correlated with the quality of life of the implanted children were the child's older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family receptiveness.

Resumo

Introdução

O impacto multidimensional da deficiência auditiva nas várias demandas da vida das crianças usuárias de implante coclear é representado por variáveis que podem influenciar os resultados de audição, linguagem e qualidade de vida desta população.

Objetivo

Avaliar os fatores influenciadores na qualidade de vida de crianças com implante coclear, considerando a idade na cirurgia, a idade auditiva, a idade na avaliação, as habilidades auditivas, a linguagem falada, o grau de permeabilidade familiar, a escolaridade e o nível socioeconômico dos pais.

Método

Participaram 30 crianças usuárias de implante coclear com idade entre 6 a 12 anos e seus respectivos pais. As crianças foram avaliadas pela "Categorias de Audição", pela "Categoria de Linguagem, e pelo questionário "Crianças com Implante Coclear: Perspectivas dos Pais". Os pais foram avaliados pela "Escala de Envolvimento Familiar".

Resultados

O implante coclear impactou a qualidade de vida das crianças, com resultados mais significativos sobre o aumento do domínio relações sociais e a diminuição do domínio suporte da família. De maneira geral, maior idade na avaliação, as melhores habilidades auditivas e de linguagem, a escolaridade da mãe e a permeabilidade da família se correlacionaram com a qualidade de vida de crianças com implante coclear.

Conclusão

os fatores influenciadores que se correlacionaram com a qualidade de vida das crianças implantadas foram a maior idade na avaliação, as melhores habilidades auditivas e de linguagem, a escolaridade da mãe e a permeabilidade da família.

https://ift.tt/2GGpIY1

Surgical outcomes of sinonasal inverted papilloma: a 17 year review

Publication date: Available online 21 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Gil Coutinho, Joana Marques, Manuel Leal, Jorge Spratley, Margarida Sá Fernandes, Margarida Santos

Abstract

Introduction

Inverted papillomas represent one of the most common benign neoplasic lesions located in the sinonasal tract. Owing to the local erosive behavior, tendency to recur and the potential for malignant transformation, surgical management of inverted papillomas is often challenging.

Objective

This study aimed to analyze the surgical outcomes of patients with inverted papillomas, according to the Krouse staging and the different surgical approaches.

Methods

Retrospective study of patients diagnosed with sinonasal inverted papillomas who underwent surgical treatment between 2000 and 2016 at a tertiary referral hospital. Cases with follow-up less than 12 months were excluded. The rate and the time of recurrence were the main outcomes. Values of p < 0.05 were considered statistically significant.

Results

Thirty-six cases with mean age of 60 years, predominantly male (72%), were included. The follow-up period ranged from 1 to 17 years, with an average of 4.5 years. Krouse T1 Stage corresponded to 11.1%; T2 occurred in 50% of cases; while T3 and T4 Stages accounted for 30.6% and 8.3% of patients, respectively. Most cases were approached by an endoscopic technique alone (83.3%), with a recurrence rate of 13.3%. Patients treated via a combined or open approach revealed a recurrence of 16.7%. No differences in the recurrence rate were reported when comparing endoscopic surgery with the open or combined techniques. Krouse Stage T3 had a significant association with inverted papillomas recurrence (p = 0.023). All inverted papilloma relapses occurred up to 2 years post-operatively. One case of malignant transformation was recorded (2.7%).

Conclusion

Endoscopic surgery did not increase the recurrence rates and can be a safe and efficient alternative to open or combined techniques. The recurrence of inverted papillomas seem to be related to the persistence of the disease and tend to occur early after primary surgery. Krouse T3 Stages may be associated with a higher recurrence of inverted papillomas.

Resumo

Introdução

Os papilomas invertidos são uma das lesões neoplásicas benignas mais comuns no trato nasossinusal. Devido ao comportamento erosivo local, à tendência a recorrência e ao potencial de transformação maligna, o tratamento cirúrgico dos papilomas invertidos é muitas vezes desafiador.

Objetivo

Este estudo teve como objetivo analisar os resultados cirúrgicos dos papilomas invertidos segundo o estadiamento de Krouse, bem como avaliar as diferentes abordagens cirúrgicas.

Método

Este foi um estudo retrospectivo de pacientes com diagnóstico de papiloma invertido nasossinusal submetidos a tratamento cirúrgico entre 2000 e 2016 em hospital terciário de referência. Casos com acompanhamento inferior a 12 meses foram excluídos. A taxa e o tempo de recorrência foram os principais desfechos avaliados. Valores-p < 0,05 foram considerados estatisticamente significantes.

Resultados

O estudo incluiu 36 casos, com média de idade de 60 anos, predominantemente do sexo masculino (72%). O período de acompanhamento variou de 1 a 17 anos, em uma média de 4,5 anos. Quanto ao estadiamento, 11,1% dos pacientes foram classificados como estágio T1 de Krouse, 50% como T2, 30,6% como T3 e 8,3% como T4. A maioria dos casos foi tratada apenas por cirurgia endoscópica (83,3%), com taxa de recorrência de 13,3%. Pacientes tratados com uma técnica combinada ou aberta apresentaram recorrência de 16,7%. Não foram observadas diferenças quanto à taxa de recorrência quando a cirurgia endoscópica foi comparada com as técnicas abertas ou combinadas. Observou-se uma associação significante entre o estágio T3 de Krouse e recorrência de papilomas invertidos (p = 0,023). Todas as recidivas de papilomas invertidos foram observadas até dois anos após a operação. Um caso de transformação maligna foi registrado (2,7%).

Conclusão

A cirurgia endoscópica não aumentou as taxas de recidiva e pode ser uma alternativa segura e eficiente às técnicas abertas ou combinadas. Os casos de recorrência do papiloma invertido parecem estar relacionados à persistência da doença e tendem a ocorrer precocemente após a cirurgia primária. Os estágios T3 de Krouse podem estar associados a uma maior recorrência.

https://ift.tt/2Nt9BxT

Recurrence patterns of sinonasal cancers after a 5‐year disease‐free period

Objectives/Hypothesis

Sinonasal cancers are rare but have a poor prognosis. Most previous studies of these cancers have focused on 5‐year disease‐free survival, but recurrences are also known to occur after this period. We examined the post–5‐year recurrence patterns in sinonasal cancer patients by histologic type to determine the indicators for extended and close follow‐up requirements.

Study Design

Retrospective chart review.

Methods

A cohort of 241 sinonasal cancer patients was included. Demographic data, cancer site and stage, pathology and treatment results, and follow‐up and survival data were collected.

Results

Of the 241 patients, a complete remission occurred in 163 (72.4%) patients, but 83 (50.9%) of these cases developed recurrence, which occurred beyond the 5‐year follow‐up period in 19 cases (11.7%). The most common post–5‐year recurrences were adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), squamous cell carcinoma (six patients, 6.7%), and olfactory neuroblastoma (no patients, 0%). Post–5‐year local recurrence was highest in adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), and squamous cell carcinoma (five patients, 5.5%). Post–5‐year regional recurrence occurred in one squamous carcinoma patient (1.1%), and distant metastasis was seen in one adenoid cystic carcinoma patient (5.5%).

Conclusions

Sinonasal cancer shows an 11.7% recurrence rate after a 5‐year disease‐free period. As this recurrence pattern varies by tumor pathology, a specific follow‐up plan is needed for each cancer type.

Level of Evidence

3 Laryngoscope, 2019

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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)