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Background: The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Rarely, burn patients treated with agents containing these glycols present with a life threatening systemic toxidrome of hyperosmolar metabolic acidosis. We present a systematic review of outcomes in burn patients treated with similar agents., Methods: Relevant studies were identified through systematic searches conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Thomson Reuters), from database inception to August 4th, 2016. All publications of clinical burn patient studies included at least one arm receiving a glycol based topical therapy., Results: A total of 61 studies involving 10,282 patients and 4 different antimicrobial medications fulfilled the inclusion criteria. Nine burn patients (0.09%) were documented to present with hyperosmolar metabolic acidosis during topical silver sulfadiazine treatment. Propylene glycol isolated from their blood accounted for the high osmole gap., Conclusion: This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Understanding the ability of cytotoxic oncology drugs, and their carriers and formulation excipients, to induce pro-inflammatory responses is important for establishing safe and efficacious formulations. Literature data about cytokine response induction by the traditional formulation of paclitaxel, Taxol®, are controversial, and no data are available about the pro-inflammatory profile of the nano-albumin formulation of this drug, Abraxane®. Herein, we demonstrate and explain the difference in the cytokine induction profile between Taxol® and Abraxane®, and describe a novel mechanism of cytokine induction by a nanosized excipient, Cremophor EL, which is not unique to Taxol® and is commonly used in the pharmaceutical industry for delivery of a wide variety of small molecular drugs., From the Clinical Editor: Advances in nanotechnology have enabled the production of many nano-formulation drugs. The cellular response to drugs has been reported to be different between traditional and nano-formulations. In this article, the authors investigated and compared cytokine response induction profiles between Taxol® and Abraxane®. The findings here provided further understanding to create drugs with better safety profiles., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Oral transmucosal fentanyl citrate lozenges (lollipops) are indicated for the oral management of breakthrough cancer pain. When abused, these sucrose-containing lozenges can cause rampant dental caries., Case Description: The authors examined a 19-year-old man whose dentist referred him because of total dental coronal destruction. After the authors questioned the patient, they concluded that his frequent oral use of sucrose-containing opioid fentanyl citrate lozenges across a three-year period caused the dental condition., Clinical Implications: Dentists should be aware that oral transmucosal fentanyl citrate lozenges are being prescribed off-label for the control of pain from nonmalignant sources. Fentanyl citrate's effective analgesic potency can lead to misuse and potential abuse. Early recognition of its misuse could prevent severe dental caries and the need for extensive dental restoration.

Consumers will pay a premium for high-performance skin and hair care products. The demand exists, and in return for the high cost, consumers expect the product to perform as claimed and to meet aesthetic standards beyond many products found in the mass market. To be successful in this highly competitive market, products must function as claimed or consumers will not repurchase. Effective contemporary high-end products must be properly formulated in nonirritating vehicles that consumers will perceive as elegant.

Study Objectives: Benzodiazepines are commonly administered to medical ICU (MICU) patients. Propylene glycol (1,2-propanediol) is the solvent used to deliver lorazepam and diazepam IV. Although propylene glycol toxicity is increasingly recognized and reported, its incidence is unknown. Herein, we describe five MICU patients who acquired severe propylene glycol toxicity due to IV lorazepam or diazepam administration. Additionally, we evaluate the incidence of propylene glycol toxicity in MICU patients receiving IV lorazepam or diazepam., Design: Case series and prospective, observational study., Setting: Eighteen-bed MICU in a 550-bed urban academic hospital., Patients and Methods: MICU patients administered IV benzodiazepines during a 3-month period were enrolled. Patients were categorized according to the IV benzodiazepine that they received. Laboratory data and highlights of their clinical course were recorded daily. The incidence of propylene glycol toxicity was determined and the groups compared., Results: Forty-four patients were enrolled. Twenty-one patients received a benzodiazepine delivered in propylene glycol (lorazepam or diazepam), and 23 patients received a benzodiazepine delivered in an alternative solvent (midazolam). We found that four patients (19%) who received IV lorazepam or diazepam had metabolic evidence of propylene glycol toxicity. None of the patients had clinical deterioration. Neither metabolic abnormality nor clinical deterioration suggestive of propylene glycol toxicity were identified in subjects receiving IV midazolam., Conclusion: Propylene glycol toxicity is a potentially life-threatening iatrogenic complication that is common and preventable. It should be considered whenever a patient has an unexplained anion gap, unexplained metabolic acidosis, hyperosmolality, and/or clinical deterioration. Close monitoring of all patients receiving IV lorazepam or diazepam for early evidence of propylene glycol toxicity is warranted.

The extent of local irritation after rectal administration of diazepam in solution was studied in 24 adults (mean weight of 70 kg). The trial was randomized using a triple cross-over design. A burning sensation was reported in 60%, 12% and 0% of subjects up to 15 min after administration of diazepam 35 mg, diazepam 10 mg and placebo, respectively. Endoscopic assessment 24 h after medication showed mechanical irritation in three subjects and local irritation probably caused by diazepam, the vehicle, or both, in four. No correlation was found between subjective complaints and objective findings. Control endoscopy 7 days after medication revealed no pathology. It is suggested that a rectal solution of diazepam in doses up to 0.5 mg kg-1 is a safe form of medication in respect of irritation of the rectal mucosa.

Despite the considerable reduction in the prevalence of dental caries in children in most industrialized societies, there remains a minority with relatively high levels of disease. The part played by diet, hygiene and medication in the incidence of caries in this susceptible group of the child population is reviewed. Methods are suggested by which these parameters may be assessed and utilized in the prediction of high caries risk children in population groups. Supplementary evidence by means of special tests will be required to support these observations and identify the remainder at risk.