Methanol as an Unlisted Ingredient in Supposedly Alcohol-Based Hand Rub Can Pose Serious Health Risk

Temporal Variation and Industry-Specific Differences of the Use of Volatile Organic Compounds from 2018 to 2023 and Their Health Risks in a Typical Industrially Concentrated Area in South China

The risk of occupational exposure to organic solvents varies across industries due to factors such as processing materials, ventilation conditions, and exposure duration. Given the dynamic nature of organic solvent use and occupational exposures, continuous monitoring and analysis are essential for identifying high-risk hazards and developing targeted prevention strategies. Therefore, this study aims to analyze the use of organic solvents and volatile organic compounds (VOCs) in different industries in Bao'an District, Shenzhen, China, from 2018 to 2023, to understand their temporal variation and industry-specific differences and to identify high-risk occupational hazards. This study includes 1335 organic solvent samples, used by 414 different industry enterprises, and 1554 air samples. The result shows that the usage of organic solvents in various industries decreased with the outbreak of the pandemic and, conversely, increased as the situation improved. The most frequently detected volatile components in organic solvents were alkanes, followed by aromatic hydrocarbons. The ratios of the detection frequency of VOCs to the total number of detected categories increased year by year after 2020, indicating a tendency towards reduction and concentration of the types of organic solvents used in industrial production. Among the 8 high-risk VOCs, toluene (22.5%), n-hexane (22.0%), xylene (16.1%), and ethylbenzene (15.3%) have relatively high detection rates, suggesting that they need to be focused on in occupational health. Through air samples, the results show that trichloroethylene and xylene pose a high risk to human health (HQ > 1). We recommend that industry should strengthen monitoring of these two VOCs.

Semiconducting 2D Copper(I) Iodide Coordination Polymer as a Potential Chemiresistive Sensor for Methanol

The development of a cost-effective, ultra-selective, and room temperature gas sensor is the need of an hour, owing to the rapid industrialization. Here, a new 2D semiconducting Cu(I) coordination polymer (CP) with 1,4-di(1H-1,2,4-triazol-1-yl)benzene (1,4-TzB) ligand is reported. The CP1 consists of a Cu2I2 secondary building unit bridged by 1,4-TzB, and has high stability as well as semiconducting properties. The chemiresistive sensor, developed by a facile drop-casting method derived from CP1, demonstrates a response value of 66.7 at 100 ppm on methanol exposure, accompanied by swift transient (response and recovery time 17.5 and 34.2 s, respectively) behavior. In addition, the developed sensor displays ultra-high selectivity toward methanol over other volatile organic compounds , boasting LOD and LOQ values of 1.22 and 4.02 ppb, respectively. The CP is found to be a state-of-the-art chemiresistive sensor with ultra-high sensitivity and selectivity toward methanol at room temperature.

Clinical presentation and management of methanol poisoning outbreaks in Riyadh, Saudi Arabia: a retrospective analysis

BACKGROUND

Acute methanol intoxication, whether unintentional or deliberate, necessitates prompt intervention to prevent severe morbidity and mortality. Homemade alcoholic beverages are a frequent source of such poisoning. This retrospective analysis examined two outbreaks of methanol intoxication in Saudi Arabia. It investigated the clinical presentation, implemented management strategies, and any lasting complications (sequelae) associated with these cases. The aim was to assess the potential impact of different treatment modalities and the timeliness of their initiation on patient outcomes.

METHODS

This was a retrospective case series of methanol poisoning cases which presented to the adult emergency department (ED) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. There were two separate outbreaks in the city, the first one was from September 1 to September 10, 2020 and the second one was from May 14 to May 20, 2021. Electronic charts were reviewed, and data were extracted to previously prepared data extraction sheets.

RESULT

From the 22 patients who arrived in the ED alive, the most common complaints were nausea or vomiting followed by altered level of consciousness. About 9% from the patient were hypotensive, 36% were tachycardic, 41% were tachypneic and 4% were having SpO2 < 94%. Brain CT was abnormal in 6 patients. Vision impairment was the most common sequalae of methanol poisoning (7 out of 12 patients who were assessed by ophthalmologist, 58%). When the patients were divided based on severity (mild, moderate, severe), nausea or vomiting and loss of consciousness were the most common complaints among the moderate group while loss of consciousness predominated in the severe group. Two patients presented with low blood pressure and were in the sever group. The severe group had a mean Glasgow Coma Scale (GCS) of 8. Most of the patients in the severity groups underwent the same management apart from those who died or deposited. Eight patients in the severe group had to be intubated.

CONCLUSION

This study demonstrates the multifaceted clinical presentation of methanol poisoning, culminating in a 17.4% mortality rate. Notably, our findings emphasize the critical role of prompt diagnosis and swift initiation of combined fomepizole therapy and hemodialysis in mitigating mortality and minimizing the potential for chronic visual sequelae associated with methanol poisoning.

Exploitations of Schiff's test and iodoform test for an effective quality assessment of alcohol-based hand sanitizers

In the period of the corona virus disease 2019 (COVID-19) outbreak, an alcohol-based hand sanitizer is one of the most in-demand products for disinfection purposes. Two major concerns are adulteration of methanol, which causes toxicity to human health, and the concentration of legal alcohol in hand sanitizers due to their effect on antivirus. In this work, the first report of the entire quality assessment of alcohol-based hand sanitizers in terms of detection of methanol adulteration and quantification of ethanol is presented. Detection of adulterated methanol is carried out based on Schiff's reagent after the oxidation of methanol to formaldehyde, giving a bluish-purple solution to detect at 591 nm. In cases where a colorless solution is observed, an iodoform reaction with turbidimetric detection is then performed for quantitative analysis of legal alcohol (ethanol or isopropanol). To comply with the regulation of quality assessment of alcohol-based hand sanitizers, a regulation chart with four safety zones is also presented, employing a combination of two developed tests. The coordinates of a point (x, y) obtained from the two tests are extrapolated to the safety zone in the regulation chart. The regulation chart also showed consistency of analytical results as compared with the gas chromatography-flame ionization detector.

The clinico-epidemiological, diagnostic and therapeutic aspects of methanol poisoning: A five-year retrospective study, northern Iran

INTRODUCTION

Methanol poisoning (MP) is a serious health issue that has become more prevalent in recent years and has resulted in numerous deaths. Early detection and timely treatment are critical for preventing fatalities and reducing the incidence of neurological complications.

PATIENTS AND METHODS

This study was designed as a retrospective investigation with the purpose of analyzing the clinico-epidemiological, diagnostic, and therapeutic aspects of patients who were admitted to two training hospitals in northern Iran due to MP. The selection of samples for this study was based on a pre-defined checklist. Following the completion of the treatment period in the hospital, the patients were categorized into three groups based on their clinical outcome. All relevant variables for each group were recorded and reported separately, using the SciPy library in the Python programming language.

RESULTS

The majority of the patients (88.12%) were male (P=0.012), the average age was 41.46, and mostly (82.18%) lived in urban regions (P=0.025). The primary clinical complaint reported was visual disorders, accounting for 75.25% of the cases, followed by nervous, gastrointestinal, respiratory, and chest pain accordingly. The average hospitalization length for the patients was 5.065 days. Out of the 101 patients, 65 (64.36%) were discharged without any complications, 17 (16.83%) were discharged with complications, and unfortunately, 19 (18.81%) were died.

CONCLUSION

A decreased level of consciousness and severe metabolic acidosis are commonly associated with unfavorable outcomes in MP. The use of systemic corticosteroids as a treatment method has a significant association with reducing mortality rates.

Hand Sanitizer Gels: Classification, Challenges, and the Future of Multipurpose Hand Hygiene Products

Hand hygiene is a crucial measure in the prevention and control of infections, and there is a growing awareness among individuals who are making a conscious effort to maintain hand cleanliness. With the advent of the SARS-CoV-2 outbreak, the demand for hand hygiene products has also gradually shifted towards those with antimicrobial properties. Among these products, hand sanitizer gels (HSGs) have gained considerable popularity as an efficient method of hand cleaning, due to their rapid drying and sustained antimicrobial efficacy. Concurrently, there has been a growing interest in novel HSGs that offer additional functions such as skin whitening, moisturizing, and anti-inflammatory effects. These novel HSGs effectively address concerns associated with the ingestion of antimicrobial ingredients and demonstrate reduced skin irritation, thereby alleviating hand dermatological issues. This review provides an extensive overview of the application scenarios, classification, and challenges associated with HSGs while emphasizing the emergence of novel components with biological functions, aiming to contribute to the advancement of hand hygiene practices and offer novel insights for the development of novel HSGs with outstanding antimicrobial properties with other multiple biological functions and desirable biosafety profiles.

Case Reports Study on Methanol Poisoning in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia

Methanol poisoning is a challenging issue due to its inducing acute multiple organ failures, and especially due to a lack of preparedness, available antidotes, and management protocols. The current study presents six cases of methanol poisoning that attended the emergency department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, between March and November 2022. All of the patients suffered from severe metabolic acidosis and visual impairment following the ingestion of homemade alcoholic beverages and colonia. Three patients were comatose, suffered from post-cardiac pulmonary arrest, and, finally, died, while the other three were non-comatose and discharged from the ICU after improvement. Management was based on clinical symptoms and other laboratory findings due to a shortage of methanol level measurement resources. The antidote, fomepizole, was not given to all of the cases due to its deficiency, and ethanol was given only to one patient due to difficulties in administering it without monitoring its concentration. Methanol poisoning and its outbreak provide insights into the dangers of hazardous homemade alcohol and other pharmaceutical preparations that might be adulterated with methanol, particularly to the shortage of suitable diagnostic testing and antidotes in addition to poor resources for management of intoxicated patients in some regions of Saudi Arabia.

Outcome of Methanol Toxicity Outbreak In Saudi Arabia: Case Series Study

Introduction Methanol poisoning is an acute medical emergency. If not recognized in time and treated properly, it can lead to a considerable magnitude of morbidity as well as mortality. This article aims to report cases of methanol toxicity, focusing on clinical presentation, management, and outcomes. Method Nine ICU-admitted patients with confirmed positive serum methanol levels were analyzed in a case series at King Fahad General Hospital in Jeddah, Saudi Arabia, between November 2022 and January 2023. Results Among the nine patients admitted to the ICU due to methanol poisoning, the majority were middle-aged males, with two females included. Gastrointestinal symptoms were seen in two-thirds of patients, while three patients required immediate mechanical ventilation due to a low Glasgow Coma Scale. Severe metabolic acidosis was observed in most cases. All patients received sodium bicarbonate and hemodialysis, with six patients also receiving fomepizole. However, two patients in the study with low initial low Glasgow Coma Scale (GCS), severe metabolic acidosis, and diffuse brain edema, did not survive. One patient reported acute complete vision loss. Conclusion This case series highlights the importance of promptly recognizing and managing methanol toxicity in ICU settings. The clinical presentation of methanol toxicity can be challenging, and early diagnosis and treatment are crucial to prevent irreversible damage.

Ocular Manifestations After Acute Methanol Poisoning

Acute methanol poisoning is first and foremost life-threatening. Otherwise, functional prognosis is mainly based on ocular impairment. In this case series we aimed to describe the ocular manifestations after acute methanol poisoning during an outbreak in Tunisia. The data from 21 patients (41 eyes) were analysed. All patients underwent a complete ophthalmological examination including visual fields, colour vision test and optical coherence tomography with evaluation of the retinal nerve fibre layer. Patients were classified into two groups. Group 1 included patients with visual symptoms and group 2 included patients with no visual symptoms. Ocular abnormalities were seen in 81.8% of patients with ocular symptoms. They included: optic neuropathy in 7 patients (63.6%); central retinal artery occlusion in 1 patient (9.1%); and central serous chorioretinopathy in 1 patient (9.1%). Mean blood methanol levels were significantly higher in patients without ocular symptoms (p = .03).

Hand sanitizer-related calls at the National Poisons Information Centre, India during the lockdown period of the Covid-19 pandemic

Background

Hand sanitizer (HS) has been increasingly used during the Covid-19 pandemic. We compared the telephonic calls received by the National Poisons Information Centre (NPIC), New Delhi, India, related to its unsafe exposure and inappropriate use during the lockdown and prelockdown periods.

Methods

We analysed and compared telephonic call records of 3 months of pre-lockdown and 3 months of the lockdown and HS-related calls in different age groups and zones during these periods.

Results

The centre received 4000 calls; of these 1583 (40%) were related to household products of which only 63 (4%) were related to HS. There was an 8-fold increase in the number of calls received at the NPIC during the lockdown compared to the pre-lockdown period seeking medical attention following unsafe exposure or inappropriate use of HS. More calls were received from the south and north zones and, in the majority of these cases, HS was ingested accidentally. In some cases, HS was ingested intentionally for suicide during the lockdown.

Conclusions

Our study shows that unsafe exposure of HS is common under conditions of stress as seen during the lockdown period of the Covid-19 pandemic. It should be kept out of reach of small children. Further, providing psychological help and counselling to older age groups under conditions of stress are important issues of concern.

Evaluation of the Safety and Efficacy of Hand Sanitizer Products Marketed to Children Available during the COVID-19 Pandemic

Hand sanitizer use in the United States (U.S.) increased after the SARS-CoV-2 outbreak. The U.S. Food and Drug Administration (FDA) released temporary manufacturer guidance, changing impurity level limits for alcohol-based hand sanitizers (ABHSs). Since the guidance took effect, the FDA has recommended against using these hand sanitizers due to concerns over safety, efficacy, and/or risk of incidental ingestion. To address current gaps in exposure characterization, this study describes a survey of ABHSs marketed to children available in the U.S., as defined by several inclusion criteria. A subset of ABHSs (n = 31) were evaluated for ethanol and organic impurities using a modified FDA method. Products with detectable impurity levels were compared to the FDA's established interim limits. Seven children's products had impurity levels exceeding the FDA's recommended interim limits, including benzene (up to 9.14 ppm), acetaldehyde (up to 134.12 ppm), and acetal (up to 75.60 ppm). The total measured alcohol content ranged from 52% to 98% in all hand sanitizers tested, ranging from 39% below, and up to 31% above, the labeled concentration. Future studies should confirm impurity contamination sources. A risk assessment could determine whether dermal application or incidental ingestion of impurity-containing hand sanitizers pose any consumer risk.

A Cluster of Five Deaths Due to Methanol Toxicity After Apparent Hand Sanitizer Ingestion in the Setting of Chronic Alcoholism

Methanol toxicity and its associated pathologies have been widely studied, however, at the beginning of the COVID-19 pandemic, there was an increase in methanol toxicity due to apparent consumption of contaminated hand sanitizer. We report a cluster of five deaths and one presumed death due to the apparent consumption of hand sanitizer, contaminated with methanol, in the setting of chronic alcoholism. The deaths occurred in Coconino County, Arizona, over a four-and-a-half-month period (June-October 2020), before and during a Food and Drug Administration recall of contaminated hand sanitizer. Methanol-related deaths are relatively uncommon in Coconino County, with only one methanol associated death (source of ingestion unknown) occurring over the previous five years.

Review of drug recalls and quality of pharmaceutical products in Nepal

OBJECTIVES

To evaluate the pattern of substandard and falsified pharmaceutical products recall in Nepal.

SETTING

We analysed drug recall notices issued by the Department of Drug Administration (DDA), Nepal, and systematically reviewed peer-reviewed research articles during January 2010 to December 2020.

PARTICIPANTS

This study did not include human participants. However, data were collected from 72 drug recall notices issued by DDA and four research papers.

RESULTS

A total of 346 pharmaceutical products were recalled during the reported period. The number of recalled pharmaceutical products has increased significantly over the past decade in Nepal. The most frequently recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements and pain and palliative medicines among others. Number of imported recalled drugs were slightly higher (42.2%) than domestic recalled drugs (40.7%). Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, higher number of modern drugs (62%) were recalled than traditional ones (35%). Hand sanitisers used to minimise COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitisers contained significant amounts of methanol (as high as 75% v/v) instead of appropriate amount of ethyl or isopropyl alcohol. The peer-reviewed research papers reported issues with labelling, unregistered drugs and drugs failed in several laboratory testing.

CONCLUSION

Our analysis showed that number of recalls of substandard and falsified drugs are increasing in Nepal. Since the recall data in this paper did not include number of samples tested and location of samples collected, more studies to understand the prevalence of substandard and falsified drugs in Nepal is recommended.

Spectroscopic methods for assessment of hand sanitizers

Sanitization of inanimate objects or body surfaces using disinfectant is essential for eliminating disease-causing pathogens and maintaining personal hygiene. With the advent of health emergencies, the importance and high demand for hand sanitizers (HS) are observed in everyday life. It is also important to know the constituent added to formulate HS, as the presence of harsh chemicals can cause skin irritation. In this study, different spectroscopic techniques were used to assess several commercially available HS along with the in-house prepared HS as per the WHO protocol. Fourier transform infrared spectroscopy and Raman spectroscopy identified the different HS chemical bonds and quantified the amount of alcohol and water in the HS. Varying amount of alcohols in HS, calibration profile was generated to identify its amount in commercial samples. Further, the commercial samples were also checked for contaminants whose presence in the HS might bring down its sanitization efficacy.

Alcohol consumption epidemic and its complications during the COVID-19 pandemic in Khuzestan Province, Iran; 2020

Background: After unprecedented demand for ethanol in the pandemic, profiteers used methanol for making illegal alcoholic drink. Methods: This cross-sectional descriptive-analytical study investigated the effects of methanol poisoning on 400 patients who referred to hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences from March 20 to September 20, 2020. Results: Ninety-eight-point five percent of patients had consumed alcohol for social reasons and only 0.3% had used it as a measure to avoid COVID-19. Eighty-seven percent of the patients used homemade alcohol bought from peddlers. The most common clinical symptom was gastrointestinal disorders (64.8%) and the most common complications were vision problems (12.3%). Ten-point-six percent (42 patients) of the patients died. The most important factors affecting mortality risk were dyspnea, neuropathic problems, abnormal radiological findings, dialysis, abnormal blood pressure, vision problems and dizziness. Conclusions: Informing the public about the risks of using homemade alcoholic beverages is essential if the associated disability and mortality has to be avoided.

Methanol Intoxication After Suicidal Ingestion of Liquid Rodenticides: A Report of Two Cases

Methanol is highly toxic to humans. Although methanol poisoning is not uncommon in developing countries, poisoning caused by ingestion of commercial products containing undeclared methanol has rarely been reported. Herein, we describe two patients who experienced methanol poisoning after ingestion of liquid rodenticides. A 39-year-old woman attempted suicide by ingesting liquid rodenticide which contained bromadiolone. She developed high anion gap metabolic acidosis and coagulopathy. Methanol poisoning was confirmed 20 hours later. She received oral ethanol therapy and hemodialysis. Vitamin K1 was also administered. She did not develop any hemorrhage or visual impairment and was discharged after 11 days. The rodenticide sample was tested and found to have a methanol concentration of 324 g/L. In another case, a 62-year-old man ingested the same brand of rodenticide. Laboratory data showed mild metabolic acidosis with an increased osmol gap, suggestive of methanol poisoning. He received hemodialysis and eventually recovered without sequelae. Liquid rodenticide may contain methanol as a solvent. Ingestion of a methanol-containing commercial product without a clear label can result in a considerable delay in diagnosis and management. Methanol poisoning should be considered for patients who present with unexplained metabolic acidosis following exposure to liquid rodenticides or other liquid commercial products.

Development and validation of a headspace GC-MS method to evaluate the interconversion of impurities and the product quality of liquid hand sanitizers

The COVID-19 pandemic has led to increased usage of hand sanitizer products by the public to prevent the spread of COVID-19 and decrease the likelihood of acquiring the disease. The increase in demand has also led to an increase in the number of manufacturers. This work describes the FDA's Center for Drug Evaluation and Research (CDER) laboratories efforts to develop tests to assess the quality of hand sanitizer products containing ethanol or isopropanol as the primary active ingredient. The products were evaluated for the active ingredient content and determination of the 12 impurities listed in the FDA Hand Sanitizer Temporary Guidance, followed by a spike recovery assay performed to verify the test results. Extensive method development was conducted including an investigation into the stability of ethanol, isopropanol, and the 12 impurities. Stability and kinetic studies confirmed the instability of acetal in acidic liquid hand sanitizer products during spike recovery assay testing. The headspace GC-MS method was validated according to ICH Q2 (R1) guidelines and the spike recovery assay was validated using three concentrations of standards for the drug product. During method application, six liquid hand sanitizer products were tested and all were determined to have ethanol or isopropanol above 70% v/v. Two liquid hand sanitizer products were determined to contain acetaldehyde as an impurity above the FDA recommended safety levels.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s41120-021-00049-8.

Oh D. Determination of Methanol in Commercialized Alcohol-based Hand Sanitizing and Other Similar Products using Headspace GC-MS

Background:

Demand for alcohol-based products, including gel- and aqueous-type hand sanitizers, room sprays, and mouthwashes, has sharply increased during the ongoing COVID-19 pandemic because of their microbicidal properties. However, toxic methanol can be found from intentional addition of methanol by manufacturers and invariable production during the manufacture alcohol (ethanol). Although the FDA has recommended that such products should contain less than 630 ppm of methanol, it is only a temporary measure established specifically to regulate such products during the current COVID-19 pandemic and hence is not strictly regulated.

Objective:

This study aims to detect and quantify the level of methanol in alcohol-based products. However, some manufacturers unethically add methanol in their products and promote them as methanol-free. Besides, they do not provide proficiency and toxicity test results. Therefore, these kinds of products need to be analyzed to determine if they are acceptable to use.

Method:

This study qualitatively and quantitatively investigates the amount of methanol in commercial alcohol-based products using a newly developed headspace gas chromatography/mass spectrometry method. Moreover, alcohol beverages which contain methanol were analyzed to be compared with the levels of methanol in alcohol-based products and determine if their methanol levels are acceptable.

Results:

Methanol concentrations in gel-type hand sanitizers (517 ppm) and mouthwashes (202 ppm) were similar to those in white wine (429 ppm) and beer (256 ppm), respectively, while that of aqueous-type hand sanitizers (1139 ppm) is 1.5 times more than that of red wine (751 ppm).

Conclusion:

Methanol levels in most of the alcohol-based products did not exceed the FDA-recommended limit.

Substandard and falsified medical product recalls in Zambia from 2018 to 2021 and implications on the quality surveillance systems

Background

Substandard and falsified (SF) medical products are removed from circulation through a process called 'product recall' by medicines regulatory agencies. In Zambia, the Zambia Medicines Regulatory Authority (ZAMRA) is responsible for recalling SF medical products from the Zambian market through passive and active surveillance methods. This study aimed to describe the prevalence of recalls of SF medical products and to analyse the frequently recalled therapeutic categories, dosage forms, categories of defects that led to the recalls and their sources with respect to the country of the marketing authorisation holder (MAH) or manufacturer.

Methods

We conducted a descriptive cross-sectional review of the product recalls issued by ZAMRA between January 2018 and December 2021. A search for all medical product alerts and recalls issued by ZAMRA was carried out by reviewing the internal post-marketing surveillance database kept at ZAMRA headquarters. Data were extracted using a structured Excel database and analysed using Microsoft Excel.

Results

A total of 119 alerts were received during the review period, of which 83 (69.7%) were product recalls. Oral solid dosage forms were the most recalled dosage form (53%). Furthermore, the number of recalls increased in 2020 (44.6%) and 2021 (22.9%), with the majority (20.5%) of the recalled products being substandard products classified as antiseptics and disinfectants and were attributed to the high demand during the COVID-19 pandemic. Manufacturing laboratory control issues were the reason for product recall in almost half (47.4%) of the cases. Most of the products recalled originated from India (38.6%), followed by Zambia (25.3%). Only one suspected falsified product was recalled between 2018 and 2021. A total of 66 recalls of the 83 products were initiated by ZAMRA, with only 17 voluntarily by foreign MAHs. No product recall was initiated by the local representatives of foreign manufacturers or MAH.

Conclusion

The majority of the pharmaceutical product recalls in Zambia were substandard products. Manufacturing laboratory control issues lead to most recalls and require investigation of the root causes, preventive action, and strict compliance with the good manufacturing practices guidelines by manufacturers.

Development of Methanol Sensor Based on Sol-Gel Drop-Coating Co3O4·CdO·ZnO Nanoparticles Modified Gold-Coated µ-Chip by Electro-Oxidation Process

Herein, novel Co₃O₄·CdO·ZnO-based tri-metallic oxide nanoparticles (CCZ) were synthesized by a simple solution method in basic phase. We have used Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Field Emission Scanning Electron Microscope (FESEM), Dynamic Light Scattering (DLS), Tunneling Electron Microscopy (TEM), and Energy-Dispersive Spectroscopy (EDS) techniques to characterize the CCZ nanoparticles. XRD, TEM, DLS, and FESEM investigations have confirmed the tri-metallic nanoparticles’ structure, while XPS and EDS analyses have shown the elemental compositions of the CCZ nanoparticles. Later, a Au/μ-Chip was modified with the CCZ nanoparticles using a conducting binder, PEDOT: PSS (poly(3,4-ethylenedioxythiophene) polystyrene sulfonate) in a sol-gel system, and dried completely in air. Then, the CCZ/Au/μ-Chip sensor was used to detect methanol (MeOH) in phosphate buffer solution (PBS). Outstanding sensing performance was achieved for the CCZ/Au/μ-Chip sensor, such as excellent sensitivity (1.3842 µAµM⁻¹cm⁻²), a wide linear dynamic range of 1.0 nM–2.0 mM (R² = 0.9992), an ultra-low detection limit (32.8 ± 0.1 pM at S/N = 3), a fast response time (~11 s), and excellent reproducibility and repeatability. This CCZ/Au/μ-Chip sensor was further applied with appropriate quantification results in real environmental sample analyses.

Inexpensive Portable Infrared Device to Detect and Quantify Alcohols in Hand Sanitizers for Public Health and Safety

The onset of Covid-19 pandemic has resulted in the exponential growth of alcohol-based hand rub (ABHR)/hand sanitizer use. Reports have emerged of ABHR products containing methanol, a highly toxic compound to humans, exposing users to acute and chronic medical illnesses. While gas chromatography-mass spectrometry (GC-MS) remains the gold-standard method for the detection and identification of impurities in ABHRs, there exist limitations at widespread volume testing. This paper demonstrates the capability of an inexpensive portable pyroelectric linear array infrared spectrometer to rapidly test ABHR and compare the performance with a benchtop Fourier transform infrared spectrometer and HS-GC-MS. Multicomponent partial least square quantification models were built with performance found to be comparable between the two spectrometers and with the HS-GC-MS. Furthermore, the portable spectrometer was field-tested with real-world samples in Malaysia on both retail products (Group A) and freely deployed public dispensers (Group B) between May and November 2020. A total of 386 samples were tested. Only 75.2% of Group A met the criteria of safe and effective ABHR [no detectable methanol and alcohol concentration above 60% (v/v)], while <50% of Group B did. In addition, 7.4 and 18.8% of Group A and Group B, respectively, were found to contain methanol above permissible limits. The high percentage of sub-standard and methanol-containing samples combined with the frequent use of ABHR by the public highlights the need for and importance of a portable and rapid testing device for widespread screening of ABHR against falsified products and protects the general public.

Alcohol-based hand sanitizer - composition, proper use and precautions

During the COVID-19 pandemic, the use of alcohol-based hand sanitizers (ABHS) increased worldwide among the public as well as the health care workers in pursuit to prevent the spread of SARS-CoV-2, the causative virus of COVID-19. Hand hygiene is one of the primary preventive measures to prevent the spread of harmful germs. Although ABHS are effective hand hygiene products and help reduce the transmission of pathogenic microorganisms, appropriate use of such products is necessary to ensure the maximum killing of pathogens and to prevent hazards associated with ABHS. The effectiveness of ABHS against different microorganisms, including SARS-CoV-2 is also documented, but proper knowledge on hand hygiene techniques, selection of appropriate hand sanitizer product, and safe handling of ABHS are required to avoid their adverse effects such as allergies, skin irritation, lung injury, fire hazards, and toxicities. The effectiveness of ABHS is dependent on several factors including its appropriate usage, manufacturing methods, the choice of active agents, and the appropriateness of the agent on the target pathogen. This article highlights the importance of proper usage, handling, and appropriate ABHS selection for maximum efficacy against intended pathogens and safe use of ABHS. User awareness can help promote the appropriate usage of ABHS and prevent its hazards, which ultimately can help in preventing the transmission of pathogenic microorganisms.

An assessment of hand hygiene practices of university students in Vietnam amid the COVID-19 pandemic: A brief report

Objective:

Effective handwashing practices help prevent the spread of coronavirus disease 2019 (COVID-19). This study examined the knowledge, frequency, and characteristics of handwashing practices among Vietnamese university students.

Methods:

An analytic cross-sectional study was conducted on all students enrolling at Phenikaa University in Vietnam. A self-developed questionnaire was used to collect information on the participants’ knowledge regarding the effectiveness of handwashing as a COVID-19 preventive measure, the moments for hand hygiene, the most appropriate practices in different situations, and frequency.

Results:

Among 728 study participants, 460 (63.2%) were from health-related faculties. Almost (97.9%; 713/728) all participants knew that handwashing could protect against the spread of infection, but less than half performed handwashing often in a normal day (47.4%; 345/728), after sneezing or coughing (48.9%; 356/728), and 7.4% (54/728) only washed hands when hands are visibly dirty. Health students used alcohol-based handrub in all situations, including those requiring handwashing with water and soap (P < 0.05).

Conclusions:

The levels of knowledge regarding the effectiveness of handwashing among study participants are high, but actual practices of handwashing are suboptimal. It is crucial to improve community education to help reinforce correct hand hygiene behaviors, including when to wash hands and which method should be used.

Canadian policy changes for alcohol-based hand rubs during the COVID-19 pandemic and unintended risks

The COVID-19 pandemic led to major changes in public policies to address supply chain disruption and escalated the price of consumer disinfectant products. To address market demands on alcohol-based hand rubs and disinfectants, Health Canada implemented major changes to the regulations regarding composition, handling, transportation, and packaging to insure product availability. Furthermore, accelerated licensing of ingredients and packaging did not meet standard medical quality guidelines yet were authorized for manufacturing and packaging of alcohol-based hand rubs and disinfectants. The accountability associated with these policy changes were reactive, including industry self-reporting, consumer reporting, and Health Canada advisories and recalls that were responsive to products after they were available in the market. Nonetheless, Canadian public health policy increased hand sanitizers availability. However, some of the interim policies have raised major public health concerns associated with ethanol quality, packaging, and labeling, and enforcement of regulations. In this paper, we review the changes in the Canadian regulations amid the current pandemic and we evaluate the unintended health risks that might arise from these changes.

Toxicology Practice During COVID-19 Pandemic: Experience of the Dammam Poison Control Center-Eastern Province, Saudi Arabia

BACKGROUND

The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems.

OBJECTIVE

To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics.

METHODS

Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019.

RESULTS

Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086).

CONCLUSION

The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.

Quick determination and discrimination of commercial hand sanitisers using attenuated total reflectance-Fourier transform infrared spectroscopy and chemometrics

Due to the outbreak of the COVID-19 pandemic, practicing personal hygiene such as frequent hand sanitising has become a norm. The making of effective hand sanitiser products should follow the recommended formulations, but the high demand worldwide for such affordable products could have made them a candidate for counterfeiting, thus deserving forensic determination and profiling for source determination or supply chain tracing. In this study, determination and discrimination of hand sanitisers was carried out by employing attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics. Fifty commercially available hand sanitisers were obtained from the market and analysed. ATR-FTIR profiles of each sanitiser were compared and decomposed by principal component analysis (PCA) followed by linear discriminant analysis (LDA). Physical observation enabled the discrimination of seven samples based on their respective colours, the presence of beads and their colours, and the physical forms of formulations. Subsequently, eight distinct patterns were observed through visual comparison of ATR-FTIR profiles of the remaining 43 samples. An initial unsupervised exploratory PCA model indicated the separation of two main groups with ATR-FTIR profiles similar to those of ethanol and isopropanol, respectively. The PCA score-LDA model provided good predictions, with a 100% correct classification into eight different groups. In conclusion, this study demonstrated a quick determination and discrimination of hand sanitiser samples, allowing screening for any restricted components and sample-to-sample comparison.

Chronic severe methanol intoxication after repeated mask cleansing due to fear of COVID-19: A new risk of coronaphobia

Background

Disproportionate fear of contracting COVID‐19 (coronaphobia) may result in inappropriate use of preventive measures that could, in turn, result in severe harm to the patient.

Objective

To describe a patient with subacute parkinsonism and cognitive dysfunction and magnetic resonance imaging (MRI) evidence of bilateral deep white matter and basal ganglia damage.

Case presentation

A 56‐year‐old female presented with a 4‐week history of insomnia, cognitive decline, and parkinsonism. Brain MRI revealed a bilateral lesion of both globus pallidus, deep white matter, and cerebellar hemispheres. Her son reported that, for the previous month, she had been cleaning her facial mask three times a day with a pure methanol solution as a disinfectant due to an intense fear of acquiring COVID‐19. Previously, she had used 97% isopropyl alcohol and had inadvertently switched to methanol. After the exposure ended, she slowly improved but 4 months later she remains severely disabled.

Conclusions

The repeated exposure to methanol vapor, the MRI findings, and the absence of other etiologies for her cognitive and parkinsonian features led to the diagnosis of chronic methanol intoxication with severe central nervous system damage. Misinformation is a likely contributory factor to such scenario. Efforts should be made by the scientific community to educate the general public on avoiding self‐damaging behaviors as a result of coronaphobia.

Development of a Chromium-free Gas Detector Tube for Alcohols

Chromium oxide(VI), (Cr(VI)) has been used in gas detector tubes as an indicator to detect alcohols. However, it is toxic and regulated to prevent environmental pollution. In this report, potassium manganate(VII) was chosen instead of Cr(VI). A samples of 100 mL of ethanol, methanol and 2-propanol vapors were passed through a gas detector tube with an aspirating pump. Sampling time was 3 min. The stain length on the tube was in the range of 20 - 300 ppm. A novel detector tube for alcohols was developed without Cr(VI).

COVID casualty: Bilateral blindness due to ingestion of spurious sanitizer

Intentional ingestion of alcohol-based handrub (ABHR) or sanitizer solution is uncommon. The coronavirus disease-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to lockdowns being put in place in many countries across the globe and resulted in a surge in ABHR usage to maintain hand hygiene. In this communication, we report the case of a 56-year-old male, a chronic alcoholic who presented during the lockdown period, with acute bilateral loss of vision following ingestion of ABHR. The handrub was found to be a nonstandardized sanitizer with no labels mentioning its constituents. Typically, the ingestion of ABHR solutions results in isopropanol or ethanol poisoning, both of which have low toxicity. Based on the clinical history and findings in our patient, a diagnosis of optic neuropathy due to accidental ingestion of sanitizer containing methyl alcohol as an unlisted ingredient was made. Our report underscores the need for strict guidelines, toxicovigilance, and surveillance systems to be in place to prevent such adulterated ABHRs from being commercially available.

COVID-19: An overview for dermatologists

Numerous unexplained pneumonia cases were reported to the World Health Organization (WHO) by Wuhan, China, in December 2020. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a zoonotic pathogen, came into sight, spreading coronavirus disease 2019 (COVID-19) all over the globe. Association of cutaneous signs and symptoms with COVID-19 is being studied worldwide, principally, to determine if these dermatoses can help in early recognition of SARS-CoV-2 infection. These dermatological manifestations can range from erythematous rash, urticaria to livedo reticularis, and acrocyanosis in patients of all age groups. Correspondingly, dermatologists treating COVID-19 patients, suffering from inflammatory dermatoses, with biologics or immunomodulators should exert caution and use specific protocols to adjust the doses of these medications. Prevention of person-to-person transmission of COVID-19 is being promoted universally, with the use of personal protective equipment (PPE), hand washes, and hand sanitizers around the clock. However, an array of cutaneous adverse effects such as contact dermatitis, irritant contact dermatitis, friction blisters, contact urticaria, acne, and infections are associated with the use of PPE. Extra-pulmonary manifestations of COVID-19 are still emerging in the community, and physicians and researchers are working together globally to strengthen the clinical management of these patients. Cases of COVID-19 continue to rise across the world, and an unprecedented approach has been taken to develop effective vaccines and therapeutic strategies against existing and forthcoming mutagenic strains of SARS-CoV-2.

Scale validation for the identification of falsified hand sanitizer: public and regulatory authorities perspectives from United Arab Emirates

Background

Since the time of declaration of global pandemic of COVID-19 by World Health Organization (WHO), falsified hand sanitizers surfaced regularly in markets, posing possible harm to public due to unlisted inclusion of methanol. The current research is an attempt to develop and validate a tool to document falsified hand sanitizer in the UAE community.

Method

A descriptive cross-sectional community-based study was conducted among 1280 randomly selected participants. Respondents were sent a web-based electronic link to the survey via email. Content validity, factor analyses and known group validity were used to develop and validate a new scale to identify falsified hand sanitizer. Test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs) were used to assess the reliability of the scale. SPSS version 24 was used to conduct data analysis.

Results

A total of 1280 participants were enrolled in the study. The content validity index (CVI) was 0.83 with the final scale of 12 items. The Kaiser-Meyer-Olkin (KMO) value was 0.788, with the Bartlett test of sphericity achieving statistical significance (p < 0.001). Our factor analysis revealed a 3-component model. The 3-factor solution was confirmed by PCFA analysis and had associations with good fit values. The PCFA for NFI was 0.970, CFI 0.978, and TLI 0.967. All values were in excess of 0.95, with RMSEA values below 0.06 at 0.03; all of these values indicated a good model fit. The Cronbach’s alpha was good overall (0.867). All factors had a Cronbach’s alpha value in excess of 0.70. The instrument demonstrated that every item met the IIC correlation standard ≥0.40. The scale displayed good overall ICC statistics of 0.867 (95% CI 0.856–0.877) with statistical significance (p < 0.001). The scale’s test-retest reliability was assessed through correlation of the falsified hand sanitizer identification score of respondents at the two time points. The test-retest correlation coefficient was 0.770 (p value < 0.01). Participants with post-graduate education were more likely to identify the falsified hand sanitizer compared to those with high school education. (p < 0.001).

Conclusions

This study developed and validated a new scale for the measurement of falsified hand sanitizer. This is expected to improve and promote collaboration between the health regulators and the public and hereby encourage customer satisfaction and participation.

Toxicological aspects of increased use of surface and hand disinfectants in Croatia during the COVID-19 pandemic: a preliminary report

All COVID-19 prevention strategies include regular use of surface disinfectants and hand sanitisers. As these measures took hold in Croatia, the Croatian Poison Control Centre started receiving phone calls from the general public and healthcare workers, which prompted us to investigate whether the risk of suspected/symptomatic poisonings with disinfectants and sanitisers really increased. To that end we compared their frequency and characteristics in the first half of 2019 and 2020. Cases of exposures to disinfectants doubled in the first half of 2020 (41 vs 21 cases in 2019), and exposure to sanitisers increased about nine times (46 vs 5 cases in 2019). In 2020, the most common ingredients of disinfectants and sanitisers involved in poisoning incidents were hypochlorite/glutaraldehyde, and ethanol/isopropyl alcohol, respectively. Exposures to disinfectants were recorded mostly in adults (56 %) as accidental (78 %) through ingestion or inhalation (86 %). Fortunately, most callers were asymptomatic (people called for advice because they were concerned), but nearly half reported mild gastrointestinal or respiratory irritation, and in one case severe symptoms were reported (gastrointestinal corrosive injury). Reports of exposure to hand sanitisers highlighted preschool children as the most vulnerable group. Accidental exposure through ingestion dominated, but, again, only mild symptoms (gastrointestinal or eye irritation) developed in one third of the cases. These preliminary findings, however limited, confirm that increased availability and use of disinfectants and sanitisers significantly increased the risk of poisoning, particularly in preschool children through accidental ingestion of hand sanitisers. We therefore believe that epidemiological recommendations for COVID-19 prevention should include warnings informing the general public of the risks of poisoning with surface and hand disinfectants in particular.

Electrocardiographic findings of methanol toxicity: a cross-sectional study of 356 cases in Iran

BACKGROUND

Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature.

METHOD

A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected.

RESULTS

The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively.

CONCLUSION

Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.

Inpatient Burden and Mortality of Methanol Intoxication in the United States

BACKGROUND

This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for methanol intoxication in the United States.

MATERIALS AND METHODS

A total of 603 hospitalized patients with a primary diagnosis of methanol intoxication from 2003 to 2014 were identified in the National Inpatient Sample database. The inpatient prevalence, clinical characteristics, treatments, outcomes, resource utilization, were investigated. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality.

RESULTS

The overall inpatient prevalence of methanol intoxication among hospitalized patients was 6.4 cases per 1,000,000 admissions in the United States. The mean age was 38±18 (range 0-86) years. 44% used methanol for suicidal attempts. 20% of admissions required mechanical ventilation, and 40% required renal replacement therapy. The three most common complications were metabolic acidosis (44%), hypokalemia (18%), and visual impairment or optic neuritis (8%). The three most common end-organ failures were renal failure (22%), respiratory failure (21%), and neurological failure (17%). 6.5% died in the hospital. Factors associated with increased in-hospital mortality included alcohol drinking, hypernatremia, renal failure, respiratory failure, circulatory failure, and neurological failure. The mean length of hospital stay was 4.0 days. The mean hospitalization cost per patient was $43,222 CONCLUSION: The inpatient prevalence of methanol intoxication in the United States was 6.4 cases per 1,000,000 admissions. The risk of in-hospital mortality mainly depended on the number of end-organ failures.

Potential methanol toxicity and the importance of using a standardised alcohol-based hand rub formulation in the era of COVID-19

OBJECTIVES

Hand sanitisers are urgently needed in the time of COVID-19, and as a result of shortages, some people have resorted to making their own formulations, including the repurposing of distilleries. We wish to highlight the importance of those producing hand sanitisers to avoid methylated spirits containing methanol and to follow WHO recommended formulations.

METHODS

We explore and discuss reports of methanol toxicity through ingestion and transdermal absorption. We discuss the WHO formulations and explain the rationale behind the chosen ingredients.

SHORT CONCLUSION

We advise those producing hand sanitisers to follow WHO recommended formulations, and advise those producing hand sanitisers using methylated spirits, to avoid formulations which contain methanol.

Overcoming the Regulatory Hurdles for the Production of Hand Sanitizer for Public Health Protection: The UK and US Academic Perspective

The COVID-19 pandemic has led to an acute shortage of hand sanitizer, which is crucial to keeping people safe and to preventing the spread of the SARS-CoV-2 virus. However, universities across the world have used their expertise to help to meet urgent demand from public bodies and the emergency services for supplies of safe and effective sanitizer. We explore here the experience of the University of Bristol, UK, in negotiating the regulatory demands and logistical challenges facing its own sanitizer production efforts. We also reflect on the different regulatory situation for US colleagues pursuing similar activities, and we share our advice for other universities wishing to follow a similar path.

Methanol, Paracetamol Toxicities and Acute Blindness

Methanol toxicity remains a common problem in developing countries including Saudi Arabia. However, it is much less available than other toxins; thus, clinical suspicion and correlation play pivotal roles in diagnosis. On the other hand, paracetamol is widely available and overdose/toxicity is highly suspected especially in young females. Diagnosis of methanol toxicity can be difficult in cases where history is not readily available and it requires a high degree of suspicion, especially when ingestion of another substance is revealed first as should not preclude the possibility of co-ingestion. We report a case of a medically free 26 year old woman who was brought to the Emergency Department (ED) of our hospital with a history of ingestion of a massive amount of paracetamol tablets and a concurrent abdominal pain with vomiting. After arrival, she became unresponsive with Glasgow Coma score (GCS) of 8/15 and was mechanically ventilated. Initial laboratory investigations identify the paracetamol level of 1200 ug/ml and a significantly high anion gap metabolic acidosis. Owing to the suspicious circumstances and the depth of acidosis, a co-ingestion of methanol and ethylene glycol was suspected. Upon further evaluation, osmolal gap was found to be significantly high as well. Since neither volatile compound screening nor Fomepizole were available in our hospital, an urgent N-acetylcysteine and sodium bicarbonate (NaHCO₃) were started alongside hemodialysis. Subsequent brain computed tomography (CT) and magnetic reasoning imaging (MRI) revealed changes in putamen and basal ganglia most consistent with methanol toxicity. She was successively extubated on day four of hospitalization with residual visual deficits that had resolved eventually after several follow-ups.