Analysis and Quantification of Alkyl (C12-22) Trimethyl Ammonium Chloride Content in Cosmetics: Regulatory Compliance Gap Analysis

Background: Exceeding the recommended Alkyl (C12-22) trimethyl ammonium bromide and chloride levels in cosmetics and personal care products is a serious health threat. Objectives: To quantify and investigate Cetrimonium chloride and Behentrimonium chloride in cosmetics and personal care products in the UAE market to gauge whether or not they adhered to requirements for safety and health. Methods: A total of 164 cosmetics products were collected and analyzed in this study. The gas chromatography–mass spectrometry (GC–MS) method was developed and validated for the determination of Cetrimonium chloride and Behentrimonium chloride surfactants in cosmetics products. With each product, Cetrimonium chloride and Behentrimonium chloride (%) were calculated. To test cross-group differences in Cetrimonium chloride and Behentrimonium chloride (%), Kruskal–Wallis test was applied. Results: Of the 125 tested cosmetics and personal care products, five (4%) exceeded the recommended Cetrimonium chloride level in rinse-off hair products (2.5%), 10 (8%) exceeded the recommended Cetrimonium chloride level in leave-on hair products (1%), and 24 (61.5%) exceeded the recommended Cetrimonium chloride level used as a preservative in cosmetics products. Moreover, of the 125 tested cosmetics and personal care products, 21 (53.8%) exceeded the recommended Behentrimonium chloride level used as preservatives in cosmetics products. Conclusions: Although several structures for cosmetics quality and control across the globe are fairly comprehensive and intricate, there is a need to make them more rigorous to apply compliance with GMP and ensure regulatory control. Doing so would help enhance the inspection and regulation of cosmetics containing Behentrimonium chloride/Cetrimonium chloride preservatives. Furthermore, there is a dire need to establish a unified cosmetovigilance worldwide.

Nitrate contamination level in groundwater of the randublatung basin and its surroundings

The community of Randublatung basin and its surroundings (Grobogan, Blora, and Bojonegoro Regencies) using groundwater for agricultural, farming, and daily needs. However, these activities can contaminate the groundwater through nitrate and chloride in fertilizers, pesticides, animal waste, and household waste. Therefore, it is crucial to know the amount of nitrate and chloride content in the groundwater of The Randublatung basin and its surroundings. This research aims to analyze nitrate and chloride content and the ratio between ions in the groundwater of The Randublatung basin and its surroundings to find contaminant resources. The method to analyze the nitrate and chloride content is using Ion Chromatography. The analysis result from 35 samples of groundwater shows that the average nitrate content in dug wells samples is 10.06 mg/L, while the average from pump wells is 6.31 mg/L. The average chloride in dug wells samples is 43.65 mg/L, and the average from pump wells is 54.57 mg/L. These nitrate and chloride level are still in safe category based on Health Ministry Indonesia and WHO. The nitrate: chloride ratio in dug wells is 1:5, 1:9 from pump wells. The ratios indicate that the nitrate’s resource is associated with the on-site sanitation and will increase if there is no mitigation action to the contaminant resource.

Low serum chloride level gives renin-angiotensin system inhibitor a prognostic impact in heart failure patients with preserved ejection fraction

Background Hypochloremia is associated with a poor prognosis of heart failure (HF) patients. This phenomenon is sustained even in HF with preserved ejection fraction (HFpEF). Serum chloride level is known to be affected by serum renin secretion; however, this relationship is one of the least investigated field in HF patients. Renin-angiotensin system (RAS) inhibitor is recommended as a first-line medication for HF patients with reduced left ventricular ejection fraction, but no prior studies of RAS inhibitors have achieved to improve the prognosis of HFpEF patients. Purpose We investigated the relationship between baseline serum chloride level and the prognostic impact of RAS inhibitor in HFpEF patients. Methods This is an observational study including 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis and whose left ventricular ejection fraction were under 50%, 506 HFpEF patients were ultimately analyzed. They were categorized into tertiles by serum chloride levels at discharge (T1: −100 mEq/L, T2: 101–104 mEq/L, T3: 105- mEq/L), and patients in each category were further divided into subgroups depending on the prescription of RAS inhibitor at discharge (RAS inhibitor group and Non-RAS inhibitor group). The primary endpoint of this study was death from any cause. Results During the observation period with 479 days of median follow-up, 77 (15.2%) died. Patients in the RAS inhibitor group had significantly better prognosis than those in the Non-RAS inhibitor group in T1 category (Log-rank: p=0.003, Figure). In contrast, there was no statistical difference in the mortality between the RAS inhibitor group and Non-RAS inhibitor group in T2 and T3 categories (Log-rank: p=0.15, p=0.81, respectively, Figure). Multivariate Cox regression analysis in T1 category revealed that taking RAS inhibitor at discharge was independently associated with a lower mortality rate, even after the adjustment of diverse covariates (hazard ratio: 0.40, 95% confidence interval: 0.20–0.80). Conclusion In this observational study, the administration of RAS inhibitor was associated with an improved prognosis of HFpEF patients only in low serum chloride level at discharge. Therapeutic strategy focusing on the chloride level may be one of the promising options to find the light on a unintervenable prognosis of HFpEF. FUNDunding Acknowledgement Type of funding sources: None.

Hyperchloremia on Admission to Pediatric Intensive Care in Mechanically Ventilated Children is Associated with Impaired Renal Function

Objective There is recent interest in the association between hyperchloremic metabolic acidosis and adverse outcomes. In vitro, hyperchloremia causes renal vasoconstriction and fall in glomerular filtration rate (GFR). The objective of this retrospective, observational study is to examine associations between chloride level at admission to pediatric intensive care (PICU) and worst GFR and requirement for renal replacement therapy. Materials and Methods All admissions to PICU between 2009 and 2019 who received invasive mechanical ventilation and had blood gas analysis performed were included. Data analyzed included patient characteristics (age, gender, diagnosis, pediatric index of mortality [PIM]-2 score); results of initial blood gas; and maximum serum creatinine (then used to calculate minimum GFR). Primary outcome measure was worst GFR during PICU stay. Secondary outcome measures were requirement for renal replacement therapy and PICU mortality. Multivariable regression analysis was used to assess if admission chloride level was independently predictive of minimum GFR during PICU stay and to examine associations between hyperchloremia (>110 mEq/L) at admission and requirement for renal replacement therapy after adjustment for confounders. Results Data were available for 2,217 patients. Median age was 16.4 months and 39% of patients were hyperchloremic at admission to PICU. Admission chloride level was independently predictive of worst GFR during PICU stay after adjustment for known confounders. Patients with hyperchloremia were not more likely to require renal replacement therapy or die than patients with normochloremia. Conclusion Prospective studies are necessary to determine if high chloride, specifically chloride containing resuscitation fluids, have a causal relationship with poor outcomes.

A chloride efflux transporter OsBIRG1 regulates grain size and salt tolerance in rice

SummaryGrain size is determined by the number of cells and cell size of the grain. Regulation of grain size is crucial for improving crop yield. However, the genes and underlying molecular mechanisms controlling grain size remain elusive. Here we report a member of Detoxification efflux carrier (DTX)/Multidrug and Toxic Compound Extrusion (MATE) family transporter, BIG RICE GRAIN 1 (BIRG1), negatively regulates the grain size in rice. BIRG1 is highly expressed in reproductive organs and roots. In birg1 grain, the size of the outer parenchyma layer cells of spikelet hulls is noticeably larger but the cell number is not altered compared with that in the wild-type (WT) grain. When expressed in Xenopus oocytes, BIRG1 exhibits chloride efflux activity. In line with the role of BIRG1 in mediating chloride efflux, the birg1 mutant shows reduced tolerance to salt stress under which the chloride level is toxic. Moreover, the birg1 grains contain higher level of chloride compared to WT grains when grown under normal paddy field. The birg1 roots accumulate more chloride than those of WT under saline condition. Collectively, our findings suggest that BIRG1 functions as a chloride efflux transporter regulating grain size and salt tolerance via controlling chloride homeostasis in rice.

Penurunan Salinitas (Kadar Klorida) Artifisial Dengan Proses Pertukaran Ion (Ion Exchange)

Brackish water caused of high chloride sodium content, giving to feel briny at water. The only chemical process can remove chloride is the ion exchange. The aim of this study was to determine the difference of percentage decreasing of chloride levels in variations of chloride level in brackish water (870 mg/l, 1712 mg/l, 2501 mg/l) and variation of sampling time (1,5 hours, 3 hours, 4,5 hours). Brackish water used the result of dilution of brines using freshwater. This process brackish water by passing into a resin media tube’s diameter 5cm and 40cm high with flow discharge 100ml/min. The results of chloride levels after the process still exceeded the quality standard Permenkes RI No.492/MENKES/PER/IV/2010. The avarage chloride levels after from the chloride 870 mg/l is 776,7 mg/l, the chloride 1712 mg/l is 1520 mg/l and the chloride 2501 mg/l is 2139 mg/l. From Two-Way-Anova test showed a significant difference between the percentage of decreasing chloride levels in various sampling time, the variation of initial chloride level, and interaction between variation in initial chloride content and sampling time.

Association of Hyperchloremia and Acute Kidney Injury in Patients With Traumatic Brain Injury

Introduction: Hypertonic saline is often used to treat patients with traumatic brain injury. It carries the undesired side effect of hyperchloremia, which has been linked to acute kidney injury (AKI). We sought to evaluate the relationship of hyperchloremia and AKI in this population and whether the absolute exposure to hyperchloremia, including maximal hyperchloremia and duration of hyperchloremia were associated with AKI. Methods: A retrospective study of severe traumatic brain injury patients who received hypertonic saline at a single academic institution. Demographics, head abbreviated injury scale, development of hyperchloremia (Cl ≥ 115), duration of hyperchloremia, highest chloride level, duration of hypertonic saline use, admission GFR, and administration of nephrotoxic medications were abstracted. The outcome of interest was the association between renal function and hyperchloremia. Results: A total of 123 patients were included in the study. Multivariable logistic regression analysis demonstrated that only duration of hyperchloremia ( p = 0.014) and GFR on admission ( p = 0.004) were independently associated with development of AKI. The number of days of hypertonic saline infusion ( p = 0.79) without the persistence of hyperchloremia and highest serum chloride levels ( p = 0.23) were not predictive of AKI development. Discussion: In patients with traumatic brain injury, admission GFR and prolonged hyperchloremia rather than the highest chloride level or the duration of hypertonic saline infusion were associated with the development of AKI.

Differential diagnostic challenges during the Covid-19 pandemic for pediatricians in an Eastern European country where newborn screening of cystic fibrosis is not available: A case report

Newborn screening (NBS) of cystic fibrosis (CF) is not available currently in Hungary. Pediatricians should be able to recognize the illness based on the symptoms alone. Lack of NBS causes differential diagnostic challenges for physicians and delayed diagnosis of CF. We present a case of a two-year-old girl who was transferred to our hospital as a suspected Covid-19 patient with one week history of fever and coughing in March 2020. As Covid-19 was excluded, the severity of the clinical picture pointed towards an acute exacerbation of an underlying chronic condition. Her symptoms such as tachypnea, wheezing, lung crackles, hepatomegaly and clubbing of the fingers were all consistent with undiagnosed CF. In the end, sweat chloride level and genetic test verified the diagnosis. This case emphasizes the need of NBS in Hungary.

Abstract 16345: Increase in Serum Chloride Level During Hospitalization Leads to Improved Clinical Outcomes in Patients With Heart Failure

Introduction: Serum chloride levels both at admission and at discharge in patients with heart failure (HF) are independently associated with the incidence of adverse clinical outcomes. However, there has been few reports focusing on the prognostic impact of the change in serum chloride level during the hospitalization on the long-term prognosis after discharge. Hypothesis: We thus hypothesized that changes in serum chloride during the hospitalization is an independent prognostic predictor after discharge in HF patients. Methods: This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis, 1,762 patients were ultimately analyzed. The primary endpoint of this study was death from any cause. Result: Overall serum chloride level was significantly decreased from the admission to discharge (103 [100-106] mEq/L to 102 [99-105] mEq/L, P<0.001). During the observation period with 512 days of median follow-up, 286 patients (16.2%) died. Multivariate Cox regression analysis revealed that increase in serum chloride level during the index hospitalization was independently associated with lower rates of mortality, even after the adjustment of diverse covariates including serum chloride level at admission (hazard ratio (HR): 0.94, 95% confidence interval: 0.90-0.98). When dividing the study population into tertiles by chloride levels at admission, patients with the lower baseline chloride level had the greater reduction in HR of the primary endpoint by the increase of chloride level during the hospitalization (Figure). Conclusion: Increase in serum chloride level during hospitalization may be associated with better post-discharge prognosis in HF patients. This could be a new therapeutic target for heart failure to improve long-term prognosis.