Antiseptic Solution Research Articles

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation.

Background:Breast pocket irrigation with antiseptic solutions is performed to reduce contamination with breast implants. The optimal antiseptic irrigation solution and the efficacy of individual practices are unclear. Oxychlorosene sodium is frequently used at our institution. Oxychlorosene is bactericidal with a mechanism of action of oxidation and hypochlorination. The purpose of our study was to compare the outcomes of oxychlorosene sodium irrigation with triple antibiotic solution (TAS) in implant-based breast reconstruction.Methods:All patients who underwent implant-based reconstruction after mastectomy were reviewed. The primary predictive variable was type of solution used for pocket irrigation (TAS or oxychlorosene). Outcome variables included surgical site infection, device removal, and wound complications.Results:Between 2013 and 2018, 331 implant-based breast reconstructions were performed. Of these, 62% (n = 206) received oxychlorosene for surgical pocket irrigation (group I), and 38% (n = 125) received TAS (group II). Group I had an 11.7% (n = 24) 90-day surgical site infection rate, with 4.9% (n = 10) requiring oral antibiotics, 2.4% (n = 5) requiring intravenous antibiotics without device removal, and 4.4% (n = 9) requiring prosthetic removal. Group II had an 11.2% (n = 14) 90-day infection rate, with 5.6% (n = 7) requiring oral antibiotics, 2.4% (n = 3) requiring intravenous antibiotics without device removal, and 3.2% (n = 4) requiring removal (P = 0.90). When comparing the cost of oxychlorosene irrigation with TAS irrigation, oxychlorosene was less expensive.Conclusions:Oxychlorosene and TAS have similar surgical site infection rates in prosthetic breast reconstruction. Ease of preparation and cost make oxychlorosene a more favorable option for antibiotic irrigation in reconstructive breast surgery with prosthetic devices.

Lumpy skin disease - A potential downfall of national economy.

Madam, the Lumpy Skin Disease, initially endemic in Africa and widely spreading to encompass the Middle East and other regions, finally has Pakistan in its grasp. It has emerged in Sindh and South Punjab, wreaking havoc in Sindh and infecting more than 20,250 animals, with more than 50 deaths being reported [1]. Internationally, the Southern, Eastern, and Southeastern countries faced economic losses as high as USD 1.45 billion due to this disease [2]. Its long-lasting and deplorable impact on the economy has been considered a prominent infection of livestock by The World Organization for Animal Health (OIE). Despite low associated mortality of 10%, it has a consequential worldwide morbidity rate of about 5-45% [3]. Transmitted by an arthropod vector, LSD is a vector-borne viral disease, which largely targets cattle including water buffaloes. The virus is shed in body secretions involving the infected animal's tears, saliva, semen, and milk [4]. The disease is characterized by a high grade, persistent fever, multiple skin nodules, lymphadenitis, a decline in milk yield, orchitis, and abortion. The economic implications encountered by farmers in the afflicted areas include low milk yield, poor skin and hide quality, and consistent degenerative thinness of animals. Although the entire cattle industry suffers from economic losses, small-scale farmers endure the greatest loss. Despite the low animal-to-human transmission, probability, the high economic losses incurred require drastic steps to prevent the further spread of the disease among cattle. Mass awareness programs among farmers should be promptly implemented, and vaccination drives should be promptly scheduled. Insect repellents and vector traps should be made available on a large scale. Steps must be taken to properly set isolation areas following the standard health protocols for infected livestock. Complications caused by the disease can be effectively treated by the usage of antimicrobials, anti-inflammatory medications, supportive therapy, and antiseptic solutions. Severely infected animals should be culled in a remote area following international standards. Highly effective clinical surveillance is required for timely detection and isolation of a suspected case [5]. Although there is no documented proof of transmission to humans, consumers should preferably avoid dairy products and meat before complete eradication of the disease. We humbly request the concerned health department take timely measures before an unprecedented loss is incurred and promote the national production of vaccination that is easily obtainable by farmers of all economic backgrounds.

Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis

Surgical site infection (SSI) is the most common postoperative complication and substantially increases health-care costs. Published meta-analyses and international guidelines differ with regard to which preoperative skin antiseptic solution and concentration has the highest efficacy. We aimed to compare the efficacy of different skin preparation solutions and concentrations for the prevention of SSIs, and to provide an overview of current guidelines. This systematic review and network meta-analysis compared different preoperative skin antiseptics in the prevention of SSIs in adult patients undergoing surgery of any wound classification. We searched for randomised controlled trials (RCTs) in MEDLINE, Embase, and Cochrane CENTRAL, published up to Nov 23, 2021, that directly compared two or more antiseptic agents (ie, chlorhexidine, iodine, or olanexidine) or concentrations in aqueous and alcohol-based solutions. We excluded paediatric, animal, and non-randomised studies, and studies not providing standard preoperative intravenous antibiotic prophylaxis. Studies with no SSIs in both groups were excluded from the quantitative analysis. Two reviewers screened and reviewed eligible full texts and extracted data. The primary outcome was the occurrence of SSI (ie, superficial, deep, and organ space). We conducted a frequentist random effects network meta-analysis to estimate the network effects of the skin preparation solutions on the prevention of SSIs. A risk-of-bias and Grading of Recommendations, Assessment, Development, and Evaluation assessment were done to determine the certainty of the evidence. This study is registered with PROSPERO, CRD42021293554. Overall, 2326 articles were identified, 33 studies were eligible for the systematic review, and 27 studies with 17 735 patients reporting 2144 SSIs (overall incidence of 12·1%) were included in the quantitative analysis. Only 2·0-2·5% chlorhexidine in alcohol (relative risk 0·75, 95% CI 0·61-0·92) and 1·5% olanexidine (0·49, 0·26-0·92) significantly reduced the rate of SSIs compared with aqueous iodine. For clean surgery, we found no difference in efficacy between different concentrations of chlorhexidine in alcohol. Seven RCTs were at high risk of bias, 24 had some concerns, and two had low risk of bias. Heterogeneity across the studies was moderate (I2=27·5%), and netsplitting did not show inconsistencies between direct and indirect comparisons. Five of ten studies that mentioned adverse events related to the skin preparation solutions reported no adverse events, and five reported a total of 56 mild events (mainly erythema, pruritus, dermatitis, skin irritation, or mild allergic symptoms); none reported a substantial difference in adverse events between groups. For adult patients undergoing a surgical procedure of any wound classification, skin preparation using either 2·0-2·5% chlorhexidine in alcohol or 1·5% olanexidine is most effective in the prevention of SSIs. For clean surgery, no specific concentration of chlorhexidine in alcohol can be recommended. The efficacy of olanexidine was established by a single randomised trial and further investigation is needed. Dutch Association for Quality Funds Medical Specialists.

A Case of Unilateral Corneal Edema after Exposure to 0.12% Cholorohexidine

Purpose: We report a case of permanent corneal opacity caused by unilateral chemical burns after exposure to a low-dose (0.12%) chlorhexidine antiseptic solution during a dental procedure.Case summary: A 33-year-old woman presented to our clinic with conjunctival injection, ocular irritation, and blurred vision in her right eye; all symptoms had been present for 2 weeks. These symptoms began several hours after a dental procedure, in which 0.12% chlorhexidine antiseptic solution had been splashed into the right eye. Initial examination revealed that the patient’s best-corrected visual acuity (BCVA) was 20/200 in the right eye. Slit lamp examination and anterior segment optical coherence tomography revealed substantial corneal edema and stromal infiltration on the nasal side. The patient’s BCVA improved to 20/20 in the right eye after 3 months of treatment with topical corticosteroid. However, the stromal opacity was permanent and the corneal endothelial cell count was substantially reduced to approximately 550 cells/mm2.Conclusions: Low-dose (0.12%) chlorhexidine on the ocular surface may cause irreversible corneal opacity and chemical burn-induced endothelial cell damage.

Folliculitis decalvans: clinical and morphological characteristics (literature review)

Folliculitis decalvans is a rare disease of primary cicatricial alopecias, about 11% of all alopecias of this group. Dermatosis was first described by the French dermatologist Charles-Eugne Quinquaud in 1888 and 1889. In recent decades, the number of publications devoted to the etiopathogenesis, clinical and histological characteristics, as well as approaches to the treatment of folliculitis decalvans has increased.
 The article presents the results of data analysis on the databases Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI.
 The etiopathogenesis of the disease is still unknown. The role of seborrhea and skin colonization by Staphylococcus aureus, as well as impaired local immune response and the presence of a genetic predisposition, have previously been discussed. Folliculitis decalvans is now thought to be a result of persistent disruption of the skin barrier that predisposes to subepidermal invasion by opportunistic microorganisms, including Staphylococcus aureus. Clinical, dermatoscopic (trichoscopic) and histological characteristics of dermatosis are being specified. Its characteristic clinical features are a persistent progressive course, the formation of alopecia foci with a rich red edge, pustules and crusts along the periphery of the alopecia foci, polytrichia and the formation of a dense scar that rises above the surrounding skin. Dermatoscopic characteristics depend on the intensity of the inflammatory process. Specific trichoscopic signs of the disease include follicular pustules, yellow tubular desquamation, yellow crusts, perifollicular erythema, perifollicular hemorrhages, and fine tortuous vessels. Depending on the number of these signs, the degree of inflammation is determined. Histological features of the disease include a massive perifollicular infiltrate, the formation of gaps between the epithelium of the follicles and the surrounding stroma, and in the final stages of the process ― fibrous tracts, diffuse fibrosis in the dermis.
 The treatment of folliculitis decalvans are antibacterial drugs, it is also possible to treat with courses of topical corticosteroids, antiseptic solutions.
 We assume that the systematization of information about the etiopathogenesis and approaches to the diagnosis and treatment of folliculitis decalvans will improve the diagnosis among other primary cicatricial alopecia and the choice of the tactics of treating folliculitis decalvans.

О ВОЗМОЖНОСТИ ПРИМЕНЕНИЯ САМОКЛЕЯЩИХСЯ ХИРУРГИЧЕСКИХ ПЛЕНОК

Abstract. Introduction. Infection of the surgical field is a common cause of purulent-septic complications. Various studies show that the majority of cases of infection of the surgical field occurs by patients' own microflora directly during surgical manipulations, as well as in the early postoperative period. Aim. The aim of the study is to study the types and possibilities of using self-adhesive surgical films. Material and methods. In the course of this study, the analysis of literature sources containing information on the use of self-adhesive surgical films was carried out. Results and discussion. A modern alternative to the treatment of the surgical field with antiseptic solutions is the use of surgical films. Self-adhesive surgical films prevent the spread of microorganisms from the skin surrounding the surgical field directly into the wound. They may be impregnated with an antiseptic or not have it in their composition. The films provide effective isolation of the surgical field, for this reason, the possibility of exogenous infection is excluded. The use of films implies the rejection of surgical underwear, which, with the standard preparation of the surgical field, is applied to the area of the intended incision. Conclusion. Currently, there is no unambiguous data on the effectiveness of the use of self-adhesive surgical films. A number of researchers note not only a significant decrease in the infection of the surgical intervention area when using surgical films, but also a reduction in the cost of medical care for patients, other works, on the contrary, either do not note noticeable differences between the use of films and surgical interventions without these antiseptic drugs or show an increase in the contamination of the surgical field when using surgical films.

Vaginal preparation with different antiseptic solutions before cesarean section for preventing postoperative infections: A systematic review and network meta-analysis.

We aimed to investigate the effect of various vaginal wash solutions on reducing risks of post-cesarean endometritis, wound infections, fever, and hospital stay duration. Scopus, Web of Science, PubMed, and Cochrane Library were searched for randomized clinical trials that compared different vaginal wash solutions to each other or to "no vaginal cleaning"; without restriction on the age of parturients or site where trials were conducted. We analyzed this frequentist network meta-analysis using the netmeta package in R software version 4.1.2; synthesized data as mean difference or risk ratio with their 95% confidence intervals. Our network meta-analysis included 29 RCTs with a total sample size of 9311 women undergoing CS. Regarding post-cesarean endometritis, we found that povidone-iodine had the highest significant risk reduction compared to "no vaginal cleaning" (RR=0.08, 95% CI [0.01, 0.69]). While regarding post-cesarean reduction of wound infection, fever, and hospital stay duration, we found that chlorhexidine 4% (RR=0.17, 95% CI [0.05, 0.65]), saline 0.9% (RR=0.12, 95% CI [0.03; 0.48]), and saline 0.9% (MD=-1.29, 95% CI [-2.18; -0.39]), respectively, had the highest significant risk reduction compared to "no vaginal cleaning." Vaginal wash solutions were associated with a significant reduction of post-cesarean endometritis, wound infection, fever, and hospital stay duration. Since povidone-iodine had the highest significant reduction of post-cesarean endometritis, we recommend setting povidone-iodine as the standard practice as pre cesarean vaginal wash solution; consistent practice guidelines of Enhanced Recovery After Surgery (ERAS).

Systematic literature review on surgical site preparation in paediatric surgery

BackgroundSurgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age.MethodsA systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections.ResultsIn total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted.ConclusionRobust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children.Trial registrationProspero registration (CRD42020166193).

Myelin toxicity of chlorhexidine in zebrafish larvae.

Chlorhexidine gluconate (CHG) is a topical antiseptic solution recommended for skin preparation before central venous catheter placement and maintenance in adults and children. Although CHG is not recommended for use in children aged <2 months owing to limited safety data, it is commonly used in neonatal intensive care units worldwide. We used zebrafish model to verify the effects of early-life exposure to CHG on the developing nervous system, highlighting its impact on oligodendrocyte development and myelination. Zebrafish embryos were exposed to different concentrations of CHG from 4 h post fertilization to examine developmental toxicity. The hatching rate, mortality, and malformation of the embryos/larvae were monitored. Oligodendrocyte lineage in transgenic zebrafish embryos was used to investigate defects in oligodendrocytes and myelin. Myelin structure, locomotor behavior, and expression levels of genes involved in myelination were investigated. Exposure to CHG significantly induced oligodendrocyte defects in the central nervous system, delayed myelination, and locomotor alterations. Ultra-microstructural changes with splitting and fluid-accumulated vacuoles between the myelin sheaths were found. Embryonic exposure to CHG decreased myelination, in association with downregulated mbpa, plp1b, and scrt2 gene expression. Our results suggest that CHG has a potential for myelin toxicity in the developing brain. To date, the neurodevelopmental toxicity of chlorhexidine gluconate (CHG) exposure on the developing brains of infants remains unknown. We demonstrated that CHG exposure to zebrafish larvae resulted in significant defects in oligodendrocytes and myelin sheaths. These CHG-exposed zebrafish larvae exhibited structural changes and locomotor alterations. Given the increased CHG use in neonates, this study is the first to identify the risk of early-life CHG exposure on the developing nervous system.

The production of Necator americanus larvae for use in experimental human infection

BackgroundAlthough there is unprecedented interest in experimental human hookworm infection, details of hookworm manufacture and characterisation have been sparsely reported. In this report, we detail the production and characterisation of Necator americanus larvae for use in a recently published clinical trial.MethodsFaeces was obtained from an experimentally infected donor. Faecal hookworm DNA was determined by quantitative PCR. Paired samples were incubated in either sterile water or sterile water mixed with antimicrobials (amphotericin and gentamicin). Coproculture was performed by modified Harada-Mori method. The harvested larvae were then processed in either sterile water or antiseptic solution. Larval yield was then calculated (larvae per gram), larval viability was determined by thermally induced motility assay and microbial burden was determined at the day of harvest, at 48 h and at 7 days.ResultsTwenty-eight faecal cultures were performed over 16 months. The faecal hookworm DNA content was variable over this time. There was no association of larval yield with faecal hookworm DNA content. Pre-treatment of faeces with antimicrobials did not influence larval yield. Larval motility was 85.3% (95% CI 79.3–91.3%). Incubation of larvae in antiseptics did not reduce viability at 14 days with a marginal mean of 68.6% (95% CI 59.1–78.1%) washed in water vs. 63.3% (95% CI 53.8 – 72.9%) when incubated in betadine (p = 0.38). Larvae washed in sterile water did not meet microbial bioburden criteria. Incubation in antiseptic resulted in acceptable microbial bioburden at 48 h but not at 7 days. Although the addition of gentamicin did reduce the microbial bio-burden acceptable levels, it was found to significantly lower larval motility at 7 days compared to incubation in sterile water and motility at 7 days 37.8% (95% CI 4.7–70.9%) vs. 67.3% (95% CI 35.2–99.3%, p < 0.001), respectively.ConclusionsDespite standardised culture methodologies and the use of a single donor, larval yield varied considerably between batches and had no association with faecal hookworm DNA. Larval viability decreases over time and the age of larvae at time of use are likely to be important. Microbial bioburden maybe temporarily reduced by incubation in antiseptics and has little effect on viability. Incubation of larvae in gentamicin is effective at reducing microbial bioburden but is deleterious to larval viability.Graphical

Stability analysis of tranexamic acid in the presence of various antiseptic solutions.

Tranexamic acid (TXA) effectively reduces blood loss and transfusion risk during total joint arthroplasty. Additionally, intraoperative irrigation with various antiseptic solutions is often utilized for the management and prevention of surgical site infection. However, interactions between various antiseptic solutions and TXA have not been investigated. The purpose of this in vitro study is to evaluate the stability of TXA in the presence of common orthopedic antiseptic solutions. Five antiseptic solutions-0.1% chlorhexidine (CHX) gluconate, 10% povidone-iodine (BTD), 0.5% sodium hypochlorite (Dakin's), 3% hydrogen peroxide (H2 O2 ), and 1.5% H2 O2 -and a 0.9% normal saline(NS) control were obtained. A stock 100 mg/ml TXA solution was diluted in each antiseptic solution to a concentration of 10.0 mg/ml to generate reference standard and stability samples. TXA stability in each solution was measured using high performance liquid chromatography at t = 0 and t = 120 min and reported as mean percent of theoretical concentration (MPT) with associated relative standard deviation (RSD). All experiments were performed in triplicate at room temperature. At t = 0 min, TXA remained stable when mixed with 0.9% NS, 0.1% CHX, 10% BTD, 3% H2 O2 , and 1.5% H2 O2 (MPT range: 102.0%-105.0%, RSD range: 0.80%-2.92%). Only 0.5% Dakin's led to significant degradation of TXA at t = 0 min (MPT: 14.3%, RSD:1.28%). At t = 120 min, TXA stability persisted for all compounds except Dakin's 0.5% (MPT: 18.4%, RSD: 28.7%). TXA efficacy may be significantly diminished when 0.5% Dakin's is used as an intraoperative irrigation solution. CHX, BTD, and H2 O2 do not degrade TXA.

A novel activated-zinc antiseptic solution effective against MRSA and Pseudomonas aeruginosa: a pig model.

The purpose of this study was to investigate the antimicrobial efficacy of a novel activated zinc solution against meticillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa after one hour, and to evaluate any untoward effect of the solution on local wound tissue at 24 hours after solution exposure in a pig wound model. A pathogen-free, commercially raised, Yorkshire-cross female pig was acquired 12 days prior to the procedure. Within one week prior to the procedure, a small loopful of test bacteria, Pseudomonas aeruginosa (pig-isolate) and MRSA (ATCC-6538), were streaked and cultured on a non-selective agar. Full-thickness wounds (n=24) were created and evenly divided into three groups: control wounds (exposed to bacteria but untreated, n=8); wounds treated with Compound 1 (n=8), and wounds treated with Compound 2 (n=8). All wounds were dressed and monitored for one hour and 24 hours. After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable total bacteria of 2.8 log colony forming units (CFUs) and 3.5 logCFUs, respectively. After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable MRSA of 2.3 logCFUs and 1.6 logCFUs, respectively (p=0.009). After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable Pseudomonas aeruginosa of 0.3 logCFUs and 0.0 logCFUs, respectively (p=0.000). After 24 hours of exposure to Compound 1 and Compound 2, there was no statistically significant increased necrosis (p=0.12, p=0.31, respectively) or neutrophilic infiltrate (Compound 2, p=0.12) when compared with control wounds. The novel activated-zinc compound used in this study demonstrated a 99.5-99.9% reduction in total bacteria, a 99.9-99.98% reduction in MRSA, and 100% eradication of Pseudomonas aeruginosa one hour after exposure. This novel solution may provide another significant tool to treat and/or prevent wound infections.

Nickel oxide Nanoparticles/Carbon Nanotubes Nanocomposite for Non‐enzymatic Determination of Hydrogen Peroxide

AbstractIn this work, nickel oxide nanoparticles‐modified multi‐walled carbon nanotubes (CNTs) were prepared and used for H2O2 sensing application. Firstly, ex situ NiO nanoparticles (NPs) were prepared and further used to decorate polyethylenimine (PEI)‐modified carboxylated CNTs. The obtained nanocomposite and its precursors were identified by using X‐ray diffraction, thermal analysis, Raman spectroscopy and SEM and TEM images, N2 adsorption‐desorption isotherms, and electrochemical techniques. The sensing properties of the NiO‐modified nanocomposite toward H2O2 were studied by electrochemical techniques using glassy carbon electrodes (GCEs) as support material. After optimizing the sensor construction, the sensor sensitivity was about of 0.83±0.01 A M−1 cm−2 with a LOD of about 1.0 μM. In addition, it showed excellent anti‐interference properties, reproducibility, and stability (over 4 months). Finally, such sensors were coupled to a flow injection device and the H2O2 concentration of some commercial antiseptic solutions were successfully obtained (with recovery ratios between 96.3–102.4 %).

A Safe and Aseptic Method of Benzalkonium Chloride Dilution for Preoperative Facial Skin and Mucosa Preparation

Background: Benzalkonium chloride (BAC) is widely used as an effective antiseptic and disinfectant not only in plastic surgery, but also in everyday life. BAC has an advantage over other antiseptics used for preoperative skin preparation, such as povidone-iodine and chlorhexidine because it causes less irritation of the skin and mucosa and is less toxic. Nonetheless, when BAC is used at higher than desired concentrations, there is a possibility of adverse effects.Methods: Prior to May 2020, 10 mL of 10% BAC was mixed with 1,000 mL of distilled water and diluted to 0.1% on a weekly basis. Afterwards, the method of diluting BAC was modified; for each patient, 1.3 mL of 10% BAC and 100 mL of normal saline were mixed immediately before facial surgery.Results: From March 2007 to May 2020, 0.1% BAC was used for preoperative skin and mucosa preparation. Erroneous dilution of BAC has caused four cases of chemical burns. All the cases were attributed to human error that resulted in higher than desired concentrations of BAC in the antiseptic solution. All the affected patients suffered from first-degree and superficial second-degree chemical burns; however, they were healed uneventfully through proper wound management. Since the application of the dilution method changed since May 2020, no complications have been reported.Conclusion: We have devised a safe and aseptic method for diluting BAC. The new dilution method, which yields a constant concentration of BAC, can be used for preoperative skin and mucosa preparation without accidents.

A Helpful Assistant for Disinfection in Hand Surgery Procedures: The LocArm Holder.

Although there is no consensus regarding the best skin disinfection technique, whatever antiseptic solution is used, the "prep and drape" portion of most upper extremity procedures requires the presence of at least one operative room assistant or scrub nurse to elevate and hold the hand and forearm. Nonetheless, especially in a busy hand surgery practice and during fast procedures, an operative room assistant or scrub nurse are frequently not available leading to a reduced time efficiency between procedures. This article describes an innovative easy-to-use and hands-free device that helps the surgeon during disinfection of the skin and the setup of the surgical field by keeping elevated the upper limb with respect for tissues. The development of the surgical arm holder starts from three easily available and washable thermoplastic splint sheets 40 × 60cm with 2.5cm thickness. The final device measures 40 × 25 × 15cm and is placed underneath the proximal third of the humerus in order to keep the upper limb suspended at about 10-15cm from the operating table. A retrospective analysis of the "surgical malpractice claims" and institutional non-conformities registered in the period 2011-2020 was conducted in our Hospital looking for bone or soft tissue complications related to the use of the device. Three thousand one hundred eighty-seven surgical procedures were performed between 2011 and 2020 using this device. The retrospective analysis of all "surgical malpractice claims" showed no skin lesions, no neurological complications (such as neuroapraxia), no need for secondary bone procedures or interference with the draping process. Our device proved to be a low-cost, easy to use and alternative solution helping surgeons during the disinfection phase, improving hospital pre-operative flow and reducing the need for other staff members to be engaged in holding the upper limb in the operating room.

Allergic shiners in a patient with cough-variant asthma: a case report

BackgroundChronic cough, with a duration of coughing of more than 8 weeks in adults, affects 5–10% of the general population. One of the most common causes of chronic cough is cough-variant asthma, which accounts for approximately one-third of cases. This phenotype of asthma is characterized by extreme sensitivity of the neuronal pathways mediating cough to environmental irritants, which results in an urge to cough. This case is an example of cough-variant asthma presenting with allergic shiners due to her severe cough.Case presentationA 38-year-old Iranian woman, who was well before the start of the coronavirus disease 2019 pandemic, presented with a nonproductive hacking cough that had begun after excessive use of antiseptic solutions. The only positive finding on physical examination was a reddish-purple rash on and around the eyelids mimicking a heliotrope rash, which had probably evolved due to the severity of the cough. The results of the pulmonary function test were within normal limits. Methacholine challenge test and chest x-ray were both normal. Chest high-resolution computed tomography revealed hyperinflation and tree-in-bud opacities. All other laboratory tests were normal. Because of the reversibility in her pulmonary function test, despite normal baseline parameters, asthma treatment was initiated, resulting in disappearance of the cough and the eye discoloration, being indicative of the correct diagnosis and proper treatment.ConclusionPatients with cough-variant asthma may often have no other classic symptoms of asthma other than cough.

Erratum: Myocardial Infarction by Percutaneous Embolization Coil Deployment in a Swine Model.

An erratum was issued for:Myocardial Infarction by Percutaneous Embolization Coil Deployment in a Swine Model. The Protocol and Discussion sections were updated. Step 3.5 was updated from: Clean the right femoral area with surgical soap and antiseptic povidone-iodine solution under sterile conditions to: Clean the right femoral area with surgical soap followed by alternating antiseptic povidone-iodine solution and alcohol 3 times under sterile conditions. Section 9 was updated from: 9. Euthanasia method Under previous sedation and anesthesia, as previously described, administer an IV sodium thiopental overdose (200 mg/kg). Confirm cardiorespiratory arrest and death by monitoring vital signs (electrocardiogram, blood pressure, capnography). to: 9. Postoperative pain assessment and monitoring During the post-surgical follow-up, monitor the general condition of the animals, including the respiratory rate, food and water intake, activity and interaction with the other individuals, appearance and coloration of the skin, and the evolution of the surgical wound. Apply a daily supervision protocol according to the following scoring criteria: - Weight: 0: Normal 1: <10% weight loss 2: 10-20% weight loss 3:> 20% weight loss - Body condition: 0: Good: non-prominent vertebrae, pelvic or spinal bones 2: Regular: evidence of spinal segmentation, palpable pelvic bones 3: Emaciation: extremely marked skeleton, little or no meat to cover - Behavior: 0: Normal: Active and interactive in your environment 1: Slight decline in activity and less interactive 2: Abnormal: pronounced decline in activity, isolated 3: Abnormal: Immobile or hyperactivity, possible self-harm - Physical appearance: 0: Normal: skin/hair shiny and eyes bright 1: Disappears embalming, skin/hair without shine 2: Poor skin/nasal secretions 3: Poor skin, abnormal or hunched posture - Behavioral disorders: 0: None 1: Inability to move normally 2: Unable to reach food/drink, isolated from other animals 3: Intention to hide/corner, does not respond to stimuli (dying) - Clinical signs: 0: None 1: Hypothermia, fever, mild respiratory failure 2: Infection of the surgical wound, moderate respiratory failure with muco-bloody secretions 3: Heart failure, severe respiratory failure (cyanosis, open mouth) Score: - 1-5: Supervise the animals once a day. - 6-12: Provide supportive therapy if necessary. - Any animal with a score of 3 in any of the above parameters or with a total score >12 will be euthanized. NOTE: The animals should be monitored daily by the animal care staff and twice a week by the research and veterinary team. Although no pain and distress are expected from the procedure, if any animal shows signs of pain, give analgesic therapy (tramadol, oral, 2-4 mg/kg, daily). If any animal does not respond to analgesic medication and shows signs of chronic pain (very low probability), euthanize the animal with an anesthetic overdose (sodium thiopental, IV, 200 mg/kg). If the surgical wound shows signs of infection (low probability) despite the antibiotic therapy administered, treat the wound daily and initiate a new antibiotic regimen (cefquinome sulphate, IM, 2 mg/kg, daily). 10. Euthanasia method Under previous sedation and anesthesia, as previously described, administer an IV sodium thiopental overdose (200 mg/kg). Confirm cardiorespiratory arrest and death by monitoring vital signs (electrocardiogram, blood pressure, capnography).

The effects of rotating magnetic field and antiseptic on in vitro pathogenic biofilm and its milieu

The application of various magnetic fields for boosting the efficacy of different antimicrobial molecules or in the character of a self-reliant antimicrobial agent is considered a promising approach to eradicating bacterial biofilm-related infections. The purpose of this study was to analyze the phenomenon of increased activity of octenidine dihydrochloride-based antiseptic (OCT) against Staphylococcus aureus and Pseudomonas aeruginosa biofilms in the presence of the rotating magnetic field (RMF) of two frequencies, 5 and 50 Hz, in the in vitro model consisting of stacked agar discs, placed in increasing distance from the source of the antiseptic solution. The biofilm-forming cells' viability and morphology as well as biofilm matrix structure and composition were analyzed. Also, octenidine dihydrochloride permeability through biofilm and porous agar obstacles was determined for the RMF-exposed versus unexposed settings. The exposure to RMF or OCT apart did not lead to biofilm destruction, contrary to the setting in which these two agents were used together. The performed analyses revealed the effect of RMF not only on biofilms (weakening of cell wall/membranes, disturbed morphology of cells, altered biofilm matrix porosity, and composition) but also on its milieu (altered penetrability of octenidine dihydrochloride through biofilm/agar obstacles). Our results suggest that the combination of RMF and OCT can be particularly promising in eradicating biofilms located in such areas as wound pockets, where physical obstacles limit antiseptic activity.

Cross sectional study on the analysis of periodontal parameters in adult patients with clear aligners orthodontics treatment versus three other types of brackets

Objective: To analyse the gingival parameters in the orthodontic treatment using clear aligners versus the three other types of brackets, i.e., conventional metal, conventional ceramic, and metal self‑ligating. Materials and methods: The current study comprised 80 individuals who came in for regular appointments and were receiving orthodontic treatment. They were then separated into four groups, each with 20 patients: Group 1 received traditional brackets (CB); Group 2 received traditional ceramic brackets (CCB); Group 3 received self-ligating (SL) brackets; and Group 4 received clear aligner (CA) treatment. The inclusion criteria were any patient under the age of 18 with a Class II or Class III skeletal link who was receiving orthodontic treatment for at least 6 months with fixed orthodontic appliances (FOA) on their teeth. Smokers, pregnant women, diabetics, and those using medications that impact gingival health or who have cardiovascular illnesses were all excluded from the study. Patients who had used antiseptic solutions or mouthwash in the previous six months, had any periodontal procedures in the previous six months, or had fixed bridges and crowns or extensive restorations adjacent to the gingival borders were also excluded.

First Report on the Phenotypic and Genotypic Susceptibility Profiles to Silver Nitrate in Bacterial Strains Isolated from Infected Leg Ulcers in Romanian Patients

Silver-ion-based antiseptics are widely used in treating chronic leg ulcers and, given the emergence of resistance to such compounds, the investigation of silver susceptibility and resistance profiles of pathogenic strains isolated from this type of wound is a topic of great interest. Therefore, in this study, 125 bacterial strains isolated from 103 patients with venous ulcers were investigated to elucidate their susceptibility to silver-nitrate solutions in planktonic and biofilm growth states, and the associated genetic determinants. The isolated strains, both in the planktonic and biofilm growth phases, showed high sensitivity to the standard concentration of 1/6000 silver-nitrate solution. It was noticed that even at concentrations lower than the clinical one (the first 2–3 binary dilutions in the case of planktonic cultures and the first 6–7 binary dilutions in the case of biofilms), the antiseptic solution proved to maintain its antibacterial activity. The phenotypic results were correlated with the genetic analysis, highlighting the presence of silver-resistance genes (sil operon) in only a few of the tested Staphylococcus sp. (especially in S. aureus) strains, Escherichia coli and Pseudomonas aeruginosa strains. These results demonstrate that despite its large use, this antiseptic remains a viable treatment alternative for the management of chronic leg wounds.