Application Of Povidone-iodine Research Articles

Topical Application of Povidone Iodine to Minimize Post Appendectomy Wound Infection

Background: Despite the use of prophylactic antibiotic and sterilization techniques and nemours methodsof wound care, post appendectomy wound infection is still high.Methods: Arandomized controlstudy (RCS) has been implied to prove, whether uses of povidone iodinejust prior to wound suturing could decrease surgical wound infection rates after surgery for appendectomy.Atotal number of 120 patients operated for cute appendicitis with open appendectomy at AL-MawaniTeachingHospital during the period from march 2016 to October 2020.Results: After appendectomy patients was randomize into three groups, group A which include 40 patientsthe subcutaneous tissue was irrigated with 1% diluted povidone-iodine solution before skin closure.Group B which contained other 40 patients the wound has been washed with normal saline, and in groupC(controlgroup) no irrigation was done.All patients were followed for surgical site infection according toSouthampton wound grade system for ten days after surgery.In this study we notice that areductionhappenedin the number of wound infection in group Acompare with group B and C.Conclusion: The uses of povidone iodine 1% before skin closure is an effective method in reducing the rateof infection of the wound after surgery for acute appendicitis.

An effective method to reduce the risk of endophthalmitis after intravitreal injection (IVI): Application of 0.25% povidone-iodine

Background/Aim: The most important complication after intravitreal injection (IVI) is endophthalmitis, which can result in severe vision loss. This study aims to investigate the effect of 0.25% povidone-iodine (PI) application before IVI on the incidence of endophthalmitis in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. Methods: A total of 15345 intravitreal anti-VEGF injections and nine endophthalmitis cases after IVI performed at the outpatient injection room of a single university hospital between January 2017 and January 2020 were included in this retrospective cohort study. Before July 2018, after applying 10% PI around the eyes and 5% PI on the eyes, an eyelid speculum was inserted, and the injection was performed. After this date, in addition to these steps, after placing a speculum and determining the injection site with a caliper, 3-4 drops of 0.25% PI were applied just before injection. Topical antibiotics were not used before or after the injection. Results: Nine cases of endophthalmitis were detected in 3 years. The most common symptoms were vision loss (9/9) and pain in the eye (7/9). All cases had conjunctival hyperemia, cells-hypopyon in the anterior chamber, and cells in the vitreous. The time between injection and re-visiting the clinic due to endophthalmitis symptoms ranged between 2-6 days, and visual acuity varied between hand motion and 0.2. While the number of endophthalmitis cases before July 2018 was 8 (8/8330) in 1.5 years, after the addition of 0.25% PI application to the protocol, only 1 case of endophthalmitis (1/7015) was seen in the last 1.5 years. The rate of endophthalmitis had decreased significantly (P=0.037). Conclusion: Since July 2018, the addition of 0.25% PI to the standard IVI protocol just before injection has significantly reduced endophthalmitis rates. With this method, endophthalmitis rates may be decreased despite the increasing number of IVIs.

Antiseptic efficacy of topical diluted povidone iodine 2.5% and 1.25% on bacterial conjunctival load with intravitreal injection

Background: Intravitreal injections (IVIs) are considered one of the most important and minimally invasive procedures for treatment of many retinal diseases. Recently the instillation of povidone iodine to the surface of the eye is the only proven prophylactic measure that can lower the risk of endophthalmitis following intravitreal injection. Objective: The study aims to assess the antimicrobial efficacy of lower povidone iodine concentrations 2.5% and 1.25% in intravitreal injection. Methodology: This is a prospective interventional study that was conducted on 60 eyes of 45 patients with diabetic macular edema, retinal vein occlusion (RVO) and age related macular degeneration (AMD). Patients were divided into three groups, group one involved 20 eyes that received application of povidone iodine 5%, groups 2 and 3 received povidone iodine 2.5% and 1.25% respectively. Conjunctival swabs were taken before and after povidone iodine in the three groups, colony forming units (CFU) were calculated to detect the efficacy of povidone iodine in decreasing the bacterial load of the conjunctiva. The patient discomfort was recorded in a chart scale to evaluate pain. Results: The CFU was markedly decreased in the 3 groups with no detected statistical significance between all groups confirming the antiseptic efficacy of lower concentrations of povidone iodine. The lower concentration 1.25% showed more patient comfort and tolerability with lower score on pain chart scale. Conclusion: Lower concentrations of povidone iodine can achieve similar antiseptic effect compared to the standard 5% concentration with better tolerability.

Does povidone-iodine application in surgical procedures help in the prevention of surgical site infections? An updated meta-analysis.

IntroductionSurgical site infections (SSIs) occur after an operative procedure and can range from superficial to deep wound infections. The World Health Organization (WHO) and the Centers for Disease Control (CDC) have proposed guidelines recommending measures to prevent SSIs. Intraoperative measures are largely focused on decontamination of the skin and intraoperative wound irrigation using soap and antiseptics and are simple, efficient, and cost-effective measures to reduce SSIs. Povidone-iodine (PVI) is a topical antiseptic widely used for the reduction of SSIs.AimA meta-analysis was conducted to determine the efficacy of preoperative or intraoperative use of PVI from randomized controlled trials (RCTs).Material and methodsA systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved PVI application versus saline or no treatment control groups across various surgical categories. The primary outcome was SSI or post-operative wound infections. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed.ResultsA total of 59 RCTs were included in the meta-analysis with information from 20,497 patients. A reduction in overall SSI incidence was found (RR = 0.70, 0.60–0.80, p = 0.0002, I2 = 44%). Subgroup analyses showed that the comparator treatment and type of procedure did not modify the effect of PVI on SSI incidence. However, inconsistent results on SSI incidence were obtained when the data were stratified by PVI application method and surgery category.ConclusionsThe results of the meta-analysis provide support for the preoperative or intraoperative use of PVI in decreasing the incidence of SSI.

Reply to comment on: Effect of topical povidone–iodine 10% plus levofloxacin 0.5% one hour before cataract surgery in eliminating perioperative conjunctival flora: randomized clinical trial

We thank Kanclrez et al. for their thoughtful comments on our recently published article.1 Previous studies showed that the povidone-iodine (PVI) application could not render sterile conjunctiva in all cases.2 Indeed, the application of 5% PVI on the conjunctiva may need 15 minutes to offer its maximum effect, which is much longer than the time lapsed in a typical theater.3 Our findings further prove that the double application of PVI on the conjunctiva in a real operating theater enhances the possibility of conjunctival sterilization. The reason that we took T3 before routine preparation and drape was to minimize any risks imposed on the patients by intervening after the final drape. Although our method does not exactly match a real scenario, in our opinion, the results could still be applied to similar clinical settings. The routine conjunctival disinfection in our setting comprised periorbital disinfection with 10% PVI and 1 mL flush of 5% PVI, which remained for at least 3 minutes before washing out with a balanced salt solution. We admit the flaw in the method that has been chosen for applying levofloxacin, and we acknowledged this limitation in the Discussion section of the original article.2 However, it should be noted that some other studies have proved the efficacy of preoperative levofloxacin.4 And, the effectiveness of intracameral antibiotics does not free us from maximum preoperative disinfection, and each of them has a distinct role. Regarding the method of anesthesia, all the patients were collected from an educational hospital, in which many patients are routinely treated with light general anesthesia and laryngeal mask insertion. The reason behind this is that many of them are uncooperative for resident-performed surgery. Although many patients are also treated with topical anesthesia at the same center, we preferred to include only one type of anesthesia for more compatibility. Their ocular or systemic characteristics, however, should not differ from those operated on with topical anesthesia, and hence, any resultant bias is unlikely. Finally, we are aware that the current standard preoperative disinfection is quite effective for most cases; however, without a doubt, the ocular surface of some cases may not render sterile by about 3 minutes of the application of PVI. Thus, we suggested that it might be helpful to use adjuvant preoperative PVI drops for the patients at a greater risk of conjunctival bacterial contamination (such as those with a lid or ocular surface disorder), cases who could not effectively handle a subclinical infection (for example, systemic immunosuppression), or monocular patients, in whom the endophthalmitis could be catastrophic. Nonetheless, the value of additional PVI drops for each of the mentioned scenarios needs verification by appropriate studies.

Thyroid storm, clouds and silver linings

J Oral Med Oral Surg 2021;27:35 Letter to the Editor Thyroid storm, clouds and silver linings John Laszlo* London, UK * Correspondence: jonlaszlo@hotmail.com Received: 9 April 2021 Accepted: 13 April 2021 Dear Editor, In addition to the use of personal protective equipment (PPE), significant interest has developed recommending topical application of Povidone Iodine (PVP-I) for pre-exposure prophylaxis (PEP) against COVID-19 transmission. PVP-I is safe, demonstrating a 99.9% reduction in MERS and SARS activity, far greater than chlorhexidine or benzalkonium-chloride [1]. As oral and nasal fluids contain greater than 107 COVID-19 viruses per mL, PVP-I is a theoretically useful PEP adjunct with PPE. However, the evidence for using PVP-I as PEP, is neither clear nor clinical, extrapolations were made assuming Covid-19 will be just as susceptible to PVP-I in-vivo, as MERS and SARS were in-vitro [1]. Placing those concerns aside, 15% of the population with Thyroid disease are excluded from PVP-I use, but a similar proportion, who are as yet undiagnosed for thyroid disease remain at physiological risk from inadvertent exposure to iodine in PVP-I [2]. In healthy patients, iodine exposure initiates the Wolff-Chaikoff effect;transiently reducing thyroid hormone levels and this is a valuable response to control hypermetabolic morbidity and mortality from the thyroid storm [3]. However, for patients with unrecognised thyroid dysfunction, iodine exposure can either lead to chronic hypothyroidism with no adaptation to Wolff-Chaikoff down-regulation, or it can lead to the Jos-Basedow phenomenon and critical thyroid storm initiation from a loss of negative feedback [3]. Therefore the 15% of patients excluded from PVP-I use are not placed at risk but those patients undiagnosed as yet not recognised as having a thyroid dysfunction will be placed at risk if exposed to PVP-I. If the bidirectional relationship between thyroid disease and kidney function is considered with regard to renal drug excretion;the association of cardiovascular and psychiatric illness with underlying and undiagnosed thyroid disease is problematic. With such patients, the risk of adverse pharmacokinetic drug interactions demands even closer attention if we are to use PVP-I for any patient. Given the positive relationship of thyroid function with RAAS (renin-angiotensin-aldosterone-system), the potential to amplify ACE 2 expression with PVP-Iodine exposure could increase COVID-19 infection risk as more ACE 2 receptors become activated and the potential for viral cellular entry increases [4]. Thyroid disease exhibits a 10:1 female to male predisposition [2], whereas the morbidity and mortality from COVID-19, with equal infectivity is predominantly male. Using PVP-I as PEP may be intuitive, but paradoxically counter-productive;as a greater risk of infection arises in patients more at risk from the effects of COVID-19 by using PVP-I. With 37 isotopes and as many molecular formulations, iodine has many benefits, for example;Silver-Iodide can precipitate rainfall and disinfect surfaces, but there are environmental and medical risks too. To realise the full PEP potential of PVP-I against COVID-19, the theoretical concerns outlined above require further analysis. Thyroid patients are not at increased risk of morbidity and mortality from COVID-19 [5] and this silver lining in a nebulous cloud of PEP should be recognised when considering measures that could potentially do more harm than good.

Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study

BackgroundTopical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota.MethodsThis randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data.ResultsAfter irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota.ConclusionsTopical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota.Trial registrationUniversity Hospitals Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000028307. Registered 1 September 2017.

Giant pyoderma gangrenosum in a patient with ulcerative colitis

Introduction:Pyoderma gangrenosum (PG) is a phenomenon of cutaneous ulceration with unknown etiology. About half the cases have associated extracutaneous manifestations or associated systemic diseases. The most commonly associated systemic disorders include inflammatory bowel disease (IBD), hematologic malignancies, autoimmune arthritis, and vasculitis. This is a case report about giant PG with ulcerative colitis (UC), which is extremely rare.Case Presentation:A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar at the base. The right shank and feet were severely swollen, restricting movement. The arteria dorsalis pedis pulse was good, with normal sensation on the skin of the right shank and feet. Laboratory examinations showed a white cell count of 11.8 × 109/L, hemoglobin was 91 g/L, erythrocyte sedimentation rate was 82 mm/h, unelevated procalcitonin, serum C-reactive protein was 131.29 mg/L, and a negative tuberculin skin test. Enteroscopy demonstrated endoscopic evidence of UC. A skin lesion biopsy showed superficial erosion and scarring. Partial epidermal hyperplasia, partial epidermal atrophy and thinning, mild edema of the dermal papill. Most of the middle and lower part of the dermis, showed dense lymphocytes, histiocytes, multinucleated giant cells, and neutrophil infiltration. PG with UC was diagnosed based on clinical manifestations, laboratory examinations and enteroscopy results.Interventions:She was treated with topical applications of povidone iodine and kangfuxin solution twice daily, methylprednisolone sodium succinate 40 mg and compound glycyrrhizin 60 mg via intravenous drip once a day, along with thalidomide 50 mg twice daily. The UC was controlled with mesalazine.Outcomes:She required multiple therapies to achieve PG healing 3 months later. No PG recurrence was observed during the 1-year follow-up.Conclusion:Recognizing the clinical features of PG and its pathogenic nature, ensuring timely management fundamental for preventing severe destruction and deformity, and control of associated diseases are important aspects of treatment. Combination therapy is essential for PG patients with IBD.

The effect of recurrent povidone-iodine usage on conjunctival flora in diabetic patients undergoing intravitreal injections.

The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema. Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection. Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (p = 0.63), and 1 month after the last injection, 18% of cultures were positive (p = 0.495). The mean HbA1C was 8.1% ± 1.7%. HbA1C of patients with positive cultures was 8.0% ± 1.1% at the first intravitreal injection and 8.2% ± 1.0% at the third intravitreal injection. This was compared with HBA1C in eyes with negative cultures: 7.4% ± 1.2% (p = 0.45) and 7.1% ± 1.0% (p = 0.14), respectively. Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.

Interceptações de leite e produtos lácteos em fiscalização de trânsito agropecuário no estado do Maranhão

The aim of the current study is to perform a systematic investigation about the interception of milk and dairy products during agricultural product transport inspections carried out in Maranhao State. A retrospective study was conducted over a five-year period; it recorded 90 mobile monitoring events that together intercepted 3,500 liters of milk, 500 liters of kitchen butter, 2,836 kg of cheese, 1,700 kg of yogurt and 100 kg of yogurt ice cream. Most of these products (n = 13/16; 75%) were intercepted during their transportation from one city to another. The most recurring law violations regarded products transported in inappropriate vehicles (e.g., in the trunk of passenger buses and minibuses and in trucks used for animal-feed transportation) and in inappropriate packages such as garbage bags, rice-packing bags, cardboard boxes and non-reusable containers for micronutrients. All law violations recorded during the interceptions resulted in product confiscation, in fine issuing and, in specific cases, in product destruction through povidone iodine application. Fines issued due to irregular transportation of animal products during the assessed period accounted for R$ 11,688.00. It was possible concluding that the transportation of milk and dairy products in Maranhao State is not in compliance with the Brazilian legislation (ordinances, decrees), a fact that may endanger public health in the investigated State, as well as in other Brazilian cities that trade these products. It is essential intensifying these inspections to help suppressing the illegal trade of milk and dairy products.

Efficacy of a povidone iodine preparation in reducing nasal methicillin-resistant Staphylococcus aureus in colonized patients

In a randomized, nonblinded, placebo-controlled trial, a single application of a 10% povidone iodine preparation significantly reduced nasal methicillin-resistant Staphylococcus aureus at 1 and 6 hours after application, but suppression was not sustained at 12 or 24 hours. Twice-daily treatment for 5 days did not reduce nasal methicillin-resistant S aureus measured 12 hours postdosing in comparison to controls. These results suggest that single preoperative applications of povidone iodine will be effective for short-term suppression of S aureus during the perioperative period.

569. Evaluation of a Povidone-Iodine Preparation for Nasal Decolonization of Methicillin-Resistant Staphylococcus aureus

BackgroundMupirocin is commonly used for nasal decolonization of Staphylococcus aureus, but it has limitations including frequent emergence of resistance and non-adherence due to the need for repeated applications. Povidone-iodine is increasingly used as an alternative for nasal decolonization because it has a low propensity for emergence of resistance and rapid in vitro antibacterial activity. However, limited data are available on the microbiological efficacy of povidone-iodine for suppression of nasal S. aureus.MethodsWe compared the effectiveness of a single application or 5 days of twice daily application of a commercial 10% povidone-iodine preparation vs. phosphate-buffered saline for a reduction in nasal MRSA in methicillin-resistant S. aureus (MRSA)-colonized patients (9–11 per treatment group). Nasal swabs were collected for quantitative culture of MRSA before and at 1, 6, 12 and 24 hours after the single application or before each dose for the 5-day regimen. Analysis of variance was used to compare MRSA colony counts in povidone iodine vs. control patients.ResultsThe concentrations of MRSA in the nares were similar for povidone-iodine and control group patients prior to treatment. As shown in the figure, the single application of povidone-iodine resulted in a statically significant reduction in nasal MRSA in comparison to controls at 2 and 6 hours after treatment (P10 colonies per swab).ConclusionOur findings suggest that single preoperative applications povidone-iodine could be useful for short-term suppression of S. aureus during the perioperative period. Additional studies are needed to evaluate the efficacy of the povidone-iodine preparation for MRSA decolonization when used at more frequent dosing intervals or in combination with chlorhexidine bathing. Disclosures All authors: No reported disclosures.

Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study.

Shunting for hydrocephalus can lead to improvement in the quality of life although the latter has been subdued by complications like shunt infection. Established protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections. Previously, we retrospectively demonstrated a low infection rate despite some of the protocol recommendations not being implemented. The aim of this study was to prospectively establish the incidence of shunt infection in the early post-shunt period following our protocol and elucidate on associated risk factors. A multicenter prospective descriptive cohort study of consecutive 209 under-5 children requiring VPS for hydrocephalus was conducted between January 2013 and November 2018. An innovative protocol insisting on intermittent application of povidone-iodine on the skin during the operation was implemented. The patients were followed-up for 3months post-surgery. Included were 211 VPS procedures performed on 209 children. The median age was 9months and 84 were males. Hydrocephalus was non-communicative in 72.0% and aqueductal stenosis was its most frequent cause (84.9%). Most surgeries were performed in the morning (90.5%), electively (95.3%), and for the first time (91%). The median duration of surgery was 65min. Shunt infection rate was 1.9% (n = 4) (95% CI 0.7 to 5.0%) per procedure. The observed infection rate was low. This suggests that the protocol followed captured the most critical components necessary to ensure low infection rates and that simple measures implemented in economically challenged environments may achieve internationally acceptable infection rates.

Dental caries experience in children of a remote Australian Indigenous community following passive and active preventive interventions.

ObjectivesTo report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API).MethodsFive consecutive cross‐sectional surveys were conducted on 4‐ to 15‐year‐old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post‐cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone‐iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) “Oral Health Surveys – Basic Methods (4th Edition)” methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS‐II) in the latter three surveys. ICDAS‐II codes of 3‐6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index.ResultsAge‐weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre‐ and post‐CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1‐year and 4‐year post‐CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6‐year period of PPI.ConclusionsThe annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long‐term viability of API programmes, CWF remains necessary in this type of community.

No role for antiseptics in routine pin site care in Ilizarov fixators: A randomised prospective single blinded control study

IntroductionPin site infection is the commonest complication of Ilizarov external fixation. The aim of the study was to examine if use of antiseptics was superior over control and further if daily dressing was superior to weekly dressing in regular pin site care in reducing the burden of pin site infection in Ilizarov fixators. Patients and methodsA total of 114 patients (2363 pin sites) were randomised to receive regular pin site care alone (30 patients, 638 pin sites) or with additional application of povidone iodine (27 patients, 561 pin sites), silver sulfadiazine (27 patients, 570 pin sites) and chlorhexidine (30 patients, 594 pin sites). The pin tracts were sub-randomised to receive daily (1212 pin sites) or weekly (1151 pin sites) dressings. The primary outcome was pin site infection days rate across all four groups. The secondary outcomes were - mean duration to first episode of infection, differences between daily and weekly dressing groups, mean duration of antibiotic therapy and incidence of re-interventions and sequelae. We also recorded frequency of bacterial pathogens in all microbiological samples submitted. Block randomization using computer-generated random numbers was used. The assessor of outcome was blinded. ResultsAll patients completed the study. Pin site infection rate days per 1000 pin site days observed was marginally less in chlorhexidine group, but was not statistically significant compared to other antiseptics and control group (Absolute value in control, povidone iodine, silver sulphadiazine and chlorhexidine groups were respectively 2.04 ± 4.27, 2.04 ± 3.65, 1.85 ± 3.37, 1.37 ± 2.35, p value 0.92). Daily dressing category showed slightly less pin site infection days rate within each group and overall, but this was also not statistically significant (1.56 ± 3.99 versus 2.10 ± 5.1, p value 0.35). There was no statistically significant difference among the groups with regard to other secondary outcomes. Methicillin Sensitive Staphylococcus aureus was the most common bacterial pathogen isolated. ConclusionUse of antiseptics does not offer any advantage in regular pin site care in Ilizarov external fixation and daily pin site care is not superior to weekly pin site care. Empirical therapy in early and low grade pin site infections must be targeted against Staphylococcus.

A Study to Assess the Effectiveness of Povidone Iodine Ointment Versus Framycetin Sulphate Cream Over Episiotomy Wound Healing among Postnatal Mothers

Background: In India around 56 % of women is undergoing for episiotomy in all vaginal deliveries and in Maharashtra the episiotomy rate is too high, as it ranges from 80% to 90% and in Pune the rate is about 80%. Objective: To assess the effectiveness of Povidone Iodine Ointment versus Framycetin Sulphate Cream over episiotomy wound healing among postnatal mothers. Methodology: Pre- experimental; one-shot case study design was used in this study and the total sample size was 40 (20 in experimental group -1and 20in experimental group -II) . The Experimental group1 was given the application of Povidone Iodine and the experimental group II was given group was given the Framycetin Sulphate Cream. Healing of episiotomy wound was assessed by using modified REEDA scale and the episiotomy Pain was assessed by Visual Analogue Scale amongst both the groups. Results: In Povidone application group, the average change in REEDA score was 1.1 on day 2, 1.6 on day 3, 2.7 on day 4 and 3.2 on day 5. In Framycetin application group, average change in REEDA score was 0.6 on day 2, 1.7on day 3, 2.5 on day 4 and 3.1 on day 5. t-values for these groups were 1.9, 0.1, 0.5 and 0.2 with 38 degrees of freedom. Corresponding to p-values were 0.034, 0.444, 0.305 and 0.405, which indicates that p-value is small (less than 0.05), the Povidone is significantly more effective as compared to Framycetin group. On day3, day 4 and day5, p-values are large (greater than 0.05), the difference between the effect of Povidine and Framycetin application is not significant. Conclusion: Hence it can be concluded that the Povidone Iodine Ointment and the Framycetin Sulphate Cream are effective in healing of episiotomy wound. But Povidone iodine has hot more effective than Framycetin in the process of healing of episiotomy wound.

A Meta-analysis of Prophylaxis of Surgical Site Infections with Topical Application of Povidone Iodine Before Primary Closure.

Povidone iodine (PVI) is a widely used antiseptic solution among surgeons. A meta-analysis based on randomized controlled trials (RCTs) was conducted to establish whether application of PVI before wound closure could reduce surgical site infection (SSI) rates. Systematic review of MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from inception to September 2017, with no language restrictions. Only RCTs were retrieved. The primary outcome was the SSI rate. Meta-analysis was complemented with trial sequential analysis (TSA). A total of 7601 patients collected from 16 RCTs were analyzed. A reduction in overall SSI rate was found (RR 0.64, 95% CI 0.48-0.85, P = 0.002, I2 = 65%), which was attributed to patients undergoing elective operations (n = 2358) and mixed elective/urgent operations (n = 2019). When RCTs of uncertain quality (n = 9) were excluded, the use of PVI before wound closure (n = 4322 patients) was not associated with a significant reduction of SSI (RR 0.81, 95% CI 0.55-1.20, P = 0.29, I2 = 51%) and was only significant in clean wounds (RR 0.25, 95% CI 0.09-0.70, P = 0.008, I2 = 0%). For the primary outcome, the TSA calculation using a relative risk reduction of 19% and an 11% proportion of control event rate (CER) with 51% of I2, the accrued information size (n = 4322) was 32.8% of the estimated optimal information size (n = 13,148). There is no conclusive evidence for a strong recommendation of topical PVI before wound closure to prevent SSI.

Skin lesions over the pocket area that may mimic cardiac implantable electronic device infection: A case series.

The early and correct diagnosis of cardiac implantable electronic device (CIED) infections is critical given that early aggressive treatment with complete removal of the system along with antimicrobial therapy dramatically improves outcomes. Pocket infection manifested by local signs of inflammation is the most common form of CIED infections. Conditions mimicking pocket infection have been described in the literature. These include various types of malignancy and rarely allergic reactions/contact dermatitis to pacemaker compounds. We aimed to describe skin lesions and disorders over the pocket area that mimic CIED infection. We present a series of five cases with skin lesions that mimic pocket infection. We document these cases with corresponding photographs. Most of them have not been described in this setting. We report the following cases of conditions that proved not to be CIED infection: One case of superficial cellulitis, one case of herpes zoster over the pocket area, one case of spontaneous bruising over the pocket a long time after implantation in a patient taking oral anticoagulation, and two cases of contact dermatitis due to prolonged postoperative application of povidone-iodine. All cases had favorable outcome after conservative treatment and no CIED infection was developed during follow-up. Clinicians should be aware of rare conditions that mimic CIED infection. Incorrect diagnosis of these disorders may falsely lead to CIED extraction.

Current Strategies for Prevention and Treatment of Postoperative Endophthalmitis

We review the prevention and treatment of postoperative endophthalmitis. Postoperative endophthalmitis is rare but has potentially blinding consequences. There is no consensus on prevention, but there are a few controlled studies with methods of decreasing the infection rate, such as use of povidone iodine and intracameral antibiotics. There remains only one randomized controlled study (Endophthalmitis Vitrectomy Study or EVS) on the treatment of postoperative endophthalmitis, but there are retrospective studies which examine the timing and various methods of vitrectomy and intravitreal antibiotics. The application of povidone iodine remains a proven method of preventing endophthalmitis, but evidence suggests that intracameral antibiotics further minimize this risk. Further research is needed to define the efficacy of intravitreal antibiotics at the time of cataract surgery. There are many questions regarding treatment, including performance of vitrectomy for eyes with visual acuities better than light perception, smaller vitrectomy port sizes, and intravitreal antibiotics and/or oral steroids.

Combination of Ultrasonic Decontamination, Soft Tissue Curettage and Submucosal Air Polishing With Povidone-Iodine Application for Non-Surgical Therapy of Peri-Implantitis: 12 Months Clinical Outcomes.

The aim of this study was to evaluate the clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant Povidone-iodine application with and without systemic antibiotics. 45 patients with chronic periodontitis comprising 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of >2 mm, probing pocket depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP) and a repeated submucosal application of Povidone-iodine. Teeth with PD >4mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (N = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. After 12 months, implants treated without AM showed significant reductions (p<0.05) of mean PD (1.4 ± 0.7 mm), CAL (1.3 ± 0.8 mm) and BOP (33.4 ± 17.2%). In deep pockets (PD >6mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm) and BOP (44.0 ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes of these parameters. However, the reduction of implant sites with PD >4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8 ± 12.6% vs. 20.8 ± 14.7%; p<0.05). The combination of ultrasonic debridement, STC and GPAP with adjuvant Povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.