Aqueous Solution Of Chlorhexidine Research Articles

Intraluminal endoscopy in diagnosis and treatment of fluid collections in acute pancreatitis

To improve treatment outcomes in patients with acute pancreatitis through a differentiated approach to transluminal drainage. There were 1074 patients with acute pancreatitis between January 2018 and December 2021 at the Sklifosovsky Research Institute for Emergency Care. EUS was used as a final diagnostic method to determine localization, dimensions, shape and contours of fluid collections. We also assessed content, presence or absence of a capsule and connection with pancreatic ductal system, possibility of intraluminal drainage under EUS control. A plastic stent with rounded ends was installed if homogeneous hypo- and anechoic cavity with clear even contours was detected. The same measure was applied in case of aspiration of serous or serous-hemorrhagic fluid. The indication for installation of covered self-expanding endoprosthesis was inhomogeneous anechoic fluid collection with hyperechoic inclusions (sequesters) and cloudy purulent content. Patients with necrotic forms underwent insertion of a cystonasal drainage tube 7Fr for sanitation of the cavity with 0.05% aqueous chlorhexidine solution. Endoscopic sequestrectomy was performed every 24-48 hours. Stent was removed in 6 (for encapsulated peripancreatic fluid collections) or 1 month (for other types of fluid collections) after discharge. According to the EUS data, endoscopic TLD was performed in 63 (46%) out of 136 patients with fluid collections. Among 63 patients with TLD, connection with pancreatic ductal system was found in 5 (7.9%) patients. These ones underwent pancreaticoduodenal stenting. Twenty-two patients underwent elective sequestrectomy after stenting of necrotic types of fluid collections with fully covered self-expanding stents. Additional percutaneous drainage was required in 11 (45.8%) of 24 patients. Complicated postoperative period was observed in 4 (6.3%) patients with acute necrotic fluid collections (bleeding from the area of pancreatogenic destruction). Four (6.3%) patients died. Autopsy revealed resolution of purulent-inflammatory process in all patients. Intraluminal surgery is possible not only for homogeneous delimited fluid collections, but also for advanced lesions including infected destructions. This approach allows us to consider endoscopic intraluminal drainage as the final minimally invasive method of surgical treatment of pancreatic necrosis. Its effectiveness is up to 45.8%.

ADAPTATION OF EARLY NEONATAL CHILDREN BORN FROM MOTHERS WHO REHIVED COVID-19 DURING PREGNANCY (DESCRIPTION OF TWO CASES)

The frequency of detection of infected children with SARS-CoV-2, which is 10% of the total number of infected, including newborns, suggests the need for careful diagnosis of pathological conditions that may occur in children, particularly in the neonatal period. If at the beginning of the detection of COVID-19 it was claimed that the coronavirus SARS-CoV-2 does not affect children, then analyzing the new data we see that 2% of patients with diagnosed clinical cases of COVID-19 are children, including newborns.
 The article describes observations of several clinical cases of early neonatal adaptation of children born to women who had mild to severe COVID-19 during the first and third trimesters of pregnancy, respectively, because these children at birth had vesicular rash, symptom, which is considered rare for this category of newborns. In 2020, 2,300 newborns were born in the neonatal department of the 3rd City Clinical Hospital of Lviv, with every 5th woman in labor (20%) relapsed to COVID-19 during pregnancy.Analyzing the course of early neonatal adaptation, we found that the adaptation period of such children may not differ from the adaptation of newborns in the number and manifestations of transient conditions characteristic of the first days of life, whose mothers did not suffer from COVID-19 during pregnancy. However, coronavirus infection in women in both the first and third trimesters of pregnancy may be associated with signs of congenital vesiculosis in children, accompanied by inflammatory changes in the blood and blood clotting in the period of early neonatal adaptation in the newborn. Children had no other signs of pathological symptoms (fever, lethargy, drowsiness, hypotension, rhinorrhea, pharyngitis, cough, respiratory disorders (tachypnea, wheezing), vomiting, diarrhea and feeding disorders)), characteristic of infectious diseases specific to newborns, which can be masked by transient states. Manifestations of transient conditions in the observed children were: milia, simple erythema, desquamative peeling of the epidermis, toxic erythema, physiological jaundice.Treatment of the affected areas of the skin with rash elements with 0.05% aqueous solution of chlorhexidine, a three-day course of ampicillin, administered to the child from the first hours of life at a dose of 100 mg / kg / day intravenously contributed to the disappearance of vesiculosis. The maintenance therapy was a multiprobiotic in the form of drops. In the presented cases, no obstacles to breastfeeding and cohabitation of mother and child were observed. In the departments of newborn maternity hospitals, it is necessary to find opportunities, for diagnostic purposes, to conduct microbiological studies of pustules and biomaterial from the mucous membranes of the genital tract to further compare the results and establish etiological factors of vesiculosis, determine biochemical blood tests - CRP, ALT, AST, LD serum, coagulation parameters.

Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand

To investigate skincare practices in the first 2 weeks of life in extremely premature infants across tertiary neonatal intensive care units (NICUs). A web-based secure survey invite was emailed to the medical directors of tertiary NICUs. The survey included questions on various aspects of skincare practices in the first 2 weeks of life in extremely premature infants (born before 28 weeks gestation). The person most familiar with local skincare practices was asked to complete the survey and only one response per unit was requested. We performed a descriptive analysis. We received responses from 30 out of 32 NICUs (response rate 93%). Twenty-five NICUs (89%) reported offering resuscitation and intensive care to infants born at ≥23 weeks gestation. All NICUs reported occurrences of skin breakdown, including medical adhesive-related skin injury (30%), abrasion/friction-associated skin injury (46%), perineal skin breakdown (55%), pressure site injury (47%) and diaper dermatitis (60%). A high level of consensus (≥75%) was observed for certain practices, such as the use of polyethylene occlusive plastic wraps at birth and aqueous chlorhexidine solution for sterile procedures, but a low level of consensus (<25%) was observed for many other practices, including the skin risk assessment tool used. Skin injuries in extremely premature infants are common and skincare practices vary considerably amongst NICUs. Clinical practice improvement projects and further clinical research will help improve consistency amongst NICUs. Further research is needed to assist the development of evidence-based guidelines and benchmarking for skincare practices in these vulnerable infants.

The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations

Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes.&#x0D; Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations.&#x0D; Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary.&#x0D; Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms.&#x0D; Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy

The Use of a Locking Plate for the Treatment of Femoral Diaphyseal Fracture in Giant Anteaters (Myrmecophaga tridactyla)

Background: The giant anteater is considered a species vulnerable to trauma due to being slow and, therefore, vulnerable to long bone fractures, such as femoral fracture. Locking plates have the potential to restore and maintain fractured bone stability, as well as reduce damage to the vascular supply. This study aims at reporting cases of two giant anteaters subjected to femoral osteosynthesis using locking plates. Cases:Two giant anteaters presenting non-weight bearing lameness on the right pelvic limbs were evaluated, diagnosed with femoral fracture of unknown etiology and submitted to osteosynthesis. A clinical evaluation was performed under chemical restraint for the adult animal and physical restraint for the young one. Crepitation and swelling in the right femur topography led to a radiographic examination, which showed a complete and transverse diaphyseal fracture of the right femur in both cases. The first one was an adult male and was subjected to osteosynthesis of the right femur using a locking plate. Once anesthetized, the animal was placed in left lateral recumbency, and the right pelvic limb was clipped and sterilized. A craniolateral incision was made to expose the femoral diaphysis. A large amount of fibrous-looking tissue was found and removed. Subsequently, the fracture was reduced and the locking plate system was positioned on the craniolateral side of the femur. An osteotomy of the femoral trochanteric crest was required to position the implant. The overlying fascia lata was closed using monofilament suture in a simple continuous pattern. The closure of the subcutaneous tissue and skin was performed using a Cushing pattern and simple interrupted pattern, respectively. Immediate postoperative radiographic examinations showed fracture reduction and bone axis alignment, with a properly positioned implant. The surgical wound was cleaned daily with 0.5% aqueous chlorhexidine solution. Seven days after surgery, the animal had a partial dehiscence at the suture site, with bone and plate exposure. Wound healing by second intention was initiated. At 127 days after surgery, a radiographic examination showed periosteal bone proliferation in the middle third of the right femur and that the bone implants were well-positioned. The second case was of a young 3.68 kg female anteater. The surgery was performed as described for the adult one, but there was no fibrosis at the fracture site and the osteotomy of the femoral trochanteric crest was not required. Closure of the fascia lata, subcutaneous tissue, and skin was performed as in Case 1. An immediate postoperative radiographic examination showed fracture reduction, bone axis alignment, and a properly positioned implant. The surgical wound was cleaned daily with 0.5% aqueous chlorhexidine solution. On the day of the surgery, the animal could already bear weight on its right pelvic limb, presenting discrete lameness with gradual improvement. Twenty-three days after surgery, a radiographic examination showed moderate periosteal bone proliferation in the middle third of the right femur. The bone implant was still well-positioned and bone healing was achieved around the 40th post-operative day.Discussion:The cases are very similar, but the younger anteater's femoral trochanteric crest didn't prevent positioning the plate. The fibrosis observed on the adult specimen is indicative of a chronic fracture, which may explain, in conjunction with the post-surgical complications, the longer time required for bone healing in the adult animal. Even so, both animals recovered fully and it's safe to deduce that the locking plate is an adequate option for internal fixation in transverse diaphyseal femoral fractures in both adult and young giant anteaters.

EVALUATION OF THE ANTIMICROBIAL EFFECT OF CHLOREXIDINE 0.12% IN PATIENTS IN THE ICU AT DIFFERENT TIMES: RANDOMIZED CLINICAL TRIAL

Objective: To evaluate the antimicrobial effect of 0.12% chlorhexidine aqueous solution under the buccal microbiota of patients undergoing mechanical ventilation in intensive care units (ICUs), analyzing the effect of this substance after 6, 8, and 12 hours of oral hygiene. Study Design: Thirty patients admitted to the ICUs of a hospital in Aracaju-SE, selected by for convenience December 2017 to January 2018, which met the inclusion criteria were randomized and divided equally into 3 groups. Oral hygiene followed the disinfection protocol adopted by the hospital, the same recommended by the Association of Brazilian Intensive Medicine. Samples of saliva were collected before, immediately after, and after 6, 8, and 12 hours according to each group. The evaluation by the technique of bacterioscopy also called Gram staining, the results were tabulated in worksheets and analyzed through the Fisher and 1-way analysis of variance tests. Results: This study showed that even in critical patients, which is common to the alteration of the normal microbiota, the aqueous solution of chlorhexidine 0.12% was also efficient as an oral disinfection agent. Conclusion: Our results indicate that the 12-hour interval still seems to be the most interesting if we consider the cost and risks regarding the greater amount of manipulation of fluids in the oral cavity of patients on mechanical ventilation.

Clinical study of an outbreak of postoperative mediastinitis caused by Serratia marcescens in adult cardiac surgery

Nosocomial infection caused by Serratia marcescens after cardiac surgery is rare but causes high rates of morbidity and mortality. Knowledge about postoperative mediastinitis due to S. marcescens is limited. The purpose of this work was to study the clinical presentation, management and outcome of an outbreak of postoperative sternal infection due to S. marcescens. During a 7-week period, a total of 54 patients underwent open heart procedures in our hospital. A postoperative wound infection caused by S. marcescens was diagnosed in 10 patients. We performed a clinical study to investigate patient characteristics and outcomes as well as the possible source of the infection. The mean age of the infected patients was 74.5 ± 10 years. Mediastinitis was present in 6 cases, superficial wound infection in 3 and isolated bacteraemia in 1. Purulent exudate through the sternal incision was observed in all infected cases except in 1 patient, who presented only with bacteraemia. Serratia marcescens was isolated from the samples taken from all infected wounds. The mean time elapsed between the operation and the isolation S. marcescens was 5.9 ± 2.4 days. Response to treatment was favourable in all cases except 1, who died. Contamination of the aqueous chlorhexidine solution used to prepare the patients' skin with S. marcescens was reported. Microbiological studies demonstrated that S. marcescens strains isolated from patients and from the aqueous chlorhexidine solution belonged to the same clone. The use of an aqueous chlorhexidine solution contaminated with S. marcescens caused an outbreak of postoperative sternal wound infections. The time elapsed between wound contamination and signs of infection was brief, but the systemic inflammatory response and tissue necrosis were limited. Alcohol-based solutions are recommended for the prevention of surgical site infections.

EVALUATION OF THE TREATMENT EFFECTIVENESS OF THE GENERALIZED PERIODONTITIS INITIAL STAGE WITH ER: YAG LASER

Purpose - to evaluate the treatment effectiveness of the initial stage of the generalizedperiodontitis with Er: YAG laser.Material and methods. 35 patients with an initial stage of generalized periodontitis wereobserved. I group consisted of patients who received standard periodontal treatment.Patients in the 2nd group received standard treatment with additional Laser Therapywith Er: YAG Laser and chlorogexidine-bigliuconate irrigation.Results. The obtained results allowed us to conclude that treatment with laser radiationis effective in the acute flow of inflammation in periodontal tissues - under the influence ofthe rays of Yag Lasers, swelling and bleeding decreases, pain disappears. Therapy is themost effective with small values of density and intermittent light effects on the focal pointof the lesion.The analysis of the results of the study have shown that the combined use of standardtreatment and Yag Lasers in the complex treatment of the initial stage of generalizedperiodontitis leads to a faster elimination of inflammatory events, stimulates regenerativeprocesses, shortens the treatment time for patients in 1,5-2 times. This indicates the higheffectiveness of radiation Yag Lasers in the treatment of inflammatory diseases in theperiodontal disease. The results of the combined use of laser light with irrigation of theoral cavity with 0,2% aqueous solution of chlorhexidine deserves particular attention.The development and introduction of new methods for the treatment of periodontaldisease with the use of effective pharmacological agents in combination with lasertherapy is an important and topical task of modern dentistry.

Application of dermal chlorhexidine antisepsis is ineffective at reducing Proprionibacterium acnes colonization in shoulder surgery.

Chlorhexidine as a skin surface antiseptic has been shown to be ineffective with respect to reducing Proprionibacterium acnes colonization within the dermis. The purpose of the present study was to determine whether the application of aqueous chlorhexidine solution to the dermal layer decreased P. acnes colonization during open shoulder surgery. The present study enrolled 50 patients who were undergoing open shoulder surgery. Patients received standard antimicrobial preparation. Three dermal swabs were taken from each patient: swab 1 following skin incision; swab taken 2 minutes to 5 minutes post-application of aqueous chlorhexidine to the dermis; and swab 3 taken 60 minutes post-application. Mean age was 57.5 years (22 males, 28 females). There were 21 patients (42%) with P. acnes present on any dermal swab. There were significantly more P. acnes positive cultures identified at swab 3 compared to swab 1 (p = 0.043). In nine patients with positive P. acnes at cultures swab 1, eight also isolated P. acnes after at swabs 2 or 3. Males were significantly more likely to have P. acnes on any swab (p < 0.001). Positive P. acnes cultures were significantly more common in patients ≤50 years (p < .001). None of the patients had any clinical signs of infection at a minimum of 1 year following surgery. Dermal application of aqueous chlorhexidine during open shoulder surgery fails to eradicate or reduce P. acnes on deep cultures.

Boerhaave syndrome in emergency abdominal surgery

Aim. To present a case of spontaneous rupture of esophagus taking into account its rarity, diversity of clinical manifestations, complexity of making a diagnosis and treatment of this disease.Methods. Over the past three years in Kazan City Clinical Hospital №7 three cases of the esophageal damage were registered. The age of the patients ranged from 48 to 67 years, including 2 females and 1 male with spontaneous rupture of esophagus.Results. A 48-year old patient was admitted to the hospital complaining of vomiting with blood followed by appearance of retrosternal pain which appeared immediately after the holiday and nutritional stress. Emergency fibrogastroduodenoscopy (FEGDS) was performed. Endoscopy revealed signs suggestive of diaphragmatic hernia, and 2 ruptures of esophageal mucous membrane up to 3 cm on the left wall of esophagus above the cardiac sphincter. The diagnosis of Mallory-Weiss syndrome complicated with bleeding was made. Surgery: laparotomy, abdominal revision. The abdominal cavity had dark hemorrhagic discharge, inflamed peritoneum and signs of diffuse peritonitis. Diaphragmatic crurotomy was performed. Revision of abdominal esophagus revealed two longitudinal ruptures of the left esophageal wall 1.5 and 3 cm long 8 cm up from the cardiac sphincter. The ruptures were sutured by discontinuous atraumatic encircling stitch. Lower mediastinum was drained with two double-lumen tubes, the gastric probe was installed through the nose. During the follow up CT scan and ultrasound of thoracic cavity were performed. Liquid nutrition through the probe lasted up to 20 days. The mediastinum was lavaged through double-lumen tube with an aqueous solution of chlorhexidine and chymotrypsin up to 32 days. The patient was discharged on day 34 in a satisfactory condition.Conclusion. One of the etiologic factors of spontaneous esophageal rupture may be diaphragmatic hernia of the esophagus with increased intraesophageal pressure; early surgical intervention, suturing of esophageal rupture, mediastinal drainage and lavage in the postoperative period are fundamental steps in the treatment of esophageal rupture.

Comparative evaluation of antibacterial activity of total-etch and self-etch adhesive systems: An ex vitro study.

Aim:The aim of this ex vivo study was to compare the antibacterial activity of total-etch and self-etch adhesive systems against Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus through disk diffusion method.Materials and Methods:The antibacterial effects of Single Bond (SB) and Adper Prompt (AP) and aqueous solution of chlorhexidine 0.2% (positive control) were tested against standard strain of S. mutans, L. acidophilus, and A. viscosus using the disk diffusion method. The diameters of inhibition zones were measured in millimeters. Data was analyzed using Kruskal-Wallis test. Mann-Whitney U test was used for pairwise comparison.Result:Of all the materials tested, AP showed the maximum inhibitory action against S. mutans and L. acidophilus. Aqueous solution of chlorhexidine 0.2% showed the maximum inhibitory action against A. viscosus. Very minimal antibacterial effect was noted for SB.Conclusion:The antibacterial effects observed for the tested different dentin bonding systems may be related to the acidic nature of the materials.

Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery

Background: As a new intraoperative disinfection method, chlorhexidine-wetted textile napkins have been employed in order to cover the upper and lower eyelid edges, eyelid skin, eyelashes, lid margins and palpebral conjunctiva during phacoemulsification cataract extraction. This study was conducted to compare the antimicrobial activity of textile napkins before and after their use. Methods: This study evaluated 80 textile napkins wetted with 0.02% aqueous solution of chlorhexidine. All textile napkins were divided into groups. The study group consisted of 60 used textile napkins which were collected from 29 patients (30 eyes) at the end of phacoemulsification, and the control group included 20 unused sterile textile napkins. Antimicrobial assay was performed by means of measuring the growth inhibition zones of the standard or clinical isolate strains under the textile napkins on the surface of agar media. Results: The number of textile napkins and the diameter of the growth inhibition zones (mm) in the study group and in the control group relating to gram-positive, gram-negative, and fungi were: 24/31 vs. 8/31, 32/30 vs. 8/30, and 4/30 vs. 4/30. The diameter of the growth inhibition zones of gram-positive bacteria was more than other investigated microorganisms. In the growth inhibition zones, exogenous microorganism colonies were not found. Conclusion: Antimicrobial activity of textile napkins wetted with 0.02% aqueous solution of chlorhexidine against gram-positive bacteria is more than gram-negative bacteria and fungi, and is preserved to the end of the phacoemulsification.

Disinfection of gutta-percha cones with chlorhexidine

This study investigated the effectiveness of detergent and aqueous solutions of 2% chlorhexidine digluconate in decontaminating gutta-percha cones (gpc) contaminated with bacteria, yeast, or bacterial spores. Gutta-percha cones were contaminated with 107-108 colony-forming units per milliliter (cfu/ml) of the following test organisms: Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, or Candida albicans. Spores of Bacillus subtilis were also tested. Contaminated gpc were treated with the chlorhexidine solutions for 1, 5, 10, or 15 min. Each cone was then transferred to a tube containing saline and the micoorganisms were recovered after homogenization for cfu determination. Both detergent and aqueous chlorhexidine solutions were effective in eliminating S. aureus, E. faecalis, and C. albicans cells adhered on the surface of gpc within 1 min of exposure. E. coli was eliminated in 5 min with detergent solution. The Bacillus subtilis spores were eliminated by chlorhexidine solutions within 5 min. The results of this study demonstrated that both aqueous and detergent solutions of 2% chlorhexidine digluconate were effective in decontaminating gpc within 5 minutes of exposure.

The effect of a polyhexamethylene biguanide mouthrinse compared with a triclosan rinse and a chlorhexidine rinse on bacterial counts and 4‐day plaque re‐growth

For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% and a 0.12% PHMB mouthwash were shown to inhibit plaque re-growth and to reduce oral bacterial counts. In this study, a 0.2% PHMB mouthrinse (A) was compared with a positive control 0.12% aqueous chlorhexidine solution (B), a commercially available 0.3% triclosan/2.0% polyvinyl methyl ether maleic acid copolymer mouthrinse (Colgate Total Plax) (C), and a negative control placebo rinse (10% ethanol, flavour) (D). The controlled clinical study was a double blind, randomized, four replicate cross - over design. Plaque re-growth was assessed with the Turesky et al. (1970) modification of the Quigley & Hein (1962) plaque index. The antibacterial effect was assessed by taking bacterial counts on the tooth surface (smears from the buccal surface of 16/26) and mucosa (smears from the buccal mucosa in opposite of area 16/26) after the professional prophylaxis and after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. Sixteen volunteers participated and, on day 1 of each study period were rendered plaque-free, ceased toothcleaning, and rinsed twice daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. A 10-day wash-out period was carried out between each rinse evaluation. Data were analysed using ancova with Bonferroni HSD adjustment for multiple comparisons (colony forming units per sample) with a significance level alpha=0.05. The 0.2% PHMB mouthrinse (A) was significantly better at inhibiting plaque than the placebo (D), but significant less effective than the 0.12% aqueous chlorhexidine solution (B). There is no significant difference between A and the 0.3% triclosan/2.0% copolymer mouthrinse (C). Bacterial count reductions (tooth surface and mucosa) with PHMB (A) were significantly greater compared with the placebo (D) and triclosan (C), but significantly lower compared with chlorhexidine (B) (tooth surface) and equally effective compared with chlorhexidine (B) (mucosa). Consistent with previous studies, a PHMB mouthrinse was shown to inhibit plaque re-growth and to reduce oral bacterial counts, indicating that PHMB could be an alternative to established mouthrinses in preventive applications.

High–Performance Liquid Chromatographic Analysis of Chlorhexidine in Saliva after Mouthrinsing

A high–performance liquid chromatographic method was developed to quantify chlorhexidine in human saliva. After addition of an internal standard and acidicdeproteinization, saliva samples were chromatographed by the reversed–phase ion–pair system using pentanesulfonate as a counterion and the eluates were detected by a diode array detector. Under optimal conditions, the baseline separation of analytes was achieved within 4.5min without interference from components in saliva matrix. The method showed high selectivity to salivary chlorhexidine, quantitative range (50.0ng/ml–50.0μg/ml), recovery (96.0–97.8%) and analytical precision (intra– and interassay CVs within 0.41%), permitting the effective application to both saliva and aqueous solutions. Chlorhexidine was found in saliva at microgram per milliliter levels for at least 8 h after mouthrinsing with 10 ml of an aqueous solution of chlorhexidine (0.1 or 1.0 mg/ml) for 1 min. The concentrations of salivary chlorhexidine were reduced by ingesting the acidic beverage and food, but not by ingesting the neutral beverage. The adsorption experiments in artificial saliva revealed that chlorhexidine was significantly adsorbed to saliva–coated hydroxyapatite, buccal epithelial cells and mucin. The proposed method will be a useful tool to study salivary chlorhexidine after oral application and its retention in the oral cavity.

Treatment of HIV-associated periodontal diseases.

Three presentations of periodontal disease are associated with HIV infection: necrotising periodontal disease; forms of atypical gingivitis and exacerbated attachment loss. Necrotising disease resembling aggressive acute necrotising ulcerative gingivitis and is the most acute and painful of these. Response to treatment by debridement of lesions, irrigation with aqueous chlorhexidine solution and oral metronidazole 200 mg, tds is almost diagnostic of the condition. Affected individuals are prone to relapse. Prevention by meticulous home care and frequent hygiene recalls is advised. The forms of atypical gingivitis are classically not plaque related. This means that persistence of gingivitis in the absence of plaque is required to establish the diagnosis. There is a consensus that these diseases are related to candidiasis. Treatment with antifungals may be contraindicated due to the emergence of resistant strains of Candida spp. Exacerbated attachment loss may be the legacy of repeated episodes of necrotic disease or may be due to accelerated periodontitis. In either event the principles of treatment are to encourage and facilitate plaque removal.

A wound healing study of chlorhexidine digluconate in guinea pigs

Formulations with and without chlorhexidine digluconate, a broad-spectrum antimicrobial, were tested for their effects on the healing of incisions and abrasions surgically induced in male guinea pigs. Formulations containing chlorhexidine were a skin cleanser formulation (4% w v ), a tinted tincture (0.5% w v ), and both 0.5 and 4% w v aqueous solutions. Control materials were saline, and both the skin cleanser and the tincture formulations without chlorhexidine. Presurgical preparation was limited to closely clipping the hair and wiping each wound area with saline to remove loose hair, dander, and dirt. Each incision and abrasion was irrigated with its assigned material at surgery and daily thereafter until necropsy. Guinea pigs were killed on Days 3, 6, 9, 14, and 21, and wound sites were removed and fixed for histologic evaluation of healing. Daily progress of the wound healing appeared comparable for all treatment groups and there was no gross evidence of treatment effects at necropsy. For the animals with incisions, there were no remarkable histological differences among the treatment groups at Day 3. At Days 6 and 9, the two formulations containing 4% chlorhexidine produced a slight delay in healing when compared with the other treatment groups. These differences decreased with time, and by Day 21, there were no remarkable histological differences among animals of the various treatment groups. For the animals with abrasions, all treatement groups with and without chlorhexidine had slightly delayed healing compared to the saline control animals on Days 3 and 6. The most pronounced effect was observed in the animals treated with the 4% aqueous chlorhexidine solution, which had a delayed healing response through Day 9. By Days 14 and 21, however, there were no detectable histological differences among the animals of the various treatment groups.

Pseudomonas pickettii as a cause of pseudobacteremia.

An outbreak of pseudobacteremia caused by Pseudomonas pickettii biovariant 1 is reported. The common source was the aqueous chlorhexidine solution prepared by the hospital pharmacy. The contamination problem caused by the antiseptic solution was eventually solved by a series of preventive measures.

Experimental evaluation of chlorhexidine gluconate for ocular antisepsis.

Chlorhexidine gluconate is a bisguanide germicide currently available with 70% isopropanol (Hibistat, Hibitane) or a detergent (Hibiclens, Hibiscrub) for preoperative skin preparation. As these solvents are toxic to the cornea, we investigated the safety and efficacy of aqueous chlorhexidine solutions for ophthalmic use. Chlorhexidine in Tris-glycine buffer was evaluated for retardation of epithelial regeneration after experimental corneal abrasion in rabbits. Irrigant concentrations of 2.0 and 4.0% chlorhexidine significantly slowed the healing rate (0.546 and 0.076 mm/h, respectively) compared with saline controls (0.938 mm/h). Irrigant concentrations of less than or equal to 1% did not statistically delay healing (P greater than 0.4). In a separate group of animals, the right conjunctivae of pigmented rabbits were inoculated with Staphylococcus epidermidis (approximately 10(7) organisms per eye) and irrigated with 40 microliters of aqueous chlorhexidine in concentrations of 0.1, 0.5, and 1.0%; the left eyes were irrigated with saline or left untreated. Quantitative conjunctival cultures were obtained, and the total number of organisms recovered per eye was calculated. All chlorhexidine-treated eyes showed significant reduction in organisms compared with either untreated or saline-irrigated control eyes (P less than 0.001). In vitro antimicrobial susceptibility testing demonstrated chlorhexidine in concentrations of 0.1 to 4% to be highly active against a variety of gram-positive and gram-negative bacterial pathogens by disk diffusion and broth diffusion assays. Topical aqueous chlorhexidine may be an alternate agent for preoperative conjunctival antisepsis.

Gingival bleeding after chlorhexidine mouthrinses.

During a clinical trial for evaluating the antiplaque effect of two flavoured chlorhexidine rinses, the observation was made that bleeding after gentle massage of the gingival margin occurred more often after chemical than after mechanical oral hygiene measures. In order to ascertain the validity of this unexpected observation, the same dental students participated in a repetition of the trial 18 months later. The results of the two trials indicate that gingival bleeding after gentle massage of the margin with the side of a periodontal probe actually occurs more frequently after rinsing twice daily with a 0.2% aqueous chlorhexidine solution for 1 week than after meticulous mechanical oral hygiene measures during an equally long time period. The average frequency of bleeding, in per cent of all examined gingival units, ranged from 1.3% after mechanical cleaning of the teeth to 5.4% after rinsing with chlorhexidine for 1 week. Neither the frequency of bleeding nor the difference between mechanical and chemical plaque control were considered to be of clinical significance. Further microbiological and histological studies are being conducted in an attempt to clarify the reason for the observed bleeding tendency.