Free Hand Research Articles

Safety and Accuracy of Robot-Assisted Cervical Screw Placement: A Systematic Review and Meta-Analysis

The purpose of this study was to compare the accuracy and safety of robot-assisted (RA) cervical screw placement with conventional freehand (FH) technique. Computer-based searches were conducted on various databases including PubMed, Embase, Cochrane Library, Web of Science, the China Biology Medicine, the China National Knowledge Infrastructure, and Wanfang Database. Inclusion criteria were studies reporting the use of RA techniques for cervical screw placement and providing data on safety and accuracy outcomes. Primary outcome indicators focused on the accuracy of screw placement, while secondary outcome indicators included operative time, intraoperative blood loss, length of hospital stay, complication rate, and radiation dose. Data from eligible studies were extracted and synthesized using a forest plot analysis. A total of 312 patients (1233 screws) from 6 studies were included, with 148 patients (47.4% with 567 screws) in the RA group. Perfect screw accuracy, as categorized by Gertzbein-Robbins grade A, was significantly superior with RA surgery compared to FH technique. RA screw implantation significantly reduced complication rates, intraoperative blood loss, length of hospitalization, and radiation dose compared to the conventional FH group. However, there was no statistically significant difference in surgery time between the RA and FH groups. RA surgery significantly improves the accuracy of cervical screw insertion and offers potential advantages in terms of reduced complications and blood loss, shorter hospital stays, and decreased radiation exposure. However, the impact on operative time remains uncertain. Further high-quality studies, including large-scale randomized controlled trials, are needed to strengthen the evidence base.

CT Guided Evaluation of Dedicated Aimer versus Free Hand Drilling Technique in the Placement of Femoral and Tibial Tunnels in Double Bundle ACL Reconstruction

Aim: The use of a dedicated aimer versus freehand, in double-bundle anterior cruciate ligament reconstruction by co-ordinate axis method on three-dimensional computed tomography (3D-CT) reconstructions models were performed to compare the locations of the femoral and tibial tunnels. Patients and Methods: Use of aimer vs free hand technique through the trans portal approach. A 3-Dimensional CT on 40 operated knees and evaluated the position of femoral and tibial tunnels on 3D-CT scan was prepared. Results: For femoral tunnel locations, the average posterior-anterior distance for anteromedial (AM) and posterolateral (PL) tunnel positions in the aimer group and freehand group were 46.8% ± 7.4% (B/C) and 34.5% ± 5.0% (A/C) and 56.4% ± 3.1% (B/C) and 40.5% ± 9.0% (A/C), respectively. For, tibial tunnel locations, mean anterior-to-posterior distances for the AM and PL tunnel in the aimer group and freehand group were 29.7% ± 2.5% (A/C) and 46.9% ± 3.8% (B/C) and 28.8% ± 4.3% (A/C) and 47.2% ± 3.6% (B/C), respectively. B/C AND A/C are the measurements posterior to the anterior tunnels for the AM and the PL tunnels, respectively. a/c and b/c are the proximal-distal measurements. Conclusion: In the present study, on comparison position of the AM and PL tunnels of the femur and tibia were fairly similar in both techniques.

Feasibility and anteversion accuracy of a patient-specific instrument for femoral prosthesis implantation in total hip arthroplasty

BackgroundThe aim of this study was to evaluate the precision and feasibility of patient-specific instruments (PSI) in total hip arthroplasty (THA) as compared to the traditional free-hand (FRH) approach.MethodsDuring the period of January 1, 2021 to December 31, 2022, a randomized allocation was used for patients receiving unilateral primary THA to either the PSI or conventional operation group. The placement and size of the PSI were specifically chosen to guide femoral neck resection and prosthesis implantation. The study analyzed component positions and evaluated radiographic and clinical outcomes in 30 patients who received PSI-assisted THAs and 30 patients who received FRH THAs. This study was registered at China Clinical Trial Registry (number: ChiCTR2300072325) on June 9th, 2023.ResultsThe use of PSI in THA resulted in significantly higher precision in achieving the desired component position as compared to the FRH approach. The PSI group showed significantly smaller absolute errors of femoral anteversion (p < 0.001). No significant differences were found in operation time, intra-operative blood loss, hospitalization duration, or time to walk after surgery.ConclusionIn conclusion, the application of patient-specific instruments in THA provides a simple and reliable solution to enhance the precision of femoral prosthesis placement with high accuracy and feasibility. This study highlights the potential benefits of using the PSI in THA.

Three-dimensional accuracy of endodontic access preparations using novel nonrestrictive static guides: A laboratory study.

This study compared the accuracy of traditional endodontic access to conservative access cavities prepared with or without novel nonrestrictive endodontic access guides by operators with different levels of clinical experience without visual aids, using a three-dimensional volumetric accuracy analysis method. The accuracy of the preparations was analysed using a novel 3D volumetric analysis by calculating the intersection and volume of the actual cavities to the planned model cavities. The experienced operator significantly outperformed the inexperienced operator in the free hand groups, while accuracy of conservative access cavities prepared using the novel guides were comparable and significantly higher than the other groups (p < 0.05). The results demonstrated clinical experience enhanced endodontic preparations accuracy and that nonrestrictive guides achieve accurate conservative access cavities which are independent of the operator skill level. Additionally, the three-dimensional volumetric analysis is a consistent and objective method to judge the accuracy of guided endodontic techniques.

Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies.

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm3), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I2) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator's experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS.

Fully guided All-on-4 technique: A controlled approach

Edentulism is a commonly occurring condition in elderly and rehabilitation becomes pertinent to restore the lost function. Single stage surgical protocols with immediate restoration of function has emerged as an effective treatment approach over the past years. All-on-4 approach, avoids the complicated procedures of bone grafting and ridge augmentation and delivers immediate restoration. A fully guided all-on-4 surgery minimizes the risks and errors involved with free hand surgery especially in the maxillary arch, and provides a more controlled approach with predictable outcomes. A combination of 3D planning and surgical template, the all-on-4 protocol, and immediate functional loading is used in this case report.

Comparative foliar anatomical study of six different varieties of Piper betle L.

The present investigation on a few selected cultivars of Piper betle L. was undertaken mainly to understand the anatomy and tissue components of the stem, leaves and petiole. This was accomplished by using basic anatomy techniques such as free hand and microtome sectioning. The varieties selected were: HY1, HY2, JB, KB, LV and SG. Major aspects of the present inquiry were - macro morphology, anatomy and histochemistry. The main focus of the study was on the internal structure of leaves and petioles to understand the role of specialised cells like enlarged hypodermal cells and mucilage cavities in retaining moisture and thereby preserving the shelf life of harvested leaves.

Effect of Weed Management Practices on Growth and Yield of Zero-Till Chickpea (Cicer arietinum L.)

A field experiment to compare weed management practices on growth and yield of zero till chickpea (Cicer arietinum L.) during rabi, 2022 at RARS, Jagtial, Telangana. Treatments include Pendimethalin 38.7 % CS @ 700 g a.i. ha-1 , Topramezone 33.6 % SC @ 20.6 g a.i. ha-1 , Quizalofop ethyl 7.5 % + Imazethapyr 15 % EC @ 100 g a.i. ha-1, T4- Propaquizafop 2.5 % + Imazethapyr 3.75 % (w/w) ME @ 125 g a.i. ha-1 , two hand weedings at 15 and 30 DAS , weed free (Season long) and Un-weeded (Check). Weed free treatment and hand weeded plots showed highest growth and yield attributing characters because of season-long weed-free conditions and better microclimate during critical period of crop respectively. Among different herbicides, Topramezone treated plot recorded higher growth parameters viz.; plant height (38.7 cm), dry matter accumulation (320.8 g m-2) and yield attributing characters viz.; total number of pods plant-1 (30.97), with seed yield (1397 kg ha-1), haulm yield (2518 kg ha-1) and harvest index (35.7 %). Post emergence herbicide topramezone can be effectively adopted for getting higher yield of chickpea in rice fallow zero tillage conditions.

A Study on the Efficacy of Alcohol Based and Alcohol Free Hand Sanitizers Available in the Market Against Staphylococcus Aureus and Salmonella Typhimurium

Hand sanitizers can be manufactured in the form of alcohol based hand sanitizer (ABHS) that contains alcohol, or alcohol free hand sanitizer (AFHS) containing benzalkonium chloride. This study determines the efficacy of ABHS and AFHS products against Staphylococcus aureus and Salmonella Typhimurium. Agar well diffusion assay was performed against the bacterial colonies grown on Mueller Hinton agar in triplicates. Wells were made by punching holes onto the agar and filled with three different brands of hand sanitizers namely 70% ABHS, 95% ABHS, and AFHS. The diameters for zone of inhibition was measured after 24 hours incubation at 37 ℃. Only AFHS product inhibited the growth of S. aureus and S. Typhimurium, whereas 70% and 95% ABHS did not exhibit any zone of inhibition. Although AFHS was proven to be useful, this finding suggests that ABHS available in the market might not necessarily be effective against S. aureus and S. Typhimurium.

Anatomical Study for Vegetative Organs of Pelargonium graveolens L.'Hér Cultivated in Iraq

The current investigation concluded an anatomical study of the cultivated species Pelargonium graveolens L. 'Hér belong to the Geraniaceae family and which cultivated as an ornamental plant, fresh specimen were collected from different region in Baghdad ,the study vegetative parts (leaf, stem and petiole) in details ,the upper and lower epidermis of leaf and epidermis of stem also studied, ordinary epidermal cells and stomatal complexes studied in term of shapes and dimensions ,the result showed that stomatal in leaf and stem is anomocytic type, the cross sections of the vegetative parts prepared by microtome and free hand sectioning. The tissues of these parts include the number and the type of layers and thickness of each one , the result showed the presence of druses crystals in parenchyma cells of the petiole, stem and leaf. Vistur type of this organs also studied and it comprises of glandular and non-glandular trichomes which occur in different types and lengths.

A comparative study of robot-assisted and traditional surgeries in the treatment of thoracolumbar fractures based on 1-year follow-up observation.

There are conflicting results for robot-assisted (RA) pedicle screw fixation compared with freehand (FH) pedicle screw fixation. This study was designed to retrospectively compare the accuracy and efficacy of RA percutaneous pedicle screw fixation and traditional freehand FH pedicle screw fixation in the treatment of thoracolumbar fractures. A total of 26 cases were assigned to the RA group, and 24 cases were assigned to the FH group. The operation time, bleeding volume, and visual analog scale (VAS) score 1 day after the operation, and the anterior/posterior (A/P) vertebral height ratio of the injured vertebrae at 3 days and at internal fixation removal 1 year after the operation were compared between the two groups. Pedicle screw position accuracy was assessed according to Gertzbein criteria. The operation times of the RA group and FH group were 138.69 ± 32.67 minutes and 103.67 ± 14.53 minutes, respectively, and the difference was statistically significant. The intraoperative blood loss was 49.23 ± 22.56 ml in the RA group and 78.33 ± 23.90 ml in the FH group, and the difference was statistically significant. There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with before the operation in both groups (P <0.05). There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with that at fixation removal in both groups (P <0.05). The application of RA orthopedic treatment for thoracolumbar fractures can achieve good fracture reduction.

Surgical approach techniques for extraction of impacted or retained mesiodens: Literature review

The mesiodens corresponds to a number anomaly of dental development, which is formed between the upper central incisors. It is diagnosed by radiographic examination and the precise therapeutic option is extraction. The aim of this study is to review the different surgical techniques used in the extraction of intraosseous mesiodens by means of a review of the literature. Methodology: The collection of information was carried out through the search and selection of articles related to surgical techniques for the extraction of intraosseous mesiodens in the electronic databases PubMed, Google Scholar and Journal of Dental Research. The selection criteria taken into account were: age not older than 5 years, key words, human studies, impacted or retained mesiodens. From a total of 113 articles, 17 were chosen that are in accordance with the criteria of this research. Results and Conclusions: The free hand surgical approach has good results, but the use of surgical guides improves patient satisfaction, reduces operative time and difficulty of surgery and facilitates more precise osteotomies and incisions, without unnecessary tissue damage resulting in a more satisfactory postoperative improvement.

Comparison of three-dimensional printed patient-specific guides versus freehand approach for radial osteotomies in normal dogs: Ex vivo model.

To compare the accuracy of three-dimensional (3D) printed patient-specific guide (PSG) with a freehand (FH) approach for radial osteotomies in ex vivo normal dogs. Experimental study. Twenty four ex vivo thoracic limb pairs from normal beagle dogs. Computed tomography (CT) images were collected preoperatively and postoperatively. Three osteotomies tested (n = 8/group) were: (1) uniplanar 30° frontal plane wedge ostectomy, (2) oblique plane (30° frontal, 15° sagittal) wedge ostectomy, and (3) single oblique plane osteotomy (SOO, 30° frontal, 15° sagittal, and 30° external). Limb pairs were randomized to a 3D PSG or FH approach. The resultant osteotomies were compared with virtual target osteotomies by surface shape-matching postoperative to the preoperative radii. The mean ± standard deviation osteotomy angle deviation for all 3D PSG osteotomies (2.8 ± 2.8°, range 0.11-14.1°) was less than for the FH osteotomies (6.4 ± 6.0°, range 0.03-29.7°). No differences were found for osteotomy location in any group. In total, 84% of 3D PSG osteotomies were within 5° deviance from the target compared to 50% of freehand osteotomies. Three-dimensional PSG improved FH accuracy of osteotomy angle in select planes and the most complex osteotomy orientation in a normal ex vivo radial model. Three-dimensional PSGs provided more consistent accuracy, which was most notable in complex radial osteotomies. Future work is needed to investigate guided osteotomies in dogs with antebrachial bone deformities.

Dynamic Implant Surgery-An Accurate Alternative to Stereolithographic Guides-Systematic Review and Meta-Analysis.

(1) Background: Dynamic guided surgery is a computer-guided freehand technology that allows highly accurate procedures to be carried out in real time through motion-tracking instruments. The aim of this research was to compare the accuracy between dynamic guided surgery (DGS) and alternative implant guidance methods, namely, static guided surgery (SGS) and freehand (FH). (2) Methods: Searches were conducted in the Cochrane and Medline databases to identify randomized controlled clinical trials (RCTs) and prospective and retrospective case series and to answer the following focused question: "What implant guidance tool is more accurate and secure with regard to implant placement surgery?" The implant deviation coefficient was calculated for four different parameters: coronal and apical horizontal, angular, and vertical deviations. Statistical significance was set at a p-value of 0.05 following application of the eligibility criteria. (3) Results: Twenty-five publications were included in this systematic review. The results show a non-significant weighted mean difference (WMD) between the DGS and the SGS in all of the assessed parameters: coronal (n = 4 WMD = 0.02 mm; p = 0.903), angular (n = 4 WMD = -0.62°; p = 0.085), and apical (n = 3 WMD = 0.08 mm; p = 0.401). In terms of vertical deviation, not enough data were available for a meta-analysis. However, no significant differences were found among the techniques (p = 0.820). The WMD between DGS and FH demonstrated significant differences favoring DGS in three parameters as follows: coronal (n = 3 WMD = -0.66 mm; p =< 0.001), angular (n = 3 WMD = -3.52°; p < 0.001), and apical (n = 2 WMD = -0.73 mm; p =< 0.001). No WMD was observed regarding the vertical deviation analysis, but significant differences were seen among the different techniques (p = 0.038). (4) Conclusions: DGS is a valid alternative treatment achieving similar accuracy to SGS. DGS is also more accurate, secure, and precise than the FH method when transferring the presurgical virtual implant plan to the patient.

Patient-specific guide systems decrease the major perforation rate of pedicle screw placement in comparison to the freehand technique for adolescent idiopathic scoliosis.

This study aimed to compare the accuracy of pedicle screw (PS) placement between a low-profile three-dimensional (3D) printed patient-specific guide system and freehand technique for adolescent idiopathic scoliosis (AIS) surgery. Patients with AIS who underwent surgery between 2018 and 2023 at our hospital were included in the study. The 3D-printed patient-specific guide was used since 2021 (guide group). PS perforation was classified using Rao and Neo's classification (grade 0, no violation; grade 1, < 2mm; grade 2, 2-4mm; grade 3, > 4mm). Major perforations were defined as grades 2 or 3. The major perforation rate of PS, operative time, estimated blood loss (EBL), and correction rate were compared between the two groups. A total of 576 PSs were inserted in 32 patients (20 patients in the freehand (FH) group and 12 patients in the guide group). The major perforation rate was significantly lower in the guide group than in the FH group (2.1% vs. 9.1%, p < 0.001). Significantly fewer major perforations were observed in the guide group than in the FH group in the upper thoracic (T2-4) region (3.2% vs. 20%, p < 0.001) and lower thoracic (T10-12) region (0% vs. 13.8%, p = 0.001). The operative time, EBL, and correction rate were equivalent between the two groups. The 3D-printed patient-specific guide notably reduced the major perforation rate of PS without increasing EBL and operative time. Our findings indicate that this guide system is reliable and effective for AIS surgery.

Application of Real-time Augmented Reality-guided Osteotomy and Apex Location in Endodontic Microsurgery: A Surgical Simulation Study Based on 3D-printed Alveolar Bone Model

IntroductionAugmented reality (AR) is a novel visualization technique in which pregenerated virtual 3D content is superimposed on surgical sites. This study aimed to validate the viability of AR-guided endodontic microsurgery (ARG) and compare the changes in objective and subjective outcomes of surgical simulation using ARG and freehand (FH) endodontic microsurgery on customized 3D-printed models. MethodsWe created and printed a customized 3D alveolar bone model with artificial periapical lesions (APLs) based on cone-beam computed tomography. Eight models with 96 APLs were equally divided into ARG and FH groups. We planned surgical trajectories on rescanned printed models. Four inexperienced residents (IRs) performed ARG and FH on the models and completed pre and intraoperative confidence questionnaires for the subjective outcome. Postoperative cone-beam computed tomography scans of the models were reconstructed and analyzed, and all procedures were timed. We used pairwise Wilcoxon rank sum tests to compare objective outcomes. Kruskal–Wallis tests and post hoc pairwise Wilcoxon rank sum tests were used to compare subjective outcomes. ResultsCompared to the FH group, the ARG group significantly reduced deviation of the volume of bone removal, root-end resection, and deviation of bevel angle, with improved confidence of the IRs (P < .05); it also significantly increased surgical time and volume of unremoved APL (P < .05). ConclusionsWe customized an APL model through 3D printing and developed and validated a low-cost AR application framework, based on free AR software, for endodontic microsurgery. ARG allowed IRs to perform more conservative and precise surgical procedures with enhanced confidence.

Visual inertial odometry enabled 3D ultrasound and photoacoustic imaging.

There is an increasing need for 3D ultrasound and photoacoustic (USPA) imaging technology for real-time monitoring of dynamic changes in vasculature or molecular markers in various malignancies. Current 3D USPA systems utilize expensive 3D transducer arrays, mechanical arms or limited-range linear stages to reconstruct the 3D volume of the object being imaged. In this study, we developed, characterized, and demonstrated an economical, portable, and clinically translatable handheld device for 3D USPA imaging. An off-the-shelf, low-cost visual odometry system (the Intel RealSense T265 camera equipped with simultaneous localization and mapping technology) to track free hand movements during imaging was attached to the USPA transducer. Specifically, we integrated the T265 camera into a commercially available USPA imaging probe to acquire 3D images and compared it to the reconstructed 3D volume acquired using a linear stage (ground truth). We were able to reliably detect 500 µm step sizes with 90.46% accuracy. Various users evaluated the potential of handheld scanning, and the volume calculated from the motion-compensated image was not significantly different from the ground truth. Overall, our results, for the first time, established the use of an off-the-shelf and low-cost visual odometry system for freehand 3D USPA imaging that can be seamlessly integrated into several photoacoustic imaging systems for various clinical applications.

Clinical application of spinal robot in cervical spine surgery: safety and accuracy of posterior pedicle screw placement in comparison with conventional freehand methods

The novel robot-assisted (RA) technique has been utilized increasingly to improve the accuracy of cervical pedicle screw placement. Although the clinical application of the RA technique has been investigated in several case series and comparative studies, the superiority and safety of RA over conventional freehand (FH) methods remain controversial. Meanwhile, the intra-pedicular accuracy of the two methods has not been compared for patients with cervical traumatic conditions. This study aimed to compare the rate and risk factors of intra-pedicular accuracy of RA versus the conventional FH approach for posterior pedicle screw placement in cervical traumatic diseases. A total of 52 patients with cervical traumatic diseases who received cervical screw placement using RA (26 patients) and FH (26 patients) techniques were retrospectively included. The primary outcome was the intra-pedicular accuracy of cervical pedicle screw placement according to the Gertzbin-Robbins scale. Secondary outcome parameters included surgical time, intraoperative blood loss, postoperative drainage, postoperative hospital stay, and complications. Moreover, the risk factors that possibly affected intra-pedicular accuracy were assessed using univariate analyses. Out of 52 screws inserted using the RA method, 43 screws (82.7%) were classified as grade A, with the remaining 7 (13.5%) and 2 (3.8%) screws classified as grades B and C. In the FH cohort, 60.8% of the 79 screws were graded A, with the remaining screws graded B (21, 26.6%), C (8, 10.1%), and D (2, 2.5%). The RA technique showed a significantly higher rate of optimal intra-pedicular accuracy than the FH method (P = 0.008), but there was no significant difference between the two groups in terms of clinically acceptable accuracy (P = 0.161). Besides, the RA technique showed remarkably longer surgery time, less postoperative drainage, shorter postoperative hospital stay, and equivalent intraoperative blood loss and complications than the FH technique. Furthermore, the univariate analyses showed that severe obliquity of the lateral atlantoaxial joint in the coronal plane (P = 0.003) and shorter width of the lateral mass at the inferior margin of the posterior arch (P = 0.014) were risk factors related to the inaccuracy of C1 screw placement. The diagnosis of HRVA (P < 0.001), severe obliquity of the lateral atlantoaxial joint in the coronal plane (P < 0.001), short pedicle width (P < 0.001), and short pedicle height (P < 0.001) were risk factors related to the inaccuracy of C2 screw placement. RA cervical pedicle screw placement was associated with a higher rate of optimal intra-pedicular accuracy to the FH technique for patients with cervical traumatic conditions. The severe obliquity of the lateral atlantoaxial joint in the coronal plane independently contributed to high rates of the inaccuracy of C1 and C2 screw placements. RA pedicle screw placement is safe and useful for cervical traumatic surgery.

Formulation and evaluation of saponin based alcohol - free polyherbal hand sanitizer

Sanitization is essential in limiting the spread of infectious diseases. Alcohol based sanitizer formulations consists of toxic compounds which are harmful to human health and not environmental friendly. The purpose of the present research is to formulate a bio-derived alcohol free hand sanitizer. Saponins are secondary metabolites that are stored in the roots of many plant species, where they may act as antimicrobial phytoprotectants. Saponins were extracted by Soxhlet extractor using methanol as solvent. Saponins were tested for their individual and synergetic antimicrobial (Agar plate diffusion method) and anti-oxidant (Ferric Reducing Antioxidant Power (FRAP) assay) activity. Polyherbal sanitizer was formulated using saponin as the main ingredient. It was evaluated for its physical parameters and antimicrobial properties. The synergistic effect of saponins was higher when compared to the individual saponins’ antimicrobial activity. The formulated polyherbal sanitizer evinced acceptable organoleptic properties with slightly acidic pH and demonstrated antimicrobial properties against selected microorganisms with maximum activity against Staphylococcus aureus (concentration =100µl, zone of inhibition diameter =24±1 mm). The antimicrobial efficacy of the formulated sanitizer was comparable to that of a commercially available hand sanitizer.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7