Povidone-iodine Group Research Articles

Treatment Outcome with Talc or Povidone Iodine in Recurrent Pneumothorax or Recurrent Pleural Effusion

Abstract Background: The present study assessed the treatment outcome of pleurodesis with talc or povidone iodine in recurrent pneumothorax or recurrent pleural effusion and the efficacy and safety of talc or povidone iodine in the same. Materials and Methods: A total of 23 patients with recurrent pneumothorax (15) and recurrent pleural effusion (8) were enrolled. Pleurodesis with either talc or povidone iodine was performed via intercostal drainage tube. Treatment outcome along with complications was studied by routine follow up of patients for 6 months. Results: A total of 23 patients (19 males and 4 females) were included in the study. 16 patients were subjected to povidone iodine pleurodesis while 7 patients underwent talc pleurodesis. Mean age of patients was 38.68+19.6 for the povidone iodine group and 43.85+16.32 for the talc group. Eight (34.78%) patients had recurrent pleural effusion whereas 15 (65.21%) patients had recurrent pneumothorax. Post procedure pain was experienced by 5 (31.25%) patients in the povidone iodine group and 4 (57.14%) patients in the talc group. Two (12.5%) and one (14.28%) patient had fever following povidone iodine and talc pleurodesis respectively. Pleurodesis was successful in 13 (81.25%) patients in the povidone iodine group and 7 (100%) patients in the talc group, during the follow up period of 6 months. Conclusion: Both talc and povidone iodine are effective pleurodesis agents and povidone iodine can be considered a good alternative to talc as a pleurodesis agent in recurrent cases of pneumothorax or pleural effusion, irrespective of the underlying cause, as it is safe, easily available and cost effective. Keywords: Recurrent pneumothorax, Recurrent pleural effusion, Pleurodesis, Talc, Povidone Iodine

Pain during PICC insertion in preterm infants: the needle is not the only problem

Objective To evaluate whether warm povidone-iodine (PI) application before peripherally inserted central catheter (PICC) placement eased pain related to the procedure in premature infants and reduced the duration of the procedure and the number of attempts. Methods A prospective randomized controlled trial was conducted with infants born before 32 weeks of gestation who required the first placement of the PICC. Skin disinfection was performed with warm PI before the procedure in the warm PI(W-PI) group, whereas PI kept at room temperature was used in the regular PI(R-PI) group. NPASS scores of the infants were evaluated three times: at baseline(T0), during skin preparation(T1), and during needle insertion(T2). Results Fifty-two infants (26 in the W-PI group,26 in the R-PI group) were enrolled in the study. The perinatal and baseline demographic characteristics did not significantly differ between the two groups. While the median NPASS scores at T0 and T2 were similar between the groups, the median T1 score was significantly higher in the R-PI group(p = .019). While the median NPASS scores at T1 and T2 were similar in the R-PI group, there was a significant difference in the W-PI group, with NPASS scores being significantly lower at T1 compared to T2. The results demonstrate that skin disinfection was just as painful as needle insertion in the R-PI group. The duration of the procedure and the number of needle insertions were significantly lower in the W-PI group. Conclusions Before invasive interventions, such as PICC insertion, we recommend warm PI as a part of non-pharmacological pain management.

Comparison of the Effectiveness between Povidone-Iodine and Bleomycin as Pleurodesis Agents in Patients with Malignant Pleural Effusion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Background: Malignant pleural effusion (MPE) is a clinical problem in which fluid accumulates in the pleural cavity. This condition is generally caused by malignancy. Pleurodesis is a medical procedure in the form of fusion of the visceral and parietal pleura in order to prevent the recurrence of pleural effusion. Pleurodesis has the risk of causing chronic inflammation, which will trigger excessive attachment between the visceral and parietal pleura. Of course, an intervention is needed to reduce the risk of inflammation, one of which is by using a pleurodesis agent, which has an anti-inflammatory effect. This study aimed to compare the efficacy of povidone-iodine compared to bleomycin as a pleurodesis agent in malignant pleural effusion patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
 Methods: Prospective cohort study, where as many as 46 research subjects participated in this study and were grouped into groups that received povidone-iodine and bleomycin. The success of pleurodesis agents was assessed by the production of WSD. Data analysis was carried out using SPSS univariate and bivariate.
 Results: The results of the study showed that there was no statistical difference between the 10% povidone-iodine agent and the bleomycin agent, where p>0.05. However, in the 10% povidone-iodine group, the success rate was 100%, while in the bleomycin group, the success rate was 82.6%.
 Conclusion: There was no significant difference in the efficacy of povidone-iodine as a pleurodesis agent compared to bleomycin in patients with malignant pleural effusion at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

Comparison of olanexidine versus povidone-iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single-center randomized clinical trial.

Surgical site infection (SSI) is one of the most common postoperative complications in gastrointestinal surgery. To clarify the superiority of 1.5% olanexidine, we conducted a randomized prospective clinical trial that enrolled patients undergoing gastrointestinal surgery with operative wound classes II-IV. To evaluate the efficacy of 1.5% olanexidine in preventing SSIs relative to 10% povidone-iodine, we enrolled 298 patients in each group. The primary outcome was a 30-day SSI, and the secondary outcomes were incidences of superficial and deep incisional SSI and organ/space SSI. In addition, subgroup analyses were performed. The primary outcome of the overall 30-day SSI occurred in 38 cases (12.8%) in the 1.5% olanexidine group and in 53 cases (18.0%) in the 10% povidone-iodine group (adjusted risk ratio: 0.716, 95% confidence interval: 0.495-1.057, p = 0.083). Organ/space SSI occurred in 18 cases (6.1%) in the 1.5% olanexidine group and in 31 cases (10.5%) in the 10% povidone-iodine group, with a significant difference (adjusted risk ratio: 0.587, 95% confidence interval: 0.336-0.992, p = 0.049). Subgroup analyses revealed that SSI incidences were comparable in scheduled surgery (relative risk: 0.809, 95% confidence interval: 0.522-1.254) and operative wound class II (relative risk: 0.756, 95% confidence interval: 0.494-1.449) in 1.5% olanexidine group. Our study revealed that 1.5% olanexidine reduced the 30-day overall SSI; however, the result was not significant. Organ/space SSI significantly decreased in the 1.5% olanexidine group. Our results indicate that 1.5% olanexidine has the potential to prevent SSI on behalf of povidone-iodine.

Betadine Soaking of Silicone Coupons Minimally Impacts Acellular Dermal Matrix Incorporation in a Preclinical Primate Model.

Microbial pathogens local to prosthetic breast devices may promote infection, inflammation, and capsular contracture. Although antimicrobial solutions have been used, their effects on human acellular dermal matrix (HADM) incorporation when used with prosthetic devices are unknown. The authors' objective was to histologically assess the effect of 10% povidone iodine (PI)-saturated tissue expander (TE) exposure on HADM biological response in a primate model. They hypothesized that PI exposure would not negatively affect the HADM biological response. Samples (1.5 × 1.5 cm) from smooth silicone TEs were saturated in saline or PI for 2 minutes and sutured to HADM to create HADM/TE constructs. Primates implanted subcutaneously with saline ( n = 9) and PI-treated HADM/TE ( n = 9) construct pairs were evaluated histologically for biological response after 2 or 4 weeks by means of a host response scoring scale (1 to 9), including recellularization, neovascularization, and inflammation. Inflammatory cells (eosinophils, lymphocytes, neutrophils, histiocytes, foreign-body giant cells) and evidence of HADM remodeling (fibroblasts, vessels) were further evaluated by means of a cell-specific scoring scale (0 to 4) and corroborated by immunostaining (CD3, CD20, CD68, FSP-1, collagen type IV). Mean histology scores were similar between saline- and PI-exposed HADM at 2 weeks (5.3 ± 0.9 and 5.6 ± 0.5; P = 0.52) and 4 weeks (4.6 ± 1.0 and 4.2 ± 0.9; P = 0.44). There was no difference in inflammatory cell presence at 2 and 4 weeks between groups. Fibroblast infiltration differences were insignificant between groups but exhibited trends toward an increase between time points for saline (1.6 ± 0.7 to 1.8 ± 0.8) and PI (1.3 ± 0.8 to 1.8 ± 1.0) groups, suggesting HADM incorporation over time. Data suggest that HADM exposure to PI-treated TEs does not negatively affect inflammation, vascularization, recellularization, incorporation, or host response to HADM in this model. PI is a surgical pocket irrigant used to address bacterial colonization, but its impact on ADM incorporation is unknown. This study demonstrates similar biologic response to ADMs adjacent to PI- or saline-saturated TEs in a primate model.

Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine

Intraoperative wound irrigation (IOWI) is an important step in preventing surgical site infection (SSI). This study compared the effectiveness of saline with gentamicin versus povidine-iodine (PI) as IOWI solutions in preventing SSI in open spine surgery. It is a prospective comparative study. Patients who had noninstrumented open spine surgery were randomized into 2 groups. Group A and B patients had their surgical wounds irrigated with saline containing gentamicin solution and dilute PI solution, respectively. Both groups were assessed for the occurrence of SSI. A total of 80 patients, divided into 2 groups of 40 each completed the study. Overall, the SSI rate was 17.5% for patients in the normal saline containing gentamicin group (A) and 2.5% for those in the dilute PI group (B), this difference was statistically significant (P= 0.025). The cervical and thoracic spine regions have the same SSI rate (7.1% and 0%, respectively) in both groups. However, in the lumbosacral region, the SSI rate was 31.6% in A and 0% in B, this was statistically significant (P= 0.006). The isolated organisms in patients with SSI were staphylococcus species (42.86% of SSI in A and 0% in B) and pseudomonas species (42.86% of SSI in group A and 100% in group B), and this difference was profound in the lumbosacral spine region (P= 0.008). IOWI with 3.5% dilute PI solution is more efficacious in preventing SSI and has wider microbial coverage compared to normal saline containing gentamicin solution as IOWI fluid in noninstrumented open spine surgery.

Urinary iodine excretion after using povidone iodine or chlorhexidine gluconate for topical disinfectant in patients undergoing thyroidectomy due to thyroid carcinoma: When to do radio active iodine therapy?

Povidone Iodine (PI) is the most frequent antiseptic used as a topical disinfectant in surgery. It has been reported high transcutaneous iodine absorption due to topical PI usage, but there is a lack of data in periods of excess iodine depletion. This is a cross-sectional study designed to assess serial urinary iodine concentration (UIC) after topical administration of PI to evaluate the transcutaneous iodine absorption and the proper iodine depletion time for safe administration of Radio Active Iodine (RAI) therapy as ablative or adjuvant therapy. Thirty-seven patients with papillary thyroid carcinoma undergoing total thyroidectomy were assigned to the PI group (n = 20) or chlorhexidine gluconate (CHG) group (n = 17). In the PI group, the UIC levels rose to a maximum of 2 times in the 4th week after administration and returned to pre-operative levels in the 8th week after. In the CHG group, there was a decrease in UIC levels due to a low iodine diet (LID) with a significant P-value of 0.001, <0.001, and 0.001 in the 2nd, 4th, and 8th weeks follow up respectively compared to the PI group. The urinary excretion of excess iodine lasts about 8 weeks after total thyroidectomy until iodine levels turn back to pre-operative values. If the thyroidectomy was prepared with PI, RAI is better to be performed 6-8 weeks after surgery rather than the standard prescription of 4 weeks.

In vivo efficacy of 2% povidone iodine, chlorhexidine gluconate, and herbal extract mouthwash on SARS-CoV-2 viral load in saliva: A randomized clinical trial.

One of the major techniques to reduce the transmission rate of COVID-19 would be to decrease the viral titers of SARS-CoV-2 in the saliva of infected patients and it is particularly useful in a dental setting. The present study evaluated the change in salivary viral load of COVID-19 patients using povidone iodine (PI), chlorhexidine (CHX), and an herbal extract (RightSure®) oral antiviral herbal mouthwash (HM) at clinically recommended duration and concentrations. Thirty individuals with SARS-CoV-2 were randomly allocated to three groups: (1) Group 1, PI mouthwash; (2) Group 2, CHX mouthwash; and (3) Group 3, HM mouthwash. A baseline salivary throat sample was collected from all the participants who were later instructed to rinse with their respective mouthwash for 30 s. A second salivary sample was collected 30 min after rinsing. The SARS-CoV-2 viral load was analyzed using real-time reverse-transcription polymerase chain reaction wherein the cyclic threshold (Ct) values were evaluated. Independent t-test analysis reported a statistically significant difference concerning the PI group (before-after comparison) (P < 0.05). The rest of the two study groups failed to report any significant difference in the nucleocapsid gene and open reading frame 1a gene levels. While all three types of mouthwash increased the Ct values, a statistically significant difference was observed with PI mouthwash, indicating that it might potentially reduce the spread of the SARS-CoV-2 virus, especially via aerosol but further studies with larger sample size and longer follow-up periods are required to investigate this relationship.

Secretome of bovine umbilical vein endothelial cells promote wound healing regeneration on the second degree rat model burn injury.

Burn injuries are an alarming indicator of the sensitivity of human tissue when confronted with high temperatures or chemicals. The current treatment for burn wounds needs to be improved and more extensive in scope. Significant research advances concerning the therapeutic potential of secretomes over the past two decades have expanded the range of therapies that utilize secretomes to encompass populations other than stem cells. This study details how the secretome extracted from the bovine umbilical vein endothelial cell (BUVEC) promotes the healing of burn injuries. The 48 rats were divided into four groups, namely the control group with povidone-iodine, the 5% BUVEC-conditioned medium (CM) cream group, the 10% BUVEC-CM cream group, the 15% BUVEC-CM cream group. Animals induced type II burns under anesthesia. Treatment is carried out topically, two times a day. Every day the wound was measured. The animals were put to sleep for samples on days 5, 13, 21, and 19. Samples in the form of skins were soaked in 4% paraformaldehyde and processed with paraffin-embedded for tissue preparations. The research results were processed using two way ANOVA. The study showed that on day 5, wound closure occurred, whereas in the povidone-iodine group, macroscopically, the wound closed faster. Epithelial repair, increased fibroblasts and collagen, and blood vessel formation greatly increased in the 15% BUVEC-CM group on days 13, 21, and 29. Taken together, BUVEC secretome promoted fibroblast regeneration, collagen formation, re-epithelialization, and hair follicle regeneration on the burn injury wound healing.

Assessment of Pre-operative Vaginal Preparation for Laparoscopic Hysterectomy.

Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine). This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications. Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively. Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.

A quality improvement study on the relationship between intranasal povidone-iodine and anesthesia and the nasal microbiota of surgery patients.

The composition of the nasal microbiota in surgical patients in the context of general anesthesia and nasal povidone-iodine decolonization is unknown. The purpose of this quality improvement study was to determine: (i) if general anesthesia is associated with changes in the nasal microbiota of surgery patients and (ii) if preoperative intranasal povidone-iodine decolonization is associated with changes in the nasal microbiota of surgery patients. One hundred and fifty-one ambulatory patients presenting for surgery were enrolled in a quality improvement study by convenience sampling. Pre- and post-surgery nasal samples were collected from patients in the no intranasal decolonization group (control group, n = 54). Pre-decolonization nasal samples were collected from the preoperative intranasal povidone-iodine decolonization group (povidone-iodine group, n = 97). Intranasal povidone-iodine was administered immediately prior to surgery and continued for 20 minutes before patients proceeded for surgery. Post-nasal samples were then collected. General anesthesia was administered to both groups. DNA from the samples was extracted for 16S rRNA sequencing on an Illumina MiSeq. In the control group, there was no evidence of change in bacterial diversity between pre- and post-surgery samples. In the povidone-iodine group, nasal bacterial diversity was greater in post-surgery, relative to pre-surgery (Shannon's Diversity Index (P = 0.038), Chao's richness estimate (P = 0.02) and Inverse Simpson index (P = 0.027). Among all the genera, only the relative abundance of the genus Staphylococcus trended towards a decrease in patients after application (FDR adjusted P = 0.06). Abundant genera common to both povidone-iodine and control groups included Staphylococcus, Bradyrhizobium, Corynebacterium, Dolosigranulum, Lactobacillus, and Moraxella. We found general anesthesia was not associated with changes in the nasal microbiota. Povidone-iodine treatment was associated with nasal microbial diversity and decreased abundance of Staphylococcus. Future studies should examine the nasal microbiota structure and function longitudinally in surgical patients receiving intranasal povidone-iodine.

Chlorhexidine (2.5%)–alcohol versus povidone-iodine (10%) alcohol for surgical site antisepsis in cesarean section in a tertiary care hospital – A prospective observational and analytical study

Background: Rising trends of cesarean section globally demand identification of most suitable pre-operative antiseptic agent to minimize surgical site infections (SSI) and its consequences. Aims and Objectives: The aims of this study were to determine, compare, and analyze SSI developing following the use of chlorhexidine (2.5%)–alcohol and povidone-iodine (10%) alcohol as pre-operative antiseptic agents in cesarean section. Materials and Methods: A prospective, observational, and analytical study was conducted in a tertiary care center for 1 year, where 300 women receiving pre-cesarean surgical site antisepsis with chlorhexidine (2.5%)–alcohol were compared with another 300 receiving povidone-iodine (10%) alcohol. Results: The two study groups were compared in terms of various sociodemographic and clinical parameters which might act as confounding factors and were found to be similar. As compared to women receiving povidone-iodine (10%) alcohol, women receiving chlorhexidine (2.5%)–alcohol had significantly lesser incidence of overall (P&lt;0.001), superficial (P&lt;0.001), and deep (P&lt;0.05) SSI, infections developing at 48 h–5 days (P&lt;0.001) and at 5 days–30 days (P&lt;0.05). There was no significant difference among the two groups with respect to wound swab culture reports and post-SSI inflammatory markers. As compared to the povidone-iodine group, in the chlorhexidine group, a significantly (P&lt;0.05) greater percentage healed with meager dressing and a significantly (P&lt;0.05) lesser percentage required secondary suturing and readmissions and had a significantly (P&lt;0.05) lesser mean duration of hospital stay. Conclusion: Chlorhexidine (2.5%)–alcohol appears to be a better pre-operative surgical site anti-septic agent than povidone-iodine (10%) alcohol in cesarean section.

&lt;strong&gt;Effect of 20% ethanol extract of Subang pineapple gel on oral mucosa incisional wound length&lt;/strong&gt;

ABSTRACTIntroduction: Incisional wound in oral mucosa is usually performed during oral surgery but can also be caused by injury. Although wounds can naturally heal, the application of medicine might help accelerate wound healing. Proving the effectiveness of natural ingredients is currently being promoted because Indonesia owns many plants that are used empirically. The use of natural substances is also supported because it is relatively easy to obtain and safe if used properly. Subang Pineapple (Ananas comosus L. Merr) is one of the produce of West Java that people consume and empirically use on wounds. Its fruit and core contain active ingredients that affect wound healing, such as bromelain enzyme, flavonoids, saponin, and alkaloids. This study aims to determine the effect of fruit ethanol extract gel of Subang pineapple on Wistar rats oral incisional wound observed from wound length. Methods: 25 rats were divided into five groups: baseline, negative control, positive control with 10% povidone-iodine, positive control with AloclairTM gel, and treatment group with 20% pineapple ethanol extract gel used as wound model on the buccal mucosa. The length of the incisional wound area was examined on days 0, 3, 7, and 14. Measurement of wound length was performed using a periodontal probe. Results: The mean of wound length was smaller especially on day 3 in the treatment group. Post-Hoc Mann-Whitney test (p&lt;0.05 considered significant) showed the wound decrease with Subang pineapple extract was better than the negative control (p=0.008) and povidone-iodine group (p=0.007) but didn’t show a significant difference with the Aloclair™ gel group (p=0.0118). Conclusion: Topical application of pineapple extract affected oral mucosa incisional wound healing and had a potential to accelerate wound closure. Further study with different concentrations and another type of wound can be suggested.Keywords: incisional wound; pineapple extract; subang pineapple; wound healing

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study

This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

Comparing the efficacy of povidone-iodine and normal saline in incisional wound irrigation to prevent superficial surgical site infection: a randomized clinical trial in gastric surgery

Prevention of surgical site infection (SSI) after gastrectomy has received increasing attention. Prophylactic incisional wound irrigation has been advocated to reduce SSI, but the choice of solution remains under debate. To compare the efficacies of wound irrigation with normal saline (NS) and povidone-iodine (PVI) for the prevention of SSI after gastrectomy, and to identify the risk factors for SSI. This randomized, single-centre clinical trial included 340 patients with gastric cancer. They were assigned at random into two groups (ratio 1:1) to receive either 0.9% NS or 1.0% PVI solution for incisional irrigation before wound closure. The primary endpoint was postoperative SSI within 30 days of gastrectomy, and the secondary endpoint was the length of hospital stay. In total, 333 patients were included in the modified intent-to-treat group, and the SSI rate did not differ significantly between the PVI group (11/167, 6.59%) and the NS group (9/166, 5.42%) [odds ratio (OR) 1.131, 95% confidence interval (CI) 0.459-3.712; P=0.655]. Moreover, the difference between the two groups in terms of length of hospital stay was not significant (P=0.301). Body mass index (BMI) (OR 2.639, 95% CI 1.040-6.694; P=0.041) and postoperative complications (OR 2.565, 95% CI 1.023-6.431; P=0.045) were identified as independent risk factors for SSI. NS and PVI had similar efficacy as prophylactic wound irrigation for the prevention of SSI after gastrectomy. The risk of SSI was higher in patients with high BMI or postoperative complications.

Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial

Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture. We conducted a multiple-period, cluster-randomised, crossover trial (Aqueous-PREP) at 14 hospitals in Canada, Spain, and the USA. Eligible patients were adults aged 18 years or older with an open extremity fracture treated with a surgical fixation implant. For inclusion, the open fracture required formal surgical debridement within 72 h of the injury. Participating sites were randomly assigned (1:1) to use either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate immediately before surgical incision; sites then alternated between the study interventions every 2 months. Participants, health-care providers, and study personnel were aware of the treatment assignment due to the colour of the solutions. The outcome adjudicators and data analysts were masked to treatment allocation. The primary outcome was surgical site infection, guided by the 2017 US Centers for Disease Control and Prevention National Healthcare Safety Network reporting criteria, which included superficial incisional infection within 30 days or deep incisional or organ space infection within 90 days of surgery. The primary analyses followed the intention-to-treat principle and included all participants in the groups to which they were randomly assigned. This study is registered with ClinicalTrials.gov, NCT03385304. Between April 8, 2018, and June 8, 2021, 3619 patients were assessed for eligibility and 1683 were enrolled and randomly assigned to povidone-iodine (n=847) or chlorhexidine gluconate (n=836). The trial's adjudication committee determined that 45 participants were ineligible, leaving 1638 participants in the primary analysis, with 828 in the povidone-iodine group and 810 in the chlorhexidine gluconate group (mean age 44·9 years [SD 18·0]; 629 [38%] were female and 1009 [62%] were male). Among 1571 participants in whom the primary outcome was known, a surgical site infection occurred in 59 (7%) of 787 participants in the povidone-iodine group and 58 (7%) of 784 in the chlorhexidine gluconate group (odds ratio 1·11, 95% CI 0·74 to 1·65; p=0·61; risk difference 0·6%, 95% CI -1·4 to 3·4). For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost. These findings might also have implications for antisepsis of other traumatic wounds. US Department of Defense, Canadian Institutes of Health Research, McMaster University Surgical Associates, PSI Foundation.

Perbandingan Skin Preparation Kombinasi Alkohol 70% dan Chlorhexidine Gluconate 4 % dengan Kombinasi Chlorhexidine Gluconate 4% dan Povidone Iodine 10% terhadap Jumlah Koloni Kuman pada Persiapan Pembedahan

This study aims to examine differences in the number of bacterial colonies after skin preparation using a combination of 70% alcohol and 4% chlorhexidine gluconate with 4% chlorhexidine gluconate and 10% povidone-iodine. This study used a quasi-experimental method with a pre-post test design. The results showed a decrease in the number of bacterial colonies by 99.84% in the 70% alcohol group and 4% chlorhexidine gluconate, and 99.77% in the 4% chlorhexidine gluconate and 10% povidone-iodine groups. While the difference in the number of bacterial colonies between the two groups, there was no significant difference with a p-value of 0.320 &gt; 0.05. In conclusion, both groups effectively reduced germ numbers, but there was no significant difference in effectiveness between the two groups.&#x0D; &#x0D; Keywords: Alcohol, Chlorhexidine, Iodine, Skin Preparation

Utility of mouth rinses with povidone-iodine and hydrogen peroxide in patients with COVID-19

IntroductionPovidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2. MethodsA “non-interventional trial” in 88 patients (43±17 yrs., 55% men) with SARS-CoV-2 in nasopharyngeal swabs (RT-PCR). 31 received mouth rinses/gargling with povidone-iodine (every 8h, two consecutive days), 17 with mouth rinses/gargling of hydrogen peroxide, and 40 controls. Were repeated PCR in 3, 11 and 17 days. ResultsAfter intervention the viral load (Log10 copies/ml) remained similar in povidone-iodine (4.3±2.7 copies/ml), hydrogen peroxide (4.6±2.9 copies/ml; p=0.40) and controls (4.4±3.0 copies/ml). The percentage of patients with a negative result in the second PCR was 27% in povidone-iodine group, 23% in hydrogen peroxide and 32% in controls; in the third PCR, 62%, 54% y 58% respectively; and in the fourth PCR, 81%, 75% y 81%. ConclusionOur results do not support the clinical usefulness of mouth rinses/gargling with povidone-iodine or hydrogen peroxide in patients with COVID-19.

Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients.

To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity. Participants 55 and older were enrolled within 24hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5mL povidone-iodine 10% or 2.5mL sodium bicarbonate to 240mL of isotonic nasal irrigation twice daily for 14days. The primary outcome was hospitalization or death from COVID-19 within 28days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive. Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X2 = 8.728, P = .0031) regardless of additive. SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.

COMBINATION OF DECIDUAL DENTAL STEM CELL AND PLATELET RICH PLASMA IN FIBROBLAST FORMATION IN THE JAWBONE REGENERATION OF WISTAR RATS

Background: Orthodontic tooth movement is caused by mechanichal forces that cause pseudo-inflammation with the result that FGF (Fibroblast Growth Factors) was activated. The combination of SHED (Stem Cell From Human Exfoliated Deciduous Theeth) and PRP (Platelet Rich Plasma) hydrogels can affect the formation of fibroblast in the alveolar bone regeneration. The purpose of this study is the effect determination of SHED and PRP hydrogels for fibroblast formation in alveolar bone regeneration in wistar rats. Method: An experimental study was held using post-test only control group design. There were four groups, namely the PRP hydrogel group, the SHED hydrogel group, the SHED and PRP hydrogel group, and the povidone iodine group (n=8) treated with orthodontic tooth movement. Their mandibular tissue was made as histologycal slide, and the FGF expression were observed microscopically with 100x magnification. The data analyzed by ANNOVA and LSD test. Result: There was a significant effect of the combination of SHED and PRP hydrogel in ordering fibroblast in alveolar bone regeneration by ANNOVA test 0.001 (&lt;0.05). This is because SHED and PRP are able to stimulate FGF expression through external stimulation. Conclusion: It concluded that the combination of SHED and PRP hydrogel affected fibroblast formation on alveolar bone regeneration in wistar rats