Topical Application Of Povidone-iodine Research Articles

Topical Application of Povidone Iodine to Minimize Post Appendectomy Wound Infection

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

Thyroid storm, clouds and silver linings

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

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

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

Transforming growth factor \u03b2 plays an important role in enhancing wound healing by topical application of Povidone-iodine

Povidone-iodine (PVI) is principally used as an antimicrobial agent. It has been found that 0.5% PVI can attenuate congestion, edema and pain induced by pressure sores. Thus this study aimed to assess the effects of 0.5% PVI on acute skin wounds. Four full-thickness excisional wounds were generated on the dorsal skin of male Sprague-Dawley rats with a 10-mm sterile punch. Two wounds were left untreated and the other two were dressed with gauze with 0.5% PVI for 1 hour per day for the first 5 days after injury. 10-mm full-thickness excisional wounds were also generated on the dorsal skin of rats treated with 10 mg/kg SB431542 and all wounds were treated with 0.5% PVI for 5 days. PVI treatment enhanced wound healing via promotion of expression of α SMA and TGF β, neovascularization and re-epithelialization. Interleukin 6 was reduced following PVI treatment. Inhibition of TGF β abolished the effect of PVI treatment on wound closure. These data show that topical application of 0.5% PVI could promote acute skin wound healing though increased expression of TGF β leading to enhanced formation of granulation tissue, even in the absence of obvious infection.

A Comparative Study on Wound Healing with Topical Application of Human Epidermal Growth Factor verses Application of Povidone-Iodine in Diabetic Wounds

Diabetic wounds or ulcers are major complication of diabetes mellitus. Diabetes is a metabolic disorder that impedes the normal steps of wound healing process Major increase in morbidity in diabetic patients is due to macro and micro vascular complications including failure of wound healing process. Diabetes is the cause for more than 3/4 th lower limb amputation Increased glucose in the tissue precipitates infection. The aim of this study is to establish whether topical application of human epidermal growth factor enhance wound healing better than conventional povidone-iodine dressing in diabetic wounds. For one group of patients, topical application of recombinant human epidermal growth factor gel over the wound and wound dressing was done twice daily For other group of patients, topical application of povidone-iodine over the wound and wound dressing done twice daily. The Human Epidermal Growth Factor Application group patients equally belonged to the male gender class interval (n=15, 50%). In the Conventional Povidone Iodine Dressing group patients, majority belonged to the male gender class interval (n=15, 50%). The association between the intervention groups and gender distribution is considered to be not statistically significant since p > 0.05 as per fishers exact test. The results of the study conclude that the topical application of human epidermal growth factor enhances wound healing significantly and is better than conventional povidine iodine dressing.

Antibiótico intracameral para prevenção de endoftalmite aguda pós-cirurgia de catarata no Brasil

Acute endophthalmitis is a serious complication of cataract surgery that, given its infectious etiology, can be prevented using antiseptics and antibiotics. Various drugs and different formulations and routes of administration have been tested for this purpose; however, thus far, besides the well-established preoperative topical application of povidone-iodine, the use of intracameral cefuroxime at the end of surgery is the most effective measure to prevent acute endophthalmitis. However, in Brazil, as in the United States, cefuroxime is not available for intraocular use. This necessitates a search for feasible alternatives to reduce the incidence of this serious surgical complication.

Use of extracts of sunflower-seed oil (Helianthus annus L.) for the treatment of cutaneous injuries in equine metatarsus: a case report

This study describes an eighteen-year-old filly after an injury in the region of the dorsal left metatarsus, admitted to veterinary assistance. In addition to the normal treatment, which was characterized by cleaning and topical application of povidone-iodine, sunflower-seed oil was applied locally in order to improve and fasten wound healing. Macroscopic and clinical improvements of the wound healing were observed. The preliminary chemical and physical analyses have shown the stearic acid as the main component. The results suggest that the sunflower-seed oil enable a faster wound healing in horses.

Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako, Mali: an open randomized trial

Pyoderma (bacterial superficial skin infection) is an extremely common disorder in tropical developing countries. In these settings, Streptococcus pyogenes is considered to be the main etiological agent. Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine-penicillin is recommended, no recommendation exists for the treatment of pyoderma in this setting. The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali, by comparison with oral erythromycin. In Bamako, 132 patients with pyoderma, diagnosed and graded as "severe" on clinical grounds, were randomly assigned to an oral treatment by either amoxicillin (50 mg/kg per day) or erythromycin; infections of the follicular appendage were excluded. Both drugs were associated with the topical application of povidone iodine. The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features, indicating successful treatment. Three patients were lost to follow-up. Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin (P = 0.00). Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali. Owing to its efficacy, added to high availability and low cost, this compound should be considered a first-line treatment of this disorder in this country, and perhaps in other countries where this condition presents in a similar way.

Changes in Staphylococcus aureus density and lesion severity after topical application of povidone-iodine in cases of atopic dermatitis

A case-control study was performed to examine the efficacy of 10% povidone-iodine solution applied to atopic dermatitis patients. The density of Staphylococcus aureus on the eczematous lesions and the lesion severity before and after the topical application of povidone-iodine were compared. We found a 10–100-fold decrease in the density of S. aureus after povidone-iodine treatment in patients colonizing S. aureus at an initial density of >1000 CFU/10 cm 2. Erythema and exudation also decreased after povidone-iodine treatment in patients colonizing S. aureus at an initial density of >1000 CFU/10 cm 2. The 10% povidone-iodine solution disinfected S. aureus cells when added immediately after the cells were mixed in human plasma; however, 10% povidone-iodine solution only reduced the density of S. aureus cells by 10–100-fold when S. aureus cells were harvested after a 24 h incubation in human plasma. Staphylococcus aureus cells harvested after 24 h incubation in human plasma were often surrounded by fibrin bundles and cells circumscribed by fibrin bundles could not be disinfected with 10% povidone-iodine solution. We suggest that S. aureus cells may produce biofilm-like structures in atopic dermatitis patients and that these structures may help S. aureus cells resist the 10% povidone-iodine treatment.

652 Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine

652 Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine

Decreased T3 and T4 levels following topical application of povidone-iodine in premature neonates.

Thyroid function and iodine levels of 30 preterm neonates were examined before and up to five days after topical exposure to 10% povidone-iodine application. Urinary iodine excretion significantly increased in the group closest to term (8.9 +/- 1.2 mg I/g creatinine x 10) vs controls (3.5 +/- 0.5 mg; p < 0.01). T3 levels significantly decreased at all sub-group gestational ages vs controls (p < 0.01-0.05). Similarly, both FT4 and TT4 levels were lower in the subgroups vs controls (p < 0.01-0.05). TSH levels however did not rise in any group. These data suggest partial failure of thyroid hormone synthesis, in a population of high-risk infants possibly already exhibiting features of the euthyroid-sick syndrome. Topical iodine-containing antiseptic solutions should be used with caution in this population since these antiseptics may modify serum thyroid hormone concentrations rapidly.

Hypothyroidism caused by topical povidone-iodine in a newborn with omphalocele

A case of physiologic hypothyroidism caused by the topical application of povidone-iodine (PVPI) in a newborn with an omphalocele is presented. The literature on systemic absorption and effects of PVPI is reviewed. A management strategy is offered.

Cisternal drainage after early operation of ruptured intracranial aneurysm.

The authors reviewed 22 cases of intracranial aneurysm of the anterior part of the circle of Willis. All patients presented with the signs and symptoms of subarachnoid hemorrhage (SAH) and were in good neurological condition on admission. In all cases, early operation was performed to obliterate aneurysm. Subarachnoid blood clots were extensively removed and cisternal drainage was done. With topical application of povidone-iodine and intravenous administration of antibiotics, cisternal drainage continued for 14 days or more after the onset of SAH in 21 cases. Five patients developed symptomatic vasospasm, which was treated with hypervolemia and hypertension, and three received shunts later for chronic hydrocephalus. The overall result demonstrated that 21 patients were independent and had returned to their previous social lives. Therefore, it was strongly recommended that patients is good neurological condition after SAH secondary to ruptured intracranial aneurysm be treated with early operation, removal of subarachnoid clots, and long term application of cisternal drainage.

Protein-Linked Iodotyrosines in Serum after Topical Application of Povidone-Iodine (Betadine)

Markedly elevated serum PBI levels occur after therapy with povidone-iodine (Betadine), an iodine-polyvinylpyrrolidone iodophor. In this study, we investigated the serum iodine compounds from a severely burned patient with normal initial thyroid function tests who was swabbed with Betadine ointment and received daily therapeutic baths in Betadine. Three and 9 days after therapy, his serum contained 93 and 168 micrograms PGI/dl, respectively (normal range, 4-8), while the serum T4 and free T4 index were normal; the serum T3 level, however, was abnormally depressed. Most of the PBI was in albumin, and hydrolysis of the serum proteins with proteases released 35% of the PBI as monoiodotyrosine, 3.2% as diiodotyrosine, 0.01% as T3, and 2.5% as T4, as determined by competitive radioassays, anion exchange, and reversed phase high pressure liquid chromatography. The same concentrations of T4 and T3 were detected before and after hydrolysis. Failure of the proteases to completely hydrolyze iodoalbumin partially explains why all of the PBI was not recovered as iodotyrosines in the serum protein hydrolysates. Povidone-iodine rapidly iodinated tyrosine residues in human serum albumin at pH 7.4 and 37 C in vitro, and the ratio of diiodotyrosine to monoiodotyrosine increased as the molar ratio of povidone-iodine to albumin was increased. It is concluded that the abnormal increase in serum PBI resulted from absorption of the iodophor into the blood where it primarily iodinated albumin and, to a lesser extent, the globulins.

Topical application of povidone-iodine in the management of decubitus and stasis ulcers

Topical application of povidone-iodine in the management of decubitus and stasis ulcers

Absorption of iodine in the neonate following topical use of povidone iodine

Topical application of povidone iodine on the umbilical cord and normal intact skin of newborn infants resulted in significantly elevated plasma iodine levels. High iodine levels were also found in two neonates who had povidone iodine applied to denuded skin. No significant alteration in thyroid function was seen. The possible toxic manifestations of high plasma iodine levels are discussed.