Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India.

Modern day dermatologists conduct different esthetic and surgical procedures, with risk of infective complications. Hence, infection control practices need to be established in dermatological practice to minimize the risk of exogenous infections. These practices include hand washing, cleaning, sterilization, disinfection, operation theater sterilization and specifications. Proper hand washing after examination of each patient and prior to any surgery with a formulation containing alcohol alone or as a combination with other agents reduces the chances of transferring infections to and from patients. Sterilization and disinfection constitute the most important aspect of infection control. Disinfectants and disinfecting procedures vary according to the environment and equipment. Proper knowledge of different processes/agents for sterilization and disinfection is essential. Disinfectants for use in hospitals should always be freshly prepared and should be of adequate strength. Sterilization is carried out most commonly using steam sterilizers or ethylene dioxide sterilizers. The waste generated during practice is a potential source of nosocomial infections and should be treated as per the proper protocol and guidelines. Trained staff to carry out these practices is essential.

Manejo anestésico de pacientes con lepra lepromatosa sometidas a esterilización quirúrgica / Anesthesic management of patients with lepromatose leprosy soment to surgical sterized

La lepra es una enfermedad granulomatosa crónica transmitida por el Mycobacterium leprae tan antigua como la humanidad. Tiene un período de incubación prolongado que dura años y produce lesiones en piel, mucosas y nervios periféricos. Las lesiones se caracterizan por nódulos que incluyen abundantes fagocitos macrófagos y células gigantes, llenas de lípidos, a menudo ocupados por bacilo o granulomas microscópicos semejantes a tuberculos duros. Se reconocen dos variantes de la enfermedad. La Tuberculosis, porque produce lesiones maculopapulosa simétricas en piel y nervios periféricos y la Lepromatosa que ocurre en pacientes más susceptibles. En ambas formas de lepra, ataca los nervios periféricos. Al infiltrar los filetes sensitivos se presenta anestesia, seguido de úlcera e infecciones de la piel que resultan de la atrofia y los traumatismos de los tejidos insensibles. Los músculos esqueléticos denervados experimentan atrofia. La variedad Lepromatosa es una enfermedad sistémica, que afecta diferentes órganos blandos del organismo.

Métodos de esterilização e desinfecção para controle de microrganismos / Methods of sterilization and disinfection to control microorganisms

Os casos de infeccoes causada por microrganismos vem aumentando a cada ano, por isso e muito importante conhecer os metodos de esterilizacao e desinfeccao. Convem ressaltar que constumam-se confudir estes dois termos. Saliente-se que a esterilizacao e um metodo utilizado para destruir toda forma de vida como bacterias, virus, fungos ou protozoarios presentes em um objeto ou em outros seres vivos atraves de metodos fisicos ou quimicos. Ja a desinfecao e o processo que geralmente utiliza um agente desinfetante para destruir microrganismos infecciosos sem causar necessariamente a esterilizacao, mas reduzindo o risco de uma infeccao. Ambos constituem os principais meios de se evitar contaminacao em laboratorios, hospitais, industrias e ate mesmo em residencias.

[Eduard Boeckmann--scientist, inventor and benefactor]. / Eduard Bøckmann--vitenskapsmann, oppfinner og velgjører.

Eduard Boeckmann (1849-1927) left a lasting legacy in Norway and in America. His scientific career started when as a medical student he won the Skjelderup gold medal for a study of the tonsils. In Bergen he presented his thesis, an experimental study dealing with the cause of keratitis, which affected many patients with leprosy. Later he published vigorously from his medical practice. In St. Paul, Minnesota, he constructed a steam autoclave based on principles that became fundamental in later autoclave technique. His autoclave was put into industrial production. In his own laboratory he worked with improvement and safe sterilization of catgut, and catgut was produced in St. Paul for 59 years, till 1960. He donated income from the catgut production to a fund for a medical library, today the Boeckmann Library of the United Hospital in St. Paul. Boeckmann had a high reputation as a doctor. His American patients were first of all Norwegian settlers in the north-western states. Both in Bergen and in St. Paul he was highly active in the professional associations.

Use of a whole blood assay to evaluate in vitro T cell responses to new leprosy skin test antigens in leprosy patients and healthy subjects.

Development of an immunological tool to detect infection with Mycobacterium leprae would greatly benefit leprosy control programmes, as demonstrated by the contribution of the tuberculin test to tuberculosis control. In a new approach to develop a 'tuberculin-like' reagent for use in leprosy, two new fractions of M. leprae depleted of cross-reactive and immunomodulatory lipids- MLSA-LAM (cytosol-derived) and MLCwA (cell wall-derived)-have been produced in a form suitable for use as skin test reagents. T cell responses (interferon-gamma (IFN-gamma) and lymphoproliferation) to these two new fractions were evaluated in a leprosy-endemic area of Nepal using a simple in vitro whole blood test. The two fractions were shown to be highly potent T cell antigens in subjects exposed to M. leprae-paucibacillary leprosy patients and household contacts. Responses to the fractions decreased towards the lepromatous pole of leprosy. Endemic control subjects also showed high responses to the fractions, indicating high exposure to M. leprae, or cross-reactive mycobacterial antigens, in this Nepali population. The new fractions, depleted of lipids and lipoarabinomannan (LAM) gave enhanced responses compared with a standard M. leprae sonicate. The cell wall fraction appeared a more potent antigen than the cytosol fraction, which may be due to the predominance of the 65-kD GroEL antigen in the cell wall. The whole blood assay proved a robust field tool and a useful way of evaluating such reagents prior to clinical trials.