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1.
Autoimmun Rev ; 19(7): 102570, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32376397

RESUMO

Now COVID-19 is causing a severe public health emergency and the mortality is rapidly increasing all over the world. In the current pandemic era, although there have been many efforts to diagnose a number of patients with symptoms or close contacts, there is no definite guideline for the initial therapeutic approach for them and therefore, many patients have been dying due to a hyperinflammatory immunological reaction labeled as "cytokine storm". Severe patients are hospitalized and the treatment is done, though they have not been established yet. Currently, however, no treatment is provided for those who are isolated at home or shelter until they get severe symptoms, which will increase the harms to the patients. In this review, we discuss some important points dedicated to the management of patients with COVID-19, which should help reducing morbidity and mortality. In this era, we suggest 7 recommendations to rescue the patients and to reduce the morbidity and mortality due to COVID-19 based on the immunological point of view.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Antibacterianos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/virologia , Humanos , Hidroxicloroquina/uso terapêutico , Pulmão/fisiopatologia , Morbidade , Antissépticos Bucais , Sprays Nasais , Pandemias , Preparações de Plantas/uso terapêutico , Pneumonia Viral/imunologia , Povidona-Iodo/uso terapêutico , Sambucus/química , Abandono do Hábito de Fumar , Esteroides/uso terapêutico
4.
BMC Infect Dis ; 20(1): 88, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000698

RESUMO

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) infections have become a global health threat. Controlling CRE transmission in hospitals is increasingly dependent on the use of disinfectants to restrict the risk of infection. Here, the susceptibility of patient-derived carbapenem resistant Klebsiella pneumoniae (CRKP) and Escherichia coli (CREC) strains against three common disinfectants and the determinants of resistance to disinfectants were investigated. METHODS: The minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs) of three common chemical disinfectants: chlorhexidine, trichloroisocyanuric (TCCA) acid and Povidone iodine (PVP-I) against 50 CRE strains were measured. The drug-resistance genes -qacEΔ1, qacA/B and cepA-were determined using polymerase chain reaction. RESULTS: A total of 36 CRKP and 14 CREC strains were collected in our hospital from 2016 to 2018. The MIC ranges of 36 CRKP strains against chlorhexidine, TCCA and PVP-I were 8~512 mg/L, 64~128 mg/L and 8~128 mg/L, respectively. For 14 CREC strains, the MIC ranges against chlorhexidine, TCCA and PVP-I were 4~128 mg/L, 64~128 mg/L and 4~128 mg/L, respectively. Moreover, against chlorhexidine and PVP-I, the MIC90 of 36 CRKP strains was higher than that of 50 CSKP strains. The qacE△1 gene was detected in 15 isolates among 36 CRKP strains (41.7%), and 8 isolates among 14 CREC strains (57.1%); while the qacA/B gene was not detected. Specifically, the cepA gene was much more prevalent than the qacEΔ1; it reached over 80% among CRKP strains. Compared to the CSKP strains, the presence of the qacEΔ1 and cepA genes was significantly higher among the CRKP strains (p < 0.05). CONCLUSION: CRE strains collected from patients in our hospital exhibit various degree of resistance to the commonly used chemical disinfectants. It is of great help to keep monitoring the tendency of the reduced susceptibility of the pan-resistant strains against disinfectants, in order to effectively control and prevent the spread of the super resistant bacteria.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Desinfetantes/farmacologia , Farmacorresistência Bacteriana/genética , Escherichia coli/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , China , Clorexidina/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Povidona-Iodo/farmacologia , Centros de Atenção Terciária , Triazinas/farmacologia
5.
J Med Microbiol ; 69(2): 298-308, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31976854

RESUMO

Introduction. Periodontitis is among the most widespread oral bacterial diseases affecting 15-20% of the world population.Aim. This study aimed to develop dental floss impregnated with povidone-iodine (PVP-I) as an antimicrobial delivery system against periodontopathogenic bacteria in a planktonic form and within biofilms.Methods. Identical lengths of dental floss impregnated with PVP-I formulations were placed on agar along with previously grown periodontal pathogens. The bioactivity of the dental floss was investigated by response-surface methodology. In order to explore the antibacterial activity of the selected formulation and the potential application in the prevention and treatment of plaque-caused diseases such as periodontitis and caries, the antibacterial and anti-biofilm activity of the selected PVP-I formulation against pathogenic bacteria were investigated.Results. The results indicated that the coating formulation containing Eudragit L-100 2.90 %, PVP-I 24.58 % and PEG 400 3.73 % had antimicrobial activity for all pathogens. The mechanism of this formulation involved disruption of bacterial cell membranes. Moreover, this formulation inhibited the formation of oral pathogenic biofilms.Conclusion. It was concluded that Eudragit L-100 and PVP-I-coated dental floss represented a potential therapeutic agent to prevent periodontal diseases and dental caries and exhibited non-toxicity to periodontal ligament cells.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Periodontite/prevenção & controle , Ácidos Polimetacrílicos/química , Povidona-Iodo/farmacologia , Antibacterianos/química , Bactérias/crescimento & desenvolvimento , Dispositivos para o Cuidado Bucal Domiciliar , Sistemas de Liberação de Medicamentos , Humanos , Periodontite/microbiologia , Povidona-Iodo/química
8.
J Hosp Infect ; 104(3): 302-304, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31743692

RESUMO

BACKGROUND: Alcoholic povidone-iodine (API) used as skin disinfection reduces the risk of postoperative infection but there is no evidence for its use on mucous membranes. We therefore conducted a tolerance study on the glans of men operated in urology. AIM: To confirm the safety of using API on mucous membranes. METHODS: The impact of applying API on the glans mucosa was measured using a chromameter. Caucasian men, without any dermatological lesion of the glans, operated by endoscopic transurethral route, were included. Measurements (L*a*b*) were made preoperatively and postoperatively by an independent person. Parameters were compared using the recognized formula ΔE = √(ΔL2 + Δa2 + Δb2). FINDINGS: Ninety-six patients, average age 68.9 ± 10.4 years, were included. For L*, the mean pre- and postoperative difference was +2.36 (P = 0.168). For a* and b*, the mean pre- and postoperative differences were +0.13 (P = 0.9085) and -0.12 (P = 0.17089), respectively. ΔE was equal to 13.92 ± 17.49 (non-significant difference). CONCLUSION: Our study is the first to analyse the impact of API on genital mucous membranes. In our study conditions, API had no impact on the mucous membranes, suggesting that it can be used safely.


Assuntos
Anti-Infecciosos Locais/farmacologia , Povidona-Iodo/farmacologia , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Humanos , Masculino , Membrana Mucosa/efeitos dos fármacos , Membrana Mucosa/microbiologia , Complicações Pós-Operatórias/prevenção & controle
9.
11.
J Matern Fetal Neonatal Med ; 33(2): 272-276, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30021481

RESUMO

Introduction: The ideal antiseptic agent for skin preparation before elective cesarean section (CS) is not yet determined. The aim of the study was to assess the impact of skin preparation by chlorhexidine-alcohol compared with povidone-iodine before elective CS on the rate of surgical site infection (SSI).Materials and methods: This prospective observational study included a total of 1424 pregnant women at term who were candidates for the elective CS and were divided into two equal groups of 712 patients in each, group 1 (chlorhexidine-alcohol group) and group 2 (povidone-iodine group). Patients were followed up at 1 week and 1 month postoperative to determine the rate of SSI.Results: The rate of SSI was 3.7% (26 patients) in the chlorhexidine-alcohol group compared with 4.6% (33 patients) in the povidone-iodine group (odds ratio: 0.7798, 95% CI: 0.46-1.3, p = .35), nine patients in the chlorhexidine-alcohol group, and 10 patients in the povidone-iodine group required resuturing (odds ratio: 0.9, 95% CI: 0.36-2.2, p = .82). Four patients (0.56%) in the chlorhexidine-alcohol group and five patients (0.7%) in the povidone-iodine group developed endometritis (p = .74). The rate or readmission because of SSI was 2.7% (19 patients) in the chlorhexidine-alcohol group and 2.9% (21 patients) in the povidone-iodine group (p = .75).Conclusions: Skin preparation with either chlorhexidine-alcohol or povidone-iodine resulted in comparable rates of SSIs. Accordingly, both are suitable antiseptic agents for skin preparation before elective CS.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Cesárea/métodos , Clorexidina/administração & dosagem , Povidona-Iodo/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Cesárea/efeitos adversos , Feminino , Humanos , Gravidez , Cuidados Pré-Operatórios/métodos
12.
Oral Maxillofac Surg ; 23(4): 507-511, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673818

RESUMO

INTRODUCTION: Povidone-iodine (PI) is thought to be an effective disinfectant and safe for many surgeons. Aspiration pneumonia is usually caused by gastric contents, but if PI solution will be aspirated, pneumonia or other complications may occur. CASE REPORT: We present a case of pneumonia to aspiration of PI solution in a 91-year-old man patient who underwent oral-maxillofacial surgery. When surgeons used PI solution for disinfection into the oral cavity, the solution seems to be sinking gradually. The patient showed severe respiratory distress and developed hypoxia. There were much frothy fluids into a tracheal tube. We suctioned through the endotracheal tube and performed bronchoscopy, that revealed a redness which appeared associated to a chemical injury on the left trachea and bronchus. His condition was complicated by ARDS and DIC. Periodical bronchial suction and guideline-based treatments of ARDS were carried in ICU. He recovered without severe complication. CONCLUSION: Although PI solution for an oral disinfection is used routinely, all operators need to be aware of the risk for PI aspiration.


Assuntos
Iodo , Pneumonia Aspirativa , Idoso de 80 Anos ou mais , Desinfecção , Humanos , Masculino , Boca , Povidona-Iodo
15.
Semin Respir Crit Care Med ; 40(3): 375-385, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31525812

RESUMO

Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to evolve best practices regarding the optimal sclerosant agents and procedural approaches in the management of these diseases.


Assuntos
Doenças Pleurais/terapia , Pleurodese/métodos , Soluções Esclerosantes/administração & dosagem , Humanos , Derrame Pleural Maligno/terapia , Pneumotórax/terapia , Povidona-Iodo/administração & dosagem , Nitrato de Prata/administração & dosagem , Talco/administração & dosagem , Tetraciclinas/administração & dosagem , Toracoscopia/métodos
17.
New Microbiol ; 42(4): 205-209, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31524943

RESUMO

In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine irrigation on incisional surgical site infection. Superficial incisional surgical site infection (SSI) following gynecologic surgery is a serious problem for both patient and surgeon in terms of increased morbidity, length of hospital stay, anxiety, and costs. Three hundred patients scheduled for abdominal surgery due to various benign gynecological pathologies were randomly assigned to one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1; saline + rifampicin in group 2; saline +10% povidone iodine in group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. The superficial incisional SSI rate increased significantly with the use of saline alone (p = 0.006). There was no significant difference between saline +10% povidone iodine and saline + rifampicin (p=0.055). The results suggest that the incidence of superficial incisional SSI is significantly reduced when irrigation is performed using rifampicin and povidone-iodine compared with using saline alone.


Assuntos
Anti-Infecciosos Locais , Procedimentos Cirúrgicos em Ginecologia , Povidona-Iodo , Rifampina , Administração Tópica , Adulto , Anti-Infecciosos Locais/administração & dosagem , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Povidona-Iodo/administração & dosagem , Estudos Prospectivos , Rifampina/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
18.
Eur Arch Otorhinolaryngol ; 276(12): 3373-3381, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560120

RESUMO

PURPOSE: Recalcitrant chronic rhinosinusitis is a persistent inflammatory condition of the sinonasal mucosa despite adequate medical therapy and sinus surgery. This study aimed to demonstrate the effectiveness and safety of dilute povidone-iodine (PVP-I) sinonasal rinses as an adjunctive therapy. METHODS: Prospective cohort study. Twenty-nine recalcitrant CRS patients with endoscopic evidence of ongoing inflammation and purulent discharge were prescribed 0.08% diluted PVP-I rinses. Changes to endoscopic modified Lund-Kennedy (MLK) scores at 7 weeks post-PVP-I rinsing served as the primary outcome measure. RESULTS: The median MLK-discharge score significantly decreased in all patients by 1.50 points post-PVP-I rinsing (p value < 0.01). The total MLK score significantly decreased in all patients by 1.50 points (p value = 0.01). Up to a 17% reduction in serum inflammatory markers was measured post-PVP-I rinsing. Sinonasal culture revealed a shift from moderate-heavy growth to lighter bacterial growth overall. Subjective SNOT-22 scores significantly improved overall by ≥ 1 minimal clinically important difference (MCID > 12; baseline median = 33; follow-up median = 20; p value < 0.01; n = 22). TSH levels increased non-significantly within normal ranges (baseline median = 1.59 mU/L; follow-up median = 1.92 mU/L; p = 0.10; n = 15). Mucociliary clearance time increased non-significantly within normal ranges (baseline median = 9 min; follow-up median = 10 min; p value = 0.53; n = 17). Olfactory Sniffin'16 scores non-significantly decreased within age-related normal ranges (baseline median = 14; follow-up median = 13; p value = 0.72; n = 18). CONCLUSION: A dilute 0.08% PVP-I sinonasal rinse as an ancillary therapy in recalcitrant CRS significantly reduces signs of infection alongside notable symptom improvement, without affecting thyroid function, mucociliary clearance or olfaction.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Povidona-Iodo/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Irrigação Terapêutica , Administração Intranasal , Adulto , Anti-Infecciosos Locais/uso terapêutico , Doença Crônica , Estudos de Coortes , Endoscopia , Feminino , Humanos , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Depuração Mucociliar , Lavagem Nasal , Povidona-Iodo/uso terapêutico , Estudos Prospectivos , Rinite/cirurgia , Índice de Gravidade de Doença , Sinusite/cirurgia , Resultado do Tratamento
19.
Skinmed ; 17(3): 155-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496469

RESUMO

Over the last decade, studies have compared the use of sterile gloves (SGs) versus nonsterile gloves (NSGs) on surgical site infection (SSI) rates in Mohs micrographic surgery (MMS). In this study, we sought to determine SSI rates before and after employment of NSGs for dermatologic procedures. Infection data were collected from January 2009 to December 2015 on 7365 tumors treated with MMS and 1620 tumors treated by surgical excision. For MMS procedures using chlorhexidine as the antiseptic, the SSI rate with SGs was 3.39% compared to 3.06% with NSGs. For surgical excisions, the SSI rate was 3.02% with SGs and 4.17% with NSG. Using NSGs for MMS tumor resection and reconstruction can provide cost savings without adversely affecting SSI rates, and could also be considered in dermatologic procedures, including electrodessication and curettage and surgical excisions.


Assuntos
Luvas Cirúrgicas/efeitos adversos , Luvas Cirúrgicas/economia , Cirurgia de Mohs/efeitos adversos , Neoplasias Cutâneas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Redução de Custos , Análise Custo-Benefício , Humanos , Povidona-Iodo/uso terapêutico , Esterilização/economia , Infecção da Ferida Cirúrgica/prevenção & controle
20.
Int J Pharm Compd ; 23(5): 418-421, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513541

RESUMO

There are multiple studies in the literature that support the use of povidone iodine in the preparation of the surgical field of cataract as the most effective means to reduce the bacteria present in the ocular surface and the risk of infection. The concentration of free iodine is related to the antiseptic activity of these compounds, being, therefore, a good indicator of its effectiveness. The objective of this study was to determine the amount of free iodine and the evolution of it in different formulations of povidone iodine eye drops. The povidone iodine 5% eye drops were prepared starting from Betadine 10% dermal or the active principle and using a solvent, phosphate-citrate buffer solution, and sodium chloride 0.9% or sterile water for injection. Aliquots of 5 mL were packed in low-absorption absorption eye drops, topaz glass vials, and polyethylene syringe. The determination of free iodine was made by volumetric titration. Titration was performed with 0.1 M sodium thiosulfate using a starch solution as an indicator. Of the 0.1 M sodium thiosulfate, 1 mL is equivalent to 12.69 mg of available iodine, and it is expressed as a percentage of free iodine in the iodized povidone (% free iodine). Eyewash titrations were performed by replacing the substance with 5 mL of eye drops and following the remaining steps. Valuations were made on days 0, 7, and 14, as well as the measurement of pH and osmolarity. The results show that there are no differences between the average results at the three measurements taken on days 0, 7, and 14. We conclude that the free iodine remains stable during the stability period of 14 days. Regarding the pH and osmolarity data, the authors believe that the best tolerated formula will be that elaborated with povidone iodine and a phosphate- citrate buffer solution.


Assuntos
Anti-Infecciosos Locais , Iodo , Soluções Oftálmicas/química , Injeções , Soluções Oftálmicas/análise , Povidona-Iodo
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