A comparison of the efficacy of normal saline and Savlon solutions in periurethral cleaning to reduce catheter-associated bacteriuria: A randomized control trial.

OBJECTIVE: Catheter-associated urinary tract infection (CAUTI) is a common nosocomial infection. However, there has been no randomized control trial (RCT) comparing the efficacy of periurethral cleaning solutions for reducing CAUTI. This study aimed to compare the efficacy of normal saline solution (NSS) and Savlon solution. METHODS: A non-inferiority cross-over RCT was conducted to compare the 2 solutions by the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization. Patients admitted to a tertiary referral hospital from June 2018 to August 2019 participated in the study. The acceptable prespecified non-inferiority margin was 10%. RESULTS: There were 265 and 275 patients in the NSS and Savlon groups, respectively. The incidence of CAUTI was 2.65/1000 catheter-days, and the median duration of catheterization was 5 days (IQR 4, 7). There was no significant difference between the incidence of SB in the NSS and Savlon groups, as indicated by the adjusted difference of 0.6 (95% CI: -3.1-4.2). CONCLUSION: This study was the first RCT in patients from multiple hospital units to compare the efficacy of the 2 solutions in the periurethral cleaning process. The study demonstrated non-inferiority of NSS to Savlon solution. THAI CLINICAL TRIALS REGISTRY STUDY ID: TCTR20180518001.

Zwitterionic gold nanorods: low toxicity and high photothermal efficacy for cancer therapy.

Novel "zwitterionic" gold nanorods (Au NRs) were constructed through a facile ligand exchange process between cetyltrimethylammonium bromide (CTAB)-Au NRs and the zwitterionic block polymer {poly(2-methacryloyloxyethyl phosohorylcholine)-b-poly(lipoic methacrylate) (pMPC-b-pLA)}. In vitro, they exhibited low dark cytotoxicity and a high therapeutic efficacy to cancer cells. Their blood circulation half-life in vivo (t1/2, ∼10 h) was 20-fold longer than that of CTAB-Au NRs (t1/2, <30 min). After intravenous administration, they accumulated in tumour sites via an enhanced permeability and retention (EPR) effect and enabled destruction of human xenograft tumours in mice after exposure of the tumour location to NIR laser irradiation at 808 nm. These studies showed that the "zwitterionic" Au NRs had low toxicity and high photothermal efficacy both in vitro and in vivo due to the suprahydrophilic, biocompatible zwitterionic polymer coating layer. They may have the potential to be a promising NIR PTT agent in the biomedical field.

Effect of irrigation with Tetraclean on bacterial leakage of obturated root canals.

The purpose of the study presented here was to evaluate the effect of Tetraclean, Hypoclean, Chlor-XTRA, 2% chlorhexidine and 6% sodium hypochlorite/17% EDTA as a final irrigant on bacterial leakage of the root canal. One hundred and fifty-five extracted human maxillary central incisors were randomly divided into five experimental groups of 25 teeth each and two control groups of 15 teeth each. The root canals in each group were irrigated with 2 ml of the relevant irrigant between each filing. The root canals in group 5 were irrigated with 5 ml of 17% EDTA at the end of root canal preparation. The teeth in each group were obturated with gutta-percha and AH-26 sealer. Positive control teeth were obturated with a single gutta-percha cone without sealer, and negative controls were obturated in the same way as experimental groups. The coronal portion of each root was placed in contact with inoculum of Enterococcus faecalis in Brain Heart Infusion (BHI) culture media. Findings showed that the mean number of days for bacterial penetration in the Tetraclean group was greater than for other experimental groups. On the other hand, the Chlor-XTRA Vista group showed the fewest mean number of days for bacterial leakage.

Capsulorrhaphy in the management of liver hydatid cyst.

INTRODUCTION: Hydatid disease is a major health problem in some parts of the world. There are several nonoperative and operative ways to treat hydatic disease. The aim of this retrospective study is to assess the rate of postoperative complications, mortality rate, hospitalization period, and recurrence for capsulorrhaphy method, and to compare it with other hydatic cyst management techniques. MATERIAL AND METHODS: An open surgical procedure using capsulorrhaphy technique was performed on 250 patients (130 men and 120 women) with uncomplicated hydatic cysts in the Northwest of Iran, between 1989 and 2011. RESULTS: The patients stayed in the hospital between 4 and 10 days, with an average of 5 days. Of the patients, 233 (93.2%) were discharged without any complications, 9 (3.6%) developed a wound infection in the abdominal wall, and 7 (2.8%) developed pulmonary atelectasis. Those who developed an infection or an atelectasis stayed in the hospital for few more days for conservative treatments. One of the patients (0.4%) had external biliary fistula and bile leak, which was treated with surgery and Roux-en-Y cystojejunostomy. During follow-ups (13.2 ± 8.5 months), incisional hernias occurred in 5 (2%) patients and hydatid cyst recurrence affected 7 (2.8) patients. The mortality rate was zero amongst the studied patients. CONCLUSION: Compared to other techniques in the literature, the results presented in the current work indicate that capsulor-rhaphy is an efficient method in terms of decreased postoperative complications, recurrence, and hospitalization period, and is a safe method with low morbidity and zero mortality rates.

Residual activity of cetrimide and chlorhexidine on Enterococcus faecalis-infected root canals.

Effective final irrigation regimen is an important step in order to achieve better disinfection and ensure residual antimicrobial effects after root canal preparation. The aim of this study was to compare the residual antimicrobial activity of 0.2% cetrimide, and 0.2% and 2% chlorhexidine in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown on uniradicular roots for 4 weeks. After root canal preparation, root canals were irrigated with 17% ethylenediaminetetraacetic acid (EDTA) to remove the smear layer. The roots were randomly divided into three experimental groups (n=26) according to the final irrigating solution: Group I, 5 mL 0.2% cetrimide; Group II, 5 mL 0.2% chlorhexidine; and Group III, 5 mL 2% chlorhexidine. Samples were collected for 50 days to denote the presence of bacterial growth. The proportion of ungrown specimens over 50 days was evaluated using the nonparametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test and the level of statistical significance was set at P<0.05. The highest survival value was found with 2% chlorhexidine, showing statistically significant differences from the other two groups. At 50 days, E. faecalis growth was detected in 69.23% specimens in Groups I and II, and in 34.61% specimens of Group III. There were no significant differences between 0.2% cetrimide and 0.2% chlorhexidine. Final irrigation with 2% chlorhexidine showed greater residual activity than 0.2% chlorhexidine and 0.2% cetrimide in root canals infected with E. faecalis.

Evaluation of the antifungal activity of four solutions used as a final rinse in vitro.

The aim of the study was to compare the antifungal activity of 1.3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), MTAD and Tetraclean as a final rinse against Candida albicans in a human tooth model in vitro. Ninety extracted human maxillary central and lateral incisor teeth were randomly divided into four groups each with 20 teeth, a positive and a negative control each with five teeth. After preparing the root canals, teeth were inoculated with Candida albicans (ATCC 10261) and incubated for 72 h. Teeth were divided into four experimental groups according to the irrigation solution as follows: NaOCl, CHX, MTAD and Tetraclean. After culturing aliquots from the experimental teeth on Sabouraud 4% dextrose agar, colony-forming units were counted. The results showed that 1.3% NaOCl and 2% CHX were equally effective and significantly superior to MTAD and Tetraclean (P < 0.05). Furthermore, antifungal efficacy of Tetraclean was significantly superior to MTAD (P < 0.05).

Photodynamic inactivation of chlorin e6-loaded CTAB-liposomes against Candida albicans.

BACKGROUND AND OBJECTIVES: Antimicrobial photodynamic inactivation (PDI) is a promising therapeutic modality for the treatment of local infections. To increase the efficacy of PDI, chlorine e6 (Ce6) was encapsulated in cationic CTAB-liposomes composed of various ratios of dimyristoyl-sn-glycero-phosphatidylcholine (DMPC) and the cationic surfactant, cetyltrimethyl ammonium bromide (CTAB). The PDI efficacy of the liposomal-Ce6 was assessed in vitro against susceptible and drug-resistant clinical isolates of Candida albicans (C. albicans) as well as in infected burn wounds. STUDY DESIGN/MATERIALS AND METHODS: Ce6 was encapsulated in CTAB-liposomes by the film hydration method. Particle size distribution and zeta potential of the cationic liposomes were measured using a Zetasizer Nano-ZS. UV-visible spectra were used to measure lipid/Ce6 (L/C) ratio and drug entrapment efficiency while differential scanning calorimetry (DSC) was used to study the thermotropic behavior of DMPC liposomes upon CTAB addition. In vivo PDI efficacy was carried out in an infected burn wound using a rat model. RESULTS: The increase in zeta potential and a shift in the phase transition temperature (Tm ) upon CTAB addition confirmed its entrapment within the lipid bilayers of the liposome. Meanwhile, the CTAB addition did not affect the Ce6 entrapment efficiency and physical attributes of the liposomes. In vitro studies showed that the PDI effect of the Ce6-loaded CTAB-liposomes was dependent on the lipid to Ce6 molar ratio (L/C), particle size and the concentration of CTAB in the liposomes. The lower L/C ratio and smaller liposomes exerted significantly higher PDI effects. In addition, an increase in the CTAB to lipid ratio led to a significant increase in the PDI effect of Ce6 against susceptible and drug-resistant clinical isolates of C. albicans after light illumination. CONCLUSIONS: Our results indicate that a low L/C ratio, high positive charge, and small particle size of CTAB-liposomes significantly enhances their PDI efficacy against C. albicans.

Actividad antimicrobiana del cloruro de 2-metacriloil oxietil trimetilamonio contra Candida sp / Antimicrobial activity of [2-(methacryloyloxy)ethyl]trimethylammonium chloride against Candida spp

Antecedentes. La estomatitis protética es la forma más común de infección bucal producida por especies de Candida, siendo Candida albicans el agente etiológico más común. Diversos autores han intentado asociar agentes antifúngicos o antisépticos a los materiales de revestimiento blando o a las resinas acrílicas de las prótesis dentales, pero sin éxito. Por ello, se ha investigado un compuesto de amonio cuaternario (2-metacriloil oxietil trimetilamonio [MADQUAT]), que copolimeriza con los metacrilatos y que podría actuar como inhibidor de levaduras. Objetivos. El objetivo de este estudio fue evaluar la actividad in vitro del MADQUAT contra especies de Candida. Métodos. Se utilizaron 31 cepas de Candida para determinar la actividad antifúngica in vitro. Se determinó la concentración mínima inhibitoria (CMI) y la concentración mínima fungicida del MADQUAT, así como de la nistatina. Resultados. El MADQUAT presentó propiedades antifúngicas en las concentraciones entre 6,25 y > 100mg/ml y actividad fungicida entre 25 y > 100mg/ml. Los estudios cuantitativos de la actividad fungistática y fungicida del MADQUAT demostraron actividad fungistática contra todas las cepas de Candida albicans, Candida krusei y Candida parapsilosis, revelando actividad fungicida contra algunas cepas de otras especies. Conclusiones. El MADQUAT presenta actividad antifúngica contra Candida spp. Además, la sensibilidad a dicho compuesto es distinta entre las diferentes especies considerando los valores de la CMI y la actividad fungicida o fungistática(AU)

Background. Candida-associated denture stomatitis is the most common manifestation of oral candidal infection, caused mainly by Candida albicans. Several authors have attempted to add antifungal agents or antiseptics to denture temporary soft lining materials or to denture acrylic resins, without relevant results. Therefore, the investigation of a quaternary ammonium functionalized compound [2-(methacryloyloxy)ethyl]trimethylammonium chloride (MADQUAT), which copolymerizes with methacrylates and which could act as a fungal inhibitor, is of paramount importance. Aims. To evaluate the in vitro activity of MADQUAT against Candida species. Methods. Thirty-one Candida strains were used to determine the in vitro antifungal activity of this compound. The minimum inhibitory concentrations and minimum fungicidal concentrations of MADQUAT and nystatin were determined. Results. MADQUAT showed antifungal properties at concentrations of 6.25 to > 100mg/ml, and fungicidal activity between 25 and > 100mg/ml. The quantitative determinations of the fungistatic and fungicidal activity of MADQUAT showed fungistatic activity against all Candida albicans, Candida krusei and Candida parapsilosis strains, revealing fungicidal activity against some strains of the other species. Conclusions. MADQUAT has antifungal activity against Candida spp. Moreover, the sensitivity to this substance varies across the different species in terms of MIC values and fungicidal or fungistatic activity(AU)

Residual effectiveness of final irrigation regimens on Enteroccus faecalis-infected root canals.

INTRODUCTION: The application of a final irrigating solution that remains active over a fairly long period of time stands as one strategy for preventing bacterial recolonization or eliminating the bacteria that persist after root canal treatment. The aim of this study was to evaluate the residual antimicrobial activity of four final irrigation regimens in root canals contaminated with Enterococcus faecalis. METHODS: Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. After preparing the roots chemomechanically, four final irrigation regimens were applied: (1) group EDTA-NaOCl, 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); (2) group MA-NaOCl, 7% maleic acid (MA) followed by 5.25% NaOCl; (3) group EDTA-CHX + CTR, 17% EDTA followed by 2% chlorhexidine (CHX) + 0.2% cetrimide (CTR); and (4) group MA-CHX + CTR, 7% MA followed by 2% CHX + 0.2% CTR. Samples were collected for 60 days to denote the presence of bacterial growth. The Fisher exact test was used to compare the percentages of specimens without E. faecalis regrowth. RESULTS: All root canals in which the final irrigant was 5.25% NaOCl yielded positive cultures on the fifth day. Groups EDTA-CHX + CTR and MA-CHX + CTR with a final irrigation of 2% CHX + 0.2% CTR showed respective percentages of samples without regrowth of 72.1% and 66.8% at 60 days. There were no statistically significant differences between these groups. CONCLUSIONS: The combination of 2% CHX + 0.2% CTR would be an effective alternative final irrigation regimen given its antimicrobial action over time.

Wound healing after mulesing and other options for controlling breech flystrike in Merino lambs: quantitative and semiquantitative analysis of wound healing and wound bed contraction.

BACKGROUND: A two-part study examined wound healing and contraction occurring after mulesing and two alternative methods of preventing breech flystrike in sheep. OBJECTIVE: To quantify wound healing using a scoring system and to assess the contractility of the wound bed of the breech after mulesing, cetrimide-intradermal treatment and application of clips. METHOD: The study group of 30 mulesed, 30 cetrimide-intradermal treated, 30 control and 10 clip-treated sheep were humanely killed at six time points from 3 to 47 days after each treatment. Wound healing post treatment was assessed using a scoring system, and contractility was assessed by the quantification of myofibroblast expression. Statistical analyses allowed comparisons of temporal wound healing and contraction between treatment groups. RESULTS: Mulesing wounds healed faster in the first 11 days, but by 19 days wound healing was similar between the mulesing and cetrimide-intradermal groups. By 32 days, all three treatment groups had similar wound healing scores. There was greater myofibroblast expression in the mulesing group in the first 11 days after treatment, but by 19 days expression was similar in both the mulesing and cetrimide-intradermal groups. The clip group had significantly less myofibroblast expression from 32 days after treatment. CONCLUSION: Wound healing is initially most rapid after mulesing, but there are similar wound healing scores in the mulesing and cetrimide-intradermal treatment groups by 19 days. Both mulesing and the cetrimide-intradermal treatment induce a similar amount of wound bed contraction, with less contraction observed after application of clips.

Assessment of the short-term systemic effect of and acute phase response to mulesing and other options for controlling breech flystrike in Merino lambs.

BACKGROUND: Mulesing is an important method of preventing flystrike of Merino sheep in Australia, but because there are important short-term welfare issues associated with mulesing, alternative methods of removing the skin folds for breech flystrike prevention are being investigated. OBJECTIVE: To examine the short-term systemic effects of mulesing and two proposed alternatives, compared with two control methods, for controlling breech flystrike. METHOD: The five treatment groups comprised 10 lambs each: (1) mulesing, (2) intradermal-cetrimide treatment, (3) clip application, (4) tail docking only and (5) no treatment. Changes in body weight, haematological and biochemical profiles, and concentrations of fibrinogen, haptoglobin and serum amyloid A were measured repeatedly for 29 days post treatment. RESULTS: The mulesing and intradermal-cetrimide groups were the only treatment groups to lose weight during the first week, with greater weight loss in the mulesing group. The mulesing group had the most marked increases in all three acute-phase protein concentrations, closely followed by the intradermal-cetrimide group, with a mild increase observed for the clip group and even less for the tail-docked group. The mulesing group was the only group to develop mild anaemia, transient hyperglycaemia and a persistent decreased albumin : globulin ratio. The neutrophil : lymphocyte ratio was above the upper reference limit for both the mulesing and intradermal-cetrimide groups. CONCLUSION: Mulesing had the greatest systemic effect in terms of the magnitude and duration of increased acute-phase protein concentrations and haematological, biochemical and body weight changes. The clips had a significantly reduced systemic effect compared with mulesing, with the intradermal-cetrimide treatment in between the two. Tail docking had a minimal systemic effect.

Wound healing after mulesing and other options for controlling breech flystrike in Merino lambs: observations on gross and microscopic wound healing.

BACKGROUND: The mulesing procedure is the main procedure used to control breech flystrike of sheep in Australia, but other permanent methods of altering breech conformation are currently being investigated and wound healing is an important component of that comparative assessment. OBJECTIVE: To qualitatively assess the gross and microscopic tissue damage and wound healing that occurs in the immediate post-treatment period after mulesing, intradermal-cetrimide treatment and clip application. METHOD: The study group of 30 mulesed, 30 cetrimide-treated, 30 control and 10 clip-treated sheep were humanely killed at six time points during the 3-47 days post treatment. Treatment sites and wound beds were examined grossly and microscopically. RESULTS: Mulesing wounds healed rapidly in a predictable manner, producing long linear scars on either side of the breech and tail by 32-47 days post treatment. Although the time course for healing post cetrimide-treatment was similar to that for mulesing, complications occurred and included inadequate wound healing because of persistence of adherent necrotic tissue, poor skin tightening around the tail, and patchy or deep penetration of the cetrimide resulting in necrosis of adjacent skin and deeper structures. The clips resulted in skin tightening around the ventrolateral breech and tail, although the formation of skin tags and clip slippage were of concern in some sheep. CONCLUSION: Wounds healed rapidly after mulesing with minimal complications. The intradermal-cetrimide treatment appeared to produce imperfect and sometimes delayed wound healing compared with mulesing. The clips resulted in comparable wound healing to mulesing, but further field trials are required to assess their effectiveness in flystrike prevention.

Potential use of cetrimonium bromide as an apoptosis-promoting anticancer agent for head and neck cancer.

A potential therapeutic agent for human head and neck cancer (HNC), cetrimonium bromide (CTAB), was identified through a cell-based phenotype-driven high-throughput screen (HTS) of 2000 biologically active or clinically used compounds, followed by in vitro and in vivo characterization of its antitumor efficacy. The preliminary and secondary screens were performed on FaDu (hypopharyngeal squamous cancer) and GM05757 (primary normal fibroblasts), respectively. Potential hit compounds were further evaluated for their anticancer specificity and efficacy in combination with standard therapeutics on a panel of normal and cancer cell lines. Mechanism of action, in vivo antitumor efficacy, and potential lead compound optimizations were also investigated. In vitro, CTAB interacted additively with gamma radiation and cisplatin, two standard HNC therapeutic agents. CTAB exhibited anticancer cytotoxicity against several HNC cell lines, with minimal effects on normal fibroblasts; a selectivity that exploits cancer-specific metabolic aberrations. The central mode of cytotoxicity was mitochondria-mediated apoptosis via inhibition of H(+)-ATP synthase activity and mitochondrial membrane potential depolarization, which in turn was associated with reduced intracellular ATP levels, caspase activation, elevated sub-G(1) cell population, and chromatin condensation. In vivo, CTAB ablated tumor-forming capacity of FaDu cells and delayed growth of established tumors. Thus, using an HTS approach, CTAB was identified as a potential apoptogenic quaternary ammonium compound possessing in vitro and in vivo efficacy against HNC models.

Evaluation of different chemical agents on the germinative layer of sheep hydatid cyst after implantation to peritoneal cavity of BALB/c.

In spite of the use of protoscolocidal agents during hydatid cyst surgery, a notable rate of disease recurrence in postoperation patients is still observed. The question remains whether living protoscolices lead to recurrence or the recurrence is due to the remainder of the germinative layer in the peritoneal cavity. The aim of this study was in vivo evaluation of different chemical (protoscolicidal) solutions on the germinative layer of the hydatid cyst. The germinative layer of sheep hydatid cyst was separated under sterile condition, divided into 0.25-cm(2) parts, and exposed to 0.5% cetrimide, 0.5% silver nitrate, 20% hypertonic saline, 15% dextrose and 25% dextrose, and normal saline as negative control for 2 min. The exposed germinative layers were implanted into the peritoneal cavity of 90 Balb/C mice (15 mice in each group). After nine months, the peritoneum was evaluated macroscopically as well as microscopically for the presence of any hydatid cyst. No hydatid cyst was observed in the peritoneal cavity of the exposed mice. The role of the germinative layer for inducing hydatid cysts in mice is questionable. However, the present study showed that the germinative layer had no role in the induction of hydatid cyst in these laboratory animals.

Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study.

In order to show the effectiveness of preoperative antiseptic mouthwash the authors undertook a prospective study in 120 patients who underwent elective surgery under general or local anesthesia. Patients were allocated toone of 4 groups, depending on whether the oral cavity was washed preoperatively with 1% cetrimide, chlorhexidine, povidon-iodine or sterilized normal saline solution (control group). Aerobic and anaerobic bacterial samples were taken from the inferior vestibulum mucosa before surgery, 5 min after the start of the operation and at the end of the procedure. The results show a statistically significant reduction in bacterial counts during procedures in which antiseptics are used to wash the oral cavity preoperatively. 1% cetrimide solution was the most successful in reducing intra-oral bacterial counts and produced the longest lasting antiseptic effect. Chlorhexidine is a good option for procedures longer than 1 hour, while povidon-iodine is recommended for procedures lasting up to 1 hour. Normal saline reduced bacterial counts in the specimen taken 5 min after washing but this short-lasting effect is due to mechanical cleansing rather than the antiseptic effect.

Laser activation of endodontic irrigants with improved conical laser fiber tips for removing smear layer in the apical third of the root canal.

With a tube etching process, conical-ended optical fibers for middle infrared lasers that have lateral emissions can be produced, a feature of benefit for delivering laser energy onto the root canal walls. This study examined the ability of these improved laser tips when Er:YAG and Er,Cr:YSGG lasers were used in root canals in which thick smear layers had been created intentionally to provide a challenge for the laser system. Smear layer was assessed from scanning electron microscopy images with an objective digital method. Lasing improved the action of ethylene diamine tetraacetic acid with cetavlon (EDTAC) in removing smear layer. Conical fibers performed better than plain fibers, but there was no difference in performance between the 2 laser systems when matched for all other parameters. These results provide a "proof of concept" for lateral emitting fibers for endodontic procedures and illustrate the novel contribution of lasing to the action of EDTAC in dissolving smear layer.

In vitro and in vivo antifungal activity of cetrimide (cetyltrimethyl ammonium bromide) against fungal keratitis caused by Fusarium solani.

Mycotic keratitis is a devastating eye infection acquired after eye injury. Cetrimide at 15 and 20 mg ml(-1) produced no surviving Fusarium solani growth with minimal inhibitory concentration value of 0.10 mg ml(-1). Topical administration of three drops (0.3 ml) of cetrimide aqueous solution of 10 mg ml(-1) at pH 6.4 three times daily succeeded to cure human severe resistant F. solani keratitis in a time course of <3 weeks, and with complete healing after 6 weeks. Cetrimide-treated rabbit corneas section appeared with normal compact epithelium and endothelium with no vacuolation in Descemet's endothelial complex: an indication that cetrimide has no significant toxic effects. So, cetrimide at 10 mg ml(-1) may be effective and safe topical therapy in patients with mycotic keratitis, especially F. solani ulcers. Currently, there is no antimycotic drug with a good corneal penetration, which is safe and has a fungicidal activity.