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1.
Indian J Dent Res ; 33(1): 69-74, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35946248

RESUMO

Aims: To determine the cytokine expression by human gingival fibroblasts in response to different calcium hydroxide (Ca(OH)2) dilutions and test the effectiveness of these dilutions in root canal dentin infected with Enterococcus faecalis (E. faecalis). Methods: UltraCal XS Ca(OH)2 dilutions were prepared (60, 10, and 1 mg\mL) and co-cultured with gingival fibroblasts for 24 and 48 hours. Untreated cells were used as controls. Expressions of interleukin (IL-1ß), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-ß), and IL-10 were analysed with real-time polymerase chain reaction (PCR). Root canals of extracted human teeth were inoculated with E. faecalis. After 21 days, canals were medicated with Ca(OH)2 dilutions for 7 days. Samples were taken to determine bacterial reduction using quantitative PCR. Analysis of variance, Tukey post-test, and Wilcoxon matched pair test were used for statistics. Results: IL-1ß and TNF-α expressions of all Ca(OH)2 dilutions were higher at 24 and 48 hours compared to the control. Similarly, all Ca(OH)2 dilutions induced TGF-ß expression at 24 hours compared to the control and continued to be higher in 60 mg/mL groups at 48 hours. In contrast, IL-10 was constitutively expressed by untreated cells in the control group and was down-regulated significantly by all Ca(OH)2 dilutions at 24 and 48 hours. All dilutions demonstrated a significant E. faecalis reduction (P < 0.001) with no significant difference between dilution groups (P > 0.05). Conclusions: All Ca(OH)2 dilutions had a differential inflammatory effect on fibroblasts and had a down-regulation effect to IL-10. All dilutions tested were effective against E. faecalis, with 60 mg/mL having the highest bacterial reduction.


Assuntos
Hidróxido de Cálcio , Irrigantes do Canal Radicular , Hidróxido de Cálcio/farmacologia , Hidróxido de Cálcio/uso terapêutico , Clorexidina/farmacologia , Citocinas , Cavidade Pulpar/microbiologia , Dentina , Enterococcus faecalis , Humanos , Interleucina-10/farmacologia , Irrigantes do Canal Radicular/farmacologia , Irrigantes do Canal Radicular/uso terapêutico , Fator de Crescimento Transformador beta/farmacologia , Fator de Necrose Tumoral alfa/farmacologia
2.
Indian J Dent Res ; 33(1): 90-93, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35946252

RESUMO

Aim: Hospitalised patients have a high risk of developing aspiration pneumonia because of poor oral care and oral microbial flora changes. Chlorhexidine (CHX) solution has been used to reduce inflammation and prevent infections in oral cavity, but it is difficult to use in inpatients. Gel-type antimicrobial agents rather than the liquid form may be effective for the oral management of hospitalised patients. Therefore, we evaluated the in vitro antimicrobial effects of CHX-containing oral gels on aspiration pneumonia-inducing bacteria compared to the CHX solution. Materials and Methods: The experimental products of two oral gel types containing 1% and 0.1% CHX, respectively, were selected. Hexamedine, a 0.12% CHX solution, was used as a positive control. The antimicrobial activity of CHX agents against six pneumonia-causing bacteria and Streptococcus mutans, one of the most common oral bacteria, was comparatively analysed using the agar disk diffusion method. Results: In the disk diffusion assay, the 1% CHX gels showed the highest inhibitory effect on all bacteria. All CHX agents including gels and solution had the highest antibacterial activity against Staphylococcus aureus compared with other bacteria. Conclusions: We confirmed the significant antimicrobial effects of the 1% CHX oral gels on aspiration pneumonia-inducing bacteria. These results suggest that CHX gels may be an effective oral care method for preventing infection in inpatients who have difficulty using the solution.


Assuntos
Anti-Infecciosos Locais , Pneumonia Aspirativa , Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/farmacologia , Clorexidina/uso terapêutico , Géis/farmacologia , Humanos , Boca , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/prevenção & controle , Streptococcus mutans
3.
Biomed Res Int ; 2022: 8856025, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35958811

RESUMO

Herbal and chemical products are used for oral care and biofilm treatment and also have been reported to be controversial in the massive trials conducted in this regard. The present review is aimed at evaluating the potential of relevant herbal and chemical products and comparing their outcomes to conventional oral care products and summarizing the current state of evidence of the antibiofilm properties of different products by evaluating studies from the past eleven years. Chlorhexidine gluconate (CHX), essential oils (EOs), and acetylpyridinium chloride were, respectively, the most commonly studied agents in the included studies. As confirmed by all systematic reviews, CHX and EO significantly control the plaque formation and gingival indices. Fluoride is another interesting reagent in oral care products that has shown promising results of oral health improvement, but the evidence quality needs to be refined. The synergy between natural plants and chemical products should be targeted in the future to accede to the formation of new, efficient, and healthy anticaries strategies. Moreover, to discover their biofilm-interfering or biofilm-inhibiting activities, effective clinical trials are needed. In this review article, therapeutic applications of herbal/chemical materials in oral biofilm infections are discussed in recent years (2010-2022).


Assuntos
Antissépticos Bucais , Óleos Voláteis , Antibacterianos/farmacologia , Materiais Biocompatíveis/farmacologia , Biofilmes , Clorexidina/farmacologia , Antissépticos Bucais/farmacologia , Antissépticos Bucais/uso terapêutico , Óleos Voláteis/farmacologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-35954713

RESUMO

Chlorhexidine (CHX) is an effective antibacterial agent and is used in dental treatment in several formulations. The aim of this study was to compare the effectiveness of CHX solution and CHX gel on dental plaque inhibition and gingivitis relief by a randomized clinical trial. Thirty-eight participants were randomly divided into two groups: control group (0.12% CHX solution) and test group (1% CHX gel). Participants were provided with CHX products and were instructed to use each product in the morning and evening for 1 week. Clinical results were evaluated by analyzing the collected data of Turesky et al. the modified Quigley-Hein Plaque Index (TQHPI), gingival index (GI) and the BANA test. Measurements were conducted 4 weeks and 8 weeks after using chlorhexidine products. The results were analyzed using repeated measured ANOVA and paired t-test. TQHPI and GI were significantly different after treatments in both groups (p < 0.001). The GI decreased more in the test group compared to the control group 4 weeks and 8 weeks later. In both groups, the BANA score also significantly decreased (p < 0.001) after 8 weeks, though the BANA score decreased relatively more in the CHX gel group than the CHX solution group. These results suggest that 1% CHX gel is more effective in reducing gingivitis and bacteria of periodontal disease than the 0.12% CHX solution. Therefore, the 1% CHX gel is expected to be actively used for non-surgical treatment of periodontal disease patients.


Assuntos
Anti-Infecciosos Locais , Gengivite , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Gengivite/tratamento farmacológico , Gengivite/prevenção & controle , Gluconatos , Humanos , Antissépticos Bucais/uso terapêutico , Resultado do Tratamento
5.
Int J Mol Sci ; 23(15)2022 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-35955437

RESUMO

Because Pseudomonas aeruginosa is frequently in contact with Chlorhexidine (a regular antiseptic), bacterial adaptations are possible. In comparison with the parent strain, the Chlorhexidine-adapted strain formed smaller colonies with metabolic downregulation (proteomic analysis) with the cross-resistance against colistin (an antibiotic for several antibiotic-resistant bacteria), partly through the modification of L-Ara4N in the lipopolysaccharide at the outer membrane. Chlorhexidine-adapted strain formed dense liquid-solid interface biofilms with enhanced cell aggregation partly due to the Chlorhexidine-induced overexpression of psl (exopolysaccharide-encoded gene) through the LadS/GacSA pathway (c-di-GMP-independence) in 12 h biofilms and maintained the aggregation with SiaD-mediated c-di-GMP dependence in 24 h biofilms as evaluated by polymerase chain reaction (PCR). The addition of Ca2+ in the Chlorhexidine-adapted strain facilitated several Psl-associated genes, indicating an impact of Ca2+ in Psl production. The activation by Chlorhexidine-treated sessile bacteria demonstrated a lower expression of IL-6 and IL-8 on fibroblasts and macrophages than the activation by the parent strain, indicating the less inflammatory reactions from Chlorhexidine-exposed bacteria. However, the 14-day severity of the wounds in mouse caused by Chlorhexidine-treated bacteria versus the parent strain was similar, as indicated by wound diameters and bacterial burdens. In conclusion, Chlorhexidine induced psl over-expression and colistin cross-resistance that might be clinically important.


Assuntos
Anti-Infecciosos Locais , Pseudomonas aeruginosa , Animais , Antibacterianos/metabolismo , Antibacterianos/farmacologia , Anti-Infecciosos Locais/farmacologia , Biofilmes , Clorexidina/farmacologia , Colistina/metabolismo , Colistina/farmacologia , Camundongos , Polissacarídeos Bacterianos/metabolismo , Proteômica , Pseudomonas aeruginosa/fisiologia , Virulência
6.
PLoS One ; 17(8): e0271558, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930577

RESUMO

INTRODUCTION: Chlorhexidine cord care is an effective intervention to reduce neonatal infection and death in resource constrained settings. The Federal Ministry of Health of Ethiopia adopted chlorhexidine cord care in 2015, with national scale-up in 2017. However, there is lack of evidence on the provision of this important intervention in Ethiopia. In this paper, we report on the coverage and determinants of chlorhexidine cord care for newborns in Ethiopia. METHODS: A standardized Nutrition International Monitoring System (NIMS) survey was conducted from January 01 to Feb 13, 2020 in four regions of Ethiopia (Tigray, Amhara, Oromia, and Southern Nations, Nationalities and Peoples Region [SNNPR]) on sample of 1020 women 0-11 months postpartum selected through a multistage cluster sampling approach. Data were collected using interviewer-administered questionnaires in the local languages through home-to-home visit. Accounting for the sampling design of the study, we analyzed the data using complex data analysis approach. Complex sample multivariable logistic regression was used to identify the determinants of chlorhexidine cord care practice. RESULTS: Overall, chlorhexidine was reportedly applied to the umbilical cord at some point postpartum among 46.1% (95% confidence interval [CI]: 41.1%- 51.2%) of all newborns. Chlorhexidine cord care started within 24 hours after birth for 34.4% (95% CI: 29.5%- 39.6%) of newborns, though this varied widely across regions: from Oromia (24.4%) to Tigray (60.0%). Among the newborns who received chlorhexidine cord care, 48.3% received it for the recommended seven days or more. Further, neonates whose birth was assisted by skilled birth attendants had more than ten times higher odds of receiving chlorhexidine cord care, relative to those born without a skilled attendant (adjusted odds ratio [AOR]: 10.36, 95% CI: 3.73-28.75). Besides, neonates born to mothers with knowledge of the benefit of chlorhexidine cord care had significantly higher odds of receiving chlorhexidine cord care relative to newborns born to mothers who did not have knowledge of the benefit of chlorhexidine cord care (AOR: 39.03, 95% CI: 21.45-71.04). CONCLUSION: A low proportion of newborns receive chlorhexidine cord care in Ethiopia. The practice of chlorhexidine cord care varies widely across regions and is limited mostly to births attended by skilled birth attendants. Efforts must continue to ensure women can reach skilled care at delivery, and to ensure adequate care for newborns who do not yet access skilled delivery.


Assuntos
Clorexidina , Mães , Etiópia , Feminino , Humanos , Recém-Nascido , Cuidado Pós-Natal , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários
7.
Surg Infect (Larchmt) ; 23(6): 590-596, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35867008

RESUMO

Background: Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is widely utilized in many medical subspecialities to reduce surgical site infections, but routine ophthalmic implementation has been limited. The aim of this study was to investigate the attitudes and actual practice of corneal specialists and oculoplastic surgeons toward MRSA decolonization as a preventive measure in ophthalmic surgery. Materials and Methods: A web-based survey was sent to cornea specialists and oculoplastic surgeons to assess their knowledge, beliefs, and practices regarding MRSA prophylaxis and the use of MRSA decolonization to prevent post-operative infections. Results: A total of 180 surgeons participated in this study: 71% of respondents agreed that MRSA colonization plays a role in post-operative infection of the eye and adnexal structures; 65% stated that MRSA decolonization could help prevent MRSA infection. Although 41% of respondents would change their management in response to a positive pre-operative MRSA screening result, only 18% performed pre-operative screening. Seventeen percent of respondents indicated that they offer pre-operative decolonization for MRSA-positive patients; the most frequently applied technique was the use of nasal antibiotic agents such as mupirocin, followed by antiseptic baths. Peri-operative MRSA prophylaxis was used by 18% of respondents; pre-operative MRSA decolonization was used in conjunction by 8.5 % of respondents. Conclusions: Although MRSA decolonization has been validated in fields outside of ophthalmology, there has not been widespread adoption of this practice among oculoplastic surgeons and cornea specialists. Prospective MRSA decolonization ophthalmic studies are necessary if evidence-based management guidelines are to be developed.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Cirurgiões , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Clorexidina/uso terapêutico , Córnea , Humanos , Mupirocina , Estudos Prospectivos , Infecções Estafilocócicas/diagnóstico
8.
Front Immunol ; 13: 899140, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35784347

RESUMO

Peritoneal fibrosis contributes to ultrafiltration failure in peritoneal dialysis (PD) patients and thus restricts the wide application of PD in clinic. Recently we have demonstrated that histone deacetylase 6 (HDAC6) is critically implicated in high glucose peritoneal dialysis fluid (HG-PDF) induced peritoneal fibrosis, however, the precise mechanisms of HDAC6 in peritoneal fibrosis have not been elucidated. Here, we focused on the role and mechanisms of HDAC6 in chlorhexidine gluconate (CG) induced peritoneal fibrosis and discussed the mechanisms involved. We found Tubastatin A (TA), a selective inhibitor of HDAC6, significantly prevented the progression of peritoneal fibrosis, as characterized by reduction of epithelial-mesenchymal transition (EMT) and extracellular matrix (ECM) protein deposition. Inhibition of HDAC6 remarkably suppressed the expression of matrix metalloproteinases-2 (MMP2) and MMP-9. Administration of TA also increased the expression of acetylation Histone H3 and acetylation α-tubulin. Moreover, our results revealed that blockade of HDAC6 inhibited alternatively M2 macrophages polarization by suppressing the activation of TGF-ß/Smad3, PI3K/AKT, and STAT3, STAT6 pathways. To give a better understanding of the mechanisms, we further established two cell injured models in Raw264.7 cells by using IL-4 and HG-PDF. Our in vitro experiments illustrated that both IL-4 and HG-PDF could induce M2 macrophage polarization, as demonstrated by upregulation of CD163 and Arginase-1. Inhibition of HDAC6 by TA significantly abrogated M2 macrophage polarization dose-dependently by suppressing TGF-ß/Smad, IL4/STAT6, and PI3K/AKT signaling pathways. Collectively, our study revealed that blockade of HDAC6 by TA could suppress the progression of CG-induced peritoneal fibrosis by blockade of M2 macrophage polarization. Thus, HDAC6 may be a promising target in peritoneal fibrosis treatment.


Assuntos
Fibrose Peritoneal , Clorexidina/análogos & derivados , Soluções para Diálise , Desacetilase 6 de Histona , Humanos , Interleucina-4 , Macrófagos/metabolismo , Fibrose Peritoneal/induzido quimicamente , Fibrose Peritoneal/metabolismo , Fibrose Peritoneal/prevenção & controle , Fosfatidilinositol 3-Quinases , Proteínas Proto-Oncogênicas c-akt , Fator de Crescimento Transformador beta/metabolismo
9.
Br J Nurs ; 31(14): S36-S46, 2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35856588

RESUMO

PURPOSE: Intensive care unit (ICU) patients are at risk for central line-associated bloodstream infection (CLABSI) with significant attributable mortality and increased hospital length of stay, readmissions, and costs. Chlorhexidine (di)gluconate (CHG) is used as a disinfectant for central line insertion; however, the feasibility and efficacy of using CHG as a locking solution is unknown. METHODS: Patients with a central venous access device (CVAD) in situ were randomized to standard care or a CHG lock solution (CHGLS) within 72 hours of ICU admission. The CHG solution was instilled in the lumen of venous catheters not actively infusing. CVAD blood cultures were taken at baseline and every 48 hours. The primary outcome was feasibility including recruitment rate, consent rate, protocol adherence, and staff uptake. Secondary outcomes included CVAD colonization, bacteraemia, and clinical endpoints. RESULTS: Of 3,848 patients screened, 122 were eligible for the study and consent was obtained from 82.0% of the patients or substitute decision makers approached. Fifty participants were allocated to each group. Tracking logs indicated that the CHGLS was used per protocol 408 times. Most nurses felt comfortable using the CHGLS. The proportion of central line colonization was significantly higher in the standard care group with 40 (29%) versus 26 (18.7%) in the CHGLS group (P=0.009). CONCLUSIONS: Using a device that delivers CHG into CVADs was feasible in the ICU. Findings from this trial will inform a full-scale randomized controlled trial and provide preliminary data on the effectiveness of CHGLS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03309137, registered on October 13, 2017.


Assuntos
Anti-Infecciosos Locais , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Anti-Infecciosos Locais/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Clorexidina/uso terapêutico , Gluconatos , Humanos , Unidades de Terapia Intensiva , Projetos Piloto
10.
Comput Intell Neurosci ; 2022: 6299435, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35855798

RESUMO

In the medical domain, needle-track nursing especially after 2 percent chlorhexidine gluconate gauze pressure bandaging is a challenging issue and needs a timely response from the research community. In this research paper, a total of 213 patients who met the inclusion and exclusion criteria after external fixation with 2% chlorhexidine gluconate gauze pressure bandaging in the second orthopaedic ward from March 2018 to December 2017 were selected and randomly divided into three groups, each with 71 cases. For needle tract care, various intervention strategies are used. Gauze pressure bandage with 2% chlorhexidine gluconate is in Group A. In group B, BID was cleaned with a sterile cotton swab containing 2 percent chlorohexanol gluconate. BID uses a 75 percent alcohol sterile cotton swab wipe for basic needle maintenance. The intervention measures suggested by each group were provided to the three groups. Finally, the effects and differences of the intervention measures used by the three groups on the infection rate of the needle tract after external fixation and patient pain scores were examined. It is worth noting that chlorhexidine disinfectant has not only evident and quick germicidal effects but also long-term bacteriostatic efficiency against germs that are difficult to develop drug resistance to. The nursing technique of chlorhexidine pressure bandaging the needle tract minimises the risk of infection, particularly severe needle tract infection. The compression bandage group had a considerably lower rate of needle tract infection than the other two groups (P0.05), according to the statistics. The pain score in the pressure bandaging group was significantly lower than the other two groups after intervention (P0.05), notably in the typical alcohol disinfection group. The use of 2 percent chlorhexidine gluconate alcohol gauze pressure dressing nursing measures can minimise the rate of needle tract infection following external fixator surgery, as well as the pain and satisfaction of patients. The needle tract nursing technique offers clinical and promotional value.


Assuntos
Anti-Infecciosos Locais , Clorexidina , Bandagens , Fixadores Externos , Fixação de Fratura , Gluconatos , Humanos , Dor , Infecção da Ferida Cirúrgica
11.
Medicine (Baltimore) ; 101(26): e29832, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35777050

RESUMO

BACKGROUND: Pulmonary hypertension (PHTN) may occur in thyroid disorders, especially in hypothyroidism. However, there is increasing evidence of PHTN in hyperthyroidism (HTH). The etiology, clinical course, management, and factors associated with outcomes of PHTN in the setting of HTH are unascertained. This systematic review consolidates available evidence on patients with HTH who developed PHTN. METHODS: We conducted a systematic review on English articles from PubMed, Scopus, and Google Scholar reporting PHTN in patients with hyperthyroidism. Data were analyzed and reported in Microsoft Excel 2020, SPSS version 26, and Jamovi version 1.2. RESULTS: We identified 589 patients with PHTN in the setting of HTH. Etiologies included Grave disease 66.7%), toxic multinodular goiter (TMNG) (16.8%), drug-induced HTH (0.3%), thyroiditis(0.8%), and toxic adenoma(0.1%). Most patients did not receive any specific management for PHTN and were managed by antithyroid treatment (97.4%). Outcomes of PHTN were reported in 181 patients, with a 94% recovery rate. Pulmonary artery pressures (PAP) before and after HTH management ranged from 22.5 to 75 mm Hg and from 24 to 50 mm Hg, respectively. Outcome analysis performed on data from case reports and series with individually identifiable data revealed a 67.6% female preponderance. An estimated 73.5% of the patients had PHTN at the initial presentation of HTH, which was associated with a better resolution rate of PHTN(OR: 12, P-value: 0.048). TRAB was positive in 47% patients with no clinical difference in outcomes. antiTG AB was reported positive in 29.4%, all of whom had an improvement, compared to an 83.3% improvement rate in those with negative antiTG AB. Various etiologies and treatments did not have any significant differences in the outcome of PHTN. CONCLUSIONS: PHTN can be present at the initial diagnosis of HTH, which is associated with better outcomes of PHTN. There is a clear female preponderance in the development of PHTN. However, resolution rates seem to be better in males. Although TRAB is associated with the development of PHTN, it does not seem to affect the outcomes. PHTN in patients with HTH does not need any specific management, with >90% resolution with antithyroid therapy. Whether any specific antithyroid therapy has a better outcome in PHTN needs to be explored prospectively.


Assuntos
Hipertensão Pulmonar , Hipertireoidismo , Hipotireoidismo , Clorexidina , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Masculino , PubMed
12.
Medicine (Baltimore) ; 101(30): e28925, 2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35905275

RESUMO

Several investigations evaluated the possibility of different types of mouth wash rinse in minimizing the SARS-CoV-2 load. However, results still controversial. The study aim is to assess the short-term efficiency of several over-the-counter mouth rinses and lozenges in minimizing the salivary viral load for SARS-CoV-2 in patients with confirmed COVID-19 in comparison to saline. This is a randomized controlled clinical trial with 4 arms. The recruited cases were randomized using a simple randomization technique and were assigned to chlorhexidine digluconate mouth rinse (CHX mouth rinse), 2 mg of chlorhexidine digluconate lozenges (CHX lozenges), povidone iodine mouth rinse (PVP-I mouth rinse) or saline as a control group. Saliva were collected from all study subjects by passive drool technique at two time points. First, prior to intervention with mouth rinse or the lozenges, the baseline saliva sample was collected. Second saliva samples were collected immediately after the mouth rinse. Real time PCR was conducted and the value threshold cycle (Ct) for each sample was recorded. Majority of the participants had an education level of high school or less (60%), were married (68.3), males (58.3%), and non-smokers (58.5%). No statistically significant differences between groups at the two times test (P > .05). However, a significant decrease of salivary viral load in all four groups combined (P-value for E genes = .027, and for S genes = .006), and in PVP-I mouth rinse specifically (P = .003 and P = .045, respectively). Povidone iodine mouth rinse showed a potential influence on the reduction of the viral load on a short-term basis. However, longer-term studies of the effect of these products should be conducted.


Assuntos
Anti-Infecciosos Locais , COVID-19 , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Humanos , Masculino , Antissépticos Bucais , Povidona-Iodo/uso terapêutico , SARS-CoV-2 , Carga Viral
13.
BMC Pediatr ; 22(1): 455, 2022 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902844

RESUMO

BACKGROUND: Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age. METHODS: A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections. RESULTS: In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted. CONCLUSION: Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children. TRIAL REGISTRATION: Prospero registration ( CRD42020166193 ).


Assuntos
Anti-Infecciosos Locais , Clorexidina , Adulto , Anti-Infecciosos Locais/uso terapêutico , Criança , Clorexidina/uso terapêutico , Humanos , Povidona-Iodo , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Sci Rep ; 12(1): 11413, 2022 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-35794229

RESUMO

Concern about resistance to chlorhexidine has increased due to the wide use of the latter. The impact of the qacA/B and smr chlorhexidine tolerance genes on the outcome of methicillin-resistant Staphylococcus aureus (MRSA) infections is unclear. We evaluated the prevalence and clinical impact of, and microbiological risk factors for, qacA/B tolerance in MRSA bacteremia. MRSA bacteremia that occurred more than two days after intensive care unit admission between January 2009 and December 2018 was identified from a prospective cohort of S. aureus bacteremia in a tertiary-care hospital from South Korea. A total of 183 MRSA blood isolates was identified, and the major genotype found was ST5-MRSA-II (87.4%). The prevalences of qacA/B and smr were 67.2% and 3.8%, respectively. qacA/B-positive isolates were predominantly ST5-MRSA-II (96.7% [119/123]), the dominant hospital clone. In a homogenous ST5-MRSA-II background, qacA/B positivity was independently associated with septic shock (aOR, 4.85), gentamicin resistance (aOR, 74.43), and non-t002 spa type (aOR, 74.12). qacA/B positivity was found to have decreased significantly in ST5-MRSA-II in association with a decline in qacA/B-positive t2460, despite the increasing use of chlorhexidine since 2010 (P < 0.001 for trend). Continuous surveillance of the qac genes, and molecular characterization of their plasmids, are needed to understand their role in MRSA epidemiology.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Clorexidina/farmacologia , Humanos , Unidades de Terapia Intensiva , Proteínas de Membrana Transportadoras/genética , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética
15.
Sci Rep ; 12(1): 12149, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35840757

RESUMO

Bacterial resistance to the antiseptic chlorhexidine (CHX), is a growing problem, recently shown to be caused by deleterious mutations to the phospholipid transport system component (mlaA) as well as efflux pump overexpression. Comparisons of CHX resistance mechanisms, such as porin deletions (ompCF), and over-expressed efflux pumps (acrB, qacE, aceI), are lacking and may be distinguishable using antiseptic rapid fluorescent dye testing assays. Using E. coli K-12 CHX adapted isolates (CHXR1), gene deletion mutants, and over-expressed transformants the phenotypes of these CHX resistance genes were compared using antimicrobial susceptibility tests (AST), rapid fluorescent propidium iodide dye-based membrane integrity assays (RFDMIA), and scanning electron microscopy (SEM). AST findings showed CHXR1, ΔacrB, ΔompCF, and transformants pCA24N-aceI and pCA24N-mlaA conferred greater (two to fourfold) MIC changes when compared to matched controls. Examination of these mutants/transformants using CHX RFDMIA showed that porin dual-deletions (ΔompCF) and mlaA alterations (ΔmlaA; pCA24N-mlaA, CHXR1) were distinguishable from controls. Results for over-expressed (pMS119EH-aceI) and deleted (ΔacrB) efflux pump RFDMIA could not be distinguished with propidium iodide, only with ethidium bromide, suggesting propidium iodide is better suited for detecting porin and mlaA associated CHX resistance mechanisms. SEM of CHXR1 and unadapted E. coli cells exposed to increasing CHX concentrations revealed that CHX does not visibly damage cell envelope integrity at any tested concentration but did identify elongated CHXR1 cells. ΔmlaA confers similar levels of CHX resistance as efflux overexpression and porin deletions, however, only outer membrane-altering porin and mlaA deletions can be reliably distinguished using RFDMIA.


Assuntos
Anti-Infecciosos Locais , Proteínas de Escherichia coli , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Clorexidina/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/genética , Escherichia coli/metabolismo , Proteínas de Escherichia coli/genética , Corantes Fluorescentes , Proteínas de Membrana Transportadoras/genética , Testes de Sensibilidade Microbiana , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Fenótipo , Porinas/genética , Propídio
16.
Hu Li Za Zhi ; 69(4): 64-75, 2022 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-35893338

RESUMO

BACKGROUND: There are many different approaches to umbilical cord care in clinical practice. Dry care is recommended by the WHO based on its ease of implementation and relatively low cost. However, the effect of dry care on the time of umbilical cord separation and related complications require further study. PURPOSE: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dry care on the time of umbilical cord separation and related adverse events in newborns. METHODS: A literature search was conducted of articles published before December 2021 in the Cochrane Library, PubMed, Medline, CINAHL, Embase, Airiti Library, and National Digital Library of Theses in Taiwan databases. The research quality of the identified articles was assessed using the Modified Jadad Scale. Statistical analyses were performed using Review Manager, version 5.3, with statistics reported as mean differences with 95% confidence intervals. RESULTS: Seven randomized controlled trials covering a total of 27,037 newborns were identified for analysis. Umbilical cord care in these studies included the following approaches: dry care, alcohol, chlorhexidine (CHX), mother's milk, and salicylic sugar powder (SSP). The results of the meta-analysis showed that umbilical cord separation time was significantly lower for the dry care approach compared to the alcohol approach (MD: -1.78 days, 95% CI: -2.4 to -1.16, three studies, n = 2,102) but not significantly different than the CHX approach (MD: -0.15 days, 95% CI [-1.99, 1.69], two studies, n = 10,519). Notably, the umbilical cord separation time for both mother's milk (MD: 1.19 days, 95% CI [0.82, 1.56], three studies, n = 730) and SSP (MD: 4.9 days, 95% CI [3.71, 6.09], one study, n = 92) approaches were reported as significantly less than the dry care approach. In addition, the CHX approach was associated with significantly fewer cord-related adverse events, while the alcohol, mother's milk, and SSP approaches were associated with rates of cord-related adverse advents similar to dry care. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Because using dry care for umbilical cord care shortens the cord separation time compared to the alcohol approach and does not increase the incidence of omphalitis, this approach should be the first choice for cord care. Both mother's milk and SSP approaches are also associated with shorter umbilical cord separation times without adverse effects, and may be used as alternatives to dry care in umbilical cord care.


Assuntos
Anti-Infecciosos Locais , Anti-Infecciosos Locais/farmacologia , Clorexidina , Humanos , Incidência , Recém-Nascido , Taiwan , Cordão Umbilical
17.
BMJ Open ; 12(7): e060105, 2022 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-35820766

RESUMO

OBJECTIVES: In low-income countries, birth weights for home deliveries are often measured at the nadir when babies may lose up of 10% of their birth weight, biasing estimates of small-for-gestational age (SGA) and low birth weight (LBW). We aimed to develop an imputation model that predicts the 'true' birth weight at time of delivery. DESIGN: We developed and applied a model that recalibrates weights measured in the early neonatal period to time=0 at delivery and uses those recalibrated birth weights to impute missing birth weights. SETTING: This is a secondary analysis of pregnancy cohort data from two studies in Sarlahi district, Nepal. PARTICIPANTS: The participants are 457 babies with daily weights measured in the first 10 days of life from a subsample of a larger clinical trial on chlorhexidine (CHX) neonatal skin cleansing and 31 116 babies followed through the neonatal period to test the impact of neonatal massage oil type (Nepal Oil Massage Study (NOMS)). OUTCOME MEASURES: We developed an empirical Bayes model of early neonatal weight change using CHX trial longitudinal data and applied it to the NOMS dataset to recalibrate and then impute birth weight at delivery. The outcomes are size-for-gestational age and LBW. RESULTS: When using the imputed birth weights, the proportion of SGA is reduced from 49% (95% CI: 48% to 49%) to 44% (95% CI: 43% to 44%). Low birth weight is reduced from 30% (95% CI: 30% to 31%) to 27% (95% CI: 26% to 27%). The proportion of babies born large-for-gestational age increased from 4% (95% CI: 4% to 4%) to 5% (95% CI: 5% to 5%). CONCLUSIONS: Using weights measured around the nadir overestimates the prevalence of SGA and LBW. Studies in low-income settings with high levels of home births should consider a similar recalibration and imputation model to generate more accurate population estimates of small and vulnerable newborns.


Assuntos
Retardo do Crescimento Fetal , Recém-Nascido de Baixo Peso , Teorema de Bayes , Peso ao Nascer , Clorexidina , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Nepal/epidemiologia , Gravidez , Prevalência
18.
PLoS One ; 17(7): e0271274, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35802692

RESUMO

This study aimed to assess the in vitro antimicrobial effects of chlorhexidine (CHX) and povidone-iodine (PI) on clinical isolates of Escherichia coli (E. coli) and Trueperella pyogenes (T. pyogenes) from the vaginal discharge of dairy cows, as well as to compare the cytotoxicity effects of CHX and PI on bovine endometrial epithelial cells (BEnEpC). In Experiment 1, 12 E. coli and 10 T. pyogenes were isolated from the vaginal discharge of cows with a uterine infection. The MIC and MBC against CHX and PI were analyzed in vitro. In Experiment 2, the cytotoxicity effects of CHX and PI on BEnEpC were analyzed using a Viability/Cytotoxicity Kit, wound scratch healing assay, and the expression of pro-inflammatory cytokine genes (IL-6, IL-8, and TNF-α). In Experiment 1, the MIC and MBC values of CHX against E. coli were 0.0002% and 0.0002 to 0.00025%, respectively. The MIC and MBC values of PI were 1.25 to 2.5% and 1.25 to 5%, respectively. For T. pyogenes, the MIC and MBC values of CHX were 0.00002%. The MIC and MBC values of PI were 1.25%. In Experiment 2, the cell viability significantly decreased, and wound closures were significantly inhibited after treatment with ≥ 0.002% CHX and ≥ 0.025% PI. The expression of IL-6, IL-8, and TNF-α significantly increased after treatment with PI. Only IL-6 showed a significant increase after cells were treated with 0.00002% and 0.0002% CHX. The results suggested that both CHX and PI had high antibacterial effects. However, veterinarians and farmers should be aware of their cytotoxicity, which decrease viability of endometrial epithelial cells and inhibit wound healing in vitro.


Assuntos
Doenças dos Bovinos , Clorexidina , Endometrite , Povidona-Iodo , Actinomycetaceae/efeitos dos fármacos , Animais , Antibacterianos/uso terapêutico , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Doenças dos Bovinos/microbiologia , Clorexidina/uso terapêutico , Endometrite/tratamento farmacológico , Endometrite/microbiologia , Endometrite/veterinária , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/veterinária , Feminino , Interleucina-6 , Interleucina-8 , Povidona-Iodo/uso terapêutico , Fator de Necrose Tumoral alfa , Descarga Vaginal
19.
J Evid Based Dent Pract ; 22(2): 101727, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35718434

RESUMO

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Sadeq A. Al-Maweri, Mohammed Nasser Alhajj, Esraa A. Deshisha, Ameera K. Alshafei, Azza I. Ahmed, Nada O. Almudayfi, Sara A. Alshammari, Alla Alsharif, Saba Kassim (2021). Curcumin mouthwashes versus chlorhexidine in controlling plaque and gingivitis: A systematic review and meta-analysis. International Journal of Dental Hygiene. Pages 1-9. SOURCE OF FUNDING: Government? Industry? Non-profit, Foundations, etc? Other? Information not available? TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.


Assuntos
Anti-Infecciosos Locais , Curcumina , Placa Dentária , Gengivite , Anti-Infecciosos Locais/uso terapêutico , Clorexidina , Placa Dentária/prevenção & controle , Gengivite/prevenção & controle , Humanos , Inflamação , Antissépticos Bucais
20.
Dent Mater ; 38(7): 1149-1161, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35680429

RESUMO

OBJECTIVES: To evaluate the inhibitory effect of a novel mussel-inspired monomer (N-(3,4-dihydroxyphenethyl)methacrylamide (DMA) on the soluble and matrix-bound proteases. METHODS: The inhibitory effect of DMA (0, 1, 5, and 10 mM) and 1 mM chlorhexidine (CHX) dissolved in 50% ethanol/water on soluble recombinant human matrix metalloproteinases (rhMMP-2, -8, and -9), as well as cysteine cathepsins (B and K) were evaluated using both fluorometric assay kits and molecular docking. The effect of CHX and DMA on matrix-bound proteases was examined by in situ zymography, and the fluorescence intensity and relative area were calculated by Image J software. All data obtained were analyzed by one-way ANOVA followed by Tukey test (α = 0.05). RESULTS: The anti-proteolytic ability of DMA increased in a dose-dependent manner except that of rhMMP-9. Inhibitory effect of 1 mM DMA against rhMMP-2, - 8, - 9, as well as cathepsin B and K was all significantly lower than 1 mM CHX (p < 0.05). The molecular docking analysis was in good agreement with the experimental results, that the binding energy of DMA was lower than CHX for all proteases. In situ zymography revealed that all DMA- and CHX-treated groups significantly inactivated the matrix-bound proteases, with a dramatic reduction of the fluorescence intensity and relative area compared with the control group (p < 0.05). SIGNIFICANCE: Under the prerequisite condition that the overall inhibitory performance on matrix-bound proteases was comparable by DMA and CHX, the more selective property of DMA could avoid inducing potential negative effects by suppressing MMP-9 when applied in dental treatment compared with CHX.


Assuntos
Anti-Infecciosos , Dentina , Anti-Infecciosos/farmacologia , Clorexidina/farmacologia , Colágeno/farmacologia , Dentina/química , Humanos , Metaloproteinases da Matriz/metabolismo , Simulação de Acoplamento Molecular , Inibidores de Proteases/farmacologia
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