Ototoxicity of povidone-iodine——A case report

Objective: The ototoxicity of povidone-iodine has been documented in animal studies. However, there is limited evidence of these ototoxic effects in humans. This is the first report to show the ototoxic effects of povidoneiodine in a human subject.Patient: A 36-year-old woman came to our hospital complaining of left unilateral persistent hearing loss. One month before presentation, her child had accidentally struck her on her left ear. She applied approximately three drops of povidone-iodine(10% weight/volume) into her left auditory canal. Immediately after application, she felt severe pain and vertigo. An audiogram revealed severe left unilateral sensorineural hearing loss. Magnetic resonance imaging showed mild enhancement of the left vestibule and basal turn of the left cochlea.Conclusions: Even a single application of povidone-iodine could cause significant hearing loss and disequilibrium. It should, therefore, be used with caution.

Evaluation of a povidone-iodine and chitosan-based barrier teat dip in the prevention of mastitis in dairy cows

Postmilking teat dip is an important tool used to prevent mastitis in the modern dairy industry.In this study,we evaluated the in vitro and in vivo efficacies of a barrier teat dip containing povidone-iodine and chitosan for the prevention of mastitis.In experiment 1,we evaluated the antibacterial effects of chitosans with different molecular weights against six mastitis-causing bacteria based on the minimal inhibitory concentration test.The results showed that 50 k Da chitosan had the maximum antibacterial activity compared with 5,150 and 350 k Da chitosans.In experiment 2,the inhibition zone test indicated that the barrier teat dip with 4.0%povidone-iodine and 1.0%chitosan had higher(P<0.05)in vitro antibacterial efficacy against most tested mastitis-causing bacteria than the barrier teat dip with 4.0%povidone-iodine and no chitosan.In experiments 3 and 4,we evaluated the efficacies of two postmilking teat dips,1)a barrier teat dip containing 1.0%chitosan and 4.0%povidone-iodine and 2)a conventional nonbarrier product containing 10%povidone-iodine in a field trial at two commercial dairy herds(1 and 2).A 56-d split-udder experiment(experiment 3)was conducted using 47 lactating Chinese Holstein cows in herd 1.Both left teats were immersed in barrier postmilking dip,and both right teats were dipped with nonbarrier postmilking dip.During a 56-d split-herd experiment(experiment 4),a total of 139 lactating Chinese Holstein cows from herd 2 were allocated to two groups:1)all teats of 67 cows were dipped in the nonbarrier teat dip,and 2)all teats of 72 cows were dipped in the barrier teat dip.Milk samples were collected and analyzed for somatic cell count(SCC),fat content,protein content,and fat-to-protein ratio prior to the start of sampling(0 d),and at 28 and 56 d after initiation.Bacteriological analysis was only performed on milk samples with SCC≥200000 cells mL^(-1).In experiment 3,no differences(P>0.05)in SCC,somatic cell score(SCS)or other milk quality indicators were observed between nonbarrier and barrier teat dip treatment teats throughout the experiment.At the end of experiment 4,compared with nonbarrier teat dip group,a reduction(P<0.05)of 29%was observed for subclinical mastitis infection prevalence in the barrier teat dip group.In the barrier teat dip group,the subclinical mastitis infection prevalence on 56 d was lower(P<0.05)than 0 d.No differences(P>0.05)in milk qualities or clinical mastitis incidence were detected between groups.Bacteriological analysis demonstrated that the barrier product containing povidone-iodine and chitosan reduced the subclinical mastitis infection prevalence induced by mastitis pathogens.This effect was mainly due to the reductions in Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia fergusonii infections.Overall,the data indicated that a barrier teat dip containing 4%povidone-iodine and 1%chitosan was more effective than 10%povidone-iodine in preventing subclinical mastitis.

Successful prolonged cardiopulmonary resuscitation after intraoperative cardiac arrest due to povidone-iodine allergy: A case report

BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk of cardiac arrest.CASE SUMMARY We present a case in which a patient with postoperative infection went into anaphylactic shock and cardiac arrest caused by povidone-iodine during secondary surgery.The patient was successfully resuscitated by 2 h of cardiopulmonary resuscitation.CONCLUSION This is the first known case of cardiac arrest caused by povidone-iodine allergy.

Effects of Povidone-Iodine or Ethanol Exposure on Bone Formation at the Osteotomy Site of the Proximal Tibia in Rats

Background: Povidone-iodine (PVI) irrigation is currently used to decrease the frequency of postoperative surgical site infections. Ethanol (EtOH) is sometimes applied to prevent local recurrence after curettage of benign bone tumors. However, the effects of PVI and EtOH on surrounding soft tissue and on bone union are unclear. The purpose of this study was to determine whether PVI or EtOH adversely affects the cancellous bone healing of the osteotomy site at the proximal tibia in rats. Methods: A cancellous bone osteotomy was performed at the right proximal tibia in 4-month-old, female, Sprague Dawley rats. Vehicle, 10% PVI, or 95% EtOH-soaked gauze was inserted into the osteotomy site and maintained for 6 minutes. The rats were euthanized 2 or 4 weeks after the osteotomy. Results: Two weeks after treatment, the bone union rate was significantly higher in the vehicle group than in the PVI group and the EtOH group (p < 0.001). However, the bone union rate was not significantly different between the PVI and EtOH groups. There was no significant difference among the three groups in the bone union rate 4 weeks after treatment. Conclusion: PVI or EtOH delayed bone union of the cancellous bone osteotomy site of the proximal tibia in the early phase (2 weeks), but not at 4 weeks, in rats.

Preliminary pharmacological evaluation of Martynia annua Linn leaves for wound healing

Objective:To evaluate the wound healing potential of fractions from ethanol extract of Martynin annua(M.annua) Linn leaves.Methods:Ethanol extract of Af.annua Linn leaves was fractionate into three different fractions(MAF-A,MAF-B and MAF-C) which were screened for wound healing potential using two models:excision and incision on rats.The thin layer chromatography(TLC) profile of all fractions were analysed and TLC of luteolin was also done.The PovidoneIodine Ointment was used as reference for comparision.Excision and incision wounds were created on dorsal portion of rats for study.Wound contraction,biochemical parameters(protein level and hydroxyproline level) and histopathological study were performed in excision wound model whereas incision model was used for determination of tensile strength.Results:The wound contraction and tensile strength of skin tissues were observed significantly greater in MAF-C fraction treated group than other two fractions(P<0.01).In excision wound method(on day 18) protein content and hydroxyproline were found significantly higher in MAF-C group than control group(P<0.01).Histopathological study also showed better angiogenesis,matured collagen fibres and fibroblast cells as compared with the control group.Conclusions:In conclusion, our findings suggest that fiaction MAF-C from ethanol extract of M.annua leaves is found most effective in wound healing.

Incidence of endophthalmitis after phacoemulsification cataract surgery:a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Effect of diluted povidone iodine in adenoviral keratoconjunctivitis on the rate of subepithelial corneal infiltrates

AIM: To evaluate the clinical characteristics of adenoviral keratoconjunctivitis, the management modalities, as well as the incidence of subepithelial corneal infiltrates(SEI).METHODS: Patients with characteristic clinical symptoms and signs, who presented to our clinic within the first week of symptoms and received the diagnosis of adenoviral keratoconjunctivitis between January 2013 and April 2016, were included in the study. A total of 211 patients were included in the study. Patients were evaluated for the incidence of clinical signs, late complications, management preferences, and the effect of diluted povidone-iodine(d-PVP-I) 2%. RESULTS: Patients’ mean age was 33.03±14.76 y. We observed an increase in the number of cases according to the years. At presentation and/or early follow-up, the clinical signs were conjunctival hyperemia(100%), conjunctival follicules(79.1%), edema of the eyelids(39.3%), chemosis(16.1%), pseudomembrane formation(16.6%), and corneal epitheliopathy(29.9%). During late follow-up 13.3% patients developed conjunctival subepithelial fibrosis, and 39.8% developed SEI. A significant decrease in the incidence of SEI development was observed in patients who used d-PVP-I 2%(P=0.032;33.3% vs 45.9%, respectively in patients who received d-PVP-I 2% and who did not).CONCLUSION: Adenoviral keratoconjunctivitis has a tremendous effect on patient’s comfort and abilities in short-term. Additionally, almost half of the patients develop visual problems related to SEI. According to our clinical experience, using d-PVP-I 2% in the first days of adenoviral keratoconjunctivitis might be helpful in reducing the risk of SEI as a complication.

Antiseptic use in the neonatal intensive care unit-a dilemma in clinical practice: An evidence based review

Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections(HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine(CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.

Antibacterial effect of povidone iodine disinfectant and antibiotic eye drops before cataract surgery

Objective:Investigate the distribution of bacteria in the conjunctival sac of two groups of cataract patients with different preoperative aseptic treatments,and compare the clinical effects of 0.5%povidone-iodine(PI)and antibiotic eye drops on killing conjunctival sac bacteria.Methods:400 cases of patients(400 eyes)who underwent cataract surgery in the Department of Ophthalmology of Baogang Hospital in Inner Mongolia from October 2019 to October 2020 were selected in a randomized controlled study.They were randomly divided into the experimental group(group A)and the control group(group B),with 200 cases in each group.Group A:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drop/time)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drop/time)before the operation;0.5%PI was administered to irrigate the conjunctival sac,with 0.9%Sodium Chloride Injection washing after 3 min;0.5%PI was administered to irrigate the conjunctival sac after operation.The corneal epithelium was observed after each irrigation.Group B:the patients were given Gatifloxacin Eye Gel(3 times/day,1 drop/time)combined with Diclofenac Sodium Eye Drops(4 times/day,1 drop/time)2 days and 1 day before the operation;0.9%Sodium Chloride Injection was administered to irrigate the conjunctival sac before and after surgical disinfection.Conjunctival sac specimens were collected for bacterial culture 2 hours before the operation,after irrigation,and after the procedure.The positive rate and the distribution of bacteria were compared between the two groups.Results:The difference in the positive rate of bacteria in the conjunctival sac between the two groups at different time points had a statistical significance(χ^(2)=11.498,p<.022).Conjunctival sac specimens were collected on admission and 2 hours before the operation.There was no significant difference in the pathogens with positive results between the two groups(p=.955;p=.073);there was a substantial difference in the distribution of positive pathogens between the two groups before and after surgical disinfection(p<.001);there was a significant difference in the distribution of pathogens between the two groups after the operation(p=.005).For Staphylococcus epidermidis,Corynebacterium,Enterococcus faecalis,Streptococcus,and other Gram-positive bacteria,there was a significant difference in the disinfection methods between the two groups at different time points(p<.001);for Staphylococcus aureus,Gram-positive cocci,and Gram-negative bacteria,there was no significant difference in the disinfection methods between the two groups at different time points(p=.113;p=.224;p=.146).There was no significant difference between the two groups with 0-10 and 101-1000 bacterial colonies at different time points(p=.370 and.071,respectively).When there were 11-100 bacterial colonies,there was a significant difference between the two groups at different time points(p<.001).There was no significant difference in corneal epithelial injury between the two groups at other time points(χ^(2)=4.133,p=.127).Conclusions:The combination of 0.5%PI disinfectant and antibiotic eye drops can effectively reduce the bacterial load of the conjunctival sac before operation.At the same time,it is safe and effective to irrigate the conjunctival sac with 0.5%PI disinfectant before the procedure.

Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley,Malaysia:a quasi-experimental study

Background Absenteeism amongst pre-school children is often due to illnesses such as hand,foot,and mouth disease,acute gastroenteritis,cold and flu,which are easily spread amongst them.This is because of weak immunity and lack of knowledge on proper hand hygiene.This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme,along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley,Malaysia.Methods A total of 377 school children,male and female,aged 5–6 years old,participated and were assigned to either the intervention or a control group.During the 2 months intervention period,children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets.The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention.Results In the test group,there was a 25%increase in the total number of absent days from the pre-intervention period to the intervention period,a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%.Results showed a significant difference(P<0·05)between the absenteeism rates for the test and control group during the intervention period.Conclusion These results suggest that proper education and intervention increase hand hygiene compliance,which may help decrease school absenteeism due to illness;however,a longer study duration may be necessary to evaluate the benefit further.

A clinical trial of premedication for unscheduled laser in situ keratomileusis surgeries and a related bacteriological analysis of conjunctival sacs

Laser in situ keratomileusis （LASIK） is a quick and effective approach for treating ametropia. It is used to treat relatively healthy corneas, and patients usually have high expectations and requirements for postoperative visual results. Therefore, the prevention of severe postoperative complications, such as corneal infections, is important.~ In China, some individuals require a rapid improvement in uncorrected visual acuity through surgery. There are also individuals from other cities seeking better medical services. Because of time limitations, the preoperative preparation time may be too short to complete a 3-day eye drop treatment with antibiotics. In this case study, we compared the bacterial eliminating effects and adverse reactions of levofloxacin eye drops （Santen Corp., Japan） and 0.5% Povidone-iodine （PVI, Nanda Pharmaceutical Corp., China） irrigation, for different time periods before unscheduled LASIK surgery.