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In dentistry, disinfection with antimicrobials is employed under different conditions and at different time points. During the COVID-19 pandemic, the use of disinfectant dental sprays was proposed, among other measures, to help prevent the transmission of infections during dental procedures that require highly effective antiseptics at particularly short contact times. The study aimed to evaluate the efficacy of electrolyzed saline (EOS) compared with other antiseptics in terms of the spread of enveloped and nonenveloped viruses by ultrasonic scaler (USS)–generated dental spray. Suspension tests were performed to evaluate the antiviral efficacy of EOS against herpes simplex virus 1 (HSV-1) and human adenovirus (HAdV), which served as models for enveloped and nonenveloped viruses, respectively. EOS, mostly composed of hypochlorous acid (HOCl), reduced the amount of both virus types in the presence or absence of artificial saliva by > 4 log10 50% tissue culture infectious dose (P < 0.001). In addition, the mechanism of virucidal effect was investigated using transmission electron microscopy. Following this assessment, a virus-laden dental spray transmission model was used to simulate virus-infected patients undergoing dental procedures with USS. Attenuation was achieved by substituting the USS coolant with one of the effective, pretested antiseptics. Due to safety concerns, nonhuman viral pathogens—equine arteritis virus (EAV) and feline calicivirus (FCV)—served as enveloped and nonenveloped virus models, respectively. Viral infection was evaluated by direct droplet/aerosol infection of RK-13 or CRFK cells. In addition, the biocompatibility of the antiseptics was tested with exposure to human oral keratinocytes. EOS demonstrated strong virucidal activity against both enveloped and nonenveloped viruses and was able to absolutely prevent airborne transmission of EAV and FCV through dental spray in the splatter and droplet/aerosol samples. The study emphasized that EOS, a chlorine-based antiseptic, is a promising, reasonably safe, broad-spectrum agent for preventing dental spray–mediated viral transmission. [ABSTRACT FROM AUTHOR]

Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated. In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved. The average success rate has been, respectively, 45.9% and 52% after a single or repeated debridement and irrigation procedures, at a mean follow-up of 53.3 months. The methodological limitations of this study and the heterogeneous material in the reviewed papers notwithstanding, this systematic review shows that debridement and irrigation procedure is associated with a rather poor outcome, even in a population of patients selected on the basis of symptoms' duration and patients should be adequately informed prior to undergo this salvage procedure. [ABSTRACT FROM AUTHOR]

Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated. In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved. The average success rate has been, respectively, 45.9% and 52% after a single or repeated debridement and irrigation procedures, at a mean follow-up of 53.3 months. The methodological limitations of this study and the heterogeneous material in the reviewed papers notwithstanding, this systematic review shows that debridement and irrigation procedure is associated with a rather poor outcome, even in a population of patients selected on the basis of symptoms' duration and patients should be adequately informed prior to undergo this salvage procedure. [ABSTRACT FROM AUTHOR]

Background: Topical sinus irrigation plays a critical role in the management of sinonasal diseases. Yet, the penetration of irrigant to targeted sinuses may be highly variable and difficult to predict. Here, we investigate the use of 3D printing as a planning tool to optimize outcomes. Methods: Eight post-operative models were 3D printed with a FormLabs Form3 printer based on individual CT scans. Irrigations were performed and video recorded with a squeeze bottle attached via silicon water-tight seal, in 4 head positions: 45° to-the-side, 90° to-the-side, 45° forward and 45° to-the-side, and 90° forward, with irrigation fluid entering the upper (conventional) or lower (backfill) nostrils. Results: Significant individual variations were observed in sinus penetration as a function of head position. In general, the maxillary sinus was the easiest to irrigate in most head positions (P <.05), followed by frontal and ethmoid, with sphenoid being the most difficult. Both the 90°-to-the-side and the 90°-forward positions were significantly more effective than the others (P <.05), with 90°-forward better for frontal sinuses and 90°-to-the-side superior for all other sinuses. The backfill was significantly superior to conventional technique in head positions involving a side tilt (P <.05). Conclusion: Variations in technique and position significantly impacted irrigation outcome. Backfill irrigation that pushes fluid against gravity to pool around the ostium, seems to provide overall better outcomes. This study demonstrates the advantage of 3D printing as a rapid planning tool to guide irrigation strategies. [ABSTRACT FROM AUTHOR]

Background: The standard of care for treatment of pyogenic flexor tenosynovitis (PFT) involves antibiotic therapy and prompt irrigation of the flexor tendon sheath, traditionally performed in the operating room. With the acceptance of wide-awake local anesthesia no tourniquet (WALANT) hand surgery and its potential ability to minimize time to flexor tendon sheath irrigation, we sought to determine whether closed irrigation of the flexor tendon sheath could be safely and effectively performed in the emergency department setting with WALANT technique. Methods: A retrospective review was conducted of the senior author's hand surgery consultations over a 12-month period. Six patients were identified who were diagnosed with PFT and subsequently underwent irrigation of the flexor tendon sheath using WALANT technique. Patient outcomes such as length of hospital stay, need for reoperation, infectious etiology, perioperative complications, and postprocedure range of motion (ROM) were identified. Results: Six patients with diagnosis of PFT underwent irrigation of the flexor tendon sheath in the emergency department with local anesthesia only. The irrigation procedures were all well-tolerated. One patient required reoperation due to lack of appropriate clinical improvement following initial irrigation. Four of 6 patients regained their preinjury ROM while the remaining 2 patients had mild proximal interphalangeal joint extension lag. There were no complications associated with the procedures. Conclusions: Surgical treatment of PFT with closed irrigation of the flexor tendon sheath in the emergency department utilizing WALANT technique was safe, effective, and well-tolerated. Local anesthesia alone can be used effectively for irrigation procedures of the flexor tendon sheath. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated a prosthesis-retaining treatment protocol for prosthetic joint infection in patients presenting at a mean of 116 days (range 10-1216 days) after primary arthroplasty. Our regime involved irrigation and debridement followed by implantation of biodegradable gentamicin loaded sponges which do not require removal after implantation. Of 34 patients with a deep infection after total hip arthroplasty, Twenty-five were treated successfully, with a mean follow-up of 35 months. There were no permanent complications. This success rate is comparable to earlier studies. Early initiation of treatment demonstrated a tendency for better results, and late chronic infections had a worse outcome. Because the sponges are degradable, a number of further surgical procedures were avoided. [ABSTRACT FROM AUTHOR]

A rotator cuff tear is an age-related common cause of pain and disability. Studies including our previously published ones have demonstrated that mesenchymal stem cells cultured under hypoxic conditions [hypoxic multipotent stromal cells (MSCs)] facilitate the retention of transplanted cells and promote wound healing. However, there are very few, if any, reports targeting the punctured supraspinatus tendons to create more or equally serous wounds as age-related tears of rotator cuff. It remains to be determined whether transplantation of bone-marrow-derived hypoxic MSCs into the punctured supraspinatus tendon improves tendon repair and, when combined with ultrasound-guided delivery, could be used for future clinical applications. In this study, we used a total of 33 Sprague-Dawley rats in different groups for normal no-punched control, hypoxic MSC treatment, nontreated vehicle control, and MSC preparation, and then evaluated treatment outcomes by biomechanical testing and histological analysis. We found that the ultimate failure load of the hypoxic MSC-treated group was close to that of the normal tendon and significantly greater than that of the nontreated vehicle control group. In vivo tracking of cells labeled with superparamagnetic iron oxide (SPIO) nanoparticles revealed an enhanced retention of transplanted cells at the tear site. Our study demonstrates that hypoxic MSCs improve rotator cuff tear repair in a rat model. [ABSTRACT FROM AUTHOR]

Purposes. This study aimed to evaluate long-term outcomes after the application of a corrosive chemical agent for ablation of epithelial tissue as a non-surgical treatment of anal fistulas. Methods. Adult patients with symptomatic perianal fistula were prospectively included in the study. The fistula tract was irrigated with a 5% silver nitrate solution. The primary outcome measured in this study was the rate of clinical healing after long-term follow-up. Factors that may affect healing were also analysed. Results. A total of 186 patients with anal fistula were analysed. After irrigation with silver nitrate, 82 (44%) patients had complete clinical healing during a median follow-up time of 50 (7–64) months. Patients with intermittent discharge had a significantly higher rate of complete clinical healing than those with continuous discharge (P <.04). Fistulas without abscesses or secondary tracts had a significantly higher rate of complete clinical healing than the other types (P =.007). Conclusion. Chemical ablation of the epithelium of the anal fistula yields promising long-term outcomes in the management of anal fistulas without surgical intervention. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of photodynamic therapy (PDT), sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHO) in the endodontic re-treatment in the removing of microorganisms from previously filled infected root canals. Materials and Methods: The study samples consist of 54 root canal treated anterior teeth with apical periodontitis were randomly divided into three groups according to the disinfection protocol. Microbiological samples from the root canals were collected after removing the gutta-percha (S1) and following the endodontic re-treatment (S2) with either 5% NaOCl, 2% CHO or PDT procedure for 1 minute. Microbiological samples were cultivated on selective plates to assess the presence or absence of microbial growth and determine the average reduction of viable microorganisms. Results: Significant reduction in the total bacterial count in all the groups at post treatment (P <.001). PDT provided statistically higher (99.74%) elimination of Enterococcus faecalis in comparison to NaOCl (95%) and CHO (88%). Conclusions: The use of PDT in endodontic re-treatment led to the significant reduction of the remaining bacterial species. So, PDT can be used for routine endodontic disinfection in failed root canal cases. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of the caffeic acid phenethyl ester (CAPE) as a root canal irrigation agent on the push-out bond strength of the AH-Plus sealer. Materials and Methods: A total of 75 single-rooted teeth were decoronated and were randomly divided into 5 groups of 15 roots for irrigation protocols: Group NaOCl: 5.25 percent NaOCl; Group CAPE: 0.5 percent CAPE; Group NaOCl + ethylenediaminetetraacetic acid (EDTA): 5.25 percent NaOCl-17 percent EDTA; Group NaOCl + CAPE: 5.25 percent NaOCl-0.5 percent CAPE; and Group CAPE + EDTA: 0.5 percent CAPE-17 percent EDTA (for 3 min each group). All root canals were then obturated and 1-mm-thick horizontal slices were obtained from different root thirds of the root canal (coronal, middle, and apical, respectively). The groups were challenged with push-out tests. Modes of failure were determined under a stereomicroscope. Results: The CAPE-EDTA-treated group presented the highest mean bond strength in the coronal region of root dentin (P <.05). The CAPE-treated group had a higher mean bond strength than the NaOCl-treated group (P <.05). The mixed mode of failure was most predominant in all groups. Conclusion: Under the presented in vitro conditions, CAPE alone or in combination with EDTA or NaOCl demonstrated a positive effect that increased the push-out bond strength of the AH-Plus sealer to root dentin. [ABSTRACT FROM AUTHOR]

Bacterial infections in the form of adherent biofilms are frequently implicated in the pathogenesis and recalcitrance of chronic rhinosinusitis. The Hydrodebrider, a disposable powered irrigation and suction device, has been developed specifically to remove biofilm from the paranasal sinuses. We conducted a prospective study to evaluate the tolerability and efficacy of the Hydrodebrider in the office setting with the use of local anesthesia. Of the original 13 adults we recruited, 10 completed the entire study protocol. All enrolled patients had previously undergone sinus surgery that involved the creation of a maxillary antrostomy large enough to allow placement of a Hydrodebrider device, and the endoscopic findings in all patients were consistent with chronic sinusitis. The standard visual analog scale for pain (range: 0 to 10) was used to measure tolerability. The 20-Item Sino-Nasal Outcome Test (SNOT-20) for symptoms was completed at baseline and at 1 and 8 weeks after the procedure. The mean pain score obtained immediately after the procedure was only 2.3, indicating that the procedure was well tolerated. The mean SNOT-20 score trended toward improvement during the first week, but then returned to near-preprocedure levels at 8 weeks. In conclusion, powered irrigation with suction is a well-tolerated procedure in the office setting and might be a useful short-term adjunct in the management of recalcitrant chronic sinusitis. [ABSTRACT FROM AUTHOR]

Irrigation as a bowel management approach has been reportedly used with children for more than 20 years. Parents managing their child’s chronic bowel problem have previously been shown to have increased emotional stress. The aim of this study was to explore professionals’ (n = 24) understanding and parents’ (n = 18) experiences of using transanal irrigation with children at home as a mid to longer term bowel management approach. This study was underpinned by action research methodology and used mixed methods determined by an action research group of parents, professionals, researchers, a voluntary sector worker, commercial representative and independent observer. Data informed the study outcome which was the development and evaluation of a shared health resource to support professionals in their holistic approach when prescribing transanal irrigation and guide parents in the areas of education, management, problem solving, support and goal setting. The resource includes constructed case studies from parents of their experiences to inform choice and decision-making between parents and professionals. The shared health resource provides an approach to initiating and evaluating transanal irrigation and is available in a paper format from key Internet sites across hospital, community and voluntary services. [ABSTRACT FROM PUBLISHER]

Objectives: We evaluated the efficacy over a short period of time of two ceruminolytic products, Otocerum (chlorobutanol, phenol, turpentine essence, ethyl alcohol; Reig Jofre Laboratories, Barcelona, Spain) and Taponoto (potassium carbonate, ethyl alcohol, glycerol, thymol; Teofarma Iberica SA, Barcelona), in adult subjects with complete occlusion of the ear canal due to cerumen. Methods: Ninety subjects with complete occlusion of the ear canal were enrolled in a randomized, subject- and observer blinded, placebo-controlled clinical trial. The subjects were randomly assigned to one of three different treatments: Otocerum, Taponoto, or sterile saline solution (control group). The test medication was instilled into an occluded ear for 15 minutes. After this treatment, the subject's ear was irrigated with 50 mL of water. The main outcome was the proportion of tympanic membranes completely visualized after treatment. Results: One subject among the 90 enrolled did not accept a second ear irrigation and was excluded from the study. Neither Otocerum nor Taponoto was superior to saline solution. Cerumen occlusion resolved in 21 of 32 subjects treated with Otocerum (65.6%), 16 of 29 treated with Taponoto (55.2%), and 12 of 28 treated with saline solution (42.9%). Conclusions: The use of Taponoto or Otocerum did not significantly improve the proportion of tympanic membranes that were completely visualized compared with saline solution when they were instilled 15 minutes before ear irrigation. [ABSTRACT FROM AUTHOR]

A child with osteogenic sarcoma of the sacral spine has complex nursing and interdisciplinary team needs. The course of one patient is discussed, both from the patient and family’s perspective and that of her inter-disciplinary care team. The need for a coordinated, holistic approach to care that involves advance planning, continual reassessment of goals, and clear communication among the team members and consulting services is clearly demonstrated. [ABSTRACT FROM PUBLISHER]

Ingestion of or exposure to potentially poisonous plants is a relatively common presenting complaint in hospital paediatric departments, especially amongst toddlers. We present a retrospective study conducted to review the hospital admissions following acute childhood poisoning with plants in the Czech Republic over a 6-year period from 1996 to 2001. Six university hospital paediatric departments and two local hospital paediatric departments were involved in the study. Information and complete data on the cases were collected on the basis of all hospital medical records and internal hospital database outcomes. A total of 174 plant exposures were analysed to tabulate the list of top species involved in plant poisonings. The aims were to provide classification according to agent frequency, clinical presentations, severity of symptoms expressed, affected age groups and gender of patients and to evaluate the treatment according to patient outcome. The most frequent ingestions were of thorn apple seeds (14.9%), followed by dumb cane exposures (11.5%) and common yew (9.8%). Thorn apple, dumb cane, golden chain and raw beans caused the most serious symptoms. There were no fatalities reported out of the reviewed medical records. Complete data on plant poisoning in children from all over the territory of the Czech Republic are not available; however, we believe that the frequency of causes and the rank of plant species commonly involved are properly reflected in our study. [ABSTRACT FROM AUTHOR]

The glutaraldehyde-stabilized umbilical vein can function well as a vascular conduit in the lower extremity at all levels, provided that the surgeon employs the maximum skills and techniques that can be brought to bear on each patient's disease process. [ABSTRACT FROM AUTHOR]