DOCSLIB.ORG

Review: Perspective on Ocular Toxicity of Presurgical Skin Preparations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Review: Perspective on Ocular Toxicity of Presurgical Skin Preparations www.surgicalneurologyint.com Surgical Neurology International Editor-in-Chief: Nancy E. Epstein, MD, Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook. SNI: Spine Editor Nancy E. Epstein, MD Clinical Professor of Neurological Surgery, School of Medicine, State U. of NY at Stony Brook Open Access Review Article Review: Perspective on ocular toxicity of presurgical skin preparations utilizing Chlorhexidine Gluconate/Hibiclens/Chloraprep Nancy E Epstein MD, FACS Clinical Professor of Neurosurgery, Schoold of Medicine, State University of New York at Stony Brook, NY and ℅ Dr. Marc Agulnick,1122 Franklin Avenue Suite 106, Garden City, NY 11530. E-mail: *Nancy E Epstein - [email protected] ABSTRACT Background: Chlorhexidine Gluconate (CHG), Hibiclens (4% CHG with 4% Isopropyl Alcohol Detergent), and Chloraprep (i.e. labeled CHG-based solutions), utilized as preoperative surgical preparatory solutions may all cause severe oculotoxicity and ototoxicity. Alternatively, 10% Povidone-Iodine (PI) solutions without detergent demonstrate minimal toxic effects on the eyes and ears. *Corresponding author: Methods: Based on studies from 1984 to 2021, we compared the safety/efficacy of CHG-based versus PI-based Nancy E Epstein, MD, FACS, solutions utilized for presurgical skin preparation near the cornea/eyes and ears (i.e., predominantly for cranial or Clinical Professor of cervical spine surgery). Neurosurgery, School of Results: Some studies documented that even minimal exposure (i.e., “splash risk”) during face/neck skin Medicine, State University of preparation with CHG-based solutions could result in irreversible corneal injury and ototoxicity. Within minutes New Yorrk at Stony Brook, NY to hours, CHG-based non-detergent solutions posed the risks of; corneal epithelial edema, anterior stromal and ℅ Dr. Marc Agulnick, 1122 edema, conjunctival chemosis, bullous keratopathy, and de-epithelialization. Notably, even occlusive dressings Franklin Avenue Suite 106, like Tegaderm could not protect against CHG penetration. Alternatively, PI-based solutions posed no to minimal Garden City, NY 11530. ocular and/or ototoxicity, while often demonstrating comparable protection against surgical site infections (SSI). [email protected] Conclusion: Chlorhexidine Gluconate (CHG), Hibiclens, and Chloraprep (i.e. CHG-based solutions) are often used as skin preparations near the face/eyes/spine (i.e., particularly anterior/posterior cervical procedures). Received : 07 June 2021 However, if these solutions come in contact with the eyes, corneal irritation, abrasions, and even blindness may Accepted : 08 June 2021 result. Alternatively, PI non-detergent solutions demonstrate safety/minimal oculotoxicity/ototoxicity, while frequently showing comparable efficacy against SSI. Published : 06 July 2021 Keywords: Chloraprep, Corneal toxicity, Hibiclens, Oculotoxicity, Ototoxicity, Povidone-iodine solution, Skin DOI preparation 10.25259/SNI_566_2021 Quick Response Code: INTRODUCTION Chlorhexidine gluconate (CHG), Hibiclens (4% CHG and 4% Isopropyl Alcohol), and Chloraprep (i.e. CHG-based solutions) presurgical skin preparations have well-documented oculotoxicity and ototoxicity. erefore, great care must be utilized to avoid eye and ear contact when utilizing these presurgical preparation solutions when performing cranial and/ or anterior or posterior cervical spine surgery, and occasionally, other procedures near the eyes/ears. Alternatively, Povidone-Iodine (PI) non-detergent solutions have demonstrated is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. ©2021 Published by Scientific Scholar on behalf of Surgical Neurology International Surgical Neurology International • 2021 • 12(335) | 1 Epstein: Review: Perspective on ocular toxicity of presurgical skin preparations utilizing Chlorhexidine Gluconate minimal eye/ear toxicity, while often showing comparable Lavacol (70% ethanol), 7.5% povidone iodine scrub (PIS plus prophylaxis against surgical site infection (SSI). Here detergent), and 10% PI solutions (PI without detergent). At 3 h, we reviewed the relative risks/benefits, and alternatives all skin preparations resulted in marked de-epithelialization, to CHG-based preoperative skin preparation solutions conjunctival chemosis, and/or anterior stromal edema except versus PI non-detergent solutions for patients undergoing the 10% PI solution without detergent and 0.9% Normal Saline. procedures near the eyes/ears (i.e. cranial surgery, spinal ey concluded that only the 10% PI solution without detergent surgery, and occasionally other procedures). and NS showed no significant toxicity, while all other skin preparations were ototoxic or oculotoxic (i.e., to the cornea). 1984 RABBIT STUDY DOCUMENTED CORNEAL TOXICITY OF CHG/HIBICLENS DOCUMENTATION OF CORNEAL TOXICITY FOR CHG-BASED SOLUTIONS In 1984, Mac Rae et al. evaluated the corneal toxicity in rabbits of multiple skin preparations [Table 1].[5] ese included; Multiple studies demonstrated significant corneal toxicity tincture of iodine (2% iodine, 2.35% sodium iodine, 46% when using CHG-based preoperative skin preparation ethanol), Hibiclens (4% chlorhexidine; 4% isopropyl alcohol solutions for cranial, cataract, or spinal surgery [Table 1].[6,9] with detergent), PhisoHex (3% hexachlorophene/detergent), Van Rij (1995) noted that mistakenly using CHG, Cetrimide Table 1: Oculotoxicity of CHG-based versus PI-based solutions when used as a skin preparation. Near the eyes/ears (i.e., face) and cervical spine. Author Ref# Study design Data Data Data Conclusion Year Journal Mac Rae et al.[5] Corneal Tox Preop Groups Study Groups Findings 1 Week; all 1984 SP NS Phisohex 5 Min AA Corneas Normal Am J Rabbits TincI (2% I, 2.35% Lavachol (70% Moderate CEE Not Conclude Ophthalmol Used NAI/46%) Ethanol Ethanol) Saline 10% PIS without BioM, Corneal Hibiclens 4% 7.5% PI Scrub/Det 3 Hrs Det Pachymetry CHG+4% Isopropyl 10% PIS No Det Marked DE, CC, Min Tox Healing Studies Alcohol Det ASE All Other Preps Tox EM Not 10% PIS and to Cornea 0.9% NS Van Rij et al.[9] Tox Keratopathy Due to Use of Irrigation 3 Years Chose Wrong Result Acute CEE, Light EM CEE, LK 1995 Accidental Use CHG, Solutions by OPH Bottle 5x BK Disrupted/ Doc Cetrimide and Cialit (Some Bottles CHG, Cetrimide 4 Pts Pen Loss ECL Ophthalmol Cataract Surgery Identical) CHG/Cetrimide and 1 Pt Cornea Covered Cialit Conjunctival Flap Murthy et al.[6] Prog UK Due to Case 45 yo F Rx for 8 wk Drops Pathology Hibiclens=CHG 2002 Topical UK with topical CHG Near Total Loss Ulceration 4% with +Det Cornea CHG (0.02%) 0.02% (+Propamidine Corneal Epithelium Loss of Bowman’s Culture 0.1%) Eye Drops Prog UK Membrane No Organisms Required Pen LK Apoptosis But Result Keratoplasty LEC Progressive UK Darouiche CHG (409) versus PI Hypothesis SSI Significantly Lower DATA CDC No REC et al.[3] (440) for Prep Surgical CHG Better an PI CHG versus PI 300-500,000 SSI/Yr/ Which to Use 2010 Site Prep to Avoid SSI <SSI Superficial and USA CHG versus PI NEJM In 30 Days Postop Deep CDC REC to Avoid SSI 2% CHG Inserted in 27 Million Catheters Operations/yr/ USA Bever et al.[1] CHG SP 2 Cases Highly Tox CHG Use Avoid If use CHGHCG 2016 High Risks Eye Tox Corneal Damage CHG to Eye Contact with Eyes Add Protect World -4% CHG SP Despite Recommend: 10% PIS AEP+ Neurosurg Tight OC Eye SP Near Eyes Tight OC Dressing (Contd...) Surgical Neurology International • 2021 • 12(335) | 2 Epstein: Review: Perspective on ocular toxicity of presurgical skin preparations utilizing Chlorhexidine Gluconate Table 1: (Continued). Author Ref# Study design Data Data Data Conclusion Year Journal Steinsapir and CHG for Ker Facial PS Toxic to Research CHG should NOT PIS Safe Effective Woodward[8] 11 Sentinel Cases Cornea PubMed be Used on Face and Choice 2017 Late1980’s Splash Risk Embase Scalp Dermatol Surg Irreversible Damage LexisNexis Risk ME Minimal Exposure Databases Brodie et al.[2] BO Dressing Protect CHG Excellent 1st Arm in vitro: CHG 3rd Arm in Vivo Advise Avoid 2018 From PreSurg CHG SP Antisepsis Pen Edge Tegaderm CHG Pen 10 min Tegaderm BO Curr Eye Res 3 Arms to Experiment Standard Concentrate At 5 min Water Never Pen Dressing with 2–4% Water No Pen with Tegaderm CHGHCG Result Ocular Injury Tegaderm Even with BO Conclusion Use Dressing- Tegaderm 2nd Arm Tegaderm Perm PI Prep to Closed Eye Central Perm Edges to CHG Not Tegaderm Water Impermeable to both CHG and Water at 90 min Ghobrial et al.[4] Preop SP CHG versus PI Compare Efficacy 2011–2015 SSI Pts No Significant 2018 6959 Consecutive Spinal SP SSI DD 48/69 Differences in J Neurosurg Surgery Pt ChloraPrep 2 (0.1%) MIS/885 IF in 51/69 Index 1st SSI PI 33 versus Spine CHGHCG versus PI Cases Surgery CHGHCG to Reduce SSI 1.1% Open 67 of 6074 38 RS Chloraprep 36 Cases Shive et al.[7] Use of CHG SP Head/ Review PubMed 14 Cases Hearing Loss 38 Cases Eye Tox- 38 Cases Eye Tox- 2021 Neck Web of Science CHG/Ear 8 Direct Install Dermatol Surg Review Tox Ears/Eyes 38 Cases Eye Tox- 17 Periocular 7 Prep of Face Surgical Prep 1 Scalp (remaining prep less 2 Drips Distant defined) Sites 3 Not specified Ker: Keratitis, Presurg: Presurgical, CI: Corneal injury, SP: Skin preparation, SC: Skin cleanser, CHG: ChlorHexidine gluconate, Sig: Significant, CD: Corneal damage,
Load more

Recommended publications
  • Antiseptics and Disinfectants for the Treatment Of
    Verstraelen et al. BMC Infectious Diseases 2012, 12:148 http://www.biomedcentral.com/1471-2334/12/148 RESEARCH ARTICLE Open Access Antiseptics and disinfectants for the treatment of bacterial vaginosis: A systematic review Hans Verstraelen1*, Rita Verhelst2, Kristien Roelens1 and Marleen Temmerman1,2 Abstract Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970- 2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel’s and Nugent’s criteria. Results: A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration’s tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole.
    [Show full text]
  • Reseptregisteret 2013–2017 the Norwegian Prescription Database
    LEGEMIDDELSTATISTIKK 2018:2 Reseptregisteret 2013–2017 Tema: Legemidler og eldre The Norwegian Prescription Database 2013–2017 Topic: Drug use in the elderly Reseptregisteret 2013–2017 Tema: Legemidler og eldre The Norwegian Prescription Database 2013–2017 Topic: Drug use in the elderly Christian Berg Hege Salvesen Blix Olaug Fenne Kari Furu Vidar Hjellvik Kari Jansdotter Husabø Irene Litleskare Marit Rønning Solveig Sakshaug Randi Selmer Anne-Johanne Søgaard Sissel Torheim Utgitt av Folkehelseinstituttet/Published by Norwegian Institute of Public Health Område for Helsedata og digitalisering Avdeling for Legemiddelstatistikk Juni 2018 Tittel/Title: Legemiddelstatistikk 2018:2 Reseptregisteret 2013–2017 / The Norwegian Prescription Database 2013–2017 Forfattere/Authors: Christian Berg, redaktør/editor Hege Salvesen Blix Olaug Fenne Kari Furu Vidar Hjellvik Kari Jansdotter Husabø Irene Litleskare Marit Rønning Solveig Sakshaug Randi Selmer Anne-Johanne Søgaard Sissel Torheim Acknowledgement: Julie D. W. Johansen (English text) Bestilling/Order: Rapporten kan lastes ned som pdf på Folkehelseinstituttets nettsider: www.fhi.no The report can be downloaded from www.fhi.no Grafisk design omslag: Fete Typer Ombrekking: Houston911 Kontaktinformasjon/Contact information: Folkehelseinstituttet/Norwegian Institute of Public Health Postboks 222 Skøyen N-0213 Oslo Tel: +47 21 07 70 00 ISSN: 1890-9647 ISBN: 978-82-8082-926-9 Sitering/Citation: Berg, C (red), Reseptregisteret 2013–2017 [The Norwegian Prescription Database 2013–2017] Legemiddelstatistikk 2018:2, Oslo, Norge: Folkehelseinstituttet, 2018. Tidligere utgaver / Previous editions: 2008: Reseptregisteret 2004–2007 / The Norwegian Prescription Database 2004–2007 2009: Legemiddelstatistikk 2009:2: Reseptregisteret 2004–2008 / The Norwegian Prescription Database 2004–2008 2010: Legemiddelstatistikk 2010:2: Reseptregisteret 2005–2009. Tema: Vanedannende legemidler / The Norwegian Prescription Database 2005–2009.
    [Show full text]
  • Ehealth DSI [Ehdsi V2.2.2-OR] Ehealth DSI – Master Value Set
    MTC eHealth DSI [eHDSI v2.2.2-OR] eHealth DSI – Master Value Set Catalogue Responsible : eHDSI Solution Provider PublishDate : Wed Nov 08 16:16:10 CET 2017 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 1 of 490 MTC Table of Contents epSOSActiveIngredient 4 epSOSAdministrativeGender 148 epSOSAdverseEventType 149 epSOSAllergenNoDrugs 150 epSOSBloodGroup 155 epSOSBloodPressure 156 epSOSCodeNoMedication 157 epSOSCodeProb 158 epSOSConfidentiality 159 epSOSCountry 160 epSOSDisplayLabel 167 epSOSDocumentCode 170 epSOSDoseForm 171 epSOSHealthcareProfessionalRoles 184 epSOSIllnessesandDisorders 186 epSOSLanguage 448 epSOSMedicalDevices 458 epSOSNullFavor 461 epSOSPackage 462 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 2 of 490 MTC epSOSPersonalRelationship 464 epSOSPregnancyInformation 466 epSOSProcedures 467 epSOSReactionAllergy 470 epSOSResolutionOutcome 472 epSOSRoleClass 473 epSOSRouteofAdministration 474 epSOSSections 477 epSOSSeverity 478 epSOSSocialHistory 479 epSOSStatusCode 480 epSOSSubstitutionCode 481 epSOSTelecomAddress 482 epSOSTimingEvent 483 epSOSUnits 484 epSOSUnknownInformation 487 epSOSVaccine 488 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 3 of 490 MTC epSOSActiveIngredient epSOSActiveIngredient Value Set ID 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 TRANSLATIONS Code System ID Code System Version Concept Code Description (FSN) 2.16.840.1.113883.6.73 2017-01 A ALIMENTARY TRACT AND METABOLISM 2.16.840.1.113883.6.73 2017-01
    [Show full text]
  • Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
    Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 William A. Rutala, Ph.D., M.P.H.1,2, David J. Weber, M.D., M.P.H.1,2, and the Healthcare Infection Control Practices Advisory Committee (HICPAC)3 1Hospital Epidemiology University of North Carolina Health Care System Chapel Hill, NC 27514 2Division of Infectious Diseases University of North Carolina School of Medicine Chapel Hill, NC 27599-7030 1 Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 3HICPAC Members Robert A. Weinstein, MD (Chair) Cook County Hospital Chicago, IL Jane D. Siegel, MD (Co-Chair) University of Texas Southwestern Medical Center Dallas, TX Michele L. Pearson, MD (Executive Secretary) Centers for Disease Control and Prevention Atlanta, GA Raymond Y.W. Chinn, MD Sharp Memorial Hospital San Diego, CA Alfred DeMaria, Jr, MD Massachusetts Department of Public Health Jamaica Plain, MA James T. Lee, MD, PhD University of Minnesota Minneapolis, MN William A. Rutala, PhD, MPH University of North Carolina Health Care System Chapel Hill, NC William E. Scheckler, MD University of Wisconsin Madison, WI Beth H. Stover, RN Kosair Children’s Hospital Louisville, KY Marjorie A. Underwood, RN, BSN CIC Mt. Diablo Medical Center Concord, CA This guideline discusses use of products by healthcare personnel in healthcare settings such as hospitals, ambulatory care and home care; the recommendations are not intended for consumer use of the products discussed. 2
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Vr Meds Ex01 3B 0825S Coding Manual Supplement Page 1
    vr_meds_ex01_3b_0825s Coding Manual Supplement MEDNAME OTHER_CODE ATC_CODE SYSTEM THER_GP PHRM_GP CHEM_GP SODIUM FLUORIDE A12CD01 A01AA01 A A01 A01A A01AA SODIUM MONOFLUOROPHOSPHATE A12CD02 A01AA02 A A01 A01A A01AA HYDROGEN PEROXIDE D08AX01 A01AB02 A A01 A01A A01AB HYDROGEN PEROXIDE S02AA06 A01AB02 A A01 A01A A01AB CHLORHEXIDINE B05CA02 A01AB03 A A01 A01A A01AB CHLORHEXIDINE D08AC02 A01AB03 A A01 A01A A01AB CHLORHEXIDINE D09AA12 A01AB03 A A01 A01A A01AB CHLORHEXIDINE R02AA05 A01AB03 A A01 A01A A01AB CHLORHEXIDINE S01AX09 A01AB03 A A01 A01A A01AB CHLORHEXIDINE S02AA09 A01AB03 A A01 A01A A01AB CHLORHEXIDINE S03AA04 A01AB03 A A01 A01A A01AB AMPHOTERICIN B A07AA07 A01AB04 A A01 A01A A01AB AMPHOTERICIN B G01AA03 A01AB04 A A01 A01A A01AB AMPHOTERICIN B J02AA01 A01AB04 A A01 A01A A01AB POLYNOXYLIN D01AE05 A01AB05 A A01 A01A A01AB OXYQUINOLINE D08AH03 A01AB07 A A01 A01A A01AB OXYQUINOLINE G01AC30 A01AB07 A A01 A01A A01AB OXYQUINOLINE R02AA14 A01AB07 A A01 A01A A01AB NEOMYCIN A07AA01 A01AB08 A A01 A01A A01AB NEOMYCIN B05CA09 A01AB08 A A01 A01A A01AB NEOMYCIN D06AX04 A01AB08 A A01 A01A A01AB NEOMYCIN J01GB05 A01AB08 A A01 A01A A01AB NEOMYCIN R02AB01 A01AB08 A A01 A01A A01AB NEOMYCIN S01AA03 A01AB08 A A01 A01A A01AB NEOMYCIN S02AA07 A01AB08 A A01 A01A A01AB NEOMYCIN S03AA01 A01AB08 A A01 A01A A01AB MICONAZOLE A07AC01 A01AB09 A A01 A01A A01AB MICONAZOLE D01AC02 A01AB09 A A01 A01A A01AB MICONAZOLE G01AF04 A01AB09 A A01 A01A A01AB MICONAZOLE J02AB01 A01AB09 A A01 A01A A01AB MICONAZOLE S02AA13 A01AB09 A A01 A01A A01AB NATAMYCIN A07AA03 A01AB10 A A01
    [Show full text]
  • Effect of Povidone Iodine, Chlorhexidine Digluconate And
    Annals of Agricultural and Environmental Medicine 2018, Vol 25, No 4, 725–731 ORIGINAL ARTICLE www.aaem.pl Effect of povidone iodine, chlorhexidine digluconate and toyocamycin on amphizoic amoebic strains, infectious agents of Acanthamoeba keratitis – a growing threat to human health worldwide Marcin Padzik1,A-F , Wanda Baltaza1,B-D , David Bruce Conn2,3,E-F , Jacek P. Szaflik4,E-F , Lidia Chomicz1,C,E-F 1 Department of Medical Biology, Medical University, Warsaw, Poland 2 Department of Invertebrate Zoology, Museum of Comparative Zoology, Harvard University, Cambridge, USA 3 One Health Center, Berry College, School of Mathematical and Natural Sciences, Mount Berry, Georgia, USA 4 Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University, Warsaw, Poland A – Research concept and design, B – Collection and/or assembly of data, C – Data analysis and interpretation, D – Writing the article, E – Critical revision of the article, F – Final approval of article Padzik M, Baltaza W, Conn DB, Szaflik JP, Chomicz L. Effect of povidone iodine, chlorhexidine digluconate and toyocamycin on amphizoic amoebic strains, infectious agents of Acanthamoeba keratitis – a growing threat to human health worldwide. Ann Agric Environ Med. 2018; 25(4): 725–731. doi: 10.26444/aaem/99683 Abstract Introduction. Free-living amoebae, ubiquitous in outer environments, in predisposing circumstances may exist as parasites, infectious agents of Acanthamoeba keratitis. In recent decades, the vision-threatening corneal infection is a growing human health threat worldwide, including Poland. The applied therapy is often ineffective due to diagnostic mistakes, various pathogenicity of Acanthamoeba strains and high resistance of cysts to drugs; many agents with possible anti-amoebic activity are still being tested.
    [Show full text]
  • Assessment of the Antibiotic Resistance Effects of Biocides
    Scientific Committee on Emerging and Newly Identified Health Risks SCENIHR Assessment of the Antibiotic Resistance Effects of Biocides The SCENIHR adopted this opinion at the 28th plenary on 19 January 2009 after public consultation. 1 Antibiotic Resistance Effects of Biocides About the Scientific Committees Three independent non-food Scientific Committees provide the Commission with the scientific advice it needs when preparing policy and proposals relating to consumer safety, public health and the environment. The Committees also draw the Commission's attention to the new or emerging problems which may pose an actual or potential threat. They are: the Scientific Committee on Consumer Products (SCCP), the Scientific Committee on Health and Environmental Risks (SCHER) and the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), and are made up of external experts. In addition, the Commission relies upon the work of the European Food Safety Authority (EFSA), the European Medicines Evaluation Agency (EMEA), the European Centre for Disease prevention and Control (ECDC) and the European Chemicals Agency (ECHA). SCENIHR Questions concerning emerging or newly-identified risks and on broad, complex or multi- disciplinary issues requiring a comprehensive assessment of risks to consumer safety or public health and related issues not covered by other Community risk-assessment bodies. In particular, the Committee addresses questions related to potential risks associated with interaction of risk factors, synergic effects, cumulative effects, antimicrobial resistance, new technologies such as nanotechnologies, medical devices, tissue engineering, blood products, fertility reduction, cancer of endocrine organs, physical hazards such as noise and electromagnetic fields and methodologies for assessing new risks.
    [Show full text]
  • Archived at the Flinders Academic Commons This Is the Publisher's Copyrighted Version Of
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Flinders Academic Commons Archived at the Flinders Academic Commons http://dspace.flinders.edu.au/dspace/ This is the publisher’s copyrighted version of this article. The original can be found at: http://pubs.acs.org/doi/abs/10.1021/bi035447%2B 15226 Biochemistry 2003, 42, 15226-15236 Interactions of the QacR Multidrug-Binding Protein with Structurally Diverse Ligands: Implications for the Evolution of the Binding Pocket† Steve Grkovic,‡ Kate M. Hardie, Melissa H. Brown, and Ronald A. Skurray* School of Biological Sciences, UniVersity of Sydney, Sydney, New South Wales 2006, Australia ReceiVed August 13, 2003; ReVised Manuscript ReceiVed October 28, 2003 ABSTRACT: The QacR multidrug-binding repressor protein regulates the expression of the Staphylococcus aureus qacA gene, a multidrug resistance (MDR) locus that is prevalent in clinical isolates of this important human pathogen. In this paper we demonstrate that the range of structurally diverse compounds capable of inducing qacA transcription is significantly more varied than previously appreciated, particularly in relation to bivalent cations. For all of the newly identified inducing compounds, induction of qacA expression was correlated with a matching ability to dissociate QacR from operator DNA. Development of a ligand-binding assay based on intrinsic tryptophan fluorescence permitted dissociation constants to be determined for the majority of known QacR ligands, with values ranging from 0.2 to 82 µM. High- affinity binding of a compound to QacR in vitro was not found to correlate very strongly with either its in vivo inducing abilities or its structure.
    [Show full text]
  • Antiseptics and Disinfectants: Activity, Action, and Resistance
    CLINICAL MICROBIOLOGY REVIEWS, Jan. 1999, p. 147–179 Vol. 12, No. 1 0893-8512/99/$04.0010 Copyright © 1999, American Society for Microbiology. All Rights Reserved. Antiseptics and Disinfectants: Activity, Action, and Resistance 1 2 GERALD MCDONNELL * AND A. DENVER RUSSELL STERIS Corporation, St. Louis Operations, St. Louis, Missouri 63166,1 and Welsh School of Pharmacy, Cardiff University, Cardiff CF1 3XF, United Kingdom2 INTRODUCTION .......................................................................................................................................................148 DEFINITIONS ............................................................................................................................................................148 MECHANISMS OF ACTION ...................................................................................................................................148 Introduction.............................................................................................................................................................148 General Methodology .............................................................................................................................................148 Alcohols ....................................................................................................................................................................151 Aldehydes .................................................................................................................................................................151
    [Show full text]
  • Medicines Regulations 1984 (SR 1984/143)
    Reprint as at 30 March 2021 Medicines Regulations 1984 (SR 1984/143) David Beattie, Governor-General Order in Council At the Government House at Wellington this 5th day of June 1984 Present: His Excellency the Governor-General in Council Pursuant to section 105 of the Medicines Act 1981, and, in the case of Part 3 of the regulations, to section 62 of that Act, His Excellency the Governor-General, acting on the advice of the Minister of Health tendered after consultation with the organisations and bodies that appeared to the Minister to be representatives of persons likely to be substantially affected, and by and with the advice and consent of the Executive Coun- cil, hereby makes the following regulations. Contents Page 1 Title and commencement 5 2 Interpretation 5 Part 1 Classification of medicines 3 Classification of medicines 9 Note Changes authorised by subpart 2 of Part 2 of the Legislation Act 2012 have been made in this official reprint. Note 4 at the end of this reprint provides a list of the amendments incorporated. These regulations are administered by the Ministry of Health. 1 Reprinted as at Medicines Regulations 1984 30 March 2021 Part 2 Standards 4 Standards for medicines, related products, medical devices, 10 cosmetics, and surgical dressings 4A Standard for CBD products 10 5 Pharmacist may dilute medicine in particular case 11 6 Colouring substances [Revoked] 11 Part 3 Advertisements 7 Advertisements not to claim official approval 11 8 Advertisements for medicines 11 9 Advertisements for related products 13 10 Advertisements
    [Show full text]
  • Ocular Disease Management 18Th18th Eeditiondition
    Joseph W. Sowka, OD Andrew S. Gurwood, OD Alan G. Kabat, OD Eyelids and Adnexa, PAGE 09 Conjunctiva and Sclera, PAGE 24 Corneal Disease, PAGE 35 Uvea and Glaucoma, PAGE 49 Vitreous and Retina, PAGE 66 Neuro-Ophthalmic Disease, PAGE 79 The Handbook of OCULAR DISEASE MANAGEMENT 18TH18TH EDITIONEDITION Supplement to JUNE 15, 2016 www.reviewofoptometry.com Dr. Sowka Dr. Gurwood Dr. Kabat 2016_RO_DiseaseGuide_Cover.indd 2 6/3/16 5:31 PM INDICATIONS AND USAGE ZYLET® (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) is a topical anti-infective and corticosteroid combination for steroid-responsive infl ammatory ocular conditions for which a corticosteroid is indicated and where superfi cial bacterial ocular infection or a risk of bacterial ocular infection exists. Please see additional Indications and Usage information on adjacent page, including list of indicated organisms. RP0915_BL Zylet.indd 2 8/12/15 1:38 PM INDICATIONS AND USAGE (continued) Ocular steroids are indicated in infl ammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superfi cial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, and where the inherent risk of steroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and infl ammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns, or penetration of foreign bodies. The use of a combination drug with an anti-infective component is indicated where the risk of superfi cial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye.
    [Show full text]