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Qian J, Lin J, Liu J, Gong Y, Zheng S, Mei L, Tang X, Xie L, Li H, Zhang C, Wang F, Yang X, Hu R, Feng H, Xian J, Tan B, Chen Y. Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: a prospective, randomized, double-blind, noninferiority trial. Int J Surg 2025; 111:697-705. [PMID: 39172724 PMCID: PMC11745714 DOI: 10.1097/js9.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/11/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study aimed to compare the nasal decolonization efficacy and comfort between chlorhexidine gluconate (CHG) and povidone-iodine (PVP) to provide an evidence basis for clinical guidance. METHODS A prospective, randomized, single-blinded, noninferior clinical trial was conducted in 174 patients with pituitary neuroendocrine tumors (PitNETs) who were scheduled to undergo transsphenoidal surgery. The noninferiority margin was δ=-0.1. The primary outcome was the effective rate of disinfection. The secondary outcomes included postoperative inflammatory indicators, the intracranial infection rate, and the proportion of intracranial infection. RESULTS The effective clearance rate of postoperative nasal bacteria was nonsignificantly different between the CHG and PVP groups (88.64% vs. 82.56%; between-group difference 6.10%; 95% CI [-5.30 to 17.50]). There was no significant difference in the incidence of postoperative central nervous system infections or serum inflammation-related indications between the two groups, but sterilization tended to occur quicker and last longer in the CHG group. CHG seemed to have advantages in terms of comfort, including less nasal irritation, less pungency, and better intranasal coloration. CONCLUSION CHG and PVP have equal efficacy in nasal decolonization before transsphenoidal surgery, but CHG seems to have comfort-related advantages in terms of less nasal irritation, less pungency, and better intranasal coloration.
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Affiliation(s)
- Jinyu Qian
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Jie Lin
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
- Department of Neurosurgery, The 943rd Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force, Wuwei, Gansu Province
| | - Jin Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Yali Gong
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University)
| | - Shufang Zheng
- Department of Hospital Infection Control, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Lu Mei
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Xin Tang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Lina Xie
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Hong Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Chao Zhang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Feilong Wang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Xue Yang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Jishu Xian
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Binbin Tan
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University)
- Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing
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Steins A, Carroll C, Choong FJ, George AJ, He JS, Parsons KM, Feng S, Man SM, Kam C, van Loon LM, Poh P, Ferreira R, Mann GJ, Gruen RL, Hannan KM, Hannan RD, Schulte KM. Cell death and barrier disruption by clinically used iodine concentrations. Life Sci Alliance 2023; 6:e202201875. [PMID: 36944419 PMCID: PMC10031031 DOI: 10.26508/lsa.202201875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Povidone-iodine (PVP-I) inactivates a broad range of pathogens. Despite its widespread use over decades, the safety of PVP-I remains controversial. Its extended use in the current SARS-CoV-2 virus pandemic urges the need to clarify safety features of PVP-I on a cellular level. Our investigation in epithelial, mesothelial, endothelial, and innate immune cells revealed that the toxicity of PVP-I is caused by diatomic iodine (I2), which is rapidly released from PVP-I to fuel organic halogenation with fast first-order kinetics. Eukaryotic toxicity manifests at below clinically used concentrations with a threshold of 0.1% PVP-I (wt/vol), equalling 1 mM of total available I2 Above this threshold, membrane disruption, loss of mitochondrial membrane potential, and abolition of oxidative phosphorylation induce a rapid form of cell death we propose to term iodoptosis. Furthermore, PVP-I attacks lipid rafts, leading to the failure of tight junctions and thereby compromising the barrier functions of surface-lining cells. Thus, the therapeutic window of PVP-I is considerably narrower than commonly believed. Our findings urge the reappraisal of PVP-I in clinical practice to avert unwarranted toxicity whilst safeguarding its benefits.
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Affiliation(s)
- Anne Steins
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Christina Carroll
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Fui Jiun Choong
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Amee J George
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- ANU Centre for Therapeutic Discovery, Australian National University, Acton, Australia
| | - Jin-Shu He
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Kate M Parsons
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Shouya Feng
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Si Ming Man
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Cathelijne Kam
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Lex M van Loon
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Perlita Poh
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Rita Ferreira
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Graham J Mann
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Katherine M Hannan
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Ross D Hannan
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Klaus-Martin Schulte
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Otagiri H, Kurita H, Yamada SI, Sakai H, Tobata H, Yanai K, Matsubara K, Eguchi T. Efficacy of cetylpridium chloride mouthwash compared to povidone iodine on oral flora for perioperative patient care: A randomized controlled feasibility study. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Lim NA, Teng O, Ng CYH, Bao LXY, Tambyah PA, Quek AML, Seet RCS. Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review. Ann Med 2022; 54:1488-1499. [PMID: 35594333 PMCID: PMC9132411 DOI: 10.1080/07853890.2022.2076902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Accumulating data suggest antiviral effects of povidone-iodine against the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This narrative review aims to examine the antiviral mechanisms of povidone-iodine, efficacy of povidone-iodine against the SARS-CoV-2 virus, and safety of povidone-iodine to human epithelial cells and thyroid function. METHODS We searched the electronic databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov and World Health Organization's International Clinical Trials Registry Platform for articles containing the keywords "povidone-iodine", "SARS-CoV-2" and "COVID-19" from database inception till 3 June 2021. RESULTS Despite in vitro data supporting the anti-SARS-CoV-2 effects of povidone-iodine, findings from clinical studies revealed differences in treatment response depending on study settings (healthy vs. hospitalized individuals), treatment target (nasal vs. oral vs. pharynx), method of administration (oral rinse vs. gargle vs. throat spray) and choice of samples used to measure study endpoints (nasopharyngeal vs. saliva). One large-scale clinical trial demonstrated reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine is also used to disinfect the oro-pharyngeal space prior to dental or otolaryngology procedures. Although existing data suggest minimal impact of povidone-iodine on thyroid function, high-quality safety data are presently lacking. CONCLUSIONS Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.Key messagesAccumulating data suggest antiviral effects of povidone-iodine against the SARS-CoV-2 virus.Findings from clinical studies reveal differences in treatment response depending on study settings, treatment target, method of administration and choice of samples used to measure study endpoints. One large-scale clinical trial observed reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak.Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.
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Affiliation(s)
- Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ooiean Teng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chester Yan Hao Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lena X. Y. Bao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy M. L. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond C. S. Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:39-45. [PMID: 33747261 PMCID: PMC7959263 DOI: 10.1016/j.jdsr.2021.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/15/2022] Open
Abstract
The Coronavirus disease in 2019 (COVID-19), also referred to as the novel ‘CoV19 (nCov19)’ is caused by a new coronavirus strain similar to Severe Acute Respiratory Syndrome (SARS-CoV-2). SARS-CoV-2 spreads via respiratory droplets, saliva, or direct contact. Therefore it is important to control the viral load in the saliva and respiratory secretions. One of the most simple and cost-effective measures that can be adopted by the public and healthcare professionals to prevent cross-contamination and community transmission, is the implementation of effective oral and throat hygiene. Recent evidence has confirmed that 0.5% povidone iodine (PVP-I) mouthrinse/gargle for 30 s can reduce SARS-CoV-2 virus infectivity to below detectable levels. PVP-I can even interrupt SARS-CoV-2 attachment to oral and nasopharyngeal tissues and lower the viral particles in the saliva and respiratory droplets. Thus, the use of PVP-I mouthrinse as a prophylactic measure has been advocated across the globe to reduce disease transmission. Although the efficacy of PVP-I against SARS-CoV-2 is proven, no review articles have yet discussed the evidence and mechanisms of PVP-I against the SARS-CoV-2. Thus, this paper highlights the rationale, safety, recommendations, and dosage of PVP-I gargle/mouthrinse as an effective method to decrease the viral loads during the pressing times of COVID-19.
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Wang L, Wang N, He MY, Liu HL, Wang XQ. Observation of the effects of three methods for reducing perineal swelling in children with developmental hip dislocation. World J Clin Cases 2020; 8:4719-4725. [PMID: 33195639 PMCID: PMC7642567 DOI: 10.12998/wjcc.v8.i20.4719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/15/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Developmental dysplasia of the hip is a developmental abnormality of the hip joint that results from hypoplasia during birth and continues to deteriorate after birth. AIM To observe the effects of magnesium sulfate wet compress, iodophor wet compress, and ice compress on reducing postoperative perineal swelling in children with developmental hip dislocation to provide effective nursing interventions in the clinic. METHODS A total of 120 children with hip dislocation after surgery in a third-class A hospital from January 2018 to January 2020 were randomly divided into four groups, the magnesium sulfate wet compress group, iodophor wet compress group, ice compress group and the control group. Data such as height, weight, age, duration of surgery, intraoperative blood loss, postoperative body temperature, swelling duration, pain score, and incidence of blisters were collected and analyzed. RESULTS There were no significant differences in height, weight, age, duration of surgery, intraoperative blood loss, and postoperative body temperature among the four groups of children. Statistical differences were observed between the intervention groups and the control group (P < 0.05). CONCLUSION All three methods significantly reduced postoperative perineal swelling in children with developmental hip dislocation, reduced the duration of postoperative perineal swelling, reduced pain, and improved the quality of care.
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Affiliation(s)
- Ling Wang
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Ning Wang
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Mei-Ying He
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Hai-Lun Liu
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xian-Qiang Wang
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing 100853, China
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Frank S, Capriotti J, Brown SM, Tessema B. Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era. EAR, NOSE & THROAT JOURNAL 2020; 99:586-593. [PMID: 32520599 DOI: 10.1177/0145561320932318] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Approaches to nasal and oral decontamination with povidone-iodine (PVP-I) have been published to reduce nosocomial spread of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). The safety of PVP-I topically applied to the nasal and oral cavity is addressed by a literature review. The specific efficacy of PVP-I against coronaviruses and its potential efficacy against SARS-CoV-2 is discussed. METHODS A review was performed utilizing PubMed and Cochrane Databases. All citations in protocols for nasal and oral PVP-I use regarding COVID-19 were independently reviewed. RESULTS Povidone-iodine has been safely administered for up to 5 months in the nasal cavity and 6 months in the oral cavity. Concentrations less than 2.5% in vitro do not reduce ciliary beat frequency or cause pathological changes in ciliated nasal epithelium, upper respiratory, or mucosal cells. Adverse events with oral use have not been reported in conscious adults or children. Allergy and contact sensitivity is rare. Chronic mucosal use up to 5% has not been shown to result in clinical thyroid disease. PVP-I is rapidly virucidal and inactivates coronaviruses, including SARS-CoV and Middle East Respiratory Syndrome (MERS). CONCLUSIONS Povidone-iodine can safely be used in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for up to 5 months. Povidone-iodine rapidly inactivates coronaviruses, including SARS and MERS, when applied for as little as 15 seconds. There is optimism that PVP-I can inactivate SARS-CoV-2, but in vitro efficacy has not yet been demonstrated.
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Affiliation(s)
- Samantha Frank
- University of Connecticut School of Medicine, Farmington, USA
| | | | - Seth M Brown
- University of Connecticut School of Medicine, Farmington, USA.,ProHealth Ear Nose and Throat, Farmington, CT, USA
| | - Belachew Tessema
- University of Connecticut School of Medicine, Farmington, USA.,ProHealth Ear Nose and Throat, Farmington, CT, USA
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