Clinical Audit of Two Standard Surgical Site Treatments Following Dental Extractions and The Impact on Incidence of Alveolar Osteitis Within a Specialist Dental Clinic

Background Alveolar osteitis is a painful condition following dental extraction associated with absence of blood clot and consequent exposure of underlying alveolar bone. It is a condition whose exact aetiology is unresolved and a known complication in up to 30-40% of dental extractions. The following report details a retrospective evaluation of two approved, long-standing wound care treatments used, post-extraction, within our clinic to assess for relationship with alveolar osteitis incidence. Methods Patients undergoing non-acute dental extraction at a dental out-patient clinic in the UK had received two different standard treatments for a period from 2000 to 2014. The treatments were mouth rinse with physiologic saline or surgical site irrigation and mouth rinse with physiologic saline-low dose aqueous chlorine used in wound and burn-site care. Retrospective, post-operative outcome analysis suggested improved outcomes with one of the standard treatments versus the other. A full retrospective audit of consecutive treatment outcomes was implemented to test the hypothesis. The audit data-collection was blinded to the treatment administered and to the identity of the treating clinician. Statistical analysis was carried out independently and blinded to the treatment modality. Results All patients were routinely reviewed within seven days and a determination of un-complicated healing vs alveolar osteitis (requiring further intervention) was made. Our results show that treatment with of aqueous chlorine in physiological saline significantly reduced the incidence of alveolar osteitis versus the control group who received physiologic saline without socket irrigation and chlorhexidine oral rinse home-care. (Odds Ratio 0.0146 Relative Risk 0.029 (95%CI 0.0093 to 0.0928) significance (p<0.001). Conclusions This is the first report to show an extremely significant reduction in the incidence of alveolar osteitis following treatment with low dose aqueous chlorine in physiological saline compared with those receiving the physiologic saline and saline mouth rinse or Corsodyl mouth rinse. This shows an approach to surgical site care is superior to the most common, reported, standard of care treatment. The impact of this has led to improved antibiotic stewardship within the clinic for dental extraction or elective oral surgery, including third molars.

Liposomal Inhalation after Tracheostomy—A Randomized Controlled Trial

Background: Tracheostomy is a common procedure in critical care. The aim of this study was to evaluate the application of a liposomal inhalation compared to standard physiologic saline (SPS) inhalation on basis of objective and subjective parameters of airway inflammation. Methods: We evaluated in this two-armed, double-blinded and randomized control group study the effect of liposomal compared with SPS inhalation in newly tracheotomized patients. The primary endpoint was defined as trend of tracheobronchial IL-6 secretion at day 1 compared to day 10. Further objective and subjective parameter were evaluated. Results: Fifty patients were randomized in each arm. Tracheal IL-6 levels decreased significantly only after liposomal inhalation. Both inhalative agents seem to have an effect on the respiratory impairment after tracheostomy. Subjective patient impairment was reduced significantly from day 1 to day 10 after tracheostomy with liposomal inhalation. Conclusions: Liposomal inhalation demonstrated an advantage over SPS inhalation in newly tracheotomized patients.

Gratophyllum Pictum (L.) Griff Extract as Anti-Inflammatory on Wistar Rat with Experimental Hemorrhoids. Study on serum IL-6, COX-2, TNF-alpha and total leucocytes in anal tissue.

The author would like to study the effects of ethanol Graptophyllum pictum (L.) Griff extract (EGPE) as anti-inflammation on wistar with experimental hemorrhoids. RCT post-test only design were done on 28 wistar, that were allocated into four groups. The 2nd , 3rd and 4th group were induced with 6% croton oil into anus for three days, the 1st group was not induced. On the 4th day, 1st and 2nd group were given physiologic saline, 3rd and 4th group was given EGPE 100 mg and 300 mg/ kg bw respectively. At the 9th day, before termination, blood was aspirated from retro-ocular region for examination of serum IL-6, COX-2 and TNF-alpha using ELISA method, and SGOT, SGPT, urea and creatinine level. Anus was removed and prepared for microscopic examination to count the leucocyte under 400 HPF. Induction of 6% croton oil was significantly increased TNF-alpha, IL-6, COX-2 and leucocyte count. Treatment with EGPE dose 100 mg and 300 mg/ kg bw significantly reduce TNF-alpha, IL-6, COX-2 and leucocyte count, dose 100 mg was even better than 300 mg except for leucocyte count. SGOT, SGPT, blood urea and creatinine were not significantly different among groups. In conclusion, the EGPE 100 mg and 300 mg have anti-inflammatory effects in hemorrhoids wistar, which can suppress IL-6, COX-2, TNF-alpha, and total leucocytes. The EGPE dose 100 mg is better than dose 300 mg. EGPE save for kidney and liver.

Does ophthalmic-grade silicone oil possess antimicrobial properties?

Purpose To test the antimicrobial properties of silicon oil (Aurosil 1000 cSt, Aurosil Plus 5000 cSt) on in vitro growth of common microorganisms causing endophthalmitis. Materials and methods Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, multi-drug resistant (MDR) strain of Klebsiella pneumoniae, Escherichia coli, Candida albicans, and Aspergillus flavus were prepared to 0.5 McFarland turbidity. The bacteria and fungi were inoculated into the silicone oils, brain heart infusion (BHI) broth for bacteria and Sabouraud dextrose agar (SDA) broth for fungi, respectively, and cultured aerobically for 30 days. From each sample, 10 μl was plated onto nutrient agar and potato dextrose agar (PDA) for testing growth of bacteria and fungi respectively. Cultures from specimens, overnight incubation, and CFU counting were repeated on days 1, 3, 5, 7, 14, 21, 24, and 30. Negative controls were brain heart infusion and physiologic saline as well as silicone oils without any inoculations. Results All bacteria showed a decrease in CFUs by the fifth day and eliminated between 21 and 30 days in silicone oil. The silicon oil, irrespective of its viscosity, had only fungistatic effect up to 30 days. Colony-forming units of microorganisms remained stable in physiologic saline during the study. In BHI and Sabouraud broth, both bacteria and fungi showed a growth pattern that was compatible with the growth curve of microorganisms. Conclusion Medical-grade silicone oil used in ophthalmology exhibited in vitro bactericidal and fungistatic activity over 30 days. Insertion of silicone oil in vitrectomy for endophthalmitis, when required, could supplement the antimicrobial activities of intravitreal antibiotics in management of endophthalmitis.

Оптическая цифровая регистрация седиментации эритроцитов и ее моделирование в форме коллективного процесса

The dependence of the sedimentation rate of donor blood on its percentage in the sample (the degree of its dilution with physiologic saline) ranging from 0.25 to 100% (whole undiluted blood) is investigated with digital video equipment. The ratio of the value of displacement of the sediment–supernatant boundary per time unit was taken as the blood sedimentation rate. In case of registration of different speeds of movement of this boundary in a given volume of the cuvette, their spatial averaging was performed. A substantial increase in the blood sedimentation rate was found experimentally at high levels of its dilution, and, conversely, at blood concentrations in physiologic saline solutions that are close to whole blood. At the same time, the rate of blood sedimentation decreased several times with blood content in the range of 30–50%. It was experimentally shown that variation of blood content in the physiologic saline solution over a wide range did not affect the evenness of sedimentation occurring for almost any blood concentration in the mixture. In other words, in the process of sedimentation of a single blood sample of a given dilution in the physiologic saline solution, the sedimentation rate does not change with time. The experimentally obtained results allowed to build a theoretical model of blood sedimentation for two cases: 1) sedimentation of free erythrocytes (highly diluted blood) and 2) sedimentation of erythrocyte aggregates (almost undiluted blood, up to whole blood). The originality of the model comes from the proposition to consider the sedimentation of cells and/or their aggregates as a collective effect, and not in the traditional form of sedimentation of individual particles or particles interacting with each other. This model gives a satisfactory agreement with experimental laws with the use of certain empirical constants. The study is useful for understanding the process of erythrocyte sedimentation.