Oral transmucosal absorption of iodine after intraoral preparation with povidone-iodine prior to oral surgeries: a randomized controlled study in 12 male patients

Possible iodophor-induced systemic iodine toxicity during transurethral seminal vesiculoscopy: a case report and literature review

RATIONALE

Iodophor, a disinfectant composed of iodine complexed with a surfactant, is extensively employed for preoperative skin preparation, burn wound management, and mucosal disinfection. Despite its extensive application in clinical practice, emerging clinical evidence has documented associations between iodophor irrigation and acute kidney injury in human. However, systemic iodine toxicity after the seminal vesicle was irrigated with iodophor during transurethral seminal vesiculoscopy (TUSV) has not been previously described.

PATIENT CONCERNS

We report the case of a 70-year-old man who developed transient hypotension, vomiting, confusion, and profound lactic acidosis after the seminal vesicles were irrigated with iodophor.

DIAGNOSES

The patient was diagnosed with confusion and profound lactic acidosis secondary to the seminal vesicle was irrigated with iodophor.

INTERVENTIONS

The patient was admitted to the intensive care unit (ICU), and continuous venovenous haemodiafiltration (CVVH) was initiated 3 h after ICU admission.

OUTCOMES

After six days, the patient's condition improved, allowing the cessation of CVVH. He was discharged from the hospital on the 22nd day after being transferred to the ICU.

CONCLUSION

This case highlights the typical characteristics of iodophor absorption during its regular application. Here, we report the first case of systemic iodine toxicity caused by iodophor irrigation during transurethral seminal vesiculoscopy.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Urinary iodine excretion after using povidone iodine or chlorhexidine gluconate for topical disinfectant in patients undergoing thyroidectomy due to thyroid carcinoma: When to do radio active iodine therapy?

Background

Povidone Iodine (PI) is the most frequent antiseptic used as a topical disinfectant in surgery. It has been reported high transcutaneous iodine absorption due to topical PI usage, but there is a lack of data in periods of excess iodine depletion.

Materials and Methods

This is a cross-sectional study designed to assess serial urinary iodine concentration (UIC) after topical administration of PI to evaluate the transcutaneous iodine absorption and the proper iodine depletion time for safe administration of Radio Active Iodine (RAI) therapy as ablative or adjuvant therapy.

Results

Thirty-seven patients with papillary thyroid carcinoma undergoing total thyroidectomy were assigned to the PI group (n = 20) or chlorhexidine gluconate (CHG) group (n = 17). In the PI group, the UIC levels rose to a maximum of 2 times in the 4th week after administration and returned to pre-operative levels in the 8th week after. In the CHG group, there was a decrease in UIC levels due to a low iodine diet (LID) with a significant P-value of 0.001, <0.001, and 0.001 in the 2nd, 4th, and 8th weeks follow up respectively compared to the PI group. The urinary excretion of excess iodine lasts about 8 weeks after total thyroidectomy until iodine levels turn back to pre-operative values.

Conclusion

If the thyroidectomy was prepared with PI, RAI is better to be performed 6-8 weeks after surgery rather than the standard prescription of 4 weeks.

Stable thyroid function despite regular use of povidone-iodine throat spray for SARS-CoV-2 prophylaxis

BACKGROUND

It is unclear whether unintentional ingestion of povidone-iodine following its application to the oropharyngeal space could affect thyroid function.

OBJECTIVE

To examine thyroid function among individuals who regularly apply povidone-iodine throat spray for SARS-CoV-2 prophylaxis.

METHODS

We designed a case-control study to compare thyroid function among participants who received povidone-iodine throat spray three times a day for 42 days ('cases') and those who received vitamin C ('controls'). Thyroid function was assessed by profiling serum TSH, free T3, and free T4; iodine status was estimated using serum thyroglobulin level, while infection status was determined by measuring anti-SARS-CoV-2 antibody against the nucleocapsid antigen. All measurements were performed in pairs, at baseline and 42 days later. Pre-post changes in thyroid function were compared between groups, before and after stratification according to baseline TSH quartiles.

RESULTS

A total of 177 men (117 cases and 60 controls) (mean age, 32.2 years) were included. Despite comparable demographics and clinical profiles, no clinically or statistically significant differences were observed in thyroid indices between 'cases' and 'controls' before and after stratification according to TSH quartiles. None of the participants developed symptomatic hypo- or hyperthyroidism throughout the study. Post-hoc analysis did not reveal differences in thyroid function according to infection status.

CONCLUSIONS

Data from this study support the overall safety of povidone-iodine use in the oropharyngeal space for SARS-CoV-2 prophylaxis among individuals with normal thyroid function and subclinical thyroid disease.

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

Objectives

To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations.

Methods

This research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence.

Results

This bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ² = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately.

Conclusion

It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.