Can portable ultrasound bladder scanner be applied to young children less than three years old?

Minh-Tung Do ^a , Louis Kim ^b , Young Jae Im ^a,b , Kwanjin Park ^{a,b, *}

Summary

Introduction The bladder scanner (BS), a portable ultrasound device specialized in bladder volume measurement, has been developed and applied to clinical assessment of postvoid residual urine, which is a requisite in evaluating patients with voiding dysfunction.

However, experiences in the application of the BS to the pediatric population remain limited despite commonly encountered reluctance to catheterization. This prospective observational study aimed to evaluate the correlation and accuracy of the newly developed pediatric module of the BS (BioCon-900) in measuring bladder volume in children 0e6 years.

Materials and methods

This study included 29 patients scheduled to undergo preventive untethering for their spinal dysraphism. When they undergo cystometry for the confirmation of normal neurologic function, bladder volume was measured by BS when recorded volume infusion reached each quartile of the age-adjusted estimated bladder capacity (EBC). The difference (bias) between measured and infused volume was expressed as a percentage of EBC (%EBC). The correlation coefficient and the Bland_Altman plot were obtained to determine the discriminating power and accuracy, respectively. The acceptable limit was set as 30%EBC.

Results

A strong correlation between the measured and infused volume (r = 0.95, P < 0.001) was found for the entire age range. This excellent correlation remained comparable between children less than three years and the older ones. Bladder volume tended to be overestimated, and the mean bias was 33 ± 22.3%EBC, and it became higher with increasing quartiles. The accuracy was acceptable in all ranges of measurement in the older group and first and second quartiles in the younger one.

Discussion

We have first evaluated the potential use of BS in 0_3 years old children and compared the results with 4_6- year-old children in whom the accuracy of BS has been demonstrated. The strong point of our study was the inclusion of data spanning all quartiles of bladder volume. The use of infused volume as reference enabled us to assess the accuracy in a more precise way than the use of ultrasound. Despite the good discriminating power, the accuracy was not acceptable in higher quartiles in the younger group. If the trend of overestimation especially higher volume, could be understood prior to measurement, it would be helpful to assume the real val.

Conclusions

The children’s module in BS showed excellent discriminating power and generally acceptable accuracy in more than four-year-old children. This may lose accuracy in higher quartiles among less than three years old children.

A global view of pediatric urology

Catherine R. deVries *

Summary

Over the course of approximately 60 years, the  field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guide-lines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is decreasing. In low-and middle-income countries (LMICs), health systems for large populations are currently in a state of stress. Here we briefly review the history of pediatric urology as a surgical subspecialty, identify unmet needs especially in LMICs and place the field in the context of a global surgical ecosystem.

Methods

The English language literature on workforce trends in pediatric urology, pediatric surgery and urology was reviewed as well as development of the emerging field of global surgery. Global surgery looks at the social, economic and political context of health systems as well as unmet clinical need. World trends in fertility rates were reviewed to identify regions of workforce surplus and gaps, supply chain needs, infrastructure and systems strengths and weaknesses.

Results

The proliferation of training programs in pediatric surgery and specialties in high-income countries (HICs) coupled with declining birth rates has led to a saturation of specialists and declining surgical case load. In LMICs, while the birth rate has also been declining, surgical specialization has not progressed. In the lowest income countries, especially in sub-Saharan Africa, training in pediatric surgical specialties and urology is rare. The broad workforce that supports surgical care, such as anesthesia, intensivist pediatrics, radiology, laboratory, and nursing face similar challenges. Supply chains for specialized pediatric urological surgery are weak.

Conclusion

There is an evolving maldistribution of pediatric surgical and pediatric urological workforce globally, with too few practitioners in LMICs and too many in HICs. The high cost of specialized equipment limits access to quality care, and the supply chain for consumables and medication is patchy. In LIC’s, basic community-based infrastructure for health including reliable electricity is lacking. Recent experience with Covid and environmental disasters has highlighted that even in HICs surgical resilience can be challenged. This is an opportunity to consider the state of children’s urological care globally and to build resilience by identifying and addressing strengths and gaps.

Effects of hypochlorous acid mouthwash on salivary bacteria including Staphylococcus aureus in patients with periodontal disease: a randomized controlled trial

Ying‑Chu Lin¹ , Cheng‑Feng Tsai^1,2* and Hsiao‑Ling Huang^3*

Abstract

Background The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD).

Methods Patients with PD were randomized into mouthwash-only (MW, n=26) and mouthwash with periodon‑tal flosser (MWPF, n=27) groups. Patients without PD were selected for the control group (n=30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time poly‑ merase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus.

Results No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51%±0.06% and 1.42%±0.37%, respectively.

Conclusions These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD.

Trial registration The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.

Keywords Antibacterial ability, Total bacterial count, Hypochlorous acid, Mouthwash, Intervention, Bacterial growth estimation

次氯酸消毒剂在骨科术后切口愈合中的应用：一项实效性随机对照试验

张 燕１，朱 迪１，孙 磊１，王任贤２

（１．徐州仁慈医院感染管理科，江苏 徐州 ２４１００４；２．台湾防疫学会，台湾 台中 ４０４４７）

［摘 要］ 目的 探讨次氯酸应用于外科术后切口愈合及减少术后切口感染的临床效果。方法 纳入某三级甲等医院足踝外科住院患者，按手术时序进行分组：第一阶段（２０２４年１０月１６日—１２月１６日）为对照组，采用４５００～５５００ｍｇ／Ｌ碘伏消毒术后切口；第二阶段（２０２４年１２月１７日—２０２５年２月１７日）为试验组，采用（１１０±１６．５）ｍｇ／Ｌ次氯酸消毒术后切口。术后第１、３、５、７、１０、１４天进行切口消毒、指标评价并记录。主要结局指标为手术部位感染，次要指标包括术后４８ｈ红肿、过敏及疼痛程度评分。结果 对照组感染发病率为０．９６％，术后４８ｈ红肿发生率为１６．９９％，疼痛评分（１．４１±０．４９）分；试验组未发生感染，术后４８ｈ红肿发生率为９．５８％，疼痛评分为（１．３６±０．４８）分。两组感染发病率及疼痛评分差异均无统计学意义（均 犘＞０．０５），红肿发生率差异具有统计学意义（犘＝０．００６）。按切口类型进行分层分析显示，开放性外伤亚组中，对照组感染发病率为３．１９％，红肿发生率为２９．７９％，疼痛评分为（１．６２±０．４９）分；试验组术后４８ｈ红肿发生率为８．１４％，疼痛评分为（１．４１±０．４９）分，两组感染发病率差异无统计学意义（犘＞０．０５），红肿发生率（犘＜０．００１）及疼痛程度评分（犘＝０．００５）差异均有统计学意义。闭合性外伤亚组中，各结局指标组间比较差异均无统计学意义（均犘＞０．０５）。结论 次氯酸溶液在闭合性外伤术后切口应用的效果与碘伏相当；在开放性外伤术后应用中，其控制术后红肿发生及疼痛的效果优于碘伏。

［关 键 词］ 次氯酸；碘伏；骨科；切口愈合；实效性随机对照试验

［中图分类号］ Ｒ１８１．３＋２ Ｒ１８７＋ ．１

Comparison of the preventive effects of slightly acidic HOCl mouthwash and CHX mouthwash for oral diseases.

Yu-Rin Kim¹ , Seoul-Hee Nam^2*

¹Department of Dental Hygiene, Silla University, Busan, Republic of Korea

²Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si, Republic of Korea

Abstract

The purpose of this study was to compare the preventive effects of the slightly acidic hypochlorous acid (HOCl) mouthwash and chlorhexidine (CHX) mouthwash as a chemical plaque control agent for oral diseases. This study was conducted for 15 patients who had no systemic disease among the patients who visited M Dental Clinic in Busan, South Korea, excluding the patients with incomplete data. The patients were divided into three groups: five patients in the 0.005% CHX (Bukwang Pharm Co., Ltd.) gargling group, five in the slightly acidic HOCl gargling group, and five in the saline gargling group. The patients were instructed to gargle with 15 ml of each mouthwash for 1 minute, and to then spit saliva for 1 min to remove the remaining gargling solution. Then the halitosis, O’Leary index, dental caries activity, bacterial species, and motility were measured. As a result, these decreased in the CHX gargling group compared to the saline gargling group, but the difference was not statistically significant (P>0.005), while there were significant decreases in the HOCl gargling group. The O’Leary index, Snyder test, bacterial motility, and Filamentous more distinctly and effectively decreased in the HOCl gargling group than in the CHX gargling group, showing statistically significant differences (p<0.05). Based on this study, CHX, which is currently widely used in dentistry, can be said to be inconvenient to use due to its strong fragrance and taste, and there have been many reports on the side effects on the oral cavity of its long-term use. Therefore, if HOCl, which is harmless to the human body and has an extensive sterilizing power, is used instead of CHX, safe and effective oral care will be achieved.

Keywords: Dental caries, Periodontal disease, Slightly acidic hypochlorous acid (HOCl), Chlorhexidine (CHX),Bacteria.

Does chlorhexidine and povidone-iodine preoperative antisepsis reduce surgical site infection in cranial neurosurgery?

BM Davies, HC Patel

Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust, UK

ABSTRACT

INTRODUCTION Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. Effective preoperative antisepsis is a recognised prophylactic, with commonly used agents including chlorhexidine (CHG) and povidone-iodine (PVI). However, there is emerging evidence to suggest an additional benefit when they are used in combination. METHODS We analysed data from our prospective SSI database on patients undergoing clean cranial neurosurgery between October 2011 and April 2014. We compared the case-mix adjusted odds of developing a SSI in patients undergoing skin preparation with CGH or PVI alone or in combination.

RESULTS SSIs were detected in 2.6% of 1146 cases. Antisepsis with PVI alone was performed in 654 (57%) procedures, while 276 (24%) had CHG alone and 216 (19%) CHG and PVI together. SSIs were associated with longer operating time (p<0.001) and

younger age (p=0.03). Surgery type (p<0.001) and length of operation (p<0.001) were significantly different between antisepsis groups. In a binary logistic regression model, CHG and PVI was associated with a significant reduction in the likelihood of developing an SSI (adjusted odds ratio [AOR] 0.12, 95% confidence interval [CI] 0.02–0.63) than either agent alone. There was no difference in SSI rates between CHG and PVI alone (AOR 0.60, 95% CI 0.24–1.5).

CONCLUSIONS Combination skin preparation with CHG and PVI significantly reduced SSI rates compared to CHG or PVI alone. A prospective, randomized study validating these findings is now warranted.

KEYWORDS

Antisepsis – Chlorhexidine – Neurosurgery – Povidone-iodine – Surgical wound infection