Povidone-Iodine versus antibiotic irrigation in breast implant surgery: Revival of the ideal solution.
Dang Tru,Yim Nicholas,Tummala Sailesh,Parsa Alan A,Parsa Fereydoun Don
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
The use of povidone-iodine alone has been advocated by several authors who continued to utilize it for pocket irrigation despite the US Food and Drug Administration (FDA)'s prohibition of 2000. However, in 2017, the FDA removed the ban against povidone-iodine use in breast augmentation. In the practice of breast augmentation, pocket irrigation with various solutions has been advocated in preventing infection and capsular contraction. However, debate continues regarding an ideal solution that is most efficacious and carries least side effects. Many studies have shown the superiority of povidone-iodine due to its broad antimicrobial spectrum, efficacy against biofilms, lack of resistance, and safe allergenic profile. Povidone-iodine is bactericidal against many multi-drug resistant organisms such as Staphylococcus aureus, Pseudomonas, Enterococcus, and Mycobacterium. In addition, povidone-iodine also has microbicidal activity against fungi, protozoa, spores, and viruses. Despite widespread clinical use and extensive testing, there have been no reports of increased tolerance or resistance to povidone-iodine in any laboratory-derived or clinical isolates to date. Meanwhile, antibiotic resistance is a growing obstacle, and virtually all Gram-negative bacteria are now resistant to bacitracin. We are pleased with the recent change in the FDA's standing on povidone-iodine use in breast implant procedures given its superior antiseptic property, excellent safety profile, lack of resistance, accessibility, and low cost.
Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study.
Tsuda Shoma,Soutome Sakiko,Hayashida Saki,Funahara Madoka,Yanamoto Souichi,Umeda Masahiro
BMC oral health
BACKGROUND:Topical 0.12% chlorhexidine has been used widely to prevent ventilator-associated pneumonia in patients undergoing mechanical ventilation. However, it is not approved for mucosal application in Japan. The aims of this study were to investigate if topical povidone iodine (i) inhibits bacterial growth and (ii) disrupts the balance of the oral microbiota. METHODS:This randomized controlled clinical trial included 23 patients who underwent mechanical ventilation in the intensive care unit. The patients were divided randomly into two groups: the intervention group (n = 16) and the control group (n = 7). All patients received oral cleaning with 3% hydrogen peroxide, followed by irrigation with tap water. The patients in the intervention group received 10% povidone iodine applied topically to the oral cavity. The concentration of total bacteria in the oropharyngeal fluid were determined before, immediately after, 1 h, 2 h, and 3 h after oral care using the Rapid Oral Bacteria Quantification System, which is based on dielectrophoresis and impedance measurements. The number of streptococci, methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Porphyromonas gingivalis, and Candida albicans before, immediately after, 1 h, and 3 h after oral care were estimated based on real-time polymerase chain reaction data. RESULTS:After irrigation of the oral cavity, the number of bacteria decreased, but increased again at 1 h after oral care in the control group; however, in the intervention group, the concentration of bacteria was significantly lower than that in the control group at 1 hour (p = 0.009), 2 h (p = 0.001), and 3 h (p = 0.001) after oral care. The growth of all bacterial species tested was inhibited in the intervention group at 3 h after oral care, suggesting that povidone iodine did not disturb the balance of the oral microbiota. CONCLUSIONS:Topical application of povidone iodine after cleaning and irrigation of the oral cavity inhibited bacterial growth in the oropharyngeal fluid of patients on mechanical ventilation while not disrupting the balance of the oral microbiota. TRIAL REGISTRATION:University Hospitals Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000028307. Registered 1 September 2017.
Airborne transmission of SARS-CoV-2: The world should face the reality.
Morawska Lidia,Cao Junji
Hand washing and maintaining social distance are the main measures recommended by the World Health Organization (WHO) to avoid contracting COVID-19. Unfortunately, these measured do not prevent infection by inhalation of small droplets exhaled by an infected person that can travel distance of meters or tens of meters in the air and carry their viral content. Science explains the mechanisms of such transport and there is evidence that this is a significant route of infection in indoor environments. Despite this, no countries or authorities consider airborne spread of COVID-19 in their regulations to prevent infections transmission indoors. It is therefore extremely important, that the national authorities acknowledge the reality that the virus spreads through air, and recommend that adequate control measures be implemented to prevent further spread of the SARS-CoV-2 virus, in particularly removal of the virus-laden droplets from indoor air by ventilation.
Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease.
Anderson Danielle E,Sivalingam Velraj,Kang Adrian Eng Zheng,Ananthanarayanan Abhishek,Arumugam Harsha,Jenkins Timothy M,Hadjiat Yacine,Eggers Maren
Infectious diseases and therapy
INTRODUCTION:As of 22 June 2020, Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV)-2 has infected more than 8.95 million people worldwide, causing > 468,000 deaths. The virus is transmitted through respiratory droplets and physical contact from contaminated surfaces to the mucosa. Hand hygiene and oral decontamination among other measures are key to preventing the spread of the virus. We report the in vitro virucidal activity of topical and oral povidone-iodine (PVP-I) products against SARS-CoV-2. METHODS:Suspension assays were used to assess the virucidal activity of PVP-I against SARS-CoV-2. Products were tested at a contact time of 30 s for virucidal activity. Viral titres were calculated using the Spearman-Kärber method and reported as median tissue culture infectious dose (TCID)/mL. RESULTS:All four products [antiseptic solution (PVP-I 10%), skin cleanser (PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and throat spray (PVP-I 0.45%)] achieved ≥ 99.99% virucidal activity against SARS-CoV-2, corresponding to ≥ 4 log reduction of virus titre, within 30 s of contact. CONCLUSION:This study provides evidence of rapid and effective virucidal activity of PVP-I against SARS-CoV-2. PVP-I-based products are widely available for medical and personal use for hand hygiene and oral decontamination, and could be readily integrated into coronavirus disease, COVID-19, infection control measures in hospital and community settings.
Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse.
Bidra Avinash S,Pelletier Jesse S,Westover Jonna B,Frank Samantha,Brown Seth M,Tessema Belachew
Journal of prosthodontics : official journal of the American College of Prosthodontists
PURPOSE:To investigate the optimal contact time and concentration for viricidal activity of oral preparation of povidone-iodine (PVP-I) against SARS-CoV-2 ('corona virus') to mitigate the risk and transmission of the virus in the dental practice. MATERIALS AND METHODS:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) USA-WA1/2020 strain, virus stock was tested against oral antiseptic solutions consisting of aqueous povidone-iodine (PVP-I) as the sole active ingredient. The PVP-I was tested at diluted concentrations of 0.5%, 1%, and 1.5%. Test media without any virus was added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol (70%) was tested in parallel as a positive control, and water only as a negative control. The test solutions and virus were incubated at room temperature (22 ± 2 °C) for time periods of 15 and 30 seconds. The solution was then neutralized by a 1/10 dilution in minimum essential medium (MEM) 2% fetal bovine serum (FBS), 50 µg/mL gentamicin. Surviving virus from each sample was quantified by standard end-point dilution assay and the log reduction value (LRV) of each compound compared to the negative (water) control was calculated. RESULTS:PVP-I oral antiseptics at all tested concentrations of 0.5%, 1%, and 1.5%, completely inactivated SARS-CoV-2 within 15 seconds of contact. The 70% ethanol control group was unable to completely inactivate SARS-CoV-2 after 15 seconds of contact, but was able to inactivate the virus at 30 seconds of contact. CONCLUSIONS:PVP-I oral antiseptic preparations rapidly inactivated SARS-CoV-2 virus in vitro. The viricidal activity was present at the lowest concentration of 0.5 % PVP-I and at the lowest contact time of 15 seconds. This important finding can justify the use of preprocedural oral rinsing with PVP-I (for patients and health care providers) may be useful as an adjunct to personal protective equipment, for dental and surgical specialties during the COVID-19 pandemic.
Povidone-iodine hand wash and hand rub products demonstrated excellent in vitro virucidal efficacy against Ebola virus and modified vaccinia virus Ankara, the new European test virus for enveloped viruses.
Eggers Maren,Eickmann Markus,Kowalski Katharina,Zorn Juergen,Reimer Karen
BMC infectious diseases
BACKGROUND:The recent Ebola virus (EBOV) epidemic highlights the need for efficacious virucidal products to help prevent infection and limit the spread of Ebola virus disease. However, there is limited data on the efficacy of virucidal products against EBOV, because the virus has a high biosafety level and is only available in a few laboratories worldwide. The virucidal efficacy of antiseptics and disinfectants can be determined using the European Standard EN14476:2013/FprA1:2015. Modified vaccinia virus Ankara (MVA) was introduced in 2014 as a reference virus for the claim 'virucidal active against enveloped viruses for hygienic hand rub and hand wash'. For EBOV, also an enveloped virus, the suitability of MVA as a surrogate needs to be proven. The aim of this study was to test the in vitro efficacy of four povidone iodine (PVP-I) formulations against EBOV: 4% PVP-I skin cleanser; 7.5% PVP-I surgical scrub; 10% PVP-I solution; and 3.2% PVP-I and 78% alcohol solution. The formulations were tested with MVA to define the test conditions, and as a secondary objective the suitability of MVA as a surrogate for enveloped viruses like EBOV was assessed. METHODS:According to EN14476, a standard suspension test was used for MVA. Large-volume plating was used for EBOV to increase test sensitivity and exclude potential after-effects. All products were tested under clean (0.3 g/L BSA) and dirty (3.0 g/L BSA + 3.0 mL/L erythrocytes) conditions with MVA for 15, 30, and 60 s. The concentration-contact time values obtained with MVA were verified for EBOV. RESULTS:Viral titres of MVA and EBOV were reduced by >99.99% to >99.999% under clean and dirty conditions after application of the test products for 15 seconds. CONCLUSIONS:All products showed excellent virucidal efficacy against EBOV, demonstrating the important role PVP-I can play in helping to prevent and limit the spread of Ebola virus disease. The efficacy against both test viruses after 15 s is helpful information for the implementation of guidance for people potentially exposed to EBOV, and confirms the excellent virucidal efficacy of PVP-I against enveloped viruses. MVA was found to be a suitable surrogate for enveloped viruses like EBOV.
[Experts recommendation on the diagnosis and treatment of oral mucosal diseases during prevention and control stage of the novel coronavirus infection].
Shanghai kou qiang yi xue = Shanghai journal of stomatology
The announcement of National Health Commission on January 20, 2020 (No. 1 of 2020) has included Novel Coronavirus Pneumonia(NCP) into the B class infectious diseases according to the law of the People's Republic of China on the prevention and control of infectious diseases, and has been managed as A class infectious diseases. People's governments at all levels and health administration departments have been paying high attention to it, and medical and health institutions have taken a series of prevention and control measures according to the law to prevent and control the spread of NCP. In the process of combating the outbreak of NCP, how to protect the oral mucosal disease physicians normatively, how to ensure hand and environmental cleaning and disinfection; how to carry out triage of the patients with oral mucosal disease accompanied by fever reasonably; how to carry out oral mucosal disease patients'self-care and self-management during this stage, are the practical problems that all levels of medical institutions and medical workers and patients will meet. For these three problems, we invited the experts from the Society of Oral Medicine, Shanghai Stomatological Association and the Oral Mucosal Disease Specialist Alliance Organization of Shanghai Ninth People's Hospital Group to write the recommendation on the diagnosis and treatment of oral mucosal disease during prevention and control stage of novel coronavirus infection, in order to provide references for oral mucosal disease medical physicians and patients in this special period. This recommendation will be updated according to the situation of epidemic prevention and control in China and the new relevant diagnosis and treatment plans.
Cetylpyridinium chloride blocks herpes simplex virus replication in gingival fibroblasts.
Alvarez Diana M,Duarte Luisa F,Corrales Nicolas,Smith Patricio C,González Pablo A
Infections with herpes simplex viruses are lifelong and highly prevalent worldwide. Individuals with clinical symptoms elicited by HSVs may suffer from occasional or recurrent herpetic lesions in the orofacial and genital areas. Despite the existence of nucleoside analogues that interfere with HSV replication, such as acyclovir, these drugs are somewhat ineffective in treating skin lesions as topical formulations only reduce in one or few days the duration of the herpetic ulcers. Cetylpyridinium chloride (CPC) is a quaternary ammonium compound present in numerous hygiene products, such as mouthwashes, deodorants, aphtae-treating formulations and oral tablets as an anti-septic to limit bacterial growth. Some reports indicate that CPC can also modulate host signaling pathways, namely NF-κB signaling. Because HSV infection is modulated by NF-κB, we sought to assess whether CPC has antiviral effects against HSVs. Using wild-type HSV-1 and HSV-2, as well as viruses that are acyclovir-resistant or encode GFP reporter genes, we assessed the antiviral capacity of CPC in epithelial cells and human gingival fibroblasts expanded from the oral cavity and its mechanism of action. We found that a short, 10-min exposure to CPC added after HSV entry into the cells, significantly limited viral replication in both cell types by impairing viral gene expression. Interestingly, our results suggest that CPC blocks HSV replication by interfering with the translocation of NF-κB into the nucleus of HSV-infected cells. Taken together, these findings suggest that formulations containing CPC may help limit HSV replication in infected tissues and consequently reduce viral shedding.
Cetylpyridinium chloride interaction with the hepatitis B virus core protein inhibits capsid assembly.
Seo Hyun Wook,Seo Joon Pyung,Cho Yuri,Ko Eunkyong,Kim Yoon Jun,Jung Guhung
Hepatitis B virus (HBV) infection is a major risk factor for chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) worldwide. While multiple hepatitis B drugs have been developed, build up of drug resistance during treatment or weak efficacies observed in some cases have limited their application. Therefore, there is an urgent need to develop substitutional pharmacological agents for HBV-infected individuals. Here, we identified cetylpyridinium chloride (CPC) as a novel inhibitor of HBV. Using computational docking of CPC to core protein, microscale thermophoresis analysis of CPC binding to viral nucleocapsids, and in vitro nucleocapsid formation assays, we found that CPC interacts with dimeric viral nucleocapsid protein (known as core protein or HBcAg) specifically. Compared with other HBV inhibitors, such as benzenesulfonamide (BS) and sulfanilamide (SA), CPC achieved significantly better reduction of HBV particle number in HepG2.2.15 cell line, a derivative of human HCC cells that stably expresses HBV. CPC also inhibited HBV replication in mouse hydrodynamic model system. Taken together, our results show that CPC inhibits capsid assembly and leads to reduced HBV biogenesis. Thus, CPC is an effective pharmacological agent that can reduce HBV particles.
Drug treatment of coronavirus disease 2019 (COVID-19) in China.
Jin Zhe,Liu Jing-Yi,Feng Rang,Ji Lu,Jin Zi-Li,Li Hai-Bo
European journal of pharmacology
Since December 2019, the coronavirus disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread throughout China as well as other countries. More than 8,700,000 confirmed COVID-19 cases have been recorded worldwide so far, with much more cases popping up overseas than those inside. As the initial epicenter in the world, China has been combating the epidemic for a relatively longer period and accumulated valuable experience in prevention and control of COVID-19. This article reviewed the clinical use, mechanism and efficacy of the clinically approved drugs recommended in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (DTPNCP) released by National Health Commission of P.R.China, and the novel therapeutic agents now undergoing clinical trials approved by China National Medical Products Administration (NMPA) to evaluate experimental treatment for COVID-19. Reviewing the progress in drug development for the treatment against COVID-19 in China may provide insight into the epidemic control in other countries.
Coronavirus disease 2019 (COVID-19): current status and future perspectives.
Li Heng,Liu Shang-Ming,Yu Xiao-Hua,Tang Shi-Lin,Tang Chao-Ke
International journal of antimicrobial agents
Coronavirus disease 2019 (COVID-19) originated in the city of Wuhan, Hubei Province, Central China, and has spread quickly to 72 countries to date. COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [previously provisionally known as 2019 novel coronavirus (2019-nCoV)]. At present, the newly identified SARS-CoV-2 has caused a large number of deaths with tens of thousands of confirmed cases worldwide, posing a serious threat to public health. However, there are no clinically approved vaccines or specific therapeutic drugs available for COVID-19. Intensive research on the newly emerged SARS-CoV-2 is urgently needed to elucidate the pathogenic mechanisms and epidemiological characteristics and to identify potential drug targets, which will contribute to the development of effective prevention and treatment strategies. Hence, this review will focus on recent progress regarding the structure of SARS-CoV-2 and the characteristics of COVID-19, such as the aetiology, pathogenesis and epidemiological characteristics.
Research Progress of Drug Treatment in Novel Coronavirus Pneumonia.
Yan Junqiang,Liu Anran,Huang Jiarui,Wu Jiannan,Fan Hua
As of March 10, 2020, more than 100,000 novel coronavirus pneumonia cases have been confirmed globally. With the continuous spread of the new coronavirus pneumonia epidemic in even the world, prevention and treatment of the disease have become urgent tasks. The drugs currently being developed are not adequate to deal with this critical situation. In addition to being controlled through effective isolation, we need a rapid response from the healthcare and biotechnology industries to accelerate drug treatment research. By reviewing the currently available literature published at home and abroad, we summarize the current research progress of drug treatment during the epidemic period. At present, the drugs that can be used for treatment mainly include antiviral drugs, antimalarials, glucocorticoids, plasma therapy, biological agents, and traditional Chinese medicine. The effectiveness and safety of drug therapy need to be confirmed by more clinical studies.
Clinical and radiological features of novel coronavirus pneumonia.
Zheng Qiuting,Lu Yibo,Lure Fleming,Jaeger Stefan,Lu Puxuan
Journal of X-ray science and technology
Recently, COVID-19 has spread in more than 100 countries and regions around the world, raising grave global concerns. COVID-19 transmits mainly through respiratory droplets and close contacts, causing cluster infections. The symptoms are dominantly fever, fatigue, and dry cough, and can be complicated with tiredness, sore throat, and headache. A few patients have symptoms such as stuffy nose, runny nose, and diarrhea. The severe disease can progress rapidly into the acute respiratory distress syndrome (ARDS). Reverse transcription polymerase chain reaction (RT-PCR) and Next-generation sequencing (NGS) are the gold standard for diagnosing COVID-19. Chest imaging is used for cross validation. Chest CT is highly recommended as the preferred imaging diagnosis method for COVID-19 due to its high density and high spatial resolution. The common CT manifestation of COVID-19 includes multiple segmental ground glass opacities (GGOs) distributed dominantly in extrapulmonary/subpleural zones and along bronchovascular bundles with crazy paving sign and interlobular septal thickening and consolidation. Pleural effusion or mediastinal lymphadenopathy is rarely seen. In CT imaging, COVID-19 manifests differently in its various stages including the early stage, the progression (consolidation) stage, and the absorption stage. In its early stage, it manifests as scattered flaky GGOs in various sizes, dominated by peripheral pulmonary zone/subpleural distributions. In the progression state, GGOs increase in number and/or size, and lung consolidations may become visible. The main manifestation in the absorption stage is interstitial change of both lungs, such as fibrous cords and reticular opacities. Differentiation between COVID-19 pneumonia and other viral pneumonias are also analyzed. Thus, CT examination can help reduce false negatives of nucleic acid tests.
Recent progress on the diagnosis of 2019 Novel Coronavirus.
Li Chun,Ren Linzhu
Transboundary and emerging diseases
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. Therefore, convenient, timely and accurate detection of SARS-CoV-2 is urgently needed. Here, we review the types, characteristics and shortcomings of various detection methods, as well as perspectives for the SARS-CoV-2 diagnosis. Clinically, nucleic acid-based methods are sensitive but prone to false-positive. The antibody-based method has slightly lower sensitivity but higher accuracy. Therefore, it is suggested to combine the two methods to improve the detection accuracy of COVID-19.
Coronavirus disease - COVID-19: new perceptives towards epidemic to pandemic.
Santhosh S B,Mohamed Sheik Tharik A,Susitra Manjari M,Balakrishnan R,Muruganandam N,Chandrasekar M J N
Journal of drug targeting
The sudden outbreak and uncontrolled spread of the novel coronavirus disease 2019 (COVID-19) has shocked the world to a degree never seen before. Due to the wide spread transmission of the virus, the number of infected cases worldwide has surpassed 16,421,958 and global death toll has spiked up to 6,52,308 from December 2019 to 27 July 2020. The virus has been labelled as a pandemic by the WHO. Virologists have found that this virus outbreak is similar to past outbreaks of viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory Syndrome that caused severe respiratory syndrome and transmitted rapidly in humans. These single stranded RNA viruses come under the genera of β-coronaviruses which ultimately infect lungs and respiratory tract. Even though the origin, source and intermediate hosts of this virus is unknown, transmittance from human-to-human through various paths has been identified globally. As of today, there are no approved drugs and vaccines. Several clinical trials are being conducted today to evaluate vaccines against the virus. The aim of our present review is to furnish brief details about the statistics, diagnosis, epidemiology, pathogenesis, prevention and treatment of COVID-19 to assist researchers and the society at large to come to grip with the deadly disease.HighlightsCumbersome outbreak of the novel Coronavirus Disease 2019 (COVID-19) became a pandemicAt June 19, 2020, as per WHO report 8,618,787 infected cases and 457,275 dead were recorded globallyMajor spread was found to be human to human transmissionsPeople with positive COVID-19 were infected with severe respiratory syndromeMore animal and clinical studies have to be done to overcome this pandemic.
A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version).
Jin Ying-Hui,Cai Lin,Cheng Zhen-Shun,Cheng Hong,Deng Tong,Fan Yi-Pin,Fang Cheng,Huang Di,Huang Lu-Qi,Huang Qiao,Han Yong,Hu Bo,Hu Fen,Li Bing-Hui,Li Yi-Rong,Liang Ke,Lin Li-Kai,Luo Li-Sha,Ma Jing,Ma Lin-Lu,Peng Zhi-Yong,Pan Yun-Bao,Pan Zhen-Yu,Ren Xue-Qun,Sun Hui-Min,Wang Ying,Wang Yun-Yun,Weng Hong,Wei Chao-Jie,Wu Dong-Fang,Xia Jian,Xiong Yong,Xu Hai-Bo,Yao Xiao-Mei,Yuan Yu-Feng,Ye Tai-Sheng,Zhang Xiao-Chun,Zhang Ying-Wen,Zhang Yin-Gao,Zhang Hua-Min,Zhao Yan,Zhao Ming-Juan,Zi Hao,Zeng Xian-Tao,Wang Yong-Yan,Wang Xing-Huan,
Military Medical Research
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
Identifying airborne transmission as the dominant route for the spread of COVID-19.
Zhang Renyi,Li Yixin,Zhang Annie L,Wang Yuan,Molina Mario J
Proceedings of the National Academy of Sciences of the United States of America
Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.
Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them.
Burton Martin J,Clarkson Janet E,Goulao Beatriz,Glenny Anne-Marie,McBain Andrew J,Schilder Anne Gm,Webster Katie E,Worthington Helen V
The Cochrane database of systematic reviews
BACKGROUND:COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. If the mouth and nose of patients with infection are irrigated with antimicrobial solutions, this may help the patients by killing any coronavirus present at those sites. It may also reduce the risk of the active infection being passed to HCWs through droplet transmission or direct contact. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose. OBJECTIVES:To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to both the patients and the HCWs caring for them. SEARCH METHODS:Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020. SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies: randomised controlled trials (RCTs); quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies. We sought studies comparing antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered with any frequency or dosage to suspected/confirmed COVID-19 patients. DATA COLLECTION AND ANALYSIS:We used standard Cochrane methodological procedures. Our primary outcomes were: 1) RECOVERY* (www.recoverytrial.net) outcomes in patients (mortality; hospitalisation status; use of ventilation; use of renal dialysis or haemofiltration); 2) incidence of symptomatic or test-positive COVID-19 infection in HCWs; 3) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 4) change in COVID-19 viral load in patients; 5) COVID-19 viral content of aerosol (when present); 6) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 7) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS:We found no completed studies to include in this review. We identified 16 ongoing studies (including 14 RCTs), which aim to enrol nearly 1250 participants. The interventions included in these trials are ArtemiC (artemisinin, curcumin, frankincense and vitamin C), Citrox (a bioflavonoid), cetylpyridinium chloride, chlorhexidine, chlorine dioxide, essential oils, hydrogen peroxide, hypertonic saline, Kerecis spray (omega 3 viruxide - containing neem oil and St John's wort), neem extract, nitric oxide releasing solution, povidone iodine and saline with baby shampoo. AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by a number of RCTs and other studies. We are concerned that few of the ongoing studies specifically state that they will evaluate adverse events such as changes in the sense of smell or to the oral and nasal microbiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for inclusion in this review, it may not be large. In these circumstances in particular it may be a challenge to weigh up the benefits against the harms if the latter are of uncertain frequency and severity.
Is the oral cavity relevant in SARS-CoV-2 pandemic?
Herrera David,Serrano Jorge,Roldán Silvia,Sanz Mariano
Clinical oral investigations
OBJECTIVES:Recent scientific evidences suggest a relevant role of the oral cavity in the transmission and pathogenicity of SARS-CoV-2. METHODS:A literature search was performed in PubMed, up to April 30, 2020, focusing on SARS-CoV-2, COVID-19, oral cavity, and antimicrobial agents. RESULTS:Oral viral load of SARS-CoV-2 has been associated with the severity of COVID-19, and thus, a reduction in the oral viral load could be associated with a decrease in the severity of the condition. Similarly, a decrease in the oral viral load would diminish the amount of virus expelled and reduce the risk of transmission, since (i) during the first 10 days, the virus mainly accumulates at the nasal, oral, and pharyngeal area; (ii) the number of angiotensin-converting enzyme (ACE2) receptor is greater in the salivary glands as compared with the lungs; and (iii) salivary droplets represent the most relevant transmission route. To reduce the oral viral load, antiseptic agents may be used, although the evidence on its efficacy is indirect and weak. CONCLUSIONS:Antiseptic mouth rinses, such as those containing cetylpyridinium chloride or povidone-iodine, may be able to decrease the severity of COVID-19 by reducing oral viral load in infected subjects and decreasing the risk of transmission by limiting viral load in droplets, generated in normal life, or in aerosols, produced during dental procedures. Well-designed clinical and preclinical research must be conducted to support these hypotheses. CLINICAL RELEVANCE:Antiseptic mouth rinses may help in decreasing the severity of COVID-19 and in reducing the risk of transmission.
Use of mouthwashes against COVID-19 in dentistry.
Vergara-Buenaventura A,Castro-Ruiz C
The British journal of oral & maxillofacial surgery
The proximity to the patient during dental care, high generation of aerosols, and the identification of SARS-CoV-2 in saliva have suggested the oral cavity as a potential reservoir for COVID-19 transmission. Mouthwashes are widely-used solutions due to their ability to reduce the number of microorganisms in the oral cavity. Although there is still no clinical evidence that they can prevent the transmission of SARS-CoV-2, preoperative antimicrobial mouth rinses with chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC), povidone-iodine (PVP-I), and hydrogen peroxide (HO) have been recommended to reduce the number of microorganisms in aerosols and drops during oral procedures. This paper therefore aims to provide a comprehensive review of the current recommendations on the use of mouthwashes against the COVID-19 pandemic and to analyse the advantages and disadvantages of most conventional antiseptic mouthwashes used in dentistry.
Global COVID-19: Warnings and suggestions based on experience of China.
Ding Zhuqing,Xie Lingling,Guan Anchen,Huang Dandan,Mao Zongfu,Liang Xiaohui
Journal of global health
Background:Corona Virus Disease 2019 (COVID-19) is spreading around the world currently, seriously threatening people's health and global security as an international public health emergency. The objective of this study is to summarize China's countermeasures and experience in response to the COVID-19 emergence in order to serve as a warning for the global COVID-19 prevention and control, and further provide some suggestions for global fighting to COVID-19. Methods:Content analysis, expert consultation, and high frequency word analysis were applied in this study. Relevant data and information were collected from official websites, the experience accumulated in China during the fighting to the novel coronavirus, and suggestions from some experts. Results:As of March 29, 2020, China had accumulated 82 419 confirmed diagnoses, and the mortality rate was 4.01%; in the mean time, the global had accumulated 596 042 confirmed diagnoses, and the mortality rate was 4.76%. Although the mortality of COVID-19 was not so high, its harmfulness couldn't be ignored. Ten facts during COVID-19 epidemic in China were summarized in the study, including: the COVID-19 is highly contagious and can be spread through many channels; although elderly people and people with underlying diseases are susceptible, young people can also be victims; isolation is the most effective way to reduce the risk of COVID-19, and secondary disasters induced by COVID-19 should be emphasized in advance. High frequent words of experts' suggestions mainly includes: material, prevention and control, pathogeny, propaganda, education, hygiene, technology, medical care, overall planning, policy, panic, etc. The main concerns of experts are from four aspects: publicity and education, various subjects, medical materials and law construction. Conclusions:COVID-19 is a new infectious disease worldwide, and its infectious source, transmission route, susceptible population, and therapy are not clear. In the face of the COVID-19 epidemic, no country can stand alone to maintain its own safety. People from all over the world should put aside their difference in ideology, religious belief, politics, economy, and culture, and only by global cooperation and globally unified actions, can we successfully overcome COVID-19 in the end.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a newly emerged pathogen: an overview.
Rathore Jitendra Singh,Ghosh Chaitali
Pathogens and disease
Coronavirus disease 2019 (COVID-19) is a viral pneumonia, responsible for the recent pandemic, and originated from Wuhan, China, in December 2019. The causative agent of the outbreak was identified as coronavirus and designated as severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). Few years back, the severe acute respiratory syndrome coronavirus (SARS- CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were reported to be highly pathogenic and caused severe infections in humans. In the current situation SARS-CoV-2 has become the third highly pathogenic coronavirus that is responsible for the present outbreak in human population. At the time of this review, there were more than 14 007 791 confirmed COVID-19 patients which associated with over 597 105 deaths in more then 216 countries across the globe (as reported by World Health Organization). In this review we have discussed about SARS-CoV, MERS-CoV and SARC-CoV-2, their reservoirs, role of spike proteins and immunogenicity. We have also covered the diagnosis, therapeutics and vaccine status of SARS-CoV-2.
The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A review of the current global status.
Bchetnia Mbarka,Girard Catherine,Duchaine Caroline,Laprise Catherine
Journal of infection and public health
There is currently an ongoing worldwide pandemic of a novel virus belonging to the family of Coronaviruses (CoVs) which are large, enveloped, plus-stranded RNA viruses. Coronaviruses belong to the order of Nidovirales, family of Coronavirinae and are divided into four genera: alphacoronavirus, betacoronavirus, gammacoronavirus and deltacoronavirus. CoVs cause diseases in a wide variety of birds and mammals and have been found in humans since 1960. To date, seven human CoVs were identified including the alpha-CoVs HCoVs-NL63 and HCoVs-229E and the beta-CoVs HCoVs-OC43, HCoVs-HKU1, the severe acute respiratory syndrome-CoV (SARS-CoV), the Middle East respiratory syndrome-CoV (MERS-CoV) and the novel virus that first appeared in December 2019 in Wuhan, China, and rapidly spread to 213 countries as of the writing this paper. It was ofﬁcially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the international committee on taxonomy of viruses (ICTV) and the disease's name is COVID-19 for coronavirus disease 2019. SARS-CoV-2 is very contagious and is capable of spreading from human to human. Infection routes include droplet and contact, and aerosol transmission is currently under investigation. It is associated with a respiratory illness that may cause severe pneumonia and acute respiratory distress syndrome (ARDS). SARS-CoV-2 became an emergency of international concern. As of July 12, 2020, the virus has been responsible for 12,698,995 confirmed cases and 564,924 deaths worldwide and the number is still increasing. Up until now, no specific treatment has yet been proven effective against SARS-CoV-2. Since the beginning of this outbreak, several interesting papers on SARS-CoV-2 and COVID-19 have been published to report on the phylogenetic evolution, epidemiology, pathogenesis, transmission as well as clinical characteristics of COVID-19 and possible treatments agents. This paper is a systematic review of the available literature on SARS-CoV-2. It was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and aims to help readers access the latest knowledge surrounding this new infectious disease and to provide a reference for future studies.
Coronavirus Disease 2019-COVID-19.
Dhama Kuldeep,Khan Sharun,Tiwari Ruchi,Sircar Shubhankar,Bhat Sudipta,Malik Yashpal Singh,Singh Karam Pal,Chaicumpa Wanpen,Bonilla-Aldana D Katterine,Rodriguez-Morales Alfonso J
Clinical microbiology reviews
SUMMARYIn recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs). Recently, a new type of viral infection emerged in Wuhan City, China, and initial genomic sequencing data of this virus do not match with previously sequenced CoVs, suggesting a novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility of other routes should not be ruled out. Compared to diseases caused by previously known human CoVs, COVID-19 shows less severe pathogenesis but higher transmission competence, as is evident from the continuously increasing number of confirmed cases globally. Compared to other emerging viruses, such as Ebola virus, avian H7N9, SARS-CoV, and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 has shown relatively low pathogenicity and moderate transmissibility. Codon usage studies suggest that this novel virus has been transferred from an animal source, such as bats. Early diagnosis by real-time PCR and next-generation sequencing has facilitated the identification of the pathogen at an early stage. Since no antiviral drug or vaccine exists to treat or prevent SARS-CoV-2, potential therapeutic strategies that are currently being evaluated predominantly stem from previous experience with treating SARS-CoV, MERS-CoV, and other emerging viral diseases. In this review, we address epidemiological, diagnostic, clinical, and therapeutic aspects, including perspectives of vaccines and preventive measures that have already been globally recommended to counter this pandemic virus.