The First Successful Heart-Lung Transplant in a Korean Child with Humidifier Disinfectant-Associated Interstitial Lung Disease

From 2006 to 2011, an outbreak of a particular type of childhood interstitial lung disease occurred in Korea. The condition was intractable and progressed to severe respiratory failure, with a high mortality rate. Moreover, in several familial cases, the disease affected young women and children simultaneously. Epidemiologic, animal, and post-interventional studies identified the cause as inhalation of humidifier disinfectants. Here, we report a 4-year-old girl who suffered from severe progressive respiratory failure. She could survive by 100 days of extracorporeal membrane oxygenation support and finally, underwent heart-lung transplantation. This is the first successful pediatric heart-lung transplantation carried out in Korea.

Effects of Disinfectants on Larval Development of Ascaris suum Eggs

The objective of this study was to evaluate the effects of several different commercial disinfectants on the embryogenic development of Ascaris suum eggs. A 1-ml aliquot of each disinfectant was mixed with approximately 40,000 decorticated or intact A. suum eggs in sterile tubes. After each treatment time (at 0.5, 1, 5, 10, 30, and 60 min), disinfectants were washed away, and egg suspensions were incubated at 25℃ in distilled water for development of larvae inside. At 3 weeks of incubation after exposure, ethanol, methanol, and chlorohexidin treatments did not affect the larval development of A. suum eggs, regardless of their concentration and treatment time. Among disinfectants tested in this study, 3% cresol, 0.2% sodium hypochlorite and 0.02% sodium hypochlorite delayed but not inactivated the embryonation of decorticated eggs at 3 weeks of incubation, because at 6 weeks of incubation, undeveloped eggs completed embryonation regardless of exposure time, except for 10% povidone iodine. When the albumin layer of A. suum eggs remained intact, however, even the 10% povidone iodine solution took at least 5 min to reasonably inactivate most eggs, but never completely kill them with even 60 min of exposure. This study demonstrated that the treatment of A. suum eggs with many commercially available disinfectants does not affect the embryonation. Although some disinfectants may delay or stop the embryonation of A. suum eggs, they can hardly kill them completely.

Toxic Inhalational Injury-Associated Interstitial Lung Disease in Children

Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.

Cytotoxicity and genotoxicity of endodontic irrigants on human cells / Citotoxicidade e genotoxicidade de irrigantes endodônticos em células humanas

OBJECTIVE: Endodontic irrigants solutions with antibacterial activity have been used in treatment of teeth with infected root canals; however, these solutions can irritate periapical tissues. The aim of this study was to evaluate the cytotoxity and genotoxicity of different endodontic irrigants solutions – sodium hypochlorite (1% and 2%), calcium hydroxide (0.2%), and HCT20 in human KB cells. MATERIAL AND METHOD: Cells were incubated with solutions for 2 and 24 hours. The cell viability was assessed after the trypan blue exclusion and the frequency of cell death mechanism (apoptotic or necrotic) was determined by acridine orange/ethidium bromide fluorescent dyeing test. The genotoxicity effects were assessed by the micronucleus assays. RESULTS AND DISCUSSION: The results showed that Ca(OH)2 alone or in combination with tergentol (HCT20), and NaOCl induced cytotoxicity in KB causing death cells by apoptosis. The micronuclei test showed that KB treated with NaOCl (1%) present an increase in the frequency of micronucleus compared to the control group.

OBJETIVO: Soluções irrigadoras com atividade antibacteriana têm sido usadas no tratamento de dentes com canais radiculares infectados; entretanto, essas soluções podem irritar os tecidos periapicais. O objetivo deste estudo foi avaliar a citotoxicidade e genotoxicidade de diferentes soluções irrigadoras – hipoclorito de sódio (1% e 2%), hidróxidode cálcio (0,2 %) e HCT em células humanas KB. MATERIAL E MÉTODO: As células foram incubadas em soluções por 2 e 24 horas. A viabilidade celular foi determinada após exclusão do tripan blue e a frequência de mecanismo de morte celular (apoptótica ou necrótica) foi determinada pelo teste acridine Orange/ethidium bromide fluorescen dyeing. Os efeitos de genotoxicidade foram determinados pelo ensaio de micronúcleos. RESULTADOS E DISCUSSÃO: Os resultados demonstraram que o Ca(OH2), isoladamente ou em combinação com Tergentol™ (HCT20) e NaOCl, induziram citotoxicidade em KB, causando morte celular por apoptose. O teste de micronúcleos demonstrou que KB tratado codm NaOCl (1%) apresentou aumento na frequência de microdnúcleos quando comparadocom o grupo controle.

Effects of formaldehyde on the frog's mucociliary epithelium as a surrogate to evaluate air pollution effects on the respiratory epithelium

The increasing use of alcohol as an alternative fuel to gasoline or diesel can increase emission of formaldehyde, an organic gas that is irritant to the mucous membranes. The respiratory system is the major target of air pollutants and its major defense mechanism depends on the continuous activity of the cilia and the resulting constant transportation of mucous secretion. The present study was designed to evaluate the effects of formaldehyde on the ciliated epithelium through a relative large dose range around the threshold limit value adopted by the Brazilian legislation, namely 1.6 ppm (1.25 to 5 ppm). For this purpose, the isolated frog palate preparation was used as the target of toxic injury. Four groups of frog palates were exposed to diluted Ringer solution (control, N = 8) and formaldehyde diluted in Ringer solution at three different concentrations (1.25, 2.5 and 5.0 ppm, N = 10 for each group). Mucociliary clearance and ciliary beat frequency decreased significantly in contact with formaldehyde at the concentrations of 2.5 and 5.0 ppm after 60 min of exposure (P<0.05). We conclude that relatively low concentrations of formaldehyde, which is even below the Brazilian threshold limit value, are sufficient to cause short-term mucociliary impairment

Evaluación de la irritabilidad dermica y oftálmica de soluciones desinfestantes utilizadas en instituciones de salud / Evaluation of didinfectant solutions used in the health institutions regarding dermic and ocular irritation effects

Se efectuó un análisis de la irritabilidad dérmica y oftálmica de 14 soluciones desinfectantes a la concentración orientada, según los manuales de procedimiento de la desinfección para uso de hospitales vigentes en el país. La prueba de irritabilidad dérmica (metodología de Draize) se aplic a las siguientes soluciones: acetato de clordexidina en solución acuosa al 1 y 0,05 por ciento y al 0,5 por ciento en solución alcohólica, hipoclorito de calcio al 1 por ciento , cloramina T al 0,5 por ciento , cetrimida al 1 por ciento , Tego 103S y Tego 103G al 1 por ciento , glutaraldeh do al 2 por ciento y las fórmulas de alcohol iodado al 1 por ciento , Galli-Valerio y la solución de formalina alcohólica antioxidante: mientras que la prueba de irritabilidad oftálmica (según Draiza) se aplicó con aquellas soluciones que puedan ser utilizadas sobre mucosas, como son: acetato de clorhexidina en solución acuosa al 0,5 por ciento , Tego al 0,5 por ciento Tego 103S al 0,5 por ciento y la iodo povidona en solución acuosa al 0,5 por ciento . Se analizaron los resultados como indica la metodología aplicada; todas las soluciones resultaron ser no irritantes a la piel. con excepción de la cetrimida al 1 por ciento que fue moderadamente irritante. Las soluciones con las cuales se estudió la irritabilidad oftálmica, resultaron ser no irritantes a la mucosa ocular del conejo, por lo que se sugiere su uso en el hombre

Pautas de bioseguridad para la atención hospitalaria en enfermería / Standart of biosecurity for the hospitable care of nursing

La atención de la salud en el hospital requiere del concurso de personas, tecnologías y equipamientos que desde un espacio permiten el cumplimiento de sus objetivos. La interacción de éstos elementos determina la presencia de riesgos tanto para los pacientes como para el personal, si no se cumplen ciertas normas de bioseguridad. El enfoque de riesgo aplicado al sistema de atención hospitalaria constituye un interesante punto de vista del presente trabajo