Musculoskeletal ultrasound guided manoeuvres - a security profile.

BACKGROUND: In daily rheumatology clinical practice, routine interventional musculoskeletal ultrasound (MSUS) guided maneuvers such as aspiration, intraarticular or periarticular drug injections require efficient cleaning and disinfection methods for both transducer and patient's skin. AIM: To study the efficacy of probe and skin disinfection measures after using simple protocols, to identify the prevalence of septic and other drug related side effects after MSUS guided interventions and to quantify the total procedure time. MATERIAL AND METHODS: Recruitment of consecutive patients with different joint/ periarticular MSUS guided interventions was made in 3 medical centers. Bacterial load was determined on the transducers footprint after dry cleaning with the removal of any gel trace and on patients' skin after rigorous skin disinfection with either Bethadine or alcohol 70° and Bethadine. Non-sterile gel was used as an ultrasound transmission medium. The time spent for some of the invasive procedures was quantified. RESULTS: Nine hundred and ninety eight MSUS guided interventional maneuvers were performed in 945 patients with inflammatory and degenerative musculoskeletal pathologies. Staphylococcus epidermidis was identified in 13.33% cases of the skin bacterial load analysis and in 37.50% cases of the footprint analysis. In two patients pathogenetic germs were detected on the skin. No septic post-procedural complications were reported. In 0.6% of the cohort other side effects occurred: aseptic osteonecrosis, skin depigmentation at injection site and iatrogenic microcristaline reactions. The median time frame dedicated to the intervention was 6 minutes. CONCLUSION: Rigorous transducer dry cleaning and Bethadine / Bethadine and alcohol 70° skin disinfection are efficacious methods. The risk for septic complications and other drug related side effects related to MSUS guided injections is very low in this context. A correct injection technique must accompany the previous requests. Rapid and safe interventional maneuvers reduce the risks and control the costs of the healthcare system.

SERS-active silver colloids prepared by reduction of silver nitrate with short-chain polyethylene glycol.

We report a fast, one-step, facile, and green preparation method that yields very stable and biocompatible silver colloids that are highly active as surface-enhanced Raman spectroscopy (SERS) platforms that has a possible application in biomedicine. Reduction of silver nitrate has been carried out using polyethylene glycol (PEG) which acts as both reducing agent and stabilizer. It turned out that the -OH groups provided by the addition of NaOH represent a key element in the successful synthesis of PEG-coated silver nanoparticles (AgNPs). The as-obtained silver colloids have been characterized by UV-visible spectroscopy, transmission electron spectroscopy, and SERS using 532- and 633-nm laser lines on a dispersive Raman spectrometer. Several analytes as methylene blue, p-aminothiophenol, amoxicillin, and Cu(PAR)2 were used to prove SERS enhancement of the obtained silver colloid. It has been found that the PEGylated AgNPs provide SERS signals comparable to those achieved using classical hydroxylamine and citrate-reduced silver colloids, thus demonstrating the ability of this new method to prepare biocompatible silver colloids.